Factors Related to Pulmonary Tuberculosis Patients Compliance to

Anti Tuberculosis Drugs: Observational Analytic Study in Working

Area of Puskesmas Pekauman Banjarmasin City

Dian Rosadi

, Fahrini Yulidasari

, Megawati

Department of Epidemiology, University of Lambung Mangkurat, Banjarbaru, Indonesia

Department of Nutrition, University of Lambung Mangkurat, Banjarbaru, Indonesia

Public Health Study Program, University of Lambung Mangkurat, Banjarbaru, Indonesia

Keywords: Pulmonary tuberculosis, compliance with anti-tuberculosis drugs, knowledge

Abstract: Tuberculosis (TB) is a disease with a high risk of transmission. One of the determinants of successful

management of tuberculosis treatment is patient adherence to therapy. Adherent patients completing treatment

is regular and complete treatment without interruption for at least six months to 9 months. Based on Report

South Kalimantan Provincial Health Office in 2017 discovered 6,656 cases / 10 177 suspected. Judging from

the data that the city of Banjarmasin is the highest town invention pulmonary TB incidence rates as much as

2,238 cases. Judging from the data on the number of pulmonary TB patients per health centre in Banjarmasin

showed that Puskesmas Pekauman occupies the highest case detection rate of pulmonary TB incidence by

2018 as many as 94 people with relapsing patients were three people and as many as seven people edited.

Therefore, Pekauman Health Center is selected as research sites. This study aims to clarify the relationship

between age, sex, education, medication side effects, knowledge, and attitude of health personnel with

compliance to anti-tuberculosis drugs. This research is an observational analytic with a cross-sectional design

using a purposive sampling technique. The population in this study were 45 patients and a sample of 30

patients. The instrument used was a questionnaire. Bivariate data analysis with fisher exact test because it

does not meet the Chi-Square test is a normal distribution of data, frequency expectation value <5 and more

than 20%. Based on the results of the research knowledge variable (p-value = 0.019) was associated with

compliance with anti-tuberculosis drugs. However, the sex variable (p-value = 1. 000) was not associated with

compliance with anti-tuberculosis drugs. The number of samples is still small, and the number of research

variables is limited.

1 INTRODUCTION

Tuberculosis (TB) is an infectious disease caused by

the bacterium Mycobacterium tuberculosis. This

infection usually attacks the lungs (pulmonary TB),

but can also attack other organs (extrapulmonary TB).

The source of transmission is smear-positive TB

patients (acid-resistant bacteria) through sputum that

it releases. TB with smear-negative also still has the

possibility of transmitting TB disease, even with a

low transmission rate. Ending the tuberculosis

epidemic is one of the goals of the SDGs (sustainable

development goals) by 2030 (Sinaga, Farida, and

Husnul, 2016; Indonesian Statistics Agency, 2016).

Tuberculosis (TB) is a disease with a high risk of

transmission. One of the determinants of the

successful management of tuberculosis therapy is

patient compliance with therapy. Patients who adhere

to treatment are those who finish treatment regularly

and thoroughly without interruption for at least six

months to 9 months. Meanwhile, non-compliance

with treatment in tuberculosis patients according to

Sari's study (2016) is if the patient does not seek

treatment for two consecutive months or more before

the treatment period is complete (Sari, Rofingatul,

and Sudibyo, 2011) . Non-compliance with treatment

will cause failure and recurrence, resulting in

resistance and continuous transmission of disease.

This condition can increase the risk of morbidity,

mortality and drug resistance both inpatients and on

the broader community. The consequences of long-

term non-compliance with treatment are deteriorating

health and increasing costs of care. Disobedience of

Rosadi, D., Yulidasari, F. and Megawati, .

Factors Related to Pulmonary Tuberculosis Patients Compliance to Anti Tuberculosis Drugs: Observational Analytic Study in Working Area of Puskesmas Pekauman Banjarmasin City.

DOI: 10.5220/0010684700002967

In Proceedings of the 4th International Conference of Vocational Higher Education (ICVHE 2019) - Empowering Human Capital Towards Sustainable 4.0 Industry, pages 349-353

ISBN: 978-989-758-530-2; ISSN: 2184-9870

349

pulmonary TB sufferers causes low cure rates, high

mortality rates and increased recurrence and more

fatal is the occurrence of germ resistance to several

anti-tuberculosis drugs or multidrug resistance so that

pulmonary tuberculosis is complicated to cure

(Ministry of Health of the Republic of Indonesia,

2011) .

Indonesia is the country with the second-largest

number of new cases in the world after India. Based

on the WHO global tuberculosis report (2017),

Indonesia's tuberculosis incidence rate was 391 per

100,000 population and mortality rate was 42 per

100,000 population, whereas according to the

modelling based on tuberculosis prevalence survey

data in 2013-2014 the prevalence rate in 2017 was

619 per 100,000 population, while in 2016 it was 628

per 100,000 population. The target of tuberculosis

prevalence in 2016 is 271 per 100,000 population. It

is followed with achievements of 257 per 100,000

population in 2017. The target is 262 per 100,000

population with achievements of 254 per 100,000

population (World Health Organization, 2017; The

Indonesian Ministry of Health, 2018).

