Vaccine stock-outs: A preventable health facility obstacle contributing to missed vaccinations in South African children.

In 2019 the National Department of Health (NDoH) conducted a national immunisation coverage survey of caregivers of children aged 24-35 months in all 52 districts of South Africa, and reported a national fully immunised under one year-old coverage of 83.9 %, and 76.8 % coverage for all vaccines scheduled up to 18 months of age. This retrospective, descriptive study was a secondary data analysis of 3576 validated Microsoft Excel® records containing the reasons for missed vaccinations collected by field workers during the 2019 national survey. The reason "vaccine out of stock" had been captured by field workers from children's vaccination cards, while other reasons given by caregivers had been captured either as pre-defined codes or free text. Free text reasons were analysed and additional codes created, and all reasons were categorised. In total, 3576 caregivers gave 8116 reasons for 8056 doses that had been missed by their children. Reasons related to health facility obstacles (HFOs) (67.9 %; 2429/3576) and personal obstacles (34.6 %; 1237/3576) constituted the major categories of reasons for missed vaccinations. Of all vaccines missed because of HFO-related reasons, 57.8 % (1403/2429) were missed because of vaccine stock-outs, affecting 39.2 % (1403/3576) of children. Other important HFOs included lack of access to vaccination services (24.5 %; 595/2429); and information about missed vaccinations and the need to return for catch-up not being shared with caregivers (17.1 %; 416/2429). These results were stratified by district and shared with the NDoH, who have initiated several projects in collaboration with other stakeholders, focusing mainly on building capacity for effective vaccine management to prevent vaccine stock-outs, and ensuring that all children are able to access vaccination services. The results of this study can be used as a baseline against which the success of future interventions emanating from these projects can be measured.