PENGARUH KARAKTERISTIK IBU BALITA, FAKTOR PEMUDAH DAN PENGUAT TERHADAP PEMBERIAN IMUNISASI DASAR LENGKAP PADA BAYI DI WILAYAH KERJA PUSKESMAS PIJORKOLING KECAMATAN PADANGSIDIMPUAN TENGGARA

Immunization is an effort of giving immunity on infants and children by incorporating the vaccine into the body so that the body makes antibodies to prevent certain diseases. The achievement of fully immunized target based on by National data is around 80-90%, while the achievement of immunization in Padangsidimpuan in 2014 by 47.1% and in Pijorkoling Health Centre in 2014, BCG immunization was obtained 49.5%, DPT / HB3 immunization was obtained 27.6%, polio immunization was obtained 32,4% and measles immunization was obtained 29,3%. The objective of this study is to determine and analyze the influence of the characteristics of mothers (work and parity), predisposing factors (knowledge and belief) and reinforcing (husband's support and the support of health professionals) to complete basic immunization on infants in sub-district Puskesmas Pijorkoling Southeast Padangsidimpuan. This type of research used analytic study with cross sectional approach. The population of this study was all mothers who have infants with sampling proportional sampling technique with a total sample of 81 respondents. Data were collected through medical records and interviews used questionnaires. Data was analyzed by univariate, bivariate used Chi-Square test at the 95% confidence level (p <0.05) and multivariate used logistic regression test. The results showed that the relationship with p value 0.036 and the support of a husband with a p value of 0.001 against the complete basic immunization on infants. In this study, the relationship of parity with p value 0.180 and the support of health professionals with p value 0.377 to complete basic immunization on infants was not found. The influence of knowledge with p value 0.001 and the value of Exp (B) 17.523 and trust with p value 0.044 and the value of Exp (B) 4.460 to complete basic immunization in infants was affected. It is suggested to the workers of Pijorkoling health center to provide counseling persuasion in improving the knowledge and encourage the mothers to give the complete basic immunization on infants. Thus the achievement of immunization target is more increasing.

Knowledge, attitude, and barriers toward polio immunization among pre-clinical students in Malaysia

Background: Polio is reported as reemerging disease in Malaysia after 27 years of being free from it. It is important to identify the awareness towards polio vaccine among the medical students who are the future and the pillars of the nation, to develop a country. Aims and Objectives: This study aims to assess the knowledge, attitude, and barriers toward polio immunization among pre-clinical medical students. Materials and Methods: A cross-sectional study was conducted among 190 pre-clinical students from a private university after obtaining informed consent and institutional ethical clearance. Data collected from Google Forms questionnaire were analyzed using SPSS version 20. Results: Insufficient knowledge, especially on disease nature, transmission, and correct dosage of vaccine, was noticed. Findings revealed that 79.5% of the students showed unfavorable attitude toward polio immunization. Year 2 students are more positive toward the vaccination compared to year 1. Main barriers toward polio immunization selected by the respondents are disagreement from the spouse, insecure about vaccine safety, and distance of the health center. Conclusion: Pre-clinical students should enhance their knowledge to be able to recognize the various barriers of polio immunization in our country and be part of the effort in solving these barriers as polio eradication is critical to ensuring a healthier future for children.

Cost-Effectiveness of Three Poliovirus Immunization Schedules in Shanghai, China

In Shanghai, China, a polio immunization schedule of four inactivated polio vaccines (IPV) has been implemented since 2020, replacing the schedules of a combination of two IPVs and two bivalent live attenuated oral polio vaccines (bOPV), and four trivalent live attenuated oral polio vaccines (tOPV). This study aimed to assess the cost-effectiveness of these three schedules in infants born in 2016, in preventing vaccine-associated paralytic poliomyelitis (VAPP). We performed a decision tree model and estimated incremental cost-effectiveness ratio (ICER). Compared to the four-tOPV schedule, the two-IPV-two-bOPV schedule averted 1.2 VAPP cases and 16.83 disability-adjusted life years (DALY) annually; while the four-IPV schedule averted 1.35 VAPP cases and 18.96 DALY annually. Consequently, ICERVAPP and ICERDALY were substantially high for two-IPV-two-bOPV (CNY 12.96 million and 0.93 million), and four-IPV (CNY 21.24 million and 1.52 million). Moreover, net monetary benefit of the two-IPV-two-bOPV and four-IPV schedules was highest when the cost of IPV was hypothesized to be less than CNY 23.75 or CNY 9.11, respectively, and willingness-to-pay was hypothesized as CNY 0.6 million in averting one VAPP-induced DALY. IPV-containing schedules are currently cost-ineffective in Shanghai. They may be cost-effective by reducing the prices of IPV, which may accelerate polio eradication in Chinese settings.

Ensuring sustainability of polio immunization in health system transition: lessons from the polio eradication initiative in Indonesia

Background Sustaining an effective evidence-based health intervention will maximize its impact on public health. Political and governmental reforms impacted on immunization program sustainability both positively and negatively. This study aims to explore the sustainability of polio immunization in a decentralized health system taking lessons learned from a polio eradication initiative in Indonesia. Methods We collected qualitative data through in-depth interviews with 27 key informants from various backgrounds at district, provincial, and national levels, consisting of frontline workers, managers, and Non-government Organizations (NGOs). We conducted thematic analysis and triangulated using document reviews. We also conducted member checking and peer debriefing to ensure trustworthiness. Results Competing priority was identified as the significant challenge to sustain government commitment for polio immunization and AFP surveillance during the transition toward a decentralized health system. Variation of local government capacities has also affected immunization delivery and commitment at the sub-national level government. The government reform has led to a more democratic society, facilitating vaccine rejection and hesitancy. The multi-sector partnership played a significant role in maintaining polio immunization coverage. Strong and continuous advocacy and campaign were essential to raising awareness of the community and policymakers to keep polio in the agenda and to maintain the high polio immunization coverage. Conclusion Competing priority was the major factor affecting high polio immunization coverage during the decentralization transition. Strong advocacy is needed at every level, from district to national level, to keep polio immunization prioritized.

Scaling up public health interventions: case study of the polio immunization program in Indonesia

Background The scaling up of public health interventions has received greater attention in recent years; however, there remains paucity of systematic investigations of the scaling up processes. We aim to investigate the overall process, actors and contexts of polio immunization scaling up in Indonesia from 1988 until 2018. Methods A mixed method study with sequential explanatory design was conducted. We carried out a quantitative survey of 323 actors involved in the polio program at national and sub-national levels, followed by Key Informant Interviews (KII)s. Document review was also carried out to construct a timeline of the polio eradication program with milestones. We carried out descriptive statistical analysis of quantitative data and thematic analysis of qualitative data. Results The scaling up of polio immunization in Indonesia started as a vertical expansion approach led by the Ministry of Health within a centralized health system. The coverage of immunization increased dramatically from 5% in the earlier 80s to 67.5% in 1987; incremental increases followed until achieving Universal Child Immunization (UCI) in 1990 and subsequently 95% coverage in 1995. Engagement of stakeholders and funding made the scaling up of polio immunization a priority. There was also substantial multisector involvement, including institutions and communities. Local area monitoring (LAM) and integrated health posts (Posyandu) were key to the polio immunization implementation strategy. Challenges for scaling up during this centralized period included cold chain infrastructure and limited experience in carrying out mass campaigns. Scaling up during the decentralized era was slower due to expansion in the number of provinces and districts. Moreover, there were challenges such as the negative perception of immunization side-effects, staff turnover, and the unsmooth transition of centralization towards decentralization. Conclusion Vertical scaling up of polio immunization program intervention was successful during the centralized era, with involvement of the president as a role model and the engine of multi sector actors. Posyandu (integrated health posts) played an important role, yet its revitalization after the reform-decentralization era has not been optimum.

