Local Culture and The Risk of Pulmonary Tuberculosis

A Case Study in Teminabuan Community Health Center, Indonesia

Authors

  • Ishaq Iskandar Master's Programme in Public Health, Universitas Mega Buana, Palopo, Indonesia
  • Imelda Naolin Health Office of South Sorong District, Sorong Selatan, Indonesia
  • Arlin Adam Doctoral Programme of Public Health, Universitas Mega Buana, Palopo, Indonesia
  • Harun Iskandar Department of Internal Medicine, Universitas Hasanuddin, Makassar, Indonesia
  • Syamsuri Syakri Department of Pharmacy, Universitas Islam Negeri Alauddin Makassar, Gowa, Indonesia

DOI:

https://doi.org/10.24252/diversity.v6i1.59052

Keywords:

cough, mastication, pulmonary, smoking, tuberculosis

Abstract

Pulmonary tuberculosis (TB) remains a persistent public health challenge globally, with Indonesia ranking among the highest burden countries. In regions such as Southwest Papua, the incidence of TB is strongly influenced by cultural practices and daily behavioral patterns, yet limited studies have explored this dimension. This study aimed to analyze behavioral factors related to pulmonary TB incidence in Teminabuan, Indonesia, focusing on ventilation practices, cough etiquette, sputum disposal, smoking, and betel nut chewing. A cross-sectional design was conducted from May to June 2024 involving 97 respondents, consisting of families and neighbors of TB patients, selected through purposive sampling. The majority of participants were indigenous Papuans (76.29%), with 44.33% consuming betel nut and 43.33% spitting indiscriminately. Bivariate analysis showed that poor ventilation, inadequate cough etiquette, and indiscriminate spitting were significantly associated with TB incidence (p < 0.05). Among these, indiscriminate spitting was the most influential factor (PR = 0.421; 95% CI: 0.194–0.648). Smoking showed no significant association, while betel nut chewing, often accompanied by spitting, was found to increase TB transmission risk. These findings underscore the urgent need for culturally sensitive interventions that address traditional practices, while promoting the principle of cleanliness as part of faith in Islam, thereby strengthening family health protection and TB control efforts.

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Author Biography

Harun Iskandar, Department of Internal Medicine, Universitas Hasanuddin, Makassar, Indonesia

Pulmonologi division Departement of Internal medicine

References

Abu-Ras, W., Aboul-Enein, B. H., Almoayad, F., Benajiba, N., & Dodge, E. (2024). Mosques and public health promotion: a scoping review of faith-driven health interventions. Health Education & Behavior, 51(5), 677-690. https://doi.org/10.1177/10901981241252800

Adeoye, B. D., Michael, T. O., & Agbana, R. D. (2024). Insights, beliefs, and myths surrounding tuberculosis among pulmonary patients with delayed healthcare access in a high-burden TB state in Nigeria–a qualitative inquiry. Frontiers in sociology, 9, 1378586. https://doi.org/10.3389/fsoc.2024.1378586

Alipanah, N., Jarlsberg, L., Miller, C., Linh, N. N., Falzon, D., Jaramillo, E., & Nahid, P. (2018). Adherence interventions and outcomes of tuberculosis treatment: A systematic review and meta-analysis of trials and observational studies. PLoS medicine, 15(7), e1002595. https://doi.org/10.1371/journal.pmed.1002595

Apatzidou D. A. (2022). The role of cigarette smoking in periodontal disease and treatment outcomes of dental implant therapy. Periodontology 2000, 90(1), 45–61. https://doi.org/10.1111/prd.12449

Balasubramnian, A., Francis, P. T., Leelamoni, K., Rakesh, P. S., & Lalu, J. S. (2022). Diagnostic and treatment delay among new pulmonary tuberculosis patients in Southern India: A cross-sectional study. Indian journal of public health, 66(Supplement), S60–S65. https://doi.org/10.4103/ijph.ijph_1079_22

