Determinant Factors for Preparedness in Facing COVID-19

Vaccinations: A Cross-Sectional Study Among Breastfeeding Mothers

in Denpasar, Bali

Gusti Ayu Dwina Mastraygung

, Ni Putu Sri Haryati

, Ni Komang Sri Ariani

Ni Made Ayu Yulia Raswati Teja

and Ni Made Nurtini

Bachelor of Midwifery Program, Faculty of Health, Institute of Technology and Health Bali, Indonesia

Keywords: Breastfeeding, Vaccination, COVID-19, Cross-Sectional Study.

Abstract: Severe acute respiratory syndrome coronavirus 2 is the infectious disease that causes coronavirus disease

2019, also known as COVID-19 (SARS-CoV-2), According to a study by the National Immunization Expert

Advisory Committee, the COVID-19 vaccine can be provided to individuals 60 years of age and older,

comorbid individuals, COVID-19 survivors, and nursing mothers after considering relevant medical histories.

This study aimed to examine the factors that affect the preparedness of breastfeeding mothers facing the

COVID-19 vaccination. This was a correlation analytic study with a cross-sectional approach. The sample was

breastfeeding mothers who visited a private clinic at Denpasar and had not received the COVID-19 vaccine,

with as many as 54 respondents. The sampling technique was non-probability sampling. Data were collected

through a questionnaire. Data were processed through a non-parametric analysis, namely Spearman’s rho

correlation. The results show that there was a relationship between level of knowledge and breastfeeding

mothers’ readiness (p < 0.05), and there was a relationship between perception of drugs and breastfeeding

mothers’ readiness (p < 0.05). In conclusion, breastfeeding mothers’ knowledge and perception affect

readiness in carrying out COVID-19 vaccinations.

INTRODUCTION

On December 2019, the World Health Organization

(WHO) first identified COVID-19 in the city of

Wuhan, China. The infection can occur at any age.

The infection fatality rate is around 1%, but is much

higher in older people or those with pre-existing

medical conditions such as heart disease, diabetes,

and chronic obstructive pulmonary disease. COVID-

19 is caused by severe acute respiratory syndrome

coronavirus 2 (SARS-CoV-2) and is spread through

direct contact with sputum droplets from an infected

person (coughing and sneezing) or indirectly through

contact with virus-contaminated surfaces (Rodrigues

et al., 2020)

https://orcid.org/0000-0002-1758-8678

https://orcid.org/0000-0001-9218-2275

https://orcid.org/0000-0002-8346-7997

https://orcid.org/0000-0003-4544-1347

https://orcid.org/0000-0003-3376-8967

On July 1st, 2021, the President of Indonesia

officially announced the implementation of an

emergency implementation of restrictions on social

activities in Java and Bali from July 3rd-20th, 2021,

due to the drastic spike in COVID-19 cases. As a

result of this announcement, several policies have

been taken, one of which is promoting a vaccine

program for pregnant women, breastfeeding mothers,

and school-age children ranging from 12-18 years old

(Ferdiansyah, 2022).

The Indonesian Ministry of Health (Kemenkes)

through the Directorate General of Disease

Prevention and Control issued circular letter number

HK.02.02/11/368/2021 regarding the implementation

of the COVID-19 vaccination. This circular contained

technical instructions for COVID-19 vaccination for

the elderly, comorbid, nursing mothers, and COVID-

Mastraygung, G., Haryati, N., Ariani, N., Teja, N. and Nurtini, N.

Determinant Factors for Preparedness in Facing COVID-19 Vaccinations: A Cross-Sectional Study Among Breastfeeding Mothers in Denpasar, Bali.

DOI: 10.5220/0011938200003576

In Proceedings of the 2nd Bali Biennial International Conference on Health Sciences (Bali BICHS 2022), pages 34-38

ISBN: 978-989-758-625-5

 2023 by SCITEPRESS – Science and Technology Publications, Lda. Under CC license (CC BY-NC-ND 4.0)

19 survivors. One of the points outlined was that

breastfeeding mothers were now allowed to get the

COVID-19 vaccine (Kementerian Kesehatan RI,

2021). Vaccines are a key strategy to stop the

escalation of the COVID-19 pandemic. As of April

2020, there were more than 100 COVID-19 vaccine

candidates that had been developed by scientists

(Pogue et al., 2020).

