Contextual Effect of Village on the Incidence of Tuberculosis in Children in Surakarta, Central Java: A Multilevel Analysis Evidence

Abstract

Background: Indonesia is in the second place with the highest burden of tuberculosis (TB) in the world. Childhood is a period of rapid growth that requires efforts to maintain children's health. At the time the child still has a low immune system making it vulnerable to a disease including TB. The problem of TB in children requires better attention in child TB control programs. This study aimed to analyze the contextual influence of villages on the incidence of TB in children. Subjects and Method: This was a case-control study conducted in 25 villages in Surakarta, Central Java, from August to September 2019. A sample of 200 children aged 0 to 18 years was selected by fixed disease sampling. The dependent variable was the incidence of TB in children. The independent variables were birth weight, BCG immunization, exclusive breastfeeding, nutritional status, parental income, home sanitation, exposure to cigarette smoke, family history of TB, and contextual effect of village. Data on TB were obtained from medical record in Surakarta community health center. The other data was collected by questionnaire. The data was analyzed by multilevel multiple logistic regression with Stata 13. Results: The risk of TB in children increased poor house sanitation (OR= 6.70; 95% CI= 1.14 to 39.27; p= 0.035), high exposure to cigarette smoke (OR= 6.71; 95% CI= 1.09 to 41.25; p= 0.040), and family history of TB (OR= 6.01; 95% CI= 1.36 to 26.39; p= 0.018). The risk of TB in children decreased with normal birth weight (≥2500 g) (OR= 0.12; 95% CI= 0.02 to 0.60; p= 0.009), BCG immunization (OR= 0.17; 95% CI= 0.04 to 0.64; p= 0.009), exclusive breastfeeding (OR= 0.08; 95% CI= 0.01 to 0.57; p= 0.011), good nutritional status (OR= 0.11; 95% CI= 0.02 to 0.66; p= 0.016), and parental income ≥Rp 1,802,700 (OR= 0.07; 95% CI= 0.01 to 0.37; p= 0.002). Village had strong contextual effect on the risk of TB in children with intra-class correlation (ICC)= 29.24%. Conclusion: The risk of TB in children increases poor house sanitation, high exposure to cigarette smoke, and family history of TB. The risk of TB in children decreases with birth weight ≥2500 g, BCG immunization, exclusive breastfeeding, good nutritional status, and high parental income. Village has strong contextual effect on the risk of TB in children.