PIG

INTRODUCTION

A. Background

Immunization is the most effective and efficient public health effort in

preventing diseases and reducing death rates such as smallpox, polio, tuberculosis,

hepatitis B, diphtheria, measles, rubella and congenital rubella syndrome (CRS),

tetanus, pneumonia (inflammation). lungs) and meningitis (inflammation of the lining

of the brain). Implementation of immunization for children under five saves around

2–3 million lives worldwide every year and contributes greatly to reducing the global

infant mortality rate from 65 per 1,000 live births in 1990 to 29 in 2018 (Nandi &

Shet,

2020).

PeThe implementation of immunization is expected to reduce the number of

children under five who die from diseases that can be prevented by immunization

(PD31) (Info Datin Ministry of Health, 2016). However, in recent years, the death

rate for children under five due to infectious diseases that could have been prevented

by immunization has still been relatively high. The 2020 WHO report stated that there

are 20 million children who do not receive immunization services for toddlers

throughout the world routinely every year. The high number of children who have not

received immunizations has resulted in several diseases that can cause paralysis and

even death, which should be preventable with vaccines, reappearing in developed

countries and
develop. These diseases include measles, pertussis, diphtheria and polio

(Hidayah et al., 2018; UNICEF, 2020).

The incidence of deaths of children under five years of age (toddlers) in

developing countries has increased in recent years. One of the factors that causes

death in children is the child's immune system which is not yet perfect. The number

of under-five deaths that occurred in China between years

From 1996 to 2015, there were 181,600 children under five. Of the total number of

deaths, 93,400 (51%) under-five deaths occurred in neonates, the majority of which

were caused by pneumonia. Meanwhile, in Africa pneumonia, diarrhea and measles

are the causes of half of child deaths (He et al., 2017; Liu et al., 2015; Sari & Nadjib,

2019).

An overview of complete basic immunization coverage in Indonesia in 2016-

2018, namely in 2016 it was 91.58%. In 2017, complete basic immunization coverage

decreased to 85.41%. In 2018, complete basic immunization coverage decreased

again from 2017, namely

57.95% (Azis et al., 2020; Riskesdas, 2018). Data in 2019, routine immunization

coverage in Indonesia was still in the unsatisfactory category, where Pentavalent-3

and MR coverage in 2019 did not reach 90% of the target. In fact, the basic

immunization program is provided free of charge by the government at Community

Health Centers and Posyandu (Ministry of Health of the Republic of Indonesia, 2020;

WHO, 2020).

PaThe COVID-19 pandemic led to more than 125 million confirmed positive

cases and 2,748,737 reported deaths worldwide as of March 26, 2021 prompting

drastic changes in global social norms including the provision of health services. This

of course has significant implications for efforts to control other infectious diseases

and diseases that can be prevented through immunization programs (Chandir et al.,

2020; WHO, 2021). Reducing the coverage of complete basic immunization will

result in the formation of immunity in infants and toddlers, thereby reducing the level

of children's health (Ministry of Health of the Republic of Indonesia,

2020).

Pan the COVID-19 pandemic that occurred in the first four months of 2020,

WHO noted a decrease in the number of children receiving the diphtheria, tetanus and

pertussis (DTP3) vaccine. This data is unusual because this is the first time in 28

years that DTP3 coverage has decreased. In addition, the COVID-19 pandemic has

caused at least 30 measles vaccination campaigns to be canceled or at risk of being

canceled by WHO and UNICEF. It is feared that this could lead to outbreaks of other

diseases. As of May 2020, three-quarters of 82 countries reported disruptions related

to immunization programs due to the COVID-19 pandemic (Ministry of Health of the

Republic of Indonesia, 2020).

The results of research conducted in West Java showed a decrease in basic

immunization coverage after the COVID-19 pandemic from 79% to 64% (Diharja et

al., 2020). This supports the results of a preliminary study conducted by researchers at

the Blahbatuh 1 Community Health Center and the Vidyan Medika Main Clinic

which showed a decrease in coverage for the implementation of complete basic

immunization after the COVID-19 pandemic, namely more than 11%. Therefore,

identify the factors that affecting complete basic immunization coverage is important

to find out the causes of the decline in complete basic immunization coverage.

The results of several studies show that there are several factors that influence

the implementation of complete basic immunization, namely the mother's age,

younger mothers are generally able to digest information about immunization better

than older mothers. Mothers who are younger and have just had children usually tend

to pay more attention to their children's health, including providing immunizations

(Prihanti et al., 2016). Maternal education, incomplete basic immunization in children

is 2.2 times more risky for mothers with low education compared to mothers with

higher education (Astuti & Fitri, 2017). Mother's work, working mother has

possibilities
0.739 times more likely to carry out complete basic immunization for babies

compared to mothers who do not work due to the lack of information received by

housewives compared to working mothers (Rakhmawati et al., 2020).

Ownership of a health card (KMS)/ Maternal and Child Health Book (KIA

Book)/ other children's health books. Owning a KMS/KIA book/child health record

book is very important, especially to know the schedule or type of immunization

given to toddlers. By owning this book, parents can find out what types of

immunizations have been given and what immunizations have not been given

(Minister of Health Regulation No. 155/Menkes/Per/1/2010 Concerning the Use of

Healthy Cards for Toddlers). According to research by Harmasdiani (2015), in

Probolinggo which shows that low maternal knowledge has a 21 times greater risk

less obedient in coming to health services and providing immunizations compared to

mothers with high knowledge.

PeCarrying out complete basic immunization is very important to reduce

morbidity and death rates due to diseases that can be prevented by immunization

(Ministry of Health of the Republic of Indonesia, 2020). Due to the importance of

complete basic immunization in improving the health status of babies and the absence

of previous research, researchers have encouraged researchers to conduct research to

find out the factors related to the implementation of complete basic immunization

after the COVID-19 pandemic.

B. Formulation of the problem

BeBased on the background description above, the problem to be researched

is "What are the factors associated with complete basic immunization status after the

COVID-19 pandemic?"

C. Research Objectives

1. General Objectives
 Understand the description of complete basic immunization and factors

related to the status of complete basic immunization in babies during the COVID-19

pandemic at the Vidyan Medika Main Clinic.

2. Specific Purpose:

a. Identifying the age, occupation, education of the baby's mother during the pandemic

COVID-19 at Vidyan Medika Main Clinic

b. Identify ownership of KMS books/KIA books/other children's health record books

during the COVID-19 pandemic at the Vidyan Medika Main Clinic.

c. Identifying mothers' knowledge during the COVID-19 pandemic at the clinic

Main Vidyan Medika.

d. Analyzing the relationship between maternal age and complete basic immunization

status in babies during the COVID-19 pandemic at the Vidyan Medika Main Clinic.

e. Analyzing the relationship between maternal education and complete basic

immunization status for babies during the COVID-19 pandemic at the Vidyan Medika

Main Clinic.

f. Analyzing the relationship between maternal employment and complete basic

immunization status for babies during the COVID-19 pandemic at the Vidyan Medika

Main Clinic.

g. Analyzing the relationship between ownership of KMS books/KIA books/other

children's health record books with the complete basic immunization status of babies

during the COVID-19 pandemic at the Vidyan Medika Main Clinic.

h. Analyzing the relationship between maternal knowledge and complete basic

immunization status for babies during the COVID-19 pandemic at the Vidyan Medika

Main Clinic.

D. Benefits of Research

1. Theoretical Benefits

Students are able to apply the knowledge and theories obtained during lectures

in analyzing data regarding factors related to complete basic immunization status in

babies during the Covid-19 pandemic. Can be used as a source of input or reference
in compiling subsequent reports regarding factors associated with complete basic

immunization status in infants during the Covid-19 pandemic.

