How to cite:
Susanti br Perangin-Angin, Nurmala Hayati Sihombing. (2022).
Determinants of Risk Factors on the Event of Lung TB. Journal
Eduvest. Vol 2(5): 853-868
E-ISSN:
2775-3727
Published by:
https://greenpublisher.id/
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May, 2022
p- ISSN 2775-3735- e-ISSN 2775-3727
DETERMINANTS OF RISK FACTORS ON THE EVENT OF
LUNG TB
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Poltekkes Kemenkes Medan, Indonesia
Email: Susanti16[email protected], [email protected]
ARTICLE INFO ABSTRACT
Received:
April, 26
th
2022
Revised:
May, 14
th
2022
Approved:
May, 16
th
2022
Pulmonary tuberculosis (TB) is one of the most prevalent
infectious diseases in the world. Based on a report by the
World Health Organization (WHO, 2012) one third of the
world's population, which is around two billion people infected
with Mycobacterium Tuberculosis. More than 8 million
populations get active TB every year and around 2 million die.
More than 90% of TB cases and deaths come from developing
countries, one of which is in Indonesia. This research is an
observational analytic study with a case control study design
that aims to determine the effect of risk factors for pulmonary
TB events using a retrospective approach. The results of this
study indicate that the most dominant variable TB incidence in
high school education cases is down to 45 people (97.8%) and
the smallest House Density is 25 people (54.3%) and the most
dominant control variable is no comorbidities namely as many
as 47 people (97.9%) and the smallest Respondents' House
Density fulfilled the requirements of 26 people (56.5%). Factors
that significantly influence the incidence of pulmonary
tuberculosis are nutritional status (p = 0,000, OR = 31,263),
respondent employment (p = 0,000, OR = 21.77), comorbidities
(p = 0,000, OR = 0.022), Ventilation (p = 0.001, OR = 4,680) and
House Humidity (p = 0,000, OR = 9,625). The results of the
study concluded that the variable that most influenced the
incidence of pulmonary TB was Nutrition Status (p = 0.002, Exp
(B) = 2.334).
KEYWORDS
Lung TB, TBC, Risk Factors
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 854
This work is licensed under a Creative Commons
Attribution-ShareAlike 4.0 International
INTRODUCTION
One of the infectious diseases with the highest prevalence in the world is
Tuberculosis (TBC/pulmonary TB). Data from WHO reports that there are about two
billion people infected with Mycobacterium Tuberculosis. Indonesia is one of the
developing countries where there are more than 90% of cases and deaths and it is reported
that more than 8 million people are affected by active TB every year and around 2 million
die (Depkes, 2012).
WHO also reported that from 2010 to March 2011, Indonesia recorded 430,000
pulmonary TB patients with 61,000 deaths. In 2009 it was reported that there were 528,063
pulmonary TB patients with 91,369 deaths and it was smaller than the situation in 2009
(Conesa-Botella et al., 2012).
In the last decade worldwide it was reported that the incidence of TB had increased
drastically. We know that TB can affect anyone, male or female, young or old, poor or rich
and anywhere. TB is also a health problem in Indonesia, both in terms of mortality and
morbidity, as well as diagnosis and therapy. Indonesia ranks third after India and China
with the largest TB problem among 22 countries where there are 101,000 deaths and
539,000 new cases every year. The increasing number of deaths continues to increase due
to tuberculosis because the number of cases of pulmonary TB in Indonesia which is
characterized by positive acid-fast bacilli in patients is 110 per 100,000, which is
increasingly difficult to implement (Endrasari, 2011).
TB disease in Indonesia is rather worrying, so we must be alert early on & get
complete information about TB disease where from the results of research reports it is
stated that there is one new patient in one minute and there is a new patient of pulmonary
tuberculosis that is contagious every two minutes.
If a person dies from tuberculosis, he will lose his income for about 15 years.
Economically it causes losses and tuberculosis also has another bad impact, namely being
ostracized by the community. And it was also reported that the highest pulmonary
tuberculosis patients were in the productive age group 15-50 years, which was around 75%.
An adult tuberculosis patient is also estimated to lose an average of 3-4 months of work
time, resulting in a loss of household income of around 20-30% (Lipsky et al., 2012).
Based on the Health Profile of the Health Office, it is stated that pulmonary TB has
many sufferers, where in 2013 the estimated target number of BTA Positive Pulmonary TB
cases was 196 people or about 80% exceeding the national target of 75%. The highest CDR
figures were in Datuk Bandar Health Center and Kampung Baru Health Center, each with
37 cases and conditions. The coverage of basic environmental health facilities in Tanjung
Balai City is still low, which can be seen in the Tanjung Balai City Health Office profile
that in 2016 from houses Those who did not meet the requirements in 2014 were provided
with 7,330 housing units (27.66%). As a result of these activities, 4,313 houses have met
the requirements as healthy homes, bringing the total healthy houses in Tanjung Balai City
to 18,894 houses or 45.99%.
Based on this study, it is strongly suspected that there is a relationship between risk
factors and the incidence of pulmonary TB at the Kampung Baru Health Center, Tanjung
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
855 http://eduvest.greenvest.co.id
Balai City. The purpose of this study was to analyze the determinants of risk factors for the
incidence of pulmonary TB at the Kampung Baru Health Center, Tanjung Balai City in
2019.
RESEARCH METHOD
This research is an observational analytic study with a case control study design
which aims to determine the effect of risk factors(Akiyama, Hamdeh, Micic, & Sakuraba,
2021). The incidence of pulmonary TB using a retrospective approach means that the risk
factors are identified or occurred in the past and meaning that the effects are identified at
this time (Kwon et al., 2020). The case group includes people who suffer from tuberculosis
which is marked by the results of the examination at the Puskesmas while the control group
includes people who are not exposed to tuberculosis (Wardhani, Dharma, & Susito, 2021).
The group is then compared about the presence of causative agents or past experiences that
may be relevant to the disease.
This research was conducted in the work area of the Kampung Baru Health Center,
Tanjung Balai City. This research was conducted by researchers in September 2019. The
population of this study was residents aged 10 - 80 years at the Kampung Baru Health
Center, Tanjung Balai City. The criteria for inclusion of cases in this study were being
willing to become research subjects by signing the research subjects by signing the
informed consent and stating pulmonary tuberculosis by the Puskesmas and domiciled in
the Kampung Baru Puskesmas area, Tanjung Balai City.
The control population was obtained from the outpatient visitor register at the
Kampung Baru Health Center Tanjung Balai City in 2019 aged 10-80 years with inclusion
criteria: willing to be a research subject by signing the research subject by signing an
informed consent letter and declared not a patient pulmonary tuberculosis and ARI by the
Puskesmas and domiciled in the area of the Kampung Baru Health Center, Tanjung Balai
City.
Controls were residents aged 10-80 years who did not suffer from pulmonary TB
diagnosed by a doctor or nurse who was recorded in the register book at the Kampung Baru
Health Center, Tanjung Balai City. Determination of the sample size used case control by
using the formula Stanley Lameshow, 1997 as below:
n = { Zα [(1+1/c)pq + Zß√[P1 (p1q1+ p0q0/ c
(P1 – P0)2
Where :
n = Estimated sample size
Estimated sample size (n) is determined with a significance level (Z1 – /2) which is
5% (1.96), the test power (Z1 – ) is 80% (0.20). f = proportion of unhealthy houses =
27.57% (30%) , c = 2 (number of controls) and R=3
In this study, the smallest R of the house sanitation variables (ventilation: 4.5;
lighting: 6.9; humidity: 3.2 and density 3 in previous studies (Priyadi, 2003; Ruswanto,
2010) obtained a sample of 46 with a ratio of cases and controls 1:1 so that the control size
is 1x 46 = 46. So, the number of samples required is 92 samples.
Sampling was done by purposive sampling where the selection of case samples was
taken from the register of the Kampung Baru Health Center from 2018 to July 2019 which
had inclusion criteria until the number of samples was met. Control samples were taken
from the register according to the inclusion criteria. Characteristics of controls and cases
by age and sex. The data used in this study are primary data obtained through the
distribution of questionnaires and followed by direct interviews with high school students
(SMA) Negeri 1 Berastagi, Karo Regency.
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 856
RESULT AND DISCUSSION
The results of this study were grouped into two groups, namely the control group
and the case group with 46 respondents each. Based on the results of research on the age
of the respondents, the majority of the case group were aged 10-50 years, namely 36 people
(78.3%), while in the control group the majority were aged 10-50 years, namely 33 people
(71.7%). Gender of respondents that the case group was mostly male, as many as 33 people
(71.7%), while in the control group most of the men were as many as 40 people (87%). The
nutritional status of the respondents that the case group was mostly lacking was 27 people
(58.7%), while the control group was mostly normal, namely 44 people (95.7%).
The Socio-Economic Condition of the respondents stated that the case group was
entirely below the minimum wage as many as 46 people (100%), while the control group
was mostly below the minimum wage, which was 43 people (93.5%). The education of the
respondents that the case group was mostly high school and below was 45 people (97.8%),
while in the control group most of the high school were below as many as 44 people
(95.7%).
The respondents' occupations that the case group mostly worked were 31 people
(67.4%), while in the control group the majority were working as many as 45 people
(97.8%). Comorbidities Respondents that the case group were equally as many as 21 people
(47.7%) and the control group mostly had no comorbidities, namely 47 people (97.9%).
The ventilation condition of the respondents that the case group was mostly unqualified as
many as 36 people (78.3%), while in the control group the majority were qualified as many
as 26 people (56.5%). The humidity of the respondent's house that the case group was
mostly unqualified as many as 44 people (95.7%), while in the control group most of them
did not meet the requirements as many as 32 people (69.6%).
Respondents' house lighting that most of the case groups did not meet the
requirements, namely as many as 40 people (87%), while in the control group most of them
did not meet the requirements as many as 30 people (65.2%).
House Density of respondents that the case group is mostly eligible, namely as many
as 25 people (54.3%), while in the control group most of them are qualified as many as 26
people (56.5%). Respondents' exposure to cigarette smoke that the majority of cases were
not met the requirements as many as 32 people (69.6%), while in the control group most of
them did not meet the requirements as many as 26 people (56.5%). The condition of the
respondent's house floor that the case group was mostly qualified, as many as 36 people
(78.3%), while in the control group most were qualified as many as 35 people (76.1%). The
condition of the walls of the respondent's house that the case group was mostly eligible,
namely 39 people (84.8%), while the control group was mostly eligible as many as 33
people (71.7%). For more details, it can be seen in the following table:
Table 1 Distribution of Proportion of Respondents by Age, Gender, Nutritional Status,
Socio-Economic Condition, Education, Occupation, Associated Diseases, Ventilation
Conditions, House Humidity, House Lighting Conditions, House Density, Cigarette
Smoke Conditions in the House, Floor Conditions and Wall Conditions in the House
Puskesmas Kampung Baru Tanjung Balai City 2019
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
857 http://eduvest.greenvest.co.id
1.
2.
Nutritional Status
Less
Normal
27
19
58,7
41,3
2
44
4,3
95,7
Amount
46
100
46
100
1.
2.
