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Reza Isfan; Pembimbing: Ratna Djuwita; Penguji: Tri Yunis Miko Wahyono, Julitasari Soendoro, Dian Ayubi, Bayu Aji
Abstrak:

Imunisasi merupakan satu tindakan pemberian kekebalan khusus kepada anak terhadap Penyakit yang Dapat Dicegah Dengan Imunisasi (PD3I), seperti tuberkulosis, difteri, pertusis, tetanus, polio, campak, dan hepatitis B, sebelum berusia satu tahun. Peningkatan cakupan imunisasi mampu menurunkan kematian akibat PD3I dari 23% tahun 1974 menjadi 10% di tahun 2000. Selama tahun 2005, Seksi Pengamatan dan Pencegahan Penyakit, Dinas Kesehatan Propinsi Sumatera Barat melaporkan 2.603 kasus campak klinis, 498 kasus hepatitis, 12 kasus tetanus neonatorum, dan 117 kasus pertusis. Kota Padang melaporkan 959 kasus campak klinis, 65 kasus hepatitis, dan 5 kasus tetanus neonatorum selama tahun 2005. Cakupan imunisasi di Puskesmas Pauh Kota Padang pada tahun 2005, adalah; BCG (89,8%), DPT1 (81,2%), DPT3 (67,8%), Polio 4 (75,8%), Hepatitis (66,6%), dan Campak (84,1%). Imunisasi dasar yang tidak lengkap, hanya memberikan perlindungan sebesar 25-40%. Perkiraan risiko untuk meninggal pada seorang anak balita yang tidak diimunisasi lengkap adalah sebesar 14 kali dibandingkan yang sudah diimunisasi lengkap. Penelitian ini menggunakan disain kasus kontrol, untuk mengetahui faktor-faktor yang berhubungan dengan status imunisasi dasar pada anak. Penelitian dilakukan di wilayah kerja Puskesmas Pauh, dengan pertimbangan jumlah penduduk yang cukup besar, cakupan imunisasi rendah, dan masyarakat yang cukup kooperatif. Kasus adalah anak usia 12 sampai 23 bulan yang tidak mendapatkan salah satu imunisasi sebelum benisia satu tahun, sedangkan sebagai kontrol adalah anak yang sudah mendapatkan imunisasi berupa BCG, DPT1, DPT2, DPT3, Poliol, Polio2, Polio3, Polio4, Campak, serta hepatitis B1, hepatitis B2, dan hepatitis B3 sebelum berusia satu tahun. Kasus dan kontrol dicari dari register imunisasi di puskesmas, dari tanggal 1 Juni 2004 sampai 31 Mei 2005. Responden pada penelitian ini adalah ibu dari kasus rnaupun kontrol yang bertempat tinggal di wilayah kerja Puskesmas Pauh pads waktu penelitian. Penelusuran variable-variabel yang diduga berhubungan dengan status imunisasi dasar dilakukan dengan mengadopsi konsep Green yang melihat faktor predisposisi (umur ibu, pendidikan ibu, pekerjaan ibu, pengetahuan ibu, sikap ibu, jumlah anak, dan pekerjaan suami), faktor pendukung (kepemilikan), dan fakt ar pendorong (anjuran). Hasil penelitian menunjukkan bahwa faktor predisposisi yang berhubungan dengan ketidaklengkapan imunisasi dasar pada anak di Puskesmas Pauh adalah umur ibu 30 tahun dengan OR = 3,10 dengan 95% CI: 1,83-5,26, pendidikan ibu yang rendah dengan OR = 2,01 dengan 95% CI: 1,10-3,69, pengetahuan ibu yang tidak bail( tentang imunisasi dengan OR = 2,16 dengan 95% CI: 1,20-3,90, dan pekerjaan suami pada sektor non formal dengan OR = 3,21 dengan 95% CI: 1,19-8,69. Faktor pendukung (kepemilikan) tidak berhubungan dengan ketidaklengkapan imunisasi dasar pada anak. Faktor pendorong berupa anjuran, berhubungan dengan ketidaklengkapan imunisasi dasar pada anak. Ibu yang tidak pernah mendapatkan anjuran imunisasi mempunyai risiko imunisasi anaknya tidak lengkap sebesar 4,17 kali jika dibandingkan dengan ibu yang mendapat anjuran dari tenaga non kesehatan, dan sebesar 3,86 kali jika dibandingkan dengan-ibu yard mendapat anjuran dari tenaga kesehatan. Anjuran untuk mengikuti program Keluarga Berencana setelah punya dua anak, tidak mempunyai Layi lagi setelah ibu berumur ? 30 tahun, meningkatkan pendidikan ibu, penggalakan kelompok belajar, penyuluhan imunisasi secara berkala dan berkesinambungan, revitalisasi posyandu, dan pelatihan imunisasi leader kesehatan diharapkan dapat ineningkatkan cakupan imunisasi pada masa yang akan datang.

