Health Seeking Behavior among Patients with Tuberculosis in Dr. Hasan Sadikin General Hospital Bandung, Indonesia in November 2012

Background: Dr. Hasan Sadikin General Hospital is the main referral hospital in West Java, Indonesia, treating yearly 1.000 tuberculosis cases of whom most  are in severe condition. The severity of the disease is probably affected by the poor patient’s health seeking behavior.The objective of this study was to assess the pattern of patients with tuberculosis’s health seeking behavior before being treated in Dr. Hasan Sadikin General Hospital, Bandung.Methods: A descriptive study was  carried out in November 2012 on 56 patients in the Drug Observed Treatment Shortcourse (DOTS) Clinic at Dr. Hasan Sadikin General Hospital (RSHS) to assess the number and type of health services visited prior to RSHS. The inclusion criteria were patients who were diagnosed with TB for the first time, aged at least 19 years old. The data were collected using an open-ended questionnaire and presented as percentage.Results: A total of 32 respondents (57%) sought for initial treatment by going to professional health care centers (the medical doctors, puskesmas, or hospitals), the rests sought for traditional treatment (7%), self-treatment (29%), or no medication prior to the treatment at RSHS (7%). Fifty five percent of respondents did more than one type of health seeking behavior. The average time between the first complaint until the respondents got treatment was 5 months.Conclusions: The patients with tuberculosis’s treatment seeking behavior is various prior to the treatment at RSHS and there are still patients who seek treatments  to the non-profesional health care. DOI: 10.15850/amj.v2n3.49

Studi Kasus Ketidakpatuhan Orang Kontak Serumah Terhadap Anjuran Pemeriksaan Tuberkulosis

Non-adherence of household contacts to undergo screening for Tuberculosis (TB) is a dynamic and complex phenomenon of the various factors related to behaviour. The objective of this study was to explore the behaviours related to non-adherence of household contacts to undergo screening for TB. This study is a descriptive case study that was conducted at the Pajajaran village, Bandung city. Participant were 9 household contacts of smear positive TB patients and 6 nurses who is working in the Pasirkaliki Community Health Center (CHC). Data collection was performed with the study documentation, non-structured passive observation, in-depth interview, and focus group discussion (FGD). Data analysis was according to Miles and Huberman model, which consist of data reduction, data display and drawing conclusions. The result includes perception of vulnerability of TB, perceptions of seriousness of TB, perceptions of benefits of TB screening, and cues to action for the TB patients household contact. The result showed that perceptions of the household contact of TB vulnerability were: fear of infection, make the separation and accept fate. Perceptions of the seriousness of TB were that TB could cause death and feelings of shame or inferiority. As for the perception of benefits was by doing screening,it will be known whether household contacts are exposed to TB or not. While the cues to action for household contact to perform screening for TB was if they are sick or have emerging symptoms of TB. The nurses knew that according to P2TB (TB management program) standards, the household contacts of TB patients should undergo screening for TB, especially for smear-positive pulmonary TB patients and paediatric TB. They knew that TB screening was done through sputum smear microscopy. Nurses\u27 perceptions about the barriers in carrying out their role and function were limited number of human resources in CHC, lack of education, and the presence of abundance tasks at the clinic.

Level of Knowledge about Tuberculosis among Type 2 Diabetes Mellitus Patients at the Endocrine Clinic Dr. Hasan Sadikin General Hospital Bandung

Background: Diabetes Mellitus (DM) is one of the risk factors for tuberculosis (TB). Knowledge of TB is essential in prevention control for the person at risk. This study aimed to describe the level of knowledge about TB among DM patients. Methods: A cross sectional study was performed involving 72 adult DM patients at the Endocrine Clinic, Dr. Hasan Sadikin General Hospital Bandung. The subjects were interviewed using a standardized questionnaire including socio-demographic information and knowledge about TB: manifestation of TB, transmission, treatment, DM-TB co-infections, and status acquiring TB information in the last 12 months. Knowledge was categorized as high, moderate and low if total scores were >75, 56–75 and <56 respectively. Data were presented descriptively as percentage and mean (SD) after testing for the normality of distribution. Results: The mean of age of subjects was 56.6 years, and 55% were female. Most were unemployed (72.2%), had an education background lower than high school (75%), and lived in Bandung (91.7%).  The mean score of knowledge was 54.4. Proportion of subjects based on the level of knowledge which is high, moderate and low, were 29.2%, 26.4%, and 44.4% respectively.  Conclusions: The level of knowledge about TB among Type 2 DM patients at the Endocrine Clinic Dr. Hasan Sadikin General Hospital Bandung was low. TB education program among DM patients needs to be improved

