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Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 2, 2022, pp. 69-75 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

 
Vol. 4, No. 2, 2022, pp. 69-75    10.26555/eshr.v4i2.5097 

  
69 

Research Article 
 
Factors Associated with Successful Tuberculosis 
Treatment in the Primary Health Care of Bekasi 
 
Kartika Putri Amalia1, Sri Rahayu2, Erna Harfiani2*  
 
1 Faculty of Medicine, UPN Veteran Jakarta, Jakarta, Indonesia 
2 Department of Pharmacy, UPN Veteran Jakarta, Jakarta, Indonesia 
 
* Correspondence: ernaharfiani@upnvj.ac.id. Phone: +6281585042313 
 
Received 06 November 2021; Accepted 5 August 2022; Published 6 August 2022 
 

ABSTRACT 

Background: Tuberculosis is still a significant disease problem globally as it is one of ten 
causes of death worldwide and in Indonesia. Bekasi is the second-largest city with 
tuberculosis patients after Bandung, with 3,355 patients in 2015. The success rate of 
treatment that has not reached the standard in the primary health care of Bekasi, West Java, 
can be related to medication adherence, age, and nutritional status. Inadequate nutritional 
intake in tuberculosis patients will increase the recovery time. The more days of irregularity 
in taking the drug increases the likelihood of the patient having a default that can lead to 
drug-resistant tuberculosis. This study aimed to determine the correlation between anti-
tuberculosis drug adherence, age, and nutritional status with tuberculosis treatment in new 
tuberculosis cases in the primary health care of Bekasi. 
Method: This was analytic observational research with a cross-sectional design study in 
311 new tuberculosis cases at 30 primary health care in Bekasi city period 2015. Data were 
analyzed using univariate data and then continued with the chi-square test and logistic 
regression test. 
Results: The results of the univariate analysis were found to obtain patients' compliance by 
84.9% adherent, productive age (91%), and nutritional status with IMT under 18.5 kg/m2 
(68.8%). Chi-square test shown there was a significant relationship between medication 
adherence (p-value = 0.000; OR = 5917.5; 95%CI = 525.57 – 66626.6), age (p-value = 
0.003; OR = 3.81; 95%CI = 1.63 – 8.90), and nutritional status (p-value = 0.000; OR = 7.88; 
95%CI = 2.38 – 26.08) with therapeutic outcome. Logistic regression analysis showed that 
anti-tuberculosis drug adherence (p-value = 0.000; OR = 5917.5) was the most dominant 
variable related to tuberculosis treatment success. 
Conclusion: We conclude that the success of tuberculosis treatment in the primary health 
care of the Bekasi period 2015 relates to anti-tuberculosis drug (medication) adherence, 
age, and nutritional status, while medication adherence has the most significant influence 
on the success of tuberculosis treatment. 

Keywords: Medication adherence; Primary health care; Tuberculosis treatment; Bekasi 

 



 

 
 

Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 2, 2022, pp. 69-75 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

 
Vol. 4, No. 2, 2022, pp. 69-75    10.26555/eshr.v4i2.5097 

  
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INTRODUCTION 

Tuberculosis (TB) is one of the significant infectious disease problems closely related to the 
environment and community behavior. This inflammatory disease of the lung parenchyma is 
caused by Mycobacterium tuberculosis. This disease is one of ten causes of death globally (1). 
In Indonesia, TB cases rose from 331,703 in 2015 to 562,049 in 2019. The new cases of 
tuberculosis had a mortality rate of 1.8 million people. Globally, the reduction in TB incidence 
between 2015 and 2019 was 9% (from 142 to 130 new cases per 100,000 population) (2). 
Indonesia had an incident rate of 395 cases/100,000 population in 2015, then increased to 845 
cases/100,000 population in 2019 (2). The prevalence of tuberculosis in Indonesia is mainly 
found in West Java amount 28,901 cases, with a success rate of 82.5%. Bekasi is the second-
largest city with tuberculosis patients after Bandung, with 3,355 patients in 2015 (3). If we refer 
to the standard from the WHO, it means that Bekasi has not succeeded in treating TBC. 