 

Immunization is a procedure on giving a special protection on children, before one year of age, from diseases that can be prevented by immunization, such as tuberculosis, diphtheria, pertuses, tetanus, polio, measles, and Hepatitis B. The escalation on the immunization coverage has reduced the mortality, caused by the diseases that can be prevented by immunization, from 23% in 1974 to 10% in 2000. During 2005, the province of West Sumatra has reported cases on 2,603 clinical measles, 498 Hepatitis, 12 tetanus neonatorum, and 117 aertuses. Meanwhile, Kota Padang has reported 959 cases of clinical measles, 65 cases of Hepatitis, and 5 cases of tetanus neonatorum. The immunization coverage at Puskesmas Pauh of Kota Padang in 2005 is: BCG (89.8%), DPT i (81.2%), DPT3 (67.8%), Polio4 (75.7%), Hepatitis (66.6%), and measles (84.1%). Uncompleted basic immunization is only giving 25-40% of protection. An estimation on risk of death for children under five who have uncompleted immunization is fourteen times compare to those who have completed immunization. The design of the study is case-control in order to find out the factors related to the child status on basic immunization. The study is carried out in the working area of Puskesmas Pauh was chosen based on total among the population approximately, the low coveragi immunization as well as the cooperative behavior of the community. The case is children age 12 to 23 months who has uncompleted one of basic immunization before one year of age. Meanwhile, the control is children who have completed basic immunization before one year of age. The completed immunization should consist of immunization on ECG, DPT1, DPT2, DPT3, Polio], Polio2, Polio3, Polio4, Measles, HepatitisB-l, HepatitisB-2, and HepatitisB-3. The case and the control are found out from puskesmas' immunization registration, during 151 June 2004 to 315` May 2005. Respondents of the study are mothers of the case and the control who lives in the working area of puskesmas. Exploration on variables that assumed to have relationship with the status of basic immunization is accomplished by applying 'the concept of Green, which is looking at the predisposing factors (age, education, occupation, knowledge, attitude, number of children, and husband's occupation), the enabling factors (ownership) and the reinforcing factors (advice). The result of the study showed that predisposing factors have relationship with incompleteness of basic immunization status of children. The predisposing factors the are relationship also between the predisposing factors with status on basic immunization are: age > 30 years (OR: 3.19 with 95% CI at 1.83 - 5.26), low education (OR: 2.01 with 95% CI at 1.10 --- 3.69), poor knowledge on immunization (OR: 2.16 with CI 95% at 1.20 - 3.90), and husband's occupation at non-formal sectors (OR: 3.21 with CI 95% at 1.19 - 8.69). There is no relationship between enabling factor (ownership) with the incompleteness of basic immunization of the children. The reinforcing factor, in this case is the advice, is correlated with the incompleteness of basic immunization of the children. The risk of mother have never had an advice about child immunization have a risk 4.17 times to have incompleteness on child immunization compare to mothers who receive the advice from non-health personnel. While the risk is lower 3.86 times if compared to mother who receive the advice from health personnel. Suggestions are addressed the mothers to: participate on family planning program after having two children, not to be pregnant after 30 years of age, to increase the level of mother education, educational package programme for the mother to foolow sustainability of IEC immunization program. Posyandu revitalization, and immunization training for should voluntary health worker about immunization. Hopely by accomplish all the suggestion the immunization coverage will bw increase in the future time.

