Is the Western Cape at risk for an outbreak of preventable childhood diseases ? Lessons from an evaluation of routine immunisation coverage

Abstract

Objective: To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape. Design: Cross-sectional Household Survey using an adaptation of the ‘30x7’ cluster survey technique. Setting: Households across the Western Cape. Subjects: 3705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. Outcome measures: Vaccination Status (1=fully vaccinated, 0= partially vaccinated) as recorded on a Road to Health card or given by history. Reasons for not vaccinating established from a questionnaire. Results: The immunisation coverage is 76.8% for vaccines due by 9 months and 53.2% for vaccines due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%) and lack of motivation (14%). Of clinic factors cited, the two commonest factors were missed opportunities (34%) and being told by clinic staff to come back another time (20%). Conclusion: While the coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunized are valuable pointers as to where interventions should be focussed