FACTORS RELATED TO THE SECOND RUBELLA MEASLES IMMUNIZATION IN KONAWE ISLANDS DISTRICT

Background: National coverage of Rubella-Measles immunization in December 2019 was 87.33%. The coverage of Rubella-Measles 2nd immunization in Southeast Sulawesi Province with the lowest achievement was in Konawe Islands Regency. at 26.35%. This study aimed to analyze the factors associated with measles-rubella 2nd immunization in Konawe Islands Regency. Methods: The design of this study is a quantitative study with a comparative study approach, namely a form of research that compares two groups or more of a certain variable. The study population was 1119 children aged 25 to 30 months, while the study sample was 152 children aged 25 to 30 months, and respondents were mothers who had children aged 25 to 30 months who were selected as samples. The sampling technique used simple random sampling. Descriptive data analysis, inferential analysis, and odds ratio with Chi-square statistical tests were used. Result: The results of the study there is a relationship between knowledge (p-value = 0.000; OR = 1.1) with Rubella Measles immunization. Conclusion: There is a knowledge relationship with measles-rubella 2 immunization in Konawe Islands District.


INTRODUCTION
Measles-Rubella immunization is one type of immunization that is included in the national basic immunization program, which functions to protect the child's body from two diseases at once, measles and German measles (rubella)(1). Meanwhile, both common measles and rubella or German measles disease cases are still common, especially in children (2). German measles also need extra attention if pregnant women suffer from the disease. In the first trimester pregnant women, rubella can cause miscarriage(3). Fetal death in the womb and congenital abnormalities in the baby, therefore measles-rubella (MR) immunization needs to be given to prevent these two dangerous diseases(4).
Health improvement depends on the performance of health workers (5). Likewise, to increase the coverage of measles-rubella 2nd (second) immunization, the role of health workers is very important, both in providing direct immunization to targets and in providing education about health problems (6).
The Ministry of Health integrated measles and rubella vaccines into the national basic immunization program in 2019, where before being integrated into the national basic immunization program, measles-rubella (MR) (7). The campaign was carried out in stages, namely, in 2017 carrying out a measles-rubella (MR) campaign on the island of Java and in 2018 outside the island of Java (8). In the program, rubella measles 2 immunization with the combination vaccine is given 2 times, namely measles-rubella 1 at the age of 9-12 months, and measles-rubella 2 at the age of 18-24 months (9).
Nationally, the coverage of Measles-Rubella immunization in 2019 reached 87.33% of the national target of 95%, while the average coverage per province outside Java was 72.79%, even the Provinces of Aceh, West Sumatra, and Riau were only 50% (10). In Southeast Sulawesi Province, the coverage of Rubella Measles 2 (two) immunization in 2019 reached 32,287 (53.3%) of the target of 60,572 under 3 years old children, still very low when compared to the national target of 95%, with the highest district or city achieving that is Kendari City of 7,365 (83.46%) of the target of 8,824 under 3 years old children and the lowest district coverage was Islands Konawe Regency of 195 (26.35%) of the target of 740 under 3 years old children (11).
Islands Konawe Regency in 2019, the coverage of Rubella Measles 1 immunization as an indicator of accessibility or the amount of service coverage was 731 (99.7%) of the target of 733 babies, while for Rubella Measles 2 immunization coverage as an indicator of effectiveness or success of the protection level was 195 (26, 35%) is still very low when compared with the national target of 95% (12). Based on preliminary studies, knowledge is a factor that causes the low coverage of rubella measles 2 immunization, lack of family support, especially husbands who are still afraid of the illness their children experience after receiving rubella measles immunization and the assumption that their children will be healthy without immunization as well as community belief factors. Still have doubts about the legal rubella measles vaccine.

METHOD
The research design used a comparative study(1). The research was carried out in 7 Primary health cara in the Konawe Islands Regency area. The study population was all toddlers aged 25-30 months, divided into two groups, namely the group that did not receive measles rubella 2 immunization as many as 934 children under five and the group that received 185 measles rubella 2 immunization while the study sample was divided into two. The group that did not get measles rubella 2 immunization was 88 children under five and the group that received measles rubella 2 immunization was 64 children under five. The sample size was determined using the Lemeshow formula. The sampling technique uses simple random sampling. Data collection using a questionnaire(2).

