FACTORS THAT INFLUENCE MEASLES IMMUNIZATION IN MRICAN

HEALTH CENTRE AT MOJOROTO DISTRICT, KEDIRI

Tita Wisata, Rofwiun, Mariyah Giptiyah, Tira Anna Kasih, Nasrul Nasehati, Ulil
Amri Pramadani, Mochamad Bilal

ABSTRACT

Background: Immunization development program is one of the priority issues in

national health that an effort to reduce the morbidity and mortality on children.
East Java is one of province the number of incomplete children immunization that
has reach 21% and children did not get immunization has reach 2.08 %.
Objective: Knowing factors mother age, tradition, education, knowledge, income,
work, attitude, siblings, family support, and health facilities has affect to the
completeness of measles immunization in Mrican at Mojoroto district, Kediri,
Methods of the Research: Analytic observation with cross sectional design. An
analysis of data using Chi-Square test and logistic regression. Result and
Discussion: There is influence between tradition (p = 0.020, OR = 4,428, CI =
95%), attitude (p = 0.00, OR = 5,616, CI = 95%), and maternal education (p =
0.000, OR = 0,236, CI = 95 %) on measles immunization with R value 0,234 in
the amount of 23,4%. Conclusion: There is influence of mother tradition factor,
attitude, and education toward measles immunization equipment at Mrican Health
Center Kecamatan Mojoroto Kediri in the amount of 23,4%
Keyword : Immunization, measles
introduction
Immunization development
program is one of the priority
activities in national health. The
program aims to protect infants and
toddlers from PD3I (immunized
preventable diseases) such as
tuberculosis, diphtheria, pertussis,
tetanus and measles. According to
estimates by the World Health
Organization (WHO), more than 12
million children are less than 5 years
old who die every year in the world,
about 2 million are caused by
immunized preventable diseases
(Nuraini VA, 2013).
Some reasons infants do not
get complete immunization is due to
reasons of information, motivation
and situation. The reason for the
information is the lack of mother's
knowledge about the need,
completeness and schedule of
immunization, the fear of
immunization and the wrong
perception circulating in society
about immunization. (Basuki et all,
2016).
Measles disease is the leading
cause of child mortality among
diseases that can be prevented by
immunization (PD3I). Measles is
very potential to cause an outbreak,
before measles immunization is
widely used in the world almost
every child can be infected with
measles (Ningtyas and Wibowo,
2014).
Kediri city is one of the cities
in East Java that has a complete basic
immunization presentation with an
average above 90% (93.36%). At the
Pakican village health center
achievement of measles
immunization in 2015/2016, measles
immunization reaches 207 out of 293
newborns (70.64%) and by
2016/2017 the rate of immunization
against measles reaches 170 out of
256 newborns, this figure has not
exceeded the target target of IDL
(complete basic immunization) by
2015 ( 91%) and 2016 (91.5%)
(Mrican Village Immunization
Report, 2015 and 2016).
Based on the description
above illustrated that the measles
immunization in the village health
center Mrican still not meet IDl
target, where in 2015 and 2016
measles immunization has not
reached IDL Indonesia target in that
year. So the researcher is interested
to know what factors influence the
coverage of measles immunization in
puskesmas Mrican Kecamatan
Mojoroto Kediri.
METHOD
Methods of data collection in
this study through observation with
primary data retrieval using
questionnaires that have been
prepared. The researcher distributed
the questionnaire directly to the
respondent then gave explanation
and purpose of the research and
informed the respondent that the
participation in this research was
voluntary and kept confidential.
RESULTS
The data obtained is the
primary data taken through
questionnaire interview.
Table 5.1 Frequency
Distribution Based on Measles
Immunization Coverage
 Individual Measles immunization Based on table 5.3 shows that
characteristi the number of respondents aged 35
c amoun percentage (%) years who are not affected by
t
measles is 166 people, measles 77
Not measles 114 52,3 people and> 35 years who are not
affected by measles by 25 people and
Measles 104 47,7 those measles 27 people.
Total 218 100.0 Table 5.4 Frequency Distributions by
Mom's Work
Based on table 5.1 shows that Individual Mothers job
the number of respondents of characteristi
mothers with children who have c Amount Percentage (%)
measles immunization is 114 people
(52.3%) and mothers with children Not working 84 38,5
who do not immunize measles is 104
Working 134 61,5
people (47.7%).
Total 218 100.0
Table 5.2 Frequency Distribution
by Age
Individual Age Based on table 5.4 shows that the
characteristic number of respondents unemployed
amount percentage(%) equal to 84 people (38,5%) and
35 166 76,1 employed mother equal to 135
person (38,5%).
>35 52 23,9
Table 5.5 Crosstab Working Mother
Total 218 100.0 With Measles
Individual Campak
Total
Based on table 5.2 shows that Incomplete Complete
the number of respondents aged 35
years of 166 people (76.1%) and> 35 mothers Not 50 34 84
years of 52 people (23.9%). working
job
Working 64 70 134
Table 5.3 Crosstab Age of
Mother With Measles Total 114 104 218