Cao, X., Wang, Y., Chen, Y., Zhao, M., Liang, L., Yang, M., Li, J., Peng, M., Li, W., Yue, Y., Zhang, H., Li, C., & Shu, Z. (2023). Advances in traditional Chinese medicine for the treatment of chronic obstructive pulmonary disease. Journal of ethnopharmacology, 307, 116229. https://doi.org/10.1016/j.jep.2023.116229

Corrales, L., Rosell, R., Cardona, A. F., Martín, C., Zatarain-Barrón, Z. L., & Arrieta, O. (2020). Lung cancer in never smokers: The role of different risk factors other than tobacco smoking. Critical reviews in oncology/hematology, 148, 102895. https://doi.org/10.1016/j.critrevonc.2020.102895

Dickerson, D., Baldwin, J. A., Belcourt, A., Belone, L., Gittelsohn, J., Keawe’aimoku Kaholokula, J., Lowe, J., Patten, C. A., & Wallerstein, N. (2020). Encompassing cultural contexts within scientific research methodologies in the development of health promotion interventions. Prevention Science, 21(Suppl 1), 33-42. https://doi.org/10.1007/s11121-018-0926-1

Esmail, H., Macpherson, L., Coussens, A. K., & Houben, R. M. G. J. (2022). Mind the gap - Managing tuberculosis across the disease spectrum. EBioMedicine, 78, 103928. https://doi.org/10.1016/j.ebiom.2022.103928

Felgueiras, F., Mourão, Z., Moreira, A., & Gabriel, M. F. (2022). A systematic review of ventilation conditions and airborne particulate matter levels in urban offices. Indoor Air, 32(11), e13148. https://doi.org/10.1111/ina.13148

Fox, G. J., Redwood, L., Chang, V., & Ho, J. (2021). The effectiveness of individual and environmental infection control measures in reducing the transmission of Mycobacterium tuberculosis: a systematic review. Clinical Infectious Diseases, 72(1), 15-26. https://doi.org/10.1093/cid/ciaa719

Galvin, J., Tiberi, S., Akkerman, O., Kerstjens, H. A. M., Kunst, H., Kurhasani, X., Ambrosino, N., & Migliori, G. B. (2022). Pulmonary tuberculosis in intensive care setting, with a focus on the use of severity scores, a multinational collaborative systematic review. Pulmonology, 28(4), 297–309. https://doi.org/10.1016/j.pulmoe.2022.01.016

Gebeyehu, E. M., Mebratu, A., Atnafu, A., & Hagos, A. (2025). Process evaluation of Tuberculosis infection control and prevention practice at public health facilities in Tegede district, Northwest Ethiopia: Facility-based cross-sectional design. PloS one, 20(2), e0314514. https://doi.org/10.1371/journal.pone.0314514

Iskandar, D., Suwantika, A. A., Pradipta, I. S., Postma, M. J., & van Boven, J. F. M. (2023). Clinical and economic burden of drug-susceptible tuberculosis in Indonesia: national trends 2017-19. The Lancet Global Health, 11(1), e117–e125. https://doi.org/10.1016/S2214-109X(22)00455-7

Islam, M. S., Chughtai, A. A., Banu, S., & Seale, H. (2021). Context matters: Examining the factors impacting the implementation of tuberculosis infection prevention and control guidelines in health settings in seven high tuberculosis burden countries. Journal of Infection and Public Health, 14(5), 588-597. https://doi.org/10.1016/j.jiph.2021.01.014

Kak, N., Chakraborty, K., Sadaphal, S., AlMossawi, H. J., Calnan, M., & Vikarunnessa, B. (2020). Strategic priorities for TB control in Bangladesh, Indonesia, and the Philippines - comparative analysis of national TB prevalence surveys. BMC Public Health, 20(1), 560. https://doi.org/10.1186/s12889-020-08675-9

Kumawat, A., Chakraborti, A., Kumar, S., Sonigra, M., Bhatnagar, A., Kumar, A., & Chopra, K. K. (2023). Study of factors leading to treatment delay in new sputum positive pulmonary tuberculosis patients and its impact on sputum conversion. Tropical Doctor, 53(2), 227-232. https://doi.org/10.1177/00494755221137118

