Analysis the Relationship of Sociodemography and Knowledge of

Diabetics Mellitus on the Pulmonary Tuberculosis Incidence

Sorimuda Sarumpaet

, Evawany Aritonang

and Syarifah

Department of Epidemiology, Universitas Sumatera Utara, Medan, Indonesia

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

Department of Health Education and Behavioural Sciences, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Patients DM, Sociodemography, Risk of Pulmonary TB.

Abstract: Indonesia ranks second highest with the highest number of TB incidents in the world, 391 per 100,000

inhabitants (WHO, 2017). International Diabetes Federation (2012) reported that DM sufferers risk 2.5

times to develop into pulmonary TB than those who do not DM. Research objectives to analyze the

relationship of sociodemography and knowledge on the risk of Pulmonary TB. The study was case control

and location of the research in 6 Puskesmas Medan city (Sering, Glugur Darat, PB Selayang, Sunggal,

Medan Deli and Simpang Limun). Case samples are DM sufferers with Pulmonary TB and control samples

are the DM sufferers who are following the TB treatment program in the health center, respectively 54 for

case samples and control. Data was analyzed by chi-square test. The results showed no relationship between

age (p = 0.163), gender (p = 0.120), education (p = 0,234), occupation (p = 0,167), knowledge (p = 0,846)

on the pulmonary TB incidence in DM sufferers.

1 BACKGROUND

According to WHO (2013), TB disease is the second

leading cause of death that has infected 9.4 million

people and killed 1.7 million people worldwide each

year. Indonesia ranks second highest with the

highest number of TB incident cases in the world, at

391 per 100,000 population (WHO, 2017). There

were 22,627 TB sufferers in North Sumatra Province

in 2013.

Based on Rachmawati (2015) in the clinic of

internal medicine Prof. Dr. Soerojo Magelang, the

average fasting blood sugar level 75.3% is bad and

postprandial sugar level 90.5% is also bad. All

patients did not regularly check HbA1c levels.

Patients with Diabetes Mellitus (DM) are more at

risk of suffering from pulmonary TB than without

DM. Hyperglycemia in people with DM causes

impaired neutrophil and monocyte function which

affects chemostactic function, phagocytosis and

decreased bacterial killing power. According to

Reis-Santos et al. (2013), decreased immunologic

response in a person will facilitate the development

of infectious diseases including Mycobacterium

tuberculosis.

Based on Magee's research (2011) shows that in

countries with a high DM prevalence, it is also

followed by a high TB prevalence. This has an

impact on the increasing health burden. The

International Diabetes Federation (2012) reports that

people with DM are at a higher risk for developing

pulmonary TB than those without DM, which is 2.5

times.

Based on data from the Central General Hospital

(RSUP) of H. Adam Malik Medan, it is known that

the number of people with type 2 diabetes have

complications of pulmonary TB hospitalization in

2017 was 124 people.

So far there has been no research that explains

the risk of pulmonary TB in patients with DM in

puskesmas (health center). For that we need to know

the factors that influence the risk of pulmonary TB

in people with DM.

2 METHOD

This study is a longitudinal observational study with

case-control design. Cases were DM patients with

pulmonary TB while controls were DM patients

218

Sarumpaet, S., Aritonang, E. and Syarifah, .

Analysis the Relationship of Sociodemography and Knowledge of Diabetics Mellitus on the Pulmonary Tuberculosis Incidence.

DOI: 10.5220/0010014202180221

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 218-221

ISBN: 978-989-758-472-5

without pulmonary TB. The population of all adult

DM sufferers (≥18 years old) registered at the

Puskesmas Sering, Glugur Darat, PB Selayang,

Sunggal, Medan Deli and Simpang Limun. The case

population was all DM patients with pulmonary TB,

while the control population was all DM patients

without pulmonary TB.

Case samples are DM patients with pulmonary

TB who are currently attending a TB treatment

program/who have recovered and are registered at

the Puskesmas Sering, Glugur Darat, PB Selayang.

Sunggal, Medan Deli and Simpang Limun. The

control sample was DM sufferers who were taking

medication and were recorded at the health center.

The sample size was calculated with following

values based on a study: confidence level = 90%,

power (1-β) = 80%, case control ratio = 1:1, odds

ratio = 3.19, obtained 108 samples, 54 each for case

and control samples. Data collection techniques

conducted interviews using a questionnaire that has

been tested for validity and reliabilityand visited

each patient's house according to the address

recorded at the puskesmas.

The analysis was carried out using univariate

analysis by presenting frequency distribution data of

proportions from cases and controls. Bivariate

analysis performed a chi-square test to assess the

degree of significance (p) and OR to determine the

influence of independent variables on the dependent

variable.

3 RESULTS AND DISCUSSION

Based on the results of the study, the risk factors for

pulmonary tuberculosis in diabetics can be seen on

the Table 1. The proportion of respondents aged ≤60

years is higher in the case group as much as 70.4%

and the control group as much as 55.6%, while

respondents aged >60 years in the case group as

much as 29.6% and the control group as much as

44.4%. Based on the results of the statistical test

analysis p value = 0.163, which means there is no

influence of age on the incidence of pulmonary TB

in patients with DM. This is in line with Lusiani

(2017) research who examined the risk factors for

manifestation of pulmonary TB in patients with type

2 DM in Surabaya in 2017 stating that there was no

significant effect between age on the incidence of

pulmonary TB in DM patients (p=1,0).

