Tuberculosis Health Care Cadres in Curug Village, Cimanggis, Depok Descriptive Study.
TUBERCULOSIS HEALTH CARE CADRES IN CURUG VILLAGE,
CIMANGGIS, DEPOK: DESCRIPTIVE STUDY
1
Ni Luh Putu Eva Yanti, 2Junaiti Sahar, 2Widyatuti
1
Nursing Study Program, Faculty of Medicine, Udayana University
2
Faculty of Nursing, University of Indonesia
Email: evayanti.nlp@gmail.com
Abstract
The establishment of Tuberculosis Health Care Cadres (TB-HHC) aims to help nurses to prevent
tuberculosis in community. This study aims to describe the condition of TB-HHC applied
tuberculosis control program in Curug Village. The results of the research showed an increase in
knowledge of TB-HCC members to control tuberculosis was 11.2% and the attitude was 5.6%.
The skills of KKP-TB to provide education was at the mean= 23.5 and a case detection and
referral skills were at the mean of=15.4. There are six cadres (from ten cadres) have a case
detection and referral skills above average. Tuberculosis Health Care Cadres can strengthen
tuberculosis eradication programs in community.
Keywords: health care cadres, tuberculosis control
INTRODUCTION
Tuberculosis (TB) is an infectious disease that is still a global burden of disease. WHO data
(2013) shows 58% of TB cases occur in Southeast Asia and the Western Pacific. Indonesia get
4th rank highest number of TB cases in the world, after China, India, and South Africa. Data
from the Ministry of Health Riskesdas RI (2013), there are five provinces with the highest
prevalence of TB in Indonesia. There are West Java, Papua, Jakarta, Gorontalo, Banten and
West Papua. West Java occupies the first position with a TB prevalence of 0,7% (the national
average of 0,4%).
The indicators of national TB control is measured in two ways: based on the discovery of new
smear positive TB cases (Case Detection Rate=CDR) and a treatment success rate (Success
Rate = SR). Nationally, the indicator discovery of new smear positive TB cases was 80%
(Kemenkes RI, 2013). The discovery of the TB cases in West Java province in 2012 amounted
to 77.35% (Data profil kesehatan Jawa Barat tahun 2012). This shows that West Java has not
yet reached the target of national indicators. One of the cities / regencies in West Java which is
still low in the discovery of new cases of TB is Depok city. Puskesmas Cimanggis, Curug
village is one of the regions with the CDR data is still low.
National strategy TB control strategies implemented by Directly Observed Treatment Shortcourse (DOTS) across Unit Pelayanan Kesehatan (UPK) including hospitals. This strategy for
TB control has been proven as the most effective and economical (Dirjen P2PL Depkes RI,
2009). This strategy is in line with community nurses role such as managers and providers of
nursing care for individuals, families, groups, and communities (Allender, Rector, & Warner,
2010). In held nursing care with tuberculosis, nurses require the participation of elements of the
community as a form of empowerment and cooperation with the public (Allender, Rector, &
Warner, 2010; Helvie, 1998; Hitchcock, Schubert, & Thomas, 1999). Empowering and
working with the community in the form of group process through the formation of support
groups or social support (Pander, Murdaugh, & Parsons, 2002).
The support group involves the role of health workers in supporting TB control program that
includes a treatment supporter (PMO), tracking of TB cases were lost to follow up, and the
discovery of TB cases in the community. The support group called Tuberculosis Health Care
Cadres (TB-HHC). Support groups effectives help families and TB clients in improving access
to TB care and increase the number of findings suspect TB (Solihin, 2014; Rejeki, 2012).
Problem statement this research: how is Tuberculosis Health Care Cadres (TB-HHC) run the
TB control programs. The purpose of this study was to describe the knowledge, attitudes, and
skills of TB-HHC in implementing the TB control program.
METHOD
The study design is quasi-experimental design with pre-post test without control. The research
held in two months. Place of research conducted in the village of Curug, Cimanggis. The
population in the research were all health cadres who are in Curug Village area totaling 88
people. Sampling was done by purposive sampling technique. The inclusion criteria are cadres
of health research in the area of RW RW 6 and 7 Village Curug. Selection criteria are based on
data puskesmas Cimanggis, that the number of TB patients are located mainly in this RW. The
number of respondents who selected 16 people.
Data collection procedures performed by conducting pre-test prior to all the respondents.
Instruments used include aspects of knowledge and attitudes about TB disease. Furthermore,
respondents receive training on TB-HHC with three topics during three meeting: 1) knowledge
of TB signs symptoms, modes of transmission, prevention, and early detection of TB cases; 2)
skills of cadres in conducting group counseling and family and how to make referrals; 3)
facilitation of health cadres in doing family counseling and group activities in the community.
