Abstract
Ibu hamil yang berada di daerah endemis malaria sangat rentan terhadap infeksi malaria selama kehamilan. Gejala malaria pada kelompok ini sering asimptomatik atau bahkan tidak terdeteksi sama sekali karena adanya efek imunitas protektif melalui infeksi yang berulang. Adanya peningkatan kadar tumor necrosis factor-alpha (TNF-α) dapat dijadikan indikator terjadinya infeksi malaria. TNF-α berperan penting dalam respons imun pada malaria akut yang menghambat terjadinya eritropoesis. Penelitian ini bertujuan untuk mengetahui hubungan antara kadar TNF-α dengan kejadian anemia pada ibu hamil didaerah endemik malaria vivax. Penelitian ini menggunakan desain potong lintang, dilakukan pada bulan Januari - Februari 2014 di lima wilayah kerja puskesmas Kota Bengkulu. Sampel penelitian adalah ibu hamil di daerah endemis malaria vivax yang diambil secara accidental sampling. Dilakukan pengambilan darah untuk pemeriksaan mikroskopis malaria, kadar TNF-α dan kadar hemoglobin (Hb). Hasil penelitian menunjukkan seluruh ibu hamil memiliki riwayat pernah terinfeksi malaria vivax, walaupun hasil pemeriksaan slide negatif. Terjadi peningkatan kadar TNF- α dengan rerata 6,90 ± 2,48 pg/mL dan penurunan kadar Hb dengan rerata 9,75 ± 0,88 g%. Uji korelasi Spearman didapatkan korelasi negatif yang kuat (r = -0,734) dan bermakna (nilai p < 0,05) antara Kadar TNF-α dengan kadar Hb. Terdapat hubungan yang bermakna antara kadar TNF-α dengan kejadian anemia. Pregnant mothers living in malaria - endemic area are very susceptible to malaria infection during pregnancy. Malaria symptoms in this group are often asymptomatic or even not detected at all due to protective immunity effect through repeated infections. Any elevation of tumor necrosis factor-alpha (TNF-α) level can be used as indicator of malaria infection. TNF-α takes an important role in immune response on acute malaria that hinders occurence eritropoesis process. This study aimed to find out relations between TNF-α level and anemia occurrence among pregnant women living in malaria vivax - endemic areas. The study used cross-sectional design conducted on January to February 2014 in five working areas in Bengkulu city. Sample of study was pregnant mothers in malaria vivax - endemic areas which was taken through accidental sampling. Blood was taken for malaria-microscopic examination, TNF-α and haemoglobine (Hb) level. The results showed that all of pregnant mothers have malaria vivax - infected record, although slide examination showed negative result. Any TNF-α level elevation with average 6.90 ± 2.48 pg/mL and decrease of Hb level with average 9.75 ± 0.88 g%. Spearman correlation test showed strong negative correlation (r = -0.734) and significant (p value < 0.05) between TNF-α level and Hb level. There was significant relation between TNF-α level and anemia occurrence.
References
1. Greenwood BM, Fidock DA, Kyle DE, Kappe SH, Alonso PL, Collins FH, Duffy PE. Malaria: progress, perils, and prospect for eradication. The Journal of Clinical Investigation. 2008; 118: 1266-76.
2. Suparman E. Malaria pada kehamilan. Cermin Dunia Kedokteran. 2004: 4 (1): 1-11.
3. Hemmer CJ, Holst FG, Kern P, Chiwakata CB, Dietrich M, Reisinger EC. Stronger host response per parasitized erythrocyte in Plasmodium vivax or ovale than in Plasmodium falciparum malaria. Tropical Medicine & International Health. 2006; 11: 817–23. 4. Nasr A, Gamal A, Osama H, Abdelhamid A. IFN-gamma and TNF associated with severe falciparum malaria infection in Saudi pregnant women. Malaria Journal. 2014; 13: 314.
5. Rogerson SJ, Mwapasa V, Meshnick SR. Malaria in pregnancy : lingking immunity and pathogenesis to prevention. American Journal of Tropical Medicine and Hygiene. 2007; 77 (6): 14-22.
