Abstract
BackgroundVaccination is one of the greatest public health interventions of all time. Vaccination coverage in South Africa has shown a steady improvement in reaching the national target. However, while there is progress nationally, there are districts within the country that are below the set target for vaccination coverage. One of the main drivers of suboptimal vaccination coverage is thought to be missed opportunities for vaccination.ObjectiveThis study aims to understand the magnitude and determinants of missed opportunities for vaccination in South Africa.MethodsThe 2016 South African Demographic and Health Survey will be used to conduct multilevel regression analyses to determine individual and contextual factors associated with missed opportunities for vaccination in South Africa. The perspectives of parents attending health care facilities in South Africa will be explored through exit interviews and focus group discussions. Similarly, perspectives of the health care providers will be sought to understand enablers and barriers to vaccination coverage at the facility level. Insights to such factors will aid in designing tailor-made interventions to improve vaccination coverage in South Africa.ResultsEthical review submission is planned for October 2020. Data collection is expected to be underway in January 2021.ConclusionsThe extent of missed opportunities in South Africa coupled with the associated factors presents an opportunity for efforts to increase uptake in districts where vaccination coverage is below the national target. Population-level data such as those from the 2016 South African Demographic Health Survey will provide an idea of the magnitude of missed opportunities for vaccination in South Africa at the national and subnational levels. The findings of the study will inform national and subnational policy implementation on vaccinations and help to find context-specific interventions to improve vaccination coverage.International Registered Report Identifier (IRRID)PRR1-10.2196/16672
Highlights
BackgroundVaccinations currently save between 2 and 3 million children every year [1]
Multivariable logistic multilevel regression models will be used to analyze the association between individual compositional and contextual factors associated with missed opportunities for vaccination
Not much is known about the burden and determinants of missed opportunities for vaccination in South Africa
Summary
Vaccinations currently save between 2 and 3 million children every year [1]. vaccines can only prevent childhood diseases if they reach the intended target populations [2]. There are challenges related to accessing the Expanded Program on Immunization These include accessing far-to-reach health care facilities, vaccine stock-outs in the facilities, and more importantly, missed opportunities for vaccination and vaccination hesitancy [7,8]. Multiple efforts are being made to improve immunization coverage; there is a need for the improvement of health service delivery vis-a-vis establishing synergy between health programs to reduce missed opportunities for vaccination [10]. The Expanded Program on Immunization is one of the most successful and cost-effective public health initiatives to reduce infant morbidity and mortality from vaccine-preventable diseases. The proposed study will provide novel insights on the magnitude and determinants of missed opportunities for vaccination to enable tailor-made strategies for addressing various factors unique to different districts, filling the key knowledge gaps, which is important for achieving vaccination goals in South Africa. Given the pragmatic nature of the project, its involvement of key national vaccination stakeholders and provincial and district stakeholders will generate knowledge that has the potential to inform policy decisions at the national level and which can be implemented at provincial and district levels
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