International Journal of Health and Pharmaceutical Relationship Between Risk Factors and The Incidence of Primary and Post Primary Tuberculosis Achnes Pangaribuan1.
Andriyani Risma Sanggul2.
Agnes Dorothy3.
Vidi Posdo A.
Simarmata4.
Vanessa Mutiara Marcelina5.
Febtusia Puspitasari6
1,3,4
Department of Internal Medicine.
Faculty of Medicine Universitas Kristen Indonesia Department of Public Health.
Faculty of Medicine.
Universitas Kristen Indonesia Department of Clinical Pathology.
Faculty of Medicine.
Universitas Kristen Indonesia Department of Cardiology andVascular.
Faculty of Medicine.
Universitas Kristen Indonesia Corresponding Author:
Email: achnes.
pangaribuan@uki.
Abstract.
Tuberculosis (TB) remains a significant global health problem, with Indonesia ranking second in the world for the highest number of cases.
This study aims to analyze the relationship between various risk factors and the incidence of primary and post-primary tuberculosis in the Merdeka Public Health Center working area in 2025.
Based on preliminary data, there are 122 TB patients in the region diagnosed using the Molecular Rapid Test (TCM).
Identified risk factors include host factors such as male gender, productive age .
Ae64 year.
, low education, and low economic status.
Additionally, home environmental factors play a crucial role in increasing transmission risk, including inadequate residential density (<9mA/perso.
, poor ventilation, lack of natural lighting, and suboptimal air humidity.
Negative preventive behaviors and exposure to cigarette smoke are also significant contributors to the incidence of the disease.
Mitigation efforts require comprehensive interventions.
These must focus not only on medical treatment but also on improving residential environmental conditions and educating the community on healthy behaviors.
Keywords: Pulmonary Tuberculosis.
Environmental Risk Factors.
Residential Density.
Merdeka Public Health Center and Mycobacterium tuberculosis.
INTRODUCTION
Tuberculosis (TB) remains a significant global health challenge characterized by high morbidity and mortality rates.
This infectious disease, caused by the bacterium Mycobacterium tuberculosis, primarily spreads through the air when an active patient expels droplet nuclei.
These bacilli not only attack the lung parenchyma but can also spread hematogenously or through the lymphatic system to various other organs.
According to the World Health Organization (WHO) 2023 report, there were approximately 8.
2 million newly diagnosed TB cases worldwide, with an incidence rate of 134 cases per 100,000 population.
Currently.
Indonesia ranks second globally in TB burden, trailing only India.
Data indicates a concerning upward trend in Indonesia, with an estimated 1,060,000 new cases and an annual mortality rate of 134,000 deaths.
Similar challenges are observed at the local level in regions such as Bogor City.
The Bogor City Health Office recorded a prevalence of 11,772 TB cases in 2024.
While case detection rates are relatively high, they are not yet aligned with treatment success, which reached only 80 percent in 2023.
This figure remains below the national target of 90 percent.
Furthermore, the emergence of Drug-Resistant Tuberculosis (DR-TB) and a high number of pediatric infections complicate disease management efforts.
In 2025, the Merdeka Public Health Center recorded 122 pulmonary TB patients, underscoring the urgent need for serious management.
To improve diagnostic accuracy, advanced tools such as the Xpert MTB/RIF Molecular Rapid Test have been implemented to simultaneously detect the presence of M.
tuberculosis and resistance to rifampicin.
The incidence of pulmonary TB is influenced by a complex interaction between agent, host, and environmental factors.
Regarding host factors, the productive age group .
to 64 year.
and males show a higher proportion of cases due to high mobility and increased environmental exposure.
Socioeconomic factors, including low education levels and poor economic status, further limit access to health information and medical services.
Additionally, the residential environment plays a vital role in disease transmission.
High residential density, suboptimal indoor temperatures, and a lack of natural lighting create microhttps://ijhp.
International Journal of Health and Pharmaceutical environments that support the survival of TB bacilli.
Previous multivariate analyses indicate that inadequate indoor humidity can increase the risk of infection by 2.
89 times.
Furthermore, insufficient natural lighting shows a very strong correlation with disease incidence, increasing the risk dozens of times over.
Beyond physical housing conditions, negative preventive behaviors and poor nutritional status weaken the host's immune system, facilitating the progression from latent infection to active disease.
Comorbidities such as Diabetes Mellitus and HIV further exacerbate the pathophysiology by impairing macrophage function.
Therefore, a deep understanding of environmental determinants and patient demographic characteristics is essential for designing effective intervention strategies.
This study aims to analyze the dominant variables contributing to pulmonary TB incidence to systematically reduce transmission rates and improve therapeutic II.
