Research Articles Open Access Sosioeconomic.
Behavioral, and Biological Determinants of Tuberculosis Incidence: A Case Study in Aceh Besar.
Indonesia Farrah Fahdhienie1*.
Fahrisal Akbar2 Faculty of Public Health.
University of Muhammadiyah Aceh.
Banda Aceh.
Aceh.
Indonesia Faculty of Public Health.
University of Muhammadiyah Aceh.
Banda Aceh.
Aceh.
Indonesia *Corresponding Author: E-mail: farrah.
fahdhienie@unmuha.
ARTICLE INFO
Manuscript Received: 30 Aug, 2024 Revised: 01 Feb, 2025 Accepted: 05 Feb, 2025 Date of publication: 02 Oct, 2025 Volume: 5 Issue: 3 DOI: 10.
56338/jphp.
KEYWORDS
Tuberculosis.
Social.
Behavioral.
Biological ABSTRACT Introduction: Tuberculosis (TB) pandemic is a significant global health concern, especially in lowand middle-income countries.
Every year the incidence and deaths due to TB continue to increase.
Preventing and controlling TB effectively requires understanding the complex interplay of the multidimensional TB risk factors, which consist of social, behavioral, and biological determinants that contribute to its spread.
This study aimed to identify and analyze the primary risk factors associated with TB incidence.
Methods: This study employed a case-control design with 44 respondents consisting of 22 laboratory-confirmed TB patients and 22 non-TB patients with matching ages and sex.
This study used a structured questionnaire was used to collect data through face-to-face interviews.
The questionnaire assessed risk factors across three key domains: social determinants, behavioral determinants, and biological determinants.
Bivariate analysis, which used a chi-square test .
-value <0.
, and multivariate analysis, which used a logistic regression test, were performed to determine risk factors most associated with TB incidence.
Results: Low income .
-value=0.
OR=6.
95%CI=1.
, high TB-related stigma .
value=0.
OR=3.
95%CI=1.
-value =0.
OR=3.
95%CI=1.
value=0.
OR=5.
95%CI=1.
value=0.
OR=4.
95%CI=1.
, history of contact with TB patients .
-value =0.
OR=7.
95%CI=0.
-value =0.
OR=5.
95%CI=1.
were significantly associated with TB incidence.
Comorbidities emerged as the strongest risk factor .
-value =0.
OR=12.
95%CI=1.
Conclusion: This study highlights several major factors influencing TB incidence, including social, behavioral, and biological determinants.
The findings suggest that effective TB control strategies should address socioeconomic conditions, promote healthy lifestyles, and involve community leaders and TB survivors in educational campaigns, stigma reduction, and early diagnosis efforts.
Understanding these health determinants can inform more targeted public policies for curbing TB Publisher: Pusat Pengembangan Teknologi Informasi dan Jurnal Universitas Muhammadiyah Palu Page | 532 J.
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INTRODUCTION
Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis .
remains a significant contributor to global mortality despite established preventative and treatment strategies .
2022, the World Health Organization (WHO) reported an estimated 10 million diagnosed TB cases and 1.
5 million deaths, solidifying its position as one of the world's deadliest infectious diseases .
This burden is not uniformly distributed.
Developing countries experience a disproportionately high concentration of TB cases .
Poverty, malnutrition, and high population density all essentially contribute to an increased risk of TB .
Countries with a high TB burden frequently face additional challenges, such as limited access to health services, inadequate early detection programs, and the growing threat of drug-resistant TB strains .
Indonesia is among the 30 countries with the highest TB burden in the world .
According to data from the Indonesian Ministry of Health, more than 800,000 TB cases were reported in Indonesia in 2022 alone .
While Indonesian TB control programs have demonstrably strived to reduce the incidence, significant challenges persist, including drug resistance, social stigma surrounding the disease, and limitations in healthcare resources .
Aceh Besar Regency has a TB incidence rate of 250-300 cases per 100,000 population and a Success Rate of 01% .
This number reflects the ongoing disease burden, requiring continued serious attention from the government and the community.
The high TB prevalence in Aceh Besar Regency is likely attributed to a variety of socioeconomic, environmental, and behavioral factors.
Active case finding efforts through population screening and contact tracing have helped to detect and treat more TB patients .
Understanding the factors influencing TB incidence is crucial for developing effective prevention and control interventions .
Socioeconomic conditions, access to healthcare facilities, and local community behaviors and habits are all recognized risk determinants for TB infection .
