Determinants of Latent Tuberculosis Infection (LTBI) among Health Workers in Community Health Centers, Makassar City: A Case-Control Study
DOI:
https://doi.org/10.6000/1929-6029.2026.15.09Keywords:
Latent tuberculosis infection, healthcare workers, mask use, contact history, BCG immunization, case-control studyAbstract
The prevalence of latent tuberculosis infection (LTBI) in Asia reaches 36% based on Tuberculin Skin Test (TST) results, and healthcare workers represent a high-risk group for occupational TB exposure. In South Sulawesi Province, 2,488 LTBI cases were reported in 2024, with Makassar City contributing the highest number. This study aimed to identify determinants of LTBI among healthcare workers in community health centers in Makassar City using a retrospective case-control design. Cases were healthcare workers with positive TST results recorded in the SITB database, while controls were healthcare workers from the same centers with negative TST results selected through simple random sampling with a 1:1 ratio. Bivariate analysis was conducted using Odds Ratios (OR), and variables with p < 0.25 were included in a multivariate logistic regression model to determine independent factors. A total of 316 cases and 316 controls were analyzed. Inconsistent mask use (AOR = 5.20; 95% CI: 3.60–7.51), history of contact with TB patients (AOR = 2.63; 95% CI: 1.82–3.80), and absence of BCG immunization (AOR = 2.30; 95% CI: 1.50–3.53) were independently associated with LTBI. Although smoking was significant in bivariate analysis, it was not retained in the final multivariate model. These findings highlight the importance of strengthening infection prevention and control practices and routine LTBI screening among healthcare workers in primary healthcare settings.
References
Nasry Noor N. Epidemiology of Infectious Diseases. First Edition. Makassar: UPT Unhas Press 2021.
Widoyono. Tropical Diseases: Epidemiology, Transmission, Prevention & Eradication. Jakarta: Erlangga Publishers 2008.
Ministry of Health of the Republic of Indonesia. Report on the Tuberculosis Control Program for the Year 2023 [Internet]. Jakarta; 2024. Available from: https://www.tbindonesia.or.id/ wp-content/uploads/2024/12/Laporan-Program-Penanggulangan-TBC-2023_Final.pdf
WHO. Global Tuberculosis Report 2024 [Internet]. 1st ed. Geneva: World Health Organization; 2024. 1 p. Available from: https://iris.who.int/server/api/core/bitstreams/ 7292c91e-ffb0-4cef-ac39-0200f06961ea/content
PDPI. Tuberculosis: Guidelines for Diagnosis and Management in Indonesia [Internet]. Revised Edition 2. Jakarta: Indonesian Lung Doctors Association; 2021. Available from: https://www.tbindonesia.or.id/wp-content/ uploads/2021/06/UMUM_PNPK_revisi.pdf
Hengky HK, Maria IL, Safar M, Khuzaimah A, Amir MY, Santoso A. Childhood Tuberculosis: Epidemiology, Etiology, Pathophysiology, Pathogenesis, Risk Factors, Prevention and Diagnosis: A Narrative Review. International Journal of Statistics in Medical Research [Internet] 2025. DOI: https://doi.org/10.6000/1929-6029.2025.14.38
Houben RMGJ, Dodd PJ. The Global Burden of Latent Tuberculosis Infection: A Re-estimation Using Mathematical Modelling. Metcalfe JZ, editor. PLoS Med 2016; 13(10): e1002152. DOI: https://doi.org/10.1371/journal.pmed.1002152
