Abstrak:

Malaria is an infectious disease caused by a malaria parasite spread by female Anopheles mosquitoes, and is currently a public health problem. Besides causing death, it also affects work productivity and income. Puskesmas Hanura, wich is included ah High Incidence Area with AMI of l59,8 per 1000 persons, has done many efforts to deal with malaria, one of those is encouraging the use of bednets by distributing them to the community. The community there uses bednets while sleeping to help prevent malaria incidence. This study used case control design, to elicit whether there is any significant relationship between exposure to mosquitoes and malaria by comparing case group and control group. Data were collected from Puskesmas I-Ianura, whit case group being patients who have been diagnosed with malaria (based on clinical symptoms and laboratory result) and control group are those who are not diagnosed with malaria, Primary data were also collected using stmctured questionnaires. The result of bivariate analysis with a confidence of 95% showed that variabels correlating with malaria incidence the use of badnets with p value = 0,000 and OR = 4,177 (95%: 2,537-6,879), the use of mosquito coil with p value = 0,038 and OR = 1,962 (95% Cl: 1,078-3,57l) and being outside the housing during night time with p value = 0,016 and OR = 1,926 (95% CI: 1,159-3,20l). The result of multivariate analiysis showed that using bednets when sleeping has a correlation with malaria incidence. Those who do not use bednets have 4,177 times begger risk to catch malaria than those who do. g. It is suggested that the community be given thorough infomation on the importance of preventing the spread of malaria. The distribution of badnets should be continued and information should be given also regarding how to use bednets properly and their benefits. It is also suggested that people should stay inside the house night.

Abstrak: Malaria adalah penyakit infeksi yang disebabkan oleh suatu parasit yanghidup di dalam darah melalui gigitan nyamuk Anopheles betina. Malaria masihmerupakan masalah di Indonesia karena hingga tahun 2015 jumlah keseluruhankasus malaria sebesar 217.025 kasus. Pada tahun 2015 Provinsi Lampung memilikijumlah kasus paling banyak setelah Papua, NTT, Papua Barat, Maluku SumateraUtara dengan jumlah kasus positif 3.991 kasus dimana Kabupaten Pesawaranmerupakan kabupaten endemis malaria. Tujuan penelitian ini adalah mengetahuihubungan perilaku dan tempat perindukan nyamuk terhadap kejadian malariasetelah dikontrol dengan variabel potensial confounder lainnya. Penelitian inimerupakan penelitian case-control dengan jumlah sampel 180 responden, dengankasus 60 dan kontrol 120 berusia ≥ 15 tahun, menggunakan data insiden. Datadianalisis dengan uji chi-square, stratifikasi, dan regresi logistik. Setelah dikontrolvariabel confounding didapatkan variabel pemasangan kawat kasa berhubungandengan kejadian malaria (OR : 3,15 ; 95% CI : 1,099-9,074; p = 0,033). Sedangkanvariabel keluar malam, obat nyamuk, penggunaan kelambu, tempat perindukannyamuk dan jarak tempat perindukan nyamuk tidak berhubungan dengan kejadianmalaria. Umur merupakan efek modifikasi terhadap hubungan antara penggunaankelambu dan kejadian malaria. Masyarakat hendaknya melakukan upayapencegahan dengan melakukan pemasangan kawat kasa pada setiap ventilasi rumahdan menutup setiap lubang pada dinding rumah yang berpotensi nyamuk bisamasuk serta menggunakan kelambu pada saat tidur malam.
Kata Kunci : Kawat kasa, Kelambu, Kejadian Malaria.

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Malaria is an infectious disease caused by a parasite that lives in the bloodthrough the bite of a female Anopheles mosquito. Malaria is still a problem inIndonesia since 2015 the total number of 217.025 of malaria cases. In 2015,Lampung province has the most number of cases after Papua, East Nusa Tenggara,West Papua, Maluku, North Sumatera amount of positive 3,991 cases in which theDistrict Pesawaran a malaria endemic districts. The main purpose of this study wasto determine the relationship of behavior and breeding places on the incidence ofmalaria after controlling for potential confounders. This study is a case-controlstudy with a sample size of 180 respondents, with 60 cases and 120 controls aged≥ 15 years, using incident data. Data were analyzed by chi-square test, stratificationand logistic regression. After adjusting confounding variables installation of wirenetting significant relationship with the incidence of malaria (OR : 3,15 ; 95% CI :1,099-9,074; p = 0,033). Out of the house at night, insect repellent, use of mosquitonets, mosquito breeding places and distances breeding places are not relationshipwith the incidence of malaria. Age is a modification effect on the relationshipbetween the use of mosquito nets and malaria. The people should take steps toprevent the installation of wire netting perform at every home ventilation and closeany holes in the walls of houses that potentially could enter and use mosquitonetting when sleeping at night. The people should take steps to prevent malaria bydoing the installation of wire netting at each home ventilation and close any holesin the walls of houses that potentially could enter and use mosquito netting whensleeping at night
Kata Kunci : Wire Netting, Mosquito Net, Malaria.

