The Description of Knowledge Level Oo Tuberculosis’ Patients in Polyclinic Dots (Direct Observed Treatment Short- Course) RSUD Dr. Soekardjo, Tasikmalaya

Tuberculosis (TB) is a disease caused by Mycrobacterium tuberculosis and this disease can be presented in the form either latent or active. This disease is transmitted through the air and mainly affects productive young adults. The purpose of this research is to investigate the description of the knowledge level of TB patients in DOTS polyclinic (Direct Observed Treatment Short-course) RSUD dr. Soekardjo Tasikmalaya. This research is a descriptive observational research with cross sectional approach by using consecutive sampling technique and this study was done by collecting information from respondents by using questionnaire as the primary data and medical record as the secondary data. Based on the results of the 136 respondents from this study, it was found that there are 54.4% fell in knowledgeable, 41.2% fell in moderately knowledgeable, and 4.4% fell in less knowledgeable at DOTS policlinic (Direct Observed Treatment Short-Course) in RSUD dr. Soekardjo, Tasikmalaya.


Introduction
Based onGlobal Tuberculosis Control WHO Report (2015), the largest number of TB cases in a row were occurred in India, Indonesia and China at 23%, 10% and 10% of the total global TB disease. The province in Indonesia with the prevalence based on the highest diagnosis of pulmonary tuberculosis was West Java at 0.7% (Anonymous, 2013, Anonymous, 2014). According to Tasikmalaya City Health Office (2015) in a study conducted by Nurliawati, et. al. (2016), stated that based on the information from the section of Prevention and Management of Infectious Diseases (P3M) Tasikmalaya City Health Office, it was obtained the data that there is an increase in the number of TB cases in 2011 with 1043 cases and 1084 cases in 2013.
Furthermore, Nurliawati et. al. (2016) said that from the results of the evaluation conducted by TB Prevention Team of Nursing Study Program STIKes BTH Tasikmalaya together with Partner 1 and Partner 2 in their respective region during February-March 2015, it was found that most people (80%) were not aware and understand the risk factors of TB and 75% of the society were not aware and comprehend the right prevention of TB transmission.
The success of pulmonary TB treatment depends not only on the medical aspects but also on social aspects such as lack of knowledge (Pradnyadewi, 2013). Based on the description above, the researchers are interested to see the description of the knowledge level of TB patients in dr. Soekardjo Tasikmalaya in which one of the hospitals that has implemented DOTS units (Direct Observed Treatment Short-course) as a strategy to overcome TB disease.

Research Methods
This research is a descriptive observational research with cross sectional approach by using consecutive sampling technique and this study was done by collecting information from respondents by using questionnaire as the primary data and medical record as the secondary data.
This research was conducted in DOTS polyclinic (Directly Observed Treatment Short-course) RSUD dr. Soekardjo Tasikmalaya. The study was conducted in April-June 2017. The data instrument in this research were primary and secondary data sources. Primary data is questionnaire related with the characteristic of the respondents in the research. On the other hand, secondary data is related with the knowledge about TB disease that will be tested in validity and reliability.
The questionnaire format contains 23 choices of questions (Table 20) using a Guttman scale measurement type with the form of dichotomous choice. The correct answer was given 1 score whereas the wrong one was given a 0 score. The way of classification by means of the total score gained from the questionnaire was divided by the total of all scores that multiplied by 100. This classification uses the argument of Arikunto (1996) which says that the score of 76-100 belongs to good category, 56-75 belongs to moderately good category, 40-55 belongs to deficient category, and less than 40 belongs to poorly category (Aspuah, 2013). Then the analysis of percentage distribution was conducted and the analysis was including patient's origin, age, education level, occupation, medical history, sputum examination, OAT category (Anti-Tuberculosis Medicine), type of TB, treatment stage, treatment type, medicine type, medicine dosage form, medicine delivery route, comorbidities, sources of information about TB disease, types of medicines consumed, payments, and knowledge categories. The data were analyzed by Chi-square test and Fisher's Exact using SPSS program version 21.

Findings and Discussions of Demographic Description
This study aims to investigate the description of the level of knowledge of TB patients in DOTS polyclinic (Direct Observed Treatment Short-Course) RSUD dr. Soekardjo, Tasikmalaya conducted in April to June 2017. The demographics in this study was include patient's origin, age, education level, occupation, medical history, sputum examination, OAT category, treatment stage, treatment type, medicine type, medicine dosage form, medicine delivery route, comorbidities, sources of information about TB disease, types of medicines consumed, payments, and knowledge categories.

