Determinant factors that contribute to the increasing tuberculosis prevalence in Rokan Hilir, Indonesia

Document Type : Research Paper

Authors

1 Doctoral Program in Environmental Sciences, Postgraduate Program, University of Riau, Indonesia

2 Postgraduate Program, University of Riau, Indonesia

3 Faculty of Medicine, University of Riau, Indonesia

10.22124/cjes.2023.6154

Abstract

Tuberculosis (TB) continues to be a severe public health problem at local, national, and global levels. At the local level, the trend of increasing the spread of TB cases in Rokan Hilir District, Indonesia requires the identification of the determinants, so that scenarios for prevention and control can be developed appropriately and effectively. Therefore, this study will identify factors contributing to increase TB incidence at the sub-district level in Rokan Hilir District. This study uses a mixed design (mixed method) consisting of observational studies, case control, and spatial approaches based on Geographic Information Systems (GIS). Observational studies were carried out on track record data of TB sufferers, demographics, and health infrastructure during the 2017-2020 period. The case-control approach was applied to socio-economic and physical environment variables in 53 case respondents and 61 control respondents. A GIS-based spatial method was used to acquire climate variability and perform interpolation, interpretation, and spatial presentation in thematic maps. The findings of TB incidents from 2017 through 2020 experienced an increasing trend of 19.58 % per year with an average number of cases (± SD) of 1,068 ± 60.97 cases/year. TB incidence increased with an expanding population (R 2 = 0.675), population density (R 2 = 0.691), number of health workers (R 2 = 0.597), and number of health facilities (R 2 = 0.509). The elevated risk of TB disease occurred in people of unproductive age [odds ratio (OR) 2.409, 95% confidence interval (CI) 1.130-5.134], low education (OR 4.027, 99% CI = 1.779-9.115), low income (OR 3.632), type of floor (OR 2.449, 95% CI = 1.144-5.239), wall type (OR 2.851, 99% CI =1.322-6.146), and occupancy density (OR 3.944, 99% CI = 1.799=8.647). Demographic, socio-economic conditions, physical environment, and the availability of health facilities and infrastructure were determinants influencing the incidence of TB. Scenario intervention on determinant factors is the key to successful TB disease control to meet the 2030 national TB disease incidence elimination target.

