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"Sampai saat ini angka kematian bayi di Indonesia masih tergolong cukup tinggi bila dibandingkan dengan negaranegara tetangga Asean. Tetanus neonatorum merupakan penyebab urutan kedua (± 20%) kematian bayi di Indonesia. Berbagai upaya dalam menurunkan angka kematian bayi telah banyak dilakukan, yang menjadi prioritas program dalam Repelita V adalah Eliminasi Tetanus Neonatorum. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang berhubungan dengan praktek pencegahan tetanus neonatorum, dengan lokasi di Kabupaten Bogor. Hasil-hasil penelitian diharapkan sebagai sumbangan pemikiran untuk pengelola program maupun pengambil keputusan dalam kegiatan penanggulangan tetanus neonatorum. Metoda penelitian dengan rancangan Cross sectional, dimana pengumpulan data dilakukan sekaligus pada suatu saat. Analisis yang dipergunakan adalah tabulasi silang dan regresi logistic. Faktor-faktor yang diteliti adalah umur ibu, paritas ibu, pendidikan ibu, pekerjaan suami, pengetahuan ibu dan sikap ibu mengenai tetanus neonatorum, serta tersedianya tenaga kesehatan sebagai variabel bebas. Sebagai variabel terikat adalah praktek pencegahan tetanus neonatorum yang meliputi imunisasi tetanus toxoid lengkap, pertolongan persalinan oleh tenaga kesehatan dan perawatan tali pusat bayi yang steril. Hasil penelitian ini menunjukkan bahwa tidak semua faktor tersebut mempunyai hubungan yang bermakna dengan praktek pencegahan tetanus neonatorum. Pengetahuan dan sikap ibu terbukti mempunyai hubungan yang bermakna dengan praktek pertolongan persalinan dengan nilai OR 2.9 dan dengan praktek perawatan tali pusat dengan nilai OR 22.9. Umur dan paritas ibu mempunyai hubungan yang bermakna dengan praktek imunisasi tetanus toxoid dengan nilai OR 2.2 dan OR 2.1. Pendidikan ibu mempunyai hubungan yang bermakna dengan praktek pertolongan persalinan dengan nilai OR 4.4. Pekerjaan suami menunjukkan kecenderungan untuk mencegah praktek perawatan tali pusat dengan nilai OR 0.3. Demikian pula dengan tenaga kesehatan menunjukkan kecenderungan untuk mencegah praktek imunisasi tetanus toxoid dan perawatan tali pusat bayi dengan nilai OR 0.4 dan OR 0.2. Disamping itu diketahui pula bahwa sekitar 65.7% responder, tingkat pengetahuannya kurang mengenai tetanus neonatorum walaupun yang mempunyai sikap positif cukup banyak yaitu 87.8%. Responden yang melaksanakan praktek imunisasi TT dan perawatan tali pusat sudah cukup baik, namun praktek pertolongan persalinan oleh dukun bayi masih cukup tinggi yaitu 65%. Mengingat hal-hal yang telah diuraikan diatas, disarankan untuk : (1) meningkatkan pengetahuan ibu mengenai tetanus neonatorum beserta upaya pencegahannya melalui penyuluhan oleh kader kesehatan khususnya kader KIA, dan (2) pembinaan terhadap dukun bayi baik terlatih maupun tidak terlatih. "

"Tetanus merupakan infeksi oleh C.tetani yang menjadi masalah kesehatan penting di negara-negara berkembang. Perjalanan penyakitnya biasanya lama, memerlukan waktu berminggu-minggu atau berbulan-bulan untuk perawatan hingga sembuh. Beberapa penelitian telah dilakukan untuk menentukan berbagai faktor yang berpengaruh terhadap prognosis tetanus. Faktor tersebut adalah derajat spasme, usia, sedasi dan takikardia yang berpengaruh signifikan terhadap mortalitas pasien tetanus. Bila pasien tetanus dapat melewati fase akut penyakitnya, masalah lain timbul seperti disfungsi otonom dan pneumonia nosokomial (sering disebabkan oleh organisme multiresisten) sebagai penyebab tersering kematian. Laporan kasus berikut menampilkan 6 kasus tetanus, tiga di antaranya mengalami pneumonia nosokomial, dan dua di antara tiga pasien tersebut geriatri berusia 70 dan 72 tahun meninggal saat di rumah sakit. (Med J Indones 2004; 14: 117-21)

