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Vol. 6, No. 2, 2024, pp. 55-63 ISSN 2656-6052 (online) | 2656-1107 (print) 
      http://journal2.uad.ac.id/index.php/eshr/index                                                   eshr@ikm.uad.ac.id 

 

 

      10.26555/eshr.v6i2.9223  

 
 

55 

 
 

  

 
Research Article  
 
Household Contacts as Risk Factor for Tuberculosis: A 
Cross-Sectional Study 
 
Ardyawati Wira Oktaviana, Liena Sofiana*, Tisa Salma Muthiah 
 
Faculty of Public Health, Universitas Ahmad Dahlan, Yogyakarta, Indonesia  
 
* Correspondence: liena.sofiana@ikm.uad.ac.id  
 
Received 23 October 2023; Accepted 31 July 2024; Published 02 August 2024 
 
ABSTRACT 
 
Background: Tuberculosis (TBC), caused by Mycobacterium tuberculosis, is an infectious 
disease that is still a global problem. Indonesia has a high burden of pulmonary tuberculosis 
and is ranked second in the world with the highest number of TBC sufferers after India. 
Tuberculosis is transmitted through infected droplets when coughing or sneezing, and close 
contact is very susceptible to the transmission process and other supporting factors. This 
study aims to determine the risk factors for TBC. 

Method: This study used a cross-sectional research design with Chi-Square analysis and 
continued with multivariate analysis and logistic Regression. The sample consisted of 430 
respondents obtained using the Accidental Sampling technique. 

Results: Factors associated with TBC in the Kapanewon Depok area were age (RP: 2.086; 
95% CI: 1.247-3.490; p= 0.006), gender (RP: 2.1; 95% CI: 1.302-3.393; p= 0.003), family 
income (RP: 3.593; 95% CI: 2.322-5.560; p= 0.000), history of household contact (RP: 
8.438; 95% CI: 5.737-12.410; p= 0.000), and history of close contact (RP: 3.881; 95% CI: 
2.49-6.051; p= 0.000). The factor that has the most influence on the incidence of TBC is a 
history of household contact with a value of Exp(B)=17.699. 

Conclusion: Risk factors for pulmonary TBC in the Kapanewon Depok area are age, 
gender, family income, history of household contact, and history of close contact. A 
relationship, namely the history of household contact, has the most influence on the 
incidence of TBC in the Kapanewon Depok area.  

 
Keywords: Age; History of Close Contact; Income; Tuberculosis; Sex 
 
 

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INTRODUCTION 

Tuberculosis (TBC) is an infectious disease caused by Mycobacterium tuberculosis, and this 
bacterium usually attacks the lungs but can attack other organs.1 TBC is still a health problem 
both in the world and in Indonesia; TBC is still the top ten cause of death globally.2 Indonesia 
has a high TBC burden, ranked second in the world after India.3 The number of case findings 
in 2019-2020 in Indonesia has decreased because of the Coronavirus disease 2019 (COVID-
19) pandemic. The case-finding rate is a way to assess progress in tuberculosis control and 
shows how many tuberculosis cases have been achieved by the program. If TBC cases are 
not detected as early as possible, it is suspected that people affected by TBC will not receive 
a TBC control program.4 

Several factors influence the incidence of TBC. Several factors influence the prevalence of 
pulmonary TBC in Indonesia, namely place of residence, education, age, gender, and 
environment. Other factors include a history of contact with TBC sufferers, previous diagnosis 
of pulmonary TBC by a health worker, Diabetes Mellitus by a doctor, and smoking.5 TBC 
patients with positive BTA have a greater risk of causing infection compared to those with 
negative BTA; the higher the number of germs in the sputum droplets, the greater the risk of 
transmission, and the longer and more often they are exposed to germs, the greater the risk 
of transmission. Meanwhile, individual factors are age and gender. The group most vulnerable 
to contracting TBC is the young adult age group, which is also the productive age group, and 
according to the results of the TBC prevalence survey, more males are affected by TBC than 
females.4 

