JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

RELATIONS WITH THE EVENT GIVING BCG IMMUNIZATION

PULMONARY TUBERCULOSIS IN CHILDREN CHILDREN IN THE
CENTER OF PULMONARY DISEASE TREATMENT Ambarawa
2007

By: Erni Murniasih and Livana

ABSTRACT
,

background: Pulmonary TB disease is still a public health problem. The

prevalence of pulmonary tuberculosis from year to year in Semarang district
remains high despite treatment strategies are applied relatively the same, namely
prevention through immunization. Case detection and treatment with DOT or
treatment strategy with direct supervision of taking medication. Prevention by
immunization is the act resulted in someone having a better endurance, so it can
defend itself against a disease or the entry of germs from the outside.
Immunization against TB is BCG vaccine immunization (BCG) has been required
in some countries and recommended in several other countries. TB disease
common in children under five in the district of Semarang when toddlers are
mostly already received a BCG vaccination. Based on the researchers conducted
this study with the aim of knowing the relationship between BCG immunization
with pulmonary TB incidence in children under five in Ambarawa Pulmonary
Disease Clinical Center. The research was conducted tanggla May 14-June 12,
2007.
Methods: This study is a non-experimental research design comparative studies
that are case-control (retrospective), which aims to determine the relationship
between BCG immunization with pulmonary TB incidence in children under five
in Ambarawa Pulmonary Disease Clinical Center. The samples are non-random
sampling of sampling saturated. The research subjects (respondents) in all
children under five who are undergoing treatment at the Lung Disease Treatment
Centers Ambarawa. The total sample of 94 respondents (47 cases and 47
controls). The data collection is done by filling out a questionnaire in the form of
closed questions were given to the parents of toddlers who meet the sample.
Result: Statistical test results using ODSS ratio (Ψ) with 95% confidence
intervals and the results obtained OR: 0.489. This means that the relationship
between immunization with BCG tuberculosis incidence such Paru.Dengan BCG
immunization can reduce the risk of pulmonary TB in children under five.

Keywords: BCG immunization, the incidence of pulmonary TB.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

PRELIMINARY

Background

Tuberculosis (TB) lung is still a public health problem. Calculation of the

World Health Organization (WHO) shows that a third of the world population has

been infected with TB germs by about 9 million new cases of TB every year. This

means that there is one person infected with Mycobacterium tuberculosis every

second. Deaths caused by tuberculosis about 1.6 million per year (Moedjiono,

2007; WHO 2006). Additionally TB kills 1 million women and 100,000 children

each year. No fewer than 583,000 patients with 262 pulmonary smear positive

cases and 140,000 deaths occur annually due to tuberculosis. In children, there

are 450,000 children under the age of 15 years died

Tuberculosis (WHO, 2003). That's why in 1993 the WHO declared a global

emergency for tuberculosis (WHO, 1994).

Household Health Survey (Household) 1995 in Indonesia indicate that

Tuberculosis is the number three cause of death after cardiovascular and

respiratory diseases in all age groups, and number one on the class of infectious

diseases. In the pattern of tuberculosis ranks seventh with a prevalence of 4.2 /

1000 population. Meanwhile, another survey showed that the prevalence of

smear-positive pulmonary tuberculosis by 2.5% which is a fairly high figure for

worldwide Pravelensi Tuberculosis of 0.01% (Misnadiarly, 1994).

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA
In the years 1994 - 1995 is expected in Indonesia there were 1.3 million new

tuberculosis cases in children under the age of 15 years and is 5-15% of all

cases of TB (Santoso, 1994).

In 2006 that the discovery of new cases (Case Detection Rate / CDR) in

Indonesia was found to be 74% or 174 704 new patients with BTA / Basal Acid

Resistant positive. Recovery rate (sucses Rate / SR) 89%. This surpassed the

global target, namely CDR SR 70% and 85%. The incidence of tuberculosis

decreased from 128 / 100,000 population in 1999 to 107 / 100,000 population in

2005. In fact, the incidence was not the same for the whole of Indonesia, where

the incidence of Sumatra 160 / 100,000 population, Jawa 107 / 100,000

population, Yogyakarta / Bali 64 / 100,000, and eastern Indonesia (Kalimantan,

Sulawesi, NTB, NTT, Maluku, and Papua) 210 / 100,000 population (MOH,

2007).

