Faktor manusia (host) yang pcnling dalam pcnccgahan malaria adalah Faklor perilaku, seperti perilaku pencegahan dan pencarian pengobatan. Salah satu Faktor pencegahan malaria berkaitan dengan pcngcmbangan program kelambunisasi adalah keteraturan masyarakat untuk tidur mcnggunakan kelambu sepanjang malam. Penelitian ini bertujuan umuk mengetahui hubungan menggunakan kclambu dengan kejadian malaria, clengan mempertimbangkan faktor-faktor: umur, jenis keiamin, pendidikan, waktu bekerja, pengetahuan tentang malaria, penyuluhan lcelambu, kecukupan kelambu, lama tinggal, pemilikan temak besar, obat anti nyamuk, kassa, dan alat pellndung diri keluar mlam. Penelitian ini dilalcsanakan di Kabupaten Lampung Selatan, dengan pertimbangan prevalensi klinis malaria di Kabupaten Lampung Selatan sangat fluktuatifl yaitu ll,5%0 tahun 2000, cenderung meningkat menjadi l3,65%¢ pada tahun 2003 dan menurun kembali menjadi ll,3%¢ di tahun 2004, scdangkan pada tahun 2005 kcmbali turun mcnjadi 9,67_ disamping, itu program kelambunisasi baru bcrjaan, lokasi pcnelitian adalah salah salu puskesmas lercndcmis di Kabupatcn Lampung Selalan, yaitu Puskcsmas Hanura. Berdasarkan pcnelitian ini didapatkan hubungan yang bermakna secara statistik antara menggunakan kelambu dengan kejadian malaria, dimana respondcn yang tidak mcnggunakan kelambu berisiko 4,82 kali terkena malaria dibandingkan dengan responden yang leralur tidur menggunakan kclambu. Faktor resiko yang berpotensi menjadi konfounder sehubungan dengan keteraturan tidur mcnggunakan kelambu dengan kejadian malaria adalah pengetahuan responden tentang cara pencegahan malaria dan status penyuluhan tentang kelambu yang dilerima oleh responden. Respondcn yang tidak tahu cara pencegahan malaria berisiko 6,64 kali dibanding responder; yang tahu tentang cara pencegahan malaria. Variabcl umur responden kelompok muda < 15 tahun beresiko terkena malaria pemah menerima pcnyuluhan kelambu akan terlindungi dari malaria 2,37 kali dibandingkan dengan responden yang beumur > 15 tahun. Berdasarkan penclitian ini diketahui menggunakan kelambu sangal mcmpengamhi keberhasilan program pengendalian malaria jika dilaksanakan dcngan mempertimbangkan upaya pcningkatan pcngetahuan masyarakat temang pencegahan malaria Serta manfaat penggunaan kelambu. Oleh karcna itu kiranya perlu dilakukan penyuluhan ulang temang manfaal penggunaan kclambu dalam pcnccgahan tcrjadinya pcnularan malaria, karcna berdasarkan penclilian ini hal tersebut dapat mcningkalkan cakupun pcnggunaan kelambu di masyarakul.

An important human factor in malaria prevention activities is behavioral factor, such as prevention behavior and care seeking. One of prevention factor of malaria which is related with bednets program is the using of bednets by the community during night-rest time. This research aims to determine correlation between the using ot' bednets by the community with malaria incidence in Hanura Health Centre, South Lampung District. The correlation will be considered to variables, which are age groups, gender, educational level, working hours, the community knowledge regarding malaria prevention, health education, length stay, ownership of cattle, mosquito coils, kassa, the using of self protection clothes during night time. The prevalence of clinical malaria in South Lampung District is fluctuated, from ll.5%o in 2000 to l3.65%o in 2003 and decreases to ll.3%a in 2004 and 9.67%o in 2005. The location of this study is Hanura Health Centre due to thc most endemic malaria condition of this health center in South Lampung District. This research finds that there is statistical significant relationship between the using of bednets by the community with malaria incidence. Non using bednets group risks 4.67 times to have malaria infection compare to using bednets group. Confounder risk factors are knowledge of the community regarding malaria prevention efforts and health education to use bednets. Lack knowledge of malaria prevention respondents risk 6.64 times compares to good knowledge of malaria prcvcntion respondents. Responden age group is risk factor for malaria incidence. Age group responden < I5 years more risk 2,32 times compare to age group 2 IS years. In conclusion, successful bednets distribution program in malaria control activities should be followed with increasing the knowledge of malaria prevention among the community and increasing health education to use bednets. Therefore, malaria control program in South Lampung District should continue malaria health education program on regular basis for the community in Hanura Health Centre. The message could consist of malaria prevention activities and the using ofbednets.