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T-2484
Depok : FKM-UI, 2006
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Tuty Suhartini; Pembimbing: Soedarto Ronoatmodjo; Penguji: Krisnawati Bantas, Julitasari Soendoro, Syahrizal Syarif, Ichsan Sudjarno
Abstrak:
Hepatitis E adalah peradangan yang menyerang organ hati yang disebabkan virus hepatitis E (HEV), yang ditularkan secara "fecal oral" melalui makanan dan minuman yang terkontaminasi oleh tinja manusia yang mengandung HEV. Di Indonesia Kejadian Luar Biasa (KLB) Hepatitis E pernah terjadi di Kabupaten Sintang Kalimantan Barat, pada tahun 1987, 1989, dan 1991 dan di Kabupaten Bondowoso Jawa Timur pada tahun 1998. Sampai dengan akhir April 2001 masih ditemukan penderita Hepatitis E yang berobat ke Puskesmas Sukosari dan Wonosari Kabupaten Bondowoso. Penelitian ini bertujuan untuk mengetahui hubungan kualitas bakteriologi air yang digunakan oleh masyarakat dengan kejadian Hepatitis E di Puskesmas Sukosari dan Wonosari Kabupaten Bondowoso tahun 2000 - 2001. Disain penelitian menggunakan disain kasus kontrol tidak berpadanan, dengan perbandingan kasus dan kontrol 1 : 1. Jumlah sampel minimal yang diperlukan sebanyak 88 kasus dan 88 kontrol. Populasi kasus adalah penderita Hepatitis E yang berobat ke Puskesmas Sukosari dan Wonosari sedang populasi kontrol adalah penderita bukan penyakit Hepatitis E yang berobat ke Puskesmas Wonosari dan Sukosari sejak 1 Januari 2000 sampai dengan 31 April 2001. Variabel dependen dalam penelitian ini adalah kejadian Hepatitis E, sedangkan variabel independen utamanya adalah, kualitas bakteriologi air. Hasil penelitian menunjukkan air yang terkontaminasi coliform berhubungan dengan kejadian HEV setelah dikontrol oleh faktor konfounder (OR : 2.45 (95% CI : 1.23 - 4.89; p = 0.01)). Variabel konfounder tersebut adalah kebiasaan minum air masak, kebiasaan jajan, kebiasaan mencuci tangan sebelum makan. Jadi orang yang menggunakan air yang terkontaminasi coliform berisiko terkena HEV 2 kali dibanding orang yang menggunakan air yang tidak terkontamininasi tinja/coliform. Bila kelompok kontrol diasumsikan mewakili populasinya, maka upaya perbaikan kualitas bakteriologi air yang digunakan masyarakat, penerapan kebiasaan minum air masak, dan mencuci tangan dengan air dan sabun sebelum makan, maka diperkirakan dapat menurunkan proporsi kejadian HEV sebesar 55%.
