Factors Affecting Discovery of Pulmonary TB Case

through Molecular Quick Method (TCM) and Information System

Treking for Transport Specimens (SITRUST) in Medan

Tukiman, Syarifah, Hiswani

Universitas Sumatera Utara, Medan, Indonesia

Keywords: Pulmonary TB, TCM, Sitrust, Case Finding.

Abstract : Globally (2016) there were 10.4 million incidents of pulmonary TB equivalent to 120 cases per 100,000

population. Medan City is sample area of the International KNCV NGO with TCM and SITRUST facilities.

The aim of the study was to analyze the sociodemographic relationship, knowledge, attitudes, and behaviors

of TB officers at the health centre with the discovery of pulmonary TB cases using the TCM and SITRUST

methods. This research used cross sectional study. The population are TB officers in health centre and TB

program managers in Medan City Health Office. Samples are 39 pulmonary TB officers in Medan City

Health Center. Data collection is done by interview using a questionnaire that has been tested before and

analyzed with the Mann-Whitney test. The results of this study were 53.8% of officers aged ≥45 years,

female sex (97.4%), having an undergraduate education (46.2%), long time serving ≥ 8 years, had attended

training (87.2% ). There is no relationship between age, sex, education, length of service, training,

knowledge, attitudes, and behaviors with pulmonary TB case finding (p> 0.05), which means that all

characteristics can use the TCM and SITRUST methods in the context of TB case finding pulmonary.

1 INTRODUCTION

Globally in 2016 there were 10.4 million incidents

of pulmonary TB equivalent to 120 cases per

100,000 population. The five countries with the

highest incidence of pulmonary TB are India,

Indonesia, China, the Philippines and Pakistan. The

highest estimated incidence of pulmonary TB in

2016 occurred in Southeast Asia (45%). The number

of new TB cases in Indonesia was 420,994 cases in

2017. The Case Notification Rate (CNR) per

100,000 population in Indonesia in 2017 was 161, an

upward trend from the previous year. Indonesia's

Case Detection Rate (CDR) coverage from 2008-

2017 tended to be a significant increase in 2017's

CDR of 43.4% (Ministry of Health RI, 2018).

The estimated burden of pulmonary TB in North

Sumatra Province in 2017 TB incidence was 73,488

with a CDR of 50%. Sumatra's CNR in 2017

increased by 185 from the previous year and the

2016 Success Rate of 92.3. Based on Regency /

City the highest CNR in 2017 was Medan City

(369). In 2017 the North Sumatra Province CDR

was 35.9%, the Medan City CDR was 58.7% and

Deli Serdang was 26.4%. Whereas in the 1-3

quarters of 2018, the North Sumatra Province CDR

was 36%, the Medan City CDR was 65% and Deli

Serdang was 27%. Pulmonary TB intervention is

given evenly in all districts / cities but the results are

significant differences in the discovery of new cases.

Medan City and Deli Serdang are sample areas of

international NGOs namely KNCV in accelerating

the process of TB elimination by providing

assistance and increasing human resources in both

other regions and regions in North Sumatra

Province. Facilities provided by the KNCV in case

finding include TCM in all districts/cities.

Specifically for Medan City and Deli Serdang, they

were also given SITRUST.

Factors causing the low case finding of

pulmonary tuberculosis in health center based on

research Nugraini et al (2015) are influenced by the

duties and responsibilities of the P2TB program

holder, laboratory staff, and the head of the health

center, funding, suspicion screening, diagnosis, and

reporting.

To overcome the above problems related to the

examination currently developed Rapid Molecular

222

Tukiman, ., Syarifah, . and Hiswani, .

Factors Affecting Discovery of Pulmonary TB Case through Molecular Quick Method (TCM) and Information System Treking for Transport Specimens (SITRUST) in Medan.

