PAPER OF ANALYZING TUBERCULOSIS ACCORDING

TO H.L BLUM THEORY

Supporting Lecturer :

Arum Siwiendrayanti, S.K.M, M.Kes.

Arranged by :

1. Zalzala Nur El Fauziah ( 6411419093 )

2. Regina Marsha Nathaniela ( 6411419098 )
3. Annisa Putri Salsabila ( 6411419101 )
4. Adam Anursa Ramadhani ( 6411419102 )
5. Roro Trias Pungkasari ( 6411419124 )

BASIC OF PUBLIC HEALTH SCIENCE

SEMARANG STATE UNIVERSITY
2019
Chapter 1 : Tuberculosis

1.1 Definition

Tuberculosis or TB is a contagious infection that usually attacks the lungs. It can also
spread to other parts of the body, like the brain and spine.Tuberculosis is caused by a type of
bacteria called Mycobacterium tuberculosis. A tuberculosis infection doesn’t mean you’ll get
sick, but there are two forms of the disease :

Latent TB : the germs are in the body, but the immune system stops them from
spreading. That means latent TB don’t have any symptoms and that
person is not contagious. But the infection is still alive in the body and
one day it become active.

Active TB disease : the germs multiply and can make someone sick. This active TB disease
can spread to others. Ninety percent of adult cases of active TB are from
the reactivation of a latent TB infection.

1.2 The Symptoms

There aren’t any symptoms for latent TB, so it need a skin or blood test to find out does
it infected or not. But there are usually signs if you have active TB disease. They include :

 A cough that lasts more than 3 weeks

 Chest pain
 Coughing up blood
 Feeling tired all the time
 Night sweats
 Chills
 Fever
 Loss of appetite
 Weight loss
1.3 Spread of Tuberculosis

Tuberculosis spread through the air, just like a cold or the flu. When someone who’s
coughs, sneezes, talks, laughs, or sings, tiny droplets that contain the germs are released. If
someone breathe in these nasty germs, that person get infected. It happen when someone
usually spend a lot of time around a person who has a high load of bactilli in their lungs. That’s
why it’s often spread among co-workers, friends, and family members. But tuberculosis germs
don’t thrive on surfaces. Some people can’t get the disease from shaking hands with someone
who has it.

1.4 Treatment

a. Treatment for Latent TB.

Depending on your risk factors, latent TB can re-activate and cause an active
infection. These are the three treatment options:

 Isoniazid (INH)
This is the most common therapy for latent TB. You typically take an isoniazid
antibiotic pill daily for 9 months.
 Rifampin (Rifadin, Rimactane)
You take this antibiotic each day for 4 months. It’s an option if you have side effects
or contraindications to INH.
 Isoniazid and rifapentine
You take both of these antibiotics once a week for 3 months under your doctor’s
supervision.

b. Treatment for Active TB

If a person have this form of the disease, that person need to take a number of
antibiotics for 6 to 9 months. These four medications are most commonly used to treat it:

 Ethambutol (Myambutal)
 Isoniazid
  Pyrazinamide
 Rifampin

Doctor may order a test that shows which antibiotics will kill the TB strain. Based on
the results, someone have to take three or four medications for 2 months. Afterward, you’ll
take two medications for 4 to 7 months.

c. Treatment for Drug-Resistant TB

If person have a TB strain that doesn’t respond to the usual medications used to
treat TB, that person have a drug-resistent strain. This means that person will be treated
with a combination of second-line drugs for a longer period of time, which may be less
effective.

1.5 Prevention

As with all health conditions, prevention of TB is always better than a cure. Here are
sone tips to prevent tuberculosis :

- The BCG vaccination

The BCG (Bacille Calmette-Guérin) is a live vaccine against tuberculosis. The BCG is
currently the only licensed vaccine against TB, and has been in use since 1921. The vaccine
is prepared from a strain of the weakened bovine tuberculosis bacillus, Mycobacterium
bovis.

- Early diagnosis

Early diagnosis and treatment is the most effective way to prevent the spread of
tuberculosis. A person with infectious tuberculosis can infect up to 10–15 other people per
year. But once diagnosed with TB, and started on treatment, the majority of patients are no
longer infectious after just two weeks of taking the medication.

