Case Study onMulti-Drug Resistance Tuberculosis in Grobogan, Central Java
Abstract
Background: Tuberculosis is a communicable disease that remains a major public health issue worldwide. Tuberculosis epidemics have become a primary public health concern for the last few decades. The problem becomes aggrevated due to the emergence of Multiple Drugs Resistant Tuberculosis (MDR-TB). It is estimated there are 6,100 MDR-TB cases annually in Indonesia. Grobogan is one of the 6 districts in ex-residentialPatiin Central Java with the second highest MDR-TB cases after Kudus. Between 2011 and 2016 the annual incidence was 23 cases with case fatality rate of 52.17%. This study aimed to investigate the different roles of MDR-TB patients, families, TB progammers, and health providers, in the incidence of MDR-TB in Grobogan, Central Java.
Subjects and Method: This was an analytic qualitative study with case study approach. The study was conducted in Grobogan, Central Java, from May to June 2017. A total of 26 informants were selected purposively for this study, consisting of 7 MDR-TB patients, 7 family members who served as drug-taking supervisor, 7 TB programmers at Community Health Centers, 1 TB programmer at District Hospital, 3 Community Health Center doctors, and 1 District Hospital doctor. The data were collected by in-depth interview, direct observation, and document review. Interactive analysis was used to analyze data, including data collection, reduction, presentation, and verification.
Results: All MDR-TB patientshad favorable perceived susceptibility, perceived severity, and self-efficacy, that drove them to adhere to TB treatment. Most patients reported that the treatment was beneficial. The existing barrier was not of serious concern that made them to stop treatment.Families of the patients had positive attitude towards TB treatment so they provided the necessary support in acessing treatment and adherence to treatment. However, TB program management at District Hospital, was sub-optimal as it did not administer appropriately the standard DOTS-TB treatment guideline, despite the existence of TB standard operating procedure. Likewise, TB treatment management by hospital doctors and private practice doctors was inadequate, due to the lack of DOTS-TB training. The lack of adherence in implementing thestandard DOTS-TB treatment guideline was the dominant causal factor for the incidence of MDR-TB in Grobogan district, Central Java.
Conclusion: Adequate DOTS-TB treatment management and quality health services at both primary and secondary level facilities are needed in the efforts to prevent MDR TB. It is suggested that the government through the District Health Office hold DOTS-TB promotion program and invest in developing skilled DOTS-TB providers.
Keywords:multidrug resistance, tuberculosis, TB management program, adherence.
Correspondence: Gunawan Cahyo Utomo. Masters Program in Public Health, Sebelas Maret University, Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: abuzahra_06@yahoo.com. Mobile: +6281390046456.
Journal of Epidemiology and Public Health (2017), 2(3): 186-200
https://doi.org/10.26911/jepublichealth.2017.02.03.01
References
Becker MH, Nancy JK (1997).The Health Belief Model and Personal Health Behavior. Thorofare. New ersey: Charles B. Slack inc.
Desmukh DR, Dhande JD (2015). Patient and Provider Reported Reasons for Lost to Follow Up in MDRTB Treatment: A Qualitative Study from a Drug Resistant TB Centre in India. PloSOne10(8):e0135802.doi:10
/journal.pone.0135802.
Dinas Kesehatan Propinsi Jawa Tengah. 2016. Laporan Evaluasi Program MTPRO Jawa Tengah Tahun 2016. Semarang: Bidang Pengendalian Penyakit dan Penyehatan Lingkungan.
Fauziah L (2013). Faktor – Faktor yang Berpengaruh Terhadap Kejadian Tuberkulosis Multi Drug Resistant (TB-MDR) di RSUP Persahabatan tahun 2013. Jakarta: Universitas Indonesia. Skripsi.
Green LW, Kreuter MW (2000). Health Education Planing. A Diagnostic Approach. The John Hopkins University; USA: Mayfield Publishing Co.
Lincoln Y, Denzin N. (2009). Hand of book Qualitative Research Edisi I. Yogyakarta : Pustaka Pelajar.
Miles, Huberman (1992). Metode Analisis Data Kualitatif. Terjemahan oleh Tjetjep Rohendi Rohidi. Jakarta: Universitas Indonesia Press.
Moleong L (2004). Metode Penelitian Kualitatif. Edisi Revisi. Bandung: Rosda Karya.
Murti B (2013). Desain dan Ukuran Sampel Untuk Penelitian Kuantitatif dan Kualitatif di Bidang Kesehatan. Cetakan ke-3. Yogyakarta: Gadjah Mada University Press.
Kementerian Kesehatan RI. (2010). Pedoman Nasional Pengendalian Tuberkulosis.Jakarta: Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan.
----------(2014). Pedoman Nasional Pengendalian Tuberkulosis. Jakarta: Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan.
(2014). Petunjuk Teknis Manajemen Terpadu Nasional Pengendalian Tuberkulosis Resistan Obat. Jakarta: Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Lingkungan.
Nugraheni K, Malik U (2015). Analisis Penyebab Resistensi Obat Anti Tuberkulosis. Jurnal Kesehatan Masyarakat: Kemas. 11(1): 8-15.
Nugroho R (2011). Studi Kualitatif Faktor Yang Melatarbelakangi Drop Out Pengobatan Tuberkulosis Paru. Jur-nal Kesehatan Masyarakat: Kemas. 7(1): 83-90.
Nurhayati I, Kurniawan T, Mardiah W (2015). Perilaku Pencegahan Penularan dan Faktor – Faktor yang Melatarbelakanginya pada Pasien Tuberkulosis Multi Drug Resistance (TB–MDR). Jurnal Keperawatan Padjajaran. 3(3): 166 – 175.
Sarwani D, Nurlaela S, Zahrotul I, (2012). Faktor Risiko Multidrug Resistan Tuberculosis (MDR-TB). Jurnal Kesehatan Masyarakat: Kemas. 8(1): 60 – 66.
Safri FM, Sukartini T, Ulfiana E (2014). Analisis Faktor yang Berhubungan dengan Kepatuhan Minum Obat Pasien TB Paru Berdasarkan Health Belief Model di Wilayah Kerja Puskesmas Umbul Sari. Kabupaten Jember. Indonesian Journal of Community Health Nursing. 2(2): 12 – 20.
Sembiring S (2008). Multidrug Resistance (MDR) pada Penderita Tuberkulosis Paru dengan Diabetes Melitus. Medan: Universitas Sumatra Utara. Tesis.
Shean K. Isaakidis P et al. (2015). Lost to Follow Up on Multidrug Resistant Tuberculosis Treatment in Gujarat. India: The When and Who of It. PloS One 10 (7): e0132543.doi:10.1371/ journal.pone.0132543.
Suharyo (2013). Determinasi Penyakit Tuberkulosis di Daerah Pedesaan. Jurnal Kesehatan Masyarakat: Kemas. 9(1): 85 -91
World Health Organization (WHO) (2015).The End TB Strategy: Global straetgy and targets for tuberculosis preventioan.care and control after 2015. see resolution WHA 67.1.
----------------(2013). Global Tuberculosis Report 2012. Switzerland.
Yin RK (2005). Studi Kasus: Desain dan Metode. Edisi Revisi. Terjemahan olehM. Djauzi Mudzakir.Jakarta:PT. Raja Grafindo Persada.
Zumla A, George A, Sharma (2015). The WHO 2014 Global Tuberculosis Report further to go.Lancet. http: www.thelancet.com vol 2 Jan 2015.