Several factors influence the success of TB therapy, including drug adherence, age, and 
nutritional status of the patient. Drug adherence is adherence to tuberculosis treatment 
regularly and thoroughly without interruption during the treatment period determined by the 
health worker (4). Aulia (2014) stated there was a relationship between age and occupation 
and successful tuberculosis treatment (5). There was a correlation between nutritional status 
and recovery of tuberculosis patients (6). The condition of tuberculosis patients can be restored 
by consuming nutritional foods to fulfill the energy and protein needed to prevent and repair 
the damage to body tissues, gain weight until it reaches normal, and balance weight and height 
(7). WHO’s 2030 target is to decrease 90% the mortality rate of the total death rate in 2015. 
This target follows the SDGs (Sustainable Development Goals) to end the tuberculosis 
epidemic by 2030 (2). This research is expected to contribute to understanding the situation of 
TB in Bekasi, which will be helpful for policymakers in creating a proper intervention. 

METHOD 

This research was an observational analytic study with a cross-sectional approach. Drug 
adherence is obedience to regular and complete treatment without interruption during the 
treatment period determined by health workers (Yuanasari, 2009). We defined the age group 
as productive age (18 – 64 years) and non-productive age (more than 64 years). For the 
nutritional status, we classified as obese (BMI>25kg/m2), normal (18.5 – 25 kg/m2) and 
underweight (BMI <18.5kg/m2).  

The population in this study were all new cases of TB patients with BTA positive from 30 
primary health care in Bekasi city in 2015 with 2,925 patients. The sample in this study 
consisted of new TB patients with BTA positive results who took anti-tuberculosis drugs in all 
primary health care in Bekasi city in 2015 and had fulfilled the inclusion criteria, amounting to 
311 patients. The inclusion criteria in this study were patients with new cases of Pulmonary 
Tuberculosis in Bekasi city primary health care who had performed sputum checks with BTA 
positive results who get OAT (Anti-Tuberculosis Drugs) at least six months with a complete 
medical record and are more than 18 years old.  

 



 

 
 

Epidemiology and Society Health Review| ESHR 
Vol. 4, No. 2, 2022, pp. 69-75 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

 
Vol. 4, No. 2, 2022, pp. 69-75    10.26555/eshr.v4i2.5097 

  
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RESULTS 

This research was conducted in 30 primary health care out of 31 in the city of Bekasi because 
the patient's medical records in one primary health care were incomplete, so the researchers 
excluded that primary health care. 
 

Table 1.  The characteristic of new cases of tuberculosis patients in Bekasi 2015 
 N = 311       % 

Gender 
Male 195 62.7 

Female 116 37.3 

Drug’s Adherence 
Yes 264 84.9 

No 47 15.1 

Age 
Productive 283 91 
Non-Productive 28 9 

Nutritional Status 
Obese 4 1.3 
Normal 93 29.9 

Underweight 214 68.8 
                         Source: Secondary data in 30 primary health care in Bekasi City, 2015. 
 

Table 1 shows that among the 311 patients, most were male, 195 patients (62.7%), and 116 
female patients (37.3%). The number of patients with medication adherence was 264 (84.9%), 
and without medication adherence were 47 patients (15.1%). Most patients were productive 
age patients, 283 patients (91%), and new cases of non-productive age were 28 patients (9%). 
There were 214 patients (68.8%) patients with underweight BMI, 93 patients were in the normal 
BMI category (29.9%), and four patients were in the obese BMI category (1.3%). 

We found a significant correlation between medication adherence and successful treatment. 
Table 2 shows the statistical tests of drug adherence using Chi-square, obtaining a p-
value <0.005. The odds ratio (OR) value in this statistical test is 5917.5, which means that 
patients who were adherent to taking the anti-tuberculosis drug (OAT) have the possibility 
(odds) of 5917.5 times for successful treatment compared with patients who were not adherent 
to taking OAT. For age versus the success of TB treatment, we found a p-value <0.05, which 
means that there was a correlation between age and the successful treatment of new cases of 
pulmonary tuberculosis patients. The OR value was 3.81, meaning that new cases of 
pulmonary tuberculosis patients with productive age have 3.81 times the possibility of 
successful treatment compared to patients with non-productive age. Last, we found a 
significant correlation between nutritional status and successful treatment. The OR value is 
7.88, meaning that obese and normal BMI patients are 7.88 times more likely to succeed in 
therapy than underweight patients. Table 3 indicates that drug adherence is the most influential 
variable in successful treatment, with a p-value of 0.000. 
 



