Analisis spasial faktor-faktor risiko kasus TB Paru BTA (+) di Kota Cirebon tahun 2008

JAENUDIN, Prof. dr. Hari Kusnanto, DrPH

2010 | Tesis |

Latar Belakang : Berdasarkan data World Health Organization (WHO) pada tahun 2007, jumlah kasus baru Tuberculosis (TB) di Indonesia sekitar 528.000 dan kematian 91.000 per tahun. Jumlah tersebut merupakan peringkat ke-3 terbanyak di dunia setelah India dan China. Di Kota Cirebon, jumlah kasus TB Paru BTA (+) dan Case Notification Rate (CNR) cenderung mengalami peningkatan dari tahun ke tahun. Case Detection Rate (CDR) kasus TB Paru BTA (+) untuk setiap tahun jumlahnya relatif berfluktuasi. Kemungkinkan jumlah kasus baru setiap tahunnya makin bertambah dan belum diketahuinya faktor risiko terkuat penyebab TB Paru BTA (+). Tujuan : Menganalisis secara spasial distribusi penderita kasus TB Paru BTA (+) dan mengetahui faktor risiko terkuat kejadian kasus TB BTA (+) di Kota Cirebon Tahun 2008. Metode Penelitian : Jenis penelitian ini merupakan penelitian survey dengan rancangan kasus kontrol menggunakan Sistem Informasi Geografis yang dilaksanakan di Kota Cirebon Propinsi Jawa Barat. Kasus adalah jumlah penderita TB Paru BTA (+) sebanyak 175 orang sedangkan kontrolnya yang tidak menderita TB Paru BTA (+) sebanyak 175 orang yang tercatat pada register TB Dinkes Kota Cirebon Tahun 2008. Dilakukan matching berdasarkan umur dan jenis kelamin. Data dikumpulkan dengan melakukan wawancara menggunakan kuesioner, pengambilan titik koordinat sampel penelitian menggunakan GPS. Analsis spasial dengan Space-Time Permutation Model menggunakan SaTScan, analisis Spatially Weighted Regression menggunakan Geoda. Data dianalisis secara univariabel, bivariabel dan multivariabel. Hasil : Terdapat hubungan yang signifikan antara faktor sosial ekonomi (tingkat pendidikan dan pendapatan), faktor lingkungan (ventilasi dan kepadatan hunian) serta keberadaan sarana pelayanan kesehatan dengan kasus TB Paru BTA (+). Terdapat dua clustering kasus TB Paru BTA (+) di dua kecamatan. Kesimpulan : Analisis spasial menggunakan aplikasi Sistem Informasi Geografis merupakan cara yang efektif untuk mengetahui distribusi kasus TB Paru BTA (+). Faktor risiko yang paling dominan berhubungan dengan kejadian TB Paru BTA (+) adalah ventilasi.

Background: Data of WHO 2007 showed there were 528,000 new TB cases in Indonesia and 91,000 deaths due to TB annually. This figure is the third in the world after India and China. At Cirebon Municipality number of positive acid fast bacillus lung TB cases and Case Notification Rate (CNR) tend to increase over years. Case Detection Rate (CDR) of positive acid fast bacillus relatively fluctuates. The probability of number of new cases increases every year and the strongest risk factor of positive acid fast bacillus lung TB is still unknown. Objective: To spatial anaysis for identify distribution of patients of positive acid fast bacillus lung TB cases and strongest risk factor of the prevalence of positive acid fast bacillus lung TB cases at Cirebon Municipality. Method: The study was a survey with case control design that used geographical information system carried out at Cirebon Municipality, Province of West Java. Cases were patients of positive acid fast bacillus lung TB (175 people) and the control group were those that did not suffer from positive acid fast bacillus lung TB (175 people) listed in TB registry of Cirebon Municipal Health Office 2008. Matching was made according to age and gender. Data were collected through interview using questionnaire. Coordinate point of samples was determined using Global Positioning System (GPS). Spatial analysis with Space-Time Permutation Model used SatScan, spatially weighted regression analysis used Geoda. Data were analyzed using univariate, bivariate and multivariate technique. Result: There was significant association between social economic factor (education and income), environmental factor (ventilation and occupation density) and availability of health service facilities and cases of positive acid fast bacillus lung TB. There were two clusterings of positive acid fast bacillus lung TB cases at two subdistricts. Conclusion: The application of Geographic Information System with spatial analysis is an effective method to determine the distribution of cases of positive acid fast bacillus lung TB. Risk factor most dominantly associated with the prevalence of positive acid fast bacillus lung TB was ventilation.

Kata Kunci : Analisis spasial,Faktor risiko,TB Paru BTA (+)