Solusi Pemberian Obat harus Disempurnakan

 Departemen kesehatan tidak akan menghentikan pemberian obat pencegahan filariasis atau kaki gajah. Namun Departemen Kesehatan akan menyempurnakan metode pemberian obatnya.

Demikian dikatakan Menteri Kesehatan Endang Rahayu Sedyaningsih seusai membuka Konferensi Nasional Promosi Kesehatan Ke-5 di Bandung, Jawa Barat, Minggu (22/11) malam.

Endang mengatakan, berdasarkan hasil investigasi Komite Ahli Pengobatan Filariasis Indonesia (KAPFI) dan Departemen Kesehatan, pengobatan massal yang dilakukan di Kabupaten Bandung tidak menyalahi aturan. Obat sudah diperiksa di laboratorium dan hasilnya tidak kedaluwarsa atau tercemar.  Adapun obat yang diberikan adalah ethylcarbamazine citrate (DEC), albendazol (obat cacing) dan parasetamol (obat penurun panas).

Sebelumnya penerima obat pencegahan filariasis di Kabupaten Bandung dirawat dan meninggal dunia setelah mendapatkan pengobatan massal, 10 November lalu.  Namun, Departemen Kesehatan membantah penyebab sakit dan meninggal akibat langsung pemberian obat pencegahan filariasis.

KAPFI juga menyatakan, kematian delapan warga Bandung bukan karena minum obat filariasis.  Dari delapan kasus kematian, tiga orang meninggal ternyata tidak mingum obat filariasis yang dibagikan saat pengobatan massal.  Adapun lima kematian terjadi karena penyakit yang telah diderita sebelumnya.

Untuk langkah ke depan, Endang mengatakan akan menyusun langkah lanjutan bersama tim yang terdiri atas pakar filariasis.  Salah satunya adalah mempertajam metode pengobatan, seperti  memberikan pertanyaan awal tentang kondisi kesehatan kepada warga sebelum melakukan pemberian obat.

"Akan sulit apabila dilakukan pemeriksaan kesehatan satu per satu," kata Endang.

Penyakit filariasis merupakan penyakit menular menahun yang disebabkan oleh cacing filaria (Brugia malayi, Brugia timori, dan Wucheria brancofti). Perantara penularannya adalah semua jenis nyamuk.

Hambat eliminasi
Secara terpisah, Direktur Pengendalian Penyakit Bersumber Binatang Departemen Kesehatan Rita Kusriati mengatakan, penghentian pengobatan massal dikhawatirkan akan menghambat eliminasi penyakit kaki gajah.  Oleh karena itu, pemerintah akan melanjutkan pengobatan massal, tetapi pelaksanaannya dievaluasi.

Menurut Rita, di Indonesia penanganan filariasis dengan model pengobatan massal berjalan sejak tahun 2002 yang pencanangan untuk pertamakalinya di lima kota kabupaten/kotamadya.  Di Indonesia ada 316 kabupaten/kota yang telah terpetakan secara epidemologis sebagai daerah endemik filariasis sampai tahun 2008.

Penghentian pengobatan massal, menurut Rita, akan berkonsentrasi besar karena dengan rata-rata prevalensi nasional filariasis 19 persen dan jumlah penduduk sekitar 220 juta, ada sekitar 40 juta penduduk akan terkena filariasis.

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Masalah Uang Hambat Pengobatan Kaki Gajah

Dinas Kesehatan (Dinkes) Kota Serang, Banten, saat ini merasa kesulitan untuk melakukan pengobatan massal penularan penyakit kaki gajah atau filariasis, karena tidak memiliki dana dari Anggaran Pendapatan Belanja Daerah (APBD).
    
"Jika tidak dilakukan pengobatan massal dipastikan  penularan penyakit kaki gajah mengancam warga lainya," kata Kepala Dinas Kesehatan Kota Serang, Asep Misbah, Minggu.

Asep mengatakan, pihaknya hingga kini belum berbuat banyak untuk melakukan pengambilan sidik darah jari (SDJ) juga pengobatan massal di daerah endemik penularan penyakit kaki gajah karena membutuhkan biaya cukup besar.

