The Relationship of the Pulmonary TB Characteristics with the Risk

Transmission at Public Health Center in Medan

S. M. Sarumpaet

, E. Aritonang

and L. Tarigan

Department of Epidemiology FKM Universitas Sumatera Utara, Medan, 20155, Indonesia

Department of Community Nutrition FKM Universitas Sumatera Utara, Medan, 20155, Indonesia

Department of Occupational Safety and Health FKM Universitas Sumatera Utara, Medan, 20155, Indonesia

Keywords: Pulmonary TB BTA+, Risk of Transmission, Patients’s Characteristics.

Abstract: TB incidence rate in Medan is 129 and CNR (Case Notification Rate) is 321 per 100,000 populations in

2016, increased to 345 per 100,000 populations in 2017. Therefore, is necessary to analyze the relationship

of pulmonary TB BTA+ characteristics patients with the risk of transmission at puskesmas in Medan. This

study using cross sectional design, independent variables is patients’s characteristics (age, gender,

occupation, and education) and dependent variable the risk of pulmonary TB transmission based on the

PMO, medication adherence, and spitting habit. Population is the entire patient with pulmonary TB BTA+

who went to Puskesmas Medan. Sample was taken with purposive sampling technique, in 10 puskesmas

from March to June 2018, got 126 patients, analyzed using Mann-Whitney test. The result shows gender,

age, education, and occupation not significantly related with the risk of transmission based on PMO.

Gender, age, and occupation also not significantly related with the risk on medication adherence. However,

age is significantly related with the risk on spitting habit. Education is also significantly related with the risk

on medication adherence. Recommended to the puskesmas officers and PMO to educate patients with TB

not to spit carelessly and take medicine regularly.

1 INTRODUCTION

Tuberculosis (TB) is an infectious disease caused by

Mycobacterium tuberculosis which is a serious

health threat to the global society. Six countries were

accounting for 60% of new cases, namely India,

Indonesia, China, Nigeria, Pakistan, and South

Africa (Kemenkes, 2016).

The estimated prevalence of all TB cases in

Indonesia was 660,000 and the incidence estimates

was 430,000 cases per year. The number of TB

deaths was estimated at 61.000 deaths per year. In

2015, the pulmonary TB Case Notification Rate

(CNR) for Indonesia was 117 per 100,000

population. Meanwhile, in North Sumatera the

prevalence rate of TB was 794/100,000 population,

incidence rate of 501/100,000 population and death

rate due to TB of 41/100,000 population, with Case

Detection Rate (CDR) of 22,961 (33.3%) and CNR

of 156/100,000 population (Kemenkes, 2016).

According to the report of Integrated TB

Information System (SITT) in 2016 in Medan, the

incidence rate was estimated to be 129 per 100,000

population. This estimation was still lower than it

supposed to occur in the community. Meanwhile, in

2016 it was obtained CNR of 321 per 100,000

population and CDR of 67.6% in Medan.

Furthermore, in 2017 there was an increase of CNR

to 345 per 100,000 population and CDR was

decreasing to 65.5%.

From the research’s result of Vidal et al, it was

found there were 1,264 (41%) infected by TB and

176 (6%) have TB out of 3,071 of domestic contacts.

The risk of TB incidence in families with new TB

cases was 3.7 times higher than families with no

new TB cases with OR = 3.7 (95% CI: 2.1-6.5).

Referring to a research by Ustero et al (2017), it

could be concluded the risk of TB transmission due

to exposure in school was lower than in households

with OR = 0.06 (95% CI: 0.03–0.12).

Based on the explanation above, it is necessary

to analyze the relationship of the characteristics of

pulmonary TB BTA+ patients with the risk of

transmission at public health center (puskesmas) in

Medan 2018.

616

Sarumpaet, S., Aritonang, E. and Tarigan, L.

The Relationship of the Pulmonary TB Characteristics with the Risk Transmission at Public Health Center in Medan.

DOI: 10.5220/0010080906160620

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

616-620

ISBN: 978-989-758-449-7

2 RESEARCH METHOD

This research is conducted using the crossectional

design whereas the independent variables are the

patient’s characteristics (age, gender, occupation,

education). Age consists of two categories which are

≤ 50 years old and > 50 years old. Gender consists

of two categories which are male and female.

