From the results of the study obtained the frequency distribution of the characteristics of respondents as listed in table 1. In general, all people potentially infected with malaria. The difference in malaria prevalence according to sex and age was related to the level of immunity and variation in susceptibility to mosquito bites [17] Based on sex, it was found that there were more male respondents at 51.5%.
Table 1 Demography of respondent characteristics
Characteristics
|
Frequency (n)
|
Percentage (%)
|
Sex
|
|
|
Male
|
35
|
51.5%
|
Female
|
33
|
48.5%
|
Age (Years)
|
|
|
17-25
|
25
|
36.8%
|
26-45
|
33
|
48.5%
|
>45
|
10
|
14.7%
|
Level of education
|
|
|
Low (elemntary-junior high school)
|
50
|
73.5%
|
High (senior high school)
|
18
|
26.5%
|
Jobs
|
|
|
Student
|
10
|
14.7%
|
Housewife
|
18
|
26.5%
|
Fisherman
|
15
|
22.1%
|
Trader
|
12
|
17.6%
|
Others
|
8
|
11.8%
|
Unemployed
|
5
|
7.4%
|
History
|
|
|
Once
|
15
|
22.1%
|
More than onces
|
53
|
77.9%
|
Adherences level
|
|
|
Low
|
38
|
55.9%
|
High
|
30
|
44.1%
|
Total
|
68
|
100%
|
Based on age, it was found that respondents aged 26-45 years had the most amount which was 48.5%. This happens because this age was a productive age, where a person usually worked outside the home so it was more susceptible to Anopheles mosquito bites. Busyness due to this activity also made respondents less concerned about the prevention of mosquito bites that should be done. This result was in accordance with [18] that 87.65% of malaria patients were from the adult age group.
Based on the level of education, it was found that there were more respondents with lower levels of education, amounting to 73.5%. This was because the level of education was affect a person in understanding information or knowledge [19]. The low level of education was related to the low awareness to seek and receive information about efforts that can be made to prevent malaria. These results were in accordance with [20] which stated that 68.6% of malaria sufferers have a low level of education.
Based on work, it was found that most respondents were housewives at 26.5%. This was because many people in the work area of the Hanura Community Health Center operate inside the house but did not close the door of the house due to the hot air, so that mosquitoes could enter the house and caused malaria infection. Malaria patients 44% were housewives [21]. Most respondents other than housewives were fishermen and fish traders who operated in the coastal area at night until early morning, making it possible to be exposed to Anopheles mosquito bites at that time. This was consistent with the results of the study [22].
Based on the history of malaria, it was found that the majority of respondents had a history of malaria more than once, amounting to 77.9%. This was because the working area of the Hanura Health Center was an endemic area with a high parasitic density so that recurrent malaria infections often occur. Infections that occur were not only vivax malaria, but also Falciparum malaria, ovale malaria and mixed malaria to severe malaria. The high cases in the region due to natural conditions that supported mosquito breeding places such as forests, lagoons and abandoned ponds
Based on the level of medication adherence, it was found that the majority of respondents had a low level of adherence, which was 55.9%.
The distribution of the results of the MMAS-8 questionnaire by respondents can be seen in table 2.
Table 2 Distribution of questionnaire results of MMAS-8
Questions
|
Yes
|
Not
|
|
n
|
%
|
n
|
%
|
|
1. Have you ever forgotten to take medicine?
|
37
|
54,4%
|
31
|
45,6%
|
2. For other reasons. In the past 2 weeks have you ever not taken a medicine?
|
31
|
45,6%
|
37
|
54,4%
|
3. Have you ever reduced or stopped taking medicine without the knowledge of your doctor because you felt the medicine given made your condition worse?
|
12
|
17,6%
|
56
|
82,4%
|
4. Have you ever forgotten to bring medicine in traveling?
|
11
|
16,2%
|
57
|
83,8%
|
5. Are you still taking your medicine yesterday?
|
33
|
48,5%
|
35
|
51,5%
|
6. Do you stop taking treatment when you feel the symptoms have been resolved?
|
16
|
23,5%
|
52
|
76,5%
|
7. Taking medicine every day is an inconvenience for some people. Did you bother having to take medicine every day?
|
11
|
16,2%
|
57
|
83,8%
|
8. How often do you forget to take medicine?
a. Never
b. Once in a while (1 times in a week)
c. Sometimes (2-3 times in a week)
d. Usually (4-6 times in a week)
e. Always (7 times in a week)
|
35
|
51,5%
|
33
|
48,5%
|
a=1
b-e=0
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
Information: n = number of respondents
Based on table 2 it was known that the majority of respondents did not take medication due to forgetfulness (question number 1). So there needs to be an effort from the health center, for example by assigning PMO (supervisors taking medication) from the family to remind them to take medicine according to the specified schedule. Besides that, education can be done to activate an alarm or reminder to take medicine every day.
