Laporan Modul Kedokteran Tropis Kelompok 2 PDF

GROUP REPORT
MODUL ILMU KEDOKTERAN TROPIS

TUBERCULOSIS INFECTION SCENARIO
GROUP 2 / A1
FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA

2018
Member of the group :
Nabilah Paramitha 011711133015

Feriawan Tan 011711133016
Melisa Indah Mustikasari 011711133018
Avira Butsainah Dienanta 011711133019
Arum Ayu Ratna Wilis 011711133020
Faiza Rahma Ebnudesita 011711133021
Dian Anggraini Permatasari M. 011711133022
Arisvia Sukma Hariftyani 011711133023
Arif Rananda 011711133024
Ayik Rochyatul Jannah 011711133025
Nur Wachid Yusuf 011711133026
Mutia Nabila Nur Afra 011711133027
Farah Azwinda 011711133028
Jonathan Christanto Sutadji 011711133029
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CONTENTS
CHAPTER I FIRST MEETING ................................................................................................ 1

CHAPTER II SECOND MEETING .......................................................................................... 4
CHAPTER III THIRD MEETING .......................................................................................... 30
CHAPTER IV SURVEY ......................................................................................................... 43
CHAPTER V FOURTH MEETING ....................................................................................... 55
BIBLIOGRAPHY .................................................................................................................... 63
CRITICAL APPRAISAL ........................................................................................................ 65
ATTACHMENT ...................................................................................................................... 68
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CHAPTER I
FIRST MEETING
1.1. Main Problem

Why the increasing of Healthy House Precentage is not being followed up by Cure
Notification Rate (CNR) decrease
1.2. Keywords
 Lung Tuberculosis
 AFB positive
 Case Notification Rate(CNR)
 Healthy House Precentage
 Surabaya
1.3. Null Hypothesis
The increase of Healthy House Precentage still can’t decrease Case Notification Rate in
Surabaya because there are other factors that can affect the increase of Case Notification Rate.
1.4. Cognitive Strategies
Cognitive strategies is an internal capability belonging to everyone, used to help the
process of thingking, learning, problem solving, and decision making (Gagne, 1974).
Cognitive strategies have the ability to cause a person’s thought process is unique and varies.
It can be referred to as executive control with accurate and incisive analysis. In every learning
need for cognitive strategies applied. This necessary as regulator of the way how students
manage their learning, when considering such a thing, think and is the regulator in taking the
actions that will be done after the process of thinking.
Picture 1. Models of learning and recall

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prroceeesses according to gagne
Tropical Medicine module currently applies a system of learning with the basic skills and
principles of showing skills systemically. It can emphasixe that the theory of metacognition
is used in this module. In this module, students are given a scenario which must then be found
to the problem, what are the factors that influence, even to countermeasure and solutions. To
make it easier to resolve such cases, students are guided to devise the right concept map in
order to answer the initial hypothesis has also been complied by students. To improve
thingking ability, students are also given the opportunity to do a field survey so that it could
observe the cases that aare being dealt with directly.
1.5. Questions List
a. Is there any data of positive AFB (Acid Fast Bacteria)?
To know the level or prevalence of tuberculosis
b. Is there any preventive and promotive action from health center?
To give active solution
c. Is there any data of death caused by tuberculosis ?
To know virulence and health center program success
d. Which area that has the highest tuberculosis transmission?
To determine healthy house list.
1.6. Learning Issues
a. What is tuberculosis?
b. What is the patophysiology of tuberculosis?
c. What are the clinical manifestations of tuberculosis?
d. What are the risk factors of tuberculosis?
e. What is suspect tuberculosis?
f. What is positive AFB?
g. What is MDR/XDR tuberculosis?
h. How to diagnose tuberculosis?
i. What are the therapy of tuberculosis?
j. What are the requirements of healthy house?
k. How to prevent and handle tuberculosis?
l. What is Case Notification Rate?
m. What is the correlation between home condition with transmission of tuberculosis?
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n. What is the correlation between economic and tuberculosis?
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CHAPTER II
SECOND MEETING
2.1. Answers
2.1.1. What is tuberculosis?
TB is an airborne disease caused by the bacterium Mycobacterium
tuberculosis. Tuberculosis transmitted trough droplet nuclei and multiplicated in
organs with great blood circulation and oxygen. Tuberculosis attack a lot of
organs. In adults tuberculosis mainly attack lungs, but in children tuberculosis can
attack bone, brains, and other vital organs.
2.1.2. What is the patophysiology of tuberculosis?
Infection occurs when someone inhales droplet nuclei that contains tubercle
bacilli. These tubercle bacilli will reach alveoli in lungs. In alveoli tubercle bacilli
will be ingested by alveolar macrophage. But several tubercle bacilli can stay alive
or remains dormant inside of alveolar macrophage. Once the macrophage dies
tubercle bacilli will be realeased and multiply. Tuberculosis can attack other organs
through lymphatic systems and bloodstream. This process will induced our immune
system to attack them. Even though there isprotection from immune system, person
that is infected by tuberculosis still can develop disease sometimes in their life. If
not treated correctly tuberculosis can turn into multidrug resistant (MDR).
2.1.3. What are the clinical manifestations of tuberculosis?
Symptoms of TB disease can be divided into general symptoms and specific
symptoms that arise according to the organs involved. Clinical features are not very
typical, especially in new cases, so it is quite difficult to diagnose clinically.
Some systemic / general symptoms that can be seen include: coughing for
more than 3 weeks (can be accompanied by blood), not too high fever that lasts a
long time, usually felt at night accompanied by night sweats. Sometimes an attack
of fever such as influenza and is arising from loss, decreased appetite and weight,
feeling bad (malaise). In addition there are also special symptoms, namely:
depending on which body organs are affected, if there is a partial blockage of the
bronchi (the channel leading to the lungs) due to suppression of enlarged lymph
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nodes, will cause a sound of "wheezing", weakening breath sounds accompanied
by tightness, if there is fluid in the pleural cavity (wrap of the lungs), can be
accompanied by complaints of chest pain, when it hits the bone, there will be
symptoms such as bone infection which at one time can form a channel and empties
into the skin above, at this estuary pus will come out, in children can be about the
brain (the lining of the brain) and called meningitis (inflammation of the lining of
the brain), the symptoms are high fever, a decrease in consciousness and
convulsions. (Retno, 2018)
2.1.4. What are the risk factors of tuberculosis?
1. Host
Based on research conducted by Rukmini (2011), Eka (2013), and
Jendra (2015), the productive age group, namely 15-54 years old, has the
greatest risk factor in tuberculosis cases. In the productive age group, a person's
mobility to meet and communicate is higher, thus increasing the risk of
transmission. When viewed in terms of sex, men have the potential for
tuberculosis than women. (Rukmini, 2011). This is in accordance with data
from Riskesdas in 2017 which showed the prevalence of tuberculosis cases in
men 20% higher than women.
Immunity status has an important role in influencing the body's
immunity. Someone with an immune status BCG (+) is better protected from
tuberculosis bacteria. Agustina (2017), found cases in the control group with
BCG (+) immunization were smaller than BCG (-) immunity.
Health conditions of patients affect complications in tuberculosis.
Tuberculosis sufferers accompanied by other diseases, such as HIV, diabetes
mellitus, or malnutrition have more severe clinical manifestations and a greater
risk of death. Tuberculosis must be combated with an immune system and good
nutritional status. If the patient experiences problems in both cases, then a
longer and more stringent therapy is needed to reduce the severity and prevent
complications in patients.
The lifestyle of tuberculosis sufferers affects the body's clinical
manifestations and immune system. Eating nutritious and balanced, regular
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exercise, avoiding cigarettes both active and passive and avoiding alcohol can
reduce the severity of tuberculosis. In addition, getting used to being healthy
can prevent tuberculosis infections from becoming active. Someone who is
infected with tuberculosis does not necessarily show symptoms of illness, but
if the immune system decreases, these symptoms will appear and become a
disease.
The habit of opening windows every morning can reduce the risk of
tuberculosis transmission. With good circulation, ventilation and lighting will
prevent the Mycobacterium tuberculosis bacteria from reproducing properly.
This is evidenced by the high incidence of tuberculosis in groups that do not
have the habit of opening windows in the morning (Agustina, 2017).
2. Agent
The agent of tuberculosis is the bacterium Mycobacterium
tuberculosis which can multiply well in damp conditions, ventilation and poor
lighting levels. This can lead to increased risk of transmission to family
members who live in one house with proper conditions as a place for breeding
bacteria (Rukmini, 2011).
The bacteria that cause tuberculosis are more difficult to overcome
when there is resistance caused by multifactors. Non-compliance of patients in
taking anti-tuberculosis drugs (ATD) can make the bacteria more resistant so
that they cannot be treated with the same drug. The non-compliance of ATD
consumption will result in high rates of treatment failure for tuberculosis
sufferers which have an impact on the many findings of new tuberculosis
sufferers with resistance to standard drugs (Tahan, 2006). In addition, ATD
resistance can occur due to inappropriate use of antibiotics in patients who are
still sensitive to the drug, such as inaccurate regimens, dosages, and length of
treatment (Sri, 2014).
3. Environtment
a. Physic
Environment plays an important role in contributing to the
transmission of tuberculosis. Physically, the environment can be viewed from
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the temperature, humidity, height of the roof and windows. A good air
temperature is around 22-32oC. Agustina (2017) asserts that the average
temperature in the case is 29.5oC, while for the control is 31.2oC. The normal
roof height is around 3.5m from the normal floor and window 10-20% of the
floor area. This is intended to make the house more spacious and better
ventilation. The bacteria contained in sputum sparks can last for several hours
at room temperature. Ventilation and lighting are needed so that the room
temperature is well maintained and the air can change effectively. Roofs, walls,
and floors that are difficult to clean will make germs stick to the place and can
be inhaled by other people.
b. Biology
Risk factors for tuberculosis include someone who is exposed to smear
positive people with active TB (positive smear contact), lives in endemic areas,
public shelters (orphanages, prisons, or other nursing homes) and poor hygiene
environments ( Winston, 2010).
1. Social-Culture
Low levels of education have high risk factors for the occurrence of
tuberculosis cases (Rukmini, 2011). Low levels of education make it harder for
someone to receive information and understand it. However, it is good with
Eka's (2013) study which explains that education is not significantly associated
with the risk of tuberculosis. This shows that tuberculosis is not only influenced
by education, but also information from puskesmas and other prevention
activities. In addition, someone sick is affected because of health literacy,
namely the capacity of a person to seek, know, and understand basic health
information and health services to determine appropriate decisions where
health literacy is not based on education (Samsriyaningsih, 2017).
Economics is very influential on tuberculosis risk factors. A low
economy as a result of low income jobs will have an impact on the quality of
food purchasing power. If the economic condition of a family is not good, then
the fulfillment of nutritional status is also not good which can affect one's
immunity. In addition, a low economic level will lead to the determination of
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unhealthy dwellings and limitations in accessing health services, such as
transportation equipment, etc. The relationship between tuberculosis and
poverty is reciprocal, namely tuberculosis causes poverty and poverty to cause
tuberculosis. (Rukmini, 2011).
Poor habits of tuberculosis sufferers, such as coughing or sneezing
carelessly, spitting and removing sputum out of place are important risk factors
for tuberculosis transmission. Tuberculosis patients with positive smear give a
greater risk of transmission than TB patients with negative smear, although
they still have the possibility of transmitting TB. The rate of transmission of
smear positive TB patients was 65%, negative smear patients with positive
culture results were 26% while TB patients with negative culture results and
positive chest photographs were 17%. Droplets from sputum spills contain
bacteria that can be inhaled and infect other people around them. If tuberculosis
sufferers are not given good education, then transmission of tuberculosis is
rapidly occurring. The most basic risk factors for transmission of tuberculosis
depend on the level of transmission (the degree of BTA sputum in smear
positive patients) and the duration of contact. The more frequent exposure and
length of contact, the greater the likelihood of transmission (Winston, 2010).
Close contact is also a factor. Close contact is people who live in the same
house as tuberculosis patient and who often come into contact with sources of
transmission, especially those with acid fast bacilli positive.
Source cases who are sputum smear-negative but culture-positive are also
infectious, but to a much lesser degree. If children patient close contact for
example care giver (WHO, 2006). A person who is not in the household but
shared an enclosed space, such as a social gathering place, workplace or
facility, for extended periods during the day with the index case during the 3
months before commencement of the current treatment episode (WHO, 2012).
The following points concerning contact are of importance for children:
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 Children (especially those < 5 years of age) who have been in close contact
with a case of smear-positive TB must be screened for TB.
 After TB is diagnosed in a child or adolescent, an effort should be made to
detect the adult source cases, and especially other undiagnosed household
cases.
 If a child presents with infectious TB, then childhood contacts must be
sought and screened as for any smear-positive source case. Children should
be regarded as infectious if they are sputum smear-positive or have a cavity
visible on CXR.
Someone who contacts with TB patients can be categorized into several
groups, namely:
1. High risk group
Frequent, prolonged and close contact in an enclosed environment during
the infectious period, for example all people who live in the same house,
close friends and relatives who often meet, work colleagues who share the
same space everyday
2. Medium risk group
Frequent but less intense contact with the index case, for example
classmates, coworkers and neighbors who are not included in the high risk
group
3. Low risk group
People who come into contact with patients in schools, workplaces, or social
environments who are not included in the high or medium risk group. (NSW
Health,2008)
2. Psychological
Psychological factors play an important role in preventing the transmission
of tuberculosis from tuberculosis sufferers. Supervisors taking medication can
help sufferers to be obedient in taking medication so that they can recover and
not be a source of transmitting tuberculosis bacteria. Tuberculosis sufferers
need to be accompanied and supported by their family and social environment
so that they have the motivation to cure the disease. Tahan (2006) explained
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that family support in the form of adherence to ATD consumption,
encouragement of successful treatment, and not avoiding patients because of
the disease will reduce the failure rate of tuberculosis treatment. Negative
stigma in the community must be suppressed, although caution and caution are
still allowed. Tuberculosis sufferers must also be educated about prevention by
other people so that they do not get infected so that they do not feel excluded
from the community.
2.1.5. What is suspect tuberculosis?
Suspect TB is a person suspected of having TB, which is characterized by
symptoms or signs of TB, with the main symptoms of coughing up phlegm 2/3
weeks or more. Cough can be followed by additional symptoms, namely phlegm
mixed with blood, coughing up blood, shortness of breath, chest pain, body
weakness, decreased appetite, weight loss, malaise, night sweats without physical
activity, fever fever more than one month.
To find out patients with suspected TB can be done by health workers through
data in the health center (at check-up) or with active movements, namely by
surveying plunge into the community. (MOH, 2006).
A person with suspected pulmonary TB when a new patient has been
diagnosed with positive smear tuberculosis, then the person can transmit the
Mycobacterium Tuberculosis bacteria to others, especially when the immune
system is weak. If patients with Positive Pulmonary TB are not immediately treated,
an increase in new cases of Positive AFB Pulmonary TB can potentially be a source
of transmission to people around them.
Because TB cases in Indonesia are high, people who go to health services with
the above symptoms will be said to be suspected of TB. Furthermore, phlegm
examination will also be carried out. Sputum examination serves to establish a
diagnosis, assess the success of treatment and determine the potential for
transmission. Sputum examinations for diagnosis in all suspected TBs are carried
out by collecting 3 sputum specimens collected in two days of sequential phlegm
at the moment (SPS):
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 S (during): Sputum collected at the time of suspected TB came first visit. When
returning home, suspect carrying a phlegm pot to collect morning phlegm on the
second day.
 P (Morning): Phlegm is collected at home on the second morning, immediately after
waking up. The pot was brought and handed over to the officers at the UPK.
 S (during): Sputum collected at UPK on the second day, when giving up morning
phlegm.
2.1.6. What is positive AFB?
AFB (Acid Fast Bacteria) is a bacteria with unique cell walls, AFB’s cell walls
contained mycolic acid. A certain staining is required to determain if a bacteria is
AFB. AFB can be determained using Ziehl-Nielssen staining. If a red bacilli
bacteria can be found then AFB test is positive.
Diagnosis of pulmonary TB in adolescents and adults is enforced by the
discovery of TB bacteria (AFB). In the national TB program, the discovery of AFB
through microscopic phlegm examination is the main diagnosis.
Based on the results of sputum examinations, it can be said that the results of
pulmonary tuberculosis are positive AFB if:
1. At least 2 out of 3 SPS sputum specimens are positive smear results.
2. 1 SPS sputum specimen results from positive smear and chest chest X-ray
showing tuberculosis.
3. 1 SPS sputum specimen results in positive smear and culture of positive TB
germs.
4. 1 or more sputum specimens are positive after 3 SPS sputum specimens on the
previous examination result in negative smear and no improvement after
administration of non-OAT antibiotics.
Whereas the condition is said to be negative smear pulmonary tuberculosis,
including:
1. At least 3 SPS sputum specimens are negative smear results
2. Abnormal chest X-ray shows a picture of tuberculosis
3. There is no improvement after administration of non-OAT antibiotics.
4. Determined (considered) by the doctor to be given treatment
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 S (during): Sputum collected at the time of suspected TB came first visit. When
returning home, suspect carrying a phlegm pot to collect morning phlegm on the
second day.
 P (Morning): Phlegm is collected at home on the second morning, immediately after
waking up. The pot was brought and handed over to the officers at the UPK.
 S (during): Sputum collected at UPK on the second day, when giving up morning
phlegm.
2.1.7. What is MDR/XDR Tuberculosis?
MDR (Multidrug Resistant) is one of the problems that develops and becomes
one of the potentials that can threaten people in the world. Some of the causes of
tuberculosis are sufferers (behavior, characteristics, socio-economic), officers
(behavior, skills), drug availability, environment (geographical), PMO (Drug
Control Monitoring), and virulence and germ count. While the risk of TB infection
is mostly external risk factors (unhealthy home environment, dense and slum
settlements) and internal factors (malnutrition, HIV / AIDS, immunosuppressant
treatment). (Izza, 2013)
These microorganisms can become resistant due to several factors and human
error makes the biggest contribution. Drug resistance can occur due to inappropriate
use of antibiotics in TB patients who are still drug sensitive, such as inaccurate
regimens, duration of treatment and drug dosage and failure to influence patients to
complete treatment programs. Disobedience of TB patients in taking medication
regularly remains an obstacle to achieving a high cure rate. The high rate of drug
withdrawal will result in high cases of bacterial resistance to antituberculosis (OAT)
drugs that require greater cost and duration of treatment. (Asri, 2014)
Broadly speaking, the resistance that occurs to antituberculosis drugs is divided
into (1) primary resistance, that is if the previous patient has never received TB
treatment, (2) secondary resistance, when the patient has a history of treatment, and
(3) initial resistance, if the treatment history unknown. (PDPI, 2003)
TB cases are categorized based on drug sensitivity testing of clinical isolates
confirmed as M. tuberculosis. The categories in question are as follows:
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1. Monoresistant: M. tuberculosis isolates are immune to one of the first-line
OATs.
2. Poliresisten: M. tuberculosis isolates are immune to two or more first-line
OATs in addition to a combination of rifampicin and isoniazid.
3. Multidrug-resistant tuberculosis (MDR-TB): M. tuberculosis isolates are
minimal resistant to isoniazid and rifampicin, the two most powerful OATs, with
or without resistance to other OATs.
4. Resistant to various OATs (extensively drug resistant tuberculosis, XDR-
TB): multiple drug resistant TB accompanied by resistance to one of the
fluorocinolones and one of three second-line injection drugs (amikacin,
capreomycin, or kanamycin).
5. Total drug-resistant tuberculosis (TDR-TB): TB is resistant to all first and
second line OATs.
6. Rifampicin resistance: resistant to rifampicin, which is detected using
phenotypic and genotypic methods, with or without resistance to other OATs.
Rifampicin resistance, whatever its variants, falls into this category, either
monoresistant, polycystic, multiple drug resistant, or various OAT resistant.
(DEPKES, 2011)
Management
Patients belonging to MDR TB are treated with second-line OAT or backup
drugs. This second-line drug is not as effective as first-line OAT because more side
effects are obtained. Therefore, the treatment strategy should be based on sensitivity
test data and the frequency of OAT use in the country. Below are some MDR-TB
treatment strategies:
• Standard treatment. Drug resistance survey data from a representative patient
population are used as the basis of the treatment regimen because of the
unavailability of individual sensitivity test results. All patients will get the same
treatment regimen. Patients suspected of having MDR-TB should be confirmed by
a sensitivity test.
• Standard treatment. Drug resistance survey data from a representative patient
population are used as the basis of the treatment regimen because of the
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unavailability of individual sensitivity test results. All patients will get the same
treatment regimen. Patients suspected of having MDR-TB should be confirmed by
a sensitivity test.
• Empirical treatment. Each treatment regimen is based on a history of previous
TB treatment and representative population sensitivity test data. Usually, the
empirical treatment regimen will be adjusted after the individual sensitivity test
results are obtained.
• Individual treatment. Treatment regimen based on a history of previous TB
treatment and sensitivity test results.
The standard MDR-TB treatment regimen in Indonesia is an intensive 6-month
phase with a combination of pyrazinamide drugs, ethambutol, kanamycin, levofl
oxacin, etionamide, and cycloserine, followed by an 18-month advanced phase with
pyrazinamide, ethambutol, levofloxacin, etionamide and cycloserine ( 6 Z- (E) -Kn-
Lfx-Eto-Cs / 18 Z- (E) -Lfx-Eto-Cs). Ethambutol and pyrazinamide can be given,
but not including standard regimen drugs. (WHO, 2011)
For the treatment of MDR-TB patients it is divided into two phases namely the
intensive and advanced phases. The length of the intensive phase of the Indonesian
standard alloy is based on conversion culture. Injection drugs are continued for 6
months, at least 4 months, after the results of sputum BTA examination or the first
culture become negative. (DEPKES, 2011)
However, according to WHO recommendations in 2011, the intensive phase of
treatment is at least 8 months. Things that can help make decisions regarding the
need to stop injecting drugs such as individual approaches, including culture results,
sputum BTA, chest X-ray, and the patient's clinical condition. The total duration of
treatment of standard alloys based on conversion culture was at least 18 months
after conversion culture. However, WHO recommends a total length of treatment
of at least 20 months. The patient's body weight is continually evaluated because
the OAT dosage regimen is also determined based on the patient's body weight to
ensure optimal concentration in the blood plasma to eliminate TB germs. So that
with continuous evaluation it can adjust the OAT dosage regimen so that there is
no dose of subterapeutic drug that can lead to further OAT resistance. (WHO, 2011)
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2.1.8. How to diagnose tuberculosis?
Diagnosis of pulmonary TB in adolescents and adults is enforced by the
discovery of TB bacteria (AFB). In the national TB program, the discovery of AFB
through microscopic phlegm examination is the main diagnosis. Other
examinations such as chest X-ray, culture and sensitivity test can be used as
supporting diagnoses as long as they are indicated. It is not justified to diagnose TB
based only on chest X-ray examination. Chest X-ray does not always give a typical
picture of pulmonary TB, so it often occurs overdiagnosis. Radiological
abnormalities of the lung do not always indicate disease activity.
Based on the results of sputum examinations, it can be said that the results of
pulmonary tuberculosis are positive AFB if:
1. At least 2 out of 3 SPS sputum specimens are positive smear results.
2. 1 SPS sputum specimen results from positive smear and chest chest X-ray
showing tuberculosis.
3. 1 SPS sputum specimen results in positive smear and culture of positive TB
germs.
4. 1 or more sputum specimens are positive after 3 SPS sputum specimens on the
previous examination result in negative smear and no improvement after
administration of non-OAT antibiotics.
Whereas the condition is said to be negative smear pulmonary tuberculosis,

