Medical Faculty

University Of Jember

International Conference Agromedicine and Tropical Diseases

ICATD 2016

Optimizing the Role of Agromedicne and

Tropical Diseases in Human Life

Proceeding

November 5, 2016

Agromedicine Research Center

Medical Faculty University Of Jember
Jember
Proceeding International Conference
Agromedicine and Tropical Diseases ICATD
2016

Editor:
dr. Al Munawir, M.Kes., Ph.D.

Reviewer:
dr. Cholis Abrori, M.Kes., M.Pd.Ked
dr. Desie Dwi Wisudanti, M.Biomed
dr. Septa Surya Wahyudi, Sp.U
dr. Rini Riyanti, Sp.PK

ISBN: 978-602-5617-09-6

Layout and Design Cover

dr. Sheilla Rachmania
dr. Muhammad Afiful Jauhari

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UPT Penerbitan Universitas Jember

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Message from the chairman of ICATD 2016

Exellencies, Ladies and Gentlemen,

First I thank the Almighty God for His help and protection not only in the preparation
for the conference, but also during and after the conference.

Onbehalf of the Commitee, it is my pleasure an privilege to wellcome the President of

University of Jember, Vice Dean of Medical Faculty to our distinguished plenary speaker, and
to all participants.

The Conference draws attendance representating academic scholars, researchers as

well as Medical Doctor, Goverenment policy makers who are interested in Agromedicine and
Tropical diseases. Beside Conference, Today, we hope to get a chance to form a scientific
community in the field of Agromedicine (Indonesian Agromedicine Society) in Bussiness
Meeting session.

The following distinguished plenary speakers are:

1. Professor Susan Brumby, From Deakin University, Australia.

2. Professor Angel Yanagihara From University of Hawaii at Manoa, USA
3. Professor Kim Euikyung From Gyeongsang National University, Jinju, South of
Korea.

Wellcome to Jember. we have a beautiful natural landscape, agriculture, plantations,

mountains, beaches, and diving spots.

So enjoy the conference.

Jember, 5th November 2016

Al Munawir, MD., PhD

Chairman

2
REMARKS FROM THE DEAN

Dear Colleques

It is great moment and pleasure for us to welcome you to the International

Conference Agromedicine and Tropical Diseases with topic “Optimizing the Role of
Agromedicne and Tropical Diseases in Human Life” in Medical Faculty University of
Jember.

The International Conference Agromedicine and Tropical Diseases with topic

“Optimizing the Role of Agromedicne and Tropical Diseases in Human Life” are
during to improve our knowledge and information in agromedicine field and tropical
diseases, we are trying to design an up to date scientific program on agromedicine
field, we also admited abstract for poster and oral presentation for participants.

In this meeting contribute Mr. Kim Euikyung from Korea, Miss. Angel Anne
Yanagihara from USA, Miss. Susan Alison Brumby from Australia, Mr. Al Munawir
from Indonesia and Miss Erma Sulistyaningsih from Indonesia, it is our goal to get
exchange information and communication between lecture and I hope we can creat
agromedicine community in the future.

Finaly, I would like to express my sincere thanks to Mr. Kim Euikyung from Korea,
Miss. Angel Anne Yanagihara from USA, Miss. Susan Alison Brumby from Australia,
Mr. Al Munawir from Indonesia and Miss Erma Sulistyaningsih from Indonesia, and
team of efford in holding this meeting and whising all to have a success.

Jember, 5th November 2016

dr. Enny SUswati, M.Kes

Dean

3
ORGANIZING COMMITTEE

Chair Person
dr. Al Munawir, M.Kes., Ph.D.

Secreary
dr. Dini Agustina, M.Biomed

Treasurer
dr. Ida Sri Surani, M.Kes

Scientific
dr. Cholis Abrori, M.Kes., M.Pd.Ked
dr. Desie Dwi Wisudanti, M.Biomed
dr. Septa Surya Wahyudi, Sp.U
dr. Rini Riyanti, Sp.PK

Programme
dr. Cicih Komariah, Sp.M
dr. M. Ali Shodikin, M.Kes., Sp.A

Publication
dr. Sheilla Rachmania
dr. Muhammad Afiful Jauhari
Ahmad Kodri Riyandoko, A.Md.Kep

Equipment
dr. Bagus Hermansyah, M.Biomed
Erfan Rosadi, SP

Meals
Dra. Lie Hartati, M.Si
Dwi Ambawani, SE

4
CONTENTS

ORAL PRESENTATION .......................................................................................... 5

Ethanolic Leaves Extract of Awar-Awar (Ficus septica) Inhibits Cells

Migration using Scratch Assay on 4T1 Breast Cancer Cells *Best presentation
By : Ika Rahmawati Sutejo (Faculty of Medicine, Jember University) ................................ 06 - 12

Analysis of Influence Health Education Based on Empowerment of the

Recitals Muslmah Community to Improvement of Fertile Age Women's
Knowledge about Reproductive Health and HIV - AIDS in Jember
By : Mury Ririanty (Faculty Of Public Heath, Jember University) ..................................... 13 - 20

The Combination THERAPY of Antiretroviral and Phyllanthus Niruri

Extract FOR HIV Patients
By : Wienta Diarsvitri (Faculty of Medicine, Hang Tuah University) ................................... 21 - 27

The Correlation Between Clean and Healthy Living and Typhoid Fever
Incidencein Sumbersari Public Health Center
By : Dwita Aryadina R (Faculty of Medicine, Jember University) ...................................... 28 - 34

Cochlear Fibroblasts Repairment in Rat Model of Diabetes Mellitus as a

Result of Curcumin Treatment (Preliminary Study)
By : Tengku Siti Hajar Haryuna (Faculty of Medicine, Sumatera Utara University) ............... 35 - 39

Potential of Indigenous Lactobacillus sp in Purple Sweet Potato (Ipomoea

batatas var. Ayamurasaki) Extract Yogurt AS Prevention of Antibiotic-
Associated Diarrhoea
By : Rohmah Munawaroh (Faculty of Agriculture Technology, Jember University) .............. 40 - 45

POSTER PRESENTATION .................................................................................... 46

Pesticide: Endangered Agricultural Workers by Causing Depression and

Suicidal Ideation *Best Poster
By : Widya Ayu Putri Maharani (Faculty of Medicine, Jember University) ...................... 47 - 53

Adverse Health Effects of Organophosphate Intoxication in Children

of Farmer Family: a Review
By : Mohammad Haedar Faraby (Faculty of Medicine, Jember University) ........................ 54 - 58

5
Top Injuries and Illnesses Among the Farmers in Different
Continents: a Review
By : Dissa Yulianita Suryani (Faculty of Medicine, Jember University) .............................. 59 - 68

The Effects of Pesticide Exposure on Respiratory Health in the

Farm Worker: a Review
By : Khrisnayu Indraswari (Faculty of Medicine, Jember University) ................................. 69 - 73

Prevalence and Risk Factors Associated with Entamoeba

Histolytica to Induce Diarrhea Among Farmer and Miner: a Review
By : Adhang Isdyarsa (Faculty of Medicine, Jember University) ...................................... 74 - 80

A Review Articles: Risk Factors for Scabies

By : Alief Ilman Zaelany (Faculty of Medicine, Jember University) ................................... 81 - 87

Role of Anchovy (Stolephorus Sp) in Apposition Process in Tension

Area of Orthodontic Tooth Movement
By : Tecky Indriana (Faculty of Dentistry, Jember University) ......................................... 88 - 94

6
PROGRAM

TIME ACTIVITIES VENUE

07:30-08:00 Registration
08:00-08:30 Opening Ceremony
08:00-08:10 Opening Dance
08:10-08:20 Report Speech by chairman of ICATD
08:20-08:30 Welcome speech and officially opened the conference
by Dean of Medical Faculty University of Jember
08:30-09:15 Session I : Keynote Speaker
Speaker : Susan Alison Brumby, Ph.D: Role
Agromedicine for Human Life in the Near Future
Moderator : dr. Laksmi Indreswari, Sp.B
09.15-09.45 Discussion
09.45-10.00 Coffee Break
10:00-11:20 Session II : Plenary Speakers (invited speakers)
Moderator : dr. Dwita Aryadina R, M. Kes
10:00-10:20 Al Munawir, Ph.D: Epidemiology, Clinical Case and Auditorium,
Experimental Research of Jellyfish Sting in dean building
Indonesia second floor

10:20-11:05 Angel Anne Yanagihara, Ph.D: New Experiments

Determine Effective Treatments for Box Jellyfish
Sting
11:05-11:35 Discussion
11:35-13:00 Session III Plenary Speakers (invited speakers)
Moderator: dr. Bagus Hermansyah, M. Biomed
11:35-12:10 Kim Euikyung, Ph.D: Perspective of Nomurai
Jellyfish for Human Life
12:10-12:30 DR.RER.BIOL.HUM dr. Erma Sulistiyaningsih,MSI :
Parasitological Infection in Agriculture Population
12.30-13:00 Discussion
13.00-13:45 Lunch Tramed
Poster session building, first
13:45-14:45 Parallel session presentation (divided in to 2 groups) floor
15:00 Closing ceremony Auditorium,
dean building
second floor

7
ORAL PRESENTATION
International Conference Agromedicine and Tropical Diseases
Optimizing the Role of Agromedicne and Tropical Diseases in Human Life

8
Ethanolic Leaves Extract of Awar-Awar (Ficus septica) Inhibits Cells Migration
using Scratch Assay on 4T1 Breast Cancer Cells

Ika Rahmawati Sutejo1, Herwandhani Putri2, Dhania Novitasari2, Edy Meiyanto2

1. Faculty of Medicine, University of Jember, Jember 68126, email:

ikarahmawati.fk@unej.ac.id
2. Cancer Chemoprevention Reasearch Centre, Faculty of Pharmacy, Universitas
Gadjah Mada, Yogyakarta 55281

Abstract

Alkaloid fenantroindolisidin is the major compound in Awar-awar (Ficus septica)

leaves which performed cytotoxic activity on various cancer cells. The aims of this
study is to observe the cytotoxic activity and migration inhibition of ethanolic leaves
extract of Awar-awar (EFs) on highly metastatic 4T1 cancer cell line. Cytotoxic effect
of EFs was evaluated by MTT assay and determined as IC 50 value, while inhibitory
effect on migration was observed by scratch wound-healing assays. Results showed
that EFs performed cytotoxic effect on 4T1 cells in a dose-dependent manner with
IC50 value 15.2±2.12 μg/mL. Based on scratch wound healing assay, 24 hours
incubation of EFs inhibited 4T1 cells migration. Therefore, EFs inhibit cancer cells
growth and cells migration. Hence, ethanolic leaves extract of awar-awar shows its
potency to be developed as co-chemopreventive agent for metastasis breast cancer
treatment. The molecular mechanism it self needs to be explored further.

Keywords: Ficus septica, Cytotoxic activity, Cells migration, 4T1

BACKGROUND
Breast cancer is the most common malignancy happened on women in
Indonesia, moreover metastasis is one of primary cause breast cancer mortality
(Kemenkes RI, 2015). Hence, the theraphy for metastasis on breast cancer is really
needed to be Explored. Awar-awar (Ficus septica Burm. F.) leaves is known for its
cytotoxic effect on some breast cancer cell line such as T47D and MCF-7 (Sekti et
al., 2010; Pratama et al., 2010).
The leaves of this plant have been used in folk medicine to treat colds, fever,
and fungal and bacterial diseases. Several phenanthroindolizidine alkaloids,
triterpenoids, lignans, acetophenones, steroids, and longchain aliphatic compounds
have been reported earlier from the leaves and roots of Ficus septica. Members of
the phenanthroindolizidine alkaloid class are known to exhibit pronounced
cytotoxicity and antiamebic, antifungal, antibacterial, and antiinflammatory activities
and to also inhibit enzymes involved in the synthesis of DNA and
Proteins (Damu et al., 2005). The ethanolic extract of Ficus septica showed a
cytotoxic effect on breast cancer T47D cell lines with IC50 value of 13 µg/mL. The

9
extract at 4.88 µg/mL also showed an optimum synergistic effect in combination with
doxorubicin (3.75 nmol) (Pratama et al., 2010). In addition, the extract induced
apoptosis and down regulated the expression of Bcl-2 protein in breast cancer cells
MCF-7 (Sekti et al., 2010).
The purpose of this study is to prove antimigration effect of EFs. 4T1 cells
were used as a model of cancer.Though derived from mice, 4T1 has similar
characteristics with humans advanced breast cancer, which is able to metastasize
towards others organs (Tao et al.,2008). Cytotoxic effect of EFs was evaluated by
MTT assay and determined as IC50 value, while inhibitory effect on migration was
observed by scratch wound-healing assays.

METHODS
Materials
Leave of Ficus septica was macerated with 70% ethanol. The procedure was done at
Medicinal Plant and Traditional Medicine, Research and Development Centre
(B2P2TO-OT) Tawangmangu, Indonesia. The plant was authenticated by a
taxonomist at Department of Pharmaceutical Biology, Universitas Gadjah Mada.
Doxorubicin was obtained from Sigma. A DMSO (Merck) solution was used to
dilute ethanolic extract of leave of Ficus septica. The final DMSO concentration was
set at less than 1%.

Cells culture
4T1 murine mammary carcinoma cells were acquired from Prof. Masashi Kawaichi
(Nara Institute of Science and Technology, Japan) and maintained in Dulbecco's
Modified Eagle's Medium (DMEM) high glucose containing Fetal Bovine Serum
(FBS) 10% (v/v) (Sigma), penisilin-streptomisin 1% (v/v) (Gibco) and Fungizone 0.5%
v/v (Gibco) in a humidified atmosphere of 5% CO2 in air 37 °C.

Cytotoxicity assay
MTT assay was performed according to (Mosmann, 1983), with slight modification.
Five thousand 4T1 cells/well was distributed into 96 well plate and incubate for 24h.
Cells were treated with various concentration of EFs. After 24 h of treatment, cells
were treated with 0.5 mg/mL of 3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium
bromide (MTT) (Biovision) and incubated further for 4 h. Cells were lysed using SDS
stopper containing 0.01 N HCl and incubated in the dark condition for overnight. After

10
incubation, cells absorbance was measured by ELISA reader plate at λ 595 nm. Cells
absorbance was converted to % cell viability. Linear regression between
concentration and % cell viability giving the equation y = Bx + A were used to
calculate IC50 value, that is the concentration inhibiting 50% cell proliferation.
Scratch wound healing assay
The 4T1 cells (7.5x cells) were cultured in 24-well plate and incubated for 24
hours. Cells starvation was done by incubating cells in culture medium supplemented
with 0.5% FBS for 24 hours. After starvation, cells were scratched by using sterile
yellow tip then treated with various concentrations of samples. The cells were
documented at 0, 18, and 24 hours (Liang et al., 2007). The results were analyzed
by using ImageJ software and converted to percent closure parameter.

Statistical analysis
One-way analysis of variance (ANOVA) followed by the least significant difference
(LSD) test were used for statistical analyses. P-values less than 0.05 were
considered significant. The results of gelatine zymography were documented and
analyzed by using Image J software before ANOVA.

RESULTS
Single Treatment of EFs Revealed Cytotoxic Effect on 4T1 cells
MTT assay was conducted to analyse cytotoxicity of EFs on 4T1 breast cancer
cells with IC50 parameter. Cytotoxic effect was observed after 24h of treatment.
Single treatment of EFs for 24h induced morphological changes. EFs induced cell
shrinkage. There were more number of cell shrinkage and fragmentation at higher
concentrations. In addition, single treatment of EFs for 24h revealed cytotoxic effect
on 4T1 cells with IC50 value of 15.2±2.12 g/mL (Figure 1).

11
 Control 10 µg/mL 50 µg/mL
(A)

(B)

Figure 1. Cytotoxic effect of single treatment of EFs on 4T1 Cells. 5x103

cells/well were seeded in 96 well plate and incubated for 24h, then treated
with EF. Cell viability was determined by using MTT assay as described in
the method. (A) Morphology cells after single treatment of EFs for 24h. (B)
Arrows indicate cells morphological changes. Cell viability profile after single
treatment of EFs for 24h. Profile of cell viability were means ± SD from 3
independent experiments.

Treatment of EFs inhibit migration of 4T1 cells

The observation of cell migration activity is done by using concentration ¼
of EFs (3.75 μg/mL). The effect on cell migration is observed at hour 0, 18, and
24. Treatment of EFs and decrease cell migration of 4T1. Dox as the main
chemotherapy in advanced cancer, has the lower antimigration activity compared to
EFs (Figure 2).

(A) 0h 18 h 24 h

Control

12
 (B)

EFs

Dox

Figure 2. Effects of EFs on 4T1 cell migration. A. The morphology of the cells after
scratch and treated with 3.75 μg/mL of EFs or 0.3 M Dox. Observation
were made after 0, 18, and 24h of treatment under an inverted microscope
with 100x magnification. B. The percentage of 4T1 closure after 18h and
24h of treatment. The area of the scratch were analyzed using ImageJ
software then % closure was calculated in accordance with the procedures
of the analysis. The results are expressed as mean±SD (n=3); *p<0.05.

DISCUSSION
The treatment of EFs is proven to have cytotoxic effect on 4T1 cells.
Mechanism of cell growth inhibition is due to apoptosis pathways. Molecular
mechanisms of EFs causes apoptosis in 4T1 cells is through p53-independent
pathways, while 4T1 breast cancer cells line is due to the lack of protein P53
expression (Tao et al., 2008).
Phytochemical study showed that active compounds in the extract of Ficus
septica were compounds of the flavonoid and alkaloid. Wu et al. (2002) found out the
active compounds from Ficus septica leaves i.e. phenanthroindolizidine alkaloids,
including ficuseptine, tylophorine, and a mixture of tylocrebrine and isotylocrebrine,
that showed potent cytotoxic effect on two human cancer cell lines. Some flavonoids
including genistin, kaempferitrin and coumarin has been also identified from leaves of
Ficus septica (Wu et al., 2002).
The treatment of EFs inhibits the migration of 4T1 breast cancer cells. Ficus
septica inhibits expression of COX-2 proteins (Mandhare et al., 2015). Those proteins
play critical role in tumor migration, invasion and angiogenesis. The interesting
finding is that Dox as the main chemotherapy in advanced cancer, has the lowest
antimigration activity compared to EFs. Bandyopadhyay et al. (2010) proved that

13
doxorubicin increases migration and invasion of 4T1 and MDAMB-231cells through
induction of TGFβ. Metastasis inhibition of doxorubicin which is seen in this study is
due to cell death caused by doxorubicin treatment. Although the mechanism is not
clear, single doxorubicin proved to inhibit the M5076 ovarian cancer cell metastasis
invivo (Sugiyama and Sadzuka, 1999).
The results of this study conclude that ethanolic leaves extract of Awar-awar
(Ficus septica) have a cytotoxic effect and antimigration activity. Hence, it has a
potential to be developed as a co-chemotherapy agent in breast cancer metastasis.
Nevertheless, further researches are still needed in order to apply such a
combination therapy for cancer patients.

REFERENCES

Bandyopadhyay, A., Wang, L., Agyin, J., Tang, Y., Lin, S., Yeh, I., De, K., & Sun, L.
(2010). Doxorubicin in Combination with a Small TGFβ Inhibitor: A Potential
Novel Therapy for Metastatic Breast Cancer in Mouse Models. Plos One, 5(4),
e10365.
Damu, A.G., Kuo, P.C., Shi, L.S., Li, C.Y, Kuoh, C.S., Wu, P.L., Wu, T.S. (2005).
Phenanthroindolizidine Alkaloids from the Stems of Ficus septica, J. Nat. Pro,.
68:1071-1075.
Kemenkes RI. (2015). Situasi Penyakit Kanker. Jakarta: Pusat data dan informasi
Kementrian Kesehatan RI.
Kemenkes RI. (2015). Stop Kanker. Jakarta: Pusat Data dan Informasi Kemenkes RI.
http:/www.depkes.go.id/infodatin-kanker.
Liang, C., Park A. Y., & Guan, J. (2007). In Vitro Scratch Assay: A Convinient &
Inexpensive Method for Analysis of Cell Migration in Vitro. Nature Protocol, 2
(2). Doi:10.1038/nprot.2007.30.
Mandhare, A.A.,Dhulap., S. A., Dhulap, A. S., & Biradar, S. C. (2015). Review on the
Anticancer and In-silico Binding Studies of Phenanthroindolizidine Alkaloids.
ImedPub journal, 1(1):5. http://www.imedpub.com.
Mosmann, T. (1983). Rapid Colorimetric Assay for Cellular Growth and Survival:
Application to Proliferation and Cytotoxicity assays. Journal of Immunological
Methods, 65: 55-63.
Pratama, R. H., Ikhtiarsyah, Y.G., Fitriasari, A., Anindyajati, Ikawati, M., Meiyanto,
E.(2011). Awar-awar Leaves Ethanolic Extract Sinergistically Enhances
Cytotoxic of Doxorubicin on T47D Breast Cancer Cells. Ind J Pharm Sci,
9(1):67–71.
Sekti, D. A., Mubarok, M. F., Armandani, I., Junedy, S., Meiyanto, E. (2010). Awar-
awar (Ficus septica Burm. F.) Leaves Ethanolic Extract Induced Apoptosis of
MCF-7 Cells by Downregulation of Bcl-2. J Trad Med,15(3):100–104.