2. Practical Benefits

a. For Health Workers

Pe It is hoped that this research will increase the knowledge of health workers

regarding factors related to the complete basic immunization status of babies during

the Covid-19 pandemic so that they can take an active role in immunization programs

to improve the health status of babies.

b. For Government Agencies

Pe This research is expected to provide information as input for government

agencies such as the Health Service to find out factors related to complete basic

immunization status in babies so that it can be used to plan health intervention

programs.

c. For Society

Pe This research is expected to provide information and knowledge to the

public, especially parents regarding factors related to the complete basic

immunization status of babies during the Covid-19 pandemic, so that parents are

willing and able to take their babies to get complete basic immunization according to

schedule. the baby's age and in accordance with health protocols.

 CHAPTER II

LITERATURE REVIEW

A. Immunization

1. Definition of Immunization

Immunization comes from the word immune, resistant or resistant. Children

are immunized, meaning they are given immunity against a particular disease.

Children are immune or resistant to one disease but not necessarily immune to other

diseases. Immunization is an effort to actively create/increase a person's immunity

against a disease, so that if one day they are exposed to the disease they will not get

sick or will only experience mild illness (Ministry of Health of the Republic of

Indonesia, 2015).

IImmunization is an effective way to prevent disease transmission and reduce

morbidity and mortality rates in infants and toddlers (Mardianti & Farida, 2020).

Immunization is the most effective and efficient public health effort in preventing

several dangerous diseases (Ministry of Health of the Republic of Indonesia, 2020).

Immunization is an effective primary prevention effort to prevent the occurrence of

infectious diseases that can be prevented by immunization (Senewe et al.,

2017).

JaImmunization is an action that deliberately provides antigens or bacteria

from a pathogen that will stimulate the immune system and cause immunity, so that

you only experience mild symptoms when exposed to the disease.

2. Benefits of Immunization

The benefits of immunization cannot be felt immediately or are not

immediately visible. The real benefit of immunization is reducing the incidence of

disease, disability and death due to diseases that can be prevented by immunization.

Immunization can not only provide protection to individuals but can also provide

protection to populations

Immunization is a healthy paradigm in the most effective prevention efforts

(Mardianti & Farida, 2020). Immunization is a health investment for the future

because it can provide protection against infectious diseases, with immunization it

can provide protection to individuals and prevent someone from falling ill and

requiring more expensive costs.

3. Barriers to immunization

PeThe differences in perceptions that exist in society cause obstacles to the

implementation of immunization. Other problems in implementing complete basic

immunization include fear that the child will have a fever, often get sick, the family

won't allow it, the immunization place is far away, they don't know where the

immunization is, and it's busy/busy (Ministry of Health of the Republic of Indonesia,

2015).

Peunderstand about immunization that immunization can cause dangerous

side effects such as pharmacological effects, action errors or what are usually called

Post-Immunization Adverse Events (AEFI) such as pain at the injection site, local

swelling, chills, seizures, this causes parents or the public not to carry their children to

health services, resulting in the majority of babies and toddlers not having received

immunizations (Ministry of Health of the Republic of Indonesia, 2015).

4. Diseases that can be prevented by immunization

Be Based on the Ministry of Health Data (2016), diseases that can be

prevented by immunization are:

a. Mandatory immunizations include: polio, tuberculosis, hepatitis B, diphtheria,

measles, rubella and congenital rubella syndrome (CRS).

b. Recommended immunizations include: tetanus, pneumonia (lung inflammation),

meningitis (inflammation of the lining of the brain), chicken pox. The reason for

providing immunization against this disease is because the incidence in Indonesia is

still quite high, which can be seen from the number of children under five who die

from diseases that can be prevented by immunization (PD3I).

c. Other immunizations are adjusted to the conditions of a particular country

5. Immunization in Indonesia

In Indonesia, an organized immunization program has been around for years

1956, in 1974 it was declared free from smallpox (Ministry of Health of the Republic

of Indonesia, 2015). Immunization activities were developed into PPI (Immunization

Development Program) in 1977, in an effort to prevent transmission of several

diseases that can be prevented by immunization (PD3I) such as Tuberculosis,

Diphtheria, Pertussis, Measles, Polio, Tetanus and Hepatitis B (Permenkes, 2017).