including:
1. At least 3 SPS sputum specimens are negative smear results
2. Abnormal chest X-ray shows a picture of tuberculosis
3. There is no improvement after administration of non-OAT antibiotics.
4. Determined (considered) by the doctor to be given treatment
In cases of childhood TB, sputum examination is quite difficult to do especially for

children under the age of 5 years. For this reason, several supporting tests were
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carried out such as tuberculin test, chest X-ray, and histopathological examination.
(Ministry of Health, 2016)
In children, the tuberculin test is the most useful examination to show moderate /
ever infected with Mycobacterium tuberculosis and is often used in "Screening TB".
The effectiveness of finding TB infection with the tuberculin test is more than 90%.
Patients with children less than 1 year old who suffer from active tuberculin test
positive tuberculosis 100%, age 1–2 years 92%, 2-4 years 78%, 4–6 years 75%, and
ages 6–12 years 51%.
There are several ways to do the tuberculin test, but until now the method of
Mantoux has been used more often. The injection site of the Mantoux test is
generally in the upper half of the front left forearm, injected intracutane (into the
skin). Assessment of the tuberculin test was carried out 48–72 hours after injection
and measured the diameter of the swelling (induration) that occurred:
1. Swelling (Induration): 0–4mm, negative Mantoux test.
Clinical meaning: no Mycobacterium tuberculosis infection.
2. Swelling (Induration): 5-9mm, the Mantoux test is doubtful.
This could be due to a technical error, a cross reaction with atypical
mycobacterium or after BCG vaccination.
3. Induration: ≥ 10mm, positive Mantoux test.
Clinical meaning: being or has been infected with Mycobacterium tuberculosis
2.1.9. What are the therapy of tuberculosis?
TB treatment aims to cure patients, prevent them death, preventing recurrence,
breaking the chain of transmission and prevent the occurrence of bacterial
resistance to anti-tuberculosis drugs (OAT).
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Treatment of tuberculosis is carried out with the principles as following:
• OAT must be given in the form of a combination of several types of drugs, in
sufficient quantities and the right dose according to the category treatment. Don't
use single OAT (monotherapy). Use OAT-Combination of Permanent Doses
(OAT-KDT) is more profitable and highly recommended. To ensure compliance
with patients taking drugs, it is done direct supervision (DOT = Directly Observed
Treatment) by a Drug Swallow Supervisor (PMO).
• TB treatment is given in 2 stages, namely intensive and advanced.
Early stage (intensive)
o At the intensive stage (early) the patient gets medication every day and needs to
supervised directly to prevent the occurrence of drug resistance.
o If intensive treatment is given appropriately, usually the patient becomes non-
infectious within a period of 2 weeks.
o Most patients with positive smear TB become negative smear (conversion) in 2
months.
Advanced Stage
o In the advanced stages patients get fewer types of drugs, however in a longer
period of time
o The advanced stage is important to kill persister germs so that prevent recurrence
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OAT alloys used in Indonesia
• OAT alloys used by the National Control Program Tuberculosis in Indonesia:
o Category 1: 2 (HRZE) / 4 (HR) 3.
o Category 2: 2 (HRZE) S / (HRZE) / 5 (HR) 3E3.
Besides these two categories, HRZE is provided Child Category: 2HRZ / 4HR
o Drugs used in the management of drug resistant TB patients at Indonesia consists
of 2nd-line OAT, Kanamycin, Capreomisin, Levofloxacin, Ethionamide,
cycloserine and PAS, and line-1 OAT, i.e. pyrazinamide and ethambutol.
• Alloy OAT category-1 and category-2 are provided in package form in the form
of a fixed dose combination drug (OAT-KDT). This KDT OAT tablet consists from
a combination of 2 or 4 types of drug in one tablet. The dose adjusted for the
patient's weight. This alloy is packed in one package for one patient.
• Combat Package.
Is a package of loose drugs consisting of Isoniasid, Rifampicin, Pyrazinamide and
Ethambutol are packaged in a blister form. Alloy OAT is provided a program to be
used in the treatment of patients which experienced the side effects of the KDT
OAT.
An anti-tuberculosis drug mixture (OAT) is provided in package form, with the
purpose of facilitating drug administration and ensuring continuity treatment to
completion. One (1) package for one patient in one treatment period.
KDT has several advantages in TB treatment:
1) The dosage of the drug can be adjusted to the body weight so that it guarantees
drug effectiveness and reduce side effects.
2) Prevent the use of a single drug so as to reduce risk the occurrence of multiple
drug resistance and reducing writing errors recipe
3) The number of tablets swallowed is much less so that the drug is given be simple
and improve patient compliance
First-line OAT alloy and designation.
a. Category-1 (2HRZE / 4H3R3)
This OAT alloy is given to new patients:
• New patients with positive pulmonary TB smear.
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• Pulmonary TB patients with negative smear positive chest X-ray
• Extra pulmonary TB patients
b. Category -2 (2HRZES / HRZE / 5H3R3E3)

