Contextual Effect of the Integrated Health Post and Other Determinants on Completeness of Basic Child Immunization: A Multilevel Analysis Evidence from Jember, East Java

Abstract

Background: Every year, more than 1.4 million children worldwide die from diseases that can be prevented by immunization. Immunization is still one of the most cost-effective preventive mea­su­res to reduce mortality and morbidity among child­ren. This study aimed to analyze the influ­ence of posyandu contextual and maternal cha­rac­teristics on the provision of complete basic im­mu­ni­za­tion in children aged 12-23 months. Subjects and Method: This was an observa­tional analytic study with a cross sectional design. The study was conduct­ed at 25 integrated health posts (posyandu) in Jember, East Java, Indonesia from Sep­tem­ber to October 2019. A sample of 200 mothers who had children aged 12-23 months was selected by simple random sampling. The dependent variable was complete basic immunization. The independent variables were maternal education, maternal knowledge, parity, maternal em­ploy­ment status, family income, maternal attitude, family support, and contextual effect of pos­yandu. The data were collected by questionnaire and analyzed by a multilevel logistic regression analysis run on Stata 13. Results: Provision of complete basic immuniza­tion increased with maternal education ≥Senior high school (b= 2.99; 95% CI= 1.26 to 4.73; p= 0.001), good maternal knowledge (b= 1.93; 95% CI= 0.38 to 3.53; p= 0.018), family income ≥Rp 2,170,000 (b= 1.18; 95% CI= -0.15 to 2.50; p= 0.081), positive maternal attitude (b= 1.92; 95% CI= 0.45 to 3.39; p= 0.011), and strong family sup­port (b= 2.29; 95% CI= 0.62 to 3.96; p= 0.007). Complete basic immunization decreased with ma­ternal parity ≥3 (b= -1.35; 95% CI= -2.68 to -0.01; p= 0.048) and mother working outside the ho­me (b= -2.67; 95% CI= -4.49 to - 0.85; p= 0.004). Posyandu had contextual effect on the pro­vi­si­on of complete basic immunization in children aged 12-23 months with ICC= 23.65%. Conclusion: Provision of complete basic im­mu­nization increases with maternal education ≥Se­nior high school, good maternal knowledge, fa­mi­ly income ≥Rp 2,170,000, positive maternal at­titude, and strong family support. Complete basic immunization decreases with maternal parity ≥3 and mother working outside the home. Posyandu has contextual effect on the pro­vision of com­ple­te basic immunization in children. Keywords: basic immunization, children aged 12-23 months, integrated health post, multilevel analysis Correspondence: Revina Fiandany Erynda. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: revinaerynda@gmail.com . Mobile: 085­36­18­0003. Journal of Maternal and Child Health (2020), 5(2): 154-166 https://doi.org/10.26911/thejmch.2020.05.02.05