skip to main content

Breaking the Chains of Tuberculosis: Quantifying the Effects of Literacy, Population Density, and Access to Improve Sanitation to Support Defense Health and Security in Indonesia

*Reinpal Falefi  -  Defense Management Study Program, Defense Management Faculty, The Republic of Indonesia Defense University, Indonesia, Indonesia
Hikmat Zakky Almubaraq  -  Defense Management Study Program, Defense Management Faculty, The Republic of Indonesia Defense University, Indonesia, Indonesia
Nora Lelyana  -  Defense Management Study Program, Defense Management Faculty, The Republic of Indonesia Defense University, Indonesia, Indonesia
Makmur Supriyatno  -  Defense Management Study Program, Defense Management Faculty, The Republic of Indonesia Defense University, Indonesia, Indonesia

Citation Format:
Abstract

Background: Tuberculosis (TB) is a global health problem. It poses a significant burden worldwide, requiring urgent control measures and research for effective reduction especially in Indonesia.

Objective: Investigating the effects of literacy, population density, and access to improved sanitation on TB incidence can provide insights into the relationship between these factors.

Methods: This study was conducted in Jakarta, Indonesia from June to July 2023, using secondary data from 2005 to 2021. It employed a quantitative cross-sectional design to examine the relationship between variables. Data were collected from the ASEAN database and analyzed using descriptive and path analysis techniques to determine variable effects and significance. The study found that the incidence of tuberculosis in Indonesia initially decreased from 2005 to 2020 but significantly increased in 2021.

Results: Population density, adult literacy rate, and access to improved sanitation all showed positive trends. Significant direct effects were observed among most variables, and indirect effects of population density on tuberculosis incidence were also identified through literacy and sanitation. The final model showed that higher population density correlated with increased access to sanitation and literacy rate, while access to improved sanitation was associated with reduced tuberculosis incidence. Overall, the model had a very good fit based on the indicators.

Conclusion: Priority investments in sanitation infrastructure, especially in densely populated areas, along with improved access to sanitation facilities, combined with targeted health education campaigns and collaboration across defense, health, and education sectors, are recommended to enhance tuberculosis prevention and control
Fulltext View|Download
Keywords: Tuberculosis; Indonesia; Health Security; Defense; Sanitation

Article Metrics:

