Abstract
Background: Hepatitis A virus infection (HAV) has generated about half of the total infection of hepatitis in the world. Poor environmental sanitation and unhealthy behavior of the society can increase the risk of Hepatitis A transmission. This study aimed to analyze the contextual effect of the village on biopsychosocial determinants of Hepatitis A. Subjects and Method: This was an analytic observational study with a case-control approach. This study was conducted from January to February 2020. This study used fixed disease sampling. The sample of this study was 200 patients consisted of 50 Hepatitis A patients and 150 non-Hepatitis A patients in villages in Pacitan Regency. The dependent variable was Hepatitis A. The independent variables were age, education, income, history of Hepatitis A vaccination, handwashing behavior, food consumption, availability of clean water, and availability of latrines. This study used questionnaires to collect the data. The data were analyzed by multilevel multiple logistic regression using Stata 13. Results: The risk of Hepatitis A infection decreased with age ≥40 years (OR= 0.06; 95% CI= 0.01 to 0.27; p<0.001), high education (OR= 0.15; 95% CI= 0.03 to 0.72; p= 0.018), high income (OR= 0.14; 95% CI= 0.03 to 0.77; p= 0.023), and history of Hepatitis A vaccination (OR= 0.07; 95% CI= 0.01 to 0.84; p= 0.036). The risk of Hepatitis A infection increased with poor hand washing behavior (OR= 5.27; 95% CI= 1.32 to 21.03; p= 0.019), unhygienic food consumption (OR= 9.67; 95% CI= 2.41 to 38.76; p= 0.001), poor clean water availability (OR= 22.64; 95% CI= 5.49 to 93.35; p<0.001), and poor latrine (OR= 4.78; 95% CI= 1.42 to 16.07; p= 0.012). Village did not have level a contextual effect on Hepatitis A infection with intra-class correlation <1%. Conclusion: The risk of Hepatitis A infection decreases with age ≥40 years, high education, high income, and history of Hepatitis A vaccination. It increases with poor hand washing behavior, unhygienic food consumption, poor clean water availability, and poor latrine. Village does not have level a contextual effect on Hepatitis A. Keyword s : Hepatitis A, vaccine, contextual effect, multilevel analysis Correspondence: Sugeng Retyono. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: sugengretyono@gmail.com. Mobile: +6287758732030. Journal of Epidemiology and Public Health (2020), 05(02): 195-106 https://doi.org/10.26911/jepublichealth.2020.05.02.07
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