Socio-Economic Situation
Under UMR
Above UMR
46
0
100
0
43
3
93,5
6,5
Amount
46
100
46
100
1.
2.
Education
Under Senior High School
D1 Above
45
1
97,8
2,2
44
2
95,7
4,3
Amount
46
100
46
100
1.
2.
Respondent Occupation
Doesn't work
Working
15
31
32,6
67,4
1
45
2,2
97,8
Amount
46
100
46
100
1.
2.
Comorbidities
There are co-morbidities
No co-morbidities
21
23
47,7
52,3
47
1
97,9
2,1
Amount
46
100
46
100
1.
2.
Ventilation State
Not eligible
Qualify
36
10
78,3
21,7
20
26
43,5
56,5
Amount
46
100
46
100
1.
2.
Home Humidity
Not eligible
Qualify
44
2
95,7
4,3
32
14
69,6
30,4
Amount
46
100
46
100
1.
2.
Home Lighting State
Not eligible
Qualify
40
6
87
13
30
16
65,2
34,8
Amount
46
100
46
100
1.
2.
House Density
Not eligible
Qualify
21
25
45,7
54,3
20
26
43,5
56,5
Amount
46
100
46
100
No.
Independent Variable
Case
Control
f
%
f
%
1.
2.
Age
10-50 year
51 years and over
36
10
78,3
21,7
33
13
71,7
28,3
Amount
46
100
46
100
1.
2.
Gender
Male
Female
33
13
71,7
28,3
40
6
87
13
Amount
46
100
46
100
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 858
1.
2.
Exposure to Cigarette Smoke
Exist
No
32
14
69,6
30,4
26
20
56,5
43,5
Amount
46
100
46
100
1.
2.
Floor Condition
Not eligible
Qualify
10
36
21,7
78,3
11
35
23,9
76,1
Amount
46
100
46
100
1.
2.
the State of the Walls of the House
Not eligible
Qualify
7
39
15,2
84,8
13
33
Amount
46
100
46
Bivariate Analysis
Based on the results of the research, the risk factors studied were Age, Gender,
Nutritional Status, Socio-Economic Condition, Education, Occupation, Comorbidities,
Ventilation Conditions, House Humidity, House Lighting Conditions, House Density,
Cigarette Smoke Conditions in the House, Floor Conditions and Circumstances Wall. The
age of the respondent has no effect on the incidence of pulmonary tuberculosis with a
probability value (p) = 0.630. The value of the Odds Ratio (OR) is 1.418 (95% CI; 0.548-
3.668) meaning that respondents suffer from pulmonary tuberculosis 1.418 times greater
with age 10-50 years compared to respondents with age > 51 years.
The gender of the respondent has no effect on the incidence of pulmonary
tuberculosis with a probability value (p) = 0.122. The Odds Ratio (OR) value is 0.381 (95%
CI; 0.130-1.112) meaning that gender is not a determining factor for the occurrence of
pulmonary tuberculosis in respondents. The nutritional status of the respondent has an
effect on the incidence of pulmonary tuberculosis with a probability value (p) = 0.000. The
Odds Ratio (OR) value is 31,263 (95% CI; 6,744-144.926) meaning that the respondent
suffers from Pulmonary Tuberculosis 31.263 times greater with undernourished nutritional
status compared to respondents with normal nutrition.
The respondent's socioeconomic condition has no effect on the incidence of
pulmonary tuberculosis with a probability value (p) = 0.242. The Odds Ratio (OR) value is
(95% CI; 0.548-3.668) meaning that respondents suffering from pulmonary tuberculosis
are 8 times greater with income below the minimum wage compared to respondents with
income above the minimum wage. The respondent's education has no effect on the
incidence of pulmonary tuberculosis with a probability value (p) = 1,000. The Odds Ratio
(OR) value is 2.045 (95% CI; 0.179-23.378), meaning that respondents suffering from
pulmonary tuberculosis are 2.045 times greater with high school education and below
compared to respondents with education > D1 and above.
The respondent's occupation has an effect on the incidence of pulmonary
tuberculosis with a probability value (p) = 0.000. The Odds Ratio (OR) value is 21.774
(95% CI; 2.733-173.473) meaning that respondents suffering from pulmonary tuberculosis
are 21.774 times greater than those who have not worked for years than those who work.
The respondent's comorbidities have an effect on the incidence of pulmonary tuberculosis
with a probability value (p) = 0.000. The Odds Ratio (OR) value is 0.022 (95% CI; 0.003-
0.175) meaning that respondents suffer from pulmonary tuberculosis 0.022 times greater
with comorbidities compared to respondents who do not suffer from comorbidities.
The ventilation condition of the respondent's house has an effect on the incidence of
Pulmonary Tuberculosis with a probability value (p) = 0.001 The Odds Ratio (OR) value
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
859 http://eduvest.greenvest.co.id
is 4.680 (95% CI; 1.881-11.643) meaning that the respondent suffers from pulmonary
tuberculosis 4.680 times greater with ventilation that does not meet the requirements
compared to with proper ventilation. The humidity of the respondent's house affects the
incidence of pulmonary tuberculosis with a probability value (p) = 0.002 Odds Ratio (OR)
value is 9.625 (95% CI; 2.043-45.37) meaning that the respondent suffers from tuberculosis
9.625 times greater with humidity that does not meet the requirements compared to
respondents who do not suffer from pulmonary tuberculosis.
