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      Vaccination coverage and timeliness in three South African areas: a prospective study

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          Abstract

          Background

          Timely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa.

          Methods

          This study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B.

          Results

          The proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl.

          Conclusions

          There were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas.

          Trial registration number

          ClinicalTrials.gov: NCT00397150

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          Most cited references29

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          Issues in the construction of wealth indices for the measurement of socio-economic position in low-income countries

          Background Epidemiological studies often require measures of socio-economic position (SEP). The application of principal components analysis (PCA) to data on asset-ownership is one popular approach to household SEP measurement. Proponents suggest that the approach provides a rational method for weighting asset data in a single indicator, captures the most important aspect of SEP for health studies, and is based on data that are readily available and/or simple to collect. However, the use of PCA on asset data may not be the best approach to SEP measurement. There remains concern that this approach can obscure the meaning of the final index and is statistically inappropriate for use with discrete data. In addition, the choice of assets to include and the level of agreement between wealth indices and more conventional measures of SEP such as consumption expenditure remain unclear. We discuss these issues, illustrating our examples with data from the Malawi Integrated Household Survey 2004–5. Methods Wealth indices were constructed using the assets on which data are collected within Demographic and Health Surveys. Indices were constructed using five weighting methods: PCA, PCA using dichotomised versions of categorical variables, equal weights, weights equal to the inverse of the proportion of households owning the item, and Multiple Correspondence Analysis. Agreement between indices was assessed. Indices were compared with per capita consumption expenditure, and the difference in agreement assessed when different methods were used to adjust consumption expenditure for household size and composition. Results All indices demonstrated similarly modest agreement with consumption expenditure. The indices constructed using dichotomised data showed strong agreement with each other, as did the indices constructed using categorical data. Agreement was lower between indices using data coded in different ways. The level of agreement between wealth indices and consumption expenditure did not differ when different consumption equivalence scales were applied. Conclusion This study questions the appropriateness of wealth indices as proxies for consumption expenditure. The choice of data included had a greater influence on the wealth index than the method used to weight the data. Despite the limitations of PCA, alternative methods also all had disadvantages.
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            Measles vaccines: WHO position paper.

            (2009)
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              Timeliness of childhood vaccinations in the United States: days undervaccinated and number of vaccines delayed.

              Only 18% of children in the United States receive all vaccinations at the recommended times or acceptably early. To determine the extent of delay of vaccination during the first 24 months of life. The 2003 National Immunization Survey was conducted by random-digit dialing of households and mailings to vaccination providers to estimate vaccination coverage rates for US children aged 19 to 35 months. Data for this study were limited to 14,810 children aged 24 to 35 months. Cumulative days undervaccinated during the first 24 months of life for each of 6 vaccines (diphtheria and tetanus toxoids and acellular pertussis; poliovirus; measles, mumps, and rubella; Haemophilus influenzae type b; hepatitis B; and varicella) and all vaccines combined, number of late vaccines, and risk factors for severe delay of vaccination. Children were undervaccinated a mean of 172 days (median, 126 days) for all vaccines combined during their first 24 months of life. Approximately 34% were undervaccinated for less than 1 month and 29% for 1 to 6 months, while 37% were undervaccinated for more than 6 months. Vaccine-specific undervaccination of more than 6 months ranged from 9% for poliovirus vaccine to 21% for Haemophilus influenzae type b vaccine. An estimated 25% of children had delays in receipt of 4 or more of the 6 vaccines. Approximately 21% of children were severely delayed (undervaccinated for more than 6 months and for > or vaccines). Factors associated with severe delay included having a mother who was unmarried or who did not have a college degree, living in a household with 2 or more children, being non-Hispanic black, having 2 or more vaccination providers, and using public vaccination provider(s). More than 1 in 3 children were undervaccinated for more than 6 months during their first 24 months of life and 1 in 4 children were delayed for at least 4 vaccines. Standard measures of vaccination coverage mask substantial shortfalls in ensuring that recommendations are followed regarding age at vaccination throughout the first 24 months of life.
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                Author and article information

                Journal
                BMC Public Health
                BMC Public Health
                BioMed Central
                1471-2458
                2011
                27 May 2011
                : 11
                : 404
                Affiliations
                [1 ]Centre for International Health, University of Bergen, Norway
                [2 ]School of Public Health, University of Western Cape, South Africa
                [3 ]Medical Research Council, South Africa
                [4 ]Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway
                Article
                1471-2458-11-404
                10.1186/1471-2458-11-404
                3126743
                21619642
                ae2e8243-1b1c-45e1-9832-02fe699c9508
                Copyright ©2011 Fadnes et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 February 2011
                : 27 May 2011
                Categories
                Research Article

                Public health
                Public health

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