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ABSTRAK
Nama : Ema Maratus Sholihah. AProgram Studi : Ilmu Kesehatan MasyarakatJudul : Studi Kualitatif Penyebab Orangtua Menolak Imunisasi Hepatitis B diDesa Cerukcuk Kecamatan Tanara Kabupaten Serang BantenPembimbing : Prof Dr. dr. Sudarto Ronoatmodjo, SKM, MKMLatarbelakang:Tidak tercapainya target imunisasi Hepatitis B di Desa CerukcukKecamatan Tanara dan adanya orangtua yang menolak imunisasi maka penting untukmengetahui penyebab orangtua menolak imunisasi Hepatitis B. Penelitian ini bertujuanuntuk mengidentifikasi penyebab orangtua menolak imunisasi hepatitis B denganmemodivikasi determinan Vaccine Hesitancy dan Health Belief Model .Metode: penelitian ini menggunakan metode kualitatif dengan mewawancara ibudengan bayi usia 0-3 bulan yang menolak imunisasi Hepatitis B dan melakukanobservasi pada pelayanan imunisasi.Hasil: perilaku orangtua yang menolak imunisasi hepatitis B disebabkan karenapengetahuan yang rendah tentang penyakit Hepatitis B dan imunisasinya, persepsiorangtua tentang hambatan melakukan imunisasi yang lebih besar dibandingmanfaatnya, besarnya peran dukun, pengaruh pengambilan keputusan oleh keluarga,masih adanya kepercayaan pada pengobatan tradisional, adanya pengalaman tidakmenyenangkan terkait imunisasi, sosial ekonomi yang rendah, peran tenaga kesehatanyang belum maksimal dalam pemberian informasi imunisasi, serta peran masyarakatyang kurang dalam mendukung iunisasi.Kesimpulan: peningkatan pengetahuan orangtua tentang penyakit hepatitis B danimunisasinya perlu ditingkatkan didahului dengan pendekatan oleh tenaga kesehatanbekerjasama dengan dengan tokoh agama dan dukun melalui kegiatan-kegiatan nonkesehatan dan kunjungan rumah untuk komunikasi interpersonal dan edukasi imunisasi..Kata kunci:Penolakan imunisasi, keraguan terhadap imunisasi, hepatitis B, penggerakanmasyarakat

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ABSTRACT
Name Ema Maratus Sholihah.AStudy Program Public HealthTitle Qualitative study cause of parents refused immunizationHepatitis B in Rural Cerukcuk Serang BantenCounsellor Prof. Dr. dr. Sudarto Ronoatmodjo, SKM, MKMBackground Low coverage of Hepatitis B immunization in Rural Cerukcuk and theexistence of parents who refused immunization so it is important to know the cause ofthe parents refused immunization Hepatitis B. This study aims to identify the cause ofparents reject hepatitis B immunization by modifying the determinants of vaccinehesitancy and Health Belief Model .Method This study used qualitative methods by interviewing mothers with infants aged0 3 months who rejected hepatitis B immunization and observed immunization services.Results the behavior of parents who reject hepatitis B immunization is due to poorparental knowledge about Hepatitis B disease and its immunization, parental perceptionof immunization constraints greater than the benefits, the magnitude of the dukun 39 s role,the influence of family decision making, the belief in traditional medicine, discomfortrelated to immunization, low social economy, the role of health workers who have notbeen maximized in providing immunization information, as well as the role of peoplewho lack support in iunisasi.Conclusions Increased parental knowledge about hepatitis B disease and its immunizationneeds to be increased preceded by approaches by health workers incollaboration with religious leaders and traditional healers through non health activitiesand home visits for interpersonal communication and immunization educationKeywords Refused immunization, vaccine hesitancy,communication, hepatitis B, socialmobilitation

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ABSTRAK
Indonesia termasuk dalam lima wilayah dengan prevalensi Hepatitis B tertinggi di dunia.Penyebaran Hepatitis B dapat dicegah dengan pemberian imunisasi Hepatitis B yangdimulai dari bayi baru lahir usia 0-7 hari HB 0 . Penelitian ini bertujuan untukmengetahui faktor-faktor yang berhubungan dengan akses imunisasi HB 0 di Indonesia.Studi dengan desain potong lintang ini menggunakan data Susenas 2016 dan Podes 2014.Sampel adalah bayi dari wanita yang pernah menikah berumur 15-49 tahun danmelahirkan bayi dengan berat lahir ge; 2,5 Kg pada dua tahun sebelum survei denganjumlah responden 18.407 individu. Hasil penelitian menunjukkan 59,63 bayimemanfaatkan imunisasi HB 0. Analisis regresi logistik logit menunjukkan variabelpendidikan, jarak, umur ibu, wilayah tempat tinggal, regional, tempat lahir bayi danpenolong persalinan berhubungan dengan akses imunisasi HB 0. Bayi yang dilahirkan difasilitas kesehatan dan ditolong oleh tenaga kesehatan memiliki peluang yang lebih baik.Disarankan untuk meningkatkan upaya promosi kesehatan, kemitraan tenaga kesehatandan mendorong ibu hamil untuk bersalin di fasilitas kesehatan dan ditolong oleh tenagakesehatan.