Individual measles
characteristi Total Based on table 5.5, it shows that
c compl the number of respondents did not
incomplete
ete
work that their children were not
35years 89 77 166 exposed to measles by 50 people,
Mothe and those who were affected by
rs age >35 years 25 27 52 measles were 34 people and working
respondents whose children were not
Total 114 104 218
affected by measles by 64 people and
those with measles 70 people.
 Table 5.6 Frequency Distribution Table 5.8 Frequency Distribution
Based on Availability of Health by Number of siblings
Facilities
Individual Health facility Individual Number of siblings
characteristic characteristi
amount Percentage(%) c amount Percentage(%)

Not 11 5,0 Much 3 1,4

available
less 215 98,6
Available 207 95
Total 218 100.0
Total 218 100.0

Based on table 5.8 shows that

Based on table 5.6 shows that the number of respondents who have
the number of respondents who do children with a large number of
not have health facilities is 11 people siblings of 3 people (1.4%) and the
(5.0%) and who have health facilities number of children who have few
amounted to 207 people (95.0%). siblings of 215 people (98.5%).
Table 5.7 Crosstab Health
Table 5.9 Crosstab Number of
Facilities With Measles.
Siblings With Measles
Individual Measles Individual Measles
characteristi Tota
incomplet complet l charac- Total
c
e e incomplete complete
teristic
Health Not 9 2 11
Num- Many 1 2 3
available
facilit
ber less 113 102 205
y available 105 102 207
of
Total 114 104 218
siblings
Based on table 5.7 shows that Total 114 104 218
the number of respondents who do
not have health facilities whose
children are not affected by measles Based on table 5.9 shows that
by 9 people, and who are affected the number of respondents with
measles 2 people and who have many siblings who are not affected
health facilities that are not exposed by measles is 1 person, and those
to measles of 105 people and those who have measles are 2, and those
affected by measles 102 people. with less than 113 relatives who are
not affected measles and 102 people
with measles.

Table 5.10 Frequency

Distribution by Tradition
 Individual attitude
Individual Tradition characteristi
characteristic c amount Percentage(%)
amount Percentage(%)
not 37 17
Not 20 9,2 appropriate
accustomed
to Appropriate 181 83,0

Accustomed 198 90,8 Total 218 100.0

to

Total 218 100.0 Based on table 5.12 shows that

the number of respondents who have
inappropriate attitude of 37 people
Based on table 5.10 shows that (17.0%) and has the appropriate
the number of respondents who are attitude of 181 people (83.0%).
not accustomed to immunization of
20 people (9.2%) and who used Table 5.13 Crosstab Mother's
immunization for 198 people Attitudes With Measles
(90.8%).
Individual Measles Total
Table 5.11 Crosstab Tradition of characteristic
Mother With Measles incomplete complete

Not 28 9 37
Individual Measles
Total appropriate
Attitude
characteristic Incomplete complete
appropriate 86 95 181
Not 16 4 20
Total 114 104 218
accustomed
Tradition to

Accustomed 98 100 198 Based on table 5.13 shows that the

to
Total 114 104
Based on table 5.11 shows that
the number of respondents who are
unaccustomed to measles that are not
affected by measles are 16 people,
and those with measles are 4 people,
and those who are accustomed to
measles that are not affected by
measles are 98 people and those with
measles are 100 people.
Table 5.12 Frequency Distribution
Based on Attitude
number of respondents with
inappropriate attitude that is not
218 affected by measles are 28 people,
and those who are affected by
measles are 9 people, and
respondents with appropriate attitude
that is not affected by measles is 86
people and those with measles are 95
people.
Table 5.14 Frequency Distribution by
Mothers Education
 Individual Mothers education High 208 95,4
characteristic
amount Percentage(%) Total 218 100.0