  1. Derakhshan-Nezhad E. An Overview of Bacterial Respiratory Tract Infections and their Etiologies. J Med Bacteriol. 2023;11(1–2):36–46
  2. WHO. Tuberculosis [Internet]. WHO. 2023 [cited 2023 Jun 17]. Available from: https://www.who.int/news-room/fact-sheets/detail/tuberculosis
  3. WHO. Global tuberculosis report 2021 [Internet]. WHO. 2021 [cited 2023 Jun 20]. Available from: https://www.who.int/publications/i/item/9789240037021
  4. Machlaurin A. Health economic evaluations of tuberculosis control in Indonesia. 2022;
  5. Papali A, Adhikari NKJ, Diaz J V, Dondorp AM, Dünser MW, Jacob ST, et al. Infrastructure and organization of adult intensive care units in resource-limited settings. Sepsis Manag Resour settings. 2019;31–68
  6. Chowdhury K, Ahmad R, Sinha S, Dutta S, Haque M. Multidrug-Resistant TB (MDR-TB) and Extensively Drug-Resistant TB (XDR-TB) Among Children: Where We Stand Now. Cureus. 2023;15(2)
  7. Jung YL, Hwang J, Yoo HS. Disease burden metrics and the innovations of leading pharmaceutical companies: a global and regional comparative study. Global Health. 2020;16(1):1–11
  8. Fukunaga R, Glaziou P, Harris JB, Date A, Floyd K, Kasaeva T. Epidemiology of tuberculosis and progress toward meeting global targets—worldwide, 2019. Morb Mortal Wkly Rep. 2021;70(12):427
  9. WHO. Indonesia commitment to eliminate TB by 2030 supported by the highest-level government [Internet]. WHO. 2021 [cited 2023 Jun 14]. Available from: https://www.who.int/indonesia/news/detail/28-11-2021-indonesia-commitment-to-eliminate-tb-by-2030-supported-by-the-highest-level-government
  10. USAID. Indonesia Tuberculosis Roadmap Overview, Fiscal Year 2021 [Internet]. USAID. 2022 [cited 2023 Jun 15]. Available from: https://www.usaid.gov/global-health/health-areas/tuberculosis/resources/news-and-updates/global-accelerator-end-tb/tb-roadmaps/indonesia
  11. López MP, Ulloa AP, Escobar FA. Tuberculosis and prison overcrowding from the perspective of social inequities in health in Colombia, 2018. Biomedica. 2022;42(1):159–69
  12. WHO. WHO consolidated guidelines on tuberculosis. Module 2: screening-systematic screening for tuberculosis disease. Geneva: World Health Organization; 2021
  13. Natarajan A, Beena PM, Devnikar A V, Mali S. A systemic review on tuberculosis. Indian J Tuberc. 2020;67(3):295–311
  14. Chiang SS, Beckhorn C, Wong M, Lecca L, Franke MF. Patterns of Suboptimal Adherence among Adolescents Treated for Drug-Susceptible Tuberculosis in Lima, Peru. Int J Tuberc lung Dis Off J Int Union against Tuberc Lung Dis. 2020;24(7):723
  15. Kemenkes RI. National Tuberculosis Program Indonesia [Internet]. Kemenkes RI. 2021 [cited 2023 Jun 20]. Available from: https://www.depkes.go.id/program/Jaminan Kesehatan Nasional/jkn-infografis-mandiri/tb.pdf
  16. Ritchie H, Roser M. Sanitation [Internet]. Our World in Data. 2019 [cited 2023 Jul 16]. Available from: https://ourworldindata.org/sanitation
  17. World Bank. Sanitation [Internet]. World Bank. 2022 [cited 2023 Jun 15]. Available from: https://www.worldbank.org/en/topic/sanitation
  18. Capone D, Cumming O, Nichols D, Brown J. Water and Sanitation in Urban America, 2017–2019. Am J Public Health [Internet]. 2020 Oct;110(10):1567–72. Available from: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2020.305833
  19. Irianti S, Prasetyoputra P. Rural–Urban Disparities in Access to Improved Sanitation in Indonesia: A Decomposition Approach. SAGE Open [Internet]. 2021 Jul 6;11(3):215824402110299. Available from: http://journals.sagepub.com/doi/10.1177/21582440211029920
  20. Ministry of National Development Planning. Indonesia’s Voluntary National Review (VNR) 2021 [Internet]. Jakarta; 2022. Available from: https://sdgs.un.org/basic-page/indonesia-34126
  21. World Bank. Indonesia: Expanding Access to Clean Water for the Rural Poor [Internet]. World Bank. 2019 [cited 2023 Jun 13]. Available from: https://www.worldbank.org/en/results/2019/07/29/indonesia-expanding-access-to-clean-water-for-the-rural-poor
  22. Ismawati E, Amertawengrum IP, Anindita KA. Portrait of Education in Indonesia: Learning from PISA Results 2015 to Present. Int J Learn Teach Educ Res. 2023;22(1):321–40
  23. Harmoko DD. Digital Literacy As A Solution To Improve The Quality Of Indonesia’s Human Resources. Res Dev J Educ. 2021;7(2):413–23
  24. Muzayanah IFU, Lean HH, Hartono D, Indraswari KD, Partama R. Population density and energy consumption: A study in Indonesian provinces. Heliyon [Internet]. 2022 Sep;8(9):e10634. Available from: https://linkinghub.elsevier.com/retrieve/pii/S2405844022019223
  25. Befii–Nwile C, Amie-Ogan OT. Classrooms provision and libraries utilization as determinants of students’ academic performance in public junior secondary schools in Rivers State. Int J Innov Dev Policy Stud. 2021;9(1):86–93
  26. Mayasari E, Risnasari D, Chei NE. Analysis of Pulmonary Tuberculosis based on Home Sanitation in Sembung Hamlet, Margopatut East Java. Str J Ilm Kesehat [Internet]. 2022 May 30;11(1):78–83. Available from: https://sjik.org/index.php/sjik/article/view/894
  27. Dye C, Lönnroth K, Jaramillo E, Williams BG, Raviglione M. Trends in tuberculosis incidence and their determinants in 134 countries. Bull World Health Organ. 2009;87(9):683–91
  28. Wu J, Dalal K. Tuberculosis in Asia and the pacific: the role of socioeconomic status and health system development. Int J Prev Med. 2012;3(1):8
  29. Freeman MC, Garn J V., Sclar GD, Boisson S, Medlicott K, Alexander KT, et al. The impact of sanitation on infectious disease and nutritional status: A systematic review and meta-analysis. Int J Hyg Environ Health [Internet]. 2017 Aug;220(6):928–49. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1438463917301529