This OAT alloy is given to positive smear patients who have been treated previous:
• Patients relapse
• The patient fails
• Patients with treatment after dropping out of treatment (default)
Note:
• For patients aged 60 years and above the maximum dose for streptomycin is
500mg without regard to weight.
19
• For pregnant women see TB treatment under conditions special.
• How to dissolve vial streptomycin 1 gram, namely with add 3,7ml of aquabidest
to 4ml. (1ml = 250mg).
c. OAT Inserts (HRZE)
The KDT insertion package is the same as an alloy package for the intensive phase
category 1 given for a month (28 days).
The use of second-line OAT, for example the aminoglycoside group (for example
kanamycin) and quinolone groups are not recommended to be given to patients new
without a clear indication because the drug's potential is much lower than first-line
OAT. Besides that it can also improve risk of resistance in second-line OAT.
- Treatment of TB in Children
most cases of child TB treatment for 6 months are sufficient adequate. After 6
months of drug administration, do a good clinical evaluation and investigation.
Clinical evaluation of childhood TB is the best parameters for assessing treatment
success. When found marked clinical improvement even though the radiological
picture is not shows a significant change, the OAT is still stopped. Child Category
(2RHZ / 4RH) The basic principles of TB treatment are at least 3 types of drugs and
given within 6 months. OAT in children is given every day, both at the stage
20
Information:
• Babies weighing less than 5 kg are referred to the hospital
• Children with BB 15-19 kg can be given 3 tablets.
• Children with BB> 33 kg, are referred to the hospital.
• Medication must be given in full, not to be split
• KDT OAT can be given by: swallowed whole or crushed just before drinking.
Treatment for prevention (prophylaxis) of tuberculosis for children.
In all children, especially toddlers who live at home or close contact with TB
patients with positive smear, an examination is required use a scoring system. If the
results of the evaluation with a scoring system obtained a score of <5, the child was
given Isoniazid (INH) with dose of 5-10 mg / kg BB / day for 6 months. If the child
has never been received BCG immunization, BCG immunization was carried out
after treatment prevention is complete.
2.1.10. What are the requirements of healthy house?
Healthy House Requirements:
House parameters cover the 3 assessment component groups:
1. House components, such as ventilation, light
2. Sanitation facilities, for example clean water facilities, sewage disposal
facilities,
3. Householder behavior, for example opening a bedroom window, opening
the family room window
a. House component group:
21
1. Building materials, are not made of materials that can release substances
that can endanger health
2. House space components and arrangement
3. Lighting, minimum intensity is 60 lux and not dazzling
4. Air quality, air temperature 18 ° C to 30 ° C, air humidity 40% to 70%, no
H2S and NH3 gas
5. Ventilation, at least 10% of floor area.
6. Noise and vibration, 45 dB.A is recommended, maximum 55 dB
7. The area of a house, the size of the bedroom is at least 8m2
b. Sanitation component group:
1. Clean water facilities, at least 60L/person/day, fulfill the requirements of
clean water
2. Management of sewage disposal must fulfill health requirements
3. Management of household waste must fulfill the requirements health
c. Occupational behavior group
1. Hand washing habits
2. The existence of mouse vectors
3. Flicking existence
2.1.11. How to prevent and handle tuberculosis?
Tuberculosis can be prevented by stopping transmission of the bacteria.
There are several ways to decrease it’s transmission. Transmission can be decrease
by improving the house ventilation and lighting, and developing a healthy lifestyle
by eating healthy, good sanitation, and good hygiene. Tuberculosis transmission
can be decreased by using mask for the patients and developing coughing, sneezing,
and throwing sputum ethics. Those ethics are not coughing, and sneezing in in front
of someone else directly, covering their mouth using tissue or handkerchief,
throwing away sputum in an area with good ventilation and lighting.
Tuberculosis can be revented by giving vaccinations towards people in
society too. By giving vaccination, society can be protected from the bacteria
because they have immune system that are ready to fight tuberculosis.
22
Improving society’s stigma about tuberculosis can prevent and handle
tuberculosis, because by improving their stigma society will stop isolating
tuberculosis patients and they can help health services ny reporting suspect
tuberculosis patients in health center.
2.1.12. What is Case Notification Rate?
Case Notification Rate is number of new and relapse TB cases notified in a
given year, per 100 000 population. “Notification” means that diagnosed in a
patients and reported to the national surveillance system and then reported to
WHO.(WHO, 2015)
Case Notification Rate can picture tuberculosis trend (increasing or decreasing)
in a country.
Based on Indonesia Health Ministry Dase Notification Rate Data from 2008
until 2017 tuberculosis in Indonesia tend to increase each year.
Numerator : Number of new and relapse cases of TB in a specified time period.

Denominator : Number of persons/total population.
Pict 2. Case Notification Rate Indonesia in 2008 until 2017

2.1.13. What is the correlation between home condition with transmission of
tuberculosis?
Many studies have stated that there is a correlation between unhealthy
homes and transmission of pulmonary TB. Several factors from home that
can be beneficial in transmission of pulmonary TB, namely:
1. Ventilation
23
Ventilation that does not meet the risk requirements is 1.8 times greater for
suffering from pulmonary TB (Izzati, 2015). Based on research conducted
by Anggraeni et al (2015), the area of less than one person is 15 times more
likely to suffer from pulmonary TB than someone who lives in a house
with adequate ventilation. In addition, 5 out of 5 people with pulmonary
TB in the Mulyorejo Public Health, Surabaya have an area of permanent
ventilation <10% of the floor area which means it is not suitable for a
healthy home (Kenedyanti et al., 2017). This is because with good
ventilation it can drain the air faster so that it reduces the number of
bacteria in the room and the sunlight can also kill the bacteria
2. Temperature
Mycobacterium tubercolusis is a mesophilic bacterium that can live at a
temperature of 25-40 ° C optimally at a temperature of 31-37 ° C.
Inappropriate temperatures can increase the risk by 2-fold to develop
pulmonary TB (Mudiyono et al, 2015).
3. Moisture
Based on the decision of the Keputusan Menteri Kesehatan Republik
Indonesia Nomor 829 / MENKES / KES / SK / VII / 1999 the intensity of
good homes is in the range of 40-70%. The humidity of a house that is not
in this range makes a person 6 times more at risk of contracting pulmonary
TB (Kenedyanti et al., 2017). The value of humidity is inversely
proportional to temperature. The high humidity, the lower the air
temperature, it can be assumed that sunlight is less in the house, making
the house moist and dark. This can make Mycobacterium tubercolusis last
for days.
4. Occupancy Density
Occupancy density that does not meet the requirements can increase a
person's risk of being infected with Mycobacterium tubercolusis by 1.6
times compared to someone who lives at optimal occupancy density (Izzati
et al., 2015). The room filled by many people will be able to increase air
humidity because people will emit sweat and water vapor. High occupancy
24
density will also increase the contact of someone with pulmonary TB
sufferers, making it easier to transmit at home (Kenedyanti et al., 2017).
5. Lighting
The study states that lighting a house that does not meet the requirements
can increase the risk of 3.7-fold for suffering from pulmonary TB
(Kurniasari et al., 2012). Natural lighting originating from the sun can kill
Mycobacterium tubercolusis because in the sun there is ultraviolet light
that is bactericidal for bacteria.
6. Floor
Floors that do not meet the requirements can increase a person's risk of
being infected with Mycobacterium tubercolusis by 4.575 times (Ayomi et
al., 2012).
7. Wall
The risk of being infected with Mycobacterium tubercolusis will increase
by 6-7 times in someone who lives in a house with a wall condition that
does not meet the requirements (Adnani et al., 2006).
8. House ceiling
The criteria for a good home sky according to the Indonesian Ministry of
Health, which is at least 2.75 which can absorb heat, are easy to clean, and
are not accident-prone. Home sky conditions that do not meet the
requirements can increase the risk of pulmonary TB occurring 5 times
higher (Adnani et al., 2006)
9. Floor of the house
The risk of being infected with Mycobacterium tubercolusis will increase
by 3-4 times in people who live in homes with floors that do not meet the
requirements (Adnani et al., 2006). Because the floor can increase
moisture, especially on the floor made of soil can make the house moist
and stuffy so that Mycobacterium tubercolusis can survive longer.
10. Window
A house without a bedroom window is a risk factor for pulmonary TB. The
risk for suffering from pulmonary tuberculosis will increase by 6-7 times
25
in a bedroom without a bedroom window. Likewise, a family without a
window can increase the risk of pulmonary TB by 7-8 times (Adnani et al.,
2015)
11. Kitchen smoke holes
Houses with kitchen smoke holes that do not meet the requirements will
increase the risk of suffering from pulmonary TB by 4-5 times higher. Poor
kitchen smoke holes can cause respiratory problems, painful eyes, bad air,
and make the home environment dirty (Adnani et al., 2015)
Research conducted in the health area of the Mulyorejo Public Center states
that 4 out of 5 pulmonary TB patients have homes that do not meet the
requirements (Kenedyanti et al., 2017). In general, someone who lives in a
house that does not meet the requirements will increase a person to be
exposed to pulmonary TB by 6-7 times compared to people who live in the
condition of the house that meets the requirements (Adnani et al, 2006).
2.1.14. What is the correlation between economic and tuberculosis?
Pulmonary SMEAR positive tuberculosis caused by multiple factors and
certain characteristics. Includes individual, environment, neighborhood,
social economy and the availability of health care facilities. Transmission of
tuberculosis could rise associated with individual characteristic that are still
lacking knowledge about the practice of healthy living. In addition it is
linked from the side of the social economy to worsen, especially if
associated with poverty. Low economic or social poverty leads to poor
working conditions and low income, so that it can lead to the occurrence of
malnutrition (Ristyo, et al.)
Economically, the main causes of the expansion of the tubrculosis germ
in Indonesia caused still low income per head, about USD 3.544 according
to bank Indonesia in 2001. Socioeconomic level is divided into education,
income, and occupation which is the cause indirectly from health problems
(Ristyo, et al.).
Based on the survey Riskesdas the year 2013, that the higher index of
ownership thet describes the capabillities of social economy then the lower
26
prevalence of tuberculosis. Below can be seen the number of pain based on
ownership of the index shows there is no difference between the groups
lowest to high. However the difference occurs at the top of the group with a
lower index than the other (Infodatin, 2018).
Picture 3. The prevalence of tuberculosis according to the characteristics of the social

economy
Research studies say that there is a significant relationship between socioeconomic
levels by the number incidence of tuberculosis pulmonary smear positive. The first
relationship education level, the higher the education level the lower numbers of events.
Level of education effect on the person’s behavior towards healthy living. If low then
owned educational ability in receive information more difficult, the desire to find out
too much lower. Both jobs and income relationships with a number of events, if someone
does not work then he has no income. Thus people with low social economy will only
be focused, how they met the basic needs of their day-today. In contrast to those who
have jobs and income with socioeconomic status of the middle to the top, they will likely
meet the needs of tertiary them like they would take bettter care of their health (Ristyo,
et al.).
2.2. Scenario Data Analysis And Scientific Information

Data Dinas Kesehatan (DKK) Surabaya indicate that the Lung TB Case Notification Rate
(CNR) with positif AFB in 2015 and 2016 are 81,80 and 83,22 for 100.000 people. While the
percentage of healthy house in 2015 and 2016 are 83,38% and 85,98%. From the data show
27
that the increase of healthy house can’t decrease the Lung TB CNR. It indicate that the increase
of Lung TB CNR affected by other factor, like host, agent, and environment.
One of host factor that affect is immunocompromised patient like HIV patient. Increasing
of HIV patient may cause more people at risk. Other than that, many cases of malnutrition can
be the one of host factor that make more people take higher risk infected by TB. Moreover,
low level of education can lead to increase TB transmission such as through the use of masks,
drug adherence. So, it is very important to educate the public about TB.
Besides the host factor, the agent factor also influence the increasing in TB incidence such
as resistancy. Multi Drug Resistance (MDR) Mycobacterium Tuberculosis makes the treatment
in patient more difficult so that patients with TB become more and more the source of
transmission. This certainly causes increasing in the spread of TB to the surrounding
community.
The last factor that can affect the incresing of TB CNR is environment factor. Ventilation,
temperature, humidity, and house wide play a role in increasing the risk of TB disease. Close
contact and density of house members also influence the high spread of the TB disease. Other
than that, health service factor can influence the patient’s recovery rate of TB disease so that
good health service are needed to contribute in reducing the incidence of TB disease.
28
2.3. Initial Concept Mapping
CNR TB
increasing
Spreading TB in
Surabaya increasing
Risk Factor
Host Agent Environment
- Age - MDR - Close contact

