Open Access Research article

Vaccination coverage and timeliness in three South African areas: a prospective study

Lars T Fadnes1*, Debra Jackson2, Ingunn MS Engebretsen1, Wanga Zembe3, David Sanders2, Halvor Sommerfelt14, Thorkild Tylleskär1 and the PROMISE-EBF Study Group

Author Affiliations

1 Centre for International Health, University of Bergen, Norway

2 School of Public Health, University of Western Cape, South Africa

3 Medical Research Council, South Africa

4 Division of Infectious Disease Control, Norwegian Institute of Public Health, Norway

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BMC Public Health 2011, 11:404  doi:10.1186/1471-2458-11-404

Published: 27 May 2011



Timely vaccination is important to induce adequate protective immunity. We measured vaccination timeliness and vaccination coverage in three geographical areas in South Africa.


This study used vaccination information from a community-based cluster-randomized trial promoting exclusive breastfeeding in three South African sites (Paarl in the Western Cape Province, and Umlazi and Rietvlei in KwaZulu-Natal) between 2006 and 2008. Five interview visits were carried out between birth and up to 2 years of age (median follow-up time 18 months), and 1137 children were included in the analysis. We used Kaplan-Meier time-to-event analysis to describe vaccination coverage and timeliness in line with the Expanded Program on Immunization for the first eight vaccines. This included Bacillus Calmette-Guérin (BCG), four oral polio vaccines and 3 doses of the pentavalent vaccine which protects against diphtheria, pertussis, tetanus, hepatitis B and Haemophilus influenzae type B.


The proportion receiving all these eight recommended vaccines were 94% in Paarl (95% confidence interval [CI] 91-96), 62% in Rietvlei (95%CI 54-68) and 88% in Umlazi (95%CI 84-91). Slightly fewer children received all vaccines within the recommended time periods. The situation was worst for the last pentavalent- and oral polio vaccines. The hazard ratio for incomplete vaccination was 7.2 (95%CI 4.7-11) for Rietvlei compared to Paarl.


There were large differences between the different South African sites in terms of vaccination coverage and timeliness, with the poorer areas of Rietvlei performing worse than the better-off areas in Paarl. The vaccination coverage was lower for the vaccines given at an older age. There is a need for continued efforts to improve vaccination coverage and timeliness, in particular in rural areas.

Trial registration number NCT00397150