Lestari, B. W., McAllister, S., Hadisoemarto, P. F., Afifah, N., Jani, I. D., Murray, M., van Crevel, R., Hill, P. C., & Alisjahbana, B. (2020). Patient pathways and delays to diagnosis and treatment of tuberculosis in an urban setting in Indonesia. The Lancet Regional Health - Western Pacific, 5, 100059. https://doi.org/10.1016/j.lanwpc.2020.100059

Malik, S. G., Oktavianthi, S., Wahlqvist, M. L., Asih, P. B. S., Harahap, A., Satyagraha, A. W., & Syafruddin, D. (2020). Non-nutritional anemia: Malaria, thalassemia, G6PD deficiency and tuberculosis in Indonesia. Asia Pacific Journal of Clinical Nutrition, 29. https://doi.org/10.6133/apjcn.202012_29(S1).04

Manghani, P., Prasad, N., Khatri, N., Paulino-Ramirez, R., Gokhale, S., Islam, K. M. M., Majumdar, P., Hoang, T., & Denny, H. (2024). Betel Quid Use and Tuberculosis Transmission: A Neglected Focus Area for Tuberculosis Control in Low- and Middle-Income Countries. Open Forum Infectious Diseases, 11(11). https://doi.org/10.1093/ofid/ofae577

Marahatta, S. B., Yadav, R. K., Giri, D., Lama, S., Rijal, K. R., Mishra, S. R., Shrestha, A., Bhattrai, P. R., Mahato, R. K., & Adhikari, B. (2020). Barriers in the access, diagnosis and treatment completion for tuberculosis patients in central and western Nepal: A qualitative study among patients, community members and health care workers. PLOS ONE, 15(1), e0227293. https://doi.org/10.1371/journal.pone.0227293

McLaren, H., Patmisari, E., Hamiduzzaman, M., Jones, M., & Taylor, R. (2021). Respect for religiosity: review of faith integration in health and wellbeing interventions with Muslim minorities. Religions, 12(9), 692. https://doi.org/10.3390/rel12090692

Mohidem, N. A., & Hashim, Z. (2023). Integrating Environment with Health: An Islamic Perspective. Social Sciences, 12(6), 321. https://doi.org/10.3390/socsci12060321

Irfan, B., Khleif, A., Badarneh, J., Abutaqa, J., Allam, A., Kweis, S., & Padela, A. (2025). Considering Islamic Frameworks to Infectious Disease Prevention. In Open Forum Infectious Diseases (p. ofaf011). https://doi.org/10.1093/ofid/ofaf011

Noora, C., Bandoh, D., Nuoh, R., Sarfo, B., Nyarko, K., & Kenu, E. (2020). Evaluation of timeliness of treatment initiation among smear positive pulmonary tuberculosis patients in Brong Ahafo Region, Ghana, 2015. Ghana Medical Journal, 54(2), 73-82. https://doi.org/10.4314/gmj.v54i2s.12

Obore, N., Kawuki, J., Guan, J., Papabathini, S. S., & Wang, L. (2020). Association between indoor air pollution, tobacco smoke and tuberculosis: an updated systematic review and meta-analysis. Public health, 187, 24-35. https://doi.org/10.1016/j.puhe.2020.07.031

Onmek, N., Kongcharoen, J., Singtong, A., Penjumrus, A., & Junnoo, S. (2020). Environmental factors and ventilation affect concentrations of microorganisms in hospital wards of Southern Thailand. Journal of Environmental and Public Health, 2020(1), 7292198. https://doi.org/10.1155/2020/7292198

Paleckyte, A., Dissanayake, O., Mpagama, S., Lipman, M. C., & McHugh, T. D. (2021). Reducing the risk of tuberculosis transmission for HCWs in high incidence settings. Antimicrobial Resistance & Infection Control, 10(1), 106. https://doi.org/10.1186/s13756-021-00975-y

Pele, M., Herawati, T., & Yona, S. (2021). Factors Influencing Transmission of Tuberculosis in Ngeu Nata Culture among Ngada Community in Kupang, East Nusa Tenggara, Indonesia: Cross Sectional Study. Journal of Public Health Research, 10(1_suppl). https://doi.org/10.4081/jphr.2021.2335