Water quality and Hepatitis E Virus at the Health Center of Sukosari and Wonosari, District of Bondowoso, for period 2000 ? 2001Hepatitis E is known as one of the liver inflammation, caused by Hepatitis E virus. The disease is transmitted by the fecal - oral route and fecally contaminated water and food. The outbreaks of Hepatitis E have been reported from District of Sintang, West Kalimantan, in the year of 1987, 1989 and 1991. So did from District of Bondowoso, Provincial of East Java in 1998. Up to the end of April 2001, there were still found the patients of Hepatitis E who were treated at the Health Center of Sukosari and Wonosari, District of Bondowoso. The Objective of this study is to identify the association between the microbiological water qualities used by community with the occurrence of Hepatitis E. The research design use unmatched case control study, with control to case ratio 1 : 1. The minimum sample size used is 88 cases and 88 controls respectively. The sources of case are patients of Hepatitis E who were treated at the Health Center of Sukosari and Wonosari. On the other hand, the sources of control are non Hepatitis E patients who were treated in both of the Health Centers mentioned before. Dependent variable in this study is the occurrence of Hepatitis E, and its main independent variable is microbiological water quality. The result of this study shown that the microbiological water quality has a significant association with the occurrence of HEV after has been adjusted by the confounder factors. (OR : 2.45; 95% CI 1.23 - 4.89; p = 0.01). Those factors are, the habit of drinking boiled water, and hand washing before eating. Therefore, respondent who used fecally contaminated water has a risk infected by HEV 2 times bigger than the respondent who used safe water. Referring to the result of this study, if control group is assumed represent its population, a water quality improvement, practical of drinking boiled water and hand washing before eating, are predicted reduce the proportion of HEV occurrence about 55%.
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T-1369
Depok : FKM UI, 2002
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Dadi Supriadi; Pembimbing: Soedarto Ronoatmodjo; Penguji: Krisnawati Bantas, Julitasari Soendoro, Sudarti kresno, Ubbay Ujziana
Abstrak:
Giving the earliest possible hepatitis B immunization to babies had become a first priority for the hepatitis B immunization programmed. This measure would give immediate protection to babies against infection caused by hepatitis B virus; it could also prevent babies from the development of some infection already occurring (through prenatal transmission) into a chronic hepatitis. It was still very hard to carry out the earliest possible hepatitis B programmed at Tasikmalaya Regency. Results of an evaluation of immunization programmed by the local Health Service in the year 2001 showed that 88.32% of the first hepatitis B immunized babies, only 0.99% had the immunization at the ages of 0 - 7 days. In an effort to increase the number of hepatitis B immunized babies, the role of health officials became very important in encouraging mothers to have their newly-born babies immunized. Close contact with mother and their babies with health officials, either at home or at health centers, were useful in improving the health of the mothers as well as their babies. The aim of the study was to see the correlation between visits to newly-born babies and the earliest possible immunization status of hepatitis B immunized babies at Tasikmalaya Regency in the year 2001, including other factors which influenced the status. The design of the study is a case control without matching, with the number of cases (non-early hepatitis B immunized babies) are 162 persons, and the numbers of controls (early hepatitis B immunized babies) are 162 persons, so that the number of the whole samples was 162 persons. Data processing was carried out through unvariate, bivariate and unconditional logistic multiple regression, with the software Stata version 6.0. Results of the study showed that mothers who had not had the opportunity of newly-born visits underwent a risk of 3.45 times of the status of babies with non-earliest possible hepatitis 13 immunization compared to mothers visited during the earliest possible child delivery (95% Cl: 1.95 - 6.10). Variables such as, pregnancy test, and place of deliveries, delivery assistants, knowledge of mother on hepatitis B immunization and mother's attitude about hepatitis B immunization controlled the results o f the study.
