DESCRIPTION OF
CHARACTERISTICS OF TYPHOID FEVER PATIENTS IN CHILDREN AGED 5-14 YEARS AT RSU
ROYAL PRIMA MEDAN PERIOD AUGUST 2022-FEBRUARY 2023
Dzaky Dhawy Dermawan1,
Qori Fadillah2, Andre Budi3
Prima Indonesia
University
Email: [email protected]1,
[email protected]2, [email protected]3
|
Abstract |
|
Infectious diseases are
still a public health problem, especially in developing countries. One of the
infectious diseases is typhoid fever. Typhoid fever is an acute infection of
the small intestine with symptoms of fever lasting more than one week, which
can cause digestive disorders and reduce the level of consciousness. This
research aims to analyze the characteristics of typhoid fever sufferers in
children aged 5-14 years at RSU Royal Prima Medan from August 2022 - February
2023. The type of research used in this research is a qualitative description
with a cross-sectional design. The population used was 46 medical records of
typhoid fever sufferers in children aged 5-14 years at RSU Royal Prima Medan
from August 2022 - February 2023. The sampling technique used in this
research used total sampling, while the number of samples used was 46
records. Medical treatment for typhoid fever patients. Data analysis uses univariate
analysis. The results of the study showed that the number of typhoid fever
sufferers in children aged 5-14 years at RSU Royal Prima Medan from August
2022 � February 2023 was 46 children, 27 of the sufferers were predominantly
male while 19 were female. All typhoid fever sufferers in this study
experienced accompanying symptoms of fever, nausea, vomiting, and diarrhea;
only five typhoid fever sufferers, or 10.9%, were accompanied by additional
accompanying symptoms in the form of abdominal pain. Normal body weight in
male patients was 19 patients, and abnormal body weight was eight patients.
Normal body weight in female patients was eight patients, and abnormal body
weight was 11 patients. All typhoid fever sufferers received RL and NaCL
therapy, only 11 sufferers received additional Cefixime therapy, and only 32
sufferers received additional Cefriaxone therapy. August 2022 � February 2023
is > 3 days. Keywords: Typhoid
Fever, Gender, Accompanying Symptoms, Nutritional Status. |
Health is the main thing that
must be considered; if the public's health status is good, then all community
activities can run smoothly. A high level of health causes the body to be in
prime condition so that all the body's organs can function as they should
without experiencing significant disturbances, which can risk reducing a
person's physiological and psychological condition and can hinder work. The
emergence of a disease, such as infectious diseases, is the biggest threat that
risks reducing the health status of people in the world (Gunawan
et al., 2022).
Infectious diseases are still a
public health problem, especially in developing countries (Kemenkes, 2021). Infectious diseases do not
recognize administrative regional boundaries, so eradicating infectious
diseases requires cooperation between regions, for example, between provinces,
districts/cities, and even between countries. (Zaidan & Hadi,
2020).
One of the infectious diseases is
typhoid fever (Ardiaria, 2019). Typhoid fever is an acute
infection of the small intestine with symptoms of fever lasting more than one
week, which can cause digestive disorders and reduce the level of
consciousness. Salmonella typhi bacteria is the cause of typhoid fever, also
known as abdominal typhus, which is an acute infectious disease of the small
intestine. Prolonged fever, bacteremia, as well as invasion and proliferation
of salmonella typhi bacteria into mononuclear phagocyte cells in the liver,
spleen, intestinal lymph nodes, and Peyer's spots are characteristic of typhoid
fever. Transmission of typhoid fever can be fecal and oral, which enters
the human body through contaminated food and drink (Muthoharoh et al.,
2020). Salmonella typhi can infect
various types of food, including water, ice cubes, raw vegetables and fruit.
This bacteria is spread through food and water that is not properly sanitized,
such as that found at roadside stalls in developing countries. Typhoid fever is
transmitted in developed countries by travelers coming from areas with endemic
typhoid fever (Putra et al., 2020).
According to WHO, typhoid fever
is an acute febrile illness that is life-threatening. Without treatment, the
case fatality rate for typhoid fever is 10-30%, decreasing to 1-4% if
appropriate therapy. Young children are at greatest risk, with common symptoms
being fever, chills, and abdominal pain. It is estimated that there are 11-21
million cases of typhoid fever and around 128,000-161,000 deaths every year.
Meanwhile, in Indonesia, the number of cases is 358-810/100,000 population in
Indonesia. The incidence of typhoid fever increases yearly, with an average
incidence of 500/100,000 in the population and a mortality rate of around
0.6-5% (Putra et al., 2020).
The prevalence of this disease in
Indonesia is 1.6% and ranks 5th in infectious diseases that occur at all ages
in Indonesia, namely 6.0% and ranks 15th in the cause of death for all ages in
Indonesia, namely 1,6%. Most cases of typhoid fever occur in the age range of 3
� 19 years (Khairunnisa et al.,
2020). Based on data from the North
Sumatra Provincial Health Service in 2020, it was reported that typhoid fever
was one of the ten diseases that caused an increase in the number of
hospitalized patients, with cases reaching 15,233, and in 2021, it was reported
that typhoid fever cases reached 11,550.
Typhoid fever usually attacks
school-age children (5 to 14 years). This age group is known for its high
levels of physical activity, which can result in neglected diet and hygiene. In
addition, a lack of parental guidance regarding clean and healthy living
behavior can lead to the emergence of unhealthy eating habits such as snacking
or eating out, where food safety is not guaranteed and can become a breeding
ground for Salmonella typhi bacteria. School children are very
vulnerable to consuming various kinds of food from street vendors and drinking
contaminated water. Children are especially susceptible to typhoid fever due to
these causes (Ramada, 2021).
Royal Prima Medan Hospital is one
of the largest private hospitals. It will become a referral center for the
community, especially the city of Medan and the community of North Sumatra in
general. RSU Royal Prima Medan has a children's polyclinic, which will make the
RSU a place for referral for pediatric patients, especially children with
typhoid fever.
From the description background back above, the
researcher is interested
in doing a study with the title "Characteristics of Typhoid
Fever Sufferers in Children Aged 5-14 Years at RSU Royal Prima Medan for the
period August 2022-February 2023".
The type of research used in this
research is a qualitative description with a cross-sectional design. The study was held at RSU
Royal Prima Medan, which is located at Jl. Father No. 68A, Sei Putih Tengah,
Kec. Medan Petisah, Medan City, North Sumatra 20118. Research will start from
July 2023 to April 2023.
The population in this study were medical records of
typhoid fever sufferers in children aged 5-14 years at RSU Royal Prima Medan
for the period August 2022 � February 2023, totaling 46 medical records.
The
sampling technique used in this research was total sampling. Total
sampling is a sampling technique where all members of the population are
sampled so the number of samples in this study was 46 samples of medical
records of typhoid fever sufferers in children aged 5-14 years at RSU Royal
Prima Medan for the period August 2022 � February 2023.
Deep data analysis study This is an analysis with a descriptive univariate method.
Table 1 Total Typhoid Fever Sufferers
|
Number of Typhoid Fever Sufferers |
n |
% |
|
Typhoid Fever in Children Aged 5-14
years |
46 |
100 |
|
Total |
46 |
100 |
�����������
From Table 1,
it can be seen that the number of sufferers of typhoid in children aged 5-14
years at RSU Royal Prima Medan for the period August 2022 � February 2023 is as
many as 46 children with a percentage of 100%.
Table 2 Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Gender at RSU Royal Prima Medan for the Period August
2022 - February 2023
|
Gender |
n |
% |
|
Man |
27 |
58.7 |
|
Woman |
19 |
41.3 |
|
Total |
46 |
100 |
�����������
Table 2 explains the characteristics of sufferer fever typhoid in
children ages 5-14 years based on type and gender at RSU Royal Prima Medan from
August 2022 to February 2023. The results study show that sufferer fever types
of typhoid sex men as many as 27 people with a percentage amounted to 58.7%,
and sufferers fever types of typhoid sex Woman as many as 19 people with a
percentage amounting to 41.3% of the total sufferers' fever typhoid in children
aged 5-14 years at RSU Royal Prima Medan for the period August 2022 � February
2023 as many as 46 children. From the results, it can be seen that the majority
of sufferers of typhoid fever in children aged 5-14 years at RSU Royal Prima
Medan for the period August 2022 � February 2023.
