iv

ABSTRAK

PREVALENSI DEMAM TIFOID PADA PASIEN ANAK-ANAK DI

RSUP SANGLAH DENPASAR

Demam tifoid adalah salah satu penyakit infeksius yang diakibatkan oleh bakteri

Salmonella typhii yang memunculkan gejala sistemik pada penderitanya. Demam tifoid

hingga saat ini masih sering dijumpai di wilayah-wilayah yang memiliki kualitas

kebersihan dan sanitasi yang tidak memadai. Wilayah tersebut umumnya beriklim

tropis dan sub-tropis. Setiap tahun, diperkirakan jumlah kasus tifoid di dunia mencapai

20 juta kasus, dimana 200.000 diantaranya berakhir kematian. Di Indonesia, prevalensi

tifoid diperkirakan mencapai 800 per 100.000 penduduk pada tahun 2007, dengan

hampir dua pertiga nya menjangkiti usia 4-19 tahun. Tingkat kematian pada pasien

rawat inap mencapai hingga 10 persen.

Penelitian ini dilaksanakan untuk mengetahui seberapa seringkah kemunculan

pasien demam tifoid pada anak-anak usia 5-11 tahun (berdasarkan kriteria usia anak

tahun 2009 menurut Departemen Kesehatan Republik Indonesia) yang terdiagnosis

positif demam tifoid dan dirawat inap di RSUP Sanglah pada periode Maret hingga

September 2016. Pengumpulan data memakai metode total sampel yang didapat dari

hasil peninjauan rekam medis pasien.

Hasilnya, dijumpai delapan pasien yang memenuhi kriteria umur yang

ditetapkan. Dengan rata-rata usia pasien anak 7,6 tahun. Proposi laki-laki dan

perempuan sama besar (50:50), sesuai dengan teori umum mengenai demam tifoid

dimana tidak ada perbedaan signifikan pada kelompok jenis kelamin. Seluruh pasien

terdiagnosis positif demam tifoid dengan pemeriksaan Tubex dengan nilai hasil

berkisar dari +4 hingga +8.

Kata kunci: demam tifoid, prevalensi, anak, RSUP Sanglah

v

ABSTRACT

PREVALENCE OF TYPHOID FEVER IN CHILDREN AT RSUP

SANGLAH DENPASAR

Typhoid fever is one of infectious disease that is caused by bacilli Salmonella

typhii which showed systemic symptoms in patient. Typhoid fever still become one of

frequent infectious diseases due to poor hygiene and sanitation, generally in tropic and

sub-tropic climate area. Each year, about 20 millions of typhoid cases are reported in

all around the world, while 200.000 of them ended with mortality. In Indonesia,

prevalence of typhoid fever in year 2007 was up to 800 cases per 100.000 population,

while two-third of them attacked age group of 4 to 19 years old. Mortality rate in

hospitalized patients was up to ten percent.

This research initiated to find out the frequency of occurrence of typhoid fever in

children who is diagnosed and hospitalized at RSUP Sanglah. Age criteria of children

is five to eleven year old, based on Indonesia Department of Health, in year 2009. Data

collecting used total sampling method which is gathered from assessment of medical

records.

Within the period from March to September 2016, eight children patients were

positive with typhoid fever. Mean age of patients is 7.6 year old. Gender proportion is

balanced (50:50) between male and female, parallel to popular theories about typhoid

fever which says there is no specific difference of typhoid fever occurrence between

male and female. All patients diagnosed by Tubex examination, with various value

from +4 up to +8.

Keyword: typhoid fever, prevalence, children, RSUP Sanglah

vi

CONTENTS

PREFACE ................................................................................................................. iii

ABSTRAK ................................................................................................................ iv

ABSTRACT .............................................................................................................. v

CONTENTS .............................................................................................................. vi

LIST OF TABLES ................................................................................................... viii

