The Status of BCG Immunization in Pre-Schoolers in Relation with

Pulmonary Tuberculosis Incidence in North Surabaya

Dini Mei Widayanti, Sapto Dwi Anggoro and Ita Hernawati

STIKES Hang Tuah Surabaya, East Java, Indonesia

Keywords : Immunization, Tuberculosis, Pre-schoolers.

Abstract: Tuberculosis (TB) is an infectious disease caused by Mycobacterium tuberculosis. Immunization is an

attempt to provide immunity to pre-schoolers by introducing vaccines into the body. The purpose of this

study was to analyze the relationship of BCG immunization status and the incidence of TB in pre-schoolers.

The research design used analytical observation with Cross-Sectional approach. Simple random sampling

was taken as data collection technique, with population of 80 pre-schoolers and 67 were appointed as the

respondents. The instruments were interviews and observations. The data were analyzed by Chi-squared test

with significance level of p <0.05. The results of the study indicated that 43 immunized pre-schoolers, 28 of

whom were not infected by lung TB, 9 were infected and 6 were suspects. The other group of 24 non-

immunized pre-schoolers indicated that 14 were not infected, 1 was infected and 9 were suspects. Chi-

square statistical test results showed that BCG immunization status had a relationship with the incidence of

TB in pre-schoolers with p = 0.033 (p <0.05).The research has come to a conclusion that BCG

immunization is very important for pre-schoolers to maintain their immunity. It is expected for parents to be

aware of getting their children immunized.

1 BACKGROUND

Tuberculosis (TB) is an infectious disease caused by

Mycobacterium Tuberculosis. According to Hidayat

(2009), immunization is an effort to provide

immunity to pre-schoolers and children by entering

the vaccine into the body to make antibodies to

prevent certain diseases. Based on the high

incidence of TB incidence in our country and the

unavoidable transmission process, the most effective

prevention is through BCG vaccination (Ikatan

Dokter Anak Indonesia, 2011). Although there has

not been proven the efficacy of BCG immunization

consistently, until now the immunization is still

effective and safe. BCG is one way to control TB

(Rahajoe, 2005 in Welldany Siregar 2008). A child

who has been immunized with BCG and yet he is

infected with TB bacteria, in general it does not

develop into tuberculosis (Mufidah, 2012). But not

all diseases can be prevented by vaccination,

including BCG vaccination to prevent tuberculosis

infection. Reduced protection by BCG is possible

due to many factors such as ineffective and efficient

BCG administration procedures (Islamiati, 2009 in

Miswan efendi 2012). From interviews with a

number of parents it has been found that some pre-

schoolers, who have been immunized in North

Surabaya are infected with TB.

Pulmonary tuberculosis is one of the chronic

infectious diseases that has become global issues

targeted in the MDGs and are also listed in the MSS

of health. In Indonesia, this disease is one of the

national priorities for disease control program

because it has a broad impact on life quality and

economy, and it often leads to death. Nevertheless,

the indicator of MSS of tuberculosis disease is only

'new case finding', whose indicator does not yet fully

describe the treatment of tuberculosis (Laksono,

2012). Eight goals of the MDGs that must be

implemented by each country that declares them; 1)

tackling poverty and hunger, 2) achieving basic

education for all, 3) promoting gender equality and

empowering women, 4) reducing child mortality, 5)

improving maternal health, 6) combating HIV /

AIDS, malaria and other infectious diseases, 7)

ensuring environmental sustainability, and 8)

developing a global partnership for development.

Indonesia as one of the participating countries in

declaring the MDGs' goals has an obligation to

implement efforts to achieve the MDGs targets and

Widayanti, D., Anggoro, S. and Hernawati, I.

The Status of BCG Immunization in Pre-Schoolers in Relation with Pulmonary Tuberculosis Incidence in North Surabaya.

DOI: 10.5220/0008329706150620

In Proceedings of the 9th Inter national Nursing Conference (INC 2018), pages 615-620

ISBN: 978-989-758-336-0

615

to monitor progress towards achievement (Dr.

Afrina Sari).

Tuberculosis (TB) is a serious problem for the

world, because it causes the major deaths compared

to other infectious diseases. It is estimated that about

one-third of the world's population has been infected

by Mycobacterium Tuberculosis. An estimated 95%

of Pulmonary TB cases and 98% of deaths spread

across the world, mostly those in developing

countries (Depkes RI 2007). Globally, there are

8,800,000 new cases of TB in the world in 2010.