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Tetanus, an infection by C.tetani continues to be a major health problem in the developing world. The course of the disease is typically prolonged, requiring weeks to months of supportive management to resolve. Several studies have been conducted to determine which factor/s really influenced the outcome of tetanus. Factors such as severity of spasms, age, sedation and tachycardia were found to significantly influence mortality. Patients now surviving the initial acute phase of their illness, but new problems have emerged autonomic dysfunction and hospital acquired pneumonia (often with multiresistant organisms) are now the commonest causes of death. This serial cases report presents six selected cases of tetanus, three patients acquired secondary pneumonia during treatment, among the three, two patients are elderly age 70 and 72 years old. Both of the presented patients died during treatment in the hospital. (Med J Indones 2004; 14: 117-21)"

"Eliminasi Tetanus Neonatorum (ETN) adalah salah satu sasaran yang disepakati dalam konperensi tingkat tinggi tentang kesehatan anak sedunia yang harus dicapai pada akhir tahun 2000. Salah satu upaya yang dilaksanakan untuk mencapai ETN tersebut adalah pemberian imunisasi tetanus toxoid kepada ibu hamil. Berbagai upaya untuk mencapai cakupan imunisasi TT ibu hamil yang optimal telah dilaksanakan, namun cakupan imunisasi TT pada ibu hamil di beberapa wilayah masih tetap merupakan masalah. Tujuan penelitian ini adalah untuk mengetahui faktor-faktor yang mempengaruhi status imunisasi TT pada ibu hamil di wilayah puskesmas Sukamanah kabupaten Bogor. Hasil penelitian ini diharapkan dapat merupakan sumbangan pemikiran untuk pengelolaan program imunisasi TT ibu hamil dalam kegiatan pencapaian eliminasi tetanus neonatorum. Metode penelitian ini dirancang dengan study kasus kontrol, sebagai kasus adalah ibu-ibu yang mempunyai anak umur kurang satu tahun dimana selama kehamilannya tidak pernah (TT0) atau tidak memperoleh imunisasi TT lengkap (TT1), sedangkan kontrol adalah ibu-ibu yang mempunyai anak umur kurang satu tahun dimana selama kehamilannya memperoleh imunisasi TT lengkap (TT2/ulang). Jumlah kasus sebanyak 170 orang dan jumlah kontrol 170 orang (perbandingan 1 kasus : 1 kontrol). Variabel yang diteliti meliputi faktor umur ibu, pendidikan, pengetahuan, sikap, jumlah anak balita, pekerjaan suami, persepsi ibu terhadap jarak, kepemilikan keluarga, pemeriksaan kehamilan dan anjuran yang diterima ibu untuk di imunisasi. Hasil penelitian ini menunjukan bahwa tidak semua faktor yang diteliti berpengaruh secara bermakna terhadap status imunisasi TT ibu hamil. Variabel yang tidak berpengaruh adalah ; umur ibu, jumlah anak balita, pekerjaan suami, pengetahuan, dan kepemilikan, sedangkan variabel yang berpengaruh adalah sikap (O.R 4,5), pendidikan (O.R 2,1), pemeriksaan kehamilan (O.R 2,2), persepsi terhadap jarak (OR 2,0) dan anjuran berpengaruh secara bermakna (O.R. 4,3). Mengingat hal-hal tersebut diatas maka disarankan kepada kepala puskesmas Sukamanah khususnya dan kepala dinas kesehatan kabupaten Bogor umumnya untuk dapat meningkatkan penyuluhan perorangan (anjuran), meningkatkan kemampuan dan sikap profesionalisme petugas, menekan terjadinya miss oportunity ANC dan imunisasi TT, membentuk pos vaksinasi khusus di daerah yang jauh dari posyandulpuskesmas serta mengusulkan kepada camat atau Dikbud untuk diadakan pendidikan kejar paket A (pendidikan sejenis) kepada ibu-ibu yang tidak sekolah atau buta huruf.

