Is the Western Cape at risk of an outbreak of preventable childhood diseases? : lessons from an evaluation of routine immunisation coverage
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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 '30 by 7' cluster survey technique. Setting. Households across the Western Cape. Subjects. A total of 3 705 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 by history. Reasons for not vaccinating were established from a questionnaire. Results. The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for those 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 the clinic factors cited, the two commonest ones were missed opportunities (34%) and being told by clinic staff to return another time (20%). Conclusion. While the coverage indicates that a great deal 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. It will need to be sustainably improved before introducing rubella vaccine as part of the Expanded Programme on Immunisations (EPI) schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused.