HUBUNGAN KEMATIAN DIFTERI PADA ANAK DENGAN STATUS IMUNISASI DI PROPINSI JAWA TIMUR

Diphtheria is an acute bacterial infection caused by Corynebacterium diphtheria, producing exotoxin which affecting upper respiratory tract such as tonsils,pharynx,larynx or nasal mucosa and characterized by thick membranes. Infection of diphtheria can caused fatality for human. Diphtheria cases in East Java have been increasing from 5 cases in 2003 to becomes 415 cases in 2011 and they have been spreading from 3 districts/cities in 2003 to becomes 36 districts/cities in 2011. The research method was a case-control.Population were children with diphtheria who died and recovered at hospital since 2007-2012. 74 children were enrolled consisted of 37 cases and 37 controls. Girls were 45 children (60.8%) and boys were 29(39.2%).More than half children were � 6 years old 46(62.2%) and 28 children(37.8%) were > 6 years old. There were 46 children (62.2%) were not immunized and 28 children (37.8%) were immunized. More than half, 45 children(60.8%) had a good nutritional status and 29 children(39,2%) were malnutrition. Socio-economic,38 parents(51.4%) had low incomes and 36 parents (48.6%) had high incomes. Parental education,57 parents(77%) were poorly educated and 17(23%) were higher education. Management of cases, 72 cases(97.3%), were appropriate with the guidelines and 2 cases(2.7%) did not appropriate. Bivariate analysis showed that children were not immunized had significantly higher risk of death due to diphtheria (OR=4.265,95%CI 1.545-11.771,p= 0.004). Malnutrition has a 11,8 times greater risk compared to good nutrition (OR=11.815,95%CI 3.707- 37.663,p=0.001). Low parental education had a 4,4 times greater risk than higher education (OR=4.469,95% CI 1.296-15.409,p=0.013). The result of multivariate analysis showed that children were not immunized had a risk 3.5 times greater than those immunized to have mortality caused by diphtheria (OR=3.591,95% CI1.118- 11.538, p=0.032). Malnutrition had a 10.6 times greater risk compared to good nutrition (OR = 10.694, 95% CI 3.222-35.494, p =0.001). There was a significant association between immunization and nutritional status with mortality due to diphtheria