Research article

Profile of The Health Workers About Immunization at Public Center In Manado Anrih R. Manthurio, Novie H. Rampengan, Hesti Lestari Department of Child Health Faculty of Medicine, University of Sam Ratulangi RSUP Prof. Dr. R. D. Kandou Manado

Background. Indonesian Demographic and Health Survey noted that from the last two years, immunization coverage seems decreased. Health workers at health center are the vital element in immunization services. High competence from the health workers, will increase qualitative and quantitative performance and immunization coverage.

Objectives. To get the profile picture from the health workers in Manado in terms of increasing the immunization coverage in Manado city

Methods We conducted a descriptive studiy, using questionnaire that consist of 19 questiones , about how to give the immunization, in what age the imminization are given, the dose of vaccine, the place where the vaccine injected. This questionnaire is given to health workers in 15 health centers in Manado, from January 2012 - March 2012. Results. From 75 respondents, there are 20 workers are trained to give immunizations, 2 workers are not trained, and 53 workers do not give immunizations at all. We found that all respondents had the range of age between 2060 years, The most recent education is Diploma III (38.7%). From the total 20 respondents whom got trained, about nine people got trained in 2005-2009 (12%). On the test level of knowledge about immunization, from 75 respondent , founded that 68 respondents answered very well (96.7%), and 6 repondent had a moderate answer. From the 68 respondents, 22 respondents who give immunizations are correctly answer all the questiones. Conclusion Health care workers from health centers who provide immunization in Manado city, have a good level of knowledge. Keyword. The level of knowledge of health workers, immunization

Abstrak Latar belakang. Dari Survei Kesehatan dan Demografi Indonesia (SKDI) diketahui bahwa pada dua tahun terakhir cakupan imunisasi tampak menurun. Sedangkan pencapaian target universal child Immunization ditunjang juga dengan pengetahuan petugas kesehatan terhadap pemberian imunisasi. merupakan unsur yang sangat penting dalam pelayanan imunisasi. terhadap pelaksanaan imunisasi rutin kdi Puskesmas. Petugas kesehatan di Puskesmas

Petugas kesehatan bertanggung jawab

Dengan adanya kompetensi yang tinggi dari petugas

kesehatan, diharapkan kinerja dan cakupan imunisasi akan meningkat baik secara kualitatif maupun kuantitatif

Tujuan Mendapatkan gambaran profil tingkat pengetahuan tenaga kesehatan di Manado untuk meningkatkan cakupan imunisasi di kota Manado.

Metode Penelitian dekskriptif dengan menggunakan kusioner sebanyak 19 pertanyaan yang diberikan pada petugas kesehatan di 15 puskesmas di manado, dari Januari 2011 Maret 2012. Variabel adalah pengetahuan tentang imunisasi, pelatihan dan tugas sehari-hari sebagai petugas kesehatan..

Hasil. Dari data yang ada, dijumpai 20 orang petugas memberi imunisasi mengikuti pelatihan, 2 petugas tidak mengikuti pelatihan, dan 53 petugas tidak memberikan imunisasi. Didapatkan bahwa responden memiliki rentang usia adalah 20-60 tahun, dengan rentang terbanyak adalah 31-40 tahun (46,7%). Pendidikan terakhir yang paling banyak ialah Diploma III (38,7%). Dari total 20 responden yang mengikuti pelatihan, jumlah terbanyak dijumpai tahun 2005-2009 yaitu sembilan orang (12%). Dari uji tingkat pengetahuan mengenai imunisasi, didapati bahwa total 68 responden menjawab dengan baik (96,7%), Dari 68 responden ini, 22 responden yang memberikan imunisasi semuanya menjawab dengan benar.

Kesimpulan Petugas kesehatan Puskesmas sekota Manado yang memberikan imunisasi memiliki tingkat pengetahuan yang lebih baik.