 

 
 

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Vol. 4, No. 2, 2022, pp. 69-75 ISSN 2656-6052 (online) | 2656-1107 (print) 
 
 

 
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Table 2. Association between medication adherence, age, and nutritional status with the 
success of TB treatment in Bekasi 2015 

 
 

Variables 
Successful Treatment (n=265) OR 

(95% CI) 
P-value 

Yes No Total 
N % N % N % 

Drug Adherence 
Yes 
No 

 
263 
   2 
 

 
99.6 
4.3 

 

 
1 
45 
 

 
0.4 
95.7 

 

 
264 
47 
 

 
100 
100 

 

 
 

5917.5 

 
 

0.000 

Age 
Productive 
Non-Productive 

                    

 
247 
18 
 

 
87.3
64.3 

 

 
36 
10 
 

 
12.7 
35.7 

 

 
283 
28 
 

 
100 
100 

 

 
3.81 

 
0.003 

Nutritional Status  
Obese and Normal 
Underweight 

                    

 
94 
171  

 
96.9 
79.9 
 

 
3 
43 
 

 
3.1 
20.1 

 

 
97 
214 

 

 
100 
100 

 

 
         7.88 

  
      0.000 

     Source: Secondary data in 30 primary health care in Bekasi City, 2015. 
 

Table 3.  Logistic Regression Result  
Variable P-value OR (Exp(B)) 

Drug Adherence  0.000 7467.18 
Age  0.503 3.366 
Nutritional Status (Obese) 0.179 - 
Nutritional Status(1) (Normal) 0.999 7992312.5 
Nutritional Status(2) (Underweight) 0.063 16.252 

                 Source: Secondary data from 30 primary health care in Bekasi City, 2015 

 
DISCUSSION  

The work of OAT to kill the bacteria, both dormant and active bacteria, will be maximized in 
patients of productive age so that successful treatment can be achieved by carrying out 
treatment to completion. This research is in line with the study conducted by Aulia (2014) that 
there is a correlation between age and successful treatment at the Sakti Community Health 
Center, Pidie District (5). The unproductive age patient can affect the drug's effectiveness 
because drug metabolism and organ function are less efficient in infants and the elderly, so 
that it can have a more powerful and more prolonged effect in both age groups. The older the 
age, the more physiological and pathological changes and a decrease in the body's defense 
system, which affects the body's ability to handle the OAT given. In this case, the body must 
deal with two problems at once, namely the tuberculosis bacilli, which damage the tissues as 
well as the OAT itself, and this situation gets worse if there are diseases that interfere with the 
function of the kidneys, liver and cardiovascular system (8). Elderly patients often become 
apathetic about their treatment and usually lack the determination or desire to complete a six-
month treatment program. They are almost three times more likely to react to OAT than 
patients of productive age (9). 

Patient compliance is influenced by the willingness and motivation to recover. In addition, 
pulmonary tuberculosis patients with medication adherence can have maximum effect of OAT, 
so it causes death to both dormant and active bacteria. According to Kurniawan's research 



 

 
 

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Vol. 4, No. 2, 2022, pp. 69-75    10.26555/eshr.v4i2.5097 

  
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(2015), of the 43 respondents studied, 30 respondents with medication adherence had 
negative BTA results at the end of treatment (10). OAT should be taken regularly according to 
schedule to avoid treatment failure and recurrence, especially in the intensive treatment phase 
(11). Widiyanto's research (2016) states that medication adherence in tuberculosis treatment 
is essential. By taking the medication regularly within two weeks, the bacteria have broken 
down and have no potential to spread (12). Therefore, it can be concluded that if medication 
adherence is high, the recovery rate of positive pulmonary tuberculosis patients will also 
increase so that the risk of drug-resistant tuberculosis cases can also be prevented. Health 
behavior or a person's level of health is determined by a person's attitude towards health 
objects. The better a person's attitude towards health, the level of one's health will also be 
better. A person's adherence to medication is influenced by the person's attitude towards the 
illness (13)(14). 

