Empowering Families in Pediatric Tuberculosis Treatment: Enhancing Adherence through Education and Support

Authors

  • Ismar Agustin Poltekkes Kemenkes Palembang
  • Azwaldi Poltekkes Kemenkes Palembang
  • Inka Noviani Poltekkes Kemenkes Palembang
  • Leha Febriani Poltekkes Kemenkes Palembang
  • Novia Wulansari Poltekkes Kemenkes Palembang

DOI:

https://doi.org/10.56988/chiprof.v4i1.92

Keywords:

Family Empowerment, Healthcare Intervention, Pediatric Tuberculosis, Support, Treatment

Abstract

This research evaluates the effectiveness of a family empowerment program in improving medication adherence among children undergoing treatment for pulmonary tuberculosis (TB) in Desa Pangkalan Benteng, Indonesia. The study integrates qualitative and quantitative methods to assess the impact of a training program to increase family knowledge about TB and its treatment regimen. The results demonstrate a significant improvement in family knowledge and children's adherence to their treatment schedule after receiving education on medication management, side effect handling, and emotional support. The findings emphasize the critical role of family involvement in ensuring that children complete their treatment regimens and suggest that comprehensive family education programs can enhance treatment outcomes. The study highlights the potential of family-centered interventions in pediatric TB care and provides recommendations for expanding such programs to other chronic diseases.

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References

V. Boradia, A. Frando, and C. Grundner, “The Mycobacterium tuberculosis PE15/PPE20 complex transports calcium across the outer membrane,” PLoS Biol., vol. 20, no. 11, pp. 1–17, 2022, doi: 10.1371/journal.pbio.3001906.

R. M. Ghazy et al., “A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients,” Sci. Rep., vol. 12, no. 1, pp. 1–16, 2022, doi: 10.1038/s41598-021-04345-x.

M. P. Rupani, S. Vyas, and I. A. Shah, “Cohort study on association between catastrophic costs and unfavorable tuberculosis treatment outcomes among TB-HIV and TB-diabetes comorbid patients in India,” BMC Public Health, vol. 24, no. 1, 2024, doi: 10.1186/s12889-024-19609-0.

S. Guo et al., “Association between Mycobacterium tuberculosis genotype and diabetes mellitus/hypertension: a molecular study,” BMC Infect. Dis., vol. 22, no. 1, pp. 1–17, 2022, doi: 10.1186/s12879-022-07344-z.

H. S. B. de Lima et al., “Access of people with pulmonary tuberculosis to government programs: Primary Care professionals’ perceptions,” Rev. Bras. Enferm., vol. 76, no. Suppl 2, pp. 1–9, 2023, doi: 10.1590/0034-7167-2022-0716.

C. Zahroh, N. Ainiyah, U. Sholeha, I. K. Sudiana, and A. Yusuf, “a Simple Model for Describing Non-Adherence To Medication in Tuberculosis Patients in a Tropical Area, Indonesia,” J. Keperawatan Soedirman, vol. 18, no. 1, pp. 18–22, 2023, doi: 10.20884/1.jks.2023.18.1.6593.

D. Watumo, M. M. Mengesha, T. Gobena, M. A. Gebremichael, and D. Jerene, “Predictors of loss to follow-up among adult tuberculosis patients in Southern Ethiopia: a retrospective follow-up study,” BMC Public Health, vol. 22, no. 1, pp. 1–12, 2022, doi: 10.1186/s12889-022-13390-8.

M. B. Brooks et al., “Tuberculosis treatment loss to follow-up in children exposed at home: A prospective cohort study,” J. Glob. Health, vol. 14, 2024, doi: 10.7189/JOGH.14.04194.

S. Adhanty and S. Syarif, “Kepatuhan Pengobatan pada Pasien Tuberkulosis dan Faktor-Faktor yang Mempengaruhinya: Tinjauan Sistematis,” J. Epidemiol. Kesehat. Indones., vol. 7, no. 1, p. 7, 2023, doi: 10.7454/epidkes.v7i1.6571.

L. D. Fitri, “Kepatuhan Minum Obat pada Pasien Tuberkulosis Paru,” J. Ilmu Kesehat. Masy., vol. 7, no. 01, pp. 33–42, 2018, doi: 10.33221/jikm.v7i01.50.

