Penanganan dan pengobatan penderita tuberkulosis paru di Kabupaten Banjarnegara

WIGATI, Haryanto, dr. Kristiani, SU

2006 | Tesis | S2 Ilmu Kesehatan Masyarakat (Kebijakan dan Manaj.

Latar belakang: Indonesia menurut laporan WHO(1999) masih merupakan penyumbang penyakit Tuberkulosis terbesar di dunia setelah India dan Cina. Secara kasar diperkirakan setiap 100.000 penduduk Indonesia terdapat 130 penderita Tuberkulosis dengan Basil tahan asam (BTA) positif.(Depkes.R.I., 2002). Kabupaten Banjarnegara dalam penanggulangan Tuberkulosis sejak tahun 1998 telah menggunakan strategi DOTS(Directly Observed Treatment shortcourse) sesuai rekomendasi WHO, tetapi sampai tahun 2004 hasil kegiatan masih rendah, angka penemuan penderita baru 36,77%, angka konversi 76,9%, angka kesembuhan masih 70,3%, dan error rate masih tinggi yaitu 7,69%. Tujuan penelitian: Penelitian ini bertujuan untuk mengetahui penanganan dan pengobatan penderita Tuberkulosis paru di Kabupaten Banjarnegara dan faktor faktor yang mendukung dan menghambat. Metode Penelitian: Penelitian ini merupakan penelitian deskriptif dengan rancangan cross sectional menggunakan metode kualitatif. Unit analisis Dinas Kesehatan dan Puskesmas di Kabupaten Banjarnegara. Populasi penelitian adalah petugas pelaksana program P2TB dari 3 Puskesmas terpilih dan petugas program P2TB DKK Banjarnegara. Sampel penelitian diambil dari hasil menstrata puskesmas atas dasar angka kesembuhan. (Stratified random sampling). Respondennya adalah: petugas puskesmas yang menangani penderitaTB paru di poliklinik (dokter, perawat), petugas pengelola P2TB puskesmas, petugas laboratorium puskesmas, supervisor program P2TB dan Kepala seksi P2P Dinas Kesehatan Kabupaten Banjarnegara. Instrumen penelitian yang digunakan kuesioner, panduan wawancara mendalam, dan Checklist untuk observasi. Hasil Penelitian: Tenaga pelaksana belum seluruhnya mengikuti pelatihan program TB paru, supervisi ke Puskesmas jadwal tidak teratur, ,penetapan diagnosis dengan pemeriksaan mikroskopis belum memenuhi ketentuan SPS, belum seluruh Puskesmas dilakukan uji silang dahak, pencatatan dan pelaporan formulir TB 01 dan TB 04 kurang lengkap, Kesimpulan: Penanganan dan pengobatan penderita TB paru belum terlaksana dengan baik, karena masih banyak tenaga yang belum terlatih, belum ada standar kriteria untuk pedoman penjaringan suspek di poliklinik, pelaksanaan penegakan diagnosis dengan mikroskopis, supervisi dan monitoring, pencatatan dan pelaporan belum berjalan sesuai dengan ketentuan yang ada dalam pedoman.

Background: According to the report of WHO (1999), Indonesia still considered as the biggest Tuberculosis disease contributor in the world after India and China. It is estimated roughly that in every 100.000 Indonesian community there are 130 Tuberculosis patients with positive Basil Tahan Asam (BTA). (Departement of Health Republic of Indonesia,2002). Based on the recommendation of WHO, Banjarnegara district has used DOTS (Directly Observed Treatment, Short course) strategy for Tuberculosis control since the year of 1998. Nevertheless, until the year of 2004 the activity result was still low, the finding rate of new patient was 36,77%, conversion rate was 76,9%, recovery rate was 70,3% and error rate was still high with 7,69%. Objective: This research was aimed to find out handling and treatment of lung Tuberculosis patient in Banjarnegara district as well as supporting and obstacle factors. Method: This was a descriptive research with cross sectional design that used qualitative method. The analysis unit was health office and Primary Health Care in Banjarnegara district. Research population was P2TB program officer in 3 selected Primary Health Care as well as P2TB program officer of Banjarnegara district health office. The sample was taken from the result of stratifying the Primary Health Care based on the recovery rate (stratified random sampling). The respondent was health care provider in the Primary Health Care who was handling the lung TB patient in polyclinic (doctor, nurse), P2TB officer in the Primary Health Care, laboratory officer in the Primary Health Care, supervisor of P2TB program and head of P2P division of Banjarnegara district health office The instrument being used was questioner, in-depth interview guidance,and checklist for observation. Result: Not all of the officers have followed the training of lung TB program, irregular supervision schedule to the Primary Health Care, determining diagnosis with microscopic examination was not yet fulfilled the SPS rule, not all of the Primary health care had phlegm cross test, recording and reporting of TB 01 and TB 04 forms was incomplete. Conclusion: Handling and treatment of lung TB patient was not yet well implemented since there were many officers who were no trained, there was no standard criteria for suspect covering guidance in polyclinic, the implementation of diagnosis was done with microscopic, supervision and monitoring as well as recording and reporting was not yet implemented based on the rule stated in the guidance.

Kata Kunci : Layanan Kesehatan,TB Paru,Pengobatan