5/26/2020 Parasitologi Kedokteran Pdf Programs
43 DAFTAR PUSTAKA Agoes, R., 2009. Peran Nyamuk dalam Ilmu Kedokteran. Dalam: Natadisastra, D., Agoes, R., Parasitologi Kedokteran Ditinjau dari Organ Tubuh yang.
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Results:The subjects ranged from 7–17 yr old (mean 9.85±1.296) and equally distributed between both sexes. Prevalence of W. Bancrofti infection was 1.98% in children. Infection was mostly found in older students (12 yr old), male, in 6th grade, but did not differ significantly ( P=0.129, 0.376, and 0.212 respectively).
On the other hand, distribution of infection was significantly different by school ( P=0.009) and sub-district ( P=0000). Most of children with LF infection were found in Tirto Sub District.
In general population, the prevalence of W. Bancrofti infection in Tirto was 4.4%. Proportion of infection in males (12.2%) was greater than females (3.8%), with 78.9% of positive cases were in adult over 20 yr old. IntroductionLymphatic filariasis (LF) is a chronic infectious disease caused by filarial worms Wuchereria bancrofti, Brugia malayi, and B. The disease is a main community health problem, which mostly affects susceptible people of all ages and sexes (,) especially in tropical and subtropical countries. About 120 million people in 58 countries are infected globally with an estimated 1.23 billion at risk of infection.
The disease usually had a very low attention (neglected) in the countries where it is prevalent. The manifestations of the disease are noticeably disfiguring (,), including lymphedema of the limbs, male genitalia (hydrocele), or swollen breast.WHO launched Global Program to Eliminate Lymphatic Filariasis (GPELF) in 2000. The GPELF targeted the elimination of LF as public health problem by 2020 through mass drug administration (MDA). From 2000 to 2013, WHO had delivered more than 5 billion doses of anti-filarial drugs to almost 984 million at-risk individuals worldwide. In 2015, Indonesia planned to carry out MDA in 106 LF endemic districts.
Pekalongan District is an endemic LF area with 62 cases chronic LF, which potentially will continue to increase and spread if not promptly treated.“Effective monitoring and evaluation are necessary to achieve the goals of LF elimination”. After MDA, LF programs must be able to assess whether the prevalence of infection decrease to a level at which transmission is no longer likely to be sustainable.
Pekalongan District had conducted partial treatment of LF only in its endemic areas (five sub-districts) since 2002. However, data from the District Health Office (DHO) of Pekalongan showed mf rate after the partial MDA (2003–2007) remained high, ranged from 1.15% to 3.90%.Pekalongan District re-implemented MDA in all sub-districts by 2015. Prior to the MDA, there was no recent data on LF prevalence. Therefore, a baseline survey should be conducted to determine the existence of new infection. LF infection in children is a marker for recent exposure to the parasite.In this study, we conducted a survey prior to the MDA. The study aimed to determine prevalence of W.
Bancrofti infection among elementary school students in endemic sub-districts. The prevalence data will be used as a baseline data because of LF elimination programs will be applied to the whole district. Study designThis was a descriptive study designed as baseline data to measure prevalence of W. Bancrofti prior to MDA. Selection of the study site was based on endemicity of LF. Endemicity data was obtained from DHO of Pekalongan. The study was carried out in five LF endemic sub-districts, namely: Buaran, Kedungwuni, Tirto, Wiradesa, and Wonokerto (mf rate in 2007 were 3.9%, 1.27%, 1.15%, 1.40%, and 1.23% respectively).
There were a total of 128 elementary schools (ES) in those sub-districts, 28 in Wiradesa, 24 in Wonokerto, 40 in Kedungwuni, 20 in Tirto, and 16 in Buaran. Fifteen ES from those areas were randomly selected.The protocol for this study was reviewed and approved by the Health Research Ethical Review Committees of the Public Health Faculty, Diponegoro University, Indonesia. The survey was conducted in Sep 2015, a month before the first round of MDA was implemented. Blood drawing and circulating filarial antigen detectionCirculating filarial antigen (CFA) detection used immunochromatographic test (ICT) from Alere Scarborough Inc., Scarborough - ME USA. A volume of 100 μL blood was drawn by finger prick using microtainer BD blue.