Abstrak: Selama lima tahun terakhir angka AMI di Puskesmas Hanura Kabupaten Lampung Selatan cenderung meningkat. Salah satu faktor yang diduga berhubungan dengan kenaikan kasus ini adalah adanya resistensi obat. Resistensi obat malaria di Lampung pertama kali dilaporkan oleh NAMRU pada tahun 2000, penelitian terakhir yang dilakukan oleh Sutanto pada tahun 2002 memperlihatkan angka resistensi klorokuin di wilayah Puskesmas Hanura mencapai 80 %. Departemen Kesehatan menganjurkan untuk dilakukan penggantian obat malaria dengan Artemisin Combination Therapy ( ACT ), tapi di Puskesmas Hanura belum pernah dilakukan analisis kelayakan penggunaan obat Artemisin Combination Therapy ( ACT ). Tujuan penelitian ini untuk mengetahui kelayakan Artemisin Combination Therapy ( ACT ) sebagai obat malaria pengganti Klorokuin di Puskesmas Hanura Lampung Selatan tahun 2005. Variabel yang digunakan dalam penelitian ini adalah Efikasi obat berupa kecepatan menghilangkan parasit, kecepatan menghilangkan gejala klinis; Penerimaan Masyarakat berupa efek samping dan sikap terhadap obat serta perbedaan efektifitas biaya. Dari hasil penelitian terhadap 56 penderita malaria yang menggunakan obat klorokuin dan 53 yang menggunakan obat ACT, diketahui bahwa dari lima variabel yang ada dan diduga berhubungan dengan efek pengobatan ( variabel jenis obat malaria, kepadatan parasit, berat badan, umur, jenis kelamin ) setelah diuji dengan analisis regresi sederhana dengan variabel dependen yaitu Efek pengobatan, ternyata yang mempunyai batas nilai signifikan ( p-value < 0,25 ) didapat 4 variabel ( jenis obat malaria, kepadatan parasit, berat badan, umur ). Dari 4 variabel tersebut kemudian diseleksi ( full model ) dengan uji signifikansi p-wald untuk melihat seberapa penting variabel itu masuk model ( dengan cara mengeluarkan satu persatu variabel yang mempunyai p-wald paling besar ). Dari seleksi tersebut tinggal satu variabel yang bertahan ( Jenis obat malaria ) dan mempunyai p-wald signifikan ( < 0,05 ). Skor penilaian kelayakan obat malaria didapat ACT mempunyai skor 9,67 dan klorokuin mempunyai skor 5,62. Kesimpulan dari hasil penelitian ini adalah Artemisin Combination Therapy ( ACT ) layak digunakan sebagai obat malaria pengganti Klorokuin di Puskesmas Hanura Lampung Selatan Melihat efikasi obat anti malaria terutama Klorokuin di Puskesmas Hanura 19,65 % perlu segera dilakukan kebijakan penggantian obat malaria yang efikasinya lebih baik (ACT). Pengobatan dengan menggunakan regimen obat anti malaria yang efektif (ACT) harus segera diperkenalkan dan dilaksanakan. Pemerintah daerah diharapkan dapat mengalokasikan anggaran daerah untuk pengadaan obat ACT.

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In the last five years AMI (Anual Malaria Inciden) rate in Puskesmas Hanura Kabupaten Lampung Selatan trend increased.. One factors that are predicted relation to increase this case is drug resistance. The first findung of Malaria drug resistance in Lampung reported by NAMRU at 2000, the last research by Sutanto at 2002 showed that resistance rate of kloroquin at Puskesmas Hanura Area is 80 %. Health Departemen of Republic Indonesia suggest that is done to change malaria drug with Artemisin Combination Therapy ( ACT ), but at Puskesmas Hanura never be done to analysis the fesibility of Artemisin Combination Therapy ( ACT ) as malaria drug. The objective of this studi to know the feasibility of Artemisin Combination Therapy ( ACT ) as a changed of malaria drug from Kloroquin at Puskesmas Hanura Lampung Selatan tahun 2005. The Variabel are used in this study are Drug Eficacy consist of the speed to lose parasite, the speed to lose malaria syndrome; The Community Acceptance are side efect and respon to the drug and the different of cost efective. The result of this study to 56 patient of malaria that use kloroquin and 53 use ACT, known that 5 varible are drug efect ( malaria drug kinds, the density of parasite , body weight, age, sex ) after tested by simple regeration analysis with dependent variable are treatment side efect pengobatan, have p-value < 0,25 are 4 variable ( malaria drug kinds, parasite density, body weight, age). For those variable (4 variable) are selected ( full model ) by uji signifikansi p-wald to know how important those variable to became in model ( the way by to get out one by one the varible that have p-wald very big ). From this selection just one varible that have p-wald signifikan ( < 0,05 ) is malaria drug kinds. The value skore of malaria drug feasibility that ACT 9,67 and kloroquin have score 5,62. The result of this studi that Artemisin Combination Therapy ( ACT ) feasible to use as a changed of Kloroquin of malaria drug at Puskesmas Hanura Lampung Selatan The eficacy of malaria drug, Klorokuin at Puskesmas Hanura just 19,65 %, so need the policy to change the malaria drug that the eficacy more better (ACT). The treatment by malaria drug more efective (ACT) soonly to promote dan be done. The local goverment have to alocate the budget to the ACT drug.