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"Mukositis adalah salah satu efek samping kemoterapi yang sering terjadi. Oral care menggunakan madu direkomendasikan untuk mencegah mukositis. Tujuan penelitian ini adalah untuk mengidentifikasi pengaruh madu terhadap mukositis akibat kemoterapi. Desain penelitian ini adalah kuasi eksperimen. Sampel diambil dengan consecutive sampling, terdiri dari kelompok intervensi yang mendapatkan oral care menggunakan madu (24 responden) dan kelompok kontrol mendapatkan oral care rutin (24 responden). Skor mukositis dievaluasi dengan Oral Assessment Guide. Data dianalisis dengan independent t test dan analysis of covarian.Hasil analisis menunjukkan terdapat penurunan yang signifikan pada rerata skor mukositis setelah intervensi pada kelompok intervensi (p=0,000). Peneliti menyimpulkan pemberian madu dalam oral care dapat menurunkan mukositis akibat kemoterapi, sehingga diharapkan hasil penelitian ini dapat diaplikasikan dalam protokol oral care pada anak yang sedang menjalani kemoterapi.

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Mucositis is known as a one common of side effects of chemotherapy. This study aimed to identify the effect of honey on nursing?s oral care intervention for chemotherapy-induced mucositis among children undergoing chemotherapy. The study was quasi experiment. A consecutive sampling was used with 24 patients were in a control group and 24 patients were in the intervention group. Intervention group were treated with oral care by using honey, while the control group received regular oral care. Mucositis score was evaluated by using an Oral Assessment Guide (OAG). Data were analyzed using independent t-test and analysis of covariance.

The result of this study showed that there was a significant reduction in the average of mucositis score after intervention in the intervention group compared to the control group (p=0.000). The study demonstrated that oral care intervention with honey was effective in managing chemotherapy-induced mucositis among children with cancer. Based on the findings, it is recommended to apply oral care with honey as a nursing intervention to patients undergoing chemotherapy."

"Pneumonia pada balita di Indonesia masih merupakan masalah kesehatan utama. Hal ini terlihat dengan tingginya angka morbiditas dan mortalitas pneumonia. Salah satu satu upaya untuk menurunkannya adalah dengan mengetahui faktor risiko yang menyebabkan terjadinya pneumonia.Penelitian ini bertujuan untuk mengetahui faktor risiko yang berhubungan dengan kejadian pneumonia pada anak balita di rumah sakit. Desain yang digunakan adalah cross sectional dengan 138 sampel.Hasil penelitian dengan regresi logistik didapatkan 4 faktor risiko yang berhubungan significant yaitu usia balita, riwayat pemberian ASI, status gizi balita dan kebiasaan merokok keluarga. Kegiatan edukasi kepada orang tua balita tentang beberapa faktor tersebut perlu ditingkatkan untuk mencegah terjadinya pneumonia.

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Pneumonia in children under five in Indonesia is still a major health problem. This can be seen in the high rates of morbidity and mortality of pneumonia. One of the efforts to lower it is by knowing the risk factors that cause pneumonia.

This study aims to determine the risk factors associated with the incidence of pneumonia in children under five in hospital. The study uses cross sectional design with 138 samples.

The results obtained with logistic regression show four significant risk factors: children under five, history of breastfeeding, nutritional status of children and family smoking habits. Promotion and awareness campaign on these factors should be conducted to prevent pneumonia."

"ABSTRAKPneumonia di Indonesia masih menjadi masalah utama dan angka kematian karenapneumonia masih tinggi. Salah satu masalah keperawatan pada pneumonia adalah gangguanbersihan jalan napas. Inhalasi nebuliser merupakan salah satu pengobatan untukmembersihkan jalan napas. Penelitian ini bertujuan untuk mengetahui faktor yangberhubungan dengan efektivitas proses unhalasi nebuliser. Desain yang digunakan adalahcross sectional dengan 142 sampel. Hasil penelitian dengan regresi logistik didapatkan 2faktor yang berhubungan signifikan yaitu dukungan keluarga (p=0,000) dan caring perawat(p=0,000). Rekomendasi untuk penelitian selanjutnya melihat efektivitas proses terapinebuliser pada pneumonia berdasarkan jenis alat yang digunakan dan dosis obat yangdiberikan.

