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The role of information sources and characteristics of children in the acceptance of Japanese encephalitis (JE) mass immunization in Bali Province



Background and purpose: Japanese encephalitis (JE) is a public health issue that can be prevented by immunization programs. Indonesia began the JE immunization campaign in Bali through simultaneous immunization for children aged 9 months to 15 years. Although information dissemination has been carried out, knowledge, perceptions and characteristics of mother and child can influence the acceptance and uptake of immunization for children. This study aims to determine the factors that influence acceptance of JE mass immunization in Bali Province.Methods: Secondary data analysis was performed on the results of the JE Supplementary Immunization Activities (SIA) Udayana University survey which consisted of 1,284 mothers and 2,107 children. The survey was conducted from June-August 2018 in nine districts/cities in Bali Province. The association between knowledge, perception and respondents’ characteristics with acceptance of JE mass immunization was analyzed with chi square test and multivariate analysis was conducted using logistic regression.Results: The proportion of children who received immunization was 93.9% (95%CI: 92.8-94.9). The results of the bivariate analysis showed that there was a significant association between acceptance of JE mass immunization with the child’s age, sex, educational status, complete basic immunization history, mother’s perception of severity, benefits, barriers, knowledge and sources of information (p<0.05). Multivariate analysis shows that the variables which significantly increase JE mass immunization acceptance are information from a combination of media and face to face education (AOR=3.95; 95%CI: 2.01-7.77), schooling children (AOR=2.43; 95%CI: 1.23-4.79), living outside of Denpasar City (AOR=2.32; 95%CI: 1.49-3.62), children who have received complete basic immunization (AOR=2.22; 95%CI:1.42-3.49), face to face information only (AOR=2.11; 95%CI: 1.21-3.70) and girls (AOR=1.68; 95%CI: 1.15-2.46).Conclusion: Information disseminated via a combination of media and face to face is the strongest variable influencing JE mass immunization acceptance. Providing appropriate information through a combination of media and face to face education by health or non-health workers needs to be considered. Keywords: Catch-up campaign, immunization campaign, Japanese encephalitis


