Knowledge and Family Support Regarding Regular Medication Taking in Tuberculosis Resistant Patients

Abstract

Knowledge and family one factor in success treatment of Multidrug-Resistant Tuberculosis (MDR TB), and is support orientation to function enhancement regularity in take anti- tuberculosis medication (OAT). Regularity is behavior Good especially in drink medication that has been given. Patient Resistant Tuberculosis (R-TB) is patients who do not complete drink drug so that bacteria the develop which results resistant. Study aim For know connection knowledge and support family to regularity taking OAT in R-TB patients at Persahabatan Hospital . Study with cross sectional technique . Sample of 104 respondents with purposive sampling method . Research results univariate showing majority 46-55 years old , male , college high or not working . Analysis results bivairat Spearman's rho method is obtained exists relationship knowledge and family with regularity drink medication in patients resistance tuberculosis . Advice on the need improved awareness in patients , evidence support family That real during operate treatment period long and digging related matters with regularity drink medicine .

INTRODUCTION

Pulmonary Tuberculosis (TB) is an infectious disease of the lungs, the disease spreads through droplets when sufferers cough, sneeze or talk. (WHO, 2020) . Tuberculosis disease that is not treated or completed, the bacteria in the sufferer's body will become resistant, resulting in Multidrug-Resistant Tuberculosis (MDR-TB) resulting in the patient's treatment taking longer. Globally, there are 150,359 confirmed cases of MDR TB with resistance (WHO, 2020) . Nationally in Indonesia there were 7,921 cases of MDR TB (RI, 2021) . The number of MDR TB cases in the East Jakarta area has increased by 12.34%, compared to 32,570 cases in 2018 (Government of the Republic of Indonesia, 2022) .

Research from Mashidayanti, Nurlely, & Kartinah ( 2020) shows the regularity of taking medication with the number of MDR TB patients being 70.6% regular, 11.8% moderately regular and 17.6% irregular. Comparative research results stating that irregular medication taking is related to knowledge in Junita, Debataraja, & Kusnandar ( 2022) stated that data on MDR-TB respondents based on knowledge stated that 53.3% had low knowledge. The conclusion is that more than half of the majority of MDR TB respondents have low knowledge of the relationship between the level of knowledge and adherence to taking medication (Dwi et al., 2019) . The results of research on family support for the regularity of taking medication in Ainiyah et al. ( 2019) stated that there was a significant relationship between the role of the family and compliance of MDR TB patients in treatment at RSUD Dr. Soetomo Surabaya (Soekotjo et al., 2019) . The results of family support for MDR TB patients in treatment include informational, assessment, emotional and instrumental family support (Kridaningsih et al., 2021a) .

The Friendship Central General Hospital (RSUP Persahabatan) is a type A hospital which was built on November 7 1963, which has become a national reference for respiration so that the services of the Friendship Hospital make a special contribution to the management of respiration located in East Jakarta (Bustamam & Setiawan, 2021) . Obtained data on the prevalence of MDR TB (2021), a total of 272 patients were treated. The prevalence rate for MDR TB (2022) is a total of 379 patients treated, consisting of new patients who have no history of treatment from patients who failed, changed the drug guide for 18-24 months, changed the OAT SO guide, died, dropped out of the drug (lost to follow up) . ), relapse, change of treatment location, suspected of having a history of close contact with MDR TB patients.

METHOD

Design study This using cross sectional with side non-probability techniques namely purposive sampling (P et al., 2019) . Study aim For know exists connection level knowledge and support family to regularity drink anti- tuberculosis drugs in patients resistance tuberculosis at Persahabatan Hospital. Study This carried out at the MDR TB Polyclinic, RSUP Persahabatan on 4 October 2022 - 30 March 2023 with population of 140 with a sample of 104 respondents take care walk in space taking MDR TB drugs (Hanif et al., 2020a) . Variable study level knowledge and support family to regularity drink medicine . Data collection with questionnaire, data analysis was carried out with data tabulation and submission hypothesis (Febrianto et al., 2019a) . H1 was tested with p value <0.05. Statistical tests used analysis Spearman's rho statistics (Hanif et al., 2020b)

RESULTS

Table 1. Distribution Frequency respondents at the MDR-TB Polyclinic, Persahabatan Hospital , East Jakarta