Clinical Characteristics and Side Effects of Multidrug Resistant Tuberculosis Therapy at Top Referral Hospital West Java Indonesia

Background: The efficacy of multidrug resistant tuberculosis (MDR TB) therapy is still being questioned. It has lesser quality, longer duration therapy and high toxicity level. This study was conducted to identify clinical characteristics and side effect of MDR TB therapy at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia as the top referral hospital in West Java. Methods: A retrospective descriptive study was performed to 142 medical records of MDR TB inpatient and outpatient at Dr. Hasan Sadikin General Hospital from January 2012–July 2013. Data was collected on October–November 2013. Data about clinical characteristics and side effects of MDR TB therapy were collected and was analyzed in the form of percentage.Results: From 142 patients, 96% had history of tuberculosis therapy. Eighty (56%) of them had positive acid fast bacilli (AFB) sputum that still remained after 5th month or more with category 2. Seventy (49%) patients used combination of pyrazinamide, capreomycin, levofloxacin, ethionamide and cycloserine (Pz-Cm-Lfx-Eto-Cs). All patients experienced side effects during therapy and the majority of them (91%) had gastroenteropathy and rheumatism. Tentamen suicide was detected in one patient. Conclusions: The MDR TB patients had history of tuberculosis therapy. The majority of patients used combination of Pz-Cm-Lfx-Eto-Cs. All patients experienced side effects during MDR TB therapy. [AMJ.2016;3(4):526–32

Knowledge, Attitude, and Practice of Undergraduate Medical Students in Indonesia on the COVID-19 Prevention

Background: Coronavirus Disease 2019 (COVID-19) caused a global pandemic since March 2020. Undergraduate medical students, who would later be referred to as students, were encouraged to educate Indonesian society about COVID-19. This study aimed to evaluate the knowledge, attitude, and practice of Indonesian students on COVID-19 prevention. Methods: An online cross-sectional study was conducted between August 22 and September 2, 2020, with a minimum sample size of 1068 subjects. The questionnaire was sent to 86 Faculty of Medicine (FoM) in Indonesia. The questionnaire consisted of knowledge, attitude, and practice section, with a total score, 15, 60, and 45, respectively. Scores above median were considered as sufficient knowledge, and positive attitude, and positive practice. Association between knowledge, attitude, and practice with gender, year of study, location of FoM, and source of information were tested using Chi-Square Test. Correlation among knowledge, attitude, and practice scores was tested using Spearman Rank Test. Results: Among 1390 participated students, 51.4%, 55.7%, and 56.3% had sufficient knowledge, positive attitude, and, positive practice, respectively. There were associations between knowledge and gender, year of study, location of FoM, and source of information (p&lt;0.05), between attitude and gender, year of study, and source of information (p&lt;0.05), and between practice and gender and source of information (p&lt;0.05). There were weak correlations between knowledge with attitude (r=0.246, p&lt;0.001) and between attitude and practice (r=0.272, p&lt;0.001). Conclusions: Half of medical students in Indonesia showed sufficient knowledge, positive attitude, and positive practice on COVID-19 prevention. Hence, improvement towards COVID-19 prevention is required

Comparison of Diabetes Mellitus Prevalence between Universal and Targeted Screening among Tuberculosis Patients in Resource Limited Settings