In 2001 to 2004 prevalence of pulmonary TB in Semarang district by 2.8%

and in 2005 decreased slightly to 2.4% (DHO Semarang, 2005.2006), but has

not reached the target set by WHO is equal to 0, 01%. The prevalence of

pulmonary TB in Semarang regency from year to year remains high despite

treatment strategies are applied relatively the same, namely prevention by

immunization (Expanded Program on Imunization), the discovery of the patient

(Case Detection) and treatment with DOTS strategy (Directly Observed

Treatment Shortcourse) or treatment with direct supervision of taking medication.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

Prevention by immunization or vaccination is an act that resulted in

someone having a better endurance, so it can defend itself against a disease or

the entry of germs from the outside (Roitt, 1997). Vaccination against
tuberculosis is Bacillus Calmette-Guerin vaccine (BCG), which has been required

in 64 countries and is recommended in several other countries (Briassoulis,

2005). Indonesia has been implementing since 1952 BCG vaccination.

From 1952 to 1978 BCG vaccination given early (immediately after birth).

With the Development Program of Immunization (PPI), in 1978, the time of

administration of BCG slowly converted into (at 3 months), although there is no

unity of opinion between clinicians and the government. In 1990 the PPI change

BCG vaccination became soon after birth (early) return (Lanasari, 1990).

TB infection common in children - children who outset generate a positive

Mantoux test but still received a BCG vaccination, so the chances of them

already had TB before being vaccinated. BCG vaccination is now recognized at

least to avoid the occurrence of severe pulmonary TB in children, miliary

tuberculosis that spreads throughout the body and tuberculous meningitis

affecting the brain, both of which can cause death in children (MOH,

2001,2002b).

If seen figures from the National Demographic and Health Survey

Indonesia (SKDI) years 2002-2003 BCG immunization coverage has reached the

target that is equal to 82.5%. Results of a preliminary study in Clinical Center

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

Lung Disease Ambarawa on 12 May 2007, data showed that in 2006 at the

Medical Center Lung Disease Ambarawa there are 426 children who suffered

from tuberculosis, and on May 12, 2007, there were 5 children under five

suffering from Pulmonary tuberculosis and 3 toddlers do not suffer from

tuberculosis, which of the eight children under five, seven children under five

have been given BCG and one child is not immunized BCG toddlers and young
children will not suffer from pulmonary TB. Based on the above issues I'm

interested in conducting research on the relationship BCG immunization with the

incidence of pulmonary tuberculosis in children under five in the Central Lung

Disease Treatment Ambarawa. Based on the background of the problems

described above, the formulation of the issue: "Is there a relationship giving BCG

immunization with the incidence of pulmonary tuberculosis in children under five

in the Central Lung Disease Treatment Ambarawa?"

Research purposes

The general objective of this research is giving BCG immunization known

relationship with the incidence of pulmonary tuberculosis in children under five

in the Central Lung Disease Treatment Ambarawa. While the specific objectives

are: First, the data known BCG immunization among children in the Central

Lung Disease Treatment Ambarawa. Secondly, knowing the incidence of

pulmonary tuberculosis in children under five in the Central Lung Disease

Treatment Ambarawa.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

RESEARCH METHODS

Types of research

This research is non experiment with comparative study research design

that is both Case Control (Retrospective), the research tried to look back,

meaning that data collection started from the effects or consequences that have

occurred (Nursalam, 2003).

Population and Sample Research

 The population of the whole subject or object with particular characteristics

to be studied (Hidayat, 2003). The study population was all toddlers and parents

of children under five, where the young children are being treated at the Medical

Center Lung Disease Ambarawa, with a population of 97 children under five (50

cases and 47 controls).

The samples are part of the population to be studied or partial amount of

the characteristics possessed. The sampling technique in this study using the

technique of Non-Random Sampling types saturated sampling is a way of

sampling by taking members of the population all be sampled (Nursalam, 2003),

with the inclusion criteria as follows: Children and parents, where the child is

undergoing treatment in Medical Center lung Disease Ambarawa, children under

5 years old, and willing to be the subject of research. While Exclusion criteria is:

do not have KMS and parents or family no one remembers at all dates of birth

and immunization have been given, and not willing to be the subject of research.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

Cases in this study were children under five suffering from Pulmonary

tuberculosis and are undergoing treatment at the Medical Center Lung Disease

Ambarawa in May 2007 to June 2007, while the control of toddlers who are not

suffering from the disease Pulmonary tuberculosis and are undergoing treatment

in the Clinical Center lung disease Ambarawa. Of the 50 cases that were taken,

there are 3 children under five who fall into the exclusion criteria, thereby

obtained the appropriate sample comprised 94 children out of 47 cases and 47

controls.