Table 3 Characteristics of Typhoid Fever
Sufferers in Children Aged 5-14 Years Based on Accompanying Symptoms at RSU
Royal Prima Medan for the Period August 2022 - February 2023
|
Accompanying Symptoms |
n |
% |
|
Fever |
46 |
100 |
|
Nauseous |
46 |
100 |
|
Vomit |
46 |
100 |
|
Stomach ache |
5 |
10.9 |
|
Diarrhea |
46 |
100 |
�����������
Table
3 explains the results of characteristics of sufferer fever typhoid in
children ages 5-14 Years based on symptom participation in RSU Royal Prima
Medan for the period August 2022 - February 2023. The results study shows that
all sufferers of fever typhoid patients experienced symptoms accompanying
fever, nausea, vomiting, and diarrhea; only five people suffered from fever
typhoid, 10.9%, accompanied by symptoms accompanying a Sick stomach.
Table 4 Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Nutritional Status at RSU Royal Prima Medan for the
Period August 2022 - February 2023
|
Gender |
Nutritional
status |
|||||
|
BB
Normal |
Total |
Abnormal
BB |
Total |
|||
|
n |
% |
n |
% |
|||
|
Man |
19 |
41.3 |
19 |
8 |
17.7 |
8 |
|
Woman |
8 |
17.4 |
8 |
11 |
23.9 |
11 |
Table 4 explains results about
characteristics of sufferer fever typhoid in children ages 5-14 Years based on
status nutrition at RSU Royal Prima Medan for the period August 2022 - February
2023, in a study, this is the nutritional status child seen from the child's BB
based on WHO. The results of the study show that the patient's weight fever
typhoid with type sex 19 normal men with percentage amounted to 41.3%, and the
patient's body weight fever Abnormal typhoid with as many as eight people with
a percentage amounting to 17.7%. Child's weight sufferer fever typhoid with
type sex There are eight normal women with a percentage amounted to 17.4%, and
the patient's body weight fever typhoid in children 11 abnormal women with a
percentage amounting to 23.9%.
Table 5 Therapy for Typhoid Fever Sufferers in Children Aged 5-14
Years at RSU Royal Prima Medan Period August 2022 - February 2023
|
Therapy |
n |
% |
|
RL |
46 |
100 |
|
NaCL |
46 |
100 |
|
Cefixime |
11 |
23.9 |
|
Ceftriaxone |
32 |
69.9 |
�����������
Table 5 explains the results of a study
about therapy used on patients with fever typhoid in children aged 5-14 years
at RSU Royal Prima Medan in the period August 2022 � February 2023. The results
of the study show that all sufferers of fever typhoid got RL and NaCL therapy;
only 11 sufferers, or 23.9 %, received it in addition to Cefixime therapy, and
only 32 sufferers, or 69.9 % of patients received additional therapy, Cefriaxone.
Table 6 Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Length of Treatment at RSU Royal Prima Medan for the
Period August 2022 - February 2023
|
Length of Treatment |
n |
% |
|
1 � 3 Days |
3 |
6.5 |
|
> 3 Days |
43 |
93.5 |
|
Total |
46 |
100 |
�����������
Table 6 explains the characteristics of sufferer fever typhoid in children
ages 5-14 years based on length of stay at RSU Royal Prima Medan from August
2022 � February 2023. The results study show that sufferer fever Typhoid
treatment takes 1 � 3 days for as many as three people, with percentage
amounting to 6.5%, and sufferers fever typhoid treatment duration > 3 days
as many as 43 people with percentage amounting to 93.5% of the total sufferers
sufferer fever typhoid in children aged 5-14 years at RSU Royal Prima Medan for
the period August 2022 � February 2023 as many as 46 children. From the results
This seen that the majority of treatment takes a long time sufferer fever
typhoid in children aged 5-14 years at RSU Royal Prima Medan for the period
August 2022 � February 2023 is > 3 days.
Discussion
Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Gender at RSU Royal Prima Medan for the Period August
2022 - February 2023
This
research is in line with research conducted by Franky (2020). The results show that typhoid
fever occurs more often in men (PUTRA, 2020).
The same conclusion was also obtained from research conducted by (Melarosa et
al., 2019) at the Sanglah Central General Hospital (RSUP)
Denpasar, which revealed that male patients - 36 out of 55 patients, or 65.5% -
more people suffer from typhoid fever than women. This is because men's
lifestyle choices make them more susceptible to infection with the salmonella
typhi bacteria, which causes typhoid fever (Melarosa et al.,
2019).
