Optimizing Pesantren Management for Tuberculosis Prevention through BREATHE Program

Abstract

Tuberculosis (TB) remains a significant public health problem in Indonesia, particularly in Islamic boarding schools (pesantren), where overcrowding, prolonged close contact, and limited institutional health governance increase transmission risks. This study aims to optimize pesantren management in TB prevention through the development of the BREATHE program (Building Resilient Environments Against Tuberculosis Hazards in Education). A mixed-methods embedded design was applied, with quantitative data collected from a cross-sectional survey of 223 students in two pesantren in Banyumas Regency to measure knowledge, attitudes, and preventive behaviors, complemented by environmental observations. Qualitative data were obtained through in-depth interviews and focus group discussions with key stakeholders, analyzed thematically using Open Code software and triangulation. Results showed that most students had low knowledge (54.3%), balanced attitudes (positive: 50.7%; negative: 49.3%), and relatively good preventive behaviors (56.5%). Environmental assessments revealed overcrowding, poor ventilation, and high humidity. Qualitative findings highlighted the absence of TB-specific Standard Operating Procedures (SOPs), limited health management capacity, stigma, and financial constraints as major barriers. Based on these insights, the BREATHE program prototype was developed, integrating governance strengthening, human resource capacity building, environmental risk control, and health service integration. This model provides a replicable framework for TB prevention in high-risk residential educational settings and contributes to global discourse on institutional health governance in Islamic education.