The lighting of the respondent's house has no effect on the incidence of Pulmonary
Tuberculosis with a probability value (p) = 0.28 The Odds Ratio (OR) value is 3.556 (95%
CI; 1.881-11.643) meaning that the respondent suffers from Pulmonary Tuberculosis 3.556
times greater than the house that has lighting who do not meet the requirements compared
to respondents who have eligible home lighting. The density of the respondent's house has
no effect on the incidence of Pulmonary Tuberculosis with a probability value (p) = 1,000
The Odds Ratio (OR) value is 1.092 (95% CI; 0.480-2.485) meaning that the respondent
suffers from Pulmonary Tuberculosis 1.092 times greater with the density of houses that
do not meet the requirements compared to respondents who have a density of houses that
meet the requirements.
Exposure to cigarette smoke at the respondent's house has no effect on the incidence
of pulmonary tuberculosis with a probability value (p) = 0.280 The Odds Ratio (OR) value
is 1.758 (95% CI; 0.746-4.142), meaning that the respondent suffers from pulmonary
tuberculosis 1.758 times greater with cigarette smoke. are at home compared to respondents
where there is no cigarette smoke at home. The condition of the floor of the respondent's
house has no effect on the incidence of Pulmonary Tuberculosis with a probability value
(p) = 1,000 The Odds Ratio (OR) value is 0.884 (95% CI; 0.334-2.342) meaning that the
respondent suffers from Pulmonary Tuberculosis 0.884 times greater with floors that do
not meet the requirements compared to respondents who have a house floor that meets the
requirements.
The condition of the walls of the respondent's house has no effect on the incidence
of pulmonary tuberculosis with a probability value (p) = 0.206 The Odds Ratio (OR) value
is 0.456 (95% CI; 0-163-1.275) meaning that the respondent suffers from Pulmonary
Tuberculosis 0.456 times greater than the condition of the walls of houses that do not meet
the requirements compared to respondents who have walls of houses that meet the
requirements. For more details, it can be seen in the following table:
Table 2 Cross-tabulation of the Effect of Age, Gender, Nutritional Status, Socio-
Economic Conditions, Education, Occupation, Associated Diseases, Ventilation
Conditions, House Humidity, House Lighting Conditions, House Density, Cigarette
Smoke Conditions in the House, Floor Conditions and Wall Conditions on The Incident
of Pulmonary Tuberculosis at the Kampung Baru Health Center, Tanjung Balai City in
2019
Risk Factor
1 LUNG TBC CASE
X
2
/
(p.value)
1.1 OR
(95% CI)
Case
Control
Jlh
%
Jlh
%
Age
(year)
10-50
51 >
36
10
78,3
21,7
33
13
71,7
28,3
0,522
(0,630)
1,418
(0,548-3,668)
Amount
46
100
46
100
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 860
Gender
Male
Female
33
13
71,7
28,3
40
6
87
13
3,25
(0,122)
0,381
(0,130-1,112)
Amount
46
100
46
100
Nutritional
Status
Less
Normal
27
19
58,7
41,3
2
44
4,3
95,7
31,472
(0,000)
31,263
(6,744-144,926)
Amount
46
100
46
100
Socio-Economic
Situation
Under UMR
Above UMR
46
0
100
0
43
3
93,5
6,5
3,101
(0,242)
Amount
46
100
46
100
Education
Under Senior
High School
D1 Above
45
1
97,8
2,2
44
2
95,7
4,3
0,345
(1,000)
2,045
(0,179-23,378
Jumlah
46
100
46
100
Respondent
Occupation
Doesn't work
Working
15
31
32,6
67,4
1
45
2,2
9
7,8
14,829
(0,000)
21,774
(2,733-173,473)
Amount
46
100
46
100
Comorbidities
There are co-
morbidities
No co-morbidities
23
23
50
50
45
1
97,8
2,2
27,284
(0,000)
0,022
(0,003-0,175)
Amount
46
100
46
100
Ventilation State
Not eligible
Qualify
36
10
78,3
21,7
20
26
43,5
56,5
11,683
(0,001)
4,680
(1,881-11,643
Amount
46
100
46
100
Home Humidity
Not eligible
Qualify
44
2
95,7
4,3
32
14
69,6
30,4
10,895
(0,002)
9,625
(2,043-45,347)
Amount
46
100
46
100
Home Lighting
State
Not eligible
Qualify
40
6
87
13
30
16
65,2
34,8
5,974
(0,28)
3,556
(1,243-10,170)
Amount
46
100
46
100
House Density
Not eligible
Qualify
21
25
45,7
54,3
20
26
43,5
56,5
0,44
(1,000)
1,092
(0,480-2,485)
Amount
46
100
46
100
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
861 http://eduvest.greenvest.co.id
Exposure to
Cigarette Smoke
Exist
No
32
14
69,6
30,4
26
20
56,5
43,5
1,680
(0,280)
1,758
(0,746-4,142)
Amount
46
100
46
100
Floor Condition
Not eligible
Qualify
10
36
21,7
78,3
11
35
23,9
76,1
0,062
(1,000)
0,884
(0,334-2,342)
Amount
46
100
46
100
the State of the
Walls of the
House
Not eligible
Qualify
7
39
15,2
84,8
13
33
28,3
71,7
2,300
(0,206)
0,456
(0,163-1,275)
Amount
46
100
46
100
Multivariate Analysis
After processing the data and the results of the analysis between the bivariate
variables between the independent and dependent variables resulting in p < 0.25, then the
independent variables were entered into the multivariate stage as shown in the following
table:
Table 3. The results of the first stage of the Double Logistics Regression Test that will be
included in the Model
No
Variable
pValue
Description
1
Age
0,629
Not Candidate
2
Gender
0,132
Not Candidate
3
Nutritional status
0,000
Candidate
4
Socio-Economic
0,046
Not Candidate
5
Education
0,605
Not Candidate
6
Profession
0,000
Candidate
7
Comorbidities
0,000
Candidate
8
Ventilation State
0,002
Candidate
9
Humidity
0,001
Candidate
10
Lighting
0,025
Candidate
11
House Density
0,553
Not Candidate
12
Smoke Exposure
0,327
Not Candidate
13
House floor
0,603
Not Candidate
14
House wall
0,068
Not Candidate
To determine the effect of the independent variables (Age, Gender, Nutritional
Status, Socio-Economic Conditions, Education, Occupation, Associated Diseases,
Ventilation Conditions, House Humidity, Lighting, House Density, Exposure to Cigarette
Smoke, Floor Conditions and Wall Conditions) with the dependent variable ( The incidence
of pulmonary tuberculosis) was simultaneously performed with multivariate analysis using
multiple logistic regression. To find the most dominant factor for pulmonary tuberculosis,
through several steps, namely:
1. There is a selection of potential variables to be included in the model. Variables
selected as candidates or considered significant. In this modeling, all candidate
variables based on the Chi-Square test with a significance level of p<0.25 were
included in the multiple logistic regression test. The use of statistical significance of
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 862
p<0.25 to allow hidden variables that are actually important to be included in the
multivariate model. Then variables that have a p-value > 0.05 will be removed
gradually (backward selection).
