Journal of Preventive Medicine and Public Health

Original Articles

Association Between Basic Immunization Status and Stunting in Toddlers Aged 12-59 Months in Indonesia: Eka Desi Purwanti, Siti Masitoh, Sudarto Ronoatmodjo; J Prev Med Public Health. 2025;58(3):298-306. Published online January 30, 2025; DOI: https://doi.org/10.3961/jpmph.24.230

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Abstract Summary PDF: Objectives
Immunization has been identified as a specific nutrition-related intervention to address the direct causes of stunting. This study examines the association between basic immunization status and stunting among toddlers in Indonesia.
Methods
We conducted a cross-sectional analysis using data from the 2021 Study of Indonesia’s Nutritional Status. A total of 70 267 toddlers, aged 12 months to 59 months, were examined. Cox regression was employed to calculate adjusted prevalence ratios (aPRs) with their 95% confidence intervals (CIs).
Results
The prevalence of stunting among children aged 12 months to 59 months in Indonesia was 23.1%, while 74.9% of children under 5 years old had complete basic immunization status. Multivariable analysis revealed a statistically significant association between basic immunization status and the incidence of stunting. Relative to toddlers with complete basic immunization, those with incomplete (partial) immunization were at a 1.18 times higher risk of stunting (aPR, 1.18; 95% CI, 1.15 to 1.22). Furthermore, toddlers who had not been immunized at all faced an even greater stunting risk (aPR, 1.27; 95% CI, 1.17 to 1.37). This association persisted after adjusting for variables such as maternal education, economic status, and the child’s birth weight.
Conclusions
Basic immunization status influences the incidence of stunting in toddlers aged 12 months to 59 months. Thus, parents must ensure that their children’s immunizations are completed according to the recommended schedule. Additionally, it is crucial to increase parental awareness regarding health service utilization, disease prevention, and the nutritional needs of toddlers.; Summary

Key Message
Stunting remains a major public health concern in Indonesia. Immunization is recognized as a specific nutrition-related intervention to address its direct causes. Using data from 70,267 toddlers aged 12–59 months, this study found that children with partial or no basic immunization had significantly higher risks of stunting (aPR 1.18 and 1.27, respectively) compared to fully immunized peers. Given the high stunting prevalence (23.1%) and suboptimal immunization coverage (74.9%), the findings underscore the need to strengthen immunization programs and enhance parental awareness of health service utilization, disease prevention, and the nutritional needs of young children.

Women’s Empowerment Facilitates Complete Immunization in Indonesian Children: A Cross-sectional Study: Gede Benny Setia Wirawan, Ni Luh Zallila Gustina, Putu Harrista Indra Pramana, Made Yuliantari Dwi Astiti, Jovvita Jonathan, Fitriana Melinda, Teo Wijaya; J Prev Med Public Health. 2022;55(2):193-204. Published online March 8, 2022; DOI: https://doi.org/10.3961/jpmph.21.592

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Objectives
The primary objective of this study was to examine the effect of women’s empowerment on the immunization of Indonesian children. The secondary objective was to examine the effect of wealth as a factor modifying this association.
Methods
We utilized data from the 2017 Indonesian Demographic and Health Survey (IDHS). The subjects were married women with children aged 12-23 months (n=3532). Complete immunization was defined using the 2017 IDHS definition. Multiple components of women’s empowerment were measured: enabling resources, decision-making involvement, and attitude toward intimate partner violence. The primary analysis was conducted using binomial logistic regression. Model 1 represented only the indicators of women’s empowerment and model 2 controlled for socio-demographic variables. Subgroup analyses were conducted for each wealth group.
Results
The primary analysis using model 1 identified several empowerment indicators that facilitated complete immunization. The analysis using model 2 found that maternal education and involvement in decision-making processes facilitated complete immunization in children. Subgroup analyses identified that wealth had a modifying effect. The indicators of women’s empowerment were strong determinants of complete immunization in lower wealth quintiles but insignificant in middle-income and higher-income quintiles.
Conclusions
To our knowledge, this study is the first to explore women’s empowerment as a determinant of child immunization in Indonesia. The results indicate that women’s empowerment must be considered in Indonesia’s child immunization program. Women’s empowerment was not found to be a determinant in higher wealth quintiles, which led us to rethink the conceptual framework of the effect of women’s empowerment on health outcomes.