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T-1328
Depok : FKM UI, 2002
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Nanang Wardhana; Pembimbing: Bambang Sutrisna; Penguji; Lukman Hakim Tarigan, Ella Nurlaela Hadi, Julitasari Soendoro
Abstrak:
Imunisasi dasar adalah suatu tindakan untuk memberikan kekebalan khusus terhadap penyakit tuberkulosis, difteri, pertusis, tetanus, poliomielitis, campak dan hepatitis B kepada anak umur 0-11 bulan. Kegiatan tersebut merupakan salah satu intervensi kesehatan yang berdaya ungkit besar terhadap penurunan angka kesakitan dan angka kematian bayi dan anak. Cakupan imunisasi menurut SDKI tahun 1997 adalah 55% anak terimunisasi lengkap. Di Jawa Barat tahun 1997 cakupan anak terimunisasi lengkap bare mencapai 42 % sedangkan di Kabupaten Majalengka cakupan anak terimunisasi lengkap 81,29%. Penelitian ini bertujuan untuk mengetahui pengaruh perilaku ibu tentang imunisasi terhadap status kelengkapan imunisasi dasar pada anak di Kabupaten Majalengka tahun 1999-2001. Desain penelitian yang digunakan adalah kasus kontrol tanpa di matching dengan jumlah sampel 159 kasus dan 159 kontrol diambil dengan cara simple random sampling. Hasil penelitian dengan menggunakan uji statistik multivariabel regresi logistik menunjukkan bahwa perilaku ibu tentang imunisasi berpengaruh terhadap status kelengkapan imunisasi dasar pada anak dengan nilai rasio odds 4,12. Artinya ibu yang memiliki perilaku tentang imunisasi kurang baik memiliki risiko 4,12 kali status imunisasi dasar pada anaknya tidak lengkap dibandingkan dengan ibu yang memiliki perilaku tentang imunisasi baik. Selain itu, status kelengkapan imunisasi dasar pada anak dipengaruhi pula oleh pendidikan ibu, jumlah anak masih hidup, aktifitas kader Pos Pelayanan Terpadu (Posyandu), aksesibilitas ke Pos Pelayanan Terpadu (Posyandu) dan pemajanan media informasi. Variabel pendidikan ibu, aktifitas kader Pos Pelayanan Terpadu (Posyandu), aksesibilitas ke Pos Pelayanan Terpadu (Posyandu) dan pemajanan media informasi saling berpengaruh independent dengan status kelengkapan imunisasi dasar pada anak. Pengaruh perilaku ibu tentang imunisasi terhadap status kelengkapan imunisasi dasar pada anak, ternyata dipengaruhi oleh kovariat antara lain pendidikan ibu dan aksesibilitas ke Pos Pelayanan Terpadu (Posyandu). Dari hasil penelitian ini diperoleh model terbaik yaitu : Logit p(X) = -2,82+ 1,05 (Perilaku ibu tentang imunisasi) + 0,90 (Aktifitas kader Pos Pelayanan Terpadu (Posyandu)) + 1,53 (Aksesibilitas ke Pos Pelayanan Terpadu (Posyandu)) + 1,50 (Pemajanan media informasi) + 1,56 (Pendidikan ibu). Untuk meningkatkan status kelengkapan imunisasi dasar pada anak, Dinas Kesehatan dengan didukung oleh program dan sektor terkait perlu melakukan suatu kajian pengembangan media informasi imunisasi dan pemberdayaan Pos Pelayanan Terpadu (Posyandu) dalam program imunisasi.
Mother's Behavior Influences on Immunization to Completeness Status of Basic Immunization for Children in Majalengka Regency in 1999-2001Basic immunization is an action to give immunity to tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, measles and hepatitis B diseases for children 0-1 l months. The activity is one of the health interventions to reduce morbidity and mortality rates. According to Indonesia Demographic and Health Survey (IDHS) in 1997 immunization coverage is 55% fully immunized children. In West Java in 1997 the fully immunized children are 42% more over in Majalengka Regency the fully immunized children are 81,29%. The research objectives knowing mother's behavior influences on immunization to completeness status of basic immunization for children in Majalengka Regency in 1999-2001. Research design by using case-control 159 sample cases and 159 controls without matching is taken by simple random sampling. The research results to use logistic regression multivariate statistic, indicated which mother's behavior on immunization influence to completeness status of basic immunization for children value to odds ratio 4.12. It means those mothers?s who has a bad behavior on immunization having risk 4.12 times status of basic immunization of her child is incompletely of we compared with the mother's who have a good behavior on immunization. Besides the completeness status of basic immunization for children is influenced by the mother's education, number of children still alive, activities of Integrated Health Service Post cadre, accessibility to Integrated Health Service Post and advance of mass immunization information. The variable of the mother's education, activities of Integrated Health Service Post cadre, accessibility to Integrated Health Service Post and advance of mass immunization information as influence as independently with status of completeness of basic immunization for children. Mother's behavior influences on immunization to completeness status of basic immunization for children which is influenced by covariate such as mother's education and accessibility to Integrated Health Service Post. The research results above are got the best model namely: Logit p(X) = -2,82 i 1,05 (mother's behavior on immunization) - 0,90 (activities of Integrated Health Service Post) + 1,53 (accessibility to Integrated Health Service Post) + 1,50 (advance or mass immunization information) 1,56 (mother's education). To increase completeness status of basic immunization for children, Department of Health supported by program and connected sector should be done the developing research of mass immunization information and revitalization of Integrated Health Service Post in immunization program.