M. Sandoval et al., “Community-based tuberculosis contact management: Caregiver experience and factors promoting adherence to preventive therapy,” PLOS Glob. Public Heal., vol. 3, no. 7, pp. 1–14, 2023, doi: 10.1371/journal.pgph.0001920.

Mardiati, A. Millizia, N. Zara, K. Atika, and N. Zakiyya, “Family-Centered Approaches to Pediatric Tuberculosis and Nutritional Challenges in North Aceh: A Qualitative Study,” Natl. J. Community Med., vol. 16, no. 2, pp. 147–155, 2025, doi: 10.55489/njcm.160220254804.

O. M. Mihailov, A. Ciubară, V. Luțenco, G. Țocu, L. Stavăr Matei, and R. Mihailov, “Clinical Strategies for Identifying Pediatric Patients with Tuberculosis at Risk of Developing Depressive Disorders.,” Clin. Pract., vol. 14, no. 6, pp. 2385–2409, 2024, doi: 10.3390/clinpract14060187.

X. Peng et al., “Epidemiological Characteristics and Disease Burden of Tuberculous Meningitis in Hospitalized Children in China: A Nationwide Retrospective Study,” J. Epidemiol. Glob. Health, vol. 15, no. 1, 2025, doi: 10.1007/s44197-025-00358-1.

S. S. Saidi and R. Abdul Manaf, “Effectiveness of family support health education intervention to improve health-related quality of life among pulmonary tuberculosis patients in Melaka, Malaysia,” BMC Pulm. Med., vol. 23, no. 1, pp. 1–9, 2023, doi: 10.1186/s12890-023-02440-5.

Y. Choi, S. Ibrahim, L. P. Park, C. R. Cohen, E. A. Bukusi, and M. J. Huchko, “Uptake and correlates of cervical cancer screening among women attending a community-based multi-disease health campaign in Kenya,” BMC Womens. Health, vol. 22, no. 1, pp. 1–12, 2022, doi: 10.1186/s12905-022-01702-4.

S. Kasuya, A. Imai, K. Uchimura, A. Ohkado, and L. Kawatsu, “Epidemiology of latent tuberculosis infection in Japan-born and foreign-born children in Japan,” West. Pacific Surveill. Response J., vol. 14, no. 4, pp. 1–7, 2023, doi: 10.5365/wpsar.2023.14.4.1008.

B. S. Tsabedze and D. S. K. Habedi, “Caregivers’ experiences and practices for malnourished children undergoing tuberculosis treatment in Eswatini,” Heal. SA Gesondheid, vol. 29, pp. 1–8, 2024, doi: 10.4102/hsag.v29i0.2349.

K. J. Sebothoma, M. D. Peu, M. M. Moagi, and N. Mshunqane, “Experiences of families living with tuberculosis patients in the North West province, South Africa,” Heal. SA Gesondheid, vol. 29, pp. 1–8, 2024, doi: 10.4102/hsag.v29i0.2530.

P. Martha et al., “Transforming Nursing Practice to Optimize Care of Patients with Tuberculosis and Associated Comorbidities in the Kilimanjaro Region , Tanzania,” pp. 1–10, 2025, doi: 10.2174/0118744346356368241218080300.

M. Biru et al., “Designing tuberculosis elimination framework through participatory processes in Ethiopia: Results from stakeholders’ discussions,” PLoS One, vol. 20, no. 3 March, pp. 1–16, 2025, doi: 10.1371/journal.pone.0318209.

C. Heunis and G. Kigozi-Male, “Exploring Managers’ Insights on Integrating Mental Health into Tuberculosis and HIV Care in the Free State Province, South Africa,” Int. J. Environ. Res. Public Health, vol. 21, no. 11, 2024, doi: 10.3390/ijerph21111528.

D. E. Anggraeni and S. R. Rahayu, “Gejala klinis tuberkulosis pada keluarga penderita tuberkulosis BTA positif,” Higeia J. Public Heal. Res. Dev., vol. 2, no. 1, pp. 91–101, 2019.