No	Respondent Characteristics	Frequency ( f )	Percentage (%)
1.	Age 17-25 years old 26-35 years old 36-45 years old 46-55 years old	18 24 27 35	17 23 26 34
	Total	104	100%
2.	Gender Man Woman	53 51	51 49
	Total	104	100%
3.	Education Not finished elementary school yet elementary school middle/high school College	3 11 38 52	3 11 36 50
	Total	104	100%
4.	Work Employee Civil Servants Entrepreneur Doesn't work	4 28 10 62	4 27 9 60
	Total	104	100%

The results of table 1 show that the frequency distribution of respondent characteristics shows that all respondents with R-TB took OAT at the MDR TB Polyclinic, Persahabatan Hospital, East Jakarta. The majority of respondents were 46-55 years old as much as 34%, men as many as 51%, university students as many as 50%, and not working as many as 59.6%.

Table 2. Frequency distribution of respondents' knowledge level at the MDR TB Polyclinic at Persahabatan Hospital, East Jakarta

Knowledge Level Category	Frequency ( f )	Percentage (%)
Good Enough Not enough	79 12 13	74% 11.5% 12.5%
Total	104	100%

The results in table 2 show that the frequency distribution of knowledge levels of 104 respondents has a good level of knowledge of 74% regarding the regularity of taking OAT.

Table 3. Frequency distribution of respondents for family support at the MDR TB Polyclinic, Persahabatan Hospital, East Jakarta

Category Support Family	Frequency ( f )	Percentage (%)
Good Not enough	91 13	87 13
Total	104	100%

The results from table 3 show that there is a frequency distribution of respondents with family support, out of 104 respondents who have good family support of 87% regarding the regularity of taking OAT.

Table 4. Frequency distribution of respondents' regularity in taking anti-tuberculosis medication (OAT) at the MDR TB Polyclinic at Persahabatan Hospital

Category Regularity Taking Medicine	Frequency ( f )	Percentage (%)
Regular Irregular _	82 22	78.8 21.2
Total	104	100%

The results from table 4 show that the frequency distribution of respondents who regularly drink OAT from 104 respondents has a good regularity of 78.8%.

Table 5. Relationship between level of knowledge and regularity of taking OAT in TB resistant patients at the MDR TB Polyclinic, RSUP Persahabatan

Knowledge	Regularity				Total		Spearman's rho
	Good		Not enough				P		R
	N	%	N	%	N	%
Good	68	65.4	22	10.6	79	76	0.001	0.355
Enough	10	9.6	2	1.9	12	11.5
Not enough	4	3.8	9	8.7	13	12.5
Total	82	82	22	22	104	100

Analysis of the results from table 5 based on the Spearman's rho test on the level of knowledge and the regularity of taking OAT, obtained a p-value = 0.001 < 0.05 with a cotingency coefficient of 0.355, so it was concluded that there was a significant relationship between the level of knowledge and the regularity of drinking OAT, which was relatively low.

Table 6. Relationship between family support and regularity of taking OAT in TB resistant patients at the MDR TB Polyclinic, Persahabatan Hospital

Family	Regularity				Total		Spearman's rho
	Good		Not enough				P	R
	N	%	N	%	N	%
Good	81	77.9	10	9.6	91	87.5	0.001	0.659
Not enough	1	12	12	11.5	13	12.5
Total	82	82	22	22	104	100

the Spearman's rho test of family support and regular OAT drinking resulted in a p-value = 0.001 < 0.05 with a cotingency coefficient of 0.659 so it was concluded that there was a significant relationship between family support and regular OAT drinking which was relatively strong.

DISCUSSION

Univariate Discussion of Knowledge

The knowledge of respondents in the research is that respondents know, understand, apply, analyze, systematic and evaluation of knowledge is very important for R-TB respondents, this understanding is the basis for R-TB respondents in regularly taking OAT by taking medication regularly for 6-24 months . This is in line with the theory of Notoatmodjo (2014) in Fadlilah & Aryanto ( 2020) states that knowledge is the result of curiosity through sensory processes, especially in the eyes and ears regarding the target object. This research is not in line with research by Junita et al. ( 2022) majority 53.3%. MDR-TB respondents had low knowledge.

The researchers concluded that there was no correlation between age, gender, education and occupation with the respondent's level of knowledge. The patient's knowledge is supported by information sources from various media which is supported by age, education and environment and the researcher concludes that the respondent's low level of knowledge is supported by the respondent's low level of education, the respondent not working and additionally from the environmental factors where the respondent lives. (Sundari et al., 2023) .