Age is one of the factors associated with the incidence of TBC.6 TBC often occurs at the young 
age group; this can be because people at that age tend to have a lot of activity and mobility 
with lots of people. A person can contract the disease if he is around and close to many people. 
Based on the distribution of TBC case data in Indonesia, the number of TBC cases in men is 
higher than in women, namely 57.5% in men and 42.5% in women.7 Most smokers are men, 
and smoking can facilitate the transmission of TBC. More men are infected with TBC than 
women. In several previous studies, gender also played a role in increasing cases of 
pulmonary TBC, such as research in Anhui Province, China, which showed that pulmonary 
TBC was higher in men than women.8 

Low socio-economic conditions also play a role in TBC disease because tuberculosis affects 
people who live in slum housing; there is no air circulation and poor nutritional consumption. 
Economic status is critical in the family, and low income can impact tuberculosis because low 
income means people do not get the health care they need.9 TBC patients whose family 
income is less than the minimum wage are at risk of developing TBC than a person with a 
family income ≥ minimum wage.9 Someone with sufficient income will invest more in their 
health in preventive terms, such as eating food with adequate nutritional status, consuming 
vitamins, and seeking treatment for healing and a clean home environment. The lower the 
income, the higher the risk of contracting pulmonary tuberculosis. This is closely related to 
nutritional status, housing conditions, neighbourhood population density, and the availability 
of adequate health services.10 Whether the air circulation is reasonable depends on the 
house's ventilation. Poor ventilation greatly influences TBC incidence because the presence 

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or absence of ventilation influences other factors that trigger tuberculosis germs to grow and 
reproduce well.11 

Environmental factors are also causing TBC disease, including household contact, which 
means contact with each other. Individuals stay indoors for at least one night or often during 
the day.12 Previous research supports the theory that household contact is a causal factor for 
TBC. This study found that positive household contacts would have more TBC cases than 
negative ones.13,14 Contact with BTA+ has a source of transmission that depends on the 
likelihood, duration, and proximity of exposure to an infectious case. Meanwhile, in another 
study, it was found that there was no relationship between a history of household contact and 
the incidence of tuberculosis because most of the respondents did not have families living in 
the same house with the status of being infected with tuberculosis.15 

One of the factors that increases the possibility of pulmonary TBC is close contact with TBC 
sufferers or sources of infection. Close contact is frequent encounters with a source of 
infection.16 In several previous studies, variations in the results of the relationship between 
close contact and TBC were found, including research that stated that a history of close 
contact was significantly related to the incidence of TBC,17,18 but this was different from other 
studies. Research states that there is no relationship between a history of close contact with 
TBC, the majority of respondents having no contact with adult BTA patients, and the presence 
of healthy living habits instilled in the family.19 

Sleman Regency has the highest number of TBC cases compared to other districts/cities in 
DI Yogyakarta. Based on the results of a preliminary study, the highest number of tuberculosis 
cases was found in Kapanewon Depok, with 98 cases. Transmission at home and lack of 
knowledge about transmission factors led to the discovery of many new cases at the Depok I, 
Depok II, and Depok III Community Health Centers. Based on this, this research will be carried 
out to determine what factors are associated with tuberculosis at Depok I, II, and III Health 
Centers. 

METHOD 

This observational study uses a cross-sectional research design conducted in March-April 
2023. The population underwent examinations at the Depok I, Depok II, and Depok III 
Community Health Centers, Sleman, Yogyakarta. The sample was calculated based on a 
sample size formula with a cross-sectional design with an unknown population of 432 people. 
Sampling was done using the accidental sampling technique, patients who visited the 
community health centre during the research period met the inclusion criteria, such as being 
willing to be respondents and residing in Depok were recruited in this study. The variables in 
this study were age, gender, family income, history of household contact, history of close 
contact, and incidence of tuberculosis. The instrument used for data collection was a 
questionnaire created by the researcher. Data were analyzed using the chi-square test and 
logistic regression test. This research has approved by the Ahmad Dahlan University research 
ethics board with registration number 012301010. 

 
 
 

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RESULTS 

The characteristics of research respondents based on age, sex, family income, educational 
status, and type of work are presented in Table 1. The distribution of research respondents 
based on the age variable is that the productive age group 15-50 years dominates the 
research subjects with 232 people (54%). In comparison, age Unproductive aged <15 years 
and ≥ 51 years amounted to 198 people (46%). Based on gender, it is dominated by women, 
who have a more significant proportion, with 238 people (55.3%), than men, with 192 people 
(44.7%). The majority of respondents had a family income ≥Regency Minimum Salary per 
month, namely 354 people (82.3%), compared to respondents who had a family income 
<Regency Minimum Salary per month with a total of 76 people (17.7%). Most respondents 
had a high school/equivalent educational status, with 250 people (58.1%). Respondents were 
dominated by the type of work as Housewives (IRT), with 115 people (26.7%) compared to 
other kinds of work. 

Table 1. Characteristics of respondents based on age, gender, family income, educational 
status, and type of work 

Variable n=432 % 
Age group   

a. Productive (15-50 years) 232 54 
b. Unproductive (<15 years and >50 years) 198 46 

Sex   
a. Male 192 44.7 
b. Female 238 55.3 

Family income   
a. < Regency Minimum Salary (2,159,519 IDR) 76 17.7 
b. ≥ Regency Minimum Salary (2,159,519 IDR) 354 82.3 

Educational    
a. Not yet in school 11 2.6 
b. Elementary school 24 5.6 
c. Junior high school 36 8.4 
d. Senior high school 250 58.1 
e. Vocational/bachelor’s degree 107 24.9 
f. Magister degree 2 0.5 

Occupation   
a. Labourers/non-formal workers 51 11.9 
b. Drivers 14 3.3 
c. Teacher 8 1.9 
d. Housewife 115 26.7 
e. Private sector employee 50 11.6 
f. BUMN/BUMD employees 2 0.5 
g. Student/Students 97 22.6 
h. Health workers 8 1.9 
i. PNS/TNI/POLRI 14 3.3 
j. Retired 23 5.3 
k. Self-employed 20 4.7 
l. Businessman 11 2.6 
m. No/Not Yet Working 17 4 

 

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Bivariate analysis is an analysis that determines the relationship between independent 
variables and dependent variables. Based on the results of statistical analysis of the Chi-
Square test between the variables age, gender, family income, history of household contacts, 
and history of close contacts, it shows a relationship with the incidence of tuberculosis in the 
Kapanewon Depok area. This can be seen from the p-value <0.05 (Table 2). Multivariate 
analysis in this study used logistic Regression (Table 3). Factors that are associated and are 
risk factors for tuberculosis include age (p-value: 0.006; RP: 2.086), gender (p-value: 0.003; 
RP: 2.102), family income (p-value: 0.000; RP: 3.593), history of household contacts (p-value: 
0.000; RP 8.438) and history of close contact (p-value: 0.000; RP 3.881). 

Table 2. Relationship between age, gender, family income, history of household contact, 
and history of close contact with the incidence of tuberculosis in the Kapanewon Depok, 

Sleman 

Variable 
Tuberculosis 

RP Sig. 
(CI 95%) Yes No 

f % f % 
Age      

0.006* 
(1.247-3.490) 

    Productive 44 19 188 81 
2.086     Unproductive  18 9 180 91 

Sex      
0.003* 

(1.302-3.393) 
     Male 39 20 153 80 

2.102      Female 23 10 215 90 
Family income      

0.000* 
(2.322-5.560) 

     < Regency Minimum Salary 27 36 49 64 
3.593      ≥ Regency Minimum Salary 35 10 319 90 

History of household contact    
0.000* 

(5.737-12.410) 
     Yes 30 70 13 30 

8.438      No 32 8 355 92 
History of close contact      

0.000* 
(2.49-6.051) 

     Yes 18 44 23 56 
3.881      No 44 11 345 89 

 
Table 3. Multivariate Analysis of Factors Affecting Pulmonary Tuberculosis in the 

Kapanewon Area, Depok 

Variable Koefisien S.E Wald df Sig OR 
Exp(B) 

CI 95% 
Min Max 

Age 1.049 0.418 6.297 1 0.012 2.855 1.258 6.479 
Sex 0.938 0.358 6.847 1 0.009 2.554 1.265 5.154 
Family income  1.684 0.421 15.996 1 0.000 5.386 2.360 12.293 
History of household 
contact 2.873 0.421 46.33 1 0.000 17.699 7.751 40.411 
History of close 
contact 1.733 0.439 15.544 1 0.000 5.655 2.390 13.381 

 
Based on logistic regression analysis (Table 3), history of household contact is the most 
dominant factor associated with the occurrence of tuberculosis with a value of Exp(B) = 17,699 
(CI 95%; 7,751-40,411) compared to other variables because it has the largest Exp(B). This 
indicates that tuberculosis is 17.6 times more likely to occur in people with a history of 

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household contact with tuberculosis patients compared to people who do not have a history 
of household contact. 

DISCUSSION 

The identical productive age group has a very high level of mobility every day, so the possibility 
of being exposed to Mycobacterium tuberculosis is greater than that of the non-productive age 
group, whose mobility is not as high as that of the productive age group. A crowded work or 
school environment and contact with many people can also increase the risk of pulmonary 
TBC. People of productive age suffer from this disease more easily because work or school 
environments like this make it more easily transmitted. Thus, people who meet many people 
can also more easily contract the disease. This productive age requires a lot of time and 
energy to work, with less rest time, lowering body endurance.20 Productive age is difficult for 
the transmission level because at this age, those affected easily interact with other people, 
have high mobility, and are allowed to spread to different people and the environment where 
they live.21 The productive age group has a relatively high frequency of travel, a busy work 
environment, various risky jobs, and extensive networks, which are often associated with the 
productive age group so that the productive age group can contract and transmit tuberculosis. 
Higher than the non-productive age group.22 Apart from that, a factor that can increase a 
person's risk of being infected by tuberculosis sufferers in the surrounding environment is the 
high mobility of those of productive age to work, which requires contact and interaction with 
many people.23 With much time spent working, people of productive age ignore health 
problems that can disrupt their immune system and cause them to be infected with 
Mycobacterium tuberculosis.24 

TBC cases are dominated by males.3 Males generally have high mobility outside the home 
because they have to work, with frequent mobility. So, the risk of contracting tuberculosis is 
more excellent for males than females. Tuberculosis cases in males are more common than 
in females; this could also be because males have better access to healthcare facilities, so 
more tuberculosis cases in males are recorded. This is following previous research, which 
found that men are 1.8 times more likely to suffer from TBC, and there is a relationship 
between gender and TBC cases.25,26 Most studies show that males are more susceptible to 
TBC infection than females. This can be caused by a heavier workload, less rest, and 
unhealthy lifestyles outside the home, such as smoking and drinking alcohol, as well as more 
social interaction and industrial pollution.27 Smoking is less common in females than males, 
so males are more susceptible to contracting pulmonary TBC.28 

Family income is an essential factor in disease prevention because having sufficient income 
makes it possible to cover medical costs, maintain a healthy home environment, and eat well. 
Someone with enough income will invest more in their health in preventive terms, such as food 
with adequate and adequate nutritional status, consuming vitamins, and seeking treatment for 
healing and a clean home environment. The lower the income, the higher the risk of 
contracting pulmonary tuberculosis. This is closely related to nutritional status, housing 
conditions, neighborhood population density, and the availability of adequate health 
services.29 Low socio-economic status in the community is related to pulmonary TBC cases. 
This is because the income level ensures the quality and quantity of food consumed. A family's 
ability to buy food depends on whether the family income is high or low.30 In line with other 