Pengambilan SDJ maupun pengobatan massal harus dilakukan di enam kecamatan di Kota Serang, setelah ditemukan dua warga positif terserang penyakit kaki gajah. 

"Penyakit kaki gajah merupakan jenis penyakit menular yang bisa mengakibatkan penderita cacat permanen pada salah satu bagian anggota tubuhnya," katanya.

Menurut dia, pengambilan sidik darah jari pada malam hari juga pengobatan massal salah satu upaya untuk mencegah penularan penyakit tersebut.

Sebab, apabila tidak dilakukan pencegahan kemungkinan warga Kota Serang bisa terserang, karena penularannya melalui gigitan berbagai jenis nyamuk.

Oleh karena itu, pemerintah Kota Serang harus mengalokasikan dana untuk pengambilan SDJ serta pengobatan massal, terutama di daerah kasus penularan di wilayah Puskesmas Singadari dan Taktakan.

Selain itu, pihaknya meminta kepada warga agar menjaga kebersihan lingkungan sekitar rumah dan halaman, sehingga tidak berkembangbiaknya populasi nyamuk.    

Dia menyebutkan, hingga saat ini sumber penularan penyakit kaki gajah ditularkan melalui gigitan nyamuk dari si penderita yang mengalami pembengkakan permanen pada bagian kaki atau tangan.

Penularan penyakit kaki gajah disebabkan infeksi cacing filaria, yang hidup di saluran dan kelenjar getah bening (limfa) yang mengakibatkan gejala akut dan kronis. Cacing ini secara klinis menimbulkan peradangan di kelenjar dan saluran getah bening, terutama pada daerah pangkal paha dan ketiak.
    
"Hingga saat ini penderita kaki gajah tidak menimbulkan kematian," ujarnya. Ditempat terpisah, keluarga penderita kaki gajah di Kecamatan Taktakan, Kota Serang,  mengaku dirinya hanya pasrah karena tidak memiliki dana untuk pengobatan.

"Sebetulnya penderita bisa berobat, namun untuk makan juga susah," kata salah satu keluarga penderita yang enggan disebutkan namanya.

Sementara itu, sejumlah warga lainya di Kota Serang menyatakan pihaknya mendesak Pemkot segera mengalokasikan dana untuk pengobatan massal untuk mencegah penularan serta penyebaran penyakit kaki gajah.
   
Alasannya, semua yang namanya jenis penyakit menular harus diberantas dan dicegah dengan cara pengobatan massal itu. "Kami khawatir penyakit ini meluas dan meyerang warga lianya," ujar Solihin (40) warga Cipocok, Kota Serang.

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Riset Kurang Mendukung

Penanggulangan sejumlah penyakit tropis seperti malaria, filariasis atau kaki gajah, dan kusta atau lepra tidak berjalan secara efektif. Kondisi ini terjadi lantaran penanganan penyakit tropis tidak didukung pengembangan riset yang memadai serta terintegrasi antarlembaga.

Peneliti dari Tropical Disease Diagnostic Center (TDDC) Universitas Airlangga Surabaya, drh CA Nidom menyatakan, penyakit tropis jadi faktor dominan dalam percaturan penyakit-penyakit di dunia. Apalagi kini tidak ada lagi batas wilayah, sehingga orang-orang dari negara sub tropis pun bisa terkena penyakit yang banyak ditemukan di negara tropis karena perpindahan penduduk.

Penyakit tropis seperti malaria, kusta dan filariasis atau kaki gajah di Indonesia jumlah penderitanya semakin meningkat dalam lima tahun terakhir. Selain itu, penyebarannya pun hampir menjangkau seluruh wilayah Tanah Air. (Kompas, 11/8)

Endemis beragam penyakit

Sebagai negara tropis, Indonesia merupakan wilayah endemis beragam penyakit tropis. ”Indonesia seharusnya lebih pintar dalam penanganan penyakit tropis. Sayangnya, pengembangan riset penyakit tropis masih belum mendapat porsi memadai,” kata Nidom.

Padahal, aspek riset penting dalam pengendalian penyakit antara lain, mengetahui variabilitas virus, dampak pemakaian insektisida terhadap kekebalan nyamuk pembawa penyakit seperti malaria. Perubahan biologi dari nyamuk bisa menjadi rangsangan terjadinya mutasi kuman atau virus sehingga lebih ganas dan resisten terhadap obat.

