Childhood immunization coverage in South Africa: Lessons from the field

Problem

Immunisation is beyond doubt a successful public health intervention and the highest priority on the health agenda worldwide. South Africa (SA) strives for 90% national immunization coverage and has dedicated R80-million per year for this purpose. Over the years improvement in immunization coverage has been observed, but the challenge remains lower coverage rates in rural parts of SA. Of high concern is measles coverage due to erratic measles outbreaks observed in some provinces in 2003.

Project

The SA Vaccination and Immunization Centre (SAVIC) is one of the leading SA forces behind promoting immunisation and advocating for increased efforts to reach and maintain high immunization coverage. As part of the SAVIC initiation the School of Public Health embarked on the social and behavioural aspect of immunization through qualitative research. The project is ongoing, this paper present data on four immunization studies.

Methods

The study setting were districts in four provinces, one urban and three rural. Study design- two qualitative in-depth focus group discussions (11 FGDs), structured quantitative interviews with mothers/caretakers and a retrospective review of measles immunisation coverage data. Quantitative data was analyzed using (SPSS) version 13.0. Qualitative was analyzed using the modified grounded approach

Results

The qualitative data provided insight and understanding of the context for lower childhood immunization coverage in different settings in SA

• Urban district, the mothers/caretakers were motivated to seek immunization for their children because of their knowledge of vaccine preventable diseases.

• Rural district, child health was maintained through faith and culture based practices, mothers/caretakers reportedly use traditional medicine to cure childhood ailments and keep their children healthy

Quantitative data highlighted discrepancy between District Health Information System (DHIS) national immunisation coverage and data extracted from districts, suggesting that reason for measles outbreak may be an accumulation of susceptible children due to low routine 2nd-dose measles immunisation coverage than reported by DHIS

The health-sector and health-providers were perceived as the major barrier for immunization uptake, mothers/caretakers cited various reasons in support of their views.

Conclusion

Conclusion cannot be drawn from quantitative data on the challenges for immunization uptake and coverage especially in SA, a country with such diversity of communities.