Screening Program For Lung Tuberculosis in Adult A-3

SCREENING PROGRAM
FOR LUNG TUBERCULOSIS

IN ADULT
A-3
14700053 – RIZCHA DEVY PRATAMI A. : Prevalence , Program Evaluation ,DOTS ,Etc.

14700055 – A.A. NGR. BRAHMANDIKA C. : Screening procedure ,PPT
People with TB suspects are detected early, whether
it symptomatic or asymptomatic (but still sustainable
to suffer TB).
By discovered an asymptomatic patient, then total treatment

can be done so that the disease will be cured easily
and doesn’t endanger themselves, the environment and can’t
be the transmission’s sources so that TB epidemic can be
avoided.
People who comes to the health service and
showing the TB symptoms
People who have contact with TB patient

With the same symptoms must do sputum examination too.
People who have contact with TB patient

although they don’t show the symptoms yet.
WHY MUST DO THE SCREENING
TB is a serious disease because it can spreads,
causing dead, and having high prevalence rate.
Some TB screening procedures must have validity,

simple, cheap, safe, acceptable, reliable, and having
adequate facilities.
A safe treatment for positive cases are available,

effective and acceptable.
Health Department of RI, 2002:
A health practitioner are expected to discover patient suspects

early, because TB is an infectious disease which
can cause dead. All patient suspects must
be tested 3 sputum specimens in 2 days
continuously (SPS).
According to WHO report in 2013, TB prevalence
PREVALENCE
rate of Indonesia was in third position

of the world after India and China.
The new TB prevalence rate estimation in 2012

was 8.600.000 persons and 1.300.000 of them
were die. (WHO, 2013)
PREVALENCE
Nationally, data of RISKESDAS in 2013, prevalence

rate of Indonesian who were diagnosed by health
practitioner in 2013 was 0,4%. Six provinces
with highest TB are West Java (0,7%),
Papua (0,6%), DKI Jakarta (0,6%), Gorontalo (0,5%),
Banten (0,4%) and West Papua (0,4%).
Annual Risk of Tuberculosis Infection (ARTI) are 1-3%, it
PREVALENCE
means that 1000 of 100.000 people were

infected every year. 10% of them were infected
and 5% of them were patients with positive BTA.
Knowing that 1 patient with positive BTA
can spread 10 persons around and causing
infections to them (depends on their immunity).
(Kemenkes, 2011)
DOTS =
Directly Observed Treatment Short-course.
A treatment and management strategy which is

used in TB countermeasures.
A comprehensive strategy which is used by primary
health practitioner in whole world to detect and
cure TB patient. TB countermeasures with its
DOTS strategies can give a high recovery rate
while WHO trageting minimal recovery rate is
85% of all detected TB patients with positive BTA.
DOTS principle is determining treatment facilities for
TB patient in order to directly observe the regularity of
taking medicine. This strategy is observed by Puskesmas
practitioner, LSM, and others which understand about
DOTS.
(Dirjen P2M & PLP, 2005).

Every programs is always having some indicators which
can be used to evaluate whether the program is
success or not, especially for case detection
rate, case notification rate and treatment success
rate.
CDR
CNR
TSR
Program target of TB countermeasures is having 70% as
minimal case detection rate from the estimation and
85% for minimal cure rate of all patients
and maintain them. This target is expected to
reduce the prevalence rate which is caused by
TB in order to reach MDG’s goals in 2015.
(Depkes RI, 2008)
There are so many factors which can influence
TSR, exclude recording performence and data report,
such as:
1. Patient doesn’t obey the treatment procedure of taking medicine (OAT)
2. Pasien berpindah fasyankes.
3. RR or MDR type TB
4. There is no PMO (or PMO is exist but less in monitoring)
Continuance...
5. OAT supply is disturbed so that the patient delayed the treatment

or doesn’t continue the medication.
6. OAT quality is weaken because of the unstandart safekeeping.
SCREENING PROCEDURES
3 sputum specimens of all TB suspects
are examined in 2 days (SPS). TB diagnosis
are enforced by the discovering of BTA. On the national TB
program, the discovering of BTA through the microscopic sputum
examination is the main diagnosis. Another examination can
be used as a supporter diagnosis as long as it is suitable
with the indication. (Depkes RI, 2007)
SCREENING IN THE DETECTION OF DISEASE
APPARENTLY WELL POPULATION
(well persons plus those with undiagnosed disease)
Population To be tested
■■о■о■
о□о□□■
■о■ ■о
оооо □■□■
о Screening Test
Negative Positive
(Person presumed (Person presumed to have
to be free of disease □■□□ the disease or be at
under study) ■■ □ increased risk in future)
□□□ ■■■ ■■■
□ Diagnostic Procedures ■
■
о Negative on test Disease or Risk Disease Risk
■ Positive on test factor Present factor Absent
no disease
□ Positives on test,
disease present THERAPEUTIC
INTERVENTION
MICROSCOPIC BACTERIOLOGY
TESTING
By the discovering of Mycobacterium tuberculosis from sputum,

pleura’s fluid, urine, faeces and tissue’s biopsy.
Sputum test by using the method of SPS
or every morning in 3 days continuously.
The weakness of this sputum BTA testing such as
sputum volume required may not under 3 ml.
Too little sputum sample will make a false
negative result.
In national TB program, the discovering of BTA through

