Timeliness and Coverage of Basic Immunization among Children

12-48 Months in Puskesmas Amplas Medan City

Juliandi Harahap

, Lita Sri Andayani

and Rina Amelia

Department of Community Medicine, Faculty of Medicine, Universitas Sumatera Utara, Jln. dr. Mansur No. 5 Kampus

USU Medan 20155

Department of Health Education and Behaviour Science, Faculty of Public Health, Universitas Sumatera Utara, Jln.

Universitas No. 21 Kampus USU Medan 20155

Keywords: Basic Immunization, Timeliness, Coverage, Puskesmas.

Abstract: Immunization is a way to increase the body’s immunity against a disease. It can prevent the occurrence of the

disease if an individual is exposed to it later in life. The completeness and timeliness of immunization are

important to ensure the optimal protection against the diseases This was an observational descriptive study

with a retrospective approach. This study was conducted in the working area of Puskesmas Amplas (health

center). The respondents were mothers who have children aged 12 – 48 months which obtained by using the

consecutive sampling method. A total of 72 mothers were interviewed using structured questionnaire and the

health cards of childen were recorded and analyzed. The aims of this study were to analyzed immunization

coverage and its timeliness and to assess the knowlegde of mothers about basic immunization. The study

found that the basic immunization coverage reached only 58.3%, while the the highest timeliness of

immunization was Hepatitis B 0 vaccine 95.8% and the lowest was Polio 4 vaccine 38.9%, where mothers

who had good knowledge about immunization only 58.3%. Therefore, it is important to increase knowledge

of mothers about immunization and take advantage of using a reminder for immunization schedule.



1 INTRODUCTION

Immunization is one of the most effective and

inexpensive ways as a public health intervention

against vaccine-preventable diseases. It is estimated

to avert 2-3 million deaths every year (WHO, 2017).

The purpose of immunization is to provide antigen

specific bacteria or viruses that have been attenuated

or killed in order to stimulate the body's immune

system to form antibodies against the disease

(Ministry of Health, 2016).

The immunization program is targeted towards

populations whom are vulnerable to communicable

diseases, namely infants, children, women of

childbearing age, and pregnant women (Ministry of

Health, 2017).

The Health Act No. 36 of 2009 states that every

child is entitled to basic immunization in accordance

with the provisions to prevent the occurrence of

diseases that can be avoided through immunization

and the government is obliged to provide full

immunization to every infant and children (Ministry

of Health, 2017).

The Ministry of Health of the Republic of

Indonesia’s goal in the years 2015-2019 is to increase

the completion of the basic immunization required of

infants aged 0-11 months to 91-93% (Ministry of

Health, 2015). Based on the 2013 Basic Health

Research (Riskesdas), completion of basic

immunization nationally reached 59.2%, whereas

based on the Indonesian Health Profile data in 2014,

completion of basic immunization amounted to

86.9%, while in North Sumatera this number was

78%. It still has not reached the desired target of the

Strategic Plan (Renstra) of 2015- 2019 which is 91-

93% (Ministry of Health, 2015).

There are many obstacles to implement the

immunization program such as lack of knowledge and

awareness of mothers and community, myths of

immunization, and black campaigns of

immunization. Therefore it is a need to analyzed the

610

Harahap, J., Andayani, L. and Amelia, R.

Timeliness and Coverage of Basic Immunization among Children 12-48 Months in Puskesmas Amplas Medan City.

DOI: 10.5220/0010080406100615

In Proceedings of the International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches (ICOSTEERR 2018) - Research in Industry 4.0, pages

610-615

ISBN: 978-989-758-449-7

basic immunization coverage and its timeliness

among children 12 – 24 months in the working area

of Puskesmas Amplas Medan and assess the level of

knowledge of mothers about the basic immunizations.

2 METHODS

This research was a descriptive observational study

with retrospective approach. This research was

conducted in working areas of Puskesmas Amplas.

The samples were obtained using consecutive

sampling method. The samples in this study were

mothers who have children aged between 12-48

months, where they interviewed by using structured

questionnaires and their children immunization

records (immunization card/other health card that

records the data of immunization) were observed and

analyzed. A total of 72 mothers who have children

aged 12 – 48 months was interviewed about their

knowledge about basic immunization and the

immunization history that their babies had during

aged 0 - 12 months. The immunization history was

cross-checked with the immunization record (health

card) or the medical record from health centre

(posyandu/puskesmas).

