A comparative study on fuzzy Mamdani-

Sugeno-Tsukamoto for the childhood

tuberculosis diagnosis
Cite as: AIP Conference Proceedings 1755, 070003 (2016); https://doi.org/10.1063/1.4958498
Published Online: 21 July 2016

Wahyuni Eka Sari, Oyas Wahyunggoro, and Silmi Fauziati

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© 2016 Author(s).
 A Comparative Study on Fuzzy Mamdani-Sugeno-
Tsukamoto for the Childhood Tuberculosis Diagnosis
Wahyuni Eka Sari1, a), Oyas Wahyunggoro 1), Silmi Fauziati 1)
1
Department of Electrical Engineering and Information Technology
Faculty of Engineering, Universitas Gadjah Mada
Jalan Grafika no.2 Yogyakarta 55281, Indonesia
a)
Corresponding author: yunieka.ti14@mail.ugm.ac.id

Abstract. World Health Organization (WHO) estimated that approximately 80 thousand children died every year in view
of Childhood Tuberculosis. The disease needs an appropriate treatment considering the difficulties in establishing a
diagnosis in pediatric patients. The incapability of children to produce sputum becomes one of the difficulties. Sputum is
used to diagnose a person suffering from tuberculosis, based on Mycobacterium tuberculosis in sputum. In this paper,
Mamdani, Tsukamoto and Sugeno-types Fuzzy Inference System are applied to assist the tuberculosis diagnosis. The
different technique in these three methods is aimed to determine the most appropriate method for such diagnosis. The
results show that, of the three types of Fuzzy Inference System, the best model is Sugeno model. Sugeno-type FIS has a
better accuracy compared to both Mamdani and Tsukamoto ones at 93%, equivalent to a fault diagnosis in 13 of 180
patients. Here, Mamdani-type FIS is provided the diagnostic accuracy of 89%, equivalent to the fault diagnosis in 20 of
180 patients. On the other hand, Tsukamoto is provided the diagnostic accuracy of 92%, equivalent to fault diagnosis in
15 of 180 patients. Based on the three systems, the most precise output is found in Sugeno-type Fuzzy with a value by
95.1% while for Fuzzy Mamdani and Tsukamoto, it values are 93.4% and 94.5%, respectively. Also, the highest level for
the system sensitivity is found in Sugeno with 97.2% in comparison to Tsukamoto FIS by 96.67% and Mamdani at
94.4%.

INTRODUCTION
Childhood Tuberculosis is a disease that causes the death of children [1]. World Health Organization (WHO)
revealed that about 80 thousand children died in 2013 of TB with an increase of approximately half a million cases
every year. Children are very susceptible to contracting TB, particularly for those found in a close contact with adult
tuberculosis patients. The main issues on Tuberculosis infection are in terms of the difficulties in detecting the
presence of Mycobacterium tuberculosis in young children. This is because the children, compared to adults are
more difficult to remove phlegm. Hence, children need a tuberculin test different from with the adults only needing
a microscopic sputum test.
World Health Organization (WHO) with the Ministry of Health and IDAI (the Indonesian Pediatric Association)
have developed a scoring system for diagnosing childhood tuberculosis [2] that should be weighted on the child's
symptoms, clinical signs, and investigations and can be conducted at the nearest health care. Every symptom in the
scoring system should be analyzed to determine whether they are within the parameters of the scoring system. In
fact, it is difficult to give a definite value for each symptom, for example, the symptoms of a cough for more than 2
weeks rated 1 or rated 2. The results obtained could be subjective as the personnel’s health can be determined by the
value in accordance with their perception.
The difficulty is to represent the knowledge of experts. The subjective knowledge of experts can be solved by
Fuzzy Logic, which can be one of the solutions in symptoms weighting of childhood Tuberculosis. This method has
been developed because for its advantages in solving problems of uncertainty, imprecision, and partial truth.
Another advantage of fuzzy logic is in its capability to be used for a decision making.