The blood was collected in a calibrated capillary tube of each individual.Blood was then added to the white portion of the sample pad of the card according to the manufacturer protocol. Once the card was closed, the timer was started. The result of the test was read exactly 10 min after closing the card. Pink control (C) and test (T) lines were visible for all valid positive tests, whereas only the control pink line appeared for negative tests. B= Chi-Square testIn general, age of students ranged from 7 to 17 yr old. Mean age of positive subjects was slightly higher compare to negative subjects, yet the difference was not significant ( P=0.129).
The subjects were equally distributed between male and female students. Proportion of positive males was higher than female, although there was no statistical difference ( P=0.376). Proportion of positive students increased with grade, i.e. 0.4, 1.4, 2.2, and 2.6 respectively from third to sixth grade. No significant difference was found between grades ( P=0.212).Distribution of LF in children can be seen in.
VariablesCFAPositiveNegativeInvalidP valuen=15%n=743%n=275%SchoolSDN Kepatihan 100.1.40.009 bSDN Coprayan00.6.9SDN Kemplong00.1.3SDN Simbang Wetan00.03391.738.3SDN Kertijayan 300.0SDN Paweden22.8.8SDN Pekajangan00.6.7SDN Kedungwuni 400.1.1SD Muhamadiyah 100.8SDN Tegaldowo54.3.3SDN Bondansari 300.0.0SDN Bebel00.8.2SDN Jeruksari00.4.3SDN Mulyorejo22.9.5SDN Kranding65.3.1Sub DistrictsWiradesa00.05.10.000 bBuaran20.99.7Kedungwuni00.09.2Tirto133.88.4Wonokerto00.8.2. B= Chi-Square testCases of LF were only found in two sub-districts, namely Buaran and Tirto Sub Districts.Proportion of positive CFA in Tirto Sub District was more than 4 times higher than in Buaran Sub District. The school with highest proportion of W.
Bancrofti antigenemia was SDN Kranding, followed by SDN Tegaldowo, SDN Paweden, and SDN Mulyorejo. Three of the schools (SDN Kranding, Tegaldowo, and Mulyorejo) were located in Tirto Sub District. Only one other school was located in Buaran Sub District. Distribution of positive CFA differ significantly according to school ( P=0.009) and sub district ( P=0.000).For further investigation, LF prevalence in general population was examined. The result showed 19 out of 436 subjects were CFA positive. Therefore, prevalence of W. Bancrofti infection was 4.4%.
Mean age was 36.8 yr old in all subjects, while in infected persons the mean age was 39.1 yr old. Proportion of infection in male (8.1%) was higher than female (2.1%). LF cases were also mapped. Shows geographical distribution of chronic and active cases of LF. Most chronic cases were found in Tirto Sub District.
DiscussionStudy on LF in Pekalongan District is an additional interest to the current effort by DHO of Pekalongan towards LF elimination. This present observation demonstrated LF cases tended to cluster in area of Public Health Center (PHC) Tirto II, especially in village Tegaldowo (SDN Tegaldowo) and Jeruksari (SDN Kranding and Mulyorejo). Tegaldowo and Jeruksari are two neighboring villages. The result, therefore, supports the potential of Tirto Sub District to serve as sentinel site for Transmission Assessment Survey (TAS). TAS is done after five years of eligible MDA program. Selection of sentinel site should be based on mapping of LF endemic areas, i.e. The region with highest cases of LF.
Tirto is qualified to be a sentinel site when MDA evaluation takes place. Once a sentinel site is selected, it should continue to serve as the sentinel site throughout the program. “Blood surveys at sentinel sites are used to establish the baseline infection level and to monitor the impact of MDA on infection prevalence periodically”.
Pekalongan District has implemented partial MDA in five endemic sub districts, started in 2002 and ended in 2007. Yet this study found prevalence of LF remains higher than the level of transmission threshold (,). According to WHO, after five years of MDA, the expected prevalence of CFA should not exceed 2%. With an overall prevalence of 1.98% in children and 4.4% in population, LF remains a public health problem in Pekalongan, especially in Tirto Sub District. Although the prevalence is lower than that of earlier observations (2014) in Indonesia (4.7%) , infection in children should receive attention.
