Is the Western Cape at risk for an outbreak of preventable childhood diseases ? Lessons from an evaluation of routine immunisation coverage

Objective: To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape. Design: Cross-sectional Household Survey using an adaptation of the ‘30x7’ cluster survey technique. Setting: Households across the Western Cape. Subjects: 3705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. Outcome measures: Vaccination Status (1=fully vaccinated, 0= partially vaccinated) as recorded on a Road to Health card or given by history. Reasons for not vaccinating established from a questionnaire. Results: The immunisation coverage is 76.8% for vaccines due by 9 months and 53.2% for vaccines due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%) and lack of motivation (14%). Of clinic factors cited, the two commonest factors were missed opportunities (34%) and being told by clinic staff to come back another time (20%). Conclusion: While the coverage indicates that a lot of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. The coverage will need to be sustainably improved before introducing rubella vaccine as part of the EPI schedule. The reasons given by caregivers for their children not being immunized are valuable pointers as to where interventions should be focusse

Investigating the disjoint between education and health policy for infant feeding among teenage mothers in South Africa: a case for intersectoral work

Background: Many low-and-middle-income countries, including South Africa, have high rates of teenage preg‑ nancy. Following the World Health Organisation recommendations, South African health policy on infant feeding promotes exclusive breastfeeding until six months of age, with gradual weaning. At the same time, South Africa’s education department, in the interest of learners, promotes adolescents’ early return to school post-partum. Yet infant feeding at school is currently not perceived as a realistic option. Methods: Recognising his this policy tension, we aimed to explore how policies are interpreted and implemented by the health and education sectors through interviews with key informants who produce, interpret and implement these policies. Using an interview guide developed for this study, we conducted in-depth interviews with 24 health policy makers, managers in both sectors, school principals and nursing staf who manage adolescent mothers (aged 16-19) and their babies. Data was analysed using thematic analysis. Results: Informants from both sectors expressed discomfort at pregnant learners remaining in school late in preg‑ nancy and were uncertain about policy regarding when to return to school and how long to breast-feed. Educators reported that new mothers typically returned to school within a fortnight after delivery and that breastfeeding was not common. While health professionals highlighted the benefts of extended breastfeeding for infants and mothers, they recognised the potential confict between the need for the mother to return to school and the recommenda‑ tion for longer breastfeeding. Additionally, the need for ongoing support of young mothers and their families was highlighted. Conclusions: Our fndings suggest educators should actively encourage school attendance in a healthy pregnant adolescent until delivery with later return to school, and health providers should focus attention on breastfeeding for the initial 4-6weeks postpartum, followed by guided support of formula-feeding. We encourage the active engage‑ ment of adolescents’ mothers and extended families who are often involved in infant feeding and care decisions. Edu‑ cation and health departments must engage to facilitate the interests of both the mother and infant: some exclusive infant feeding together with a supported return to school for the adolescent mothe

The cost of harmful alcohol use in South Africa

Background. The economic, social and health costs associated with alcohol-related harms are important measures with which to inform alcohol management policies and laws. This analysis builds on previous cost estimates for South Africa.Methods. We reviewed existing international best-practice costing frameworks to provide the costing definitions and dimensions. We sourced data from South African costing literature or, if unavailable, estimated costs using socio-economic and health data from secondary sources. Care was taken to avoid possible causes of cost overestimation, in particular double counting and, as far as possible, second-round effects of alcohol abuse.Results. The combined total tangible and intangible costs of alcohol harm to the economy were estimated at 10 - 12% of the 2009 gross domestic product (GDP). The tangible financial cost of harmful alcohol use alone was estimated at R37.9 billion, or 1.6% of the 2009 GDP.Discussion. The costs of alcohol-related harms provide a substantial counterbalance to the economic benefits highlighted by the alcohol industry to counter stricter regulation. Curtailing these costs by regulatory and policy interventions contributes directly and indirectly to social well-being and the economy.Conclusions. Existing frameworks that guide the regulation and distribution of alcohol frequently focus on maximising the contribution of the alcohol sector to the economy, but should also take into account the associated economic, social and health costs. Current interventions do not systematically address the most important causes of harm from alcohol, and need to be informed by reliable evidence of the ongoing costs of alcohol-related harms

Violence, alcohol and symptoms of depression and in Cape Town's poorest communities: results of a community survey

Introduction This paper summarises key findings from the first of three household surveys conducted in three high-violence areas in the Cape Town, investigating community members’ experiences of alcohol use, their built environment, violence and symptoms of depression, together with their views on alcohol and other interventions. Methods A stratified random sample of 1500 dwellings, 1200 in Khayelitsha and 300 in Gugulethu and Nyanga (“Gunya”) was selected using GIS address data for formal areas and aerial photography for informal areas. Fieldwork took place from July to November 2013. Responses to questions were summarized by area, gender, age and formal vs. informal settlement type. Results After substitution and data cleaning, 1213 Khayelitsha households and 286 Gunya households were included. In Gunya, 29% of respondents reported that they or their family members had been affected by at least one violent crime (murder, assault, domestic violence, rape) in the past year, compared with 12% in Khayelitsha. Using a CES-D-10 cut-off of 10, 44% of respondents were classified as depressed. More than half the respondents reported having experienced some form of alcohol nuisance. Respondents were supportive of alcohol interventions such as increased taxes and police regulation of outlets, particularly in Gunya (87%) and amongst female respondents (76%). Satisfaction with infrastructure such as street lighting and drainage was generally low. Conclusions The results describe the co-occurring burdens of alcohol and drug use, violence, depression and deprivation in our study populations

Poverty and common mental disorders in low and middle income countries: A systematic review.

