Male, Smoking, Undernutrition, and Poor Ventilation Significantly Drive Tuberculosis Infection Rates in Bogor

Tim Editor Rabu, Oktober 07, 2026

Ilustration by AI 
FORMOSA NEWS

In September 2026, medical researchers Andriyani Risma Sanggul, Morado Natanael Sidauruk, Kelly Ivana, Yudha Putra Santoso, and Welly Salutondok from Universitas Kristen Indonesia published a cross-sectional epidemiological study analyzing key risk factors for primary and secondary pulmonary tuberculosis (TB). Conducted in the operational area of the Warung Jambu Public Health Center (Puskesmas Warung Jambu) in Bogor City, West Java, the study evaluated 100 patient cases to determine the environmental, behavioral, and biological drivers of local TB transmission. Published in Jurnal Multidisplin Madani (MUDIMA), the empirical findings demonstrate that male sex, active cigarette smoking, undernutrition, and substandard home ventilation significantly increase the probability of developing active pulmonary tuberculosis. These findings matter because Indonesia ranks second globally in total TB burden, making targeted local risk-factor interventions essential to achieving the nation’s 2030 TB elimination targets.

Tackling Indonesia's High Tuberculosis Burden at the Community Level

Tuberculosis, caused by the airborne bacterium Mycobacterium tuberculosis, remains one of the world's most persistent public health threats. According to World Health Organization (WHO) reporting, Indonesia accounts for approximately 10 percent of all global TB cases, trailing only India. West Java represents one of the country's most heavily burdened provinces, recording over 224,000 cases in recent years due to high population density, economic activity variations, and differing healthcare access levels.

Within Bogor City, local health centers such as Puskesmas Warung Jambu play a pivotal role in frontline disease surveillance and treatment management. While the facility achieved high screening rates—handling over 1,300 presumptive TB individuals in 2025—identifying specific social, environmental, and behavioral drivers remains necessary. Environmental factors like indoor air quality, along with personal habits and physical immunity, dictate whether exposure leads to active infection. Pinpointing these local determinants allows health authorities to design precise interventions rather than relying solely on generalized treatment protocols.

Epidemiological Research Methodology

The research team conducted an observational analytic study utilizing a cross-sectional design between June and July 2026 at Puskesmas Warung Jambu in Bogor City, West Java.

  •  Study Population and Sample: The study evaluated 100 respondents selected from patients receiving care at Puskesmas Warung Jambu, drawn from a total service catchment population of 28,486 individuals.
  • Inclusion and Exclusion Criteria: The sample included patients diagnosed with active primary or secondary pulmonary TB. Patients with multidrug-resistant TB (MDR-TB), extensively drug-resistant TB (XDR-TB), or extrapulmonary TB were excluded.
  • Data Sources: Primary data regarding household environments and lifestyle behaviors were gathered via structured questionnaires. Secondary clinical data were extracted from the official Tuberculosis Information System (SITB).
  •  Statistical Analysis: Data were processed using SPSS software version 24.0. Univariate frequency distributions were generated, followed by bivariate Chi-square tests to determine statistical associations, Prevalence Ratios (PR), and 95% Confidence Intervals (CI). Ethical clearance was formally granted by the Health Research Ethics Committee of the Faculty of Medicine at Universitas Kristen Indonesia.

Key Findings and Statistical Risk Drivers

The study revealed that 44.0 percent of affected respondents presented with primary pulmonary TB, while 30.0 percent suffered from secondary pulmonary TB. Bivariate statistical testing isolated four primary risk factors that significantly drive disease occurrence ($p < 0.05$):

  • Male Sex as a Major Predictor: Male respondents faced an nearly ninefold higher risk of developing pulmonary TB compared to female respondents ($\text{PR} = 8.77$; $95\%\text{ CI: } 3.51\text{--}21.88$; $p < 0.001$). This elevated risk aligns with higher outdoor mobility, workplace exposures, and behavioral habits among men.
  • Active Cigarette Smoking: Active smokers demonstrated a six-and-a-half-fold increase in pulmonary TB risk compared to non-smokers ($\text{PR} = 6.50$; $p < 0.001$). Inhaled tobacco smoke impairs mucociliary clearance and alveolar macrophage defense mechanisms in the lungs.
  •  Undernutrition and Immune Compromise: Body mass index (BMI) analysis proved that undernutrition significantly correlates with active TB ($\text{PR} = 1.70$; $95\%\text{ CI: } 1.36\text{--}2.11$; $p < 0.001$). Nutritional deficiencies weaken cellular immunity, increasing susceptibility to bacterial multiplication.
  • Substandard Housing Ventilation and Window Sizes: Houses with permanent ventilation areas smaller than $1\text{ m}^2$ ($\text{PR} = 1.53$; $p < 0.001$) and window areas under $1\text{ m}^2$ ($p < 0.001$) exhibited significantly higher disease rates. Restricted air exchange allows infectious respiratory droplets to linger in living spaces.
  • Non-Significant Variables: Age, education level, employment, income, HIV coinfection, diabetes mellitus, bedroom window area, indoor lighting, and passive smoking showed no statistically significant associations in this specific cohort ($p > 0.05$).

Public Health Implications and Strategic Recommendations

These empirical insights provide actionable pathways for municipal health authorities, urban planners, and clinical practitioners working toward disease control:

  • Targeted Community Screening: Public health centers should focus active case-finding programs on high-risk demographic segments, particularly working-age men and active smokers.
  • Integration of Smoking Cessation and Nutrition: TB management programs must integrate smoking cessation counseling and nutritional support alongside standard anti-tuberculosis antibiotic regimens.
  • Healthy Housing Policies: Urban health policies should enforce minimum home ventilation and natural window lighting standards to curb airborne pathogen transmission in densely populated residential zones.

Academic Insight

Highlighting the complex nature of community transmission, lead investigator Andriyani Risma Sanggul and her colleagues from Universitas Kristen Indonesia noted:

"Tuberculosis transmission in urban communities is driven by an interplay of biological susceptibility, behavioral habits, and physical living conditions. Addressing active smoking, undernutrition, and inadequate home ventilation through integrated community health interventions is vital to breaking the transmission cycle and supporting national elimination goals."

Primary Author Profile

  •  Full Name: Dr. Andriyani Risma Sanggul, M.Kes.
  •  Co-Authors: Morado Natanael Sidauruk, Kelly Ivana, Yudha Putra Santoso, and Welly Salutondok
  • Academic Degree: Doctor / Master of Health (M.Kes.)
  • University Affiliation: Faculty of Medicine, Universitas Kristen Indonesia (UKI), Jakarta, Indonesia
  • Field of Expertise: Public Health, Community Medicine, and Infectious Disease Epidemiology

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