DOI: 10.5220/0010014302220227

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 222-227

ISBN: 978-989-758-472-5

Test (TCM) with Xpert MTB / RIF which is fast and

can identify the presence of MTB and resistance to

rifampicin simultaneously, so that early initiation of

accurate therapy can be given and can reduce the

incidence of TB by general. At present, TCM

examination with Xpert MTB / RIF is the only

molecular examination covering all required

rebehavior elements including all reagents for the

Polymerase Chain Rebehavior (PCR) process in one

cartridge. Xpert MTB / RIF examination detects

qualitative MTB complex DNA from direct

specimens, both sputum, and no sputum. In addition

to detecting complex MTB, Xpert MTB / RIF

examination also detects mutations in the rpoB gene

that cause resistance to rifampicin. Xpert MTB / RIF

examination can diagnose TB and rifampicin

resistance quickly and accurately.

In addition to TCM, a Treking Information

System for Specimen Transport (SITRUST) was

also developed, an information system to monitor

the movement of shipments of test sample packages

starting from the order process, pick-up by courier,

confirmation of receipt, feedback related to the

conditions of the test sample to the recapitulation of

the test sample inspection results. SITRUST consists

of a form of a web-based application for managing

data and user accounts of SITRUST and an Android-

based mobile application that is used to send and

receive test samples. The main users of the

information system are program management

officers and laboratory analysts from the health

facilities and correctional institutions, couriers,

health services and the TB Sub-Directorate. In

addition to functioning as a tracking device,

SITRUST also supports the electronic recapitulation

of recording and reporting of sample shipments.

Rye, et al (2007) stated that there was a

significant correlation between TB suspicion

screening (OR = 8.92; 95% CI 2.36-38.65), IEC

services on TB (OR = 8.85; 95% CI = 2.16 -36.97),

and DOTS training (OR = 5.84; 95% CI = 1.54-

26.77) for the discovery of new cases in Palu City.

Research Saomi et al (2013) states there is a

relationship between educational background (p =

0.027; OR = 8.0) and knowledge (p = 0.023; OR =

9.75) to the discovery of cases of pulmonary TB in

the Ex-Pati Pati.

2 METHODS

This research model is quantitative. Quantitative to

see the relationship between the independent

variables and the proportion of case finding targets

in both study sites. Mann-Whitney test is used to see

the relationship between dependent and independent

variables.

3 RESULTS

3.1 Respondent Characteristic

Characteristics of respondents can be seen by using

a questionnaire through interviews which include

sociodemography (age, gender, last education, long

on duty and training experience). Respondents in

this study were 39 TB officers in Medan City Health

Center. The proportion of respondents based on

characteristics can be seen in the Table 1.

Table 1: Distribution of characteristics based on

sociodemography (age, sex, recent education, long on

duty, and training experience) of TB officers in Medan

city health center.

Characteristic n %

Age

<45 years old 18 46,2

≥45 years old 21 53,8

Total 39 100

Sex

Male

Female

Total

2,6

97,4

100

Recent Education

Senior High School 4 10,3

Diploma 17 43,6

Bachelor 18 46,2

Total 39 100

Long on duty

<8 years 18 46,2

≥ 8 years 21 53,8

Total 39 100

Training experience

Has never been

12,8

Ever

Total

87,2

100

Based on the Table 1, the results show that the

proportion of the age group of TB workers in Medan

majority is ≥45 years (53.8%), female (97.4%),

having a bachelor degree (46.2%), the majority have

been an officer in the pulmonary TB program for ≥8

years (53.8%), and the majority of staff had attended

pulmonary TB training (87.2%).

Based on Maryun's research (2007) that the

majority of TB workers are> 40 years old (42.3%).

In the Nuraisya study (2018), the same results were

Factors Affecting Discovery of Pulmonary TB Case through Molecular Quick Method (TCM) and Information System Treking for

Transport Specimens (SITRUST) in Medan

223

obtained with the majority of TB workers being

aged 46-55 years (48.8%).

