Determinants of TB-RO Affecting Confirmation Have Not Started

the Treatment

R. Kintoko Rochadi

, Erna Mutiara

and Syarifah

Department of Health Education and Behavioral Sciences, Universitas Sumatera Utara, Medan, Indonesia

Department of Biostatistics and Population, Universitas Sumatera Utara, Medan, Indonesia

Department of Health Education and Behavioral Sciences, Universitas Sumatera Utara, Medan, Indonesia

Keywords: Sociodemography, TB-RO Confirmation, Starting Treatment.

Abstract: Indonesia is 8th of the most TB-RO in the world. Indonesia for January-June 2010 there were 3.507

suspected TB-RO, 504 confirmed TB-RO and RO 377 were treated for TB. From 2012 to 2017 cases of TB-

RO in North Sumatra Province were 893 cases. A total of 717 cases (80.3%) underwent treatment, 20%

(176 Patients) did not want to undergo treatment. Cases that did not start treatment Became a source of

transmission of TB-RO in the community so that experienced Increase in TB-RO. For this reason, it is

important to know the factors that affect patients confirmed that TB-RO does not start treatment in Medan.

This type of observational research is case control design. The study population was all patients with TB-

RO in Medan City recorded in the e-TB Manager 61 patients data. Case sample was 13 people and the

control sample was 31 people. Interview of data collection using a questionnaire and analyzed by univariate

and bivariate. The results showed that many patients with TB-RO could not be met because of the

incompatibility of addresses with reviews those registered in the e-TB Manager and many had died.

Bivariate results had no relations with sociodemographic and behavioral-RO starting TB treatment.

1 INTRODUCTION

Cases of drug-resistant pulmonary TB (TB-RO) are

increasing at the global and Indonesian levels.

Currently Indonesia is ranked eighth in the order of

the most cases of TB-RO in the world (Ministry of

Health Republic of Indonesia, 2011). The main

factor causing an increase in TB-RO cases is due to

the management of TB patients not according to the

standard (ISTC) and program errors, health workers

and the community. In Indonesia from January to

June 2010 there were 3,507 suspected TB-ROs, 504

confirmed TB-ROs and 377 were treated with TB-

ROs. It is estimated that there are around 6,300 TB-

RO cases each year (Burhan, 2010).

From 2012 until 2017-RO TB cases in North

Sumatra province as many as 893 cases while it was

willing to undergo the treatment as many as 717

cases (80.3%), the rest almost 20% (176 patients)

did not want to undergo treatment. Cases that do not

want to start this treatment will be a source of

transmission of TB in the community so that the

RO-RO TB cases are increasing because it will

transmit TB-RO also to the surrounding community.

Of the patients who underwent the treatment is also

known that the dropout rate treatment from year to

year is still high, higher than the number that can be

tolerated, True i.e. 5% (provincial health office of

North Sumatra, 2018).

Medan is the region with the highest TB cases in

Sumatra RO Utara. Until November 2018-RO TB

cases that have been confirmed in the city of Medan

324, which has not yet started treatment 61 patients

(19%). More patients who already take medication

as many as 282 cases (81%), with the status of the

treatment was 119 patients (42%), more patients

with no status in the treatment (56%).

For that, we need to know the factors that affect

patients confirmed TB-RO but not initiate treatment

in Medan.

2 METHOD

The research was conducted in the city of Medan.

Using a case-control study design that is examining

factors that influence TB treatment RO. Population

case study of all patients who have no TB-RO

Rochadi, R., Mutiara, E. and Syarifah, .

Determinants of TB-RO Affecting Conﬁrmation Have Not Started the Treatment.

DOI: 10.5220/0010014102130217

In Proceedings of the 3rd International Conference on Social and Political Development (ICOSOP 3 2019) - Social Engineering Governance for the People, Technology and Infrastructure in

Revolution Industry 4.0, pages 213-217

ISBN: 978-989-758-472-5

213

treatment and registered and have a valid address

corresponding e-TB Manager that is 13 people.

Population control TB-RO that has been treated with

a ratio of 3: 1, the total population of the cases

obtained 31 respondents. Collecting data using

interviews using questioner. the sample was 44 cases

and control. Analyze data by univariate and chi-

square test, the variables with P <0.05 to be related.

3 RESULT

3.1 Effect of Age with TB-RO

Based on Table 1, the proportion of respondents

aged ≤40 years in the case group as much as 30.8%

lower than the control group 41.9%. While

respondents aged> 40 years in the case group as

much as 69.2% greater than the control group

58.1%. Results using chi-square analysis showed

that it contained no significant effect between age

and treatment of TB-RO status (p = 0.723> 0.05).