Keywords


Aditama, RTY 2012, Distribution analysis and risk factors of pulmonary tuberculosis through mapping by region at Candilama Health Centre Semarang Last Quarter of 2012. Udinus Health Journal [In Indonesian].
Alini & Rosilawati 2017, Correlation between home conditions for pulmonary TB patients and the success of pulmonary TB treatment at RSUD Dr. RM. Pratomo Bagansiapiapi. PREPOTIVE: Journal of Public Health, 1: 32-40, [In Indonesian], DOI: https://doi.org/10.31004/prepotif.v1i1.11.
Calundu, R 2018, Health Management (Vol. 1). Sah Media. [In Indonesian].
Chenciner, L, Annerstedt, KS, Pescarini, JM & Wingfield, T 2021, Social and health factors associated with unfavourable treatment outcome in adolescents and young adults with tuberculosis in Brazil: A national retrospective cohort study. The Lancet Global Health, 9: e1380-e1390. DOI: https://doi.org/10.1016/S2214-109X(21)00300-4.
Dani, A & Suswani, A 2020 Physical environment factors with events of home lung tuberculosis in public health Bonto Bahari. Comprehensive Health Care, 4: 116-129, DOI: https://doi.org/10.37362/jch.v4i3.516.
Datiko, D, Hadgu, A, Jerene, D & Suarez, PG 2020, High urban tuberculosis case notification rates can be misleading: Evidence from an urban setting in Ethiopia. BMC Public Health, 20: 1-6. DOI: https://doi.org/10.1186/s12889-020-8290-z.
Datiko, DG, Yassin, MA, Theobald, SJ, Blok, L, Suvanand, S, Creswell, J & Cuevas, LE 2017 Health extension workers improve tuberculosis case finding and treatment outcome in Ethiopia: A large-scale implementation study. BMJ Global Health, 2(4), p.e000390. DOI: http://dx.doi.org/10.1136/bmjgh-2017-000390.
de Abreu e Silva, M, Di Lorenzo Oliveira, C, Teixeira Neto, RG & Camargos, PA 2016, Spatial distribution of tuberculosis from 2002 to 2012 in a midsize city In Brazil. BMC Public Health, 16: 1-8. DOI: https://doi.org/10.1186/s12889-016-3575-y.
de Alencar Ximenes, RA, de Fátima Pessoa Militão de Albuquerque, M, Souza, WV, Montarroyos, UR, Diniz, GT, Luna, CF & Rodrigues, LC 2009, Is it better to be rich in a poor area or poor in a rich area? A multilevel analysis of a case–control study of social determinants of tuberculosis. International Journal of Epidemiology, 38: 1285-1296. DOI: https://doi.org/10.1093/ije/dyp224.
Delavari, S, Zandian, H, Rezaei, S, Moradinazar, M, Delavari, S, Saber, A & Fallah, R 2016, Life Expectancy and Its Socioeconomic Determinants in Iran. Electronic physician, 8: 3062. DOI: https://doi.org/ 10.19082%2F3062.
Dent, BD 1999, Cartography: Thematic Map Design. McGraw-Hill.
Dhamayanti, G & Rahmaniati, M 2020, Spatial analysis of pulmonary tuberculosis in Central Kalimantan in 2017. Journal of Biostatistics, Population, and Health Informatics, 1: 1-10. [In Indonesian].
Riau Provincial Health Office (Dinkes) 2018, Riau Province health profile 2018. [In Indonesian]. [cited 2022 Oct. 28]. Available from: https://dinkes.riau.go.id/sites/default/files/2020-12/Profil%20Kesehatan%20 Provinsi%20Riau%20Tahun%202018.pdf.
Riau Provincial Health Office (Dinkes) 2020, Riau Province health profile 2020. (In Indonesian) [cited 2022 Oct 28]. Available from: https://dinkes.riau.go.id/sites/default/files/2022-01/Profil%20Kesehatan%20Provinsi%20 Riau%20Tahun%202020.pdf.
Dotulong, J, Sapulete, MR & Kandou, GD 2015, The relationship between age, gender and occupancy density risk factors with the incidence of pulmonary TB in Wori Village, Wori District. Journal of Community and Tropical Medicine, [In Indonesian] 3: 57-65. Available from: https://ejournal. unsrat.ac.id/ index.php/JKKT/article/view/7773.
Fares, A 2011, Seasonality of Tuberculosis. Journal of Global Infectious Diseases, 3(1), pp.46–55. DOI: https://doi.org/10.4103%2F0974-777X.77296.
Fitriyani, S & Sari, M 2021, Spatial-temporal sociodemographic analysis and climate variability on the incidence of positive smear pulmonary tuberculosis in West Java Province in 2013-2017. Journal for Healthy Communities (JUKMAS), 5: 140-150, [In Indonesian],  DOI: https://doi.org/10.52643/ jukmas.v5i2.1514.