(Hendry J, WHO, Global Tuberculosis Control

2011). In Indonesia every year there are 1.3 million

children under 15 years old who are infected with

TB germs and annually there are 450,000 child

deaths due to this disease as recorded by Samallo in

FKUI. A preliminary study conducted by researchers

on February 4, 2015, drawn from the data of 5 pre-

schoolers at Perak Timur Surabaya Community

Health Center, resulted in 40% TB, 20% suspect and

40% non-TB.

Tuberculosis (TB) is accepted as a major issue. It

needs a thorough handling as well as the attention of

health care services, government and society as a

whole (Wahyu, 2008). Based on the results of the

theory of several factors related to the occurrence of

lung tuberculosis in children include: immature

immune system, close contact with adults with

tuberculosis nearby (parents, close relatives, and

caregivers), and lack of awareness of parents to

immediately vaccinate BCG in newborns (Wahyu,

2008 in Miswan Efendi 2012). Pre-schoolers who

suffer from pulmonary TB are mostly due to

transmission from adult patients. Transmission of

tuberculosis disease from air contaminated by

Mycobacterium Tuberculosa released by the patients

when cough in the form of droplets (Depkes RI ,

2005). One effort to prevent the occurrence of

pulmonary TB disease is by immunization.

However, reduced protection by BCG is possible

due to many factors such as ineffective and efficient

BCG administration procedures (Islamiati, 2009 in

Miswan Efendi 2012). This study aims at finding the

correlation of the BCG immunization status and

Pulmonary TB incidence in Preschoolers.

2 METHODS

This research used Analytical observation design

with Cross-Sectional approach, by which the

researcher intended to describe the relationship of

BCG Immunization Status with Pulmonary TB

incidence in Toddler in North Surabaya. The

population in this research is all 80 patients of pre-

schoolers at Puskesmas Tambak Gringsing, Perak

Timur of Surabaya. The sample of this research was

a group of 67 respondents who met with the

following criteria: inclusive kriteria is mothers

possessing KMS (Health Status Card) and mothers

with 0-5 year old children. Exclusive kriteria is

mothers who were unwilling to participate in the

research.

The sampling technique undertaken in this

research was simple random sampling. The

independent variable was the status BCG

immunization. In addition, the dependent variable of

this research was the incidence of pulmonary TB in

children under five years old.

The instrument used in this research were

observations and interviews. The Status of BCG

Immunization were looked upon the respondents’

Health Status Card or The so-called KMS. It was

intended to identify the immunization status. Apart

from that medical record document was used to

determine the status of TB incidence in pre-

schoolers with several criteria of: TB-sufferers

(TBSF), TB-suspects (TBSS), and Non-TB-sufferers

(NTBSF). In data collection, the researcher asked

the for informed consents from the respondents prior

to interviews and observations. However, this phase

was initiated with a permit from the Head of East

Perak region Puskesmas.

2.1 Data Analysis

Data analysis technique is done by statistical test

with Chi-Square analysis with significance value

0,05 meaning p <α 0,05 hence hypothesis accepted

which mean there is relation of BCG immunization

status with the incidence of pulmonary tuberculosis

in under five years old children in Tambak

Gringsing, Perak Primary Care Unit of Surabaya. If

p> α 0.05 means the hypothesis is rejected, which

means that there is no relationship between BCG

immunization status and the incidence of pulmonary

tuberculosis in under five years old children in

Tambak Gringsing, Perak Primary Care Unit of

Surabaya.

2.2 Research Ethics

This research has undergone ethical procedure in

terms of: btaining ethical clearance issued by LP3M

Stikes Hang Tuah Surabaya number:

SKET/01.a/III/2015/LP3M/SHT, providing

Informed Consent sheet, assuring confidentiality and

considering anonimity.

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

616

3 RESULTS

3.1 Research Results

3.1.1 Respondents’ Characteristics

Based on table 1, it was found that most of the

respondents aged> 30 years. Based on table 2, it was

found that most of the respondents are female. Based

on table 3, it was found that the respondents'

education was secondary school. Based on table 4, it

was found that the majority of respondents' parents’

occupation was house-wife. Based on table 5, it was

found that the respondents’ family income was

<2.700.000. Based on table 6, it is found that the

majority of the respondents was 2-4 years 53.7% (36

respondents). Based on table 7 The majority of the

respondents’ sex was female. Based on table 8, it

was found that the respondent's time of getting

vaccination was mostly at the age of 1-5 months old.