Value OR = 1.61, indicating the status of TB-RO

treatment 1.6 times the tendency occurred on the

respondents were aged ≤ 40 years versus> 40 years.

The study is in line with research Yusi, et al

(2018) in Semarang obtained a value of p = 0.098,

which means there is no significant effect between

age determinant Treatment. Research Dessisa et al in

East Shoa, Ethiopia (2018) obtained by value p =

0,700 which means there is no effect between age

and treatment of TB-RO.At age range before

entering old age, a person is less able to adjust to the

problems encountered. In developmental age on

psychosocial aspects, someone who is considered to

have entered the middle to late adult life adjustment

skills of adaptation in which a person diagnosed

with TB disease will be having a good attitude and

behavior in achieving recovery to resolve the

problems faced. In contrast to the theory on the

results of the study, the prevalence of age> 40 years

higher than the ≤40 years.

3.2 Effect of Gender with TB-RO

Based on Table 2, the proportion of respondents who

sex men in groups of 8 cases (61.5%) and control

group of 20 people (64.5%). While respondents were

female in a case group of five people (38.5%) and a

control group of 11 people (35.5%). Results of

analysis using the chi-square test showed that in this

study there was no significant effect between the

sexes with RO TB treatment status (p = 1.000>

0.05). Value OR = 1.136, indicating the status of TB

treatment RO 1-time tendency occurred on the

respondents were male sex than women.

The study is in line with research Wulandari

(2015), that shows the value of p = 0.592, which

means there is no influence of gender with

medication adherence in patients with advanced lung

TB. Backed by research Anderson et al. (2013)

obtained the value p = 0.256, which means there is

no influence of gender with TB treatment success

RO.

In this case, each patient with TB has the

motivation to achieve recovery. Their motivation to

start treatment and regularly OAT drinking

behaviors will increase the likelihood of successful

treatment. The chances of success of TB treatment

between men and women are equal because TB

treatment programs do not discriminate based on

gender.

Table 1: Effect of age with status treatment.

Age

Status Treatment

P OR 95% Cl

Case Control

N % n %

≤40 years 4 30.8 13 41.9

0.723 1.625

0.410

6.449

>40 years 9 69.2 18 58.1

Total 13 100 43 100

Table 2: Effect of gender in medicine status.

Gender

Status Treatment

P OR 95% Cl Case Control

n % n %

Male 8 61.5 20 64.5

1,000 1.136 0.298 to 0.693 Female 5 38.5 11 35.5

Total 13 100 31 100

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Table 3: Effect of education with treatment status.

Education

Status Treatment

P OR 95%Cl

Case Control

n % n %

Low 5 38.5 14 45.2

0.940 1,318 0.351 to 4.945 High 8 61.5 17 54.8

Total 13 100 33 100

Table 4: Effect of work by status of respondents.

Occupation

Status Treatment

P OR 95%Cl Case Control

n % n %

Not Employed 9 69.2 19 61.3

0.738

0.704

0.177-2.802

Employed 4 30.8 12 38.7

Total 13 100 31 100

3.3 Effect of Education with TB-RO

According to the Table 3, the proportion of

respondents with low education in case group as

much as 38.5%, lower than in the control group as

much as 45.2%. While the highly educated

respondents in the case group as much as 61.5%, the

rate is higher than in the control group as much as

54.8%. Results using chi-square analysis showed

that there is no influence of this research study with

TB-RO treatment status (p = 0.940> 0.05). Value

OR = 1.318, indicating the status of TB treatment

RO 1.3 times the tendency to occur in less educated

respondents compared educated.

This study is in line with Rusman and Basri

(2019) in the Health Center Indramayu Jatisawit

obtained p = 0.082 which means there is no

influence of education with pulmonary TB

treatment. According to Green, education is a major

factor forming behavior. OAT adherence is one of

the behaviors that can be assessed by both

observation and recall. In general, the higher a

person's education, the better their behavior

(Notoadmojo, 2010). The results of the above cross-

tabulation obtained by those who have not started

treatment was higher in the lower than the higher

education, so the results prove that education is not a

determinant of treatment TB-RO.

3.4 The influence of Jobs with TB-RO

Based on Table 4 the proportion who do not work in

the case group as much as 69,2% and in the control

group that did not work as much as 61.3%, while the

proportion of respondents who worked in the group

amounted to 30.8% of cases and the control group

by 38.7% Results of analysis using the chi square

indicates that there is no influence of this research

work to the status of TB-RO treatment (p = 0.520>

0.05). Value OR = 0.704, indicating the status of TB

treatment RO0.7 times leanings of respondents did

not work

The study is in line with research of Yusi, et al.

(2018) in Semarang obtained value of p = 0.995,

which means there is no influence between work and

determinants of treatment. Backed by research

Kuchukhidze et al. in Geogia, USA (2014) obtained

the value p = 0:11, which means there is no effect of

treatment status job.