Gultom, ML 2020, Characteristics of pulmonary TB patients at the Balai Jaya Health Center, Rokan Hilir Regency in 2020. Santa Elisabeth College of Health Sciences. Medan, (In Indonesian), Available from: https://repository.stikeselisabethmedan.ac.id/wp-content/uploads/2021/11/MELIZA-GULTOM.pdf.
Harling, G, Ehrlich, R & Myer, L 2008 The social epidemiology of tuberculosis in South Africa: A multilevel analysis. Social Science & Medicine, 66(2), pp.492-505. DOI: https://doi.org/10.1016/ j.socscimed.2007.08.026.
Harmono, S, Degeng, INS, Setyosari, P & Sulton, S 2018, Public awareness of exercising regularly during productive age of 20-40 years old in the Digital Era. European Journal of Physical Education and Sport Science, DOI: DOI: http://dx.doi.org/10.46827/ejpe.v0i0.2068.
Hidayatunnisa, NA, Probandari, AN & Maryani, M 2021, Relationship between gender and education level of public healthcare officers with perceptions of tuberculosis in the context of tuberculosis infection prevention and control in Surakarta. South East Asia Journal of Clinical Epidemiology and Evidence Based Medicine, 2: 18-24. Available from: https://seajceebm.e-journal.id/SEAJCEEBM/article/view/10.
Janis, N 2014, BPJS for health, supply and demand for health services. Ministry of Finance Jakarta. (In Indonesian)
Jiang, Q, Liu, Q, Ji, L, Li, J, Zeng, Y, Meng, L, Luo, G, Yang, C, Takiff, HE, Yang, Z & Tan, W 2020, Citywide transmission of multidrug-resistant tuberculosis under china’s rapid urbanization: A retrospective population-based genomic spatial epidemiological study. Clinical Infectious Diseases, 71: 142-151. DOI: https://doi.org/10.1093/cid/ciz790.
Jiang, W, Rahman, FM, Wibowo, A, Sanjaya, A, Silitonga, PII, Tang, S & Long, Q 2022, The co-management of tuberculosis-diabetes co-morbidities in Indonesia under the national tuberculosis control program: Results from a cross-sectional study from 2017 to 2019. BMC Public Health, 22: 1-10. DOI: https://doi.org/10.1186/s12889-022-13017-y.
Juwita, R, Fentia, L & Masnarivan, Y 2021, Modelling of tuberculosis risk factors. Endurance Journal: Scientific Study of Health Problems, 6: 170-179. (In Indonesian), DOI: http://doi.org/ 10.22216/jen.v6i1.5531.
Kak, N, Chakraborty, K, Sadaphal, S, AlMossawi, HJ, Calnan, M & Vikarunnessa, B 2020, Strategic priorities for TB control in Bangladesh, Indonesia, and the Philippines–Comparative analysis of national TB prevalence surveys. BMC public health, 20(1), pp.1-7, [In Indonesian],  DOI: https://doi.org/10.1186/s12889-020-08675-9.
Ministry of Health of the Republic of Indonesia (Kemenkes RI) 1999, Decree of the Minister of Health of the Republic of Indonesia Number 829/Menkes/SK/VII/1999 concerning Housing Health Requirements. (In Indonesian).
Ministry of Health of the Republic of Indonesia (Kemenkes RI) 2011, Regulation of the Minister of Health of Indonesia Number 1077/Menkes/PER/2011 concerning Guidelines for air sanitation in home rooms [In Indonesian].
Ministry of Health of the Republic of Indonesia (Kemenkes RI) 2020, National strategy for combating tuberculosis in Indonesia 2020-2024. Directorate General of Disease Prevention and Control of the Ministry of Health. Jakarta, [In Indonesian], Available from: https://tbindonesia.or.id/wp-content/uploads/2021/06/NSP-TB-2020-2024-Ind_Final_-BAHASA.pdf.
Ministry of Health of the Republic of Indonesia (Kemenkes RI) 2022, Indonesia health profile 2021. (In Indonesian), [cited 2022 Oct 28]. Available from: https://www.kemkes.go.id/ downloads/resources/download /pusdatin/profil-kesehatan-indonesia/Profil-Kesehatan-2021.pdf.
Kenedyanti, E & Sulistyorini, L 2017, Analysis of Mycobacterium tuberculosis and physical conditions of houses with pulmonary tuberculosis incidence. Epidemiology Journal, 5: 152-162, [In Indonesian], DOI: 10.20473/jbe.v5i2.2017.152-162.
Koh, GC, Hawthorne, G, Turner, AM, Kunst, H & Dedicoat, M 2013, Tuberculosis incidence correlates with sunshine: An ecological 28-year time series study. PloS one, 8: e57752. DOI: https://doi.org/10.1371/journal.pone.0057752.
Kustanto, A 2020, The role of socioeconomic and environmental factors on the number of tuberculosis cases in Indonesia. Journal of Development Economics, 18(2), pp.129-146. DOI: https://doi.org/ 10.29259/ jep. v18i2.12553.
