Social Determinants and Risk Factors for Tuberculosis Patients: A Case Control Study at Health Services Applying Directly Observed Treatment Shortcourse (DOTS) in Bandar Lampung, Indonesia

Tuberculosis (TB) control programs should place more emphasis on social determinants which either directly or through TB risk factors can influence TB incidence. This study aims to identify the influence of social determinants and TB risk factors on TB incidence. A total of 238 smear-positive TB patients and 238 patients without TB were obtained from all smear-positive TB patients and TB suspects treated at Directly Observed Treatment Shortcourse (DOTS) health service facilities in Bandar Lampung, Indonesia. Data were collected by structured interview questions which were then analysed using both bi-variable chi-square analysis and multivariable logistic regression analysis. The results showed that social determinants (education and income per capita), housing conditions (ventilation and house density index), and household food security (food budget) proved to be significant influences on TB incidence. These indicators may explain the 50.7% variation in TB incidence. In conclusion, a TB control program should highlight social determinants, housing conditions, and household food security improvements. However, such a program would require the participation of all related institutions and should also be supported by appropriate government policies. Keywords: tuberculosis, social determinants, housing conditions, household food security, health access, DOTS strateg