Location and Time Research

 This research was conducted at the Center for Lung Disease Treatment

Ambarawa, at Jln address. Kartini No. Semarang Regency Ambarawa 20 50 611,

in May-June 2007. Center for Lung Disease Treatment Ambarawa taken as a test

site with consideration of the location is quite close to where the researchers and

may represent the entire population.

Research instrument

Measuring instruments and aids used questionnaires to interview,

equipped with Towards Health Card (KMS) to cross-check the date of birth and

immunization has been given. Questionnaires are a number of written questions

that are used to obtain information from respondents in terms of reports about his

personal or things - things that are known (Arikunto, 2006). Questionnaire to

measure variables and variable BCG immunization

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

the incidence of pulmonary tuberculosis in children, researchers used a

questionnaire in the form of closed questions (Closed Ended) dichotomous

Choice kinds, namely pertayaan which only provides two answers / alternatives,

and respondents only choose one of them (Arikunto, 2006).

Data collection technique

The data collection is done by filling out a questionnaire in the form of

closed questions were given to the parents of toddlers who meet the sample. If

there are respondents who refused to engage or participate in the study,

researchers looked for a replacement in accordance with the criteria of the

sample. There are two kinds of data, namely: Primary Data obtained directly from
respondents directly from respondents by distributing questionnaires to parents

of children under the research samples. The results of questionnaires were

recorded in a questionnaire and answer sheet is then performed to facilitate the

analysis of the data encoding, to get the case done distributing questionnaires to

parents of toddlers who suffer from pulmonary tuberculosis disease of children

who are undergoing treatment at the Medical Center Lung Disease Ambarawa.

While the control is obtained by distributing questionnaires to the parents of

children who suffer from diseases other than pulmonary tuberculosis children

who are undergoing treatment at the Medical Center Lung Disease Ambarawa.

Second, the secondary data obtained from the register of children at Medical

Center Lung Disease Ambarawa that includes the name, type

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

sex, place and date of birth, name of parents, home address, and the health

status of children under five.

Data analysis

This study uses quantitative data analysis, namely: Univariate analysis

to describe the characteristics of each - each variable studied using frequency

distribution. Bivariate analysis to identify the relationship of independent variables

(immunization of BCG) and dependent variable (incidence of pulmonary

tuberculosis in children). The statistical test used is the Odds Ratio (Ψ) with 95%

confidence intervals (Riwidikdo, 2006). The formulation Odds Ratio (OR) is as

follows:

The proportion of affected cases Odds

Ratio () exposure
 Proporsikelompokkontrolyang struck
=
exposure

As for how to deduce the value of the odds ratio is as follows: First, when OR> 1,

meaning that heightens the risk. Second, if OR = 1, meaning that there is no

association / relationship. Third, OR <1, meaning at reducing risk.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

RESULTS AND DISCUSSION

RESEARCH RESULT

Overview of Respondents

This research was conducted at the Center for Lung Disease Treatment

Ambarawa on May 14th - June 12th, 2007, with the number of 94 respondents

consisting of 47 respondents as cases and 47 respondents as a control. The

characteristics of respondents by age and sex can be described as follows:

Patients with pulmonary tuberculosis in children under five who became

the subject of research at the Institute of Lung Disease Treatment Ambarawa

largely ≤ 3 years old (68%) (Table 1). Patients with pulmonary tuberculosis in

children under five who became the subject of research at the Institute of Lung

Disease Treatment Ambarawa largely male sex (60%) (Table 2).

Based on the tabulated results for BCG immunization of 94 respondents

(47 cases and 47 controls), can be explained that as many as 91 respondents

(96.8%) and that did not receive the BCG immunization as many as three

respondents (3.2%) (Table 3).

Respondents suffering from Tuberculosis as many as 47 respondents

(50%) and respondents who did not suffer from Tuberculosis as much as 47

respondents (50%) (Table 4).

