FAKTOR RISIKO DAN DISTRIBUSI SPASIAL TUBERKULOSIS PARU BASIL TAHAN ASAM (BTA) POSITIF DI KABUPATEN TAPIN PROPINSI KALIMANTAN SELATAN TAHUN 2011

EKA BUDI SATRIA, dr. Iswanto, Sp.P,FCCP

2012 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar belakang Incidence rate Tuberkulosis (TB) paru Basil Tahan Asam (BTA) positif di Kabupaten Tapin pada tiga tahun terakhir cenderung meningkat, yaitu 79 per 100.000 penduduk pada tahun 2008 menjadi 81 per 100.000 penduduk tahun 2009 dan 85 per 100.000 penduduk pada tahun 2010. Angka Case Detetction Rate (CDR) pada tiga tahun terakhir masih rendah yaitu pada tahun 2008 (38%), 2009 (38%) dan 2010 (40%). Penelitian ini bertujuan untuk mengetahui faktor risiko dan distribusi spasial kejadian TB paru BTA positif di Kabupaten Tapin. Metode Jenis penelitian yang digunakan adalah observasional dengan rancangan case control. Subjek penelitian pada kasus adalah semua penderita TB paru BTA positif kasus baru yang berusia ≥ 15 tahun dan tercatat di register TB puskesmas, sedangkan kontrol adalah penduduk dengan hasil pemeriksaan BTA negatif yang berusia ≥ 15 tahun yang datanya tersedia di register TB puskesmas. Sampel penelitian berjumlah 210 orang terdiri dari 105 kasus dan 105 kontrol. Pemilihan kontrol dilakukan dengan matching terhadap umur dan jenis kelamin. Analisis dilakukan secara univariabel, analisis bivariabel case control matching dengan uji McNemar, serta analisis multivariabel menggunakan conditional logistic regression dengan tingkat kemaknaan 95%. Hasil Hasil analisis bivariabel didapatkan kontak serumah penderita TB (p=0,006, OR=3,80, 95%CI 1,52–9,49), indeks massa tubuh (p=0,008, OR=2,50, 95%CI 1,31–4,77), luas ventilasi rumah (p=0,014, OR=2,45, 95%CI 1,24–4,83) berhubungan secara statistik dan merupakan faktor risiko kejadian TB paru BTA positif. Hasil analisis multivariabel kontak serumah penderita TB (Sig=0,011, Exp(β)=3,267, 95%CI 1,31-8,14) memiliki risiko terkuat terhadap kejadian TB paru BTA positif. Distribusi spasial menunjukkan bahwa terdapat klaster kasus pada kasus TB paru BTA positif , kontak serumah penderita TB dan waktu pemastian diagnosis (triwulan). Kasus TB paru BTA positif banyak ditemukan di pemukiman penduduk yang padat dengan kondisi rumah yang rapat dan luas ventilasi rumah yang tidak memenuhi syarat kesehatan. Kesimpulan Kontak serumah TB, indeks massa tubuh dan luas ventilasi rumah berhubungan secara statistik dengan dengan kejadian TB paru sedangkan faktor risiko terkuat terhadap TB paru BTA positif adalah adanya kontak serumah penderita TB. Ditemukan adanya klaster kasus TB paru BTA positif, kontak serumah penderita TB, dan waktu pemastian diagnosis di Kabupaten Tapin.

Background: Incidence rate (IR) of positive acid-fast bacillus lung TB at District of Tapin in the past three years tendedd to increase, i.e. 79 per 100,000 people in 2008, 81 per 100,000 people in 2009 and 85 per 100,000 people in 2010. Case Detection Rate (CDR) in the past three years was low, i.e. 38% in 2008, 38% in 2009, and 40% in 2010. Objective: The objective of the study was to identify risk factors and spatial distribution of positive acid-fast bacillus lung TB at District of Tapin. Method: The study was observational with case control design. Subject of the study of the experiment (case) group were all patients of positive acid-fast bacillus lung TB as new cases of 50 years old or above and recorded at the TB registry of health centers, whereas the control group were the people having negative acidfast bacillus examination of 15 years of age or above of which the data were available at the TB registry of health centers. Samples of the study consisted of 210 people comprising 105 cases and 105 control. The selection of control was made through matching of age and gender. Data analysis used univariate, bivariate case control matching with McNemar test, and multivariate with conditional logistic regression at significance 95%. Results: The result of bivariate analysis showed that in house contact with TB patients (p=0.006, OR=3.80, 95%CL 1.52-9.49), body mass index (p=0.008, OR=2.50, 95%CL 1.31-4.77), width of house ventilation (p=0.014, OR=2.45, 95%CI 1.24-4.83) were statistically associated and risk factors of the incidence of positive acid-fast bacillus lung TB. The result of multivariate analysis showed that in house contact with TB patients (Sig=0.011, EXP(β)=3.267, 95%CI 1.31-8.14) was the most dominant risk for the incidence of positive acid-fast bacillus lung TB. Spatial distribution showed that there was cluster of cases of positive acidfast bacillus lung TB, in house contact with TB patients and timing of diagnostic decision (quarterly). Cases of positive acid-fast bacillus lung TB were generally found in densely populated area with dense housing condition and width of house ventilation that did not meet health requirement. Conclusion: In house contact with TB patients, body mass index, and width of house ventilation were statistically associated with the incidence of lung TB whereas the strongest risk factor of positive acid-fast bacillus lung TB was in house contact with TB patients. There was a cluster of cases of positive acid-fast bacillus lung TB, in house contact with TB patients, and the timing of diagnostic decision at District of Tapin.

Kata Kunci : risk factors, tuberculosis, spatial distribution, District of Tapin