3.1.2 Variables

Specific data presented table data about the

relationship of BCG immunization status with the

incidence of pulmonary tuberculosis in under five

years old children in Tambak Gringsing, Perak

Primary Care Unit of Surabaya. From these results

can be known whether or not there is a strong

relationship between the two variables with

Table 1: Respondents’ characteristics based on age.

Characteristics

(

mother’s a

)

Frequency Percentage

(

)

<25

5 7.5

25-30 year

>30

44.8

47.8

Total 67 100

Table 2: Respondents’ characteristics based on the

parents’ sex.

Characteristic

(sex)

Frequency Percentage (%)

Female 45 67.2

Male 22 32.8

Total 67 100

Table 3: Respondents’ characteristics based on the

parents’ educational background.

Characteristic

(

endidikan

)

Frequency Percentage (%)

Uneducated

Primary

Junior Hi

20.9

37.3

Senior High

College

37.3

4.5

Total 67 100

Table 4: Respondents’ characteristics based on the

parents’ occupation.

Characteristic

(

occu

ation

)

Frequency Percentage (%)

Civil Servant 2 3

Private

Own Business

House-wife

Unemployed

16.4

20.9

55.2

4.5

Total 67 100

Table 5: Respondents’ characteristics based on

parents’ income.

Characteristic

(

income

)

Frequency Percentage

(

)

<2.700.000 53 79.1

2.700.000

>2.700.000

17.9

Total 67 100

Table 6: Respondents’ characteristics based on

children’s age.

Characteristics

(Current age)

Frequency Percentage (%)

1-2 year 13 19.4

2-4 year

5 year

53.7

26.9

total 67 100

Table 7: Respondents’ characteristics based on the

children sex.

Characteristic

(Children’s Sex)

Frequency Percentage (%)

Female 35 52.2

Male 32 47.8

Total 67 100

Table 8: Respondents’ characteristics based on under

five-year-old children’s time of BCG immunization.

Characteristic

(Age when

Immunized

)

Frequency Percentage

(%)

Not immunize

24 35.8

1-5 months

6-10 months

11-15 months

58.2

4.5

1.5

Total 67 100

The Status of BCG Immunization in Pre-Schoolers in Relation with Pulmonary Tuberculosis Incidence in North Surabaya

617

statistical analysis Chi-Square test. Table 9 showed

that respondents based on immunization status who

did not immunize BCG were 35.8% (24

respondents), and BCG immunization was 64.2%

(43 respondents). Table 10 shows that 62.7% (42

respondents) did not have TB, which suspected TB

as much as 22.4% (15 respondents), and 14.9% for

TB (10 respondents). Table 11 showed the

relationship of immunization status and the

incidence of tuberculosis in children. Based on Chi-

Square test results obtained value = 0.033 <α = 0.05,

which means there is a statistically significant

relationship between immunization status and the

incidence of pulmonary TB in infants.

4 DISCUSSION

4.1 BCG Immunization Status of

Children Under 5 Years Old at

Tambak Gringsing, Perak Timur of

Surabaya

The results of the research in Table 5.9 showed that

respondents were 24 respondents (35.8%) who were

not immunized and 43 respondents (64.2%) were

immunized.

According to Maryanti, et al (2011) BCG

immunization is a preventive effort for the type of

tuberculosis infection (TB) in children. An

immunization used to prevent the occurrence of

severe TB disease due to the incidence of primary or

minor TB disease can occur despite BCG

immunization, prevention of BCG immunization for

severe tuberculosis such as tuberculosis in the lining

of the brain, tuberculosis Milier (in all lung fields) or

TB BCG bone immunization is a vaccine containing

TB germs that have been attenuated.

The frequency of BCG immunization is 0-11

months, but it is generally given to 2 or 3 months of

age (Hidayat, 2009).

4.2 The Incidence of Pulmonary TB

The result of the research in table 5.10 shows that

the respondents of lung tuberculosis cases in infants

as many as 42 respondents (62.7%) did not suffer

tuberculosis with respondents who vaccinated at 1-5

months of age as many as 25 (64.1%) respondents,

6-10 months 2 (66.7% ) of respondents, and 11-15

month olds as many as 1 (100%) respondents, while

unvaccinated were 14 (58.3%) respondents.