Densely populated and unhygienic living environments, limited access to health services, and unhealthy lifestyles .
uch as smoking and alcohol consumptio.
can all weaken the immune system and raise the risk of TB infection .
While numerous studies have explored the relationship between socioeconomic and behavioral factors in relation to the incidence of TB in Indonesia, there remains a limited understanding of how these factors specifically interact at the local level, particularly in Aceh Besar.
The majority of previous studies focused on individual or group risk factors separately, without considering the complex dynamics between socioeconomic conditions, health behaviors, and biological factors in increasing the risk of TB.
In addition, limited local data on socioeconomic and behavioral determinants specific to Aceh Besar hinder the development of effective evidence-based interventions for TB control.
For instance, not many studies have deeply analyzed how income levels, access to health services, housing density, or smoking habits and adherence to TB treatment contribute to TB incidence in the region.
Therefore, this present study attempts to fill this gap by presenting a holistic analysis of the socioeconomic, behavioral, and biological factors that influence TB incidence in Aceh Besar.
Elucidating these factors will inform the development of more targeted interventions aimed at reducing TB prevalence in the region.
The public health significance of this study lies in its potential to provide a scientific foundation for policymakers to design targeted TB prevention and control programs.
Furthermore, the study can contribute to public health education by raising awareness about TB prevention and reducing the stigma associated with the disease.
METHOD
Study design and setting This case-control study investigated risk factors associated with TB incidence in Aceh Besar Regency.
Indonesia.
The study recruited participants from the Ingin Jaya Community Health Center in 2023.
A total of 44 participants were included, comprising 22 confirmed TB cases .
ase grou.
and 22 age- and sex-matched controls without TB diagnoses.
Study procedure A structured questionnaire was used to collect data through face-to-face interviews.
The questionnaire assessed risk factors across three key domains: social determinants, behavioral determinants, and biological Social determinants included education in three levels: elementary .
ompleted elementary school/equivalen.
, secondary .
ompleted junior high school/equivalen.
, and tertiary .
ompleted colleg.
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Behavioral, and Biological Determinants of Tuberculosis Incidence: A Case Study in Aceh Besar.
Indonesia Income was determined by the amount of monthly income received by respondents.
It was classified as high if it equaled or exceeded the Regency Minimum Wage (IDR 3,413,.
and low if it fell below it .
Stigma was classified as low if the score was at or above the mean and high if the score was below the mean .
Knowledge was classified as sufficient if the score was at or above the mean and insufficient if the score was below the mean .
Food security is a household food condition.
If three indicatorsAifood availability, affordability, and utilizationAiare satisfied, a household's food condition was considered food-secure.
if one of the indicators was not met, it was considered food-insecure .
Behavioral determinants included preventive behavior.
It was categorized as practiced if the score was at or above the mean and not practiced if it was less than the mean .
Smoking habit was also considered as a behavioral determinant, measured by identifying the respondent's status as a smoker or non-smoker .
The last behavioral determinant was contact history.
If a family member had TB, the contact history was classified as having a history.
if not, it was not .
Biological determinants, which consist of comorbidities, were categorized as present if the respondent had comorbidities such as diabetes mellitus, cancer, and others.
If the respondent had no comorbidities, it was classified as absent .
Of the 9 individual risk factors examined in this study, only three risk factors .
nowledge, stigma, and TB prevention behavio.
need to be tested for their reliability and validity.
The analysis of validity was attained by calculating the corrected item-total correlation, which represents the correlation between a given item and all other The questions were valid if the corrected item-total correlation value was higher than the r table.
With 88 respondents, the r table used for comparing with the corrected item-total correlation value was 0.
The result of the validity test for the variable of knowledge .
finding all items for this variable exhibits the corrected item-total correlation value higher than the r table, except for one question with a corrected item-total correlation value of -0.
The variable of stigma .
was the finding also indicated that one question was invalid with the corrected item-total correlation of 0.
170, which was lower than the r table, and was excluded from the final For the preventive behavior variable, the measurement was conducted using 20 questions which all were valid and were therefore deemed suitable for inclusion in the final questionnaire.
To evaluate the questionnaire's internal consistency and reliability, the Cronbach's alpha coefficient was computed.
Every variable obtained a Cronbach's alpha value greater than 0.
60, suggesting a satisfactory degree of dependability.
