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RISK FACTORS FOR TUBERCULOSIS IN BOGOR REGENCY
Tuniroh
Master of Public Health Study Program, Faculty of Public Health, Universitas Muhammadiyah Jakarta K.H. Ahmad Dahlan St., Cireundeu, Ciputat South Tangerang, Banten 15419
Email: [email protected]
ABSTRACT
Tuberculosis, or Pulmonary TB, is dangerous if not managed correctly and appropriately. Bogor Regency is one of the regencies in West Java Province with the highest incidence of TB. This study aims to determine the risk factors for TB events in Bogor Regency. This research method is descriptive-analytic with a cross- sectional approach. The sample of this study is the community who went to the public health center in Bogor Regency, as many as 25 TB sufferers. Data were collected using interviews and observations. Then it is quantitatively analyzed. Results: The results showed that 60% of respondents were > 40 years old, 68%
were women, 40% were unemployed, and 68% had low family incomes. Similarly, 56% were exposed to cigarette smoke with environmental factors, and 68% had a family history of TB. While for the home environment, all indicators show substandard values with a 52-68% percentage. 56-64 % of respondents' knowledge and attitude are not good. Conclusion: from the results of the study, I found that the risk factors for TB in Bogor regency are young age, female gender, not working, low income, a dense living environment and home conditions that are not up to standard, close contact of TB patients in their families and have knowledge and attitudes towards TB prevention that are not good. The need to pay attention to TB risk factors to reduce TB cases in Bogor Regency.
Keywords: TB, Pulmonary TB, Bogor Regency, Risk factors for TB
INTRODUCTION
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis. Most of these germs attack the lungs (80%) but can also attack other organs (20%), such as the spine, brain, and lymph nodes. Tuberculosis patients who do not get treatment or stop treatment before the treatment period, or a drug dropout, can cause complications that impact death. People with BTA (+) pulmonary tuberculosis is transmitting to those around them, especially those in close contact. Each BTA (+) pulmonary TB sufferer can transmit to 10-15 people per year. The transmission power of a person with BTA pulmonary tuberculosis (+) is determined by the many bacteria secreted from the lungs.
The main symptoms of tuberculosis are coughing up phlegm for 2 weeks or more, coughing up blood, shortness of breath, weight loss, decreased appetite, malaise, sweating at night without physical activity, and sometimes accompanied by fever for more than a month.
TB Treatment with STATE DOTS (Directly, Observed, Treatment, Short Course) is a treatment recommended by WHO in dealing with TB and is very effective. In treating TB, the patient must obediently take the drug until it is declared cured. In this case, it is necessary to take the drug supervisor from family members, village officials, or parties respected by the patient. The goal is for the patient to take medicine
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until it is declared cured obediently. Suppose the treatment of TB patients is interrupted not up to six months at a particular time. In that case, the patient's disease can recur, and germs become resistant, impactingmore significant treatment costs.
Until now, TB is still a worldwide concern. It is still a severe problem in some countries. There is not even a country in the world that is TB-free. The number of morbidities and deaths from TB is still high.
Globally, TB cases in 2019 are estimated at 10 million. The WHO 2020 report shows Indonesia is the second highest contributor to TB cases after India. The Ministry of Health (Kemenkes) noted that there were 385,295 cases of tuberculosis (TB) found and treated in Indonesia in 2021. This number is down 2.04% from the previous year's 393,323 cases.
West Java Province is one of the provinces in Indonesia, consisting of 27 regencies/cities with a population of 48,683,861 in 2018. At the national level, West Java province is ranked first in contributing to TB sufferers, with a total number of cases of 85,359 people.
Bogor Regency is the largest regency in West Java, with a population of approximately 5 million people. According to the health profile of Bogor Regency, the number of suspect cases of pulmonary TB in 2019 at 45,879. The total number of cases is 16,337 adult cases, and 2,101 are tuberculosis cases for children aged 0-14 years. The prevalence in Bogor Regency was 227/per 100,000 population in 2018.
Many risk factors trigger the onset of TB events. Some of them are due to environmental factors. Environmental factors include the illumination of the house, humidity, temperature, walls, floors of the house, and the density of the dwelling. In addition to environmental factors, gender factors, age, income, knowledge, and attitudes towards TB prevention also influence the occurrence of TB disease.
Based on the problem description above, researchers are interested in analyzing risk factors for TB events in the Bogor Regency work area.
METHOD
This type of research is descriptive-analytic with a cross-sectional design. The population is all TB patients who seek treatment at a public health center in Bogor Regency. Interviews are conducted when the patient is at the public health center, and then observation is carried out with visits to the patient's homes.
The sample of this study was 25 people. The sampling technique used is proportional random sampling. The densely populated areas in Bogor Regency are Cibinong, Citeurep, and Ciawi. With public health center in the region are cibinong health centers, mekar works, karadenan, Ciawi, Citapen, Banjarsari, citeurep and Tajur.
The variables of this study are in the form of individual and family characteristics, namely gender, family income, family history of TB, access to information about TB, cigarette exposure at home, age,
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knowledge, and attitudes towards the prevention of Tuberculosis disease. Other variables include lighting, humidity, roof conditions, walls, and floors of houses, as well as residential density. Individual and family characteristic variables are measured using a structured questionnaire validated in advance. Interviews measured respondents.
RESULTS AND DISCUSSION
The characteristics of respondents can be seen in table 1; we can conclude that respondent participation in age has many differences. The two categories of 40-year-old < and 40-year-old ≥ are 20%
at odds. The younger age group participated more in the study. Sex variables between men and women were 1:2, and women participated 2 times more in this study. For job characteristics, the dominance of respondents is more that do not work. The category of housewives we enter is a category that does not work. Family income was also interviewed in this study, the cut of point income category based on the median value of the income variable was Rp 1,500,000, and the respondent households in this study were more low income (< Rp 1,500,000).
