ABSTRACT RISK FACTOR OF TUBERCULOSIS COINFECTION TO THE HIV/AIDS VICTIM AT LABUANG BAJI HOSPITAL MAKASSAR IN 2014 By Sri Syatriani and Musdalifah STIK Makassar, Indonesia
Introduction Tuberculosis (TB) is an opportunistic infection disease which occurred most often to the HIV infection. Nowadays, coinfection HIV – TB is the main causal factor of mortality in the world caused by this infectious agent. Objectives The research aims to acknowledge the risk factor of smoking history, alcohol consumption history and nutrition status on the TB coinfection to the HIV/AIDS victims at Labuang Baji Hospital Makassar. Methods The research is analytical observational research with case-control design. The sampels are divided into two, they are 23 cases and 46 controls, so the total respondents are 69 people. The sampling acquisition is using Accidental Sampling. Result The research result shows that the risk of smoking history to the TB coinfection with the level of trust reaching 95% gained OR value = 5,6. The risk of alcohol consumption to the TB coinfection with the leve of trust reaching 95% gained OR value = 2,91 and the risk of nutition status to the TB coinfection with the level of trust 95% gained OR value = 5,65.
Conclusion The conclusion is that smoking history and nutrition status are the risk factor of TB coinfection, while alcohol consumption history is meaningless factor to TB coinfection. The suggestion is the necessity of strategic and better health service to improve the control of TB to HIV/AIDS victims. Keywords: TB Coinfection, HIV/AIDS, smoking history, alcohol consumption history and nutrition status.
ABSTRAK FAKTOR RISIKO KEJADIAN KOINFEKSI TB PADA PENDERITA HIV/AIDS DI RSUD LABUANG BAJI MAKASAAR TAHUN 2014
Sri Syatriani1 dan Musdalifah1 Sekolah Tinggi Ilmu Kesehatan (STIK) Makassar, Indonesia
Introduction Tuberkulosis (TB) merupakan penyakit infeksi oportunistik yang paling sering dijumpai pada infeksi HIV. Koinfeksi HIV-TB sekarang ini merupakan penyebab mortalitas utama di dunia dikarenakan oleh agen infeksius tersebut. Objectives Penelitian bertujuan untuk mengetahui faktor risiko riwayat merokok, riwayat mengkomsumsi alkohol dan status IMT terhadap kejadian Koinfeksi TB pada penderita HIV/ASID di RSUD Labuang Baji Makassar.
Methods Penelitian adalah penelitian observasional analitik dengan rancangan case control. Sampel dibagi menjadi dua yaitu kasus dan kontrol sebesar 23 kasus dan 46 kontrol sehingga total responden sebanyak 69 orang. Pengambilan sampel dilakukan dengan menggunakan teknik Accidental Sampling.
Result Hasil penelitian menunjukkan bahwa risiko riwayat merokok terhadap kejadian Koinfeksi TB dengan tingkat kepercayaan 95% diperoleh nilai OR =5,6 ,risiko riwayat mengkomsumsi alkohol terhadap kejadian Koinfeksi TB dengan tingkat kepercayaan 95% diperoleh nilai OR = 2,91dan risiko stasus IMT terhadap kejadian Koinfeksi TB dengan tingkat kepercayaan 95% diperoleh nilai OR =5,65.
Conclussion Kesimpulan Riwayat merokok merupakan faktor risiko kejadian koinfeksiTB, riwayat mengkomsumsi alkohol merupakan faktor risiko tidak bermakna dengan kejadian koinfeksi TB, Sedangkan status IMT merupakan faktor risiko kejadian koinfeksi TB. Saran Diperlukan suatu strategi pelayanan kesehatan yang lebih baik untuk meningkatkan pengendalian dan pencegahan TB pada pasien HIV/AIDS.