3 RESULTS

3.1 Characteristics of Mothers and

Children

Characteritics of mothers and their chidren showed in

Table 1, where the majority of the mothers were aged

between 20-30 years, where 40 (55.6%) of the

mothers were in that age range. Majority mothers had

education at senior high school level 42 people

(59.3%). Most of the mothers were either housewives

or unemployed 58 people (80.6%). Meanwhile in

term of gender of childen, there were boys 51.4% and

girls 48.6%.



Table 1: Characteristics of mothers and children.

Characteristics n %

Mother Age (years)

20 - 30

30 - 40

>40

55.6

40.3

4.1

Educational Level

Primay School

Junior High School

Senior High School

Universit

2.8

13.9

59.3

Mother Work

Not Working/Housewife

Privat Employee

Government Office

80.6

15.3

4.1

Children Gender

Boys

Girls

51.4

48.6

3.2 Basic Immunization Coverage and

Mothers’ Knowledge

The coverage of basic immunization in this study was

defined as complete immunization if a child aged less

than 12 months completed his/her immunization by

receiving one dose of Hepatitis B 0 vaccine, one dose

of BCG vaccine, four doses of Polio vaccine, three

doses of Pentavalent vaccine (DPT-HB-Hib), and one

dose of Measles vaccine. The status of immunization

coverage among 72 children in this study can be seen

in Table 2 below.

Table 2: Basic immunization coverage.

Coverage n %

Complete

Incomplete

58.3

41.7

Total 72 100

Table 2 showed that the completeness of basic

immunization coverage only reached 58.3%, and

about 42% of children didn’t complete their basic

immunization.

Based on the type of immunization, the

completeness of each immunization as shown in

Table 3 below.

Timeliness and Coverage of Basic Immunization among Children 12-48 Months in Puskesmas Amplas Medan City

611

Tabel 3: Coverage for each immunization.

Basic

Immunization Type

Complete Incomplete

n % n %

Hep B0 69 95.8 3 4.2

BCG 71 98.6 1 1.4

Polio 1 60 83.3 12 16.7

Polio 2 70 97.2 2 2.8

Polio 3 69 95.8 3 4.2

Polio 4 56 77.8 16 22.2

Pentavalent 1 72 100 0 0

Pentavalent 2 68 94.4 4 5.6

Pentavalent 3 64 88.9 8 11.1

Measles 66 91.7 6 8.3

The completeness of basic immunization was

vary among the type of vaccination where the highest

coverage was Pentavalent 1 (100%), follwed by BCG

(98.6%) and Hepatitis B 0 (95.8%). Meanwhile the

lowest coverage was immunization of Polio 4 as

much as 77.8%.

Table 4: Basic Immunization coverage and mothers’

knowledge.

Level of

Knowled

Basic Immunization

Covera

Total

Complete Incomplet

n % n % n %

Poor 1 1.39 5 6.94 6 8.33

Average 1

20.8

9 12.5

33,3

Good 2

36.1

22.2

58.3

Total 4

58.3

41.6

100

The knowledge about basic immunization is

important thing that influnce mothers behavoir

regarding implementation of immunization

programs. Table 4 revealed that majority of

respondents was had good knowledge level about

basic immunization as much as 58.33%. Table 4 also

showed that from the 42 respondents (58.33%) that

have completed required immunizations for their

children, there were 26 respondents (36.11%) with a

good level of knowledge, 15 respondents (20.83%)

with an average level of knowledge and 1 respondent

(1.39%) with a poor level of knowledge of basic

immunization. Meanwhile, from the 30 respondents

(41.67%) that have not completed the required

immunizations for their children, there were 16

respondents (22.22%) with a good level of

knowledge, 9 respondents (12.50%) with an average

level of knowledge and 5 respondents (6.95%) with a

poor level of knowledge of basic immunization.