Advances of Science and Technology for Society

AIP Conf. Proc. 1755, 070003-1–070003-6; doi: 10.1063/1.4958498
Published by AIP Publishing. 978-0-7354-1413-6/$30.00

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 Fuzzy logic development possesses a number of methods. The most well known fuzzy methods are Fuzzy
Mamdani, Tsukamoto and Sugeno. Many studies have been successfully used based on this method. The research
has been developed for detecting breast cancer [3] and typhoid fever [4] which produce nearly 84% and 94%
accuracy using fuzzy logic. In the medical problem, fuzzy expert system method can also be used for the prostate
cancer [5], classification of anti-tuberculosis [6], predicting of Mycobacterium Tuberculosis [7], expert systems for
lung tuberculosis [8] and decision support system for tuberculosis [9] and also classification of chronic kidney
disease [10]. Fuzzy logic can also be combined with other methods of Artificial Intelligence, i.e. Neural Networks
and Genetic Algorithms. The combination of Genetic-Neuro-Fuzzy [11] methods is able to make a fairly good
diagnosis for tuberculosis.
Based on the ability of these three methods in various fields, this research is designed to compare among
Mamdani, Sugeno and Tsukamoto methods with a purpose to determine which is the best fuzzy method for the
detection of Childhood Tuberculosis. In this paper, three methods will be measured for identifying the fuzzy method
that has the most similar accuracy or approach to the diagnosis of the lung specialist. This paper is organized as
follows. Section 2 describes the methodology of Mamdani, Sugeno, and Tsukamoto Fuzzy Inference Systems.
Section 3 and 4 describes the experiment process and also shows the result of the experiment. Finally, conclusions
are addressed in Section 5.

MAMDANI-SUGENO-TSUKAMOTO FUZZY INFERENCE SYSTEMS

The most fundamental difference among Mamdani, Tsukamoto, and Sugeno FIS is in terms of how crisp output
is generated from input fuzzy. Mamdani uses the Center of Gravity technique for defuzzification process; while
Sugeno FIS and Tsukamoto FIS use Weighted Average to calculate the crisp output. Sugeno has a better processing
time for a weighted average defuzzification. Due to nature interpreted and intuitive from the rule base, Mamdani-
type is widely used, especially for decision support applications. Table 1 presents a number of differences among
Fuzzy Mamdani-Sugeno-Tsukamoto.
TABLE 1. Design methods for FIS
FIS Type Fuzzification Inference process Defuzzification
Mamdani Singletone Min-max Center of Gravity
Sugeno Singleton Min-product; Order 0 Weighted Average
Tsukamoto Singletone Min-max Height Method

DEVELOPMENT OF MAMDANI SUGENO TSUKAMOTO FIS

The three methods of Fuzzy Inference System were tested in the tuberculosis diagnosis. The early process is
fuzzification as the process of changing real or crisp input into the fuzzy set. The second process is the inference,
which is an act or consequent derived from the premises logically based on fuzzy sets and the last one is
defuzzification, the process of changing from the fuzzy values to crisp values based on the composition of fuzzy
rules. Table 2 described the scoring systems that used for fuzzification process.
TABLE 2. Scoring System of Tuberculosis [2]
No. Symptoms Score
1 Nutritional status
- Very thin < 16.99
- Thin 17 – 18.49
- Normal – 24.99
- Fat > 25
2 Fever
- Very often > 21 days
- Often 20 – 8 days
- Rarely < 7 days
3 Cough
- Very often > 21 days
- Often 20 – 10 days
- Rarely < 9 days

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 Based on Table 2, it is found that the input variables had a continuous function including the variables of fever,
cough and nutritional status. The variables had a discrete function including Tuberculosis Contact, Tuberculin Test,
Enlarged Lymph Nodes, Swollen Joints and X-Rays. The values of the variables that had a discrete function are 0
for negative and 100 for positive scores.

