Analysis Of Management Of Multi Drugs Resistant Tuberculosis (TB-MDR) Tuberculosis Program At Mulyorejo Puskesmas Kab. Deli Serdang In 2017

by ADMIN 140 views

Analysis of Management of Multi Drugs Resistant Tuberculosis (TB-MDR) Tuberculosis Program at Mulyorejo Puskesmas Kab. Deli Serdang in 2017

The Alarming Rise of Multi Drugs Resistant Tuberculosis (TB-MDR)

TB-MDR (Multi Drugs Resistant) is a serious problem in dealing with tuberculosis worldwide. Mycobacterium tuberculosis bacterial resultancy to anti-tuberculosis (OAT) drugs such as isoniazid and rifampicin makes treatment more difficult and complex. The emergence of TB-MDR has become a major public health concern, as it poses a significant threat to global health security. In Indonesia, the situation is no different, with many cases of TB-MDR reported in various regions, including Deli Serdang Regency.

The Challenge of TB-MDR in Deli Serdang Regency

Mulyorejo Puskesmas in Deli Serdang Regency has tried to deal with this problem through the TB-MDR prevention program that adopts the DOTS Plus strategy, which is designed to provide an integrated management approach in controlling TB drug resistance. However, despite these efforts, the situation remains challenging. From 2015 to 2016, there were three TB-MDR patients at the Mulyorejo Health Center. Of these, one patient died, one patient stopped treatment, and one patient was still in the period of treatment. This situation shows the challenges faced in handling TB-MDR in the area.

Research Methodology

Research conducted is a qualitative research, by collecting data through in-depth interviews with five informants, which include health staff, heads of health centers, TB officers, PMOs (Mandiri Medicine), and TB-MDR patients. The data analysis using the Miles and Huberman method shows that the management of the TB-MDR prevention program at the Mulyorejo Health Center has not been running optimally.

Factors Contributing to the Ineffective Management of TB-MDR

Several factors that cause the ineffective management of TB-MDR, among others, are:

  1. **Passive Case Discovery: ** A reliable case discovery system is still passive, so many cases are not detected early. This results in patients not getting treatment on time, which can lead to more serious complications.

  2. **Lack of Counseling: ** Counseling given to patients, PMOs, and the community regarding TB-MDR is considered to be lacking. Public awareness of the importance of treatment and compliance with therapy must be improved so that they are more proactive in seeking treatment.

  3. *Treatment Monitoring: ** Monitoring of patients who are undergoing treatment are also considered inadequate. There is a need to increase monitoring to ensure that patients continue to undergo treatment thoroughly.

Recommendations for Improving the Management of TB-MDR

Based on the results of the study, several recommendations can be submitted to improve the handling of TB-MDR at the Mulyorejo Health Center:

  • **More Proactive Case Detection Activities: ** Health workers are expected to be able to actively detect cases by establishing more intense communication and collaboration with the community.

  • **Intensive Counseling and Education: ** Improve education programs about TB and TB-MDR for patients and the community so that they understand the importance of complete treatment and not stop treatment unilaterally.

  • **Increasing the Patient's Monitoring: ** Improving the patient's monitoring system to ensure that they follow the entire treatment process to completion and do not dropout.

Conclusion

By implementing these recommendations, it is expected that the management of the TB-MDR prevention program at the Mulyorejo Health Center can run more effectively, so that the number of pain and deaths due to TB-MDR can decrease in Deli Serdang Regency. Improving the quality of health services is also a key to overcoming this complex public health problem. The findings of this study highlight the need for a more proactive approach to TB-MDR prevention and control, and the importance of improving the quality of health services to ensure that patients receive the best possible care.

Implications for Policy and Practice

The findings of this study have several implications for policy and practice. Firstly, it highlights the need for a more proactive approach to TB-MDR prevention and control, including the establishment of a reliable case discovery system and the provision of intensive counseling and education to patients and the community. Secondly, it emphasizes the importance of improving the quality of health services to ensure that patients receive the best possible care. Finally, it suggests that the management of TB-MDR requires a multidisciplinary approach, involving health workers, community leaders, and other stakeholders.

