The Impact of Soil Transmitted Helminth (Sth) Towards Anemia Case in Elementary School Student in the District of Northwest Sumba

Background: Anemia is a condition where body is having less eritrosit. Worms is an infectious sickness caused by worms’ parasite that endanger health. Worms sickness that usually infects and gives very bad affect is worms infection transmitted through soil or usually called “Soil Transmited Helmintes (STH).” In directly STH could affects supply and absorption and food metabolism to human body. Cumulatively, STH caused disadvantages like decreasing in calori and protein and loss of blood. This research aims to analysis impact factors of The Infection of Soil Transmitted Helminth (STH) towards. Subjek and Method: This is a quantitative research with cross sectional study design. This research is done in the District of Northwest Sumba, East Nusa Tenggara Province. Subject of this research is elementary schoold students with number of sampels are 105 students chosen by using Multistage Random Sampling Technique. Independent Variabel is the Infektion of Soil Transmitted Helminth and dependent variabel is Anemia. Data collecting technique is by checking the faeces using direct method and by checking capiler blood using strip test method, continued by interviewing using quisionaire and analyzed using simple Logistic Regresion. Result: Number of Infektion of Soil Transmitted Helminth (STH) cases in elementary school students in the District of Northwest Sumba is 40%. Worms’ egg found majority are Ascaris lumbricoides and Trichuris trichiura (38.1%), in a single infection was found Ascaris lumbricoides (31%) and Trichuris trichiura (21%), and the minority worms found were Hookworm Ancylostoma duodenale (2.4%). Number of anemia cases in Elementary School students is 57.1%. Statictic examination test shows that the infection of Soil Transmitted Helminth (STH) positively and significantly affects the anemia cases with (OR= 27,3; 95% CI = 13,1-57,0; p = 0.001). Conclusion: The probability of infection of Soil Transmitted Helminth (STH) positively and significantly affects the anemia cases in Elementary School Students.


Introduction
Anemia is a condition where a human body suffers lack of eritrosit. Anemia could happen due to less haemoglobin which means less oxygen throughout the body. When oxygen is less then that person will feel weak. This sickness' indication could be known through the checking of lower eyelid, hands' and feet's nail tip and mouth mucous. According to WHO a person could be diagnosed with anemia when haemoglobin content in men's < 13 g/dl, children aged 12-13 and women not pregnant < 12 g/dl, children aged 6 months to 5 years and pregnant women < 11 g/dl. Children aged 5-11 years < 11.5 g/dl. (Departemen Kesehatan Republik Indonesia, 2006) Kasuma's research result (2016) prevalence of anemia in Elementary School Students in SDN Oetona Kupang City shows 56.2%, according to gents, anemia cases are more in boys (60.3%) and girls 39.7%. This result goes hand in hand with the result from Aryani in Local Government Clinic in Bajarakan II, where anemia prevalence in Elementary School Students is 51.8% and it happens more in boys (55.2%). (Departemen Kesehatan Republik Indonesia. 2007) Research of Sirajudin, cs (2015) with majority participants are male students and students aged 10-11 years shows that anemia cases are prominent in students with worms (51.6%) that students without worms (27.6%). (Depkes, 2010) Worms is an infectious sickness caused by worms' parasites that endangers health. Worms sickness that usually infects and gives very bad affect is worms infection transmitted through soil or usually called Soil Transmited Helmintes (STH). Regarding STH, people still find it unimportant, since it can't cause death. Although in reality the impact of STH can cause health decreament even death. (Direktorat Jenderal & PL Kemenkes, 2013) Worms mainly found in territory with high humidity especially in society with bad personal hygiene and environment's sanitation. Kinds of worms that dangerous are roundworms (Ascaris lumbricoides), hookworm (Ancylostoma duodenale and Necutor americanus) and Trichuris trichiura. (Kartini, 2016) STH's infection can give a grave impact on health both directly and indirectly. Directly, STH could affects supply and absorption and food metabolism to human body. Cumulatively, STH caused disadvantages like decreasing in calori and protein and lost of blood. Besides, decreasing nutritious, STH can impede physical growth, intelligence, working productivity, and decrease body's immunity which makes body is susceptible to disease and other infections. (Kartini, 2016) According to data of WHO worms cases in the world are still high where 1 billion people are infected by Ascaris lumbricoides, 795 million are infected by Trichuris trihiura and 740 million are infected by Hookworm. (Mardiana, 2014) While In 2011 data collected through survey done in several Districts/Cities, got various numbers: District of Lebak and Pandeglang has high average that is 62% and 43.78%, in the District of Sleman in Jogjakarta the prevalence is 21,78%, in the District of West Lombok and Mataram City shows the prevalences 29.47% and 24,53%. And the last, in the District of West Sumba, the prevalence is 29.56%. (Kasuma, 2016). According to those data, it means that Indonesia is an endemic region with STH.
In the provionce of NTT itseld, according to the research done by Fridolina Mau in 2017 in the District of West Sumba and Central Sumba, stated that 568 students of Elementary School (91.0%) infected by STH. The highest prevalence is infectious of A. Lumbricoides 28.5%, followed by T. Trichiura 5.9% and mixed infection 65.6% in the district of West Sumba, and in Central Sumba the highest prevalence is A. Lumbricoides 30.0%, followed by T. Trichiura 17.1% and mixed infection 46.8%. (Mau, 2017) Factors that encourage endemic of hookworm is nature factor: tropical weather that supports the growth of worms' eggs and larva. Clay is a kind of soil that suitable for the growth of roundworms and hookworms, while sandy soil is suitable for T. Trichiura. High humidity also supports the growth of worms' eggs. While sunshine and wind could fasten the drying and spread the eggs of T. Trichiura in dust [9]. Another factor is household environment. School children are members of family that still need control in their everyday activity. Regarding health, playing behaviour should be put full attention especially in regards to sanitation condition of household environment. A good household sanitation will surely give safe and comfy for the children to play. In rural society, it is common when children play with their friends' in house yard and garden. In this case, there should be vigilance of possibility for children get in touch with hookworms that in fact needs soil to get multiplied. (Sumanto, 2010) Infection can happen to all age, whether it is to babies, children, or even adults. Most of infection cases happen to school chidren because in that age there are many contacts with soil. (Syahrir & Sukfitrianty dan, 2016)

