Family-Centered Approaches to Pediatric Tuberculosis and Nutritional Challenges in North Aceh: A Qualitative Study

Authors

  • Mardiati Department of Pediatric, Faculty of Medicine, Universitas Malikussaleh, Aceh, Indonesia
  • Anna Millizia Department of Anesthesiology, Faculty of Medicine, Universitas Malikussaleh, Aceh, Indonesia
  • Noviana Zara Department of Family Medicine, Faculty of Medicine, Universitas Malikussaleh, Aceh, Indonesia
  • Khania Atika Faculty of Medicine, Universitas Malikussaleh, Aceh, Indonesia
  • Najwa Zakiyya Faculty of Medicine, Universitas Malikussaleh, Aceh, Indonesia

DOI:

https://doi.org/10.55489/njcm.160220254804

Keywords:

Pediatric Tuberculosis, Family-center Approach, Nutritional Status, North Aceh

Abstract

Background: Pediatric tuberculosis (TB) remains a major global health issue, particularly in low- and middle-income countries. In areas such as Aceh, the nutritional needs of pediatric TB patients are frequently neglected, with treatment primarily addressing the causes of infection and insufficient family involvement. This study aimed to analyze the nutritional problems related to pediatric TB in North Aceh Regency, Aceh Province, Indonesia.

Methodology: This qualitative study employed phenomenological analysis through in-depth face-to-face interviews with pediatric patients, their guardians, healthcare professionals, and hospital administrative staff at Cut Meutia General Hospital, North Aceh, from July to September 2024. Conducted in Indonesian, the interviews were audio-recorded with consent and analyzed using thematic analysis.

Results: This study examined 28 pediatric TB patients, equally divided by sex, with a mean age of 2.6 years. Most were normally nourished, and nearly half had pulmonary TB, primarily contracted from household contact. This study identified five key themes: increasing TB incidence, pediatric TB treatment challenges, nutritional concerns, inadequate sanitation, and strategies to address treatment and nutritional issues in children with TB.

Conclusions: The proposed interventions include increasing TB awareness, promoting BCG vaccination, considering socioeconomic factors, enhancing treatment adherence, and integrating nutritional support into management strategies.

References

World Health Organization. Global Tuberculosis Report 2023. Geneva, Switzerland: World Health Organization; 2023 [cited 2024 May 19]. Available from: https://www.who.int/publications/i/item/9789240083851

Bagcchi S. WHO's Global Tuberculosis Report 2022. Lancet Microbe. 2023 Jan 1;4(1):e20. DOI: https://doi.org/10.1016/S2666-5247(22)00359-7 PMid:36521512

World Health Organization. Roadmap towards ending TB in children and adolescent. 2nd ed. Switzerland; 2018 [cited 2024 Aug 19]. Available from: https://iris.who.int/bitstream/handle/10665/275422/9789241514798-eng.pdf

Maphalle LNF, Michniak‐Kohn B, Ogunrombi M, Adeleke OA. Pediatric Tuberculosis Management: A Global Challenge or Breakthrough? Children. 2022;9(8):1120. DOI: https://doi.org/10.3390/children9081120 PMid:36010011 PMCid:PMC9406656

Lazulfa RWA, Wirjatmadi B, Adriani M. Tingkat Kecukupan Zat Gizi Makro Dan Status Gizi Pasien Tuberkulosis Dengan Sputum Bta (+) Dan Sputum Bta (-). Media Gizi Indonesia. 2018;11(2):144. DOI: https://doi.org/10.20473/mgi.v11i2.144-152

Yusuf R, Nurleli. Hubungan Status Gizi Dengan Kejadian TB Paru. J Kesehat Saintika Meditory. 2018;1(1):35-44.

