Tesis

Luaran Status Nutrisi pada Anak Balita dengan Tuberkulosis di Unit Rawat Jalan Rumah Sakit Cipto Mangunkusumo = Nutritional status outcome in children under five years old with tuberculosis at Outpatient Clinic Cipto Mangunkusumo Hospital.

Latar belakang: Malnutrisi merupakan masalah utama di negara berkembang dan menimbulkan banyak implikasi dalam tumbuh kembang anak. Malnutrisi sering dikaitkan dengan berbagai penyakit infeksi, salah satunya adalah TB. Terapi medikamentosa berupa pemberian OAT dan nutrisi adekuat diharapkan dapat meningkatkan status nutrisi. Penelitian spesifik yang mengamati perkembangan luaran status nutrisi pada pasien TB anak belum pernah dilakukan di Indonesia. Tujuan: (1)Mengetahui proporsi status nutrisi awal pasien TB anak dan karakteristiknya (2)Mengetahui perubahan status nutrisi dan perubahan berat badan dengan kesesuaian dosis dan keteraturan minum OAT (3)Mengetahui hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi. Metode: Penelitian kohort retrospektif dilakukan pada 62 anak dengan penyakit TB dan gizi kurang/buruk usia 1 bulan - 5 tahun yang terdiagnosis pertama kali pada 1 Januari 2010 - 31 Desember 2015. Usia, jenis kelamin, tempat tinggal, jenis TB, lama terapi, efek samping, jalur nutrisi, status nutrisi dan berat badan saat awal diagnosis, bulan ke-2,4,6 dinilai dalam penelitian ini. Hasil: Proporsi pasien TB anak dengan gizi kurang adalah 53/62 (85,5%). Sebagian besar subyek berusia 2 tahun, lelaki, bertempat tinggal di DKI Jakarta dan sakit TB paru (42,8%). Seluruh subyek mendapat OAT yang sesuai dan hanya 1 subyek yang minum OAT tidak teratur. Sebanyak 45,2% subyek mendapat terapi OAT selama 6 bulan. Efek samping OAT yang ditemukan adalah neuropati perifer (1 subyek), peningkatan SGOT dan SGPT (1 subyek) dan kolestasis (1 subyek). Proporsi subyek yang mendapat nutrisi enteral adalah 15/62 (24,2%). Sebanyak 56/62 (90,3%) subyek dengan dosis OAT sesuai mengalami perbaikan status nutrisi dan 55/61 (90,1%) subyek yang minum OAT teratur mengalami perbaikan status nutrisi. Peningkatan berat badan sebesar 5% tiap 2 bulan dan 17% setelah 6 bulan terapi OAT terjadi pada 97% subyek. Tidak ada hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi (p = 0,161). Simpulan: Perbaikan status nutrisi terjadi pada 90% subyek. Peningkatan berat badan pada 97% subjek setiap 2 bulan adalah 5% dan 17% pada bulan ke-6 terapi OAT. Tidak terdapat hubungan keteraturan pengobatan OAT dengan perubahan status nutrisi (p = 0,161)
Kata kunci: malnutrisi, tuberkulosis, obat anti tuberkulosis, nutrisi, status nutrisi



Background: Malnutrition is one of the major problems in developing countries and has many implications in growth and development of children. Malnutrition is always associated with many infection diseases, one of them is tuberculosis. Medical management includes antituberculosis therapy and adequate nutrition are indicated to improve nutritional status. There is no specific study regarding this outcome in Indonesian children. Aim: (1)To determine the nutritional status proportion of children with tuberculosis and their characteristics (2)To determine nutritional status outcome and body weight gain associated with adequate dosage and regular antituberculosis therapy (3)To identify correlation between regular antituberculosis therapy and nutritional status outcome. Methods: A retrospective cohort study was performed in 62 children aged 1 month-5 years who have been first diagnosed with tuberculosis from January 2010 to December 2015. Age, sex, lodging, type of tuberculosis, duration of treatment, side effect, nutritional route, nutritional status, body weight at start, 2 , 4 th and 6 th month of antituberculosis therapy were evaluated in this study. Result: The proportion of mild-moderate malnutrition in children with tuberculosis is 53/62 (85.5%). Most of the subjects are 2 years old, male, live in Jakarta and have pulmonary TB (42.8%). All subjects received standard therapy with adequate dosage and only 1 subject did irregular therapy. The duration of treatment is 6 months for 45.2% subjects. The side effects were peripheral neuropathy (1 subject), elevation of transaminase enzymes (1 subject) and cholestasis (1 subject). Subjects received enteral nutrition are 15/62 (24.2%). There are 56/62 (90.3%) subjects with adequate dosage improved nutritional status and 55/61 (90.1%) subjects with regular treatment improved nutritional status after 6 months treatment. Body weight gain in 97% subjects was 5% every 2 months and 17% at the end of the treatment. No correlation between regular antituberculosis therapy and nutritional status outcome (p = 0.161). Conclusion: Nutritional status improvement was found in 90% subjects. Body weight gain in 97% subjects was 5% in every 2 months and 17% after 6 months of treatment. No correlation between regular antituberculosis therapy and nutritional status outcome (p = 0.161).
Keywords: malnutrition, tuberculosis, antituberculosis therapy, nutrition, nutritional status