Bivariate analysis by looking at the value of Odds Ratio (OR) with a

confidence interval (CI) 95% done with cross tabulation (crosstab) in

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

descriptive Statistics, The relationship between BCG immunization

the incidence of Tuberculosis in children under five. This is indicated by

OR value <1 ie, OR = 0.489 at variable BCG immunization with

confidence interval lower limit and the upper limit of 5.586 to 0.043 (Table 5).
Following

This served tabulation 1 to 5 are displayed .berurutan:

Table 1. Characteristics of respondents by age at Medical Center Lung Disease

Ambarawa on May 14th - June 12th, 2007
Age Case Control Total
N % N % N %
≤3 32 68 19 40 51 54
year
>3 15 32 28 60 43 46
year
Total 47 100 47 100 94 100
Source: primary data, in 2007

Table 2. Characteristics of respondents by sex at Medical Center Lung Disease

Ambarawa on May 14th - June 12th, 2007
Type Case Control Total
sex N % N % N %
woman 19 40 22 47 41 44
Man 28 60 25 53 53 56
Total 47 100 47 100 94 100
Source: primary data, in 2007
 Table 3. BCG immunization in infants Polyclinics
Lung Disease Ambarawa
BCG immunization Frequency %
BCG immunization 91 96.8%
Not Immunization BCG 3 3.2%
Total 94 100%
Source: primary data, in 2007

http://www.skripsistikes.wordpress.com
administrati JOURNAL OF HEALTH SOLAR MEDIKA
on
BCG YOGYAKART
immunization

Table 4 Tuberculosis incidence obtained from the register toddlers

toddler in Central Lung Disease Treatment
Ambarawa
Tuberculosis incidence Frequency %
tuberculosis 47 50%
Not Tuberculosis 48 50%
Total 94 100%
Source: primary data, in 2007

Table 5. Results of Analysis of Relationship Bivariat BCG immunization

Genesis Tuberculosis
case Total control OR (95% CI)

N % N % N %
BCG immunization 45 96 46 98 91 97 0.489
not Immunization 2 4 1 2 3 3 (0.043 -
BCG 5.586)
Total 47 100 47 100 94 100
Source: Primary Data and Secondary Data, , In 2007

Discussion

BCG immunization,

Berdasarkanhasilpenelitianbahwasebagianbesarresponden

BCG get as many as 91 respondents (96.8%). This matter

means that the respondent has been given BCG immunization. immunization

BCG immunization is part of the factors analyzed to predict

the incidence of pulmonary tuberculosis in children. BCG immunization to protect

children

of TB meningitis and miliary TB with a degree of protection of about 86% (Wahab,

2002). In this case raises the hypothesis that BCG protects against the spread of

bacteria haematogenously, but are not able to limit the growth of such localized

focus on pulmonary TB. BCG

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

protecting children from leprosy with protection capabilities estimates vary from

20% in Burma up to 80% in Uganda (Wahab, 2002).

Tuberculosis incidence,

Based on research conducted by researchers took the 47 respondents

who suffered from pulmonary TB. Pulmonary TB is a contagious disease caused

by Mycobacterium tuberculosis invades the lungs (Main, 2003). Rod-shaped

germ have special properties that is resistant to acid staining that is known Basil

Hold acid (BTA). Smear positive TB patients as an intermediary for the spread of

germs into the air in the form of droplets (splash of blood) when coughing and

sneezing (MOH, 2002). TB in children is based on the clinical picture, the picture

of chest x-rays and tuberculosis tests. So should pay attention to things that have

a history closely related to the TB BTA psitif, a positive tuberculosis test (>

10mm). Overview radiographs suggestive of TB, there is a reaction more

redness quickly (within 3-7 days) after BCG immunization. Cough for more than 3

weeks, pain and fever prolonged or repeated for no apparent reason, weight loss

for no apparent reason or no rise in a month despite the handling of good

nutrition, as well as the clinical symptoms specific (lymph nodes, brain , bone,

etc.), (Ministry of Health, Republic of Indonesia, 2002).