Developments in technology, information and communication, especially in

the health sector, have encouraged improvements in the quality of immunization

services, marked by the discovery of several new vaccines such as Rotavirus,

Jappanese Encephalitis, and others. Apart from that, technological developments have

also occurred
combining several types of vaccines as a combination vaccine has been proven to

increase immunization coverage, reduce the number of injections and contact with

staff (Ministry of Health of the Republic of Indonesia, 2015).

6. Government Program for Immunization

Be Based on Minister of Health Decree Number 12 of 2017 concerning the

Implementation of Immunization, the main government activities for immunization

are:

a. Routine Immunization

Routine immunization activities are mandatory and continuous immunization

activities that must be carried out within a predetermined time period according to age

and immunization schedule. Based on the target age group, routine immunization is

divided into:

1) Routine immunization for babies

2) Routine immunization for women of childbearing age

3) Routine immunization for school children

Be Based on the place of routine immunization services, they are divided into:

1) Immunization services inside the building are carried out at community health

centers, supporting community health centers, hospitals, maternity homes and

polindes

2) Immunization services outside the building are carried out at posyandu, home and

school visits

3) Routine immunization services can also be provided by the private sector, such as

hospitals, practicing doctors and practicing midwives

b. Additional Immunizations

Additional immunization is an immunization activity that is not mandatory, it is

only carried out on the basis of the discovery of problems from the results of monitoring

and evaluation, which includes additional immunization including

2) Backlog fighting

Backlog sais an active effort to complete basic immunization for children aged 1-

3 years. Implemented in villages that have not achieved (Universal Child Immunization /

UCI) for two years.

3) Crashing programs

This activity is aimed at areas that require rapid intervention due to specific

problems such as:

a)The infant mortality rate due to VPD is high

b) Infrastructure (manpower, facilities, funds) is lacking

c)Villages that for three consecutive years have not achieved (Universal Child

Immunization/ UCI).

This activity usually takes a relatively long time, requires a lot of energy and

costs, so it is very necessary to evaluate indicators that need to be determined, for

example measles, or integrated measles and polio.

4) PIN (National Immunization Week)

PeNational Immunization is an activity to break the chain of spread of the polio

or measles virus by providing polio and measles vaccines to every baby and toddler

without considering previous immunization status. Providing measles and polio

immunization during PIN, in addition to breaking the chain of transmission, is also

useful as a repeat immunization

 CHAPTER III

KCONCLUSIONS AND SUGGESTIONS

A. CONCLUSION

1. Implementation of Immunization

a. KeseHatan is a healthy state, both physically, mentally, spiritually and socially,

which allows everyone to live a productive life socially and economically. Health is

a very important element for the progress of a country and every country has a goal

in health service efforts to improve the level of health by providing professional

health personnel and adequate and modern health facilities. The state also makes

legal regulations that regulate the rights, obligations, functions and responsibilities

of the parties involved in the health sector.

b. Imunization is the administration of viral or bacterial antigens into the body so that

the body can make a substance to prevent certain diseases. Meanwhile, what is

meant by vaccine is a material used to stimulate the formation of anti-substances

which are inserted into the body through injections such as the BCG, DPT, Measles

vaccines, and by mouth such as the Polio vaccine. The aim of immunization is to

provide protection against diseases that can be prevented by immunization. The

immunization program in Indonesia aims to reduce the incidence of disease and

death rates due to diseases that can be prevented by immunization (PD3I). At this

time diseaseste These are dysentery, tetanus, whooping cough (pertussis), smallpox

(measles), polio, and tuberculosis.

c. StThe strategy carried out by the Government in implementing immunization is to

increase immunization coverage in order to reduce morbidity and infant mortality

rates. People can get free access to immunization services if they do it at

government facilities. To maintain the quality of immunization services, the

government carries out joint supervision and guidance with BPOM regarding the

provision and distribution of vaccines. Regulation of the Minister of Health Number

12 of 2017 concerning the Implementation of Immunization has been established to

 serve as a guideline for implementing immunization in government, private and

community settings, seeking to equalize the reach of Immunization services by

involving various related sectors; and strive for quality service.

