Progress towards obtaining valid vaccination coverage data in South Africa

Burnett, Rosemary J.; Dlamini, Nonhlanhla; Meyer, Johanna Catharina; Fernandes, L.; Motloung, Bontle R; Ndlovu, Tshepiso H; Simango, Hlamarisa A; Kibuuka, Dan; Dochez, Carine; Montwedi, Diedericks N; Nkwinika, Varsetile Varster; Mphahlele, M. Jeffrey

doi:10.17159/sajs.2019/6060

Cited by 8 publications

(11 citation statements)

References 9 publications

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“…South African provinces have a high level of autonomy in the development and adaptation of policies, including those related to the provision of vaccination services [ 22 ]. There may therefore be wide variation across the provinces in the logistics of ensuring access to vaccination services and, perhaps, the behavioural and social drivers of vaccination [ 7 , 23 , 24 , 25 , 26 , 27 ]. Thus, it is essential to conduct appropriately designed research to understand the reasons for the high burden of missed opportunities for vaccination, as well as more general reasons why a substantial proportion of children are not vaccinated in South Africa [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

2020

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Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa.

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Section: Discussionmentioning

confidence: 99%

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

2020

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“…1 South Africa in particular, has been in the spotlight concerning its immunization coverage data. 2 WHO and the United Nations Children's Fund (UNICEF) estimates of immunization coverage for 2018 showed that about onethird of children in South Africa are not fully vaccinated. 3 Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa.…”

Section: Introductionmentioning

confidence: 99%

“…However, immunization coverage through the Expanded Programme on Immunization of South Africa (EPI-SA) during the first year of life, shows that South Africa is not on track in terms of reaching the GVAP targets by the year 2020. 2 Evidence from studies done outside of South Africa attributes incomplete childhood vaccination to a host of factors such as socioeconomic status, residential areas, mother's level of education, number of children in a family and the mother's age and media exposure. [6][7][8][9][10] In South Africa, limited evidence attributes incomplete vaccination among children to factors like vaccine stock-outs, lack of awareness of the vaccination schedule by the mothers or caregivers, and nonattendance of antenatal care during pregnancy.…”

Section: Introductionmentioning

confidence: 99%

Incomplete vaccination and associated factors among children aged 12–23 months in South Africa: an analysis of the South African demographic and health survey 2016

Ndwandwe

Nnaji

Mashunye

et al. 2020

Human Vaccines & Immunotherapeutics

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Background: Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain undervaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12-23 months in South Africa. Methods: The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12-23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette-Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI). Results: About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42-6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27-5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30-5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47-0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31-6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03-5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35-7.15) provinces were maintained in both magnitude and direction. Conclusions: There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that...

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“…In South Africa, the value that vaccinations deliver remains far below the substantial benefits that they can offer [ 43 ]. While there have been significant investments and efforts in ensuring universal access to immunization services in South Africa, it is evident that in some districts and many neighborhoods, there are eligible children who are missing out on this very critical health intervention [ 44 , 45 ]. How much of this gap is due to missed opportunities for vaccination remains uncertain.…”

Section: Discussionmentioning

confidence: 99%

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis

Ndwandwe¹,

Ngcobo²,

Adamu³

et al. 2020

JMIR Res Protoc

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Background Vaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination. Objective This study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa. Methods The 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa. Results Ethical review submission is planned for October 2020. Data collection is expected to be underway in January 2021. Conclusions The extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage. International Registered Report Identifier (IRRID) PRR1-10.2196/16672

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Progress towards obtaining valid vaccination coverage data in South Africa

Cited by 8 publications

References 9 publications

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa

Incomplete vaccination and associated factors among children aged 12–23 months in South Africa: an analysis of the South African demographic and health survey 2016

Country-Level Assessment of Missed Opportunities for Vaccination in South Africa: Protocol for Multilevel Analysis

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