Typhoid
fever can occur in all genders, both women and men, and this is not an
indication that the incidence of typhoid fever is more common in men than
women. In the male gender, if we look at this disease, it is closely related to
personal hygiene, poor food hygiene, and dirty environments, and usually
transmission occurs through water contaminated with Salmonella Typhi. Contaminated food or carriers are the main source of transmission of fever.
Typhoid fever can happen to anyone, especially patients who do not understand
food choices and personal hygiene. Variations in disease prevalence between
genders may also be associated with societal attitudes, sociodemographics, and
roles in life.
Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Accompanying Symptoms at RSU Royal Prima Medan for the
Period August 2022 - February 2023
The results of research
regarding the characteristics of typhoid fever sufferers occurring
in children aged 5-14 years based
on accompanying symptoms at RSU Royal Prima Medan for the period August 2022 �
February 2023 show that all typhoid fever sufferers in this study experienced
accompanying symptoms of fever, nausea, vomiting and diarrhea, only five people
suffered from typhoid fever or 10.9% who were accompanied by additional
accompanying symptoms in the form of stomach pain.
In this study, fever, nausea,
vomiting, and diarrhea were the main accompanying complaints or symptoms in
typhoid fever patients at RSU Royal Prima Medan from August 2022 to February
2023. The results of this study are in line with research conducted by Rianti (2017) with research entitled clinical profile children with typhoid fever at
the Dr. Sardjito Yogyakarta Central General Hospital, the results of which
showed that fever was the main complaint in all patients (100%), other
complaints that were frequently found were anorexia (54.4%), nausea (49.4%),
vomiting (41.8%), headache (37.3%), cough (37.3%), abdominal pain (34.2%),
constipation (30.4%) and diarrhea (29.7%). The most common signs found in
patients were liver enlargement (29.7%), abdominal tenderness (20.3%),
lymphadenopathy (13.3%), lethargy (13.3%), dirty tongue (12.0% ), enlarged
spleen (6.3%) and decreased consciousness (4.4%). Rose spots were not found in
all subjects (Lestari & Arguni, 2017).
Typhoid fever is caused by the
presence of salmonella typhi bacteria, and its endotoxin stimulates the
synthesis and release of pyrogens by leukocytes in inflamed tissue. Typhoid
patients often have bad breath due to prolonged fever. The lip mucosa is dry,
sometimes chapped, and the tongue looks dirty and pale. The tip and edges of
the tongue are reddish and trembling, and in general, patients often complain
of abdominal pain, especially in the epigastric region (heartburn), accompanied
by nausea and vomiting. At first, the patient often experienced constipation,
in the following week the patient sometimes experienced diarrhea (Ulya & Widyawati, 2020).
Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Nutritional Status at RSU Royal Prima Medan for the
Period August 2022 - February 2023
The results of research regarding the characteristics of typhoid fever
sufferers in children aged 5-14 years based on nutritional status at RSU Royal
Prima Medan for the period August 2022 - February 2023 show that the body
weight of typhoid fever sufferers with normal gender is 19 people with a
percentage of 41 .3%. The abnormal body weight of typhoid fever sufferers was
eight people, with a percentage of 17.7%. The body weight of children suffering
from typhoid fever with normal female gender was eight people with a percentage
of 17.4%, and the weight of typhoid fever sufferers in girls who were abnormal
was 11 people with a percentage of 23.9%.
Both the bacterial infection caused by Salmonella typhi and the prognosis
of a disease are correlated with nutritional conditions. Various vitamins,
minerals and nutrients in food are very important to prevent problems and meet
the body's increased nutritional needs due to disease (Farhadi &
Ovchinnikov, 2018). Medical examination and
treatment should include nutritional assessment, especially for pediatric
patients who have protracted dietary requirements. Nutritional status is the state of the body's ability to balance food
intake with nutritional needs. Certain medical disorders have been linked to
nutritional status as a cause or risk factor, according to certain studies. For
example, in children who are malnourished. An imbalance between calorie
expenditure and nutritional intake and needs is known as malnutrition, which
can interfere with a child's growth and development. Inadequate nutrition can
worsen mucositis and neutropenia, delay recovery from illness, and increase the
risk of infection (Runco et al., 2020). The results of nutritional status evaluations can show various levels of
malnutrition as well as the relationship between a person's health and certain
diseases.