6. Aribodor DN, Nwaorgu OC, Eneanya CI, Okoli I, Worley RP and Etaga HO. Association of low birth weight and placental malaria infection in Nigeria. Journal of Infection in Developing Countries. 2009; 3(8): 620- 3.
7. Guyat HL, Snow RW. Impact of malaria during pregnancy on low birth weight in Sub- Sahara Africa. Clinical Microbiology Reviews. 2004; 17: 760-9.
8. Dinas Kesehatan Provinsi Bengkulu. Profil kesehatan Provinsi Bengkulu. Bengkulu: Dinas Kesehatan Provinsi Bengkulu; 2012.
9. Sudigdo. Dasar–dasar metodologi penelitian klinis. Edisi ke-5. Jakarta: Sagung Seto; 2012.
10. Sarangi A, Mohapatra PC, Dalai RK, Sarangi KA. Serum IL-4, IL12 and TNF-Alpha in malaria: a comparative study associating cytokine responses with severity of disease from the Coastal Districts of Odisha. Journal of Parasitic Diseases. 2014; 38: 143-7.
11. Rogerson SJ, Mwapasa V and Meshnick SR. Malaria in pregnancy: linking immunity and pathogenesis to prevention. American Journal of Tropical Medicine and Hygiene. 2007: 77 (6); 14-22.
12. White NJ. Determinants of relapse periodicity in Plasmodium vivax malaria. Malaria Journal. 2011; 10: 297-331.
13. Pascual CC, Kai OJ, Cheung Op, Williams S, Lowe B, Nyanoti M, et al. Supression of erythropoiesis in malaria anemia is associated with hemozoin in vitro and in vivo. Journal Blood. 2006; 108: 2569-77.
14. Panichakul T, Payuhakrit W, Panruba P, Wongborisuth C, Hongeng S and Udomsangpetch. Suppression of erythroid development in vitro by Plasmodium vivax. Malaria Journal. 2012; 11: 173-80.
15. Varney H. Buku ajar asuhan kebidanan Edisi 4. Jakarta: EGC; 2006.
16. Waryana. Gizi reproduksi. Yogyakarta: Pustaka Rihama; 2010.
17. De Beaudrap, Turyakira E, White LJ, Williams S, Lowe B, Nyayoti M, et al. Impact of malaria during pregnancy on pregnancy outcomes in a Gundan prospective cohort with intensive malaria screening and propmt treatment. Malaria Journal. 2013; 12:139-50.
18. Flora R, Bina M, Sigit P Profil zat besi ibu hamil di daerah endemis malaria. Kesmas: Jurnal Kesehatan Masyarakat Nasional. 2013; 8(5): 195-8.
19. Sylvia AP. Patofisiologi. Konsep klinis proses-proses penyakit. Edisi ke6. Jakarta: EGC; 2006.
20. Prentice AM, Iron Metabolism, Malaria, and other infections: what is all the fuss about? The Journal of Nutrition. 2008;138 (12): 2537-41.
21. Rosenthal PJ. Artesunate for the treament of severe falciparum malaria. The New England Journal of Medicine. 2008; 359: 1829-36.
22. Raiten DJ, Namaste S, Brabin B. Considerations for the safe and effective use of iron interventions in areas of malaria burden–executive summary. International Journal for Vitamin and Nutrition Research. 2011;81 (1): 57-71.
Recommended Citation
Flora R , Mukni M , Girsang BM ,
et al.
Tumor Necrosis Factor-α sebagai Prediktor Terjadinya Anemia pada Ibu Hamil di Wilayah Endemis Malaria.
Kesmas.
2015;
9(3):
288-292
DOI: 10.21109/kesmas.v9i3.695
Available at:
https://scholarhub.ui.ac.id/kesmas/vol9/iss3/14
Included in
Biostatistics Commons, Environmental Public Health Commons, Epidemiology Commons, Health Policy Commons, Health Services Research Commons, Nutrition Commons, Occupational Health and Industrial Hygiene Commons, Public Health Education and Promotion Commons, Women's Health Commons