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The Factors Which Influenced of Toxoid Tetanus Immunization Status in Sukamanah Puskesmas, Kabupaten Bogor In 2000Elimination of Tetanus Neonatorum is one of targets of World Health Summit for Children in high level that must be achieved by the year 2000. One effort which has done to reach ETN is giving toxoid tetanus immunization to pregnant mother. There are so many efforts to reach the coverage of TT immunization that have done well in every area but it is still face the problems.

The purpose of the research is to find out some factors that have influenced the status of TT immunization for pregnant mother in Sukamanah Health Centre, Bogor District. The result of research is contributing some ideas for the management of pregnant mother TT program in increasing elimination of neonatorum of tetanus activating.

The research applies a case control design the case are, mother who has a baby, during her pregnancy has not ever given (TT0) or full of TT (TT1), while the control is mother who has baby that during her pregnancy has taken full of TT (TT2/booster). About it case and 170 control had beed interviewed (1 case : 1 control).

The factor of attitude has been researched including: the mother's age, education, knowledge, number of children under 5 year age, husband's occupation, mother's perceive of distance, owner's family, checking the pregnancy up, and suggestion to do immunization which has revived by the mother.

The result of the study reveals that there is the significant relationship between attitude (O.R. = 4,5), education (O.R.= 2,1), examination during pregnancy (ANC) (OR = 2,2), perceived of distance ( OR = 2,0) and suggestion (O.R.= 4,3) of TT immunization status of pregnant mother.

Based on the result of the study, it is recommended to the head of Sukamanah Health Centre and the head of Bogor District Health office to early out the personal health education (Counseling), to improve the ability and performance of the staff, to reduce the miss opportunity of ANC and immunization, to establish the vaccination centre at the remote are, and to give a recommendation to the Head of Sub district or Department of Education in order to give education package to the literacy mother."

"Angka kematian bayi di Indonesia masih tergolong cukup tinggi bila di bandingkan dengan negara-negara Asean. Sekitar 40 % kematian bayi terjadi pada saat neonatal (bulan pertama kehidupan bayi). Tetanus nennatorum masih merupakan salah satu penyebab tersering kematian neonatal di Indonesia. Dari 126.000 kematian neonatal, sekitar 50.000 diantaranya meninggal karena tetanus neonatorum. Bangsa Indonesia telah bertekad untuk mengeliminasi tetanus neonatorum di pilau Jawa dan Bali pada akhir tahun 1995 dan di seluruh Indonesia pada tahun 2000. Di Kotamadya DT. II Tangerang pada tahun 1994 - 1996 terdapat 20 kasus tetanus neonatorum ( laporan dari rurnah sakit ) sehingga masih dirasakan cukup sulit untuk mencapai eliminasi tetanus neonatonirn ( kejadian tetanus neonatorum setinggi-tingginya 1 per 10.000 kelahiran hidup ). Desain penelitian ini adalah kasus kontrol. Kasus adalah pendataan tetanus neonatorum yang di dapat dari rumah sakit pada tahun 1994 - 1995 sebanyak 20 kasus, sedangkan kontrol adalah bayi yang tidak menderita tetanus neonatorum yang lahir pada tahun 1994 - 1995 yang bertempat tinggal yang sama dengan kasus sebanyak 40 kasus. Untuk mengetahui besarnya hubungan faktor-faktor yang berperan dengan kejadian tetanus neonatorum di lakukan perhitungan Odd Ratio. Hasil penelitian menunjukan adanya hubungan yang bermakna antara status imunisasi tetanus toksoid ibu hamil, tenaga penolong persalinan, sterilitas alat pemotong tali pusat, obat/bahan perwatan tali pusat dengan kejadian tetanus neonatarum. Dari hasil penelitian ini penulis menyarankan untuk dilakukan peningkatan kualitas imunisasi mulai dari perencanaan, pcngawasan mutu vaksin, cold chain, bimbingan dan supenisi ke tenaga pelaksana dii puskesmas serta meningkatkan kerjasama lintas program, lintas sektoral dengan rnembina peran serta masyarakat dan sektor swasta. Selain itu ditingkatkan cakupan persalinan oleh tenaga kesehatan/ persalinan di dampingi oleh tenaga kesehatan, bekerjasama dengan bidan praktek swasta, komitmen dan dukungan politis perlu ditingkatkan dalam upaya akselerasi penuntnan tetanus neonatorum.