Summary

Citations

Citations to this article as recorded by

Factors associated with decision-making autonomy in healthcare utilization among married women from the Indonesia demographic health survey 2017
Sofa D. Alfian, Meliana Griselda, Mochammad A. A. Pratama, Sameer Alshehri, Rizky Abdulah
Scientific Reports.2025;[Epub] CrossRef
Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low- and Middle-Income Countries
Anna Kalbarczyk, Natasha Brownlee, Elizabeth Katz
Vaccines.2024; 12(6): 625. CrossRef
Health Beliefs and Socioeconomic Determinants of COVID-19 Booster Vaccine Acceptance: An Indonesian Cross-Sectional Study
Gede Benny Setia Wirawan, Ngakan Putu Anom Harjana, Nur Wulan Nugrahani, Pande Putu Januraga
Vaccines.2022; 10(5): 724. CrossRef

Hepatitis A Outbreak in a Facility for the Disabled, Gyeonggi Province, Korea: An Epidemiological Investigation: Yeonhwa Chang, Chanhee Kim, Nayoung Kim, Joon Jai Kim, Heeyoung Lee; J Prev Med Public Health. 2021;54(5):370-375. Published online September 2, 2021; DOI: https://doi.org/10.3961/jpmph.21.349

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Abstract Summary PDF

Objectives
The number of cases of hepatitis A virus (HAV) infections has sharply increased in Korea, especially among young adults. In this study, an HAV outbreak in a facility for disabled people was investigated, and we found epidemiological differences both between 2 different generations and between generally abled and disabled groups.
Methods
We analyzed the incubation period and attack rate of an HAV outbreak and investigated the prevalence of HAV antibodies among the staff and residents of a facility for the disabled. We performed a retrospective cohort study during the HAV outbreak, which lasted from February 8 to 25, 2019, including examinations of HAV antibody tests and post-exposure HAV vaccination for the staff or residents of the facility.
Results
There were 9 confirmed cases in 2 staff members and 7 residents. Among 53 people (30 staff and 23 residents), except for the 9 confirmed cases and 1 staff member with a known history of HAV infection, HAV seroprevalence was seen in 16.7% of the staff under 40 years of age and 95.2% of those over 40 years of age, while the corresponding rates in the residents were 0.0% and 58.8%, respectively.
Conclusions
This result implies that it is necessary to prioritize HAV vaccination for vulnerable groups and workers of residential care facilities.

Summary

Korean summary
본 연구는 장애인 거주시설에서 발생한 A형간염 유행 사례를 다루고 있다. 그 결과 거주시설 소속의 장애인들은 종사자들보다 높은 발병률(attack rate)을 나타냈을 뿐만 아니라, 비슷한 연령의 일반 인구집단보다 낮은 항체유병률을 나타내는 것으로 확인되었다. 거주시설 소속의 장애인들과 같이 취약한 인구집단은 예방접종 이력을 확인하기 어려울 뿐만 아니라 병원체에 자연스럽게 노출 기회가 적을 수밖에 없기 때문에, 예방접종 정책 수립 시 우선 접종의 대상으로 고려될 필요가 있다.

Citations

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CURRENT FEATURES OF THE HEPATITIS EPIDEMIC PROCESS IN THE VINNYTSIA REGION
Dmytro V. Palii, Iryna G. Paliy, Olena O. Voinalovych, Mariia O. Shostatska
Clinical and Preventive Medicine.2025; (2): 132. CrossRef
The Shifting Epidemiology of Hepatitis A in the World Health Organization Western Pacific Region
Nina G. Gloriani, Sheriah Laine M. de Paz-Silava, Robert D. Allison, Yoshihiro Takashima, Tigran Avagyan
Vaccines.2024; 12(2): 204. CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
Journal of Bacteriology and Virology.2023; 53(2): 74. CrossRef
A Study on the Detection Rate of Hepatitis A from Gastroenteritis Patients and the Genotype Analysis of Hepatitis A Virus in Busan
Sun Hee Park, Chanhee Kim, Summi Lee, Jihye Jeong, Junghye Choi, Seung Ju Lee
Journal of Bacteriology and Virology.2023; 53(2): 74. CrossRef