- Medical - XDR - Family
Record support
- Education - Economy
- Worker - Satisfaction on
- Knowledge health service
- Attitude -Criteria of a
- Behaviour healthy home
- Social relation
with neighbor
Control TB
29
CHAPTER III
THIRD MEETING
3.1 Survey Questions

KUESIONER TB
I. Identitas Responden
A. Identitas responden
1. Nama Responden :
2. Umur :
3. Jenis Kelamin :
□ Laki-laki □ Perempuan
4. Latar Belakang Pendidikan
a. Tidak Sekolah
b. SD
c. SLTP
d. SLTA
e. Sarjana/S1
f. Magister/S2
5. Pekerjaan
a. Tidak Bekerja
b. Petani
c. Wiraswasta
d. PNS
e. Lain-lain : ...................
Hubungan dengan pasien : ..........................
B. Status TB
a. Apakah di rumah Anda saat ini ada penderita TB?
o Ya o Tidak
b. Jika ada, kami akan menanyakan beberapa pertanyaan berkaitan dengan pasien
30
1) Identitas Pasien
a. Nama :
b. Umur :
c. BB/TB :
2) Jenis Kelamin :
3) Latar Belakang Pendidikan
g. Tidak Sekolah
h. SD
i. SLTP
j. SLTA
k. Sarjana/S1
l. Magister/S2
4) Pekerjaan
f. Tidak Bekerja
g. Petani
h. Wiraswasta
i. PNS
j. Lain-lain : ...................
C. Riwayat Migrasi
1. Apakah Anda/penderita pernah melakukan perjalanan ke luar kota Surabaya dalam
satu bulan terakhir?
a. Ya b. Tidak
2. Jika pernah, berapa kali Anda melakukan perjalanan ke luar Kota Surabaya dalam
a. 1 – 2 Kali
b. 3 – 4 Kali
c. 5 – 6 Kali
d. Lebih dari 6 Kali
e. Tidak berlaku/tidak pergi ke luar kota dalam 1 bulan terakhir
31
3. Apakah keluarga Anda pernah melakukan perjalanan ke luar kota Surabaya dalam
o Ya o Tidak
D. Status Gizi
1. Berat Badan:
2. Tinggi Badan:
3. Dalam jangka waktu 7 hari terakhir, berapa kali Anda makan dalam sehari?
a. 1 Kali
b. 2 Kali
c. 3 Kali
d. Lainnya….
4. Apa makananyang sehari-hari Anda konsumsi? (Boleh pilih lebih dari satu)
o Nasi
o Sayur
o Lauk-pauk
o Susu
o Buah
o Lainnya……
E. Riwayat Kesehatan dan Penyakit

1. Apakah Anda atau anggota keluarga mempunyai penyakit berikut?
o Darah tinggi
o Kencing manis
o Asma
o Gagal ginjal
o Penyakit Jantung
Iskemik
o Sakit liver (hati)
o Lainnya
(………………)
32
2. Apakah anda atau anggota keluarga anda memiliki riwayat alergi?
a. Ya (……………) b. Tidak
3. Apakah keluarga Anda pernah terserang TB sebelumnya?
a. Ya b. Tidak
o Diri sendiri
o Anggota keluarga
4. Jika ada, TB apa?

o Paru
o Tulang
o Kelenjar
o Meninges
o Lain-lain (…………..)
5. Jika ada, kapan terserang TB?
a. 1 bulan yang lalu
b. 3 bulan yang lalu
c. >6 bulan yang lalu
(………….............)
II. Pengetahuan
1. Menurut Anda, apa yang 5. Apa TB paru bisa disembuhkan?
menyebabkan TB paru? a. Bisa
a. Kuman M. Tuberculosis b. Tidak
b. Suka pergi keluar rumah
c. Sakit hati atau banyak pikiran 6. Mengapa Anda harus berobat secara
d. Kerja keras teratur?
a. Batuk berdahak
2. Apakah gejala TB yang sering b. Batuk berdahak selama 1 minggu
ditemukan? c. Batuk berdahak lebih dari 2
a. Batuk berdahak minggu
33
b. Batuk berdahak selama 1 d. Batuk berdahak setaip saat
minggu
c. Batuk berdahak lebih dari 2 7. Apakah Anda mengetahui lama waktu
minggu pengobatan TB sampai sembuh?
d. Batuk berdahak setaip saat a. 2 bulan
b. 4 bulan
3. Melalui apakah TB menular? c. 6 bulan
a. Sentuhan d. 8 bulan
b. Percik dahak
c. Lewat jarum suntik
d. Lain-lain/tidak tahu 8. Apakah Anda mengetahui program
4. Dimana tempat utama peyakit TB? TOSS TB?
a. Paru a. Ya
b. Tulang b. Tidak
c. Kulit
d. Lain-lain/tidak tahu
III. Sikap Perilaku Pencegahan Penyakit TB

1. Penyuluhan tentang penyakit TB diperlukan untuk masyarakat
a. Ya
b. Tidak
2. Penyuluhan tentang rumah sehat diperlakukan untuk masyarakat guna mengurangi kasus
TB
a. Ya
b. Tidak
3. Persebaran penyakit TB dapat dicegah
a. Ya
b. Tidak
4. Program pengobatan TB secara tuntas mampu menyembuhkan pasien
a. Ya
b. Tidak
34
5. Orang yang berada dalam lingkungan yang sama dengan penderita dapat beresiko tertular
a. Ya
b. Tidak
6. Dukungan keluarga dapat meningkatkan kualitas hidup penderita TB
a. Ya
b. Tidak
7. Semakin lama penyakit TB diketahui, semakin sulit untuk menyembuhkan
a. Ya
b. Tidak
IV. Pertanyaan Praktik

1. Apakah anda menutup mulut saat batuk dan bersin?
a. Ya b. tidak
2. Jika menutup mulut, apa yang Anda gunakan untuk penutup mulut?
a. Tisu atau sapu tangan c. telapak tangan
b. Lengan baju d. lainnya,…….
3. Apabila menggunakan tisu atau sapu tangan, apa yang anda lakukan dengan tisu atau
sapu tangan tersebut ?
a. membuang tisu sembarangan
b. mencuci sapu tangan dengan sabun dan direndam dengan detergen
c. lainnya, ……
4. Apa bentuk dukungan dan motivasi keluarga terhadap kondisi anda ?
a. memberi support dan semangat dengan kata kata
b. mengingatkan jadwal minum obat
c. menemani dan mengantar pengobatan ke rumah sakit
d. tidak ada
5. Apakah keluarga, teman, dan tetangga menjauhi anda dengan kondisi anda saat ini?
(setelah sakit tb)
a. Ya b. tidak
35
6. Apakah anda rutin dalam meminum obat sesuai dengan arahan dan jadwal dari
puskesmas?
a. Ya c. tidak
b. Terkadang Lupa
7. Apakah anda berinteraksi dan bertemu dengan tetangga sekitar rumah anda?
a. Sering c. tidak pernah
b. Jarang
8. Apakah jendela rumah rutin dibuka?
a. Ya b. tidak
9. Apakah anda rutin dalam kontrol di puskesmas sesuai dengan arahan dan jadwal dari
puskesmas?
b. Jarang
V. Pertanyaan Tambahan
1. Berapakah besar rata-rata pendapatan keluarga Anda perbulannya sebelum dikenakan
pajak?
2. Siapakah pengambil keputusan dalam keluarga Anda?
3. Bagaimanakah status hubungan Anda?
o Lajang
o Menikah
o Cerai/Berpisah
o Tidak menikah namun tinggal serumah
o Memilih untuk tidak menjawab
VI. Umpan Balik

1. Apakah Anda mengalami kesulitan dalam menjawab pertanyaan yang diajukan?
o Ya o Tidak
2. Apakah ada kesulitan yang Anda rasakan dalam pengobatan TB?
3. Apakah Anda memiliki pertanyaan yang ingin Anda ajukan?
36
KUESIONER KONDISI RUMAH
1. Ventilasi Rumah: ... %
o Kurang
o Baik
*Ukuran ventilasi ( >10 % dari luas lantai pada seluruh ruangan)
2. Suhu Rumah : .... oC
3. Kepadatan hunian rumah
Berapa orang yang tinggal menetap di rumah ini………….…orang
Luas lantai rumah/bangunan …………………………………m2
Jumlah luas lantai rumah/bangunan
Kepadatan hunian = Jumlah anggota keluarga yang tinggal serumah
= …………………m2/orang
4. Berapa luas ruang keluarga (A) =…..m2
Berapa luas ruang tidur (B) =…..m2
5. Berapa kelembapan udara rumah =……..%
Berapa kelembapan udara ruang keluarga =……..%
Berapa kelembapan udara ruang tidur =……..%
6. Sanitasi rumah penderita TB paru:
Petunjuk pengisian
Berilah (✓) pada kolom yang telah disediakan
No. Uraian Jawaban
1 2 3 4 5
Pencahayaan rumah
Ventilasi rumah
Ketersediaan fasilitas mandi
Sistem pembuangan air kotor
Sistem pembuangan sampah rumah tangga
Sistem pembuangan tinja
37
KUESIONER PUSKESMAS
1. Berapakah jumlah pegawai di Puskesmas?

2. Berapakah jumlah Pos Pelayanan yang ada ?
3. Apa saja program pelayanan khusus TB yang telah dilaksanakan di Puskesmas Kali Kedinding?
4. Berapa Jumlah Kasus TB di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017?
5. Berapa Jumlah Kasus Baru TB di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017
6. Berapa Jumlah Penderita TB yang mendapatkan pengobatan di Puskesmas kali kedinding pada
2013, 2014, 2015, 2016, 2017?
7. Berapa Jumlah penderita TB yang telah mendapatkan pengobatan dan dinyatakan telah sembuh
di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017?
8. Berapa Jumlah penderita TB yang meninggal dunia di Puskesmas kali kedinding pada 2013,
2014, 2015, 2016, 2017?
9. Apakah ada kasus MDR/XDR TB di Puskesmas kali kedinding dalam 5 tahun terakhir?
10. Berapa jumlah kasus MDR/XDR TB di Puskesmas Kali Kedinding pada 2013, 2014, 2015,
2016, 2017?
11. Apakah ada-data data Tambahan mengenai kasus TB di Puskesmas kali kedinding dalam 5 tahun
terakhir?
12. Berapa jumlah pasien BTA positif di wilayah kerja Puskesmas Tanah Kali Kedinding tahun 2018
(data terakhir)? . . . . . . . . . . . . . . . . orang
13. Berapa jumlah pasien BTA positif di wilayah kerja Puskesmas Tanah Kali Kedinding tahun 2017?
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
38
18. Pasien BTA positif paling banyak berada dalam skala . . . .
□ Scanty
□ 1+
□ 2+
□ 3+
19. Berapa jumlah pasien TB yang pengobatannya berhasil pada 2013, 2014, 2015, 2016, 2017?
20. Berapa prosentase pasien TB yang pengobatannya berhasil dibanding dengan seluruh penderita
TB yang mendapatkan pengobatan pada 2013, 2014, 2015, 2016, 2017?
21. Regimen apa saja yang digunakan pada pasien TB yang berobat ke puskesmas ini?
Regimen Terapi pada Pasien TB Baru Frekuensi penggunaan pada jumlah
total kasus TB yang muncul (dalam %)
a. 2HRZE/4HR
b. 2HRZE/6HE
c. 2HRZE/4(HR)3
d. 2(HRZE)3 /4(HR)3
e. 2HRZE/4HRE
f. Lain-lain ………………………
g. Lain-lain ……………………...
Keterangan:
H = isoniazid, R = rifampicin, Z = pyrazinamide, E = ethambutol, S = streptomycin
39
KUESIONER KONDISI PUSKESMAS
1. Suhu Puskesmas : ... oC
2. Kelembapan
Berapa kelembapan ruang periksa =……%
Berapa kelembapan ruang tunggu pasien =……%
3. Sanitasi
Petunjuk pengisian
No. Variabel Memenuhi Syarat
Ya Tidak
1. Lokasi :
a. berada pada tempat yang cukup terkena cahaya
matahari
2. Ruangan poli TB
a. terpisah dari ruangan lainnya
b. cukup terkena sinar matahari
3. Ventilasi
a. tersedia dan berfungsi dengan baik
b. antara 10-20% dari luas lantai
4. Dinding
a. Rata
b. Bersih
c. Berwarna terang
d. Mudah dibersihkan
5. Atap
a. Bebas dari serangga dan tikus
b. Tidak bocor
c. Berwarna terang
d. Mudah dibersihkan
6. Pintu
40
a. Mudah dibuka maupun ditutup
b. Kuat
c. Aman
7. Lantai
a. Kuat
b. Bersih
c. Pertemuan antar lantai membentuk konus/melengkung
d. Kedap air
e. Rata
f. Tidak licin
g. Mudah dibersihkan
8. Air bersih
a. Jumlah mencukupi
b. Tidak berbau, tidak berasa, dan tidak berwarna
9. Toilet
a. Bersih
b. Tersedianya air bersih yang cukup
c. Tersedia sabun dan alat pengering
d. Toilet untuk pria terpisah dengan wanita
10. Tempat sampah
a. Sampah diangkut tiap 24 jam
b. Ditiap ruang penghasil sampah tersedia tempat
sampah
c. Dibuat dari bahan kedap air dan mempunyai tutup
11. Tempat cuci tangan
a. Tersedia air cuci tangan yang cukup memadai
41
KUESIONER PELAYANAN PUSKESMAS
Petunjuk pengisian
Keterangan
STS : Sangat Tidak Setuju S : Setuju
TS : Tidak Setuju SS : Sangat Setuju
No. Pertanyaan Jawaban

