ABSTRACT
@#Tuberculosis (TB) is one of the leading causes of morbidity and mortality. It is carrying a heavy public health problem burden in Indonesia. This study aimed to determine the risk of poor knowledge of TB, socioeconomic status, malnutrition and contact history with TB cases with the incidence of TB in Medan. This was a cross sectional study conducted between May – August 2019 in Medan municipality, in the three highest TB cases incidence public health centers (puskesmas). Structural interviews were conducted to solicit demographic data, clinical data, as well as the risk factors. Logistic regression was conducted to assess the potential risk factors associated with the infection. We enrolled 260 clinically suspected cases of TB, comprising 135 (51.9%) cases positive for TB and 125 (48.1%) cases negative for TB. In multivariate model, those who had contact history with active TB cases and those who malnourished had higher odds of having TB infection, with adjusted odds ratio (aOR): 5.58 (95%CI:3.13–9.93) and aOR: 3.36 (95%CI: 1.87–6.02), respectively. Having contact history with TB active case and malnutrition were the most significant risk factors of TB incidence in Medan municipality, North Sumatera, Indonesia. Therefore, educating patients on the importance of cough or sneezes etiquette procedures including use of face masks to minimize the risk of infection.
ABSTRACT
@#Dengue fever (DF) infection continues to present as a serious public health problem in Medan municipality, North Sumatera, Indonesia. The number of DF cases continuously increasing recently. However, space time clusters of DF have not been investigated yet. A study was undertaken to detect clusters of DF incidence during 2015-2018 in Medan. Spatial geo-reference was conducted to 151 village coordinates by geocoding each village’s offices. A retrospective space-time scan statistic analysis based on population data and monthly DF incidence was performed using SaTScan TM v9.4.4. Data of DF during 1 January 2015-31 December 2018 were analyzed using Poisson model to identify the villages at high risk of DF. The test of significance of the identified clusters of DF was based on comparing the likelihood ratio (LLR) against the null distribution obtained from Monte Carlo hypothesis testing. Total number of permutation was set to 999 and the significance level was set as 0.05. The highest LLR number was determined as the most likely cluster, while the rests were as the secondary clusters. This analysis identified 13 significant clusters. These DF clusters were initially spatially concentrated in the southwest and center of Medan and the last two years of study moved towards the northern part and identified in the last four months (September-December) of each year, which were the rainy seasons in the area. Most likely clusters were most frequently detected in the last three-year period of study in Anggrung village. Thirteen statistically significant DF clusters were identified in the 2015-2018 period. This may assist health authorities to improve the DF preventive strategies and develop public health interventions especially in the cluster’s area.