Maternal knowledge and attitudes towards rotavirus diarrhea and vaccine acceptance in Yogyakarta, Indonesia: a qualitative study

  • Mei Neni Sitaresmi Faculty of Medicine, Public Health and Nursing UGM/ DR Sardjito Hospital
  • Holly Seale School of Population Health, UNSW Sydney
  • Anita E. Heywood School of Public Health and Community Medicine, UNSW Sydney
  • Retna Siwi Padmawati Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
  • Yati Soenarto Department of Child Health, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Yogyakarta, Central Java
  • Chandini Raina MacIntyre Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
  • Jarir Atthobari Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta
Keywords: vaccine acceptance; knowledge; mother; rotavirus

Abstract

Abstract

Background Rotavirus is a leading cause of hospitalized diarrhea cases in Indonesia. Despite the rotavirus vaccine being recommended by the Indonesian Pediatric Society since 2011, it has yet to be been included in the Indonesian national immunization program (NIP) schedule.

Objective To explore maternal knowledge of and attitudes towards rotavirus diarrhea, as well as barriers to vaccine acceptance in Yogyakarta, Indonesia.

Methods We conducted 26 in-depth interviews in two districts (rural and urban areas) of Yogyakarta Province, Indonesia. Participants included women in their third trimester of pregnancy and mothers of infants younger than 14 weeks. We then proceeded with thematic analysis.

Results Participants did not perceive diarrhea as being a priority health problem. Very few had heard of rotavirus diarrhea or were aware of vaccine availability. While participants would accept vaccinating their children against rotavirus, some key barriers impacted vaccine use. As the rotavirus vaccine is not included in the Indonesian NIP, parents perceived it as not essential. Parents were concerned about the safety and benefit of the vaccine due to its perceived newness. Other concerns were cost and halal status. Participants expressed a need for more information on the vaccine's effectiveness and safety, with their primary healthcare providers (HCPs) considered to play the most important role in vaccine acceptance.

Conclusions In Yogyakarta, Indonesia, awareness of the seriousness of rotavirus disease and the availability of the rotavirus vaccine is low. Its newness, safety, efficacy, and cost, and doubts about its halal status, were barriers to vaccine acceptance. Information and recommendations from HCPs play an essential role in vaccine acceptance.

Author Biographies

Holly Seale, School of Population Health, UNSW Sydney

 

 

 

Retna Siwi Padmawati, Department of Health Behavior, Environment, and Social Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta

 

 

 