STS TS S SS
1. Fasilitas yang dimiliki puskesmas memadai
2. Lingkungan puskesmas bersih dan nyaman
3. Pelayanan petugas kesehatan baik
4. Pelayanan pada poli kesehatan baik
5. Dokter dan petugas kesehatan datang tepat
waktu
6. Dokter dan petugas kesehatan berpenampilan
bersih dan rapih
7. Dokter dan petugas kesehatan yang lain
ramah dan sopan
8. Dokter dan petugas kesehatan dapat
berkomunikasi dengan baik
9. Dokter dan petugas kesehatan memberikan
informasi mengenai penyakit dengan baik
10. Petugas kesehatan dapat memberikan arahan
tata cara meminum obat dengan baik
11. Pengobatan di puskesmas dapat diakses
dengan BPJS
12. Petugas kesehatan memberikan informasi
mengenai program pemerintah (terutama
mengenai penanggulangan TB)
42
CHAPTER IV
SURVEY
The survey was conducted on Saturday, December 15, 2018 at 08.00 in the home of the
respondent's patients under the scope of the Tanah Kali Kedinding Health Center. The survey
included activities for collecting sputum specimens in the morning and while, filling out
questionnaires, and making observations about the respondent's house. Sputum specimens taken
at the patient's home are then taken to the Microbiology laboratory for an acid-resistant bacteria
(BTA) examination.
A. Laboratory Results
No Name Age Duration of Tx Results
1. Etik Sabata 52 th < 2 month BTA -
2. Sus Indrayati 60 th < 2 month BTA -
3. An. Afra 4 th < 2 month Cannot be checked
4. Sariyem 52 th < 2 month BTA +
5. Galih Rafindo 24 th < 2 month BTA -
6. Tjung Kem 48 th ≥ 2 month BTA +
Liong
7. Rohaya 55 th < 2 month BTA +
Tokarimah
8. Ikhwan 42 th < 2 month BTA -
9. Alief K. 26 th < 2 month BTA -
Indrayana
10. Alfin Yudha A. 27 th < 2 month BTA -
11. M. Zuhairin 20 th < 2 month BTA +
12. Supiran 56 th < 2 month BTA +
13. Samiyah 52 th < 2 month BTA -
14. Nur Hayati 23 th < 2 month BTA -
43
Presentase respondents with BTA positif = 5/14 x 100%
= 35,7%
Respondents potential of MDR = 1/14 x 100%
= 7,1%
The percentage of BTA + in respondents and MDR potential is still high so that the risk
as a source of TB transmission for the surrounding environment is also high. This can be caused
by some factors, such as the low level of compliance with drug consumption, irregular control to
the health center, the quality of the drug not in accordance with the standards, and the lack of
supervision by the drug supervisor (PMO).
B. Survey Results based on Questionnaire

1. Age
The calculation of the survey results on age is divided
Age into 3 main groups, there are the unproductive age group, 0-
15 years and ≥65 years, and productive age, 16-64 years.
0%7%
The data in addition shows that the largest percentage of
0-15 yo
respondents in the Tanah Kali Kedinding Health Center is
16-64 yo
the productive age group, that is 16-64 years. The productive
93% ≥65 yo
age group has a higher risk factor due to several factors, such
as the intensity of mobilization for high work and frequent
interaction with others.
2. Gender
The calculation of the survey results on gender who
Gender suffering tuberculosis disease is divided into 2 main
groups, there are men and women.
The data in addition shows that the largest percentage of
respondents in the Tanah Kali Kedinding Health Center is
43% men
women man. There are 8 man respondents and 6 women
57%
respondents. Man group has a higher risk factor due to
44
several factors, such as the intensity of mobilization for high work and frequent
interaction with others.
3. Education
Educational background plays an important
Education role in determining risk factors due to the ability to
0% Not School understand and carry out recommendations /
8% PAUD/TK
9% suggestions from health workers regarding TB
25% Elementary
8%
prevention and prevention programs. Education is
JHS
8% divided into several groups, namely no school, early
SHS
42% childhood / kindergarten, elementary school
Bachelor
Master (elementary), junior high school (junior high school),
high school (high school), bachelor (S1), and master
(S2). The data in addition shows that reponden as TB as many as 42% of respondents have
a SHS background and 37% have less education (Not school, early childhood /
kindergarten, elementary, and JHS). Respondents who continue their education to college
are only 25%.
4. Job
Assessment of work is associated with the
Job intensity of respondents meeting and talking
with colleagues who can increase the risk of
21% Unemployment transmission of TB. Based on the data above,

7% Teacher most respondents did not work / were closed to
0% 72% Entrepreneur
reduce the risk of transmission to coworkers. A
Others
small proportion of respondents still actively
work as traders, health workers, private workers,
and factory employees. Respondents who actively work with BTA + status and poor
health behavior can increase the risk of transmission of TB to the work environment.
45
5. Nutrition
The nutritional status of respondents was assessed
Nutrition based on the Body Mass Index (BMI) of the
Indonesian Ministry of Health in 2011.
10% Less
Based on survey data, it can be seen that more
25%
16% Normal nutritional status is normal, but 25% of respondents
Overweight still have less nutrition which can increase TB risk for
49% Obesity respondents. Poor nutrition will inhibit TB healing due
to lack of food intake affecting the respondent's
immunity status.
Status Man Woman

Less < 18 kg/m2 < 17 kg/m2
Normal 18-25 kg/m2 17-23 kg/m2
Overweight 25-27 kg/m2 23-27 kg/m2
Obesity >27 kg/m2 > 27 kg/m2
6. Family History
Family History related to the risk of TB include
Family History diabetes mellitus, asthma, malnutrition, and family
Asma members / relatives affected by TB first. Based on the
data in addition it can be explained that DM has a high
DM
17% comorbid with TB, which is equal to 17% and DM
25%
TB family history in respondents by 25%. Respondents with
25%
17% DM or family history of DM have a higher risk because
Asma-TB
8% 8%
DM can worsen clinical symptoms of TB and TB can
DM-TB worsen blood glucose control in DM.
46
7. Knowledge
Knowledge about TB is based on questions on the
Knowledge questionnaire regarding the causes and symptoms of TB, the
way TB is transmitted, the cure rate, the duration of
treatment, the main location for TB, and government
14%
29% Less
programs related to TB. Knowledge assessment is good if
Enough
the respondent answers ≥6 correctly from 7 questions, quite
57% Good
well if the respondent answers 4-5 correctly from 7
questions, and is not good if the respondent answers
menjawab3 correctly from 7 questions.
Based on the data in addition it can be explained that the respondents had sufficient
knowledge about TB. As many as 29% have poor knowledge about TB so more attention
is needed to emphasize education on respondents and other TB sufferers.
8. Attitude
The attitude of respondents was assessed based on their ability to
Attitude understand TB disease through several statements submitted in the
7%
questionnaire. The attitude of the patient is good if he is able to
Good answer correctly ≥5 of 7 statements and is bad if he is able to
93% Bad answer correctly ≤4 out of 7 statements.
 Good: 13 respondents
 Bad: 1 respondents
The data in addition shows that the respondent's attitude towards TB disease through
the statement on the questionnaire is good.
47
9. Practice
Assessment of responses from respondents from this
Practice aspect of practice was based on the behavior of
respondents during sneezing / coughing, the compliance
of respondents in taking medication, and their regularity
43%
control in the health center and respondents' habits in
good
bad opening windows in the morning. For criteria good ≥ 4 and
57%
bad<3. The data obtained from respondents in the Tanah
Kali Kedinding Health Center for the Practice aspect were
obtained as follows:
 Good = 8 respondents
 Bad = 6 respondents
In the data above shows that the behavior of respondents is still dominated by
attitudes that are not good in terms of respondents' behavior when sneezing / coughing,
respondents' compliance in taking drugs, and their regularity in control of the health
center and respondents' habits in opening the window in the morning. This can be a risk
factor that can increase the risk of transmission and spread of tuberculosis around
patients.
10. Psychology
Psychology aspect of psychology is based on support from family and
7% relatives in succeeding the tuberculosis treatment program for
sufferers. Data obtained from respondents in the Tanah Kali
good
Kedinding Health Center for aspects of Psychology are
bad
93% obtained as follows:
 Good = 13respondents
 Bad = 1 respondent
48
According to the data above shows that most of the respondents have received
family support in undergoing tuberculosis treatment programs. This can be one of the
supporting factors, especially in their psychological aspects. And this can be a
supporting factor in the effort to succeed the program effort in controlling tuberculosis.
11. Interaction
Interaction aspect of interaction is based on the intensity of respondents'
interactions with the surrounding environment. High
interaction followed by behavior of respondents who are less
43% good
well will increase transmission of Tuberculosis. Data
57% bad
obtained from respondents in the Tanah Kali Kedinding
Health Center for aspects of interaction are obtained as
follows:
12. Economy
Economy economic aspect is based on the average family income
7%
before tax is imposed compared to the number of family
less members covered. Based on BPS: less income ≤ Rp.
income
21% enough 401,220.00 and enough income >Rp. 401,220.00. Data
income obtained from respondents at the Tanah Kali Kedinding
72%
no data
Health Center for economic aspects are obtained as follows:
 Less income = 3 respondents

 Enough income = 10 respondents
 Unknown = 1 respondent
49
According to data, most respondents in the family income range are sufficient.
So, the economic aspect in the risk factors for tuberculosis in the area of the community
health center is not too influential.
C. Healthy Home Analysis

1. Ventilation
Assessment of healthy homes seen from the aspect of ventilation.
Ventilation Healthy homes are said to be well ventilated if the ventilation is
10% - 20% of the floor area. Data obtained from respondents
22% good
inTanah Kali KedindingHealth Center for the assessment of
bad healthy homes seen from the aspect of ventilation are obtained as
78%
follows:
2. Density
Assessment of healthy homes seen from the aspect of density.
Density Density is measured from the area of the house compared to the
number of occupants of the house. A healthy home is said to have
good density if the value obtained is more than 10 m2. Data
36% good
bad
obtained from respondents in the Tanah Kali Kedinding Health
64%
Center for the assessment of healthy homes viewed from the aspect
of density were obtained as follows:
50
3. Humidity
Healthy home assessment seen from the aspect of humidity. A
Others healthy home is said to have good humidity if the humidity is 40%
-60%. Data obtained from respondents in the Tanah Kali
Kedinding Health Center for healthy home assessment seen
36% good
bad
from the humidity aspect were obtained as follows:
64%
4. Lighting
Assessment of healthy homes viewed from the lighting aspect.
Lighting Healthy homes are said to have good lighting if the respondent can
read the newspaper's writing clearly in the room without the lights
on. Data obtained from respondents in the Tanah Kali Kedinding
36% good
bad
Health Center for the assessment of healthy homes viewed from
64%
the lighting aspect are obtained as follows:
5. Others
Assessment of healthy homes is seen from other aspects such
Humidity as bathroom facilities, sewerage systems, garbage disposal
systems and sewage disposal. Data obtained from respondents in
the Tanah Kali Kedinding Health Center for a healthy home
43% good
57% bad
assessment seen from several additional aspects were obtained as
follows:
51
Conclusion of the data Healthy Home Analysis:
To conclude from the assessment of a healthy house which is seen from the 5 aspects, it is
dominated by poor or bad grades. This shows that the ratio of healthy homes to respondents with
TB still needs improvement in several aspects. A healthy home is very influential on the spread of
the Mycobacterium tuberculosis bacteria. Where the condition of the house with less ventilation,
high humidity, and lighting that is lacking is an optimal condition for Mycobacterium tuberculosis
to live. These bacteria can infect humans (hosts) where their immune conditions are low. Or they
can be latent or have entered the host's body but cause no symptoms and replication does not occur
if the host's immune condition is high. In addition, high house density can be potential in the
transmission of Mycobacterium tuberculosis from TB sufferers to people around it. Especially
families who are single home with him.
The ratio of healthy homes to some respondents in the Tanah Kali Kedinding Health Center
area is still low. Education is needed for those who have the potential to be the source of the
transmission. The education can be in the form of suggestions to change their behavior in opening
windows in the morning so that air exchange from inside and outside the house occurs, and sunlight
containing UV light can also enter. So that such conditions can minimize the life of the bacterium
Mycobacterium tuberculosis. That way, one of the risk factors for the occurrence and transmission
of tuberculosis can be reduced.
D. Analysis of Tanah Kali Kedinding Health Center’s Data

