Analysis of the Behavior of WBP to Terminate the Pulmonary TB

Transmission Chain in Medan and Lubuk Pakam Prison

Lina Tarigan, R. Kintoko Rochadi and Syarifah

Faculty of Public Health, Universitas Sumatera Utara, Medan Indonesia

Keywords: Behaviour, Termination of TB Transmission Chain, WBP.

Abstract: Indonesia still holds the 2nd place in terms of the number of TB patients in the world. The prevalence of

pulmonary TB in prisons is estimated to be 3 times higher than the general population. According to the report

from the Department of Law and Human Rights of Sumatera Utara Province, from 2009 to 2011, the number

of new pulmonary TB cases among the residents of prison/correctional facility tended to increase every year,

an increase of an average of 7.2%. A research on the behavior of Warga Binaan Pemasyarakatan (WBP) is

carried out to terminate the TB transmission (sputum, coughing, smoking, wearing masks, sleeping history

and smoking) behavior. The type of this research is cross-sectional with the entire population of WBP in

Medan and Lubuk Pakam Prison. The data collection is performed by interview using a questionnaire. The

data analysis is conducted by univariate and bivariate. The results show there is a relationship of knowledge

with cough behavior (p = 0.011) and wearing mask behavior (p = 0.011), there is a relationship between

attitude and sleeping in one room behavior (p = 0.032). There is no relationship between knowledge and

attitude with smoking behavior and throwing sputum behavior.

1 INTRODUCTION

Tuberculosis is still one of the public health problems

in Indonesia. Tuberculosis is an infectious disease

caused by Mycobacterium tuberculosis bacteria

which mostly attacks the productive age groups and

those who come from the weak economic groups. The

number of TB cases in Indonesia is around 5% of the

total TB patients in the world. The incidence of

pulmonary TB is still high in the community;

Indonesia still ranks second in the world with the

highest number of patients. Reportedly, there are 1

million cases of pulmonary TB or 399 cases per

100,000 populations (WHO, 2016). The prevalence

of pulmonary TB in prisons is estimated to be 3 times

higher than the general population (Direktorat

Jenderal Pemasyarakatan Kementerian Hukum dan

HAM RI, 2012). A report from the Department of

Law and Human Rights of Sumatera Utara Province

states that from 2009 to 2011, the number of new

pulmonary TB cases among the residents of prison /

correctional facility tended to increase every year, an

increase of an average of 7.2% (Direktorat Jenderal

Pemasyarakatan Departemen Hukum dan Hak Asasi

Manusia RI, 2016).

The majority of UPT Correctional Facilities

residents exceed the capacity and do not have special

infectious care rooms. This causes discomfort,

inadequate environmental sanitation, increasing the

susceptibility of transmission of various diseases,

especially TB amongst the WBP and prisoners.

Tuberculosis become the number four disease and the

second largest cause of death in UPT Correctional

Facilities according to the data of the Directorate

General of Corrections in 2014 (Kemenkumham dan

Kemenkes RI, 2015).

The quarterly data of the UPT Correctional

Facilities in 2014 showed 3,623 of suspected TB and

734 of TB patients. The cure rate among new MDR

TB patients is 41% in 2012 and 38% and 48% in 2013

and 2014, respectively. In 2014, there are 21 narcotics

prisons and 5 general prisons which functioned as

rehabilitation prisons for narcotics cases with 1,073

HIV patients in UPT Correctional Facilities in

Indonesia (Kemenkumham dan Kemenkes RI, 2015).

The high number of WBP and injecting drug users

(IDU) and the increase in people with Human

Immunodeficiency Virus (HIV) in several UPT

Correctional Facilities will increase the number of

morbidity and deaths due to TB (Kemenkumham dan

Kemenkes RI, 2015).

176

Tarigan, L., Rochadi, R. and Syarifah, .

Analysis of the Behavior of WBP to Terminate the Pulmonary TB Transmission Chain in Medan and Lubuk Pakam Prison.

DOI: 10.5220/0010013601760180

In Proceedings of the 3rd International Conference on Social and Political Development (ICOSOP 3 2019) - Social Engineering Governance for the People, Technology and Infrastructure in

Revolution Industry 4.0, pages 176-180

ISBN: 978-989-758-472-5

In accordance with the data from the Directorate

General of Corrections (Directorate General of PAS),

in 2011 from all reports of all correctional facilities

and prisons in Indonesia it is found there are 11% of

TB cases from the suspected TB examined (911 /

7,972) and 66 people (0.8%) passed away due to TB.

Other data from the Directorate General of PAS in

2011 report that TB ranks 4th out of 10 of the most

diseases suffered by prisoners and is the second

leading cause of death after HIV-AIDS (Direktorat

Jenderal Pemasyarakatan Kementrian Hukum dan

H.A.M RI, 2014).