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Among Asean countries, infant mortality rate in Indonesia is substantially high . Approximately 40 % of infant mortality occurred in the neonatal phase ( the first month of infant life ). Tetanus neonatorum still is one of the major causes of neonatal mortality in Indonesia. From 126,000 neonatal immortality 50,000 is approximately caused by tetanus neonatorum. The Government of Indonesia have targeted to eliminate tetanus noenatorum in Java and Bali at the end of 1995 and all over Indonesia in 2000.

During 1994 - 1996 there were 20 cases of neonatal tetanus observed in Tangerang district hospital ( based or: report from hospital ). Assuring near nor all cases with treated in the hospital phase may be more cases in the whole district.

Case control design was use in this research. A number of 20 eases of neonatal tetanus were identified base on tetanus neonatorum data from hospital in 1994 - 1996. The control were 40 infants with no tetanus neoantorum which were born in 1994 - 1996 and lived in the same area with the cases. To find facie rs suspected as related to tetanus neonatorum, odd ratio was calculated.

The result of the research demonstrated treat neonatal tetanus is related to ( 1 ) TT immunization of pregnant mother, (2) the help of midwives, (3 ) sterilization of equipment utilised in cutting the umbilical cord and ( 4 ) wormed care of the umbilical cord.

From this research writer recommended to improve the immunization quality starting from planning, control of vaccine quality, cold chain management, provision of guidance and supervision to staffs in puskesmas qually important is to improve cooperation among programs, among sectors, by building participation of the communities and private sector. The role of medical personnel to help delivery, also steamed be increased. This can be done by establishing cooperation with private midwives and enclosing political commitment and support."

"[ABSTRAKATS telah banyak digunakan di Indonesia dalam mengobati tetanus. Sejak tahun 2010, penggunaan HTIG sebagai antitoksin semakin meningkatTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Method: Penelitian retrospektif pada kasus tetanus anak yang dirawat di Rumah Sakit Cipto Mangunkusumo dari 2006-2014Results: Ada 69 pasien tetanus anak yang menjadi subjek penelitian, dengan kelompok usia terbanyak adalah 1 ? 5 tahun yaitu 53,6 % dan proporsi laki-laki lebih banyak dibanding perempuan (2:1), dengan 59,4 % subyek tidak pernah mendapat imunisasi dasar. Port d‟entree terbanyak adalah OMSK (47,8 %) dan tetanus derajat 3 merupakan diagnosis terbanyak (39,1 %). Semua subjek datang dirawat dengan gejala trismus, disertai kejang rangsang (75,4 %), kaku kuduk dan opistotonus (73,9 %), spasme spontan (69,6 %) dan perut papan 65,2 % subjek. Enam puluh tujuh persen subjek diobati dengan ATS dan 33 % dengan HTIG. Lama rawat subjek yang mendapat ATS 9,98 (SB 4,58) dan HTIG 10,91 (SB 5,88) hari. Subjek yang meninggal di akhir perawatan, pada kelompok ATS 4,4 % dan HTIG 21,7 %. Pada kelompok ATS, trismus terjadi selama 8 hari sejak dirawat, kejang rangsang dan kaku kuduk 3 hari, opistotonus dan perut papan 2 hari serta kejang spontan 1 hari. Sedangkan pada kelompok HTIG, trismus 8 hari, kejang rangsang, kaku kuduk, opistotonus dan perut papan 2 hari serta kejang spontan selama 1 hri. Tidak ada data mengenai risus sardonicus. Harga HTIG satu juta rupiah lebih murah dibanding ATS (Rp 4.414.711,- vs Rp 5.512.724,-) ATS dan HTIG memiliki efektifitas yang sama dalam hal lama rawat, lama terjadinya spasme dan hasil akhir perawatan. Harga HTIG lebih murah dibanding ATS. Disarankan memilih HTIG sebagai pilihan pertama pengobatan tetanus anak dan ATS hanya digunakan bila HTIG tidak dapat diberikan.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.

