Relationship between house environmental factors and tuberculin skin

test among elementary school students

M. Hidayat, M. Lubis & I. Fudjiati

Departments of Child Health Medical School, Faculty of Medicine Universitas Sumatera Utara, Medan, North
Sumatera, Indonesia

ABSTRACT: Introduction: Tuberculosis is a major cause of death in the world. The increasing TB cases can
be affected by population density, temperature, ventilation, lighting, and humidity. Tuberculin Skin Test (TST)
is a tuberculosis diagnostic test with sensitivity and specificity of 90% and can be used to detect children who
infected with tuberculosis.
Methods: A cross sectional study was conducted among elementary school students in Singkuang Village,
North Sumatera on April 2016
Results: Univariate analysis showed that the relationship between ventilation, residential density, temperature
and TST was statistically significant (P=0.006, 0.001, 0.005 respectively). Bad ventilation was associated with
higher risk in positive TST of PR=4.6 (95% CI= 1.43-14.70), while bad temperature of PR=8.8 (95% CI= 3.34-
22.85), and residential density of PR= 9.4 (95% CI =1.33-66.49).
Conclusion: There is a relationship between house environmental factors and TST among elementary school
students.
Keywords: tuberculin skin test, environmental factors, students

1 INTRODUCTION for Mandailing Natal area, TB cases in 2011 was 961

Tuberculosis (TB) is caused by Mycobacterium tu-
berculosis which is still the main cause of death in the
world. By 2014, it is estimated that 9.6 million people
worldwide suffer from TB and cause 1.5 million
deaths annually, with an estimated 1 million children
suffering from TB and 140,000 cases of deaths among
children in the world.(1)
Indonesia is ranked the 3rd country with the highest
incidence of TB in the world as many as 1 million
new TB cases per year after Africa, and India, where
there is an incidence of doubling compared to
2014.(1) It is estimated that TB prevalence rate in In-
donesia is 297 per 100,000 population with cases only
annually reaches 460,000 cases. (2)
In North Sumatra Province, the incidence of pul-
monary TB is 21,145 people, with the result of new
case finding coverage of 17,459 cases or 82,57%.
This figure has increased when compared with the
year 2011 that is 76.57% and 2010 is 68.86%. Based
on the survey, Medan city is the biggest sufferer com-
pared to the population of each regency / city, while
cases consisting of 956 new cases and 5 old cases.
Number of Pulmonary TB cases with BTA (+)
reached 853 cases.(3)
Research in 2006 in Banyumas District concluded
that there is an association between pulmonary tuber-
culosis with lighting, dwelling density, ventilation,
the existence of bedroom windows, floor type, sleep-
ing room division, wall type, outside humidity, out-
door temperature, patient contact and status nutri-
tion.5
The results of the research in 2007 in Paseh Vil-
lage Sumedang District concluded that there is a rela-
tionship between variable humidity of the house, den-
sity of house occupants, the area of house ventilation
and home lighting with the incidence of tuberculosis
in children.6
The results of the above two studies differ from
those conducted in Pinolosian Bolaang Mongondow
district south in 2012, which stated that ventilation
conditions did not have a significant relationship with
the incidence of pulmonary TB.7
 Tuberculin Test / Tuberculin Skin Test (TST) is a
relevant tuberculosis diagnostic test, with a sensitiv-
ity and specificity of 90%. Based on tuberculin test
results, we can find the tuberculin index as a guide to
determine the level of tuberculosis infection so as to
measure the prevalence of tuberculosis infection and
ARTI (Annual Risk of Tuberculosis Infection) in
children.8,9
Based on the background presented, to confirm
previous research, the researchers are interested to ex-
amine the relationship between environmental factors
with tuberculin test results in elementary school chil-
dren.
2 MATERIALS AND METHOD
2.1 Population and Sample
The target population in this study was elementary
school age children. The affordable population in
this study is elementary school-aged children in
Singkuang Village. The study sample was an
affordable population that met the inclusion criteria.
The sample is selected by Consecutive Sampling
technique
2.2 Data analysis
Data analysis by chi-square to determine the relation-
ship between categorical variables with significance
level at p <0,05 and
3 RESULT
The study was conducted in Singkuang Village, Man-
dailing Natal Regency, North Sumatera. The total
sample included in this study was 50 children accord-
ing to inclusion and exclusion criteria. The female sex
slightly dominates with the proportion of 54 %.
