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

Document Type : Research Paper


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



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.


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