3.3 Basic Immunization Timeliness and

Mothers’ Knowledge

The timeliness of basic immunization in this study

was defined as right time, if a baby aged less than 12

months received his/her immunization in line with

national imunizations program schedule, ie; hepatitis

B vaccine 0 at 0 – 7 days, BCG vaccine at 1 month,

Polio 1, 2, 3 and 4 vaccines at 1, 2, 3 and 4 months,

Pentavalent 1, 2, and 3 vaccine at 2, 3, and 4 months,

and Measles vaccine at 9 months. The status of

timeliness of childen in working areas of Puskesmas

Amplas as in Table 5 below.

Table 5: Timeliness of basic immunization.

Timeliness n %

ht time 18 25

Not right time 54 75

Total 71 100

Based on Table 5, only 25% of the respondents

who received the immunization at the recomended

schedule, majority respondents did not receive the

immunization at the appropriate time (75%).

Tabel 6: Timeliness for each immunization.

From Table 6 above, it can be revealed that

highest percentase of timeliness among basic

Basic

Immunization

Type

Right Time Not Right Time

n% n %

B 0 66 91.7 6 8.3

BCG 56 77.8 16 22.2

Polio 1 40 55.6 32 44.4

Polio 2 32 44.4 40 55.6

Polio 3 31 43.1 41 56.9

Polio 4 28 38.9 44 61.7

Pentavalent 1 36 50 36 50

Pentavalent 2 29 40.3 43 59.7

Pentavalent 3 26 36.1 46 63.9

Measles 43 59.7 29 40.3

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

612

immunizations was Hepatitis B 0 as much as 91.7%

which meant the baby received Hepatitis B 0 at the

right time as recommended schedule. The lowest

percentage of immunization timeliness was

Pentavalent 3 as much as 36.1%. The hepatitis B 0

immunization is given to a baby at 0-7 days after

his/her delivery, while the Pentavalen 3 vaccine is

given at age 4 months.

Table 7: Basic immunization timeliness and mothers’

knowledge.

Level of

Knowled

Timeliness of Basic

Immunization

Total

on Right

Time

Not on

Right

Time

n % n % n %

Poor 0 0 6 8.33 6 8.33

Average 5 6.95 1

26.39 2

33,3

Good 1

18.05 2

40.28 4

58.3

Total 1

25 5

75 7

100

Table 7 showed that from 18 respondents

(25%) that were timely for immunizations, 13

respondents (18.05%) had a good level of knowledge,

5 respondents (6.95%) had an average level of

knowledge and no respondents had poor level of

knowledge on basic immunization. Meanwhile, from

54 respondents (75%) that were not on time to

immunize their children, 29 respondents (40.28%)

had a good level of knowledge, 19 respondents

(26.39%) had an average level of knowledge and 6

respondents (8.33%) have a poor level of knowledge

on basic immunization.

Table 8: Coverage and timeliness of basic immunizations.

Basic

Immunizatio

Complet

e and on

Right

Time

Complete

but

Not on

Right

Time

Incomplet

n % n % n %

Hepatitis B 0 6

91.

3 4.2 3 4.2

BCG 5

77.

20.

1 1.4

Polio 1 4

55.

27.

16.7

Polio 2 3

44.

52.

2 2.8

Polio 3 3

52.

3 4.2

Polio 4 2

38.

22.2

Pentavalent 1 3

50.

0 0

Pentavalent 2 2

40.

54.

4 5.6

Pentavalent 3 2

36.

52.

8 11.1

Measles 4

59.

31.

6 8.3

Table 8 data showed that the majority of

respondents got complete and timely immunization of

Hepatitis B 0, which amounted to 66 infants (91.6%).

Meanwhile, the majority of respondents had

completed but untimely immunizations of Pentavelen

2, which amounted to 39 babies (54.2%). Lastly, the

most incomplete of administrations was the Polio 4

immunization, with 16 of the respondents (22.2%)

having not completed it.