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ABSTRACTPneumonia is still a major problem and mortality due to pneumonia is still high in Indonesia.One of the nursing problems in pneumonia is a disorder airway clearance. Inhalationnebulizer is one of treatment to clear the airway. This study aim to know factors related to theof the inhalation nebulizer therapy. The design used a cross sectional study with 142 samples.Logistic regression analysis of data found that 2 significant factors related with familysupport (p = 0.000) and caring (p = 0.000). Recommendations for future research look at theeffectiveness of the nebulizer therapy in pneumonia based on the type of equipment used and the doseof drug administered"

"Latar Belakang: Pneumonia berat masih menjadi masalah kesehatan utama di Indonesia dan dunia. Sistem imun diketahui memiliki peranan penting dalam patogenesis pneumonia, namun tidak banyak studi yang menilai hubungan antara kadar CD4 dan CD8 darah dengan mortalitas akibat pneumonia berat pada pasien dengan status HIV negatif. Tujuan: Mengetahui data hubungan dan nilai potong kadar CD4 dan CD8 darah dengan angka mortalitas 30 hari pada pasien pneumonia berat di RSCM. Metode: Penelitian berdesain kohort prospektif yang dilakukan di ruang rawat intensif RSCM periode Juni-Agustus 2020. Keluaran berupa kesintasan 30 hari, nilai titik potong optimal kadar CD4 dan CD8 darah untuk memprediksi mortalitas 30 hari dan risiko kematian. Analisis data menggunakan analisis kesintasan Kaplan-Meier, kurva ROC dan multivariat regresi Cox.Hasil: Dari 126 subjek, terdapat 1 subjek yang loss to follow up. Mortalitas 30 hari didapatkan 26,4%. Nilai titik potong optimal kadar CD4 darah 406 sel/μL (AUC 0,651, p=0,01, sensitivitas 64%, spesifisitas 61%) dan kadar CD8 darah 263 sel/μL (AUC 0,639, p=0,018, sensitivitas 62%, spesifisitas 58%). Kadar CD4 darah < 406 sel/μL memiliki crude HR 2,696 (IK 95% 1,298-5,603) dan kadar CD8 darah < 263 sel/μL memiliki crude HR 2,133 (IK 95% 1,035-4,392) dengan adjusted HR 2,721 (IK 95% 1,343-5,512). Bila sepsis dan tuberkulosis paru ditambahkan dengan kadar CD4 darah dan CD8 darah, didapatkan nilai AUC 0,752 (p=0,000). Kesimpulan: Kadar CD4 dan CD8 darah memiliki akurasi yang lemah dalam memprediksi mortalitas 30 hari pasien pneumonia berat. Kadar CD4 darah < 406 sel/μL dan kadar CD8 darah < 263 sel/μL memiliki risiko mortalitas 30 hari yang lebih tinggi.

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Background: Severe pneumonia is a major health problem in Indonesia and the world. The immune system is known to play an important role in the pathogenesis of pneumonia, but few studies have assessed the relationship between blood CD4 and CD8 count and mortality from severe pneumonia in patients with negative HIV status.

Objectives: Knowing the correlation data and the cut-off value of blood CD4 and CD8 count with a 30-days mortality rate in severe pneumonia patients at RSCM. Methods. This study is a prospective cohort study conducted at RSCM intensive care rooms from June to August 2020. The outputs were 30-days survival rate, optimal cut-off value for blood CD4 and CD8 count to predict 30-days mortality and mortality risk. Data analysis used Kaplan-Meier survival, ROC curves and multivariate Cox regression analysis.

Results: Of the 126 subjects, there was 1 subject who lost to follow up. The 30- days mortality rate was 26.4%. The optimal cut-off value for blood CD4 count was 406 cells/μL (AUC 0.651, p=0.01, sensitivity 64%, specificity 61%), blood CD8 count was 263 cells/μL (AUC 0.639, p=0.018, sensitivity 62%, specificity 58%). CD4 blood count < 406 cells/μL had a crude HR of 2.696 (95% CI 1.298- 5.603) and blood CD8 count < 263 cells/μL had a crude HR of 2.133 (95% CI 1.035-4.392) with an adjusted HR of 2.721 (CI 95% 1,343-5,512). If sepsis and pulmonary tuberculosis were added to the blood CD4 and CD8 count, the AUC value was 0.752 (p=0.000).

