Relative Risk and Distribution Assessment of Tuberculosis Cases: A Time-Series Ecological Study in Aceh, Indonesia

  • Novi Reandy Sasmita Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Mhd Khairul Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Mumtaz Kemal Fikri Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Latifa Rahayu Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Zurnila Marli Kesuma Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Selvi Mardalena Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Rumaisa Kruba Department of Statistics, Faculty of Mathematics and Natural Sciences, Universitas Syiah Kuala, Banda Aceh, Indonesia
  • Virasakdi Chongsuvivatwong Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
  • M. Ischaq Nabil Asshiddiqi School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong
DOI: https://doi.org/10.56338/mppki.v8i6.7264
Keywords: Relative Risk, Tuberculosis, Standardized Morbidity Ratio, Aceh Province, Indonesia

Abstract

Introduction: Tuberculosis (TB) remains a critical public health issue, particularly in high-incidence regions like Aceh Province, Indonesia. This study aimed to estimate the Relative Risk (RR) and analyze significant differences in the temporal distribution of TB cases across Aceh Province.

Methods: A time-series ecological study was conducted using TB case and population data from 23 districts/cities in Aceh Province between 2016 and 2022. Data were analyzed using R software, applying descriptive and inferential statistics. The Standardized Morbidity Ratio (SMR) method estimates RR and is categorized into five risk levels. The Kolmogorov-Smirnov test assessed data normality, guiding the selection of statistical tests. The Friedman and Wilcoxon Signed-Rank tests examined differences in TB case distribution trends.

Results: Significant spatial and temporal variations in TB risk were identified. Districts such as Banda Aceh (RR = 2.29–2.13) and Lhokseumawe (RR = 1.89–2.21) consistently demonstrated high RR from 2016 to 2022, reflecting persistent TB transmission. A general upward trend in TB cases was observed across districts, with significant spatial variation (p < 0.001), highlighting a worsening TB burden.

Conclusions: The study emphasizes the urgent need for targeted public health interventions tailored to TB's unique spatial and temporal dynamics in Aceh Province, Indonesia. Applying SMR and robust statistical analyses provides valuable insights to inform localized TB control policies and strengthen management strategies in high-burden areas.

References

World Health Organization. Global Tuberculosis Report 2023. November. Geneva; 2023.

Ministry of Health Indonesia. Indonesia Health Profile 2023 [Internet]. Ministry of Health Indonesia. Jakarta; 2024. Available from: https://kemkes.go.id/app_asset/file_content_download/172231123666a86244b83fd8.51637104.pdf

Aceh Provincial Health Office. Aceh Health Profile 2022. Banda Aceh; 2022.

Sasmita NR, Phonna RA, Kesuma ZM, Kamal S, Yusya N. Spatial-Temporal Epidemiology of COVID-19 in Aceh, Indonesia: A Statistical Perspective. Unnes J Public Heal. 2024;3(2):67–79.

Antaria A. Tuberculosis control in Indonesia: Theory and Research. First edit. Rubbi TA, Rahnawati, editors. Vol. 7, Journal GEEJ. Malang: Literasi Nusantara Abadi Grup; 2024. 1–144 p.

Newman TB, Kohn MA. Evidence-Based Diagnosis. Evidence-Based Diagnosis. 2020.

Diah IM, Aziz N. The Comparison between Standardized Mortality Ratio, Poisson-Gamma and Stochastic Sic Model for Pneumonia Disease Mapping in Malaysia. J Inf Commun Technol [Internet]. 2022 Oct 19;21(4):549–70. Available from: https://e-journal.uum.edu.my/index.php/jict/article/view/14423

Puspita T, Suryatma A, Simarmata OS, Veridona G, Lestary H, Athena A, et al. Spatial variation of tuberculosis risk in Indonesia 2010-2019. Heal Sci J Indones [Internet]. 2021 Dec 16;12(2):104–10. Available from: https://ejournal2.litbang.kemkes.go.id/index.php/hsji/article/view/5467

Diah IM, Aziz N, Kasim MM. Tuberculosis disease mapping in Kedah using standardized morbidity ratio. AIP Conf Proc. 2017;1891:1–5.