1. Service Program of TB
a. TB DOTS
b. TB MDR
c. Home Visit
d. Cak Ning 1-20
e. Satgas TB
52
2. Number of TB cases
The highest number of TB cases
Case TB was found in 2018, there are 113
115
cases. Starting in 2013 there was an
110 increase in the number of TBs until
105 2015. Then in 2016 there was a
Case TB
100 decrease in the number of TB cases to
102 cases and the year with the
95
2013 2014 2015 2016 2017 2018 smallest case number in the last 5
years. In 2017 it rose to 113 cases. This needs better treatment and prevention efforts so
that TB cases do not increase. All TB patients in Tanah Kali Kedinding Health Center
get free treatment. Treatment is divided into 2 categories, there are category I 2HRZE /
4HR and category II 2HRZE / 6HE.
3. Number of Death Patients

The lowest TB mortality rate
Number of Death Patient occurred in 2018 amounting to 15
60
cases. In 2013-2015 there was an
50
40
increase in TB deaths of 33 cases, 42
30 Number of Death cases and 52 cases per year. 2015 was
20 Patient
the year when the TB mortality rate
10
reached the highest level.
0
2013 2014 2015 2016 2017 2018 Furthermore, the TB mortality rate
decreased by 48 cases in 2016 and 45 cases in 2017. It can be concluded that Tanah Kali
Kedinding Health Center managed to treat it well so as to reduce TB death cases.
53
4. Number of MDR / XDR TB Cases
In the Tanah Ked Ked Health
Number of MDR/XDR TB Center there were several cases of
Cases MDR found in 2 cases in 2013, 2
4 cases in 2015, and 3 cases in 2017.
3
There was an increase in MDR TB
2 Number of
MDR/XDR TB Cases cases in 2017 and was the year when
1
the MDR TB rate was highest.
0
2013 2015 2017
5. The Amount of Successful Treatment in TB Patients

The highest rate of treatment
Successfull Treatment success occurred in 2016 where 99
120
patients completed TB treatment.
100
80
The treatment success rate in 2013
60 Successfull was 85 cases. Then it declined in
40 Treatment
2014 to only 80 cases. In 2016-2017
20
there were a sharp increase of 98 and
0
2013 2014 2015 2016 2017 2018 99 cases which could be resolved
well. In 2017 93 patients were able to complete treatment. Whereas in 2018, there were
only 26 patients who successfully completed the treatment program. The success rate of
TB treatment in the Tanah KaliKedinding Health Center is 56.5%.
54
CHAPTER V
FOURTH MEETING
5.1 Final Concept Mapping
CNR TB
increasing
After sputum examination, 5

patients were found with BTA +
from 14 patients
Spreading TB in
Surabaya increasing
Risk Factor
Host Agent - Environtment

Close contact
- Family
- Age - MDR support
- Medical - XDR - Economy
Record - satisfaction on
- Education health service
- Worker -Criteria of a
- Knowledge healthy home
- Attitude - Social
- Behaviour relation with
neighbor
Education about the risk Education about the

of TB and its criteria for a
transmission through healthy home and
Succes rate increasing
promotion and eliminate the
Spreading
Control TB TB
prevention decreasing community's stigma
about TB
55
Concept Mapping Analysis
The increasing number of CNR in TB cases can lead to a broader spreading of TB in
Surabaya. To control this condition, we can interfere with repairing the risk factors surrounding.
The spreading of TB can be accelerated by components from host, agent, and environment. From
host factor, there are age, medical record, educational background, occupation, knowledge,
attitude, and behavior. From agent factor, there are types of bacteria infecting the host whether it
is sensitive type or MDR/XDR type. From the environment, there are close contact, family support,
economy satisfaction on health service, criteria of healthy home, social relation with neighbors.
Based on our survey on December 15, 2018, there are six factor that still counted as a
problem in TB control. From host, there are three factors:
a. Educational background
Many of TB patients have low educational background. This can lead to low knowledge
about TB spreading and how the infection occurs. Many people don’t aware about the
symptoms of TB because at a glance it is like the symptoms of common cold. Many patients
in our survey say that they know there are plenty of people coughing more than 2 weeks
and don’t make a step to bring themselves to healthcare providers. The untreated TB can
spread to family, younglings, neighbors and other close contacts. This results in the
increasing number of TB cases.
b. Knowledge about TB
Based on our survey, most of the patients don’t know about TB well. Most of them stated
that they don’t know what can cause TB, how it spreads, and what behavior can be improve
to control the spreading. From this minimal knowledge, the probability to spread TB is
increasing. In this factor, we can improve it by giving some education about the disease.
c. Behavior
Behavior that still can be a problem in this survey is how the patients cough and what they
do after the cough. Most of the patients still don’t know the urgency of doing the right
thing. Some of them use mask in certain condition, but don’t use it in daily activity. Also,
most of the patients don’t know how to cough properly. Some cough in the bathroom and
closed room which can be a spreading place for TB bacteria. We can improve this by giving
some education about the proper behavior.
56
Form environment, there are three factors :
a. Close Contact
Definitions of close contact also varied considerably in the requisite intensity of
exposure to patients. Some studies had a broad definition, with close including any known
others used expressions such as intimate, sharing the air for a prolonged period, or
specifying a minimum duration of exposure in other closed spaces such as the workplace .
WHO currently recommends contact investigation in two high-risk populations:
children aged <5 yrears and people living with, or at high risk of, HIV infection. Recently,
the WHO has also launched the first international standards for the investigation of contacts
of patients with infectious TB (WHO,2013). In Surabaya there are 1 Cak and 15 Ning
programs to reduce the risk of TB transmission. Cak means tracing and Ning means
screening. So, every time one TB patient is found, screening will be conducted on 15
surrounding families both front, back, right, and left. It is expected that if there are new
patients can be treated immediately and can reduce the spread.
Early identification means a better chance of cure and, especially, a reduction in
further transmission. Furthermore, contact investigation allows identification of people
who are latently infected and at high risk for active TB, who can be treated preventively.
b. Criteria of healthy home
The criteria for a healthy home are if it meets seven criteria, namely a ceiling roof,
a permanent wall (wall / board), a type of non-soil floor, windows, adequate ventilation,
adequate natural lighting, and not densely populated (greater than 8 m2 / person ) As many
as 24.9% of houses in Indonesia are included in the criteria of a healthy home. Whereas in
East Java there are 24.6% of houses included in healthy homes. (Ministry of Health, 2010)
By looking at these data, it can be said that the number of healthy houses in Indonesia,
especially East Java, is still low.
The low number of healthy houses can increase the spread of Tuberculosis. That is
because, the condition of the house with poor lighting, poor air circulation, and poor
ventilation will make it easier for Mycobacterium tuberculosis to multiply. That way, the
number of TB germs increases and the transmission of TB becomes easier. These factors
also play a role due to the way TB is transmitted through droplet nuclei. If air circulation
is not good, the droplet nuclei in the room will continue to be in the room.
57
c. Social relation with neighbors
Based on our survey results, there are still many people who isolate TB patients in
their daily lives. In addition, there is also a TB disease that stigmatizes as a curse or
something similar and away from the sufferer. Of course it can have an impact on the social
conditions of patients and their families. The patient's social and psychological condition
is very influential on the outcome of the therapy being undertaken. Patients who are
ostracized and underestimated certainly feel worse and lose their enthusiasm for recovery.
This certainly can increase the spread of TB cases.
From the risk factors described, there are several coping strategies to deal with TB infection
cases, including providing education about the risk of TB and its transmission through
promotion and prevention. One of them is by giving TB socialization to the community through
leaflets, explaining the good ethics of coughing, explaining the ways of transmission, close
contact, and prevention, improving TB-related stigma in the community, promoting clean and
healthy living behavior, increasing ventilation, increasing the sun's lighting. to the house, use
a fan / AC to improve air circulation or get used to frequently opening windows
5.1. Final Hypothesis

Based on the data and survey there are several factors that cause the increase of Case
Notification Rate. The factors based on the house are bad ventilation of the house, bad
lighting, and high density habitation. Based on host are bad coughing, sneezing, throwing
sputum habit, lack of the usage of self protection equipment, bad lifestyle, and low knowledge.
This can cause the increase of tuberculosis transmission around their neighbourhood and can
spread to another area.
5.2. Solution Strategy And Review Evidence
5.2.1. Prevention Strategy
A. Improve society education about tuberculosis
 Brief explanation about tuberculosis
Using leaflet that was made, general description about tuberculosis explained
towards society using language that is easy to understand and accompanied by
pictures. Pictures in leaflet can help society to understand more easily and
58
information can be remembered so they can teach other people about tuberculosis
too.
 Reminding other health services to give information twards tuberculosis patient as
good as possible by giving list of informations that are mandatory to know. Such as
information about AFB (Acid Fast Stain) result, rontgen photo result, causes of
disease transmission, risks if tuberculosis is not treated, risk if drugs are not
consumed properly, and how to prevent transmission.
 Explaining government programs to handle tuberculosis. Several of it are TOSS,
CAK NING, and promote International Standard for Tuberculosis Care (ISTC).
 Giving brief explanation about tuberculosis transmission. How it can be transmitted
and risk factors that can increase tuberculosis transmission.
 Giving brief explanation about tuberculosis prevention and how to prevent it in
everyday life.
 Giving explanation how to prevent transmission for tuberculosis patients to protect
other people from getting infected.
 Giving explanation towards society that tuberculosis is not a curse and other bad
stigma about tuberculosis. By correcting society’s view about tuberculosis,
tuberculosis patients can feel safe and their psychological burden can be decreased.
B.Healthy House
 Education about healthy lifestyle and clean environment. Memberitahukan kriteria
rumah sehat dengan ventilasi dan udara yang cukup
 Tell society about healthy house criteria.
 Education about how important ventilation, low humidity, and lighting for
tuberculosis prevention.
 Education about facilityusage that can make tuberculosis patients condition worse
such as increasing transmission by using air conditioner and fan.
59
5.2.2. Success Indicator
 Patients can answer questions about tuberculosis after education about tuberculosis.
Patients ability to answer the questions correctly indicates that petients understand
and can receive information that was given to them.
 Follow up patients behaviour for preventive behaviour and other behaviour by
asking family member to pay attention and reminding patients.
5.2.3. Evaluation Plans