Occupation is classified into two, unemployment

and employed. Next, Education is grouped into two,

which are lower level (elementary school and middle

school) and higher level (high school and

university).

The dependent variable is the risk of pulmonary

TB transmission based on the role of Medication

Consumption Supervisor (PMO), medication

adherence, and spitting habit. The role of PMO is

measured based on the presence of PMO as well as

the role of PMO in reminding the patients to take the

medicine, using a mask when coughing, coughing up

sputum in the provided place, and encouraging the

patients to take a rest. Medication adherence is

measured based on the regularity of medication

consumption and in filling the prescription

according to the schedule determined by puskesmas.

Spitting habit is measured based on the availability

of provided place to cough up sputum and the risk of

contact with the patient’s sputum.

The variables are measured using questionnaires

and scoring of the respondents’ answers, obtained

through direct interview. Before the interview with

pulmonary TB BTA+ patients is conducted, the

questionnaires have been tested with reliability test

and the obtained value of Alpha Croncbach is 0.819

with the validity value of all questionnaires of <0.05.

Beforehand, the proposal has received an approval

by the Ethical Commision of Health Research,

Faculty of Nursing Universitas Sumatera Utara

(Komisi Etik Penelitian Kesehatan Fakultas

Keperawatan) with registered number:

1317/III/SP/2018.

The population of this study is the entire

outpatient patient with pulmonary TB BTA+ in

Puskesmas Medan. The sample was taken with

purposive sampling technique, which is the entire

patient with pulmonary TB BTA+ in 10 (ten)

puskesmas with the highest number of visits from

patient with pulmonary TB BTA+, gathered from

the previous data. This research is executed from

March to June 2018 with 126 samples. The analysis

is performed using Mann-Whitney test.

3 RESULT AND DISCUSSION

3.1 Univariate Analysis

Result shows the obtained distribution of

respondent’s characteristic can be seen as in table 1.

Table 1: Distribution Proportion of Patient with

Pulmonary TB BTA+’s Characteristic in Medan

Characteristic f %

Gende

Male 90 71.4

Female 36 28.6

Age

≤ 50

ears ol

84 66.7

> 50

ears ol

42 33.3

Education

Lower Level 23 18.3

Higher Level 103 81.7

Occu

ation

Unem

ment 36 28.6

90 71.4

Total 126 100.0

Table 1 demonstates patient with pulmonary TB

BTA+ based on gender, there are 90 male patients

(71.4%), which is higher than female patients with

only 36 people (28.6%). The similar result was

obtained in a research by Ndungu et al in Nairobi

[

the result displayed the proportion of male was

significantly higher than female (p<0.05).

Furthermore, in a study performed by Panjaitan F

(2012) the same result was acquired, more men were

suffering from tuberculosis with the ratio of 3 : 2.

Based on age, the majority of samples (66.7%)

are within the age group of ≤ 50 years old. A study

conducted by Rukmini and Chatarina howed age

(OR: 0.473, p=0.018) and gender (OR:1.613,

p=0.027) were included in the risk factor affecting

the incidence of adult with pulmonary TB in

Indonesia.

Followed by Suswati in Jember District in

2006 displayed 54% of 200 respondents were within

the age range of 15 to 35 years old.

In Indonesia, it is

estimated patient with pulmonary TB is at the

productive age range of 15 to 50 years old. This is

likely due to people within the productive age range

have more interaction with pulmonary TB patients,

hence it grows the risk of being infected.

Based on education, the largest number of

patients is within the higher level category (high

school and university) with 103 people (81.7%).

This differs from a study by Ndungu et al in Nairobi,

the result indicated half of the patients (53.3%) did

The Relationship of the Pulmonary TB Characteristics with the Risk Transmission at Public Health Center in Medan

617

not complete the secondary education and only 16

people (6.2%) have completed tertiary education.

The next result shows most of patients (71.4%)

are the employed category (laborer, entrepreneur,

and civil servant/military/police), which in line with

the number of patient with pulmonary TB is within

the productive age category of 66.7%.