Odhiambo JN, Dolan CB. Spatial and spatio-temporal epidemiological approaches to inform COVID-19 surveillance and control: a review protocol. Syst Rev [Internet]. 2022 Dec 14;11(1):1–6. Available from: https://systematicreviewsjournal.biomedcentral.com/articles/10.1186/s13643-022-02016-0

Guo J, Liu C, Liu F, Zhou E, Ma R, Zhang L, et al. Tuberculosis disease burden in China: a spatio-temporal clustering and prediction study. Front Public Heal [Internet]. 2025 Jan 7;12(1):1–12. Available from: https://www.frontiersin.org/articles/10.3389/fpubh.2024.1436515/full

Carlos de Abreu L, Elmusharaf K, Eduardo Gomes Siqueira C. A time-series ecological study protocol to analyze trends of incidence, mortality, lethality of COVID-19 in Brazil. J Hum Growth Dev [Internet]. 2021 Dec 1;31(3):491–5. Available from: https://revistas.marilia.unesp.br/index.php/jhgd/article/view/12667

Sasmita NR, Ikhwan M, Suyanto S, Chongsuvivatwong V. Optimal control on a mathematical model to pattern the progression of coronavirus disease 2019 (COVID-19) in Indonesia. Glob Heal Res Policy [Internet]. 2020 Dec 5;5(1):1–38. Available from: https://ghrp.biomedcentral.com/articles/10.1186/s41256-020-00163-2

Saputra A, Sofyan H, Kesuma ZM, Sasmita NR, Wichaidit W, Chongsuvivatwong V. Spatial patterns of tuberculosis in Aceh Province during the COVID-19 pandemic: a geospatial autocorrelation assessment. IOP Conf Ser Earth Environ Sci [Internet]. 2024 Jun 1;1356(1):012099. Available from: https://iopscience.iop.org/article/10.1088/1755-1315/1356/1/012099

Earlia N, Bulqiah M, Muslem M, Karma T, Suhendra R, Maulana A, et al. Protective Effects of Acehnese Traditionally Fermented Coconut Oil (Pliek U Oil) and its Residue (Pliek U) in Ointment against UV Light Exposure: Studies on Male Wistar Rat Skin (Rattus novergicus). Sains Malaysiana [Internet]. 2021 May 31;50(5):1285–95. Available from: https://www.ukm.my/jsm/pdf_files/SM-PDF-50-5-2021/9.pdf

Agustia M, Noviandy TR, Maulana A, Suhendra R, Muslem M, Sasmita NR, et al. Application of Fuzzy Support Vector Regression to Predict the Kovats Retention Indices of Flavors and Fragrances. In: Proceedings of the International Conference on Electrical Engineering and Informatics. Banda: IOPScience; 2022. p. 13–8.

Palupi S, Chongsuvivatwong V, Surya A, Suyanto S, Kumwichar P. Cross-Risk Between Tuberculosis and COVID-19 in East Java Province, Indonesia: An Analysis of Tuberculosis and COVID-19 Surveillance Registry Period 2020–2022. Cureus [Internet]. 2023 Sep 7; Available from: https://www.cureus.com/articles/177994-cross-risk-between-tuberculosis-and-covid-19-in-east-java-province-indonesia-an-analysis-of-tuberculosis-and-covid-19-surveillance-registry-period-2020-2022

Awang AC, Samat NA. Leptospirosis disease mapping with standardized morbidity ratio and Poisson-Gamma model: An analysis of Leptospirosis disease in Kelantan, Malaysia. J Phys Conf Ser [Internet]. 2017 Sep;890:012168. Available from: https://iopscience.iop.org/article/10.1088/1742-6596/890/1/012168

Sasmita NR, Arifin M, Kesuma ZM, Rahayu L, Mardalena S, Kruba R. Spatial Estimation for Tuberculosis Relative Risk in Aceh Province, Indonesia: A Bayesian Conditional Autoregressive Approach with the Besag-York-Mollie (BYM) Model. J Appl Data Sci [Internet]. 2024 May 15;5(2):342–56. Available from: https://bright-journal.org/Journal/index.php/JADS/article/view/185

Azharuddin, Sasmita NR, Idroes GM, Andid R, Raihan, Fadlilah T, et al. Patient Satisfaction And Its Socio-Demographic Correlates In Zainoel Abidin Hospital, Indonesia: A Cross-Sectional Study. Unnes J Public Heal. 2023;12(2):57–67.