Chapter I

INTRODUCTION .................................................................................................... 1

1.1. Background …………………………………………………………...… 1

1.2. Problem Identification ……………………………………………….…. 3

1.3. Aim ……………………………………………………………………... 3

1.4. Benefit …………………………………………………………………... 3

Chapter II

LITERATURE REVIEW ........................................................................................ 4

2.1. Epidemiology ............................................................................................. 4

2.2. Etiology...................................................................................................... 4

2.3. Pathogenesis .............................................................................................. 5

2.4. Clinical manifestations .............................................................................. 6

2.5. Relapse ....................................................................................................... 7

2.6. Chronic carrier ........................................................................................... 8

2.7. Diagnosis ................................................................................................... 8

vii

Chapter III

CONCEPTUAL FRAMEWORK ........................................................................... 10

3.1. Mind concept ............................................................................................. 10

3.2. Research concept ....................................................................................... 11

Chapter IV

RESEARCH METHODS ........................................................................................ 12

4.1. Research design ......................................................................................... 12

4.2. Place and time of research ......................................................................... 12

4.3. Population, sample population, and sample criteria .................................. 12

4.4. Research variable ....................................................................................... 13

4.5. Research instrument................................................................................... 13

Chapter V

RESULTS & DISCUSSION .................................................................................... 15

5.1. Result ......................................................................................................... 15

5.2. Discussion .................................................................................................. 16

Chapter VI

CONCLUSION AND SUGGESTION ................................................................... 18

6.1. Result ......................................................................................................... 18

6.2. Discussion .................................................................................................. 18

REFERENCES ......................................................................................................... 19

viii

LIST OF TABLES

Table 1 Age of children patients with typhoid fever............................................. 15

Table 2 Age group of children patients ................................................................. 15

Table 3 Sex group of children patients…… .......................................................... 16

Table 4 Positive Tubex value of patients .............................................................. 16

1

CHAPTER I

INTRODUCTION

1.1. Background

Typhoid fever is one of the infectious disease caused by bacterium

Salmonella typhi or Salmonella paratyphi. Today, typhoid fever is still being as

serious health problems in developing country that caused huge amount of

morbidity and mortality. Transmission usually by fecal-oral contamination to

food and water supply that has poor hygiene maintenance as well as over

population area with inadequate sanitation. Incidence number around the world

reach over 20 million cases annually, which about 200,000 of them caused death

(Kanj et al., 2015). Paratyphoid fever, which shows more benign, identical

symptoms with typhoid had about 5,400,000 cases in 2000 (Buckle, Walker and

Black, 2012; Guerrant, Walker and Weller, 2011). High prevalence of typhoid fever

number is indicated in area with tropic or sub-tropic climate, such as central Asia

(301 per 100,000 population), south Asia (409 per 100,000 population), southeast

Asia (196 per 100,000 population), central Africa (557 per 100,000 population)

and east Africa (537 per 100,000 population) (Mogasale et al., 2014).

In Indonesia, typhoid prevalence in 2007 was about 358 – 810 cases per

100,000 populations, which 64% of the cases found in 3 – 19 years old. Mortality

rate varies from 3.1 – 10.4% among hospitalized patients. Typhoid cases

occurred throughout the year but peaking in dry season (Hatta, 2008). Indonesia

Health Department reported in year 2010 that typhoid fever was the third most

common health problems in hospitalized patients in Indonesia (41,081 cases)

2

(Suhendro et al, 2014). Typhoid incidence more prevalent in

countryside/suburban population than urban area, population with less economic

income and inadequate education understanding.

Typhoid fever symptoms have systemic effect, consist of fever, malaise,

headache, hepatosplenomegaly, rash, anorexia, and gastrointestinal problems.

Fatality rate as small as 1 - 4% if treated with proper antibiotics, but raise up to

30 - 40% in complicated patients with perforated intestine, which happened in 1

– 3% in hospitalized patients (Neil et al., 2012 and Buckle, Walker and Black, 2012).

Gold standard diagnosis is blood culture, however, it takes up to seven days with

well-equipped tools and skilled staff, such a common problem faced by

developing country (Thriemer et al., 2012).

Indonesia is one of the countries that were mentioned before, has high

prevalence of typhoid fever due to its tropic climate. Denpasar city has dense

population with various kind of living style. Unhygienic lifestyle is regularly

found, such as in the traditional market, food sold with poor sanitation by street

hawkers, or people’s habit to throw their litter not in the proper place, either

because they are unconcerned about hygiene or because there are insufficient

sanitation accommodations. Health problems due to infectious disease caused by

dirty environment may appear and develop anytime, where children are more

susceptible to the effect. Typhoid fever can spread through food and water

contamination, whether by direct fecal oral route or by animal vectors. This

research will determine how vast typhoid fever as one of the infectious disease,

affect the children.

3

1.2. Problem Identification

Based on previous background, this research is developed to measure the

prevalence of typhoid fever at RSUP Sanglah, Denpasar, and correlate it to

patient’s age.

1.3. Aim

Knowing the prevalence of typhoid fever at RSUP Sanglah, Denpasar.

Knowing the correlation of age to typhoid incidence.

1.4. Benefit

For health practitioner and stakeholder: as a knowledge about typhoid fever

prevalence at RSUP Sanglah, Denpasar, and source for assessment of health

promotion in general population.

For writer: to accomplish the task given by medical department of Faculty

of Medicine, Udayana University.