Lolan, YP, Permana, IS & Akmal, D 2022, Relationship of environmental factors with the incidence of tuberculosis. Himalayan Journal of Community Medicine and Public Health, 3: 1-5. DOI: 10.47310/Hjcmph.2022.v03i03.001.
Maharjan, B, Gopali, RS & Zhang, Y 2021, A scoping review on climate change and tuberculosis. International Journal of Biometeorology, 65(10), pp.1579-1595. DOI: https://doi.org/10.1007/s00484-021-02117-w.
Mappau, Z & Basri, S 2020, Spatial analysis of pulmonary tuberculosis in Gowa Regency, South Sulawesi Province, Indonesia. European Journal of Molecular & Clinical Medicine, 7: 4531-4548. Available from: https://www.ejmcm.com/pdf_3037_992077fe30cbaa2a736b8dabea25c87d.html.
Meitasari, P 2020, March. The relationship between education and economic status on pulmonary tuberculosis. In 5th Universitas Ahmad Dahlan Public Health Conference (UPHEC 2019), pp. 158-160. Atlantis Press, DOI: https://doi.org/10.2991/ahsr.k.200311.030.
Misbah, T 2020, Climatic spatial analysis of pulmonary tuberculosis incidence in Mandailing Natal District in 2020. Namira, 6(2), [In Indonesian].
Mohidem, NA, Hashim, Z, Osman, M, Muharam, FM, Elias, SM & Shaharudin, R 2021, Environment as the risk factor for tuberculosis in Malaysia: A systematic review of the literature. Reviews on Environmental Health, 36: 493-499, DOI: https://doi.org/10.1515/reveh-2020-0096.
Nida, S 2014, Spatial Epidemiology of tuberculosis (TB) incidence in South Tangerang City in 2009-2013. (In Indonesian), Available from: https://repository.uinjkt.ac.id/dspace/handle/123456789/26160.
Nurany, H, Raharjo, M & Adi, MS 2022, Environmental quality factors with the incidence of pulmonary tuberculosis: A literature review. Serambi Engineering Journal, 7(3), DOI: https://doi.org/10.32672/jse.v7i3.4351.
Nurjana, MA 2015, Risk factors for pulmonary tuberculosis of productive age (15-49 years) in Indonesia. Health Research and Development Media, 25: 20736. (In Indonesian), DOI: https://dx. doi.org/10.22435/mpk.v25i3.4387.163-170.
Pangaribuan, L, Kristina, K, Perwitasari, D, Tejayanti, T & Lolong, DB 2020, Factors influencing the incidence of tuberculosis at the age of 15 and over in Indonesia. Health Systems Research Bulletin, 23: 10-17, (In Indonesian), DOI: https://doi.org/10.22435/hsr.v23i1.2594.
Pratiwi, RD, Pramono, D & Junaedi, J 2020, Socio-economic and environmental risk factors of tuberculosis in Wonosobo, Central Java, Indonesia. KEMAS: Journal of Public Health, 16: 61-70, DOI: https://doi.org/10.15294/kemas.v16i1.12636.
Pratiwi, RN, Winda, S, Suparno, AS & Tosepu, R 2021, A Systematic literature the impact of the climate to the case of tuberculosis (TB): A review. In IOP Conference Series: Earth and Environmental Science (Vol. 755, No. 1, p. 012089). IOP Publishing. Available from:  https://iopscience.iop.org/article/10.1088/1755-1315/755/1/012089/pdf.
Purnama, SG, 2016, Textbook of environmental based diseases. Denpasar: Udayana University, (In Indonesian).
Puspita, T, Suryatma, A, Simarmata, OS, Veridona, G, Lestary, H, Athena, A, Pambudi, I, Sulistyo, S & Pakasi, TT 2021, Spatial variation of tuberculosis risk in Indonesia 2010-2019. Health Science Journal of Indonesia, 12(2), pp.104-110. DOI: https://doi.org/10.22435/hsji.v12i2.5467
Qin, T, Hao, Y, Wu, Y, Chen, X, Zhang, S, Wang, M, Xiong, W & He, J 2022, Association between averaged meteorological factors and tuberculosis risk: A systematic review and meta-analysis. Environmental Research, p.113279. DOI: https://doi.org/10.1016/j.envres.2022.113279.
Resende, LSO and Santos-Neto, ETD 2015, Risk factors associated with adverse reactions to antituberculosis drugs. Journal Brasileiro de Pneumologia, 41: 77-89, [In Indonesian], https://doi.org/10.1590/S1806-37132015000100010.
Saputra M, Marlinae L, Rahman F, & Rosadi D 2015, The national health insurance program from the aspect of human resources for implementing health services. KEMAS: Journal of Public Health. Regional and Rural Development Planning, 1: 202-216, [In Indonesian],   DOI: https://doi.org/10.15294/ kemas.v11i1.3462.