Sasaki D, Sofyan H, Sasmita NR, Affan M, Nizamuddin N. Assessing the Intermediate Function of Local Academic Institutions During the Rehabilitation and Reconstruction of Aceh, Indonesia. J Disaster Res [Internet]. 2021 Dec 1;16(8):1265–73. Available from: https://www.fujipress.jp/jdr/dr/dsstr001600081265

Koura KG, Hashmi S, Menon S, Gando HG, Yamodo AK, Budts A-L, et al. Leveraging Artificial Intelligence to Predict Potential TB Hotspots at the Community Level in Bangui, Republic of Central Africa. Trop Med Infect Dis [Internet]. 2025 Apr 3;10(4):93. Available from: https://www.mdpi.com/2414-6366/10/4/93

Gao C, Wang Y, Hu Z, Jiao H, Wang L. Study on the Associations between Meteorological Factors and the Incidence of Pulmonary Tuberculosis in Xinjiang, China. Atmosphere (Basel). 2022;13(4):1–15.

Rao M, Johnson A. Impact of Population Density and Elevation on Tuberculosis Spread and Transmission in Maharashtra, India. J Emerg Investig [Internet]. 2021;4(1):1–5. Available from: https://emerginginvestigators.org/articles/21-056

Gichuki J, Mategula D. Characterisation of tuberculosis mortality in informal settlements in Nairobi, Kenya: analysis of data between 2002 and 2016. BMC Infect Dis [Internet]. 2021 Dec 31;21(1):718. Available from: https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-021-06464-2

Syarifah Khodijah, Artha Prabawa. Spatial Analysis of Risk Factors for Tuberculosis Incidence in South Jakarta City in 2022. Media Publ Promosi Kesehat Indones [Internet]. 2024 Jun 1;7(6):1518–24. Available from: https://jurnal.unismuhpalu.ac.id/index.php/MPPKI/article/view/5208

Teibo TKA, Andrade RL de P, Rosa RJ, Tavares RBV, Berra TZ, Arcêncio RA. Geo-spatial high-risk clusters of Tuberculosis in the global general population: a systematic review. BMC Public Health [Internet]. 2023 Aug 19;23(1):1586. Available from: https://doi.org/10.1186/s12889-023-16493-y

Kustanto A. The role of socioeconomic and environmental factors on the number of tuberculosis cases in Indonesia. J Ekon Pembang [Internet]. 2020 Dec 5;18(2):129–46. Available from: https://ejournal.unsri.ac.id/index.php/jep/article/view/12553

Mohidem NA, Hashim Z, Osman M, Shaharudin R, Muharam FM, Makeswaran P. Demographic, socio-economic and behavior as risk factors of tuberculosis in Malaysia: a systematic review of the literature. Rev Environ Health [Internet]. 2018 Dec 19;33(4):407–21. Available from: https://www.degruyter.com/document/doi/10.1515/reveh-2018-0026/html

Surya Hajar FD, Siregar YI, Afandi D, Nofrizal. Determinant factors that contribute to the increasing tuberculosis prevalence in Rokan Hilir, Indonesia. Casp J Environ Sci. 2023;21(1):13–34.

