EVALUATION OF THE USE OF ANTIMALARIA MEDICINES IN HANURA HEALTH CENTRE PESAWARAN DISTRICT PERIOD JANUARY-DECEMBER IN 2018 Evaluation Of The Use Of Antimalarial Medicines In Hanura Health Centre Pesawaran District period January-December In 2018

Malaria is a public health problem in Indonesia, especially those living in isolated areas. This is published in Presidential Regulation No. 5/2010 concerning the National Medium Term Development Plan for malaria endemic areas, which are divided into high, medium and low endemic areas. High endemic if the API is greater than 50 out of 1,000 population in the provinces of Maluku, Papua, North Sumatra and East Nusa Tenggara. Moderate endemic if the API is 1 to less than 50 dari 1,000 population in the provinces of Aceh, Bangka Belitung, Jambi and West Nusa Tenggara. Low endemic if the API is 0-1 per 1,000 population in Kalimantan, Sulawesi, and parts of Java. This study aims to determine the evaluation of the use of antimalarial drugs with the characteristics of age, sex, and type of malaria plasmodium at the Hanura Public Health Centre based on the criteria of the right indication, the right drug, the right dose, the right interval of drug administration (4T). This research is a descriptive research with purposive sampling method. Collection of prescription data and medical records in January-December 2018. The results showed that in cases of Malaria based on age, the most common cases occurred in the age range of 56-65 years, amounting to 99.6%, based on sex experienced in men by 77.41%, based on body weight the most occurred at 41-59 kg at 45.16%, based on the type of plasmodium experienced plasmodium vivax mostly at 84.95%. Based on these data, it was concluded that the evaluation of the use of antimalarial drugs based on 4T criteria was 100% accurate indication, 100% correct drug, 72.04% correct dose, 98.92% correct interval of drug administration.


INTRODUCTION
World Malaria Report on 2015 states that malaria has attacked 106 countries in the world. Global commitment to the Millennium Development Goals (MDGs), placing efforts to eradicate malaria into one common goal, namely ensuring a healthy life and striving for the welfare of all people. (1)Malaria is still a threat to public health status, especially for people living in remote areas. This is reflected in the issuance of Presidential Regulation Number 5 of 2010 concerning the National Medium-Term Development Plan for 2010-2014 where malaria is a priority disease that needs to be tackled. (2) Malaria infects about half a billion people in tropical and subtropical countries each year. The number of malaria cases in Indonesia in 2010 was 465,764 and in 2015 it had decreased to 209,413 cases. (3). According to Riskesdas 2018, the prevalence of malaria based on a history of blood tests in 2018 was 12%, with the highest 2018 age group at 0-11 months and 5-9 years of age being 1.0% (4).
Some areas in Lampung Province are endemic areas that have the potential to develop malaria. The number of malaria endemic villages is 223 villages or 10% of all villages and the malaria morbidity rate per year is 1,000 people. The highest malaria morbidity rate in the Regency / City in 2015 was in Pesawaran District with the largest cases found in Lampung Province. (5) The Pesawaran health office stated that the API in the Pesawaran district area for a period of 5 years (2012 -2 016) fluctuated / not fixed. The Malaria Parasite Rate per 1,000 population is the morbidity rate for patients who are positive for malaria. The highest positive case of malaria based on the health center in Pesawaran District in 2016 was the Hanura Health Center, with the highest number of cases, namely 1,738 cases. (6) The types of malaria parasites that play a major role in malaria transmission are Plasmodium falciparum and Plasmodium vivax. The type of malaria falciparum becomes severe malaria and is the only parasite that can cause microvascular disease. Symptoms of fever are continuous intermintent and can cause some serious complications such as cerebral malaria (brain malaria) and cause death. (3) The treatment given is the radical treatment of malaria by killing all stages of parasites present in the human body. (4)One of the biggest challenges in malaria treatment efforts in Indonesia is the decrease in the efficacy of the use of several anti-malarial drugs, and there is even resistance to chloroquine. Since 2004 the main drug of choice for malaria has been a combination drug derived from Artemisinin known as Artemisinin-based Combination Therapy (ACT).(5) The artemisinin combination was chosen to improve the quality of malaria treatment that was already resistant to chloroquine where this artemisinin had a better therapeutic effect. (6) The treatment program as an effort to overcome the malaria problem, aims to reduce morbidity, prevent death and cure patients. (7) Plasmodium vivax type malaria patients often do not comply with the rules for taking medication according to the treatment schedule and according to the prescribed dosage (8). Treatment failure was defined as the inability to clear malaria parasites or prevent recurrence after administration of antimalarial drugs. Many factors can contribute to treatment failure, namely wrong dosage, poor patients, non-adherent patients, poor drug quality and drug resistance. (9) Based on the description above, this study aims to determine the use of antimalarial drugs in outpatient poly outpatients at the Hanura Public Health Center, Pesawaran Regency, based on the parameters of the right frequency, the right indication, the right drug, the right dose (4T).

