Tuberculosis is still an endemic disease and a global health problem, especially in developing countries. Globally, in 2019, 7.1 million people were diagnosed with tuberculosis (new cases and relapses). The incidence of tuberculosis fell by 9% (from 142 to 130/100,000 population), the achievement is not yet in line with the target of reducing the incidence of tuberculosis by 20%. Indonesia ranks second highest tuberculosis cases globally [1]. Confirmed tuberculosis cases in 2019 amounted to 543,874 cases, a decrease when compared to the number of confirmed cases in 2018 of 566,623 cases. Meanwhile, the Case Notification Rate (CNR) in 2018 amounted to 214/100,000 residents, then experienced an insignificant decrease in 2019 to 203 / 100,000. While the achievement of treatment success has reached the national target of 86.6% (>85%) [2]. West Java Province accounted for TB cases of 109,463 cases in 2019 with a Success Rate in all cases of 79,943 cases (85,8%) [3].

Bandung city is the second highest contributor of tuberculosis cases in West Java. The city of Bandung has 11,959 cases of tuberculosis with CNR which is 477 per 100,000 residents. Risk factors for high cases of tuberculosis in urban areas such as the city of Bandung are due to the growth of dense and slum areas, low healthy lifestyles, and decreased quality of environmental health [4].

Babakansari Health Center is a health center located in Kiaracondong District, Bandung City. In 2019 there were as many as 80 tuberculosis sufferers who were recorded and undergoing treatment at the Puskesmas, consisting of 56 cases of pulmonary tuberculosis, and then increased in 2020 to 77 cases. The Babakansari Health Center has a target of finding cases in 2020 of 316 cases and examination of suspected tuberculosis at 1733.

In triassic epidemiology theory states that an infectious disease is a sweet manifest due to interactions between agents, hosts and environments. Agents are the causative factors of disease, can be bacteria, viruses, protozoa and others. The host factor can be a person or animal that becomes a place for agents to grow and multiply. The host factor is influenced by the history of the disease, heredity, education, age, gender, psychic condition, and endurance. The next factor is the environment. According to the theory of environmental knots, healthy or sick a group of people is the result of the relationship between humans and the environment [5].

Other studies examining environmental factors and the incidence of tuberculosis state that humidity and harm are one of the important factors in tuberculosis transmission [6]. Seeing the above phenomenon will certainly make it difficult for all parties to eliminate tuberculosis. Based on the data and description of the above problems, the purpose of this study is to analyze the relationship of environmental factors with the incidence of tuberculosis.

The types of research used are observational analytics and Cross Sectional design. Cross Sectional is used to analyze a relationship between the cause of disease risk and the cause of a health problem by making observations simultaneously and at the same time [7]. This research was conducted in the Working Area of the Babakansari Health Center in Bandung City in March - August 2021. The population in this study is suspected tuberculosis that conducted laboratory examinations and recorded in the babakansari Health Center tuberculosis report as many as 368 people. The study sample of 98 respondents was taken at random simply, with the criteria for samples doing routine treatment and not yet resistant tuberculosis drugs.

The instruments used are questionnaires, thermo hygrometer observation sheets and lux meters. The data was analyzed using univariate analysis, to see the frequency distrubusi of each variable studied, then bivariate analysis was carried out using a chi-square test with a signification value of 0.05.

This research was conducted in the working area of Babakansari Health Center, Bandung City. Respondents were taken randomly with a sample number of 98 respondents who were suspected tuberculosis patients who visited babakansari health center. The research results data is then analyzed and presented in the form of univariate and bivariate tables.

Table 1. Description of the Characteristics of Respondents

Table 1 shows that most age groups are at risk (60.2%), female (60.2%), and highly educated (73.5%).

Table 2 shows that room temperature measurement results are mostly categorized as qualified (73.5%), air humidity measurement results are mostly categorized as ineligible (72.4%), and room confidence measurement results more than half of respondents are categorized as ineligible (67.3%).

Table 3. Chi Square Test of Environmental Factors with Incidence of Tuberculosis

Table 3 explains that the environmental factors associated with the incidence of tuberculosis are temperature (p=0.004), humidity (p=0.031), and lighting (p=0.012).