This is in line with the results of Rye's research

(2009) which shows that the majority of TB workers

are female (78.6%). This is in line with the results of

Widjanarko's research (2006) which shows that the

majority of TB workers have D3 and above

education (57.7%). This is different from Maryun's

research (2007) that the majority of TB workers

have D3 education (69.2%) with the lowest

proportion of S1 education (3.8%). The majority of

staff have D3 education and above, this meets the

minimum qualification standard for health workers

to have a minimum D3 education. Based on the

research results of Ratnasari (2015) in Rembang

Regency, it shows that the level of education has no

relationship with the achievement of officers on the

case detection rate (CDR) in the pulmonary TB

program. From these results it can be concluded that

having a high education is no guarantee to produce

satisfactory performance.

The results of Nuraisya's study (2018) also

showed that the majority of officers had 12 years of

service. Maryun's research (2007) also shows a

consistent result that the majority of officers have a

working period of 11-20 years (34.6%). The results

of Husein's research (2012) showed that the majority

of officers had lama3 years of service (65%) with p>

0.05, ie the length of work had no relationship with

the performance of TB officers in the discovery of

pulmonary TB cases.

Table 2: Relationship between age of pulmonarytb

program officers and pulmonary TB case finding through

TCM and SITRUST methods in Medan city health center.

No Age

TB Case Finding

n SD Mean

<45 years old

18 4,754 37,39

2 ≥45 years old 21 3,948 51,76

Based on the Table 2, it can be seen that there are

18 TB case findings aged <45 years with a standard

deviation of 4.754 and as many as 21 TB case

findings aged ≥45 years with a standard deviation of

3,948.

Based on the Mann-Whitney test p value <0.05

(p = 0,703), which means there is no significant

difference between age and the discovery of

pulmonary TB cases in Medan City Health Center.

This is in line with the study of Widjanarko

(2006) which shows that age and sex have no

relationship with pulmonary TB case finding. Based

on the results of this study, it cannot be said that

holders of pulmonary TB programs at the older age

will produce better case findings than younger

officers. This can be proven by the existence of

some younger officers with high TB cases.

Table 3: Relationship between the sex of the pulmonary

TB program officer with pulmonary TB case finding

through the TCM and SITRUST method in Medan city

health center.

No Sex

TB Case Finding

n SD Mean

1 Male 1 - 1,00

2 Female 38 0,001 2,00

Based on the Table 3, it can be seen that there is

1 male case finding of TB. There is only 1 male case

so no standard deviation is obtained. There are as

many as 38 TB cases that are female with a standard

deviation of 0.001.

Based on the Mann-Whitney test p values <0.05

(p = 0, 109), which means there is no significant

difference between the sexes and the discovery of

pulmonary TB cases in Medan City Health Center.

This is in line with Widayat's (2006) research

which shows that there is no relationship between

the sex of TB workers and the role of health workers

in TB case finding. Some male health workers at the

health center perform their roles in TB case finding

well and some perform their roles unfavorably.

Likewise, with female health workers, some carry

out their roles well and some don't. This shows that

there are similarities between male and female

officers. Thus the TB case finding results do not

have a relationship with sex.

Table 4: Relationship between the recent education of

pulmonary tb program officers and pulmonary tb case

finding through TCM and SITRUST methods in Medan

city health center.

No Recent Education

TB Case Finding

n SD Mean

1 Senior High School 4 0,001 1,00

2 Diploma 17 0,001 2,00

3 Bachelor 18 0,001 3,00

Based on the Table 4 it can be seen that the most

TB case finding is done by officers with a bachelor's

education, namely 18 cases, with a standard

deviation of 0.001.

Based on the Mann-Whitney test p values <0.05

(p = 0, 945), which means that there is no significant

difference between the recent education and the

discovery of pulmonary TB cases in Medan City

Health Center.

This is not in line with Maryani's (2015) study

which found that the majority of TB workers had

Diploma education (66%). Education is an effort in

ICOSOP 3 2019 - International Conference on Social Political Development (ICOSOP) 3

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providing knowledge to individuals. The higher the

level of one's education, the higher the level of

knowledge. In this study, it was found that the

majority of TB workers had an undergraduate level

of education (46.2%), but in interviews conducted

relating to staff knowledge, there were still officers

who did not know/were wrong in answering

questions about TB or TB case finding with TCM.