Susilawati MD, Sari YD, Rachmawati R, Julianti ED. Asupan Zat Gizi Makro Dan Mikro Penderita Tuberkulosis Paru Rawat Jalan Sebelum Dan Sesudah Terapi Intensif Dengan Konseling Gizi Di Kabupaten Bogor. Penelitian Gizi dan Makanan. 2018;41(1):55-64. DOI:https://doi.org/10.22435/pgm.v41i1.1860

Aibana O, Acharya X, Huang CC, Becerra MC, Galea JT, Chiang SS, et al. Nutritional Status and Tuberculosis Risk in Adult and Pediatric Household Contacts. PLoS One. 2016;11(11):e0166333. DOI: https://doi.org/10.1371/journal.pone.0166333 PMid:27835678 PMCid:PMC5105945

Gwela A, Mupere E, Berkley JA, Lancioni C. Undernutrition, Host Immunity and Vulnerability to Infection among Young Children. Pediatric Infectious Disease Journal. 2019 Aug 1;38(8):E175-7. DOI: https://doi.org/10.1097/INF.0000000000002363 PMid:31306401 PMCid:PMC7613497

Aketi L, Diayisu JS, Kashongwe Z, Nkabikueni G, Kalambay PK, Kayembe JM. Maternal Knowledge of Tuberculosis and Bacillus Calmette Guerin Vaccination in Pediatric Health Services in Kinshasa. J Tuberc Res. 2017;05(01):30-43. DOI: https://doi.org/10.4236/jtr.2017.51004

Sathenahalli VB, Minarey N, Gornale V, Kumar R, Joshi K, Singh HP. Association of tuberculosis with severe acute malnutrition. J Evol Med Dent Sci. 2015;4(68):11865-70. DOI:https://doi.org/10.14260/jemds/2015/1710

Tezol Ö, Alakaya M, Akar A, Kuyucu N. Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Med J. 2019;19(1):96-107. DOI:https://doi.org/10.17098/amj.542155

Carvalho ACC, Cardoso CAA, Martire T, Migliori GB, Sant'Anna CC. Epidemiological Aspects, Clinical Manifestations, and Prevention of Pediatric Tuberculosis From the Perspective of the End TB Strategy. Jornal Brasileiro De Pneumologia. 2018;44(2):134-44. DOI: https://doi.org/10.1590/s1806-37562017000000461 PMid:29791553 PMCid:PMC6044667

Seniwati T, Wanda D, Nurhaeni N. Effects of Patient and Family-Centered Care on Quality of Care in Pediatric Patients: A Systematic Review. Nurse Media Journal of Nursing. 2023;13(1):68-84. DOI: https://doi.org/10.14710/nmjn.v13i1.48114

Farzeen T, Sarah M, Raiya H. Interviews in Healthcare: A Phenomenological Approach A Qualitative Research Methodology. Journal of Public Health International. 2021 Feb;4(2):10-5. DOI: https://doi.org/10.14302/issn.2641-4538.jphi-21-3881

DiCicco‐Bloom B, Crabtree BF. The qualitative research interview. Med Educ. 2006;40(4):314-21. DOI: https://doi.org/10.1111/j.1365-2929.2006.02418.x PMid:16573666

Christou PA. How to use thematic analysis in qualitative research. Journal of Qualitative Research in Tourism. 2023;3(2):79-95. DOI: https://doi.org/10.4337/jqrt.2023.0006

Khairunnisa C, Siagian A, Siregar F, Zuska F. Supports and Obstacles in Managing Pulmonary Tuberculosis in Utara Aceh District. In: Proceedings of the 6th Batusangkar International Conference, BIC 2021, 11-12 October, 2021, Batusangkar-West Sumatra, Indonesia. 2022. DOI: https://doi.org/10.4108/eai.11-10-2021.2319617

Fithriasari M, Wahyuni CU. Pengaruh Faktor Pajanan Dan Status Gizi Terhadap Kejadian TB Anak Yang Tinggal Serumah Dengan Penderita TB Paru Dewasa. Jurnal Ilmiah Kesehatan Media Husada. 2017;6(1):93-108. DOI: https://doi.org/10.33475/jikmh.v6i1.65

Setyoningrum RA, Maharani RA, Hapsari R, Pratama A, Chafid P. Risk Factors of Tuberculosis in Children with Adult Household Tuberculosis Contact. Paediatrica Indonesiana p-ISSN. 2024;64(4):287-92. DOI: https://doi.org/10.14238/pi64.4.2024.287-92