Subject and Method
This research uses analytical research with quantitative approach by using cross sectional study design. This research is done in Government and Privat Elementary School in 3 subdistricts in the District of Northwest Sumba.

Discussion
Worms is an infectious sickness caused by worms' parasites that endangers health. Worms sickness that usually infects and gives very bad affect is worms infection transmitted through soil or usually called Soil Transmited gjhs.ccsenet.org Global Journal of Health Science Vol. 11, No. 5;2019 Helmintes (STH). Regarding STH, people still find it unimportant, since it can't cause death. Although in reality the impact of STH can cause health decreament even death (Depkes, 2010).

This research result shows that 40% of Elementary School Children in the District of Nortwest Sumba infected by
Soil Transmitted Helminth (STH). This is different from the research done by Mau (2017) (2017), the highest prevalence is infection of A. Lumbricoides 28.5%, followed by T. Trichiura 5.9%. (Mau, 2017). The difference of STH's infections numbers between district of Northwest Sumba, West Sumba, and Central Sumba are caused by school children in Nortwest Sumba are regularly get anti-helminth medicine from Central Government Clinic, although still some are infected with it. Other factor that affect high number of STH's infection is lack of personal hygiene such as not using footwear when doing outdoor activities, not washing hands and feet after direct concat with soil, the habits of playing with mud, finger nails not regularly cut and direct contact with friends that makes worms' eggs easily move.
Anemia is a condition where a human body suffers lack of eritrosit. Anemia could happen due to less haemoglobin which means less oxygen throughout the body. When oxygen is less then that person will feel weak. This sickness' indication could be known through the checking of lower eyelid, hands' and feet's nail tip and mouth mucous. According to WHO a person could be diagnosed with anemia when haemoglobin content in men's < 13 g/dl, children aged 12-13 and women not pregnant < 12 g/dl, children aged 6 months to 5 years and pregnant women < 11 g/dl. Children aged 5-11 years < 11.5 g/dl. (Departemen Kesehatan Republik Indonesia, 2006) This research's result shows that 57.1% of Elementary School children in the district of Northwest Sumba are infected with anemia. This result is almost similar with research done by Kasuma (2016) about prevalence of anemia in Elementary School Children in SDN Oetona Kupang City that showed 56.2%. (Departemen Kesehatan Republik Indonesia, 2007) This can be caused by various factors, among which eating and sleeping pattern, kinds of food consumed, and other sickness that triggers anemia. According to Sarjuddin S (2015), the habit of eating breakfast and food consumed significantly affected to anemia cases. (Depkes, 2010) Worms is an infectious sickness caused by worms' parasites that endangers health. Worms sickness that usually infects and gives very bad affect is worms infection transmitted through soil or usually called Soil Transmited Helmintes (STH). Regarding STH, people still find it unimportant, since it can't cause death. Although in reality the impact of STH can cause health decreament even death (Depkes, 2010

Research's Ethic
Explain to parents and school children and ask parents' agreement on taking specimen of faeces and blood. Guarantee the privacy and anonymity.

Appreciation
Researchers' gratitude is for the Director of Health Polytechnic of Health Ministry in Kupang, the Government of Northwest Sumba District, and scool children's parents whoo gave their full support in this research.

Recommendation
To reduce number of anemia cases in elementary school children in Northwest Sumba, it is suggested to Regional Government through the Department of Health so that in can be proceeded by givinganti-Hermith medication massively at least once in 6 months to elementary school children dan keep the promotion of health regularly in schools about STH effect to anemia in children.