Shrestha AB, Siam IS, Tasnim J, Dahal A, Roy P, Neupane S, et al. Prevalence of latent tuberculosis infection in Asian nations: A systematic review and meta‐analysis. Immunity Inflammation & Disease 2024; 12(2): e1200. DOI: https://doi.org/10.1002/iid3.1200
Ding C, Hu M, Guo W, Hu W, Li X, Wang S, et al. Prevalence trends of latent tuberculosis infection at the global, regional, and country levels from 1990–2019. International Journal of Infectious Diseases 2022; 122: 46-62. DOI: https://doi.org/10.1016/j.ijid.2022.05.029
Ogu C, Ebenezar C, Nwaogwugwu O, Ogu R, Nduka I. Tuberculin Skin Test Reactivity among Health Care Workers in the Abia State University Teaching Hospital, Aba South-east Nigeria. TOIDJ 2024; 16(1): e18742793270091. DOI: https://doi.org/10.2174/0118742793270091240126112157
Park JS. The Prevalence and Risk Factors of Latent Tuberculosis Infection among Health Care Workers Working in a Tertiary Hospital in South Korea. Tuberc Respir Dis 2018; 81(4): 274. DOI: https://doi.org/10.4046/trd.2018.0020
Belo C, Naidoo S. Prevalence and risk factors for latent tuberculosis infection among healthcare workers in Nampula Central Hospital, Mozambique. BMC Infect Dis 2017; 17(1): 408. DOI: https://doi.org/10.1186/s12879-017-2516-4
Guo HY, Zhong QH, Zhou J, Zhao ZM, Zhang XL, Chen ZH, et al. Risk of prevalence of latent tuberculosis infection in healthcare workers—an idiographic meta-analysis from a Chinese perspective. J Thorac Dis 2021; 13(4): 2378-92. DOI: https://doi.org/10.21037/jtd-20-1612
Fenty A. Factors Associated with Latent Tuberculosis Infection Among Healthcare Workers at Lubuk Alung Specialized Lung Hospital. Master's thesis, Andalas University 2016.
Erawati M, Andriany M. The Prevalence and Demographic Risk Factors for Latent Tuberculosis Infection (LTBI) Among Healthcare Workers in Semarang, Indonesia. JMDH 2020; 13: 197-206. DOI: https://doi.org/10.2147/JMDH.S241972
Angelia A, Doda DVD, Manampiring AE. Prevalence of Latent Tuberculosis and Evaluation of Hospital Policies Based on Healthcare Workers' Perceptions of Tuberculosis Prevention. JBM 2020; 12(3): 192. DOI: https://doi.org/10.35790/jbm.12.3.2020.31632
Maulana I. Factors Associated with Latent Tuberculosis Infection Among Healthcare Workers at the West Sumatra Lung Hospital. Padang: Thesis, Andalas University 2023.
Alfiyyah A. Analysis of Quality Control of Pulmonary Tuberculosis (TB) Infection Among Staff at Hospital X in Depok in 2024 [Internet]. Depok: Thesis, FKM-UI; 2024. Available from: https://lib.fkm.ui.ac.id/detail?id=137386& lokasi=lokal
Apriani L, McAllister S, Sharples K, Alisjahbana B, Ruslami R, Hill PC, et al. Latent tuberculosis infection in healthcare workers in low- and middle-income countries: an updated systematic review. Eur Respir J 2019; 53(4): 1801789. DOI: https://doi.org/10.1183/13993003.01789-2018
South Sulawesi Provincial Health Office. South Sulawesi Provincial TB Management 2025;
Makassar City Health Department. TB Manager of Makassar Province 2025.
Nasry Noor N, Arsin AA. Basic Epidemiology. First Edition. Makassar: Unhas Press 2022.