BACKGROUND: Diabetes Mellitus (DM) increases the risk of active Tuberculosis (TB) infection and treatment failure. Therefore, screening of DM is important in TB patients. However, it may not be possible to screen all patients where resources are limited. This study aimed to compare the sensitivity of universal screening and targeted screening methods in the detection of DM among TB patients. SUBJECT AND METHODS: TANDEM study was conducted from February to June 2016. This project consisted of prevalence study and clinical trial on TB-DM. A sample of TB patients aged ≥ 35 years old was selected for this study. The prevalence of the universal screening method was compared with that of the targeted method in the detection of DM among the TB patients. RESULTS: By universal screening, 128 out of 748 (17.11%) TB patients were confirmed to have DM. By targeted screening, 30 out of 85 (35.29%) TB patients were confirmed to have DM. This difference in prevalence between the two screening methods was statistically significant (p<0.001). Mean age (year) of TB patients with DM was 53.38 (SD=9.72), whereas mean HbA1c was 10.77% (SD=3.10). CONCLUSION: The prevalence of targeted screening method in the detection of DM among TB patients was higher than that of universal screening method. The targeted screening method has the potential to be used in resource-poor settings. Keywords: prevalence, diabetes mellitus, universal screening, targeted screening, tuberculosi

Genetic polymorphism related to ethambutol outcomes and susceptibility to toxicity

The World Health Organization (WHO) stated that ensuring access to effective and optimal treatment is a key component to eradicate tuberculosis (TB) through the End TB Strategy. Personalized medicine that depends on the genetic profile of an individual is one way to optimize treatment. It is necessary because of diverse drug responses related to the variation in human DNA, such as single-nucleotide polymorphisms (SNPs). Ethambutol (EMB) is a drug widely used as the treatment for Mycobacterium Tuberculosis (Mtb) and/non-tuberculous mycobacteria and has become a potential supplementary agent for a treatment regimen of multidrug-resistant (MDR) and extensively drug-resistant (XDR) TB. In human genetic polymorphism studies of anti-tuberculosis, the majority focus on rifampicin or isoniazid, which discuss polymorphisms related to their toxicity. Whereas there are few studies on EMB, the incidence of EMB toxicity is lower than that of other first-line anti-TB drugs. To facilitate personalized medicine practice, this article summarizes the genetic polymorphisms associated with alterations in the pharmacokinetic profile, resistance incidence, and susceptibility to EMB toxicity. This study includes 131 total human studies from 17 articles, but only eight studies that held in the low-middle income country (LMIC), while the rest is research conducted in developed countries with high incomes. Personalized medicine practices are highly recommended to maintain and obtain the optimal therapeutic effect of EMB

Quantitative Measure to Differentiate Wicket Spike from Interictal Epileptiform Discharges

A number of benign EEG patterns are often misinterpreted as interictal epileptiform discharges (IEDs) because of their epileptiform appearances, one of them is wicket spike. Differentiating wicket spike from IEDs may help in preventing epilepsy misdiagnosis. The temporal location of IEDs and wicket spike were chosen from 143 EEG recordings. Amplitude, duration and angles were measured from the wave triangles and were used as the variables. In this study, linear discriminant analysis is used to create the formula to differentiate wicket spike from IEDs consisting spike and sharp waves. We obtained a formula with excellent accuracy. This study emphasizes the need for objective criteria to distinguish wicket spike from IEDs to avoid misreading of the EEG and misdiagnosis of epilepsy

Factors Influencing Private Practitioners to Report Tuberculosis Cases

One of the key elements in tuberculosis (TB) management is a system for recording and reporting, in which every health care provider needs to report every TB case to an authorized primary health center (PHC) to support effective treatment. This study was conducted to investigate the present condition of TB recording and reporting system and evaluate several factors that might influence PP behavior regarding the reporting of TB cases to a PHC in Bandung, Indonesia. Face-to-face interviews with PP and the head of the PHC were performed. Data were coded, categorized, and analyzed statistically by Fischer’s exact test. We found that there were four factors influencing the reporting of TB cases by PP to PHC, including self-awareness, ignorance, lack of time, and poor implementation of recording and reporting system. The level of PP self-awareness was significantly associated with the reporting of TB cases (p<0.05). Private sector involvement, improvement in the recording of treatment follow-up, and the use of electronic based reporting were considered important by participants to construct a well-established recording and reporting system for TB cases. In conclusion, there are still room for improvement in the reporting and recording system of TB cases in PHC. Keywords: recording, reporting, tuberculosis, self-awareness, practitioner