Pulmonary Tuberculosis Case Before and During Pandemic COVID-19: Prevalence and Frequency Distribution Differences at Arifin Achmad General Hospital, Riau Province

Abstract

Background: The COVID-19 pandemic severely disrupted tuberculosis (TB) control efforts, leading to a global "diagnostic deficit."

Objectives: This study aimed to compare the incidence and frequency distribution of new pulmonary TB cases before and during the pandemic at Arifin Achmad General Hospital, Riau Province.

Methods: Adhering to STROBE guidelines, this observational cross-sectional study analyzed 343 medical records from March 2018 to March 2022. Comparison was made between the pre-pandemic (2018–2020) and pandemic (2020–2022) periods using Chi-square analysis and Odds Ratios.

Results: New pulmonary TB case notifications significantly declined by 33.5%, falling from 206 cases (60.1%) pre-pandemic to 137 cases (39.9%) during the pandemic. Of the total cases, 291 (84.8%) were drug-sensitive (DS-TB) and 52 (15.2%) were drug-resistant (DR-TB). Bivariate analysis revealed highly significant associations (p < 0.001) between the pandemic period and both smoking history and a history of COVID-19 infection. Significant associations were also found with comorbidities, including Diabetes Mellitus and HIV (p = 0.01).

Conclusion: The observed decline reflects a diagnostic deficit driven by healthcare disruptions and reduced health-seeking behavior rather than a true reduction in incidence. The biological synergy between SARS-CoV-2 and Mycobacterium tuberculosis likely catalyzed active disease in vulnerable groups. Healthcare systems must prepare for a "time lag" phenomenon, where undiagnosed community transmission leads to a future surge in advanced TB presentations. Intensified active case-finding is essential to mitigate the pandemic's long-term epidemiological impact. 

Keyword: COVID-19 Pandemic, Incidence, Time Lag, Tuberculosis

Latar Belakang: Pandemi COVID-19 telah sangat mengganggu upaya pengendalian tuberkulosis (TB), yang mengakibatkan terjadinya “defisit diagnosis” secara global.

Tujuan: Penelitian ini bertujuan untuk membandingkan insidensi dan distribusi frekuensi kasus TB paru baru sebelum dan selama pandemi di Rumah Sakit Umum Arifin Achmad, Provinsi Riau.

Metode: Sesuai dengan pedoman STROBE, studi observasional cross-sectional ini menganalisis 343 rekam medis dari Maret 2018 hingga Maret 2022. Perbandingan dilakukan antara periode pra-pandemi (2018–2020) dan pandemi (2020–2022) menggunakan analisis Chi-square dan Odds Ratios.

Hasil: Laporan kasus TB paru baru menurun secara signifikan sebesar 33,5%, dari 206 kasus (60,1%) pada periode pra-pandemi menjadi 137 kasus (39,9%) selama pandemi.

Kesimpulan: Penurunan yang diamati mencerminkan kekurangan dalam diagnosis yang disebabkan oleh gangguan layanan kesehatan dan berkurangnya perilaku mencari perawatan kesehatan, bukan penurunan insiden yang sesungguhnya. Sinergi biologis antara SARS-CoV-2 dan Mycobacterium tuberculosis kemungkinan besar memicu penyakit aktif pada kelompok rentan. Sistem layanan kesehatan harus bersiap menghadapi fenomena “time lag”, di mana penularan di masyarakat yang tidak terdiagnosis akan menyebabkan lonjakan kasus TB stadium lanjut di masa depan. Peningkatan upaya pencarian kasus secara aktif sangat penting untuk memitigasi dampak epidemiologis jangka panjang dari pandemi ini.

Kata kunci: Insidensi, Pandemi COVID-19, Time Lag, Tuberkulosis