Do Community Health Centers Have Contextual Effect on the Risk of Recurrence in Patient with Tuberculosis? A Multilevel Evidence from Surakarta, Central Java

Background: Community Health Centers play­ed an important role in tuber­culosis con­trol. Ho­w­ever, Community Health Centers’ con­tex­tual effect toward tuberculosis recurrence has not yet been discovered. The study aims to analyze socio-demography and clinical factors of first tuber­culosis episode and Community Health Centers’ contextual effect toward tuber­culosis recurrence. Subjects and Method: It was analytic obser­vational study with case control approach. The study was conducted in the city of Sura­kar­ta, Central Java, from December 2019 up to January 2020. Sample collection toward 204 tuberculosis patients who had completed their treatment or were confirmed cured, were con­duc­ted by using simple random sampling at individual level and stratified random sampling at community health centers level. The de­pen­dent variable was tuber­culosis recurrence. The independent variables were family income, le­vel of education, BCG vaccination status, smo­­­­king history, initial bac­terio­logical test, weight gain, DM, and COPD. The data were collected through medical record and interview. The data were analyzed by using multi­level multiple logistic regression with Stata 13. Results: In individual level, the preventive factor toward tuberculosis recurrence among other were high income (OR= 0.24; 95% CI= 0.06 up to 0.92; p= 0.037), high level of educa­tion (OR= 0.18; 95% CI= 0.04 up to 0.84; p= 0.029), BCG vaccination status (OR= 0.11; 95% CI= 0.02 up to 0.67; p= 0.017), and high weight gain (OR= 0.06; 95% CI= 0.01 up to 0.28; p< 0.001). Meanwhile, the independent predictors toward tuberculosis recurrence (OR= 7.11; 95% CI= 1.65 up to 30.64; p= 0.009) and diabetes mellitus (OR= 10.85; 95% CI= 2.13 up to 55.29; p= 0.004). In the level of Community Health Centers, high ratio between health workers/ tuberculosis patients significantly cor­related with lower tuberculosis (OR= 0.01; 95% CI< 0.01 up to 0.44; p= 0.016). Community health Centers had contextual effect toward tuberculosis re­currence with Intra-Class Cor­relation (ICC) by 38.67%. Conclusion: Factors in individual and com­munity health centers level may affect tuber­culosis recurrence. Community Health Centers has contextual effect toward tuberculosis re­cur­rent. Keywords: Tuberculosis recurrence, tuber­culosis, predictor, Community Health Center, multi­­level analysis Correspondence: Muvida. Masters Program in Public Health, Universitas Sebelas Maret, Jl. Ir. Su­ta­­mi No. 36 A, Surakarta 57126, Central Java. Email: muvida­md@­gmail.com. Mobile: +628­965­1­4­­50435. Journal of Epidemiology and Public Health (2020), 5(1): 65-78 https://doi.org/10.26911/jepublichealth.2020.05.01.07