FAKTOR - FAKTOR RISIKO YANG BERPENGARUH TERHADAP VAKSINASI HEPATITIS B-1 PADA BAYI UMUR < 7 HARI ( Studi Kasus di Kabupaten Demak dan Temanggung)

Abstract

Background. Hepatitis B is an infectious disease affecting liver caused by hepatitis B Virus (HBV). It may develop chronically and cause liver cirrhosis, become hepatocellular carcinoma as terminal stage. It is estimated that more than 11 million Indonesians are infected by this virus. Hepatitis B vaccination is the most most effective strategy to reduce the diseases incidence, it should be given 3 doses with the first dose of hepatitis B-1 at the age of < 7 days. In Central-Java, hepatitis B-1 vaccination rate is still lower (34.5%) than the target (90%). Many factors affected the vaccination rate such as : factors of mother, health workers, and environment. Objectives. To know the rates of factors of mothers, health workers, and environment on hepatitis B-1 vaccination on babies aged < 7 days. Method. Case-control design was used in this study, consisted of 160 babies as cases and 160 babies as controls. The cases population was taken from babies having their vaccination at the age of > 7 days, and the controls were babies vaccinated with hepatitis B-1 at the age of < 7 days. The research location has been done in district of Demak and Temanggung, Central Java in the year 2004. Result. Risk factors of mother which affecting vaccination hepatitis B-1 at the age < 7 days were : low education (OR = 3,32; 95% CI = 0,52 — 20,12), working mother (OR = 2,74; 95% CI = 1,27 — 5,89), mother's lack of knowledge (OR = 4,35; 95% CI = 2,21 — 8,57), ANC < 4 times (OR = 2,56; 95% CI = 1,09 — 6,03). Risk factors of health workers were midwives in another village (OR = 1,60; 95% CI = 1,02 — 2,51), midwives were not trained using uniject HB (OR = 9,13; 95% CI = 1,20 — 69,45), labor helper was not a health worker (OR = 2,99; 95% CI = 1,55 — 5,77), no neonatal visit (OR = 12,49; 95% CI = 5,62 — 27,77). Risk factors of environment were birth place, not qualified health requirement (OR = 2,11; 95% CI = 1,28 — 3,47), low educated husbands (OR = 7,40; 95% CI = 1,06 — 51,64), high hepatitis B-1 vaccination cost (OR = 1,90; 95% CI = 1,12 — 3,24), not informed about hepatitis B-1 application at the age S 7 days (OR = 9,97; 95% CI = 5,05 — 19,69), and social cultural believes about hepatitis B-1 was not favourable (OR = 5,54; 95% CI = 1,65 — 18,66). Factors which not affecting the rate was no local government instruction for hepatitis B-1 vaccination (OR = 1,29; 95% CI = 0,29 — 5,77) Conclusion. Risk factors were proved to influence hepatitis B-1 vaccination on babies aged < 7 days. Influencing factor from mother was mother's working status. From the health worker's factor were midwives in the village were not trained to use Uniject HB, no neonatal visit, labour helper was not a health worker. The affecting environmental factors were no information about the application of hepatitis B-1 at the age < 7 days, social cultural believes about hepatitis B-1 was not favourable, uniject vaccines were not available in the midwives stock. Suggestion. Hepatitis B-1 at the age of 15_ 7 days should be given along with the neonatal visit (KN-1), Posyandu service for mothers who are working should be open at afternoon hours, it is necessity training for midwives about vaccination using Uniject HB, dessiminatlon of information about the importance of hepatitis B-1 vaccination at the age of S 7 days should be given to the community, the labour of babies should be done by the health personnals (midwives), planning of the provision of Uniject