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Relationship between house environmental factors and tuberculin skin

test among elementary school students

M. Hidayat, M. Lubis & I. Fudjiati

Departments of Child Health Medical School, Faculty of Medicine Universitas Sumatera Utara, Medan, North
Sumatera, Indonesia

ABSTRACT: Introduction: Tuberculosis is a major cause of death in the world. The increasing TB cases can
be affected by population density, temperature, ventilation, lighting, and humidity. Tuberculin Skin Test (TST)
is a tuberculosis diagnostic test with sensitivity and specificity of 90% and can be used to detect children who
infected with tuberculosis.
Methods: A cross sectional study was conducted among elementary school students in Singkuang Village,
North Sumatera on April 2016
Results: Univariate analysis showed that the relationship between ventilation, residential density, temperature
and TST was statistically significant (P=0.006, 0.001, 0.005 respectively). Bad ventilation was associated with
higher risk in positive TST of PR=4.6 (95% CI= 1.43-14.70), while bad temperature of PR=8.8 (95% CI= 3.34-
22.85), and residential density of PR= 9.4 (95% CI =1.33-66.49).
Conclusion: There is a relationship between house environmental factors and TST among elementary school
Keywords: tuberculin skin test, environmental factors, students

1 INTRODUCTION for Mandailing Natal area, TB cases in 2011 was 961

cases consisting of 956 new cases and 5 old cases.
Tuberculosis (TB) is caused by Mycobacterium tu- Number of Pulmonary TB cases with BTA (+)
berculosis which is still the main cause of death in the reached 853 cases.(3)
world. By 2014, it is estimated that 9.6 million people Research in 2006 in Banyumas District concluded
worldwide suffer from TB and cause 1.5 million that there is an association between pulmonary tuber-
deaths annually, with an estimated 1 million children culosis with lighting, dwelling density, ventilation,
suffering from TB and 140,000 cases of deaths among the existence of bedroom windows, floor type, sleep-
children in the world.(1) ing room division, wall type, outside humidity, out-
Indonesia is ranked the 3rd country with the highest door temperature, patient contact and status nutri-
incidence of TB in the world as many as 1 million tion.5
new TB cases per year after Africa, and India, where The results of the research in 2007 in Paseh Vil-
there is an incidence of doubling compared to lage Sumedang District concluded that there is a rela-
2014.(1) It is estimated that TB prevalence rate in In- tionship between variable humidity of the house, den-
donesia is 297 per 100,000 population with cases only sity of house occupants, the area of house ventilation
annually reaches 460,000 cases. (2) and home lighting with the incidence of tuberculosis
In North Sumatra Province, the incidence of pul- in children.6
monary TB is 21,145 people, with the result of new The results of the above two studies differ from
case finding coverage of 17,459 cases or 82,57%. those conducted in Pinolosian Bolaang Mongondow
This figure has increased when compared with the district south in 2012, which stated that ventilation
year 2011 that is 76.57% and 2010 is 68.86%. Based conditions did not have a significant relationship with
on the survey, Medan city is the biggest sufferer com- the incidence of pulmonary TB.7
pared to the population of each regency / city, while
Tuberculin Test / Tuberculin Skin Test (TST) is a Positif 14 28
relevant tuberculosis diagnostic test, with a sensitiv- Negatif 36 72
Total 50 100
ity and specificity of 90%. Based on tuberculin test
results, we can find the tuberculin index as a guide to Tabel 2. Prevalence ratio of home environmental factors
determine the level of tuberculosis infection so as to Risk factor PR P (CI 95%)
measure the prevalence of tuberculosis infection and Ventilasi 4.66 0.005 (1.481-14.709)
ARTI (Annual Risk of Tuberculosis Infection) in Suhu 8.86 0.001 (3.438-22.850)
children.8,9 Kepadatan 9.34 0.005 (1.33-66.490)
Based on the background presented, to confirm
previous research, the researchers are interested to ex- 4 DISCUSSION
amine the relationship between environmental factors
with tuberculin test results in elementary school chil- This study showed that the percentage of low birth
dren. weight was higher than normal birth weight in
elementary school children in Singkuang village.
2 MATERIALS AND METHOD Previous research in Nepal has a relatively high
prevalence of LBW, ranging from 14% to 32% .
2.1 Population and Sample (Maleqpour, 2004) The Ministry of Health of the
Republic of Indonesia states that there has been an
The target population in this study was elementary increase in the prevalence of LBW from 2005 by 24.3
school age children. The affordable population in per 1000 live births and in 2006 to 25.9 per 1000
this study is elementary school-aged children in births life. One of the main causes of high infant
Singkuang Village. The study sample was an mortality is low birth weight or LBW (<2500 gram).
affordable population that met the inclusion criteria. One effort done in tackling the problem of LBW is to
The sample is selected by Consecutive Sampling assess the condition of the mother and various factors
technique that affect the condition when pregnant. In general,
the level of education is a factor that affects birth
2.2 Data analysis weight, because the level of education can describe a
person's level of knowledge about a matter related to
Data analysis by chi-square to determine the relation- health maintenance. (Adi et al, 2015)
ship between categorical variables with significance The study also found that the majority of children
level at p <0,05 and have an underweight body mass index. In 2010, 3.7
million elementary school children with underweight
3 RESULT body mass. The majority of BMT underweight can be
caused by risk factors from the development of body
The study was conducted in Singkuang Village, Man- mass, one of which is the problem of malnutrition is
dailing Natal Regency, North Sumatera. The total also higher in low income communities than people
sample included in this study was 50 children accord- who have high incomenya. The nutritional
ing to inclusion and exclusion criteria. The female sex deficiencies found in primary school children are lack
slightly dominates with the proportion of 54 %. of protein and less nutritional problems can not be
The study also found that the majority of children overcome, especially in primary schools in poor and
have negative tuberculin test. The relationship be- underdeveloped areas. A person's nutritional
tween ventilation, residential density, temperature knowledge level affects attitudes and behaviors in
and TST was statistically significant (P=0.006, 0.001, choosing foods, which determine whether or not a
0.005 respectively). Bad ventilation was associated person understands the nutritional benefits of the food
with higher risk in positive TST of PR=4.6 (95% CI= consumed. (Yudesti & Prayitno, 2013)
1.43-14.70), while bad temperature of PR=8.8 (95% This study shows the association of birth weight
CI= 3.34-22.85), and residential density of PR= 9.4 with cognitive function in elementary school children
(95% CI =1.33-66.49). in Singkuang village. The result of statistical test with
Chi-square test get P value = 0.0001 which shows
there is significant correlation between birth weight
with cognitive function in elementary school children
in Singkuang village. One of the effects of LBW is
the slow growth of children seen in weight gain that
Tabel 1. Percentage of house environmental factors does not reach normal levels when they are one year
Classification Tuberkulin Percentage old. In addition, LBW is very susceptible to
test (%) (%) deficiencies and disturbances in the balance of
various nutrients, making it susceptible to permanent Dinas Kesehatan Propinsi Jawa Tengah.Pertemuan Sosialisasi
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