14
Sugiyama, T.& Sadzuka, Y. (1999). Combination of Theanine with Doxorubicin
Inhibits Hepatic Metastasis of M5076 Ovarian Sarcoma. Clin. Cancer Res. 5,
413–416.
Tao, K., Fang, M., Alroy, J., & Sahagian, G.G. (2008). Imagable 4T1 Model for the
Study of Late Stage Breast Cancer. BMC Cancer, 8:228.
Wu, P.L., Rao, K.V., Su, C.H., et al (2002). Phenanthroindolizidine Alkaloids and
Their Cytotoxicity from the Leaves of Ficus septica. Heterocycles, 57: 2401-8.

15
ANALYSIS OF INFLUENCE HEALTH EDUCATION BASED ON EMPOWERMENT
OF THE RECITALS MUSLMAH COMMUNITY TO IMPROVEMENT OF FERTILE
AGE WOMEN'S KNOWLEDGE ABOUT REPRODUCTIVE HEALTH
AND HIV - AIDS IN JEMBER

Mury Ririanty1 Rohmati2, Qurrotul Ainy3

Afiliation: muryririanty@yahoo.com
+ 6281 55918737, 123 Faculty Of Public Heath – University Of Jember

Abstract
Reproductive health more widely in the incidence of sexually transmitted diseases
(STDs) in the community, some of which are Fluor albus, Syphilis, Genital Herpes
and HIV / AIDS. Results of a preliminary study in Ajung, District Kalisat, Jember, said
as many as 45.83% of women of childbearing age decided to get married at the age
of less than sixteen years of age (≤ 16 years), 25% of married couples have a
miscarriage early .Therefore it required an effort in the form of reproductive health
education and HIV-AIDS by empowering communities through the potential of
existing areas that recitation Muslim community. The aim is to increase knowledge of
reproductive health and HIV - AIDS Ajung women of childbearing age who are mostly
active in the region following the study group. The purpose of this study was to
analyze the influence of reproductive health education and HIV-AIDS through the
empowerment of the increased knowledge of reproductive health of women of
reproductive age (WUS) in Ajung, District Kalisat, Jember in 2015. The research is a
Quasi-Experimental by Wilcoxon. The collection of data by way of a test method that
is Pree-test and post-test and observation of health pendiidkan with extension
methods and training of cadres recitation. The results showed that there is significant
influence between the methods of health education programs to increase knowledge
WUS on Reproductive Health (p = 0.0001). Based on the research results of the
proposed suggestions for the Ajung, in order to maintain the sustainability of
educational programs and conduct intensive cooperation with the Bureau of
Women's Empowerment and Family Planning (BPPKB) Jember and other institutions
that held a follow-up training of cadres with coverage reproductive health more wide
by involving cadres who have been trained.
Keywords: Heath Education, Reproductive Health, HIV - AIDS.

INTRODUCTION
Reproductive health is a state of physical health, mental, and social well-being
as a whole on all matters relating to the systems, functions and processes of
reproduction and not only the conditions that are free of disease and disability
(BKKBN, 2010). Knowledge of reproductive health is still very limited in the society,
especially among women of reproductive age in rural areas.
Women of childbearing age are social groups vulnerable to reproductive
health problems. Various kinds of threats and reproductive health problems that are
often experienced by women of childbearing age (WUS) is a high rate of early
16
marriage, accuracy in choosing contraception, pregnancy problems, miscarriages
and a contributing factor, as well as the threat of various types of venereal diseases
both infectious and non-infectious. The level of knowledge of reproductive health in
the village WUS WUS lower than in the city. This is affected by the limitations of the
community in reaching and accessing information, particularly reproductive health.
Ajung is a village located in the district Kalisat, Jember. Reports Population in
March 2014 states that the village Ajung has a population of 9276 inhabitants, among
whom were 2,908 souls of women of childbearing age, 5,784 inhabitants of
productive age, 2,265 souls age population is young, and 696 lives of older women,
with a sex ratio much population 4,604 male and 4,672 female residents (Jember in
Figures, 2014). Meanwhile, according to the Central Bureau of Statistics 2010
census, the population of men in this village as many as 4,452 people and women as
many as 4,538 people. The total number of villagers Ajung year 2010 of 8990. Thus,
it can be interpreted that the population Ajung from mid-2010 to 2014 increased by
286 people.
Referring to the education to be taken, as many as 1,358 child attended
elementary school, junior high and 286 children taking non Dispendik, and there are
a number of non-formal TPQ 6 in the village Ajung (Subdistrict Kalisat in figures,
2011). Culture in the village Ajung, the majority of young people who have completed
primary school lead directly married off by her parents. Evidently, the percentage of
married people under the age of 16 years as much as 45.83%. This is contrary to
Law Decree No. 1 of 1974 on marriage Article 7, paragraph 1, which limits the
minimum age for women to marry is 16 years old.
Based on health standpoint, the data sub-district health centers and midwives
Kalisat Ajung explained that the infant mortality rate (IMR) in the year 2014 as of
January as many as three events and six babies have low birth weight (LBW). While
the number of births on March 15th 2014 that a number of live births, number 5
infants dying at the same time. Reproductive health more widely in the incidence of
sexually transmitted diseases (STDs) in the community, some of which are Fluor
albus, Syphilis, Genital Herpes and HIV / AIDS.
Peoples Ajung’s known as a religious community. This is evidenced by the
study groups that exist in the four hamlets. The number of prayer groups in every
village around more than 5 groups. Each study group was attended by 40
participants even more than 100 people from various walks of life, especially in the
productive age range of 15-64 years. The timing of the study is usually done for one

17
week once. However, despite the strong religious, rural community education Ajung
is low, especially in the field of reproductive health.
Based on Field Experience Learning (PBL) in 2014 conducted by students of
the Faculty of Public Health University of Jember, there are some issues related to
reproductive health, among others, as much as 45.83% of them decided to get
married at the age of less than sixteen years of age (≤ 16 years ) and the impact of
25% of couples married early miscarried. Results of interviews conducted also
mentions the proportion of the miscarriage incident in mid 2014 at 13.79%. So it can
be said of every 100 pregnancies 14 of them can be miscarried and the rest that
were born alive. Therefore, the need for health education about the importance of
reproductive health knowledge.
Health education is not only done within a short time, but continue to be
implemented as the program continues. So it takes a cadre of reproductive health
which can deliver reproductive health information it receives to the public through a
religious approach. Religion predicted more effective approach to reproductive health
education to the community Ajung. This is because the community is very active
gathered in the recitals in their respective regions.
Based on the description it is determined empowerment healthy Muslim Koran
as reproductive health education method of fertile women (WUS) in the village Ajung,
District Kalisat, Jember. This program is a reproductive health education program
through the religious approach which operate by forming a cadre selected from
various recitals in the village Ajung. Kader was elected a delegate each study group
who voluntarily want to follow the training. The number of elected cadres is limited to
40 people. This is done on the consideration of the effectiveness of training both in
terms of delivery, media usage, and practice independent counseling will be done by
volunteers. Furthermore, the cadres will be required to transfer their knowledge to
their respective study groups on a regular time. The purpose of this study was to
determine the effect of the analysis of community-based health education lectures
muslmah empowerment to women of childbearing age increased knowledge about
reproductive health and HIV - AIDS in Jember

METHOD
The type and design of research used in this study is quasi-experimental or
quasi experimental using non-randomized design approach Preetest-posttest group
design (Saraswati, 2011). Data analysis performed in this study were univariate and

18
bivariate analysis by using statistical test data normality test to determine whether the
data are normally distributed or not. Because the data is not normally distributed, the
test used is the Wilcoxon test is a nonparametric test with paired samples
characteristics and scale nominal data. Variables used in this study consisted of the
dependent variable, namely: increased knowledge of women of childbearing age on
reproductive health education while the independent variables are reproductive
health and HIV - AIDS on empowerment activities
In this study, the experimental group that the group receiving reproductive
health training methods that implement empowerment Pree-test, got the intervention,
and post-test counseling schedule and practice independently cadres. Pree-test and
post-test carried out for 15 minutes. And intervention is the provision of material,
discussions and practices carried out for 150 minutes. As for the practice of post-
training counseling implemented empowerment throughout the study in each area in
accordance with the time schedule.

RESULT
This study aims to determine the effect of the empowerment program to
increase knowledge of women of childbearing age in the village Ajung, District
Kalisat, Jember. The following description of the general characteristics of
respondents.
Tabel 4.1 Carakteristic Of Respondents
Kraja Ajung Ajung Sumber Desa Ajung
n Sub Tengah Oloh Malang Total
Variabel
Villag Sub Sub Sub Respond %
e Village Village Village ents
Sex
Male - - - - - -
Female 9 9 9 8 35 100%
Religion
Islam 9 9 9 8 35 100%
Age (year)
<15 - - - - - -
15-25 4 5 4 2 15 42,9%
26-35 4 3 5 4 16 45,7%
36-45 1 1 - 2 4 11,4%
> 45 - - - - -
Marital Status
Single - - - - - -
Married 9 9 9 8 35 100%

19
 School
No school
Not completed - - 1 2 3 8,6%
primary school
complete 5 4 7 5 21 66,8%
primary school
junior high 2 3 - 1 6 17,1%
school
graduation 2 2 1 - 5 14,3%
graduating from
high school

Pekerjaan
IRT 22 44 55 22 1313 37,1%
37,1%
PNS 22 -- -- -- 22 5,7%
5,7%
Swasta 33 11 22 -- 66 17,1%
17,1%
Lain-lain 2 4 2 6 14 40%

Based on Table 4.1 it is known that in Krajan, Central and Ajung Oloh Ajung
each respondent while there are as many as 9 in Malang source as much as 8
respondents. All respondents religion is Islam and was married. The proportion of the
age of majority in the age range 26-35 years (45.7%) and the majority of respondents
last education was complete primary school (66.8%). As for the statistical description
of research data measured through knowledge empowerment program for training
and post-training practice empowerment program. Knowledge of respondents are
grouped into three, namely higher knowledge, knowledge of medium and low
knowledge. Considered good if the score of respondents 73% -100%, the moderate
category if the score of the answers of respondents 40% -72% and categorized as
low if the answer score <40%.

Table 4.2 Measurement of Respondents Knowledge Based Training Material

through Pre-test and Post test
Materi Pengetahuan Pre test Post test
Frequency % Frequency %
Pregnancy and High 10 28,7% 29 82,8%
miscarriage Medium 16 45,7% 6 17,2%
Low 9 25,6% - -
Contraception High 7 20% 27 77,1%
Medium 14 40% 7 20%
Low 14 40% 1 2,9%
Reproductive High - - 24 68,6%
Health, STDs Medium 4 11,4% 8 22,9%
and HIV-AIDS Low 31 88.6% 3 8,5%

20
 Based on the data processing of survey results revealed that respondents'
knowledge low average of several reproductive health before intervention by the
empowerment program. Meanwhile, after the given intervention empowerment
program, the majority of respondents considered good knowledge. Therefore, do
advanced data analysis to determine the major comparison of knowledge before and
sesuadah intervention empowerment program.

Table 4.3 Comparison of knowledge before and after the intervention program
Posttest-pretest Mean Rank Z P
Negative Positive
Ranks Ranks
Pregnancy and 0,00 35 -3,464 0,001
miscarriage
Contraception 0,00 35 -3,317 0,001
Reproductive Health, 0,00 35 -5,568 0,000
STDs and HIV-AIDS

Based on the above statistical test, the third test has a p <0.05 in the sense
that H0 is rejected. It can be concluded that there are differences between the
respondents' knowledge before and sesuadah of interventions for empowerment
program on any matter with significant value on material pregnancies and
miscarriages of 0.001; tools, medicines and methods kontrasespsi 0,001 and 0,000
reproductive tract infections.
The testing of independent counseling practices by respondents to the public
in the study conducted statistical tests comparing Mac Nemar with mental
respondents to provide reproductive health education training program before being
granted the empowerment and after their training.

Table 4.4 Comparison of whether or not the practice is carried out by

responden before and after the intervention program

after the intervention program

Before Total
Not the practice Practice
Not the practice 8 27 35
practice 0 0 0
Total 8 27 35

21
 Based on the above table, it can be seen that of the 35 respondents who have
never practiced counseling before the program, 27 are able to practice reproductive
health education after the program empowerment (77.1%). As many as 8
respondents (22.9%) still do not practice counseling. However, after tests of
significance using Mac Nemar, it can be seen that the significance value of 0.000.
That is, there are differences in the behavior of the respondents to practice
independently reproductive health education before and after the training program of
empowerment and reproductive health education and HIV - AIDS.

DISCUSSION
Knowledge and awareness on ways to maintain and improve reproductive health and
HIV - AIDS is the beginning of the empowerment of the Muslim women in the study
Ajung. These results indicate that the presence and knowledge of the cadres
kesadfaran be early onset of ability, because ability is the result of their learning
process throughout the intervention program. Learning itself is a process that begins
with the transfer of knowledge from the source of knowledge to the subject of study
(Notoatmodjo, 2012). Therefore, healthy Muslim teaching cadres who are able to
maintain and improve health as well as through a learning process that starts with
obtaining health information -AIDS reproductive health and HIV. With health
information raises kesadran health and the result is knowledge that is applied in
everyday life. The results also show that empowerment with health education
intervention in the cadre has been cultivating the potential of communication in the
Muslim Koran, to develop mutual cooperation, explore the contribution of the
community as well as partnerships with related institutions.

CONCLUSION
After analysis and statistical tests, it can be concluded that there is influence
methods of empowerment to the improvement of reproductive health knowledge
among women of reproductive age in Ajung, District Kalisat, Jember Regency Year
2015. For the village Ajung order to maintain the sustainability of development
programs and cooperation intensive with Women Empowerment and Family Planning
(BPPKB) Jember and other institutions that held a follow-up training of cadres with
reproductive health coverage more widely. For further research, it is recommended
that examines the influence of Muslim teaching methods empowerment programs in
urban areas. So that can know the effectiveness of the method when applied to

22
programs in urban areas. Thus the recommendation from the Muslim-based
community empowerment study could be advocated to the government to put in
place well in many areas of town or village.

ACKNOWLEDGEMENT
The author would like to thank the Ministry of Research Technology and
Higher Education of the Republic of Indonesia who have given financial support
through the Community Service Student Creativity and author of the 2015 fiscal year
as a supervisor in the event. The author also expressed his gratitude to the Women
Empowerment and the Family planning (BPPKB) Jember, the Commission on HIV /
AIDS Jember as resource persons. A big thank you to all of the reproductive health
cadres who have actively participated in the empowerment program recitation.

REFERENCES

The National Population and Family Planning (BKKBN). 2010. Adolescent and
Reproductive Health. Jakarta: BKKBN
The Central Bureau of Statistics (BPS) Jember. 2011. District of Kalisat In Figures.
Jember: BPS
The Central Bureau of Statistics (BPS) Jember. Jember 2014. In Figures. Jember:
BPS
Notoatmodjo, Soekidjo. 2010. Health Promotion Theory and Applications. Jakarta:
Rineka Reserved
Saraswati, L.K. 2011. Effect of Health Promotion Against Cervical Cancer Awareness
and Participation of Women in the Early Detection of Cervical Cancer. Thesis.
Health Professions Education. Master Program in Family Medicine. Eleven
University in March. Surakarta.
Law Law Republic of Indonesia Number 1 Of 1974 on marriage
Law Republic of Indonesia Number 36 Of 2009 on Health

23
 THE COMBINATION THERAPY OF ANTIRETROVIRAL AND PHYLLANTHUS
NIRURI EXTRACT FOR HIV PATIENTS

Wienta Diarsvitri1, Retno Budiarti2, Budiarto Adiwinoto3

1
Dept. of Community Medicine, Faculty of Medicine, Hang Tuah University, Surabaya
60244, Indonesia
2
Dept. of Microbiology, Faculty of Medicine, Hang Tuah University, Surabaya 60244,
Indonesia
3
Dept. of Clinical Pathology, Faculty of Medicine, Hang Tuah University, Surabaya
60244, Indonesia

Abstract

Some in vitro researches reported that application of Phyllanthus niruri extract

exhibited HIV reverse transcriptase enzyme inhibitor and immunostimulator effects.
A quasi-experimental trial with a pretest-posttest control group design, a combination
of antiretroviral therapy (ART) and capsules of Phyllanthus niruri extract (contained
50 mg dried powdered extracts of P. niruri) were administered to 15 HIV patients in
the intervention group, while ART and placebo capsules (contained 50 mg dried
powdered extracts of Amylum manihot) were administered to 13 HIV patients in the
control group from a teaching hospital in Surabaya, Indonesia and a teaching
hospital in Sidoarjo, East Java, Indonesia.
After six months of therapy, results from paired t-test revealed the treatment group
achieved higher absolute CD4 cell count than the control group (p<0.001). Therefore,
the combination of antiretroviral and Phyllanthus niruri extract is more effective to
increase CD4 cells count on HIV patients.

INTRODUCTION

HIV infection and AIDS are a global problem. Indonesia was one of five countries
in the South-East Asia Region, which accounts for the majority of HIV burden (World
Health Organization, 2013). The HIV-positive adult prevalence in Indonesia is stable
at 0.3% regionally, but sub regional epidemic is still rising (Ministry of Health of the
Republic of Indonesia, 2016).

Up to the present time, the management of patients with HIV and AIDS in
Indonesia is concentrated in clinical therapy by using a combination of antiretroviral
therapy (ART) to optimize efficacy and reduce the likelihood of developing a drug
resistance (Ministry of Health of the Republic of Indonesia, 2016).

24
 There has not been any published research on ART cost carried out in
Indonesia, however providing free ART during lifetime of each HIV-infected individual
requires a huge amount of funding. In addition, large sections of population
especially in developing countries still rely on a broader, safer and also cheaper
repertoire of herbal medicine (Wachtel-Galor and Benzie, 2011).

Since the ancient past, the Indonesian traditional herbal medicines, or jamus,
have been known and practiced in the Indonesian community to maintain good
health and to treat diseases (Elfahmi et al., 2014).

Of many Phyllanthus species from Euphorbiaceae family that are widely

distributed in most tropical countries, only a few have been studied and indicated to
possess potential benefits in clinical practice (Dirjomuljono and Tjandrawinata, 2011).

Scientific studies have showed that extracts and purified isolated compounds of
Phyllanthus niruri possessed antiviral effects against herpes simplex virus (HSV),
dengue virus (DENV), hepatitis B and HIV reverse transcriptase enzyme (Naik and
Juvekar, 2003; Ogata et al., 1992). In addition, Phyllanthus niruri exhibited
immunostimulator (Bagalkotkar et al., 2006; Choudhari et al., 2011), and
hepatoprotector (Chatterjee and Sil, 2006; Harish and Shivanandappa, 2006;
Velusami et al., 2011) effects. Therefore, this study aimed to determine the
effectiveness of a combination between the first line of ART and Phyllanthus niruri
extract, compared to ART only in HIV patients.

METHODS

This study was a quasi-experimental trial on 28 stage 2 and 3 treatment naïve

HIV patients at Dr. Ramelan Naval Hospital, Surabaya and Sidoarjo General
Hospital, Sidoarjo, East Java Province, Indonesia. The study was carried out from
September 2013 to March 2015.

The research ethics approvals were acquired from the Human Research Ethics
Committee at Hang Tuah University (No. 04/M/DU/KEPUHT/IX/2013) and Dr.
Ramelan Naval Hospital, Surabaya (No. 65/EC/KERS/2013).

The purpose, procedure and conditions of the study were explained beforehand
to the patients who met the inclusion criteria. All study participants agreed not to take

25
any vitamin or other herbal medicine during the study period. A written consent was
obtained from each patient who agreed to participate voluntarily in the study.

The absolute CD4 cells count and CD4 percentage were measured with
immunofluorescence analysis using flow-cytometry (World Health Organization,
2007) using BD FACSCaliburTM (Fluorescence Activated Cell Structure) count. The
liver function tests were carried out according to the International Federation of
Clinical Chesmistry (IFCC) recommendation using Dimension ® RxL® Max, Siemens.
All laboratory tests were performed at the Clinical Pathology Laboratory, Dr. Soetomo
General Hospital, Surabaya. The demographic characteristics and adherence to
therapy were evaluated using questionnaire.

The intervention group was provided with a combination of the first-line ART and
capsules of Phyllanthus niruri extract for six months, while the control group was
provided with the first-line ART and placebo for six months. The intervention group
took two capsules of Phyllanthus niruri extract (each contained 50 mg extract of
Phyllanthus niruri) three times a day, 15 – 30 minutes after meal, before taking ART.
The control group took two capsules of placebo contained 50 mg of Amylum manihot
three times a day. The Phyllanthus niruri extract and placebo capsules were
produced by the same company and provided in the same weight, shell color, and
bottle.

RESULTS

Table 1 – Comparison of clinical and laboratory tests between intervention and control
groups
Intervention Control Test results
Characteristics
n = 15 n = 13 (2-sided)
No (%) No (%)
Absolute CD4 before treatment 229.7 (66.9) 216.2 (57.7) Indep t-test,
cells count p = 0.576
after 6 months 315.9 (101.3) 241.7 (60.9) Indep t-test,
p = 0.030

Twenty-eight HIV patients were participated in this study. The mean of age in
the control group was significantly older than that in the treatment group (2-sided
independent t-test, p = 0.039). There was not any other significant difference in
demographic characteristics, clinical, adherence to therapy, and laboratory test
26
results before treatment between intervention and control groups (Table 1 and Table
2).