Low 55 25,2
Based on table 5.16 shows that
High 163 74,8 the number of respondents who are low
knowledge as many as 10 people (4.6%)
Total 218 100.0 and high knowledge as many as 208
people (95.4%).
Based on table 5.14 shows that Table 5.17 Crosstab mothers
the number of respondents who have Knowledge With Measles
low education amounted to 55 people
(25.2%) and highly educated 163
people (74.8%). Individual
Measles Total
characteristic
Table 5.15 Crosstab mothers
incomplete Complete
Education With Measles
Mothers Low 4 6 10
Individual Measles
characteristic Total knowledge High 110 98 208
incomplete complete
Total 114 104 218
Mothers Low 17 38 55
education Based on table 5.17 shows that the
high 97 66 163 number of respondents of mothers with
low knowledge who are not affected by
Total 114 104 218
measles as many as 4 people, and those
affected by measles as many as 6 people,
and mothers with high knowledge that is
Based on table 5.15 shows that the not affected by measles as many as 110
number of respondents of mothers people and those with measles counted
with low education who were not 98 people.
affected by measles were 17 people,
and those who were exposed to Table 5.18 Frequency Distribution by
measles were 38 people, maternal income
respondents with higher education
Individual income
who were not affected by measles characteristi
were 97 people and those with c amount Percentage (%)
measles were 66.
Low 24 11,0
Table 5.16 Frequency
Distribution Based on Mother's high 194 89
Knowledge Total 218 100.0
Individual Mothers knowledge
character Based on table 5.18 shows
amount Percentage (%) that the number of respondents who
have low income as many as 24
Low 10 4,6 people (11.0%) and who have high
 income as much as 194 people (IK95%)
(89.0%).
Table 5.19 Crosstab Income
Tradition (1) 1,488 0,020 4,428
With Measles
attitude (1) 1,726 0,000 5,616
Individual Measles
characteristic Total
incomplete complete Mothers
-1,391 0,000 0,249
education(1)
Low 9 15 24
income Constants -3,722 0,001
high 105 89 194
Table 5.3 shows that there are 3
Total 114 104 218
variables that can influence measles
Based on table 5.19 shows that the immunization in children under five
number of respondents with low years old, namely tradition (p =
income who are not affected by 0.020), attitude (p = 0.000) and
measles as many as 9 people, and mothers education (p = 0.000).
those affected by measles as many as Based on the coefficient value of
15 people, and respondents with high each variable obtained logistic
income not affected by measles as regression equation as follows:
many as 1105 people and those y = constants + (1,488) (X1) +
affected by measles were 89 people. (1,726) (X2) + (-1,391) (X3)
Information:
Table 5.20 Results of Bivariate constants = -3,722
Analysis X1 = tradition(0= not
Sig. N used to immunization,
1 = accustomed to
Mothers age 0.590 218 immunization
Mothers work 0.120 218 X2 = attitude(0=not
Health facility 0.089 218 appropriate, 1=appropriate)
Number of siblings 0.607 218 X3 = mothers education
Tradition 0.018 218 (0=low, 1=high)
Attitude 0.003 218 The application of the
Mothers education 0.000 218 obtained equation is to predict the
Mothers knowledge 0.524 218 probability of a toddler to get
income 0.186 218 measles immunization using the
Based on table 5.20 shows formula:
that there is a relationship (p <0.05) p = 1/(1+e-y)
between attitudes, traditions and where :
maternal education against measles p = probability for the occurrence of
immunization, but not with maternal good nutritional status (normal) for
age, maternal employment, health toddlers
facilities, number of siblings, e = exponential
mother's knowledge and income. y =constants + a1x1 + a2x2 + a3x3
a = coefficient value of each variable
Table 5.21 Hasil Analisis Multivariat x = value of the independent variable
Variable coefficient P OR example:
A toddler with a tradition liar riate
accustomed to immunization,
appropriate attitude and high 7 Not 3,27%
mothers education, then: . fami approp
y =constants + (1,488) (x1) + (1,726) liar riate High
(x2) + (-1,391) (x3)
8 Not 11,96%
y = -3,722 + (1,488) (1) + (1,726) (1)
. fami approp
+ (-1,391) (1)
liar riate low
y = -1,899
thus, the probability is: From the table above it can
p = 1/1+exp[-(y)] be concluded that if the tradition of
p = 1/1+exp[-(-1,899)] immunization, attitudes and
p = 1/1+ 6,679212 education are low, then the chance of
a toddler to get measles
p = 1/7,679212 = 0,130222
immunization is 37.56% and very
So if the tradition used to immunize, inversely with if the tradition is not
appropriate attitude and high accustomed to immunization,
maternal education, a toddler has a inappropriate attitude and higher
probability (opportunity) 13% to get education so that only have a chance
measles immunization. to get measles immunization only
Another example: 0.59%.
Tabel 5.23 R square table
Table 5.22 Probability of Toddlers
Getting Measles Immunization Model Summary
tradi attitude Moth Measles
tion ers immuni S
-2 Log Cox &
educa zation t Nagelkerk
likeliho Snell R
tion e e R Square
od Square
p
1 Fami Appro 13,0%
. liar priate High 258,811
5 a
,175 ,234
2 Fami Appro 37,56%
. liar priate Low
The magnitude of the