3.2 Bivariate Analysis

Result shows the relationship of patient with

pulmonary TB BTA+’s characteristic with the risk

of transmission based on the presence of PMO in

puskemas in Medan in 2018 as can be viewed in

table 2. Table 2 shows gender, age, education, and

occupation do not have significant relationship with

the risk of transmission of pulmonary TB based on

the presence of PMO (p>0,05). Gender and age do

not have significant relationship with the risk of

transmission of pulmonary TB based on the presence

of PMO, this is possibly because the selection of

PMO determined by the patient’s family in

accordance with the advice of puskesmas officer and

not based on the gender and age of patients. The

selection of PMO is commonly based on certain

criterias, such as someone who has a close

relationship the patient and trusted to be able to

monitor the drug adherence as well as the habit in

monitoring the risk of transmission to other people.

This also applies to education and occupation,

neither of them have significant relationship with the

risk of transmission of pulmonary TB based on the

presence of PMO. Table 3 displays independent

variable (gender, age, and occupation) do not have

significant relationship with the risk of transmission

of pulmonary TB (p>0.05) based on medication

adherence, only education has a significant

relationship with the risk of transmission of

pulmonary TB based on medicine adherence

(p<0.05).

Education has a significant relationship with

the risk of transmission of pulmonary TB based on

medicine adherence, whereas patient with higher

education level tends to have lower medicine

adherence than patient with lower education level.

This is possibly because patient with higher

education level is busier and more preoccupied. In

addition to that, patients with high education level

are more likely to ignore the PMO’s message,

meanwhile patients with lower education level are

more obedient to PMO. In contrary, by Suswati in

Jember District showed there is no relationship

between education and medicine adherence of

patient with pulmonary TB. Table 4 displays gender,

education, and occupation do not have significant

relationship with the risk of transmission of

pulmonary based on spitting habit (p>0.05).

However, age has a significant relationship with the

risk of transmission of pulmonary TB based on

spitting habit (p<0.05).

Patients who are under the age of 50 years old

with spitting habit have higher chance in

transmitting pulmonary TB than patients who are

over the age of 50 years old. People who are below

the age of 50 years old have more outdoor activities,

thus it is more difficult for them to search a place to

cough up sputum in order to minimize the risk of

transmission. On the other hand, people who are

over the age of 50 years old mostly retired and spend

most of their time at home, hence the risk of

transmission is lesser.

From a study’s result by Putri et al it is obtained

the value of p=0.481 (p>0.05), which displayed

spitting habit did not have association with the

incidence of pulmonary TB. In the study, most of the

respondents have bad spitting habit (60.5%), such as

cough up sputum in any place, cough up sputum on

the bathroom floor, in the ditch, and cough up

sputum into a tissue or in a special container then

keeping it for days in the room.

According to the study above, it is recommended

for the TB puskesmas officer to motivate and

educate the patient with pulmonary TB not to cough

up sputum everywhere. As well as to PMO to be

more intensive in reminding patient with pulmonary

TB to take the medication in order to accelerate the

convertion of sputum, thus it would not become a

source of transmission to other people.

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

618

Table 2: The Relationship of Patient with Pulmonary TB BTA+’s Characteristic with The Risk of Transmission Based on

The Presence of PMO in Puskesmas in Medan 2018

Characteristic Category n Average SD p Median (min-

)

Gender

Male

90 2.08

1.800

0.491

2 (0-7)

Female 36 1.86 1.839 2

(

0-7

)

Age

≤ 50

ears ol

84 2.15 1.853

0.205

(

0-7

)

> 50 years ol

42 1.74 1.697 1.5 (0.7)

Education

Lower Level 23 1.91 1.782

0.767

2 (0-6)

Higher Level 103 2.04 1.820 2 (0-7)

Occupation

Une

ement 36 2.17 1.612

0.317

(

0-6

)

90 1.96 1.884 2

(

0-7

)

Table 3: The Relationship of Patient with Pulmonary TB BTA+’s Characteristic with The Risk of Transmission Based on

Medicine Adherence in Puskesmas in Medan 2018

Characteristic Category n Average SD p Median (min-

)

Gender Male 90 13.86 8.242 0.116 12.5 (1-35)

Female 36 15.94 7.139 15

(

4-30

)

Age ≤ 50

ears ol

84 14.74 8.242 0.608 14

(

1-32

)

> 50 years ol

42 13.88 7.461 13 (3-35)

Education Lower Level 23 10.70 7.622 0.013 9 (3-25)

Higher Level 103 15.29 8.218 14 (1-35)

Occupation Une

ement 36 13.44 7.205 0.452 12.5

(

3-30

)