Data from the Basic Health Research (Riskesdas)

in 2013 showed that the prevalence of pulmonary TB

diagnosed by health workers in Indonesia was 0.3%

and South Kalimantan Province was ranked 12th as a

contributor to the prevalence of pulmonary TB in

Indonesia (RI Ministry of Health, 2013) . The South

Kalimantan Provincial Health Office report in 2017

found 6,656 cases / 10,177 suspected. Judging from

the data that the city of Banjarmasin is the highest city

finding pulmonary TB incidence as many as 2,238

cases (South Kalimantan Provincial Health Office,

2017). Judging from the data on the number of

pulmonary TB patients per PUSKESMAS in

Banjarmasin City, it was found that the Pekauman

PUSKESMAS occupies the highest number of cases

of pulmonary TB in 2018 with 94 people with three

patients recurring and seven deaths (Banjarmasin

City Health Office, 2018) . Therefore Pekauman

Health Center was chosen as a research site.

Based on this description, it is felt necessary to

research factors related to adherence to taking anti-

tuberculosis medication in pulmonary tuberculosis

patients in the working area of Pekauman Health

Center.

2 METHOD

This research is a type of quantitative research. This

study uses a cross-sectional study design using a

purposive sampling technique. The number of

respondents in this study totalled 30 pulmonary

tuberculosis patients who were still being treated. The

instrument used in this study was a questionnaire. The

questionnaire in this study consisted of 2 types,

namely, a questionnaire that included self-identity

such as gender and a questionnaire relating to the

knowledge and attitudes of health workers. The

bivariate analysis uses the fisher exact test statistic

test because it does not meet the Chi-Square test,

which is typically distributed data, the expected

frequency value <5 and more than 20%.

3 RESULTS AND DISCUSSION

3.1 Univariate Analysis

This analysis aims to get a picture of the frequency

distribution data of each variable, namely an

independent variable that includes gender, knowledge

and attitude of health workers and the dependent

variable, compliance with medication). The

description of independent and dependent variables

are as follows:

Table 1: Frequency distribution of adherence to taking anti-

tuberculosis drugs, gender, knowledge and attitude of

health workers.

Variable Respondents

Amount (n) Percentage

(100%)

Compliance with Anti-

Tuberculosis Medication

Obedien

25 83.3

Not obey 5 16.7

Gende

Male 19 63.3

Girl 11 36.7

Knowledge

High 21 70

Low 9 30

Attitudes of Health Workers

Positive 30 100

Negative 0 0

Source: Primary Data from 2019 Research Results

Table 1 shows that the frequency of compliance

shows that the number of respondents is higher than

the number of non-adherent respondents (83.3%

compared to 16.7%). In the gender frequency

distribution, it shows that the number of respondents

is male - greater than the number of women (63.6%

compared to 36.7%).In the frequency distribution of

knowledge shows that the number of respondents

with high knowledge is greater than the number of

respondents with low knowledge (70% versus 30%).

ICVHE 2019 - The International Conference of Vocational Higher Education (ICVHE) “Empowering Human Capital Towards Sustainable

4.0 Industry”

350

In the frequency distribution of attitudes of health

workers showed that all the number of respondents

rated the attitude of health workers positive (100%).

3.2 Bivariate Analysis

This analysis aims to explain the relationship between

two variables, namely between each independent

variable which includes the sex, knowledge and

attitude of health workers with the dependent

variable, namely medication adherence. However, the

independent variable is the attitude of health workers

not included in the bivariate analysis because the

results of the univariate analysis did not show varied

results.

Table 2: Relationship Between Gender and Knowledge

with Compliance with Taking Anti-Tuberculosis Drugs.

Variable Compliance with

Anti-Tuberculosis

Medication

Total P-

value

Obedient Not

obey

Gende

1,000

Male 16

(84.2%)

(16.7%)

(100%)

Girl 9

(83.3%)

(16.7%)

(100%)

Knowledge

0.019

High 20

(95.2%)

(4.8%)

(100%)

Low 5

(55.6%)

(44.4%)

(100%)

Source: Primary Data from 2019 Research Results

Based on table 2, the results of the study show that

knowledge is a variable that is related to adherence to

taking anti-tuberculosis medication, while gender is

not related to adherence to taking anti-tuberculosis

medication.

Based on the Fisher exact test results, it can be

seen that there is no relationship between sex with

adherence to taking anti-tuberculosis drugs (p-value

= 1,000). Based on the results of this field because all

patients with pulmonary TB male or female want to

recover from the disease and do not want to transmit

it to their families, so they are obedient to follow the

guidelines given despite the drug-taking a long time.