At the four meeting were post-test and evaluation skills of cadres do counseling and early
detection through role play activities. Skills evaluation instruments using observation sheet
check list.
RESULT
Tabel 1. Distribution of knowledge and attitude of TB-HHC before and after training
Item
n
Pre test
Post test
Percentage of increasing
pre-post test
Knowledge
16
8,38
9,44
11,2%
Attitude
16
21,06
22,31
5,6%
Tabel 2. Distribution of evaluation skill TB-HHC members to conduct health education and
early detection suspect TB
Initials
RW
Conduct Health Education
Cadres
Early detection suspect TB and
referral
Total point
Total point
K1
6
25
16
K3
6
26
17
K4
6
23
13
K2
6
20
13
K7
6
20
15
K9
7
27
18
K12
7
24
16
K15
7
20
14
K11
7
25
16
K10
7
25
16
23,5
15,4
Mean
DISCUSSION
TB training to health volunteers have been conducted three meetings during one month. The
purpose of training is to teach members about TB-HHC in order to conduct health education to
members of the public in their respective areas and can immediately make early detection if it
finds the case with TB symptoms. According to Allender, Rector and Warner (2010), methods
of health education provided to the public in accordance with the number of lots using the
lecture method. Training is one form of health education with the lecture method. This method
can measure the cognitive abilities of individuals before and after training. The results indicate
an increase in knowledge and attitude of TB-HHC before and after training on TB. The same
thing happened on research conducted Pratiwi, Betty, Hargono, Widya (2012), showed 12,5%
increase knowledge of health workers and community leaders before and after training on
tuberculosis. Training with the lecture method effectively increases the knowledge and attitude
of health workers about tuberculosis.
Supervision of cadres ability to do health education, TB early case detection and referral
conducted on 10 members of the TB-HHC. The result is 60% of the TB-HHC supervised
demonstrate the ability above average. The results of the final report of scientific work carried
Rejeki (2012), showed that 82% of TB-HHC who received training were able to do health
education to family and community. This is related to TB-HHC experience have been trained to
provide information and talk in front of people simplify their skills to educate and communicate
with family referred to all cases of TB for sputum examination. However, there are still
members of the TB-HHC who refused supervised by reason of fear and yet confidently in
public. This happens because, member of TB-HHC rarely practice when accompanied by a
nurse or by members of the TB-HHC who more skilled.
CONCLUSION
There is an increased knowledge and attitudes TB-HHC after training on TB prevention and
early detection. The TB-HHC members skill in performing TB health education and early
detection still lacking. So the nurse who responsible of TB program needs to conduct guidance
and assistance ongoing basis to improve skills in health education, detection and referral of TB
cases and conduct home visits in TB treatment monitoring.
REFERENCE
Allender, J.A., Rector, C., Warner, K.D. (2010). Community Health Nursing: Promoting and
Proctecting the Public’s Health 7th Edition. Philadelphia: Lippincott Williams & Wilkins
Dirjen P2PL Depkes RI. (2009). Pelatihan Penanggulangan TB MDR: Modul 1 Pengantar
Pelatihan. Jakarta: Depkes RI
Helvie, C. O. (1998). Advanced Practice Nursing in the Community. Thousand Oaks, CA: Sage
Hitchcock, J.E., Schubert, P.E dan Thomas, S.A. (1999). Community Health Nursing: Caring in
Action. New York: Delmar Publishers
Kementerian Kesehatan RI. (2013). Riset Kesehatan Dasar 2013. Jakarta: Kemenkes Republik
Indonesia
Kemenkes RI. (2013). Petunjuk Teknis Manajemen Terpadu Pengendalian Tuberkulosis
Resistan Obat. Jakarta: Kemenkes RI
Pender, N., Murdaugh, C. L., Parsons, M.A. (2002). Health Promotion in Nursing Practice 4rd
Edition. New Jersey: Pearson Education, Inc
Pratiwi, N. L., Betty, R., Hargono, R., Widya, N. E. (2012). Kemandirian Masyarakat dalam
Perilaku Pencegahan Penularan Penyakit TB Paru. Buletin Penelitian Sistem Kesehatan
Vol. 15, No.2; April 2012
Rejeki, H. (2012). Kelompok Pendukung sebagai Bentuk Intervensi Pengendalian TB Berbasis
Pemberdayaan Masyarakat di Kelurahan Pasir Gunung Selatan Kota Depok. Karya lmiah
Akhir . Tidak dipublikasikan. FIK: UI
Solihin, J. R. (2014). SMS TB sebagai media intervensi keperawatan komunitas untuk
meningkatkan kepatuhan dan deteksi kasus TB di kelurahan Cisalak Pasar, Cimanggis,
Depok. Karya Ilmiah Akhir . Tidak dipublikasikan. FIK: UI
WHO. (2013). Global Tuberculosis Report 2013. Akses 30 Desember 2013; 12.15 WIB.