Research conducted by Lamria et al. in 2013-2014, whose results are based on age group, the older a person is, the higher the risk for TB. The older the age, the more the body's resistance will decrease, making it easy to get sick.
Pulmonary TB disease has always been associated with poverty. According to WHO (2003), 90%
of TB sufferers in the world attack groups with weak or poor socioeconomics, and the relationship between the two is reciprocal, where TB disease is the cause of poverty. Because of poverty, humans suffer from TB. Families with higher incomes will be better able to maintain the cleanliness of their household environment, provide good drinking water, buy adequate food in quantity and quality for their families, and finance the health care they need. Meanwhile, people with low socioeconomic conditions result in poor nutritional conditions, unhealthy housing, and insufficient access to health services.
Table 1. Characteristics of Respondents
Variable Category Sum Percentage
Age <40 th
>40 th
15 10
60 40
Gender Woman
Man
17 8
68 32
Work ASN/Employee
Farmer Merchant Doesn't work
4 7 4 10
16 28 16 40
Family Income Tall
Low
8 17
32 68
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TB history from family members reached more than half of the respondents. The family is the person who interacts most often with sufferers so that they become at risk of developing TB if there are family members affected by the disease. Meanwhile, in this study, exposure to cigarette smoke, both as an active smoker and a passive smoker, reached 56%.
TB transmission generally occurs through the air. When TB sufferers actively splash mucus or sputum when coughing or sneezing, TB bacteria will come through the mucus and be carried into the air. In one cough, people with tuberculosis can emit about 3,000 sputum splashes. Furthermore, TB bacteria will enter other people's bodies through the air they breathe. TB bacteria residing in the air can last for hours, especially if the room is dark and humid, before finally being inhaled by others. Generally, contagion occurs in a room where sputum splashes are for a long time. People at high risk of TB transmission often meet or live in the same place as people with TB, such as their families. This means that if family members are affected by TB, other family members are significantly at risk of contracting TB. Even so, with smokers or those exposed to cigarette smoke, the risk of developing TB increases considerably with the number of cigarettes per day and the length of smoking.
Smoking is a significant risk factor for cardiovascular disease andother leading causes of death worldwide, namely cerebrovascular, lower respiratory tract infections, COPD, TB, and airway cancer. The relationship between smoking and TB was the first reported risk factor for TB in 1918. In this study, I found that smokers have a higher risk compared to the group of passive and non-smokers. Research in India also shows that smokers are more likely to be infected with pulmonary TB than non-smokers.
Table 2. Family History of Cigarette Smoke Exposure and TB
Variable Category Total Percentage
Exposure to cigarette smoke Yes
Not
14 11
56 44
Family history of TB Yes
Not
17 8
68 32
The variables measured from the physical environment of the house are lighting, humidity, roof condition, walls and floors, and residential density, categorized as standard and non-standard. This study found that more homes in slums and densely populated settlements did not meet the standards or requirements regarding lighting, humidity, roof conditions, and walls and floors. These houses are also not eligible for the number of dwellings in each home. As stated in table 3.
Based on the theory of causing disease, tuberculosis is one of the diseases with the idea of a web of causation, namely, with many causes. The leading cause (necessary factor) is an agent that must be present for the disease, namely mycobacterium tuberculosis. The second type of cause or good factor is the supporting factor of the agent that causes the occurrence of diseases, such as densely populated living
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conditions with less standard house conditions, such as ventilation, humidity, roof condition, and floor condition.
Table 3. Variables of The Home Environment
Variable Category Total Percentage
Lighting Standard
Non-standard
10 15
40 60
Moisture Standard
Non-standard
8 17
32 68
Roof condition Standard
Non-standard
12 13
48 52
Floor condition Standard
Non-standard
10 15
40 60
Occupancy Density Standard
Non-standard
9 16
36 64
In this study, I found that more people did not know well about the causes of TB, transmission, and prevention of this disease. Meanwhile, their attitudes are more unsupportive of TB prevention efforts.
The results of the research analysis conducted by Darmawan et al. showed a significant relationship between the level of knowledge and the incidence of pulmonary TB in the Padang Serai Health Center working area, Bengkulu city. The more knowledgeable a person is, the higher the risk of developing pulmonary TB compared to someone well-informed.
In this study, it is in line with Putri Kurniasari that the studyresult has an attitude relationship with the incidence of tuberculosis in Pekalongan City (p= 0.009. This proves that a poor or negative attitude is a risk factor for tuberculosis. This result is by Notoatmodjo's (2007) opinion, which explains that attitude is a readiness to interact with objects in a specific environment as a passion for things. The process of attitude formation can occur due to stimuli, such as knowledge of tuberculosis diseases. These stimuli will stimulate the respondent to respond in the form of a positive or negative attitude that can eventually be manifested into behavior or not. The attitude of respondents in this study is how respondents' responses to the incidence of tuberculosis disease support or do not support the statements contained in the questionnaire.
Table 4. Knowledge Variables and Attitudes
Variable Category Total (112) Percentage
Knowledge Good
Bad
9 16
36 64
Attitude Support
Does not support
11 14
44 56
CONCLUSIONS AND SUGGESTIONS
This study concluded that the risk factors for TB in Bogor regency are young age, female gender, a dense living environment, home conditions that are not up to standard, and close contact of TB patients
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in their families. The advice researchers give is the need to pay attention to TB risk factors to reduce TB cases in Bogor Regency.
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file:///C:/Users/user/Downloads/2594-Article%20Text-21953-1-10-20200505.pdf http://eprints.ums.ac.id/62139/1/NASKAH%20PUBLIKASI.pdf
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