Evaluasi Implementasi Program Pelaksanaan Imunisasi Pneumococcal Conjugate Vaccines (PCV) di Kota Yogyakarta Tahun 2022-2024

Noorkhalisah, Prof. dr. Mei Neni Sitaresmi, SpA(K)., Ph.D; dr. Risalia Reni Arisanti

2025 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pneumonia masih menjadi salah satu penyebab utama kematian pada anak di bawah lima tahun, dengan kontribusi sebesar 15,3% terhadap mortalitas balita secara global. Di Kota Yogyakarta, program imunisasi PCV mulai dilaksanakan pada September 2022 dengan capaian yang tinggi pada dua dosis pertama (PCV1 dan PCV2 >90%). Namun, cakupan PCV3 masih rendah—60% pada tahun 2023 dan 75% pada tahun 2024. Meskipun program telah berjalan, kasus pneumonia tidak menunjukkan penurunan yang signifikan pada tahun 2023. Penelitian ini bertujuan untuk mengevaluasi pelaksanaan program imunisasi PCV di Kota Yogyakarta tahun 2022–2024. 

Metode: Penelitian ini terdiri dari tiga sub-studi; evaluasi program, evaluasi sistem surveilans, dan studi analitik. Evaluasi program dan evaluasi surveilans imunisasi PCV menggunakan desain deskriptif kuantitatif, sedangkan studi analitik faktor-faktor yang mempengaruhi kelengkapan dan ketepatan waktu imunisasi PCV dengan desain observasional analitik cross sectional. Data primer dikumpulkan melalui kuesioner, wawancara, dan observasi, sementara data sekunder diperoleh dari dokumen program dan sistem pelaporan imunisasi. Evaluasi program dan evaluasi surveilans terdapat 19 responden yang terdiri dari kepala seksi pencegahan dan pengendalian penyakit menular, koordinator imunisasi di Dinas Kesehatan dan Puskesmas diambil menggunakan total sampling. Studi analitik terdiri dari 405 responden yang diambil menggunakan cluster sampling. 

Hasil: Program imunisasi PCV telah dilaksanakan dengan baik tetapi masih terdapat tantangan kehabisan stok PCV pada akhir tahun 2022, media KIE perlu disediakan kembali untuk meningkatkan cakupan imunisasi PCV lanjutan. Sistem surveilans imunisasi PCV transisi dari SIMUNDU ke ASIK belum sederhana, fleksibilitas, dan stabil, serta pencatatan dan pelaporan imunisasi masih perlu diperkuat. Sedangkan kelengkapan dan kualitas pada kategori cukup baik, analisis dan interpretasi data, umpan balik, ketepatan waktu, dan akseptabilitas dalam kategori baik. Pada analisis multivariat, penerimaan imunisasi ganda (aOR 49,18; 95% CI: 21,30 - 113,5) dan kepemilikan rumah sendiri (aOR 1,93; 95% CI: 1,04 - 3,58) berhubungan secara signifikan dengan kelengkapan imunisasi PCV. Selain itu, pengetahuan (aOR 1,85; 95% CI: 1,12 – 3,03) dan penerimaan imunisasi ganda (aOR 22,04; 95% CI: 6,55 - 74,08) berhubungan secara signifikan dengan ketepatan waktu, serta usia kehamilan prematur (aOR 0,29; 95% CI:0,09 – 0,88) secara signifikan menurunkan ketepatan waktu imunisasi PCV. 

Kesimpulan: Program imunisasi PCV di Kota Yogyakarta 2022 – 2024 dilaksanakan dengan baik, meskipun terdapat tantangan pada sistem logistik, strategi Komunikasi, Informasi, Edukasi (KIE), dan peningkatan cakupan PCV 3. Surveilans imunisasi PCV masih terkendala di pencatatan dan pelaporan, kesederhanaan, fleksibilitas, dan stabilitas. Penerimaan imunisasi ganda dan kepemilikan rumah sendiri mempengaruhi kelengkapan imunisasi PCV. Sedangkan pengetahuan dan penerimaan imunisasi ganda berhubungan dengan ketepatan waktu dan usia kehamilan prematur dapat menurunkan ketepatan waktu imunisasi PCV. 

Background: Pneumonia is still a leading cause of death in children under five, responsible for 15.3% of global child mortality. In Yogyakarta City, the PCV immunization program began in September 2022, achieving high coverage for the first two doses (PCV1 and PCV2 >90%). However, PCV3 coverage remained lower—60% in 2023 and 75% in 2024. Despite the program, pneumonia cases did not show a significant decline in 2023. This study aims to evaluate the implementation of the PCV immunization program in Yogyakarta City during 2022–2024. 

Methods: This study consists of three sub-studies: program evaluation, surveillance system evaluation, and analytical study. Program evaluation and PCV immunization surveillance evaluation used a quantitative descriptive design, while the analytical study of factors affecting PCV immunization completeness and timeliness used a cross-sectional analytical observational design. Primary data were collected through questionnaires, interviews, and observations, while secondary data were obtained from program documents and immunization reporting systems. The program evaluation and surveillance evaluation involved 19 respondents, including heads of the infectious disease prevention and control section, immunization coordinators at the Health Office, and Public Health Centres (PHC), selected using total sampling. The analytical study included 405 respondents selected using cluster sampling.

Results: The PCV immunization program has been implemented well, but there were still challenges with PCV stock shortages at the end of 2022. IEC media needs to be provided again to increase the coverage of follow-up PCV immunization. The PCV immunization surveillance system transition from SIMUNDU to ASIK is not yet simple, flexible, and stable, and immunization recording and reporting still need to be strengthened. Meanwhile, completeness and quality were rated as fair, while data analysis and interpretation, feedback, timeliness, and acceptability were rated as good. In the multivariate analysis, acceptance of multiple injections (aOR 49.18; 95% CI: 21.30–113.5) and home ownership (aOR 1.93, 95% CI: 0.09–0.88) are significantly associated with the completeness of PCV immunization. In addition, knowledge (aOR 1.85, 95% CI: 1.12–3.03) and acceptance of multiple injections (aOR: 22.04; 95% CI: 6.55–74.08) were significantly associated with timely immunization, while preterm pregnancy (aOR: 0.29; 95% CI: 0.09–0.88) significantly reduced the timeliness of PCV immunization.

Conclusions: The PCV immunization program in Yogyakarta City for 2022–2024 has been implemented well, despite challenges in the logistics system, Information, Education, and Communication (IEC) strategy, and increasing PCV 3 coverage. PCV immunization surveillance is still hampered by issues in recording and reporting, simplicity, flexibility, and stability. Acceptance of multiple injections and home ownership sections influence the completeness of PCV immunization. Meanwhile, knowledge and acceptance of multiple injections related to timeliness and preterm pregnancy can reduce the timeliness of PCV immunization.

Kata Kunci : Imunisasi PCV, Surveilans, Kelengkapan, Ketepatan Waktu, Imunisasi Ganda/ PCV Immunization, Surveillance, Timeliness, Completeness, Multiple Injection