90 14.86 8.261 14

(

1-35

)

Table 4: The Relationship of Patient with Pulmonary TB BTA+’s Characteristic with The Risk of Transmission Based on

Spitting Habit in Puskesmas in Medan 2018

Characteristic Category n Average SD p Median (min-

)

Gender

Male 90 4.34 3.043

0.312

4 (1-27)

Female 36 3.72 1.560 3.5 (1-8)

Age

≤ 50 years ol

84 4.58 3.078

0.009

4 (1-27)

> 50

ears ol

42 3.33 1.476 3

(

1-6

)

Education

Lower Level 23 3.96 1.894

0.923

(

1-7

)

her Level 103 4.21 2.869 4

(

1-27

)

Occupation

Uneployement 36 3.81 1.636

0.658

4 (1-7)

Employe

90 4.31 3.034 4 (1-27)

4 CONCLUSIONS

The result shows gender, age, education, and

occupation not significantly related with the risk of

transmission based on PMO. Gender, age, and

occupation also not significantly related with the risk

on medication adherence. However, age is

significantly related with the risk on spitting habit.

Education is also significantly related with the risk

on medication adherence.

ACKNOWLEDGEMENT

Thank you to the Directorate of Research and

Community Service, General Directorate of

Research Empowerment and Development, The

Ministry of Research, Technology, and Higher

Education as the source of research fund, DRPM

Kemenristekdikti with research scheme Applied

Superior University of Fiscal Year 2018 Number

255/UN5.2.3.1/PPM/KP-DRPM/2018.

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619

REFERENCES

Dinas Kesehatan Kota Medan, 2016. Laporan Sistem

Informasi TB Terpadu (SITT).

Kemenkes, 2016. Infodatin Tuberkulosis. Available from

http://www.depkes.go.id/download.php?file=downloa

d/pusdatin/infodatin/InfoDatin-2016-TB.pdf

Ndungu, P.W., Revathi, G., Kariuki, S., Ng’ang’a, Z.,

2013. Risk Factors in the Transmission of

Tuberculosis in Nairobi: A Descriptive

Epidemiological Study. Jurnal. Advances in

Microbiology, 2013,3: 160-165. Available from

http://file.scirp.org/pdf/AiM_2013053114155458.pdf.

doi:10.4236/aim.2013.32025

Putri E.A, Martini, Saraswati L.D, Faktor Risiko

Tuberkulosis Paru Pada Warga Binaan

Pemasyarakatan di Lembaga Pemasyarakatan Kelas I

Semarang. Jurnal Kesehatan Masyarakat (e-Journal).

Volume 6, Nomor 1, Januari 2018 (ISSN: 2356-3346).

Available from

http://ejournal3.undip.ac.id/index.php/jkm

Rukmini and Chatarina U.W., 2011. Faktor-faktor yang

Berpengaruh Terhadap Kejadian TB Paru Dewasa di

Indonesia (Analisis Data Riset Kesehatan Dasar Tahun

2010). Jurnal. Buletin Penelitian Sistem Kesehatan,

Vol. 14 No.4 Oktober 2011: 320-331. Available from

https://media.neliti.com/media/publications/20972-ID-

faktor-faktor-yang-berpengaruh-terhadap-kejadian-tb-

paru-dewasa-di-indonesia-ana.pdf

Suswati, E., 2006. Hubungan Tingkat Pendidikan Dengan

Kepatuhan Menelan obat Pada Penderita Tuberkulosis

Paru. Vol. 3, No. 1, hal 67-73. Available from

https://media.neliti.com/media/publications/210249-

hubungan-tingkat-pendidikan-dengan-kepat.pdf

Ustero P, Kay A.W, Ngo K, Golin R, et al. (2017). School

and household tuberculosis contact investigations in

Swaziland: Active TB case finding in a high HIV/TB

burden setting. Available from

http://journals.plos.org/plosone/article?id=10.1371/jo

urnal.pone.0178873

Vidal R, Miravitlles M, Cayla J.A, Torrella M, de Gracia

J, Morell F. 1997. Increased risk of tuberculosis

transmission in families with microepidemics. Eur

Respir J 1997; 10: 1327–1331. Available from

https://www.ncbi.nlm.nih.gov/m/pubmed/9192937/

doi: 10.1183/09031936.97.10061327

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