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research, most respondents in their study came from low-income families with confirmed 
TBC.31 Poverty has a close relationship with tuberculosis rates in Indonesia.32 People with low 
income and classified as poor will find it challenging to meet their food needs, so they will 
experience malnutrition; they will be at higher risk of contracting TBC compared to those who 
have good nutritional status.31 

The results show that people diagnosed with pulmonary TBC also have family members who 
have or have previously suffered from TBC. Transmission can occur through airborne 
diseases, where TBC bacilli are found in the saliva splashes released by TBC when coughing, 
sneezing, or singing. Household contact with TBC patients is a factor that causes TBC, and 
this study found that positive household contact caused more TBC cases than harmful 
household contact.33 Apart from that, other research supports that the status of the contact 
relationship with the sufferer and the place of residence are factors in the occurrence of 
symptoms in pulmonary TBC. One of the factors causing this relationship is that families tend 
to have the intensity and frequency of making direct contact with sufferers. The existence of 
family relationships also makes it difficult for someone to avoid contact because of the 
responsibility to care for or visit patients.34 

The possibility of a relationship between a history of household contact and the incidence of 
TBC is caused by unhealthy home conditions. One of the health requirements for a residential 
home is ventilation, which meets the requirements for air circulation, lighting, and supporting 
factors for air quality. High levels of residential density and unhealthy housing conditions can 
cause poor air quality. This makes it easier for pulmonary TBC to spread to people who live 
in the same house and the surrounding environment.35 

Respondents often interact with TBC patients for quite a long time, and the intensity of their 
contact is almost the same as household contact. Most respondents did not know of 
colleagues or colleagues who had TBC, so this could result in infection without the 
respondents realizing it. People with close contact with active TBC patients are more likely to 
become infected and suffer from the disease. TBC risk increases in cases of close contact 
and long periods.36 Individuals who interact with people with pulmonary tuberculosis for more 
than six months have a seven times greater risk of infection than those who do not interact for 
less than six months.37 A person's level of Mycobacterium tuberculosis infection is determined 
by the number of droplets in the air and the length of time they breathe the air. The longer the 
contact with a high concentration of droplets, the more germs will enter the lung tissue. Post-
primary infection occurs when the body's health declines. This happens in the lung tissue over 
several months to years if the body's condition is stable.36 

CONCLUSION 

Based on the research results, there is a relationship between age, gender, family income, 
history of household contact, and close contact with the incidence of TBC in the Kapanewon 
Depok area. The factor that most influences the incidence of pulmonary TBC is a history of 
household contact with TBC sufferers. Suggestions to the Community Health Center are to 
increase screening activities to detect cases in high-risk groups early, for example, people 

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who have a history of contact with TBC sufferers. Advice to the public to increase awareness 
of preventive measures if they have household contact or close contact with TBC sufferers. 

Acknowledgement 

This research was carried out with assistance from various parties. We want to thank the 
Institute for Research and Community Service at Ahmad Dahlan University for funding it under 
contract number PD-083/SP3/LPPM-UAD/VIII/2023 and the Depok 1, Depok 2, and Depok 3 
Community Health Centers for permitting it. 

Declarations 

Authors' contribution 

The authors of this article have contributed to its writing, including the first author, who 
contributed to data collection, data processing, data analysis, and discussion; the second 
author, who contributed to data collection, data validity, data processing, data analysis, and 
preparation of the discussion; and the third author, who contributed to data processing, data 
analysis, and discussion. 

Funding statement 

The funding agency should be written in full, followed by the grant number in square 
brackets and the year or state, “This research has not received external funding” for 
research without a donor.  

Conflict of interest 

There is no conflict of interest in this research.  

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