J. Pfeil et al., “Updated recommendations on the treatment of infectious diseases in refugees in childhood and adolescence in Germany (situation as of 30 March 2022), registered as S1 guidelines (AWMF-Register Nr. 048-017): Statement of the German Society for Pediatric Infectious diseases (DGPI), the German Society for Tropical Paediatrics & International Child Health (GTP), the Professional Association for Pediatric and Adolescent Physicians (BVKJ) and the German Society of Pediatrics and Adolescent Medicine (DGKJ) with participation of the Federal Association of Physicians of German Public Health Departments (BVÖGD), the German Society of Pediatric Surgery (DGKCH), the German Society for Gynecology and Obstetrics (DGGG), German Society of General and Family Medicine (DEGAM), the Alliance Pediatric and Adolescent Health (formerly the German Academy for Pediatric and Adolescent Medicine, DAKJ), the German Society for Tropical and Travel Medicine and Global Health (DTG), the German Society for Global and Tropical Surgery (DTC) and the Swiss Pediatric Infectiology Group (PIGS),” Monatsschr. Kinderheilkd., vol. 170, no. 7, pp. 632–647, 2022, doi: 10.1007/s00112-022-01499-4.

A. Amoah, J. Issaka, C. Ayebeng, and J. Okyere, “Influence of women empowerment on childhood (12–23 months) immunization coverage: Recent evidence from 17 sub-Saharan African countries,” Trop. Med. Health, vol. 51, no. 1, 2023, doi: 10.1186/s41182-023-00556-2.

R. Seth, T. G. Girotra, I. Mohammad, Y. Qaiyum, I. Taneja, and S. Raman, “Mobile health van as an intervention to provide clinical support and health promotion to street children and marginalised populations in the National Capital Region of Delhi: a mixed-methods evaluation,” BMJ Paediatr. Open, vol. 9, no. 1, 2025, doi: 10.1136/bmjpo-2024-002988.

H. Takahashi et al., “BCG vaccinations drive epigenetic changes to the human T cell receptor: Restored expression in type 1 diabetes,” Sci. Adv., vol. 8, no. 46, 2022, doi: 10.1126/sciadv.abq7240.

R. L. de Medeiros et al., “Analysis of catastrophic costs incurred by patients with multidrug-resistant tuberculosis in an outpatient clinic in the state of Rio de Janeiro,” Rev. Soc. Bras. Med. Trop., vol. 56, no. October, pp. 1–9, 2023, doi: 10.1590/0037-8682-0148-2023.

T. Y. Akalu, A. C. A. Clements, H. F. Wolde, and K. A. Alene, “Economic burden of multidrug-resistant tuberculosis on patients and households: a global systematic review and meta-analysis,” Sci. Rep., vol. 13, no. 1, pp. 1–11, 2023, doi: 10.1038/s41598-023-47094-9.

H. M. Tesfahun et al., “Management of rifampicin-resistant tuberculosis in conflict-affected areas: The case of Iraq,” PLoS One, vol. 19, no. 1 January, pp. 1–14, 2024, doi: 10.1371/journal.pone.0296952.

K. O. Adagba, A. A. Aliyu, C. L. Ejembi, A. A. Olorukooba, and I. A. Joshua, “Comparative Study of Patients’ Adherence between Hospital-based and Community based Treatment for Multidrug Resistant Tuberculosis (MDR-TB) in Kaduna State,” J. Community Med. Prim. Heal. Care, vol. 35, no. 1, pp. 112–124, 2023, doi: 10.4314/jcmphc.v35i1.10.

L. C. Anye, M. E. Agbortabot Bissong, A. L. Njundah, and J. N. Siewe Fodjo, “Depression, anxiety and medication adherence among tuberculosis patients attending treatment centres in Fako Division, Cameroon: cross-sectional study,” BJPsych Open, vol. 9, no. 3, pp. 1–9, 2023, doi: 10.1192/bjo.2023.42.

G. I. Benoit Vásquez, A. L. Morrobel, D. Benjumea-Bedoya, and H. del Corral-Londoño, “Barriers and facilitators for isoniazid preventive therapy (IPT) administration in children under 5 years of age in the Dominican Republic,” BMC Infect. Dis., vol. 22, no. 1, pp. 1–12, 2022, doi: 10.1186/s12879-022-07333-2.

M. D. Ionescu et al., “The Challenging Diagnosis of Interstitial Lung Disease in Children—One Case Report and Literature Review,” J. Clin. Med., vol. 11, no. 22, 2022, doi: 10.3390/jcm11226736.

