1 ABSTRAK
Multidrugs Resistant Tuberculosis merupakan masalah terbesar terhadap pencegahan dan pemberantasan TB dunia. Untuk Indonesia, TB MDR berada di urutan ke 9 dari 27 negara dengan kasus TB MDR terbanyak. Kasus TB MDR diperkirakan sebesar 1,8% dari kasus baru dan 17% dari kasus dengan pengobatan ulang. Sejak tahun 2012 RSUP H.Adam Malik telah menjadi rumah sakit rujukan TB MDR dan telah mengobati 52 orang pasien yang berasal dari berbagai kabupaten/kota yang ada Di Provinsi Sumatera Utara. Penelitian ini bertujuan untuk mengetahui faktor-faktor yang memengaruhi terjadinya TB MDR di Provinsi Sumatera Utara Tahun 2013.
Jenis penelitian ini adalah kajian analitis dengan rancangan studi kasus kontrol. Populasi kasus sebanyak 52 orang dan populasi kontrol sebanyak 82 orang. Jumlah sampel sebanyak 44 kasus dan 44 kontrol. Sampel diambil menggunakan teknik purposive sampling. Analisis data secara univariat, bivariat dan multivariat menggunakan uji regresi logistik berganda.
Hasil analisis bivariat menunjukkan variabel pendidikan (p = 0,01, OR= 3,13, 95% CI: 1,30 – 7,56), pengetahuan (p = 0,01, OR = 3,13, 95% CI: 1,30 – 7,56), sikap (p = 0,01, OR = 3,28 95% CI: 1,33 – 8,10, efek samping obat (p = 0,00, OR = 7,60, 95% CI: 2,67 – 21,62), pengawas menelan obat (p = 0,01), OR = 3,40, 95% CI: 1,35 – 8,53), keterlambatan diagnosis (p = 0,01, OR = 6,50, 95% CI: 2,45 – 17,2), perilaku petugas kesehatan (p = 0,01, OR = 5,80, 95% CI: 2,30 – 14,61)., jarak ke fasilitas pelayanan kesehatan (p = 0,01, OR = 3,13, 95% CI: 1,30 – 7,56), pendapatan (p = 0,01, OR = 6,92, (95% CI: 2,10 – 22,77), ketersediaan OAT ( p = 0,03, OR = 2,77, 95% CI: 1,17 – 6,59). dan ketidakteraturan berobat (p = 0,01, OR = 5,80 (95% CI: 2,30 – 14,6), berpengaruh terhadap kejadian TB MDR dan variabel yang tidak berpengaruh adalah pekerjaan (p = 0,83) dan kualitas obat (p = 0,08). Hasil analisis multivariat variabel yang berpengaruh signifikan terhadap kejadian TB MDR adalah ketidakteraturan berobat (p : 0,01 , OR = 13,29,95% CI: 3,10 – 56,92).
Diharapkan kepada Dinas Kesehatan Provinsi Sumatera Utara agar dapat mensosialisasikan faktor risiko TB MDR dan memperkuat pengobatan lini pertama dengan strategi DOTS. RSUP H.Adam Malik melakukan pembinaan tentang program TB strategi DOTS dan program PMDT. Kepada masyarakat diharapkan datang ke fasyankes membawa orang-orang yang dicurigai menderita TB.
Kata Kunci : TB MDR, Faktor Instrinsik, Faktor Ekstrinsik
2
ABSTRACT
Multidrugs Resistant Tuberculosis (MDR-TB) is the biggest problem in preventing and eradicating TB in the world. For indonesia, MDR-TB is at the 9th (ninth) position of the 27 countries with the most MDR-TB cases. It is predicted that 1.8% of the MDR-TB was of the new case and 17% was of the re-treatment cases. H.Adam Malik General Hospital has been a referral hospital for MDR-TB since 2012 and has treated 52 patients from various districts/cities in the Province of Sumatera Utara. The purpose of this study was to find out the factors influencing the incident of MDR-TB in Province of Sumatera Utara in 2013.
The population of this analytical study with case-control design was 52 persons for case group and 82 persons for control group. The samples for this study was 44 patients for case group and 44 patients for control group selected from through purposive sampling technique. The data obtained were analyzed through univariate analysis, bivariate analysis and multivariate analysis using multiple logistic regression tests.
The result of multivariate analysis showed that the variable that had significant influence on the incident of MDR-TB was knowledge (p = 0.01, OR = 3.13; 95% CI: 1.30 – 7.56), delay in diagnosis (p = 0.01, OR = 6.50; 95% CI: 2.45 – 17.2), distance to health service facility (p = 0.01, OR = 3.13; 95% CI: 1.30 – 7.56) the irregular treatment (p = 0.01, OR = 13.29; 95% CI: 3.10 – 56.92) and the variable which had the most dominant influence on the incidence of MDR-TB was the irregular treatment (p = 0.01, OR = 13.29; 95% CI: 3.10 – 56.92).
The management of Sumatera Utara Provincial Health Service is expected to be able to socialize the risk factor of MDR-TB and to strengthen the first-line treatment with DOTS strategy. The management of H. Adam Malik General Hospital should provide guidance on TB program, DOTS strategy, and PMDT program. The community members are expected to come to the health service facility bringing those who are suspected to be suffering from TB.
Keywords : MDR-TB, Instrinsic Factor, Extrinsic Factor