Piwko, A. M. (2021). Islam and the COVID-19 pandemic: Between religious practice and health protection. Journal of religion and health, 60(5), 3291-3308. https://doi.org/10.1007/s10943-021-01346-y

Pradipta, I. S., Idrus, L. R., Probandari, A., Puspitasari, I. M., Santoso, P., Alffenaar, J. W. C., & Hak, E. (2022). Barriers to optimal tuberculosis treatment services at community health centers: a qualitative study from a high prevalent tuberculosis country. Frontiers in pharmacology, 13, 857783. https://doi.org/10.3389/fphar.2022.857783

Quan, Z., Xu, J., Li, M., Cheng, C., Mijiti, P., Jiang, Q., Takiff, H., Ren, Z., & Gao, Q. (2024). Transmission of tuberculosis in rural Henan, China: a prospective population-based genomic spatial epidemiological study. Emerging microbes & infections, 13(1), 2399273. https://doi.org/10.1080/22221751.2024.2399273

Rai, S., Singh, D. K., & Kumar, A. (2021). Microbial, environmental and anthropogenic factors influencing the indoor microbiome of the built environment. Journal of Basic Microbiology, 61(4), 267-292. https://doi.org/10.1002/jobm.202000575

Shafique, S., Bhattacharyya, D. S., Nowrin, I., Sultana, F., Islam, M. R., Dutta, G. K., Del Barrio, M. O., & Reidpath, D. D. (2024). Effective community-based interventions to prevent and control infectious diseases in urban informal settlements in low-and middle-income countries: a systematic review. Systematic Reviews, 13(1), 253. https://doi.org/10.1186/s13643-024-02651-9

Shah, H. D., Nazli Khatib, M., Syed, Z. Q., Gaidhane, A. M., Yasobant, S., Narkhede, K., Bhavsar, P., Patel, J., Sinha, A., Puwar, T., Saha, S., & Saxena, D. (2022). Gaps and Interventions across the Diagnostic Care Cascade of TB Patients at the Level of Patient, Community and Health System: A Qualitative Review of the Literature. Tropical Medicine and Infectious Disease, 7(7), 136. https://doi.org/10.3390/tropicalmed7070136

Tamara, L., Kartasasmita, C. B., Alam, A., & Gurnida, D. A. (2022). Effects of Vitamin D supplementation on resolution of fever and cough in children with pulmonary tuberculosis: A randomized double-blind controlled trial in Indonesia. Journal of global health, 12, 04015. https://doi.org/10.7189/jogh.12.04015

Tewatia, P., Kaushik, R. M., Kaushik, R., & Kumar, S. (2020). Tobacco smoking as a risk factor for tuberculous pleural effusion: A case-control study. Global health, epidemiology and genomics, 5, e1. https://doi.org/10.1017/gheg.2020.1

Trajman, A., Campbell, J. R., Kunor, T., Ruslami, R., Amanullah, F., Behr, M. A., & Menzies, D. (2025). Tuberculosis. Lancet (London, England), 405(10481), 850–866. https://doi.org/10.1016/S0140-6736(24)02479-6

World Health Organization. (2022). Tuberculosis deaths and disease increase during the COVID-19 pandemic. https://www.who.int/news/item/27-10-2022-tuberculosis-deaths-and-disease-increase-during-the-covid-19-pandemic

Yablonskii, P. K., Kudriashov, G. G., & Avetisyan, A. O. (2019). Surgical resection in the treatment of pulmonary tuberculosis. Thorac Surg Clin, 29(1), 37-46. https://doi.org/10.1016/j.thorsurg.2018.09.003

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Published

2025-08-31

How to Cite

Iskandar, I., Naolin, I., Adam, A., Iskandar, H., & Syakri, S. (2025). Local Culture and The Risk of Pulmonary Tuberculosis: A Case Study in Teminabuan Community Health Center, Indonesia. Diversity: Disease Preventive of Research Integrity, 6(1), 49–57. https://doi.org/10.24252/diversity.v6i1.59052

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