RESULT
Table-1 shows that out of 152 respondents, 85 (55.9%) of respondents had less knowledge of rubella measles immunization. Family support. It shows that out of 152 respondents, 77 (50.7%) had less family support for MR immunization. Confidence. It shows that out of 152 respondents, 17 (11.2) respondents were not sure about the legal rubella measles immunization vaccine.
Table-2 shows the results of statistical tests using Chi-squared analysis at α = 5% and df = 1, the value of X2 is calculated> X2 table (64,597> 3,841), meaning that there is a relationship between knowledge and rubella measles 2 in Islands Konawe Regency. The results of the relationship closeness test show the Phi (Φ) coefficient of 0.665, this shows the strength of a strong relationship between knowledge and measles-rubella 2nd and the Odds Ratio (OR) value of knowledge against measlesrubella 2nd at the 95% level (CI), obtained OR of 25,468. This means that less knowledge has a risk of 25,468 times greater than good knowledge. Family support shows the results of statistical tests using Chisquared analysis at α = 5% and df = 1, the value of X2 is calculated> X2 table (1,660 <3,841), meaning that there is no relationship between family support and measles-rubella 2nd in Islands Konawe Regency. Because there was no relationship between family support and rubella measles 2 immunization, the relationship closeness test was not continued, and the Odds Ratio (OR) value of family support for measlesrubella 2nd at the 95% level (CI), obtained an OR of 1.615. This means that less family support has a risk of 1.615 times greater than good family support. The level of confidence shows the results of statistical tests using Chi-squared analysis at α = 5% and df = 1, obtained the value of X2 count> X2 table (1,919 <3,841), meaning that there is no confidential relationship with measlesrubella 2nd in Islands Konawe Regency. Because there is no relationship between belief and rubella measles 2 immunization, the relationship closeness test and the confidence Odds Ratio (OR) value for measles-rubella 2 at the 95% level (CI) were not continued, an OR of 2,600 was obtained. This means that beliefs with less risk are 2,600 times greater than good beliefs.

Relationship of knowledge with rubellameasles 2 nd immunization
Knowledge is the result of knowing, and this happens after someone senses an object. Knowledge is generally obtained from experience, it can also be obtained from books, mass media, and from electronic media (15).
The results showed that of the 67 well-informed respondents, there were 14 respondents (15.9%) who did not receive rubella measles 2 immunization, this indicates that knowledge is not the dominant factor in influencing respondents to immunize measles-rubella 2, because even though they know the importance of immunization rubella measles 2 but because they have other activities sometimes forget to bring their children to get rubella measles 2 immunization. Of 67 respondents who have good knowledge, there are 53 respondents (82.8%) who received measlesrubella 2 immunization, this shows that the better a person's level of knowledge, the more he has the awareness to immunize his child because he already understands and understands the purpose and benefits for his child's health.
Then from 85 respondents who had a low level of knowledge, there were 74 respondents (84.1%) who did not receive rubella measles 2 immunization, respondents who had less knowledge were more likely to not do measles-rubella 2 immunization, this was probably due to measles immunization. rubella is relatively new so not all people know it. Lack of public knowledge of this matter made it unaware that at this time measles-rubella 2 immunization was a continuation of the measles-rubella 1 immunization. The 85 respondents who had a low level of knowledge, there were 11 respondents (17, The statistical test results show that the calculated chi-square value (X² hit) = 64,597> X² tab = 3,841, which means there is a relationship between knowledge and rubella measles 2 immunization in Konawe Islands District, by closeness test ( = 0.665) shows the strength of a strong relationship between knowledge and rubella measles 2, with an Odds ratio OR value of 25,468, which means that less knowledge has a risk of 25.46 times greater than good knowledge.
Another study conducted, the results of the chi-square test found that respondents who did not receive rubella measles immunization were found in respondents with poor knowledge, p = 0.006 <0.05, thus concluding that there is a relationship between knowledge and the use of receiving rubella measles an immunization. Rejection of rubella measles immunization is also caused by poor knowledge of mothers because this immunization program is still new and rubella disease is not familiar to mothers (16).

