FAKTOR-FAKTOR YANG MEMPENGARUHI PERBEDAAN IMUNISASI BIAS MEASLES RUBELLA SAAT PANDEMI COVID-19 DAN SEBELUM PANDEMI COVID-19 DI KABUPATEN KULON PROGO 2020

BIMA ADI LAKSONO, dr. Mei Neni Sitaresmi, SPA(K., Ph.D

2021 | Tesis | MAGISTER ILMU KESEHATAN MASYARAKAT

Latar Belakang: Coronavirus Disease 2019 (COVID-19) saat ini menjadi pandemi diseluruh dunia. Indonesia melaporkan kasus pertama tanggal 2 Maret 2020. Efek pandemi mengakibatkan gangguan layanan kesehatan esensial seperti imunisasi rutin. Bulan imunisasi anak sekolah (BIAS) dilakukan untuk memberikan perlindungan kepada anak-anak usia sekolah dasar (SD) terhadap penyakit campak, difteri dan tetanus. Tidak tercapainya cakupan imunisasi Measles Rubella (MR) berpotensi menyebabkan terjadinya kejadian luar biasa penyakit Measles dan menjadi indikator buruk nya layanan kesehatan esensial. Provinsi Yogyakarta menggunakan vaksin MR sejak tahun 2017. Kabupaten Kulon Progo merupakan salah satu kabupaten yang cakupan imunisasi BIAS MR >95% saat pandemi. Faktor-faktor yang mempengaruhi layanan BIAS saat pandemi yaitu faktor lingkungan, faktor perilaku dan faktor layanan kesehatan. Penelitian ini bertujuan untuk menilai perbedaan implementasi imunisasi BIAS MR sebelum pandemi (2019) dan pandemi (2020). Tujuan: Penelitian ini bertujuan untuk menilai implementasi BIAS MR selama pandemic COVID-19 dan menilai faktor-faktor perbedaan implementasi imunisasi BIAS MR sebelum pandemic (2019) dan pandemic (2020) di Kabupaten Kulon Progo. Metode: Kualitatif dengan melakukan wawancara mendalam, observasi pelaksanaan imunisasi dan kajian dokumen laporan cakupan imunisasi. Responden dipilih dengan menggunakan teknik purposive sampling. Sampel penelitian yaitu 12 subjek dengan tiga variasi subjek (petugas puskesmas, guru & orang tua) di wilayah Kokap, Pengasih dan Temon. Variabel penelitian yaitu faktor perilaku, faktor lingkungan dan faktor pelayanan kesehatan. Hasil: Cakupan imunisasi BIAS MR tahun 2019 dan 2020 tidak berbeda namun ada puskesmas yang mengalami kenaikan dan penurunan cakupan BIAS MR. perbedaan terlihat dari waktu pelaksanaan dan mengikuti aturan khusus saat pandemic COVID-19. Faktor-faktor yang mempengaruhi implementasi kegiatan BIAS MR sebelum pandemi (2019) dan saat pandemic (2020) yakni faktor lingkungan (sistem pembelajaran, kasus COVID-19 di lingkungan sekolah, peran sekolah & guru), faktor perilaku (Protokol kesehatan, kondisi anak, kecemasan wali murid), Faktor pelayanan kesehatan (Adaptasi pelayanan esensial, SDM, fasilitas dan logistik). Kesimpulan: Studi ini menyoroti keberhasilan Kabupaten Kulon Progo dalam mempertahankan cakupan imunisasi BIAS MR >95% pada masa pandemi COVID-19 seperti kolaborasi lintas sektor yang kuat dalam pelaksanaan BIAS MR.

Background: Coronavirus Disease 2019 (COVID-19) is currently a worldwide pandemic. Indonesia reported the first case on March 2, 2020. Pandemic effects result in the disruption of essential health services such as routine immunizations. Vaccine-preventable diseases are carried out to protect to elementary school-age children against measles, diphtheria, and tetanus. The non-achievement of Measles-Rubella (MR) immunization coverage has the potential to cause an extraordinary incidence of Measles disease and become a poor indicator of essential health services. Yogyakarta province has been using Measles-Rubella vaccine since 2017. Kulon Progo Regency is one of the districts with vaccine-preventable diseases coverage >95% during the pandemic. Factors that affect vaccine-preventable diseases during pandemics are environmental factors, behavioral factors, and health care factors. The study aims to assess differences in the implementation of vaccine-preventable diseases before pandemics (2019) and pandemics (2020). Objective: This study aims to assess the implementation of MR BIAS during the COVID-19 pandemic and assess the factors of differences in the implementation of BIAS MR immunization before the COVID-19 pandemic (2019) and during COVID-19 pandemic (2020) in Kulon Progo Regency. Method: Qualitative by conducting in-depth interviews, observations of immunization implementation and review of immunization coverage report documents. Respondents were selected using purposive sampling techniques. The study sample was 12 subjects with three variations of subjects (health center officers, teachers &parents) in the Kokap, Pengasih and Temon regions. Research variables are behavioral factors, environmental factors and health care factors. Result: The immunization coverage of vaccine-preventable diseases MR in 2019 and 2020 is no different but there are health centers that experience an increase and decrease in coverage of vaccine-preventable diseases MR. Differences are seen from the timing of implementation and following special rules during the COVID-19 pandemic. Factors that affect the implementation of MR vaccine-preventable diseases activities before the pandemic (2019) and during the pandemic (2020) are environmental factors (learning systems, COVID-19 cases in the school environment, the role of schools &teachers), behavioral factors (Health protocols, child conditions, student guardian anxiety), health care factors (Adaptation of essential services, human resources, facilities and logistics). Conclusion: This study highlights the success of Kulon Progo Regency in maintaining the coverage of vaccine-preventable diseases MR >95% during the COVID-19 pandemic such as strong cross-sector collaboration in the implementation of vaccine-preventable diseases MR

Kata Kunci : Immunization, COVID-19, Pandemic, Measles-Rubella