This finding is in line with research by Dewanty et al.

in 2016, obtained a p-value of 1,000 which shows that

there is no significant relationship between sex with

adherence to treatment of patients with pulmonary TB

in the working area of Nguntoronadi I Puskesmas

Wonogiri District. The results showed that there were

no significant differences in the number of

disobedient men and women because both men and

women have the same workload (Sinaga, Farida, and

Husnul, 20160]. Besides, according to Kondo et al. in

2014 the results of the chi-square test showed p-value

= 0.459, that gender did not have a relationship with

the level of adherence for treatment of pulmonary TB

patients. Based on the results of research in the field

in one house, several generations in the house

affected by pulmonary TB, starting from parents and

children. Even so, not all family members were

genuinely obedient in completing their treatment.

However, the high number of male patients allows

broad transmission. The finding is because the men

are mostly out of the house for a living. The frequency

of leaving the house allows transmission of

pulmonary TB disease. Therefore, compared to the

women, their possibility is higher,

Based on the Fisher exact test results, it can be

seen that there is a relationship between knowledge

and adherence to taking anti-tuberculosis drugs (p-

value = 0.019). The higher the respondent's

knowledge, the more compliant with taking TB

medicines. Conversely, the lower the knowledge, the

more disobedient respondents are taking pulmonary

TB medicine. The respondent's tremendous

knowledge about the length of TB treatment until it

was declared healed, so the respondent was compliant

in taking TB medication according to the schedule

from the health worker's statement. Based on field

results, this is because every new pulmonary TB

patient will undoubtedly be explained related to

pulmonary TB diseases such as an explanation of how

transmission, treatment, and prevention of

transmission. The results of this study are in line with

research conducted by Aprianor in 2018 obtained p-

value 0.006> 0, 05 shows that there is a significant

relationship between knowledge and medication

adherence (Sinaga, Farida, and Husnul,

2016Indonesian Statistics Agency, 2016). Besides,

Prihananta research in 2016 that knowledge with the

level of treatment compliance in pulmonary

tuberculosis patients in Dr Soehadi Prijonegoro

Sragen Hospital with a significance value (p) of

0.009. So it can be interpreted that there is a

significant relationship between knowledge and the

level of medication adherence in tuberculosis patients

at RSUD Dr Soehadi Prijonegoro Sragen. The better

the knowledge of pulmonary tuberculosis patients,

the better the compliance of pulmonary tuberculosis

patients in treatment. Factors that influence the

regularity of taking medication in pulmonary

tuberculosis patients in addition to the knowledge of

the patient itself is also the knowledge of the person

who supervises in taking medication, for example,

family or health workers. With a positive relationship

Factors Related to Pulmonary Tuberculosis Patients Compliance to Anti Tuberculosis Drugs: Observational Analytic Study in Working Area

of Puskesmas Pekauman Banjarmasin City

351

between knowledge and level of compliance, this

requires the relevant parties to provide counselling to

the public about the dangers of pulmonary

tuberculosis and the importance of compliance in

treatment. Consultation with the right media is the

right way to the right target. It will undoubtedly be

able to help increase the knowledge of patients so that

the level of adherence in treatment will also increase

(Sinaga, Farida, and Husnul, 20163).

4 CONCLUSIONS

Based on the results of this study, the conclusion

obtained is that there is a relationship between

knowledge and adherence to taking anti-tuberculosis

medication in pulmonary tuberculosis patients in the

working area of Pekaumaun Public Health Center,

Banjarmasin. While gender variables did not show a

relationship with adherence to taking anti-

tuberculosis drugs in pulmonary tuberculosis patients

in the working area of Pekaumaun Public Health

Center, Banjarmasin, it is suggested that the patients

with pulmonary TB should undergo treatment

according to doctor's advice and adhere to treatment.

They should listen and observe the rules and

directions form health workers and PMO. When there

are complaints or side effects of drugs such as fall

risk, mortal risk, because of the side effects of drugs,

they should notify the carer and overcome it by

administering drugs or vitamins. Moreover, increase

knowledge about pulmonary tuberculosis by

attending counselling and communication with health

workers at the health centre. For Pekauman Health

Center, it is better to play an active role by conducting

counselling/inserting materials in every meeting with

patients or the community in posyandu activities /

other activities, because the role of health workers

and PMO is very influential on the success of

treatment. For the Banjarmasin Health Office, it is

better to conduct monitoring and evaluation in all

PUSKESMAS, hospitals, private clinics, private

doctor practices so that TB management must be

following DOTS. For Pekauman Health Center, it is

better to play an active role by conducting

counselling/inserting materials in every meeting with

patients or the community in posyandu activities /

other activities, because the role of health workers

and PMO is very influential on the success of

treatment. For the Banjarmasin Health Office, it is

better to conduct monitoring and evaluation in all

PUSKEMAS, hospitals, private clinics, private

doctor practices so that TB management must be

following DOTS. For Pekauman Health Center, it is

better to play an active role by conducting

counselling/inserting materials in every meeting with

patients or the community in posyandu activities /

other activities, because the role of health workers

and PMO is very influential on the success of

treatment. For the Banjarmasin Health Office, it is

better to conduct monitoring and evaluation in all

PUSKESMAS, hospitals, private clinics, private

doctor practices so that TB management must be

following DOTS.

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