The results of the reliability test indicated that variables of knowledge, stigma, and TB prevention behavior were reliable, exhibiting CronbachAos alpha of 0.
902, 0.
943, and 0.
945, respectively.
Data analysis Univariate analysis was performed by calculating the frequency distribution.
Bivariate analysis was conducted using the chi-square test .
-value <0.
In addition, multivariate analysis was carried out using the logistic regression test, assuming that all significant variables were analyzed at this stage.
Ethical consideration This study has received Ethical Approval from the Health Research Ethics Committee of the Faculty of Medicine.
Syiah Kuala University Number: 017/EA/FK/2024, on January 25, 2024.
RESULTS
The Characteristics of Respondents According to the respondents characteristics (Table .
, there were more male respondents .
3%) than female respondents .
7%), with the elderly making up the largest age group at 61.
4% and adolescents making up 18.
Married respondents comprise the largest percentage of the sample .
5%), while unmarried respondents comprise Page | 534 J.
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Table 1.
Respondent characteristics distribution Characteristics Sex Male Female Age Adolescence (O .
Adult .
Elderly (>.
Marital Status Married Unmarried Widow/Widower Frequency .
Percentage (%) The Univariate Analysis The study sample reflected a range of educational backgrounds, with 45.
5% having completed secondary education .
igh school or equivalen.
and a significant portion .
%) fell below the regional minimum wage in terms of income.
Furthermore, the study identified concerning levels of social vulnerability and health knowledge.
Over 43% of participants reported high levels of stigma associated with TB, and a similar proportion .
2%) demonstrated insufficient knowledge about the disease.
Additionally, over half .
8%) of the households faced food insecurity (Table .
Table 2.
Univariate analysis of TB incidence Variable TB incidence Case Control Education Tertiary Secondary Elementary Income < Minimum Wage Ou Minimum Wage Stigma High Low Knowledge Insufficient Sufficient Food Security Food-Insecure Food-Secure Preventive Behavior Not Practiced Practiced Smoking Habit Yes Contact History Have Do Not Have Comorbidities Present Absent Frequency .
Percentage (%) Page | 535 Sosioeconomic.
Behavioral, and Biological Determinants of Tuberculosis Incidence: A Case Study in Aceh Besar.
Indonesia The Bivariate Analysis Bivariate analysis results indicated a significant association .
-value = 0.
between income and TB Respondents with income lower than the minimum wage had a 6.
9 times increased risk of developing TB compared to those with income equal to the minimum wage (OR = 6.
Similarly, respondents with high stigma and insufficient knowledge regarding TB exhibited a significant association with TB incidence .
-value = 0.
This group had a 3.
8 times greater risk of TB infection.
Additionally, factors such as food insecurity .
-value = 0.
lack of preventive measures .
-value = 0.
, contact history with TB patients .
-value = 0.
, and presence of comorbidities .
-value = 0.
were all significantly associated with increased TB incidence (Table .
Table 3.
Bivariate analysis of TB incidence Variable Education Tertiary Secondary Elementary Income < Minimum Wage Ou Minimum Wage Stigma High Low Education Insufficient Sufficient Food Security Food-Insecure Food-Secure Preventive Behavior Not Practiced Practiced Smoking Habit Yes Contact History Have Do Not Have Comorbidities Present Absent Cases .
Control .
p-value OR .
% CI) 500 .
*p-value < 0.
05: significant The Multivariate Analysis Multivariate analysis (Table .
identified comorbidities as the most significant risk factor associated with TB incidence .
-value = 0.
Individuals with comorbidities were found to have a 12 times increased risk of TB infection compared to those without comorbidities (OR = .
Table 4.
Multivariate analysis of TB incidence Variable Income Stigma Knowledge Food Security Preventive Behavior Contact History Comorbidities *p-value < 0.
05: significant p-value OR .
% CI) 780 .
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DISCUSSION
A growing body of evidence suggests an association between socioeconomic status, particularly income, and the incidence of tuberculosis (TB) .
This relationship is likely multifaceted.
Individuals with lower income may experience restricted access to healthcare services crucial for TB prevention, detection, and treatment.
This limited access could stem from financial barriers, geographical remoteness of healthcare facilities, or a lack of awareness regarding TB .
Furthermore, low income often correlates with less favorable living conditions, characterized by inadequate nutrition and crowded environments.
Such factors can contribute to increased transmission of TB as evidenced by previous research .