” Tanpa studi epidemiologi, penanganan masalah penyakit tropis di suatu daerah ibarat menembak dalam gelap. Kita tidak mengetahui efektivitas pengobatan, sejauh mana mutasi virus, sehingga pemberantasan penyakit akan sulit dilakukan hingga tuntas,” ujarnya menegaskan.

Peneliti senior dari Lembaga Biologi Molekuler Eijkman, Herawati Sudoyo, Senin (11/8), di Jakarta, menjelaskan, lemahnya kegiatan riset mengakibatkan mayoritas penyakit tropis sulit diatasi termasuk malaria dan demam berdarah dengue (DBD). Masalah yang dihadapi adalah terjadinya mutasi virus dan meningkatnya resistensi kuman penyakit terhadap beberapa jenis obat.

Penelitian juga diperlukan untuk menguji sejauh mana efektivitas suatu obat yang akan digunakan di Indonesia. Selama ini penggunaan obat dari luar negeri hanya ”dikopi” dan diterapkan di Indonesia tanpa lebih dulu dilakukan riset ilmiah mengenai efektivitas obat itu dan efek sampingnya.

Belum aplikatif

Sementara itu, Deputi Bidang Pengembangan Sistem Ilmu Pengetahuan dan Teknologi Menristek Prof Amin Soebandrio menilai, kemajuan riset bidang penyakit tropis di Indonesia sudah cukup pesat. Saat ini ada sejumlah lembaga penelitian yang memfokuskan diri pada riset penyakit tropis di Jakarta maupun di lembaga perguruan tinggi di sejumlah kota di Tanah Air.

Sejumlah riset yang dilakukan sudah sampai pada tingkat seluler dan molekuler yang nantinya diterapkan ke tingkat aplikasi klinis yaitu pengembangan deteksi virus dan bakteri, serta pembuatan vaksin. ”Tetapi memang hasil penelitian yang ada belum aplikatif, masih perlu diuji pada hewan coba, baru kemudian diuji klinis pada manusia dengan skala luas,” ujarnya.

Lembaga Eijkman sendiri secara aktif mempelajari sejumlah penyakit tropis seperti malaria, demam berdarah dengue dan hepatitis. Sebagian riset itu berkolaborasi dengan lembaga riset asing seperti Universitas Oxford. ”Kegiatan riset dilakukan di Indonesia, dan dipublikasikan secara internasional atas nama staf dari Lembaga Eijkman. Jadi, kedudukan kami sejajar,” ujarnya.

Hasil riset yang dilakukan antara lain berhasil menemukan dasar molekul resistensi kuman terhadap obat, mutasi gen pada plasmodium valsivarum dan hubungannya dengan resistensi parasit itu terhadap obat anti malaria di sejumlah daerah endemis seperti Papua.

Dana minim

Sejauh ini, Nidom menilai dukungan pemerintah masih sangat minim terhadap pengembangan riset penyakit tropis baik dari segi pendanaan maupun fasilitas riset. Di TDDC Unair, misalnya, mayoritas dana operasional penelitian penyakit tropis diperoleh dari kerja sama dengan lembaga penelitian asing di antaranya Universitas Kobe Jepang.

Amin Soebandrio mengakui, dukungan pemerintah dalam pendanaan riset masih minim. Saat ini Kementerian Ristek mengalokasikan anggaran tahun 2008 sebesar Rp 110 miliar untuk enam bidang penelitian, termasuk kesehatan. Idealnya, tiap bidang mendapat anggaran sekitar Rp 100 miliar. Padahal, untuk mengembangkan suatu prototipe vaksin satu jenis penyakit, misalnya, butuh dana berkisar Rp 50 miliar hingga Rp 100 miliar.

Hambatan lain adalah, aktivitas penelitian penyakit tropis berjalan sendiri-sendiri tanpa ada jejaring yang kuat. Hal ini menyebabkan daya jangkau penelitian rendah, dana penelitian yang diperoleh terbatas, aktivitas penelitian yang dikerjakan juga kadang tumpang tindih.

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What Causes Elephantiasis?