Our finding shows a significant correlation between nutritional status and successful treatment. 
Nutritional status can determine the condition of their immune system. A poor nutritional quality 
that occurs before the patient suffers from Tuberculosis can increase the patient's susceptibility 
to infection with Mycobacterium tuberculosis. The poor nutritional status after a patient is 
infected can be caused by decreased appetite in tuberculosis patients, so the successful 
treatment is also supported by patient compliance in taking OAT. Poor nutritional status in 
tuberculosis patients is caused by anorexia, impaired nutrient absorption, or increased body 
catabolism (1). There is a correlation between nutritional status (BMI) and recovery in 
pulmonary tuberculosis patients at the pulmonary clinic of RSUD Sidoarjo. There is clear 
evidence that poor nutrition reduces the immunity to Tuberculosis. Malnutrition in tuberculosis 
patients can reduce the healing period and increase the mortality rate compared to tuberculosis 
patients who are not malnourished (6). Nutritional status affects the successful treatment of 
Tuberculosis. Normal and obese BMI increases immunity so that people can survive 
pulmonary Tuberculosis and accelerate the healing process (15). Based on Puspitasari et al. 
(2017), there is a relation between nutritional status and successful treatment in pulmonary 
tuberculosis patients. Good nutritional status has a faster recovery time. Balanced nutrition can 
help to maintain immunity and prevent various diseases, especially pulmonary Tuberculosis 
(12). 

Medication adherence in tuberculosis treatment is essential because by taking the medication 
regularly for 2 weeks, the bacteria have been divided and have no potential to be transmitted 
(16). In the intensive (initial) stage, the patient receives medication every day to prevent the 
occurrence of resistance to all OATs, especially rifampicin. If the intensive treatment is given 
appropriately, usually, the infectious patient becomes non-infectious within 2 weeks. Most of 
the positive BTA became negative within 2 months (at the end of intensive treatment). In the 
advanced stage, the patient gets fewer drugs but for a more extended period. The progressive 
step is essential to kill the remaining bacteria still in the body, especially persistent bacteria, so 
the patient can recover and prevent the recurrence. So medication adherence is vital to 
successful treatment (6)(15). 

The final result in multivariate analysis with logistic regression is that medication adherence is 
the most influential variable in the successful treatment, with a p-value of 0.000. Patient 
compliance is influenced by the willingness and motivation to recover (13). Health workers 



 

 
 

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Vol. 4, No. 2, 2022, pp. 69-75    10.26555/eshr.v4i2.5097 

  
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have conveyed to tuberculosis patients through health promotion and education so that 
patients take medication according to the type, dose, method, time to drink, and the number of 
days of taking the appropriate medicine recommended by the doctor. Medication adherence is 
essential because if the treatment is not carried out regularly and does not follow the 
predetermined time, there will be resistance to the bacteria called Multi Drugs Resistance 
(MDR) (15). Various drugs in standard therapy have different target populations for 
mycobacterium tuberculosis. Isoniazid is an inhibitor of cell wall synthesis, actively kills growing 
bacteria, and plays a crucial role in eradicating replicating bacteria. Rifampicin is an inhibitor 
of RNA synthesis, active against both replicating and non-replicating bacteria. Pyrazinamide, 
considered an inhibitor of proton motive force, only appears in its active form under acidic 
conditions during the first 2 months of therapy. Rifampicin and pyrazinamide played a 
significant role in shortening the duration of treatment from more than 24 months to only 6 
months. Each agent's mechanism of action determines the drug's role in the treatment of 
mycobacterium tuberculosis (10).  

CONCLUSION 

Based on the results of research analysis and discussion, it can be concluded that the success 
rate of treatment on 30 primary health care in Bekasi City in 2015 was high, with the majority 
of new cases of pulmonary tuberculosis patients with successful medication on 265 patients 
(85.2%). In 2015, new cases of pulmonary tuberculosis patients on 30 primary health care in 
Bekasi City were 264 patients (84.9%). Most of the new cases of pulmonary tuberculosis 
patients were patients of productive age, as many as 283 patients (91%). Patients with 
underweight BMI were 214 patients (68.8%). There was a significant correlation between 
medication adherence (p-value=0.000), age (p-value=0.003), and nutritional status (p-
value=0.000) with the successful treatment at 30 primary health care in Bekasi in 2015. 
Medication adherence is the most dominant variable of the successful treatment at 30 primary 
health care in Bekasi in 2015 compared to nutritional status and age variables.  

Acknowledgment 

The authors would like to acknowledge to Medical Faculty of UPN Veteran Jakarta and Primary 
health care in Bekasi, West Java, Indonesia. 