Tuberculosis Tuberculosis namely that attacks lung tissue, excluding the

pleura (lining of the lung). Based on the results of the examination of sputum,

pulmonary TB is divided into: 1) smear positive pulmonary TB: if at least two of

three specimens of sputum smear positive result SPS, or a sputum specimen

SPS

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

positive smear result and chest X-ray shows a picture of active TB. 2) smear

negative pulmonary TB: if the inspection SPS 3 sputum specimens negative

smear result and chest X-ray shows a picture of active tuberculosis. This is

because the incidence of TB is influenced by many factors including: age, sex,

BCG immunization, nutrition, Infant Low Birth Weight (LBW), BMS (ASI),

education Mother, smoking in the family (MOH, 2002 ).

Relationship Between BCG immunization with pulmonary TB incidence In

Childhood.

BCG immunization is part of the immunization factor analyzed to predict

the incidence of pulmonary tuberculosis children. From the results of analysis

there were 45 cases (96%) who received BCG immunization and 2 cases (4%)

who did not receive BCG immunization. The variables are statistically significant

relationship. Bivariate analysis obtained at Odds Ratio (RO) at a confidence

interval (CI) 95% amounting to 0.489, which means children with Tuberculosis

not get BCG 0.489 times greater than children who are not suffering from

Tuberculosis. Thus the research hypothesis is accepted.

 The results are consistent with Briassoulis discovery (2005) that BCG

does not completely protect children against Tuberculosis, also Main theory

(2003) that the level of 70-80% effectiveness of BCG vaccine could protect most

people from TB germs.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

Pizzo research and Wilfert (1994) concluded that cell - immunocompetent

cells of the body have been formed completely by the time the baby is born, then

by giving early BCG vaccination will cause an immune response that early

anyway, especially cellular immune response instead of humoral immune

responses. Because the immune response is closely related to the body's ability

to fight disease, the results of research conducted authors give an indication that

the immunization will raise the body's resistance to disease can thereby prevent

Tuberculosis Tuberculosis early.

In research conducted by the author, children under five suffering from

Tuberculosis largely been immunized BCG because of the policy of the Ministry

of Health in 2002 that children born in hospitals and healthcare facilities

adequate BCG immunization is given soon after birth.

Infants and children are not obtained from BCG immunization of children

who live far away from health facilities were adequate and parents forget or do

not know information about BCG immunization for their children should be given

BCG immunization in the incubation period (after birth or until the age of 2

months).

Children who have been given BCG (no scarring or scar on his right arm)

and apparently suffering from Tuberculosis likely because children have been
infected with TB germs before being given a BCG immunization or child suffering

from Tuberculosis since factor-

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

Other factors not examined by researchers such as nutritional status, low birth

weight babies, breast milk (ASI), maternal education, and smoking in the family.

Based on the analysis turns Bivariat toddlers who do not contribute

significantly BCG immunization BCG relationship with the incidence of

Tuberculosis in children under five. It can be interpreted that children who are not

immunized BCG is able to increase the incidence of pulmonary tuberculosis in

children under five (OR = 0.489; 95% CI = 0043 to 5.586). Infants and children

who do not have a tendency to experience imunisai BCG Tuberculosis amounted

to 0.489 times that of children under five who received BCG immunization. Thus

it can be said that BCG can reduce the risk of incidence of Tuberculosis in

children under five.

CONCLUSION

Based on research that has been done it can be concluded that the results

obtained are as follows: First, the toddler who was treated at the Medical Center

Pulmonary Disease - Pulmonary Ambarawa, most respondents are given BCG

immunization. Second, Genesis Pulmonary tuberculosis occurs mostly in children

who are not immunized against BCG. Thirdly, There is a statistically significant

relationship between immunization with BCG Tuberculosis incidence in children

under five.
http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA

BIBLIOGRAPHY

Anonymous 2005, low birth weight babies, Taken on April 21, 2007,
Available:
http://www.biomed.ee.itb.ac.id/telemedika/m_balita.php?table=bblr,

Arikunto, S, Prof., Dr., 2002, the procedure of the research a practical approach,
Rineke copyright, Jakarta.

Atmosukarto, k., 1993, the effect of nutritional status on infant morbidity due to
tuberculosis in Indonesia, the Indonesian public health magazine, 48: 8-11.

National Family Planning Coordinating Board, 2002-2003, Survey and health

dmografi Indonesia, Jakarta.
th
Beneson, US, 1996 Control of communicable disease in man, 15 ed, American
Public Health Association, Washington DC.

Buor, D., 2001, Mother's hood education and child mortality in Ghana, Health
Policy, 64: 297-309, Available: http://www.sciencedirect.com,

Davies, PDO, 1993, the relationship between smoking and tuberculin, TB news,
02 / IX: 1-7.