Elephantiasis is a syndrome most often caused by an obstruction of the lymphatic vessels, which results in extreme swelling of the skin and tissues, typically in the lower trunk and body. It primarily affects the legs and genitals, resulting in baggy, thickened and ulcerated skin, along with fever and chills.

Elephantiasis can be very painful and uncomfortable and reduces the sufferer’s ability to lead a normal life. A serious complication of elephantiasis can be obstructed blood vessels, which limit blood supply and cause the skin to become infected and gangrenous.

Elephantiasis has two main forms and several related disorders:

Lymphatic filariasis, which is the most common form of elephantiasis, is caused by a parasitic disease resulting from a bite from an infected mosquito. This form of elephantiasis is caused most commonly by the Wuchereria bancrofti parasite, but also can be caused by Brugia malayi and Brugia timori,. These parasites are all nematodes, or roundworms, that are transmitted by mosquitoes. The parasite inhabits the lymphatic vessels, resulting in their inability to drain the affected extremities.

It is not definitely known if the parasite itself is the sole reason of the swelling, or if the fact that the immune system is working to fight the parasitic infection contributes to it. Lymphatic filariasis affects people primarily in the tropics and is concentrated in Africa. It is estimated that 120 million people spread over 80 countries are affected by elephantiasis. Approximately one-third of these suffer serious cases of the disorder.

Nonfilarial elephantiasis, the second type of elephantiasis, is non-parasitic. This type is more common to Africa’s central mountains. It is caused by repeated contact with volcanic ash in the area. The primarily barefooted population receives chemicals from the soil into their feet, and the chemicals travel to the lymphatic vessels and irritate and block them.
Elephantiasis
Elephantiasis Is Caused By
Loa Loa
Microfilariae

Hereditary lymphedema is a disorder related to elephantiasis. It is a genetic disorder that, either by an underdevelopment of the lymph vessels or other factors, causes an accumulation of fluid in the affected extremities.

Treatment of elephantiasis depends on the type of the disorder the person is afflicted with. Lymphatic filariasis is treated with medication designed to kill the parasite. These medications include Suramin, Diethylcarbamazine, Ivermectin, Metrifonate, Mebendazole and Levamisole. Recent studies of use of the antibiotic doxycycline show promise. Medicines must be taken early after the primary infection, but they can have toxic side effects. The problem with effective treatment of elephantiasis is that it is difficult to diagnose it early enough.

Doctors have found that careful, daily cleaning of the affected areas helps prevent secondary skin infections that may be associated with elephantiasis. Surgical treatments are usually only effective on scrotal elephantiasis, but not on limbs. Unfortunately, there is no vaccine available at this time.

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Mass Treatment of elephantiasis Citizens Lebak

Tens of thousands of people who lived in a number of areas in Lebak obtain mass treatment of filariasis or elephantiasis.
    
"Until now, mass treatment with elephantiasis, is continuing because it was feared transmitting it to other people," said Head of Communicable Diseases Eradication and Restructuring Lingungan, Lebak District Health Office, Dr Alwan Aminudin Friday.

He said the current number of people with elephantiasis, is still high because of the declared clinically as many as six people and dozens of others expressed positive elephantiasis.

Mass treatment of elephantiasis, which was held in Cipanas subdistrict, Lebak Gedong and Maja because in these areas are endemic areas of filariasis transmission.

Mass treatment in the area is already the third year by a team of District Health Office and the Ministry of Health Centre.

"Transmission of disease elephantiasis in the three districts were declared not free," he said.
According to him, elephant foot disease is not deadly, but patients may experience permanent disability in one part of his body.

Therefore, mass treatment should be done to prevent the transmission of the disease. If residents stricken with elephantiasis positive disease can certainly cause social penyandangf in the community.
    
In addition, productivity will be low pederita that ultimately the decline of human quality in Lebak regency. He mentioned, mass treatment in endemic elephantiasis should be done for five consecutive years for declared free from endemic areas elephantiasis.
    
"Currently, in the three districts that are just entering the year declared endemic keiga amssal treatment," he said.

Participants mass treatment with elephantiasis, followed by all citizens including children under the age of two years, pregnant women, nursing mothers and people with chronic disease

"With the mass treatment of this elephant's foot, is expected ditemukakan again penmuan filariasis cases in the community," he explained.