Table 5: Relationship between the long on duty of

pulmonary TB program officers and pulmonary TB case

finding through TCM and SITRUST methods in Medan

city health center.

No Long on duty

Case Finding TB

n SD Mean

1 <8 years 18 1,96 3,08

2 ≥8 years 21 8,17 18,80

Based on the Table 5, it can be seen that TB case

finding is mostly done by officers with a duty of ≥8

years with 21 cases, with a standard deviation of

8,17.

Based on the Mann-Whitney test, p-value <0.05

(p = 0, 945), which means that there is no significant

difference between the long on duty with TB case

finding in Medan City Health Center.

Husein's research (2012) shows that there is no

relationship between the length of work and the

discovery of pulmonary TB cases. The study also

shows a consistent result, namely the length of time

the officer has no relationship to the case detection

rate in the Pulmonary TB program. In the results of

this study also showed the same thing because some

of the officers who had kerja8 years of work had a

case-finding rate that was below average and vice

versa with officers who had a length of work <8

years.

Table 6: Relationship between training experience of

pulmonary TB program officers and pulmonary TB case

finding through TCM and SITRUST methods in Medan

city health center.

Training

Experience

TB Case Finding

n SD Mean

1 Has never been 5 0,001 1,00

2 Ever 34 0,001 2,00

Based on the Table 6, it can be seen that the TB

case finding is more in the officers who have done

training compared to those who have never been

done, namely the discovery of 34 cases in the

officers who have done training with a standard

deviation of 0.001.

Based on the Mann-Whitney test, p-value <0.05,

which means there is no significant difference

between the experience of TB staff training and the

case finding of pulmonary TB cases in Medan City

Health Center.

This is different from the research results of

Ratnasari (2015) which shows that there is a

relationship between training conducted by officers

and the discovery of pulmonary TB cases. In the

results of this study, the majority of officers had

attended training (87.2%), but there was still low

pulmonary TB case finding rates. According to the

results of research Rye (2009) states that there is a

relationship between DOTS training with the

discovery of pulmonary TB cases because the

training of someone aims to look for the expected

capacity improvement. It is expected that the

increased ability will be directly proportional to the

results of improved performance which ultimately

results in the discovery of good cases of pulmonary

TB. Also, the training aims to improve the

effectiveness of officers in achieving work results by

specified and specific work implementation

techniques. In connection with TCM training, there

are still officers who are found not to know about

TCM, even though the existence of TCM is expected

to provide better results in TB case finding in the

community.

Table 7: Relationship between knowledge of pulmonary

TB program officers and pulmonary TB case finding

through TCM and SITRUST methods in Medan city

health center.

No Knowledge

TB Case Finding

n SD Mean

1 Low 19 3,36 16.26

2 High 20 4,26 26,5

Based on the Table 7, it can be seen that TB case

finding is more in officers who have high knowledge

compared to officers who have low knowledge,

namely the discovery of 20 cases in officers who

have higher education with a standard deviation of

4.26.

Based on the Mann-Whitney test, p-value <0.05,

which means there is no significant difference

between the knowledge of TB officers and the

discovery of pulmonary TB cases in Medan City

Health Center.

This is in line with research Rye (2009) which

shows that there is no relationship between the

knowledge of officers with the discovery of

pulmonary TB sufferers in the city of Palu. It means

that TB officers with good knowledge or lack the

Factors Affecting Discovery of Pulmonary TB Case through Molecular Quick Method (TCM) and Information System Treking for

Transport Specimens (SITRUST) in Medan

225

same opportunity to find patients with pulmonary

TB. In this study, it was obtained that some officers

who had high knowledge resulted in a case-finding

rate that was below average. Also, it was found that

officers who still lacked knowledge of TCM and

SITRUST due to the program that had just been

enacted and training that was lacking by officers.

