Evaluasi Implementasi Penemuan Kasus Tuberkulosis Anak di Kabupaten Boyolali Tahun 2023

Sriyani Rangi, dr. Riris Andono Ahmad, MPH, PhD; dr. Amalia Setyati, Sp.A (K)

2024 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang: Selama 3 tahun terakhir cakupan penemuan kasus tuberkulosis (TB) anak di Kabupaten Boyolali masih dibawah target nasional mencapai 95% kurang dari target. Penelitian ini bertujuan untuk mengevaluasi program, surveilans dan mengidentifikasi hubungan antara pengetahuan, persepsi petugas kesehatan terhadap praktik penemuan kasus TB Anak di Kabupaten Boyolali tahun 2023.

Metode: Penelitian ini menggunakan kombinasi deskriptif kualitatif - kuantitatif dan cross sectional. Pengumpulan data primer menggunakan kuesioner kepada 24 programer dan wasor TB serta 120 pelaksana penemuan kasus anak TB di Puskesmas. Data sekunder diperoleh dari SITB dan dianalisis menggunakan deskriptif dan regresi linear

Hasil: Ditemukan sebanyak 468 kasus TB anak selama tahun 2023. Sebagian besar kasus ditemukan di fasilitas kesehatan (faskes) swasta sebesar 68,2%. Kekuatan program selama tahun 2022 adalah memberikan apresiasi kepada dokter setiap menemukan, melaporkan kasus TB dan pandemi berakhir. Serta kekuatan lainnya yaitu penanganan tuberkulosis melalui pendekatan public-private mix, evaluasi monitoring rutin, memiliki alat TCM, sistem surveilans terintegrasi dan bimbingan penginputan data, sedangkan kelemahan dalam program dan surveilans adalah keterbatasan tenaga terlatih, belum ada SOP kolaborasi jejaring internal puskesmas, keterbatasan sarana, sebagian kasus terkonfirmasi TB anak dengan hasil skoring <6>

Kesimpulan:Penemuan kasus TB anak selama tahun 2023 melebihi target sebesar 48%. Pemberian apresiasi kinerja kepada dokter termasuk dokter praktik mandiri dan swasta mempengaruhi penerapan pendekatan publik-private mix dalam penanganan tuberkulosis tahun 2022 sehingga berkontribusi pada peningkatan penemuan kasus TB anak Namun, perlu mempertimbangkan kualitas dan akurasi diagnosis penegakan diagnosis TB anak secara klinis. Diperlukan pelaksanaan On the Job Training (OJT) secara berkala untuk meningkatkan akurasi dalam mendiagnosis TB anak secara klinis, guna menghindari overdiagnosis atau underdiagnosis.

Background: Over the past 3 years, the coverage of pediatric tuberculosis (TB) case finding in Boyolali District has been below the national target of 95%. This study aims to evaluate the program, surveillance, and identify the relationship between knowledge, perceptions of health workers, and the practice of finding cases of childhood TB in Boyolali District in 2023.

Methods: This study used a combination of descriptive qualitative-qquantitative and cross-sectional. Primary data collection used questionnaires to 24 TB pro-grammers and supervisors and 120 implementers of pediatric TB case finding at Puskesmas. Secondary data were obtained from SITB and analyzed using descriptive and linear regression.

Results: A total of 468 pediatric TB cases were found during 2023. Most cases were found in private health facilities (68.2%). The strengths of the program during 2022 were giving appreciation to doctors for finding and reporting TB cases and the end of the pandemic. Other strengths include handling TB through a public-private mix approach, routine monitoring evaluations, having TCM tools, an integrated surveillance system and guidance on data entry, while weak-nesses in the program and surveillance are limited trained personnel, no SOP for collaboration with the puskesmas internal network, limited facilities, some con-firmed cases of childhood TB with scoring results <6>

Conclusion: Pediatric TB case finding during 2023 exceeded the target by 48%. The provision of performance appreciation to physicians, including independent and private practitioners, influenced the implementation of the public-private mix approach in TB management in 2022, contributing to the increase in pediatric TB case finding. However, it is necessary to consider the quality and accuracy of the clinical diagnosis of pediatric TB. Regular implementation of on the job training (OJT) is required to improve accuracy in clinically diagnosing pediatric TB and to avoid overdiagnosis or underdiagnosis.

Kata Kunci : Keywords: evaluation, surveillance, program, case finding, child TB