Vol.4, No.04, April 2023
E-ISSN: 2723-6692
P-ISSN: 2723-6595
http://jiss.publikasiindonesia.id/
Journal of Indonesian Social Science, Vol. 4, No. 04, April 2023 390
Determinants of Success in Treatment of Tuberculosis (TB)
Patients at the Karang Rejo Health Center, Balikpapan City
Aspiansyah
Fakultas Ilmu Kesehatan Masyarakat, Institut Ilmu Kesehatan STRADA Indonesia
Email: mmhafiy@gmail.com
Corresponding Author: [email protected]
ARTICLE INFO
ABSTRACT
Submitted
:02-04-2023
Received
:05-04-2023
Approved
:15-04-2023
Tuberculosis is one of the infectious diseases that is still a public
health problem around the world. Balikpapan City in 2020, the
number of patients infected with tuberculosis was 937 patients. As
for 2021, there are 1,152 new patients and for 2022 until June there
are 566 new patients. According to data obtained by the Karang Rejo
Health Center, it is known that the number of patients infected with
tuberculosis in 2020 was 36 people, then in 2021 as many as 18
people, and in 2022 as many as 17 people. This study aims to
determine the determining factors for the success of treatment of
tuberculosis (TB) patients at the Karang Rejo Health Center,
Balikpapan City. This study used the design method of cross-
sectional analytical research. The sample in this study was 17
patients in 2022. Using data analysis through two steps, namely
univariate analysis and bivariate analysis using the Chi Square test
and the Fisher's Exact test. The results showed that there was no
significant association between treatment status (P-Value 0.63), age
(P-Value 0.46), sex (P-Value 0.56), occupation (P-Value 0.48),
diagnosis type (P-Value 0.27), OAT guidance (P-Value 0.56) and
adherence rate to cadres (P-Value 0.79) with successful tuberculosis
treatment. Meanwhile, there is a relationship between the source of
the drug and the success of tuberculosis treatment with a P-Value of
0.05.
Keywords: Tuberculosis;
determinant factor; patient
treatment
Attribution-ShareAlike 4.0 International (CC BY-SA 4.0)
1. Introduction
Tuberculosis is an infectious disease that is still a public health problem throughout
the world. Tuberculosis is a disease caused by the bacterium Mycobacterium1. The world has
declared tuberculosis to be one of the world's priority goals to eradicate, namely through the
Sustainable Development Goals (SDGs). In this case, the target is to set tuberculosis as a goal
in the health sector, namely the end of the tuberculosis epidemic). Since 1995, the DOTS
(Directly Observed Treatment Short course) strategy has been recommended by the World
Health Organization (WHO) and the International Union Against Tuberculosis and Lung
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Diseases (IUATLD) as a strategy to combat tuberculosis and has proven to be the most
effective (Rikmasari, 2018).
Several factors can influence the emergence of tuberculosis in patients, namely, (1)
the age factor, in Indonesia tuberculosis is most common among young adults, with an
estimated 75% of patients diagnosed with tuberculosis are of working age. (2) Gender factor,
which affects men more than women because most of them smoke. (3) Smoking habits can
weaken the immune system and make it easier to get sick, especially for men who are used
to smoking4 (4) Environmental factors, someone who lives in a slum, dark environment and
no sunlight will be susceptible to tuberculosis. (5) Occupational factors can be a factor due to
direct contact with sick people. The risk of contracting tuberculosis in the workplace is health
workers who often have direct contact with patients. (6) The economic status factor, the most
important factor in the family, is that there are still many low-income people who can
transmit tuberculosis to tuberculosis sufferers because low-income people are unable to
meet their health needs. (Sutisna et al., 2016)
One way to deal with the high incidence of tuberculosis is in the form of the DOTS
program, namely the Directly Observed Treatment Shortcourse, or tuberculosis treatment
directly supervised by medical personnel (PMO). One of the contents of the DOTS program is
a short-term combined anti-tuberculosis treatment (OAT) with direct supervisors. A PMO
(Medical Supervisor) is required to ensure regularity of care (Pameswari et al., 2016). This
effort is an effort that is used for tuberculosis patients at the Karang Rejo Health Center. The
indicator used to evaluate treatment is the success rate of the program. The treatment
success rate consists of the cure rate and the total number of treatments. There are factors
that can affect the success of tuberculosis treatment.
The external factor of the patient's environment that influences adherence behavior
in undergoing treatment is PMO. The PMO is a health cadre whose duty is to schedule
treatment for tuberculosis patients, the correct procedure for taking tuberculosis medication,
provide an understanding of the side effects of drugs, and remind patients not to stop taking
tuberculosis medication(Yanti, 2016). This is because it can be resistant and repeated again
as before the treatment from the start. The role of tuberculosis health cadres is that when a
patient does not come for treatment at the puskesmas, they contact the patient and visit the
house to check the availability of the drug. If there is no response from the patient, the
tuberculosis health worker will come to the tuberculosis patient's house.