FIB vaccine kept by the midwives should be based on cohort data of pregnant mothers. Latar belakang. Penyakit hepatitis B merupakan penyakit infeksi pada hati yang disebabkan oleh virus hepatitis B (VIM), dapat berkembang menjadi penyakit kronis sehingga terjadi pengerasan hati (liver cirrhosis) yang selanjutnya dapat berkembang menjadi kanker hati (carcinoma hepatacelluler), diperkirakan 11 juta lebih penduduk Indonesia telah terinfeksi virus ini. Vaksinasi hepatitis B merupakan strategi yang paling efektif untuk mengurangi penyakit akibat virus ini, yaitu dengan memberikan tiga dosis vaksin hepatitis pada bayi dengan hepatitis B-1 pada umur 7 hari. Di Jawa Tengah, vaksinasi hepatitis B-1 masih sangat rendah (34,52%) belum mencapai target (90%). Banyak faktor yang berpengaruh terhadap vaksinasi hepatitis B-1, diantaranya dipengaruhi yang berkaitan faktor ibu, tenaga kesehatan dan lingkungan. Tujuan. Mengetahui pengaruh faktor ibu, tenaga kesehatan dan lingkungan terhadap vaksinasi hepatitis B-1 pada bayi umur .0 7 hari setelah kelahirannya. Metode. Desain penelitian yang digunakan studi kasus kontrol dengan 160 kasus dan 160 kontrol. Kasus dinyatakan dengan bayi yang divaksinasi hepatitis B-1 pada umur > 7 hari, sedangkan kontrol bayi umur 7 hari. Lokasi penelitian di Kabupaten Demak dan Temanggung Propinsi Jawa Tengah tahun 2004. Analisis data multivariate dengan menggunakan regresi logistik. Hasil. Faktor risiko yang berpengaruh terhadap vaksinasi hepatitis B-1 pada bayi umur 5 7 hari dari faktor ibu : pendidikan ibu rendah (OR = 3,32; 95% CI = 0,52¬20,12), ibu status bekerja (OR = 2,74; 95% CI = 1,27-5,89), pengetahuan ibu kurang (OR = 4,35; 95% CI = 2,21-8,57), frekuensi ANC < 4 kali (OR = 2,56 95% CI = 1,09-6,03); faktor tenaga kesehatan : keberadaan bidan di desa lain (OR = 1,60; 95% CI = 1,02-2,51), bidan tidak dilatih Uniject HB (OR = 9,13; 95% CI = 1,20-69,45), penolong persalinan non nakes (OR = 2,99; 95% CI = 1,55-5,77), tidak ada kunjungan neonatal (OR = 12,49; 95% CI = 5,62-27,77); faktor lingkungan : tempat melahirkan non sarkes (OR = 2,11; 95% CI = 1,28-3,47), pendidikan suami rendah (OR = 4,52; 95% CI = 1,51-13,53), vaksin uniject HB pemah habis di bidan desa (OR = 7,40; 95% CI = 1,06-51,64), biaya vaksinai hepatitis B-1 (OR = 1,90; 95% CI = 1,12-3,24), tidak mendapat informasi hepatitis B-1 .0 7 hari (OR = 9,97; 95% CI = 5,05-19,69), sosial budaya hepatitis B-1 bersifat menghambat (OR = 5,54; 95% CI = 1,65-18,66), yang tidak berpengaruh yaitu tidak ada kebijakan Pemda setempat tentang vaksinasi hepatitis B-1 (OR = 1,29; 95% CI = 0,29-5,77). Kesimpulan. Faktor-faktor risiko yang terbukti berpengaruh terhadap vaksinasi hepatitis B-1 pada bayi umur 7 hari, faktor ibu : ibu dengan status bekerja. Faktor tenaga kesehatan : bidan di desa tidak dilatih dengan Uniject HB, tidak ada kunjungan neonatal, penolong persalinan non tenaga kesehatan. Faktor lingkungan : ibu tidak mendapat informasi hepatitis B-1 7 hari, sosial budaya hepatitis B-1 yang bersifat menghambat, vaksin Uniject HB pemah habis di bidan di desa. Saran. Vaksinasi hepatitis B-1 pada bayi umur 7 hari harus diberikan bersamaan pada kunjungan neonatal (KN-1), pelaksanaan posyandu pada sebagian besar ibu dengan status bekerja di laksanakan sore hari, perlu pelatihan bidan tentang vaksinasi hepatitis B-1 pada bayi dengan Uniject HB, ditingkatan penyuluhan pada masyarakat tentang pentingnya vaksinasi hepatitis B-1 pada bayi umur lc 7 hari dan melahirkan ditolong oleh tenaga kesehatan, dalam perencanaan kebutuhan vaksin uniject HB di bidan di desa hams berdasarkan data kohor ibu hamil.