Determinant Indicators of Under-Reporting Case of Tuberculosis (A Mix Method Study)

Abstract

WHO estimates that nearly 40% of all patients with TB are under-reported to local or national TB surveillance programs
every year. Indonesian TB Jetset (Research Network) in 2018 stated Indonesia ranked 2nd in the top ranking of tuberculosis
case discovery, in Indonesia in 2017 the incidence of TB cases was 1,020,000, the number of cases detected was 710,000 or
(70%), so that 310,000 or 30% undetected. This study aims to determine what influences the occurrence of under-reporting
cases Hospital TB in Kudus and develop predictive index of under-reporting tuberculosis. Moreover, this study is expected to
help eliminate the under-reporting cases 10%rate of tuberculosis that occurred in Kudus from the 44% proportion that occurred
nationally based on the MDGs 2017 WHO targets and the targets of the national TB control program contained in the 2014
National Tuberculosis Control Guidelines. This study uses a mix-method of sequential explanatory design. In this quantitative
study, we assessed nine indicators of unreported tuberculosis cases to determine how many indicators were associated with
unreported cases. The number of samples in this quantitative study was 700 tuberculosis cases recorded at SITB DKK Kudus
Regency and medical record data for tuberculosis cases in seven hospitals in Kudus. Meanwhile, qualitative research explores
perceptions and information from medical personnel and hospital doctors regarding the reasons for choosing the underreporting
case indicator. The number of informants in the qualitative research was 35 informants consisting of specialist doctors, general
practitioners, nurses and hospital staff. Multilevel logistic regression analysis was performed for quantitative data, and content
analysis for qualitative data. The findings of the quantitative and qualitative sections of the study were mixed in interpretation.
The results showed that there were six indicators that affected under-reporting including: Competency of doctors in SITB was
good (OR=0.09; CI95%= 0.05 to 0.17; p<001), Competence of health workers in SITB was good (OR=0.05; CI95% = 0.02 to
0.09; p<001), Commitment of health workers in SITB was strong (OR=0.13; 95% CI= 0.07 to 0.24; p<001), and AFB positive
patient status (OR=0.35; 95% CI= 0.18 to 0.67; p=0.002). While the results of the qualitative research support the finding
that most health workers and doctors who handle tuberculosis cases in hospitals in Kudus do not have SITB certificates, both
nationally and regionally, only a few have attended training and have certificates. There is no integration between the SIM
Hospital with SITB Hospital or DKK which causes the occurrence of under-reporting of high tuberculosis cases in Kudus. It
can be concluded that there are six indices associated with underreporting cases of tuberculosis in Kudus Hospital.