R. Permana, “Exploration of Concordance Behavior between Tuberculosis Patients , Families , and Healthcare Workers in Supporting Treatment Adherence : A,” pp. 1–9, 2025, doi: 10.2174/0118749445365074250103103825.

I. I. Kallon and C. J. Colvin, “A qualitative exploration of continuity of TB care in clinics after discharge from hospitals in Cape Town, South Africa,” BMC Health Serv. Res., vol. 22, no. 1, pp. 1–14, 2022, doi: 10.1186/s12913-022-08880-9.

R. Washington et al., “A mixed methods evaluation of a differentiated care model piloted for TB care in south India,” J. Public health Res., vol. 12, no. 3, 2023, doi: 10.1177/22799036231197176.

C. Della Bella et al., “Performance evaluation of the LIOFeron®TB/LTBI IGRA for screening of paediatric LTBI and tuberculosis,” Eur. J. Pediatr., vol. 184, no. 2, p. 147, 2025, doi: 10.1007/s00431-025-05972-6.

C. E. Navarro, D. Benjumea-Bedoya, A. F. Estupinan-Bohorquez, and I. D. Florez, “Cost-effectiveness analysis comparing QuantiFERON test and tuberculin skin test for the diagnosis of latent tuberculosis infection in immunocompetent children under 15 years of age in Colombia,” BMJ Open, vol. 15, no. 3, p. e087333, 2025, doi: 10.1136/bmjopen-2024-087333.

P. Nhassengo et al., “‘They didn’t look at me with good eyes’–experiences of the socioeconomic impact of tuberculosis and support needs among adults in a semi-rural area in Mozambique: A Qualitative Study,” Glob. Public Health, vol. 19, no. 1, pp. 1–11, 2024, doi: 10.1080/17441692.2024.2311682.

V. Watch, G. Anga, C. Kilalang, F. Pulsan, J. D. Vince, and T. Duke, “Children with palliative care needs in Papua New Guinea, and perspectives from their parents and health care workers: a qualitative study,” BMC Palliat. Care, vol. 22, no. 1, pp. 1–8, 2023, doi: 10.1186/s12904-023-01177-6.

S. Singh et al., “Wealth-based inequalities in tuberculosis prevalence among households having children and young adults in India: insights from Indian demographic and health surveys (2015–2021),” BMC Infect. Dis., vol. 25, no. 1, 2025, doi: 10.1186/s12879-024-10301-7.

S. Suprijandani, S. Setiawan, P. Pathurrahman, S. Wardoyo, and A. M. Rahayyu, “The behaviour of TB patients in East Lombok through a health belief model approach,” J. Health. Popul. Nutr., vol. 44, no. 1, p. 23, 2025, doi: 10.1186/s41043-025-00746-0.

Y. S. Kurniawan, K. T. A. Priyangga, P. A. Krisbiantoro, and A. C. Imawan, “Open access Open access,” J. Multidiciplinary Appl. Nat. Sci., vol. 1, no. 1, pp. 1–12, 2021.

D. T. Wademan et al., “Psychosocial experiences of adolescents with tuberculosis in Cape Town,” PLOS Glob. Public Heal., vol. 4, no. 9 September, pp. 1–15, 2024, doi: 10.1371/journal.pgph.0003539.

I. Smith et al., “What matters most? A qualitative study exploring priorities for supportive interventions for people with tuberculosis in urban Viet Nam,” BMJ Open, vol. 13, no. 8, pp. 1–11, 2023, doi: 10.1136/bmjopen-2023-076076.

N. Mphothulo, S. Hlangu, J. Furin, M. Moshabela, and M. Loveday, “Navigating DR-TB Treatment care: a qualitative exploration of barriers and facilitators to retention in care among people with history of early disengagement from drug-resistant tuberculosis treatment in Johannesburg, South Africa,” BMC Health Serv. Res., vol. 25, no. 1, p. 122, 2025, doi: 10.1186/s12913-025-12265-z.

M. C. S. da Motta et al., “People with pulmonary tuberculosis in primary health care: social networks and repercussions of illness,” Rev. Gauch. Enferm., vol. 45, p. e20230302, 2024, doi: 10.1590/1983-1447.2024.20230302.en.

S. Molldrem et al., “Botswana tuberculosis (TB) stakeholders broadly support scaling up next-generation whole genome sequencing: Ethical and practical considerations for Botswana and global health,” PLOS Glob. Public Heal., vol. 3, no. 11, pp. 1–22, 2023, doi: 10.1371/journal.pgph.0002479.

