Penelusuran Masalah/Topik Penelitian

Oleh : Nur Sayyid Jalaluddin Rummy

NIM : 131914153002

1. Bidang Keahlian : Keperawatan Komunitas

2. Kasus : TBC pada masyarakat di Surabaya
3. Kajian Masalah :

TB adalah sebuah penyakit yang disebabkan oleh bacteri yang disebarkan dari
orang ke orang (CDC, 2016) dan berlanjut menjadi penyebab utama dari penyakit yang
mematikan di dunia.TB memiliki beban lebih dari 50% di 5 negara : India, Indonesia,
China, Philippines, and Pakistan (WHO, 2017). Peningkatan infeksi TB tidak luput dari
berbagai faktor, yaitu usia, jenis kelamin, status gizi, tingkat kebersihan, ventilasi,
suhu, pencahayaan, kepadatan penghuni dan pendidikan (Rahmawati 2015). Dalam
sebuah penelitian yang dilakukan di Canada pada suku Inuit dari 261 responden
menunjukan bahwa umur, jenis kelamin, suku dan kepadatan hunian berhubungan
dengan terjadinya infeksi TB yang tersembunyi (LTBI) (Kilabuk 2019).
Indonesia menempati urutan ketiga dunia dengan jumlah terbanyak. Jawa Timur
menempati posisi kedua dengan jumlah temuan 57.014 kasus. Dan di Surabaya
menepati urutan pertama dengan 7.000 atau 23,2 dari total penderita TB di seluruh
Jawa Timur.
Penderita TB paru dapat menyebarkan kuman ke udara dalam bentuk percikan
dahak (droplet nuclei)pada waktu batuk atau bersin, sekali batuk dapat menghasilkan
sekitar 3000 percikan dahak. Percikan dahak yang mengandung kuman dapat bertahan
di udara pada suhu kamar selama beberapa jam. Orang dapat terinfeksi jika percikan
dahak itu terhirup dalam saluran pernafasan. Satu penderita TB paru BTA (+)
berpotensi menularkankepada 10-15 orang per tahun sehingga kemungkinan setiap
kontak dengan penderita akan tertular.3,7Apabila penderita TB paru BTA (+) batuk
maka ribuan bakteri tuberculosis berhamburan bersama “Droplet” napas penderita
yang bersangkutan sehingga berpotensi menularkan ke orang lain.
Sampai saat ini belum diketahui hubungan antara jenis kelamin, usia,
lingkungan fisik rumah, pendidikan, gaya hidup dan kepadatan hunian dengan kejadian
tuberkulosis paru di Surabaya. Selain itu potensi penularannya juga belum diketahui
dan dilakukan penelitian. Penelitian ini untuk membuktikan factor-faktor yang
berpengaruh terhadap tuberculosis paru ke anggota keluarga.
 Spider Web

ODHA dan
Tinggal Penderita
bersama gangguan
penderita TBC
imun lainnya

Culture Umur

Faktor Resiko
Kepadatan Life Stlye
Hunian

Faktor Eksternal TBC Faktor Internal Education

Environment

Petugas
Jenis kelamin
Kesehatan

Faskes Reliance
Keaslian Penelitian

No Judul Karya Ilmiah Variabel Jenis Hasil

danPenulis Penelitian
1. Social determinants of - Social Kuantitatif Results 261 participants
health among determinants of completed the questionnaire.
residential areas with a health among Most participants identified
high tuberculosis residential areas as Inuit (82%). Unadjusted
incidence in a remote - a high risk ratios demonstrated that
Inuit community tuberculosis age, education, smoking
incidence tobacco, crowded housing
conditions and Inuit ethnicity
were associated with LTBI.
After adjusting for other
SDH, multivariable analysis
showed an association
between LTBI with
increasing age (relative risk,
RR 1.07, 95% CI 1.04 to
1.11), crowded housing (RR
1.48, 95% CI 1.10 to 2.00)
and ethnicity (RR 2.76, 95%
CI 1.33 to 5.73) after
imputing missing data.
Conclusion Among high-risk
residential areas for TB in a
remote Arctic region of
Canada, crowded housing
and Inuit ethnicity were
associated with LTBI after
adjusting for other SDH.
2. Association of CKD - CKD Kuantitatif 408,873 people with
with Incident - Incident predialysis CKD and the
Tuberculosis Tuberculosis same number of controls.
1704 patients with active
Mycobacterium tuberculosis
 (incidence rate
=137.5/100,000 person-
years) in the predialysis CKD
group and 1518 patients with
active Mycobacterium
tuberculosis (incidence rate
=121.9/100,000 person-
years)
in the matched controls. The
active Mycobacterium
tuberculosis risk was
significantly higher in the
predialysis CKD group. The
risk factors for active
Mycobacterium tuberculosis
among the predialysis CKD
group were old age, men,
current smoking, low income,
underlying diabetes, chronic
obstructive pulmonary
disease, and Kidney Disease
Improving Global Outcomes
CKD stage 1
(eGFR$90 ml/min per
1.73m2with persistent
albuminuria) or stage
4/5without dialysis (eGFR,30
ml/min per
1.73 m2).
3. -
4. Analisis factor resiko - Fator-faktor Kuantitatif Kejadian TB paru
kejadian TB paru di - Kejadian TB berhubungan dengan :
wilayah kerja Paru 1. Umur
puskesmas palembang 2. Pendidikan
3. Tipe lantai
4. Ventilasi
 5. Kepadatan Hunian
6. Kontak dengan penderita
7. Status gizi

5. Prevalence and - Prevalence and Kuantitatif Results: A total of 487 TB

determinants of latent determinants of HCWs were recruited at the
tuberculosis infection latent 31 TB-designated hospitals;
among frontline tuberculosis 33.9% of them tested positive
tuberculosis healthcare infection for LTBI. At the institutional
workers in southeastern - frontline level, a low TB epidemic
China: A multilevel tuberculosis level, regular infection
analysis by individuals healthcare control training for HCWs,
and health facilities workers and regular maintenance of
ultraviolet disinfection
equipment were found to be
significantly associated with
a lower LTBI rate among
HCWs. At the individual
level, alcohol use, a greater
number of years working on
TB, and a longer weekly
duration of contact with TB
patients were identified as
associated factors for LTBI
among HCWs.
6. Hubungan factor resiko - Jenis kelamin Kuantitatif The results of the bivariate
umur,jenis kelamin dan dan kepadatan analysis were shown to be
kepadatan hunian hunian associated with the incidence
dengan kejadian - Kejadian TB of pulmonary tuberculosis is;
penyakit TB paru di Pare age (p = 0.012) and gender (p
Desa Wori = 0.000). From the overall
results of the study that
examined risk factors
associated with the incidence
of pulmonary tuberculosis
were age and sex
7. Risk Factor and -Enviroment and Kuantitatif Results of sputum
Potential of Behavior examination in contactracing
Transmission of - TB as many as 65 people were
Tuberculosis in Kendal successfully retrieved from
District, Central Java 44 cases of research, the
results showed that there are 3
smear positive(4.6%) and 62
negative smear (95.4%).
Risk factors that affect the
incidence of lung tuberculosis
is residential densityp=0.002,
OR=7.841, CI=2.126 to
28.920, room temperature
p=0.001, OR=8.048,
CI=2.279 to 28.424, p=0.018
indoor humidity, OR=4.705,
CI=1.310 to 16.894, the type
of house floorp=0.016,
OR=5.266, CI=1.356 to
20.446, a habit of throwing
sputumany placep=0.016,
OR=4.402, CI=1.322 to
14.660, habit cough / sneeze
without closing them out hp
=<0.001, OR=9.137,
CI=2.694 to 30.992.
8. Social determinants of - the distribution Kuantitatif The following determinants
pulmonary tuberculosis of social and explain 43% of the variability
in Argentina economic factors of TB’s incidence rate among
- TB different jurisdictions:
overcrowding, proportion of
households with a sewage
network, proportion of
examined patients with
respiratory symptoms and
 proportion of patients who
discontinued treatment.
9. Extent and - Extent and Kuantitatif The incidence of CHE was
determinants of determinants of 52.8% and out-of-pocket
catastrophic health catastrophic (OOP) payments were 93% of
expenditure for health the total costs for TB care.
tuberculosis care in expenditure Compared with patients
Chongqing - tuberculosis care without delay, the incidence
municipality, China and intensity of CHE were
higher in patients who had
patient delay or diagnostic
delay. Patients who
experienced patient delay or
diagnostic delay, who was a
male, elderly (≥60 years), an
inhabitant, a peasant,
divorced/widow, the New
Cooperative Medical Scheme
membership had greater risks
of incurring CHE for TB care.
Having a higher educational
level appeared to be a
protective factor. However,
hospitalisation was not
associated with CHE after
controlling for other variables
10. The association of - The Kuantitatif Results: In total, 192
household fine association of individuals in 96 matched
particulate matter and household fine pairs were included. The
kerosene with particulate median 24-hour time-
tuberculosis in women matter and weighted average PM2.5 was
and children in Pune, kerosene nearly seven times higher
India - tuberculosis in than the WHO's
women and recommendation of 25 μg/m3,
children and did not vary between
controls (179 μg/m3; IQR:
 113-292) and cases (median
157 μg/m3; 95% CI 93 to 279;
p=0.57). Reported use of
wood fuel was not associated
with TB (OR 2.32; 95% CI
0.65 to 24.20) and kerosene
was significantly associated
with TB (OR 5.49, 95% CI
1.24 to 24.20) in adjusted
analysis. Household PM2.5
was not associated with TB in
univariate or adjusted
analysis. Controlling for
PM2.5 concentration,
kerosene was not
significantly associated with
TB, but effect sizes ranged
from OR 4.30 (95% CI 0.78
to 30.86; p=0.09) to OR 5.49
(0.82 to 36.75; p=0.08)
11. Predictors of - the factors Kualitatif Fifty-eight (56.9%) patients
Tuberculosis outcomes associated were successfully cured
amongst drug sensitive drug sensitive compared to 44 (43.1%) who
patients in Boteti sub- TB treatment successfully completed
district outcomes treatment. Patients that
attended the clinics by foot
(ARR 3.38) (P < 0.05),
females (ARR: 1.25) and HIV
negative patients (ARR: 1.20)
were more likely to achieve
TB cure. Patients that
attended the facility with a
vehicle were 2.12 (P < 0.000),
a primary school and above
education (ARR: 1.59),
travelled less than 5 km
 (ARR: 1.05) and less than 38
years of age (ARR:1.02) were
more likely to complete TB
treatment.
12. High prevalence of - the prevalence Kuantitatif At initial evaluation, 3 of the
infection and low and incidence 150 children included were