Other external efforts made to increase patient adherence in undergoing treatment
are through the family, the family is the patient's closest family member, so that they can
monitor the patient's daily adherence to taking medication. In this role, the patient will
consistently take to the puskesmas and take tuberculosis medicine (Eko, 2019). The things
that can affect the successful treatment of tuberculosis patients are treatment status, age,
gender, occupation, type of diagnosis, OAT guidelines, drug sources, and level of adherence
to cadres. Based on this description, the researchers conducted research on "Determining
Factors for the Success of Treatment of Tuberculosis (TB) Patients at the Karang Rejo Health
Center, Balikpapan City".
2. Materials and Methods
This study used an analytic cross sectional research design method. The sample in this
study was 17 patients in 2022 at the Karang Rejo Health Center. The sample selection used
total sampling with retrospective data collection based on TB patient registers according to
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the source of the drug, namely the TB program. This study uses data analysis through two
steps, namely using univariate analysis and bivariate analysis.
The univariate analysis was used to identify respondents based on their
characteristics (treatment status, age, gender, occupation, type of diagnosis, OAT guidelines,
drug sources, and level of adherence to cadres) and the data was presented in tabular form.
Bivariate analysis to determine the relationship between treatment status, age, gender,
occupation, type of diagnosis, OAT guidelines, drug sources, and level of adherence to cadres.
Each of these variables was tested with data on treatment success (the end result of
treatment) using the Chi Square test and Fisher's Exact test (Sugiyono., 2017).
3. Results and Discussions
A. Univariate analysis
Univariate analysis was used to obtain data on treatment status, age, gender,
occupation, type of diagnosis, OAT guidelines, source of drugs, and level of adherence to
cadres.
Table 1. Frequency distribution of respondents based on treatment status,
age, gender, occupation, type of diagnosis, oat guidelines, source of medicine, and level of
adherence to cadres
No
Characteristics of respondents
%
1
Treatment Status
Standard Compliant
82,3
Not Standard
17,6
Total
100
2
Age
0-25 years
29,4
26-50 years
41,1
>50 years
29,4
Total
100
3
Gender
Man
76,5
Woman
23,5
Total
100
4
Work
Laborer
23,5
IRT
11,7
Private
Employees/BUMN/BUMD
17,6
Student / Student
17,6
Doesn't work
29
Total
100
5
Diagnostic Type
Clinically Diagnosed
47
Bacteriological Diagnosed
53
Total
100
6.
OAT guide
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Category 1
76,5
Children Category
23,5
Total
100
7.
Drug Source
Program TBC
100
Total
100
8
Level of Compliance with
Cadres
Comply
94,1
Disobedient
5,9
Total
100
Table 1 shows that the majority of respondents who received standard treatment were
14 people with a presentation of 82.3%. The majority of the age group is 26-50 years with a
percentage of 41.1%. In terms of gender, the majority were male as many as 13 people with
a percentage of 76.5%. The majority of respondents did not work, namely as many as 5 people
with a percentage of 29.4%. Characteristics of respondents based on the majority of the type
of diagnosis with the type of clinical diagnosis as many as 8 people with a percentage of 47%.
Respondent characteristics based on OAT guidelines with category 1 were 13 people with a
percentage of 76.5%. Characteristics of respondents based on the TB program as many as 17
people with a percentage of 100%. Characteristics of respondents based on the level of
adherence to cadres The majority of respondents obeyed cadres as many as 16 people with a
percentage of 94.1%.
B. Bivariate Analysis
Bivariate analysis is an analysis to determine the relationship between variables. The
statistical test used to determine the relationship between these variables is a test that
squares and test Fisher’s exact test .
Table 2. Relationship between treatment status and Success
treatment of tuberculosis patients
Treatment Status
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,63
Standard Compliant
13
76,5
1
5,8
14
82,3
Not Standard
3
17,6
0
0
3
17,6
Based on the table, shows that in the category of successful treatment of cured patients,
the majority of respondents were in the category of standardized treatment status, namely
13 people with a percentage of 76.5%. In the category of non-standard treatment status, there
were 3 people with a percentage of 17.6%. The results of the analysis using the test whose
squares generate value p-value (0.63) > α (0.05) it can be concluded that there is no
relationship between treatment status and the success of tuberculosis treatment at the
Karang Rejo Health Center, Balikpapan City (Damayanti, 2019a).