METHODS
This study utilizes an observational analytic design with a cross-sectional approach to identify risk factors for primary and secondary TB at the Merdeka Community Health Center (Puskesmas Merdek.
Bogor City.
The study was conducted over two months, from December 2025 to January 2026.
The research population includes all TB patients who have undergone treatment at this location, totaling 50 individuals.
Sampling was conducted using total sampling, involving 50 respondents who met the inclusion and exclusion criteria.
Inclusion criteria consist of primary or secondary TB patients willing to participate as Conversely, patients categorized with MDR-TB.
XDR-TB, and extrapulmonary TB were excluded from the study sample.
The research instrument used is a digital questionnaire via Google Forms.
This instrument includes an informed consent form, personal data, and a list of questions regarding risk factors.
Data collected consist of primary data through questionnaires and secondary data obtained from medical records or the health centerAos website.
The research workflow began with faculty supervision, instrument design, and validity and reliability testing.
The researcher then identified respondents, established initial contact, and sought informed consent before data collection.
Collected data were processed through editing, coding, scoring, entry, and cleaning stages.
Statistical data analysis was performed using SPSS 0 software.
Univariate analysis was used to describe the frequency distribution of each variable, while bivariate analysis was applied to test the relationship between risk factors and the incidence of primary and secondary TB in the region.
RESULT AND DISCUSSION
Overview of Primary and Secondary TB Patients Fig 1.
Primary and Secondary TB Patients Patient Age Table 2.
Patient Age < 25 years old 25-50 years old Total Total Percentage https://ijhp.
International Journal of Health and Pharmaceutical Research findings show that most TB patients fall within the 25Ae50 year age group .
%).
This indicates that the productive age group is at the highest risk for TB incidence in the Merdeka Community Health Center work area.
These findings align with research by Manullang et al.
, which states that the productive age group has a higher risk of exposure to Mycobacterium tuberculosis due to high mobility and social interaction.
WHO also reports that the global TB incidence is most frequently found in the productive age group because of high outdoor activity levels and repeated environmental exposure.
Gender Table 3.
Gender Gender Male Female Total Frequency .
Percentage (%) Research findings indicate that TB patients are predominantly male .
%) compared to females, with a statistically significant relationship ( p = 0.
000 ).
This result aligns with a study by Haddase et al.
, which states that men have a higher risk of suffering from pulmonary TB than women.
This difference is attributed to behavioral factors such as smoking habits, outdoor activities, and exposure to unhealthy work environments, which are more frequently found in men.
IMT
Tabel 4.
IMT
BMI Category Underweight Normal Total Primary TB n (%) 7 .
%) 31 .
%) 38 .
%) Secondary TB n (%) 4 .
%) 8 .
%) 12 .
%) Total n Based on the research results, most TB patient respondents have a normal BMI, indicating that TB incidence is not only found in individuals with poor nutritional status.
Nevertheless, statistical analysis shows no significant relationship between BMI and TB incidence .
> 0.
This finding is consistent with research by Pralambang and Setiawan .
, which states that TB can occur in individuals with normal nutritional status because other factors, such as germ exposure, environmental conditions, and comorbidities, play a more significant role.
A study by Akbar et al.
also explains that while nutritional status affects the immune system, a normal BMI does not fully protect someone from the risk of Mycobacterium tuberculosis infection.
Educational Background Table 5.
Educational Background
Educational Background
Did not graduate High School
High School Graduate Bachelor's Degree Total
(%)
p-value 0,000 The results show that the largest group of TB patients did not graduate from high school .
%), and there is a significant relationship between education level and TB incidence ( p = 0.
000 ).
This result is in line with research by Darmin et al.
, which shows that low education levels are significantly associated with the incidence of pulmonary TB.
Low education is linked to limited knowledge regarding TB prevention, low awareness of clean and healthy living behaviors, and delays in seeking healthcare services.
Diabetes Mellitus Tabel 6.
Diabetes Melitus
Yes
Total
Primary TB
TBC
Secondary TB
Total
p-value 0,014 95% CI
1,294-28,494
6,071
https://ijhp.
International Journal of Health and Pharmaceutical Bivariate analysis shows that respondents with diabetes mellitus have a 6.
071 times greater risk of experiencing TB compared to respondents without diabetes, with a statistically significant relationship .
= Diabetes mellitus is known to impair immune system function, specifically macrophage and lymphocyte activity, thereby increasing the risk of developing active TB.
This aligns with a study by Suwirda et al.
, stating that diabetes mellitus patients have a higher susceptibility to pulmonary TB infection compared to individuals without diabetes.
Active and Passive Smokers Table 7.