The absolute CD4 cells count data were normally distributed and had a
homogenous variance. The 2-sided independent t-tests showed there were
differences in absolute CD4 cells count ( p = 0.030) after six months of therapy
between intervention and control groups. The intervention group significantly had
higher mean of absolute CD4 cells count (315.9 cells/L) compared to control group
(241.7 cells/L), and had higher CD4% (19.5%) compared to control group (12.7%)
after six months of therapy.

DISCUSSION

This was the first report of the effectiveness of a combination of the first line ART
and Phyllanthus niruri extract for HIV patients. The increase of absolute CD4 cell
counts in the intervention group was due to immunostimulator and reverse-
transcriptase inhibitory effects of Phyllanthus niruri. Several active phytochemicals in
Phyllanthus niruri were flavonoids, alkaloids, terpenoids, lignans, polyphenols,
tannins, coumarins and saponins. Coumarins and repandusinic acid (hydrolysable
tannins) inhibited the reverse-transcriptase enzyme and HIV-1 replication (Kostova et
al., 2006; Ogata et al., 1992).

Phenolic compounds were known to demonstrate inhibitory action in the HIV

replication, from fusion, adsorption, reverse-transcription, integration and protein
cleavage (Hassan Khan and Ather, 2007). Terpenoid compounds were known to
have anti-HIV activity (Chinsembu and Hedimbi, 2009), while flavonoids showed
immunostimulator effect by increasing the phagocytosis activity of macrophage and
stimulating activation of effector cells such as lymphocytes and macrophages to
release cytokines, interleukins and tumor necrosis factor alpha (TNF-alpha) (Zalizar,
2013).

Although herbal medicinal products are widely considered to be of lower risk

compared to synthetic drugs, they are not completely excluded from the possibility of
having toxic or other adverse effects (De Smet, 2004). Deficiencies such as under-
reporting of adverse reactions, lack of toxicological information on herbs, and the

27
quality of the reported information present challenges when signals of safety concern
arise (Asare et al., 2011).
We suggested a randomized clinical trial with bigger sample size to be carried
out with the same purpose as this study.

CONCLUSION

The combination of the first line of ART and Phyllanthus niruri extract was more
effective in increasing the absolute CD4 cells count compared to the administration of
ART alone in HIV patients.

ACKNOWLEDGEMENTS

This study was funded by the Health Professional Education Quality (HPEQ) Project,
IBRD Loan No. 7737-ID, 2013. We express our sincere gratitude to Prof. Soeprapto
Ma’at; the director and staffs of Dr. Ramelan Naval Hospital Surabaya; Director and
staffs of Sidoarjo General Hospital, Sidoarjo; NGO “Genta” Sidoarjo; the head and
staffs of Clinical Pathology Laboratory, Dr. Soetomo General Hospital, Surabaya; the
head and staffs of Puskesmas Perak Timur Surabaya, and all of our study
participants for supporting this research.

REFERENCES

Amin, Z., 2005. The effect of Phyllanthus extract as an additional treatment in

tuberculosis patients with minimal and moderately advanced radiological lesion.
University of Indonesia.
Antons, C., Antons-Sutanto, R., 2009. Traditional Medicine and Intellectual Property
Rights: A Case Study of the Indonesian jamu Industry, in: Antons, C. (Ed.),
Traditional Knowledge, Traditional Cultural Expressions and Intellectual Property
Law in the Asia-Pacific Region. Kluwer Law International, p. 420.
Asare, G.A., Addo, P., Bugyei, K., Gyan, B., Adjei, S., Otu-Nyarko, L.S., Wiredu,
E.K., Nyarko, A., 2011. Acute toxicity studies of aqueous leaf extract of
Phyllanthus niruri. Interdiscip. Toxicol. 4, 206–10. doi:10.2478/v10102-011-0031-
9
Bagalkotkar, G., Sagineedu, S.R., Saad, M.S., Stanslas, J., 2006. Phytochemicals
from Phyllanthus niruri Linn. and their pharmacological properties: a review. J.

28
 Pharm. Pharmacol. 58, 1559–1570. doi:10.1211/jpp.58.12.0001
Chatterjee, M., Sil, P.C., 2006. Hepatoprotective effect of aqueous extract of
Phyllanthus niruri on nimesulide-induced oxidative stress in vivo. Indian J.
Biochem. Biophys. 43, 299–305.
Chinsembu, K., Hedimbi, M., 2009. A Survey of Plants with Anti-HIV Active
Compounds and their Modes of Action. Med. J. Zambia 36, 178–186.
doi:10.4314/mjz.v36i4.
Choudhari, B. a, Rangari, V.D., Darvekar, V.M., 2011. Formulation development for
treatment and management of HIV-AIDS. Int J Pharm Pharm Sci. 3, 105–8.
De Smet, P.A.G.M., 2004. Health risks of herbal remedies: An update. Clin.
Pharmacol. Ther. 76, 1–17.
Dirjomuljono, M., Tjandrawinata, R., 2011. Clinical Trials Involving Phyllanthus
Species, in: Kuttan, R., Harikumar, K.B. (Eds.), Phyllanthus Species: Scientific
Evaluation and Medicinal Applications. CRC Press, p. 388.
Elfahmi, Woerdenbag, H.J., Kayser, O., 2014. Jamu: Indonesian traditional herbal
medicine towards rational phytopharmacological use. J. Herb. Med.
doi:10.1016/j.hermed.2014.01.002
Harish, R., Shivanandappa, T., 2006. Antioxidant activity and hepatoprotective
potential of Phyllanthus niruri. Food Chem. 95, 180–185.
doi:10.1016/j.foodchem.2004.11.049
Hassan Khan, M.T., Ather, A., 2007. Potentials of phenolic molecules of natural origin
and their derivatives as anti-HIV agents. Biotechnol. Annu. Rev. 13, 223–264.
doi:10.1016/S1387-2656(07)13009-X
Kostova, I., Raleva, S., Genova, P., Argirova, R., 2006. Structure-activity
relationships of synthetic coumarins as HIV-1 inhibitors. Bioinorg. Chem. Appl.
2006. doi:10.1155/BCA/2006/68274
Ministry of Health of the Republic of Indonesia, 2016. HIV/AIDS Progress Report
Fourth Quarter 2015 (Laporan Perkembangan HIV-AIDS Triwulan IV Tahun
2015). Jakarta.
Naik, A.D., Juvekar, A.R., 2003. EFFECTS OF ALKALOIDAL EXTRACT OF
PHYLLANTHUS NIRURI ON HIV REPLICATION. Indian J. Med. Sci. 57, 387–
93.
Ogata, T., Higuchi, H., Mochida, S., Matsumoto, H., Kato, A., Endo, T., Kaji, A., Kaji,
H., 1992. HIV-1 reverse transcriptase inhibitor from Phyllanthus niruri. AIDS Res.
Hum. Retroviruses 8, 1937–1944.
Velusami, C., Sharma, S., Bhaskarmurthy, D., Arogya, S., Agarwal, A., 2011.
Hepatoprotective activity of the Phyllanthus species on tert-butyl hydroperoxide
(t-BH)-induced cytotoxicity in HepG2 cells. Pharmacogn. Mag. 7, 229.
doi:10.4103/0973-1296.84237
Wachtel-Galor, S., Benzie, I., 2011. Herbal Medicine: An Introduction to Its History,
Usage, Regulation, Current Trends, and Research Needs, in: Benzie, I.,
Wachtel-Galor, S., (eds) (Eds.), Herbal Medicine:biomolecular and Clinical
29
 Aspect. CRC Press, p. 500.
World Health Organization, 2013. HIV/AIDS in the Southeast Asia Region: Progress
towards MDG 6A, 2012, Update. World Health Organization, Regional Office for
South-East Asia, New Delhi.
World Health Organization, 2007. Laboratory guidelines for enumerating CD4 T
Lymphocytes in the context of HIV/AIDS. New Delhi.
Zalizar, L., 2013. Flavonoids of Phyllanthus niruri as immunomodulators: a prospect
to animal disease control. ARPN J. Sci. Technol. 3, 529–532.

30
 The Correlation Between Clean and Healthy Living and Typhoid Fever
Incidence in Sumbersari Public Health Center

Dwita Aryadina R.1, Arinda Lironika S.2

1
Department of Public Health, Faculty of Medicine, University of Jember
dr.dwita@gmail.com
2
Clinical Nutrition Program, Departement of Health, State Polytechnic of Jember

Abstract

Background: Typhoid Fever can be commonly found in developing countries, mainly

in tropical and subtropical regions. This disease poses a fatal threat and is a serious
health issue due to the way it is spread by various factors.One of the measures taken
to reduce the widespread of the disease is the implementation of a clean and healthy
living (CHL) within a household.
Materials and Methods: The research is an analytical survey using the case control
design study using30 respondents in Sumbersari Public Health Center. Both the
typhoid and non typhoid group (the control group) consists of 15 respondents. A CHL
questionnaire is used and categorized based on the score interpretation of the CHL
parameters. Among the CHL paramaters measured were the habit of hand washing,
food hygiene, anddining at vendor habits. The correlation between CHL and Typhoid
Fever incidence is tested with Chi Square.
Results: From 30 respondents, 74% were within the ideal category of CHL. The Chi
Square test shows a significant correlation between CHL and Typhoid Fever
Incidence with an odd ratio of 3.143. This means that respondents with a less than
ideal CHL will have a 3.143 times greater riskof contracting the Typhoid Fever.
Conclusion: A significant correlation between a clean and healthy living and Typhoid
Fever indicidence is confirmed. An Odd Ratio with a factor of 3.143 shows that
respondents with a less than ideal CHL will have a 3.143 times greater risk of
contracting the Typhoid Fever.

Keywords: Clean and Healthy Living, Typhoid Fever, Sumbersari

INTRODUCTION
Typhoid Fever is a systemic infection caused by Salmonella Typhi and can be
commonly found in developing countries, mainly in tropical and subtropical regions [1].
This disease poses a fatal threat and is a serious health issue due to the way it is
spread by various factors such as urbanization, overpopulation, environmental
hygiene, contaminated water source, bad sanitation, and low standards of the food
processing industry.
It is extremely difficult to pinpoint the number of cases of worldwide typhoid
fever due to the fact that this symptom has a wide range of clinical spectrum.
According to WHO data in 2003, there are 1 million cases of typhoid fever worldwide,

31
with a death toll of 600.000 cases. The incidents in indonesia alone averages up to
900.000 cases per year with a fatality number of 20.000 victims, 77% of them
between the ages of 3 -19 years old[2]. Data released from RISKESDAS in 2007
mentions that typhoid fever has been responsible for 1,6% of all fatalities in the
population for all age range[3].
The incidence of typhoid fever for each region differs from one to the other.
The number of people infected with typhoid fever in 2009 increased to 80.850 with a
fatality of 1013 cases. Sumbersari Public Health Center is one of the prime source of
public health service in Sumbersari. Data in January to June 2016 shows that typhoid
fever is ranked as the number one from 10 most frequent diseases of hospitalized
patients at Sumbersari Public Health Center. During the same period from January to
June 2016, 479 from 1249 hospitalized patients were infected with typhoid fever[4].
This shows the urgency of finding out what causes this high incidence and how to
prevent it.
One of the measures taken to reduce the widespread of the disease is the
implementation of a clean and healthy living (CHL). Implemented on a micro scale
such as within a household, this particular way of living forms a habitual behaviour of
cleanliness and hygiene, and encourages each member of the family to actively
participate in raising health awareness in society.

METHODS
The research is an analytical survey using the case control design study using
30 respondents in Sumbersari Public Health Center. Both the typhoid and non
typhoid group (the control group) consists of 15 respondents each.
In this research, primary data was acquired by an interview technique asked
by a surveyor. The interview was conducted by asking a set of questions from the
questionnaire. The questionnaire itself was neatly structured with closed ended
question type, asking about Clean and Healthy Living (CHL). The CHL questionnaire
is used and categorized based on the score interpretation of the CHL parameters.
Among the CHL paramaters measured were the habit of hand washing, food
hygiene,dining at vendor habits and current domicile.
Some of the secondary data was acquired from the medical records of
hospitalized patients in Sumbersari Public Health Center from the month of January
until June 2016. The respondents used in this research were chosen by the simple
random sampling method.

32
 Furthermore, the characteristics of the respondents were elaborated
descriptively with tables and numbers. Whilst the correlation between Clean and
Healthy Living and Typhoid Fever incidence is tested with Chi Square.

RESULT
The characteristics of the respondents observed in this research is based on
age, sex, education, and occupation. 15 respondents from the control group is aged
between 6 to 66 years old, while the age range from the typhoid patients group is
between 5 to 82 years old. Other characteristics of the respondents can be seen in
Table 1:
Table 1. Respondent Characteristics
Characteristics Non Typhoid Group Typhoid Group
Sex Female 10 6
Male 5 9
Education Kindergarten 1 1
Primary School 1 5
Junior High 5 2
Senior High 5 1
Graduate 3 3
None 0 3
Occupation Student 2 5
Employee 6 5
None 7 5

Based on the questionnaires answered by the respondents, scores were given

to each of the CHL parameters, and subsequently categorized based on the
interpretation of those scores. Based on the scoring interpretation of the CHL
questionnaires, the number of respondents from each category can be seen in Table
2:
Table 2. Cross Tabulation Result
Typhoid Group Non Typhoid Group
Less than ideal CHL 8 0
Ideal CHL 7 15
Total 15 15

From 30 respondents, 8 of them (26%) are within the less than ideal category
of CHL, while 74% of the respondents are within the ideal CHL category. From 15
non typhoid respondents, all of them lead an ideal CHL.

33
 Results from cross tabulation show that most of the respondents who lead an
ideal CHL is not prone to contracting the typhoid fever compared to those who lead a
less than ideal CHL. Evidently, the Chi Square test shows a significant correlation
between CHL and the Typhoid Fever incidence. An Odd Ratio with a factor of 3.143
is obtained, meaning that respondents with a less than ideal CHL will have a 3.143
greater risk of contracting the Typhoid Fever.
Using the Mann Whitney test there is a significant difference between the
Typhoid and Non Typhoid Group in terms of the scores in parameters used to identify
CHL.The results are shown in Table 3:
Table 3.CHL parameter scores of each group.
Parameters Typhoid Group Non Typhoid p
Group
Hand Washing 22 46 0.002
Food Hygiene 54 59 0.069
Dining at Vendor habit 24 43 0.029
Current Domicile 26 30 0.150
Total CHL score 126 178 0.000

Based on Table 3 above, a significance coefficient (p) of 0.002 is obtained

from the hand washing parameter, 0.069 is obtained from food hygiene parameter,
0.029 from dining at vendor habit, 0.150 from state of the current domicile, and 0.000
from the total score of the CHL. From a statistical standpoint a significant difference
only exists when the significance coefficient is less than 0.05, which leads to the
conclusion that there is no significant difference from the typhoid and non typhoid
patients seen from the food hygiene and state of current domicile parameter. A
significant difference can only be found within the hand washing parameter, dining at
vendor habit, and the overall score of the CHL from patients of Sumbersari Public
Health Center.

DISCUSSION
Results from a Chi Square testing using a Bi-variate analysis show the
correlation between CHL with the incidence of typhoid fever. Based on the
calculation of the p-value, a score of 3.143 odd ratio is obtained which means that
respondents who lead a less than ideal CHL will be 3.143 times more likely to
contract the typhoid fever. As has been previously pointed out, bad hygiene is
34
strongly related to typhoid fever and it drastically reduces the quality of life. Good
personal hygiene is the most important factor that prevents a person from contracting
infectious disease. To avoid infectious disease, one needs the self awareness to
keep a hygienic lifestyle.[5]
Results from the Mann-Whitney U test shows that significant difference is
found wihin the hand washing parameter, dining at vendor habit, and the overall
score of the CHL from patients of Sumbersari Public Health Center. This was also
found in previous studies which shows that 59% of the respondents who failed to
hand wash with soap before a meal and after relieving themselves have a bigger risk
of contracting the typhoid fever.[6] Hand washing after relieving oneself and before
touching their food and drink is the main factor in preventing typhoid fever. [7] The sole
purpose of hand washing is to cleanse the hand from all form of dirt, protect oneself
from infectious disease, and maintaining a good habit. [8] Hand washing properly has
been proven to reduce the number of contamination incidence. The proper method of
hand washing is by using soap and running water. Anti bacterial soap is not
necessary, but soap in liquid form is more advised, cleaning the hands for more than
15 seconds by rubbing the hands clean from the wrist to the gap between the fingers
and nails, and drying the hands out with clean towel or hand drier. [9]
In this study, dining at vendor habit is measured from how often a person
dines out, and how they consume the meal (either takeaway meals or dine-in meals).
In similar studies, it is shown that there is a relation between the risk factor of a dining
out habit with the incidence of typhoid fever. From those studies, 95% of the
respondents have a habit of dining out and buying their meals from street vendors
which sells food in open space.[10] Regarding this, there are 4 important factors in
food preparation namely the CHL of the person in charge of food preparation, the
hygienic condition of the ingredients, the hygiene of the cooking utensils, and the
hygiene of where the food are processed.[5]
Buying meals from street vendors is a huge contributing factor in contracting
infectious disease. Additionally, according to Ma’rufi, among the factors that play an
important role in food preparation from street vendors is the type of processed food,
the preparation of the ingredients, the way it is cooked and served, time between
preparation and consumption, the temperature of both the raw ingredients and
served food, and finally the hygienic conduct of the consumer.[11]

35
 This study attempts to show how an ideal CHL such as hand washing before
meals and after relieving oneself, and diminishing the habit of dining at vendors can
reduce the risk of contracting typhoid fever.

CONCLUSION
A significant correlation between a clean and healthy lifestyle and Typhoid
Fever is confirmed. An Odd Ratio with a factor of 3.143 shows that respondents with
a less than ideal CHL will have a greater risk of contracting the Typhoid Fever by a
3.143 factor.
There is a signicant difference in the CHL of typhoid fever and non typhoid
fever patients namely within the parameters of hand washing, dining at vendors habit,
and overall score of the CHL.

ACKNOWLEDGEMENT
I wish to thank the students of the Public Health Clinical Profession who have
helped in the collection of primary and secondary data at Sumbersari Public Health
Center.

REFERENCES

[1] Widodo, D. Demam Tifoid. Buku Ajar Ilmu Penyakit Dalam Jilid III. Edisi 4.
Jakarta: Pusat Penerbitan Ilmu Penyakit Dalam Fakultas Kedokteran Universitas
Indonesia; 2006. p.1774-1775

[2] World Health Organization. Background document: The diagnosis,treatment and

prevention of typhoid fever. Communicable Disease Surveillance and Response
Vaccines and Biologicals.2003.p.27

[3] Badan Penelitian dan Pengembangan Kesehatan Departemen Kesehatan RI.

Laporan Nasional 2007 RISKESDAS.2008.p.xiii;107-108

[4] Sumbersari Public Health Centre. Data of 10 Frequent Diseases; January-June

2016. 2016

[5] Herliani, D., Husin, U.A., Nilapsari, R. Hubungan antara Faktor Risiko dengan
Kejadian Demam Tifoid pada Pasien yang dirawat di Rumah Sakit Al-Islam
Bandung Periode Februari-Juni 2015. p.1053

[6] Rohmawati, R.N. Hubungan antara Faktor Pengetahuan dan Perilaku dengan
Kejadian Demam Tifoid. Universitas Muhammadiyah Surakarta.2010.

36
[7] Chin, J. Control of Communicable Diseases Manual (CCDM).17th edition.APHA.
2000
[8] PMI . Pedoman Perawatan Keluarga. Jakarta: PMI. 2006

[9] Fiji Ministry of Health. Guidelines for the diagnosis, management, and prevention
of typhoid fever. 2010. p.7

[10] Artanti, N.W. Faktor Resiko Demam Tifoid terhadap Prevalensi Penyakit Demam
Tifoid. 2005

[11] Ma’rufi, I., Keman, S. Notobroto, HB. Faktor Sanitasi Lingkungan yang Berperan
terhadap Prevalensi Penyakit Demam Tifoid. Kesehatan Lingkungan. 2005.

37
 COCHLEAR FIBROBLASTS REPAIRMENT IN RAT MODEL OF
DIABETES MELLITUS AS A RESULT OF CURCUMIN TREATMENT
(PRELIMINARY STUDY)
Tengku Siti Hajar Haryuna, Ana Maria
Otorhinolaryngology Department of Faculty of Medicine
Universitas Sumatera Utara, Medan, Indonesia.

Abstract

Background
Previous research suggests that curcumin is able to decrease malondialdehyde
(MDA) expression due to oxidative stress related to noise exposure on fibroblasts of
cochlear lateral wall. The literature shows that the damage of fibroblasts on cochlear
lateral wall in diabetes mellitus is happened in similar manner to the damage caused
by noise exposure. Therefore, this study aims to prove that curcumin also able to
reduce MDA expression on fibroblast of cochlear lateral wall of diabetes mellitus rat
models.
Materials and Methods
This preliminary study conducted on 9 male Wistar strain Rattus norvegicus rats
which were divided into 3 groups. Group 1 serve as the control group which received
intraperitoneal injection of citrate buffer and oral CMC through nasogastric tube.
Group 2 is diabetes mellitus group model which received streptozotocin injection at
a dose of 60mg / kg b.w single dose, administered intraperitoneally. Group 3 received
the same treatment as group 2, followed by curcumin treatment with a dose 400 mg /
kg b.w / day for 8 days. All rats underwent termination and necropsy procedure on
their temporal bones for immunohistochemical assay to determine the expressions of
MDA.
Result
The increased expression of MDA was detected in the diabetic group (without
curcumin treatment). Curcumin treatment decreased the expression of MDA
significantly (p <0.005).
Conclusion
Curcumin could repair the cochlear damage related to oxidative stress due to
diabetes mellitus via decreased expressions of MDA on cochlear fibroblasts in rat
models of diabetes mellitus.
Keywords: Diabetes Mellitus, Cochlea, Fibroblast, Curcumin, Malondialdehyde.