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ABSTRACTTo evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.;Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given., Background: ATS has been widely used in Indonesia in tetanus management. Since 2010, the use of antitoxin HTIG as increasingTujuan: mengevaluasi perbedaan luaran pada tetanus anak antara yang mendapat ATS dan HTIG.Objective: To evaluate the differences between the outcomes in pediatric tetanus who received HTIG and ATSMethod: A retrospective study on pediatric tetanus case who admitted to Cipto Mangunkusumo Hospital since 2006 to 2014Results:There were 69 patients with pediatric tetanus as study subjects, with 1-5 years as the largest age group is 53.6% and the proportion of men more than women (2: 1), with 59.4% of the subjects never got primary immunization. The most of port d'entree was CSOM (47.8%) and tetanus grade 3 as most fequent diagnosis (39.1%). All subjects came hospitalized with symptoms of trismus, accompanied spasms excitatory (75.4%), neck stiffness and opisthotonos (73.9%), spontaneous seizures (69.6%) and 65.2% of the subjects belly board. Sixty-seven percent of subjects treated with ATS and 33% with HTIG. Length of stay subjects who received ATS 9.98 (SB 4.58) and HTIG 10.91 (SB 5.88) a day. Subjects who died at the end of hospitalization, the ATS group is 4.4% and and HTIG group is 21.7%. In the ATS group, trismus occurred during the 8 days of hospitalization, a stiff neck and spasms excitatory 3 days, opisthotonos and belly boards 2 days and 1 day of spontaneous seizures. While the group HTIG, trismus 8 days, spasm excitatory, stiff neck, and abdomen board opistotonus 2 days and spontaneous seizures for 1 day. No data on risus sardonicus. Price HTIG one million rupiahs cheaper than ATS (Rp 4,414,711, - vs Rp 5,512,724, -) ATS and HTIG have the same effectiveness in terms of length of stay, duration of occurrence of spasms and outcomes of hospitalization. HTIG price is cheaper than the ATS. HTIG can the first choice treatment of pediatric tetanusr and ATS are only used when HTIG can not be given.]"

