DOMESTIC ENVIRONMENT AND SOCIO-ECONOMIC FACTORS OF TUBERCULOSIS IN BANDUNG AND WEST TIMOR TITIK RESPATI GILARSI

ABSTRACT The study set out to examine whether there is any relationship between domestic environmental conditions and the prevalence of Tuberculosis in two districts in Indonesia, Bandung District and Timor Tengah Selatan (TTS) District. The data used to investigate the relationship between domestic environmental conditions and the prevalence of TB was selected from BES (Benefit Evaluation Study) survey data. BES was undertaken by Indonesia National Health Institute Research and Development and Indonesia Central Bureau of Statistic.

INTRODUCTION As large cities continue to sprawl, some age- old infectious diseases still remain as major health problems in both the developed and developing countries. Over several decades tuberculosis (TB) appeared to have been subdued but in the past decades it has reemerged with renewed intensity. Although National effort towards the elimination of TB started long before Independence Day in 1945, Indonesia hasn’t been able to control the disease. In Indonesia, tuberculosis is still the number one cause of death from infectious diseases.

Several researchers have suggested that poor living and socio-economic conditions are closely associated with TB transmission. However, there are limited studies showing this relationship between TB and the environment in Indonesia. Notwithstanding the lack of research data, observations and anecdotal evidence from the treatment of patients indicates that the domestic environment factors play an important role in the transmission and control of TB. These factors include the quality of housing, numbers of people in each house, the effectiveness of ventilation and the socio-economic status of the household unit.

Background Tuberculosis (TB) is still a major global health problem that claims more than two million lives per year and infects almost one third of the world population. It became so frightfully uncontrolled in some countries that in 1993 the World Health Organization declared TB to have the status of a global health emergency. In 1999 it was estimated that there were 8.4 million new cases, up from 8.0 million in 1997 (WHO, 2001a). Published research shows that 95% of TB cases occur in developing countries and 75 to 80% of them are people in their productive age group of years (MOH, 1999; Snider et al., 1994).

Indonesia is one the countries with the highest prevalence of TB in the world. It ranks third highest in the number of TB cases after India and China (MOH, 2000a). The prevalence for TB based on a survey in 1993 in 14 provinces was 0.2% % (MOH, 2001). In 1995, Indonesian National Household Health Survey estimated that TB is the number one cause of death from infection (National Annual TB Report, 2000). Tuberculosis cases in Indonesia are currently still high while in the other two countries it is declining. If this trend continues, Indonesia will become the number one country with the most number of TB cases.

Figure 2.2.Triangle of Environment, agent and host

Aims: To examine whether the relationship between domestic environmental conditions and the prevalence of Tuberculosis (TB) in Bandung District and Timor Tengah Selatan District. Design of the study This study used data from The Benefit Evaluation Study (BES) undertaken by Indonesia National Health Institute Research and Development and Indones ia Central Bureau of Statistic.

Figure 3.2 Map of Study area (Source: Modified MOH, 2001)

Result: Table 1. Overview of TTS and Bandung

Table 2. Sample Profiles

The Analysis of selected demographic variables with TB prevalence. Table 3. Selected Chi squared results from cross tabulation of TB prevalence with selected demographic variables.

Table 4. Risk Estimates of TB prevalence with selected demographic variables.

The Analysis of Selected Domestic Environmental Factors and TB Prevalence Number of bedroom and number of bedroom with window and ventilation, household density and bedroom with window and ventilation density were variables analyse to show type of housing and living conditions. These were analyzed to determine the relationship between the variables and the difference between cases and non cases of TB. The findings are presented in Table 5.

Table 5. Selected Chi squared results from cross tabulation of TB prevalence with selected domestic environmental factors.

Table 6.Risk Estimates of TB prevalence with selected housing variables.