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Table 3. Relationship between Age and successful treatment of tuberculosis patients
Age
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,46
0-25 years
5
29,4
0
0
5
29,4
26-50 years
6
35,2
1
5,9
7
41,1
>50 years
5
29,4
0
0
5
29,4
Based on the table, it shows that in the category of successful treatment, most recovered
patients were in the 26-5-year age category, namely 6 people with a percentage of 35.2%. In
the 0-25 year age category, there were 5 people with a percentage of 29.4%. In the age
category of 50 years and over there were 5 people with a percentage of 29.4%. Results
Analysis using test who squares earned value p value (0.46) > α (0.05) it can be concluded
that there is no relationship between age and the success of tuberculosis treatment at the
Karang Rejo Health Center, Balikpapan City.
Table 4. The relationship between gender and the successful treatment of
tuberculosis patients
Gender
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,56
Man
12
70,5
1
5,9
13
76,4
Woman
4
23,5
0
0
4
23,5
Based on the table, it shows that in the category of successful treatment of cured
patients the majority of respondents were in the male gender category, namely 12 people
with a percentage of 70.5%. In the female gender category, there were 4 people with a
percentage of 23.5%. Based on the results of the analysis using the test who squares earned
value p value (0.56) > α (0.05) so it can be concluded that there is no relationship between
gender and the success of tuberculosis treatment at the Karang Rejo Health Center,
Balikpapan City.
Table 5. The relationship between work and the success of treating tuberculosis
patients
Work
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,48
Laborer
3
17,6
0
0
3
17,6
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IRT
2
11,7
0
0
2
11,7
Private
Employees/BUMN/B
UMD
3
17,6
1
5,9
4
23,5
Student / Student
3
17,6
0
0
3
17,6
Doesn't work
5
29,4
0
0
5
29,4
Based on the table, it shows that in the category of successful treatment of recovered
patients, the majority of respondents were in the category of non-working respondents,
namely 5 people with a percentage of 29.4%. In the category of laborers,
private/BUMN/BUMD employees, students, there are 3 people each with a percentage of
23.5%. In the IRT job category there are 2 people with a percentage of 11.7%. The results of
the analysis using the test who squares gain value p value (0.48) > α (0.05) so it can be
concluded that there is no relationship between work and the success of tuberculosis
treatment at the Karang Rejo Health Center, Balikpapan City.
Table 6. Relationship between the type of diagnosis and success
treatment of tuberculosis patients
Diagnostic Type
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,27
Clinically Diagnosed
7
41,1
1
5,9
8
47
Bacteriological
Diagnosed
9
52,9
0
0
9
53
Based on the table, it shows that in the category of successful treatment of cured
patients, the majority of respondents were in the diagnosis type category of respondents
diagnosed with bacteriology, namely as many as 9 people with a percentage of 52.9%. In the
category of clinical diagnosis, there were 7 people with a percentage of 41.1%. Based on the
results of the analysis using the test who squares earned value p value (0.27) > α (0.05) so it
can be concluded that there is no relationship between the type of diagnosis and the success
of tuberculosis treatment at the Karang Rejo Health Center, Balikpapan City.
Table 7. The relationship between oat guidance and the successful treatment of
tuberculosis patients
OAT guide
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,56
Category 1
12
70,5
1
5,9
13
76,5
Children Category
4
23,5
0
0
4
23,5
Based on the table it shows that in the category of successful treatment of cured patients
the majority of respondents were in the OAT guide category of category 1 respondents,
namely 12 people with a percentage of 70.5%. In the OAT guide category, there were 4
children with a percentage of 23.5%. Based on the results of the analysis using the test who
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squares earned value p-value (0.56) > α (0.05) so it can be concluded that there is no
relationship between OAT guidelines and the success of tuberculosis treatment at the Karang
Rejo Health Center, Balikpapan City.
Table 8. Relationship between the source of drugs and successful treatment of
tuberculosis patients
Drug Source
Treatment success
Healed
Die
Total
P. Value
N
%
N
%
N
%
0,05
Program TBC
16
94,1
1
5,9
17
100
Based on the table, it shows that both in the category of successful treatment of
recovered patients, the majority of respondents were in the category of drug sources, namely
16 people with a percentage of 94.1%. Based on the results of the analysis using the test who
squares gain value p value (0.05) = α (0.05) it can be concluded that there is a relationship
between drug sources and the success of tuberculosis treatment at the Karang Rejo Health
Center, Balikpapan City.
Table 9. The relationship between the level of patient adherence to cadres and the
successful treatment of tuberculosis patients
Patient Compliance Rate
Treatment success
Healed
Die
Total
P.
Value
N
%
N
%
N
%
0,79
Comply
15
88,2
1
5,9
16
94,1
Disobedient
1
5,9
0
0
1
5,9
Based on the table, it shows that in the category of successful treatment of recovered
patients, the majority of respondents were in the category of patient compliance, namely 16
people with a percentage of 88.2%. Respondents were in the category of non-adherent
patient compliance level, namely 1 person with a percentage of 5.9%. Based on the results of
the analysis using the test chi square earned value p value (0.79) > α (0.05) so it can be
concluded that there is no relationship between the level of patient compliance with the
success of tuberculosis treatment at the Karang Rejo Health Center, Balikpapan City.