The occurrence of TB in prisons is usually

reported to be much higher than the average level

reported in the general population. TB has been

reported as the most common cause of death in

prisons located in the country, even the risk of TB

infection will be 100 times greater in prisons than in

the community, due to prisons in Indonesia often

exceeds its capacity and is overcrowded, with

inadequate infrastructure and ineffective

environmental and sanitation measures (WHO,

2002). In addition, the behavior of WBP, namely

prisoners also play a role in the transmission of

pulmonary TB. The intended behavior is attitude,

knowledge, sexual behavior, and drug use.

Prisoners are a special group that has a high risk of

TB, the TB matter in prisons are expected to be high

due to the condition of the prison facilitates the spread

of TB infection due to the duration and repeated

exposure to Mycobacterium tuberculosis as a result of

late detection of cases, lack of isolation space (special

space for suspected TB) , inaccurate treatment of

infectious TB cases, high turnover of prisoners or

detainees through inter-prison transfers, free prisoners

and recidivists, poor ventilation and lack of direct

sunlight and poor sanitation hygiene (Departemen

Hukum dan HAM Republik Indonesia, 2008).

2 METHODS

The study is conducted in Medan and Lubuk Pakam

Prison. Using a cross-sectional study design that

examines the relationship of knowledge and attitudes

toward the behavior of terminating pulmonary TB

transmission (coughing, expectoration, wearing

masks, smoking and sharing a room). The population

is all WBP with pulmonary TB in Medan and Lubuk

Pakam Prison. Data collection is carried out by

interviews using questionnaires. The size of the

sample is the number population of 59 respondents.

Data analysis is performed by univariate and chi-

square test, variables with p <0.05 are stated to have

a relationship.

3 RESULT

3.1 Cough Behaviour

As seen on the Table 1, the proportion of respondents'

knowledge with bad cough behavior is greater with

low knowledge (43.3%) than high knowledge

(10.3%), but inversely the proportional to

respondents with good cough behavior, the high

knowledge is higher (89.7%) compared to low

knowledge (56.7%). But in contrast, a good attitude

is higher than poor attitude toward bad and good

cough behavior. Based on the chi-square test, there is

a significant relationship between knowledge and

cough behavior (p = 0.001), while attitude does not

have a significant relationship with cough behavior (p

= 0.0683).

Table 1: The relationship of knowledge and attitudes with cough behavior.

Variable

Cough Behavior

Total

95%

Bad Good

f % f % f %

Knowledge*

Low 13 43.3 17 56.7 30 100

0.011 6.627 1.640-26.777

High 3 10.3 26 89.7 29 100

Attitude

Good 12 30 28 70 40 100

0.683 1.607 0.441-5.680

Poor 4 21.1 15 78.9 19 100

Based on the result, knowledge has an influence

on the cough behavior of WBP, the higher the

knowledge of WBP, the better the cough behavior.

This is in line with research performed by Agustina

(2017) in Surabaya, which obtained p-value = 0.018

which means there is a difference in knowledge in the

family who live together. Lack of knowledge and

access to information causes a person to have limited

knowledge about the dangers of unhealthy behavior

so there is less motivation to adopt healthy behavior.

Analysis of the Behavior of WBP to Terminate the Pulmonary TB Transmission Chain in Medan and Lubuk Pakam Prison

177

For example, those who are less exposed to warnings

about smoking, poor eating habits, and lack of

exercise are likely not to understand the potential of

long-term danger of unhealthy behavior.

3.2 Sputum Disposal Behavior

Based on the Table 2, the proportion of high

knowledge is greater than low knowledge in WBP

with bad sputum disposal behavior, while WBP with

good sputum behavior, the proportion of low

knowledge is greater than high knowledge. Compared

with attitude, bad sputum removal behavior is

relatively the same, while good sputum removal

behavior is higher than bad attitude. Based on the chi-

square test, there is no significant relationship

between knowledge and attitudes toward sputum

removal behavior.

Although the result shows that there is no

significant relationship, however, there are

significant differences, therefore it could be

concluded that the better the attitude of a person, the

better their sputum removal behaviour.

3.3 Smoking Behavior

As shown in the Table 3, the proportion of knowledge

on smoking and non-smoking behavior is relatively

the same, whereas, in attitudes, the proportion of good

attitudes is greater than the poor attitudes. Based on

the chi-square test, it is found that there is no

significant relationship between knowledge (p =

0.905) and attitude (p = 0.653) with smoking

behavior.

Based on the result of the study, the fact that

knowledge does not affect smoking behavior can be

caused by various things, the majority of WBP are

smokers so that it can affect the actions of other WBP,

despite having high knowledge but because the

environment encourages smoking, the non-smoking

WBP eventually becomes smokers.

Table 2: Relationship of knowledge and attitudes with sputum disposal behavior.

Variable

Sputum Disposal Behavior

Total

p RP 95 %CI

Bad Good

f % f % f %

Knowledge*

Low 4 13.3 26 86.7 30 100 0.465 0.484 0.125-1.871

High 7 24.1 22 75.9 29 100

Attitude

Good 6 31.6 13 68.4 19 100 0.149 0.310 0.081-1.190

Poor 5 12.5 35 87.5 40 100

Table 3: The Relationship of knowledge and attitudes with smoking behavior.