Meanwhile, the Head of Puskesmas Cipanas, Suripto, say, mass treatment is carried out elephant foot in the working areas as many as 40,000 residents.

Until now, he added, Elephant foot disease cases in the District of Cipanas befall residents of Kampung Seah, Cipanas Village. has been declared clinically.

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New City Free Optimistic Elephant's Foot

City District Government, South Kalimantan, is optimistic in 2015 the New Town are free of disease elephantiasis (filariasis).
    
Chief Public Health Alert Notices drg through Ambarita Mardiman Disease Eradication Head, M Kes, in Kota Baru on Sunday, said the conviction was based upon the New City Health Department efforts through counseling and supplementation Dietyl Carbamezin, Albendazol, and Paracetamol and Blood Sidik Jari ( SDJ).

"In this way we hope people become more aware of and can anticipate the spread of elephantiasis disease early on," he said.

Meanwhile, in Kota Baru today was detected about 36 people with elephantiasis, a disease caused by filarial worms Wuchereria bancrofti, Brugia malayi, and Brugia timori.

North Sea Island, Kota Baru, as many as four people; North Kelumpang (11 people); Pamukan II (one person); South Kelumpang (one person), and South Sea Island (seven people).

Sub Sea Island West (three people); Middle Kelumpang (one person); and District Sei Durian much as two people; barnacle, Island East Sea (two people); Marabatuan, Nine Island (one person); South Pamukan (one person); Mangrove (one person); and Sampanahan one people with elephantiasis.

For eradication and break the chain of transmission of the disease elephantiasis, particularly in areas of endemic filariasis, Public Health Service directly conduct mass treatment round four times in a row.

For the last treatment is not known how much the success rate of these tablets.
    
Mardiman hope this year evaluation of disease eradication programs elephantiasis allocated sufficient funds.

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5 Villages in Pekalongan endemic disease elephantiasis

At least five villages in Pekalongan, Central Java, expressed as an elephant foot disease endemic area  with the  number of  patients  in the tens  of people.
    
Chief Medical Officer Pekalongan Pekalongan Dwi Herrera Wibawa on Friday, said the number of elephant foot disease endemic area in 2009 was increased, when compared to the previous year that only three regions.
    
Five elephant foot disease endemic area is Kelurahan Pasir Sari, Bandengan, Pebean with the number of patients reached 10 people, while 28 patients Bumirejo Kelurahan Tegal Rejo, and as many as 12 patients.
    
"The disease is caused elephantiasis filariasis worm that is spread through mosquito bites. If the worm into the human body, will cause the leg until the thigh swollen and will harden if left unchecked," he said.
    
He said, to prevent the spread of the disease elephantiasis, the Public Health Service has conducted treatment to all residents affected by the disease by giving the drugs' Carbamazine Diethyl Citrate (DEC), albendazole, and vitamin B6.
    
For patients who have reached the chronic category will be given the drug to be taken three times daily for 10-12 days. "For patients with positive 'filaria' whose leg has been enlarged and will recover despite experiencing temporary disability of the foot remains swollen. But the swelling would be cured within a period of five years," he said.

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Banten Must Fight Serious elephantiasis

Banten Provincial Government should seriously combat the spread of disease elephantiasis (filariasis) by giving the allocation of funds for mass treatment. As stated by observers of infectious disease problems in Rangkasbitung Dr. Alwan Amirudin Saturday.
    
Alwan said the type of infectious disease would be prevented as early as possible so as not to spread, extending and transmitting it to other citizens.

Therefore, local governments must allocate funds for prevention and eradication.

"I am concerned if it did not attack city government allocated funds for elephant foot disease prevention," he said.

According to him, or elephantiasis, filarial disease is transmitted by various species of mosquitoes of the person who suffered permanent swelling in the feet or hands. Filariasis will attack the members of the feet and hands like the size of an elephant.
    
To prevent the disease, especially in areas of endemic disease elephantiasis, first performed taking blood Sidik Jari (SDJ) at night, because it is transmitted through mosquito bites.

"This blood sampling could not be done in the daytime," he said. After that, carried to a laboratory blood studies Ministry of Health (MoH) in Jakarta to ensure negative or positive.

Furthermore, to citizens around the elephant foot disease endemic area, would have made mass treatment.

