Assessment of the associated factors of measles immunization dropout: A community-based study in a high-dropping region 10.55131/jphd/2024/230105

Main Article Content

Jaleha Jaleha
Bagoes Widjarnarko
Henry Setyawan Susanto
Ani Margawati
Soeharyo Hadisaputro
Suhartono Damas
Kholisotul Hikmah
Eko Dian Septiawan

Abstract

Measles is a viral disease that can be prevented through vaccination and is a leading cause of childhood mortality. Immunizing children against measles is a highly effective and cost-efficient public health intervention. However, there are still gaps in vaccination coverage; some children do not receive complete immunization. We aimed to describe caregivers' factors and identify determinants of vaccine dropout. We used community-based participatory research and in-depth interviews. The study included 430 caregivers of infants aged between 12 and 36 months. Most infants came from low-income families, had only one sibling, and lived more than 1 km from the vaccination centers. The study found that lack of support from family (Adj. PR=4.23; 2.82 – 6.33; p<0.001) and social support (Adj. PR=2.43; 1.33 – 4.45; p= 0.04) was the main reason for vaccine dropout, followed by the distance from the vaccination centers (Adj. PR= 1.47; 1.07 – 2.00; p= 0.02), and low socioeconomic status (Adj. PR= 1.40; 1.05 – 1.88; p= 0.02). In conclusion, the absence of support from family, and local leaders, and the distance of households from measles vaccination providers were the determinants of the measles vaccine dropout rate. To address these issues, the study recommends that healthcare workers engage local leaders in collaborative efforts to deliver integrated health education in the local dialect. This will help to ensure that all children receive the full course of immunization against measles, and reduce the risk of childhood mortality.

Article Details

How to Cite
1.
Jaleha J, Widjarnarko B, Susanto HS, Margawati A, Hadisaputro S, Damas S, Hikmah K, Septiawan ED. Assessment of the associated factors of measles immunization dropout: A community-based study in a high-dropping region: 10.55131/jphd/2024/230105. J Public Hlth Dev [internet]. 2024 Dec. 31 [cited 2025 May 16];23(1):57-71. available from: https://he01.tci-thaijo.org/index.php/AIHD-MU/article/view/271429
Section
Original Articles
Author Biographies

Jaleha Jaleha, Doctoral Program in Medicine and Health Sciences, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Doctoral Program in Medicine and Health Sciences, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Bagoes Widjarnarko, Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Henry Setyawan Susanto, Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Ani Margawati, Department of Nutrition Science, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Department of Nutrition Science, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Soeharyo Hadisaputro, Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Faculty of Medicine, University of Diponegoro, Semarang, Central Java, Indonesia

Suhartono Damas, Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Faculty of Public Health, University of Diponegoro, Semarang, Central Java, Indonesia

Kholisotul Hikmah, Tuberculosis Unit of The Global Fund, Provincial Health Office of West Kalimantan, Indonesia

Tuberculosis Unit of The Global Fund, Provincial Health Office of West Kalimantan, Indonesia

Eko Dian Septiawan, Mempawah District Health Office, West Kalimantan, Indonesia

Mempawah District Health Office, West Kalimantan, Indonesia

References

CDC. Measles (Rubeola) 2020 [Internet]. [Cited 2024 May 10]. Available from: https://www.cdc.gov/ measles/hcp/index.html#:~:text=Measles

Naim HY. Measles Virus: A Pathogen, Vaccine, and a Vector. Hum Vaccin Immunother. 2015;11(1):21–26. doi: 10.4161/hv.34298

WHO. Measles. 2023 [Internet]. [Cited 2024 May 1]. Available from: https://www.who.int/news-room/fact-sheets/detail/measles

Sanyaolu A, Okorie C, Marinkovic A, Ayodele O, Abbasi AF, Prakash S, et al. Measles outbreak in unvaccinated and partially vaccinated children and adults in the United States and Canada (2018-2019): A narrative review of cases. Inquiry. 2019;56: 4695801989 4098. doi: 10.1177/0046958019894 098

Minta AA, Ferrari M, Antoni S, Portnoy A, Sbarra A, Lambert B, et al. Morbidity and Mortality Weekly Report: Progress toward Measles Elimination-Worldwide, 2000-2022. MMWR Morb Mortal Wkly Rep. 2023;72(46):1262-1268. doi: 10.15585/mmwr.mm7246a3

Chacko S, Kamal M, Hastuti EB, Mildya F, Kelyombar C, Voronika V, et al. Progress toward Measles and Rubella Elimination-Indonesia, 2013-2022. MMWR Morb Mortal Wkly Rep 2023;72:1134–1139. doi: 10.15585/ mmwr.mm7242a2