Variable

Smoking Behaviour

Total

p RP 95% CI

Smoking

Non-

Smoking

f % f % f %

Knowledge

Low 13 43.3 17 56.7 30 100

0.905 0.819

0.294-2.285

High 14 48.3 15 51.7 29 100

Attitude

Good 10 52.6 9 47.4 19 100 0.653 0.665 0.222-1.993

Poor 17 42.5 23 57.5 40 100

3.4 Mask Wearing Behavior

Based on the Table 4, the proportion of low

knowledge (43.3%) is greater than high knowledge

(10.3%) in the behavior of not wearing mask,

inversely the proportional of the behavior of wearing

mask, the proportion of high knowledge (89.7%) is

greater than low knowledge (56.7%), the value of p

on the square-test = 0.01 which means there is a

significant relationship between knowledge and the

use of masks. The proportion of good attitudes is

higher than poor attitudes. Based on the square-test,

attitude does not have a significant relationship with

the use of masks (p = 0.683).

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This result is in line with Yuliastuti (2014) on their

study in Rumkital Dr. Ramelan Surabaya, the study

obtained a value of p = 0.001 on knowledge, means

there is an influence of knowledge about TB with the

use of masks. Information exposure will result in more

knowledge than people who have not been exposed to

the information. The respondents’ environment that

supports information exposure will support TB

prevention. Good knowledge will influence the

prevention of pulmonary TB transmission behavior,

one of which is the behavior of wearing masks.

Knowledge is one important factor that is very

necessary in developing themselves, because the

higher the knowledge, the easier it is to develop and

receive information that comes from outside.

3.5 Sharing a Room Behavior

As seen on the Table 5, the proportion of high

knowledge is greater than low knowledge in WBP

with sharing a room behavior at risk, whereas WBP

who is not at risk, low knowledge is greater than high

knowledge, this shows knowledge has no influence in

determining behavior. Furthermore, based on the chi-

square test, the value of p = 0.152 is obtained,

meaning there is no relationship between knowledge

with sharing a room behavior and other factors that

cause a lot of high knowledge but have a risk because

of the placement in one room unintentionally with

patients with pulmonary TB. Although, previously

the patient is isolated despite having high knowledge

but due to regulations they finally have to share the

same room with patients with pulmonary TB.

The proportion of good attitudes is equally higher

at risk and non-risk WBP. The value of p = 0.032,

which means there is a significant relationship

between attitude and sharing a room behavior.

Knowledge is one of the factors that influence a

person's attitude. The higher the knowledge

possessed, the more it will contribute to the formation

of a good attitude. The formation of attitudes cannot

be separated from the factors that influence it such as

personal experience, culture, other people who are

considered important, the mass media, and emotional

factors of the individual. From the result, it is noted

that most of the attitudes and knowledge on WBP

included in both categories. Thus, it can be seen that

the action of wearing a mask for people who are not

infected with pulmonary TB will be better on WBP

who are behaving well.

Based on a study of Herdayati & Rosalina (2013),

it is obtained a value of p = <0.0001 which means

there is a relationship between the presence of TB

people in detention with TB transmission in prison.

The presence of TB patients in detention rooms used

to describe the number of AFB + in the environment

is known to be significantly related whereas people

who live in a room with TB patients have a risk of

14,802 times higher.

Table 4: The Relationship of knowledge and attitudes with mask wearing behavior.

Variable

Mask Wearing

Total

RP 95% CI

No Yes

f % f % f %

Knowledge*

Low

13 43.3 17 56.7 30 100

0.01

6.627 1.640-26.777

High 3 10.3 26 89.7 29 100

Attitude

Good 4 21.1 15 78.9 19 100 0.68

1.607 0.441-5.860

Poor 12 30 28 70 40 100

Table 5: Relationship of knowledge and attitudes with sharing a room behavior.

Variable

Sharing a Room

Behaviour

Total

RP 95% CI

Risk No-Risk

f % f % f %

Knowledge*

Low 9 30 21 70 30 100

0.152 2.500 0.859-7.273

High 15 51.7 14 48.3 29 100

Attitude

Good 12 63.2 7 36.8 19 100

0.032 4.000 1.265-12.653

Poor 12 30 28 70 40 100

Analysis of the Behavior of WBP to Terminate the Pulmonary TB Transmission Chain in Medan and Lubuk Pakam Prison

179

4 CONCLUSIONS

There is a relationship between knowledge and cough

behavior (p = 0.01) and mask wearing behavior (p =

0.01). There is a relationship between attitudes with

sharing a behavior (p = 0.03). There is no relationship

between knowledge with smoking behavior (p =

0.90), sputum disposal behavior (p = 0.46) and

sharing a room behavior (p = 0 , 12). There is no

relationship between attitude and coughing behavior

(p = 0.68), sputum disposal behavior (p = 0.14),

smoking behavior (p = 0.65), mask wearing behavior

(p = 0.68).

ACKNOWLEDGMENTS

Thank you to the TALENTA Research Institute,

Universitas Sumatera Utara for providing the

research funding with contract number: 4167 /

UN5.1.R / PPM / 2019. April 1, 2019.

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