Malaria merupakan masalah kesehatan dunia termasuk Indonesia. Kasus baru malaria tahun 2009/2010 di seluruh indonesia berdasar Riskesdas 2010 masih tinggi, yaitu 22,9 permil. Beberapa penelitian sebelumnya telah menemukan adanya hubungan antara perilaku dalam mencegah gigitan nyamuk dengan kejadian malaria, tetapi dalam wilayah yang sebatas lokasi penelitian di tingkat kabupaten atau suatu provinsi. Sehingga peneliti merasa tertarik untuk melakukan analisa pada sampel rumah tangga yang ada pada seluruh provinsi di indonesia menggunakan data sekunder Riskesdas 2010. Tujuan penelitian ini adalah untuk mengetahui hubungan antara penggunaan obat anti nyamuk dan hubungan antara penggunaan kelambu sewaktu tidur dengan kejadian malaria di indonesia tahun 2010. Desain penelitian ini adalah cross-sectional, dengan mencari hubungan dua vaiabel utama (Penggunaan obat anti nyamuk dan penggunaan kelambu sewaktu tidur) terhadap terjadinya penyakit malaria. Sumber data adalah data sekunder Riskesdas 2010 dengan total sampel adalah 251.833 responden. Hasil penelitian mendapatkan proporsi responden yang menderita malaria sebesar 2,6 % dan yang tidak menderita malaria 97,4%. Dapat dikatakan bahwa prevalensi malaria di Indonesia tahun 2010 sebesar 26‰. Analisis bivariat menunjukan adanya hubungan bermakna obat anti nyamuk dengan kejadian malaria (p=0,000) dan mendapatkan nilai odds ratio 1,34 (95% Cl: 1,26 – 1,42). Sedangkan hubungan penggunaan kelambu dengan kejadian malaria diperoleh nilai odds ratio (OR)= 0,471 dan 95% Cl: 0,448-0,495 (p= 0,000). Kemudian dilakukan analisis multivariat guna melihat hubungan variabel utama dengan outcome setelah mengontrol pengaruh dari variabel confounder. Didapat hasil, variabel obat anti nyamuk memiliki OR=1,515 (95% CI = 1,25 – 1,84) dengan nilai p = 0,000, setelah dikontol variabel kelambu, variabel endemisitas, dan dikontrol juga dengan adanya variabel interaksi obat anti nyamuk oleh kelambu. Sedangan variabel penggunaan kelambu, dari hasil analisis memiliki OR=0,750 (95% CI = 0,604 - 0,931) dengan nilai p = 0,009, setelah dikontol variabel penggunaan obat anti nyamuk, varibel endemisitas, dan dikontrol juga dengan adanya variabel interaksi kelambu oleh obat anti nyamuk. Kata kunci : Malaria, Obat anti nyamuk, Kelambu, Riskesdas 2010.

Malaria is a major health problem globaly including Indonesia. Based on Riskesdas 2010 data, incidence of malaria 2009/2010, is high, 22.9‰. Previous studies found an association of behavior in preventing mosquito bites with the incidence of malaria, but in a limited area like in the district or a province. So the researcher was interested to analize the households sample in all provinces in Indonesia using Riskesdas 2010 data. The objective of this study was to determine the relationship between the use of anti-mosquito repellent/insecticide and mosquito bed net with the incidence of malaria in Indonesia by the year of 2010. Study design is cross-sectional, to find the relationship of two main variabels (the use of anti-mosquito repellent/insecticide and the use of mosquito bed net) to the occurence of malaria. Data sources are Riskesdas 2010 data, with a total sample of respondents are 251,833. The results obtain proportion of respondents who infected by malaria of 2.6% and 97.4% did not infected by malaria. It could be argued that the prevalence of malaria in Indonesia in 2010 are 26‰. Bivariate analysis showed a significant relationship of anti-mosquito with malaria incidence (p = 0.000) and obtain the value of odds ratios 1.34 (95% Cl: 1.26 to 1.42). While the relationship with the incidence of malaria bed net use values obtained odds ratio (OR) = 0.471 and 95% Cl: 0.448 to 0.495 (p = 0.000). Then performed multivariate analysis to see the relationship with the primary outcome variables after controlling for the influence of confounder variables. The result, anti-mosquito variable has odds ratio = 1.515 (95% CI = 1.25 to 1.84) with p-value = 0.000, adjusted by net variable, endemicity, and controlled also by the presence of interactions anti-mosquito by bed nets . As a Bed nets variabel, the results of the analysis has odds ratio 0.750 (95% CI = 0.604 to 0.931) with a pvalue = 0.009, adjusted by the use of anti-mosquito, endemicity, and also controlled by an interaction anti-mosquito by bed nets . Key words: Malaria, Anti-mosquito, Mosquito bed net, Riskesdas 2010.