The results of this study indicate that

transmission of pulmonary TB can be at risk in the

age group ≤60 years or>60 years in people with DM.

This is in accordance with the nature of pulmonary

TB which can be transmitted directly from sputum

of TB patients with Acid Fast Bacilli Positive

(AFB+) by spreading TB germs into the air in the

form of sputum droplets (droplet nuclei). Based on

data from the Ministry of Health (2018), it is found

that pulmonary TB sufferers occur in all age groups

ranging from infants to the elderly.

Table 1: Relationship of sociodemography on the incidence of pulmonary TB in patients with DM.

Sociodemography

Respondent Status

OR (90% CI)

Case Control

f % F %

1,90

(0,92-4,19)

0,163

Age

≤60 38 70,4 30 55,6

>60 16 29,6 24 44,4

Gender

Male 28 51,9 19 35,2

1,98

(0,92-3,96)

0,120

Female 26 48,1 35 64,8

Education

Low 17 31,5 24 44,4

0,54

0,234

High 37 68,5 30 55,6

(0,26-1,13

Occupation

Not working 29 53,7 37 29

0,53

0,167

Working 25 46,3 17 25

(0,21-1,39)

Total 54 100 54 100

Analysis the Relationship of Sociodemography and Knowledge of Diabetics Mellitus on the Pulmonary Tuberculosis Incidence

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By sex, know that the proportion of respondents

based on male sex is higher in the case group by

51.9% and in the control group by 35.2% while

female respondents tend to be low in the case group

by 48.1% and high in the control group by 64.8%.

Based on the results of the statistical test analysis,

the value of p=0.120 means that there is no influence

of sex on the incidence of pulmonary TB in patients

with DM. The results of this study are in line with

the study of Nasr et al. (2016) in Egypt stating that

there was no significant effect of sex on the

incidence of pulmonary TB in DM patients (p=0.86).

The results of this study indicate that pulmonary TB

is an infectious disease that can attack anyone

without knowing the sex and have the same

opportunity in people with DM.

Based on education it can be seen that the

proportion of respondents with higher education is

higher in the case group by 68.5% and in the control

group by 55.6%, while respondents with low

education in the case group by 31.5% and in the

control group by 44.4%. Based on the results of the

statistical analysis test p value = 0.234 which means

there is no influence between education on the

incidence of pulmonary TB in patients with DM.

This is in line with the research of Hapsari (2017)

who conducted a study in Tambaksari District,

Surabaya, which stated that there was no

relationship of education on the incidence of

pulmonary TB in patients with DM (p = 0.608).

This is different from the results of

Juwatiningsih's research (2013), which states that the

variable that influences the risk of pulmonary TB

infection in patients with DM is the level of

education (OR = 203,83)with a p value <0.05. Based

on work, it can be seen that the proportion of

respondents not working in the case group was

53.7% and in the control group was 68.5%, while

the respondents who worked in the case group were

46.3% and in the control group by 31.5%. Based on

the results of the statistical analysis test, the value of

p=0.167 means that there is no relationship of work

on the incidence of pulmonary TB in patients with

DM. This is different from the study of Hapsari

(2017) which states that there is a work effect on the

incidence of pulmonary TB in patients with type 2

DM (p = 0.022) and DM patients who do not work

have a risk of 3,297 suffering from pulmonary TB

compared with patients with type 2 diabetes mellitus

who work . Work is a measure of socioeconomic

level and a person's health problems, because work

is a source of income that affects a person's

socioeconomic and nutritional status. Fulfillment of

nutrition that is not good allows the condition of a

person's body will be vulnerable to disease and

reduce the body's immune status. In poor

environmental conditions, a person with poor

nutritional status will be vulnerable to contracting

infectious diseases, especially pulmonary

tuberculosis. Whereas in this study the work had no

effect on the occurrence of TB in patients with DM,

possibly because the respondents were those seeking

treatment at the puskesmas using BPJS so that they

were in the socioeconomic group and relatively

homogeneous nutritional status both in cases and

controls.

From the Table 2; the proportion of respondents

with low knowledge in the case group is 40.7% and

in the control group is 44.4%, while respondents

who are knowledgeable in the case group are 59.3%

and in the control group are 55.6%.

Based on the results of the statistical test analysis

p value = 0.846 which means there is no influence

between knowledge on the incidence of pulmonary

TB in patients with DM. This shows that between

high and low knowledge have the same chance of

TB occurrence. In this study respondents who suffer

from DM are patients who seek treatment at the

Health Center where they get the same information

from puskesmas staff about the knowledge and risk

of TB that can arise due to suffering from DM.

Table 2: Relationship of knowledge on the incidence of pulmonary TB in patients with DM.

Knowledge

Respondent Status

(90% CI)

Case Control

f % f %

0, 85

(0,41-1,74)

0,846

Low 22 40,7 24 44,4

High 32 59,3 30 55,6

Total 54 100 54 100

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4 CONCLUSION

The results showed that there was no gender

relationship on the incidence of pulmonary TB in

DM patients (p = 0.120), there was no effect of

education on the incidence of pulmonary TB in DM

patients (p = 0.234), there was no occupational

relationship on the incidence of pulmonary TB in

DM patients (p=0.167), there was no relationship of

knowledge on the incidence of pulmonary TB in

patients with DM (p = 0.84).

ACKNOWLEDGEMENT

Thanks to the Research Institute of Universitas

Sumatera Utara who has given the research fund

with the contract number: 4167/UN 5.1.

R/PPM/2019 dated 01 April 2019.

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