kasus TB melalui rujukan tersangka TB oleh bidan desa di Kabupaten Siak Suyanto, Dwi Sri Rahayu , Winarto , Fifia Chandra , Doni Pahlevi , Muhammad Noor Farid Sumanto Simon , Budiarti Setyaningsih , Eka Sulistiany Parade Riset TB Nasional. Jakarta, 11-12 Maret 2015
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Peningkatan penemuan kasus TB melalui rujukan tersangka TB oleh
Budiarti Setyaningsih , Eka Sulistiany Parade Riset TB Nasional. Jakarta, 11-12 Maret 2015
IntroductionInsufficient TB case finding situation
In Riau province, the case detection rate (CDR) has not reached the national target of 70%.
Districts the number of estimated new infectious tuberculosis cases
the number of new smear-positive
Case Detection Rate
Pelalawan 518 316 61
Kota Dumai 435 251 57.7
Rokan Hulu 814 368 45.21
Kuantan Singingi 501 213 42.51
Rokan Hilir 949 373 39.3
Bengkalis 855 294 34.39
Indragiri Hulu 623 186 29.86
Kepulauan Meranti 302 78 25.83
Kota Pekanbaru 1539 362 23.52
Kampar 1180 275 23.31
Siak 646 138 21.36
Indragiri Hilir 1135 160 14.1
Passive case Finding
TB BTA
+
Suspect
Research Purpose:
To asses midwife potential impact to increase the detection of tuberculosis cases.
Quasi Experiment PrePost Test Disaign
ControlPre
Control Post
Intervention Pre
InterventionPost
n=50
n=52
Random Sampling
ControlPre
Control Post
Intervention Pre
InterventionPost
From Mei up to Oktober
2013
The Record of suspect number
referring to Puskesmas
TB training Research Formulir Socialisation
November 2013
Desember-Juni 2014
Intervention Group Activities
• TB Building Capacity Training among village midwife in identifying patient with TB symptoms (Suspects)
• Suspects were referred by village midwife to Puskesmas for free sputum examination.
• Provide ongoing mentoring and support by phone and field visit
Control Group Activities
• Suspects were referred by village midwife to Puskesmas for free sputum examination.
• Provide support by phone and field visit
Data Collection
• Form• Data Dinas Kesehatan• Observation and
Interview
ANALIZE METHOD
• Descriptive• Regression
– Multiple linear regression untuk analisis perbandingan rata-rata jumlah tersangka per desa
– Multiple poisson regression untuk analisis perbandingan proporsi:
• tersangka yang dirujuk oleh bidan• tersangka yang memeriksakan dahak• tersangka yang BTA positif
RESPONDENTS CHARACTERISTICS
Table 2. Characteristics of intervention and control midwives (n
= 102)
Characteristics Intervention Group Control Group P value
Age,years-mean (SD) 31.1 (+4.9) 31.6(+5.4) <0.05
Length of working experience, year-mean(SD) 7,5 (+ 4,3) 7,1 (+ 5,46) <0.05
Distance from village to Puskesmas,kilometer-mean(SD) 9,1 (+ 10,3) 12,4 (+ 11,7) >0.05
Proportion of Midwive Diploma,% 96.4% 96.4% <0.05
Proportion of Previous TB Training Experience,% 1.75% 3.64% <0.05
The knowledge scores pre training,point-mean(SD) 72,3 (+ 14,7) 67,9 (+ 11,0) >0.05
The knowledge scores post training,point-mean(SD) 80,4 (+ 7,3) <0.05
P-values were calculated using Pearson's chi-squared test or Fisher's exact test for categorical variables and t-test or Mann–Whitney U-test for continuous variables.
ANALIZE OF NUMBER AND AVARAGE SUSPECT REFFERING BY MIDWIFE
Number of TB Suspect
POSTPRE
DIFF 27
DIFF 184
DIFF 157
Teble 3. The mean difference of suspect referred in each village pre and post of research time
Group ResearchTime
Mean of suspect
SE 95% CI
Control Pre 2.6 2.4 0 – 7.2
Post 3.1 2.4 0 – 7.7
Difference 0.5 3.3 -6.1 – 7.0
Intervensi Pre 9.9 2.4 5.2 – 14.6
Post 13.3 2.4 8.6 – 18
Difference 3.3 3.4 -3.3 – 10.0
The mean difference
2.8 4.8 -6.5 – 12.2
ANALYZE PROPORTION OF SUSPECT REFERRED
DIAGRAM CONSORT
Table 4 Referral and Sputum examination rates in the control and intervention group after implementation
of intervention measures
Registered Referred TB Referral rate Referral arrival
Sputum examination rateTB suspects suspects
n n % n %A B C D E
Before Control 147 ? ?
Intervention 545 ? ?
After Control 174 73 41.90% 43 58.90%
Intervention 729 133 18.20% 106 79.70%
Table 5. Positive BTA smear examination rate
VARIABELKELOMPOK
KONTROL INTERVENSIn % n %
Suspect getting sputum examination
43 100,0 106 100,0
Positive BTA smear 8 18,6 21 19,8
Table 6. The Comparison of Ratio Proportion on Control and Intervention Group
Ratio SE P-value 95%CI
Proportion of suspect referred by midwife
0.44 0.06 0.00 0.33 – 0.53
Proportion of suspect getting sputum examination
1.83 0.43 0.011 1.15 – 2.91
Proportion of BTA positive examination result
1.1 0.4 0.88 0.5 – 2.4
Absolute of BTA positive examination result
2.5 1.0 0.028 1.1 – 5.6
Conclusion
Referral of patients with TB symptoms by village Midwife to Puskesmas is an effective way of increasing detection.
Acknowledgements
• We thanks to the Ministry of Health• Siak’s Midwife involved for their active
participation.• United States Agency for International