,24,.
Additionally, limited resources associated with lower income may hinder individuals' ability to maintain overall health, potentially impacting immune system function and thereby influencing susceptibility to TB infection .
Low-income communities frequently experience a higher prevalence of inadequate sanitation and poor ventilation within their homes, creating environments conducive to the spread of TB bacteria .
Besides, limited housing options often lead to densely populated neighborhoods in these areas, increasing the likelihood of exposure to infectious individuals .
Substandard housing conditions, characterized by poor ventilation and inadequate sanitation, are disproportionately prevalent within low-income communities.
This situation creates a significant risk factor for TB transmission .
Ae.
Adding to the vulnerability, individuals with lower incomes may have restricted access to education and healthcare services, potentially limiting their awareness and knowledge of TB transmission risks, preventive measures and early treatment-seeking behavior .
Individuals with lower incomes may be more likely to hold jobs in settings with a higher risk of TB exposure, such as poorly ventilated factories or mines with significant dust generation .
Workers in the informal sector or those with lower incomes often lack comprehensive health insurance or paid sick leave.
This lack of coverage can create financial barriers to seeking healthcare and may delay the diagnosis and treatment of TB .
Low-income individuals may frequently relocate for work opportunities.
This mobility can heighten the risk of TB transmission due to temporary and crowded living situations and disruptions in access to established healthcare services in new locations .
All in all, low income becomes a substantial risk factor for TB incidence.
It creates a breeding ground for TB transmission through a combination of social and economic disadvantages .
Therefore.
TB control strategies increasingly incorporate efforts to address social and economic equity in an attempt to decrease disease prevalence.
Interventions often encompass broader socioeconomic initiatives aimed at improving income levels, living conditions, and access to quality healthcare services for vulnerable populations .
The holistic approach that integrates socioeconomic factors into TB management is crucial for effectively reducing the incidence and spread of the disease .
The stigma surrounding TB presents a significant public health challenge, negatively impacting various aspects of disease prevention, detection, and treatment .
Individuals experiencing TB symptoms may exhibit treatment-seeking delays due to apprehension regarding discrimination and social rejection within their communities or workplaces .
Furthermore.
TB-related stigma can evoke feelings of shame and diminished self-esteem, ultimately discouraging individuals from seeking a diagnosis and initiating treatment .
Fear of disclosure can lead patients to discontinue treatment for TB prematurely, concerned that others might discover their illness .
This clandestine approach to treatment, which frequently lacks appropriate medical supervision, can result in non-adherence to prescribed regimens, raising the possibility that drug-resistant TB strains will emerge .
Additionally.
TB-related stigma can contribute to psychological distress, including depression and anxiety, which can negatively impact physical health and hinder a patient's ability to follow treatment protocols consistently .
Patients experiencing social isolation due to stigma may have diminished access to crucial social support networks, which are essential for successful TB treatment .
Furthermore, negative TB stigma in the workplace can result in job loss or reduced income, hindering a patient's ability to follow treatment regimens consistently .
Delays in seeking a diagnosis, often fueled by fear of stigmatization, can lead to increased TB transmission within communities as undiagnosed individuals continue to spread the bacteria .
Stigma can also impede health education and outreach initiatives aimed at raising awareness about TB prevention strategies .
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Indonesia due to stigma, hindering efforts to prevent and treat the disease .
Public health programs designed to control TB may face resistance from communities experiencing stigma, leading to reduced program participation and effectiveness .
Ultimately, mitigating stigma holds the potential to significantly reduce the incidence and overall negative impact of TB on public health .
A well-established body of evidence highlights the critical role of knowledge in TB incidence.
Adequate understanding of the disease can significantly influence various aspects of prevention, detection, and treatment success .
Individuals equipped with knowledge regarding TB transmission routes, specifically airborne transmission through infected coughs or sneezes, are better positioned to adopt preventive measures such as maskwearing and maintaining distance from those suspected of infection .
Furthermore, knowledge about the importance of good ventilation, environmental hygiene practices, and adequate nutrition can contribute to reducing the spread of TB within communities .
Similarly, awareness of the characteristic symptoms of TB, including a persistent cough lasting more than two weeks, fever, night sweats, and weight loss, can prompt individuals to seek medical attention earlier.
Early diagnosis is crucial for minimizing transmission and maximizing cure rates .
Knowledge about TB screening is vital in promoting early detection of cases, particularly among high-risk populations such as individuals living with HIV or healthcare workers .
