The environmental and behavioral aspect to prevent TB transmission among children in the slum area of .pptx

lecture

1. The environmental and behavioral aspect to prevent TB transmission among children in the slum area of Surabaya city  Dr. M. Atoillah Isfandiari , M.D., M.Kes Department of Epidemiology , Biostatistics, and Promotion and Health Behavior Faculty of Public Health Universitas Airlangga , Surabaya, Indonesia

2. Introduction WHO data in 2022 estimates that the number of TB patients worldwide is 10.6 million people and 1.3 million of them are children. Indonesia is the second largest country contributing TB cases worldwide after India In Indonesia, children are a group at risk of contracting TB from surrounding adults. The coverage of pediatric TB cases in Indonesia has increased from 2020 (51.31%) to 2021 (60.22%).
Environmental characteristics have an important role in the risk of spreading TB cases, especially areas with poor basic sanitation, lack of access to clean drinking water, lack of household waste treatment, and low socioeconomic status. Surabaya is one of the largest cities in Indonesia and quite populated, as per March 2024 the population is 3.009.286, and also currently also one of region contributing to the high number of TB cases among children in Indonesia.

3. INTRODUCTION Epidemiologically monitoring to be addressed: 1) case detection rate / CDR; 2) case notification rate/CNR; 3) The success rate of TB patient treatment in all cases; 4) Coverage of discovery of drug-resistant cases; 5) The success rate of treatment of drug-resistant TB patients; 6) Percentage of TB patients who know HIV status The estimated number of TB suspects in Surabaya is 60,804 patients in 2023, while the achievement is 81,903 patients or 127.85%

4. Why is TB in children should be addressed ? Difficulty diagnosing TB in children . Children find it difficult to have phlegm , if they can phlegm is not necessarily TB in children giving confirmed bacteriological results / BTA positive The actual burden of TB prevalence among children in the community is not yet known TB in children is considered non- contagious The availability of funds Most of the children affected by TB are in the poor community including those who live in the slums with difficult access to health services

5. ( Pediatric ) TB situation in the slums Urban slums with high population density, poor sanitation, and lack of adequate sewage disposal systems, contribute to the increase in pediatric TB cases The behavior of spitting, uncovering the mouth when coughing, delayed referral to health services in slums while the TB symptoms are already found, accelerates the spread of infection Efforts to prevent the spread of TB in slums by specifically targeting behavior change and improving environmental sanitation are important to be carried out as an effort to reduce the number of TB in children.

6. ( Pediatric ) TB situation in the slums Previous research shows that the chance of finding TB cases in urban slums is five times greater than in non-slum areas Urbanization in the city of Surabaya has resulted in the spread of slum environments widespread Data from the Surabaya City Health Office shows that in 2020, the percentage of TB cases among children in the slums of Surabaya city was 5.8% and it decreased in 2021 to 4.5% and also in 2022 to 3.5%, but in October 2023 there weas a significant increase of 5.1%. Our study is to identify the role of stakeholders in TB prevention and control efforts in the city of Surabaya as well as the preparation of the Child TB Management Model and its relationship with environmental sanitation and behavior in the Slum Area of Surabaya City

7. On going study Our study was carried out with a convergent parallel mixed methods approach (Convergent Parallel Mixed Methods Design) by combining quantitative and qualitative data at the same time, then the data was integrated to see the confirmation and/or contradiction. A quantitative approach using a cross-sectional study design was carried out to analyze environmental sanitation conditions and community behavior in individuals in the slum area of Surabaya City. A qualitative approach is carried out to find out the TB control efforts that have been carried out by the community, health workers and stakeholders at the community level. An interview guide document will be developed to explore information on efforts that have been made in the context of prevention and control related to sanitation and behaviors that can increase the risk of spreading TB, as well as factors (both individual, socio-cultural, and economic) that may affect these behaviors and sanitation conditions. Quantitative Approach
The variables that will be identified in this study are demographic characteristics, knowledge, attitudes, behaviors , and sanitation conditions related to TB prevention.