DISCUSSION
The results of the study stated that there was no significant relationship between
treatment status and successful treatment of tuberculosis patients at the Karang Rejo Health
Center, Balikpapan City. The category of treatment status in the national TB control data is
divided into two aspects, namely the patient's treatment status according to standards and
the patient's treatment status not according to standards. Patient treatment status according
to standard is a procedure for handling patients starting from finding cases/diagnoses, drug
guidelines (OAT), program monitoring to program reporting. Lack of tuberculosis
management, especially in health facilities that have not implemented TB services according
to national guideline standards such as the absence of finding the right diagnosis,
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inappropriate drug guidelines, not carrying out monitoring of treatment programs, and the
absence of standard records and reporting (Anggraeni & Kardiwinata, 2020).
In the age category, the results of the study stated that there was no significant
relationship between age and the success of tuberculosis treatment at the Karang Rejo Health
Center, Balikpapan City. In contrast to research
7
Others say that there is a relationship
between age and the treatment status of pulmonary TB patients. The test results stated that
there was a significant relationship between age and the success of pulmonary tuberculosis
treatment. The results showed that there was no relationship between gender and the
successful treatment of tuberculosis patients at the Karang Rejo Health Center, Balikpapan
City (Wulandari, 2018).
The categories of tuberculosis incidence based on the type of diagnosis are divided
into two, namely tuberculosis patients with a bacteriological diagnosis and tuberculosis
patients with a clinical diagnosis. A bacteriological diagnosis is a TB patient whose biological
test results, namely sputum and tissue, prove positive (Sutisna et al., 2016). Examination of
the biological test through a series of direct microscopic examination, TB TCM, and culture.
A clinically diagnosed tuberculosis patient is a patient who does not meet the
bacteriologically diagnosed component but is diagnosed as an active TB patient by a health
worker, and it is decided to be given the TB program as a tuberculosis treatment (Regulation
of the Minister of Health of the Republic of Indonesia, 2016).
The results of the study prove that there is no relationship between OAT guidelines
and the success of tuberculosis treatment at the Karang Rejo Health Center, Balikpapan City.
Treatment of pulmonary tuberculosis at the puskesmas for adult patients with OAT FDC
category I consist of 2 parts: Intensive/initial treatment with 6 packs of RHZE capsules (150
mg rifampicin, 75 mg isoniazid, 400 mg pyrazinamide and 275 mg ethambutol) for 2 months;
and a high-level regimen of 6 blister packs of RH tablets (150 mg rifampicin and 150 mg
isoniazid) for 4 months. In the treatment of pulmonary tuberculosis in children, the
tuberculosis drug Combipak is used with a fixed combination of category 1 drugs according
to the Ministry of Health's 2RHZ(E)/4RH guidelines, namely H. (INH, rifampicin,
pyrazinamide and ethambutol) used within 6 months. According to the OAT category
guidelines, class I requires 6 months of treatment and class II requires 8 months of treatment
with different drug doses
(Damayanti, 2019b). Another study found that there was a
significant relationship between the instructions for giving OAT and the successful treatment
of tuberculosis patients, which was supported by the correct instructions, the type, amount
of drug and sufficient duration of treatment, the patient followed these instructions. from
doctors/recommendations from health workers and regularly. Follow the OAT instructions
(Maulidya et al., 2017).
The results of the study found that there was a relationship between the source of the
drug and the success of tuberculosis treatment at the Karang Rejo Health Center, Balikpapan
City. The success of patient treatment is influenced by drug sources that are in accordance
with OAT guidelines. The drugs used are in accordance with the TB program provided by the
health facility (100%). Patients who take TB program drugs regularly have a 95% chance of
recovery compared to patients who do not receive TB program drugs.
The results of the study said that there was no relationship between patient
compliance with cadres and the success of tuberculosis treatment at the Karang Rejo Health
Center, Balikpapan City. Patient compliance with cadres is an internal factor in the patient's
desire to recover. Compliance is influenced by family support and the patient's level of
understanding of tuberculosis treatment. Health cadres are tasked with monitoring patients
taking medication (PMO) so good cooperation is needed between patients and health cadres
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for the recovery of patients while undergoing treatment.
4. Conclusion
The success of tuberculosis treatment at the Karang Rejo Health Center in Balikpapan
City is based on treatment status, age, gender, occupation, type of diagnosis, OAT guidelines,
drug sources, and level of adherence to cadres. Based on the results of the study, it was found
that there was no significant relationship between the categories of treatment status, age,
gender, occupation, type of diagnosis, OAT guidelines, and level of adherence to cadres with
the successful treatment of tuberculosis patients. While the category of drug sources has a
relationship with the success of treatment of tuberculosis patients.
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