Oktaviani RD, Lestari P, Maranatha D, Setyoningrum RA. Profile of Tuberculosis in Children in Taman District, Sidoarjo Regency, Indonesia. Folia Medica Indonesiana. 2022;58(1):15. DOI: https://doi.org/10.20473/fmi.v58i1.29190

Mardiati M, Fitri H. Gambaran Status Gizi Pada Pasien Tuberkulosis Paru (TB Paru) Usia 0-5 Tahun yang Menjalani Rawat Jalan di Poli Anak RSUD Cut Meutia Aceh Utara Tahun 2022. Jurnal Medika Nusantara. 2023;1(3):165-73. DOI: https://doi.org/10.59680/medika.v1i3.412

Farsida F, Febrianti R, Lutfy N, Rahmini R, Syahniar R. Relationship between Nutritional Status and Living Conditions with the Risk of Tuberculosis in Children. Jurnal Kesehatan Masyarakat. 2023;18(3):341-8. DOI: https://doi.org/10.15294/kemas.v18i3.35343

Martinez L, Cords O, Liu Q, Acuna-Villaorduna C, Bonnet M, Fox GJ, et al. Infant BCG Vaccination and Risk of Pulmonary and Extrapulmonary Tuberculosis Throughout the Life Course: a Systematic Review and Individual Participant Data Meta-Analysis. Lancet Global Health. 2023;10(9):100-106.

Dias SM, Castro S, Ribeiro AI, Krainski ET, Duarte R. Geographic Patterns and Hotspots of Pediatric Tuberculosis: The Role of Socioeconomic Determinants. Jornal Brasileiro De Pneumologia. 2023;e20230004. DOI: https://doi.org/10.36416/1806-3756/e20230004 PMid:37341241 PMCid:PMC10578936

Siddalingaiah N, Chawla K, Nagaraja SB, Hazra D. Risk factors for the development of tuberculosis among the pediatric population: a systematic review and meta-analysis. Eur J Pediatr. 2023;182(7):3007-19. DOI: https://doi.org/10.1007/s00431-023-04988-0 PMid:37130994 PMCid:PMC10354179

Bhunia SK, Dey S, Pal A, Giri B. Evaluation of socio-demographic profile and basic risk factors of tuberculosis patients in South 24 Parganas district of West Bengal, India: a hospital-based study. Afr Health Sci. 2023;23(3):358-65. DOI: https://doi.org/10.4314/ahs.v23i3.42 PMid:38357120 PMCid:PMC10862564

Obaromi D, Ndege J, Yongsong Q. Disease mapping of tuberculosis prevalence in eastern Cape Province, South Africa. J Public Health (Bangkok). 2019;27:241-8. DOI: https://doi.org/10.1007/s10389-018-0931-7

Wanahari TA, Bakhriansyah M, Haryati H, Rudiansyah M, Isa MR, Djallalluddin D, et al. Socioeconomic Determinants of Tuberculosis Cases in Indonesia, 2010-2013: An Ecological Study. Open Access Maced J Med Sci. 2022;10(E):1489-95. DOI: https://doi.org/10.3889/oamjms.2022.7694

Andom AT. Understanding Barriers to Tuberculosis Diagnosis and Treatment Completion in a Low-Resource Setting: A Mixed-Methods Study in the Kingdom of Lesotho. PLoS One. 2023;18(5):e0285774. DOI: https://doi.org/10.1371/journal.pone.0285774 PMid:37167298 PMCid:PMC10174523

Faust L, Abdi K, Davis K, He C, Mehrotra C, Stibolt E. The roll-out of child-friendly fixed-dose combination TB formulations in high-TB-burden countries: a case study of STEP-TB. J Epidemiol Glob Health. 2019;9(3):210-6. DOI: https://doi.org/10.2991/jegh.k.190812.001 PMid:31529940 PMCid:PMC7310820

Sari RF, Martini M, Raharjo M. The influence of the quality of Tuberculosis services with adherence to taking Anti-tuberculosis drugs. Qanun Medika-Medical Journal Faculty of Medicine Muhammadiyah Surabaya. 2023;7(1):21-31. DOI: https://doi.org/10.30651/jqm.v7i1.15582