Directorate of Health Surveillance and Quarantine. Performance Report of 2023. 2024 [Internet]. [Cited 2024 April 23]. Available from:

Gastañaduy PA, Goodson JL, Panagiotakopoulos L, Rota PA, Orenstein WA, Patel M. Measles in the 21st century: Progress toward achieving and sustaining elimination. J Infect Dis. 2021;224:S420–S428. doi: 10.1093/infdis/jiaa793

Hayman DTS. Measles Vaccination in an Increasingly Immunized and Developed World. Hum Vaccin Immunother. 2019;15(1):28–33. doi: 10.1080/21645515.2018.1517074

Mebrat A, Dube L, Kebede A, Aweke Z. Determinants of Incomplete Childhood Vaccination among Children Aged 12-23 Months in Gambela Region, Southwest Ethiopia: A Case Control Study. Ethiop J Health Sci. 2021;31(1):63–72. doi: 10.4314/ ejhs.v31i1.8

Mihret Fetene S, Debebe Negash W, Shewarega ES, Asmamaw DB, Belay DG, Teklu RE, et al. Determinants of full immunization coverage among children 12–23 months of age from deviant mothers/caregivers in Ethiopia: A multilevel analysis using 2016 demographic and health survey. Front Public Health. 2023;11:1085279. doi: 10.3389/fpubh.2023.1085279

Ichimura Y, Yanagisawa N, Thandar MM, Pathammavong C, Phounphenghuk K, Nouanthong P, et al. The determinants of immunization coverage among children aged between 12 and 35 months: a nationwide cross-sectional study in Lao People’s Democratic Republic. BMC Public Health. 2022;22(1): 2259. doi: 10.1186/s12889-022-14522-w

Sheikh N, Sultana M, Ali N, Akram R, Mahumud RA, Asaduzzaman M, et al. Coverage, Timelines, and Determinants of Incomplete Immunization in Bangladesh. Trop Med Infect Dis. 2018;3(3):72. doi: 10.3390/tropicalmed3030072

Shiferie F, Gebremedhin S, Andargie G, Tsegaye DA, Alemayehu WA, Mekuria LA, et al. Vaccination dropout and wealth related inequality among children aged 12–35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey. Front Pediatr. 2023;11: 1280746. doi: 10.3389/fped.2023. 1280746

Ntenda PAM, Sixpence A, Mwenyenkulu TE, Mmanga K, Chirambo AC, Bauleni A, et al. Determinants of pentavalent and measles vaccination dropouts among children aged 12–23 months in The Gambia. BMC Public Health. 2022;22(1):520. doi: 10.1186/s12889-022-12914-6

Mempawah Health Office. Global Update and Surveillance in the Context of the Impact of Covid-19 on Routine Immunization Coverage. 2023.

Badan Pusat Statistik Kabupaten Mempawah. Population by Gender (Person), 2020-2022. 2023 [Internet]. [Cited 2024 April 13]. Available from: https://mempawahkab.bps.go.id/indicator/40/230/1/jumlah-penduduk-menurut-jenis-kelamin-.html

Badan Pusat Statistik. Sosial Dan Kependudukan [Internet]. [Cited 2024 April 24]. Available from: https://mempawahkab.bps.go.id/subject/23/kemiskinan.html

Quattrochi JP, Hill K, Salomon JA, Castro MC. The effects of changes in distance to nearest health facility on under-5 mortality and health care utilization in rural Malawi, 1980-1998. BMC Health Serv Res. 2020; 20(1):899. doi: 10.1186/s12913-020-05738-w

Ministry of Health Republic Indonesia. 2019 Indonesia Health Profile. 2024 [Internet]. [Cited 2024 April 24].

Cunniff L, Alyanak E, Fix A, Novak M, Peterson M, Mevis K, et al. The impact of the COVID-19 pandemic on vaccination uptake in the United States and strategies to recover and improve vaccination rates: A review. Hum Vaccin Immunother. 2023;19(2): 2246502. doi: 10.1080/21645515. 2023.2246502

Stewart R. Inference 1: chance, bias, and confounding. In: Martin P, and others (eds). Practical Psychiatric Epidemiology. 1 edn. Oxford University Press; 2013;p.221–238. doi: 10.1093/med/9780198515517.003.0012

Ilhami I, Afif M. The Influence of Family Support on Providing Complete Primary Immunizations. JPK. 2020;8(2):198-205; doi: 10.20473/jpk.v8.i2.2020.198-205

Rogers K. Immunization Noncompliance: Gauging the Cause, Effect, and Management in the School Setting. NASN School Nurse. 2019; 34(3):140–144. doi: 10.1177/19426 02X18799868