Ture Z. Latent Tuberculosis Infection in Healthcare Workers: A Cross-Sectional Study from a Tertiary Hospital in Central Anatolia. J Clin Pract Res 2024; 484-90. DOI: https://doi.org/10.14744/cpr.2024.23434
Nababan B, Triasih R, Chan G, Dwihardiani B, Hidayat A, Dewi SC, et al. The Yield of Active Tuberculosis Disease and Latent Tuberculosis Infection in Tuberculosis Household Contacts Investigated Using Chest X-ray in Yogyakarta Province, Indonesia. Tropical Med 2024; 9(2): 34. DOI: https://doi.org/10.3390/tropicalmed9020034
d’Ettorre G, Karaj S, Piscitelli P, Maiorano O, Attanasi C, Tornese R, et al. Right to Occupational Safety: Prevalence of Latent Tuberculosis Infection in Healthcare Workers. A 1-Year Retrospective Survey Carried out at Hospital of Lecce (Italy). Epidemiologia 2023; 4(4): 454-63. DOI: https://doi.org/10.3390/epidemiologia4040038
Klayut W, Srisungngam S, Suphankong S, Sirichote P, Phetsuksiri B, Bunchoo S, et al. Prevalence, Risk Factors, and Result Features in the Detection of Latent Tuberculosis Infection in Thai Healthcare Workers Using Quanti FERON-TB Gold Plus. Cureus [Internet] 2024; [cited 2025 May 8]. DOI: https://doi.org/10.7759/cureus.60960
Boucaid A, Zegmout A, Bhairis M, Amraoui M, Laaraje A, Kabiri EH, et al. Epidemiology of Latent Tuberculosis in Moroccan Healthcare Workers: Prevalence Patterns and Predisposing Factors. Cureus [Internet] 2024; [cited 2025 May 13]. DOI: https://doi.org/10.7759/cureus.75740
Meregildo-Rodriguez ED, Yuptón-Chávez V, Asmat-Rubio MG, Vásquez-Tirado GA. Latent tuberculosis infection (LTBI) in health-care workers: a cross-sectional study at a northern Peruvian hospital. Front Med 2023; 10: 1295299. DOI: https://doi.org/10.3389/fmed.2023.1295299
Dias SP, Brouwer MC, Van De Beek D. Sex and Gender Differences in Bacterial Infections. Richardson AR, editor. Infect Immun 2022; 90(10): e00283-22. DOI: https://doi.org/10.1128/iai.00283-22
Sopacuaperu SKV, Wowor TJF. Factors Associated with the Incidence of Pulmonary Tuberculosis in Xyz. Journal of Science and Technology 2024.
Al-Khamesy KSA, Al-Shehari MM, Al-Moyed KAKA, Atf-allah JYY, Al-Shamahy HA, Al-Hadad AM. Prevalence and Risk Factors of Latent Tuberculosis Among Healthcare Workers in Sana’a City, Yemen Using Whole Blood Interferon-Γ Release Assay. Univ J Pharm Res [Internet] 2022; [cited 2025 May 13]. DOI: https://doi.org/10.22270/ujpr.v7i5.833
Birroudhoh F. Early Detection of Latent Tuberculosis Infection (LTBI) in Household Contacts of Tuberculosis Patients Using the Mantoux Test at the Rengel Community Health Center. ARL 2024; 8(10): 2867-70. DOI: https://doi.org/10.46799/arl.v8i11.2218
Morrison H, McShane H. BCG: Past, Present and Future Direction. In: Christodoulides M, editor. Vaccines for Neglected Pathogens: Strategies, Achievements and Challenges [Internet]. Cham: Springer International Publishing 2023 [cited 2025 Nov 19]. pp. 171-95. DOI: https://doi.org/10.1007/978-3-031-24355-4_8
Chanpho P, Chaiear N, Kamsa-ard S. Factors Associated with Latent Tuberculosis Infection among the Hospital Employees in a Tertiary Hospital of Northeastern Thailand. IJERPH 2020; 17(18): 6876. DOI: https://doi.org/10.3390/ijerph17186876
Wardani HR, Mertaniasih NM, Soedarsono S. Risk Factors Of Latent Tuberculosis Infection In Healthcare Workers At Hospitals In Jember City Indonesia. AJID 2021; 15(1): 34-40. DOI: https://doi.org/10.21010/ajid.v15i1.4