Time and Place of Research
This research was conducted in February 2020 at the UPT Puskesmas Hanura Hospital Pesawaran District.

Types of research
This research is a descriptive with purposive sampling method.. Purposive sampling, namely sampling based on certain considerations made by the researcher himself based on previously known characteristics or characteristics of the population that meet the inclusion and exclusion criteria.

Population and Research Sample
The population in this study were patients suffering from malaria in the outpatient clinic at the Hanura Public Health Center, Pesawaran District, in the January-December 2018 period.
Determination of the sample using the Slovin formula.

Research variable
The independent variables in this study include medical records (age, gender, diagnosis) and prescription (use of antibiotics), while the dependent variable in this study is rationality based on 4T indicators.(Right indication, Right Drug, Right Dosage, Right Frequency)

Data collection
The data collected in this study is by looking at the medical records of patients diagnosed with uncomplicated malaria at the Hanura Public Health Center, Pesawaran Regency.

Data analysis
Data analysis conducted in this study, the study used descriptive analysis, which included patient characteristics (age, gender, doctor's diagnosis and distribution of malaria drug use). The data obtained were analyzed descriptively qualitatively, then the data was tabulated and the results of the research could be assessed for accuracy based on 4 T criteria.(Right indication, Right Drug, Right Dosage, Right Frequency)

RESULTS AND DISCUSSION
The subjects of this study were outpatients with a diagnosis of Malaria in the January-December 2018 period at the Hanura Public Health Center, Pesawaran Regency. The number of samples taken based on the calculation results of 93 samples from medical records and prescriptions. Patient characteristics in this study were based on age, gender, body weight and Plasmodium.  2015) showed that there was a significant relationship between age and malaria (p value = 0.002). This is because the age group is a group where this age allows to work and travel outside the house so that it is more likely to be in contact with the malaria vector. Therefore the incidence of malaria ranges in the ages of 56-65 years compared to other ages (8).   Rumagit et al, 2013) with different results where the highest percentage was caused by plasmodium falciparum as many as 45 cases or 66.2%. This is in accordance with the theory that plasmodium vivax reproduces well and has the potential to make contact with humans and transmit malaria, which is supported because of environmental factors such as rain, temperature, humidity,

Evaluation of the Use of Antimalarial Drugs
To find out the rational use of drugs can be seen from several criteria. The criteria used in evaluating the use of antimalarial drugs in this study were 4T (Right indication, Right Drug, Right Dosage, Right Frequency)  Based on the accuracy of the drug (   The right time interval increases the success in the right treatment, the right time interval also reduces the toxic effects in the body.

Conclusion
Based on the results and discussion of research evaluating the use of antimalarial drugs at the Hanura Public Health Center UPT for the January-December 2018 period, the following conclusions can be drawn:

Suggestion
For further research that will conduct research on the Evaluation of the Use of Antimalarial Drugs, it is necessary to conduct research using retrospective methods. It is expected to study more sources and references related to malaria by looking at the patient's recovery which includes interviews with patients and doctors who write prescriptions.