Moreover, knowledge regarding the necessity of completing the entire TB treatment regimen, which typically spans six to nine months, is essential for promoting treatment adherence and reducing the risk of drug-resistant TB strains emerging .
A proper understanding of TB is essential for eliminating related anxieties and debunking common myths.
Misconceptions such as the incurability of TB or the perceived ineffectiveness of treatment can be effectively countered through targeted educational interventions .
TB education initiatives can also significantly reduce the stigma surrounding the disease.
When communities understand that TB is a treatable condition, not a consequence of personal misconduct, they are more likely to offer support to infected individuals .
Indeed, fostering a knowledgebased environment within communities can cultivate a more robust network of social support for TB patients, ultimately contributing to successful treatment outcomes and recovery .
Investment in educational programs designed to disseminate information about TB prevention and the importance of adhering to treatment regimens can demonstrably reduce TB incidence.
Dissemination strategies can take many forms, reaching a variety of populations through mass media campaigns, workplaces, and educational institutions .
Also, healthcare professionals equipped with a comprehensive understanding of TB diagnosis and treatment protocols are better positioned to provide high-quality care to their patients .
Similarly, policymakers with a solid knowledge base regarding TB can advocate for the implementation of effective control policies, including securing adequate funding for prevention and treatment programs .
Public knowledge regarding TB and the critical importance of accessible healthcare services serves as a powerful driver for advocacy efforts aimed at establishing more inclusive and effective health systems .
Undoubtedly, a well-informed populace is essential for successful TB control initiatives .
Through the implementation of effective educational and outreach programs, communities can acquire a deeper understanding of TB prevention strategies, early detection methods, and treatment options.
Ultimately, this enhanced knowledge base empowers communities to play a more active role in reducing TB incidence and mitigating the overall disease burden .
There is a documented correlation between the incidence of TB and food security.
Adequate nutrition plays a critical role in maintaining a robust immune system, which is essential for preventing infections such as TB .
Conversely, nutritional deficiencies, particularly those involving protein, vitamins, and minerals, can compromise immune function and increase an individual's susceptibility to TB infection .
Food security contributes to overall health, which plays a significant role in preventing various diseases, including TB .
Both forms of malnutrition, calorie deficiency and micronutrient deficiencies, have been linked to increased TB susceptibility .
Malnutrition can also exacerbate the prognosis for individuals already infected with TB by hindering their bodies' ability to combat the infection effectively .
Food insecurity's complex effects make it a significant obstacle to controlling TB.
Individuals experiencing food insecurity face a heightened vulnerability to TB infection.
Additionally.
TB patients with inadequate dietary intake experience worse health outcomes compared to their food-secure counterparts .
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Sufficient dietary consumption gives patients the energy and stamina to follow the frequently complex and timeconsuming TB treatment regimens .
There is a close link between food security and socioeconomic status .
Poverty can significantly restrict access to a nutritious diet, thereby contributing to increased TB incidence .
Furthermore, food insecurity often co-exists with substandard living conditions characterized by overcrowding and inadequate sanitation, further amplifying the risk of TB transmission within these communities .
Implementation of programs that address food insecurity, such as targeted food distribution or nutritional supplementation initiatives, has been demonstrably effective in reducing TB incidence .
These interventions are particularly crucial in areas with a high prevalence of food insecurity .
A comprehensive approach to TB control necessitates integrating healthcare services with food security This collaborative approach ensures TB patients receive the necessary medical care and the critical nutritional support required for recovery .
In addition, public health initiatives to raise awareness about the importance of good nutrition and strategies to achieve food security can empower communities to take preventative measures against TB .
Campaigns promoting food security can reduce vulnerability to TB and other infectious diseases .
Integrating food security considerations into TB control strategies offers a multi-pronged approach.
By addressing this crucial determinant of health, we can improve overall community health and bolster immune function, ultimately reducing the incidence and impact of TB .
This effort requires a collaborative effort involving sectors beyond healthcare, including agriculture and economic development, to ensure equitable access to sufficient and nutritious food for all individuals .
Preventive behaviors demonstrably influence TB incidence rates .
Appropriate measures can significantly reduce the risk of TB transmission and effectively control its spread within communities .
Infected individuals should use medical masks to mitigate the airborne transmission of TB bacteria, particularly in crowded or poorly ventilated settings .