INTRODUCTION
Diabetes mellitus (DM) is a metabolic disease caused by chronic degenerative
absolute insulin deficiency due to destruction of pancreatic β cells (type 1 diabetes)
or relative deficiency due to ineffective use of insulin (type 2 diabetes) [1]. Various
studies have been conducted to investigate hearing loss in patients with DM and

38
showed a positive correlation. Hearing loss in diabetes related to hyperactivity of
oxygen free radicals and leads to oxidative stress. Oxidative stress due to increased
reactive oxygen species (ROS) resulted in apoptosis in neuronal cells, which underlie
neuropathic complications due to diabetes. ROS is considered as one of the main
causes in the process of cochlear cell death due to hyperglycemia [2,3,4].
Lipid peroxides are disintegrated quickly and form reactive carbon
compounds, among these, malondialdlehyde (MDA) is an important reactive carbon
compound which is used commonly as an indicator of lipid peroxidation, and has
become one of widely reported analytes for the purpose of estimating oxidative stress
effects on lipids [5].
The antioxidant compounds overcome the toxicity of oxidative stress
generated or enhanced by a number of conditions like nutritional imbalance,
xenobiotics and their metabolic products, strenuous physical activities, and hereditary
disorders.The attenuation properties of antioxidants protect the key biomolecules
such as DNA, proteins, and lipids by scavenging reactive oxygen species (ROS). The
use of curcumin, a herbal plant product, as an antioxidant is relatively safe as its
toxicity is not reported even up to 10 g/day. The curcumin displays antioxidant
properties due to the presence of phenolics and methoxy groups on the phenyl ring
and 1,3-diketone groups. It acts as a strong antioxidant by neutralizing free radicals
and by showing metal binding characteristics. Curcumin has potential to cross blood
brain barrier in mammalian systems and exerts protective effect [6].

MATERIALS AND METHODS

This experimental study was conducted on Wistar strain white rats (Rattus
norvegicus) with randomized posttest-only control group design. Preliminary study
conducted on 9 male Wistar strain Rattus norvegicus rats which were divided into 3
groups. Group 1 serve as the control group which received intraperitoneal injection
of citrate buffer and oral CMC through nasogastric tube. Group 2 is diabetes mellitus
group model which received streptozotocin injection at a dose of 60mg / kg b.w
single dose, administered intraperitoneally. Group 3 received the same treatment as
group 2, followed by curcumin treatment with a dose 400 mg / kg b.w / day for 8
days. Streptozotocin administered intraperitoneally at a dose of 60 mg / kg B.W
(single dose). Curcumin derived from Curcuma longa L. (Turmeric).
All rats underwent termination and necropsy procedure on their temporal
bones for immunohistochemical assay to determine the expressions of MDA.

39
RESULT
The expression of MDA were found to be increased in the DM model without
curcumin treatment group (group 2) compared to other groups (group 1 and 3).
Curcumin decreased the expression of MDA in DM model (group 3).
Immunohistochemical assay on cochlear fibroblast resul shown in Figure 1 below:

A B C

Fig. 1 The expression of MDA in each group (40x zoom): (A) group 1; (B) group 2;
(C) group 3. The white arrow indicates the expression of MDA in cochlear
fibroblasts marked by the brown color.
Data in table 1 showed significant differences for the expressions of MDA
(P<0.05) in DM rat model group without curcumin treatment compared to control
group. A dose of 400 mg curcumin per day for 8 days showed statistically significant
decrease in the expression of MDA compared to untreated DM group (P<0.05).

Table 1: The results of ANOVA test for MDA expression in all groups
Mean difference ±
Group P value
Standard Error
*
Group 1 Group 2 -5.800 ± .730 .000
Group 3 .600 ± .730 1.000
Group 2 Group 3 6.400 ± .730 .000*
*indicates significant p value at <0.05

Data in table 1 showed significant differences for MDA expression (P<0.05) in

all groups, except in group 1 compared to group 3. A dose of 400 mg curcumin per

40
day for 8 days showed statistically significant decrease in MDA expression compared
to untreated group(P<0.05).

DISCUSSION
The expression of MDA was found to be increased significantly in the
cochlear fibroblasts of diabetes model group (group 2) compared to control group
(group 1) (P<0.05) in this present study. The increased expression of MDA in
diabetes model group was evoked by the increased levels of hydroxyl radical (OH•)
due to the spontaneous reduction of hydrogen peroxide (H 2O2) by free transition

metal ions through Fenton and Haber-Weiss reactions, resulting in increased lipid
peroxidation process directly to polyunsaturated fatty acids (PUFA) contained in the
cell membranes. The finding in this study is in accordance with findings of Kumari et
al. (2014) [7]. who found increased level of MDA in diabetics patients compared to
normal subjects. Sumathi et al (2013) [8] in a cross sectional study which includes
hundred diabetic patients found that diabetic subjects suffering from sensorineural
hearing loss has increased levels of serum MDA compared to diabetic subject
without hearing loss.
Lipid peroxidation is one of the most widely used indicators of free radical
formation, a key indicator of oxidative stress. Measurement of lipid peroxidation has
historically relied on the detection of thiobarbituric acid (TBA) reactive compounds
such as malondialdehyde (MDA) generated from the decomposition of lipid
peroxidation products [9]. Lipid peroxidation is a chain reaction initiated by the
hydrogen abstraction or addition of an oxygen radical, leading to oxidative damage of
PUFA. The end products of lipid peroxidation include the cytotoxic aldehydes, such
as MDA and 4-hydroxyalkenal (4-HAE), that possess high reactivity to proteins and
DNA, and hydrocarbon gasses such as ethane [10].
In this present study, curcumin proved to be able to decrease the expression
of MDA in cochlear fibroblasts (P<0.05). Curcumin is able to reduce the accumulation
of MDA due to lipid peroxidation by preventing the spontaneous reduction of
hydrogen peroxide (H2O2) caused by free transition metal ions through Fenton and

Haber-Weiss reactions, resulting in decreased lipid peroxidation process directly to

PUFA contained in the cell membranes.

41
CONCLUSION

This present study indicates that curcumin is effective agent in the treatment of
oxidative damage in fibroblasts within the cochlear animal model of diabetes mellitus
through decreased expressions of MDA. It provides more insight into the mechanism
of curcumin as an exogenous antioxidant against diabetes related oxidative stress
and may serve as a scientific basis in the traditional systems of medicine for the
management of diabetes related sensorineural hearing loss in the future.

REFERENCES

1. ADA (American Diabetes Association). Standard of medical care in diabetes

(2011). Diabetes care 34(1): 511-561. (2014).

2. Aladag I., Eyibilen A., Guven M., Atis O & Erkokmaz U: Role of oxidative stress in
hearing impairment in patients with type two diabetes mellitus. The Journal of
Laryngology & Otology. 123:957–963, 2009

3. Aronson D: Hyperglycemia and the Pathobiology of Diabetic Complications

:Fisman EZ, Tenenbaum A (eds): Cardiovascular Diabetology: Clinical, Metabolic
and Inflammatory Facets. Adv Cardiol. Basel, Karger, vol 45:1–16. 2008

4. Giacco F. & Brownlee M: Oxidative and diabetic complications. Circ Res.

106:1449–1458. 2010

5. Evans, P. and Halliwell, B. : Free radicals and hearing: Cause, consequence, and
criteria. Ann NY Acad Sci, 884, pp.19-40. 1999
6. Goodsell, D.S., 2007. Molecule of the month: Superoxide dismutase.
[online].Availableat:<http://www.rcsb.org/pdb/education_discussion/molecule_of_t
he_month/download/SuperoxideDismutase.pdf [Accessed 15 February 2015].

7. Kumari M. K. & Sankaranarayana T. Evaluation of Oxidative Stress in Type 2

Diabetes Mellitus Patients. IOSR Journal of Dental and Medical Sciences.
2014;13 (5) pp.46-50.

8. Sumathi K., Rani J., Saravanan D. Significance of malondialdehyde (mda) in

diabetic cochleopathy. Int J Pharm Bio Sci; 2013 4(3): pp. 959 – 962

9. Grotto D, Maria LS, Valentini J, Paniz C, Schmitt G, Garcia SC, et al. Importance
of the lipid peroxidation biomarkers and methodological aspects for
malondialdehyde quantification. Quim Nova 2009;32:169-74.

10. Repetto M, Semprine J, Boveris A. Lipid peroxidation: Chemical mechanism,

biological implications and analytical determination. In: Catala A. editor. Lipid
peroxidation. 1st ed. Rijeka: InTech; 2012. p. 3-30.

42
 POTENTIAL OF INDIGENOUS Lactobacillus sp IN PURPLE SWEET POTATO
(Ipomoea batatas var. Ayamurasaki) EXTRACT YOGURT AS PREVENTION OF
ANTIBIOTIC-ASSOCIATED DIARRHOEA

Rohmah Munawaroh
Mahasiswa Jurusan Teknologi Hasil Pertanian, Teknologi Pertanian, Universitas
Jember
Jl. Kalimantan 37 Kampus Tegalboto Jember

Abstrack

Diarrhoea, as a common side effect of antibiotics, increases treatment costs

and length of stay in acute healthcare facilities. One potential strategy to prevent this
side effect is the concurrent use of probiotic bacteria or yeast. This review discusses
the evidence for the efficacy of probiotics in the prevention of antibiotic. The
treatment from Niken Tari (2015) was followed as: S0 = Control (commercial culture
as Lactobacillus bulgaricus (Lb) Streptococcus thermophilus (St), S1 = probiotic
culture Lactobacillus plantarum commercial + Dad 13, namely St: Lb: Dad 13 = 1: 1:
0.5, S2 = + probiotic culture Lactobacillus plantarum commercial Mut7, namely St:
Lb: Mut7 = 1: 1: 0.5, S3 = + commercial probiotic cultures Lactobacillus acidophilus
SNP-2, namely St: Lb: SNP-2 = 1: 1: 0.5. The results showed that the antidiarrheal
activity qualitatively indigenous Lactobacillus sp ATCC 35281 against EPEC occurred
on treatment Y1 (yogurt with probiotic Lactobacillus plantarum Dad 13 and
supplementation of purple sweet potato extract) with inhibition zone diameters of 12,
8 mm. Antidiarrheal activity of Lactobacillus plantarum quantitatively indigenous sp
ATCC 35281 against EPEC largest storage for one week, also occurred in the
treatment of Y1 (yogurt with probiotics Llactobacillus Dad plantarum 13 and
supplementation of purple sweet potato extract) with the ability to decrease the
number of colonies EPEC ATCC 35281 by 5 log cycles (from 1.05 initially. 107 CFU /
ml to 8.5. 102 CFU / ml).

Keywords: Yogurt, Purple Sweet Potato Extract, diarrheal, Lactobacillus sp

Indigenous

PENDAHULUAN

Menurut data Riskesdas tahun 2007 dan 2013, terdapat peningkatan

prevalensi kasus gizi kurang, gizi buruk, anak pendek, dan penyakit infeksi seperti
diare (Balitbangkes, 2014). Mobilitas masyarakat yang cukup tinggi dapat juga
meningkatkan resiko penyebaran penyakit infeksi. Penyakit diare masih merupakan
masalah kesehatan masyarakat di negara berkembang seperti di Indonesia, karena
morbiditas dan mortalitas-nya yang masih tinggi.

43
 Secara nasional angka kematian dari Diare oleh penyebab infeksi tertentu
pada tahun 2014 sebesar 1,14% (Kemenkes, 2014). Tahun 2013 diare menempati
urutan ketiga dengan jumlah 524 kasus, terjadi peningkatan dari tahun 2012,
sedangkan tahun 2014 tidak jauh berbeda dari tahun 2013 namun terjadi penurunan
menjadi 510 kasus (Dinkes, 2013Upaya pencegahan infeksi oleh E.coli yang bersifat
patogen dapat dilakukan dengan cara menekan pertumbuhan E.coli pada saluran
pencernaan.
Hal yang dilakukan biasanya adalah pemberian antibotik. Namun untuk saat
ini pemberian antibiotik secara empiris jarang diindikasikan pada diare akut infeksi,
karena 40% kasus diare infeksi sembuh kurang dari 3 hari tanpa pemberian
antibiotik. 2 Antibiotik diindikasikan pada pasien dengan gejala dan tanda diare
infeksi, seperti demam, feses berdarah, leukosit pada feses, mengurangi ekskresi
dan kontaminasi lingkungan, persisten atau penyelamatan jiwa pada diare infeksi,
diare pada pe lancong, dan pasien immunocompromised. Pemberian antibiotik dapat
secara empiris ,tetapi terapi antibiotik spesifi k diberikan berdasarkan kultur dan
resistensi kuma
Hal yang dapat dilakukan selain dengan antibiotik adalah dengan
mengkonsumsi prebiotik atau probiotik. Menurut Wang (2009) probiotik dapat
memperbaiki efek perlindungan usus besar terhadap berbagai mikroorganisme
pathogen usus.
Sinbiotik merupakan gabungan dari prebiotik dan probiotik yang mempunyai
peran yang sangat penting bagi kesehatan. Probiotik adalah suplemen dalam
makanan yang mengandung bakteri yang sangat menguntungkan. Sedangkan
prebiotik adalah suatu bahan makanan yang dapat memberikan pengaruh positif
bagi kesehatan karena dapat memacu pertumbuhan dan aktifitas mikrobia didalam
saluran pencernaan kita. Komponen prebiotik yang paling banyak digunakan adalah
kelompok oligosakarida seperti yang terdapat dalam pisang, apel, jagung, kentang
dan umbi-umbian termasuk ubi jalar ungu. Pada ubi jalar ungu terkandung
oligosakarida yang dapat dipecah menjadi asam oleh bakteri probiotik misalnya
Bakteri Asam Laktat (BAL) (Silalahi dan Netty, 2003).
Suplementasi yogurt dengan ekstrak ubi jalar ungu Yogurt adalah bahan
makanan yang terbuat dari susu yang difermentasikan oleh bakteri asam laktat.
Yogurt mempunyai rasa yang unik yaitu mempunyai rasa asam dan memiliki khasiat
bagi kesehatan (Hosono, 2004). Bakteri yang terdapat di dalam yogurt yaitu
Lactobacillus bulgaricus dan Streptococcus thermophilus. Yogurt biasanya

44
ditambahkan Lactobacillus acidophilus, agar mempunyai efek fungsional bagi
kesehatan. Yogurt yang sudah ditambahkan bakteri probiotik dapat dikatakan
minuman probiotik (Waspodo,2001).
Ubi jalar merupakan komoditi pangan yang penting di Indonesia dan
diusahakan penduduk mulai daerah dataran rendah sampai dataran tinggi. Ubi jalar
relatif murah dan mudah didapat karena banyak dijumpai dipasaran. Dewasa ini,
berbagai penelitian tentang pemanfaatan ubi jalar ungu guna peningkatan nilai
ekonomis yang pernah dilakukan misalnya tepung ketela ungu, bakpao ketela ungu,
sirup ubi jala r ungu dll (Abdullah, 2005).

BAHAN DAN METODE

Alat dan Bahan
Ubi jalar ungu (Ipomoea batatas L) yang diperoleh dari pasar lokal daerah
Sukoharjo, kultur bakteri asam laktat koleksi FNCC (Food and Nutrition Culture
Collection) dari PAU Pangan dan Gizi UGM Yogyakarta berbentuk agar tegak, terdiri
dari Streptococcus thermophillus FNCC 0040 dan Lactobacillus bulgaricus FNCC
0041, serta kultur bakteri asam laktat indigenous yang mempunyai sifat probiotik
seperti Lactobacillus plantarum Dad 13, dan Lactobacillus plantarum Mut 7 dan
Lactobacillus plantarum SNP-2. Untuk pemeliharaan kultur bakteri asam laktat,
digunakan media MRS (de Mann Rogossa Sharp) Agar/Broth. Bahan-bahan kimia
penunjang pembuatan prebiotik ubi jalar ungu melalui fermentasi laktat
seperti,sukrosa, skim serta bahan kimia penunjang lain seperti alkohol 70 %, spiritus,
dan aquades diperoleh dari Lab. Biologi-Kimia dan Mikrobiologi Fakultas Pertanian
Univet Bantara Sukoharjo.
Penelitian oleh Niken Tari (2015) ini dilakukan dengan rancangan acak
lengkap pola searah (RAL), dengan 4 macam perlakuan yaitu jenis BAL dan masing-
masing perlakuan diulang 3 kali. Adapun perlakuan tersebut sebagai berikut : S0=
Kontrol ( berupa kultur komersial St dan Lb, S1= Kultur komersial + probiotik Dad 13,
yaitu St : Lb : Dad 13= 1:1:0.5, S2= Kultur komersial + probiotik Mut7, yaitu St : Lb :
Mut7 = 1:1:0.5, S3= Kultur 5komersial+probiotik SNP-2 yaitu St : Lb : SNP-2 =1:1:0.

HASIL DAN PEMBAHASAN

Uji Aktivitas Anti Diare Secara Kualitatif

45
Kuantitatif Selama 1 Minggu
Penyimpanan
Kemampuan anti diare Bakteri Asam Laktat yang terdapat pada yogurt
dengan suplementasi ekstrak ubi jalar ungu dilakukan dengan mempertarungkan
antara Bakteri Asam Laktat yang terdapat pada yogurt dengan suplementasi ekstrak
ubi jalar ungu pada berbagai perlakuan dengan Enteropathogenic Escherichia coli
(EPEC) ATCC 35218, menggunakan media TBX sebagai media selektif
pertumbuhan E.coli Pengamatan dilakukan dengan mengamati trend penurunan total
E.coli selama 0 dan 1 minggu penyimpanan. suplementasi ekstrak ubi jalar ungu,
dihitung sebagai pengurangan jumlah E. coli mula-mula (CFU/ml) terhadap jumlah
E.coli setelah ditarungkan dengan BAL yang ada pada masing-masing perlakuan
yogurt dengan suplementasi ekstrak ubi jalar ungu selama 1 minggu penyimpanan
(CFU/ml). Pengujian antidiare menggunakan EPEC (Enteropathogenic Escherichia
coli ATCC 35218) dikarenakan bakteri ini sering menginfeksi timbulnya penyakit yang
menyerang saluran pencernaan baik pada manusia maupun hewan serta sensitif
terhadap antimikrobia (antidiare) yang dihasilkan BAL. Jumlah koloni E.coli mula-
mula selama 1 minggu penyimpanan rata-rata 107 CFU/ml. Penyimpanan yaitu
minggu ke 0 atau 4 jam pertama setelah Enteropathogenic Escherichia coli ATCC
35218 dipertarungkan dengan BAL indigenous yang ada pada yogurt dengan
penambahan ekstrak ubi jalar ungu, jumlah Enteropathogenic Escherichia coli ATCC
35218 rata-rata mengalami penurunan 2 log cycle atau 105 CFU/ ml pada semua
perlakuan baik pada Y0, Y1, Y2 maupun Y3. Setelah 1 minggu penyimpanan, jumlah
Enteropathogenic Escherichia coli ATCC 35218 menurun 3 log cycle yaitu menjadi
104 CFU/ml dan 6,25. 104 CFU/ml masing-masing setelah ditarungkan dengan BAL
yang ada pada yogurt dengan penambahan ekstrak ubi jalar ungu pada perlakuan
Y0, (yogurt dengan penambahan ekstrak ubi jalar ungu tanpa probiotik) dan Y3
(yogurt dengan penambahan ekstrak ubi jalar ungu dan penambahan probiotik
Lactobaciluus acidophilus SNP2 yang berasal dari feses bayi yang menkonsumsi
ASI). Jumlah Enteropathogenic Escherichia coli ATCC 35218 mengalami penurunan
paling besar sebanyak 5 log cycle yaitu menjadi 8,5.102 CFU/ml setelah
dipertarungkan dengan BAL pada perlakuan Y1 (yogurt dengan suplementasi
ekstrak ubi jalar ungu dan penambahan probiotik Lactobacilus plantarum Dad 13
yang berasal dari dadih), sedangkan jumlah E.coli mengalami penurunan paling kecil
ketika dipertarungkan dengan BAL pada yogurt dengan perlakuan Y2 (yogurt dengan
suplementasi ekstrak ubi jalar ungu dengan penambahan probiotikyang berasal dari

46
growol). Kemampuan mikrobia probiotik BAL indigenous pada perlakuan Y1,Y2
maupunY3 dalam menekan pertumbuhan bakteri pathogen EPEC ATCC 35218
disebabkan karena kemampuannya untuk memproduksi senyawa antimikrobia
sebagai metabolit primer seperti asam laktat dan asam asetat, hidrogen peroksida
dan dengan menghasilkan bakteriosin yang merupakan senyawa protein yang
menunjukkan aktivitas antibakteri terhadap bakteri sejenis. Akumulasi senyawa
tersebut di dalam sel terjadi karena BAL probiotik tersebut tidak menghasilkan enzim
katalase (Salminen dan Wright, 1993).
Hasil uji daya hambat antidiare secara kulatatif yang dilakukan oleh Intan
Niken pada tahun 2015 menunjukkan bahwa BAL probiotik indigenous yang
ditambahkan pada yogurt dengan suplementasi ekstrak ubi jalar ungu terhadap
EPEC ATCC 35218 menunjukkan zona penghambatan antimikrobia (antidiarea) BAL
indigenous pada yogurt dengan suplementasi ekstrak ubi jalar ungu terhadap EPEC
ATCC 35218. bahwa perlakuan Y1 yaitu yogurt dengan suplementasi ekstrak ubi
jalar ungu dengan penambahan probiotik Lactobacilus plantarum Dad 13 yang
berasal dari dadih menunjukkan zona hambat paling besar sebesar 12, 8 mm diikuti
Y3 (yogurt dengan suplementasi ekstrak ubi jalar ungu dengan penambahan
probiotik Lactobacilus acidophilus SNP2 yang berasal dari feses bayi ASI), Y2
(yogurt dengan suplementasi ekstrak ubi jalar ungu dengan penambahan probiotik
Lactobacilus plantarum Mut7 yang berasal dari growol) dan Y0 (yogurt dengan
suplementasi ekstrak ubi jalar ungu tanpa penambahan probiotik) masing-masing
dengan diameter zona hambat = 12,5 mm, 12,3 mm dan 12,0 mm.