Because BCG immunization is an immunization

given to infants aged 0-2 months who aims to

prevent tuberculosis. Due to an imperfect immune

system, close contact with adults with tuberculosis

around them (parents, close relatives, and carers)

(Wahyu, 2008).

According to Herry (2011), there are three

pulmonary TB risk factors, namely density, density

of residence affecting the cause of disease

transmission. The more densely settled, the more

rapid the disease transmitted through the air, the

temperature in the room closely related to the

density of shelter and ventilation. Pulmonary TB

germs will become inactive by sunlight that can kill

the vital function of the organism. Density of

residence set by Depkes (2008).

Table 9: Respondents’ characteristics based on

immunization status.

Immunization

Status

Frequency Percentage (%)

Non BCG

immunized

24 35.8

BCG Immunized 43 64.2

Total 67 100

Table 10: The incidence of pulmonary tb in children

under 5 year old.

The Incidence

of TB

Frequency Percentage (%)

Not Infecte

42 62.7

TB Suspects

TB Infected

22.4

14.9

Total 67 100

Table 11: The correlation of BCG immunization status

and the incidence of pulmonary tb in children under 5

year old at Tambak Gringsing, Perak.

BCG

Imm

uniza

tion

Statu

Incidence in under 5 Year old Children

Non TB

Suspect

TB Total

f % f % f % n %

24 100

Yes

43 100

Total

67 100

Result of Chi-Square didapatkan

nilai ρ = 0.033 < α = 0.05

INC 2018 - The 9th International Nursing Conference: Nurses at The Forefront Transforming Care, Science and Research

618

Contact history, close and prolonged contact

with adult TB sufferers who live at home, also

facilitate the occurrence of TB transmission. House

contact with TB patients is one of the risk factors for

TB.

4.3 The Correlation of BCG

Immunization Status and The

Incidence of Pulmonary TB

The relationship between immunization status

relationship with the incidence of pulmonary

tuberculosis in infants as shown in Table 5.11

according to Chi-Square test results obtained ρ =

0.033 <α = 0.05, it means statistically there is a

relationship of BCG immunization status with the

incidence of pulmonary tuberculosis in toddlers at

Tambak Gringsing, Perak Timur Primary Care Unit

of Surabaya..

Based on the research data, 67 (100%) were not

immunized with BCG of 24 people (62.7%) and

those who did not have TB 14 people (58.3%) were

more dominant than those who did not immunize

with the suspect as many as 9 people (37.5%),

immunization with TB as much as 1 (4.2%). BCG

immunization is an immunization given to infants

aged 0-2 months who aims to prevent tuberculosis

(TB). According to Maryanti, et al (2011) BCG

vaccine given to infants aged 0-12 months by

intracutan injection with a dose of 0.05 ml. BCG

vaccine otherwise successful when tubercular

conversion occurs at the injection site.

Based on the result of the immunization research,

there were 43 people (64.2%) who had not TB 28

people (65.1%), the TB 9 people (20.9%), and the

suspect 6 people (14.0%). According to Rahajoe,

2005 in Welldany siregar 2008 Although it has not

proven the efficacy of BCG immunization

consistently, so now the immunization is still

effective and safe given. BCG is one of the efforts of

TB prevention efforts. The occurrence of pulmonary

tuberculosis in children can be caused by several

things other than due to contact with adult patients

and BCG immunization.

Other factors include children occupying densely

populated homes, children's homes in humid

conditions, house ventilation and children's

inadequate temperature, insufficient house lighting,

exposure to cigarette smoke, economic status,

nutritional status and toddlers who are not

exclusively breastfed.

5 CONCLUSIONS

Based on the results of the research that has been

done in Ponds Gringsing Area Puskesmas Perak

Timur Surabaya, it can be concluded as follows: 1)

BCG immunization was mostly given to pre-

schoolers; 2) Most pre-schoolers do not suffer from

Pulmonary TB; 3) There is a relationship between

the status of BCG immunization with the incidence

of pulmonary tuberculosis. This study could be

accepted as a source of information for future

research, healthcare services, as well as parents.

However, this study could be lack of accuracy in

determining Limitations of the study were in terms

some technical problems in collecting data that

might affect the accuracy of data report.

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