Individual and Environmental Risk Factors of Tuberculosis: A New Evidence from Ponorogo, East Java

Diana Sayidah, Setyo Sri Rahardjo, Bhisma Murti


Background: For centuries, TB has been linked anecdotally with environmental risk factors that go hand-in-hand with poverty: indoor air pollution, tobacco smoke, malnutrition, over­crowded living conditions, and excessive alcohol use. But to date, there is no empirical evidence from East Java, Indonesia, to support these anecdotal evidences. The purpose of this study was to provide new evidence on the individual and environmental risk factors of tuberculosis in Po­no­ro­go, East Java.

Subjects and Method: A case control study was conducted in Ponorogo, East Java, from April to May 2018. A sample of 200 study subjects was selected for this study by fixed disease sampling. The dependent variable was tuberculosis. The independent variables were age, gen­der, education, nutritional status, dwelling density, smoking, and alcohol drinking. Data on tuberculosis infection status were obtained from the medical record at District Health Office Po­no­­rogo. The data were collected by questionnaire and analyzed by a multiple logistic re­gres­sion on Stata 13.

Results: Age ≥ 44 years (b= 3.18; 95% CI= 1.66 to 4.69; p<0.001), nutritional status (b= 1.42; 95% CI= 0.02 to 2.82; p=0.046), dwelling density ≥ 5 (b= 1.87; 95% CI= 0.37 to 3.36; p=0.014), smoking (b= 2.23; 95% CI= 0.61 to 3.85; p=0.007), and alcohol drinking (b= 2.83; 95% CI= 1.38 to 4.27; p<0.001) were associated with increased risk of tuberculosis. Higher education (b= -2.56; 95% CI= -4.16 to -0.96; p=0.002) and female (b= -1.36; 95% CI= -2.92 to -0.20; p=0.087) were associated with decreased risk of tuberculosis.

Conclusion: Age, nutritional status, dwelling density, smoking, alcohol drinking, education, and female, are shown in this study to be the risk factors of tuberculosis.

Keywords: tuberculosis, individual factor, environmental factor

Correspondence: Diana Sayidah. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Sutami No. 36 A, Surakarta 57126, Central Java. Email: Mobile: +6282234721294.

Journal of Epidemiology and Public Health (2018), 3(3): 353-360

Full Text:



Ambaw F, Mayston R, Hanlon C and Alem A. (2015). Determinants, Course and Impact on Pathways to Care and Treatment Outcomes in a Primary Care Setting in Southern Ethiopia a Study Protocol. BMJ Open, 5: 1–10.

Anyim LD, Alduendae JL, Velarde HV, Cruz AT, Ergara HF, Mendoza DM and Sancho CG. (2014). Comparison of Bacteriological Conversion and Treatment Outcomes among MDR-TB Patients with and Without Dia-betes in Mexico: Preliminary Data. Rev Port Pneumol, 23(1): 27-30.

Babu RG and Laxminarayan R. (2012). The Unsurprising Story of MDR-TB Resistance in India. Tuberculosis, 92: 301-306.

Blaser N, Zahnd C, Hermans S, Vizcaya LS, Estill J, Morrow C, Egger M. (2016). Tuberculosis in Cape Town: an Age-Structured Transmission Model. Epidemics, 14.54–61.

Dotulong JFJ, Sapulete MR, Kandou GD. (2015). Hubungan Faktor Risiko U-mur, Jenis Kelamin dan Kepadatan Hunian dengan Kejadian Penyakit Tb Paru di Desa Wori Kecamatan Wori. Jurnal Komunitas Kedokteran dan Tropik, 3 (2).

Fogel Z, Napiorkowska A, Kaminski M, Kopec EA, Zwolska Z, Bielecki J, Jagielski T.(2015). Second-line Anti-tuberculosis Drug Resistance and its Genetic Determinants in Multidrug-resistant Mycobacterium Tuberculosis Clinical Isolates. Journal of Microbiology, Immunology and Infection. 49: 439-444.

Hoza AS, Sayoki GM, Mfinanga SGM and Onig BK. (2015). Anti-TB Drug Resistance in Tanga, Tanzania: A Cross sectional Facility-base Prevalence Among Pulmonary TB Patients. Asian Pacific Journal of Tropical Medicine, 8(11): 907–913.

Kapur A, Harries AD (2013). The Double Burden of Diabetes and Tuberculosis Public Health Implications. Diabetes Researchand Clinical Practical, 1: 10-19.

Kemenkes RI (2016). Profil Kesehatan Indonesia tahun 2015. Jakarta: Kemenkes RI.

Ma E, Ren L, Wang W, Takahashi H, Wa-gatsuma Y, Ren Y, Gao F et al. (2014). Demographic and Socioeconomic Disparity in Knowledge About Tuber-culosis in Inner Mongolia, China. Journal of Epidemiology, 25(4): 312-320.

Narasimhan WHO. (2013). Guideline: Nutritional Care and Support for Patients with Tuberculosis.

Prosser G, Brandenburg J, Reiling N, Barry CE, Wilkinson RJ and Wilkinson KA. (2016). The Bacillary and Macrophage Response to Hypoxia in Tuberculosis and the Consequences for T Cell Antigen Recognition. Microbes and Infection.1-16.

Parna K, Purjer ML, Ringmets I and Tekkel M. (2014). Educational Differences in Cigarette Smoking Among Adult Population in Estonia, 1990-2010: Does The Trend Fit The Model of Tobacco Epidemic?. BMC Public Health, 14(709): 1-8.

Silva RD, de Luna FDT, de Araujo AJ, Ca-melo ELS, Bertolozzi MR, Hino P, Lacerda SNB et al. (2017). Patients’ Perception Regarding The Influence of Individual and Social Vulnerabilities on The Adherence to Tuberculosis Treatment: A Qualitative Study. BMC public health, 17(725): 1-9.

Rao VG, et al. (2017). Smoking And Alcohol Consumption: Risk Factors For Pul-monary Tuberculosis Among The Tribal Communits in Central India. Indian Journal of Tuberculosis, 64: 40-43.

Theron G, Peter J, Zijenah L, Chanda D, Mangu C, Clowes P, Rachow A et al. (2015). Psychological Distress and its Relationship with Non-Adherence to TB Treatment: a Multicentre Study. BMC Infectious Diseases, 13-19.

Umanah TA, Ncayiyana JR and Nyasulua PS. (2015). Predictors of Cure Among HIV Co-Infected MultidrugResistant TB Patients at Sizwe Tropical Disease Hospital Johannesburg, South Africa. Trans R Soc Trop Med Hyg, 109: 340–348.

World Health Organization (2016). Global Tuberculosis Report 2016. Geneva: WHO Press.

Young, F, Critchley JA, Johnstone LK and Unwin NC. (2009). Globalization And Health a Review of CoMorbidity Between Infectious and Chronic Disease in Sub Saharan Africa : TB and Diabetes Mellitus, HIV and Metabolic Syndrome, and the Impact of Globalization. BMC Public Health, 9: 1–9.

Zhang C, Wang Y, Shi G, Han W, Zhao H, Zhang H and Xi X. (2017). Deter-minants of Multidrug-Resistant Tuberculosis in Henan Province in China: A Case Control Study. BMC Public Health, 16(42): 1-9.

Zumla E, Ghose B, Vaibhav S and Michael E. (2017). Socioeconomic Disparities in Smoking Behavior and Early Smoking Initiation Among Men in Malawi. Tobacco Use Insights, 10: 1-7.


  • There are currently no refbacks.