Keyword : Koinfeksi TB dan HIV/AIDS, riwayat merokok, riwayat mengkomsumsi alkohol, status IMT
INTRODUCTION HIV or Human Immunodeficiency Virus is a virus attacking white blood cell inside the body (limfosit) that cause the decrease of human immune. People who have HIV in their blodd may look healthy and not needing treatment. However, those people can spread the virus to other people by having risky sexual intercourse and sharing injection tools with other people. Acquired Immunodeficiency (AIDS) is a compilation of disease symdroms caused by the decrease of human immune by HIV infection which is a RNA virus and included in family Retroviridae. As the body immune getting worse, those people with HIV start to show syndroms caused of opportunistic infection, that is infection caused by microorganism which usually not causing serious disease to a healthy man. Many kind of opportunistic infection can occur in any good organ, whether it is the digestion system, breathing system, nerves system or purifier or other organ. These various opportunistic infection can be vary from bacteria, virus, fungus, parasite or else. The speed of HIV spreading in the world reaching 16 thousands people per day and Indonesia is the fastest in Asia. According to PPM & PL Health department of Indonesia stated that the number of HIV cases in Indonesia (January – March 2012) reaching 5,991 cases, while new cases of AIDS are 551 cases, mostly in 300 cities in 32 provinces. The proportion of the highest HIV is at the age of 25-49 years old, then age 20-24 and the age group > 50years. The highest HIV cases proportion is reported on the age group 30-39 years old, followed by the age group 20-29 years old and the age group of 40-49 years old. Tuberculosis (TB) is a contagious disease caused by the germ Mycobacterium tuberculosis. The tuberculosis disease is still a global health problem and it is the second cause of death after HIV. WHO is predicting that in 2011 there are 8,7 million new cases of TB (13% is a coinfection to HIV) and 1,4 million people died because of tuberculosis (WHO, 2012). Riskedas report shows that in 2010 TB prevalence in Indonesia is 0,725%. TB prevalence tend to increase based of the age. Based on the sex, female is higher than male. Based on living area, countryside is higher than city and based on educational level, lower educational lever is higher than the high educational level (Health department RI, 2010). TB coinfection often happens to people with HIV, and more than 25% of HIV carrier caused by TB. People with HIV are 30 times riskier to have TB compared to people without HIV infection. As a respond to the double epidemic for HIV and TB, WHO is recommending 12 collaborative activities of HIV / TB in which one of them is a profilaxis with Isoniazid (INH preventive therapy / IPT). When the HIV/AIDS epidemic increases, TBC is one of the death cause and also coinfection occurred to HIV/AIDS patients. Indonesia is included as a country with the high load of TB, with 189/100.000 incidents and prevalence 289/100.000 people in 2010. The surveys from health ministry of Indonesia in 2011 shows that HIV prevalence to the risky population is 1-14%. TB coinfection often happens to people with HIV and more than 25% of death to HIV carrier are caused by TB. HIV carrier is 30 times riskier to have TB compared to those people without HIV.
HIV and AIDS infection cases is increasing as the growth of high mortality. TB infection spread widely in the HIV patients around 10-25%. Based on the medical data recorded in Labuang Baji Hospital, the number of HIV / AIDS carrier increase to 88 and those who are infected with TB are 25 people. Research Method The research is held in Labuang Baji Hospital Makassar. The research design used is case control to identify the rate of smoking history risk, alcohol consumption history risk and the nutrition status. Samples are divided into two groups, they are: a. Cases of patients who visit Labuang Baji hospital Makassar and be claimed to have TB coinfection with HIV/AIDS, there are 23 people. b. Control in which patients who visit Labuang baji hospital and be claimed not to have TB coinfection with HIV/AIDS. The primary data is collected through questionnaire by interviewing the respondents. The secondary data is taken from the local institution, that is Labuang Baji Hospital. Results and Discussion Univariat Analysis Characteristic of Research Variable Table 1. Characteristic of Research Variable Case
Control %
Characteristic of Research Variable Smoking History a. Smoking b. No Smoking
N
%
n
21 2
91,3 8,7
30 16
65,2 34,8
Alcohol Consumption History a. Consume b. No Consume
21 3
91,3 8,7
36 10
78,3 21,7
Nutrition Status a. Occur b. Good
19 4
82,6 17,4
21 25
45,7 54,3
Sumber : Data Primer Univariat analysis is done to get the general ideas by describing the respondents variables used in the related research with the TB coinfection to HIV/AIDS carrier.