4 DISCUSSIONS

4.1 Basic Immunization Coverage

The completeness and timeliness of immunization are

very important to ensure the effectiveness of

immunization in order to achieve the optimal level of

antibody to protect children from the diseases. The

immunization behavior of children depends on the

behavior of their mothers, where many factors may

influence that behavior. One of the influencing

factors is the knowledge of mothers about these

immunizations. This study found that the level of

knowledge of mothers was good as much as 58.33%,

while the rest were average and poor knowledge level

respectively 33.34% and 8.33%. Meanwhile, the

majority of mothers in this study was mothers aged

20 – 30 amounted to 55.6%, with background

education at least senior high school as much as

83.3%, and most of them with the status of not

working or housewife. It’s acknowledged that the

higher level of education will result in the better level

of knowledge. A study in Yogyakarta 2016, revealed

that the majority (80%) of respondents had a good

level of knowledge about immunization and more

than half (57%) were senior high school graduates,

while only 8% had a poor level of knowledge about

immunization. A study conducted by Destiyanta

(2015) found that there was no relationship between

education and timeliness of measles immunization.

Kusmita and Kartini (2015) which showed that the

majority of respondents who were high school

Timeliness and Coverage of Basic Immunization among Children 12-48 Months in Puskesmas Amplas Medan City

613

graduates had a good level of knowledge about

immunization.

In addition, a study done by Rahayu

and Wahtini (2017) also supported the results of this

study.

In this study it was found that majority of children

who had complete immunization coverage were 42

infants (58.3%). This study has not yet reached the

target of a Strategic Plan (Renstra) in 2014 amounted

to 90%. The same thing was also reported in the study

(Thaib, 2013) obtained 83.5% of respondents had

complete basic immunization status, 15.5% did not

complete, and 1% never immunized. The reasons of

incomplete basic immunization were parents’ anxiety

and afraid of side effects immunization.

evaluation of immunization Hepatitis B in District of

Asahan, found that the reasons for the incompleteness

of immunization were mother did not aware of time

of immunization and children were sick (Harahap,

2008).

Other results obtained from studies by (Tanjung,

2017) at the General Hospital of Dr Haji Adam Malik

Medan showed, that the number of infants who were

fully immunized reached as many as 46 infants

(40.7%) while, 67 infants (59.3%) had incomplete

immunizations. This result is not much different with

a complete basic immunization coverage study done

in Padang in 2013. Basic immunization coverage in

South Sulawesi in 2012 amounted to 88.8%

(Makamban, 2014).

4.2 Basic Immunization Timeliness

In this study, the timeliness of basic immunization

among 72 children aged 12-48 months was

inadequate, where 54 respondents (75%) didn’t

immunize on right time as recommended schedule

and only 18 respondents (25%) immunized on right

time. The timeliness for immunization of Hepatitis B

0 reached to 91.7% which meant the baby received

Hepatitis B 0 at the right time as recommended

schedule. The lowest percentage of immunization

timeliness was Pentavalen 3 as much as 36.1%. The

schedul of hepatitis B 0 immunization is 0 -7 days,

while the Pentavalen 3 vaccine is at age 4 months.

The results of this study was better than the results

from Fauziah (2016) where the accuracy of

immunization in Sri Martuti Clinic, Yogyakarta was

only 63.3%. Based on the data profile of Gedang Sari

Yogyakarta Health Center in 2011, the coverage for

immunizations Hepatitis B 0 was 90.48%, and only

41.7% (25 respondents) were timely in their

immunizations, while 58.3% (35 respondents) were

not. Based on a study by Azizah and Rahmawarti

(2012), it can be concluded that a higher level of

education can increase parent compliance of required

immunization for children and therefore increase

overall immunization coverage and timeliness.

research conducted by Irawati (2011), revealed that

the mother's level of knowledge regarding the

timeliness of immunization, in which a poor level of

knowledge results in increasing noncompliance of

immunization schedules.

In addition, this study also found that the roles of

health providers in the immunization of children aged

12-48 months in Puskesmas Amplas were well

executed, but there were only a few officers who went

to the citizens’ houses to remind residents of

immunization schedules. The results were similar to

a study conducted by Supardi (2001) in Bangka

District Health Center which stated that the role

played by health provider will further enhance the

implementation of the immunization program.

5 CONCLUSIONS

The coverage and timeliness of basic immunization

among children aged 12 – 24 months in the working

area of Puskesmas Amplas were 58.3% and 25%

respectively. This basic immunization coverage

consists of receiving one doses of Hepatitis B0

vaccine, one dose of BCG vaccine, four doses of

Polio vaccine, three doses of Pentavalent vaccine and

one dose of Measles vaccine before the child reaches

age one year, while the timeliness of basic

immunization refers to when a child receives each

type of immunization at the right time in line with the

recommended schedule by national immunization

program. In order to attain higher coverage and

timeliness of basic immunization, it is important to

increase knowledge of mothers about immunization

and take advantage of using a reminder for

immunization schedule.