2. Then the next step is testing simultaneously with the enter method to identify the most
influential factors on the incidence of pulmonary tuberculosis in respondents. In the
first stage of the multiple logistic regression test, a significant p value of less than 0.05
was chosen (p <0.05).
3. And the third step is if in the first stage there is still a variable that has a p value> 0.05
then a second stage logistic test is carried out by only testing the variable with a p value
<0.05.
In this study, the independent variable with a value of <0.25 based on the Chi-Square
test and can be used as a candidate model in the first stage of the logistic regression test
(Nutrition Status, Occupation, Comorbidities, Ventilation and Humidity Conditions), while
the variables Age, Gender , Socio-Economic Conditions, Education, Lighting, House
Density, Smoke Exposure, House Floor Conditions and House Wall Conditions were not
included in the multiple logistic regression modeling.
Multivariate Modeling I
Variable
B
pvalue
OR
95 % CI
Lower
Upper
Nutritional status
2,344
0,002
10,428
2,340
46,467
Respondent's Job
1,744
0,079
5,722
0,817
40,056
Comorbidities
-3,910
0,01
0,020
0,002
0,203
Home Ventilation
1,376
0,63
3,975
0,926
16,911
Home Humidity
0,422
0,715
1,525
0,158
14,681
Multivariate Modeling II
Variable
B
pvalue
OR
95 % CI
OR
Changes
Lower
Upper
Nutritional status
2,419
0,001
11,230
2,596
48,581
7,691 %
Respondent's Job
1,795
0,071
6,021
0,859
0,859
5,22 %
Comorbidities
-3,995
0,001
0,018
0,002
0,002
-10 %
Home Ventilation
1,471
0,035
4,356
1,111
1,111
185,639 %
Multivariate Modeling III
Variable
B
pvalue
OR
95 % CI
OR
Changes
Lower
Upper
Nutritional status
2,373
0,001
10,725
2,557
44,981
4,71 %
Comorbidities
-4,096
0,001
0,017
0,002
0,171
5,882 %
Home Ventilation
1,479
0,045
4,390
1,032
18,669
-0,774 %
Humidity
0,6117
0,591
1,853
0,195
17,636
-16,73 %
Final Multivariate Modeling
Variable
B
pvalue
OR
95 % CI
Lower
Upper
Nutritional status
2,344
0,002
10,428
2,340
46,467
Respondent's Job
-3,910
0,001
0,020
0,002
0,203
Comorbidities
1,376
0,063
3,957
0,926
16,911
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
863 http://eduvest.greenvest.co.id
Home Ventilation
0,422
0,715
1,525
0,158
14,681
Home Humidity
1,744
0,079
5,722
0,817
40,056
Based on the final multivariate modeling, to see the most dominant variable on the
incidence of pulmonary TB is to look at the largest OR, then the largest OR is the
Nutritional Status variable where the OR is 10.428 and the confounding variables are
ventilation, humidity and work because p value > 0 ,05. choose 2 correct answer items
among the 6 answer choices, namely as many as 13. So the number of Knowledge items =
839 / 1500 = 55.9% so categorized the Student Knowledge Score is Less Good.
B. Discussion
Comparison of characteristics between age, gender and socio-economic conditions,
education, lighting, house density, smoking behavior, floor and wall conditions did not
differ, but there were differences in nutritional status, occupation, comorbidities,
ventilation, humidity between samples and controls. so that it may affect the incidence of
pulmonary tuberculosis.
The results of the bivariate analysis showed that of the fourteen independent
variables that were significant for the incidence of pulmonary tuberculosis, and with a p
value of <0.05, the variables were nutritional status, occupation, comorbidities, ventilation
and humidity.
Age characteristics can affect the incidence of pulmonary tuberculosis because the
older a person is, the more susceptible they are to pulmonary tuberculosis. The results of
the study were that the total age of 10-50 years in cases and controls was 75% and > 51
years 25%. The statistical results were p>0.05 (p=0.630) and OR = 1.418 (0.548-3.668)
meaning that there was no significant relationship between age and the incidence of
pulmonary TB.
Gender can also cause pulmonary tuberculosis. The results of the study total cases
and controls in male sex was 79% and female was 21%, where this was due to the smoking
habit factor in men almost twice as much as women. Pulmonary TB disease tends to be
higher in male than female (according to WHO), but at least in a year period there are about
1 million women who die from pulmonary TB, it can be concluded that women are more
likely to die from pulmonary TB than women. with the consequences of the process of
pregnancy and childbirth. In the male gender this disease is higher because of smoking
tobacco and drinking alcohol so that it can reduce the body's defense system, so that it is
more easily exposed to the causative agent of pulmonary agents.