Family Univariate Discussion

The family support of the respondents in this study was that the respondents were always supported by the family in reminding them to take medication at regular times every day, and the family was always ready, accompanying, providing support and assistance during the duration of treatment. This research is in line with the theory of Rismayanti et al. ( 2021) which states that family support is the attitude, actions and acceptance of the family towards family members who need help. There are no comparative journals so that researchers can conclude that family support is real evidence for sick family members, especially R-TB patients, in regularly taking medication so that infection or resistance to the drug does not occur (Febrianto et al., 2019b ) .

Researchers found that respondents who had less family support were due to a correlation between the respondent's education and family support, but there was no correlation between age, gender and employment with family support. The results of the interview showed that the respondent was a migrant to the capital city, there was no family who was aware and supportive, and the respondent did not want his family members to be infected by the disease suffered by the respondent.

Univariate discussion of regularities

The regularity of respondents in this study is the activities and events experienced by respondents when taking medication which are carried out regularly at the same time and carried out every day. This research is in line with the theory from KBBI ( 2016) which states that regularity is an activity, situation or a process that occurs repeatedly or more regularly or the process is in the form of good and real things in accordance with what has been planned. This research is not in line with research by Beda Ama & Suhermi ( 2020) which stated that 78.6% had irregular medication intake with the occurrence of MDR-TB and 21.4% had good regularity.

Based on the results obtained, the researchers concluded that R-TB respondents had less regularity due to the side effects of OAT, were bored with the length of treatment, felt tired, struggled alone in healing, the amount of medication given, lack of motivation to recover and lack of system support from the environment or families and respondents who have good regularity because these respondents are continuously reminded by their families to take their medication on time (Kridaningsih et al., 2021b) .

Bivariate discussion of knowledge level

the Spearman's rho test research obtained a p-value = 0.001 < 0.05 with a coefficient of 0.355, which concluded that there was a relatively low relationship between the level of knowledge and the regularity of taking OAT . This research is in line with research by Hasina et al. ( 2023) that with the Spearman's rho test, the p-value was 0.030 or <0.05 and had a correlation coefficient = 0.287, which means there is a relationship between knowledge and low medication adherence. The level of knowledge is a factor that can measure a person's obedience to something that is within him. Both practically, theoretically and indirectly through behavioral awareness of direction, rules and motivation. This level of knowledge is supported by the person's age, education, occupation and surrounding environment. The level of knowledge can also influence a person's regularity in taking OAT (Junita et al., 2022) .

This research is in contrast to research by Felicia, Nani Fattiya Suryani ( 2021) The results of the Spearman's rho statistical test showed a p-value of 0.0655 (p = >0.05), which means there is no relationship between knowledge and adherence to taking advanced anti-tuberculosis medication (OAT) in pulmonary TB sufferers. There is no relationship between knowledge about multidrug resistance for tuberculosis and adherence to taking medication in tuberculosis patients at the Oebobo Helath Center Government Clinic of Kupang City with a p-value of 0.338 > 0.05 (Djuma et al., 2018) .

People who have less knowledge will be at risk of contracting ongoing tuberculosis (MDR TB) compared to people who have good knowledge (Windiyaningsih & Badaruddin, 2021) .

Researchers concluded that the level of knowledge of R-TB respondents could influence the long-term regularity of taking OAT because the level of knowledge is a factor that can be measured in the regularity of respondents taking medication. Researchers concluded that respondents with less knowledge were new patients, because the patient had delayed seeking treatment for more than 2 months, respondents only suspected that the cough they were experiencing was just an ordinary cough, researchers concluded that the droplets in the respondent had become immune so that the diagnosis of MDR-TB started from the respondent's environment and the presence of a family who has a history of MDR TB/TB resistance, then there are respondents who are disobedient or irregular in taking medication according to the doctor's instructions for 6 - 24 months, recurrence, failure in category 1 treatment, dropping out of treatment (loss of follow up ) and have been treated but the results are unknown ( los follow up ). Respondents stated in their interviews that undergoing treatment was unpleasant, respondents did not have the motivation to recover, the length of treatment and this knowledge is the most important group regarding information about R-TB disease which requires taking medication regularly so that it can prevent death. (Haryati et al., 2022) .