Thakur G, Thakur S, Thakur H. Status and challenges for tuberculosis control in India – Stakeholders’ perspective. Indian J Tuberc [Internet]. 2021 Jul;68(3):334–9. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0019570720301980

Andrade HLP de, Ramos ACV, Crispim J de A, Santos Neto M, Arroyo LH, Arcêncio RA. Spatial analysis of risk areas for the development of tuberculosis and treatment outcomes. Rev Bras Enferm [Internet]. 2021;74(2):1–7. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71672021000200169&tlng=en

Teo AKJ, Singh SR, Prem K, Hsu LY, Yi S. Duration and determinants of delayed tuberculosis diagnosis and treatment in high-burden countries: a mixed-methods systematic review and meta-analysis. Respir Res [Internet]. 2021 Dec 23;22(1):1–28. Available from: https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-021-01841-6

Obeagu EI. Tuberculosis diagnostic and treatment delays among patients in Uganda. Heal Sci Reports [Internet]. 2023 Nov 15;6(11):1–5. Available from: https://onlinelibrary.wiley.com/doi/10.1002/hsr2.1700

Li X, Yang H, Wang H, Liu X. Effect of Health Education on Healthcare-Seeking Behavior of Migrant Workers in China. Int J Environ Res Public Health [Internet]. 2020 Mar 30;17(7):23–44. Available from: https://www.mdpi.com/1660-4601/17/7/2344

Rahayu L, Sasmita NR, Adila WF, Kesuma ZM, Kruba R. Spatial Estimation of Relative Risk for Dengue Fever in Aceh Province using Conditional Autoregressive Method. J Appl Data Sci [Internet]. 2023 Dec 1;4(4):466–79. Available from: http://bright-journal.org/Journal/index.php/JADS/article/view/141

Pathak D, Vasishtha G, Mohanty SK. Association of multidimensional poverty and tuberculosis in India. BMC Public Health [Internet]. 2021 Dec 11;21(1):1–12. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-021-12149-x

Jiang W, Dong D, Febriani E, Adeyi O, Fuady A, Surendran S, et al. Policy gaps in addressing market failures and intervention misalignments in tuberculosis control: prospects for improvement in China, India, and Indonesia. Lancet Reg Heal - West Pacific [Internet]. 2024 May;46:101045. Available from: https://doi.org/10.1016/j.lanwpc.2024.101045

MacPherson P, Shanaube K, Phiri MD, Rickman HM, Horton KC, Feasey HRA, et al. Community-based active-case finding for tuberculosis: navigating a complex minefield. BMC Glob Public Heal [Internet]. 2024 Feb 8;2(1):9. Available from: https://bmcglobalpublichealth.biomedcentral.com/articles/10.1186/s44263-024-00042-9

Published
2025-06-05
How to Cite
Sasmita, N. R., Khairul, M., Fikri, M. K., Rahayu, L., Kesuma, Z. M., Mardalena, S., Kruba, R., Chongsuvivatwong, V., & Asshiddiqi, M. I. N. (2025). Relative Risk and Distribution Assessment of Tuberculosis Cases: A Time-Series Ecological Study in Aceh, Indonesia . Media Publikasi Promosi Kesehatan Indonesia (MPPKI), 8(6), 407-417. https://doi.org/10.56338/mppki.v8i6.7264
Issue
Vol. 8 No. 6: JUNE 2025 - Media Publikasi Promosi Kesehatan Indonesia (MPPKI)
Section
Article

Copyright (c) 2025 Media Publikasi Promosi Kesehatan Indonesia (MPPKI)

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Authors who publish with Media Publikasi Promosi Kesehatan Indonesia retain the copyright of their work. The journal applies a Creative Commons Attribution-ShareAlike 4.0 International License (CC BY-SA 4.0), which grants the following rights:

  1. Copyright Retention: Authors retain the copyright of their work, maintaining full control over their intellectual property without restrictions.

  2. Right of First Publication: Authors grant the journal the right of first publication of their work. This ensures that the work is initially published and credited in Media Publikasi Promosi Kesehatan Indonesia.

  3. License to Share and Reuse: The work is licensed under CC BY-SA 4.0, allowing others to copy, distribute, remix, and build upon the work for any purpose, even commercially, as long as proper credit is given to the authors, and any new creations are licensed under the same terms.