Distribution of Respondents' Ageand Body Weight
From the demographic data in Table 1 obtained, the distribution of respondents' of the TB patient respondents were as follows:

The Relationship Between Patients' Age and TB Incidence
Result of data analysis Table 1 by using Chi Square statistic test obtained ρ 0,023 <ρ (0,05) showed that there was difference between patient age and cases of TB in group of male gender with female gender group. If it was seen from the cases of TB, there were more adults with the majority of women more experienced TB cases compared with men. This can happen because of limited information, and financial dependence in transportation can cause difficulties for women to seek treatment as well as concern about the effects of TB diagnosis they receive.
Judging from the characteristics of TB patients according to the age group, the largest age proportion is in the age range 23-45 years were 57 people. Pulmonary TB incidence at productive age may be due to high activity and mobility which provides greater opportunities for contact with others including with TB patients as well as the high risk of contracting pulmonary TB (Setiadi, et al., 2014).
Productive age is the most vulnerable age to disease exposure, such as Tuberculosis, it can occur because of the interactive effects with risks and exposure (including lifestyle, such as smoking, occupation, pollution from air as well as industry exposure) and there are variations in geographical area and age group (Allotey, et al., 2008).
In Rukmini's study (2011), stated that the age group of 55-74 years old has a lower risk of developing TB than the productive age group (15-34 years old), because in the productive age it usually has a fairly solid activities. They tend to spend half of their lives outside the home, whether for work or socializing. The level of one's productivity can be affected by unbalanced optimal rest time with the amount of activity used. The high productivity which is not balanced with the effort to maintain health when the immune system decreases will make a person susceptible to suffer the disease. In addition, there were 80% of workers that desperate to work despite the condition of their body which is not healthy enough, so that their diseases were easily spread in the environment (Prawira, 2015).

The Relationship of Medical History and TB Incidence
In Table 2, based on TB classification of previous medical history, the result of data analysis using Chi Square statistic test obtained ρ = 0.927> ρ (0,05) showed that there was no significant difference between medical history and TB incidence in male group with female group.
Based on the previous explanation, it can be seen that one of the causes of new cases of TB was the community does not know the symptoms and late diagnosis of TB, smoking habits, economic status, lack of nutrition, drink alcohol and ignorance that the free TB treatment is a factor supporting new TB incidence.
This is similar to the Legesse study, et. al. (2010) says that this may be due to the fact that people may not suspect that early symptoms (cough, fever and sweating) are caused by pulmonary tuberculosis, unless accompanied by other severe symptoms (eg: chest pain or haemoptysis). In Paz-Soldan study, et. al. (2014) said that almost all participants of the study were aware of the delay in seeking their own TB diagnosis. The main reason for delaying the search for treatment is the lack of knowledge and confusion on symptoms of TB, fear and embarrassment of receiving TB diagnosis, and the tendency of patients to self-medicate before seeking formal medical attention. The result of data analysis in Table 3 using Fisher's Exact statistic test obtained ρ = 0,472> ρ (0,05) can be concluded that there was no difference between sputum examination with TB patient in male group and female group. There is no relationship between sputum examination with TB patients because it is not guaranteed that people either male or female are diligently carry out sputum examination. This is because there was no difference regarding the awareness to heal both in men and women.
In addition, based on the Table 7, the results of sputum examination was there were more negative acid-fast bacili (AFB) instead of positive AFB. This can be happen because TB patients with positive AFB have experienced conversion to negative AFB within 2 months (Radji, et al., 2015 ).

The Relationship of Stage of Treatment and Number of Patients
The results of data analysis in Table 4 using Fisher's Exact statistic test obtained ρ = 0.115> ρ (0,05), it can be concluded that there was no difference between treatment stage with the number of patients in the male group and female group. Based on Table 4 and Table 5 which included in the intensive phase was the OAT 4KDT package, and the kombipak package is HR. The 4KDT package consists of 4 types of drugs: Isoniazid (H), Rimfapicin (R), Pyrazinamide (Z), and Ethambutol (E) consumed daily for 56 days. While the advanced stage is kombipak package and OAT 2KDT package consists of 2 types of drugs are Isoniazid (H), and Rifampicin (R) and HRZE are consumed for 3 times a week in 16 weeks.