LF in children is a marker for relatively recent exposure to the parasite and is a sensitive indicator of LF endemicity. This study supports the need for targeting children in LF elimination campaign.“LF prevalence in Indonesia varied from 0.5 to 27.6%. The high rates of LF were found in Maluku, Papua, West Papua, East Nusa Tenggara, and North Maluku”. All people at risk are involved in this program. The efficacy of six annual rounds of MDA was studied in Alor Island, eastern part of Indonesia. Microfilaria rates in Alor decreased significantly after MDA intervention, from 26% to 0.17%. MDA may be recommended for other parts of Indonesia.
However, the challenge of MDA was mostly related to the infrastructure of MDA implementation and the compliance with drug administration. Therefore, LF elimination in remote area in Indonesia is a major challenge. This result showed the prevalence of LF in children increased with age. The similar type of prevalence was also reported from other endemic areas (–). Increasing of LF prevalence according to the age in an endemic area correlates with the duration of exposure to the infection (,).
In this study, the existence of concurrent prevalence of LF both in children and adults was observed in Tirto Sub Districts. Transmission had occurred in the area. Knowledge of LF prevalence in children is very important for understanding the future status of the disease.
In this case, the global elimination program decided to protect children from LF (,), because children who are close to adults are more exposed to infection. This result will help to develop public health strategies for treatment of LF infection in children and to reduce the future disease burden in the adult population.This study confirmed previous epidemiological studies that proportion of LF was higher in male than female (,). Higher prevalence in male usually due to the possibility to be exposed to mosquitoes. If left untreated, they may experience lymphatic damages and develop hydrocele by around 10–15 yr old, because the parasites seem to prefer the lymphatic of scrotum. This study also found LF cases between families, with all family members were infected. The clustering of LF cases possibly due to genetic (–) or environmental (,) factors.
A study in Mauke, Pacific Island revealed a strong association of genetic and LF in population. Several other studies in LF endemic areas also showed the infection and microfilariae burden tend to cluster in families, which was mostly due to genetic factor (–).As control effort is implemented, maps of the progress in control can help highlight success and indicate where further effort is required. Mapping of LF was conducted to show the distribution of active LF infection and chronic cases in Pekalongan District.
Both chronic cases in older population and infection in children were mostly found in Tirto Sub District. Tirto is lowland, which located 4 m above sea level. There are two coastal areas in the sub district. Several villages experience tidal inundation and are continuously affected by stagnant water or flood. The existence of stagnant water may serve as breeding places of LF vector Culex quinquefascitus.
Quinquefascitus was confirmed as LF vector in Samborejo Village, located in Tirto Sub District (, ).During the first three years of partial MDA in Pekalongan District (2002–2005), the coverage increased, i.e. 80.8%, 81.9%, and 90.2% respectively. This impacted in the decrease of mf rate to 0.14% throughout the District in 2007.
Tirto and Buaran were two sub-districts with lowest MDA coverage compared to other sub-districts. Consequently, in this study, we found positive cases only in students from Tirto and Buaran. Therefore, the result of this study confirmed the importance of high percentage coverage of MDA to reduce LF transmission.Information on LF prevalence and associated burdens is necessary to evaluate its public health implication and subsequently plan for control intervention. The study showed LF infection both in children and adult. This may serve as baseline prevalence before implementation of MDA.
Infected children usually did not show clinical signs. Nevertheless, school-based mass chemotherapy in lower age groups is necessary to prevent clinical manifestations associated with LF infection in the adults later in life.This study described prevalence and geographical distribution of LF in Pekalongan District, and might be used for mapping of population at risk and monitoring the disease.Limitation of this study related to the selection of study areas. Five sub-districts with high number of chronic LF cases were included in this study. The sub-districts were previously known as LF endemic areas. Therefore, the result cannot be generalized to other non-endemic areas. ConclusionCases of W. Bancrofti infection exist in Pekalongan District, both in children (1.98%) and adults (4.4%).
LF infection in children is a marker for relatively recent exposure to the parasite and is a sensitive indicator of LF endemicity. Therefore, this result will help to develop public health strategies for treatment of LF infection in children and to reduce the future disease burden in the adult population. Based on geographical distribution, LF infection was found clustering in Tirto Sub-district, located on the northern coast of Central Java. The result supported the potential of Tirto Sub District to serve as sentinel site for Transmission Assessment Survey (TAS). This study may serve as baseline data prior MDA program. Monitoring and evaluation of the program before second round of MDA should be done to measure the prevalence and effect of MDA.