References

1. Liu L, Oza S, Hogan D, Chu Y, Perin J, Zhu J, et al. Global, regional, and national causes of under-5 mortality in 2000–15: an updated systematic analysis with implications for the Sustainable Development Goals. Lancet. 2016;388:3027–35. DOI: https://doi.org/10.1016/S0140-6736(16)31593-8.
2. Clark A, Black R, Tate J, Roose A, Kotloff K, Lam D, et al. Estimating global, regional and national rotavirus deaths in children aged <5 years: current approaches, new analyses and proposed improvements. PLoS One. 2017;12:e0183392. DOI: https://doi.org/10.1371/journal.pone.0183392.
3. Hakim MS, Nirwati H, Aman AT, Soenarto Y, Pan Q. Significance of continuous rotavirus and norovirus surveillance in Indonesia. World J Pediatr. 2018;14:4–12. DOI: https://doi.org/10.1007/s12519-018-0122-1.
4. Nirwati H, Wibawa T, Aman AT, Wahab A, Soenarto Y. Detection of group A rotavirus strains circulating among children with acute diarrhea in Indonesia. Springerplus. 2016;5:97. DOI: https://doi.org/10.1186/s40064-016-1724-5.
5. Nirwati H, Hakim MS, Aminah S, Dwija IBNP, Pan Q, Aman AT. Identification of rotavirus strains causing diarrhoea in children under five years of age in Yogyakarta, Indonesia. Malays J Med Sci. 2017;24:68–77. DOI: https://doi.org/10.21315/mjms2017.24.2.9.
6. Wilopo SA, Kilgore P, Kosen S, Soenarto Y, Aminah S, Cahyono A, et al. Economic evaluation of a routine rotavirus vaccination programme in Indonesia. Vaccine. 2009;27Suppl.5:67–74. DOI: https://doi.org/10.1016/j.vaccine.2009.09.040.
7. Crawford SE, Ramani S, Tate JE, Parashar UD, Svensson L, Hagbom M, et al. Rotavirus infection. Nat Rev Dis Primers. 2017;3:17083. DOI: https://doi.org/10.1038/nrdp.2017.83.
8. Guerrant RL, DeBoer MD, Moore SR, Scharf RJ, Lima AA. The impoverished gut—a triple burden of diarrhoea, stunting and chronic disease. Nat Rev Gastroenterol Hepatol. 2013;10:220–9. DOI: https://doi.org/10.1038/nrgastro.2012.239.
9. Pinkerton R, Oriá RB, Lima AAM, Rogawski ET, Oriá MOB, Patrick PD, et al. Early childhood diarrhea predicts cognitive delays in later childhood independently of malnutrition. Am J Trop Med Hyg. 2016;95:1004–10. DOI: https://doi.org/10.4269/ajtmh.16-0150.
10. World Health Organization. Rotavirus vaccines WHO position paper: January 2013 - Recommendations. Vaccine. 2013;31:6170–1. DOI: https://doi.org/10.1016/j.vaccine.2013.05.037.
11. International Vaccine Access Center (IVAC). A report on current global access to new childhood vaccines VIEW-hub report?: global vaccine introduction and implementation. 2019. [cited 2022 Aug 25]. Available from: https://www.jhsph.edu/ivac/wp-content/uploads/2019/05/VIEW-hub_Report_Mar2019.pdf
12. Debellut F, Clark A, Pecenka C, Tate J, Baral R, Sanderson C, et al. Re-evaluating the potential impact and cost-effectiveness of rotavirus vaccination in 73 Gavi countries: a modelling study. Lancet Glob Health. 2019;7:e1664–74. DOI: https://doi.org/10.1016/S2214-109X(19)30439-5.
13. Soares-Weiser K, Bergman H, Henschke N, Pitan F, Cunliffe N. Vaccines for preventing rotavirus diarrhoea: vaccines in use. Cochrane Database Syst Rev. 2019;3:CD008521. DOI: https://doi.org/10.1002/14651858.CD008521.pub4.
14. World Health Organization. Principles and considerations for adding a vaccine to a national immunization programme: from decision to implementation and monitoring. 2014. [cited 2022 Aug 25]. Available from https://www.who.int/publications/i/item/9789241506892
15. Seale H, Sitaresmi MN, Atthobari J, Heywood AE, Kaur R, MacIntyre RC, et al. Knowledge and attitudes towards rotavirus diarrhea and the vaccine amongst healthcare providers in Yogyakarta Indonesia. BMC Health Serv Res. 2015;15:528. DOI: https://doi.org/10.1186/s12913-015-1187-3.
16. Padmawati RS, Heywood A, Sitaresmi MN, Atthobari J, MacIntyre CR, Soenarto Y, et al. Religious and community leaders’ acceptance of rotavirus vaccine introduction in Yogyakarta, Indonesia: a qualitative study. BMC Public Health. 2019;19:368. DOI: https://doi.org/10.1186/s12889-019-6706-4.
17. Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349–57. DOI: https://doi.org/10.1093/intqhc/mzm042.
18. Benninghoff B, Pereira P, Vetter V. Role of healthcare practitioners in rotavirus disease awareness and vaccination–insights from a survey among caregivers. Hum Vaccin Immunother. 2020;16:138–47. DOI: https://doi.org/10.1080/21645515.2019.1632685.
19. Harjaningrum AT, Kartasasmita C, Orne-Gliemann J, Jutand MA, Goujon N, Koeck JL. A qualitative study on knowledge, perceptions, and attitudes of mothers and health care providers toward pneumococcal conjugate vaccine in Bandung, West Java, Indonesia. Vaccine. 2013;31:1516–22. DOI: https://doi.org/10.1016/j.vaccine.2013.01.007.
20. Oldin C, Golsäter M, Schollin Ask L, Fredriksson S, Stenmarker M. Introduction of rotavirus vaccination in a Swedish region: assessing parental decision-making, obtained vaccination coverage and resulting hospital admissions. Acta Paediatr. 2019;108:1329–37. DOI: https://doi.org/10.1111/apa.14674.
21. Apte A, Roy S, Bavdekar A, Juvekar S, Hirve S. Facilitators and barriers for use of rotavirus vaccine amongst various stakeholders and its implications for Indian context–a systematic review. Hum Vaccin Immunother. 2018;14:2760–7. DOI: 10.1080/21645515.2018.1489190.
22. Grabenstein JD. What the World’s religions teach, applied to vaccines and immune globulins. Vaccine. 2013;31:2011–23. DOI: https://doi.org/10.1016/j.vaccine.2013.02.026.
23. Ames HMR, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database of Syst Rev. 2017;2:CD011787. DOI: https://doi.org/10.1002/14651858.CD011787.pub2.
24. George MS, Negandhi P, Farooqui HH, Sharma A, Zodpey S. How do parents and pediatricians arrive at the decision to immunize their children in the private sector? Insights from a qualitative study on rotavirus vaccination across select Indian cities. Hum Vaccin Immunother. 2016;12:3139–45. DOI: https://doi.org/10.1080/21645515.2016.1219824.
25. Kementrian Kesehatan Republik Indonesia. Peraturan Menteri Kesehatan Republik Indonesia, nomer 12 tahun 2017 tentang penyelenggaraan imunisasi 2017. [cited 2022 Aug 25]. Available from: http://hukor.kemkes.go.id/uploads/produk_hukum/PMK_No._12_ttg_Penyelenggaraan_Imunisasi_.pdf.
Published
2022-10-31
How to Cite
1.
Sitaresmi M, Seale H, Heywood A, Padmawati R, Soenarto Y, MacIntyre C, Atthobari J. Maternal knowledge and attitudes towards rotavirus diarrhea and vaccine acceptance in Yogyakarta, Indonesia: a qualitative study. PI [Internet]. 31Oct.2022 [cited 19Apr.2024];62(5):333-0. Available from: https://www.paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/2661
Section
Developmental Behavioral & Community Pediatrics
Received 2021-05-10
Accepted 2022-10-31
Published 2022-10-31