Authors' contribution 

K, E, and S contributed to the research design. K developed the theory, collected the data, 
and performed the computations. S and E verified the analytical methods. All authors 
discussed the results and contributed to the final manuscript. 

Funding Statement 

 This research has not received external funding 

Conflict of interest 

There is no conflict of interest in this research.  



 

 
 

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REFERENCES 

1.  Amaliah R. Factors associated with failure of conversion of patients with smear-positive 
pulmonary TB of the intensive phase treatment in the district of Bekasi in 2010. Universitas 
Indonesia; 2010.  

2.  WHO. Global Tuberculosis Report: Excecutive Summary 2020. Genewa; 2019. Available 
from: https://cdn.who.int/media/docs/default-source/hq-tuberculosis/global-tuberculosis-
report-2020/execsumm_11nov2020.pdf?sfvrsn=be12e34e_9 

3.  Central Statistics Agency of West Java Province. West Java in Figures of Years 2015 
(Profil Daerah Propinsi Jawa Barat Tahun 2015). Bandung; 2015.  

4.  Widiyanto A. The Relationship Between Compliance with Taking Medicines Healing of 
smear positive pulmonary TB patients at Puskesmas Delanggu Kabupaten Klaten. Integr 
J Heal Sci. 2016;6:35–40.  

5.  Aulia Y. Relationship of age, sex, and occupation with the success of tuberculosis 
treatment in patients who have received treatment in Sakti sub-district, Pidie, Aceh. 
Postgraduate Thesis Program, Syiah Kuala University. 2014. Available from: 
https://etd.unsyiah.ac.id/index.php?p=show_detail&id=4522  

6.  Fatimah, S, Intiyati, A, Mukhis, A AY. The Relationship of Nutritional Status By Curing 
Pulmonary TB Patients in Lung Poly at Sidoarjo Regional Hospital. 2012;60–74.  

7.  Darmanto D. Respirologi (Respirology Medicine). EGC. Jakarta; 2015.  
8.  Salsabela FE, Suryadinata H, Desy IF. Overview of Nutritional Status in Tuberculosis 

Patients at Hasan Sadikin General Hospital Bandung (Gambaran Status Nutrisi pada 
Pasien Tuberkulosis di Rumah Sakit Umum Pusat Hasan Sadikin Bandung). J Sist 
Kesehat. 2016;2(2):84–9.  

9.  Yuanasari. Evaluation of Anti Tuberculosis Drug Use and Compliance In Adult Patients 
with a Diagnosis of Pulmonary Tuberculosis at the Mantingan Ngawi Public Health Center 
for the Period of February-April 2009. Surakarta; Faculty of Pharmacy, Muhammadiyah 
University of Surakarta. Universitas Muhammadiyah Surakarta; 2009.  

10.  Kurniawan, N, HD, SR IG. Factors Affecting the Success of Pulmonary Tuberculosis 
Treatment. 2015;735–8.  

11.  Irianti T, Kuswandi, Yasin NM, Kusumanintyas RA. Mengenal Anti-Tuberkulosis. Grafika 
Indah. Yogyakarta: Grafika Indah; 2016. Available from: 
https://repository.ugm.ac.id/273526/1/Draft Buku Antituberkulosis 14 Desember.pdf   

12.  Kementerian Kesehatan. Pemerintah RI. Permenkes RI Nomor 67 tentang 
Penanggulangan Tuberkulosis. Indonesia Ministry of Health. Jakarta; 2016.  

13.  Ministry of Health RI. Indonesia Health Profile 2020. Jakarta: Balitbang Kemenkes RI. 
Jakarta; 2021.  

14.  Puspita E. Gambaran Status Gizi pada Pasien Tuberculosis Paru yang Menjalani Rawat 
Jalan di RSUD ARIFIN ACHMAD PEKANBARU. JOM FK. 2016;3(2):1–16.  

15.  Indonesia Ministry of Health. Tuberculosis Finds a Cure Until Healed. Indonesia Ministry 
of Health. Jakarta; 2015.  

16.  Salsabela, FE, Suryadinata, H AI. Overview of Nutritional Status in Tuberculosis Patients 
at Hasan Sadikin Central General Hospital. Padjajaran University. 2016.  

 
 


