Penderita pneumonia yang dirawat di Rumah Sakit Cibabat Cimahi selama periode 2000-2003 sebanyak 1.559 orang, 120 orang diantaranya meninggal dunia CFR=7,71%, sedangkan di Rumah Sakit Hasan Sadikin Bandung selama periode yang sama telah merawat sebanyak 1.792 orang, 112 orang diantaranya meninggal dunia CFR=6,63%.Tingginya CFR penderita pneumonia di kedua rumah sakit tersebut menarik penulis untuk mengadakan penelitian, terutama pada balita yang cukup banyak penderitanya. Studi awal diketahui bahwa pada penderita pneumonia yang tidak meninggal di Rumah Sakit Cibabat terdapat sebanyak 36,5% memiliki gejala tambahan yang tidak lain sebagai penyakit penyerta pneumonia. Bagaimana dengan balita yang meninggal dunia?. Untuk itu penelitian yang penulis lakukan ini adalah untuk mengetahui pengaruh penyakit penyerta terhadap kematian balita akibat pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Hasan Sadikin Bandung. Desain penelitian yang digunakan pada penelitian ini adalah kasus kontrol, dengan jumlah sampel sebanyak 170 balita, yang terdiri 85 balita sebagai kasus dan 85 balita sebagai kontrol. Variabelvariabel yang diteliti adalah kematian balita penderita pneumonia sebagai variabel terikat, sedangkan sebagai variabel bebas adalah penyakit penyerta, sianosis, umur, jenis kelamin, status gizi, status imunisasi, status rujukan, kelas perawatan, dan lokasi tempat tinggal. Seluruh variabel yang diteliti bersumber dari data rekam medik di kedua rmah sakit tersebut sejak Januari 2000 sampai bulan Juni 2004.Hasil penelitian menunjukkan bahwa ada pengaruh penyakit penyerta terhadap kematian balita penderita pneumonia di Rumah Sakit Cibabat Cimahi dan Rumah Sakit Masan Sadikin Bandung. Balita penderita pneumonia disertai penyakit penyerta berisiko 3,38 kali dibandingkan dengan balita tanpa disertai penyakit penyerta. (p=0,00, OR=3,38, 95%CI=1,68--6,85). Ada pengaruh sianosis terhadap kematian balita akibat pneumonia, balita penderita pneumonia dengan gejala umum sianosis berisiko 7,42 kali meninggal dunia akibat dibandingkan balita tanpa gejala umum sianosis. (p=0,00, OR=7,42 95%CI=2,97-19,13).Melihat hasil penelitian diatas disarankan dalam menangani balita penderita pneumonia di Rumah Sakit agar lebih mewaspadai adanya penyakit penyerta dan gejala umum sianosis.Daftar Kepustakaan : 57 (1991-2004)

---

South-East Asia Region World Health Organization (SEARO-WHO) reported that communicable diseases have caused 40% of 10.5 million of deaths among children under-five year olds in the world. In the 6 SEARO-countries, including Indonesia, it was estimated that about 9 of 10 deaths were caused by pneumonia, diarrhea, measles and malnutrition.

Based on an extrapolation of a result of Household Health Survey in 1992, the mortality rate of pneumonia among under-five children in Indonesia is about 6 per 1,000 under-five children. Therefore it is estimated that among under-five children, 150.000 deaths occur every year due to pneumonia. It means that pneumonia has significantly contributes on death among children, especially in the under-five group.

Cibabat Hospital in Cimahi has treated about 1,559 pneumonia cases during the period of 2000-2003, and among all those cases, 120 patient died (CFR=7.71%). Hasan Sadikin General Hospital in Bandung during the same period has managed 1,792 pneumonia cases with 112 deaths among the treated cases (CFR 6,63%).

There are several factors influencing pneumonia caused mortality, such as a) age (< 2 months), b) socio-economic status, c) malnutrition, d) low birth weight, e) low mother education, f) low health care coverage, g) high house density, h) inadequate immunization, i) contracting chronic diseases.

The objective of this study was to know the effect of underlying diseases on under-five child mortality due to pneumonia in Cibabat Hospital in Cimahi and in Hasan Sadikin General Hospital in Bandung.

The study results showed that there was an effect of underlying diseases on the under-five child mortality caused by pneumonia in both hospitals. An under-five pneumonia case with underlying disease(s) was 3.38 times more likely to cause death as compared to under-five pneumonia case without underlying disease(s). It was also found that cyanosis, as one of the common signs of emergency in pneumonia, also increased the risk of death. A pneumonia case with cyanosis was 7,42 times at risk to cause death than the case without cyanosis.

Based on our study, it is recommended that the medical staffs in the hospitals to be aware of the existing underlying diseases and to conduct integrated case management The medical staffs, as well as the mothers are also suggested to pay attention on the sign of cyanosis. This sign is actually not so difficult to be recognized, although it was frequently ignored. This common sign of cyanosis is important in pneumonia treatment in the field, using several case management approaches, including oxygenation.

The Ministry of Health and its relevant structures are also encouraged to establish the Integrated Management Program of the Under-five Child Sickness, especially related to pneumonia, by providing sufficient health) medical facilities (such as oxygen contractor) in the community health centers and the hospitals.

References: 57 (1991 - 2004)