KESIMPULAN
Potensi minuman fungsional yoghurt dengan penambahan ekstrak ubi jalar
ungu dapat menurunkan EPEC ATCC 35218 segingga dapat digunakan sebagai
obat anti diare dengan berbasis pangan lokal dan dapat mengantikan antibiotik
dalam penanganan penyakit diare.

DAFTAR PUSTAKA
Andriani ,MAM dan LU Khasanah. 2009. Kajian Karaktristik Fisiko Kimia dan
Sensori Yogurtdengan Penambahan Ekstrak Ubi Jalar (Ipomoea batatas
L). Artikel Ilmiah Penelitian Universitas Sebelas Maret. Surakarta

47
Erawati, F.S. 2009. Efektifitas Sari Ubi Jalar Merah (Ipomoea batatas L.)
sebagai Media Pertumbuhan Bakteri Asam Laktat (L. casei, Lactobacillus
acidophilus, B. bifidum). Surabaya. ITS.

Legowo, A.M. 2005. Diversifikasi ProdukOlahan dengan Bahan Baku Susu.

Semarang. Fakultas

Simadibrata M, Daldiyono. Diare akut. In: Sudoyo AW, Setiyohadi B, Alwi I,

Simadibrata M, Setiati S, editors. Buku Ajar Ilmu Penyakit Dalam. Jakarta:
Interna Publishing; 2010. p.548-56.

Niken Tari, A. I..Catur Budi Handayani, Ahimsa Kandi Sariri. 2012. Pengaruh Kultur
Indigenous Lactobacillus sp Jurnal Teknologi Hasil Pertanian, Vol. VIII, No.
Agustus 2015 70 dalam Pembuatan Yogurt Ubi Ungu : Kajian Tingkat
Keasaman, pH dan Total Padatannya. Jurnal Teknologi Hasil Pertanian
UNS. ISSN : 1979-0309 Vol No1 Maret 2012

Niken Tari, A. I..Catur Budi Handayani, Ahimsa Kandi Sariri. 2012. Uji Potensi
Antidiare Lactobacillus Sp Indigenous Sebagai Kultur Starter Pada Yogurt
Dengan Suplementasi Ekstrak Ubi Jalar Ungu. Jurnal Teknologi Hasil
Pertanian Vol VIII No2 Agustus 2015

Niken Tari, A. I..Catur Budi Handayani, Ahimsa Kandi Sariri. 2012. Pengaruh Kultur
Indigenous Lactobacillus sp Jurnal Teknologi Hasil Pertanian, Vol. VIII, No.
Agustus 2015 70 dalam Pembuatan Yogurt Ubi Ungu : Kajian Tingkat
Keasaman, pH dan Total Padatannya. Jurnal Teknologi Hasil Pertanian
UNS.ISSN : 1979-0309 Vol No1 Maret 2012

Niken Tari, A. I..Catur Budi Handayani, Ahimsa Kandi Sariri. 2012. Uji Potensi
Antidiare Lactobacillus Sp Indigenous Sebagai Kultur Starter Pada Yogurt
Denga Suplementasi Ekstrak Ubi Jalar Ungu. Jurnal Teknologi Hasil
Pertanian Vol VIII No2 Agustus 2015

48
POSTER PRESENTATION
International Conference Agromedicine and Tropical Diseases
Optimizing the Role of Agromedicne and Tropical Diseases in Human Life

49
 Pesticide: Endangered Agricultural Workers by Causing Depression
And Suicidal Ideation

Widya Ayu Putri Maharani, Ida Srisurani Wiji A.

Medical Faculty, Jember University; dr.rani82@yahoo.com

Abstract
Introduction: The increased usage of pesticides is associated with the increased of
neuropsychiatric disorder include depression and suicidal ideation among agricultural
workers in different socioeconomic and demographic area. These studies examined
symptoms of neurological and psychological distress previously exposed to
pesticides that cause suicidal ideation. Methods: The mean number of suicide rate
on agricultural workers previously exposed to pesticides obtained from direct method
using the existing data and the others were obtained from direct interview and
specific questionnaires which conducted on agricultural workers. The multivariate
analysis used on these studies consists of multiple linear regression and logistic
regression. Result: Among the agricultural workers and the data that were analyzed,
it shows that pesticides exposure associated with depression and suicidal ideation.
Significant characteristics of increasing symptoms with increasing number of previous
exposure to pesticide were seen by the somatisation, obsessive-compulsiveness,
interpersonal sensitivity, anxiety and especially depression. Moreover, the increased
probability of suicidal ideation significantly associated with the increased of the
episodes of exposure to pesticides. Conclusions: These studies indicate that
pesticides exposure can be the cause of depression and suicidal ideation in
agricultural workers. When the symptoms of neurological and psychological distress
are detected, a monitoring must be available to prevent the suicidal ideation.
However, further appropriately designed studies are needed to confirm the causal
relationships.

Keyword: pesticide, depression, agricultural worker

INTRODUCTION
The development of industrial agriculture has resulted in increased usage of
pesticides. Exposure to pesticides can cause multiple human health effects. The
more these pesticides are used, the higher the people's exposure to these toxins will
be, with increased adverse effects on human health. A WHO task group has lately
estimated that the number of pesticide poisoning may soar to three million cases and
result in more than 250,000 deaths. However, the problem is more complicated
according to a recent survey in Asia, indicating that as many as 25 million farmhands
suffer episodic poisoning every year1.
Due to the changes in our lifestyles, we are constantly exposed to various
chemicals. The water we drink, food we eat, the air we breathe and the environment

50
in which we live are all might be contaminated by these pesticide toxins which can
damage the mechanism of muscle, heart, lung, and even brain. The most part used
in farming are Anti-cholinesterase compounds, organophosphates (OPs), and
carbamates (CMs) and they can affect mammalian systems by inhibiting acetyl
cholinesterase (AChE) at the synapses and muscular junctions, which may result in
hyper cholinergic preponderance1. Careless use of pesticides like organophosphates
may cause diverse health complications by upsetting the endocrine, nervous,
immune systems, reproductive, and can change the human behavior 1,2.
The connection between the exposure and an associated behavioral change may
not be easy to recognize, but the consequences can last for many years. Knowledge
about the association between pesticide exposures and psychiatric symptoms comes
from case reports, human studies, animal studies, and epidemiological evidence.
Many people are at risk of pesticide exposure. Those who work in landscaping,
agriculture or other settings in which pest problems are treated with chemicals are at
risk. Drift from aerial spraying of pesticides puts those working, living, or playing
downwind at risk. The spray and runoff can contaminate both surface and ground
water. Pest control in urban dwellings can put residents around the area at risk.
Studies among farm workers have shown an association between pesticide
poisoning and psychiatric problems, particularly depressive disorders3-11. However,
this association is not so clear when analysing pesticide exposure – without
poisoning – and the occurrence of psychiatric problems6,12,13. Several pesticides,
especially organophosphates, are neurotoxic and have been associated with
increased psychiatric problems, particularly depression3-6,12-15. These problems could
contribute to the incident of suicide among exposed workers 6,12,19. Furthermore, in
several parts of the world deliberate pesticide poisoning has been the main method
of suicide12, although this is not the case in Brazil16,17.
These studies aim to identify the depression symptoms and suicidal thoughts by
the different socioeconomic and demographic characteristics of agricultural workers.
Moreover, these studies will evaluate the influence of factors related to occupation
and health condition on depression symptoms and suicidal ideation.

51
METHODS
Data were obtained from the existing data to find the mean suicidal rate per micro
region on agricultural workers previously expose to pesticides in one study22. In two
studies, data were obtained from direct interview and specific questionnaires which
conducted on agricultural workers8,23.
These studies use multivariate analysis. One study uses multiple linear regression
to examine the association between pesticide (pesticide exposure and pesticide
poisonings) and suicide rates (for entire population include socioeconomic,
demographic, and cultural factors)22 and two studies use logistic regression to
analyze all surveyed risk factors as independent variables and presence of
depression symptoms and suicidal ideation as dependent variables, also to compare
all poisoned and subcategories of poisoned to non poisoned agricultural workers 8,23.

RESULTS AND DISCUSSION

Among the agricultural workers and the data that were analyzed, it shows that
pesticides exposure associated with depression and suicidal ideation. The study
show that there are different results in the agricultural workers (banana workers)
between poisoned to never poisoned banana worker by pesticides. That can be seen
on Table 18.
Significant characteristics of increasing symptoms with increasing number of
previous exposure to pesticide were seen by the existence of the five symptom
dimensions of somatisation, interpersonal sensitivity, obsessive-compulsiveness,
anxiety, and depression as well as the general severity index. In the other hand,
banana workers who only poisoned by carbamate pesticide have less symptoms than
banana workers who poisoned by two or more types of pesticide.
Table 2 shows the prevalence of suicidal ideation by workers’ exposure
categories, together with the adjusted ORs for poisoned workers as compared to non
poisoned reference workers8. Banana worker who had been poisoned by
organophosphate pesticide were over three times have bigger thought of suicidal
ideation in the previous month compared to the banana worker who never poisoned
by organophosphate pesticide. Among those who poisoned by carbamate pesticide,
the potential of having suicidal thought was also elevated but not significantly. The
increased probability of suicidal ideation associated with the number of episodes of
poisoning.

52
 *Table 1.

*Table 2.

CONCLUSION

The results of this study are consistent with other published reports on the
neuropsychological effects of pesticides overexposure, including depressive
symptoms and a higher prevalence of suicidal thoughts, and are supportive of the
priori hypothesis that was verified in the multivariate analysis for all suicides and in
the stratified analysis. This result is consistent with many studies 12,18-21 and
substantiates the possible relationship with occupational pesticide exposure.
Clearly, stronger designs of study are needed to clarify the pathophysiology and
prove causality, in particular intended studies among highly exposed agricultural
workers. Some of data obtained from the 1990s continue to be relevant because of

53
the continued widespread use of pesticides in different socioeconomic and
demographic area in developing countries in general.
Overall, the results of this study show that we need a depression and suicide
monitoring system for agricultural workers who complain of neurological symptoms
caused by pesticide exposure or exhibit commonly found key symptoms.

ACKNOWLEDGEMENT
The author would like to thank all who supported this journal, especially for author’s
college teacher, committee of ICATD and Medical Faculty of Jember University.

REFERENCES
1. Malekirad AA, Faghih M, Mirabdollahi M, Kiani M, Fathi A, Abdollahi M.
Neurocognitive, Mental Health, and Glucose Disorders in Farmers Exposed to
Organophosphorus Pesticides. Arh Hig Rada Toksikol 2013;(64):1-8.

2. Taghavian F, Vaezi G, Abdollahi M, Malekirad AA. A Comparative Study of the

Quality of Life, Depression, Anxiety and Stress in Farmers Exposed to
Organophosphate Pesticides with Those in a Control Group. J Chem Health
Risks 2016;6(2):143-151.

3. Stallones L, Beseler C. Pesticide Poisoning and Depressive Symptoms among

Farm Residents. Ann Epidemiol 2002;12(6):389–94.

4. Beseler C, Stallones L, Hoppin JA, Alavanja MC, Blair A, Keefe T, et al.

Depression and Pesticide Exposures in Female Spouses of Licensed Pesticide
Applicators in the Agricultural Health Study Cohort. J Occup Environ Med/Am
College Occup Environ Med 2006;48(10):1005–13.

5. Beseler CL, Stallones L, Hoppin JA, Alavanja MC, Blair A, Keefe T, et al.
Depression and Pesticide Exposures among Private Pesticide Applicators
Enrolled in the Agricultural Health Study. Environ Health Perspect
2008;116(12):1713–9.

6. London L, Beseler C, Bouchard MF, Bellinger DC, Colosio C, Grandjean P, et

al. Neurobehavioral and Neurodevelopmental Effects of Pesticide Exposures.
Neurotoxicology 2012;33(4):887–96.

7. Faria NM, Facchini LA, Fassa AG, Tomasi E. Estudo transversal sobre sau´ de
mental de agricultores da Serra Gau´ cha (Brasil). Revista de Saude Publica
1999;33(4): 391–400.

8. Wesseling C, van Wendel de Joode B, Keifer M, London L, Mergler D, Stallones

L. Symptoms of Psychological Distress and Suicidal Ideation among Banana
Workers with a History of Poisoning by Organophosphate or N-Methyl
Carbamate Pesticides. Occup Environ Med 2010;67(11):778–84.

54
9. Weisskopf MG, Moisan F, Tzourio C, Rathouz PJ, Elbaz A. Pesticide Exposure
and Depression among Agricultural Workers in France. Am J Epidemiol
2013;178(7):1051–8.

10. Beseler CL, Stallones L. A Cohort Study of Pesticide Poisoning and Depression
in Colorado Farm Residents. Ann Epidemiol 2008;18(10):768–74.

11. Beard JD, Umbach DM, Hoppin JA, Richards M, Alavanja MC, Blair A, et al.
Suicide and Pesticide Use Among Pesticide Applicators and Their Spouses in
the Agricultural Health Study. Environ Health Perspect 2011;119(11):1610–5.

12. London L, Flisher AJ, Wesseling C, Mergler D, Kromhout H. Suicide and

Exposure to Organophosphate Insecticides: Cause or Effect?. Am J Indus Med
2005;47(4):308–21.

13. Freire C, Koifman S. Pesticides, Depression and Suicide: A Systematic Review

of the Epidemiological Evidence. Int J Hyg Environ Health 2013;216(4):445–60.

14. Lima CS, Nunes-Freitas AL, Ribeiro-Carvalho A, Filgueiras CC, Manhaes AC,
Meyer A, et al. Exposure to Methamidophos at Adulthood Adversely Affects
Serotonergic Biomarkers in the Mouse Brain. Neurotoxicology 2011;32(6):718–
24.

15. Keifer MC, Firestone J. Neurotoxicity of Pesticides. J Agromed 2007;12(1):17–

25.

16. Brasil MS. Mortalidade por suicı´dio. In: Sau´ de Brasil 2007, Uma ana´ lise da
situac¸a˜o de sau´ de. Brası´lia: Ministe´ rio da Sau´ de - SVS; 2008: 326–51
[cap 7].

17. Marin-Leon L, Oliveira HB, Botega NJ. Suicide in Brazil, 2004–2010: The
Importance of Small Counties. Revista panamericana de salud publica Pan Am
J Public Health 2012;32(5):351–9.

18. Meyer A, Koifman S, Koifman RJ, Moreira JC, de Rezende Chrisman J, Abreu-
Villaca Y. Mood Disorders Hospitalizations, Suicide Attempts, and Suicide
Mortality among Agricultural Workers and Residents in an Area with Intensive
Use of Pesticides in Brazil. J Toxicol Environ Health Part A 2010;73(13–
14):866–77.

19. Stallones L. Suicide aand Potential Occupational Exposure to Pesticides,

Colorado 1990–1999. J Agromed 2006;11(3–4):107–12.

20. van Wijngaarden E. An Exploratory Investigation of Suicide and Occupational

Exposure. J Occup Environ Med 2003;45(1):96–101.

21. Lee WJ, Alavanja MC, Hoppin JA, Rusiecki JA, Kamel F, Blair A, et al. Mortality
among Pesticide Applicators Exposed to Chlorpyrifos in the Agricultural Health
Study. Environ Health Perspect 2007;115(4):528–34.

55
22. Faria NM, et al. Association between Pesticide Exposure and Suicide Rates in
Brazil. Neurotoxicol 2014; (4):355-362.

23. Joo Y, et al. Risk Factors Associated with Depression and Suicidal Ideation in a
Rural Population. Environ Health Toxicol 2016; 31.

DISCLAIMER

Statements of fact and opinion published in this journal express solely the
opinions based on the journals that have been reviewed by author. Author is
responsible for all contents in this journal including the facts, statements, citing
resources, and so on. Material submitted to this journal is original and not published
or submitted for publication elsewhere. Otherwise, author is not involved in any
research of this journal and cannot be held responsible for the lacks and the
possibility if the implication, main result, or conclusion is not apparent and different in
other work. The reader should make his/her own evaluation as to the
appropriateness or otherwise of any experimental technique described or conclusion
of this journal.

CORRESPONDENCE TO:
Widya Ayu Putri Maharani
Medical Faculty of Jember University
Jember 68121, East Java, Indonesia
Email: aayuputry@gmail.com

56
Adverse Health Effects of Organophosphate Intoxication in Children of Farmer
Family: A Review

Mohammad Haedar Faraby; Ida Sri Surani Wiji Astuti

dr.rani82@yahoo.com
Medical Faculty, University of Jember

Abstract

Background: Children are more vulnerable to organophosphate intoxication due to

their organ systems which are still growing and developing. In Agricultural country,
like Indonesia, children of farmer family are exposed to organophosphate from their
farmer parents with poor hygiene, pesticide drift from nearby fields, and playing in
fields. Methods: Articles were searched through Google Scholar and Ebscohost,
then they were selected according to the relevance of this topic. We found three
selected articles. The study design used a cross sectional study with sample size of
180 farmer children and another study by using 95 farmer children and 85 control
children. In otherwise, cohort study with 601 pregnant women as sample size was
conducted. Result: Children with organophosphate metabolites in their urine are
associated with DNA damage (P= 0.001). Children of farmer family are 1.5 to 2.0 fold
more likely to have DNA damages that can lead to cancer in their adulthood
(P<0.05). The existence of organophosphate metabolites in maternal urine during
pregnancy is associated with an average 7.0 IQ points deficits in children (P<
0.001). Conclusion: Children of farmer family must avoid exposures of
organophosphate due to their vulnerability to intoxication and the adverse health
effects produced that can lower the quality of life in their future life.
Keywords: Children of Farmer Family, Intoxication, Organophosphate

INTRODUCTION

Organophosphate pesticides are widely used in agriculture. In 2007, 15 million

kilograms of organophosphate pesticides were used in the United States,
representing 36 percent of all insecticides used. In California, 1.6 million kilograms of
organophosphate pesticides were used in agriculture in 2008. 1 In agricultural country,
especially Indonesia, pesticide use to protect farm from harmful insects is supposed
to be the last option. But as we know, almost all farmer in Indonesia use pesticides
for their farms. In 1987, 18.7 million kilograms pesticides were used in agriculture in
Indonesia.2 Studies published have not yet describe recent pesticide use in
Indonesia. The higher use of pesticide in recent years is more likely due to the
possible emergence of resistant insects to pesticide causing more pesticide needed
to kill them. With this massive amount of organophosphate pesticide use and
frequent unethical use of pesticides, farmer and other people living near farmland,
especially children, are at risk of organophosphate intoxication.

57
 Children are more vulnerable to organophosphate intoxication than adults. Their
organ systems are still immature and developing. In addition, the dose of
organophosphate per body weight is likely to be higher in children. 1 Children also
have unique age-related behavior that make them more susceptible to
organophosphate exposure.3 Children of farmer family are more likely to be exposed
to organophosphate due to their normal tendency to explore the envirenment orally
and by playing in the farmfield nearby. They may also be exposed to
organophosphate from pesticides tracked into their homes by household members,
by pesticides drift, or from breastmilk of their farmworker mother.

In case of organophosphate intoxication, children are more susceptible to

harmful and toxic effects of organophosphate. The depression of
acetylcholinesterase (AChE), enzyme that regulates acetylcholine level, in
organophosphate intoxication is causing more severe effects due to the low level of
AChE found in children.3 Children also have lower levels and activity of enzymes
that detoxify activated form of certain organophosphates pesticides. 1

METHODS

Articles were searched through Google Scholar and Ebscohost. They were
selected according to the relevance of this topic. Three articles were selected. The
study design used in the first article was a cross sectional study with sample size of
180 farmer children aged between 7 and 12 years old. Spot urine samples were
collected and stored at 4o C for 24 hours and then transferred to laboratory where
they were frozen at -20o C. Measurement of organophosphate pesticides urine
metabolites used gas chromatography-mass spectrometry (GC-MS). Genotoxicity
was assessed using comet assay method with sample of exfoliated buccal mucosa
cell. The data were analyzed using SPSS for Windows version 20. DNA damage
level is indicated by the tail length, which is the distance of DNA migration from the
body of nuclear. A p < 0.05 was considered statistically significant.