PurposeLymphatic filariasis (LF) is a chronic infection of Brugia malayi, Brugia timori, and Wuchereria bancrofti and is a mosquito-transmitted disease. Mass drug administration (MDA) needs to be done annually to control LF and requires adherence of endemic populations to take medication properly. Maintaining high coverage of MDA is a challenge because the activity needs to be done in several years. This study would like to know the compliance of the community in taking medication during MDA periods in Pekalongan district using the health belief model (HBM) approach. Patients and methodsStudy population was people living in endemic areas in Pekalongan district, Central Java Province.
This was a cross-sectional study. HBM approach was used to analyze community perceived in regard to MDA. There were six of the 19 subdistrict selected as study location, and 100 subjects were selected from each sub-district.
Therefore, a total of 600 subjects participated in this study. Data were collected using the structured questionnaire. Data were analyzed quantitatively using the Chi-squared test. Multivariate analysis was used for logistic regression. ResultsResults of this study showed that the mean age of subjects was 38.6 years and had been staying in their villages for more than 30 years. Gender, marital status, history of LF, history of LF in the family, and external cues to action did not relate to MDA compliance.
Perceived susceptibility, perceived severity, perceived benefits, and perceived barriers were factors related to the compliance of MDA. After multivariate analysis, the perceived susceptibility did not have relationship with compliance. IntroductionLymphatic filariasis (LF) is a chronic infection of Brugia malayi, Brugia timori, and Wuchereria bancrofti, is transmitted by mosquito, and causes a chronic infection., The distribution of LF includes all tropical and subtropical areas., LF causes the permanent malformation of several body parts and is one of the most important infectious causes of permanent limb disability worldwide. Disability-adjusted life year (DALY) of LF is the highest among all other tropical diseases.
LF is also a major cause of poverty due to the loss of productivity, which eventually becomes an economic burden of family and society.–LF does not cause direct mortality, but its severe morbidity and the absence of prompt treatment may cause lifelong disability. In LF, inflammation and lymphedema are repeated several times in a year.
It leads to lymphatic damage and chronic swelling of organs such as the legs, arms, scrotum, vulva, and breasts. This produces physical burden to the patients and psychosocial stigma both to the patients and their family. Distressing feeling, embarrassment, guilt, behavioral withdrawal, and self-isolation are among characteristics of LF patients,– which affect patients’ quality of life.,Mass drug administration (MDA) uses a single dose of diethylcarbamazine citrate (DEC) and albendazole. The aim of MDA is to decrease the microfilaria rate and transmission rate of LF. However, the drug (DEC) does not have effect to kill adult worm.
Therefore, MDA must be implemented annually for 5 or more consecutive years to all the eligible population, until the adult worms either die or stop producing microfilaria. MDA coverage needs the compliance of population to take the medication properly. Several areas with poor resources find difficulties to maintain the coverage of MDA in years. In order to increase MDA compliance, we need to know the determinant of health-seeking behavior in community, both in public and in private health care sectors.
Considering the limitation of MDA, implementation of vector control must be improved as a complement for MDA in order to achieve LF elimination.Indonesia started to conduct MDA in 106 endemic districts in 2015, including Pekalongan district, Central Java Province. Pekalongan district reported 62 chronic LF cases, consisted of swelling on legs (71%), hands (2%), and genitalia (17%). The existence of chronic cases suggests that LF transmission has occurred for years and potentially increased or spread if not treated properly.
Pekalongan district had been conducted MDA in endemic subdistricts since 2002–2007. Yet, the microfilaria rate during MDA (2003–2007) remained high, ranged 1.15–3.90%. A study in Pekalongan district in 2015 showed that the LF prevalence was 1.98% in school students and 4.36% in general population. Filariasis infection in children is a marker of recent exposure to filarial worms. This may be related to a lack of community adherence in taking LF drugs during the MDA period.The success of regular program can decrease the transmission of LF, but unable to eliminate the adult worm.