Kata kunci. Tingkat pengetahuan petugas kesehatan, imunisasi

Introduction Immunization is the provision of anti infants and children into the body to induce immunity against the disease.Immunization managed to increase life expectancy, since the establishment of the Expanded Programme on Immunisation (EPI) by the World Health Organization (WHO), the basic child immunization coverage increased from 5% to nearly 1, 2,3 80% in the whole world. From the Indonesian Demographic and Health Survey (SKDI) note that in the last two years immunization coverage appears to have declined.Immunization services in health centers especially the city of Manado for the achievement of universal child Immunization (UCI) has not reached the target of 100%. Based on data from the Health Department of Manado, the percentage of primary immunization coverage for the month of October 2011 is Hepatitis B (Hb) <7 days 42%, Bacillius Guerine Calmette (BCG) 72%, Polio 1 72%, Diphtheria Pertussis Tetanus (DPT) / Hb 1 71% 2 68% Polio, DPT / Hb 2 67% 3 64% Polio, DPT / Hb 3 65% 4 4 63% Polio, Measles 66% Based on the background above, the writer is interested in conducting research on health knowledge Health Center overview Manado derby against immunization. Methods This analysis study with descriptive analytic design to evaluated. The study was conducted in November 2011 - January 2012 in Manado City Health Center. 1. Flow Data Collection Officers shirts Manado health center Approval. Giving questionnaires. Analysis of data. ABC Description: A = Health care workers who provide immunization and immunization trained B = HCWs who do not get immunized and immunization training C = Health care providers do not provide immunization 2. Data collection instruments To measure knowledge of health research instrument used was a questionnaire. G. Processing and Data Analysis 1. Data processing Data processing is as follows: a. Editing is done directly by the researcher to the questionnaire. The purpose of editing is to ensure that the data obtained by the questionnaire all been filled, relevant and can be read properly.

b. Coding is the answers each question was coded according to the coding instructions. Done to simplify the coding of data obtained. To answer correct = 1, incorrect = 0. c. Scoring after all variables were coded later each component summed variables. d. Processing after all fields filled and properly, the next step is to process the data to be analyzed. Process data is done by the data mengentri questionnaire results to the computer. e. Cleaning the data back-checking activities already dientri dat if there is a mistake or not. 2. Analysis of data a. Descriptive Data analysis is the analysis done scoring. Data presented in tables and interpreted. Knowledge Assessment Criteria To measure knowledge using the formula:

SP P= SM Description: P = value attainment (%) SP = Score obtained SM = Score up all the questions are answered correctly below Answers to knowledge questions were scored 1 for a correct answer and a wrong answer was given a score of 0. Based on the results and then the results are interpreted on the following criteria: 29 a.Good knowledge = 75-100% b.Moderate Moderate = 50-75% c. Bad Knowledge = < 50% b. The statistical test - Chi square test to analyze the differences between the two groups of subjects. - Meaningful statistically significant if p <0.05 - Using SPSS windows version 17. X 100 %

RESULTS The study was conducted in 15 health centers Manado with a sample of 20 people to immunize health workers with training (A) and 2 people for health workers to immunize without training (B) and 53 people for health workers providing immunization

Knowledge of health workers to immunize the training is good. Picture of the distribution of the knowledge of health workers to immunize based on years of training can be seen in Table 4.6 below. Table 4.1 Distribution of health knowledge by years of training

DISCUSSION Knowledge of immunization in general have a significant impact on the immunization status of children, required a good knowledge of health and 5,6 ibu. Results of research conducted in 75 health workers at the health center of Manado city health officials found that giving immunizations have 100% good level of education and for health workers to immunize 88.7% had a good level of education. This study shows that knowledge workers who provide immunization better than officers who are not immunized, although not statistically significant (Table 4.4). These results contrast with the results of the study Widsnugoro, et al in 117 health workers in Kalasin, Thailand, where only 55.6% had a good 7,8,9 knowledge of the imunisasi. Good knowledge also supported by several factors such as education, training, information and 10 pengalaman. Knowledge of health care workers on immunization can be obtained through formal and non-formal education. For example, formal education is to attend a school of health, education and non-formal training. A good education is also supported with good health facilities, and health facilities to the city of Manado is good enough to improve health education with several medical schools and hospitals are used as a place of learning. Studying at a hospital early work experiences that train health workers in providing health se rvices primarily for the provision 11,12 of services imunisasi. From this study, it was found that the knowledge of health workers towards immunization factors play a greater role is training and frekuwensi immunization by health workers. Training health workers to immunization is one of the EPI program to improve

immunization coverage. Routine immunization is also supporting increased immunization coverage, as is done in India in 1978. Knowledge of health care workers against immunization by education level less play (table 4.5). These results contrast with research Joao and Gunnar in Niassa Mozambique showed that health care workers who work in health centers with low education and work experience have little knowledge about immunization 5,13,14 unfavorable. Education in the form of training for immunization techniques are essential to increasing immunization coverage, due to the training, the level of knowledge of health workers to the better immunization. From research conducted last year of the most widely followed by health workers is 2005-2009 (table 4.3), and have a good knowledge of the immunization .9,15,16 (table 4.6) Data obtained from the city of Manado for the Health Department immunization coverage in October 2011 still showed the achievement of a low 42% for HBO, 72% for BCG, 72% for Polio1, 71% for DPT/Hb1, Polio2 68% for, 67% for DPT/Hb2, 64% for Polio3, DPT/Hb3 65% for, 63% for Polio4, and 66% for measles. Research conducted shows that health workers who provide immunizations have good knowledge, but the city of Manado immunization coverage remains low, as there are several other factors that support the lain5: - Knowledge of parents of low immunization Due to lack of knowledge of the parents, the child's immunization against late. According to research by Karlen Luthy (2008), education and health counseling to parents have a vital role in the success of imunisasi.30, 35 - Geographic Manado Achievement of immunization coverage for health center located alongside the town of Manado lower than the health center located in the city of Manado, This is caused by the implementation of immunization for health centers located alongside the city of Manado is only done once a month while the implementation of immunization at the health center in the city of Manado performed four times during a month . Lack of transportation for people 5 living island is also a factor berpengaruh. - Socialization by health professionals of the 17 importance of immunization to the tua. From observations in the field, often by health workers to provide the date of return, without explaining what the side effects when immunization is not carried out regularly.

