Environmental housing conditions of TB patients in a tidal-flooded area [TBN 074]

Who

The study included 25 households of registered pulmonary tuberculosis (TB) patients living in tidal-flood–affected coastal areas of Pekalongan, Indonesia. These households were selected from the service areas of Tirto II, Kramat Sari, and Dukuh primary health centers using total sampling from the eligible population. Of 52 registered TB cases, only 25 households met inclusion criteria.

Inclusion criteria were:

• confirmed active pulmonary TB,
• residence in tidal-flood–affected zones,
• willingness to participate.

Exclusion criteria were:

• untraceable address,
• duplicate residence,
• relocation,
• death.

Respondent characteristics reported were:

• age range 8–70 years, mean 46.12 ± 17.78 years,
• 56% male and 44% female,
• 80% married,
• 84% had education at elementary level or lower,
• 52% laborers, 32% housewives,
• 84% earned < IDR 1,000,000/month,
• 16% had BCG immunization history,
• mean TB illness duration 3.64 ± 2.29 months,
• mean residence duration 33.24 ± 21.38 years,
• 12% reported household transmission.

Important ambiguity: the report describes “respondents” as TB patients, but the actual unit of analysis appears to be the household/house, not the individual patient. The presence of respondents aged 8 years is also insufficiently explained in the methods.

What

The study examined the physical environmental characteristics of houses occupied by TB patients, focusing on housing conditions as a composite variable with six indicators:

1. occupancy density,
2. ventilation area,
3. indoor humidity,
4. indoor temperature,
5. lighting intensity,
6. floor type.

Key findings:

• 20% of households had occupancy density below the standard of 9 m²/person.
• 92% failed to meet the ventilation standard of ≥10% of floor area.
• Mean household humidity was 78.31% RH, above the recommended 40–60% RH.
• 84% of houses exceeded the recommended temperature limit of 30°C, with room temperatures around 32°C.
• 64% of households had inadequate lighting below 60 lux.
• 92% had waterproof flooring; 8% did not.
• Overall, only 1 household (4%) had adequate housing conditions, while 96% were classified as inadequate.

Authors’ apparent conclusion: most houses of TB patients in these tidal-flood–affected areas had poor environmental housing conditions, especially ventilation, humidity, temperature, and lighting.

Interpretation that is justified: the study shows a high prevalence of substandard housing conditions among households with TB patients.

Interpretation that is not justified: the study does not establish that these housing conditions caused TB, because there was no comparison group and the design was purely descriptive.

When

Data were collected between October 2023 and August 2024.

Where

The study was conducted in tidal-flood–affected coastal areas of Pekalongan, Indonesia, specifically in the service areas of:

• Tirto II Primary Health Center,
• Kramat Sari Primary Health Center,
• Dukuh Primary Health Center.

The setting was household-based, with direct observation and environmental measurement in:

• bedrooms,
• living rooms,
• kitchens,
• bathrooms.

Why

The study aimed to describe whether the homes of TB patients in flood-affected coastal areas met healthy housing standards. The implied rationale is that poor housing environments may facilitate TB transmission or persistence, especially in settings affected by chronic tidal flooding, dampness, heat, and poor ventilation.

The knowledge gap addressed appears to be the limited description of housing environmental conditions among TB-affected households in a coastal tidal-flood context.

How

This was a descriptive quantitative study. The single main variable was housing condition, measured using six environmental indicators.

Data collection methods:

• structured environmental assessment questionnaire adapted from prior validated instruments,
• dichotomous scoring for each indicator,
• classification into good, moderate, or poor housing condition categories,
• direct measurements in all major rooms.

Tools used:

• digital thermohygrometer for temperature and humidity,
• Smart Sensor AS803 lux meter for lighting intensity,
• measuring tape for room dimensions and ventilation area.

Environmental standards used:

• occupancy density: ≥9 m²/person,
• ventilation: ≥10% of floor area,
• humidity: 40–60% RH,
• temperature: 18–30°C,
• lighting: ≥60 lux,
• waterproof flooring as acceptable.

Quality procedures:

• instrument calibration against hospital-standard instruments,
• trained researchers,
• standardized protocols,
• informed consent and administrative authorization.

Strength of evidence

This is a descriptive cross-sectional household environmental assessment, which is a low level of evidence for causality. It is useful for describing conditions but not for determining whether poor housing conditions increase TB risk.

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Overall concise interpretation

Among 25 TB-affected households in tidal-flood–affected Pekalongan, 96% were classified as having inadequate housing conditions. The most prominent deficits were poor ventilation, high humidity, high indoor temperature, and insufficient lighting. However, because the study was small, descriptive, and lacked a non-TB comparison group, it supports only a description of housing conditions, not a conclusion that these conditions caused TB.

Source: Irnawati, I., Wulan, D. R., Rahmatullah, R., Kartikasari, D., Permadi, Y. W., & Arifin, M. (2026). Environmental housing conditions of tuberculosis patients in a tidal-flooded area: Evidence from one of the world’s second-highest tb-burden countries. BIS Health and Environmental Science, 3, V326012.