Conclusion: Blood CD4 and CD8 count had poor accuracy in predicting 30-days mortality in patients with severe pneumonia. The group with blood CD4 count < 406 cells/μL and blood CD8 count < 263 cells/μL had a higher risk of 30-days mortality."

"Pengetahuan ibu merupakan faktor penting untuk keberhasilan merawat balita pneumonia, baik di rumah sakit maupun di rumah. Penelitian ini bertujuan untuk mengetahui perbedaan pengaruh edukasi audiovisual pneumonia terhadap pengetahuan ibu, lama hari rawat dan rehospitalisasi balita di RSUD DKI Jakarta. Desain penelitian ini menggunakan kuasi eksperimen dengan two group pre post test design. Sebanyak 64 responden yang diambil menggunakan tekhnik consecutive sampling. Masing-masing diberikan edukasi selama 3 hari, 32 melalui audiovisual dan 32 melalui leaflet. Hasil penelitian menunjukkan ada perbedaan pengetahuan ibu, lama hari rawat, dan rehospitalisasi pada kedua kelompok (p<0,05). Pengetahuan post edukasi merupakan faktor yang paling dominan memengaruhi lama hari rawat dan rehospitalisasi pneumonia balita setelah dikontrol dengan pendidikan ibu dan kepadatan hunian. Kesimpulan dari penelitian ini adalah edukasi audiovisual lebih efektif meningkatkan pengetahuan ibu sebelum dan setelah edukasi (p=0,001), memperpendek lama hari rawat (p=0,001), dan mengurangi risiko rehospitalisasi (p=0,047) dibandingkan dengan edukasi melalui leaflet. Rekomendasi untuk peneliti selanjutnya adalah melakukan randomisasi dengan menggunakan desain eksperimen murni.

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Mother's knowledge is a main factor of pneumonia care in young ages children, while hospitalization or after discharge. Our Objective was determined the effectiveness education used audiovisual to mother’s knowledge, length of stay and re-admission at 3 Public Hospitals DKI Jakarta. This research used quasy-experimental with pre post test design. Total was 64 respondent included, 32 each group. Intervenstions was given for 3 days, one group used audiovisual  and other used leaflet.

The results showed that both groups was significant diferenciance on mother’s knowledge, length of stay and re-admission (p <0.05). Knowledge after education is the most dominant factor of length of stay and re-admission of pneumonia under five years children. Audiovisual education more effective increased mother’s knowledge before and after education (p=0.001), shorted length of stay (p=0.001), and reduced the risk of re-admission (p=0.047) than leaflet education. Further research especially intervention research, it is necessary to randomized used RCT."

"Latar Belakang : Pneumonia komunitas merupakan satu masalah kesehatan yang besar. Mortalitas akibat pneumonia komunitas masih tinggi, terutama di Indonesia bila dibandingkan dengan negara-negara lain. Skor CURB-65 merupakan sistem skoring yang telah dipakai secara luas, namun memiliki beberapa kekurangan sehingga diperlukan sistem skor baru untuk menilai derajat keparahan pneumonia komunitas. Saat ini telah diperkenalkan sistem skor expanded-CURB-65 yang dinilai dapat lebih baik dalam hubungannya sebagai prediktor mortalitas 30 hari pneumonia komunitas. Tujuan : Menilai performa kalibrasi dan diskriminasi skor expanded-CURB-65 untuk digunakan dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Umum Pusat Nasional dr.Cipto Mangunkusumo. Metode : Penelitian ini merupakan studi kohort prospektif dengan subyek penelitian pasien pneumonia komunitas yang datang ke IGD, poliklinik paru atau dirawat di ruang rawat RSCM. Keluaran yang dinilai adalah mortalitas pasien dalam 30 hari. Dilakukan penilaian performa diskriminasi skor expanded-CURB-65 menggunakan area under the curve AUC . Performa kalibrasi dinilai dengan plot kalibrasi dan tes Hosmer-Lemeshow. Hasil : 267 pasien ikut serta dalam penelitian ini dengan angka mortalitas 31,5 . Performa kalibrasi ditunjukkan oleh plot kalibrasi skor expanded-CURB-65 dengan r = 0,94 serta uji Hosmer-Lemeshow dengan nilai p = 0,57. Performa diskriminasi skor expanded-CURB-65 ditunjukkan oleh kurva ROC dengan nilai AUC 0,796 IK95 0,74-0,86. Simpulan : Mortalitas meningkat seiring peningkatan kelas risiko expanded-CURB-65. Expanded-CURB-65 menunjukkan performa kalibrasi dan diskriminasi yang baik dalam memprediksi mortalitas 30 hari pasien pneumonia komunitas di Rumah Sakit Cipto Mangunkusumo.

