title: Modifiable determinants of attitude towards dengue vaccination among healthy inhabitants of Aceh, Indonesia: Findings from a community-based survey.
abstract: To explore and understand the attitude towards dengue vaccination and its modifiable determinants among inhabitants of Aceh (northern Sumatra Island, Indonesia), the region that was most severely affected by the earthquake and tsunami of 26 December 2004.
  
  
  
  A community-based, cross-sectional study was conducted among 535 healthy inhabitants in nine regencies (Kabupaten or Kotamadya) of Aceh that were selected randomly from November 2014 to March 2015. A set of validated, pre-tested, structured questionnaires was used to guide the interviews. The questionnaires covered a range of explanatory variables and one outcome variable (attitude to dengue vaccination). Multi-step logistic regression analysis and Spearman's rank correlation were used to test the role of explanatory variables for the outcome variable.
  
  
  
  More than 70% of the participants had a poor attitude towards dengue vaccination. Modifiable determinants associated with poor attitude to dengue vaccination were low education level, working as farmers and traditional market traders, low socioeconomic status and poor knowledge, attitude and practice regarding dengue fever (P < 0.05). The KAP domain scores were correlated strongly with attitude to dengue vaccination, rs = 0.25, rs = 0.67 and rs = 0.20, respectively (P < 0.001). Multivariate analysis found that independent predictors associated with attitude towards dengue vaccination among study participants were only sex and attitude towards dengue fever (P < 0.001).
  
  
  
  This study reveals that low KAP regarding dengue fever, low education level and low socioeconomic status are associated with a poor attitude towards dengue vaccination. Therefore, inhabitants of suburbs who are working as farmers or traditional market traders with low socioeconomic status are the most appropriate target group for a dengue vaccine introduction program.
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia; Tropical Disease Centre, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia; Department of Microbiology, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia. Electronic address: harapan@unsyiah.ac.id.
authors.forename: Harapan
authors.initials: H
authors.lastname: Harapan
authors.affiliation: Department of Statistics, Faculty of Mathematics and Natural Sciences, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Samsul
authors.initials: S
authors.lastname: Anwar
authors.affiliation: Department of Biology, Faculty of Teacher Training and Education, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Aslam
authors.initials: A
authors.lastname: Bustaman
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Arsil
authors.initials: A
authors.lastname: Radiansyah
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Pradiba
authors.initials: P
authors.lastname: Angraini
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Riny
authors.initials: R
authors.lastname: Fasli
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Salwiyadi
authors.initials: S
authors.lastname: Salwiyadi
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Reza Akbar
authors.initials: RA
authors.lastname: Bastian
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Ade
authors.initials: A
authors.lastname: Oktiviyari
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Imaduddin
authors.initials: I
authors.lastname: Akmal
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Iqbalamin
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Jamalul
authors.initials: J
authors.lastname: Adil
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Fenni
authors.initials: F
authors.lastname: Henrizal
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Darmayanti
authors.initials: D
authors.lastname: Darmayanti
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Rovy
authors.initials: R
authors.lastname: Pratama
authors.affiliation: Medical Research Unit, School of Medicine, Syiah Kuala University, Banda Aceh, Indonesia.
authors.forename: Jhony Karunia
authors.initials: JK
authors.lastname: Fajar
authors.affiliation: Faculty of Medicine and Health Sciences, State Islamic University Maulana Malik Ibrahim, Malang, Indonesia.
authors.forename: Abdul Malik
authors.initials: AM
authors.lastname: Setiawan
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: Mandira Lamichhane
authors.initials: ML
authors.lastname: Dhimal
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Kuch
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: David Alexander
authors.initials: DA
authors.lastname: Groneberg
authors.affiliation: Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
authors.forename: R Tedjo
authors.initials: RT
authors.lastname: Sasmono
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany; Nepal Health Research Council (NHRC), Ministry of Health Complex, Kathmandu, Nepal.
authors.forename: Meghnath
authors.initials: M
authors.lastname: Dhimal
authors.affiliation: Institute of Occupational Medicine, Social Medicine and Environmental Medicine, Goethe University, Frankfurt am Main, Germany.
authors.forename: Ruth
authors.initials: R
authors.lastname: Mueller
keywords: Attitude towards vaccination; Dengue; Dengue fever; Dengue vaccine; Indonesia; Vaccine introduction program