School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
S Afr Med J. 2019 Jul 26;109(8):562-569. doi: 10.7196/SAMJ.2019.v109i8.13244.
Although immunisation services are available to all children in South Africa (SA), many children miss or have delays in receiving vaccines. There are limited data on factors associated with missed or delayed vaccination in children in this setting.
To assess vaccination coverage and factors associated with missed and delayed diphtheria-tetanus-pertussis vaccine third dose (DTP3) vaccination in children aged 12 - 59 months in two SA communities.
We used data from household-level healthcare utilisation surveys conducted in Soweto in 2012 and in Pietermaritzburg in 2013. Information on vaccination status was recorded from the Road to Health cards or vaccination history from clinics for children aged <5 years. Factors associated with missed or delayed DTP3 vaccination were assessed using unconditional logistic regression.
Of a total of 847 eligible children aged 12 - 59 months, 716 had available vaccination information. Overall DTP3 vaccination coverage was high for both sites: 90.6% in Pietermaritzburg and 93.9% in Soweto. However, 32.6% and 25.2% of DTP3 vaccinations were delayed (received after 18 weeks of age) in Pietermaritzburg and Soweto, respectively. The median delay for DTP3 vaccinations was 4.7 weeks (interquartile range 1.7 - 23.0). Factors associated with delayed DTP3 vaccination included being born in 2010 (adjusted odds ratio (aOR) 3.0, 95% confidence interval (CI) 1.4 - 6.3) or 2011 (aOR 2.7, 95% CI 1.3 - 5.7) compared with being born in 2008, probably due to vaccine shortages; a low level of education of the primary caregiver, with children whose caregivers had completed secondary education having lower odds of delayed vaccination (aOR 0.5, 95% CI 0.3 - 0.9) than children whose caregivers only had primary education; and maternal HIV status, with unknown status (aOR 3.5, 95% CI 1.6 - 7.6) associated with higher odds of delay than positive status. Factors associated with missed DTP3 vaccination (not vaccinated by 12 months of age) included two or more children aged <5 years in a household (aOR 2.4, 95% CI 1.2 - 4.9) compared with one child, and household monthly income <ZAR500 (aOR 3.4, 95% CI 1.1 - 11.4) compared with ≥ZAR2 000.
Despite high overall DTP3 coverage observed in two communities, many vaccinations were delayed. Vulnerable groups identified in this study should be targeted with improved vaccination services to enhance uptake and timeliness of vaccination.
尽管南非（SA）为所有儿童提供免疫服务，但许多儿童仍错过或延迟接种疫苗。关于这方面儿童错过或延迟接种疫苗的相关因素的数据有限。
评估在两个南非社区中，12-59 个月龄儿童的白喉-破伤风-百日咳疫苗第三剂（DTP3）接种率以及与错过和延迟接种 DTP3 相关的因素。
我们使用了 2012 年在索韦托和 2013 年在彼得马里茨堡进行的家庭层面医疗保健利用调查的数据。对于 <5 岁的儿童，从道路健康卡或诊所的疫苗接种记录中记录接种状况信息。使用非条件逻辑回归评估与错过或延迟 DTP3 接种相关的因素。
在总共 847 名 12-59 个月龄的合格儿童中，有 716 名儿童提供了可用的疫苗接种信息。两个地点的总体 DTP3 接种覆盖率都很高：彼得马里茨堡为 90.6%，索韦托为 93.9%。然而，DTP3 接种中有 32.6%和 25.2%在彼得马里茨堡和索韦托分别延迟（接种年龄超过 18 周）。DTP3 疫苗接种的中位延迟为 4.7 周（四分位距 1.7-23.0）。与 2008 年出生相比，2010 年（调整后的优势比（aOR）3.0，95%置信区间（CI）1.4-6.3）或 2011 年（aOR 2.7，95%CI 1.3-5.7）出生的儿童 DTP3 接种更有可能延迟，这可能是由于疫苗短缺；主要照顾者的教育程度较低，与仅接受过小学教育的照顾者相比，接受过中学教育的照顾者的儿童接种疫苗的可能性较低（aOR 0.5，95%CI 0.3-0.9）；以及母亲的 HIV 状况，未知状况（aOR 3.5，95%CI 1.6-7.6）与阳性状况相比，具有更高的延迟可能性。与错过 DTP3 接种（12 个月时未接种）相关的因素包括家庭中年龄 <5 岁的儿童有两个或更多（aOR 2.4，95%CI 1.2-4.9），与一个儿童相比，以及家庭每月收入 <ZAR500（aOR 3.4，95%CI 1.1-11.4），与 ≥ZAR2000 相比。
尽管在两个社区中观察到总体 DTP3 接种率较高，但仍有许多疫苗接种延迟。本研究中确定的弱势群体应作为目标，以改善疫苗接种服务，提高疫苗接种的覆盖率和及时性。