Therefore, MDA needs to be done annually for minimum 5 years due to the life cycle of worms in the human body. MDA coverage requires the adherence of endemic populations to take medication properly, which seems difficult for the areas with poor resources. Therefore, this study would like to explore the community drug adherence during MDA periods in Pekalongan district.This study uses health belief model (HBM) approach to know the perception of society to LF treatment. The theory of HBM assuming decision toward health action is based on people’s opinion concerning with disease effect on health.
This theory consists of perceived threat and benefit in complying of suggesting health action. HBM approach is done with the purpose of self-efficacy or self-effort to determine what is good for him/her.
Components of HBM theory need to be measured to create a better health education program. Study sitePekalongan district consists of 19 subdistricts.
This study was conducted during August 2016 in six subdistricts, ie, Buaran, Kedungwuni, Tirto, Wiradesa, Wonokerto, and Siwalan. The six subdistricts were selected according to the existence of active or chronic LF. Two villages were then selected from each subdistrict. Selection of the village was also based on the existence of active or chronic LF. The LF data were taken from District Health Office of Pekalongan district. The selected villages consisted of Paweden and Kertijayan in Buaran subdistrict, Tangkil Kulon and Capgawen in Kedungwuni subdistrict, Tegaldowo and Jeruksari in Tirto subdistrict, Pekuncen and Karangjati in Wiradesa subdistrict, Sijambe and Bebel in Wonokerto subdistrict, and Sepait and Siwalan villages in Siwalan subdistrict.
Study subjectThe population in this study was aged ≥15 years who lived in endemic area in Pekalongan district, Central Java. The selection of age range was the assumption that they have been able to communicate well.
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Sampling method used in this study was multistage sampling as seen in. At the first level, we determined six subdistricts where LF cases were found.
In the second stage, two villages were selected according to the largest number of chronic and active cases. In the third stage, two sub-villages were selected from each village, based on the existence and nonexistence of active or chronic cases LF.
At each of sub-village, a cluster random sampling technique was implemented. From each of the sub-village, 25 subjects were randomly selected.
The subject in each subdistrict, therefore, was 100 persons. Overall, the study subject of the survey was 600. VariablesThe variables in this study consisted of characteristics that include name, age, gender, duration of stay in endemic areas, education, employment, income, marital status, number of family members, history of LF, and treatment.
HBM variables include the knowledge of LF, perceived susceptibility, perceived severity, perceived benefit, perceived barriers, cues to action, and practice of taking LF medication during MDA period.Knowledge consisted of LF as hereditary disease, LF as infectious disease, LF transmission, LF prevention, LF treatment, and MDA. Perceived susceptibility is one’s belief of the change in getting a certain condition.
Perceived susceptibility consisted of awareness that LF may attack all people, self-belief that he/she is at risk of contracting LF, feel the need to take medicine, and the feeling persists despite not experiencing LF symptoms. Perceived severity is one’s belief of how serious a condition and its consequences.
Perceived severity consisted of understanding that LF is a severe disease, that one will have severe difficulties in life if exposed to LF, and that LF causes embarrassed in social life, causes a person to be shunned by the social environment, and causes the malformation of several body parts.Perceived benefit is one’s belief in the efficacy of the advised action to reduce the risk or seriousness of impact. Perceived benefit consisted of the feeling that medication during MDA may prevent from LF, a person may avoid LF transmission by taking the medicine, and a person may prevent LF by taking medicine from health officer during MDA, although the medication is done once a year yet it may protect a person from LF. Perceived barrier is one’s belief in the tangible and psychological costs of the advised behavior. Perceived barrier consisted of the feeling that a person will experience side effects after taking LF medication, difficulty in reaching drug distribution, difficulty in swallowing medicine, and prohibition from family to take the preventive medicine.Cues to action are strategies to activate the readiness of a certain condition. Internal cues to action consisted of a person feels of having LF symptoms indicating that he/she suffers from LF, a person feels the need to take the medicine to prevent LF, and a person fears of contracting LF. External cues to action consisted of the role of health officer to remind a person to take the preventive LF medicine, often hear or see announcement to join MDA in order to prevent LF, familiar with LF patients who did not take the medicine, a local public figure suggested to follow MDA by taking the medicine.Each question was scored according to the answer. Positive answers were scored 1, while the negative ones were 0.