8. Age Group Sex Male Female Total (1) (2) (3) (4) 0-4 104.840 100.697 205.537 5-9 112.646 107.932 220.578 10-14 114.971 108.751 223.722 15-19 111.554 105.395 216.949 20-24 108.114 104.767 212.881 25-29 112.144 111.731 223.875 30-34 112.890 112.399 225.289 35-39 116.922 116.175 233.097 40-44 113.851 116.202 230.053 45-49 104.984 108.127 213.111 50-54 90.939 94.977 185.916 55-59 74.458 81.644 156.102 60-64 59.759 67.727 127.486 65-69 44.970 53.587 98.557 70-75 25.884 31.485 57.369 75+ 22.115 34.586 56.701 TOTAL 1.431.041 1.456.182 2.887.223 Surabaya Demography 2023

9. TB Cases among Children in Indonesia Proportion of pediatric TB cases among all cases treated in Indonesia from 2010 to 2018 ranged from 9.4% to 11%. As per the modelling case Pediatric TB is estimated to be around 10-15%. The data shows a tendency to overdiagnosis , underdiagnosis or underreported cases of Pediatric TB

10. Diagnosis for TB in Children in Indonesia The main obstacle in the management of TB in children is the enforcement of diagnosis.
The difficulty in finding Mycobacterium tuberculosis in children leads to the establishment of TB diagnosis in children that requires a combination of clinical aspects and any other relevant supporting examinations .
Diagnosis in Children SHOULD NOT be based solely on Thoracic Photographs . Bacteriological examination ( miscroscopic or Gen- Xpert ) is still the main examination to confirm TB diagnosis in children .
The approach to diagnosing TB in children uses a scoring system prepared by the Ministry of Health of the Republic of Indonesia together with IDAI (Indonesian Pediatrician Association ).
The Pediatric TB Scoring System is a weighting of symptoms , clinical signs and supporting examinations that can be carried out in Limited Service Facilities . Each symptom in the scoring system must be examined to determine whether it is included in the parameters of the scoring system .
The scoring system for diagnosing Pediatric TB in Indonesia is as follows :

11. Parameter 1 2 3 Skor TB Contact Unclear - Family report,BTA (-)/BTA unclear /NA BTA Mantoux test Negatif - - Positif (≥10 mm or ≥5 mm Nutritional status/ body weight - BW/ H <90% atau BW/Age <80% Clinically Under nourished or BW/ H <70% atau BW/ age <60% - FUO - ≥ 2 weeks - - Chronic cough - ≥ 3 weeks - - Colli, axilla , and inguinal Limphadenopathy - ≥ 1 cm, more than 1 , - - Bone swelling ( knee , hip , phalanx )/ - yes - - Thorax Ro Normal/ unclear Suggestive appearance - - Total score

12. Map of Density in Indonesia 2023

13. Bivariate analysis of Population density and the proportion of Pulmonary TB per 1000 population in Surabaya 2023 Population density Proportion of Pulmonary TB Medium (1-2) High (>2) Low Medium ( 8089-17806) High ( > 17806)

14. Healthy Home Coverage and TB Proportion 2019-2023 BIVARIATE ANALYSIS OF HEALTHY HOUSING CONDITION AND THE PROPORTION OF PULMONARY TB PER 1000 POPULATION SURABAYA 2023 Proportion of Pulmonary TB Medium (1-2) High (>2) Housing Condition Low Medium (78- 89%) High (>89%)

15. Population Density, Healthy House Coverage, and Proportion of Pulmonary TB in Surabaya City 2019-2023 BIVARIATE ANALYSIS OF POPULATION DENSITY, HEALTHY HOUSING CONDITION AND THE PROPORTION OF PULMONARY TB PER 1000 POPULATION SURABAYA 2023 Proportion of pulmonary TB : 1,64/1000 population Population density : 3377/km2 Healthy housing condition : 96,15% Proportion of pulmonary TB : 2,77/1000 population Population density : 35511/km2 Healthy housing condition : 83,19% Proportion of Pulmonary TB Medium (1-2) High (>2) Low(<1)

16. CONSIDERATION Despite still being in the trajectory , TB program coverage in Surabaya should be improved to achieve the target. There is a close relationship between housing conditions , population density , and the incidence of TB in various areas of Surabaya, based on the bivariate analysis .
Our current study is dedicated to investigating the profound influence of behavior and environmental factors on TB transmission among children . We are confident that the results will significantly inform policymaking efforts concerning the containment of TB transmission , especially among children in Surabaya. Consequently , it is imperative to employ advanced data collection methods , including comprehensive screening and diagnosis.

17. THANK YOU