Nair SA, Raizada N, Sachdeva KS, Denkinger C, Schumacher S, Dewan P, et al. Factors associated with tuberculosis and rifampicin-resistant tuberculosis amongst symptomatic patients in India: a retrospective analysis. PLoS One. 2016;11(2):e0150054. DOI: https://doi.org/10.1371/journal.pone.0150054 PMid:26918818 PMCid:PMC4769074

Nugroho MA, Kumboyono K, Setyoadi S. Analisa Kepatuhan Minum Obat Anti Tuberculosis: Perbandingan Penggunaan Layanan Pesan Singkat dengan Pengawas Minum Obat. Jurnal Akademika Baiturrahim Jambi. 2023;12(1):74-84. DOI: https://doi.org/10.36565/jab.v12i1.588

Vukugah TA, Ntoh VN, Akoku DA, Leonie S, Jacob A. Research Questions and Priorities for Pediatric Tuberculosis: A Survey of Published Systematic Reviews and Meta‐Analyses. Tuberc Res Treat. 2022;2022(1):1686047. DOI: https://doi.org/10.1155/2022/1686047 PMid:35178252 PMCid:PMC8844079

Reuter A, Hughes J, Furin J. Challenges and controversies in childhood tuberculosis. The Lancet. 2019;394(10202):967-78. DOI: https://doi.org/10.1016/S0140-6736(19)32045-8 PMid:31526740

Shitol SA, Saha A, Barua M, Towhid KMS, Islam A, Sarker M. A qualitative exploration of challenges in childhood TB patients identification and diagnosis in Bangladesh. Heliyon. 2023 Oct 1;9(10). DOI: https://doi.org/10.1016/j.heliyon.2023.e20569 PMid:37818012 PMCid:PMC10560773

Manillaturrochmah M, Fatmaningrum W, Setyoningrum RA, Utomo B. Relationship of Nutritional Status with Tuberculosis Lungs of Children Aged 0-5 Years in Surabaya. Asian Journal of Social and Humanities. 2023;1(04):154-61. DOI: https://doi.org/10.59888/ajosh.v1i04.15

Padmapriyadarsini C, Shobana M, Lakshmi M, Beena T, Swaminathan S. Undernutrition & tuberculosis in India: Situation analysis & the way forward. Indian Journal of Medical Research. 2016;144(1):11-20. DOI: https://doi.org/10.4103/0971-5916.193278 PMid:27834321 PMCid:PMC5116882

Sinha P, Davis J, Saag L, Wanke C, Salgame P, Mesick J, et al. Undernutrition and tuberculosis: public health implications. J Infect Dis. 2019;219(9):1356-63. DOI: https://doi.org/10.1093/infdis/jiy675 PMid:30476125 PMCid:PMC6941617

Sinha P, Lönnroth K, Bhargava A, Heysell SK, Sarkar S, Salgame P, et al. Food for thought: addressing undernutrition to end tuberculosis. Lancet Infect Dis. 2021;21(10):e318-25. DOI: https://doi.org/10.1016/S1473-3099(20)30792-1 PMid:33770535

Zuraida ZF, Wijayanti SPM. Risk Factors Associated With Childhood Tuberculosis: A Case Control Study in Endemic Tuberculosis Area. Int J Community Med Public Health. 2018;5(11):4702. DOI: https://doi.org/10.18203/2394-6040.ijcmph20184559

Appiah PK, Osei B, Amu H. Factors Associated With Nutritional Status, Knowledge and Attitudes Among Tuberculosis Patients Receiving Treatment in Ghana: A Cross-Sectional Study in the Tema Metropolis. PLoS One. 2021;16(10):e0258033. DOI: https://doi.org/10.1371/journal.pone.0258033 PMid:34648547 PMCid:PMC8516225

Mazhar O, Khan SA, Qaisar MA, Bhatti ZI, Qureshi MA. Incidence of Several Forms of Tuberculosis (TB) and Their Bacillus Calamette Guerin (BCG) Vaccination Status among Children. Pakistan Journal of Medical & Health Sciences. 2022;16(06):1071. DOI: https://doi.org/10.53350/pjmhs221661071

