Multilevel Analysis: Village Does Not Have Contextual Effect on Hepatitis A Outbreak in Pacitan, East Java, Indonesia

Sugeng Retyono, Setyo Sri Rahardjo, Bhisma Murti


Background: Hepatitis A virus infection (HAV) has generated about half of the total infection of hepatitis in the world. Poor envi­ronmental sanitation and unhealthy behavior of the society can increase the risk of Hepatitis A transmission. This study aimed to analyze the contextual effect of the village on biopsycho­social determinants of Hepatitis A.

Subjects and Method: This was an analytic observational study with a case-control ap­proach. This study was conducted from Janu­ary to February 2020. This study used fixed disease sampling. The sample of this study was 200 patients consisted of 50 Hepatitis A pati­ents and 150 non-Hepatitis A patients in villages in Pacitan Regency. The dependent variable was Hepatitis A. The independent vari­ables were age, education, income, history of Hepatitis A vaccination, handwashing behavior, food consumption, availability of clean water, and availability of latrines. This study used questionnaires to collect the data. The data were analyzed by multilevel multiple logistic regression using Stata 13.

Results: The risk of Hepatitis A infection decreased with age ≥40 years (OR= 0.06; 95% CI= 0.01 to 0.27; p<0.001), high education (OR= 0.15; 95% CI= 0.03 to 0.72; p= 0.018), high income (OR= 0.14; 95% CI= 0.03 to 0.77; p= 0.023), and history of Hepatitis A vaccina­tion (OR= 0.07; 95% CI= 0.01 to 0.84; p= 0.036). The risk of Hepatitis A infection  increased with poor hand washing behavior (OR= 5.27; 95% CI= 1.32 to 21.03; p= 0.019), unhygienic food consumption (OR= 9.67; 95% CI= 2.41 to 38.76; p= 0.001), poor clean water availability (OR= 22.64; 95% CI= 5.49 to 93.35; p<0.001), and poor latrine (OR= 4.78; 95% CI= 1.42 to 16.07; p= 0.012). Village did not have level a contextual effect on Hepatitis A infection with intra-class correlation <1%.

Conclusion: The risk of Hepatitis A infection decreases with age ≥40 years, high education, high income, and history of Hepatitis A vacci­nation. It increases with poor hand washing behavior, unhygienic food consumption, poor clean water availability, and poor latrine. Villa­ge does not have level a contextual effect on Hepatitis A.

Keywords: Hepatitis A, vaccine, contextual effect, multilevel analysis

Correspondence: Sugeng Retyono. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java, Indonesia. Email: Mobile: +6287758732030.

Journal of Epidemiology and Public Health (2020), 05(02): 195-106

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