3 Not 9,67% relationship strength of the
. Fami approp independent variables (tradition,
liar riate Low attitude and education of mothers)
that affect the dependent variable in
4 Not 2,59% this study can be seen through R
Fami approp square as much as 23.4% while the
liar riate High rest of 76.6% can be explained by
various other factors. This shows that
5 Not Not 2,36%
the independent variables (tradition,
fami approp
attitudes and education of the
liar riate Low
mother) have weak relationship
6 Not Not high 0,59% strength.
fami approp
DISCUSSION
The characteristic of tradition
toward measles immunization in this
study has a p-value of 0,018, which
means that there is a relationship
between tradition toward measles
immunization. This is in accordance
with the theory Rahmawati (2014)
Customs are included in ethnic
groups where ethnic groups include
homogeneous groups based on living
habits and biological or genetic
homogeneity. Ethnic groups are
based more on differences in
customs, living habits and possibly
social, economic and environmental
conditions, types of work and others.
The result of the analysis of the
influence of the tradition on the
completeness of immunization
obtained p value of 0.015 (p <)
which means there is a traditional
influence on the incompleteness of
immunization in infants or toddlers.
OR = 0.022 means that family
tradition accustomed to giving
immunization to infants or toddlers is
at risk of 45.45 times causing infants
or toddlers to get complete
immunization compared to
unaccustomed family tradition
(Epidemiologic Journal, 2014). This
variable has significance equal to
0,020 which means significant value
<0,05 so that there is strength of
relationship and influence incidence
of measles immunization 4,428 times
(OR = 4,428).
Characteristics of attitudes
toward measles immunization in this
study have a p-value of 0.003, which
means there is a relationship between
attitudes toward measles
immunization. This is consistent with
Tampemawa's (2015) research that
some respondents have a good
attitude towards immunization status
as much as 76 respondents, from 76
respondents who gave Immunization
Complete to their children of 65.6%
(57 respondents) and incomplete
immunization of 21, 8% (19
respondents), seen from significance
value of 0,003 thus probability
(significance) less than 0,05 (0,003
<0,05), hence there is relation
between mother attitude with
immunization status. Viewed from
the OR (Odds Ratio) indicates that
the mother who has a good attitude is
likely to give complete immunization
as much as 8 times greater than the
mother has a bad attitude towards the
status of immunization. The variable
in this study has significance of
0.000 which means significant value
<0,05 so that there is relationship
strength and influence the incidence
of measles immunization 5,616 times
(OR = 5,616). The characteristics of
maternal education on measles
immunization in this study have a p-
value of 0.000, which means that
there is a relationship between
maternal education on measles
immunization. This is in accordance
with research Rahmawati (2014) is
the mother who has infants or
toddlers with the most complete
immunization status in mothers with
education level 9 years (upper
secondary education) of 84.1%.
While mothers with infants or infants
with incomplete immunization status
are mostly at the education level <9
years (basic education) of 72.7%.
Statistic test results obtained p value
of 0.000 (p <) which means there is
a relationship between the level of
education to the completeness of
immunization in infants or toddlers.
OR = 14.095 means that mothers
with education level <9 years are at
risk 14,095 times cause incomplete
basic immunization in infant or
toddler compared to mother who
have level of education 9 years.
The variable in this study has
significance of 0.000 which means
significant value <0,05 so that there
is strength of relationship and
influence the incidence of measles
immunization 0,249 fold (OR =
0,249).
CONCLUSION
1. There is a relationship
between tradition, attitude
and education of mother to
give measles immunization at
Mrican Health Center
Kecamatan Mojoroto Kediri is
23,4%
2. The number of children who
are not immunized against
measles at Mrican Health
Center Kecamatan Mojoroto
Kediri is 114 children
(52,3%).
3. Most mothers aged at Mrican
Health Center Kecamatan
Mojoroto Kediri is age 35
years (76,1%).
4. Most mothers work at Mrican
Health Center Kecamatan
Mojoroto Kediri is working
(61,5%).
5. Availability of health
facilities at Mrican Health
Center Kecamatan Mojoroto
Kediri amounted to 95%.
6. The number of siblings <4
people is the highest in
Mrican Health Center
Kecamatan Mojoroto Kediri
(98.6%).
7. The most tradition in Mrican
Health Center Mojoroto
district in Kediri is
accustomed to immunization
in the family (90.8%).
8. Most attitudes in Mrican
Health Center Kecamatan
Mojoroto Kediri are suitable
in basic immunization (83%).
9. Mother's most knowledge in
Mrican Health Center
Mojoroto district in Kediri
city is high knowledge
(95,4%).
10. Most family income in
Puskesmas Mrican Mojoroto
district in Kediri city is high
that is> Rp.1.000.000 per
month (89%).
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