Active and Passive Smokers Active Smoker
Tidak Total
Passive Smoker
Yes
Total
Primary TB
,4%)
,6%)
TBC
Secondary TB
,3%)
,7%)
Primary TB
TBC
Secondary TB
p-value Total
0,031
Total
p-value 0,011 95% CI
1,089-17,250
4,333
95% CI
1,380-22,724
The research shows that active smokers have a 4.
333 times greater risk of experiencing TB .
= .
, while passive smokers have a 5.
6 times greater risk .
= 0.
These findings align with research by Tandang et al.
, which states that there is a significant relationship between smoking habits and the incidence of pulmonary TB.
Exposure to cigarette smoke can damage respiratory defense mechanisms and lower local lung immunity, facilitating Mycobacterium tuberculosis infection.
Household Density Table 8.
Household Density Household Density Crowded Not Crowded Total
Primary TB
TBC
Secondary TB
Total
p-value 0,007 95% CI
1,513-25,410
The research results show a significant relationship between occupancy density and the incidence of pulmonary tuberculosis .
= 0.
Respondents living in high-density houses have a greater risk of contracting TB.
Housing conditions with many occupants in limited space increase the chances of close contact between infected individuals and healthy ones, facilitating the spread of Mycobacterium tuberculosis through airborne droplets.
This finding is consistent with a recent study by Wahyuni et al.
, which found that high household density is significantly related to pulmonary TB incidence in Indonesian urban areas due to poor air exchange and more frequent interpersonal contact.
Ventilation Area Table 9.
Ventilation Area
Ventilation Size
<800 cm
>800 cm2
Total
Primary TB
TBC
Secondary TB
Total
p-value 0,03 95% CI
1,095-17,915
4,429
Analysis shows that house ventilation sizes that do not meet standards are significantly associated with the incidence of pulmonary TB .
= 0.
Insufficient ventilation causes poor air exchange, increasing the concentration of airborne droplets containing TB germs and facilitating the transmission process.
This finding aligns with a recent study by Ramadhan & Sari .
, which states that good house ventilation significantly reduces the risk of pulmonary TB infection by ensuring smoother airflow and reducing the accumulation of TB droplets in closed spaces.
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International Journal of Health and Pharmaceutical Window Area Table 10.
Window Area
Window Size
<5000 cm2
>5000 cm2
Total
Primary TB
TBC
Secondary TB
Total
p-value 95% CI
0,032
1,069-19,799
Research results also indicate that substandard window sizes are related to TB incidence.
Narrow windows inhibit the entry of air and sunlight, creating a damp environment that supports the survival of Mycobacterium tuberculosis bacteria.
This is consistent with the latest research by Nugraha et al.
which found that inadequate window size is associated with an increase in household pulmonary TB cases due to lack of air circulation and natural ultraviolet light exposure that helps inactivate the bacteria.
Lighting Table 11.
Lighting Lighting Category Poor Good Total Primary TB Secondary TB Total Research results show that poor lighting inside the house is associated with the incidence of pulmonary TB.
Lack of sufficient sunlight exposure makes it easier for Mycobacterium tuberculosis bacteria to survive in the home environment because natural ultraviolet rays, which play a role in killing germs, are not optimal.
This finding matches recent research by Prasetyo & Utami .
, stating that houses with poor natural lighting have a higher risk of pulmonary TB incidence due to the minimal amount of sunlight entering the rooms.
IV.
CONCLUSION
Characteristics of TB patients at the Merdeka Community Health Center in 2025 show that most patients are within the productive age group, are male, and have low education levels.
They live in houses with substandard environmental conditions, are exposed to active or passive smoking at home, and some have diabetes mellitus as a comorbidity.
Additionally, the majority maintain a normal nutritional status.
The distribution of TB cases at the Merdeka Community Health Center in 2025 includes both primary and secondary pulmonary TB cases, with primary pulmonary TB cases being more prevalent than secondary cases.
The education level of TB patients has a significant relationship with the incidence of pulmonary TB at the Merdeka Community Health Center in 2025, where lower education levels correlate with an increase in TB cases.
Household environmental conditions, including occupancy density, ventilation size, and window size, have a significant relationship with the incidence of pulmonary TB at the Merdeka Community Health Center in 2025.
Smoking status, including both active and passive smokers, has a significant relationship with the incidence of pulmonary TB at the Merdeka Community Health Center in 2025.
Diabetes mellitus has a significant relationship with the incidence of pulmonary TB at the Merdeka Community Health Center in 2025, with diabetes patients showing a higher risk of developing TB.
Nutritional status based on Body Mass Index (BMI) shows no significant relationship with the incidence of pulmonary TB at the Merdeka Community Health Center in 2025, as the majority of TB patients possess a normal nutritional status.
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International Journal of Health and Pharmaceutical REFERENCES