Because patients assictance schedule just held one time, then evaluation plan
will be continued by health center in treatment attempt.
5.3. List of Information Delivered to Community
Tuberculosis (TB) is a highly contagious and dangerous infectious disease. Over the
past 10 years, the number of TB case notifications has tended to increase throughout the world.
Therefore, there are a number of things that people need to know about TB, namely:
a. Definition
TB is an infectious disease caused by the bacterium Mycobacterium tuberculosis. TB
can attack various organs, especially the lungs. If not treated immediately, TB can cause
complications.
b. Data and Facts
In 2017, there are an estimated 10 million new TB cases worldwide, of which 5.8 million
are men, 3.2 million are women and 1 million are children. People living with HIV account for
9% of the total. Eight countries accounted for 66% of new cases: India, China, Indonesia, the
Philippines, Pakistan, Nigeria, Bangladesh and South Africa. In 2017, 1.6 million people died
from TB, including 0.3 million among people with HIV. Globally, TB mortality rates dropped
by 42% 2000 and 2017. The severity of national epidemics varies greatly between countries. In
2017, there were fewer than 10 new cases per 100 000 inhabitants in most high-income
countries, 150‒400 in most of the 30 high-burden TB countries, and above 500 in some
countries including Mozambique, the Philippines and South Africa. Globally in 2017, 558,000
people with TB were resistant to rifampicin (RR-TB), which is a first-line treatment. Of these,
82% are multidrug resistant TB (MDR-TB). 160,000 cases of MDR / RR-TB were detected in
2017. Of these, a total of 140,000 people were registered and began treatment with first-line
60
treatment. The treatment success rate is 55% so it remains low globally. Among MDR-TB cases
in 2017, 8.5% were estimated to have extensive drug-resistant TB (XDR-TB).
c. Risk factor
Risk factors can be seen from several aspects, namely:
1. Health: low immunity in a person can increase the risk of TB infection. Examples of
such low immunity diseases are HIV (greatest), diabetes mellitus, and malnutrition.
2. Employment: health workers such as doctors and nurses, especially those who often
contact TB patients, will have high risk factors for contracting TB.
3. Environment: family, neighbors, coworkers, and people around TB patients can
contract TB. If the TB patient and those people live or are in the same place with ventilation,
they also increase the risk factors for transmission.
4. Habits: habits like smoking can increase the risk of TB infection.
d. Way of transmission
Bacterial particles from TB patients released into the air by coughing, sneezing,
laughing, and other activities that open the mouth become agents of Mycobacterium
tuberculosis transmission. These particles are called water droplet nuclei. As the name suggests,
these particles will be very easily transmitted through the air. Therefore, good natural
ventilation in the home and room, the use of masks, and good cough ethics from the sufferer
can reduce the transmission factor.
e. Symptoms
Symptoms of TB are coughing up phlegm for more than 2 weeks, coughing with blood,
shortness of breath, body weakness, decreased appetite, decreased weight, night sweats without
physical activity, and feverish.
f. Control effort
1. Administrative Control
This control is an effort to reduce exposure of TB patients to those who do not have TB.
This control can be in the form of data collection and pemisaan TB patients. Thus patients are
suspected, infected with TB, risk TB and patients who have a high risk of developing TB can
also be immediately followed up. In addition, the Directly Observed Treatment Shortcourse
(DOTS) program is included in this level of control.
2. Environmental Control
61
This type of control can be either increased natural ventilation of the room.
3. Control with Self Protection
This control can be the use of masks when around TB patients.
g. Education
TB patients and those around them must understand that TB is very easily transmitted,
especially through the air. Therefore, education must be given regarding the ethics of coughing.
The patient who is coughing is instructed to turn his head and cover his mouth / nose with tissue.
If you don't have tissue, your mouth and nose are covered with your hands or the base of your
arms. After coughing, the hands are cleaned, and the tissue is removed in the trash bin
specifically provided for this. (yellow / infectious bag).
The community must also know the symptoms of TB so that it can be immediately brought to
the top health services. The public must also be informed that in Indonesia, TB treatment is free
so that they do not discourage the public from checking their condition if they are suspected of
being infected with TB.
62
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http://www.kalbemed.com/Portals/6/05_215CME_Masalah%20Tuberkulosis%20Resist
en%20Obat.pdf. [accessed in 7 December 2018]
Badan Litbangkes Depkes RI, 2007. Riset Kesehatan Dasar 2007, Jakarta : Departemen Kesehatan
RI.
Dotulong, Jendra F.J. 2015. Hubungan Faktor Risiko Umur, Jenis Kelamin Dan Kepadatan Hunian
Dengan Kejadian Penyakit Tb Paru Di Desa Wori Kecamatan Wori. Jurnal Kedokteran
Komunitas dan Tropik : Volume III No. 2 April 2015. [online]. Available in :
https://ejournal.unsrat.ac.id/index.php/JKKT/article/view/7773/7336. [accessed in 7
December 2018]
Fitriani, Eka. 2013. Faktor Risiko yang Berpengaruh dengan Kejadian Tuberkulosis Paru. Unnes
Journal f Public Health. [online]. Available in ;
https://journal.unnes.ac.id/sju/index.php/ujph/article/view/3034. [ accessed in 8
December 2018]
Handayani, Samsriyaningsih. Lestari, Pudji., Margono, Hendy Muagiri., Rehatta, Nancy
Margareta., Yulianti, Erikavitri., Prajitno, Jongky Hendro., Umijati, Sri. 2017. Buku Ajar
Aspek Sosial Kedokteran. Surabaya : Airlangga University Press.
Hutapea. 2006. Pengaruh Dukungan Keluarga terhadap Kepatuhan Minum Obat Anti
Tuberkulosis.
Infodatin. (2018). Tuberkulosis. Pusat Data dan Informasi KEMENKES RI.
NSW Health. 2008. Tuberculosis Contact Tracing. [online]. Available in :
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/PD2008_017.pdf . [
Accessed in 9 December 2018]
Rukmini dan Chatarina. 2011. Faktor-Faktor Yang Berpengaruh Terhadap Kejadian Tb Paru
Dewasa Di Indonesia (Analisis Data Riset Kesehatan Dasar Tahun 2010). [online]
available in : http://ejournal.litbang.depkes.go.id/index.php/hsr/article/view/1369/2193.
[accessed in 7 December 2018]
Sari,Ristyo P, Mas Imam Ali A, Pepin Nahariani. (2012). Hubungan Tingkat Sosial Ekonomi
63
Dengan Angka Kejadian Tb Paru Bta Positif Di Wilayah Kerja Puskesmas Peterongan
Jombang Tahun 2012.
Werdhani, R. (2017). Patofisiologi, Diagnosis, Dan Klafisikasi Tuberkulosis. Jakarta: Departemen
Ilmu Kedokteran Komunitas, Okupasi, dan Keluarga FKUI.
Winston C, Menzies H. Pediatric and Adolescent Tuberculosis in the United States, 2008-2010.
PEDIATRICS [Internet]. 2012 [cited 7 December 2018];130(6):e1425-e1432. Available
in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602373
Wulandari, Agustuna Ayu., Nurzaluli, dan Adi, M. Sakundarno. 2015. Faktor Risiko dan Potensi
Penularan Tuberkulosis Paru di Kabupaten Kendal, Jawa Tengah. Jurnal Kesehatan
Lingkungan Indonesia Vol. 14 No.1 / April 2015. [online]. Available in :
https://ejournal.undip.ac.id/index.php/jkli/article/view/10031/7993. [accessed in 7
December 2018]
World Health Organization. 2018. TB comorbidities and risk factors. [online]. Avalaible in :
https://www.who.int/tb/areas-of-work/treatment/risk-factors/en/. [accessed in 7 Decmber
2018]
WHO. 2018. Tuberkulosis. [online]. Available in : https://www.who.int/tb/areas-of-
work/laboratory/contact-investigation/en/ [Accessed in 15 December 2017]
World Health Organization, Geneva, Switzerland. 2006. Guidance for National Tuberculosis
Programmes on the management of tuberculosis in children. [online]. Available in :
http://www.stoptb.org/wg/dots_expansion/assets/documents/IJTLD_OS_ChildhoodTB_C
hapter1.pdf. [accessed in 9 December 2018]
64
CRITICAL APPRAISAL
Group : 2
Title : Increase of Tuberkulosis Cases at Pacarkeling Health Center,
Surabaya, Year 2009–2011
1. FORMAT PAPER
ADA / TIDAK (SEBUTKAN
HALAMANNYA)
ITEM TELAAH
 Title A (29)
 Abstract and or Summary A (29)
 Introduction, background A (29-30)
 Method A (30-31)
 Result A (31-37)
 Discussion A (31-37)
 Acknowledgement NA
 Reference A (37)
A: Available
NA: Not Available
Conclusion: Complete
65
2. VALIDITY OF RESEARCH
The objective of study: to describe the trend of tuberculosis epidemiology on 2009-2011
based on time, age, gender, medicine status, and location
Methodology
Item
Design Cross Sectional (30)
* Hierarchy of evidence 4
Sample Tuberculosis Patient in Pacarkeling health

center (31)
Sample size Tuberculosis Patient in Pacarkeling health
center on 2009 – 2011 (31)
Eligibility criteria No
Sampling frame Tuberculosis Patient in Pacarkeling health

center (31)
Methodology Data collection is done with interviews (in-
depth interviews) to medical staff and
paramedics regarding the description of the
program or activities that have been carried out
and which will be carried out in an effort to
prevent and eradicate TB disease and problems
experienced during the implementation of the
program. (30)
Measurement and or assessment
-
Instrument Secondary data from Pacarkeling Health
Center in the form of: POA Pacarkeling Health
66
Center in 2009–2011, P2KPUS Report of
Pacarkeling Health Center for 2009–2011,
LB1 data for Pacarkeling Community Health
Center for 2009–2011, TB data for 2009–
2011, Working area of Pacarkeling
Community Health Center include
Pacarkeling and Pacarkembang Villages ( 31)
Randomization Used all of secondary data of Tuberculosis
patient on 2009-2011 (31)
Intervention Data on programs or activities that have been
carried out and will be carried out in an effort
to prevent and eradicate TB and the problems
experienced during the implementation of the
program through in-depth interviews. (30)
Analysis method Descriptive data analysis of trends in TB
disease according to time, age, gender,
treatment status, and place in the working area
of the Pacarkeling Health Center. (31)
The suitable of design and objective of study : Suitable

Conclusion : Valid
3. IMPORTANCE OF STUDY
This journal contain the trend and prevalance of Tuberculosis since 3 years in Pacarkeling
health center. This journal is valid enough because the format is complete enough and the
methodology is written on the text is good enough.
67
ATTACHMENT
Leaflet
68
Kuesioner
KUESIONER TB
III. Identitas Responden
A. Identitas responden
6. Nama Responden :
7. Umur :
8. Jenis Kelamin :
9. Latar Belakang Pendidikan
m. Tidak Sekolah
n. SD
o. SLTP
p. SLTA
q. Sarjana/S1
r. Magister/S2
10. Pekerjaan
a. Tidak Bekerja
b. Petani
c. Wiraswasta
d. PNS
e. Lain-lain : ...................
Hubungan dengan pasien : ..........................
C. Status TB
a. Apakah di rumah Anda saat ini ada penderita TB?
o Ya o Tidak
b. Jika ada, kami akan menanyakan beberapa pertanyaan berkaitan dengan pasien
1) Identitas Pasien
d. Nama :
69
e. Umur :
f. BB/TB :
2) Jenis Kelamin :
3) Latar Belakang Pendidikan
s. Tidak Sekolah
t. SD
u. SLTP
v. SLTA
w. Sarjana/S1
x. Magister/S2
4) Pekerjaan
f. Tidak Bekerja
g. Petani
h. Wiraswasta
i. PNS
j. Lain-lain : ...................
C. Riwayat Migrasi
4. Apakah Anda/penderita pernah melakukan perjalanan ke luar kota Surabaya dalam
c. Ya d. Tidak
5. Jika pernah, berapa kali Anda melakukan perjalanan ke luar Kota Surabaya dalam
f. 1 – 2 Kali
g. 3 – 4 Kali
h. 5 – 6 Kali
i. Lebih dari 6 Kali
j. Tidak berlaku/tidak pergi ke luar kota dalam 1 bulan terakhir
6. Apakah keluarga Anda pernah melakukan perjalanan ke luar kota Surabaya dalam
70
o Ya o Tidak
D. Status Gizi
5. Berat Badan:
6. Tinggi Badan:
7. Dalam jangka waktu 7 hari terakhir, berapa kali Anda makan dalam sehari?
e. 1 Kali
f. 2 Kali
g. 3 Kali
h. Lainnya….
8. Apa makananyang sehari-hari Anda konsumsi? (Boleh pilih lebih dari satu)
o Nasi
o Sayur
o Lauk-pauk
o Susu
o Buah
o Lainnya……
E. Riwayat Kesehatan dan Penyakit

6. Apakah Anda atau anggota keluarga mempunyai penyakit berikut?
o Darah tinggi
o Kencing manis
o Asma
o Gagal ginjal
o Penyakit Jantung
Iskemik
o Sakit liver (hati)
o Lainnya
(………………)
7. Apakah anda atau anggota keluarga anda memiliki riwayat alergi?
71
a. Ya (……………) c. Tidak
8. Apakah keluarga Anda pernah terserang TB sebelumnya?
a. Ya b. Tidak
o Diri sendiri
o Anggota keluarga
9. Jika ada, TB apa?

o Paru
o Tulang
o Kelenjar
o Meninges
o Lain-lain (…………..)
10. Jika ada, kapan terserang TB?
a. 1 bulan yang lalu
b. 3 bulan yang lalu
c. >6 bulan yang lalu
(………….............)
IV. Pengetahuan
3. Menurut Anda, apa yang 5. Apa TB paru bisa disembuhkan?
menyebabkan TB paru? c. Bisa
e. Kuman M. Tuberculosis d. Tidak
f. Suka pergi keluar rumah
g. Sakit hati atau banyak pikiran 6. Mengapa Anda harus berobat secara
h. Kerja keras teratur?
e. Batuk berdahak
4. Apakah gejala TB yang sering f. Batuk berdahak selama 1 minggu
ditemukan? g. Batuk berdahak lebih dari 2
e. Batuk berdahak minggu
f. Batuk berdahak selama 1 h. Batuk berdahak setaip saat
minggu
72
g. Batuk berdahak lebih dari 2 7. Apakah Anda mengetahui lama waktu
minggu pengobatan TB sampai sembuh?
h. Batuk berdahak setaip saat a. 2 bulan
b. 4 bulan
3. Melalui apakah TB menular? c. 6 bulan
e. Sentuhan d. 8 bulan
f. Percik dahak
g. Lewat jarum suntik
h. Lain-lain/tidak tahu 8. Apakah Anda mengetahui program
4. Dimana tempat utama peyakit TB? TOSS TB?
e. Paru c. Ya
f. Tulang d. Tidak
g. Kulit
h. Lain-lain/tidak tahu
III. Sikap Perilaku Pencegahan Penyakit TB

1. Penyuluhan tentang penyakit TB diperlukan untuk masyarakat
a. Ya
b. Tidak
2. Penyuluhan tentang rumah sehat diperlakukan untuk masyarakat guna mengurangi kasus
TB
a. Ya
b. Tidak
3. Persebaran penyakit TB dapat dicegah
a. Ya
b. Tidak
4. Program pengobatan TB secara tuntas mampu menyembuhkan pasien
a. Ya
b. Tidak
5. Orang yang berada dalam lingkungan yang sama dengan penderita dapat beresiko tertular
a. Ya
73
b. Tidak
6. Dukungan keluarga dapat meningkatkan kualitas hidup penderita TB
a. Ya
b. Tidak
7. Semakin lama penyakit TB diketahui, semakin sulit untuk menyembuhkan
a. Ya
b. Tidak
IV. Pertanyaan Praktik

1. Apakah anda menutup mulut saat batuk dan bersin?
a. Ya b. tidak
2. Jika menutup mulut, apa yang Anda gunakan untuk penutup mulut?
a. Tisu atau sapu tangan c. telapak tangan
b. Lengan baju d. lainnya,…….
3. Apabila menggunakan tisu atau sapu tangan, apa yang anda lakukan dengan tisu atau
sapu tangan tersebut ?
a. membuang tisu sembarangan
b. mencuci sapu tangan dengan sabun dan direndam dengan detergen
c. lainnya, ……
4. Apa bentuk dukungan dan motivasi keluarga terhadap kondisi anda ?
a. memberi support dan semangat dengan kata kata
b. mengingatkan jadwal minum obat
c. menemani dan mengantar pengobatan ke rumah sakit
d. tidak ada
5. Apakah keluarga, teman, dan tetangga menjauhi anda dengan kondisi anda saat ini?
(setelah sakit tb)
a. Ya b. tidak
6. Apakah anda rutin dalam meminum obat sesuai dengan arahan dan jadwal dari
puskesmas?
a. Ya c. tidak
74
b. Terkadang Lupa
7. Apakah anda berinteraksi dan bertemu dengan tetangga sekitar rumah anda?
b. Jarang
8. Apakah jendela rumah rutin dibuka?
a. Ya b. tidak
9. Apakah anda rutin dalam kontrol di puskesmas sesuai dengan arahan dan jadwal dari
puskesmas?
b. Jarang
V. Pertanyaan Tambahan
4. Berapakah besar rata-rata pendapatan keluarga Anda perbulannya sebelum dikenakan
pajak?
5. Siapakah pengambil keputusan dalam keluarga Anda?
6. Bagaimanakah status hubungan Anda?
o Lajang
o Menikah
o Cerai/Berpisah
o Tidak menikah namun tinggal serumah
o Memilih untuk tidak menjawab
VI. Umpan Balik