In spite of high levels of poverty in low and middle income countries (LMIC), and the high burden posed by common mental disorders (CMD), it is only in the last two decades that research has emerged that empirically addresses the relationship between poverty and CMD in these countries. We conducted a systematic review of the epidemiological literature in LMIC, with the aim of examining this relationship. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD. In community-based studies, 73% and 79% of studies reported positive associations between a variety of poverty measures and CMD, 19% and 15% reported null associations and 8% and 6% reported negative associations, using bivariate and multivariate analyses respectively. However, closer examination of specific poverty dimensions revealed a complex picture, in which there was substantial variation between these dimensions. While variables such as education, food insecurity, housing, social class, socio-economic status and financial stress exhibit a relatively consistent and strong association with CMD, others such as income, employment and particularly consumption are more equivocal. There are several measurement and population factors that may explain variation in the strength of the relationship between poverty and CMD. By presenting a systematic review of the literature, this paper attempts to shift the debate from questions about whether poverty is associated with CMD in LMIC, to questions about which particular dimensions of poverty carry the strongest (or weakest) association. The relatively consistent association between CMD and a variety of poverty dimensions in LMIC serves to strengthen the case for the inclusion of mental health on the agenda of development agencies and in international targets such as the millenium development goals

Is the Western Cape at risk of an outbreak of preventable childhood diseases? Lessons from an evaluation of routine immunisation coverage

OBJECTIVE: To determine the routine immunisation coverage rates in children aged 12 - 23 months in the Western Cape. DESIGN: Cross-sectional Household Survey using an adaptation of the '30 by 7' cluster survey technique. SETTING: Households across the Western Cape. SUBJECTS: A total of 3 705 caregivers of children aged 12 - 23 months who had been living in the Western Cape for at least 6 months. OUTCOME MEASURES: Vaccination status (1 = fully vaccinated; 0 = partially vaccinated) as recorded on a Road-to-Health card or by history. Reasons for not vaccinating were established from a questionnaire. RESULTS: The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for those due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%), and lack of motivation (14%). Of the clinic factors cited, the two commonest ones were missed opportunities (34%) and being told by clinic staff to return another time (20%). CONCLUSION: While the coverage indicates that a great deal of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions, including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. It will need to be sustainably improved before introducing rubella vaccine as part of the Expanded Programme on Immunisations (EPI) schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused

Immunisation coverage of the Western Cape Province : household survey 2005

Includes bibliographical references.[Objective] To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape and factors affecting immunisation coverage. [Design] Cross-sectional Household Survey using an adaptation of the '30x7' cluster survey technique (multi-stage sampling). [Setting] Households across the Western Cape. [Subjects] 3705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. [Outcome Measures] Vaccination Status (1=fully vaccinated, 0=partially vaccinated) as recorded on a Road to Health card or given by history. Factors affecting caregivers' vaccination behaviour established from a questionnaire. [Results] The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for vaccines due by 18 months. The reasons given for not being imunised were clinic-related factors (47%), lack of information (27%), lack of information (27%), caregiver being unable to attend the clinic (23%) and lack of motivation (14%). Of clinic factors cited, the two commonest factors were missed opportunities (34%) and being told by clinic staff to come back another time (20%). Factors enhancing coverage included possession of a Road-to-Health card, caregiver knowledge about vaccines and perceived attitude of clinic staff. Certain racial inequities in coverage were also apparent, particularly in the Boland-Overberg Region. [Conclusion] While the coverage indicated that a lot of good work has been done, the coverage was insufficient to prevent outbreaks of measles and other common childhood conditions including polio. The coverage was too low to consider not running periodic mass campaigns for measles and polio. The reasons given by caregivers for their children not being immunized and factors associated with increased coverage are valuable pointers as to where interventions should be focused

Is the Western Cape at risk of an outbreak of preventable childhood diseases? : lessons from an evaluation of routine immunisation coverage

The original publication is available at http://www.samj.org.zaObjective. To determine the routine immunisation coverage rates in children aged 12-23 months in the Western Cape. Design. Cross-sectional Household Survey using an adaptation of the '30 by 7' cluster survey technique. Setting. Households across the Western Cape. Subjects. A total of 3 705 caregivers of children aged 12-23 months who had been living in the Western Cape for at least 6 months. Outcome measures. Vaccination status (1 = fully vaccinated; 0 = partially vaccinated) as recorded on a Road-to-Health card or by history. Reasons for not vaccinating were established from a questionnaire. Results. The immunisation coverage was 76.8% for vaccines due by 9 months and 53.2% for those due by 18 months. The reasons given for not being immunised were clinic-related factors (47%), lack of information (27%), caregiver being unable to attend the clinic (23%), and lack of motivation (14%). Of the clinic factors cited, the two commonest ones were missed opportunities (34%) and being told by clinic staff to return another time (20%). Conclusion. While the coverage indicates that a great deal of good work is being done, the coverage is insufficient to prevent outbreaks of measles and other common childhood conditions, including polio. The coverage is too low to consider not running periodic mass campaigns for measles and polio. It will need to be sustainably improved before introducing rubella vaccine as part of the Expanded Programme on Immunisations (EPI) schedule. The reasons given by caregivers for their children not being immunised are valuable pointers as to where interventions should be focused