The research results show that TB coinfection event to the HIV/AIDS respondents at Labuang Baji hospital, 91,3% of them are smoking patients in cases group, while on control group there are 34,8% respondents who do not smoke. Based on the research results show that TB coinfection to HIV/AIDS respondents at Labuang Baji Hospital in the cases group are 91,3% of them consume alcohol and within the control group, 78,3% of them also consume alcohol. The research results show that TB coinfection to the HIV/AIDS respondents at Labuang Baji hospital, in which the most cases occur 82,6% with nutrition status (<18,5) and within the control group, respondents with good nutrition status are 54,3% (18,522,9). Bivariat Analysis a. Smoking history to TB coinfection From the interview with respondents, it is acknowledged that there are respondents who used to smoke but then tried to consume less or even quit smoking after being convicted for HIV/AIDS. There are also respondents who were only trying to smoke for fun. Table 2 Risk Factor Smoking History with Coinfection TB-HIV/AIDS RSUD Labuang Baji Makassar
Smoking History
Coinfection TB Cases Control n % n %
n
%
Smoking
21
51
73,9
91,3
30
65,2
CI 95%
Total OR
LLUL 1,16 5,6
No Smoking
2
8,7
16
34,8
18
26,1
Total
23
100
46
100
69
100
26,98
Source: Primary Data Based on the odds ration with the level of trust reaching 95%, gained OR value = 5,6 with lower limit value (LL) = 1,16 and upper limit value (UL) = 26,98. Because of the value in LL and UL covering the value of A, then statistically it is said that the hypothesis is accepted. The interpretation of bivariate analysis between smoking history and Tb coinfection is that respondents who smoke are 5,6 times riskier to have TB coinfection compared to those respondents who do not smoke. Therefore, we can conclude that smoking history is a risky factor of having TB coinfection and have meaningful relationship.
b. Alcohol consumption history to TB coinfection From the interview, it is acknowledged that there are respondents who used to consume alcohol but then tried to consume less or even quit consuming alcohol after being convicted for HIV/AIDS. There are also respondents who were only trying to consume alcohol for fun or simply because being asked by their colleagues. Table 3 Risk Factor Alcohol Comsuption History Koinfection TB-HIV/AIDS RSUD Labuang Baji Makassar Koinfection TB Alcohol consumption history Consumption No Consumption Total
Cases n 21
% 91,3
Control n 36
% 78,3
Total n 57
CI 95% OR
% 82,6
LLUL 0,58
2 23
8,7 100
10 46
12,7 100
12 69
17,4 100
2,91
14,60
Soucer: Primary Data The test result odd ratio with the level of trust 95%, gained OR value = 2,91 with lower limit value (LL) = 0,58 and upper limit value (UL) = 14,6 shows that alcohol consumption history is a risk factor which is meaningless to the TB coinfection. The interpretation of bivariate analysis between alcohol consumption history with TB coinfection is that HIV/AIDS patients with alcohol consumption history is a risk factor which is meaningless to the TB coinfection.
c. Nutrition status to TB coinfection Tabel 4 Risk Factor Nutrition Status With Koinfection TB-HIV/AIDS RSUD Labuang Baji Makassar Koinfection TB CI 95% Total Nutrition OR Cases Control Status LLn % n % n % UL 19 82,6 45,7 Occur 21 40 58,0 1,66 Good 4 17,4 25 54,3 29 42,0 5,65 19,2 23 100 46 100 69 100 Total 3 Source: Primary Data Based on odd ratio test with the level of trust 95%, gained OR value = 5,65 with lower limit (LL) = 1,16 and upper limit (UL) = 19,23. Because of the lower limit and upper limit value cover the value of 1, then statistically it is meaningful to say that the research hypothesis is accepted. The interpretation of bivariate analysis between nutrition status and the TB coinfection is that less nutrition status is 5,65 times riskier to have TB coinfection compared to respondents with good nutrition status (18,5 – 22,9). Thus, we can conlude that nutrition status is a risk factor of having TB coinfection and having meaningful relationship. Conclusion Based on the aims to achieve within this research is that acknowledging risk factors of TB coinfection to HIV/AIDS carrier at Labuang Baji hospital Makassar within 2014, then it is concluded that: 1. Smoking history is 5,6 times riskier to cause TB coinfection on HIV/AIDS carrier and have a meaningful relationship. 2. Alcohol consumption history is 2,91 times riskier to cause TB coinfection to HIV/AIDS carrier and have a meaningful relationship. 3. Less nutrition status (<18,5) is 5,65 times riskier to have TB coinfection to HIV/AIDS carrier and have a meaningful relationship. Suggestions 1. Health officer is suggested to have a workshop to HIV/AIDS carrier to stop smoking. 2. Health officer is suggested to have a workshop to HIV/AIDS carrier to stop consuming alcohol. 3. Health officer is suggested to have a workshop to HIV/AIDS carrier to pay attention to their nutrition status.
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