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Background : Community acquired pneumonia is a major health problem. Mortality due to community pneumonia is still high, especially in Indonesia compared to other countries. The CURB 65 score is a widely used scoring system, but has some drawbacks so a new scoring system is needed to assess the severity of community pneumonia. Currently, the expanded CURB 65 scoring system has been assessed better to predict 30 day mortality of community acquired pneumonia.

Aim : To evaluate calibration and discrimination performance of the expanded CURB 65 score in predicting 30 days mortality of community acquired pneumonia patients at the National Center General Hospital dr.Cipto Mangunkusumo.

Method : This study was a prospective cohort study with the study subjects community acquired pneumonia patients who came to the Emergency Room ER , pulmonary polyclinics or hospitalized in RSCM. The assessed outcome was patient mortality within 30 days. Discrimination performance of the expanded CURB 65 score assessed using the area under the curve AUC . Calibration was evaluated with calibration plot and Hosmer Lemeshow test.

Results : 267 patients participated in the study with a mortality rate of 31.5. Calibration plot of expanded CURB 65 score showed r 0,94 and Hosmer Lemeshow test showed p 0,57. Discrimination was shown by ROC curve with AUC 0,796 CI95 0,74 0,86.

Conclusion : Mortality increases with increasing risk class of expanded CURB 65. Expanded CURB 65 showed a good calibration and discrimination performance in predicting 30 day mortality higher in community acquired pneumonia patients in Cipto Mangunkusumo Hospital."

"ABSTRAKPneumonia adalah radang paru-para dengan diagnosa nafas ccpat dan sesak sertaadanya tarikan dinding dada bagian bawah ke daiam. Pneumonia disebabkan olehmilcroorganisme patogen (bakteri, virus, mikoplasma), aspirasi bahan atau produkberbahaya Pneumonia dipengaruhi antara lain faktor linglcungan tisik rumah dankaralcteristik anak. Pneumonia masih menjadi masalah di Indonesia khususnya di KotaTasikmalaya. Diperkirakan proporsi penyakit pneumonia penyebab keniatian pada bayisebesar l6,4%, sedangkan proporsi penyakit pneumonia pada balita sebesar 25%.Tujuan penelitian ini adaiah untuk mengetahui hubungan kcjadian pneumonia padabalita dengan faktor lingkungan Esik kamar tidur dan karakteristik anak.' Desain penelitian case control dengan pendekatan retrospektifl Sampel sebanyak300 responden terdiri dari 150 orang kasus dan _150 orang kontrol. Hasil analisis datadiperoleh hasil yaitu dari sepuluh variabel diteliti, yang mempunyai hubungan bermaknadengan kejadian pneumonia yaitu hanya delapan variabel terdizi dari jenis kelamin(p=0,00l;OR=2,3), status imunisasi (p=0,009;OR=1,9l), status gizi (p=0,013;OR=5,04), pembeiian ASI(p=0,028;OR=0,58), ventilasi (p=0,003;OR=0,48),pencahayaan (p=0,022,0R=0,55), kepadatan hunian (p=o,oo9;oR=o,s) dan asap obatnyamuk bakar (p=0,003; OR=2,l ). -Dari hasil uji multivariat tanpa interaksi, faktor dominan yang mempengaruhikejadian penyalcit pneumonia pada anak balita adalah status gizi dengan nilai B 1,799dan OR = 6,041 (CI 95%=l,607-22,713). Scdangkan hasil uji multivariat denganintemksi diperoleh' hasil bahwa faktor dominan yang mempengaruhi kejadianpneumonia anak balita adalah interaksi antara asap obat nyamuk dengan status gizidengan nilai B 1,040 dan OR-2,828 (CI 95%=1,66?7-4,7988). Pada perhitunganprobabiiitas didapatkan hasii bahwa balita yang menderita pneumonia memilikiprobabililas adds 15,6 kali punya riwayat status imunisasi tidak Iengkap (DPT danCampak), status gizi kurang dan ada asap obat nyamuk bakar di dalam kamar tidurdibanding balita yang tidak menderita pneumonia Dari hasil penelitian ini disarankan agar anak balita diimunisasi Iengkap (DPTdan Carnpak), diberi asupan makanan dengan gizi seimbang, dan tidak menggunakanobat anti nyamuk bakar di dalam kamar tidur, serta perlu disosialisasikan faktor-faktor'yang berhubungan dengan kcjadian pneumonia pada balita.