Bivariate discussion of family support

The research results that have been tested for Spearman's rho show a p-value = 0.001 < 0.05 with a correlation value of 0.659, indicating that there is a strong relationship between family support and the regularity of drinking long-term OAT. One of the factors that influences the determination of the treatment program a patient receives is the family (Pitters, Kandou, and Nelwan, 2019). The success of treatment is supported by the existence of a family's socio-economic relationship so that there is compliance in treatment. This is shown by the p value of 0.0349 or <0.05, which means that there is a significant relationship to the success of treatment with family support, namely psycho-socio-economic (Bhatt et al., 2019) . The role of the family and compliance of MDR TB patients in treatment (Ainiyah et al., 2019) . The role referred to in this research is family support for MDR TB patients in treatment in the form of informational, assessment, emotional and instrumental family support. This could be related to family support in compliance with the treatment of pulmonary TB patients with the prevention of MDR TB in outpatients. Research from Wahidahwati (2020), the results of the Spearman's rho test obtained a p-value of 0.000 or <0.05 with a value of r = 0.962, which means that there is a very strong influence between family support in the treatment of pulmonary TB patients on preventing more MDR TB (Andani & Savitri, 2022) .

This research is in contrast to the research of Sofiana et al. ( 2022) stated that there was no relationship between family support and compliance with taking tuberculosis medication. The presence or absence of family support and treatment compliance in tuberculosis patients is because family support is not a strong reason for respondents to fully comply or not comply with the implementation. Patient compliance could be influenced by other factors. One of these factors is that patients accidentally delay taking medication so that they end up forgetting. This can be seen from the aspect of punctuality or regularity in taking medication. The results of this study were that there were still patients who answered that they forgot to take medication. This is supported by the age factor, because age is a determining factor in patient non-compliance with treatment. In old age, a person's adherence to taking medication is higher because he is busier with work and can seek treatment regularly (Sebayar, 2020) .

Researchers concluded that 13% of respondents who had a lack of family support were respondents who always sought treatment independently without family support , did not have a family, lived alone in urban areas, their families did not accept the respondent's illness, respondents who lived overseas alone, and their families who did not provide system support to the respondent, and the respondent was self-motivated to recover in treatment without support and assistance from the family.

CONCLUSION

The results of the research that has been carried out can be concluded that the majority are in the 45-55 year old category, male, have a tertiary education, and are unemployed. Knowledge level is good and support family is good . There is connection level knowledge and support family to regularity taking OAT in R-TB patients .

REFERENCES

Ainiyah, S. N., Soedarsono, S., & Umiastuti, P. (2019). The Relationship Between Family’s Assessment Support And Mdr Tb Patient’s Adherence On Treatment In Rsud Dr. Soetomo Surabaya. Juxta: Jurnal Ilmiah Mahasiswa Kedokteran Universitas Airlangga, 10(2), 75. Https://Doi.Org/10.20473/Juxta.V10i22019.75-78

Andani, N. M. L., & Savitri, P. D. (2022). Persistent Secondary Spontaneous Pneumothorax As A Complication Of Tuberculosis Infection: A Case Report. Intisari Sains Medis, 13(1), 131–135. Https://Doi.Org/10.15562/Ism.V13i1.1260

Beda Ama, P. G., & Suhermi, S. (2020). Pengaruh Faktor Klinis Dan Keteraturan Minum Obat Dengan Terjadinya Tb Mdr Di Wilayah Kerja Puskesmas Kecamatan Pasar Rebo Jakarta Timur. Jurnal Ilmiah Kesehatan, 12(1), 15–27. Https://Doi.Org/10.37012/Jik.V12i1.115

Bhatt, R., Chopra, K., & Vashisht, R. (2019). Impact Of Integrated Psycho-Socio-Economic Support On Treatment Outcome In Drug Resistant Tuberculosis – A Retrospective Cohort Study. Indian Journal Of Tuberculosis, 66(1), 105–110. Https://Doi.Org/10.1016/J.Ijtb.2018.05.020

Bustamam, N., & Setiawan, I. (2021). Efek Proteksi Profilaksis Isoniazid Terhadap Infeksi Tuberkulosis Pada Pasien Hiv Di Rumah Sakit Pengayoman Cipinang. Tuberculosis, 6, 7.