Understanding of vaccines is very important to

receiving the vaccine itself. Vaccine effectiveness

greatly affects vaccine acceptance, but some people

think that vaccine effectiveness is still low (Mannan

& Farhana, 2021). Unlimited access to information or

news about the COVID-19 pandemic can expose one

to sensational and worrying images (Klemm et al.,

2016). Various myths, rumours, and misinformation

can quickly spread through online media, especially

social media (Vosoughi et al., 2018). This implies that

social media has an important role in disseminating

information about COVID-19, including about

vaccines.

The pregnancy and breastfeeding periods are

natural and physiological processes for every woman.

The postpartum period is the recovery period for all

female reproductive organs to recover before the next

pregnancy. Since March 2020, the WHO has strongly

recommended that breastfeeding mothers who are

confirmed positive for COVID-19 breastfeed

according to health recommendations and existing

health protocols. Breast milk is the most appropriate

food for babies because it has many benefits such as

containing antibodies that help protect against various

kinds of diseases. It is safe, clean, and provides all the

energy and nutrients a baby needs for their first month

of life. It continues to provide up to half or more of a

child’s nutritional needs during the second half of the

first year, and up to one third of the second year

(Pereira et al., 2020).

Until now, not much research has been done on

the spread of the COVID-19 virus to babies through

breast milk. The National Immunization Expert

Advisory Committee has submitted a study that

COVID-19 vaccines can be administered to the 60

and over age group, comorbid individuals, COVID-

19 survivors, and breastfeeding mothers by first

reviewing additional health history (Kementerian

Kesehatan RI, 2021)

Reluctance to get vaccinated is a well-known

phenomenon and a serious threat. Reluctance to

vaccinate against COVID-19 can be a limiting step in

global efforts to control the current pandemic.

Various concerns are held by breastfeeding mothers

when carrying out the COVID-19 vaccination. It is

necessary to conduct a deeper study of the factors that

affect breastfeeding mothers’ readiness to carry out

the COVID-19 vaccination, including knowledge and

perception of the number of pregnancies. This will

allow later efforts to be made to increase

breastfeeding mothers’ awareness about the

importance of COVID-19 vaccination.

2 METHOD

The research design used was correlative analytic

with a cross-sectional study approach. The population

in this study were breastfeeding mothers with a

sample size of 54 people obtained through a total

sampling technique. The inclusion criteria were

breastfeeding mothers with children aged 0-6 months

who had never received the COVID-19 vaccine and

were willing to be respondents.

The independent variable in this study was level

of knowledge and perception, while the dependent

variable was breastfeeding mothers’ readiness. The

primary data collection tool was a questionnaire. The

questionnaire used in this study was developed based

on the literature review and discussion within the

research team. The questionnaire was reviewed by

experts in survey research for face validity. Data

collection was carried out over the course of two

months with data analysed using SPSS for Windows

version 26, with a non-parametric statistical test using

Spearman’s rho technique. Research ethics approval

was issued from ITEKES Bali.

3 RESULT

Based on the research that has been done, the

following results were obtained:

3.1 Respondents’ Characteristics

Table 1: Frequency distribution of respondents’ character-

istics based on age, occupation, and education (n = 54).

Caracteristics Sam

le F

(

)

rou

20-30 years ol

54 100

Occupation

Housewife 32 59.3

Self-em

1 1.9

Private secto

21 38.9

Education

Middle School 3 5.6

High School 44 81.4

College 7 13

Determinant Factors for Preparedness in Facing COVID-19 Vaccinations: A Cross-Sectional Study Among Breastfeeding Mothers in

Denpasar, Bali

Table 1 shows that the respondents had an age range

of 20-30 years (100%), with most being housewives

(59.3%) who were senior high school graduates

(81.4%).

3.2 Knowledge Level

Figure 1: Breastfeeding mothers’ knowledge levels about

the COVID-19 vaccine (n = 54).

Based on Figure 1, 25 breastfeeding mothers had

good knowledge about the COVID-19 vaccine

(46.3%), 20 mothers had sufficient knowledge (37%),

and nine had poor knowledge (16.7%).