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ABSTRACTPneumonia is implementation of lengs with fast breath and short - windeddiagnosis and existence of chest wall with drawal at down part move inside. Pneumoniais caused of pathogen microorganism (bacterium, virus, rnicoplasma), materialsaspiration or dangerous product Pneumonia is aifected by the factors of house physicalenvironment and children characteristics. Pneumonia still become serious problem inIndonesia especially at T asikmalaya City. It was predicted that proportion of pneumoniadisease caused to the death of baby is l6,4%, while proportion of pneumonia desease ofchlidren imder Eve is 25%. The objective of this research was to lcnow the relationbetween pneumonia case of children under tive years with physical environment factorof badroom and child characteristic.The research design was case control design and retrospective approach. Thesamples were 300 respondents consist of 150 and 150 controls. The result of dataanalysis was got : fiom ten variables studied, the variables that have significant relationave 8 varables consisted of sex (p=0,00l,OR=2,3), immunization status (p=0,009,OR=l,9l), nutrition status (p=0,0l3,0R=5,04), giving ASI (p=0,027,0R=0,58),ventilation (p=0,022,0R=0,48), lighting (p=0,22,0R=0,55), bed room density(p=0,009,0R=0,5), smoke of medicine for fighting mosquito (p=0,003,0R=2,l). Frommultivariate test result without interaction was indicated that dominant factors whichaffected on pneumonia disease occurrence of children under live years old werenutrition status by B-value = l,799 and OR-value == 6,041 CI 95% = 1,607-22,7l3,whereas multivariate test by interaction was obtained a result that dominant factorswhich affected on pneumonia occurrence of children gander five years old wereinteraction between smoke of medicine for fighting mosquito and nutrition status by B-value = 1,040 and OR~value = 2,828 Cl 95% = 1,667-4,7988. At probability calculation,it was got the result that children under tive years old who suliered from pneumonia hadodd probability 15,6 times of having incomplete immunization status (DPT andMeasles), less nutrition statins and there were smoke of bumed mosquito repellent in the bed room compared to chlidren under tive years who suffered from pneumonia. Fromthe result ol' research, it was suggested that children under five years old should beimmunized completely (DPT and Measles immunization) it must be given thc lbodsuply with ballanced nutrient and don't use burned mosquito repellent in bad room and itneed to be sosialized the factors which have relation with pneumonia cases of childrenunder five years old.

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"Pneumonia merupakan penyakit mematikan nomor satu di dunia dengan prevalensi 44%. Di Indonesia, pneumonia balita merupakan penyebab kematian nomor dua setelah diare dengan proporsi 15,5%. Pneumonia merupakan penyakit yang disebabkan oleh virus dan bakteri yang dipengaruhi oleh pencemar fisik dan kimia. Tujuan penelitian ini adalah untuk menganalisis kualitas udara rumah dengan kejadian pneumonia balita dengan metode cross sectional. Hasil penelitian menunjukan hubungan signifikan terjadi pada PM10 dan PM2.5 (p < 0.05) dengan nilai risiko 4,40 dan 3,20. Hubungan tidak signifikan terjadi antara kepadatan hunian rumah dan kamar, ventilasi rumah dan lubang penghawaan dapur, perokok dalam rumah dan penggunaan obat nyamuk bakar, SO2, NO2 dan CO (p > 0.05) dengan pneumonia.

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Pneumonia is number one deadly disease in the world with the prevalance of 44%. In Indonesia, pneumonia in toodler is the leading cause of death after diarrhea with proportion of 15,5%. Pneumonia is a disease caused by a virus and bacteria that is influence by physical and chemical contaminants. Cross sectional method used in this research to analyze the indoor air quality and incidence of pneumonia. Significant correlation occur between PM10 and PM2.5 (p < 0.05) with odd ratio 4.40 and 3.24.

The results of this research showing absence of the relation between the density of a dwelling house and room, ventilation in the house and in the kitchen, smokers in the house and the use of mosquito coil, SO2, NO2 and CO (p > 0.05) with pneumonia."

"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)

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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)"