The second article used cross sectional study design with sample size of 95
farmer children aged 9 to 11 years whose schools were located less than 2 km from
paddy farmland, had at least one family member working in the farmland, and have
stayed in the agricultural village since they were born and 85 control children whose
school and house were located at least 10 km from the agricultural community. This
study was conducted during the vegetative and reproductive phases of paddy
farming where organophosphate pesticide were used. Blood samples were used to
detect organophosphate exposure. Blood samples used were 10 µL capillary blood
collected by finger prick. Buccal mucosa cells were collected from gently scraping the
mucosa of inner lining of cheek. The cells then used for genotoxicity assessment.
Organophosphate exposure is evaluated by monitoring the blood cholinesterase level
using a blood cholinesterase test kit (Lovibond, AF267; Tintometer Ltd., UK).
Meanwhile the genotoxicity assessment evaluated by comet assay to see the extend
of DNA damage and by micronuclei (MN) to see the end point of genotoxicity effect.

58
 The other study was a cohort study with sample size of 601 pregnant
womenurin. Urine samples were collected at two times durigng pregnancy. The first
sample was collected at enrollment into the study, between 5 and 27 weeks of
gestation (median, 13 weeks). The second urine sample was collected between 18
and 39 weeks gestation (median, 26 weeks). Organophosphate exposure was
indicated by the presence of urinary dialkyl phosphate (DAP). DAP metabolites
concentrations were measured using gas chromatography/tandem mass
spectrometry and qualified using isotope dilution calibration. Cognitive abilities were
assessed by using Wechsler Intellegence Scale for Children, 4th edition (WISC-IV) at
7 years old children.

RESULT

In the first article, children with detectable urinary pesticide had a longer tail
length (median 43.5; IQR 30.9 to 68.1 µm) as compared to children with undetectable
urinary pesticides (median 24.7; IQR 9.5 to 48.1 µm). There was a significant
association between the extent of DNA damage and pesticide detection.

Table 4.1 Comet tail length (µm) and its association with pesticide detection
Pesticide N Median (IQR) P value
Detection

No 96 24.7 (9.5 to 48.1)

0.001
Yes 84 43.5 (30.9 to 68.1)

In the second article, the level of blood cholinesterase was used to reflect the
cholinesterase depression among farm children. Table 4.2 highlights farm children’s
overexposure (56.31%) to organophosphate pesticides compared with normal blood
cholinesterase (79.55%) content in the control group. The blood cholinesterase level
was determined based on the pH color indicator, which changes based on the
colorimetric principle for quick field sampling among children.

Table 4.2 Comparison of Blood Cholinesterase level (%) Among Study Population
Biomarker of exposure Farm Control t statisticsa P value
Children Mean (SD)
Mean (SD)

Blood cholinesterase 56.32 (12.35) 79.55 -12.072 <0.005*

level (13.48)
a
Independent t test N = 95 (farm children) N = 85 (control).
* P value is significant at 0.05 level.

Table 4.3 shows at least 1.5- to 2-fold significant increase in genotoxicity risk
among farm children compared with the control group. In this context, different effects
of DNA alteration on a buccal cell are demonstrated by MN assay and comet assay.

59
Table 4.3 Comparison of Biomarker of Effect (Genotoxic Risk) Among Study
Population
Biomarker of exposure Farm Control t P value
Children Mean (SD) statisticsa
Mean (SD)

Micronuclei (per 1000 5.05 (2.45) 2.92 (1.54) 7.09 (160) <0.005*
cells)

Comet tail length (µm) 8.45 (3.89) 4.38 (1.66) 9.28 (130) <0.005*

In the third article, averaging the two maternal urinary DAP concentrations
measured during pregnancy yielded significant associations with poorer cognitive
scores (Table 4.4). Higher prenatal DAP concentrations were associated with lower
scores on all four cognitive domains, the strongest associations being for Verbal
Comprehension [βfor a 10-fold increase in concentration = –5.3; 95% confidence
interval (CI),–8.6 to –2.0]. A 10-fold increase in DAP concentrations was associated
with a decrease of 5.6 Full-Scale IQ points (95% CI,–9.0 to –2.2).

Table 4.3 .Change in cognitive scores in children tested at 7 yearsof age, for a 10-
fold increase in maternal DAP concentrations (nmol/L) averaged over pregnancy.
DAP
Cognitive test
n β-Coefficient (95% p-value
(WISC-IV scale)
CI)

Working Memory 298 –4.3 (–7.7 to –0.9) 0.01

Processing Speed 298 –3.4 (–6.8 to –0.1) 0.04

Verbal Comprehension 329 –5.3 (–8.6 to –2.0) <0.01

Perceptual reasoning 329 –4.0 (–7.9 to –0.1) 0.04

Full-Scale IQ 297 –5.6 (–9.0 to –2.2) <0.01

DISCUSSION

Organophosphate exposures in children of farmer family were high according to

these findings. Children of family farmer was not only harmed by the acute effects of
organophosphate intoxication but also suffered the chronic adverse health effects
such as genotoxicity and neurodevelopmental problems.

Children who had depressed level of AChE may suffer from cellular dysfuction
leading to increased free radical and reactive oxygen species (ROS) activities in
erythrocytes. This cellular dysfunction may cause increased oxidative stress due to
insufficient balance by antioxidants, and ultimately leads to alteration in cell structure

60
formation. The elevated ROS level and decreased regulation of ROS scavenger and
antioxidant enzymes are known to cause damage to the nuclei acids, proteins, and
lipids. To date, oxidative stress has been considered an effective measure to
determine the cumulative organophosphate exposure. 3

As for the neurodevelopmental problems acquired by the children of farmer

family, it is known that the nervous systems especially the brain of children is still
immature and developing rapidly.4 The disruption of these process resulted a
neurodevelopmental problem that yields more severe outcomes to the younger
children who has the highest risk of exposure.

CONCLUSION

Children of farmer family must avoid exposures of organophosphate due to their

vulnerability to intoxication and the adverse health effects produced that can lower
the quality of life in their future life. This demands the ethical and reduction of
organophosphate pesticides.

ACKNOWLEDGEMENT

We would like to thank the commitee of International Conference on

Agromedicine and Tropical Diseases for the chance to participate in their events.

REFERRENCES
1. Bouchard MF, Chevrier J, Harley KG, Kogut K, Vedar M, Calderon N, Trujillo C,
Johnson C, Bradman A, Barr DB, Eskenazi B. Prenatal exposure to
organophosphate pesticides and IQ in 7-year-old children. Environmental health
perspectives. 2011 Aug 1;119(8):1189.

2. Sulistiyono L. Dilema penggunaan pestisida dalam sistem pertanian tanaman

hortikultura di Indonesia. Makalah Pengantar ke Falsafah Sains. Sekolah Pasca
Sarjana S. 2004;3.

3. How V, Hashim Z, Ismail P, Md Said S, Omar D, Bahri Mohd Tamrin S. Exploring

cancer development in adulthood: cholinesterase depression and genotoxic effect
from chronic exposure to organophosphate pesticides among rural farm children.
Journal of agromedicine. 2014 Jan 2;19(1):35-43.

4. Sutris JM, How V, Sumeri SA, Muhammad M, Sardi D, Mokhtar MM, Muhammad
H, Ghazi HF, Isa ZM. Genotoxicity following organophosphate pesticides exposure
among orang asli children living in an agricultural island in kuala langat, Selangor,
Malaysia. The international journal of occupational and environmental medicine.
2016 Jan 1;7(1 January):705-42.

61
 TOP INJURIES AND ILLNESSES AMONG THE FARMERS
IN DIFFERENT CONTINENTS: A REVIEW

Dissa Yulianita Suryani, Ida Sri Surani Wiji A

Medical Faculty, Jember University; dr.rani82@yahoo.com

Abstract

Background: Accidents and illness in agriculture are a problem of global importance.

The hazards of working in agriculture are manifold (machines, animals, heights,
pesticide exposure). Three continents in the world which have agricultural sector
such as Europe (Switzerland), Asia (Indonesia), and Africa (Tanzania) are focused in
this study. Methods: This study retrospectively analyzes all farming accidents and
diseases in three continents. The data used are secondary data, where secondary
data obtained by collecting documentations about the conditions of farmers respond
to agricultural injuries and illnesses from the relevant research in accordance with the
problems. Results: Majority of farmers complained to suffer fatigue (minor injuries) in
upper back (92.8%), mid back (93.6%), and lower back (91.8%), respectively.
Patients with injuries to the chest were most likely to suffer from severe injuries,
followed by patients with injuries to the abdomen and patients with injuries to the
head. The most illnesses are caused by pesticide exposure and remaining
agricultural materials in air. Conclusion: Injuries in agriculture are accompanied by
substantial morbidity and mortality, and range from minor injuries to severe multiple
injuries. The injuries of the body of farmers consist of injury in hand, arms, legs,
thighs, and feet. Agricultural illnesses have serious effect in farmer’s organ such as
lung, skin and etcetera.
Keywords: top injuries, illnesses, farmer, Europe, Asia, Africa

INTRODUCTION
Accidents in agriculture are a problem of global importance Half of the
world's labour force, 1.3 billion people, works in agriculture Agriculture consistently
3
ranks as one of the most dangerous occupations , along with mining and
construction. Traumatic injuries and poisoned in agriculture are a serious public
health problem. Several studies have examined a wide range of potential risk factors
for injuries related to agricultural work, such as hard physical work, handling
machines and animals, working at heights and poisoned of pesticide exposure. All of
these mechanisms may lead to trauma and health problems 4. Moreover, agriculture
involves multiple seasonal tasks that have to be undertaken quickly to take
advantage of good weather conditions, leading to long working hours and
subsequent sleep deprivation factors that significantly increase injury risk 4. Even
though several preventive measures have been undertaken such as safety education

62
of farm workers, installation of fall prevention devices and increased security of
agricultural vehicles fatality rates have remained consistently high.

The farming population in Europe especially in Switzerland has decreased in

recent years, but 2.1% of Switzerland’s population still involved in agriculture.
According to Swiss Accident Statistics, agriculture is the most dangerous
occupational sector in Switzerland, followed by the construction and wood industries.
In 2010, a total of 165.7 per 1000 people working in agriculture suffered an injury;
0.03 per 1000 people died.5

Previous study identified acute pesticide poisoning (APP) as a major problem

in the farming community in Africa especially in Tanzania. Pesticide formulations
distributed by licensed pesticide retailers are extensively used in Tanzania. Over
13,000 metric tons (MT) of pesticide formulations were imported and distributed for
use during 2003 and 2004. Given previous evidence of unsafe handling practices in
Tanzania, the huge quantity of pesticides distributed suggests a high potential for
human exposure, health injuries and illness. On the other hand, previous research in
Tanzania found that 68% of farmers reported episodes of feeling sick after routine
application of pesticides and their pesticide-related health symptoms included skin
problems and neurological symptoms.6

According to the 2002 ILO estimates for Asia, the expected rates of fatal
injuries per 100 000 was about 35 in the agriculture sector; 13 in the industry sector
and 7 in the service sector. However, the total number of fatal accidents reported to
ILO was 12 or only 0.08% of the expected numbers. This trend was seen with the
remaining Member Countries, with Indonesia reporting 6%. The prevalence of non-
fatal injuries as indexed by the country report of three days absence due to accident,
converted as a rate per 100 000 were as follows: 8.9 for Indonesia.7 The aim of this
study was therefore to describe farmers’ injuries and illnesses in different continents.

METHODS
This study retrospectively analyzes all farming accidents and diseases in three
continents. The data used are secondary data, where secondary data obtained by
collecting documentations about the conditions of farmers respond to agricultural
injuries and illnesses from the relevant research in accordance with the problems.
Secondary data analysis from literature journal was conducted in this study, which is

63
from database such as Scopus, DOAJ, Google Scholar, and also from grey
literatures from the report of Ministry of Health Indonesia, Indonesian Public Health
Assosiation (IPHA), and others sources.

RESULT
In Switzerland, table 1 is about the patient characteristics from 815 patients
were found a male predominance of 96.3% versus 3.7% females (p <0.0001). Injury
severity did not differ by gender. Injuries to the upper extremities were most common.
Overall injuries to the chest were most severe, followed by injuries to the head and
the abdomen. A total of 70 patients (8.6%, 70/815) were severely injured. Patients
with injuries to the chest were most likely to suffer from severe injuries followed by
patients with injuries to the abdomen and to the head. Patients suffering from a fall
were significantly more likely to be severely injured. Hospitalization was associated
with machine- and fall-related injuries. Patients with severe injuries were more likely
to be hospitalized. Patients suffering from a fall and patients with severe injury were
more likely to die than others. Table 2 lists the distribution of injury severity amongst
the injury etiologies. Patients suffering from a fall had a larger number of diagnose
than others. Patients suffering from a fall had more severe injuries of the head/ neck
than others, whereas patients with injuries in relation to the use of machines had
more severe injuries to the lower
extremities than others.

64
 Past lifetime pesticide poisoning was reported by 93% of farmers In Tanzania,
Africa. The agents reported as responsible for poisoning were Organophosphates
(42%) and WHO Class II agents (77.6%). Most farmers were involved in cultivation of
vegetables and coffee in Tanzania. The respondents were mostly male (88.4%) and
age ranged from 18–66 years with an average age of 37.5 years. Most farmers had
less than 7 years of education (88%). Approximately 93% of respondents reported
previous poisoning by pesticides in their lifetimes (past year inclusive) with frequency
ranging from 1 to a maximum of 7 times; 76.4% of the poisoned respondents
reported two or more poisonings and 63.5% reported 3 or more poisonings at some
point in the past. The 112 farmers with past APP reported approximately 432 past
poisonings in total. Actions taken after poisoning (not mutually exclusive) included
drinking milk (25%), attending a health facility (21%), consulting a pharmacist (13%),
applying cream to the affected area (6%), and washing the affected part of body
(3%). However, most respondents (60%) reported taking no action following the
poisoning. Of 23 farmers who reported attending health facility for poisoning in the
past year, there were no records of their poisoning in health facility records for 18
cases. Overall, of farmers who claimed to have experienced a previous poisoning,
95.9% did not appear in health facility surveillance records.

The active ingredients most commonly reported by farmers as associated with

poisoning were Mancozeb (80%), Profenofos (72%), Chlorpyrifos (48%), Endosulfan
(35%), Lambda Cyhalothrin (5%) and Cypermethrin (5%). Of the agents involved in
reported poisonings, 42.4% were OP and 77.6% were moderately toxic products
(WHO Class II). Among the products reported (n = 494) as handled by the farmers,
26% were OP pesticides, and 49% were WHO class II products (Table 3). Lifetime

65
Poisoning signs and symptoms reported as experienced by the farmers are listed in
Table 4. There were 875 symptoms associated with the 432 past poisonings reported
by the 112 farmers.

A wide variety of types of PPE was reported by farmers. The PPE most often
used were gumboots (38.3%). Other reported PPE included long coats (n = 8),
hats/helmets (n = 8), hand gloves (n = 6), overalls (n = 6), respirators (n = 6) and
facemasks (n = 3). Most farmers (66.9%) reported no PPE use at all. Of 40 farmers
(33.1%) reporting PPE use, the number of different PPE items used ranged from 1 to
6. However, the quality and condition of the PPE were poor. Over 60% of the 117
PPE types reported among the 40 users were damaged or extremely contaminated
when inspected. Most (4 out of 6) respirators reportedly used by the farmers were
actually disposable dust masks unsuitable as PPE to prevent inhalation of pesticide
droplets.

Associations between frequency of past poisoning and high symptom

reporting There were marginally significant associations between high poisoning and:
(i) washing spraying equipment close to water sources; and (ii) unsafe pesticide
disposal practices. There was also a significant inverse association between high
poisoning with storage of pesticides in living house. There were marginally significant
associations between reporting high number of symptoms (over 10 poisoning
symptoms) and a number of risk behavior : (i) failure to use PPE; (ii) failure to

66
practice equipment calibration; (iii) equipment wash area; (iv) equipment storage
area; (v) pesticide storage area; and (vi) age

In Indonesia, There are 31 occupational diseases, recognized by Indonesian

law, as caused by work or working conditions and the work environment. These are:

1. Pneumoconiosis (pneumokoniosis) caused by mineral dust forming scar tissue

(silicosis, antrakosilikosis, asbestosis) and silicotuberculosis(silikotuberkolosis)
where in silicosis (silikosis) was the main factor causing dissability and death.
2. Lung and bronchial disease (bronkhopulmoner) caused by hard metal dust.
3. Lung and bronchial disease (bronkhopulmoner) caused by cotton dust, vlas,
henep and sisal (bissinosis).
4. Asthma caused by work that caused by over exposure to substances at work.
5. Alveolitis allergika caused by external factors such the inhalation of organic dust.
6. Disease caused by beryllium (berilium) or its toxic compounds.

67
7. Disease caused by cadmium (kadmium) or its toxic compounds.
8. Disease caused by phosphorus (fosfor) or its toxic compounds.
9. Disease caused by chromium (krom) or its toxic compounds.
10. Disease caused by manganese (mangan) or its toxic compounds.
11. Disease caused by arsenic (arsen) or its toxic compounds.
12. Disease caused by mercury (raksa) or its toxic compounds.
13. Disease caused by lead (timbal) or its toxic compounds.
14. Disease caused by fluor or its toxic compounds.
15. Disease caused by carbon disulfide (karbon disulfide) toxic.
16. Disease caused by halogen derivatives (derivat halogen) from aliphatic
hydrocarbon hidrokarbon alifatik) or aromaticsc(aromatik) toxic compounds.
17. Disease caused by benzene (benzena) or homologous toxic substances.
18. Disease caused by derivatives of nitrogen (derivat nitro) and amina from benzene
or homologous toxic compounds
19. Disease caused by nitroglycerin (nitrogliserin) or nitric acid esters(ester nitrat
acid).
20. Disease caused by alcohol, glycol or ketone (alkohol, glikol or keton).
21. Disease caused by gas or vapor causing asphyxia (asfiksia) or poisoning by
carbon monoxide (karbon monoksida), hidrogensianida, hydrogen sulphide
(hydrogen sulfida), or derivatives that are poisonous, such as zinc, brass and
nickel ammonia (amoniak seng, braso and nikel).
22. Auditory abnormalities caused by noise.
23. Disease or injury caused by mechanical vibration (muscle disorder, gout, bone
joints, blood vessels or the edge nervous).
24. Disease or injury caused by working in pressurized air.
25. Disease or injury caused by electro magnetic radiation and ionize radiation.
26. Skin disease (dermatosis) due to physical, chemical or biological causes.
27. Skin cancer epitelioma primer caused by ter, pic (chemical names), bitumen,
mineral oil, antrasena or its compounds or its products or the residue of those
substances.
28. Lung cancer or mesothelioma caused by asbestos (asbes).
29. Infection caused by virus, bacteria or parasites in working environments with
special risks.
30. Diseases caused by high or low temperature or radiation or high air humidity.
31. Diseases caused by the other chemical subtances includemedicines.

68
DISCUSSION
Various sources of potential domestic and occupational pesticide exposure were
noted during the survey. Firstly, the frequent storage of pesticides in homes indicated
a high potential for exposure of farmers and family members due to storage in highly
accessible places. Moreover, some of the products found stored within homes
included moderately hazardous WHO Class II products such Chlorpyrifos, Profenofos
and Endosulfan. Endosulfan is an organochlorine pesticide banned in many countries
for health and environmental concerns and has been included in the list of POPs
scheduled for elimination.

Storage of pesticides in unguarded sites in residences is common in many

developing countries. The prevalence of unguarded domestic storage was higher in
this study (68%) compared to a previous Tanzanian study (43%), probably because
respondents in this study were not informed in advance of the researcher’s visit, so
had no time to rearrange the stored products before the visit. Even so, the true
prevalence of pesticide storage within households may have been slightly higher
than reported given that the prevalence was higher (89.4%) in observed households
compared to those where only farmer self-report was available (68.8%). However,
agreement between observation and selfreport in observed houses was generally
high (77%) and the positive predictive value of self-reported indoor storage was 80%,
suggesting that underreporting of household storage was not substantial and there
was probably good validity for the self-report measure.

Secondly, failure to use PPE appeared to be another problem generating potential for
significant pesticide exposure. This is supported by the finding of a significant
association between high poisoning symptoms and nonusage of PPE. Non-use of
PPE might be caused by unavailability or high cost of PPE. The use of dust masks,
which are relatively cheap, may suggest that farmers’ choices of PPE were
influenced by considerations of minimizing costs. Similar findings about non usage of
PPE amongst farmers have been reported in studies conducted in northern Greece
and India and is often reported in other developing countries. For example, Clark and
colleagues reported that, in the tropics, use of PPE is poorly tolerated because of
discomfort associated with hot and humid conditions and prohibitive costs.

However, even when PPE was used, their protective role was limited in this study.
For example, the most commonly reported PPE were gumboots, which were

69
completely inadequate as sole protection. Also, the fact that farmers who reported
use of respirators as protection were, on observation, mostly using disposable dust
masks, which are not effective protection when spraying toxic pesticides, may
paradoxically increase risk because the users mistakenly believe they are protected
and so may not follow other safety precautions. Farmers who reported using
respirators were not able to distinguish between a respirator and dust mask,
highlighting the importance of measuring not only the presence but also the proper
and appropriate use of PPE.Two implications arise from these findings. Firstly, if
studies do not examine the appropriateness of PPE used, the literature may over-
report use of PPE. Secondly, had PPE use in this study been more appropriate, the
association between failure to use PPE and symptoms may have been even stronger
than that found in the study.