3.3 Breastfeeding Mothers’ Perception

Figure 2: Breastfeeding mothers' perceptions of the

COVID-19 vaccine (n = 54).

Figure 2 shows that the majority of breastfeeding

mothers had a positive perception of the COVID-19

vaccine, with as many as 34 respondents holding this

view (63%). as the remaining 20 mothers (37%) had

a negative perception of the COVID-19 vaccine.

3.4 Breastfeeding Mothers’ Readiness

Figure 3: Breastfeeding mothers’ readiness in facing

COVID-19 vaccination (n = 54).

Diagram 4 shows that 35 of the breastfeeding mothers

were ready to face the COVID-19 vaccination

(64.8%), while the remaining 19 (35.2%) felt

unprepared.

3.5 Bivariate Analysis

Based on the analysis results using Spearman’s rho

test, it was found that the relationship between

breastfeeding mothers’ knowledge with COVID-19

vaccination readiness had a p-value of below 0.01 (n

= 54), which means there was a relationship between

knowledge and breastfeeding mothers’ readiness in

facing COVID-19 vaccination.

The bivariate analysis between breastfeeding

mothers’ perception and readiness in facing COVID-

19 vaccination obtained a p-value of less than 0.01,

which means there was a relationship between

breastfeeding mothers’ perception and readiness in

facing COVID-19 vaccination.

4 DISCUSSION

Vaccination is the provision of vaccines that are

specifically made to actively generate or increase a

person's immunity against a disease. If one day they

are exposed to the disease, they will then not get sick

or only experience mild illness and will not become a

transmission source (Indonesian Ministry of Health,

2020). This is in line with research conducted by

those who found that receiving the COVID-19

vaccine was associated with a decrease in the

percentage of reported COVID-19 events (Mannan &

Farhana, 2021)

The Indonesian Ministry of Health (Kementerian

Kesehatan RI, 2021), through the Directorate General

of Disease Prevention and Control, issued circular

9 (16.7 %)

25 (46.3 %)

20 (37 %)

19(35,2%)

35(64,8%)

20(37%)

34(63%)

Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences

letter number HK.02.02/11/368/2021 regarding

COVID-19 vaccination implementation. This

contained technical instructions for COVID-19

vaccination for the elderly, comorbid individuals,

nursing mothers, and COVID-19 survivors. One of

the points outlined was that breastfeeding mothers

were now allowed to receive the COVID-19 vaccine

Based on the results of the study, it was found that

25 of the breastfeeding mothers had sufficient

knowledge about the COVID-19 vaccine (46.3%),

while the rest had good (37%) and lacking knowledge

(16.7%). These results are in line with research

(Kalpana Kartika, 2021) concerning "The

Relationship between Knowledge and Community

Readiness in Receiving the COVID-19 Vaccine at the

Padang Laweh Health Center, Sijunjung Regency"

which stated that high knowledge (54 respondents;

54%) was due to the large amount of information

circulating about COVID-19 through social media,

mass media, as well as physical posters and banners

about COVID-19. This high knowledge was also

influenced by respondents’ high educational levels.

This allowed for the public to know about the

COVID-19 vaccination, its targets, the people to get

it, its benefits, and its side effects. In line with

research conducted by (Nancy Otieno et al., 2020),

knowledge was found to be related to the pregnant

women’s acceptance of the influenza vaccine in

Kenya.

5 CONCLUSION

This study consisted of 54 breastfeeding mothers,

with the majority in the 20–30 year age range. Their

educational backgrounds mostly stopped at senior

high school and they were mostly housewives.

In terms of knowledge, most respondents had

sufficient COVID-19 vaccination knowledge with the

majority having a positive perception and ready to

carry out the COVID-19 vaccine. Based on the data

analysis, it was found that there was a relationship

between knowledge, perception, and mothers’

readiness to breastfeed in receiving the COVID-19

vaccine. The drawback in this study was the small

number of respondents, meaning further research

needs to be done with a larger sample size and with

mixed methods.

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Bali BICHS 2022 - The Bali Biennial International Conference on Health Sciences