In contrast to the results of Maryani's study

(2015) at the Kartasura Community Health Center

which found that there was a relationship between

the level of knowledge of health workers and the

role of TB suspects discovery, with the Spearman

test that obtained a significance value of 0.00 (p-

value <0.05). The results of the study found that the

majority of health workers had insufficient

knowledge (46%).

Table 8: Relationship between attitudes of

pulmonarytb program officers and pulmonary tb case

finding through tcm and sitrust methods in medan city

health center.

No Attitude

TB case finding

n SD Mean

1 Not good 19 1,98 29,42

2 Good 20 2,38 36,30

Based on the Table 8, it can be seen that TB case

finding is more in officers who have a good attitude

compared with officers who have less attitude,

which is found 20 cases in officers who have good

attitude with a standard deviation of 2,38.

Based on the Mann-Whitney test, p-value <0.05,

which means that there is no significant difference

between the attitudes of TB workers and the

discovery of pulmonary TB cases in Medan City

Health Center.

This is different from the results of Widjanarko's

research (2006) which shows that there is a

relationship between the attitude of TB workers with

the discovery of suspected pulmonary TB.

Ratnasari's research (2015) also shows the same

results that there is a relationship between the

attitudes of the officers and the achievement of the

officers towards the case detection rate in the

Pulmonary TB program in Rembang Regency. From

the results of this study obtained an overview of

officers who have attitude scores above average but

have low case finding results.

Based on the Table 9, it can be seen that the

discovery of more TB cases in officers who have

good behavior compared with officers who have bad

behavior, namely the discovery of 25 cases in

officers who have good behavior with a standard

deviation of 0.66.

Table 9: Relationship between behavior of pulmonary TB

program officers and pulmonary TB case finding through

TCM and SITRUST methods in Medan city health center.

No Behavior

TB Case Finding

n SD Mean

1 Not good 14 0,49 3,64

2 Good 25 0,66 5,76

Based on the Mann-Whitney test, p-value <0.05,

which means that there is no significant difference

between the behavior of TB officers and the

discovery of pulmonary TB cases in Medan City

Health Center.

The behavior illustrates the process of finding

pulmonary TB cases using the TCM method and the

SITRUST application, which includes TB officers

conducting the TCM method in sputum examination,

providing information to TB suspects regarding the

TCM method, and using the SITRUST application

in the process of sputum delivery until receiving the

results of the examination using the TCM method .

Research by Boehme, et al (2010) on rapid

molecular tests of tuberculosis and rifampicin

resistance conducted at five trial sites namely Peru,

Azerbaijan, Cape Town, South Africa, and India

with the conclusion that the MTB / RIF test provides

sensitive detection of tuberculosis resistance and

rifampicin directly from sputum in less than 2 hours.

Research conducted by Lawn, et al (2011) states that

the MTB/RIF Expert Test greatly accelerates the

time for diagnosis, with approximately 2 hours

compared to 1 day for smear microscopy, 16 days

using liquid culture and 20 days using solid culture.

This study also demonstrated the ability to quickly

and reliably detect 90% of TB cases including

almost 77% of smear-negative cases. So the faster

the detection time, the faster the TB sufferers get

treatment.

According to the TB program holders in Medan

City Health Center, the implementation of SITRUST

has run quite well. With SITRUST, the process of

sending sputum specimens from the health center to

the hospital where the TCM examination is made is

easier and benefits patients in terms of time and

money. Besides the benefits provided, there are

obstacles in its implementation. In Medan, there are

only 3 hospitals which serve as TCM examinations

from all health center in Medan. In the process,

checking with TCM only takes about 2 hours to get

results, but every specimen that is taken for TCM

examination must queue up before the inspection

process is carried out. The queuing process is the

obstacle so that the patient receives phlegm

examination results longer. Because of these

ICOSOP 3 2019 - International Conference on Social Political Development (ICOSOP) 3

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constraints, several health centers have implemented

regulations that patients suspected of having special

conditions such as those suspected of having MDR

as well as patients with complications whose sputum

examination will be sent to use TCM examination. If

the patient still shows symptoms of regular TB, then

the examination is only done with a conventional TB

examination at the health center.

