IDENTIFICATION AND EXPLORATION OF FACTORS THAT CONTRIBUTE TO THE LOW RATE OF TUBERCULOSIS CASE DETECTION IN KELURAHAN CIPINANG, EAST JAKARTA

Pasaribu, Luxi Riajuni (2012) IDENTIFICATION AND EXPLORATION OF FACTORS THAT CONTRIBUTE TO THE LOW RATE OF TUBERCULOSIS CASE DETECTION IN KELURAHAN CIPINANG, EAST JAKARTA. Project Report. Pusat Penelitian dan Pengembangan Biomedis dan Teknologi Dasar Kesehatan.

Abstract

This research identifies and explores factors that contribute to the low detection rate by investigating whether there were economic, social, and cultural circumstances impacting on the community, health system and practice of TB Case Detection conducted by health providers in the area. The study also identified the reason for missing and delayed cases. This research was conducted in Kelurahan Cipinang in East Jakarta, a particularly endemic area with a low TB Case Detection Rate. The domestic environments of the respondents have also been investigated to identify whether there was any relationship with the problem. This research applied case study method to address the research questions. The study participants were 13 community people which included patients, suspected TB persons, relapsed TB persons, housewife, teachers, and health cadre; 6 formal and informal community leaders; and 3 health providers of Kelurahan Cipinang and Puskesmas Kelurahan Cipinang. The data was collected by in-depth semi-structured, individual interviews, the researcher investigated "how" or "why" questions and events that were not controlled or behaviours that could not be manipulated in the current phenomena of the case in their natural context. This research found several factors that contribute to the low rate of TB case detection in Kelurahan Cipinang, East Jakarta. The major problem found was the poverty in the community. These poor people experience social, physical, psychological, and behavioural disadvantages that were linked to each other and relevant to the research questions. The social circumstances that were found in the community were lack of education, the religious and cultural beliefs, homelessness, poor quality of housing, bad water and sanitation of the canal, and no money for transport, for the registration fee at the Puskesmas, and for the laboratory examination fee. The physical circumstances that were found in the community participants were: poor nutrition, TB symptoms, and emaciated. The psychological circumstances that were found in the community were low self-worth, stress, anxiety, stigma, and no family support. The behavioural circumstances that occurred were delaying visiting the Puskesmas, seeking help from friends, smoking, gambling, and drugs. Meanwhile, the Puskesmas had problems in implementing the DOTS strategies especially of microscopic examination. They did not have adequate infrastructure and facilities to provide accurate examination and to have safe work environment. Inadequate training for health providers also had lead to a lack of teamwork between staff of the Puskesmas. Lack of communication between health providers and community leaders contributed to the lack of political commitment in the system and practice of DOTS including the TB Case Detection. Strategies are recommended to address the problems and to alleviate the poverty. These recommendations are likely to be very successful because they were developed from the suggestions made by participants.

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