Fuzzification
Conducting fuzzification is made of the membership function of each input variable. From the membership
function, the crisp value is converted into fuzzy values by means of a fuzzification technique. This research used
obfuscation techniques singleton for all three Fuzzy Inference Systems.

(a) (b)

(d)
(c)
FIGURE 1. The Membership Function of Variable inputs; (a) cough variable; (b) fever variable; (c) nutritional status; (d) x-ray

(a) (b)
FIGURE 2. Membership Function of Variable Output; (a) Output Mamdani Fis; (b) Output Sugeno Fis

The analysis process of Fuzzy Inference System Mamdani, Tsukamoto and Sugeno have used MATLAB software and web-
based application with 180 patient data from the Special Hospital of Lung Respira Yogyakarta. Figure 1 presents the tuberculosis
diagnosis using Mamdani, Sugeno and Tsukamoto-types FIS. Variable x-ray in Figure 1 (d) has a discrete membership function.

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The value is zero (0), if not detected and value is one (1) if there are spots on the lungs. Variable contact TB, tuberculin test,
enlarged glands and swelling of bone has the same membership function with Figure 1 (d). Figure 2 presents the output variable.

Inference Process
Inference process involved a number of rules from the experts indicating whether someone is sick or not.
Mamdani and Tsukamoto's Fuzzy rules are written on the formula 1 as follows:
if A1 (X1, …., Xn)then C1(Y1, …., Ym) (1)
where A represents a fuzzy predicate for the independent of variables and C states fuzzy predicate for the
dependent variable. On the other hand, Sugeno fuzzy rules are written on the formula 2 as follows,
if X1 is A1 AND X2 is A2 then y = z (2)
where X is the input value and A is the antecedent and z are constants firmly. Fuzzy Sugeno model used the
order-0. In this study, Fuzzy Mamdani and Tsukamoto used min implications while Sugeno inference engine used
the product implications. Figure 3 presents the minimum and product implications

FIGURE 3. Minimum and Product Implication

Figure 3 illustrates two inputs: variable x and variable y with consequent of z. W1 refers to an implication min
by selecting the smallest value whereas W2 is the implication product by multiplying two inputs. In general, the
rules described in Table 3 have been formed from eight input variables experiencing the fuzzification process.
TABLE 3. Fuzzy Rules to Detect Childhood Tuberculosis
Rule No Antecedent Consequent
If contact TB is positive AND Tuberculin test is positive AND nutritional status is
Positive
1 normal AND cough is rarely AND fever is often AND enlarged lymph is negative
tuberculosis
AND swollen arthritis is negative AND X-Ray is positive
If contact TB is negative AND Tuberculin test is negative AND nutritional status is
2 very thin AND cough is often AND fever is often AND enlarged lymph is negative Pneumonia
AND swollen arthritis is negative AND X-Ray is negative
If contact TB is negative AND tuberculin test is negative AND nutritional status is
3 normal AND cough is rarely AND fever is rarely AND enlarged lymph is negative Cough
AND swollen arthritis is negative and X-Ray is negative

Based on Table 3, it is found that Mamdani and Tsukamoto's consequent values have the positive conditions of
tuberculosis, pneumonia, and cough. In FIS Sugeno the consequent is a numerical value with the consequent
positive for tuberculosis more than 6, pneumonia in the range of 6 to 4 and for a healthy condition less than 4. Fuzzy
rules are formed by 35 rules. Actually, each feature multiplied will generate 1152 rules. The relevant rule is 35 rules.
Table 3 shows three examples of 35 rules. Based on fuzzy rules, a consequent can be classified into three
outcomes: positive tuberculosis, pneumonia or a normal cough.