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T-1117
Depok : FKM-UI, 2001
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Olivia Esrana Simbolon; Pembimbing: Prastuti Soewondo C.;Penguji: Hasbullah Thabrany, Mardiati Nadjib, Harmein Harun, Julitasari Soendoro
Abstrak:
Penyakit campak sangat menular terutama menyerang anak-anak yang tidak mempunyai kekebalan terhadap penyakit campak. Penyakit campak merupakan masalah kesehatan yang cukup serius baik di negara maju maupun negara berkembang, walaupun dapat dicegah dengan imunisasi namun KLB masih sering terjadi. Di Indonesia imunisasi campak dimulai tahun 1983 dan cakupan campak 80 % telah dicapai pada tahun 1990 dan dapat dipertahankan sampai sekarang. Namun cakupan tinggi belum terdistribusi merata sampai ke desa, sehingga masih terjadi KLB (Kejadian Luar Biasa) campak yang sering mengakibatkan kematian khususnya pada anak dengan gizi buruk. Cakupan tinggi menyebabkan terjadinya pergeseran umur penderita campak, bukan hanya pada balita tetapi mulai tinggi pada anak sekolah. Perubahan pola epidemi campak merubah strategi program. Serta mengacu kepada sidang WHA untuk menurunkan angka insidens campak sebesar 90% dan angka kematian campak sebesar 95%, dan sidang WHO 1996 yang menyatakan kemungkinan penyakit campak dapat dieradikasi karena pejamu hanya manusia. WHO membuat target global eradikasi campak pada tahun 2005 - 2010 dan menilai kinerja setiap negara terhadap upaya pengendalian campak. Berdasarkan kriteria WHO, maka Indonesia saat ini masuk dalam phase reduksi kasus dan pencegahan KLB campak. Namun strategi pencapaian diserahkan pada kemampuan keuangan masing-masing negara. Untuk mengantisipasi hal tersebut selain irunisasi rutin bayi, pada tahun 2000 telah diberikan imunisasi campak tambahan pada anak sekolah kelas 1 - 6 SD (catch up) di 2 propinsi (DKI Jakarta & Jawa Barat), serta crash program campak anak balita di desa rawan campak (resiko tinggi) di 13 propinsi di Indonesia. Sebelum mengadop kegiatan catch up ke propinsi lain serta mengingat keterbatasan keuangan negara, maka diperlukan evaluasi ekonomi analisis biaya hasil (cost effectiveness analysis) dari kegiatan campak tambahan tersebut. Sesuai dengan tujuan penelitian yaitu untuk mendapatkan gambaran tentang model kegiatan imunisasi campak yang paling "cost effective" dalam upaya pengendalian campak, mengetahui biaya satuan per kegiatan serta komponen biaya terbesar, juga untuk mengetahui kecenderungan penurunan kasus setelah imunisasi campak