Therapy for Typhoid Fever Sufferers in Children Aged 5-14
Years at RSU Royal Prima Medan Period August 2022 - February 2023
The results of research regarding therapy for typhoid fever sufferers in
children aged 5-14 years at RSU Royal Prima Medan for the period August 2022 �
February 2023 show that all typhoid fever sufferers in this study received RL
and NaCL therapy, only 11 sufferers or 23.9% who received additional Cefixime
therapy, and only 32 sufferers or 69.9% of sufferers received additional
Cefriaxone therapy.
This research is in line with research conducted by Luvita
(2021), where the results show that
typhoid fever therapy uses cefixime and ceftriaxone. Based on the type of
inpatients with typhoid fever at RSUD, Dr. Soeroto Ngawi uses five types of
antibiotics, namely ceftriaxone, cefotaxime, cefixime, thiamphenicol, and chloramphenicol.
Based on the data, the antibiotic ceftriaxone is the most commonly prescribed
(67%), with 67 patients receiving this type of drug.
The trend is to treat typhoid fever with second-line antibiotics, such as
the cephalosporin group, because many patients experience multi-drug resistance
or MDR. Currently, the chloramphenicol group�which inhibits bacterial protein
synthesis�is the first line of treatment for typhoid fever. Inhibiting the
enzyme peptidyl transferase, the drug attaches to ribosomal subunit 50 and
prevents the formation of peptide bonds during bacterial protein synthesis.
Ceftriaxone is the current antibiotic of choice. This drug was chosen because
of its ability to lower body temperature, ease of short-term administration,
and high level of safety for adults and children (Melarosa et al.,
2019).
Characteristics of Typhoid Fever Sufferers in Children
Aged 5-14 Years Based on Length of Treatment at RSU Royal Prima Medan for the
Period August 2022 - February 2023
The results of research regarding the characteristics of typhoid fever
sufferers in children aged 5-14 years based on nutritional status at RSU Royal
Prima Medan for the period August 2022 - February 2023 show that there are three typhoid fever sufferers
whose treatment duration is 1 - 3 days with a percentage of 6.5%. , and 43
people with typhoid fever who had a treatment period of >3 days, with a
percentage of 93.5% of the total number of typhoid fever sufferers in children
aged 5-14 years at RSU Royal Prima Medan for the period August 2022 � February
2023 were 46 children. From these results, it can be seen that the majority of
the length of stay for typhoid fever sufferers in children aged 5-14 years at
RSU Royal Prima Medan from August 2022 � February 2023 is > 3 days.
The results of this study are in line with
research conducted by Satriani
(2020), where the results show the average length of treatment for typhoid
fever patients in hospitals. Ibnu Sina Makassar for the period January 2016 �
December 2017 is 5.07 or rounded up to 5 days. Apart from that, the shortest
treatment duration is one day, and the longest treatment duration is 20 days (Zaidan & Hadi, 2020).
The length of treatment for typhoid fever
patients depends on the severity of the typhoid fever patient and the therapy
received. It is possible for patients to have a length of stay of 1-3 days due
to appropriate medication administration, the patient's severity level not
being too severe, and the presence of complications and comorbidities that are
not severe. Meanwhile, in patients who are hospitalized for more than three
days, there are indications that patients tend to receive inappropriate medication.
Patients should receive combination antibiotic therapy but only receive single
antibiotic therapy. The length of a patient's stay in the hospital can be
influenced by several factors, such as the severity of the disease, the side
effects of medication, and the possibility that the patient has already taken
medication before entering the hospital.
1. The
number of typhoid fever sufferers in children aged 5-14 years at RSU Royal
Prima Medan for the period August 2022 � February 2023 is 46 children.
2. The
number of sufferers was 27 male and 19 female.
3. All
typhoid fever sufferers in this study experienced accompanying symptoms of
fever, nausea, vomiting, and diarrhea; only five typhoid fever sufferers, or
10.9%, were accompanied by additional accompanying symptoms in the form of
abdominal pain.
4. Normal
body weight in male patients was 19 patients, and abnormal body weight was
eight patients. Normal body weight in female patients was eight patients, and
abnormal body weight was 11 patients.
5. All
typhoid fever sufferers received RL and NaCL therapy, only 11 sufferers
received additional Cefixime therapy, and only 32 sufferers received additional
Cefriaxone therapy.
The
majority of the length of stay for typhoid fever sufferers in children aged
5-14 years at RSU Royal Prima Medan for the period August 2022 � February 2023
is > 3 days.
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