S. S. Chiang et al., “Identifying adolescents at risk for suboptimal adherence to tuberculosis treatment: A prospective cohort study,” PLOS Glob. Public Heal., vol. 4, no. 2, pp. 1–16, 2024, doi: 10.1371/journal.pgph.0002918.

R. Zhang et al., “Factors predicting self-report adherence (SRA) behaviours among DS-TB patients under the ‘Integrated model’: a survey in Southwest China,” BMC Infect. Dis., vol. 22, no. 1, pp. 1–11, 2022, doi: 10.1186/s12879-022-07208-6.

L. J. Gutiérrez-Téllez, F. K. Llanos-Tejada, and K. G. Vargas-Ponce, “Family social climate and adherence to the treatment of patients with pulmonary tuberculosis in a reference hospital in Lima-Perú,” Neurol. Neurocir. y Psiquiatr., vol. 51, no. 1, pp. 13–18, 2023, doi: 10.35366/111040.

K. Petros de Guex et al., “Roadblocks and resilience: A qualitative study of the impact of pediatric tuberculosis on Tanzanian households and solutions from caregivers,” Glob. Public Health, vol. 18, no. 1, 2023, doi: 10.1080/17441692.2023.2196569.

Q. Nazhofah and Ella Nurlaella Hadi, “Dukungan Keluarga terhadap Kepatuhan Pengobatan pada Pasien Tuberculosis : Literature Review,” Media Publ. Promosi Kesehat. Indones., vol. 5, no. 6, pp. 628–632, 2022, doi: 10.56338/mppki.v5i6.2338.

C. Zahroh, N. N. Setiadi, N. Ainiyah, E. Setiyowati, E. Kusuma, and Mulyadi, “the Convention of Regular Treatment With Sphetic Conversion During Intensive Tuberculosis Treatment,” Rev. Gest. Soc. e Ambient., vol. 18, no. 5, pp. 1–13, 2024, doi: 10.24857/rgsa.v18n5-080.

I. Nadatien, A. Muhith, and M. Ibad, “and recovery motivation in pulmonary Tuberculosis patients m er us e m er on al,” vol. 12, pp. 3–6, 2024, doi: 10.4081/hls.2024.

M. Das et al., “Challenging drug-resistant TB treatment journey for children, adolescents and their care-givers: A qualitative study,” PLoS One, vol. 16, no. 3 March, pp. 1–15, 2021, doi: 10.1371/journal.pone.0248408.

P. M. Amuge et al., “Correction: Facilitators and barriers to initiating and completing tuberculosis preventive treatment among children and adolescents living with HIV in Uganda: a qualitative study of adolescents, caretakers and health workers (AIDS Research and Therapy, (2024), 21, 1, (59), 10.1186/s12981-024-00643-2),” AIDS Res. Ther., vol. 21, no. 1, 2024, doi: 10.1186/s12981-024-00651-2.

Z. Dememew et al., “A High Burden of Infectious Tuberculosis Cases Among Older Children and Young Adolescents of the Female Gender in Ethiopia,” Trop. Med. Infect. Dis., vol. 10, no. 3, pp. 1–11, 2025, doi: 10.3390/tropicalmed10030079.

G. Sakhare, Y. Chitte, R. Munje, S. Joshi, and M. Bhakare, “Using spirometry for screening and diagnosis of chronic respiratory diseases in primary health care: findings from a community health project in rural India,” J. Glob. Heal. Reports, vol. 8, pp. 1–10, 2024, doi: 10.29392/001c.116246.

O. Al-Jourani et al., “Identification of d-arabinan-degrading enzymes in mycobacteria,” Nat. Commun., vol. 14, no. 1, 2023, doi: 10.1038/s41467-023-37839-5.

D. P. Baloyi et al., “Navigating complex care pathways–healthcare workers’ perspectives on health system barriers for children with tuberculous meningitis in Cape Town, South Africa,” PLOS Glob. Public Heal., vol. 4, no. 8, pp. 1–13, 2024, doi: 10.1371/journal.pgph.0003518.