- Case finding

Limiting the spread of TB can be done through raising awareness of TB, so people with TB
symptoms know to seek help. Outreach workers and volunteers also work within
communities with high rates of TB to find people with symptoms and refer them for testing.
When someone is diagnosed with infectious TB, their close contacts are screened for the
illness which known as contact tracing.

- Managing your environment

As TB is an airborne infection, TB bacteria are released into the air when someone with
infectious TB coughs or sneezes. The risk of infection can be reduced by using a few simple
precautions :

 Good ventilation
because TB can remain suspended in the air for several hours with no ventilation
 Natural light
UV light kills off TB bacteria
 Good hygiene
covering the mouth and nose when coughing or sneezing reduces the spread of TB
bacteria.

- A healthy immune system

Having a healthy immune system is the best form of defence against TB: 60% of adults
with a healthy immune system can completely kill TB bacteria.
Chapter 2 : H.L Blum Theory

According to Hendrik L Blum there are 4 factors that affect the status of the level of
public or individual health. These factors can be described as follows:

2.1 Behavior

Behavior is the first factor that influences the degree of public health because healthy
or unhealthy health environment of individuals, families and communities is very dependent
on human behavior itself. In addition, it is also influenced by habits, customs, beliefs, socio-
economic education, and other behaviors attached to him.

2.2 Environment

The environment is very varied, generally classified into three categories, namely those
related to physical, biological, and social aspects. The environment is related to physical
aspects, for example garbage, water, air, soil, science, housing, and so on. Biological aspects,
for example animals, rheumatic bodies, plants. Whereas the social environment is the result of
human interaction such as culture, education, economics, and so on

2.3 Health services

Health care is the third factor that influences the degree of public health because the
existence of health facilities is crucial in health recovery services, prevention of disease, and
the treatment and nursing of groups and communities. The availability of facilities is influenced
by the location, health service providers, information and community motivation to come to
the facility in obtaining services and the health service program itself whether it is in
accordance with the needs of the people who need it.

2.4 Heredity

Heredity (genetic) is a factor that has existed in humans who are brought from birth, for
example from hereditary diseases such as diabetes mellitus and bronehial asthma.

Four factors interact with each other that affect individual health and community health
status. Among these factors the human lifestyle factor is the biggest and most difficult
determinant factor, followed by environmental factors. Because the human environment is also
very influenced by people's lifestyles.
Chapter 3 : The Analysis

3.1 Based on the Behaviour Factor

There are some behaviour factors that affects Tuberculosis disease,

a. Smoking
Smokers have a 2-3 times higher risk of suffering from tuberculosis. Smoking
can fall out the vibrating hairs in our respiratory tract. Even though, vibrating hairs'
function are to reject dust or foreign particles that enter with the air. Other than that, the
Tuberculosis germs also can easily enter our bodies, so the person will be positively
affected by tuberculosis.

b. Not eat nutritious foods

Malnutrition is a risk factor for tuberculosis. Food is vital for humans, and
Tuberculosis is very easy to attack people who have low endurance. For example, a
source to get endurance is protein that is the raw material for antibody formation. So, if
we have enough endurance in our body, we can reduce the risk of infected tuberculosis.

c. Behaviour of spitting carelessly

Tuberculosis is a disease that can be transmitted through saliva. If a person with
Tuberculosis spits in any place randomly and carelessly, there is more bigger risk of
transmitting the disease to others than if they spits in a place that should be.

d. People's behaviour share drinks with the same straw or bottle.

Sharing drinks with the same straw or bottle can increase the risk of infection
with Tuberculosis. Because if we share drinks with people with tuberculosis, we
automatically will definitely be infected, given that this disease can be transmitted
through saliva.