microscopic sputum examination is the main diagnosis.
Test result will be avowed as positive when
2 of 3 BTA’s SPS specimens are positive.
If only 1 positive specimen, then next
test is required to be done (thorax radiograph or
SPS examination is repeated).
Thorax Radiograph
Most of TB cases, the main diagnosis is enforced by
microscopic sputum test and doesn’t need thoracic
radiograph. But in certain condition, thoracic radiograph
is required to be done with some indication such as:
1. Just 1 of 3 SPS sputum specimens whose result is

positif BTA. In this case, thoracic radiograph is reiquired
to support the diagnosis of positif BTA TB.
2. All these 3 sputum specimens have negatif result
after the test is repeated 2 times and there is
no repair after the non-OAT antibiotic gift.
3. Those patients was suspected to have chronic astma which

need special treatment and management.
1. Target is not achieved.
Program target of TB countermeasures is having 70%
as minimal case detection rate from the estimation
and 85% for minimal cure rate of all
patients ...(Depkes RI, 2008)
And from graph we note that Indonesia
has depression in CDR from 2012 until
2014, and just has 46%. Even though the minimal ...
CDR target from Depkes is 70%.
And same with TSR, from the graph we
note that Indonesia is only has 74%, so that
minimal cure rate from Depkes is also not
achieved. It means that from 2012 until
2014, program target of TB countermeasures from
Health Departement of RI is not achieved.
2. Unreachable for certain regions.
For certain health service whose place is

far away from laboratories, they will post
the sputum specimen and needs so much
more time. Maybe that’s why Papua, Sulut
and Jambi having very low TSR presentation.
Similarly to thorax radiograph. Not all Puskesmas
have complete medical devices. In some region,
they have to go to the health facilities whose
place is far enough.
“Thank You”
Daftar Pustaka
Alfa G. A. Poluan, Elvie Loho, Ramli H. Ali. (2012). “Hubungan Gambaran Foto Toraks dan Uji
Tuberkulin pada Anak dengan Diagnosis Tuberkulin Paru di RSUP Prof.DR.R.D/Kandou Manado
Periode Januari 2012 – Desember 2012”. Manado: Fakultas Kedokteran Universitas Sam Ratulangi.
Eni Yulvia Susilayanti, Irvan Medison, Erkadius. (2014). “Profil Penderita Penyakit Tuberkulosis Paru BTA Positif yang
Ditemukan di BP4 Lubuk Alung periode Januari 2012 – Desember 2012”. Jurnal Kesehatan Andalas. 2014; 3(2). Padang:
Fakultas Kedokteran Universitas Andalas. http://jurnal.fk.unand.ac.id (Diakses pada tanggal 1 Maret 2016).
Kementerian Kesehatan RI, Direktorat Jenderal Pengendalian Penyakit dan Penyehatan Masyarakat. (2014). “Pedoman
Nasional Pegendalian Tuberkulosis”. Jakarta: KEMENTERIAN KESEHATAN RI. (Diakses pada tanggal 23 Maret 2016)
Khotijah, Bobby Pasca Kambodiansyah, Asri Kurniastuti. (2015). “5R Sebagai Upaya Pencegahan Primer Penularan
Tuberkulosis di Tempat Kerja”. Hasil-Hasil Penelitian dan Pengabdian LPPM Universitas Muhammadiyah Purwokerto.
ISBN : 978-602-14930-3-8. Surakarta: Department of Public Health and Preventive Medicine, Faculty of Medicine,
Sebelas Maret University. (Diakses pada tanggal 1 Maret 2016).
Noor Edi Widya Sukoco. (2011). “Hubungan Antara Perilaku Pencegahan dan Kepatuhan Berobat Penderita TB di
Indonesia”. Buletin Penelitian Sistem Kesehatan. Vol. 14 No. 1 Januari 2011: 68–74. (Diakses pada tanggal 1 Maret 2016).
Tika Triharinni, Muhammad Atoillah Isvandiari. (2014). “Analisis Faktor yang Terkait Test Tuberculin pada Anak dengan
Riwayat Kontak TB”. Jurnal Berkala Epidemiologi. Vol. 2, No. 2 Mei 2014: 151–160. Surabaya: Departemen Epidemiologi
Fakultas Kesehatan Masyarakat Universitas Airlangga. (Diakses pada tanggal 1 Maret 2016).

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SCREENING PROGRAM

FOR LUNG TUBERCULOSIS

14700053 – RIZCHA DEVY PRATAMI A. : Prevalence , Program Evaluation ,DOTS ,Etc.

By discovered an asymptomatic patient, then total treatment

People who have contact with TB patient

People who have contact with TB patient

Some TB screening procedures must have validity,

A safe treatment for positive cases are available,

A health practitioner are expected to discover patient suspects

rate of Indonesia was in third position

The new TB prevalence rate estimation in 2012

Nationally, data of RISKESDAS in 2013, prevalence

means that 1000 of 100.000 people were

A treatment and management strategy which is

(Dirjen P2M & PLP, 2005).

5. OAT supply is disturbed so that the patient delayed the treatment

By the discovering of Mycobacterium tuberculosis from sputum,

In national TB program, the discovering of BTA through

1. Just 1 of 3 SPS sputum specimens whose result is

3. Those patients was suspected to have chronic astma which

For certain health service whose place is

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