J. P. Pais et al., “Synthesis, Activity, Toxicity, and In Silico Studies of New Antimycobacterial N-Alkyl Nitrobenzamides,” Pharmaceuticals, vol. 17, no. 5, pp. 1–19, 2024, doi: 10.3390/ph17050608.

P. Waterous et al., “Person-centered and youth-oriented interventions to improve TB Care for adolescents and young adults,” PLOS Glob. Public Heal., vol. 4, no. 11, pp. 1–17, 2024, doi: 10.1371/journal.pgph.0003659.

H. C. Karamagi et al., “Mapping health service coverage inequalities in Africa: A scoping review protocol,” BMJ Open, vol. 13, no. 5, 2023, doi: 10.1136/bmjopen-2022-068903.

Z. Yerlikaya, R. Miranda-CasoLuengo, Y. Yin, C. Cheng, and W. G. Meijer, “Clade-1 Vap virulence proteins of Rhodococcus equi are associated with the cell surface and support intracellular growth in macrophages,” PLoS One, vol. 20, no. 1 January, pp. 1–15, 2025, doi: 10.1371/journal.pone.0316541.

M. A. Appiah et al., “Barriers to tuberculosis treatment adherence in high-burden tuberculosis settings in Ashanti region, Ghana: a qualitative study from patient’s perspective,” BMC Public Health, vol. 23, no. 1, pp. 1–12, 2023, doi: 10.1186/s12889-023-16259-6.

Y. S. Handajani, E. Schröder-Butterfill, E. Hogervorst, Y. Turana, and A. Hengky, “Functional Dependency and Its Associated Factors among Older Adults in Indonesia,” Aging Med. Healthc., vol. 14, no. 3, pp. 146–155, 2023, doi: 10.33879/AMH.143.2022.05051.

M. Tareke, A. B. Bayeh, M. Birhanu, and A. Belete, “Psychological distress among people living with chronic medical illness and the general population, Northwest Ethiopia: A comparative cross-sectional study,” PLoS One, vol. 17, no. 12 December, pp. 1–13, 2022, doi: 10.1371/journal.pone.0278235.

L. Vanleeuw, S. Atkins, N. Gwiji, N. Sicwebu, and W. Zembe-Mkabile, “Beyond the illness: a qualitative exploration of the burden of caring for people with tuberculosis on caregivers and their households in South Africa,” Glob. Public Health, vol. 19, no. 1, p. 2413654, 2024, doi: 10.1080/17441692.2024.2413654.

N. K. Fauk, G. A. Asa, C. McLean, and P. R. Ward, “‘I Was Very Shocked, I Wanted It to Be Over’: A Qualitative Exploration of Suicidal Ideation and Attempts among Women Living with HIV in Indonesia,” Int. J. Environ. Res. Public Health, vol. 21, no. 1, 2024, doi: 10.3390/ijerph21010009.

P. Wang, Y. Cai, G. Zhang, L. Jiang, and Y. Li, “Establishment of an indirect ELISA for Mycobacterium tuberculosis MTB39A protein antibody,” Appl. Microbiol. Biotechnol., vol. 107, no. 20, pp. 6339–6349, 2023, doi: 10.1007/s00253-023-12715-w.

W. Rakhmawati and K. Piasai, “Is tuberculosis in children a severe disease?,” J. Keperawatan Padjadjaran, vol. 11, no. 1, pp. 1–3, 2023, doi: 10.24198/jkp.v11i1.2282.

J. O. Iruedo and M. K. Pather, “Lived experiences of patients and families with decentralised drug-resistant tuberculosis care in the Eastern Cape, South Africa,” African J. Prim. Heal. Care Fam. Med., vol. 15, no. 1, pp. 1–16, 2023, doi: 10.4102/PHCFM.V15I1.4255.

Y. Liu, Y. Zhu, W. Liu, C. Wan, and Q. Guo, “Death from human cytomegalovirus infection in a girl with congenital thymic dysplasia,” Virol. J., vol. 19, no. 1, pp. 1–8, 2022, doi: 10.1186/s12985-022-01915-x.

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Published

2025-02-20

How to Cite

Agustin, I., Azwaldi, Noviani, I., Febriani, L., & Wulansari, N. (2025). Empowering Families in Pediatric Tuberculosis Treatment: Enhancing Adherence through Education and Support. International Journal Scientific and Professional, 4(1), 291–298. https://doi.org/10.56988/chiprof.v4i1.92