Nutritional status plays a role as a risk factor for pulmonary tuberculosis. Poor
nutritional status increased the risk of pulmonary tuberculosis 31 times greater than normal
nutritional status, with OR = 31,263; 95% CI = 6.744-144.926. The results of this study are
the same as the results of previous studies which showed that people with BMI <18.5 had
11.31 times greater risk of developing pulmonary tuberculosis with BMI 18.5 with OR
values: 11.331 and 95% CI 4.05<OR <31.59 (Priyadi, Juhaeni, & Taufiq, 2020). The
condition of a person with poor nutrition then there is a reciprocal relationship with
infectious diseases where if a person is exposed to infection from the disease he is suffering
from, it will worsen the nutritional state and vice versa if someone is in poor nutrition it
will make it easier to get infectious diseases.
Common diseases related to nutritional problems include diarrhea, tuberculosis,
measles and whooping cough. The results of research by Elvia Karyadi (2002) from the
regional nutrition center at the University of Indonesia stated that the number of TB
sufferers with malnutrition or excess nutrition in adults (18 years and older) is a This is an
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 864
important problem because in addition to having the risk of certain diseases, it can also
affect work productivity.
Home sanitation is at risk for the incidence of pulmonary tuberculosis, but the
components of the house that are most at risk for the incidence of pulmonary tuberculosis
are house ventilation and humidity in the house. People who live in homes that have
ventilation areas that do not meet the requirements have a 4 times greater risk of being
infected with pulmonary tuberculosis than people who live in homes that have adequate
ventilation, with OR values: 4,680; 95%CI: 1.881-11.643.
The results showed that the total cases and controls in the socioeconomic conditions
of the respondents were below the minimum wage as much as 96.7% and above the
minimum wage was 3.3% and statistically p <0.05 (p = 0.242). The results of the bivariate
analysis showed that respondents with income the average is below the minimum wage as
a factor in the incidence of pulmonary tuberculosis, but after being included in the
multivariate analysis, the average income level of the respondents is not a risk factor for
the incidence of pulmonary tuberculosis. That after being compared with other people's
studies, this study is similar to the research conducted by Priyadi (2003) which showed that
the level of expenditure was not related to the incidence of pulmonary tuberculosis, but
several studies showed a relationship between low income and the incidence of pulmonary
tuberculosis (Coker, 2003). Ratnasari, 2005; Mahfudin, 2006). Family income will have an
impact on daily lifestyles, including food consumption, health care, besides that it will also
affect home ownership (house construction). The head of the family who has an income
below the minimum wage will consume food with nutritional levels that are not according
to the needs of each family member so that they have poor nutritional status and will make
it easier to get infectious diseases including pulmonary tuberculosis (Latenstein et al.,
2020).
The results of the study found that the total cases and controls in the respondent's
education were the third high school under as much as 96.7% and control as much as 3.3%.
And statistically p<0.05 (p=1,000), OR = 2.045 (0.179-23.378), meaning that there is no
relationship between education and the incidence of pulmonary tuberculosis. Education
about pulmonary tuberculosis is influenced by educational background which has a positive
effect on healing, this is in accordance with what was stated by the Ministry of Health of
the Republic of Indonesia that the relatively low level of education in patients with
pulmonary tuberculosis causes limited information about the symptoms and treatment of
pulmonary tuberculosis. Low education does not guarantee that it can lead to a lack of
public awareness of personal health in this case in the form of prevention of disease
problems.
The results showed that the total cases and controls in the respondent's work were
17.4% of unemployed cases and 82.6% of working cases with p<0.05 (p=0.000) meaning
that there was a significant relationship between work and pulmonary TB. Differences in
the work that a person has causes there are differences in the socioeconomic status they
have (Notoatmodjo, 2007). Every job is a burden for the perpetrator. The burden in question
is the physical, mental and social workers. The abilities of the workers differ from one
another, namely the physical, mental or social of the workers. The abilities of the workers
differ from one another in terms of skills, compatibility, nutritional status, gender, age and
body size.
Unqualified humidity with humidity > 70% increased the risk 9 times greater than
the house with humidity 40-70% against pulmonary tuberculosis with OR value: 9.625;
95%CI: 2,043-45,347.Ventilation is an indicator to obtain room humidity that is acceptable
to the body as well as the ability to kill germs in the house. This study is in accordance with
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
865 http://eduvest.greenvest.co.id
previous studies which showed that the incidence of pulmonary tuberculosis would be at
risk with ventilation <10% (OR: 229.994; 95% CI: 3.39-265.51), humidity >70% (OR:
9.299; 95% CI: 2.2-37.84) (Rikyandini, 2012).
The same thing is also in line with the research conducted by Helda Suarni on the
risk factors associated with the incidence of pulmonary TB in Pancoran Mas District,
Depok in 2009, the results showed that the ventilation condition of the house was a risk
factor with OR = 14,182, this means that ventilation conditions are less has a risk of
transmission of 14,182 times from good ventilation (Asari & Helda, 2021).
It is reported that the house is declared healthy and comfortable, if the air temperature
and humidity of the room are in accordance with normal human body temperature. Air
temperature and humidity are strongly influenced by air conditioning and lighting.
Insufficient or uneven ventilation will make the room feel stuffy or stuffy and will cause
high humidity in the room (Ministry of Housing and Regional Infrastructure, 2002).
Indicators of humidity in the house are very closely related to the conditions of ventilation
and lighting in the house (Putri, Thohari, & Sari, 2022).