Masks can also serve as protective equipment for healthy individuals, especially those working in high-risk environments .
Maintaining good ventilation within enclosed spaces is essential for reducing the concentration of infectious TB bacteria in the air and thereby minimizing the risk of transmission .
Regularly opening windows and doors to enable air circulation is recommended in homes, schools, and workplaces .
Covering the mouth and nose with a tissue or inner elbow when coughing or sneezing prevents the expulsion of infectious droplets into the air and protects others .
Proper disposal of used tissues in bins, followed by thorough handwashing after coughing or sneezing, further enhances hygiene and minimizes transmission risks .
Following a healthcare professional's instructions for the entire course of TB treatment is essential for successful outcomes.
This approach ensures complete eradication of TB infection and minimizes the risk of developing drug-resistant strains .
Social support networks, encompassing family and community members, can play a crucial role in promoting treatment adherence among TB patients .
Implementation of educational programs targeted at raising awareness about TB transmission routes, preventive measures, and the importance of treatment adherence can foster positive behavioral changes within communities, ultimately contributing to a healthier public health environment .
Disseminating accurate information about TB through various media channels, including educational institutions, workplaces, and social media platforms, can challenge existing stigma and foster preventive behaviors .
Individuals with compromised immune systems can reduce their risk by avoiding crowded and poorly ventilated environments .
Workplaces and companies are responsible for ensuring well-ventilated workspaces that are not overcrowded .
Routine TB screening programs, particularly among high-risk populations, are essential for early case identification and prompt intervention to prevent transmission .
Healthcare facilities should prioritize early detection strategies and ensure accessibility for individuals experiencing potential TB symptoms .
Maintaining a balanced and nutritious diet is vital in strengthening the immune system and reducing susceptibility to TB infection .
Additionally, healthy lifestyle choices such as avoiding smoking, limiting alcohol consumption, and prioritizing general well-being can enhance TB protection .
The consistent and widespread adoption of preventive behaviors across communities holds immense promise for significantly reducing tuberculosis (TB) incidence.
Educational initiatives and supportive health policies are essential for fostering positive behavioral changes within the population.
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Individuals with a history of contact with infectious TB cases exhibit an exacerbated vulnerability to contracting the disease themselves .
Household members of active TB patients are at exceptionally high risk due to their constant exposure to bacteria expelled through coughing or sneezing .
Similarly, friends, colleagues, or others in frequent close contact with active TB patients, mainly in poorly ventilated enclosed spaces, experience a higher risk of infection .
Working and academic environments characterized by inadequate ventilation and overcrowding can facilitate TB transmission among individuals nearby .
Settings with high population density and poor ventilation, such as prisons, orphanages, and dormitories, pose a significant risk for TB transmission within these communities .
Contact tracing, a crucial public health intervention, involves identifying and evaluating individuals who may have been exposed to an active TB case.
Early identification through contact tracing allows prompt intervention before symptoms develop and further transmission occurs .
Close contacts of active TB patients should undergo routine TB screening, which may contain a symptom examination and, if indicated, diagnostic tests such as chest X-rays or tuberculin skin tests .
For high-risk individuals, particularly children and those with compromised immune systems, who have been exposed to TB, prophylactic therapy may be employed to prevent the progression to active disease .
Educating close contacts on TB transmission prevention strategies, the importance of screening, and the early signs and symptoms of TB can significantly contribute to preventing further spread .
The use of masks by both active TB patients and their close contacts can effectively reduce the risk of airborne transmission .
Maintaining proper ventilation in homes and workplaces and regularly practicing good hygiene are essential for preventing TB transmission in high-risk settings .
Psychological support and counseling may be necessary for close contacts to understand their risk profile, the significance of sticking to preventive measures, and the importance of TB screening .
Ensuring accessible healthcare services for TB screening and treatment for close contacts is paramount for controlling TB transmission within communities .
By implementing effective contact tracing and management protocols, healthcare systems can identify high-risk individuals and initiate interventions to prevent further TB dissemination .
This strategy requires collaboration between individuals, communities, and healthcare systems to ensure that all close contacts receive the necessary education, screening, and treatment.
Comorbidity, the co-existence of other medical conditions alongside TB, exerts a significant influence on both the risk of developing TB and the course of treatment and disease outcomes .
Human immunodeficiency virus (HIV) infection compromises the immune system, making individuals more susceptible to TB infection .
Furthermore.
