Coverage and Determinants of Second-Dose Measles Vaccination Among Under-Five Children in Aceh Jaya District, Aceh Province, Indonesia

Indonesia is aiming for measles elimination status by 2020. However, high number of measles cases are still prevalent and there are still coverage differences among provinces. Measles immunization coverage also varies among surveys and routine coverage report. With the addition of second-dose measles vaccination (MCV2), measles infections in the country is expected to decrease. However, MCV2 coverage has been low after 2 years of implementation. Aceh Province was chosen for this study because its low coverage. This study aimed to measure the coverage and investigate the determinants of MCV2 in Aceh Jaya, Aceh Province. Dataset from “Assessment of the New 2nd Dose Measles Policy and the School-based Immunization Program in 2 Provinces (Aceh and South Sulawesi)” was used. There were a total of 300 children aged 25 – 37 months with coverage of MCV2 54% in Aceh Jaya District, Aceh Province. After further selection, 129 observations underwent bivariate and multivariate analysis using logistic regression. After controlling all variables, only experience of prompt service at the healthcare provider was associated with child receiving MCV2. We suggest future studies to look more into health care services and willingness to get vaccination. Additionally, with this result we hope the government could improve health care services in their facilities in order to achieve higher coverage

Recognition of and care-seeking for maternal and newborn complications in Jayawijaya district, Papua province, Indonesia: a qualitative study

Background: Indonesia\u2019s progress on reducing maternal and newborn mortality rates has slowed in recent years, predominantly in rural areas. To reduce maternal and newborn mortality, access to quality and skilled care, particularly at the facility level, is crucial. Yet, accessing such care is often delayed when maternal and newborn complications arise. Using the \u201cThree Delays\u201d model originated by Thaddeus and Maine (1994), investigation into reasons for delaying the decision to seek care, delaying arrival at a health facility, and delaying the receiving of adequate care, may help in establishing more focused interventions to improve maternal and newborn health in this region. Methods: This qualitative study focused on identifying, analyzing, and describing illness recognition and care-seeking patterns related to maternal and newborn complications in the Jayawijaya district of Papua province, Indonesia. Group interviews were conducted with families and other caregivers from within 15 villages of Jayawijaya who had either experienced a maternal or newborn illness or maternal or newborn death. Results: For maternal cases, excessive bleeding after delivery was recognized as a danger sign, and the process to decide to seek care was relatively quick. The decision-making process was mostly dominated by the husband. Most care was started at home by birth attendants, but the majority sought care outside of the home within the public health system. For newborn cases, most of the caregivers could not easily recognize newborn danger signs. Parents acted as the main decision-makers for seeking care. Decisions to seek care from a facility, such as the clinic or hospital, were only made when healthcare workers could not handle the case within the home. All newborn deaths were associated with delays in seeking care due to caretaker limitations in danger sign identification, whereas all maternal deaths were associated with delays in receiving appropriate care at facility level. Conclusions: For maternal health, emphasis needs to be placed on supply side solutions, and for newborn health, emphasis needs to be placed on demand and supply side solutions, probably including community-based interventions. Contextualized information for the design of programs aimed to affect maternal and newborn health is a prerequisite