ACKNOWLEDGEMENTS

The authors gratefully acknowledge that the present

research was support by the Directorate of Research

and Community Service of the Directorate General

for Research and Development of the Ministry of

Research, Technology and Higher Education by the

agreement of Funding Research and Community

Service for the Fiscal Year 2018 with the contract

number: 215/UN5.2.3.1/PPM/KP-DRPM/2018

ICOSTEERR 2018 - International Conference of Science, Technology, Engineering, Environmental and Ramiﬁcation Researches

614

REFERENCES

Azizah N, Rahmawati VE, 2012. Relationship Capital

Knowledge Level About the Importance of Primary

Immunization with BPS Compliance Implement

Immunization Hj. Umm Salama in Kauman,

Peterongan, Jombang. Proceedings Seminas. October

18; 1 (2).

Destiyanta AP, 2015. The relationship between the level of

education, employment, and knowledge of mothers

with accuracy following the measles immunization

schedule in the Puskesmas Weru region. Thesis,

University of Muhammadiyah Surakarta.

http://eprints.ums.ac.id/id/eprint/39740

Fauziah A, 2016. Relationship with the mother's knowledge

level of punctuality to immunize infants in BPS Sri

Martuti, Bantul, Yogyakarta. Respati Medical Journal.

October: 11 (4).

Harahap J, 2008. Evaluation of Hepatitis B Immunization

Coverage among Child Aged 12 -24 months in Asahan

District, North Sumatera Province. Jurnal Penelitian

Rekayasa, Vol. 1 No.2

Hikmayati DM, Rahman M, and Rahayu A, 2013.

Relationship Between Mothers With Educational Level

Completed Primary Immunization Status In Toddlers

At the Malay Village Ilir. UNLAM.

Irawati D, 2011. Characteristics of Capital Factors

Associated with Accuracy combo DPT and measles

immunization in Pasuruan. Hospital Majapahit.

February 1; 3.

Kusmita E and Kartini F. The relationship between

mother’s knowledge and time in performing BCG

immunization at Endang Midwifery Clinic in Pleret

Bantul Yogyakarta, STIKES'Aisyiyah Yogyakarta.

Makamban Y, Salmah U, and Rahma, 2014. Factors

Associated with Complete Basic Immunization

Coverage in Infants in Puskesmas between Makassar.

Thesis. UNHAS. 1-13.

Ministry of Health, 2017. Data and information on the

health profile of Indonesia 2016. Jakarta.

Ministry of Health, 2016. Immunization situation in

Indonesia. Jakarta: Center for Data and Information.

Ministry of Health. 2015. Surveillance Directorate,

Immunization, Quarantine and Health Matra and the

Directorate General of PP & PL Ministry of Health.

Immunization Pregnant women, babies, and toddlers in

Indonesia.

Rahayu TA and Wahtini S, 2017. The correlatipn between

mother knowledge about measles immunization and the

implementation of measles booster immunization in

working area of Puskesmas Kotagede 1 Yogyakarta

Thesis. UNISA

Supardi, 2001. Relationship management aspects of

monitoring the management of the local area (pws)

immunization with immunization coverage health

centers in Bangka 2001. [Internet]. Downloaded from:

http://eprints.undip.ac.id/6563.

Tanjung IC, Rohmawati L, and Sofyani S, 2017. Complete

Basic Immunization Coverage and Influential Factors.

Sari Paediatrics. Nov 27; 19 (2): 86-90.

Thaib TM, Darussalam D, Yusuf S, and Andid R, 2016.

Basic immunization coverage of children aged 1-5

years and some related factors in the Polyclinic

Hospital Children Mother and Child (RSIA) Banda

Aceh. Sari Paediatrics. Nov 16; 14 (5): 283-7.

World Health Organization, 2017. Health topics:

Immunization.http://www.who.int/topics/immunizatio

n/en/

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