incidence of disease in of latent diagnosed with TB disease
child contacts of tuberculosis (2.0%). The prevalence of
patients with drug- infection LTBI was 58.7%. The
resistant tuberculosis (LTBI) and incidence of LTBI was 19.9
tuberculosis per 100 children per year, and
(TB) disease was especially high during
- children in the first 6 months of follow-
close contact up (33.3 per 100 children per
with patients year). No additional cases
with drug- with incident disease were
resistant TB diagnosed during follow-up.
(DR-TB) After adjustment, prevalent
LTBI was significantly
associated with the child's
age, sleeping in the same
house, higher household
density, the index case's age,
positive smear result and
presence of lung cavities
13. Prevalence of bovine - Prevalence of Kuantitatif the results showed that age
tuberculosis and its bovine and animal origin were
associated risk factors tuberculosis identified as significant
in the emerging dairy and its predictors for BTB positivity
belts of regional cities associated risk but sex and body condition
in Ethiopia factors score were not related to BTB
- TB status. Descriptive analysis
revealed that herds having
‘BTB history’ showed
slightly higher likelihood of
being BTB positive compared
 to farms having no previous
BTB exposure.
14. Estimating the annual - Estimating the Kuantitatif Of 4808 adolescents
risk of infection with annual risk of returning for TST readings
Mycobacterium infection with (96% of those enrolled),
tuberculosis among Mycobacterium mean age was 14.4 (SD 1.9),
adolescents in Western tuberculosis 4518(94%) were enrolled in
Kenya in preparation - Adolescents school and 21(0.4%) gave a
for TB vaccine trials previous history of
tuberculosis. Among
adolescents with TST
reactivity, the mean TST
induration was 13.2 mm (SD
5.4). The overall prevalence
of latent TB infection was
1544/4808 (32.1, 95% CI
29.2–35.1) with a
corresponding annual risk of
TB infection (ARTI) of 2.6%
(95% CI 2.2–3.1). Risk
factors for a positive TST
included being male (OR 1.3,
95% CI 1.2,1.5), history of
having a household TB
contact (OR 1.5, 95% CI
1.2,1.8), having a BCG scar
(OR 1.5,95% CI 1.2,1.8),
living in a rural area (OR 1.4,
95% CI 1.1,1.9), and being
out of school (OR 1.8, 95%
CI 1.4,2.3).
15. Treatment outcomes - evaluation of Kuantitatif There were 1222 EPTB
and risk factors of socio- patients presenting 13.1% of
extra-pulmonary demographic all TB cases during 2006–
tuberculosis in patients factors, clinical 2008. Pleural effusion and
with co-morbidities
 manifestations, lymph node TB were the most
co-morbidities frequent types and accounted
- patients with for 45.1% of all EPTB cases
EPTB and their among study participants.
treatment Treatment success rate was
outcomes 67.6%. The best treatment
completion rates were found
in children ≤15 years (0.478
[0.231–1.028]; p = 0.05). On
multivariate analysis, age
group 56–65 years (1.658
[1.157–2.376]; p = 0.006),
relapse
cases (7.078 [1.585–31.613];
p = 0.010), EPTB-DM (1.773
[1.165–2.698]; p = 0.008),
patients with no formal
(2.266
[1.254–4.095]; p = 0.001) and
secondary level of education
(1.889 [1.085–3.288]; p =
0.025) were recorded as
statistically positive
significant risk factors for
unsuccessful treatment
outcomes. Patients at the risk
of EPTB
were more likely to be
females (1.524 [1.311–
1.746]; p < 0.001), Malays
(1.251 [1.056–1.482]; p =
0.010) and Indians
(1.450 [1.142–1.842]; p =
0.002), TB-HIV (3.215
[2.347–4.405]; p < 0.001),
EPDM-HIV (4.361 [1.657–
11.474]; p = 0.003),
EPTBHIV-
HEP (4.083 [2.785–5.987]; p
< 0.001), those living in urban
areas (1.272 [1.109–1.459]; p
= 0.001) and no formal
education (1.361 [1.018–
1.820]; p = 0.037).
1. Masalah
Analisis factor yang berhubungan dengan angka kejadian TB di Surabaya
2. Rumusan Masalah:
a. Apakah hubungan jenis kelamin dengan angka kejadian TB di Surabaya
b. Apakah ada hubungan usia dengan angka kejadian TB di Surabaya
c. Apakah ada hubungan antara kepadatan tempat tinggal dengan angka kejadian TB di
Surabaya
d. Apakah ada hubungan tingkat pendidikan dengan angka kejadian TB di Surabaya
e. Apakah ada hubungan gaya hidup dengan angka kejadian TB di Surabaya
f. Apakah ada hubungan karakteristik tempat tinggal dengan angka kejadian TB di Surabaya
3. Tujuan Penelitian
Tujuan Umum : Mengetahui factor-faktor yang berhubungan terhadap angka kejadian TB di
Surabaya
Tujuan Khusus :
a. Mengetahui hubungan jenis kelamin dengan angka kejadian TB di Surabaya
b. Mengetahui hubungan usia dengan angka kejadian TB di Surabaya
c. Mengetahui hubungan antara kepadatan tempat tinggal dengan angka kejadian TB di
Surabaya
d. Mengetahui hubungan tingkat pendidikan dengan angka kejadian TB di Surabaya
e. Mengetahui hubungan gaya hidup dengan angka kejadian TB di Surabaya
f. Mengetahui hubungan karakteristik tempat tinggal dengan angka kejadian TB di Surabaya
4. Manfaat
Manfaat Teoritis
Hasil penelitian ini dapat menjelaskan factor-faktor yang berpengaruh terhadap angka
kejadian TB di Surabaya
Manfaat Praktis
Hasil penelitian ini diharapkan dapat dilakukan sebagai upaya promotif, preventif, dan
rehabilitative bagi masyarakat untuk mengurangi angka kejadian TB di Surabaya
 Kerangka teori

