Evaluasi Implementasi Program Imunisasi PCV Serta Analisis Pengaruh KAP Orang Tua dan Riwayat Kesehatan Anak dengan Ketepatan dan Kelengkapan Imunisasi PCV di Kota Salatiga

ARUMSARI WULANDARI, Bayu Satria Wiratama, S.Ked, MPH, Ph.D, FRSPH; Prof. dr. Mei Neni Sitaresmi, SpA(K), Ph.D

2026 | Tesis | S2 Ilmu Kesehatan Masyarakat

Latar Belakang: Pneumonia masih menjadi penyebab utama kematian balita secara global dan nasional, dengan CFR infeksi akibat pneumokokus sebesar 1-6%, serta menunjukkan tren peningkatan kasus di Kota Salatiga pada tahun 2022-2024. Imunisasi PCV merupakan strategi pencegahan utama yang direkomendasikan WHO dan telah diimplementasikan secara nasional sejak 2022, termasuk di Kota Salatiga. Namun, capaian imunisasi PCV di Salatiga hingga 2024 masih fluktuatif dan belum mencapai target, mengindikasikan implementasi program belum optimal. Tantangan yang dihadapi meliputi adaptasi program baru, keterbatasan sistem pencatatan dan pelaporan, serta faktor individu dan sosial yang dapat mempengaruhi ketepatan dan kelengkapan imunisasi PCV sehingga diperlukan penelitian komprehensif yang menilai aspek program, surveilans dan faktor determinan di tingkat masyarakat.

Metode: Penelitian ini mencakup sub studi evaluasi surveilans, evaluasi program, serta analitik. Evaluasi program dan surveilans dilakukan dengan pendekatan mix method concurrent, sedangkan untuk sub studi analitik dilakukan dengan desain studi cross sectional. Subjek penelitian untuk evaluasi program dan surveilans terdiri dari 27 pengelola program imunisasi, sedang sub studi analitik melibatkan 368 orang tua anak usia 13-23 bulan. Pada studi evaluasi program dan surveilans, data akan dianalisis secara deskriptif (kuantitatif) dan tematik (kualitatif). Sedangkan pada sub studi analitik data akan di analisis baik secara deskriptif, bivariat maupun multi variat menggunakan Generalized Linear Model (GLM) dengan Regresi Poisson dan robust variance estimator.

Hasil: Implementasi program imunisasi PCV di Kota Salatiga secara umum telah berjalan dengan baik, ditandai dengan ketersediaan jadwal pelayanan, vaksin, dan sistem distribusi logistik yang memadai. Namun, masih ditemukan beberapa kesenjangan, antara lain keterbatasan pelatihan vaksinator, belum optimalnya monitoring dan evaluasi, praktik pelayanan yang tidak sesuai standar, serta kelemahan dalam pemantauan rantai dingin. Pada aspek surveilans, seluruh puskesmas telah melakukan pelaporan melalui aplikasi ASIK, tetapi kualitas data masih belum optimal akibat ketidaklengkapan pencatatan, ketidaksesuaian data manual dan ASIK, serta rendahnya pemanfaatan data untuk analisis dan pengambilan keputusan. Studi analitik menunjukkan bahwa cakupan kelengkapan imunisasi PCV relatif tinggi, sedangkan ketepatan waktu imunisasi masih rendah. Analisis multivariat menunjukkan bahwa perilaku orang tua berhubungan secara signifikan dengan ketepatan, kelengkapan, dan outcome gabungan imunisasi PCV.

Kesimpulan: Implementasi program imunisasi PCV di Kota Salatiga telah berjalan dengan baik, namun masih memerlukan penguatan pada mutu pelayanan, kepatuhan terhadap SOP, serta monitoring dan supervisi. Sistem surveilans telah mendukung pencatatan dan pelaporan, tetapi pemanfaatan data untuk analisis dan pengambilan keputusan belum optimal. Perilaku orang tua merupakan determinan utama ketepatan dan kelengkapan imunisasi PCV. Peningkatan keberhasilan program memerlukan penguatan tata kelola program, optimalisasi fungsi surveilans, dan intervensi perubahan perilaku orang tua.

Background: Pneumonia remains a leading cause of mortality among children under five globally and in Indonesia, with CFR of 1-6% for pneumococcal infections, has shown an increasing trend in cases in Salatiga City form 2022-2024. Although PCV immunization has been implemented nationwide since 2022, coverage in Salatiga City remained below target by 2024, indicating suboptimal program implementation. Challenges related to program adaptation, recording and reporting systems, and individual and social factors may affect the timeliness and completeness of PCV immunization, highlighting the need to evaluate program implementation, surveillance, and community-level determinants.

Methods: This study comprised three sub-studies: a surveillance evaluation, a program evaluation, and an analytical study. The program and surveillance evaluations used a concurrant mixed-methods approach, whereas the analytical sub-study used a cross-sectional design. The program and surveillance evaluation included27 immunization program managers, while the analytic sub-study involved 368 parents of children aged 13–23 months. Quantitative data from the program and surveillance evaluations were analyzed descriptively, while qualitative data were analyzed thematically. In the analytical sub-study, data were analyzed descriptively, bivariately, and multivariately using a Generalized Linear Model (GLM) with Poisson regression and a robust variance estimator.

Results: Overall, the implementation of the PCV immunization program in Salatiga City was satisfactory, as evidenced by the availability of immunization schedules, adequate vaccine supplies, and an established vaccine logistics distribution system. Nevertheless, several gaps were identified, including limited vaccinator training, suboptimal monitoring and evaluation, non-standard immunization practices, and weaknesses in cold chain monitoring. In terms of surveillance, all community health centers reported immunization data through the ASIK application. However, data quality remained suboptimal due to incomplete recording, inconsistencies between manual records and the ASIK database, and limited use of surveillance data for analysis and decision-making. The analytical study showed that the completeness of PCV immunization coverage was relatively high, while the timeliness of immunization remained low. Multivariable analysis demonstrated that parental behavior was significantly associated with the timeliness, completeness, and combined outcome of PCV immunization.

Conclusion: The implementation of the PCV immunization program in Salatiga City has generally been satisfactory; however, further improvements are needed to strengthen service quality, adherence to standard operating procedures (SOPs), monitoring, and supportive supervision. The surveillance system has facilitated immunization recording and reporting, although the use of surveillance data for analysis and decision-making remains suboptimal. Parental behavior was identified as the primary determinant of timely and complete PCV immunization. Improving program performance requires strengthening program governance, optimizing surveillance functions, and implementing behavioral interventions targeting parents.

Kata Kunci : Pneumococcal Conjugate Vaccine (PCV); evaluasi program imunisasi; surveilans; perilaku; ketepatan imunisasi; kelengkapan imunisasi