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ABSTRACT
Indonesia is among the five regions in the world with the highest Hepatitis B prevalence.One of the efforts to prevent Hepatitis B infection is to give Hepatitis B birth dose vaccineto infants at age 0 7 day HB 0 . This research aimed to analyze factors related to theaccess of HB 0 vaccinations in Indonesia. This cross sectional study was using Susenas2016 and Podes 2014 data, sample size was 18.407 babies of married women whose agebetween 15 49 years and gave birth baby birth weight ge 2,5 Kg in the last two yearsbefore the survey was done. About 59,63 infants accesses HB 0 vaccination. Logisticregression analysis model logit resulted marginal effects which showed variabel of ageand education of the mother, region, place of birth, distance and birth attendants hadrelationship with access the HB 0 vaccination. To increase the HB 0 vaccinationcoverage, it is recommended that the government or the policy makers should improveprograms and acess through health promotions, partnerships among health personnels,as well as encourage facility based delivery.

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[Latar belakang. Infeksi virus hepatitis B (VHB) di Indonesia masih tinggi dengan rerata prevalensi 9,4%. Tingginya prevalensi HB ini terkait dengan terjadinya infeksi VHB pada masa dini kehidupan, terutama melalui transmisi vertikal. Di Indonesia proporsi transmisi vertikal 45,9% dan 5,2% ibu hamil HBsAgnya positif. Cara paling efektif mengontrol infeksi VHB adalah dengan imunisasi, namun terdapat perbedaan seroproteksi titer anti-HBs pada usia lebih dari 10 tahun di berbagai tempat. Selain itu terdapat faktor-faktor yang dapat memengaruhi titer anti-HBs, namun penelitian ini masih jarang dan belum pernah dilakukan di Manado. Tujuan. Mengetahui seroproteksi titer anti-HBs dan faktor-faktor yang dapat memengaruhi titer anti- HBs tersebut. Metode. Penelitian analitik observational dengan desain potong lintang. Penelitian dilakukan dengan stratified random sampling pada usia 10-15 tahun di Kecamatan Tuminting, Kota Manado sejak Oktober sampai November 2014. Data dianalisis dengan SPSS 22. Hasil. Dari 48 sekolah terpilih 10 sekolah dengan 105 anak sebagai subyek penelitian, namun hanya 23 anak yang mempunyai seroprotektif (21,9%). Sebanyak 76 (72,4%) subyek adalah perempuan, 78 (74,3%) subyek berstatus gizi baik dan 98 (93,3%) subyek memiliki berat badan lahir ≥ 2.500 gram. Dari buku imunisasi didapatkan 26 (24,8%) subyek dengan vaksinasi HB-1 ≤ 7 hari dan 45 (42,9%) subyek dengan jarak HB-2 dan HB-3 ≥ 2 bulan. Didapatkan 86 (81,9%) ibu subyek berusia 20-35 tahun, 64 (60,9%) ibu subyek berpendidikan SMA dan 79 (75,2%) orangtua subyek berpenghasilan ≥ 2 juta per bulan. Analisis multivariat didapatkan faktor pemberian HB-1 < 7 hari atau ≥ 7 hari (p=0,02) dan jarak pemberian HB-2 dengan HB-3< 2 bulan atau ≥ 2 bulan (p<0,001) berperan terhadap seroproteksi HB pada anak. Simpulan. Penelitian ini mendapatkan angka seroproteksi HB yang rendah (21,9%) serta faktor pemberian HB-1 ≤ 7 hari atau > 7 hari dan jarak pemberian HB-2 dengan HB-3 < 2 bulan atau ≥ 2 bulan berperan terhadap seroproteksi HB pada anak usia 10-15 tahun.;Background. Hepatitis B viral (HBV) infection in Indonesia is still high with average prevalence of 9.4%. The high prevalence of hepatitis B (HB) is related to the occurence of HBV infection during the early life, especially through vertical transmission. In Indonesia proportion of vertical transmission 45.9% and 5.2% pregnant women have HBsAg positive. The most effective way to control HBV infection is with immunization HB, but there is differential in anti-HBs seroprotection titer at the age more than ten years in many locations. In addition there are factors that