However, it is important to recognise that PPE too often it becomes a substitute for
more important and sustainable safety measures, consistent with good occupational
health and safety practice. For example, Integrated Pest Management (IPM), safer
application methods and use of less toxic agents or mechanical barriers to pests are
important ways to reduce reliance on, and, hence, human exposure to pesticides in
agriculture. There is a hierarchy of controls in occupational health in terms of which
PPE should never be the first and only strategy. Further, it is important to
acknowledge that PPE usage may be a proxy for safer practices in general. Farmers
who use PPE may be more likely to practice better hygiene when handling
pesticides, so the direct effect of PPE use may be difficult to establish from cross-
sectional data. Longitudinal rather than crosssectional studies would be better suited
to testing this hypothesis.

CONCLUSION
Injuries in agriculture are accompanied by substantial morbidity and mortality,
and range from minor injuries to severe multiple injuries. The injuries of the body of
farmers consist of injury in hand, arms, legs, thighs, and feet. Agricultural illnesses
have serious effect in farmer’s organ such as lung, skin and etcetera.

REFERENCES
1. Pickett W, Hartling L, Dimich-Ward H, Guernsey JR, Hagel L, Voaklander DC,
et al. Surveillance of hospitalized farm injuries in Canada. Injury prevention:

70
 journal of the International Society for Child and Adolescent Injury Prevention.
2001;7(2):123–8. Epub 2001/06/29.
2. Rautiainen RH, Lehtola MM, Day LM, Schonstein E, Suutarinen J, Salminen
S, et al. Interventions for preventing injuries in the agricultural industry.
Cochrane database of systematic reviews (Online). 2008(1):CD006398. Epub
2008/02/07.

3. Kachan D, Fleming LE, LeBlanc WG, Goodman E, Arheart KL, Caban-

Martinez AJ, et al. Worker populations at risk for work-related injuries across
the life course. Am J Ind Med. 2012;55(4):361–6. Epub 2011/12/

4. Lilley R, Day L, Koehncke N, Dosman J, Hagel L, William P. The relationship

between fatigue-related factors and work-related injuries in the Saskatchewan
Farm Injury Cohort Study. Am J Ind Med.2012;55(4):367–75. Epub
2012/01/04.

5. Carmen A. Pfortmuellera, Daniel Kradolferb, Mirco Kunzc, Beat Lehmannb,

Gregor Lindnera, Aristomenis K. Exadaktylosb. Injuries in agriculture – injury
severity and mortality. Swiss Med Wkly. 2013;143:w13846.

6. Elikana E Lekei, Aiwerasia V Ngowi and Leslie London. Farmers' knowledge,

practices and injuries associated with pesticide exposure in rural farming
villages in Tanzania. BMC Public Health 2014, 14:389.

7. Irfani TH. The Prevalence Of Occupational Injuries And Illnesses In Asean:

Comparison Between Indonesia And Thailand. Public Health of Indonesia.
2015 September;1(1): 19-29

71
The Effects Of Pesticide Exposure On Respiratory Health In The Farm Worker :
A Review
Khrisnayu Indraswari, Ida Srisurani Wiji Astuti
Medical Faculty, Jember University; dr.rani82@yahoo.com

Abstact

Background: Non-protective work practices followed by farm workers during

spraying of pesticides to protect. Objective : This article aims to review the effect of
pesticide exposure on respiratory health in the farm workers. Methods: A cross
sectional study for respiratory health related to farm worker pesticide exposure and
using a preliminary questionnaire specifically designed for this study. Other journal
was using 82 workers employed in processing pesticides and in 60 control workers
not exposed to irritants and employed in a soft drink bottling plant.Results:
Prevalence of respiratory problems among study subjects which was found to be
36.75% which was highly significant as compared to controls (3.89%); respiratory
problems like dry cough , dyspnoea were found to be significantly more among
pesticide sprayers as compared to controls. Using chi square shows statistical
significance for increasing prevalence of respiratory illness observed with increasing
pesticide exposure. Conclusion: It is very necessary to monitor health risks among
farm workers to prevent pesticide exposure regularly and make awareness
programme with implementation of proper legislations for safe methods of spraying
pesticides, so the adverse health effects among farm workers could be minimized
and urge all farmers to wear PPE to avoid exposure to pesticides.
Keyword : respiratory health, farm worker, pesticide exposure

INTRODUCTION
Pesticides are one of chemical substances using for the destruction of
environmental and make disadvantage for people. Pesticides contain many
substances that are actually harmful. The generic term “pesticides” covers over 1000
various chemical substances, and they have been increasingly used on plants and
livestock since the 1950s. There are three main categories of pesticide and their
numerous chemical groups, they are insecticides, herbicides, fungicides. There are
also other categories based on target organisms, such as nematicides, acaricides,
rodenticides and fumigants.1
It is about 45% of pesticide use in the USA occurs in agriculture. In Europe,
although international efforts to promote the sustainable use of pesticides in
agriculture and reduction to use pesticides in several countries, overall pesticide use
did not decline substantially in theWHO European Region during the period of 1990s.
In developing nations, there are so many pesticides that contains more toxic are used
72
extensively, creating significant acute health problems and also local environmental
contamination.2,8
In agriculture, most pesticides enter through body dermally, followed by
respiratory and oral routes. Respiratory symptoms have been reported in association
with pesticide exposures include wheezing, airway irritation, dry/sore throat, cough,
breathlessness and chest tightness. It can disturb with work and when people have
asthma should avoid exposure that may trigger asthma. In the United States, recent
reports based on surveys conducted and Sweden suggest that work-related asthma
is a problem among farm workers. 3, 4,10
Actually using Personal Protective Equipments (PPE) like safety masks, gloves etc.
is very important for farm worker the during the aerial spraying of pesticides resulting
in the entry of pesticides in the blood stream via respiratory tract through inhalation
which can adversely affect respiratory system. The health effects of pesticide
inhalation without PPE have been documented in a number of epidemiologic studies
5,7,9
reporting higher risk of respiratory symptoms
In this review article, we critically reviewed some journals to explain the
evidence available to date about the relationships between the effects of pesticide
exposure on respiratory health in the farm workers.

METHOD

Using a cross sectional study for respiratory health related to farm pesticide exposure
and using basis of the results of a preliminary questionnaire specifically designed for
this study. Other journal was using 82 workers employed in processing pesticides
and in 60 control workers not exposed to irritants and employed in a soft drink
bottling plant. Using chi square shows statistical significance for increasing
prevalence of respiratory illness observed with increasing pesticide exposure.

RESULT AND DISCUSSION

73
 Table 3 shows various respiratory problems dry cough, productive cough,
dyspnoea, wheezing, irritation of throat, blood stained sputum, observed among
pesticide sprayers and control subjects stratified by smoking habits. Prevalence of
overall respiratory problems among study subjects which was found to be 36.75%
which was highly significant as compared to controls (3.89%). Prevalence of overall
respiratory problems among study subjects which was found to be 36.75% which was
highly significant (p,0.01) as compared to controls (3.89%), respiratory problems like
dry cough, dyspnoea were found to be significantly more among pesticide sprayers
as compared to controls. No cases among control group were observed for
productive cough, wheezing, irritation of throat and blood stained sputum. 5
Table 5 shows exposure wise distribution of respiratory illness among pesticide

Source : Fareed,2013

Source : Fareed,2013
sprayers which illustrates that exposure time elevates the respiratory problems
among pesticide sprayers.

74
 Source : Zuskin,2008
Pesticide exposure was taken into consideration as product of number of years and
number of hours; number of hours are the average hours of spraying pesticides per
week throughout the year, and according to which 4 groups were established,
namely ,11, 11–50, 51–100, 101 and above. It was seen that the group having most
time of pesticide exposure exhibited most prevalence of respiratory problems. Chi
square value for linear trial was found to be 5.09 and p-value was found to be 0.02
which shows statistical significance for increasing trend in prevalence of respiratory
illness observed with increasing pesticide exposure5.The prevalences of acute
symptoms during the work shift in pesticide workers are presented in Table 3.Large
numbers of workers complained of these acute symptoms and differences between
men and women are noted. 6
Farmworkers was spraying pesticide did not used any precautionary measures
while spraying of pesticides. It could make the incidence of respiratory distress.
During spraying, these workers woreminimum clothes, i.e. only underwear and not
even vests. So, there was not protected the body from substances that contain in the
pesticide, such as aerosol. In the present study, respiratory symptoms like dry cough,
productive cough, wheezing, irritation of throat and blood stained sputum were found
5
to be significantly more among pesticide sprayers.

CONCLUSION
Unawareness of the hazardous health effects of pesticides among farm
workers, they followed incorrect work practices without taking PPE and precautionary
measures of handling and spraying pesticides, which eventually resulted in exposure
of pesticides among them. Actually, it is very necessary to monitor health risks
associated with pesticide exposure regularly among farm workers and make
awareness programme with implementation of proper legislations for safe methods of
spraying pesticides, so the adverse health effects among farm workers could be
minimized. And have shown that exposure to toxins in the pesticide processing
industry can result in measurable changes in symptoms and lung function. Preventive
75
measures should include worker safety and education programs, medical
surveillance for early identification of affected workers and screening for sensitive
individuals. Further studies should particularly focus on pesticide exposure
assessment and specific pesticide identification so that all farm worker know the
effect of pesticide exposure.

REFERENCES
1. Mamame, Ali, Isabelle Baldi, Jean François Tessier2, Chantal Raherison,
Ghislaine.2012 Occupational exposure to pesticides and respiratory health.
France. EVR

2. Damalas, C, Spyridon D, Koutroubas. 2015. Editorial Farms’ Exposure to

Pesticides: Toxicity Types and Ways of Prevention. Greece: Department of
Agricultural Development, Democritus University of Thrace.

3. Mazurek JM, Schleiff PL.2010. Physician recognition of work related asthma

among US farm operators. Fam Med 42(6):408–413.

4. Rask-Andersen, A. 2010. Asthma increase among farms: a 12-year follow-up.

Upsala J Med Sci:1–12 doi:10.3109/03009734.2010.503287

5. Fareed, M. 2013. Adverse Respiratory Health and Hematological Alterations

among Agricultural Workers Occupationally Exposed to Organophosphate
Pesticides: A Cross- Sectional Study in North India. India : Indian Institute of
Toxicology Research (CSIR-IITR).

6. Zuskin, Eugenja. 2008. Respiratory Function in Pesticide Workers. American

College of Occupational and Environmental Medicine.

7. Henneberger, P. 2014. Exacerbation of symptoms in farm pesticide applicators

with asthma. USA: Springer-Verlag Berlin Heidelberg.

8. Hernandez AF, Parron T, Alarcon R.2011. Pesticides and asthma. Curr Opin
Allergy Clin Immunol 11(2):90–96.

9. Bouvier. 2014. Occupational exposure to pesticides and respiratory health.Review

Occupational Exposure. France.

10. Ye, ming, Jeremy Beach , Jonathan W. Martin 3, Ambikaipakan Senthilselvan.

2013. Occupational Pesticide Exposures and Respiratory Heal. International
Journal of Environmental Research and Public Health.

76
 PREVALENCE AND RISK FACTORS ASSOCIATED WITH ENTAMOEBA
HISTOLYTICA TO INDUCE DIARRHEA AMONG FARMER AND MINER: A
REVIEW
Adhang Isdyarsa, Ida Srisuryani Wiji Astuti
Medical Faculty, Jember University; dr.rani82@yahoo.com

Abstract

Background: Due to the agricultural disease that rising prevalence in development

country. Amoebiasis like diarrhea is the common problem which Entamoeba
histolytica as the main causative. Especialy for poeple who live as farmer and miner.
The study were focus in Nigeria, Vietnam, Malaysia, and India which are in tropical
climate and agricultural environment. The main subjects of their research are the
family of farmer, miner, and student in that 2 environment. Material & Methods: All
the study use cross-sectional methode, which taken from primary data like
questionnaire and stool analyze. But there are 2 different methods for statistic
analyze Chi-square using SPSS and STATA that using Microsoft Acces database
which not make significant differential. Result: Stool sampling in each country tell
different result, India only 23,4% positive, Vietnam had 25% positive, Malaysia
showed Negrito had the highest prevalence 29,5%, and Nigeria had 26,7% positive
infection of E. Histolytica. Conclusion: The most common factors of infection were
self hygiene and healthy lifestyle. But in this 4 journal the result slightly different in
the same profession as farmer in India and Vietnam, Malaysia. The most significant
risk factor are soil borne which had high humidity level and water disposal from rice
field irigation.

Keywords: Entamoeba histolytica, diarrhea, risk factors.

INTRODUCTION

Amoebiasis is a condition due to the infection by the protozoan parasite

Entamoeba histolytica. The disease is still considered a major public health problem
in developing countries of the world. It is recorded that 450 million persons are
infected every year, with an incidence of 50 million, and 100,000 death tolls Method 1.
Amoebiasis is widespread in its distribution, occurring in all parts of the world. The
invasive amoebiasis is more prevalent in certain areas of the world including West
and South-East Africa, China, the whole South-East Asia, Mexico and western
portions of South America, and the India subcontinent. Poor environmental
sanitation, personal hygiene and overcrowding as well as ignorance are some of the
major factors that influence the high incidence and prevalence of E. histolytica in
these regions2.
In Hanoi about 80 percent of vegetable production is from urban and peri-urban
areas irrigated with diluted wastewater3. The use of household sewage, and human

77
and animal excreta in agriculture and aquaculture has a long tradition in Vietnam 4.
Despite the potential health risk for intestinal disease of using excreta and animal
waste in agriculture5, 85% of farmers in northern provinces of Vietnam regularly use
human excreta in agriculture6. A study in Hanoi, Vietnam, on the epidemiology and
aetiology of diarrhoeal diseases in adults engaged in wastewater-fed agriculture and
aquaculture has showed that the diarrhoeagenic Escherichia coli and E. histolytica
were the most common pathogens7,8.
In India, the term amoebiasis depicts a condition of harboring protozoa E.
histolytica with or without clinical manifestation. Symptomatic disease usually occurs
in 10% of infected individuals9. India is a mosaic of myriad geographical, socio-
cultural & political distribution. Disease distribution, its determinants are also varying
in nature, leading to differential intervention need in the same country. They report a
detailed analysis of the prevalence of amoebiasis in a rural community of West
Bengal including some socio-economic and socio-demograpic correlates10.
In Malaysia, food and water-borne diseases which are closely associated with
environmental and personal hygiene practices are still among the major health
problems especially among Orang Asli communities; Malaysian aborigines
comprising 0.6% of the total population. The prevalence of E. histolytica/E. dispar/E.
moshkovskii in Malaysia ranges from 1% to 61%11. To the best of our knowledge,
there is a paucity of available documented data describing the prevalence and risk
factors for E. histolytica/E. dispar/E. moshkovskii in the Proto-Malay and Negrito that
can be used for comparison with Senoi ethnic group 12.
In Nigeria, amoebiasis is prevalent and widespread13. There have been several
reports from various parts of Nigeria14,15,16, which recognized them as important
health problems especially among young children. Several epidemiological studies
have indicated a high prevalence of intestinal parasitic infections among Nigerian
children2.

MATERIAL AND METHOD

The data analyzed in different way for each study. In Nigeria they just tell that
the data obtained were analyzed using Chi- Square statistics. And then in Bengal
India they used by Epi-info statistical software, version 3.2, June 2008 and data
2,10
presentation (map) was done by Map Window GIS, open source 4.6.602. . The
study in Vietnam Data was double-entered in a Microsoft Access database and

78
validated. Analysis was performed using STATA version 10.1 (StataCorp, College
Station, TX, USA).Variables related to personal hygiene behaviour were highly
intercorrelated. Therefore, we included only one variable (hand washing with soap) in
the multivariable model to avoid collinearity18. For the third regio Data was entered in
a Microsoft Access and was cross-checked by the technical staff in order to ensure
that data were entered correctly. Statistical analysis was performed using the SPSS
version 20 (SPSS, Chicago, IL, USA). A Chi-squares test twice was used to test the
associations between the variables. The level of statistical significance was set as
P<0.05.

RESULT

The researcher in Vietnam identified and enrolled 46 cases and 138 controls.
Thirty-one cases (67.4%) were found in Nhat Tan and 15 cases (32.6%) in Hoang
Tay commune. The results of the univariable and multivariable conditional logistic
regression analysis are presented in Table 2, respectively.

Source: Duc, 2011

And then in Bengal India, in table 2 they specifically tried to find out the
important determinants of amoebiasis in the community as major parasitic load was
due to E. histolytica/E. dispar infestation. Majority of the affected persons were
asymptomatic (52.10%). Like previous finding, infestation was highest among those
who complained of suffering from ‘frequent amoebiasis’ (44.12%). It was lowest in
asymptomatic group (13.75%), followed by complaint of abdominal discomfort
(19.20%). This finding was statistically significant and it reveals awareness of the
community for amoebiasis.

79
 Source: Samanta, 2011

Table 4 shows in Malaysia the results from the logistic regression analysis
between E. histolytica/E. dispar/E. moshkovskii infection and risk factors, taking into
account the random effect of households. The data confirmed not washing hands
after playing with soil or gardening and the presence of other family members
infected with E. histolytica/E. dispar/E. moshkovskii as significant risk factors in all
ethnic groups. It also further confirmed that eating with hands (OR = 3.65; 95% CI =
1.08, 12.34; P = 0.037), consuming raw vegetables (OR =2.46; 95% CI = 1.08, 5.62;
P = 0.032), and close contact with domestic animals (OR= 3.71; 95% CI = 1.31,
10.52; P = 0.014) were significant risk factors of E. histolytica/E. dispar/E.
moshkovskii infection among the Senois.

80
 Source: Anuar, 2012
The last study in Nigeria indicated that the prevalence of amoebiasis among
school age children in Lafia is 26.7%. Thirty two (32) of the 120 stool samples
examined were positive. The highest prevalence (40.0%) was observed in GSS
Tudun Kauri while SJCA had the least prevalence rate (16.7%).

Source: Rine, 2013

Conclusion
The conclusion made by researcher in Vietnam said their study documents that
agricultural practice in which human and animal excreta and household waste water
are used as fertiliser and for irrigation are not relevant for the transmission of E.
histolytica. It confirms that in these settings other transmission routes such as
contaminated hand are of importance and provides further arguments that basic
personal hygiene measures such as hand washing with soap must be further
promoted. And in the Bengal India the result reiterates the need for organized efforts
for improvement of basic sanitation needs in the area to curb the parasitic
morbidities.
But in Malaysia the study showed high prevalence of E. histolytica/E. dispar/E.
moshkovskii in Orang Asli communities with the highest prevalence was observed
among Negrito ethnic group. Poor personal hygiene practices such as not washing
hands after playing with soil or gardening and before eating and eating raw
81
vegetables and close contact with domestic animals were the risk factors of E.
histolytica/E. dispar/E. moshkovskii infection

REFERENCES
1. Nokes, C. and Bundy, D.A.P. 1994. Does helminth infection affect mental
processing and educational achievement?Parasitol. Today. Vol. 10(14-8)

2. Rine, R.C., Manasseh, K., and Suleiman, H.C. 2013. Prevalence of Intestinal
Amoebiasis in School Age Children in Lafia, Nasarawa State, Nigeria.
International Research Journal of Biological Sciences. Vol. 2(7).

3. Lai, T. 2002. Perspectives of peri-urban vegetable production in Hanoi.

International Potato Center (CIP), Lima, Peru.

4. Shuval, H.I., Adin, A., Fattal, B., Rawitz, E., and Yekutiel, P. 1986. Wastewater
irrigation in developing countries: Health effects and technical solutions. World
Bank Technical Paper Number 51 The International Bank for Reconstruction
and Development/The World Bank.

5. WHO. 2006. Guidelines for the safe use of wastewater, excreta and greywater.
Excreta and Greywater use in agriculture Geneva, Switzerland. World Health
Organization. Vol.4.

6. Phuc, P.D, Konradsen, F., Phuong, P.T., Cam, P.D., and Dalsgaard, A.2006.
Practice of using human excreta as fertilizer and implications for health in
Nghean Province, Vietnam. Southeast Asian J Trop Med Public Health. Vol.
37(222-229).

7. Do, T.T., Bui, T.T., Molbak, K., Phung, D.C., and Dalsgaard, A.2007.
Epidemiology and aetiology of diarrhoeal diseases in adults engaged in
wastewater-fed agriculture and aquaculture in Hanoi, Vietnam. Trop Med Int
Health. Vol. 12(23-33).

8. Hien, B.T.T., Trang, D.T., Schuetz, F., Cam, P.D., Molbak, K., and Dalsgaard,
A. 2007. Diarrhoeagenic Escherichia coli and other causes of childhood
diarrhoea: a case-control study in children living in a wastewater-use area in
Hanoi, Vietnam. Journal of Medical Microbiology. Vol. 56 (1086-1096).

9. Park, J.E. 2009. Park’s textbook of Preventive & Social Medi-cine. Jabalpur.
Vol.20th.

10. Samanta, S., Mehra, S., Maiti, T.K., Ghosh, P., and Ghosh, S.K. 2011. A
Community Based Epidemiological Study on Intestinal Amoebiasis in Rural
West Bengal, India. Asian Journal of Medical Science.Vol. 2 (164-168).

11. Tengku, S.A., Norhayati, M. 2011. Public health and clinical importance of
amoebiasis in Malaysia: A Review. Trop Biomed. Vol 28 (194–222).

