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JOURNAL READINGEffect of Vitamin A on
Severity of Acute Diarrhea in Children
Pembimbing:
dr. H Suryono Wibowo, Sp.ACLINICAL STAGE PEDIATRI
JAKARTA ISLAMIC HOSPITAL, CEMPAKA PUTIH
Oleh :Hanna Anggitya
2010730138
Latar Belakang
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Diare adalah penyebab terbesar kematian di Indonesia;
Effect of vitamin A on severity of acute diarrhea in children*
Objektif
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Menemukan efektivitas Vitamin A dalam mengurangi diare akut berat pada anak-anak
Effect of vitamin A on severity of acute diarrhea in children*
Beberapa penelitian telah menunjukkan adanya efektivitas antara vitamin A dengan diare, tetapi masih belum terdapat kesimpulan.
Defisiensi Vit. A adalah penyebab akibat terjadinya diare;
Vit. A adalah vitamin anti-infeksi
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Effect of vitamin A on severity of acute diarrhea in children*
Latar Belakang; Penelitian
Effect of vitamin A on severity of acute diarrhea in children*
Metodologi
Penelitian
Pengambilan SampelPopulasi Penelitian
Anak-anak usia 6 bln-5 thn dengan diare akut di Puskesmas Hinai Kiri, Secanggang district, Langkat Regency, North Sumatera -Agustus 2009-Januari 2010
Consecutive sampling methode , melalui Anamnesis, PF, & pengisian kuesioner.
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
*Kriteria InklusiAnak usia 6 bulan sampai 5 tahun dengan diare akut
*Kriteria EkslusiAnak dengan dehidrai berat, kolera, malnutrisi,
Ensefalitis, Meningitis, Sepsis, BP, dan TBC; Anak yang konsumsi vit A selama 4 bulan; Anak yang menderita morbili 6 minggu terakhir; Anak dengan def. Vitamin A berat
Metodologi
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Effect of vitamin A on severity of acute diarrhea in children*
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Jumlah sampel
129 sample
Uji Statistik:- Independent T test : Vit. A (nominal) dengan
frekuensi, volume, dan durasi (numerik);- Chi square: vit. A dengan konsistensi;
P value 0,05 CI 95%
Metodologi
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
129 children with diarrhea
Enrolled in the study(n = 120)
9 excluded :5 had severe malnutrition2 had severe dehydration2 had parents refused to paticipate
Vitamin A group (n = 60) Placebo group (n = 60)
Final analysis (n=60) Final analysis (n= 60)
Vit A: 6-11 bln/BB ≤10 kg: 100.000
IU ≥12 bln/BB>10 kg : 200.000
IU
Penilaian : 1.Frekuensi diare;2.Konsistensi feses;3.Volume feses setiap kali
diare
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Characteristics Vitamins A
Group(n=60)
Placebo Group(n=60)
Mean age (SD), months 21.9 (13.48) 26.2 (10.91)
Sex, n (%)
Male 32 (53.3) 30 (50.0)
Female 28 (46.7) 30 (50.0)
Mean BW/BH* (SD) 95.2 (1.67) 97.2 (2.03)
Mean diarrheal frequency (SD), times/day
5.1 (1.86) Sama 5.1 (1.32)
Stool consistency, n (%)
Liquid 54 (90.0) 52 (86.7)
Soft 6 (10.0) 8 (13.3)
Mean stool volume (SD), mL/episode 73.5 (28.92) 78.0 (24.82)
Mean diarrheal duration (SD), hours 22.9 (12.74) 29.3 (16.18)
Dehydration status, n (%)
No dehydration 41 (68.3) 42 (70.0)
Mild-moderate 19 (31.7) 18 (30.0)
* BW : body weight ; BH: body height
HASIL
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Stoolconsistency
Vitamin A group n=60
Placebo groupN=60
P valueDef
(-)*n(%)
Liquidn(%)
Soft n(%)
Normal n(%)
Def (-)*n(%)
Liquidn(%)
Soft n(%)
Normal n(%)
Day 1 045
(75.0)14
(23.3)1 (1.6) 0
52 (86.7)
8 (13.3)
0 0.117
Day II 1(1.7)16
(26.6)36
(60.0)7
(11.7)0
46 (76.6)
14 (23.4)
0 0.001
Day III8
(13.4)0
20 (33.3)
32 (53.3)
1 (1.6)17
(28.4)42
(70.0)0 0.001
Day IV27
(45.0)0 5 (8.3)
28 (46.6)
4 (6.7) 1 (1.6)50
(83.3)5 (8.3) 0.007
Day V 41
(68.3)0 0
19 (31.7)
26 (43.3)
019
(31.7)15
(25.0)0.001
*def.(-) = no defecation
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Duration of diarrhea
Vitamin A mean (SD)
Placebo mean (SD)
95% CI Of difference
P Value
Duration between treatment until recovered
84.0 (19.51)
117.2 (21.68) -40.60; -25.79 0.001
Duration between intial symptomps of diarrhea until recovered
106.9 (27.73)
146.5 (32.30) -40.70; -29.46 0.001
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
4x/day
2,5x/day
1,5x/day
1x/day
4x/day
3,5x/day
3x/day
2x/day
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Lebih tinggivolumenya Pada kel. placebo
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Pada penelitian ini:
VADDIARE
DISKUSI
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
1.Steatorrhea menghilangkan vitamin yang larut dalam lemak;
2. Merusak brush border intestinal sehingga mencegah fungsi retinyl esterase yang berkontibusi terhadap absorpsi vitamin A
Defisiensi Vit. A akibat Diare
Diare akibat Def. Vitamin A
1.VAD dapat merusak epitel usus, dapat menimbulkan pengurangan sekresi mukus, dan melemahkan pertahanan lokal terhadap infeksi;
2. Menyebabkan deplesi sel goblet, abnormalitas struktur vilus, dan atrofi vilus sehingga mengakibatkan gangguan pada fungsi imun humoral dan selular.
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
1. Penelitian hanya dilakukan berdasarkan
anamnesa kepada orang tua atau nanny,
tidak dilakukan dengan observasi
langsung;
2. Tidak dilakukan pemeriksaan lebih lanjut
untuk mengetahui etiologi dari diare;
3. Penelitian juga tidak menilai faktor
predisposisi dari diare, seperti tingkat
pendidikan ibu, kebersihan air atau
kondisi lingkungan.
KETERBATASAN PENELITIAN
Effect of vitamin A on severity of acute diarrhea in children*
*sumber: Original Article. Pediatrica Indonesiana. Marlisye marpaung, dkk. Effect of vitamin A on severity of acute diarrhea in children, okt 2014*
Pemberian vitamin A dapat mempercepat
kesembuhan dari konsistensi feses , frekuensi, dan
durasi diare;
Suplementasi vitamin A efektif dalam mengurangi
diare akut yang berat pada anak usia <5 tahun.
KESIMPULAN