  30. Költringer FA, Annerstedt KS, Boccia D, Carter DJ, Rudgard WE. The social determinants of national tuberculosis incidence rates in 116 countries: a longitudinal ecological study between 2005–2015. BMC Public Health [Internet]. 2023 Feb 15;23(1):337. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-023-15213-w
  31. WHO. 2.1 TB incidence [Internet]. WHO. 2021 [cited 2023 Jul 15]. Available from: https://www.who.int/publications/digital/global-tuberculosis-report-2021/tb-disease-burden/incidence
  32. Cardoso BA, Fonseca F de O, Moraes Neto AHA de, Martins ACGS, Oliveira NV da S, Lima LNGC, et al. Environmental aspects related to tuberculosis and intestinal parasites in a low-income community of the Brazilian Amazon. Rev Inst Med Trop Sao Paulo [Internet]. 2017 Aug 7;59. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652017005000230&lng=en&tlng=en
  33. Noykhovich E, Mookherji S, Roess A. The Risk of Tuberculosis among Populations Living in Slum Settings: a Systematic Review and Meta-analysis. J Urban Heal [Internet]. 2019 Apr 19;96(2):262–75. Available from: http://link.springer.com/10.1007/s11524-018-0319-6
  34. Dakhode S, Muntode P, Gaidhane A. A Cross Sectional Assessment of Tuberculosis (TB) Related Knowledge and Awareness among Urban Slum Dwellers in Wardha District. Indian J Public Heal Res Dev. 2019;10(12)
  35. Penaloza R, Navarro JI, Jolly PE, Junkins A, Seas C, Otero L. Health literacy and knowledge related to tuberculosis among outpatients at a referral hospital in Lima, Peru. Res Rep Trop Med. 2019;1–10
  36. Deutsch-Feldman M, Pratt RH, Price SF, Tsang CA, Self JL. Tuberculosis — United States, 2020. MMWR Morb Mortal Wkly Rep [Internet]. 2021 Mar 26;70(12):409–14. Available from: http://www.cdc.gov/mmwr/volumes/70/wr/mm7012a1.htm?s_cid=mm7012a1_w
  37. Foster I, Galloway M, Human W, Anthony M, Myburgh H, Vanqa N, et al. Analysing interventions designed to reduce tuberculosis-related stigma: A scoping review. PLOS Glob Public Heal. 2022;2(10):e0000989
  38. Datiko D, Hadgu A, Jerene D, Suarez PG. High urban tuberculosis case notification rates can be misleading: evidence from an urban setting in Ethiopia. BMC Public Health. 2020;20:1–6
  39. de Abreu e Silva M, Di Lorenzo Oliveira C, Teixeira Neto RG, Camargos PA. Spatial distribution of tuberculosis from 2002 to 2012 in a midsize city in Brazil. BMC Public Health [Internet]. 2016 Dec 1;16(1):912. Available from: http://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-016-3575-y
  40. Rao & Johnson. Impact of population density and elevation on tuberculosis spread and transmission in Maharashtra, India. J Emerg Investig. 2021;4(November):1–5
  41. Penaloza R, Navarro JI, Jolly PE, Junkins A, Seas C, Otero L. Health literacy and knowledge related to tuberculosis among outpatients at a referral hospital in Lima, Peru. Res Rep Trop Med [Internet]. 2019 Mar;Volume 10:1–10. Available from: https://www.dovepress.com/health-literacy-and-knowledge-related-to-tuberculosis-among-outpatient-peer-reviewed-article-RRTM
  42. Li Y, Zhang S, Zhang T, Cao Y, Liu W, Jiang H, et al. Chinese health literacy scale for tuberculosis patients: a study on development and psychometric testing. BMC Infect Dis [Internet]. 2019 Dec 20;19(1):545. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4168-z
  43. Ezeosim BN. Tuberculosis-Associated Knowledge, Stigma, and Health Seeking Behavior Among Traders in Onitsha Main Market, Anambra State, Nigeria. Walden University; 2023
  44. Baral S, Yadav RK, Yadav DK, Marahatta SB, Baral Y, Khadka KB, et al. Feasibility of implementing public-private mix approach for tuberculosis case management in Pokhara Metropolitan City of western Nepal: a qualitative study. Front Public Heal. 2023;11:1132090
  45. Millet J-P, Moreno A, Fina L, del Baño L, Orcau A, de Olalla PG, et al. Factors that influence current tuberculosis epidemiology. Eur Spine J [Internet]. 2013 Jun 8;22(S4):539–48. Available from: http://link.springer.com/10.1007/s00586-012-2334-8
  46. Pelissari DM, Diaz-Quijano FA. Household crowding as a potential mediator of socioeconomic determinants of tuberculosis incidence in Brazil. Gao L, editor. PLoS One [Internet]. 2017 Apr 18;12(4):e0176116. Available from: https://dx.plos.org/10.1371/journal.pone.0176116
  47. Jo Y, Baik Y, Shrestha S, Pennington J, Gomes I, Reja M, et al. Sub-district level correlation between tuberculosis notifications and socio-demographic factors in Dhaka City corporation, Bangladesh. Epidemiol Infect [Internet]. 2021 Sep 2;149:e209. Available from: https://www.cambridge.org/core/product/identifier/S0950268821001679/type/journal_article
  48. Horner J, Wood JG, Kelly A. Public health in/as ‘national security’: tuberculosis and the contemporary regime of border control in Australia. Crit Public Health. 2013;23(4):418–31
  49. Mancuso JD. Tuberculosis Screening and Control in the US Military in War and Peace. Am J Public Health [Internet]. 2017 Jan;107(1):60–7. Available from: https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2016.303502
  50. Falefi R, Almubaroq HZ, Lelyana N, Eze HI. Military Health and Social Determinants of Health: A Scoping-Systematic Review. Soc Med. 2023;16(2):63–75
  51. Biselli R, Nisini R, Lista F, Autore A, Lastilla M, De Lorenzo G, et al. A historical review of military medical strategies for fighting infectious diseases: From battlefields to global health. Biomedicines. 2022;10(8):2050
  52. O’Shea MK, Wilson D. Tuberculosis and the military. BMJ Mil Heal. 2013;159(3):190–9
  53. Rath N, Nikam C, Seidel S, Sinha A, Arora V. YES, WE HAVE the POWER to END TB! Indian J Tuberc. 2023;

Last update:

No citation recorded.

Last update:

No citation recorded.