3.2 Based on the Environment Factor

The importance of counseling about the physical environment of the house, especially
houses that are densely populated, ventilated, floor types and types of walls that do not meet
the requirements to prevent pulmonary TB disease. Besides ventilation or windows must
always be open every day, especially in the morning so that sunlight can enter the house to kill
tuberculosis germs and increase immunity against M. Tuberculosis through the activation of
vitamin D with the help of sunlight.
Patients with pulmonary TB must maintain contact with their healthy family,
temporarily reduce contact with other families during treatment to prevent transmission to
family members, especially vulnerable groups, infants and the elderly. Families of pulmonary
TB sufferers must be given an understanding that their families suffering from pulmonary TB
should always be tried in a place that has adequate air ventilation, waterproof walls and floors
and good lighting to reduce the risk of pulmonary TB disease severity.

3.3 Based on the Health Services Factor

Tuberculosis Treatment
TB can be detected through sputum examination. Some other tests that can be done to
detect this infectious disease are chest X-ray, blood test, or skin test (Mantoux).

a. Treatment for Latent TB.

Depending on your risk factors, latent TB can re-activate and cause an active
infection. These are the three treatment options:

 Isoniazid (INH)
This is the most common therapy for latent TB. You typically take an isoniazid
antibiotic pill daily for 9 months.
 Rifampin (Rifadin, Rimactane)
You take this antibiotic each day for 4 months. It’s an option if you have side effects
or contraindications to INH.
 Isoniazid and rifapentine
You take both of these antibiotics once a week for 3 months under your doctor’s
supervision.

b. Treatment for Active TB

If a person have this form of the disease, that person need to take a number of
antibiotics for 6 to 9 months. These four medications are most commonly used to treat it:
  Ethambutol (Myambutal)
 Isoniazid
 Pyrazinamide
 Rifampin

Tuberculosis Caring
Health services for people with tuberculosis is now very easy to get because almost all
regions have a health center or hospital in addition to that health workers are now trained to
handle tuberculosis cases. Beside that, the government has also prepared a DOTS (Directly
Observed Treatment, Short-course) program that will help patients get treatment for free. For
TB patients who have already checked into a puskesmas or hospital and received medicine can
continue treatment at home, but this must be under the supervision of the PMO or the supervisor
taking medication. Because TBC treatment requires a very long time and should not be
interrupted so the risk to drop out and have to repeat again is high. PMO also Give
encouragement to patients to want regular medical treatment, provide counseling to family
members of TB patients who have suspicious symptoms of TB to immediately go to the Health
Care Unit.

3.4 Based on the Heredity Factor

In some countries, people do not have clear knowledge so that knowledge about the
spread of tuberculosis is still confusing. As a result many people believe that TB is hereditary
or can be spread through food and water. In developing countries a major effect of the resulting
stigma and discrimination can be the social isolation of patients, both within and outside of the
family. Within the family the patient may be forced to eat and sleep separately because of the
fear of transmission. Patients may even isolate themselves to avoid infecting others. There are
also myths about how TB can be cured. In 2019 the Chief Minister of Uttarakhand in India,
said that living in close proximity to a cow could cure a person of tuberculosis, which of course
it can't.

Actually, there are several factors that cause people to be more susceptible to TB
infection. At the global level, the most important risk factor is HIV. This problem is common
in sub-Saharan Africa, which has high HIV value. Tuberculosis is closely related to excessive
dense population and malnutrition which makes TB one of the main poverty diseases. People
who have a higher risk of TB include people who inject drugs, residents and employees of
places that support it, vulnerable people like prisoners and homeless shelters, poor people who
do not have access to health care adequate, high-risk ethnic minorities, and health workers
serving these people. Chronic lung disease is another important risk factor. Silicosis increases
the risk up to 30 times greater. People who smoke have double risk of TB than people who do
not smoke. The presence of certain diseases can also increase the risk of developing
Tuberculosis, including alcoholism / alcoholism and diabetes mellitus (the risk is tripled).
Although genetic vulnerability can also have an effect, researchers have not yet explained the
extent of its role.

But based on the gene studies, there is strong evidence that host genes influence
individual susceptibility to tuberculosis. Thus far, however, the identity of the genes involved
has remained elusive. Complementary strategies to find these genes include a genome wide
linkage screen and association based candidate gene studies. Although candidate gene studies
may identify the actual genes involved in the development of tuberculosis, linkage will simply
identify the chromosomal location of the genes.