Factors Influencing Vaccination in Korea: Findings From Focus Group Interviews: Bomi Park, Eun Jeong Choi, Bohyun Park, Hyejin Han, Su Jin Cho, Hee Jung Choi, Seonhwa Lee, Hyesook Park; J Prev Med Public Health. 2018;51(4):173-180. Published online May 25, 2018; DOI: https://doi.org/10.3961/jpmph.18.063

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267 Download
15 Crossref

Abstract PDF

Objectives
Immunization is considered one of the most successful and cost-effective public health interventions protecting communities from preventable infectious diseases. The Korean government set up a dedicated workforce for national immunization in 2003, and since then has made strides in improving vaccination coverage across the nation. However, some groups remain relatively vulnerable and require intervention, and it is necessary to address unmet needs to prevent outbreaks of communicable diseases. This study was conducted to characterize persistent challenges to vaccination.
Methods
The study adopted a qualitative method in accordance with the Consolidated Criteria for Reporting Qualitative Research checklist. Three focus group interviews were conducted with 15 professionals in charge of vaccination-related duties. The interviews were conducted according to a semi-structured guideline, and thematic analysis was carried out. Data saturation was confirmed when the researchers agreed that no more new codes could be found.
Results
A total of 4 main topics and 11 subtopics were introduced regarding barriers to vaccination. The main topics were vaccine hesitancy, personal circumstances, lack of information, and misclassification. Among them, vaccine hesitancy was confirmed to be the most significant factor impeding vaccination. It was also found that the factors hindering vaccination had changed over time and disproportionately affected certain groups.
Conclusions
The study identified ongoing unmet needs and barriers to vaccination despite the accomplishments of the National Immunization Program. The results have implications for establishing tailored interventions that target context- and group-specific barriers to improve timely and complete vaccination coverage.

Summary

Citations

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Twenty Years of Progress and the Way Forward: Immunization Registry Information System in Korea
Junghee Kim, Minju Song, Seohyeon Ahn, Seunghyun Lewis Kwon
Journal of Korean Medical Science.2024;[Epub] CrossRef
Parental intention to vaccinate daughters with the human papillomavirus vaccine in Korea: a nationwide cross-sectional survey
Yejin Ha, Kyeongmin Lee, Bomi Park, Mina Suh, Jae Kwan Jun, Kui Son Choi
Epidemiology and Health.2023; 45: e2023076. CrossRef
Letter to the Editor: Effectiveness of the Varicella Vaccine Among Korean Children: Suggestions for Future Research
BongKyoo Choi, Hyunjeong Cho, Younchul Shin, Eun-Kyoung Lee
Journal of Korean Medical Science.2022;[Epub] CrossRef
Vaccine hesitancy and emerging parental norms: A qualitative study in Taiwan
Chen‐I Kuan
Sociology of Health & Illness.2022; 44(3): 692. CrossRef
Physical and mental health characteristics related to trust in and intention to receive COVID-19 vaccination: results from a Korean community-based longitudinal study
Ye Jin Jeon, Youngrong Lee, Ji Su Yang, Young Su Park, Sun Jae Jung
Epidemiology and Health.2022; 44: e2022064. CrossRef
Vaccine Hesitancy and Concerns About Vaccine Safety and Effectiveness in Shanghai, China
Abram L. Wagner, Zhuoying Huang, Jia Ren, Megan Laffoon, Mengdi Ji, Leah C. Pinckney, Xiaodong Sun, Lisa A. Prosser, Matthew L. Boulton, Brian J. Zikmund-Fisher
American Journal of Preventive Medicine.2021; 60(1): S77. CrossRef
Paradoxical health care utilization patterns among children in Korea who did not receive mandatory pneumococcal vaccination
Sangho Sohn, Kwan Hong, Hari Hwang, Byung Chul Chun
Vaccine.2021; 39(7): 1096. CrossRef
Differential Demographic and Clinical Characteristics between MMR Vaccinated and Unvaccinated Children in South Korea: A Nationwide Study
Dongwon Yoon, Juhwan Kim, Juyoung Shin
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Vivian Colón-López, Diana T. Medina-Laabes, Roxana Soto Abreu, Olga L. Díaz Miranda, Ana P. Ortiz, María E. Fernández, Pamela C. Hull
BMC Public Health.2021;[Epub] CrossRef
The need for pertussis vaccination among older adults and high-risk groups: a perspective from advanced economies of the Asia Pacific region
Leong Hoe Nam, Cheng-Hsun Chiu, Jung Yeon Heo, Margaret Ip, Ki-Suck Jung, Robert Menzies, Rodney Pearce, Philippe Buchy, Jing Chen, Michael Nissen, Kyu-Bin Oh
Expert Review of Vaccines.2021; 20(12): 1603. CrossRef
Comparison of the Seroprevalence of Measles Antibodies among Healthcare Workers in Two Korean Hospitals in 2019
Yee Gyung Kwak, Je Eun Song, Gang-Bok Oh, In Hye Jeong, Chong Rae Cho, Namhee Kim, Hyeon Mi Yoo, Gyeong Min Yoo, Myung Jin Lee, Baek-Nam Kim
Infection & Chemotherapy.2020; 52(1): 93. CrossRef
Unvaccinated children as community parasites in National Qualitative Study from Turkey
Sıddıka Songül Yalçin, Ayça Gelgeç Bakacak, Osman Topaç
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Alexandre de Figueiredo, Clarissa Simas, Emilie Karafillakis, Pauline Paterson, Heidi J Larson
The Lancet.2020; 396(10255): 898. CrossRef
Sustained Vaccination Coverage during the Coronavirus Disease 2019 Epidemic in the Republic of Korea
Jeong Hee Yu, Hang jin Jeong, Seon Ju Kim, Jae Young Lee, Young June Choe, Eun Hwa Choi, En Hi Cho
Vaccines.2020; 9(1): 2. CrossRef
Why do some Korean parents hesitate to vaccinate their children?
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Epidemiology and Health.2019; 41: e2019031. CrossRef