Yuen CM, Szkwarko D, Dubois MM, Shahbaz S, Yuengling KA, Urbanowski ME, et al. Tuberculosis care models for children and adolescents: a scoping review. Bull World Health Organ. 2022;100(12):777-788L. DOI: https://doi.org/10.2471/BLT.22.288447 PMid:36466210 PMCid:PMC9706349

Carwile ME, Hochberg NS, Sinha P. Undernutrition is feeding the tuberculosis pandemic: A perspective. J Clin Tuberc Other Mycobact Dis. 2022;27(March):100311. DOI: https://doi.org/10.1016/j.jctube.2022.100311 PMid:35313724 PMCid:PMC8928739

Rahmadiyah DC, Sahar J, Widyatuti, Sartika RAD, Hassan H. Family Resilience With Stunted Children Aged Below 5 Years: A Qualitative Study in Depok City, Indonesia. Glob Qual Nurs Res. 2024;11. DOI: https://doi.org/10.1177/23333936231221753 PMid:38250089 PMCid:PMC10799585

Tezol Ö, Alakaya M, Akar A, Kuyucu N. Clinical and Laboratory Evaluation of Pediatric Tuberculosis Cases in Light of Nutritional Indicators. Ankara Med J. 2019;19(1):96-107. DOI: https://doi.org/10.17098/amj.542155

Oktaviani RD, Lestari P, Maranatha D, Setyoningrum RA. Profile of Tuberculosis in Children in Taman District, Sidoarjo Regency, Indonesia. Folia Medica Indonesiana. 2022;58(1):15-20. DOI: https://doi.org/10.20473/fmi.v58i1.29190

Won HS, Lee HS, Ahn JY. Analysis of Factors Affecting the Rate of Latent Tuberculosis Infection and Management in Pediatrics. Children. 2022;9(10):1567. DOI: https://doi.org/10.3390/children9101567 PMid:36291503 PMCid:PMC9600534

Kementerian Kesehatan RI. Buku Saku Kader Kesehatan: Pemberian Makanan Tambahan (PMT) Penyuluhan. Jakarta: Kementerian Kesehatan RI; 2024 [cited 2024 Sep 19]. Available from: https://ayosehat.kemkes.go.id/download/hmer/379dd249f3b5252fca7e80c484c883c4.pdf

Eviheriyanto, Misna M, Flora R. Analisis Perencanaan dan Penganggaran Program Pemberian Makanan Tambahan Ke Balita Di Wilayah Kerja Dinas Kesehatan Kota Pangkal Pinang. Jurnal Endurance. 2023;8(1):187-93.

Tarigan APSB, Ami GC, Zara N. Studi Kasus Gizi Buruk Dengan Tuberkulosis Paru Pada Anak Usia 10 Bulan Di Desa Teumpok Tungku Puskesmas Meurah Mulia Tahun 2023. GALENICAL: Jurnal Kedokteran dan Kesehatan Mahasiswa Malikussaleh. 2024;3(2):49-73. DOI: https://doi.org/10.29103/jkkmm.v3i2.10037

Aubel J, Martin SL, Cunningham K. Introduction: A family systems approach to promote maternal, child and adolescent nutrition. Matern Child Nutr. 2021;17(S1):1-9. DOI: https://doi.org/10.1111/mcn.13228 PMid:34241950 PMCid:PMC8269145

Khairunnisa C, Siagian A, Siregar FA, Zuska F. Pulmonary Tuberculosis Control Model with Social Medicine by Medical Students and Community Leaders in North Aceh District. NeuroQuantology. 2022;20(7):3138.

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2025-02-01

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Mardiati, Millizia A, Zara N, Atika K, Zakiyya N. Family-Centered Approaches to Pediatric Tuberculosis and Nutritional Challenges in North Aceh: A Qualitative Study. Natl J Community Med [Internet]. 2025 Feb. 1 [cited 2025 Feb. 17];16(02):147-55. Available from: https://njcmindia.com/index.php/file/article/view/4804

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