tambahan dilaksanakan. Penelitian dilakukan di Kabupaten Bogor di 56 puskesmas yang terdiri dari 28 Puskesmas Desa UCI yang melaksanakan imunisasi rutin dan catch up (model-2) dan 28 Puskesmas Desa Non-UCI yang melaksanakan imunisasi rutin, catch up dan crash program (model-3) pada tahun 2000 dan sebagai pembanding adalah puskesmas yang soma (tahun 1999) yang hanya melaksanakan imunisasi rutin (model-1). Rancangan penelitian studi operasional (OR) evaluasi ekonomi analisis biaya efektif (CEA). Berdasarkan jenis data retrospektif dengan analisa deskriptif. Hasilnya adalah biaya satuan: rutin Rp.8.141, catch up Rp.3.275, crash program Rp. 3.552. Biaya satuan yang paling cost effective adalah pada kegiatan masal catch up yaitu 40% dari biaya satuan rutin. Komponen biaya yang terbesar dari 3 kegiatan dan model imunisasi adalah pada biaya operasional (96,50% - 99,96%). Sedang jenis biaya terbesar pada biaya operasional imunisasi rutin adalah biaya vaksin, gaji, alat suntik dan transport lapangan. Hanya pada daerah sulit, transport lapangan lebih tinggi dart biaya alat suntik. Untuk kegiatan catch up dan crash program biaya operasional terbesar adalah biaya vaksin, alat suntik dan gaji. Terjadi penurunan kasus campak yang bermakna pada puskesmas yang sama, dengan membandingkan kegiatan imunisasi model-2 dan model-3 (tahun 2000) terhadap model-1 (1999). Penurunan kasus di puskesmas model-2 sebesar 49,5% dan di puskesmas model-3 sebesar 59,4%, sedangkan di Kabupaten Bogor penurunan kasus campak sebesar 65,3%. Pada tahun 2000 dikedua kelompok model penelitian dan di Kabupaten Bogor tidak terjadi KLB campak, dimana selama 9 tahun (1991-1999) selalu terjadi KLB campak. Proporsi penurunan kasus terbesar terjadi pada kelompok umur balita yaitu di puskesmas model-2: umur < 1 tahun (66,2%), dan umur l - 4 tahun (68,3%). Di puskesmasmodel-3: umurcl tahun (50%) dan 1 - 4 tahun (75,1%). Soma dengan di,Kabupaten Bogor penurunan kasus campak terbesar pada kelompok umur balita yaitu < 1 tahun (72,5%) dan umur 1 - 4 tahun (76,2%). Berdasarkan hasil CE-ratio dart kedua model imunisasi campak tambahan, model yang paling cost effective adalah model-2 yaitu imunisasi rutin bayi dan catch up anak SD. Model-2 ini efektif untuk menurunkan kasus dan mencegah terjadinya KLB berarti dapat memutuskan transmisi virus dari anak sekolah kepada anak balita dirumah, namun demikian untuk menghilangkan desa rawan campak kegiatan crash program harus tetap dilakukan di desa-desa dengan cakupan rendah 2-3 tahun.