Temperature is associated with the incidence of tuberculosis. The air temperature in the house is said to be ideal if it ranges from 18-30^oC. Inappropriate temperatures will potentially lead to conducive bacterial growth and cause health problems such as dehydration. Mycobacterium tuberculosis bacteria can live and grow well at temperatures ranging from 31^oC-37^oC [8].

Temperature measurements are carried out in the living room where the room is a spacious room where family members gather. This is in accordance with research conducted in Surabaya where home temperature measurements are carried out at the point where family members often gather, including tuberculosis sufferers. Observations in the field showed that respondents with unqualified home temperature had a habit of rarely opening the windows of a house or room. The reason is because many family members do activities outside the home (school / work) so it is not safe if the window of the house is open and some respondents think that opening the window will make dust enter the house. Windows or doors that rarely open cause impaired air circulation [9].

Another study in the United States stated that the average daily minimum temperature (with positive effects) is an important climate factor in. This may be due to the adverse effects of minimum air temperature on the patient's respiratory system, and the lifestyle of people closer in cold weather which increases the risk of exposure to tuberculosis infectious agents [10]. Similar results were reported in other studies. In a time series analysis study in Fukuoka (Japan), Onozuka and Hagihara found a significant positive association between extreme cold temperatures and cases of tuberculosis incidence [11]. Our results are also consistent with findings in Pakistan [12].

Humidity is associated with the incidence of tuberculosis. High humidity is a living place for Mycobacterium tuberculosis bacteria. Ideally a house has humidity ranging from 40-60%. If the air humidity <40% then it is necessary to make an effort to open the ventilation of the house either windows or doors. If the air humidity >60%, then it needs efforts such as installing glass tiles or using a humidifier so that humidity becomes ideal [13].

The results showed that there were respondents who had qualified home humidity but suffered from tuberculosis. According to researchers, someone who has a qualified physical environment condition of the house has more high degrees of health. But good environmental factors are not enough for a person to avoid tuberculosis, the need for the application of healthy behaviors by all family members such as not smoking in the house and consuming a balanced diet so that the body's resistance is strong. The results of observations made by researchers are known that most of the respondents' homes are in densely populated neighborhoods. The houses feel stuffy because many people rarely open windows. The absence of air exchange in the house can trigger high levels of humidity. Unhealthy environmental conditions and high humidity in the house can trigger the fertile growth of tuberculosis-causing bacteria [9].

In our study, the risk of tuberculosis was more in those who lived at home with ineligible inertia. Research in Hong Kong states that a higher risk of tuberculosis notification occurs when relative humidity is 60.0–63.6% [14]. A study in Southwest China revealed that minimum relative humidity correlates inversely with the number of tuberculosis cases [15].

Although moisture inaction was inconsistent among these four studies, these findings suggest that lower humidity levels are closely associated with more cases of tuberculosis with slowness effects of varying lengths. One possible reason for the explanation is that in dry conditions the body's airway mucus secretion and cleansing of exogenous pathogens is reduced, which can make people more susceptible to mycobacterium tuberculosis infection [16].

Lighting is associated with the incidence of tuberculosis. A room ideally has 60 lux of lighting, while for corridors it is at least 20 lux [5]. Lighting should be ideal because sunlight has a role to kill bacteria and other microorganisms, especially those found in the home environment. A humid and dark home environment will make mycobacterium tuberculosis bacteria live and multiply [17].

The results showed that there were respondents who had qualified home lighting but suffered from tuberculosis. According to researchers, someone who has a qualified physical environment condition of the house has more high degrees of health. All family members need to adopt healthy behaviors such as not smoking indoors, applying the correct cough ethics and consuming a balanced diet so that the immune system is strong. The results of observations made by researchers showed that most of the respondents' homes did not have enough natural lighting. This is because the respondent's house is in small alleys where sunlight is blocked by house buildings. Coupled with the habits of people who rarely open windows and doors make the conditions in the house dark and humid.

The results of the above study are in line with other studies that state that most people with pulmonary tuberculosis have poor home lighting. The results of statistical tests showed a significant association between lighting and tuberculosis incidence [18]. Other studies have shown a significant association between lighting and the incidence of tuberculosis, as well as the condition of homes with ineligible lighting 3.5 times the chance of developing tuberculosis [18]

The authors declare that they have no conflict of interest

No funding sources

 The study was approved by the Institutional Ethics Committee of Bhakti Kencana University.

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