82
12. Anuar, T.S., Al-Mekhlafi, H.M., Ghani, M.K.A, Osman, E., Yasin, A.M., Nordin,
A., Azreen, S.N., Salleh, F.M., Ghazali, N., Bernadus, M., and Moktar, N. 2012.
Prevalence and Risk Factors Associated with Entamoeba histolytica/ dispar/
moshkovskii Infection among Three Orang Asli Ethnic Groups in Malaysia. Plos
One. Vol. 7 (10).

13. Ajero, C.M., Nwoko, B.E.B., Nwoke, E.A. and Ukaga, C.N. 2008. Human
Amoebiasis: Distribution and Burden; and the Nigerian Environment. Intl Sci.
Res.Vol. 1(130 – 134).

14. Adeyeba, O.A. and Akinlabi, A. 2002. Intestinal parasitic infections among
school children in a rural community, southwest Nigeria. Nig J. Parasitol. Vol. 23
(11-18).

15. Ogbe, G.E. and Isichei, M. 2002. Intestinal helminth infection in primary school
children in areas of operation of Shell Petroleum Development Company of
Nigeria (SPDC), Western Division in Delta State. Nig. J. Parasitol. Vol. 23 (3-
10).

16. Ukpai, O.M. and Ugwu, C. 2003. The prevalence of gastrointestinal tract
parasites in primary school children Ikwuano Local Government Area of Abia
State, Nigeria. Nig. J. Parasitol. Vol. 24 (129-136).

17. Agbolade, O.M., Akinboye, D., and Awolaja, A. 2004. Intestinal helminthiasis
and urinary schistosomiasis in some villages of Ijebu North, Ogun State,
Nigeria. Afr. J. Biotech. Vol. 3 (206- 209).

18. Duc, P.P., Viet, H.N., Hattendorf, J., Zinsstag, J., Cam, P.D., and Odermat, P.
2011. Risk Factors for Entamoeba histolityca infection in an Agricultural
Communitu in Hanam Province, Vietnam. Biomed Central. Vol. 4 (102).

83
 A REVIEW ARTICLES: RISK FACTORS FOR SCABIES

Alief Ilman Zaelany. Ida Sri Surani Wiji Astuti.

Medical Faculty, Jember University, dr.rani82@yahoo.com

Abstract

Background: Scabies is a global problem and it’s also one of the most common skin
disorders in children. Its main symptom was itch that can become severe at night.
Scabies has a different epidemiological distribution among different communities
worldwide due to some factors. Transmission of scabies is usually due to direct or
indirect contact. Delay in diagnosis may result in the spread of the scabies mite.
Several studies have highlighted to find Scabies risk factors. Materials and
Methods: A review article of journals and papers that was searched using Google
Scholar and PubMed. Than reviewer selected some journals and paper that
considered to be related with this topic. This review use 4 journals and 1 paper. Four
of them focusing on finding the risk factors for scabies, and 1 journal is finding the
most related factor with hygiene in patient with scabies. Result: Personal hygiene
and sharing towel, clothes, bed and other equipment either contaminated or not were
mentioned in 3 studies because scabies has a strong contagious capacity. Two of
five studies mentioned overcrowding (population’s density), poor economic condition,
and environment as the risk factors of scabies. Family history, education, existence
of livestock or rodent, seasonal condition, and move to contaminated area, were
mentioned once on each studies. Conclusion: there were many risk factors for
scabies, and it can be really different between one to another person, and the most
frequent risk factors are personal hygiene and sharing towel, clothes, bed, and other
equipment.

Keywords: scabies, risk factor, itch.

INTRODUCTION
Scabies is an infection which has occur for long time and yet so many people
still infected. It is caused by the mite Sarcoptes scabiesi. Scabies occur worldwide
and its prevalence is estimated to be about 300 million cases yearly1. The classic
manifestation of scabies include generalized itching which often becomes worse at
night, and abnormal skin lesions (papules, pustules, nodules, and occasionally
urticarial)2. The skin lesion are often noted on finger webs, on the flexor surfaces of
the wrist, on the elbows, in the axillae, and on the buttocks and genitalia. Although
the primary approach for diagnosis of scabies is focusing clinical symptoms, but its
diagnosing is based on the identification of mites extracted from lesions by scraping
with a scalpel and microscopic assessment3. The disease may be spread from
objects, but easily transmitted by direct skin-to-skin contact, with a higher risk with
prolonged intimate contact such as sexual contact. This disease also common in

84
healthcare practitioner due to frequent contact with potential carriers. In previously
unexposed healthy individual, the interval between exposure and the onset of itching
is usually 4-6 weeks. In persons who have previously had scabies, re-exposure may
produce symptoms in 48 hours or less due to allergic symptoms are persists for
many days even after eradication of parasites4. The action of mites moving itch
which may resemble an allergic reaction in appearance. There is usually a two to six
weeks incubation period between infestation and presentation of symptoms and prior
exposure of scabies the incubation period in likely to be much shorter as little as 1 to
4 days5. There were already many research according to this topic. That researches
are concerning to find risk factors for scabies. Because of that we need to make a
conclusion from that researches to find the most related risk factor for scabies.

METHODS
Any language literature especially English language literature search was
conducted using Google scholar and PubMed. The search terms were broken into
three categories. Group 1 related to scabies, group 2 related to the risk factor of
scabies, and group 3 related to a review article about scabies risk factor. From that
search writer found many documents. Than writer doing some filtering process to
choose some of documents that are most related to this topic. Than writer choose 5
article, four of them are journals and the other one is a paper. Some documents that
using army as the subject was excluded, because writer more concern to the risk
factors of scabies in general.

RESULT
The result from each document were different and also some document
mentioning same point. For the first journal the research was using 52 scabies
patients and also selected 104 non scabies control patients, and having result as
shown in table 1.

85
 Table 1

The 2nd journal was using 283 diagnosed case of scabies that were selected through
non-probability purposive sampling according to pre-defined inclusion and exclusion
criteria. And the result of the study shows high frequency of scabies in patients. They
found that poor economic conditions, bad hygienic practices, overcrowding and
unhygienic living conditions, scarcity of water, sharing for towels and clothing
materials associated with higher frequency of scabies.
For the research paper, study was using 900 subjects that were analyzed for
scabies, that’s divided into two groups, rural area and urban area. The result was
shown at table 2.

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 Table 2

For the 3rd journal was using 49 sample. This research was done to analyze the
factors which affect the hygiene of scabies patients. The last journal was using
3,625,966 subjects that are covered by the studied provinces, and the result of this
studies was shown at table 3.

87
 Table 3

DISCUSSION
From the 1st journal showing that to prevent scabies, proper management of the
nursing home setting, including adequate cleaning of the contaminated clothing,
bedding and equipment, in combination with treating all suspected scabies patients,
and contact isolation are important and necessary2. From the result of 2nd journal
shows that poor economic conditions, bad hygienic practices, overcrowding and
unhygienic living conditions, scarcity of water, sharing for towels and clothing
materials associated with higher frequency of scabies5.

88
In the 3rd journal that the sample was divided into two group, showing result for the
west region of Iran especially Kermanshah province faced with high prevalence and
this high disease burden can be determined by some potential factors such as
residency in rural areas, family history of scabies, lower educational level, household
density, lower monthly income, low personal hygiene, the existence of livestock or
rodents at home, seasonal conditions, and movement to contaminated areas3. At
last for the research paper, it is clearly shown that personal hygiene plays important
role in development of scabies4.
That made personal hygiene and sharing towel, clothes, bed and other equipment
either contaminated or not were mentioned in 3 studies because scabies has a
strong contagious capacity. Two of five studies mentioned overcrowding
(population’s density), poor economic condition, and environment as the risk factors
of scabies. Family history, education, existence of livestock or rodent, seasonal
condition, and move to contaminated area, were mentioned once on each studies.

CONCLUSION
There were many risk factors for scabies, and it can be really different between one
to another person, and the most frequent risk factors are personal hygiene and
sharing towel, clothes, bed, and other equipment. Education really needed to
eradicate this disease because it really contagious.

ACKNOWLEDGEMENT
The authors are really grateful to anyone that supporting and doing any assistance.

REFERENCES
1. Chosidow, O. (2006) Clinical Practice. Scabies. The New England Journal
Medicine, 354, 1718-27

2. Wang CH, Lee SC. Huang SS, Kao YC, See LC, Yang SH. (2011) Risk Factors
for Scabies in Taiwan

3. Nazari Mansour, Azizi Aziz. (2014) Epidemiological Pattern of Scabies and Its
Social Determinant Factors in West of Iran

4. Rathore Praaveen, Saxena Praveer. (2013) Prevalence & Risk Factors for
Scabies among OPD Population of Tertiary Care Hospital

89
5. Zeba Nudrat, Shaikh DM, Memon KN, Khoharo HK. (2014) Scabies in Relation to
Hygiene and Other Factors in Patients Visiting Liaquat University Hospital, Sindh,
Pakistan

6. Sriwinarti Ika, (2015) Faktor-faktor yang Berhubungan dengan Higienitas Pasien

Skabies di Puskesmas Panti Tahun 2014

90
 ROLE OF ANCHOVY (Stolephorus sp) IN APPOSITION PROCESS IN TENSION
AREA OF ORTHODONTIC TOOTH MOVEMENT
Tecky Indriana

Faculty of Dentistry, Jember University, Indonesia

Corresponding Address: Faculty of Dentistry, Jember University, Jalan Kalimantan
37, Jember, Indonesia.
Email: tecky_indriana@ymail.com

Background: Relapse still occurs in around 61.5% of post orthodontic treatment.

One cause of relapse is less optimum apposition process in tension area. Therefore,
material that can speed up the apposition process is required. One alternative
material is anchovy (Stolephorus sp), as a source of calcium and protein.
Objective: to analyze the role of anchovy (Stolephorus sp) in apposition process in
tension area of orthodontic tooth movement.
Materials and Methods: In this laboratory animal study, we randomly divided 36 rats
into six groups of six rats each. Control group (K) received orthodontic mechanical
stress, observed on days 7 (K1), 14 (K2), and 21 (K3); treatment group (P) received
orthodontic mechanical stress, added with anchovy (Stolephorus sp) in a dose of
0.0168 g/day/g BW rats, observed on days 7 (P1), 14 (P2), and 21 (P3). On day 8
groups (K1, P1), day 15 groups (K2, P2), and day 22 group (K3, P3) were sacrificed.
Maxillary bone was taken for measurement of woven bone through HE staining.
ANOVA and Tukey's HSD statistical tests were used for data analysis.
Results: Mean woven bone in group (P) on day 14 showed a significant increase
(p<0.05) compared that on day 7, but there was no significant increase (p>0.05) on
day 21. The group (K) on day 14 showed no significant increase (p> 0.05) compared
to day 7, but on day 21 it showed significant increase (p<0.05).
Conclusion: Delivery of anchovy (Stolephorus sp) may enhance apposition process
by the formation of woven bone on day 14.

Keywords: anchovy (Stolephorus sp), apposition, woven bone

BACKGROUND

Orthodontic treatment is aimed to remove dental malocclusions that the teeth remain
[1]
in the appropriate arch . The end of the orthodontic treatment requires a retention
tool that aims to maintain the results of the dental care so as not to relapse. So far,
relapse is anticipated by providing retention device, called the retainer, for a certain
duration which still takes around 6-12 months. Basically retention preventing relapse,
or in other words, to prevent tooth malocclusion back to the starting malocclusive
[2]
position . Studies showed that in 200 cases of malocclusion relapse is found in
61.5% post-retention, so it can be said that relapse is a long-term problems and long-
[3]
term follow-up for the dentist and the patient .Orthodontic treatments always use
mechanical forces to move teeth. Orthodontic strength results in changes of once
alveolar bone and cell function. These changes include remodeling process, the

91
bone formation on the tension side (apposition) and bone resorption on the pressure
[4]
side, so that the teeth will move to the new position . Relapse occurs because
apposition process in tension area has not been optimum.
Bones require sufficient nutrient and minerals intake to meet the needs of
nutrients and minerals as well as adeqaute collagen formation for regeneration and
proper functioning. The most dominant mineral found in bones and teeth is calcium,
[5,6]
whose content is approximately 99% . One alternative to meet the needs of bone
calcium is by eating anchovies, because the anchovy (Stolephorus sp) has a mineral
[7]
content, protein and vitamins which is thought to stimulate apposition process in
tension area of orthodontic tooth movement.
The purpose of this study was to analyze the role of anchovy (Stolephorus sp) in
apposition process in tension area of orthodontic tooth movement.

MATERIALS AND METHODS

The study used post-test only control group design using experimental animals male
Wistar rats (Rattus norvegicus L), ±2 months old with body weight 250 ± 50 g.
Sample size in each study group was s 6 mice. Samples were divided into six
groups, comprising three control groups and three treatment groups by random
sampling method. A total of 36 male Wistar rats (Rattus norvegicus L) were divided
into two groups randomly, the control groups (K), which was then divided into three
groups randomly (K1, K2, K3), and then the treatment groups (P) which were also
divided into three groups randomly (P1, P2, P3). Before the treatment, first of all the
experimetnal animals in control and treatment groups were injected with anesthetic
ketamine hydrochloride 50 mg/kg intraperitoneally for easy installation of NiTi closed
coil spring (Ormco, Orange, USA) as mechanical stressor fastened between first
maxilar permanent teeth and maxillary central incicive teeth using 0:01 inch stainless
steel wire ligature (3M Unitek, Monrovia, CA, USA) and were fixed with FUJI type I
(3M Unitek, Monrovia, CA, USA).

Rats in control groups (K) were given with orthodontic mechanical stress and
standard fed as well as sterile distilled water ad libitum and cmc with sonde, and
observed for 7 days (K1), 14 days (K2) and 21 days (K3). Rats in treatment groups
(P) were given with mechanical pressure and extra feed of anchovy (Stolephorus sp)
at a dose of 0.0168 g/day/g BW rats with stomach sonde, standard feed and
sterilized distilled water ad libitum and observed for 7 days (P1), 14 days (P2) and 21

92
days (P3). On day 8, 15 and 22 all male Wistar white rats (Rattus norvegicus L) were
sacrificed by anesthesia via intraperitoneal injection of ketamine hydrochloride in
lethal doses. Further, we carried out incision and retrieval of maxillary bone for
preparation of periodontal tissue examination for the measurement of woven bone
using hematoxyllin eosin staining (HE).

RESULTS

Table 1. Mean and standard deviations of woven bone area and comparative test
results between studied groups on days 7, 14 and 21

Woven bone area (µm)

Groups n 7 days 14 days 21 days p

K 6 1.068±0.085a.a 1.178±0.053a.a 1.355±0.102a.b 0.000*

P 6 1.332±0.085b.a 1.646±0.182b.b 1.733±0.169b.b 0.001*
p 0.003* 0.000* 0.000*
Notes: * difference is present between groups
abc
:same superscript indicates difference between groups

Normality test of Kolmogorov-Smirnov on woven bone area in groups K and P

showed normal distribution (p> 0.05). Homogeneity test using Levene's test showed
woven bone area between the groups revealed homogeneous variance (P> 0.05),
while testing between studied groups with ANOVA showed significant difference (P
<0.05) between control and treatment groups. Tukey HSD comparative test showed
mean woven bone area in control groups had insignificant n increase (p>0.05) on day
14 compared to that on day 7, but there was significant increase (p<0.05) than that
on day 21. Treatment groups showed significant increase (p>0.05) on day 14
compared to day 7, but no significant increase (p> 0.05) was found on day 21
compared to day 14.

93
Figure 1. Comparison of woven bone area in control and treatment groups on days 7,
14, 21

Figure 2. HE examination showed the width woven bone area in each group
(magnification 200x)
DISCUSSION

The results of study on days 7,14 and 21 showed that mean woven bone area
in treatment groups was significantly higher than that in control groups. Based on
studied groups, woven bone in control groups showed no significant increase on day
14 compared to day 7, but increased significantly compared to that on day 21. In
treatment group significant increase was found on day 14 compared to day 7, but
there was a significant increase on day 21 compared to day 14. This proved that
anchovy administration can enhance apposition process by the formation of woven

94
bone on day 14 in tension area of orthodontic tooth movement, whereas in control
group increased formation of the woven bone occurs on day 21.
Anchovy (Stolephorus sp), which contains proteins, minerals and vitamins as
nutrients, can stimulate the formation of new bone (woven bone) in tension area of
orthodontic movement. Each content of the anchovy (Stolephorus sp) is digested by
the digestive system and deposited in bones. Calcium found in anchovy given with
gastric sonde to the rats in treatment group was absorbed from the intestine into
extracellular fluid. Approximately 30-80% of the calcium is absorbed and the
remainder is excreted through the feces. Absorption occurs within the intestinal
lumen especially in the upper intestine. Calcium absorption in the intestine occurs by
active transport and few absorption takes place by passive diffusion. Active transport
is facilitated by 1,25- dihydroxycholecalciferol, which is a metabolite of vitamin D
formed in the kidneys. Calcium ion absorption from gastrointestinal tract is actively
taken out fom the intestine by a system in epithelial cells' brush border that involves
calcium-dependent ATPase. Absorption through passive diffusion occurs when
calcium ions enter high levels of 1,25-dihydroxycholecalciferol down because of
increased plasma calcium. As a result, the absorption of calcium were adapted to be
higher when calcium intake is low and decreases if calcium intake is high. Some
calcium from the extracellular fluid will also be secreted into the gastrointestinal tract.
So about 90% the amount of calcium intake will be excreted in the stool . [8].
Calcium ions concentration in extracellular fluid is maintained in a state of
homeostasis. If calcium ions concentration in extracellular fluid decreases, there will
be an increase in calcium absorption in the intestine, reabsorption in the kidneys as
well as the retrieval from the bone, so the calcium ion concentration will be back to
normal. Vice versa, if calcium ion concentration in extracellular fluid increases, there
will be a decrease in calcium absorption in the intestine, reabsorption in the kidney as
[8]
well as a decrease in bone resorption .The calcium in extracellular fluid will be
deposited in the bone during bone formation process. Cells involved in bone
formation are osteoblasts. Osteoblasts secrete collagen molecules (collagen
monomers) and base substance (proteoglycans). Monomer Collagen will polymerize
rapidly to form collagen fibers and the resulting network is osteoid. Within a few days
after the osteoid is formed, calcium salts begin to experience precipitation on the
surface of collagen fibers. Initial deposited calcium salts is an amorphous compound,
a mixture of salt which will undergo substitution process and the addition of atoms, or
[8]
reabsorption and reprecipitation to became hydroxyapatite crystal .

95
 Anchovy also has high protein content. The basic element that constitutes
protein is the amino acid. Amino acid contained much in the anchovy is glycine.
Glycine is the smallest amino acids that can fill the remaining places at the center of
the triple-helix structure of the collagen. Total percentage of amino acid glycine in the
anchovy is not known with certainty. The content of the amino acid glycine in
anchovy may allegedly enhance bone collagen formation process.
The presence of orthodontic mechanical pressure may induce mechano-
transductions that activates ion channel in cell membrane, which furthermore may
stimulate extracellular ATP, which would regulate P2X7 purinergic receptor in
ostoblasts as well as in osteoclasts. [9] Then, calcium derived from anchovy
(Stolephorus sp) will bind to P2X7 in osteoblasts so that there will be a process of
bone formation by osteoblasts, whereas in osteoclasts calcium binding with P2X7
may cause apoptosis of the osteoclasts.

CONCLUSION
The administration of anchovy (Stolephorus sp) may accelerate apposition the
process in tension area of orthodontic tooth movement by woven bone formation on
day 14. Without anchovy (Stolephorus sp) administration, woven bone formation
acceleration occurs on day 21.

REFERENCES

1. Profit WR, and Fields, HW., 2000. Contemporary Orthodontics, ed.3. Mosby,
Philladelpia, . 145-294

2. Shawesh M., Bhatti B., Usmani T., Mandall N. 2010. Hawley retainers full-ot part
time? A randomized clinical trial. Eur J Orthod. 32 : 165-70

3. Shebani A., Valaci N., Vasooghi M., Noorbakhsh M., 2010. Incidence of relaps in
orthodontic treatment and related factors. Journal of Research in Dental
Sciences 7 (2) : 32-41

4. Cronau M, Ihlow D, Meesenburg K, Fanghanel J, Dathe H, Nageri H. (2006).

Biomechanical featurs Of The Periodontium : an Experimental Pilot study In Vivo.
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5. Pal Aukrust, Charlotte.JH, Thor Ueland, Egil lien, Fredrik Muller, Terje
Espevik,Jens Bollerslev and Stig S.F ,1999., Decreased bone formative and
enhanced resoptive markers in human immnuodeficiency virus infection :
indication of normalization of the bone remodeling process during higly active
antiretroviral therapy. Journal of Clinical endocrinology and metabolism. 84: 145-
150

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6. Burr, D.B. 2002. Bone Material Properties and Mineral Matrix Contributions to
fracture Risk or Age in Women and Men. J.Musculoskeletal Neuron Interact,
Vol.2 : 201-204

7. Saanin, H. 1984. Taksonomi dan Kunci Identifikasi Ikan Jilid I. Binacipta,

Bandung.

8. Guyton & Hall ,2006. Textbook of Medical Physiology. 11th Ed., Elsevier
Saunders, Philadelphia, Pennsylvania. 1152 pgs

9. Dixon S.J, Sims S,M., 2000. P2 purinergic receptors on osteoblasts and

osteoclasts. Potential target for drug development. Drug Development Research.
49: 187-200

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