The Drug use Profile
The use of specific drugs used in patients with tuberculosis is a drug with OAT group (Anti Tuberculosis Drugs). From Table 5, it can be seen that the most frequently used drugs are OAT 4KDT packages with 65 people (47.8%) people, 2KDT with 64 people (47.1%) people, and kombipak HR packages with 6 people (4.4% ), and HRZE with 1 person (7%).   was mostly included in good (54.4%) and good enough (41.2%) categories. These results indicate that most respondents have known about TB disease and how to treat it. Based on observations during the study, it can happen because TB patients have been given health education by TB officers at the hospital when they were first diagnosed with tuberculosis. In addition, it can also occur because RSUD dr. Soekardjo Tasikmalaya City has been supporting DOTS program that specifically handles TB treatment so that health workers can conduct health education either provide information or education well to patients with tuberculosis.

Tuberculosis Patients' Knowledge
Increased knowledge can make a person change the perceptions and habits of a person in terms of behavior. In Martin's study, et. al. (2016) concluded that behavior which was based on good knowledge would have a good impact on behavior instead of one which not based on good knowledge, which means that patients are more health-conscious, if they have been exposed to pulmonary TB disease, they can do prevention to the transmission of the disease to their family and their surrounding areas.
In addition, the environmental factors can also affect the knowledge of the respondents. In other words, environmental factors will be directly proportional to the knowledge, it can happen because the environment can affect the process of entry of knowledge of a person into residing environment.
Respondents with poor knowledge level showed 4.4%. Nurses especially community nurses play an important role in overcoming this problem. The researcher observed that this happened because the respondent was not well understood with what was submitted by the health officer because of the condition of the patient itself so that to absorb the knowledge from the officer was less effective. Furthermore, it can also happen because the respondent is experiencing hearing loss and also the patient's age already old enough so that the understanding of what was delivered by the officer was less absorbed. Other factors can also occur because the education of respondents, where the higher the education of respondents the higher the knowledge of the respondents. However, it cannot be denied, because there are some people with a high education is not necessarily well knowledgeable. This can be directed through health education oriented to the provision of information to the Drug Swallowing Supervisor (PMO), so that the PMO can provide little information about tuberculosis, prevention and the effects of non-adherence to treatment or swallowing of medicines to less-knowledge TB respondents so that they would not become a source of transmission for their family members and the society around them. The respondents who have a high level of knowledge about TB can be given the motivation to complete treatment into completion.
Based on Table 20, the respondents' knowledge about TB disease was measured by 23 questions. Where it is known that most respondents in the study know the meaning, causes, signs and symptoms, function of sputum and x-ray examination, mode of transmission, treatment, prevention, and function of PMO (Superintendent Swallowing Drug). But most of the majority of respondents know less about the transmission of TB. One of which is on the feeding tool as a medium for TB mediator. The results of this study are similar to those of Solliman, et. al. (2016) which states that 53.0% of respondents lack knowledge about TB transmission.
Then, the respondents also do not know about the side effects of TB treatment, it happens because of lack of knowledge of the respondents about it. Particularly with regard to transmission and the side effects of drug use and lack of masses can affect one's knowledge because the mass media holds a lot of information and allows many people to easily access it so that it is easily accessible the information allows a person to gain knowledge. The next factor is the environment, where knowledge is gained from what we saw and hear every day, where the environment plays a role to form a successful mindset processed from the knowledge we can from that environment. Furthermore, the experience where the brain will automatically save every event recorded by the senses so that any new events associated with the old events will make the individual easy to digest the scope of science being studied. The last factor is age, where the increasing age can increase one's knowledge, attitude, and action to prevent transmission of TB disease.
According to Martin, et. al. (2016) says that one's attitude can change with the acquisition of additional information about a particular object through persuasion and the pressure of its social group. So, it can be concluded that someone who has good knowledge will get a good attitude towards

The Relationship Between Gender and Knowledge Categories
The results of data analysis in Table 8 using Chi Square statistical test obtained ρ 0,029 <ρ (0,05) showed that there was difference between gender type with knowledge category in group of knowledgeable, moderately knowledgeable, and less knowledgeable.
Based on the Table 8, mostly female were better in knowledge about TB disease than male, it can happen because the majority of female were unemployed and they were housewife so that they have more time than male in order to get information easily from their environment and electronic media more than the majority of male who had to work hard in order to support the needs of themselves and their family. This is similar to Solliman's research, et. al. (2012) and Samargandi, et. al. (2012) which revealed that female have better knowledge about TB disease than male. Samargandi, et. al. (2012) adds that the increased knowledge of diseases among female may only reflect the fact that female are usually more sharp and diligent than male.