Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu‐Natal, South Africa*

Abstract

ObjectivesTo analyse coverage of childhood vaccinations in a rural South African population and investigate whether maternal HIV status is associated with children’s vaccination status.Methods2 431 children with complete information, 12–23 months of age at some point during the period January 2005 through December 2006 and resident in the Africa Centre Demographic Surveillance Area at the time of their birth were investigated. We examined the relationship between maternal HIV status and child vaccination status for five vaccinations [Bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis (DTP3), poliomyelitis (polio3), hepatitis B (HepB3), and measles] in multiple logistic regressions, controlling for household wealth, maternal age, maternal education and distances to roads, fixed and mobile clinics.ResultsCoverage of the five vaccinations ranged from 89.3% (95% CI 81.7–93.9) for BCG to 77.3% (67.1–83.6) for measles. Multivariably, maternal HIV-positive status was significantly associated with lower adjusted odds ratios (AOR) of child vaccination for all vaccines [(AOR) 0.60–0.74, all P≤ 0.036] except measles (0.75, P= 0.073), distance to mobile clinic was negatively associated with vaccination status (all P≤ 0.029), household wealth was positively (all P≤ 0.013) and distance to nearest road negatively (all P≤ 0.004) associated with vaccination status.ConclusionPositive maternal HIV status independently reduces children’s probability to receive child vaccinations, which likely contributes to the morbidity and mortality differential between children of HIV-positive and HIV-negative mothers. As a means of increasing vaccination coverage, policy makers should consider increasing the number of mobile clinics in this and similar communities in rural Africa.

Health Care Utilization and Access to Human Immunodeficiency Virus (HIV) Testing and Care and Treatment Services in a Rural Area with High HIV Prevalence, Nyanza Province, Kenya, 2007

“…However, because these distance differences were relatively small and maps did not identify large pockets of underserved area, it does not appear that distance was a major barrier to enrollment in HIV care. Although other studies have indicated a significant distance-decay effect in health care use with increasing distance for pediatric sick visits, 6 acute infections, 1 pediatric immunizations, 40 infant deliveries, 41 and ART, 42 it is unclear if this holds true for HIV services currently in this adult population and region. Kenya has rapidly decentralized HIV care services to lower level facilities, and although comprehensive HIV care services, including ART, are not available at all healthcare facilities, they are much more available than in prior years.…”

HIV/HBV coinfection in children and antiviral therapy

“…A survey of over 2000 children between the ages of 12 and 23 months in South Africa found maternal HIV status to be a risk factor for decreased immunization coverage for several childhood immunizations, including HBV [53]. …”

Non-uptake of childhood vaccination among the children of HIV-infected mothers in sub-Saharan Africa: A multilevel analysis

“…Some of these findings are in conformity with an earlier South African study. 18 These findings show that the unemployed status of HIV-infected mothers contributes to their children being incompletely vaccinated. The inability of the unemployed and poorer mothers to source funds for transport to health centres for scheduled vaccinations may be a vital reason for the non-uptake of the vaccines.…”