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Vaccines (Basel). 2020 Nov 25;8(4). doi: 10.3390/vaccines8040705.

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

Vaccines

Duduzile Ndwandwe, Chukwudi A Nnaji, Charles S Wiysonge

Affiliations

  1. Cochrane South Africa, South African Medical Research Council, Francie Van Zijl Drive, Parow Valley, Cape Town 7501, South Africa.
  2. School of Public Health and Family Medicine, University of Cape Town, Anzio Road, Observatory, Cape Town 7925, South Africa.
  3. Department of Global Health, Stellenbosch University, Francie Van Zijl Drive, Cape Town 7505, South Africa.

PMID: 33255767 PMCID: PMC7712226 DOI: 10.3390/vaccines8040705

Abstract

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.

Keywords: South Africa; demographic and health survey; low- and middle-income countries; missed opportunities for vaccination; vaccination coverage

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