Measles is a serious infectious disease afflicted predominantly children under five who are susceptible to the disease. In most developing countries, measles is still one of the leading causes of children morbidity and mortality. Instead of significant achievement of EPI Program, outbreaks of measles are still frequently occurred. Measles vaccine was introduced and included into routine EPI in 1983 and UCI coverage (> 80 %) was achieved in 1990, and has been sustained until now. The problem that we are facing is the UCI coverage is not equally distributed which leads to the occurrence of measles outbreaks in pocket villages. The outbreaks claim many deaths among malnourished children. High coverage of measles vaccination has shifted the age of the cases to the right, where older children are affected and not only children under five. The changes of this disease pattern calls for revision of the EPI program strategy. The changes of the strategy is also revered to WHA resolution which has set the target of measles disease reduction by 90% and mortality reduction by 95%. Due to the natural history of disease, with potent vaccine measles could be eradicated like smallpox and polio. WHO has set the global target for measles eradication in 2005 - 2010 and plays a great roles in evaluating the performance of it's member countries towards measles eradication. WHO has conducted external evaluation and considered Indonesia is now at the stage of measles reduction and prevention of measles outbreaks occurrence. WHO member countries implemented different strategies in achieving their measles reduction target, it is very much depend on the available resources of each country. Indonesia, beside routine basic immunization program to infant has also in the year 2000 introduced additional measles vaccination to school children year 1 -- 6 elementary school in DKI Jakarta and West Java which is known as catch-up activities. Crash program for children under five was also introduced in measles high risk areas in 13 provinces. The introduction of catch-up campaign and crash program was based on epidemiological evidence. Cost effectiveness analysis need to be undertaken before deciding to adopt catch-up campaign and crash program approaches as national policy. The objectives of the cost effectiveness analysis study are to get better picture and better understanding of the most cost effective model of measles vaccination, unit cost for each activity, the biggest budget component, trend of measles reduction after additional measles vaccination been implemented. The study was conducted in Bogor Regency involved 56 health centres, consists of 28 health centres have achieved village UCI coverage in 2000, which are implementing routine immunization and catch-up campaign (model-2) and 28 health centres who have not achieved village UCI coverage in 2000 which are implementing routine immunization, catch-up as well as crash program (model-3) control health centres were the same health centres who in 1999 implemented routine immunization (model-1) only. The study design was operational research (OR), economic evaluation cost effectiveness analysis (CEA). Using retrospective data with descriptive analysis. From data analysis it is evidence that the unit cost for different approaches are the following: - Routine immunization Rp. 8141 - Catch-up campaign Rp. 3275 - Crash program Rp. 3552 The most cost effective is catch-up campaign which is only 40% of the cost of routine immunization. The biggest component of those three different approaches comes from the operational cost which is 96,5% - 99,96% of the total cost. In routine, the biggest cost of the operational cost is for vaccine, salaries, syringes and transportation. Only in remote different areas cost for transportation is bigger than cost for syringes. In catch-up campaign and crash program the biggest operational cost are for vaccines, syringes, salaries. It is evidence that there has been significance reduction of measles cases in model-2 and model-3 approaches (2000) as compare to model-1 (1999). Measles reduction in health centres for model-2 approach 49,5%, model-3 approach 59,4%, while for the whole Bogor Regency the measles reduction was 65,3%. It is also found that in 2000, measles outbreaks was not occurred in the study areas and in the Bogor Regency where in the last 9 years (1991-1999) measles outbreaks has always been occurred. If we look at the age distribution the significant reduction was found in underfive group. Health centres model-2: < 1 year (66,2%), 1 - 4 years (68,3%). In health centres model-3: < 1 year (50%), I - 4 years (75,1%). Similar figure is also found in Bogor Regency where significant measles reduction was in underfive age group; < 1 year (72,5%), 1 - 4 years (76,2%). Finally, based on CE-Ratio calculation, model-2 was the most cost effective which include routine immunization and catch-up campaign for elementary school children. In conclusion model-2 is effective to reduce cases and to prevent measles outbreaks and is capable to cut the viral transmission from school children to children under five in their respective households. Hence, to reduce the number of high risk villages, crash program should be implemented continuously in low coverage villages at least for
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Depok : FKM-UI, 2001
S2 - Tesis   Pusat Informasi Kesehatan Masyarakat
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Dian Ayubi; Promotor: Soekidjo Notoatmodjo; Ko-promotor: Adang Bachtiar, Sudijanto Kamso; Penguji: Hadi Pratomo, Haryoto Kusnoputranto, Boediharto, Suprijanto Rijadi, Julitasari Soendoro
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Depok : FKM-UI, 2006
S3 - Disertasi   Pusat Informasi Kesehatan Masyarakat
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:: Pengguna : Pusat Informasi Kesehatan Masyarakat
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