Di Indonesia, malaria masih merupakan masalah kesehatan masyarakat yang perlu mendapat perhatian.Obat malaria yang digunakan dalam program Nasional di Indonesia yaitu kombinasi Artesunat dengan Amodialuin, di laboratorium amodiakuin sudah terbukti bereaksi silang dengan klorokuin sehingga dikhawatirkan kombinasi artesunat-amodiakuin penggunaannya tidak akan bertahan lama di Indonesia. Hal ini didukung dengan data di lapangan yang memperlihatkan variasi efektifitas artesunat-amodiakuin di berbagai daerah malaria. Laporan uji efikasi artesunat-amodiakuin di Lampung memperlihatkan efektifitasnya 80% terhadap P.falciparum. karena itu diperlukan kombinasi artemisinin lain yang aman, efektif, murah, dapat digunakan balk Untuk P.falciparum dan P.vivax serta tidak mengandung komponen yang bereaksi silang dengan klorokuin_ Untuk itu digunakan alternatif kombinasi Dihidroartemisinin --- Piperakuin sebagai pilihan. Tujuan penelitian ini untuk mengetahui perbedaan risiko kejadian yang tidak diitiginkan pada terapi dengan pengobatan kombinasi dihidroartemisinin-piperakuin dibandingkan terapi Artestinat-Amodiakuin untuk penderita malaria P.falciparum tanpa komplikasi. Penelitian dilakukan di Puskesmas Hanura, Kabupaten Lampung Selatan, propinsi Lampung. Desain penelitian yang digunakan merupakan penelitian Uji Klink Acak terkontrol atau Randomized Controlled Trial (RCT), Uji klinis terbuka (open trial) . Penelitian dilakukan mulai September 2005 sampai November 2006. Dengan pertimbangan waktu, tenaga dan biaya, pada penelitian ini menggunakan jumlah sampel sebanyak 106 orang (55 orang untuk dihidroartemisinin-piperakuin dan 51 orang untuk artesunat-amodiakuin). Analisis statistik yang dilakukan adalah analisis univariat, bivariat dengan Chi Square dan multivariat dengan logistic regression dengan backward elimination. Proporsi kejadian yang tidak diinginkan yang timbul dengan pemakaian obat malaria DHA-Piperakuin , yaitu Sakit kepala, lesu dan lemah, gangguan pada sistim gastro intestinal, dan Gangguan lain pada hari 1-3 adalah 69%, 67%, 60%, 67% berurutan, dan untuk Artesunat-Amodiakuin 67%, 67%, 76,5%, 67% berturutan. Pada hari 7-28 kejadian yang tidak diinginkan yang timbul dengan pemakaian obat malaria DHA-Piperakuin seperti disebutkan diatas, yaitu 24%, 7%, 9%, 24% berurutan, dan untuk Artesunat-Amodiakuin 24%, 18%, 14%, 23,5% berturutan. Perbandingan proporsi terjadinya kejadian yang tidak diinginkan dengan penggunaan obat DHA-Piperakuin mempunyai risiko relatif lebih sedikit atau hampir sama dibandingkan penggunaan obat Artesunat-Amodiakuin.

Malaria needs to be taken into consideration in Indonesia, in particular in Eastern part, as its incidence rate is still high thereby causing high mortality rate amongst the children under five years of age and bearing women. To date, a drug combination of Artesunate-Amodiaquine is widely used by the Indonesia National Program. However, this combination seems unlikely to be chosen in the future as Amodiaqume was experimentally proven to cause a cross-reaction to Chloroquine. Moreover, several data from the field showed a wide diversity of the effectivity of this drug combination, In example, an efficacy trial performed in Lampung has shown the 80% effectivity of this combination drug administration. Consequently, another drug combination,.e.g. Dihydroartemisinine (DHA) - Piperaquine to be considered as an alternate drug of choise. This study aims to investigation the risk discrepancies of Adverse Event (AEs) between DHA-Piperaquine and Artesunate-Amodiaquine administration during therapy in P.falciparum malaria patients without complication. This study uses a randomized Controlled Trial (RCT), open trial was conducted at health district Hanura, South Lampung from September 2005 to November 2006. 106 subjects (55 with DHA-Piperaquine and 51 with Artesunate Amodiaquine administration) were included due to time, financial and energy constraints in this study. Findings were analyzed using linivariate, Bivariate with the Chi Square test and the logistics regression with backward elimination (Multivariate analysis). This study result shows that on day 1 to 3, the AEs due to DHA - Piperaquine administration were headache, weakness, gastrointestinal disturbance, an others of 69%, 67%, 60%, 67% respectively, while those of Artesunate - Amodiaquine were of 67%, 67%, 76,5%, 67% respectively. On day 7 to 28, the AEs due to DHA Piperaquine administration were definitely similar to above mention AEs of 24%, 7%, 9%, 24% respectively, while AE rate after Artesunate-Amodiaquine administration were 24%, 18%, 14%, 23,5% respectively. The DHA-Piperaquine appeared to have less or almost the same the mild AEs of Artesunate-Amodiaquine administration.

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.