"PendahuluanAngka kematian dan angka kesakitan karena penyakit infeksi khususnya pada bayi dan anak balita, masih sangat tinggi di Indonesia. Hasil survai LitBangKes Republik Indonesia (1980) menunjukkan angka kematian spesifik pada golongan umur 1 - 4 tahun sebesar 19,6 per 1000. Angka kematian yang paling besar terjadi pada golongan umur di bawah satu tahun yaitu 90,3 per 1000 kelahiran hidup. Sebab kematian yang paling menonjol pada golongan umur tersebut ialah : diare (24,1%), infeksi saluran pernafasan (22,1%) dan tetanus neonatorum (20%) . Penyakit-penyakit ini sebenarnya dapat dicegah melalui imunisasi. Diperkirakan imunisasi dapat mencegah 31.5% kematian bayi dan 22,72 kematian anak balita (1). Program imunisasi melalui Pengembangan Program Imunisasi (PPI) telah dilaksanakan sejak tahun 1977 dan telah meliputi Iebih dari 45,000 desa. Hasil cakupan imunisasi melalui program ini masih belum mencapai sasaran yang diharapkan. Pada tahun 1985 sebagai berikut : BCG 52% , DPT2 37% , DPT3 11% , TT2 24% , Polio-3 10% , Campak 11,7%, sedangkan WHO memperkirakan hasil yang dicapai ialah DPT3 6% dan Polio-3 7%. Angka tersebut menunjukkan drop out imunisasi ulang DPT dan polio masih tinggi.Zat-zat imunopotensiator diketahui mempunyai efek meningkatkan reaksi imunitas iubuh terhadap imunogen. Levamisol adalah salah satu imunopotensiator non-spesifik yang telah diketahui mampu meningkatkan baik fungsi imonitas selular maupun humoral. Dilaporkan obat tersebut efektif untuk : a) mencegah dan mengobati infeksi menahun rekuren di kulit, mukosa, mata, saluran pernafasan, juga infeksi sistemik yang disebabkan oleh virus, bakteri, jamur dan sebagainya ; b) menghilangkan anergi pasca infeksi virus dan riketsia ; c) mengobati penyakit reumatik, termasuk artritis reumatoid, lupus eritematosus sistemik dan sindrom Reiter ; d) menekan angka kekambuhan pada penderita kanker, terutama setelah operasi, radioterapi atau kemoterapi. Penggunaan levamisol sebagai ajuvan dalam imunisasi telah pula dilaporkan oleh beberapa peneliti, baik pada pada hewan percobaan maupun pada manusia.Tujuan penelitian untuk membuktikan manfaat levamisol sebagai ajuvan dalam meningkatkan sintesis zat anti-tetanus. Bila levamisol terbukti mampu meningkatkan sintesis zat anti-tetanus, maka manfaat ini diharapkan akan mempercepat tercapainya kadar zat anti yang optimal, walaupnn terjadi drop out."