Score for each variable was summed up. The total scores of variables perceived susceptibility, perceived severity, perceived benefit, and perceived barrier were then categorized as good ( median) and poor (≤ median). Variables internal cues to action and external cues to action were categorized as yes ( median) and no (≤ median). Data collectionData were collected using structured questionnaire. The questionnaire included personal characteristics (age, gender, duration of living in endemic area, level of education, level of income, marital status, history of LF, and treatment). The questionnaire was also derived from HBM conceptual framework. The HBM is based on six concepts (perceived susceptibility, perceived severity, perceived benefit, perceived barriers, and cues to action).
Adherence toward MDA was also included in the questionnaire.The structured questionnaire was tested before use to see if the questionnaire can be applied in the field. The test was conducted to learn whether the questions in questionnaire can be apprehended by respondents. Four persons with academic background of public health had selected and trained to be enumerator. One of the investigators (LDS) organized the data collection in the field. Characteristicsn=600%GenderMale19031.7Female41068.3EducationNot graduated elementary school8213.7Graduated elementary school24741.5Graduated junior high school15525.8Graduated senior high school10217.0college142.3OccupationUnemployed, housewives, students23739.5Labor20934.8Merchant579.5Tailor233.8Entrepreneur223.7Private employees183.0Fishermen101.7Retired50.8Builder40.8Others152.6Marital statusMarried49382.2Death divorced193.2Divorced91.5Single79AgeMean38.8Median38.0Standard deviation13.74Minimum15Maximum85Length of stayMean34.2Median32.0Standard deviation16.28Minimum1Maximum85. Perceived toward compliance of MDAshows community perceived toward MDA.
There were 88.2% of respondents agreed that LF can affect everybody. As much as 87.7% of respondents felt the need to take LF medication and 86.7% felt the need to take LF drugs to prevent from the disease. In general, subjects had good perceived susceptibility related to LF (72.7%). Also shows that in general, most of the subject had a good perceived severity toward LF (80.7%). The majority of subjects agreed that LF is a severe disease and will cause difficulty to those who are affected. Most of subjects disagreed that LF causes embarrassed; on the other hand, they agreed LF causing shunned. Most subjects had a good perceived benefit toward MDA (76.8%).
The majority of subjects believed that MDA protects them from LF. They also agreed that MDA removes the fear of being infected by LF. In general, more than half of subjects had good perceived barriers, ie, they did not face any difficulties to participate in the MDA program (64.8%). They mentioned not to have health problem experience during MDA. Most of them claimed to have family support to take the drug. Most subjects (83.3%) had internal cues to action-related LF prevention and taking medicine and more than half of subjects (66.8%) did not have external cues to action. Relationship of perceived factors to the compliance of MDAshows gender, marital status, history of LF, history of LF in the family, and external cues to action did not relate to MDA compliance ( P=0.605, 0.480, 0.079, 0.314, and 0.109, respectively).
On the contrary, perceived susceptibility, perceived severity, perceived benefits, and perceived barriers, in addition with the role of elimination officers, were factors related to compliance of MDA ( P. VariablesNoncomplianceComplianceP-valuen=124%n=369%GenderMale3926.710773.30.605Female8524.526275.5Marital statusMarried74.60.480Death divorce323.11076.9Divorce00.07100.0Single1626.74473.3Experiencing LFYes00.09100.00.079No74.4Family experiencing LFYes00.03100.00.314no74.7Role of elimination officerNot optimum8534.416265.6. DiscussionThe use of HBM to identify community perceived toward MDA was based on the fact that a decision toward health action is based on people’s opinion of disease and health. Due to the high cost of MDA program, efforts should be address to evaluate what is the best implementation of the program.
This study addressed the role of community perceived in the MDA compliance during the program.The result of our study was in agreement with several prior studies on the assessment of MDA of LF that showed most respondents were female., Male population usually works at noon, which caused that more female respondents were found. People live in endemic areas for years must aware of LF infection. Risk of LF transmission increases in individual who lived in endemic area for 10 years.
Having a household member with lymphedema, or being a patient him/herself, might affect the awareness of LF risk. These factors will influence them to comply with the MDA. On the contrary, an individual without personal experience of having LF or having LF patients around may be harder to comply. In this study, all subjects who had the history of LF or had family member with LF came from endemic area.