http://www.who.int/tb/publications/global_report/en/index.html
CIMANGGIS, DEPOK: DESCRIPTIVE STUDY
1
Ni Luh Putu Eva Yanti, 2Junaiti Sahar, 2Widyatuti
1
Nursing Study Program, Faculty of Medicine, Udayana University
2
Faculty of Nursing, University of Indonesia
Email: evayanti.nlp@gmail.com
Abstract
The establishment of Tuberculosis Health Care Cadres (TB-HHC) aims to help nurses to prevent
tuberculosis in community. This study aims to describe the condition of TB-HHC applied
tuberculosis control program in Curug Village. The results of the research showed an increase in
knowledge of TB-HCC members to control tuberculosis was 11.2% and the attitude was 5.6%.
The skills of KKP-TB to provide education was at the mean= 23.5 and a case detection and
referral skills were at the mean of=15.4. There are six cadres (from ten cadres) have a case
detection and referral skills above average. Tuberculosis Health Care Cadres can strengthen
tuberculosis eradication programs in community.
Keywords: health care cadres, tuberculosis control
INTRODUCTION
Tuberculosis (TB) is an infectious disease that is still a global burden of disease. WHO data
(2013) shows 58% of TB cases occur in Southeast Asia and the Western Pacific. Indonesia get
4th rank highest number of TB cases in the world, after China, India, and South Africa. Data
from the Ministry of Health Riskesdas RI (2013), there are five provinces with the highest
prevalence of TB in Indonesia. There are West Java, Papua, Jakarta, Gorontalo, Banten and
West Papua. West Java occupies the first position with a TB prevalence of 0,7% (the national
average of 0,4%).
The indicators of national TB control is measured in two ways: based on the discovery of new
smear positive TB cases (Case Detection Rate=CDR) and a treatment success rate (Success
Rate = SR). Nationally, the indicator discovery of new smear positive TB cases was 80%
(Kemenkes RI, 2013). The discovery of the TB cases in West Java province in 2012 amounted
to 77.35% (Data profil kesehatan Jawa Barat tahun 2012). This shows that West Java has not
yet reached the target of national indicators. One of the cities / regencies in West Java which is
still low in the discovery of new cases of TB is Depok city. Puskesmas Cimanggis, Curug
village is one of the regions with the CDR data is still low.
National strategy TB control strategies implemented by Directly Observed Treatment Shortcourse (DOTS) across Unit Pelayanan Kesehatan (UPK) including hospitals. This strategy for
TB control has been proven as the most effective and economical (Dirjen P2PL Depkes RI,
2009). This strategy is in line with community nurses role such as managers and providers of
nursing care for individuals, families, groups, and communities (Allender, Rector, & Warner,
2010). In held nursing care with tuberculosis, nurses require the participation of elements of the
community as a form of empowerment and cooperation with the public (Allender, Rector, &
Warner, 2010; Helvie, 1998; Hitchcock, Schubert, & Thomas, 1999). Empowering and
working with the community in the form of group process through the formation of support
groups or social support (Pander, Murdaugh, & Parsons, 2002).
The support group involves the role of health workers in supporting TB control program that
includes a treatment supporter (PMO), tracking of TB cases were lost to follow up, and the
discovery of TB cases in the community. The support group called Tuberculosis Health Care
Cadres (TB-HHC). Support groups effectives help families and TB clients in improving access
to TB care and increase the number of findings suspect TB (Solihin, 2014; Rejeki, 2012).
Problem statement this research: how is Tuberculosis Health Care Cadres (TB-HHC) run the
TB control programs. The purpose of this study was to describe the knowledge, attitudes, and
skills of TB-HHC in implementing the TB control program.
METHOD
The study design is quasi-experimental design with pre-post test without control. The research
held in two months. Place of research conducted in the village of Curug, Cimanggis. The
population in the research were all health cadres who are in Curug Village area totaling 88
people. Sampling was done by purposive sampling technique. The inclusion criteria are cadres
of health research in the area of RW RW 6 and 7 Village Curug. Selection criteria are based on
data puskesmas Cimanggis, that the number of TB patients are located mainly in this RW. The
number of respondents who selected 16 people.
Data collection procedures performed by conducting pre-test prior to all the respondents.
Instruments used include aspects of knowledge and attitudes about TB disease. Furthermore,
respondents receive training on TB-HHC with three topics during three meeting: 1) knowledge
of TB signs symptoms, modes of transmission, prevention, and early detection of TB cases; 2)
skills of cadres in conducting group counseling and family and how to make referrals; 3)
facilitation of health cadres in doing family counseling and group activities in the community.
At the four meeting were post-test and evaluation skills of cadres do counseling and early
detection through role play activities. Skills evaluation instruments using observation sheet
check list.