Relationship of family support with rubella-measles 2 nd immunization
Family support is an attitude, action, and family acceptance of supportive family members who are always ready to provide assistance and assistance if needed. In this case, the recipient of family support will know that other people care, appreciate, and love him (17).
The results showed that of the 75 respondents who stated good family support, 39 respondents (44.3%) did not receive rubella measles 2 immunization and 36 respondents (56.3%) received rubella measles 2 immunization. , mothers or inlaws) to mothers of toddlers are very important, especially support in the form of getting information about measles-rubella immunization and encouragement and attention, so that mothers under five will feel that immunization is very important to increase the child's immunity to a disease.
Of the 77 respondents who stated that the role of health workers was lacking, there were 49 respondents (55.7%) who did not receive rubella measles 2 immunization and 28 respondents (43.7%) who received rubella measles 2 immunization. This was due to a lack of family support ( husbands, mothers or in-laws) where most of the husbands work as farmers so that they do not have free time or prepare facilities or facilities so that their children can go to health service facilities, and some parents or in-laws think that their children will be healthy even though the children do not get rubella measles immunization 2.
The statistical test results show that the calculated chi-square value (X² hit) = 1,660 <X² tab = 3,841, which means no there is a relationship between family support and rubella measles 2 immunization in Konawe Islands District, by closeness test ( = 0.118) It shows that the strength of the relationship is very weak between family support and measles-rubella 2, with an Odds ratio OR value of 1.615 which means that less family support has a 4.76 times greater risk compared to good family support.
The results of this study are in line with research conducted by (18), the results of statistical tests using the chi-square test at a 95% confidence level orα = 0.273 obtained p-value> α so that Ho is accepted, which means that there is no relationship between family support and interest in measlesrubella immunization in Bukit Wolio Indah Village, Bau-Bau City (18).

Confidence association with rubellameasles 2 nd immunization
In the community there are still some groups that do not receive rubella measles immunization, generally ignoring disease prevention and only prioritizing curative. Several factors cause the community to not receive vaccines, including the perception of beliefs based on religion regarding the process of making vaccines containing pork and vaccines without halal certification. These two things lead to a bad perception of the community towards immunization (19).
The results showed that of the 135 respondents who stated that they believed in measles-rubella 2 immunization, 75 respondents (61.4%) did not receive rubella measles 2 immunization and 60 respondents (93.7%) received rubella measles 2 immunization. This is because most mothers under five are aware of the objectives and benefits of the immunization program, so even though there is an issue stating that the vaccine used for rubella measles immunization is forbidden and has not received halal certification from the MUI, but given the large benefits obtained from immunization and the existence of a fatwa from the Indonesian Ulema Council that allows children to be immunized against rubella measles.
The 17 respondents who stated that they were not sure about rubella measles 2nd immunization, there were 13 respondents (38.6%) who did not receive rubella measles 2 immunization and 4 respondents (6.3%) who received measles-rubella 2nd immunization. This is because in a small number In the community there is still a debate about the legal status of the prohibition of the rubella measles vaccine, there are still parents of toddlers who refuse to give measles-rubella immunization because parents' awareness of the importance of immunization for children under five is still low, so with the existence of issues circulating about the legal status of rubella measles vaccine make it a guideline for them not to immunize their children even though there is a fatwa from the Indonesian Ulema Council that allows children to be immunized.
The result of the statistical test shows that the calculated chi-square value (X² hit) = 1.919 <X² tab = 3,841, which means no there is a relationship between beliefs and measles-rubella 2nd immunization in Islands Konawe District, by closeness test ( = 0.134) shows the strength of the very weak relationship between beliefs and rubella measles 2, with an Odds ratio OR value of 2,600, which means that fewer beliefs have a 2.60 times greater risk than good beliefs. This is different from the research conducted by (20) hypothesis testing using the Linear Regression test obtained the Sig value. 0,000 so that it is stated that there is a relationship between Islamic religious beliefs and the acceptance of the measles-rubella vaccination. The coefficient correlation value is 0.469 which shows a moderate correlation with a positive correlation between belief and acceptance of rubella measles vaccination.