Callender D. Vaccine Hesitancy: More than a Movement. Hum Vaccin Immunother. 2016;12(9):2464–2468. doi: 10.1080/21645515.2016.1178434

Damnjanović K, Graeber J, Ilić S, Lam WY, Lep Ž, Morales S, et al. Parental decision-making on childhood vaccination. Front Psychol. 2018; 9:735. doi: 10.3389/fpsyg.2018.00735

Bogale SK, Cherie N, Bogale EK. Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: Cross-sectional study. PLoS One. 2022;17(11):e0276565. doi: 10.1371/journal.pone.0276565

Radzyminski S, Callister LC. Mother’s Beliefs, Attitudes, and Decision Making Related to Infant Feeding Choices. J Perinat Educ. 2016;25(1): 18–28. doi: 10.1891/1058-1243.25.1. 18

Shearer JC, Nava O, Prosser W, Nawaz S, Mulongo S, Mambu T, et al. Uncovering the Drivers of Childhood Immunization Inequality with Caregivers, Community Members and Health System Stakeholders: Results from a Human-Centered Design Study in DRC, Mozambique and Nigeria. Vaccines (Basel). 2023;11(3):689. doi: 10.3390/vaccines11030689

Powelson J, Magadzire BP, Draiva A, Denno D, Ibraimo A, Benate BBL, et al. Determinants of immunisation dropout among children under the age of 2 in Zambézia province, Mozambique: a community-based participatory research study using Photovoice. BMJ Open. 2022;12(3): e057245. doi: 10.1136/bmjopen-2021-057245

Ernsting A, Knoll N, Schneider M, Schwarzer R. The enabling effect of social support on vaccination uptake via self-efficacy and planning. Psychol Health Med. 2015;20(2):239–246. doi: 10.1080/13548506.2014.920957

Galanis P, Katsiroumpa A, Sourtzi P, Siskou O, Konstantakopoulou O, Katsoulas T, et al. Social Support Mediates the Relationship between COVID-19-Related Burnout and Booster Vaccination Willingness among Fully Vaccinated Nurses. Vaccines (Basel). 2023;11(1):46. doi: 10.3390/vaccines11010046

Kayembe-Ntumba HC, Vangola F, Ansobi P, Kapour G, Bokabo E, Mandja BA, et al. Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study. Arch of Public Health. 2022;80(1):18. doi: 10.1186/s13690-021-00782-2

Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, et al. Vaccine Equity in Low and Middle Income Countries: A Systematic Review and Meta-Analysis. Int J Equity Health. 2022;21(1):82. doi: 10.1186/s12939-022-01678-5

Thapa K, Adhikary P, Faruquee MH, Suwal BR. Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal. Adv Prev Med. 2021;2021:1319090. doi: 10.1155/ 2021/1319090

Srivastava S, Fledderjohann J, Upadhyay AK. Explaining socioeconomic inequalities in immunisation coverage in India: New insights from the fourth National Family Health Survey (2015-16). BMC Pediatr. 2020;20(1):295. doi: 10.1186/s12887-020-02196-5

Okwaraji YB, Mulholland K, Schellenberg JR, Andarge G, Admassu M, Edmond KM. The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia. A community based cross sectional study. BMC Public Health. 2012;12:476. doi: 10.1186/ 1471-2458-12-476

Shemwell SA, Peratikos MB, González-Calvo L, Renom-Llonch M, Boon A, Martinho S, et al. Determinants of full vaccination status in children aged 12-23 months in Gurùé and Milange districts, Mozambique: Results of a population-based cross-sectional survey. Int Health. 2017;9(4):234–242. doi: 10.1093/inthealth/ihx020

Rajaonarifara E, Bonds MH, Miller AC, Ihantamalala FA, Cordier L, Razafinjato B, et al. Impact of health system strengthening on delivery strategies to improve child immunisation coverage and inequalities in rural Madagascar. BMJ Glob Health. 2022;7(1):e006824. doi: 10.1136/bmjgh-2021-006824

Sato R. Association between access to a health facility and continuum of vaccination behaviors among Nigerian children. Hum Vaccin Immunother. 2020;16(5):1215–1220. doi: 10.1080/ 21645515.2019.1678360

Johns NE, Hosseinpoor AR, Chisema M, Danovaro-Holliday MC, Kirkby K, Schlotheuber A, et al. Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013-2014 facility data and Demographic and Health Survey 2015-2016 individual data in Malawi. BMJ Open. 2022;12(7):e061346. doi: 10.1136/bmjopen-2022-061346