2. Apakah Anda mengalami kesulitan dalam menjawab pertanyaan yang diajukan?
o Ya o Tidak
2. Apakah ada kesulitan yang Anda rasakan dalam pengobatan TB?
3. Apakah Anda memiliki pertanyaan yang ingin Anda ajukan?
75
KUESIONER KONDISI RUMAH
7. Ventilasi Rumah: ... %
o Kurang
o Baik
*Ukuran ventilasi ( >10 % dari luas lantai pada seluruh ruangan)
8. Suhu Rumah : .... oC
9. Kepadatan hunian rumah
Berapa orang yang tinggal menetap di rumah ini………….…orang
Luas lantai rumah/bangunan …………………………………m2
Jumlah luas lantai rumah/bangunan
Kepadatan hunian = Jumlah anggota keluarga yang tinggal serumah
= …………………m2/orang
10. Berapa luas ruang keluarga (A) =…..m2
Berapa luas ruang tidur (B) =…..m2
11. Berapa kelembapan udara rumah =……..%
Berapa kelembapan udara ruang keluarga =……..%
Berapa kelembapan udara ruang tidur =……..%
12. Sanitasi rumah penderita TB paru:
Petunjuk pengisian
No. Uraian Jawaban
1 2 3 4 5
Pencahayaan rumah
Ventilasi rumah
Ketersediaan fasilitas mandi
Sistem pembuangan air kotor
Sistem pembuangan sampah rumah tangga
Sistem pembuangan tinja
76
KUESIONER PUSKESMAS
22. Berapakah jumlah pegawai di Puskesmas?

23. Berapakah jumlah Pos Pelayanan yang ada ?
24. Apa saja program pelayanan khusus TB yang telah dilaksanakan di Puskesmas Kali Kedinding?
25. Berapa Jumlah Kasus TB di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017?
26. Berapa Jumlah Kasus Baru TB di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017
27. Berapa Jumlah Penderita TB yang mendapatkan pengobatan di Puskesmas kali kedinding pada
2013, 2014, 2015, 2016, 2017?
28. Berapa Jumlah penderita TB yang telah mendapatkan pengobatan dan dinyatakan telah sembuh
di Puskesmas kali kedinding pada 2013, 2014, 2015, 2016, 2017?
29. Berapa Jumlah penderita TB yang meninggal dunia di Puskesmas kali kedinding pada 2013,
2014, 2015, 2016, 2017?
30. Apakah ada kasus MDR/XDR TB di Puskesmas kali kedinding dalam 5 tahun terakhir?
31. Berapa jumlah kasus MDR/XDR TB di Puskesmas Kali Kedinding pada 2013, 2014, 2015,
2016, 2017?
32. Apakah ada-data data Tambahan mengenai kasus TB di Puskesmas kali kedinding dalam 5 tahun
terakhir?
33. Berapa jumlah pasien BTA positif di wilayah kerja Puskesmas Tanah Kali Kedinding tahun 2018
(data terakhir)? . . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
. . . . . . . . . . . . . . . . orang
77
39. Pasien BTA positif paling banyak berada dalam skala . . . .
□ Scanty
□ 1+
□ 2+
□ 3+
40. Berapa jumlah pasien TB yang pengobatannya berhasil pada 2013, 2014, 2015, 2016, 2017?
41. Berapa prosentase pasien TB yang pengobatannya berhasil dibanding dengan seluruh penderita
TB yang mendapatkan pengobatan pada 2013, 2014, 2015, 2016, 2017?
42. Regimen apa saja yang digunakan pada pasien TB yang berobat ke puskesmas ini?
Regimen Terapi pada Pasien TB Baru Frekuensi penggunaan pada jumlah
total kasus TB yang muncul (dalam %)
h. 2HRZE/4HR
i. 2HRZE/6HE
j. 2HRZE/4(HR)3
k. 2(HRZE)3 /4(HR)3
l. 2HRZE/4HRE
m. Lain-lain ………………………
n. Lain-lain ……………………...
Keterangan:
H = isoniazid, R = rifampicin, Z = pyrazinamide, E = ethambutol, S = streptomycin
78
KUESIONER KONDISI PUSKESMAS
4. Suhu Puskesmas : ... oC
5. Kelembapan
Berapa kelembapan ruang periksa =……%
Berapa kelembapan ruang tunggu pasien =……%
6. Sanitasi
Petunjuk pengisian
No. Variabel Memenuhi Syarat
Ya Tidak
1. Lokasi :
b. berada pada tempat yang cukup terkena cahaya
matahari
2. Ruangan poli TB
c. terpisah dari ruangan lainnya
d. cukup terkena sinar matahari
3. Ventilasi
c. tersedia dan berfungsi dengan baik
d. antara 10-20% dari luas lantai
4. Dinding
e. Rata
f. Bersih
g. Berwarna terang
h. Mudah dibersihkan
5. Atap
e. Bebas dari serangga dan tikus
f. Tidak bocor
g. Berwarna terang
h. Mudah dibersihkan
6. Pintu
79
d. Mudah dibuka maupun ditutup
e. Kuat
f. Aman
7. Lantai
h. Kuat
i. Bersih
j. Pertemuan antar lantai membentuk konus/melengkung
k. Kedap air
l. Rata
m. Tidak licin
n. Mudah dibersihkan
8. Air bersih
c. Jumlah mencukupi
d. Tidak berbau, tidak berasa, dan tidak berwarna
9. Toilet
e. Bersih
f. Tersedianya air bersih yang cukup
g. Tersedia sabun dan alat pengering
h. Toilet untuk pria terpisah dengan wanita
10. Tempat sampah
d. Sampah diangkut tiap 24 jam
e. Ditiap ruang penghasil sampah tersedia tempat
sampah
f. Dibuat dari bahan kedap air dan mempunyai tutup
11. Tempat cuci tangan
b. Tersedia air cuci tangan yang cukup memadai
80
KUESIONER PELAYANAN PUSKESMAS
Petunjuk pengisian
Keterangan
STS : Sangat Tidak Setuju S : Setuju
TS : Tidak Setuju SS : Sangat Setuju
No. Pertanyaan Jawaban

STS TS S SS
1. Fasilitas yang dimiliki puskesmas memadai
2. Lingkungan puskesmas bersih dan nyaman
3. Pelayanan petugas kesehatan baik
4. Pelayanan pada poli kesehatan baik
5. Dokter dan petugas kesehatan datang tepat
waktu
6. Dokter dan petugas kesehatan berpenampilan
bersih dan rapih
7. Dokter dan petugas kesehatan yang lain
ramah dan sopan
8. Dokter dan petugas kesehatan dapat
berkomunikasi dengan baik
9. Dokter dan petugas kesehatan memberikan
informasi mengenai penyakit dengan baik
10. Petugas kesehatan dapat memberikan arahan
tata cara meminum obat dengan baik
11. Pengobatan di puskesmas dapat diakses
dengan BPJS
12. Petugas kesehatan memberikan informasi
mengenai program pemerintah (terutama
mengenai penanggulangan TB)
81
Inform Consent
Penjelasan untuk Mendapatkan Persetujuan
(Information for Consent)
“SURVEY JENTIK NYAMUK DAN DAHAK PENDERITA TB PADA

BLOK KEDOKTERAN TROPIS MAHASISWA FK UNAIR
SEMESTER 3 TAHUN 2018/2019”
Bapak dan/atau Ibu yang terhormat, kami dari mahasiswa semester 3 FK UNAIR
2018/2019 memohon partisipasi Bapak/Ibu dalam survey ini. Survey ini adalah upaya kami untuk
mempelajari penyakit yang berkaitan dengan daerah tropis, dalam segi diagnosa maupun tataksana
pencegahan dan pengobatan. Hasil survey ini diharapkan dapat memberikan ilmu pengetahuan
baru kepada kami dan memberi saran kepada pemerintah untuk memperbaiki program mengenai
tuberkulosis.
Bapak dan/atau Ibu akan kami berikan kertas berisi pertanyaan yang akan diisi
berhubungan dengan pengambilan dahak dan penyakit tuberkulosis. Mohon kiranya pertanyaan -
pertanyaan berikut dapat dijawab dengan baik sesuai dengan apa yang Bapak dan/atau Ibu ketahui.
Survey ini tidak akan berdampak apapun kepada Bapak dan/atau Ibu baik itu risiko
psikologik maupun sosial, semua jawaban dan identitas Bapak dan/atau Ibu akan kami rahasiakan.
Bapak dan/atau Ibu pun berhak mengundurkan diri dalam keikutsertaan di survey ini setiap saat.
Surabaya, ...............................
Yang menerima penjelasan, Yang memberi penjelasan,
.................................................. ....................................................
Subyek Survey NIM.
82
Pernyataan Persetujuan Setelah Penjelasan (PSP)
(Informed Consent)
untuk Menjadi Subyek
“SURVEY JENTIK NYAMUK DAN DAHAK PENDERITA TB PADA

BLOK KEDOKTERAN TROPIS MAHASISWA FK UNAIR
SEMESTER 3 TAHUN 2018/2019”
Yang bertanda tangan di bawah ini :

Nama : …………………………………………………… Usia : ................................................
Alamat : …………………………………………............................... .........................................
............................................................................................................................................
Menyatakan bahwa :
• Telah membaca / diberi penjelasan tentang : tujuan survey, prosedur yang dilakukan,
resiko dan ketidak nyamanan (fisik, psikologik, sosial), serta manfaat survey terhadap
subyek dan orang lain.
• Dan saya telah diberi kesempatan untuk menanyakan hal–hal yg belum jelas dan telah
diberikan jawaban yang memuaskan.
• Dengan ini saya menyatakan secara sukarela untuk ikut sebagai subyek dalam survey ini.
• Dan saya tahu bahwa saya berhak untuk mengundurkan diri dari survey setiap waktu.
Surabaya, ........................
Yang bersangkutan Saksi / Saksi–saksi
................................. .................................
Bila subyek buta huruf atau buta, maka pernyataan persetujuan dinyatakan dengan cap jempol
(kanan atau kiri) dan seorang saksi yang tidak terlibat dalam survey tersebut.
83

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GROUP REPORT

MODUL ILMU KEDOKTERAN TROPIS

FAKULTAS KEDOKTERAN UNIVERSITAS AIRLANGGA

Nabilah Paramitha 011711133015

CHAPTER I FIRST MEETING ................................................................................................ 1

1.1. Main Problem

Picture 1. Models of learning and recall

The following points concerning contact are of importance for children:

Whereas the condition is said to be negative smear pulmonary tuberculosis,

In cases of childhood TB, sputum examination is quite difficult to do especially for

b. Category -2 (2HRZES / HRZE / 5H3R3E3)

a. House component group:

Numerator : Number of new and relapse cases of TB in a specified time period.

Pict 2. Case Notification Rate Indonesia in 2008 until 2017

Picture 3. The prevalence of tuberculosis according to the characteristics of the social

2.2. Scenario Data Analysis And Scientific Information

Host Agent Environment

- Age - MDR - Close contact

3.1 Survey Questions

E. Riwayat Kesehatan dan Penyakit

4. Jika ada, TB apa?

III. Sikap Perilaku Pencegahan Penyakit TB

IV. Pertanyaan Praktik

VI. Umpan Balik

1. Berapakah jumlah pegawai di Puskesmas?

No. Pertanyaan Jawaban

B. Survey Results based on Questionnaire

21% Unemployment transmission of TB. Based on the data above,

Status Man Woman

 Less income = 3 respondents

C. Healthy Home Analysis

D. Analysis of Tanah Kali Kedinding Health Center’s Data

3. Number of Death Patients

5. The Amount of Successful Treatment in TB Patients

After sputum examination, 5

Host Agent - Environtment

Education about the risk Education about the

5.1. Final Hypothesis

5.2.3. Evaluation Plans

WHO. 2018. Tuberkulosis. [online]. Available in : https://www.who.int/tb/areas-of-

work/laboratory/contact-investigation/en/ [Accessed in 15 December 2017]

 Abstract and or Summary A (29)

 Introduction, background A (29-30)

Sample Tuberculosis Patient in Pacarkeling health

Sampling frame Tuberculosis Patient in Pacarkeling health

The suitable of design and objective of study : Suitable

III. Identitas Responden

E. Riwayat Kesehatan dan Penyakit

7. Apakah anda atau anggota keluarga anda memiliki riwayat alergi?

9. Jika ada, TB apa?

III. Sikap Perilaku Pencegahan Penyakit TB

IV. Pertanyaan Praktik

VI. Umpan Balik

22. Berapakah jumlah pegawai di Puskesmas?

No. Pertanyaan Jawaban

“SURVEY JENTIK NYAMUK DAN DAHAK PENDERITA TB PADA

Subyek Survey NIM.

“SURVEY JENTIK NYAMUK DAN DAHAK PENDERITA TB PADA