Ventilation in the house has many functions, besides keeping the air flow in the
house fresh, it also frees the room air from bacteria, especially pathogenic bacteria, because
there is always a continuous flow of air. Another function is to keep the room in the house
always in optimum humidity. Insufficient ventilation will increase the humidity in the room
due to evaporation and absorption of fluids from the skin. High room humidity will be a
good medium for the growth and reproduction of pathogenic bacteria, including
tuberculosis germs (Wati & Ridlo, 2020). Tuberculosis germs are able to survive in dark
and damp places and will be dormant in dry and cold places. Pulmonary tuberculosis
bacteria will die at 1000C heating for 5-10 minutes, or at 600C for 30 minutes. The ability
of tuberculosis bacteria to develop at a temperature of 350C-370C, does not grow at a
temperature of 250C or more than 400C, and tuberculosis bacteria will thrive in an
environment with high humidity, because tuberculosis will thrive in an environment with
high humidity, because water makes up more than 80% the volume of bacterial cells and is
the best medium for the growth and survival of bacterial cells (Hapsari, 2019).
From the results of the study, it can be seen that the total lighting conditions for cases
and controls were mostly lighting conditions that did not meet the requirements, namely
87% in cases and 65.2% in controls. After processing the data, the statistical test results
obtained p value > 0.05 (p = 0.28), so there was no significant relationship between lighting
conditions and the incidence of pulmonary tuberculosis. This is not in accordance with the
results of research by Musadad (2001) who conducted research on the relationship between
home environmental factors and the incidence of pulmonary tuberculosis transmission in
the household, from the study it was found that poor lighting conditions had a 3.7 times
risk of contracting tuberculosis. pulmonary culosis when compared with the sun-kissed
house.
Variables that are not proven as risk factors after obtaining the adjusted OR value
include age, gender, socioeconomic conditions, education, lighting, occupancy density,
smoking behavior, floor conditions and wall conditions.
Occupancy density according to the OR value shows that it is not a risk factor for
the incidence of pulmonary tuberculosis. That this result is the same as the research
conducted by Priyadi (2003) which showed that occupancy density had no relationship with
the incidence of pulmonary tuberculosis.
The area of the house that is not proportional to the number of residents will
cause overcrowded where we know that residential density is one of the elements in house
sanitation where the density of residents in one residential house will greatly affect the
occupants. This situation makes it unhealthy which is also the cause of the lack of
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 866
consuming oxygen or fresh air, so if in a family there is someone who suffers from
infectious diseases, especially tuberculosis, it is easier to spread it to other family members
(Wati & Ridlo, 2020).
After conducting the research, exposure to cigarette smoke was also not statistically
proven as a risk factor for pulmonary tuberculosis. This study is different from the results
of research conducted by Wijaya (2012) which showed that smoking can increase
pulmonary tuberculosis infection, the risk of disease development, and the cause of death
in tuberculosis patients. From the results of data collection, the proportions between the
case and control groups were both greater in exposure to cigarette smoke in the family,
namely 69.6% in cases and 56.5% in controls.
Habits or activities that can interfere with health include smoking habits where
smoking can interfere with the effectiveness of some respiratory defense mechanisms, the
results of cigarette smoke can stimulate mucosal formation and reduce cilia movement,
including tuberculosis bacteria and result in susceptibility to pulmonary tuberculosis
infection (Aditama & Winarto, 2021).
From the results of the study, it was found that the total conditions of the type of
floor that met the requirements of cases and controls were 77% and those who did not meet
the requirements were 23%. The results of the statistical test obtained p value = > 0.05 (p
= 1,000), so there was no significant relationship between the condition of the floor type at
home and the incidence of pulmonary tuberculosis. Odds ratio 0.884 ( 0.334-2.32) which
means that the condition of the floor is not a risk factor for pulmonary tuberculosis in
respondents.
When compared with the results of other people's studies, this study is in
accordance with research conducted by Toni Lumban Tobing on the influence of behavior
of pulmonary TB patients and sanitation conditions on the prevention of potential
transmission of pulmonary TB with p = 0.414 and OR = 0.7 with 95% CI (0.321 -1.599).
From the results of the study, it was found that the total condition of the condition of
the walls of the house that met the requirements of cases and controls was 78% and those
who did not meet the requirements were 22%. statistical test results obtained p value> 0.05
(p = 0.206), then there is no significant relationship between the condition of the walls of
the house with the incidence of pulmonary tuberculosis. The odds ratio is 0.456 (0.163-
1.275), which means that the condition of the walls of the house is not a risk factor for
pulmonary tuberculosis.
CONCLUSION
Based on the results of the analysis and discussion, it can be concluded that the
factors that significantly influence the incidence of pulmonary tuberculosis are nutritional
status (p = 0.000, OR = 31.263), respondent's occupation (p = 0.000, OR = 21.77),
comorbidities ( p=0.000, OR=0.022), Ventilation Condition (p=0.001, OR=4.680) and
House Humidity (p=0.000, OR=9.625). The factors that had no significant effect on the
incidence of pulmonary TB were Age (p=0.630, OR=1.418), Gender (p=0.122, OR=0.381),
Socio-Economic Condition (p=0.242, OR=), Education (p =1,000, OR=2,045), Lighting
(p=0,28, OR=3,56), House Density (p=1,000, OR=1,092), Smoking Behavior (p0,280,
OR= 1,7582), Circumstances Floor (p=1,000, OR=0,884) and Wall Condition (p=1,000,
OR=0,466). The results of the multivariate test found that one variable that had the most
influence on the incidence of pulmonary tuberculosis was Nutritional Status (p=0.002,
Exp(B)=2.344).