Saunders, MJ & Evans, CA 2020, COVID-19, Tuberculosis and poverty: Preventing a perfect storm. European Respiratory Journal, 56: 1-5. DOI: https://doi.org/10.1183/13993003.01348-2020.
Septia, A, Rahmalia, S & Sabrian, F 2014, Relationship between family support and medication adherence in pulmonary TB patients. Online Journal of Nursing Study Program Students at the University of Riau, 1: 1-10, (In Indonesian), Available from: https://jom.unri.ac.id/index.php/JOMPSIK/article/view/3399.
Shaweno, D, Shaweno, T, Trauer, JM, Denholm, JT & McBryde, ES 2017, Heterogeneity of distribution of tuberculosis in Sheka Zone, Ethiopia: Drivers and temporal trends. The International Journal of Tuberculosis and Lung Disease, 21: 79-85, DOI: https://doi.org/10.5588/ijtld.16.0325.
Slocum, TA 1999, Thematic Cartography and Visualization. Prentice-Hall.
Suhardi, IB, Agustina Citrawati, ST & Astuti, IRD 2021, Participatory ergonomics implementation in occupational health and safety. Deepublish, [In Indonesian].
Sunengsih, N & Jaya, IGNM 2021, A Bayesian spatiotemporal autoregressive model with constant and temporally varying coefficients: An application to hotspot detection of childhood tuberculosis in Bandung City, Indonesia. Communications in Mathematical Biology and Neuroscience, pp. 1-16. DOI: https://doi.org/10.28919/cmbn/5960.
Tandirogang, N, Mappalotteng, WU, Raharjo, EN, Paramitai, S, Bulan, DE & Yasir, Y 2020, The spatial analysis of extra-pulmonary tuberculosis spreading and its interactions with pulmonary tuberculosis in Samarinda, East Kalimantan, Indonesia. Infectious Disease Reports, 12: 8727, DOI: https://doi.org/10.4081/idr.2020.8727.
Tanrikulu, AC, Acemoglu, H, Palanci, Y & Dagli, CE 2008, Tuberculosis in Turkey: High altitude and other socio-economic risk factors. Public Health, 122: 613-619. DOI: https://doi.org/10.1016/j.puhe.2007.09.005.
Teo, AKJ, Singh, SR, Prem, K, Hsu, LY & Yi, S 2021, Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: A mixed-methods systematic review and meta-analysis. Respiratory Research, 22: 1-28. DOI: https://doi.org/10.1186/s12931-021-01841-6.
Wardani, DWSR & Wahono, EP 2020, Spatio-temporal dynamics of tuberculosis clusters in Indonesia. Indian Journal of Community Medicine: Official Publication of Indian Association of Preventive & Social Medicine, 45: 43. DOI: https://doi.org/10.1051/e3sconf/202020212006.
Wikurendra, EA 2019, Literature review: Factors influencing the incidence of pulmonary tuberculosis and its management. (In Indonesian), DOI:  https://doi.org/10.31227/osf.io/r3fmq.
World Health Organisation (WHO) 2020, Global tuberculosis report 2020. Geneva. [Cited 2022 Sep 5]. Available from: https://www.who.int/publications/i/item/9789240013131
World Health Organisation (WHO) 2021, Global tuberculosis report 2021. Geneva. [Cited 2022 Sep 5]. Available from: https://www.who.int/publications/i/item/9789240037021.
World Health Organization (WHO). ‎2019‎. WHO consolidated guidelines on drug-resistant tuberculosis treatment. [Cited 2022 Sep 5]. Available from: https://apps.who.int/iris/handle/10665/311389
Yasin, M & Priyono, J 2016, Factor analysis of age, salary and dependents on the production of the home shoe industry in Sidoarjo (Case study in Krian District). Journal of Economics and Business, 1: 95-120, (In Indonesian),  DOI: https://doi.org/10.1234/jeb17.v1i01.638.
Zhang, CY & Zhang, A 2019, Climate and air pollution alter incidence of tuberculosis in Beijing, China. Annals of Epidemiology, 37: 71-76. DOI: https://doi.org/10.1016/j.annepidem.2019.07.003.
Zhou, J, Ma, X, Tian, J, Hong, F & Li, J 2021, Spatial distribution and risk factors of adverse treatment outcomes of tuberculosis in Guizhou, China, 2013-2018. Scientific Reports, 11: 1-13. DOI: https://doi.org/10.1038/s41598-021-86994-6.
Zulaikhah, ST, Ratnawati, R, Sulastri, N, Nurkhikmah, E & Lestari, ND 2019, Correlation between knowledge, behaviour and home environment with pulmonary tuberculosis transmission in the working area of ​​Bandarharjo Public Health Centre Semarang. Journal of Environmental Health Indonesia, 18: 81-88. [In Indonesian], DOI: https://doi.org/10.14710/jkli.18.2.81-88.