Tahap 4 Tahap 3 Tahap2 Tahap 1

Diagnosa Diagnosa Diagnosa Diagnosa
Administrasi dan Administrasi dan Administrasi dan Administrasi
Kebijakan Kebijakan Kebijakan dan Kebijakan

Faktor Predisposisi

( Predisposing factors)
PROGRAM KESEHATAN - Pengetahuan Genetik
- Sikap
- Pekerjaan
- Umur
- Pendidikan

Faktor Pemungkin
Komponen (Enabling factors)
Pendidikan Perilaku
Program - Pustu/Polindes Individu Kualitas Kesehatan
- Obat-obatan Kelompok Hidup
Kesehatan - Sarana kesehatan dan
- Alat-alat Masyarakat

Kebijakan
Organisasi
Faktor Penguat

(Reinforcing factors) Faktor

Lingkungan
- Dukungan Psikologi
masyarakat
Komunikasi tidak Sosial
- Dukungan Tokoh
langsung: masyarakat Ekonomi
Pengembangan staf, - Insentif
pelatihan, supervisi, - Penghargaan
konsultasi, umpan - Penyuluhan

Implementasi Evaluasi Proses Evaluasi Dampak

Evaluasi Hasil

Sumber, : Lawrence W. Green, Health Program Planning : An

Educational and Ecological Approach 2005