Eduvest – Journal of Universal Studies
Volume 2 Number 5, May 2022
867 http://eduvest.greenvest.co.id
REFERENCES
Aditama, N. P., & Winarto, Agus Edi. (2021). Pengabdian Kepada Masyarakat
Melalui Revitalisasi BUMDes Sebagai Layanan Sosial Pada Bamuju Bamara
Desa Sungai Tabuk. ADI Pengabdian Kepada Masyarakat, 1(2), 41–53.
Akiyama, Shintaro, Hamdeh, Shadi, Micic, Dejan, & Sakuraba, Atsushi. (2021).
Prevalence and clinical outcomes of COVID-19 in patients with autoimmune
diseases: a systematic review and meta-analysis. Annals of the Rheumatic
Diseases, 80(3), 384–391.
Asari, Hazella Rissa Valda, & Helda, Helda. (2021). Hubungan Obesitas dengan
Kejadian Hipertensi pada Lansia di Posyandu Lansia di Wilayah Kerja
Puskesmas PB Selayang II Kecamatan Medan Selayang, Medan. Jurnal
Epidemiologi Kesehatan Indonesia, 5(1).
Conesa-Botella, Anali, Meintjes, Graeme, Coussens, Anna K., van der Plas, Helen,
Goliath, Rene, Schutz, Charlotte, Moreno-Reyes, Rodrigo, Mehta, Meera,
Martineau, Adrian R., & Wilkinson, Robert J. (2012). Corticosteroid therapy,
vitamin D status, and inflammatory cytokine profile in the HIV-tuberculosis
immune reconstitution inflammatory syndrome. Clinical Infectious Diseases,
55(7), 1004–1011.
Depkes, R. I. (2012). Profil Kesehatan Republik Indonesia 2012. Diakses pada
tanggal.
Endrasari, Yohana. (2011). Hubungan Antara Tuberkulosis Paru Dengan Diabetes
Melitus Sebagai Faktor Risiko.
Hapsari, Afin. (2019). GAMBARAN FAKTOR RISIKO LINGKUNGAN RUMAH
PADA PENDERITA TUBERKULOSIS DI WILAYAH KERJA PUSKESMAS
TEGALREJO KABUPATEN MAGELANG. Universitas Ngudi Waluyo.
Kwon, Byoung Soo, Kim, Youlim, Lee, Sang Hoon, Lim, Sung Yoon, Lee, Yeon
Joo, Park, Jong Sun, Cho, Young Jae, Yoon, Ho Il, Lee, Choon Taek, & Lee,
Jae Ho. (2020). The high incidence of severe adverse events due to
pyrazinamide in elderly patients with tuberculosis. PloS One, 15(7), e0236109.
Latenstein, Anouk E. J., van der Geest, Lydia G. M., Bonsing, Bert A., Koerkamp,
Bas Groot, Mohammad, Nadia Haj, de Hingh, Ignace H. J. T., de Meijer,
Vincent E., Molenaar, Izaak Q., van Santvoort, Hjalmar C., & van Tienhoven,
Geertjan. (2020). Nationwide trends in incidence, treatment and survival of
pancreatic ductal adenocarcinoma. European Journal of Cancer, 125, 83–93.
Lipsky, Benjamin A., Berendt, Anthony R., Cornia, Paul B., Pile, James C., Peters,
Edgar J. G., Armstrong, David G., Deery, H. Gunner, Embil, John M., Joseph,
Warren S., & Karchmer, Adolf W. (2012). 2012 Infectious Diseases Society
of America clinical practice guideline for the diagnosis and treatment of
diabetic foot infections. Clinical Infectious Diseases, 54(12), e132–e173.
Priyadi, Rudi, Juhaeni, Ade Hilman, & Taufiq, Hilda. (2020). The Effect of A
Combination Organic Manure Fermented (Porasi) and Biological Fertilizer
(M-Bio) on The Growth and Yield of Cayenne Pepper (Capsicum frustescens
L.) Bara Variety. AGRICOLA, 10(2), 74–84.
Putri, Adinda Mega, Thohari, Imam, & Sari, Ernita. (2022). KONDISI FISIK
RUMAH (JENIS DINDING, JENIS LANTAI, PENCAHAYAAN,
Susanti br Perangin-Angin, Nurmala Hayati Sihombing
Determinants of Risk Factors on the Event of Lung TB 868
KELEMBABAN, VENTILASI, SUHU, DAN KEPADATAN HUNIAN)
MEMPENGARUHI KEJADIAN PENYAKIT TUBERKULOSIS DI
WILAYAH KERJA PUSKESMAS KRIAN SIDOARJO TAHUN 2021.
Gema Lingkungan Kesehatan, 20(1), 22–28.
Rikyandini, Very. (2012). Faktor-Faktor Yang Berhubungan Dengan Kejadian
Tuberkulosis Pada Usia Kerja Di Wilayah Kerja Puskesmas Kecamatan
Nguter Kabupaten Sukoharjo. Universitas Muhammadiyah Surakarta.
Wardhani, Puspa, Dharma, Kelana Kusuma, & Susito, Susito. (2021). THE
EFFECTIVENESS OF FAMILY EMPOWERMENT IN THE LATENT TB
INFECTION TOWARDS TB PATIENTS’OBEDIENCE AND CAREGIVER
BURDEN. Journal of Nursing Care, 4(1).
Wati, PDCA, & Ridlo, Ilham Akhsanu. (2020). Perilaku Hidup Bersih dan Sehat
pada Masyarakat di Kelurahan Rangkah Kota Surabaya. Jurnal Promkes: The
Indonesian Journal of Health Promotion and Health Education, 8(1), 47–58.
