Peningkatan penemuan 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

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

Development • TB Care I• KNCV