can affect anti-HBs titer, but these studies are rare and have ever been done in Manado. Objective. Knowing anti-HBs seroprotection titer and factors that can affect the anti-HBs titer. Method. Analitic observational study with cross sectional design. Research was done with stratified random sampling in children age 10-15 years old at Tuminting district, Manado city since October until November 2014. Analise data with SPSS 22. Results. From 48 schools, selected 10 schools with 105 children as subject of research, but only 23 (21.9%) children who were having seroprotective (21,9%). A total of 76 (72.4%) subjects were female, 78 (74.3%) subjects with good nutrition status and 98 (93.3%) subjects had ≥2,500 grams birth weight. From the immunization record book 26 (24.8%) subjects were obtained with HB-1 vaccination done at ≤7 days of age and 45 (42.9%) subjects with the distance between HB-2 and HB-3 were ≥2 months. Mother’s age was found 86 (81.9%) were 20-35 years old, 64 (60.9%) mothers’s education were high school graduated and 79 (75.2%) parents subjects had income ≥2 million per month. From multivariate analysis obtained that administration of HB-1 ≤7 days or >7 days (p=0.02) and distance between administration of HB-2 and HB-3 <2 months or ≥2 months (p<0.001) had important role in HB seroprotection in children. Conclusion. This study obtained a number of low HB seroptotection (21.9%) as well as administration of HB-1 ≤7 days or >7 days and distance between administration of HB-2 and HB-3 <2 months or ≥2 months had important role in HB seroprotection in children age 10-15 years old., Background. Hepatitis B viral (HBV) infection in Indonesia is still high with average prevalence of 9.4%. The high prevalence of hepatitis B (HB) is related to the occurence of HBV infection during the early life, especially through vertical transmission. In Indonesia proportion of vertical transmission 45.9% and 5.2% pregnant women have HBsAg positive. The most effective way to control HBV infection is with immunization HB, but there is differential in anti-HBs seroprotection titer at the age more than ten years in many locations. In addition there are factors that can affect anti-HBs titer, but these studies are rare and have ever been done in Manado. Objective. Knowing anti-HBs seroprotection titer and factors that can affect the anti-HBs titer. Method. Analitic observational study with cross sectional design. Research was done with stratified random sampling in children age 10-15 years old at Tuminting district, Manado city since October until November 2014. Analise data with SPSS 22. Results. From 48 schools, selected 10 schools with 105 children as subject of research, but only 23 (21.9%) children who were having seroprotective (21,9%). A total of 76 (72.4%) subjects were female, 78 (74.3%) subjects with good nutrition status and 98 (93.3%) subjects had ≥2,500 grams birth weight. From the immunization record book 26 (24.8%) subjects were obtained with HB-1 vaccination done at ≤7 days of age and 45 (42.9%) subjects with the distance between HB-2 and HB-3 were ≥2 months. Mother’s age was found 86 (81.9%) were 20-35 years old, 64 (60.9%) mothers’s education were high school graduated and 79 (75.2%) parents subjects had income ≥2 million per month. From multivariate analysis obtained that administration of HB-1 ≤7 days or >7 days (p=0.02) and distance between administration of HB-2 and HB-3 <2 months or ≥2 months (p<0.001) had important role in HB seroprotection in children. Conclusion. This study obtained a number of low HB seroptotection (21.9%) as well as administration of HB-1 ≤7 days or >7 days and distance between administration of HB-2 and HB-3 <2 months or ≥2 months had important role in HB seroprotection in children age 10-15 years old.]