Immunisation and vitamin A capsule coverage in a semi-urban area of KwaZulu-Natal Province, South Africa

Abstract

Background. The Expanded Programme on Immunisation (EPI) in South Africa (SA) has had a large effect on vaccine-preventable illnesses, yet there is little in the literature describing access to and utilisation of the programme beyond 1 year of age. Coverage of vitamin A supplementation is examined through District Health Information System data, but this does not give a fair assessment of the lifetime coverage in a child or provide any correlation with the immunisation status of the child. 

Objectives. To describe utilisation and dropout rate with the vitamin A and immunisation programmes over the first 6 years of life among children aged 6 - 8 years in a semi-urban population in KwaZulu-Natal (KZN) Province, SA. A secondary objective was to investigate whether access and dropout rates are associated between these two programmes. 

Methods. A retrospective cohort analysis was performed on 923 anonymised Road-to-Health cards, extracting information on immunisation and vitamin A coverage.

Results. Overall, 92.9% (95% confidence interval (CI) 91.2 - 94.6) and 88.5% (95% CI 86.4 - 90.5) of children were fully immunised by 12 months and 18 months of age, respectively. The percentage of children fully immunised by 6 years of age dropped to 44% (95% CI 41.2 - 47.6). The dropout rates for measles, and diphtheria, pertussis and tetanus 1 - 3 vaccination were 2.4% and 1.2%, respectively. Vitamin A had an overall coverage of 34.9% during 6 - 60 months of life for this population, with children receiving, on average, three doses (interquartile range 2 - 5).

Conclusion. Despite good immunisation coverage in the first 18 months of life, there was relatively poor vitamin A coverage, suggesting a need for re-evaluation of the current vitamin A capsule distribution programme.