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Original Article

Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia

Osong Public Health and Research Perspectives 2021;12(3):158-168.
Published online: June 2, 2021

1Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Denpasar, Indonesia

2Bali Provincial Health Office, Denpasar, Indonesia

Corresponding author: Anak A. S. Sawitri Department of Public Health and Preventive Medicine, Faculty of Medicine, Universitas Udayana, Jalan PB Sudirman, Denpasar, Bali 80232, Indonesia E-mail: sagung_sawitri@unud.ac.id
• Received: August 29, 2020   • Revised: January 17, 2021   • Accepted: March 24, 2021

© 2021 Korea Disease Control and Prevention Agency

This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

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Citations

Citations to this article as recorded by  Crossref logo
  • Japanese encephalitis in Bali, Indonesia: ecological and socio-cultural perspectives
    I Made Kardena, Anak Agung Ayu Mirah Adi, Nyoman Mantik Astawa, Mark O’Dea, Michael Laurence, Shafi Sahibzada, Mieghan Bruce
    International Journal of Veterinary Science and Me.2021; 9(1): 31.     CrossRef

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Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia
Osong Public Health Res Perspect. 2021;12(3):158-168.   Published online June 2, 2021
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Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia
Osong Public Health Res Perspect. 2021;12(3):158-168.   Published online June 2, 2021
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Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia
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Limitations of immunization registers at community health centers for measuring immunization coverage: a case study of the Japanese encephalitis mass immunization program in Bali Province, Indonesia
District Total cluster Description of selected clusters
Description of households
Planned Surveyed (%) Cluster with eligible subjects (%) Households with eligible subjects (%) Children
Bali 4,450 441 436 (98.9) 431 (98.9) 2,193 (39.0) 3,331
Tabanan 792 40 40 (100) 40 (100) 221 (42.5) 309
Gianyar 565 40 40 (100) 40 (100) 240 (46.2) 348
Denpasar 442 91 87 (95.6) 85 (97.7) 400 (36.0) 623
Badung 553 62 62 (100) 61 (98.4) 351 (44.0) 537
Klungkung 285 30 30 (100) 29 (96.7) 130 (33.3) 189
Karangasem 570 47 46 (97.9) 46 (100) 179 (29.9) 301
Bangli 353 30 30 (100) 30 (100) 178 (45.8) 273
Buleleng 620 71 71 (100) 71 (100) 369 (40.3) 552
Jembrana 270 30 30 (100) 29 (96.7) 125 (32.1) 199
Carer Total sample (%) Immunized children By recall alone (%) After validation (%) Difference in percentage (%)
Point 95% CI 99% CI Point 95% CI 99% CI
Bali 3,331 3,146 93.8 92.8-94.9 92.4-95.2 74.9 72.8-77.2 72.1-77.9 20.1
Relationship with childrenb) 3,316 3,132 93.8 92.8-94.9 92.5-95.2 75.1 72.8-77.3 72.1-78.0 19.9
 Mother 2,110 (63.6) 1,980 93.2 91.8-94.6 91.4-95.0 75.0 72.2-77.9 71.3-78.8 19.5
 Father 933 (28.1) 887 94.3 92.4-96.1 91.8-96.7 74.7 70.4-78.9 69.1-80.3 20.8
 Grandfather/grandmother 160 (4.8) 154 96.6 93.7-99.6 92.8-100 72.3 62.2-82.4 58.9-85.7 25.2
 Other relative 113 (3.4) 111 98.7 96.7-100 96.1-100 81.8 71.3-92.2 67.9-95.6 17.1
Districta) Total sample Immunized children By recall alone After validation Difference in percentage (%)
Point (%) 95% CI 99% CI Point (%) 95% CI 99% CI
Bali 3,331 3,146 93.8 92.8−94.9 92.4−95.2 74.9 72.8−77.2 72.1−77.9 20.1
Denpasar 623 571 91.3 88.7−93.9 87.8−94.8 58.1 53.4−62.8 51.9−64.3 36.4