4 CONCLUSION

The majority of TB workers in Medan are in the age

category ≥45 years (53.8%), female sex (97.4%),

last education S1 (46.2%), length of service ≥8 years

(53.8% ), and had attended training (87.2%).

There is no relationship between age, sex, last

education, length of service, experience in training,

knowledge, attitudes, and behaviors of TB officers

with TB case finding using the TCM and SITRUST

methods in Medan City.

ACKNOWLEDGMENT

Thank you to the TALENTA Research Institute,

University of North Sumatra for providing and

researching with contract number: 4167 / UN5.1.R /

PPM / 2019 dated April 1, 2019.

REFERENCES

Boehme, C., 2010. Rapid molecular detection of

tuberculosis and rifampicin resistance. The New

England Journal of Medicine, 363(11), 1005-1015.

Health Office of North Sumatra Province, 2018. TB

control program policies in North Sumatra Province.

Medan.

Husein, R.D., Sormin, T., 2012. Factors related to the

performance of pulmonary tb program officers against

new case findings in south lampung regency. Journal

of Nursing, 8(1), 52-59.

RI Ministry of Health, 2017. Technical guidelines for

examination of tb using molecular rapid tests. Jakarta.

RI Ministry of Health, 2018. Infodatin tuberculosis.

Jakarta.

RI Ministry of Health, 2018. SITRUST application usage

guide. Jakarta.

Lawn, S.D., Nicol, M.P., 2011. Xpert MTB/RIF Assay:

development, evaluation, and implementation of a new

rapid molecular diagnostic for tuberculosis and

rifampicin resistance. Future Microbiol, 6(9), 1067-

1082.

Maryani, 2015. Relationship of health staff knowledge

level about tuberculosis with the role of health

workers in finding tuberculosis suspects in kartasura

health center. Thesis. Husada College of Health

Sciences: Surakarta.

Maryun, Y., 2007. Several factors related to the

performance of lung tb program officers against scope

of new bta (+) case discovery in Tasikmalaya city in

2006. Thesis. Universitas Diponegoro: Semarang.

Nugraini, K.E., Cahyati, W.H., & Farida, E., 2012.

Evaluation of the input of health center case detection

rate (CDR) achievement of lung TB in the 2012

pulmonary disease management program (p2tb)

(qualitative study in the city of Semarang).

Nuraisya, M., et al., 2018. Description of factors related to

the finding of cases of pulmonary tuberculosis in

batang district based on characteristics, performance

of health center staff and laboratory facilities. Journal

of Public Health, 6(2), 34-42.

Ratnasari, D., 2015. Factors associated with the

achievement of officers against case detection rate

(CDR) in the pulmonary tb program in rembang

district. Thesis. Universitas Negeri Semarang:

Semarang.

Rye, Awusi, et al., 2009. Factors affecting the discovery of

lung TB patients in Palu city, Central Sulawesi

province. Kedokteran Masyarakat News, 25(2).

Saomi, E.E., Chayati, W.H., & Indarjo, S. (2013). The

relationship of individual characteristics with the

discovery of pulmonary tuberculosis cases in pati pati

Ex-2011. Journal of Public Health, Universitas Negeri

Semarang. Retrieved from http://journal.unnes.ac.id/

sju/index.php/ujph

Widayat, E., 2006. The influence of characteristics,

knowledge and attitudes of officer holders of the

health center pulmonary tuberculosis program to the

discovery of pulmonary tb suspects in blora regency.

Thesis. Universitas Diponegoro: Semarang.

Widjanarko, B., et al., 2006. The influence of

characteristics, knowledge and attitude of health clinic

holder officers of the pulmonary tuberculosis program

against the discovery of a pulmonary tb suspect in

Blora regency. Indonesian Health Promotion Journal,

1(1), 41-52.

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Transport Specimens (SITRUST) in Medan

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