Health Impact Assessment of Free Immunization Program in Jinju City, Korea: Keon Yeop Kim, So Youn Jeon, Man Joong Jeon, Kwon Ho Lee, Sok Goo Lee, Dongjin Kim, Eunjeong Kang, Sang Geun Bae, Jinhee Kim; J Prev Med Public Health. 2012;45(4):267-275. Published online July 31, 2012; DOI: https://doi.org/10.3961/jpmph.2012.45.4.267

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59 Download
3 Crossref

Abstract PDF

Objectives

This study was conducted to assess the potential health impacts and improve the quality of the free immunization program in Jinju City by maximizing the predicted positive health gains and minimizing the negative health risks.

Methods

A steering committee was established in September 2010 to carry out the health impact assessment (HIA) and began the screening and scoping stages. In the appraisal stage, analysis of secondary data, a literature review, case studies, geographic information systems analysis, a questionnaire, and expert consultations were used. The results of the data collection and analyses were discussed during a workshop, after which recommendations were finalized in a written report.

Results

Increased access to immunization, comprehensive services provided by physicians, the strengthened role of the public health center in increasing immunization rates and services, and the ripple effect to other neighboring communities were identified as potential positive impacts. On the other hand, the program might be inaccessible to rural regions with no private clinics where there are more at-risk children, vaccine management and quality control at the clinics may be poor, and vaccines may be misused. Recommendations to maximize health gains and minimize risks were separately developed for the public health center and private clinics.

Conclusions

The HIA provided an opportunity for stakeholders to comprehensively overview the potential positive and negative impacts of the program before it was implemented. An HIA is a powerful tool that should be used when developing and implementing diverse health-related policies and programs in the community.

Summary

Citations

Citations to this article as recorded by

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Yunhwa Kim, Ji-Young Hwang, Kyung-Min Lee, Eunsil Lee, Hosun Park
Vaccines.2021; 9(5): 492. CrossRef
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Epidemiological Impact of the Korean National Immunization Program on Varicella Incidence
Jaehun Jung, Young-Jin Ko, Young-Eun Kim, Kyungmin Huh, Byung-Joo Park, Seok-Jun Yoon
Journal of Korean Medical Science.2019;[Epub] CrossRef

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