Badung 537 518 95.8 93.8−97.8 93.1−98.5 86.8 83.0−91.0 81.8−91.7 9.4
Tabanan 309 296 95.4 92.6−98.3 91.6−99.2 70.4 64.7−76.2 62.8−78.1 26.2
Gianyar 348 336 97.1 95.3−98.8 94.7−99.4 80.1 75.2−84.9 73.7−86.5 17.5
Klungkung 189 184 98.5 96.8−100 96.2−100 92.1 87.8−96.4 86.5−97.8 6.5
Karangasem 301 287 95.6 93.0−98.1 92.2−98.9 72.5 66.7−78.3 64.8−80.2 24.2
Bangli 273 268 98.8 97.6−99.9 97.3−100 - - - -
Buleleng 552 506 89.5 86.5−92.6 85.5−93.5 - - - -
Jembrana 199 180 88.7 83.3−93.9 81.6−95.7 - - - -
Characteristic District with validation District without validation Total p
Respondenta) 1,430 645 2,075
 Age (y), median (interquartile range) 39 (13) 38 (14) 39 (13) 0.064
 Sex 0.364
  Female 960 (67.1) 446 (69.1) 1,406 (67.8)
  Male 470 (32.9) 199 (30.9) 669 (32.2)
 Relationship with children 0.167
  Father 871 (60.9) 415 (64.3) 1,286 (62.0)
  Mother 411 (28.7) 182 (28.2) 593 (28.6)
  Grandfather, grandmother/other 148 (10.4) 48 (7.4) 196 (9.4)
 Education <0.001
  No schooling yet 53 (3.7) 31 (4.8) 84 (4.1)
  Elementary school 244 (17.1) 236 (36.6) 480 (23.1)
  Junior high school 245 (17.1) 156 (24.2) 401 (19.3)
  High school 618 (43.2) 187 (29.0) 805 (38.8)
  College or higher 270 (18.9) 35 (5.4) 305 (14.7)
 Occupation <0.001
  Farmer 147 (10.3) 205 (31.8) 352 (17.0)
  Seller 91 (6.4) 44 (6.8) 135 (6.5)
  Housewife 390 (27.3) 172 (26.7) 562 (27.1)
  Private staff 306 (21.4) 32 (5.0) 338 (16.3)
  Entrepreneur 277 (19.4) 75 (11.6) 352 (17.0)
  Labor 73 (5.1) 54 (8.4) 127 (6.1)
  Other 146 (10.2) 63 (9.8) 208 (10.0)
Childb) 2,307 1,024 3,331
 Age at immunization 0.591
  9–59 mo 1,670 (72.4) 732 (71.5) 2,402 (72.1)
  5–15 y 637 (27.6) 292 (28.5) 929 (27.9)
 Sex 0.083
  Female 1,092 (47.3) 518 (50.6) 1,610 (48.3)
  Male 1,215 (52.7) 506 (49.4) 1,721 (51.7)
 Education 0.682
  No schooling yet 601 (26.1) 287 (28.0) 888 (26.7)
  Preschool 195 (8.5) 84 (8.2) 279 (8.4)
  Elementary 976 (42.3) 426 (41.6) 1,402 (42.1)
  Junior high 535 (23.2) 227 (22.2) 762 (22.9)
 Order in the family <0.001
  First-born 935 (40.5) 357 (34.9) 1,292 (38.8)
  Second-born 838 (36.3) 346 (33.8) 1,184 (35.5)
  Third-born 390 (16.9) 194 (18.9) 584 (17.5)
  Fourth-born 108 (4.7) 80 (7.8) 188 (5.6)
  Fifth-born 19 (0.8) 31 (3.0) 50 (1.5)
  Sixth- to tenth-born 17 (0.7) 16 (1.6) 33 (1.0)
District Child Invalid records, n (%) Missing register (%) Missing name (%) Missing date (%) Missing mark (%) Missing date and mark (%) Cannot be determined (%)
Tabanan 309 82 (26.5) 2.4 2.4 9.8 52.4 6.1 28.0
Klungkung 189 12 (6.3) 16.7 0 8.3 0 0 75.0
Karangasem 301 64 (21.3) 20.3 26.6 3.1 23.4 0 32.8
Gianyar 348 49 (14.1) 26.5 20.4 8.2 18.4 2.0 30.6
Badung 537 37 (6.9) 5.4 35.1 2.7 5.4 0 56.8
Denpasar 623 215 (34.5) 11.2 14.4 6.5 0.9 0 67.9
Table 1. Cluster and household characteristics
Table 2. The gap in weighted coverage of the Japanese encephalitis immunization program by recall and by validation according to carera)

CI, confidence interval.

Calculated based on children’s data, since 1 household may have more than 1 child.

Missing=15.

Table 3. The gap in weighted coverage of the Japanese encephalitis immunization program by recall and by validation according to district

CI, confidence interval.

Recall coverage was calculated from 9 districts, while the validation coverage was calculated from 6 districts.

Table 4. Comparison of sociodemographic characteristics of respondents and children in districts with and without validation in Bali

Data are presented as n (%) unless otherwise specified.

Calculated based on respondents’ data.

Table 5. Characteristics of invalid records for each district in Bali