PENINGKATAN PENEMUAN TUBERKULOSIS MELALUI PENYULUHAN KESEHATAN TERINTEGRASI DI MASYARAKAT, PEMBERDAYAAN TENAGA KESEHATAN DESA DAN PENERAPAN ALGORITME OLEH PETUGAS PUSKESMAS PADA PELAYANAN KESEHATAN DASAR DI PROVINSI KALIMANTAN TIMUR TAHUN 2011 - 2012

RAHMAT BAKHTIAR, DR. MPPM, Prof. dr. Hari Kusnanto J. SU, Dr.PH.; Prof. dr. H. Barmawi Hisyam, SpPD-KP

2015 | Disertasi | S3 Ilmu Kedokteran

Pendahuluan: Meskipun upaya pengendalian tuberkulosis (TB) dengan strategi Directly Observed Treatment Shortcourse (DOTS)telah diterapkan sejak tahun 2000 dan program Pencegahan dan Pengendalian Tuberkulosis (P2TB)merupakan program prioritas di provinsi Kalimantan Timur, TB masih merupakan masalah kesehatan masyarakat. Sampai tahun 2014, indikator kinerja penemuan kasus TB seperti case notification rate 92 per 100.000 penduduk dan case detection rate hanya 30 - 35% jauh dari target nasional sebesar 70% sedangkan angka kesembuhan 79,5%. Mengacu pada strategi nasional program TB, sejak tahun 2010, ekspansi program keberbagai sektor telah dilakukan tetapi penemuan kasus TB tetap tidak meningkat. Penelitian ini bertujuan untuk menemukan intervensi efektif yang dapat meningkatkan penemuan kasus TB secara konsisten. Metode: Penelitian ini adalah riset operasional dengan quasi experimental pretest - posttest nonequivalence control group design. Penelitian dilakukan di tiga Kabupaten yaitu kabupaten Kutai Kartanegara, Kutai Timur dan Kutai Barat. Peneliti menggunakan two independent proportion dengan PASS sebagai dasar dalam menentukan jumlah Puskesmas dalam penelitian ini. Didapatkan 12 Puskesmas dengan rincian 9 Puskesmas dengan intervensi dan 3 Puskesmas sebagai kontrol. Pemilihan Puskesmas dan kabupaten dipilih secara acak. Seluruh masyarakat yang berdomisili di Puskesmas penelitian dijadikan sebagai sampel dalam penelitian ini. Intervensi penyuluhan kesehatan terintegrasi di masyarakat, pemberdayaan tenaga kesehatan di desa serta penerapan algoritme penemuan kasus oleh petugas puskesmas merupakan variabel bebas. Output program TB seperti jumlah terduga TB, penderita TB BTA positif dan positivity rate merupakan variabel terikat. Penelitian dilakukan pada Januari 2011 - Desember 2012. Data dianalisis menggunakan regresi poisson dengan general estimating equivalence (GEE) menggunakan Stata. Hasil penelitian: Analisis data longitudinal terhadap seluruh intervensi menggambarkan belum terdapat pola yang konsisten dalam peningkatan jumlah suspek dan penderita TB BTA positif di Puskemas. Jumlah terduga TB di Puskesmas dengan intervensi penyuluhan kesehatan terintegrasi di masyarakat meningkat 2,36 kali dibandingkan Puskesmas kontrol, 1,68 kali dibandingkan intervensi pemberdayaan tenaga kesehatan di desa dan 1,14 kali dibandingkan intervensi penerapan algoritme penemuan kasus. Intervensi penyuluhan kesehatan terintegrasi di masyarakat meningkatkan jumlah terduga TB, kasus TB BTA positif dan menurunkan positivity rate. Kesimpulan: Meskipun belum terdapat pola yang konsisten, intervensi penyuluhan kesehatan terintegrasi di masyarakat dapat meningkatkan jumlah terduga TB, jumlah penderita TB BTA positif di Puskesmas.

Introduction: Despite the implementation of tuberculosis (TB) control using Directly Observed Treatment Shortcourse (DOTS)strategy since 2000 and TB prevention and control priority program at Kalimantan Timur province, TB still becomes a health problem in the community. In 2014, performance of TB indicators show that case notification rate was 92 per 100.000 population, case detection rate was only 30% - 35% far below the national target of 70% and treatment success rate among sputum smear positive TB cases was 79,5%. Since 2010, TB national program strategy has been expanded to all sectors, yet TB case detection shows no increase. Objective: The study aimed to identify effective intervention that could increase TB case detection consistently. Method: The study was quasi experimental with pretest - post-test non equivalence control group design. It was carried out in three districts, i.e. Kutai Kartanegara, Kutai Timur and Kutai Barat. Number of health centers was determined through two independent proportion with PASS. There were 12 health centers comprising 9 health centers as intervention 3 health centers as control. Health centers and districts were selected randomly. All of the communities living nearby the health center were taken as samples. The independent variables were intervention of integrated health socialization in the community, health staff empowerment in the village and the implementation of detection algorithm by staff of the health center whereas the dependent variable was output of TB program such as number of patients with presumptive TB, new cases of TB smear positive and positivity rate. The study was carried out from January 2011 to December 2012. Data were analyzed using poisson regression and general estimating equivalence using Stata. Result: Longitudinal data analysis to all intervention showed there was no consistent pattern in the increased number of patients with presumptive TB and new cases of TB smear positive at the health center. Intervention of integrated health socialization in the community increased the number of patients with presumptive TB 2.36 times than that of in the health center as control; 1.68 times higher in health staff intervention in the village and 1.14 times higher than the intervention of case detection algorithm implementation. Intervention on integrated health socialization in the community could increase the number of of patients with presumptive TB, new cases of TB smear positive and decrease positivity rate. Conclusion: Although there was no consistent pattern intervention of integrated health socialization in the community could increase the number of patients with presumptive TB, new cases of TB smear positive at the health center.

Kata Kunci : integrated health socialization, village health staff, algorithm - patients with presumptive TB, new cases of TB smear positive, positivity rate