The study also found that the majority of children
have negative tuberculin test. The relationship be-
tween ventilation, residential density, temperature
and TST was statistically significant (P=0.006, 0.001,
0.005 respectively). Bad ventilation was associated
with higher risk in positive TST of PR=4.6 (95% CI=
1.43-14.70), while bad temperature of PR=8.8 (95%
CI= 3.34-22.85), and residential density of PR= 9.4
(95% CI =1.33-66.49).
Tabel 1. Percentage of house environmental factors
Classification Tuberkulin Percentage
test (%) (%)
Positif 14 28
Negatif 36 72
Total 50 100
Tabel 2. Prevalence ratio of home environmental factors
Risk factor PR P (CI 95%)
Ventilasi 4.66 0.005 (1.481-14.709)
Suhu 8.86 0.001 (3.438-22.850)
Kepadatan 9.34 0.005 (1.33-66.490)
4 DISCUSSION
This study showed that the percentage of low birth
weight was higher than normal birth weight in
elementary school children in Singkuang village.
Previous research in Nepal has a relatively high
prevalence of LBW, ranging from 14% to 32% .
(Maleqpour, 2004) The Ministry of Health of the
Republic of Indonesia states that there has been an
increase in the prevalence of LBW from 2005 by 24.3
per 1000 live births and in 2006 to 25.9 per 1000
births life. One of the main causes of high infant
mortality is low birth weight or LBW (<2500 gram).
One effort done in tackling the problem of LBW is to
assess the condition of the mother and various factors
that affect the condition when pregnant. In general,
the level of education is a factor that affects birth
weight, because the level of education can describe a
person's level of knowledge about a matter related to
health maintenance. (Adi et al, 2015)
The study also found that the majority of children
have an underweight body mass index. In 2010, 3.7
million elementary school children with underweight
body mass. The majority of BMT underweight can be
caused by risk factors from the development of body
mass, one of which is the problem of malnutrition is
also higher in low income communities than people
who have high incomenya. The nutritional
deficiencies found in primary school children are lack
of protein and less nutritional problems can not be
overcome, especially in primary schools in poor and
underdeveloped areas. A person's nutritional
knowledge level affects attitudes and behaviors in
choosing foods, which determine whether or not a
person understands the nutritional benefits of the food
consumed. (Yudesti & Prayitno, 2013)
This study shows the association of birth weight
with cognitive function in elementary school children
in Singkuang village. The result of statistical test with
Chi-square test get P value = 0.0001 which shows
there is significant correlation between birth weight
with cognitive function in elementary school children
in Singkuang village. One of the effects of LBW is
the slow growth of children seen in weight gain that
does not reach normal levels when they are one year
old. In addition, LBW is very susceptible to
deficiencies and disturbances in the balance of
various nutrients, making it susceptible to permanent
damage in physical and mental growth. (Abadi et al,
2013) Many children who start living with very low
birth weight have problems when they start school.
Other impacts of LBW include inability to focus on
learning, visual-motor disturbance, answering skills
of lower questions, and poor motor skills.
(Malekpour, 2004)
In this study also showed relationship of body
mass index with cognitive function in elementary
school children in Singkuang village. The result of
statistical test with Chi-square test get P value = 0,356
where there is no correlation between body mass
index and cognitive function in elementary school
children in Singkuang village. Lower BMI
(Underwight) and Obesity tend to have lower
cognitive scores. (Julia et al, 2009) The results of this
study may occur possibly because the condition of
cognitive function of children is influenced by
environmental factors, including education in
schools, and community culture. This causes the child
is less motivated to obtain new information and the
potential of the child does not develop to the
maximum so not only the condition of cognitive
function is influenced by the mass weight of the child
index. 40
5 CONCLUSION
The results of this study can be concluded that the
initial screning of cognitive impairment with its
relation to LBW and nutritional status is that there is
a relationship between birth weight with cognitive
function in elementary school children in Singkuang
village, with P value 0.01 and no relationship between
body mass index and cognitive function In
elementary school children in Singkuang village, with
P value 0.356.
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