RESULT
Tabel 1. Distribution of knowledge and attitude of TB-HHC before and after training
Item
n
Pre test
Post test
Percentage of increasing
pre-post test
Knowledge
16
8,38
9,44
11,2%
Attitude
16
21,06
22,31
5,6%
Tabel 2. Distribution of evaluation skill TB-HHC members to conduct health education and
early detection suspect TB
Initials
RW
Conduct Health Education
Cadres
Early detection suspect TB and
referral
Total point
Total point
K1
6
25
16
K3
6
26
17
K4
6
23
13
K2
6
20
13
K7
6
20
15
K9
7
27
18
K12
7
24
16
K15
7
20
14
K11
7
25
16
K10
7
25
16
23,5
15,4
Mean
DISCUSSION
TB training to health volunteers have been conducted three meetings during one month. The
purpose of training is to teach members about TB-HHC in order to conduct health education to
members of the public in their respective areas and can immediately make early detection if it
finds the case with TB symptoms. According to Allender, Rector and Warner (2010), methods
of health education provided to the public in accordance with the number of lots using the
lecture method. Training is one form of health education with the lecture method. This method
can measure the cognitive abilities of individuals before and after training. The results indicate
an increase in knowledge and attitude of TB-HHC before and after training on TB. The same
thing happened on research conducted Pratiwi, Betty, Hargono, Widya (2012), showed 12,5%
increase knowledge of health workers and community leaders before and after training on
tuberculosis. Training with the lecture method effectively increases the knowledge and attitude
of health workers about tuberculosis.
Supervision of cadres ability to do health education, TB early case detection and referral
conducted on 10 members of the TB-HHC. The result is 60% of the TB-HHC supervised
demonstrate the ability above average. The results of the final report of scientific work carried
Rejeki (2012), showed that 82% of TB-HHC who received training were able to do health
education to family and community. This is related to TB-HHC experience have been trained to
provide information and talk in front of people simplify their skills to educate and communicate
with family referred to all cases of TB for sputum examination. However, there are still
members of the TB-HHC who refused supervised by reason of fear and yet confidently in
public. This happens because, member of TB-HHC rarely practice when accompanied by a
nurse or by members of the TB-HHC who more skilled.
CONCLUSION
There is an increased knowledge and attitudes TB-HHC after training on TB prevention and
early detection. The TB-HHC members skill in performing TB health education and early
detection still lacking. So the nurse who responsible of TB program needs to conduct guidance
and assistance ongoing basis to improve skills in health education, detection and referral of TB
cases and conduct home visits in TB treatment monitoring.
REFERENCE
Allender, J.A., Rector, C., Warner, K.D. (2010). Community Health Nursing: Promoting and
Proctecting the Public’s Health 7th Edition. Philadelphia: Lippincott Williams & Wilkins
Dirjen P2PL Depkes RI. (2009). Pelatihan Penanggulangan TB MDR: Modul 1 Pengantar
Pelatihan. Jakarta: Depkes RI
Helvie, C. O. (1998). Advanced Practice Nursing in the Community. Thousand Oaks, CA: Sage
Hitchcock, J.E., Schubert, P.E dan Thomas, S.A. (1999). Community Health Nursing: Caring in
Action. New York: Delmar Publishers
Kementerian Kesehatan RI. (2013). Riset Kesehatan Dasar 2013. Jakarta: Kemenkes Republik
Indonesia
Kemenkes RI. (2013). Petunjuk Teknis Manajemen Terpadu Pengendalian Tuberkulosis
Resistan Obat. Jakarta: Kemenkes RI
Pender, N., Murdaugh, C. L., Parsons, M.A. (2002). Health Promotion in Nursing Practice 4rd
Edition. New Jersey: Pearson Education, Inc
Pratiwi, N. L., Betty, R., Hargono, R., Widya, N. E. (2012). Kemandirian Masyarakat dalam
Perilaku Pencegahan Penularan Penyakit TB Paru. Buletin Penelitian Sistem Kesehatan
Vol. 15, No.2; April 2012
Rejeki, H. (2012). Kelompok Pendukung sebagai Bentuk Intervensi Pengendalian TB Berbasis
Pemberdayaan Masyarakat di Kelurahan Pasir Gunung Selatan Kota Depok. Karya lmiah
Akhir . Tidak dipublikasikan. FIK: UI
Solihin, J. R. (2014). SMS TB sebagai media intervensi keperawatan komunitas untuk
meningkatkan kepatuhan dan deteksi kasus TB di kelurahan Cisalak Pasar, Cimanggis,
Depok. Karya Ilmiah Akhir . Tidak dipublikasikan. FIK: UI
WHO. (2013). Global Tuberculosis Report 2013. Akses 30 Desember 2013; 12.15 WIB.
http://www.who.int/tb/publications/global_report/en/index.html