Evaluasi Implementasi Penemuan Kasus Tuberkulosis Anak di Kabupaten Sukoharjo Tahun 2025

NANANG YULIANA, dr. Vicka Oktaria, MPH, Ph.D ; dr. Amalia Setyati, Sp.A (K)

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Penelitian ini bertujuan mengevaluasi implementasi program dan sistem surveilans penemuan kasus TB anak di puskesmas serta menganalisis faktor-faktor yang berhubungan dengan perilaku pencarian layanan kesehatan orang tua/pengasuh/wali anak yang didiagnosis TB di Kabupaten Sukoharjo. 

Metode: Penelitian ini terdiri atas tiga sub-studi, yaitu evaluasi program menggunakan Logic Model, evaluasi sistem surveilans berdasarkan kerangka WHO (2006) dan studi analitik dengan desain cross sectional  menggunakan Andersen’s Behavioral Model. Penelitian dilaksanakan di Kabupaten Sukoharjo tahun 2025. Sub studi evaluasi program dan surveilans dilakukan pada 12 puskesmas dan dinas kesehatan menggunakan total sampling, sedangkan sub studi analitik melibatkan 128 orang tua/pengasuh/wali anak umur 0-14 tahun yang terdiagnosis TB dengan pendekatan cluster sampling. Data dianalisis secara deskriptif, sedangkan sub studi analitik dilakukan analisis bivariat dan multivariat menggunakan regresi logistik.  

Hasil: Implementasi penemuan kasus TB anak di puskesmas secara keseluruhan telah didukung oleh regulasi nasional, keterlibatan tenaga kesehatan multidisiplin, ketersediaan anggaran, sarana jejaring rujukan, serta pelaksanaan penemuan kasus secara aktif dan pasif. Namun masih ditemukan beberapa kelemahan yaitu peningkatan kapasitas suber daya manusia yang masih kurang, penggunaan formulir TB anak yang belum optimal, serta pelaksanaan investigasi kontak dan pemeriksaan diagnostik yang belum optimal. Sistem surveilans telah melaksanakan deteksi kasus secara aktif dan pasif, meskipun deteksi kasus masih didominasi penemuan pasif. Secara umum atribut surveilans telah terpenuhi, dengan kegunaan dan stabilitas menunjukkan hasil optimal, sedangkan atribut kelengkapan, ketepatan waktu, penerimaan, fleksibilitas, dan kesederhanaan telah berjalan baik namun belum optimal. Pada sub studi analitik, 64,84% responden memiliki perilaku pencarian layanan kesehatan yang tidak tepat. Faktor yang berhubungan secara bermakna dengan perilaku pencarian layanan kesehatan adalah karakteristik usia responden (aOR=2,88;95%CI:1,17-7,13; p=0,022) dan status bekerja (aOR=0,46; 95%CI: 0,21-0,99; p=0,048).

Kesimpulan: Implementasi program dan sistem surveilans penemuan kasus TB anak di puskesmas Kabupaten Sukoharjo sesuai pedoman dan mendukung penemuan kasus TB anak, namun masih diperlukan penguatan pada penemuan kasus aktif, investigasi kontak, tindak lanjut anak terduga hingga pemeriksaan diagnostik, serta kualitas pencatatan dan pelaporan. Selain itu, karakteristik usia dan pekerjaan orang tua/pengasuh/wali berhubungan dengan perilaku pencarian layanan kesehatan. Oleh karena itu, penguatan kapasitas tenaga kesehatan, optimalisasi pelaksanaan investigasi kontak dan tindak lanjut pemeriksaan diagnostik, selain itu pengembangan komunikasi perubahan perilaku, edukasi mengenai tanda dan gejala serta pemeriksaan dini sesuai karakteristik sasaran perlu menjadi prioritas untuk meningkatkan penemuan kasus TB anak di tingkat puskesmas.

Background: This study aimed to evaluate the implementation of the childhood TB case detection program and the surveillance system at primary health care centers, as well as to analyze factors influencing the health seeking behavior of parents, caregivers, or guardians of children diagnosed with TB in Sukoharjo District.

Methods: This study employed a bundling study approach consisting of three sub studies, a program evaluation using the Logic Model, a surveillance system evaluation based on the WHO (2006) surveillance evaluation framework, and an analytical study with a cross sectional design guided by Andersen’s Behavioral Model. The study was conducted in Sukoharjo District, Indonesia, in 2025. The program and surveillance evaluation were carried out in all 12 primary health care centers and the District Health Office using total sampling. The analytical sub study included 128 parents, caregivers, or guardians of children aged 0-14 years diagnosed with TB, selected using cluster sampling. Data were analyzed descriptively, while analytical sub study employed bivariate and multivariable logistic regression analyses.

Results: The implementation of childhood TB case finding at primary health care facilities was generally supported by national regulations, multidisciplinary health personnel, budget availability, facilities, and referral networks, with both active and passive case finding activities implemented.  However, several gaps remained, including limited capacity building for health personnel, suboptimal use of childhood TB forms, and suboptimal implementation of contact investigation and diagnostic examinations. The surveilans system implemented both active and passive case detection, although case detection remained predominantly passive. Overall, the evaluated eurveillance attributes were fulfilled, with usefullness and stability demonstrating optimal performance, while completeness, timeliness and stability showing optimal performance, while completeness, timleliness, acceptability, flexibility, and simplicity were functioning well but were not yet optimal. In the analytical sub study, 64.84% of respondents demonstrated inappropriate health seeking behavior. Age (aOR=2,88;95%CI:1,17-7,13; p=0,022) and employment status (aOR=0,46; 95%CI: 0,21-0,99; p=0,048) were significantly associated with health seeking behavior.

Conclusion: The implementation of childhood TB case detection program and surveillance system at primary health care centers in Sukoharjo District has generally been conducted; however, strengthening active active case finding, contact investigation, and the quality of recording and reporting remains necessary. In addition, parental/caregiver age and employment status were associated with health-seeking behavior. Therefore, strengthening the capacity of healthcare workers, improving contact investigation and follow up persumptive childhood TB cases  through diagnostic examination and enhancing parental/caregiver education on the signs and symptoms of childhood TB and the importance of early healthcare seeking should be prioritized to improve childhood TB case detection at the primary healthcare level

Kata Kunci : Tuberkulosis anak, evaluasi program, sistem surveilans, penemuan kasus, perilaku pencarian layanan kesehatan