Djuma, A. W., Octrisdey, K., & Titing, H. A. (2018). Relationship Between Knowledge Of Mdr-Tb And The Role Of Dots Supervisor With Medication Adherence Of Tb Patients In Oebobo Local Government Clinic Of Kupang City Tuberculosis Is A Chronic Kota Kupang , In 2016 There Were 343 New Cases Of Pulmonary Tuberc. 463–471.

Dwi, I. A., Roro, R. W. P., & Piesta, P. B. P. (2019). Diagnosis Dan Tatalaksana Skrofuloderma Pada Anak Dengan Infeksi Human Immunodeficiency Virus Dan Gizi Buruk. Jk Unila Jurnal Kedokteran Universitas Lampung, 3(2). Http://Repository.Lppm.Unila.Ac.Id/Id/Eprint/21579

Fadlilah, S., & Aryanto, E. (2020). Faktor Yang Berhubungan Dengan Pengetahuan Tb Paru Dan Dukungan Sosial Pasien Rs Khusus Paru Respira. Jurnal Ilmiah Keperawatan Sai Betik, 15(2), 168. Https://Doi.Org/10.26630/Jkep.V15i2.1804

Febrianto, F. W., Kusumaningrum, D., & Mustika, A. (2019a). Hubungan Penurunan Kadar Cd4 Dengan Pola Kepekaan Mycobacterium Tuberculosis Terhadap Rifampisin Pada Pasien Ko-Infeksi Tb-Hiv Di Rsud Dr. Soetomo Surabaya. Jurnal Kedokteran Syiah Kuala, 19(1), 5–9.

Febrianto, F. W., Kusumaningrum, D., & Mustika, A. (2019b). Hubungan Penurunan Kadar Cd4 Dengan Pola Kepekaan Mycobacterium Tuberculosis Terhadap Rifampisin Pada Pasien Ko-Infeksi Tb-Hiv Di Rsud Dr. Soetomo Surabaya. Jurnal Kedokteran Syiah Kuala, 19(1), 5–9. Https://Doi.Org/10.24815/Jks.V19i1.18044

Felicia, Nani Fattiya Suryani, I. (2021). Hubungan Pengetahuan Dan Efikasi Diri Terhadap Kepatuhan Minum Obat Anti Tuberkulosis ( Oat ) Tahap Lanjutan Pada Penderita Tb Paru. Jurna Prosiding Nasional Unimur, 655, 1388–1399.

Hanif, A., Jatmiko, S. W., Dewi, L. M., & Lestari, N. (2020a). Perbedaan Parameter Hematologi Pada Pasien Tuberkulosis (Tb) Dengan Dan Tanpa Infeksi Human Immunodeficiency Virus (Hiv). Biomedika, 12(2), 72–78.

Hanif, A., Jatmiko, S. W., Dewi, L. M., & Lestari, N. (2020b). Perbedaan Parameter Hematologi Pada Pasien Tuberkulosis (Tb) Dengan Dan Tanpa Infeksi Human Immunodeficiency Virus (Hiv). Biomedika, 12(2), 72–78. Https://Doi.Org/10.23917/Biomedika.V12i2.10290

Haryati, H., Wicaksono, B., & Rahmawaty, D. (2022). Heimlich Valve As Ambulatory Treatment For Persistent Pneumothorax In A Patient With Pulmonary Tuberculosis: A Case Report And Literature Review. Journal Of Cardio-Thoracic Medicine, 10(4).

Hasina, S. N., Rahmawati, A., Faizah, I., Sari, R. Y., & Rohmawati, R. (2023). Hubungan Tingkat Pengetahuan Dengan Kepatuhan Minum Obat Anti Tuberkulosis (Oat) Pada Pasien Tuberkulosis Paru. Jurnal Ilmiah Permas: Jurnal Ilmiah Stikes Kendal, 13(2), 453–462. Https://Doi.Org/10.32583/Pskm.V13i2.908

Junita, Debataraja, N. N., & Kusnandar, D. (2022). Penerapan Analisis Fisher ’ S Exact Test Pada Kasus Multidrug Resistant Tuberculosis ( Mdr-Tb ) Di Kalimantan Barat. Buletin Ilmiah Math.Stat. Dan Terapannya (Bismaster), 11(3), 477–482.

Kbbi. (2016). Kamus Besar Bahasa Indonesia (Kbbi). Kementerian Pendidikan Dan Budaya.