"It's very costly because it amounted to thousands of people," he said. Amirudin Alwan explained that currently merupkan elephantiasis disease transmission threat to society, local government is not serious when allocating funds to hold a mass treatment.

According to him, to turn off the filarial worm virus that patients can take medicine Dethyl Carbamazine (DEC) for repeated for the worms die and do not undermine the victim's body.
    
Transmission of infectious disease elephantiasis due to filarial worms, which live on the tract and lymph nodes (lymph nodes) that result in acute and chronic symptoms.

They were clinically cause inflammation in the lymph glands and channels, especially in the groin area and underarms. However, the type of elephant foot disease does not cause death, but can cause social burden in society.

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The absence of Inhibition Treatment Fund elephantiasis

Health Office (DHO) Serang, Banten, now find it difficult to conduct mass treatment of disease transmission or filariasis elephantiasis, because they do not have the funds from the Revenue Budget Regional Budget (APBD).
    
"If treatment is not ensured bulk transmission of the disease elephantiasis threaten other residents," said Chief Medical Officer of Serang, Asep Misbah, on Sunday.

Asep said it has yet to do much to make taking blood finger prints (SDJ) is also mass treatment in endemic elephantiasis of disease transmission because it requires a substantial cost.

SDJ-making and mass treatment should be conducted in six districts in the city of Serang, after the discovery of two positive people stricken with the disease elephantiasis.

"Elephant foot disease is a type of contagious disease that can lead to permanent disability in one part of his body," he said.

According to him, taking finger prints on the night blood mass treatment is also an effort to prevent transmission of the disease.

Because, if not done the prevention of possible attacks can be attacked by city residents, because of transmission through the bite of various species of mosquitoes.

Therefore, the government should allocate funds Serang to SDJ-making and mass treatment, especially in the cases of transmission in the health center and Taktakan Singadari.

In addition, it asked the residents for keeping the environment clean house and yard, so no breeding populations of mosquitoes.

He mentioned, until recently the source of transmission of the disease elephantiasis is transmitted through mosquito bites from the patient who suffered permanent swelling in the feet or hands.

Transmission of infectious diseases caused by elephantiasis, filarial worms, which live on the tract and lymph nodes (lymph nodes) that result in acute and chronic symptoms. These worms cause inflammation clinically in lymph glands and channels, especially in the groin area and underarms.

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Overcome elephantiasis

The city government (municipal) and district government (Pemkab) Serang, Banten, was asked to hold a mass treatment of disease elephantiasis (filariasis), following the cases of new patients in the two regions.
     
"I as a citizen of course very much hope the local government held a mass treatment of elephantiasis," said one resident waterfall, waterfall district, Serang, Sofyan (45) Thursday.

Sofyan said that, based on surveillance results Banten Provincial Health Office in 2003 found new cases of people with elephantiasis disease.

In both regions are found as many as six cases of filariasis patients, so the need for mass treatment because it can transmit to other citizens.

Elephantiasis disease transmitted through mosquito bites various jenis.Karena it, the only thing to prevent the disease should be conducted mass treatment.

Treatment was conducted for all citizens of the City and County of Serang Serang, for five consecutive years.

"If treatment is not ensured mass Serang Serang and yet free of the disease ggajah foot," said Sofyan who also graduated from the academy nurse.

According to him, transmission of disease elephantiasis to be a threat to society, so that the local government immediately allocate funds for mass treatment.

Disease elephantiasis due to filarial worm infection, who live in tract and lymph nodes (lymph nodes) that result in acute and chronic symptoms.

Therefore, for the deadly virus filarial worms that patients can take medicine Dethyl Carbamazine (DEC) for repeated for the worms die and do not undermine the victim's body.

Clinical elephantiasis cause inflammation in the lymph glands and channels, especially in the groin area and underarms.

However, until now elephantiasis disease does not cause death, but it could cause social burden in society.

Meanwhile, the Chief Medical Officer of Serang, Asep Misbah, said it until now do not have the funds to gpengobatan disease elephantiasis.

"The possibility of an elephant foot disease is steadily increasing, because there is no mass treatment," kkataya.

Patients with elephantiasis disease in its territory are found in two health centers and now people are still in control.

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