Background: As the second-highest country in tuberculosis (TB) cases globally, Indonesia has experienced an increasing trend of notification rate in the last ten years; however, the 34 provinces may have different risks. This study aims to examine TB risk variation across Indonesia in 2010-2019. Methods: A descriptive analysis was conducted on TB routine data of 2010-2019 from the Ministry of Health. Cases included all types of TB patients. Total cases, incidence rate (IR), and standardized morbidity ratio (SMR) were calculated for each province and national level during the period. Distributions of IRs and SMRs were displayed on maps. Results: During 2010-2019, 3,866,447 TB cases occurred in Indonesia, and the national IR was 1,523 per 100,000 populations. The highest proportion of cases and IR were in West Java (20.6%, 314 per 100,000); while the lowest was in North Kalimantan (0.2%, 3 per 100,000). Higher risks of TB occurred in DKI Jakarta (SMR 1.9), Papua (1.7), North Sulawesi (1.7), Maluku (1.5) and West Papua (1.5) among others. The smallest SMRs were found in Bali and Yogyakarta (0.5). Conclusion: TB risk varied across Indonesia in 2010-2019, with a higher risk in DKI Jakarta and several provinces in eastern Indonesia. Given the underreporting nature of routine data, validation is required when using the finding of this study in the local-level intervention. Keywords: tuberculosis, TB, standardized morbidity ratio, spatial variation, risk Abstrak Latar belakang: Sebagai negara dengan jumlah kasus tuberkulosis (TB) terbesar kedua di dunia, Indonesia menunjukkan tren peningkatan notification rate di sepuluh tahun terakhir. Akan tetapi, risiko TB di 34 provinsi bisa saja berbeda-beda. Artikel ini bertujuan mengkaji variasi risiko TB di Indonesia pada tahun 2010-2019. Metode: Data rutin TB tahun 2010-2019 dari Kementerian Kesehatan dianalisis secara deskriptif. Kasus TB didefinisikan sebagai semua tipe pasien TB. Total jumlah kasus, incidence rate (IR), dan standardized morbidity ratio (SMR) dihitung untuk tiap provinsi dan tingkat nasional selama periode tersebut. Sebaran IR dan SMR diplot di atas peta. Hasil: Selama 2010-2019, terdapat 3.866.447 kasus TB dan IR nasional 1.523 per 100.000 populasi. Proporsi kasus dan IR terbesar ada di Jawa Barat (20,6%, 314 per 100.000) dan terkecil di Kalimantan Utara (0,2%, 3 per 100.000). Risiko TB lebih tinggi di antaranya terjadi di DKI Jakarta (SMR 1,9), Papua (1,7), Sulawesi Utara (1,7), Maluku (1,5) dan Papua Barat (1,5). Standardized Morbidity Ratio terendah ditemukan di Bali dan Yogyakarta (0,5). Kesimpulan: Dapat disimpulkan bahwa risiko TB beragam di seluruh Indonesia selama 2010-2019, di mana DKI Jakarta dan beberapa provinsi di timur Indonesia memiliki risiko lebih tinggi. Mengingat adanya kurang lapor dalam data rutin, validasi diperlukan jika menggunakan temuan studi ini dalam intervensi di tingkat lokal. Kata kunci: tuberkulosis, TB, standardized morbidity ratio, variasi spasial, risiko
Background There are limited measures of the impact of the COVID-19 pandemic on tuberculosis (TB) control in high-burden countries like Indonesia. Methods We analysed district-level data of reported TB cases, treatment and deaths, COVID-19 incidence and mortality, health care capacity, economic status, education level, and public health development index from all 514 districts in Indonesia. We compared data before (2016-2019) and during (2020-2021) the pandemic. Findings Compared to the preceding year (2019), in the first pandemic year (2020) the TB case notification declined by 31% (from median 172 [IQR 129-244] in 2019 to 119 [IQR 87-170] in 2020 per 100,000 population; 565,669 vs 393,323 cases, respectively); mortality increased by 8% (from median 4.2 [IQR 2.0-7.4] to 5.0 (IQR 3.1-7.5) per 100,000 population; 13,059 vs 14,148 deaths, respectively); and the overall proportion of cases who started treatment declined by 7% (from 98% to 91%). The second pandemic year (2021) saw a partial recovery of case notifications (median 142 [IQR 99-204]; 473,006) and deaths (4.1 [IQR 2.5-6.8]; 12,016), but a persistently reduced treatment coverage (84%). Reductions in TB notifications between districts were associated with higher COVID-19 incidence and fewer per capita GeneXpert machines for TB diagnosis. Likewise, reduced TB treatment coverage was associated with fewer per capita doctors, and increased reported TB deaths was associated with fewer per capita primary health centres, lower per capita domestic expenditure and higher education. Interpretation The COVID-19 pandemic significantly, yet unevenly, impacted the national TB control programme across Indonesia, with the greatest impacts in districts with the least resilient health systems.
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