Immunisation coverage and reasons associated with non-immunisation in Alexandra township, September 1988.

Regular annual measles outbreaks in Alexandra prompted a revision of immunisation strategies at the Alexandra Health Centre and University Clinic (AHC) and an immunisation coverage survey in September 1988. Forty-five clusters of 7 children aged 12-23 months were studied. Eighty-two per cent of mothers were in possession of a 'Road to Health' card, 12% said they had the card elsewhere, 3% reported it lost and 3% had never had a card. Thirty-three per cent of the children completed the immunisation schedule on time, 50% by 1 year of age and 61% by the time of the interview. The influence of sociodemographic, immunisation knowledge, and health service access variables on immunisation rates were analysed. Those children with a non-AHC 'Road to Health' card (P less than 0.01), the squatters (P less than 0.05), and those living farthest away from the clinic (P less than 0.05) were the only groups with a statistically significant lower on-time immunisation rate. Those children with a non-AHC 'Road to Health' card (P less than 0.01) and those whose caregivers could not or had difficulty reading a simple message in English (P less than 0.01 and P less than 0.05, respectively) had a significantly lower immunisation rate by 1 year of age and by interview. A child health outreach programme, started immediately after the survey, has begun to address some of the determinants of immunisation uptake described in this survey.