2. Principle of Benefit

a.Hlaw is a set of rules and guidelines for life to regulate order in a society involving

the government; principle is a basis or foundation; Legal principles are the basis for

thinking in the formation of positive law and are the broadest basis, functioning as a

basis for legal measures and as a basis for providing direction.

b. The principle of utility has the value of creating the greatest happiness for the

greatest number of people; in the sense that legislation as a legal product must be

able to provide adequate happiness for almost all of society; The principle of justice

contains values mewrealize everyone's interests in accordance with their rights, in

the sense that being fair means giving something that someone else should have and

getting something that should belong to him, meaning that being fair is a person's

behavior towards other people. Justice aims to create a balance between self-interest

and the interests of the general public; The Humanitarian Principle contains the

value of realizing respect for other human beings as fellow human beings who have

their own uniqueness, in the sense of always respecting fellow human beings in a

fair and civilized manner, so as to avoid conflicts between fellow human beings.

c. Principle of Benefit, Principle of Justice and Principle of Humanity

AsaBenefits are linked to the principle of justice, namely realizing the value of

providing maximum happiness to as many people as possible by giving to each

person according to their respective rights. The principle of benefit is linked to the

principle of humanity, namely the realization of providing the greatest happiness to

as many people as possible by respecting and respecting fellow human beings in

accordance with human dignity in a fair and civilized manner.

3. PenImmunization implementation is linked to the principle of benefitPeThe

importance of implementing an immunization program as a preventive health effort

for everyone, by giving rights to children who receive immunizations by stimulating

 the emergence of immune reactions in the bodies of people who receive

immunizations that can protect them from the threat of diseases, even though there

is a risk of side effects. Resulting from immunization; the principle of benefit

supported by the principle of justice and the principle of humanity, meaning that

something that provides happiness for as many people as possible by providing the

rights that each person has, even though it is fair for one person it becomes unfair

for others, is accompanied by the value of respect for fellow human beings. ; so that

a temporary answer can be formulated in the form of a working hypothesis: if

regulations regarding immunization are determined, then the principle of benefit is

fulfilled.

B. SUGGESTIONS

1. AgarKemeThe Ministry of Health carries out the Duties and Functions of the

Ministry as a policy maker regarding immunization which aims to continuously

monitor the community's need for legal regulations, because it is an effort to create

the greatest happiness for the greatest number of people and it is the right of

everyone to get adequate health services. primed to be healthy physically, mentally

and spiritually so that we can carry out economic and social activities.

2. AgarInProp/District/City National Health Agency as the supervisor and supervisor

of health service facilities to play an active role in fostering and supervising the

implementation of immunization in each health facility, because the aim of

immunization is not only to provide protection against diseases that can be

prevented by immunization, but also to realize respect for each person's human

values. fair and civilized, namely being a human being who is completely free from

defects.
3. Agarsahealth facilities where immunizations are carried out, apart from having

to meet quality qualification standards and comply with SOPs, also always

provide the right of every citizen to be able to live physically, mentally and

spiritually healthy, because it is fair if every citizen gets their rights in

accordance with what is His part as a human being has the right to obtain

maximum happiness.

4. AgarRelaxa Health always provides immunization services in accordance with its

authority as a professional and does not discriminate between clients based on

either economic or social position, because it is the human right of every human

being to receive preventive protection so that they can live as healthy human

beings in accordance with humanity which aims to realize prosperity nation and

state in accordance with the principles of social justice for all Indonesian people.

5. AgarImmunization service users are always aware of the consequences of the

dangers of pandemics which can cause disability and death by continuously

carrying out a regular and effective immunization process, because the value of

creating a healthy life also results in the formation of a mentally and spiritually

healthy life, so that immunization service users can improving socio-economic

welfare which will bring happiness to oneself and one's family.