Kridaningsih, T. N., Widiyanti, M., Adiningsih, S., Hutapea, H. M. L., Fitriana, E., & Natalia, E. I. (2021a). Profile Of Hiv/Aids Patients Coinfected With Tuberculosis In Bumi Wonorejo Health Centre And Santo Rafael Clinic Nabire, Papua. Jurnal Kedokteran Brawijaya, 31(4), 247–252.

Kridaningsih, T. N., Widiyanti, M., Adiningsih, S., Hutapea, H. M. L., Fitriana, E., & Natalia, E. I. (2021b). Profile Of Hiv/Aids Patients Coinfected With Tuberculosis In Bumi Wonorejo Health Centre And Santo Rafael Clinic Nabire, Papua. Jurnal Kedokteran Brawijaya, 31(4), 247–252. Https://Doi.Org/10.21776/Ub.Jkb.2021.031.04.10

Mashidayanti, A., Nurlely, N., & Kartinah, N. (2020). Faktor Risiko Yang Berpengaruh Pada Kejadian Tuberkulosis Dengan Multidrug-Resistant Tuberculosis (Mdr-Tb) Di Rsud Ulin Banjarmasin. Jurnal Pharmascience, 7(2), 139. Https://Doi.Org/10.20527/Jps.V7i2.7928

P, D. Y., Dian S, D., Gayatri, A. Y., Utama, M. S., Somia, A., & Parwati M, T. (2019). Karakteristik Pasien Hiv/Aids Dengan Koinfeksi Tuberkulosis Pada Poliklinik Vct Rsup Sanglah. Medicina, 50(2). Https://Doi.Org/10.15562/Medicina.V50i2.275

Pemerintah Republik Indonesia. (2022). Statistik Jakarta. Tingkat Penghunian Kamar Hotel Selama Pandemi Hingga Januari 2022.

Ri, K. (2021). Petunjuk Teknis Penatalaksanaan Tuberkulosis Resisten Obat Di Indonesia 2020.

Rismayanti, E. P., Romadhon, Y. A., Faradisa, N., & Dewi, L. M. (2021). Hubungan Dukungan Keluarga Dengan Tingkat Keberhasilan Pengobatan Pasien Tuberkulosis Paru. The 13 Th University Research Colloqium, 191–197.

Sebayang, A. N. O. (2020). Perawatan Diagnostik Dan Konservatif Hidropneumotorax Karena Tuberkulosis Pada Anak Laki-Laki Berusia 17 Tahun. Scripta Score Scientific Medical Journal, 2(1), 58–63. Https://Doi.Org/10.32734/Scripta.V2i1.3527

Soekotjo, F. N., Sudarwati, S., & Alam, A. (2019). Clinical Profile Of Tb In Children At Pediatric Outpatient Clinic Hasan Sadikin Hospital Bandung 2016. Journal Of Medicine & Health, 2(3). Https://Doi.Org/10.28932/Jmh.V2i3.1221

Sofiana, L., Ayu, S. M., Amelia, D., Adiningsih, P., Sa’diyah, U., Putri, N., Azizah, A. R., & Safitri, A. A. (2022). Medication Adherence Of Tuberculosis Patients In Yogyakarta: A Cross Sectional Study. Journal Of Health Education, 7(2), 95–106. Https://Doi.Org/10.15294/Jhe.V7i2.60607

Sundari, A. R. P., Tursina, A., & Siddiq, T. B. (2023). Gambaran Karakteristik Pasien Infeksi Oportunistik Tuberkulosis Dengan Hiv/Aids Di Rsud Al-Ihsan. Bandung Conference Series: Medical Science, 3(1), 166–171. Https://Doi.Org/10.29313/Bcsms.V3i1.5762

Wahidahwati. (2020). Pengaruh Kinerja Keuangan Dan Corporate Social Responsibility Terhadap Nilai Perusahaan Perbankan Yang.

Who. (2020). Constitution Of The World Health Organization. Public Health Reports, 61, 1268–1279. Https://Doi.Org/10.1163/9789004634121_013

Windiyaningsih, C., & Badaruddin, H. (2021). Factors Influenced Of Drug-Resistant Tuberculosis And Non-Drug-Resistant Tuberculosis Patients In Pulmonary Hospital Dr. M. Goenawan Partowidigdo, Bogor District. Tarumanagara Medical Journal, 3(2), 238–248. Https://Doi.Org/10.24912/Tmj.V4i1.13714