Many toddlers are falling through SA's vaccination net

One in 10 of Mpumalanga’s children under the age of two has not had any of the shots required under the government’s childhood immunisation programme, according to the South Africa Demographic Health Survey (DHMS) 2016 released on Monday by Statistics SA.

The finding signals potentially deadly weaknesses in the childhood immunisation programme, as inadequate coverage of the population increases the likelihood of disease outbreaks. Both Gauteng and the Western Cape have had measles outbreaks this year.

The DHMS 2016 found only half (53%) of SA’s children aged between 12 and 23 months had received all their vaccinations at the appropriate age.

The immunisation gaps were greatest in Mpumalanga and Gauteng, where 10.4% and 6.6% of children in this age group had fallen through the net.

Health Minister Aaron Motsolaedi said he would investigate why the vaccination programme was missing the mark in Mpumalanga, and try to increase the opportunities children to be vaccinated. "We need to catch children wherever we find them – clinic, crèche or school," he said.

Deputy director-general for HIV/AIDS, TB and maternal and child health Yogan Pillay said the health department had only recently received the survey and needed to study it more closely. "We would like to see the confidence intervals around some of these numbers to see whether they are a true representation of the population," he said.

The SADHS 2016 report is based on interviews with approximately 13,000 households, and is the third such survey conducted in SA: the previous two were carried out in 1998 and 2003.

The data on immunisation rates was obtained where possible from written vaccination records, which are contained in a child’s Road-to-Health booklet. If the booklet was not available, mothers were asked to recall which vaccinations their children had received and when. The booklet was available for two thirds of the children aged between 12 and 23 months.

The SADHS 2016 quashed the myth that young women are deliberately falling pregnant in order to access the child support grant, Statistician-General Pali Lehohla said when he released the report. The survey found teenage pregnancy rate had remained virtually the same between 1998 and 2016, at 71 per 1000 women.

"There is a notion that grants influence young girls to produce children, but the evidence before us is that isn’t true. The data dispenses with that myth," said Lehohla.

The child support grant was introduced in 1998, and currently stands at R380 a month. Children are the primary beneficiaries of the government’s welfare grant system, and are expected to amount to 12.82 million of the 18.06 million beneficiaries by the 2019-2020 fiscal year.

Motsoaledi said the 2016 SADHS findings on teenage pregnancy added to research commissioned by former social development minister Zola Skweyiya which found the overwhelming majority of teenage mothers registered their children for grants only after they turned two.

Teenage pregnancy was a concern because children born to very young mothers were at higher risk of illness and death, said Statistics SA. Teenage mothers were also more likely to have complications in pregnancy and fail to finish school. The survey found about 16% of women aged between 15 and 19 had begun childbearing.

The survey found SA’s fertility rate has steadily declined over the past two decades, from an average of 2.9 live births for every woman aged between 15 and 44 in 1998 to 2.6 in 2016.

It also highlighted the challenge SA faces in tackling its HIV epidemic, finding 2 out of 5 women (42%) and one in three men (35%) who had multiple sexual partners said they had not used a condom the last time they had sex.

Motsoaledi said the government had improved its HIV prevention strategies, which were detailed in the latest National Strategic Aids Plan. It had also launched a R3bn programme targeting girls and young women at high risk of HIV last year, called "She Conquers".

BDlive