TB is a prevalent opportunistic infection in patients with untreated HIV/AIDS .
Treatment regimens for autoimmune diseases, such as lupus or rheumatoid arthritis, often incorporate immunosuppressive medications that can heighten the risk of TB infection .
Diabetes mellitus can exacerbate the risk of developing active TB due to its immunosuppressive effects, rendering the body more vulnerable to TB bacterial infection .
Certain chronic health conditions, such as chronic renal failure or post-kidney transplant status, can adversely affect the immune system and increase TB susceptibility .
Additionally, pre-existing heart or lung diseases, including chronic obstructive pulmonary disease (COPD) or severe asthma, can complicate the course of TB and impede the recovery process .
Cancer therapies, such as chemotherapy or radiotherapy, can also weaken the immune system and increase the risk of TB infection .
Smoking harms lung function and diminishes the body's capacity to combat infections, including TB .
Furthermore, poor socioeconomic conditions, characterized by limited access to healthcare and overcrowded living environments, can contribute to an increased risk of TB, particularly in vulnerable populations residing in resourcelimited settings .
The presence of comorbidities often requires adjustments to TB treatment regimens to minimize the risk of adverse drug interactions or compromised treatment efficacy .
Effective management of TB in patients with comorbidities demands a holistic approach that involves a coordinated healthcare team to ensure all aspects of care are addressed .
Educating individuals with comorbidities about their heightened risk of TB is crucial for raising awareness and promoting preventive measures and early detection strategies .
Assuring equitable access to healthcare services for TB screening, diagnosis, and treatment is paramount, especially for those with pre-existing medical conditions that elevate their TB risk .
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By adopting a comprehensive and holistic approach that incorporates coordinated management of TB and its comorbidities, we can demonstrably reduce the burden of TB and mitigate its impact on individuals with other health conditions .
Raising public awareness, launching educational programs, and implementing focused preventive measures can collectively control TB transmission and protect susceptible individuals with comorbidities.
Strategies to reduce TB-related stigma include public awareness campaigns through the use of social media, television, radio, and community discussions to disseminate information that TB is curable and not a disease to be ashamed of.
Testimonials of survivors can encourage individuals who have recovered from TB to share their experiences to inspire others.
Training for health workers by providing specialized training to medical personnel allows them to provide friendly and non-discriminatory services to TB patients.
Furthermore, a community-based approach that involves community leaders, religious leaders, and health cadres can be implemented to support TB patients socially and psychologically.
Strategies to improve TB knowledge can be achieved through school and workplace education by integrating TB education into the school curriculum and workplace health programs.
Community-based counseling can be carried out by holding group discussions at community health centers, integrated health posts for child health .
, and places of worship to increase community understanding.
Moreover, interactive and digital media can be utilized using infographics, animated videos, and mobile applications to disseminate information about TB in an engaging and easy-to-understand manner.
Strategies to address food insecurity as a risk factor for TB include food aid programs to provide nutritional packages to families of TB patients, especially the underprivileged, to accelerate recovery and boost immunity.
Urban agriculture and food security can be organized to encourage initiatives such as community gardens or hydroponics to increase community access to nutritious food.
Partnerships with the private sector, such as inviting companies and NGOs, can also be established to support the distribution of nutritious food to vulnerable groups, especially in areas with high TB rates.
CONCLUSION
The incidence of TB was discovered to be associated with low income, high stigma, insufficient knowledge, food insecurity, non-practicing TB prevention, contact history, and comorbidities.
Among the analyzed variables, comorbidity emerged as the most closely associated risk factor for TB incidence.
Based on the findings, it is recommended that TB awareness education campaigns be conducted.
TB survivors be engaged in sharing recovery experiences, community or religious leaders be involved, and economic empowerment training be provided to risk Additionally, there is a need for policy support programs for TB patients who are unable to work, food assistance or subsidies for TB patients and families, and integration of TB education in school curriculum and worker AUTHORAoS CONTRIBUTION STATEMENT All authors contributed equally to the conception and design of the study.
CONFLICTS OF INTEREST
The authors declare no conflicts of interest.
SOURCE OF FUNDING STATEMENTS
This study was self-funded by the authors.
No external funding was received to support this research.
ACKNOWLEDGMENTS
We gratefully acknowledge the Puskesmas Ingin Jaya.
Aceh Besar Regency.
TB program coordinator.
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BIBLIOGRAPHY