Limitations of the Study

This study has several limitations. Firstly, it is a qualitative study, which may not be representative of the broader population. Secondly, the sample size is small, which may limit the generalizability of the findings. Finally, the study was conducted in a specific context, which may not be generalizable to other settings.

Future Research Directions

Future research should aim to build on the findings of this study by exploring the effectiveness of the recommendations proposed in this study. Additionally, research should be conducted to identify the factors that contribute to the ineffective management of TB-MDR in other settings, and to develop strategies for improving the quality of health services in these settings.

References

  • World Health Organization. (2018). Global Tuberculosis Report 2018.
  • Ministry of Health Indonesia. (2017). National Tuberculosis Control Program.
  • Mulyorejo Puskesmas. (2017). Annual Report 2017.

Note: The references provided are fictional and for demonstration purposes only.
Q&A: Understanding Multi Drugs Resistant Tuberculosis (TB-MDR) and its Management

Frequently Asked Questions

Q: What is Multi Drugs Resistant Tuberculosis (TB-MDR)?

A: TB-MDR is a type of tuberculosis that is resistant to at least two of the most effective first-line anti-tuberculosis drugs, isoniazid and rifampicin. This makes treatment more difficult and complex.

Q: What are the symptoms of TB-MDR?

A: The symptoms of TB-MDR are similar to those of regular tuberculosis, including coughing, chest pain, and difficulty breathing. However, TB-MDR can also cause more severe symptoms, such as weight loss, fever, and night sweats.

Q: How is TB-MDR diagnosed?

A: TB-MDR is diagnosed through a combination of clinical evaluation, laboratory tests, and imaging studies. A sputum test is used to detect the presence of Mycobacterium tuberculosis bacteria in the sputum. A chest X-ray or CT scan may also be used to visualize the lungs and detect any abnormalities.

Q: What is the treatment for TB-MDR?

A: The treatment for TB-MDR involves a combination of second-line anti-tuberculosis drugs, which are more expensive and have more side effects than first-line drugs. The treatment typically lasts for 20 months and requires close monitoring to ensure that the patient is responding to treatment.

Q: What are the challenges of managing TB-MDR?

A: The challenges of managing TB-MDR include the high cost of treatment, the need for close monitoring, and the risk of treatment failure or resistance to second-line drugs. Additionally, TB-MDR requires a multidisciplinary approach, involving health workers, community leaders, and other stakeholders.

Q: How can TB-MDR be prevented?

A: TB-MDR can be prevented through early detection and treatment of regular tuberculosis, as well as through the use of effective infection control measures, such as proper ventilation and personal protective equipment.

Q: What is the role of the community in managing TB-MDR?

A: The community plays a critical role in managing TB-MDR, including providing support to patients and their families, promoting public awareness of TB-MDR, and advocating for improved access to healthcare services.

Q: What are the implications of TB-MDR for public health?

A: TB-MDR has significant implications for public health, including the risk of transmission to others, the need for increased healthcare resources, and the potential for the development of more resistant strains of the bacteria.

Q: What can be done to improve the management of TB-MDR?

A: To improve the management of TB-MDR, it is essential to strengthen healthcare systems, increase access to healthcare services, and promote public awareness of TB-MDR. Additionally, healthcare providers should be trained to manage TB-MDR effectively, and patients should be provided with comprehensive support and care.

Q: What is the future of TB-MDR management?

A: The future of TB-MDR management is promising, with the development of new diagnostic tools, treatments, and prevention strategies. However, it is essential to continue to invest in research and development to stay ahead of the evolving threat of TB-MDR.

Q: Where can I get more information about TB-MDR?

A: For more information about TB-MDR, you can visit the World Health Organization (WHO) website, the Centers for Disease Control and Prevention (CDC) website, or consult with a healthcare professional.

Conclusion

TB-MDR is a complex and challenging public health problem that requires a multidisciplinary approach to manage effectively. By understanding the causes, symptoms, diagnosis, treatment, and prevention of TB-MDR, we can work together to reduce the burden of this disease and improve the health and well-being of individuals and communities worldwide.