Ministry of Health, 1994, Neonatal tetanus and low birth weight babies, Jakarta.

Ministry of Health, 2001 Beware of tuberculosis in children, Taken on December

4, 2006, Available: http://www.ppmplp.depkes.go.id,

Department Health, 2002a, National Guidelines for Prevention of tuberculosis,

mold 8th, Jakarta.

Ministry of Health, 2002b, National Guidelines for Immunization,

Jakarta.

Ministry of Health, 2002c, monitoring the growth of children, Jakarta.

Ministry of Health, 2007, the spread of tuberculosis in 2004, Kompas, Jakarta

Service Semarang District Health 2005, Report of Pulmonary Tuberculosis

Control program 2001-2005, Semarang.

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA
Service District Health Semarang, 2006, Report of pulmonary tuberculosis
prevention program in 2005, Semarang.

Gerdunas-TB, 2002, tuberklosis prevention program, module-1 national

tuberklosis response training, Jakarta.

Ghoto, R, G ,, 1993, Rev mother's milk is best, Taken on July 4, 2006, Available:
http://www.ncbi.nlm.gov/entrez/query.fcgi,

Ghufron, A., 1994, Smoking and alcohol consumtion as risk factors for
developing pulmonary tuberculosis, Taken on April 21, 2007, Available:
http://www.sciencedirect.com,

Hidayat, Alimul.Aziz.A., 2003, nursing research and scientific writing techniques,

Salemba Medika, Jakarta.

Huebner, RE, 1993, The tuberculin skin test, Clinical Infectious Diseases, &: 968-
975.

Naidoo, E., 2003, Aspects of nutrition and immunity in patients with tuberculosis,
medical Nutrition Indonesia, 2 (6): 8-10.

Lanasari, R., 1990, immunization programs and problems in Indonesia, the World
Mirror of Medicine, 65: 3-4.

Machfoedz, Ircham, MS 2005, Technics made the measuring instrument field of

health research nursing and midwifery, Fitramaya, Yogyakarta.

Moedjiono, AW, 2007, countermeasures tuberklosis, Compass No. 259.23

2007.hal March 42, Jakarta.

Nursalam, 2003, Concepts and Implementation Methodology of Nursing

Research: Guidelines for Theses and Nursing Research Instruments, Issue
1, Salemba Medika, Jakarta.

Pittard, WB, 1998, the classification of low birth weight babies, Indonesian edition
(4): 100-129, EGC, Jakarta.

Riwidikdo, H, S. Kp, 2006 Health Statistics: Learning Easy Data Analysis

Techniques in Health Research, PARTNERS CENDEKIA Press, Yogyakarta.
th
Roitt, IM, 1997, Essential Immunology, 9 ed, Blackwell Science, London.

Roth, A., 2004, Low birth wight and bacillus Calmette-Guerin vaccination at birth,
taken on date 2 April 2007, Available:
http://www.ncbi.nlm.gov/entrez/query.fcgi,

http://www.skripsistikes.wordpress.com
JOURNAL OF HEALTH SOLAR MEDIKA YOGYAKARTA
Santoso, GM, 1994, Pulmonary tuberculosis, diagnostic guidelines and
terapi.Laboratorium / SMF child health sciences, general hospital Dr. Soetomo,
Surabaya.

Top, A., 2003, Tuberculosis, Taken on July 4, 2004, Available:

http: //www.infeksi,com/penyakit,

Wahab, A.Samik ,, 2002, Immune System Immunization and immune diseases,

First edition, Widya Medika, Jakarta.

WHO, 1993, Breastfeeding in maternal and newborn health, Taken on April 21,
2007, Available: http://www.who.int/reproductive-health/bublication,

WHO, 1994, TB-A global emergency, the WHO report on the tuberculosis
epidemic, (WHO / TB / 94 177), Geneva.

WHO, 2002, Nutrient adequacy of exclusivebreastfeeding for the term infant

during the fist six months of life, Taken on April 21, 2007, Available:
http://www.int/child-adolescent-health,

WHO 2003 global tuberculosis control: Country profile Indonesia, Taken On

date 9 August 2006 Available:
http://www.who.int/gpt/publication/index.htm,

http://www.skripsistikes.wordpress.com