Rosamarlina, Jahiroh, Lisdawati V, Hendrawati N, Sundari T, Rusli A, et al. Duration of Work Improves Risk of Latent TB Infection in Health-Care Workers. In: Proceedings of the 4th International Symposium on Health Research (ISHR 2019) [Internet]. Bali, Indonesia: Atlantis Press 2020 [cited 2025 May 15]. DOI: https://doi.org/10.2991/ahsr.k.200215.053
Almohaya A, Aldrees A, Akkielah L, Hashim AT, Almajid F, Binmoammar T, et al. Latent tuberculosis infection among health-care workers using Quantiferon-TB Gold-Plus in a country with a low burden for tuberculosis: prevalence and risk factors. Ann Saudi Med 2020; 40(3): 191-9. DOI: https://doi.org/10.5144/0256-4947.2020.191
Ministry of Health of the Republic of Indonesia. Guidelines for Training and Competency Improvement in the Health Sector [Internet]. Jakarta: Directorate of Health Workforce Quality Improvement; 2023. Available from: https://ditmutunakes.kemkes.go.id/assets/images/panduan/695368_pedoman-pelatihan-dan-peningkatan-kompetensi-bidang-kesehatan_20240226151838.pdf
WHO. WHO guidelines on tuberculosis infection prevention and control: 2019 update. Geneva: World Health Organization; 2019. 1 p. https://www.ncbi.nlm.nih.gov/books/ NBK539297/pdf/Bookshelf_NBK539297.pdf
Yasaratna NR, Weerasinghe MC. Risk Factors for Latent Tuberculosis among Health-care Workers in Sri Lanka. WHO South-East Asia Journal of Public Health 2024; 13(1): 9-15. DOI: https://doi.org/10.4103/WHO-SEAJPH.WHO-SEAJPH_42_24
Yusnitasari As, M. Thaha Il, Syafar M. Comorbidity Of Diabetes Mellitus On Clinical Manifestations And Quality Of Life In Patients With Pulmonary Tuberculosis. Mkmi 2016; 11(2): 86-91. DOI: https://doi.org/10.30597/mkmi.v11i2.529
Deddy Herman, Rizanda Machmud, Nur Indrawaty Lipoeto. Unraveling the Link between Obesity and Tuberculosis: A Systematic Review of the Underlying Mechanisms. Bioscmed 2024; 9(2): 6453-66. DOI: https://doi.org/10.37275/bsm.v9i2.1205
Qader GQ, Seddiq MK, Rashidi KM, Manzoor L, Hamim A, Akhgar MH, et al. Prevalence of latent tuberculosis infection among health workers in Afghanistan: A cross-sectional study. Kumar R, editor. PLoS ONE 2021; 16(6): e0252307. DOI: https://doi.org/10.1371/journal.pone.0252307
Solberg RB, Fretheim A, Elgersma IH, Fagernes M, Iversen BG, Hemkens LG, et al. Personal protective effect of wearing surgical face masks in public spaces on self-reported respiratory symptoms in adults: pragmatic randomized superiority trial. BMJ 2024; 386: e078918. DOI: https://doi.org/10.1136/bmj-2023-078918
Erawati M, Andriany M. Determinants of latent tuberculosis infection among nurses at public health centers in Indonesia. Belitung Nurs J 2022; 8(1): 28-34. DOI: https://doi.org/10.33546/bnj.1846
Sujana SP, Hamda FH, Latif YI, Asyary A. The association between secondhand smoke exposure and risk of developing active tuberculosis in individuals with latent tuberculosis infection: a systematic literature review 2025.
Suci D, Arsin AA, Noor NN, Saleh LM, Nasir S. Risk Factor Analysis of Latent Tuberculosis Infection in Mamuju Tengah Regency 2024; 14(2): 622-632.
Zhou G, Guo X, Cai S, Zhang Y, Zhou Y, Long R, et al. Diabetes mellitus and latent tuberculosis infection: an updated meta-analysis and systematic review. BMC Infect Dis 2023; 23(1): 770 DOI: https://doi.org/10.1186/s12879-023-08775-y
Downloads
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Policy for Journals/Articles with Open Access
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work
Policy for Journals / Manuscript with Paid Access
Authors who publish with this journal agree to the following terms:
- Publisher retain copyright .
- Authors are permitted and encouraged to post links to their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work .