Correlation between polio immunization coverage and overall morbidity and mortality for COVID-19: an epidemiological study

We conducted the current analysis to determine the potential role of polio vaccination in the context of the spread of COVID-19. Data were extracted from the World Health Organization’s (WHO) Global Health Observatory data repository regarding the polio immunization coverage estimates and correlated to the overall morbidity and mortality for COVID-19 among different countries. Data were analyzed using R software version 4.0.2. Mean and standard deviation were used to represent continuous variables while we used frequencies and percentages to represent categorical variables. The Kruskal-Wallis H test was used for continuous variables since they were not normally distributed. Moreover, the Spearman rank correlation coefficient (rho) was used to determine the relationship between different variables. There was a significantly positive correlation between the vaccine coverage (%) and both of total cases per one million populations (rho = 0.37; p-value < 0.001) and deaths per one million populations (rho = 0.30; p-value < 0.001). Moreover, there was a significant correlation between different income groups and each of vaccine coverage (%) (rho = 0.71; p-value < 0.001), total cases per one million populations (rho = 0.50; p-value < 0.001), and deaths per one million populations (rho = 0.39; p-value < 0.001). All claims regarding the possible protective effect of Polio vaccination do not have any support when analyzing the related data. Polio vaccination efforts should be limited to eradicate the disease from endemic countries; however, there is no evidence to support the immunization with live-attenuated vaccines for the protection against COVID-19.

Public Health Response to Restore Polio Free Status in Malaysia

Malaysia started the polio immunization programme since 1972 and achieved polio-free certification in 2000. After 27 years from the last reported polio case in 1992, on 8 December 2019, the Ministry of Health Malaysia announced the return of polio into the country when the first polio case detected in Sabah involving a 3-month-old male child (Abdullah, N.H., 2019). The child confirmed to be infected with vaccine-derived poliovirus type 1 (VDPV1) which later classified as a circulating vaccine-derived poliovirus type 1 (cVDPV1). Further test confirmed that the virus is genetically linked to poliovirus (PHL-NCR-2) circulating in the southern Philippines (Alleman, M.M. et al., 2020). To date, a total of four polio cases were confirmed in Sabah of which due to vaccine-derived poliovirus type 1 (VDPV1). The vaccine-derived poliovirus type 2 (VDPV2) was also detected from environmental samples taken from various locations in Sabah.

Scaling Up Public Health Interventions: A Case Study of the Polio Immunization Program in Indonesia

Background: The scaling up of public health interventions has received greater attention in recent years; however, there remains paucity of systematic investigations of the scaling up processes. We aim to investigate the overall process, actors and contexts of polio immunization scaling up in Indonesia from 1988 until 2018. Methods: A mixed method study with sequential explanatory design was conducted. We carried out a quantitative survey of 323 actors involved in the polio program at national and sub-national levels, followed by Key Informant Interviews (KII)s. Document review was also carried out to construct a timeline of the polio eradication program with milestones. We carried out descriptive statistical analysis of quantitative data and thematic analysis of qualitative data.Results: The scaling up of polio immunization in Indonesia started as a vertical expansion approach led by the Ministry of Health within a centralized health system. The coverage of immunization increased drastically from 5% in the earlier 80s to 67.5% in 1987; incremental increases followed until achieving Universal Coverage Immunization (UCI) in 1990 and subsequently 95% coverage in 1995. Engagement of stakeholders and funding made the scaling up of polio immunization a priority. There was also substantial multisector involvement, including institutions and communities. Local area monitoring (LAM) and integrated health posts (Posyandu) were key to the polio immunization implementation strategy. Challenges for scaling up during this centralized period included cold chain infrastructure and limited experience in carrying out mass campaigns. Scaling up during the decentralized era was slower due to expansion in the number of provinces and districts. Moreover, there were challenges such as the negative perception of immunization side-effects, staff turnover, and the unsmooth transition of centralization towards decentralization.Conclusion: Vertical scaling up of polio immunization program intervention was successful during the centralized era, with involvement of the president as a role model and the engine of multi sector actors. Posyandu (integrated health posts) played an important role, yet its revitalization after the reform-decentralization era has not been optimum.