"Angka kematian bayi (AKB) di Indonesia hingga saat ini masih sangat tinggi dimana Tetanus neonatorum merupakan salah satu penyebab utama kematian bayi yang menempati urutan ke-5 (SKRT 1995). Upaya untuk mengeliminisasi tetanus neonatorum terus dilakukan Departemen Kesehatan dengan target menurunkan insiden menjadi < 1 per 1.000 kelahiran hidup pada tahun 2000.Salah satu strategi Departemen Kesehatan mencapai Eliminasi Tetanus Neonatorum (ETN) adalah meningkatkan cakupan imunisasi TT ibu hamil. Namun evaluasi tahun 1999/2000 menunjukkan cakupan yang masih rendah. Oleh karena itu Depkes mulai mengembangkan intensifikasi imunisasi TT kepada wanita usia subur (WUS). Hingga tahun 2000, Kabupaten Serang melaporkan cakupan imunisasi TT WUS > 3 kali mencapai 77,3%. Salah satu Puskesmas yang memiliki cakupan imunisasi TT WUS rendah adalah Puskesmas Anyer.Penelitian ini bertujuan untuk mengidentifikasi faktor-faktor yang berhubungan dengan status imunisasi TT WUS di Puskesmas Anyer, dengan menggunakan desain survei cross sectional. Responden terdiri dari 300 orang wanita usia subur. Variabel yang diteliti meliputi faktor umur, pendidikan, status perkawinan, pengetahuan, sikap, pekerjaan, persepsi tentang jarak, anjuran, dan kebutuhan terhadap pelayanan kesehatan/imunisasi TT.Hasil penelitian menunjukkan beberapa variabel mempunyai hubungan yang bermakna secara statistik dengan status imunisasi TT WUS (p<0,05). Variabel yang mempunyai hubungan bermakna tersebut adalah umur (OR=3,60), status perkawinan (5,60), pengetahuan (3,60), sikap (4,45), anjuran petugas kesehatan (2,63), anjuran petugas non kesehatan (7,14) dan kebutuhan terhadap pelayanan kesehatan (2,89). Sementara variabel persepsi tentang jarak, tingkat pendidikan, dan status pekerjaan tidak menunjukkan hubungan yang bermakna secara statistik (p>0,05).Berdasarkan analisis multivariat diketahui bahwa variabel yang paling berpengaruh adalah pengetahuan, umur, status perkawinan dan anjuran petugas non kesehatan. Diantara ke empat variabel tersebut, status kawin merupakan variabel yang paling besar mempengaruhi status imunisasi TT WUS.Mengacu pada hasil penelitian, maka untuk meningkatkan cakupan imunisasi TT WUS disarankan agar penjangkauan sasaran melalui kegiatan sweeping perlu dipertahankan mengingat kegiatan yang bersifat mass campaign masih dirasakan cukup efektif. Selain itu upaya sosialisasi TT WUS melalui media penyuluhan yang tepat bagi kelompok sasaran antara, seperti kader dan perangkat desa perlu dibuat mengingat pengaruhnya kepada sasaran utama program cukup besar. Untuk mempercepat tercapainya target jangka panjang yaitu dihentikannya imunisasi TT ibu hamil, maka perlu dilakukan pentahapan target TT WUS sehingga status imunisasi TT5 mendekati l00%. Penyesuaian jadwal dengan mengadopsi konsep interval minimal pada pelaksanaan imunisasi TT rutin pada ibu hamil sangat diperlukan untuk meningkatkan perlindungan individu sekaligus untuk meningkatkan efisiensi imunisasi TT.

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Factors Contributed To Tetanus Toxoid Immunization Status among Child Bearing Age Women in Anyer Puskesmas Service Area, District Of Serang, In the Year 2001Infant mortality rate is considerably still high in Indonesia where Neonatorum tetanus as the fifth major cause of infant deaths in Indonesia (Household Health Survey 1995). The Ministry of Health has been adopting various efforts to eliminate tetanus neonatorum targeted reducing of neonatal tetanus incidence rate down to below 1 per 1000 live births by the end of 2000.

One of the strategies in the Ministry of Health in order to eliminate neonatal tetanus is achieving high coverage of routine tetanus-toxoid (TT) immunization for pregnant women. Annual evaluation still shows low level of coverage up till the fiscal year 1999/2000, therefore the implementation of program acceleration of TT immunization targeting child-bearing age women (CBAW) as a new approach. By the year 2000, 77.3% of CBAW in Serang District health service area have received TT immunization minimum 3 doses. Anyer is one health centers of health centers in Serang District which reports the lowest coverage.

The objective of this study is to identify the factors contributing to TT immunization status of CBAW in Anyer puskesmas service area, using cross sectional study design. This survey included 300 CBAW. The study factors are age, educational level, marriage status, knowledge, attitude, job, perception about distance, motivator and need for health services/TT immunization.

The study shows several variables are having significant relationship with TT status of CBAW (p<0.05). Those variables are age, (OR=2.014), marriage status (OR= 3.286), knowledge (OR=2.626), and non-health motivator (OR=2.268). Other variables such as distance, attitude, need of health service, health motivator, education level, and job in this study do not show significant influence to TT status (p>O.05).

Thesis study recommends, sweeping of TT CRAW in a mass campaign is an effective approach in increasing the coverage and cadres or village administrators are the important motivators. The program long term goals in terminating TT immunization for pregnant women requires a good plan of TT CBAW until all or almost all of CBAW achieve the TT-5 status. Adjusting the TT immunization schedule by adopting the minimum-interval concept into the routine immunization for pregnant women is needed to increase the individual protection, as well as to increase the efficiency of TT immunization."