Respondents at least answered "yes" to questions number 4 and number 7. This was show the high awareness of respondents to carry drugs when traveling during the treatment period. Respondents also did not feel bothered having to take medication every day because of their desire to recover.
The level of adherence to take medication in patients with vivax malaria in the working area of Hanura Health Center was still relatively low as listed in table 1. This was influenced by various factors, including health service system factors, drug factors, health personnel factors, and patient factors (age, education level, occupation and history of malaria infection).
The level of adherence to take medication in patients with vivax malaria by age category can be seen in table 3. In patients with low adherence, the age category of 25-45 years has the greatest proportion of 55.3%. This was because patients in adulthood (25-45 years) were included in the productive age which requires them to work and carry out daily activities. This busyness tends to make patients forget and irregular in undergoing malaria treatment until completion. This was consistent with Farouk's study which states that 62% of patients aged 15-50 years have low levels of adherence [12].
Table 3 Adherence level based on age
Adherence level
|
17-25 years
|
25-45 years
|
>45 years
|
Total
|
n
|
%
|
n
|
%
|
n
|
%
|
n
|
%
|
High
|
12
|
40%
|
12
|
40%
|
6
|
20%
|
30
|
100%
|
Low
|
13
|
34.2%
|
21
|
55,3%
|
4
|
10,5%
|
38
|
100%
|
Total
|
25
|
|
36
|
|
10
|
|
68
|
100%
|
Information :
n = number of respondents
The level of adherence to take medication in patients with vivax malaria based on their level of education can be seen in table 4. In patients with low adherence, the proportion of patients with low education was greater namely 81.6%. This was because education affected all aspects of human life, both thoughts, feelings, and attitudes, including compliance with taking treatment [23].
Table 4 Adherence level based on education level
Adherence level
|
High education
|
Low education
|
Total
|
n
|
%
|
n
|
%
|
n
|
%
|
High
|
11
|
36,7%
|
19
|
63,3%
|
30
|
100%
|
Low
|
7
|
18,4%
|
31
|
81,6%
|
38
|
100%
|
Total
|
18
|
|
50
|
|
68
|
100%
|
Information :
n = number of respondents
The higher the level of education, the easier it would be to receive information from health workers about the importance of malaria treatment until completion and what risks could occur if treatment was not done properly. This was consistent with research by Wuryanto in Banjarnegara which stated that the level of education would influence a person in understanding information or knowledge [13]. This fact seems to be a problem in the working area of the Hanura Community Health Center, because 73.5% of the population was still low educated. Therefore it was necessary to make efforts to improve medication adherence on the part of the Hanura Community Health Center continuously with a simple language and easily understood by all levels of education.
The level of adherence to take medication in patients with vivax malaria based on work can be seen in table 5. In patients with low adherence, the number of patients who work had a greater proportion of 57.9%.
Table 5 Adherence level based on jobs
Adherence level
|
Employe
|
Unemploye
|
Total
|
n
|
%
|
n
|
%
|
n
|
%
|
High
|
23
|
76,7%
|
7
|
23,3%
|
30
|
100%
|
Low
|
22
|
57,9%
|
16
|
42,1%
|
38
|
100%
|
Total
|
45
|
|
23
|
|
68
|
100%
|
Information :
n = number of respondents
This was because the majority of malaria sufferers work as fishermen and fish traders who are active in catching fish and buying and selling fish at night until early morning. This time is in conjunction with the medication schedule that was determined by the Hanura Health Center, at 21:00 at night so patients were tend to forget to take treatment at that time. The results of this study were consistent with Okuboyejo's research which stated that respondents who worked tend to have low treatment adherence [24]. Therefore it was necessary to do education from the Hanura Health Center to carry and continue taking the drug even though working.
The level of adherence to take medication in patients with vivax malaria based on a history of malaria could be seen in table 6.
Table 6 Adherence level based on history of malaria
Adherence level
|
History of malaria >1x
|
History of malaria 1x
|
Total
|
n
|
%
|
n
|
%
|
n
|
%
|
High
|
17
|
56,7%
|
13
|
43,3%
|
30
|
100%
|
Low
|
36
|
94,7%
|
2
|
5,3%
|
38
|
100%
|
Total
|
53
|
|
15
|
|
68
|
100%
|
Information :
n = number of respondents