It is also evident in this study that compliance was higher in endemic areas than in nonendemic ones.Before MDA, health officer should socialize community that everyone is at risk of contracting LF, despite his/her normal physical appearance. This may due to the fact that chronic sign of LF occurs 10–15 years after infection. A previous model showed that people with knowledge about being at risk for LF were also more likely to obey the suggested treatment. However, the finding was not significant. This was in accordance with our recent study, which showed that perceived susceptibility did not have relationship with MDA compliance.A previous study has shown that communities who witness the existence of LF patients in the community will realize that everyone is at risk of contracting the LF and tend to be more obedient to consume the drug. Moreover, the perception that a person may suffer from LF influenced the individual’s expression of willingness to participate in the next MDA program.– In nonendemic areas, community pays a little attention and gives less priority to LF.
Hence, MDA coverage in the area is generally low. People considered LF is not a serious illness and did not feel the need to take medication during MDA.Subjects in endemic areas were mostly agreed to take DEC annually, while most of subject in nonendemic area were disagreed. Several previous studies revealed that an individual who has positive perceived about the benefit of MDA tends to comply with the medication during MDA., Health promotion programs usually stressed on the advantages of disease’s treatment or prevention. In general, health practitioners must think over health as a motivation to achieve compliance. On the contrary, in nonendemic areas, the condition may not applicable. The message about the seriousness of LF seems to be highlighted to encourage people to consume drugs.Many previous studies revealed that the primary reasons for people to obey the treatment were the hope to be cure from LF, or to avoid LF. Both health and nonhealth benefits are equally influence the compliance of MDA.
Therefore, health promotion should not only focus on health but also consider the nonhealth benefits. These include social acceptance, being perceived as healthy family, being a good and obedient citizen, and being wise in preventing LF infection. The appropriate campaigns of MDA may increase the demand for the tablets.
LF has been shown to be related with the cycle of poverty. Acute attack LF is preventing an individual from working, thereby decreasing income. Patients with chronic LF require regular medical assistance and may suffer from associated stigmas. Therefore, MDA campaign should address the economic and social benefits of treatment.A study conducted by Cantey et al revealed that addressing the barriers against MDA experienced can help to improve compliance. In HBM theory, if the perceived benefit is higher than perceived barrier, people will tend to adhere in taking medicine during MDA program.
Several literatures revealed that perceived benefit and self-efficacy were significantly associated with compliance., Study conducted by Adhikari et al proved that almost all of its subjects did not realize that LF patients might be asymptomatic for years. This result was also evidenced in other disease, such as malaria. Complete participation in malaria elimination program was significantly associated with the perceptions that targeted malaria elimination was worthwhile.
They usually started the awareness of LF manifestation when the swollen of the limb or chronic stage has already begun. The unawareness contributes in community perceived that they will not be infected.
This will then cause community behavior to not comply in taking medicine. Our study showed that almost all subjects in nonendemic area did not have internal cues to action that triggered to compliance during MDA. And previous study showed respondents who were visited directly by health officials in their own homes had significantly higher medication adherence than respondents who were not visited by officers.
With door-to-door visitation by officers, the community perception of the importance of taking LF medication will increase.In this study, variables such as characteristics, role of elimination officer, and HBM were tested to find the factors associated with medication adherence in the MDA program. The results are listed in. There was no difference in adherence based on the characteristics of age (using independent t-test, data not shown), gender, marital status, or the presence of LF patients in the family, both overall and after adjusted by the category of endemic.
In terms of demographic characteristics, these results were consistent with prior research that age, gender, level of education, illiteracy, and the presence of family members who have lymphedema are not the predictors of medication adherence., Instead, the role of elimination officer and variables of HBM (except external cues to action) were factors associated with LF medication adherence during the implementation of MDA program. Once adjusted based on the endemic and nonendemic, the role of elimination officer and HBM variables remained related to the medication adherence of LF.The results of this study support the importance of health promotion to increase community knowledge about the MDA and benefits in the control of LF. HBM variables in this study proved to be related to medication adherence LF. This should be taken into consideration when making the socialization of POMP the community to meet the treatment coverage target of 85%.This study has some limitations, which have to be pointed out. The retrospective nature of interview in regard to MDA compliance may lead to recall bias. Selection bias may also occur because the locations were selected purposively.
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