In this case, the type of risky work that can cause

a person to be exposed to substances that can

interfere with lung function and possible work is that

someone has direct contact with a TB patient.

Traders and workers are more likely to have poor

TB treatment outcomes because traders and workers

have longer working hours and there are no definite

time limits. So it is possible to have a less

permissive attitude to start TB treatment and get less

support to start treatment from the surrounding

environment as a stimulus to increase patient

motivation in achieving healing and successful

treatment. However, it is different from the results of

research respondents who do not work have a higher

proportion of not starting treatment than those who

work, this is because respondents who used to work

are no longer able to work because of the pain

experienced.

3.5 Influence of Income with TB-RO

According to the Table 5, the proportion of income

in the case group 100% of low-income, whereas in

the control group at 93.5% low income and low

income of 6.5%. Results using chi-square analysis

Determinants of TB-RO Affecting Conﬁrmation Have Not Started the Treatment

215

showed that it contained no significant effect

between age and treatment of TB-RO status (p =

1.000> 0.05). Value OR = -20.40, indicating the

status of TB treatment RO 1.3 times the tendency to

occur in low income compared high income.

Not meaningless variable revenue due for 100%

of the cases and more than 90% in the control to be

the subject of research, have in common is living in

families with low-income economic status UMR.

The similarity in the characteristics of family income

in case and control groups, each group has the

opportunity determinant of treatment.

3.6 Influence Knowledge with TB-RO

Based on the Table 6, the proportion of respondents

who are knowledgeable lower in the case of 6

(31.6%) and a control group of 13 people (68.4%).

While the high knowledgeable respondent group of

7 cases (28.0%) and the control group of 18 people

(72.0%). Results of analysis using the chi-square test

showed that in this study there was no significant

effect between knowledge and RO TB treatment

status (p = 1.000> 0.05). Value OR = 0.843,

indicating the status of TB treatment RO 0.8 times

the tendency to occur at low knowledgeable

respondents compared knowledge.

This study is in line with research Utami, Tunru

and Yusnita (2018) in Johar Baru sub-district health

center in Central Jakarta variable results obtained

knowledge p = 0.069, no effect of the level of

knowledge with the successful treatment of TB-RO.

3.7 Attitudes Influence with TB-RO

Based on the Table 7, the proportion of respondents

whose attitude is not good in the case group of five

people (55.6%) and control by 4 people (44.4%).

While both groups of respondents’ attitude of 8

cases (22.9%) and the control group of 27 people

(77.1%). Results of analysis using the chi-square test

showed that in this study there was no significant

effect between attitude with TB-RO treatment status

(p = 0.098> 0.05). Value OR = 0.237, indicating the

status of TB treatment RO 0.2 times the tendency

occurred on the respondents' attitude is not better

than a good attitude. The study is in line with

Mientarini, Sudarmanto, Hasan (2018) obtained the

value p = 0.321, which means there is no influence

by the gesture with medication adherence.

Differences in the characteristics of respondents

can influence the attitudes of TB patients while

undergoing Trartmen. The factors that influence

attitude is one's knowledge. The higher the person's

knowledge will contribute to the formation of a good

attitude. Attitude formation cannot be separated

from their factor- factors that influence such a

personal experience, culture, others that are

considered important, the mass media, as well as

emotional factors of the individual. It is clear that

the level of acceptance or respondents were

permissive to TB drugs will affect the behavior of

the TB treatment success to be good or vice versa

can be poor. Success to be good or vice versa can be

poor.

Table 5: Effect of income to the status of respondents.

Income

Status Treatment

P OR 95% Cl Case Control

n % n %

Low 13 100 29 93.5

1,000 20.40 0,000

High 0 0 2 6.5

Total 13 100 33 100

Table 6: Effect of income to the status of respondents.

Income

Status Treatment

P OR 95% Cl

Case Control

n % n %

Low 13 100 29 93.5

1,000 20.40 0,000 High 0 0 2 6.5

Total 13 100 33 100

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Table 7: Effect of attitude to the status of respondents.

Attitude Status Treatment

P OR 95%Cl Case Control

N % n %

Not Good 5 77.1 4 44.4

0.98 0.237 0.051 to 1.098

Good 8 22.9 27 55.6

Total 13 100 31 100

4 CONCLUSION

No influence of sociodemographic (age, sex,

education, occupation, income), knowledge and

attitude with TB RO Treatment Status.

ACKNOWLEDGMENT

Thank you to the TALENTA Research Institute,

University of North Sumatra for providing research

funding, with contract number: 4167 / UN5.1.R /

PPM / 2019 April 1, 2019.

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