  1. Kementerian Kesehatan RI. Petunjuk teknis kampanye imunisasi Japanese enchepalitis (JE). Ditjen P2P Kemenkes RI, editor. Jakarta: Kementerian Kesehatan RI; 2017. 1–96 p.
  2. Kari K, Liu W, et al. A hospital-based surveillance for Japanese encephalitis in Bali, Indonesia. BMC Med [Internet]. 2006 Dec 7;4(1):8. Available from:
  3. WHO. Media centre Japanese encephalitis [Internet]. 2015 [cited 2018 Oct 5]. p. 8–11. Available from:
  4. SAGE. Background Paper on Japanese Encephalitis Vaccines [Internet]. Geneva; 2014. Available from:
  5. WHO. Japanese encephalitis vaccines [Internet]. WHO Position Paper. Elsevier; 2015. Available from:
  6. Liu W, Clemens JD, et al. Cost-effectiveness of Japanese encephalitis ( JE ) immunization in Bali , Indonesia. Vaccine. 2008;26:4456–60.
  7. Wirawan DN, Muliawan P, et al. Laporan penelitian. Vol. 1, Jurnal Manajemen. Denpasar; 2013.
  8. Heffelfinger JD, Li X BN. Japanese Encephalitis Surveillance and Immunization — Asia and Western Pacific Regions. MMWR Morb Mortal Wkly Rep [Internet]. 2016;66(2017):579–583. Available from:
  9. Tsai TF. New initiatives for the control of Japanese encephalitis by vaccination: Vaccine. 2002;18:1–25.
  10. Sawitri AAS, Yuliyatni CDP, et al. Coverage Evaluation of Japanese encephalitis Supplementary ImmunizationActivities (JE SIA) in Bali Island [Internet]. Denpasar; 2018. Available from: Unpublished report
  11. Institute of Medicine. New Vaccine Development Establishing Priorities. Volume II. Vol. II. Washington DC: National Academy Press; 1986. 1–432 p.
  12. WHO. Manual for the Laboratory Diagnosis of Japanese Encephalitis Virus Infection [Internet]. 2007 [cited 2018 Oct 5]. p. 1–52. Available from:
  13. Valido EM, Laksanawati IS, et al. Acceptability of the dengue vaccination among parents in urban poor communities of Quezon City, Philippines before and after vaccine suspension. BMC Res Notes [Internet]. 2018;11(1):661. Available from:
  14. Brieger D, Edwards M, et al. Knowledge, attitudes and opinions towards measles and the MMR vaccine across two NSW cohorts. Aust N Z J Public Health. 2017;41(6):641–6.
  15. Prabandari GM, Musthofa SB, et al. Beberapa Faktor Yang Berhubungan Dengan Penerimaan Ibu Terhadap Imunisasi Measles Rubella Pada Anak Sd Di Desa Gumpang, Kecamatan Kartasura, Kabupaten Sukoharjo. J Kesehat Masy. 2018;6(4):573–81.
  16. Turiho AK, Okello ES, et al. Perceptions of human papillomavirus vaccination of adolescent schoolgirls in western Uganda and their implications for acceptability of HPV vaccination: A qualitative study. BMC Res Notes. 2017;10(1):1–16.
  17. Krawczyk A, Perez S, et al. Parents’ decision-making about the human papillomavirus vaccine for their daughters: Ii. qualitative results. Hum Vaccines Immunother. 2015;11(2):330–6.
  18. Berenson AB, Laz TH, et al. Effect of the decision-making process in the family on HPV vaccination rates among adolescents 9-17 years of age. Hum Vaccines Immunother. 2014;10(7):1807–11.
  19. Tsuchiya Y, Shida N, et al. Factors associated with mothers not vaccinating their children against mumps in Japan. Public Health [Internet]. 2016;1–11. Available from:
  20. Ahmed SM, Rahman TAA-E, et al. Mothers ’ awareness and knowledge of under five years children regarding immunization in Minia city Egypt. Life Sci J. 2014;10(May).
  21. BPS. Penduduk Provinsi Bali Menurut Kabupaten/Kota, Jenis Kelamin, dan Status Migrasi Seumur Hidup Hasil Sensus Penduduk 2010 [Internet]. Denpasar; 2018 [cited 2019 Apr 11]. p. 1. Available from:
  22. Danchin M. A positive approach to parents with concerns about vaccination for the family physician. 2014;43(10):690–4.
  23. Kaufman J, Ryan R, et al. Face-to-face interventions for informing or educating parents about early childhood vaccination. Cochrane Database Syst Rev [Internet]. 2018 May 8;2018(5):1–113. Available from:
  24. Hilber AM, Bosch-Capblanch X, et al. Gender and Immunisation: Summary Report for SAGE, November 2010. 2010;(November 2010). Available from:
  25. WHO. Vaccine Hesitancy Survey Questions Related to SAGE Vaccine Hesitancy-Examples of survey questions designed to assess determinants of vaccine hesitancy [Internet]. 2016 [cited 2019 Jun 4]. p. 1–8. Available from:
  26. Badan Pusat Statistik. Angka Partisipasi Sekolah Berdasarkan Provinsi 2003-2015 [Internet]. Denpasar; 2018 [cited 2019 Aug 5]. p. 1. Available from:
  27. Dinas Kesehatan Prov. Bali. Laporan Monitoring Kampanye Japanese encephalitis (JE) di Provinsi Bali Tahun 2018. Denpasar; 2018.
  28. Hu Y, Li Q, et al. Determinants of Childhood Immunization Uptake among Socio-Economically Disadvantaged Migrants in East China. Int J Environ Res Public Health. 2013;10:2845–56.
  29. Awoh AB, Plugge E. Immunisation coverage in rural–urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis. J Epidemiol Community Health [Internet]. 2016;70(3):305–11. Available from:
  30. Skinner CS, Tiro J, et al. The Health Belief Model. In: Glanz K, Rimer BK, Viswanath K, editors. Health Behavior : Theory, Research, and Practice. Fifth edit. San Fransisco: Jossey Bass; 2015. p. 98–118.
  31. Tagbo B, Uleanya N, et al. Mothers’ knowledge, perception and practice of childhood immunization in Enugu. Niger J Paediatr [Internet]. 2012;39(3). Available from:
  32. Jheeta M. Childhood vacination in Africa and Asia: the effects of parents’ knowledge and attitudes. Bull World Health Organ [Internet]. 2008 Jun 1;2008(6):419–419. Available from:
  33. Abraham C, Sheeran P. The Health Belief Model. In: Conner M, Norman P, editors. Predicting and changing health behaviour Research and Practice with Social Cognition Models. Third. London: Open University Press; 2015. p. 49–50.
  34. Kumar D, Singh AJ. Response of Various Stakeholders towards Newly Introduced Japanese Encephalitis Vaccine in a North Indian State. J Vaccines. 2014;2014:1–4.
  35. Schülein S, Taylor KJ, et al. Factors influencing uptake of HPV vaccination among girls in Germany. BMC Public Health [Internet]. 2016;16(1):1–8. Available from:
  36. Anello P, Cestari L, et al. Socioeconomic factors influencing childhood vaccination in two northern Italian regions. Vaccine [Internet]. 2017;35(36):4673–80. Available from:
  37. Ogboghodo E, Esene H, et al. Determinants of uptake of pentavalent vaccine in Benin city, Southern Nigeria. Int J Community Med Public Heal [Internet]. 2016;3(11):3195–201. Available from:

How to Cite

Suardani, N., Wirawan, D. N., & Sawitri, A. A. S. (2019). The role of information sources and characteristics of children in the acceptance of Japanese encephalitis (JE) mass immunization in Bali Province. Public Health and Preventive Medicine Archive, 7(2), 75–84.




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Nyoman Suardani
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Dewa Nyoman Wirawan
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Anak Agung Sagung Sawitri
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