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 Defuzzification
Defuzzification process has many successfully applied methods. In this study, three different processes were
used including centroid defuzzification method or Center of Gravity for Mamdani fuzzy, fuzzy weighted average for
Tsukamoto and Height method for fuzzy Sugeno. The centroid method of calculating the crisp value is used the
formula 3 as follows:

y* =
¦ yP ( y)dy
r
(3)
¦ P ( y)
r

where y is the value of firm consequent and μR (y) refers to the membership degree of variable y. On the
weighted average, the method is used the average value of the degrees of membership and firm value input
variables. The method of calculating the weighted average crisp value is conducted using formula 4 as follows:
P ( y) y
y* ¦ P ( y)
(4)

where y is the value of the firm and the consequent μR (y) is the membership degree of variable y. At Height
simple method the maximum value of the degree of membership as in formula 5 is selected. The function is called
singleton.
y * = any point in hgt (R) (5)
where hgt (R) refers to the set of all points reaching the maximum value among μR (y).

RESULTS AND DISCUSSION

Mamdani-type Fuzzy Inference System was on the tests on 180 patient data. It diagnosed that 173 patients are
positively suffering from tuberculosis. However, based on the calculations it is only 170 patients actually suffering
from TB. The accuracy value is obtained by 89% or approximately 160 patients with 93.4% precision and 94.4%
sensitivity level. So, based on the results, Mamdani-type FIS has an error rate of diagnosis 11%, or about 20
patients. The following Figure 4 describes the overall results of the Fuzzy Inference System.

FIGURE 4. Diagram of Evaluation Systems using Confusion Matrix

Based on the analysis, Tsukamoto-type FIS diagnosed that 175 patients are positive to suffer from tuberculosis.
However, based on calculations, it is actually only 174 patients of TB. The accuracy value obtained 92% or
approximately 165 patients with 94.5% precision and sensitivity level of 96.67%. Based on the results Tsukamoto
FIS has an error rate of diagnosis of 8%, or about 15 patients.
Sugeno-type Fuzzy Inference System is applied to the tests on 180 patient data. Based on the analysis, Sugeno-
type FIS has diagnosed that 178 patients are positive suffering from tuberculosis. However, based on calculations, it
is only 175 patients actually suffering from tuberculosis. The accuracy value of 93% is obtained approximately 167
patients with a level of precision of 95.1% and 97.2% sensitivity level. Thus, based on the results obtained, Sugeno-

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type FIS is capable of delivering some good results for the tuberculosis diagnosis. Diagnoses error rate is 7% or
approximately 13 patients.

CONCLUSION
This study shows the results of the performance comparison of Mamdani, Sugeno and Tsukamoto fuzzy
inference system. The system are measured based on the level of accuracy, precision and sensitivity of the system.
These three systems have been constructed by tested using patient data tuberculosis. The evaluation of experiment
shows that the best accuracy is Sugeno fuzzy inference systems. The quality of data and the amount of data greatly
affect the value of the accuracy of the system. Fuzzy Sugeno has advantages in interpreting the rules for computing
the fuzzy inference and defuzzification than fuzzy mamdani and Tsukamoto. Triangular membership function is
quite good to represent the knowledge from experts. The simplest computing can use the model trapezoidal
membership function but does not guarantee the accuracy of the system. The best ways to build tuberculosis
diagnosis system are the singletone technique for fuzzification with a minimum product to the inference process and
a weighted average for defuzzification process. The main contribution of this study is choosing the better or best
fuzzy system for tuberculosis diagnosis.
For the further research of the development of diagnostics for tuberculosis needs to be held by adding the
number of sample data. Sufficient amount of data accuracy and precision will generate a better system. System will
be more intuitive if the membership function and rules can be adapted to the actual condition of. Artificial neural
network can be used to adjust the membership function and rule right. The diagnosis of tuberculosis can also be
developed by means of Artificial Intelligence methods such as artificial neural networks or neural network combined
with fuzzy logic type II. Genetic algorithms, ant algorithms and particle swarm optimization can be used to optimize
the process of inference as well.

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