- The absence of reports from general practitioners and specialists who provide immunizations to the Health Department clinic outside the city of Manado. 11. Conclusion From the results of this study concluded that health center staff who provide immunizations Manado city rivals have good knowledge. There was no difference in the formal educational background of knowledge about immunization. REFERENCES 1. Ali M. Pengetahuan, sikap dan perilaku ibu bekerja dan ibu tidak bekerja tentang imunisasi. Medan : USU Digital Library; 2002. h. 1, 12-14. Ranuh IGN. Imunisasi upaya pencegahan primer. Dalam: Ranuh IGN, Suyitno Hariyono, Hadinegoro SRH, Kartasasmita CB, Ismoedijanto, Seodjatmiko, penyunting. Pedoman Imunisasi di Indonesia. Edisi 3. Jakarta: Badan penerbit ikatan dokter anak Indonesia; 2008. h. 2-8. Bentsi-Enchill AD, Duclos P, Folb PI. Sustaining chilhood vaccination programmes-not all about cost. Vaccine: children & practice 2002;5:26-9. Dinas Kesehatan Kota Manado. Profil Kesehatan Kota Manado; 2009. Diunduh dari : http : // www.dephut.go.id/ halaman / PDF/ INFPROP/ Sulut/ lahankritis/ Menado/ bab_II.pdf. h. 3. Notoadmojo S. Ilmu Kesehatan Masyarakat. Jakarta: PT.Rineka Cipta; 2007. Notoadmojo S. Ilmu Kesehatan Masyarakat: Prinsip-Prinsip Dasar. Jakarta: PT. Rineka Cipta; 1997. h. 95-133. Notoadmojo S. Pendidikan dan Perilaku Kesehatan. Jakarta: PT. Rineka Cipta; 2005.h. 121-24. Hidayat, AAA. Pengantar Ilmu Kesehatan Anak untuk Pendidikan Kebidanan. Jakarta: Salemba Medika; 2008. h. 55. Sugitno Hariyanto. Jenis vaksin. Dalam: Ranuh IGN, Suyitno Hariyono, Hadinegoro SRH, Kartasasmita CB, Ismoedijanto, Seodjatmiko, penyunting.Pedoman Imunisasi di Indonesia. Edisi 3. Jakarta: Badan Penerbit Ikatan Dokter Anak Indonesia; 2008. h. 23-27. WHO. Recommended Routine Immunizations for Children. 2009; Diunduh

12.

13.

2.

14.

3.

15.

4.

16.

5. 6.

17.

dari: http: // www.who.int / immunization / policy / Immunization_rountine_table2. pdf. Advisory Committee on Immunization Practices. Policy statement--Recommended childhood and adolescent immunization schedulesUnited States, 2010. Pediatrics 2010 Jan; 125 (1): 195-6. Advisory Committee on Immunization Practices. Catch-up Immunization Schedule for Person Aged 4 Months Through 18 Years Who Start Late or WHO Are More Than 1 Month Behind. 2010; Diunduh dari: http: // www.cdc.gov / vaccines. Ravhengani M, Manfe M, Makinta J, Teffo LS, Masekoa NO, Nycubu BN. Immunization Knowledge Practice and Coverage Survey: Ganteny Province. School of Public Health, University of Limpopo. Savic; 2007. h.1-37. Widsanugorn O, Suwattana O, Rashid MHO, Sakamoto J. Healthcare Workers Knowledge and Practices Regarding Expanded Program on Immunisation in Kalasin, Thailand. Nagoya J Med. Sci. 2011; 177-85. Joao Carlos de T M, Gunnar B. Cold chain management: Knowledge and practices in primary health care facilities in Niassa, Mozambique. Ethiop J Health Dev, 2007; 21: 16. Department of Health and Family Welfare. Government of India.Facilitators's guide : Immunization handbook for medical officers 2008. p 1-100 Choi BKA, Manning ML. The Immunization status of Home-schooled Children in America. Journal of Pediatric Health Care Januari 2010. 24(1); p 42-7.

7.

8.

9.

10.