Submitted in fulfilment of the requirements for the Degree of Master of Technology in Nursing, Durban University of Technology, Durban, South Africa, 2015 / Brief background: The Expanded Programme on Immunisation (EPI) is one of the most powerful and cost-effective public health programmes to improve child survival. In South Africa the programme remained fragmented because of the system of apartheid until 1995 when the national EPI was formed through the unification of all immunisation services in the country. Since then there have been significant advances in immunisation service delivery in South Africa. Amongst the revisions that were made in 2009 was the change of the EPI schedule. Aim of the study The aim of the study was to investigate the factors that influence the uptake of the revised EPI for children between the ages of 6 to 12 years at Umlazi Township, KwaZulu-Natal in order to improve immunisation coverage. Methodology A descriptive quantitative design was used to conduct the study. A total of ten primary health care clinics were included in the study. Data was collected from child caregivers and health care workers using self-directed questionnaires. Results: It was worth noting that although the results of the study revealed that the EPI coverage for children between the ages 6 to 12 years remained low in Umlazi Township, however, the programme was well-implemented. Several factors that influenced the uptake of the immunisations were identified and these factors could be used to strengthen the EPI programme in Umlazi. Factors that had a negative influence on the uptake of immunisations were also identified and these factors could be used to develop strategies address the challenges.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Achieving high vaccination coverage is crucial in the control, prevention and elimination of childhood vaccine preventable diseases. The Expanded Program of Immunization (EPI) aims for 95% coverage for each antigen and complete vaccination schedules for 90% of children under 12 months of age. All the vaccines included in the national vaccination schedule (Bacille Calmette Guerin (BCG), Oral Polio Vaccine, Diphtheria-Pertussis-Tetanus (DPT) vaccine, Measles and Hepatitis B vaccine are provided free of charge in the primary health services in South African public health care facilities. Although the coverage of all vaccines in South Africa has increased especially in recent years, the EPI targets has not been achieved yet in some parts of the coutnry and there are still differences within provinces. Therefore, the primary objective of this study was to investigate the prevalence and determinants of childhood immunization coverage at Primary Healthcare facilities, Bushbuckridge, sub district of the Mpumalanga Province, South Africa. The mean age of the children was 1.4±2.5 years (ranged: 1 months to 12 years. Slightly more than half (56%) of the children were less than 6-months. Nearly two-thirds (63%) of the children were females and only 37% were males. Methodology: A cross-sectional descriptive study was conducted among selected Primary Healthcare facilities in Ehlanzeni District, Bushbuckridge Sub- district, Mpumalanga Province. Simple random sampling was used to get a minimum sample size of 426 mothers and/or caregivers paired with their children required for the study. The researcher administered a validated or tested self-designed questionnaires to the participants. Data analysis was done using the STATA statistical software version 12 for Windows (STATA Corporation, College Station, Texas). Results: The mean age of the participants was 34.1±9.2 years ranged from 15 to 57 years. Almost one-third (28.6%) of the mothers and/or caregivers were 40 years and older and the majority (70%) were unmarried. Majority of the participants had secondary ix education with 65.5% and 23.4% had primary education. Nearly eighty per cent (79.2%) of the maternal and/or caregivers were unemployed. The prevalence rate of fully immunized children was 88% and a significant higher proportion of children in the age group 12 years at 57% were likely not to be fully immunized (p<0.05), followed by age group 6 -11 years, 18 months – 5 years, 6-8 months and 9-11 months at 48%, 26%, 17% 13% respectively. No statistical significant relationship was found between maternal and/or caregiver age, marital status, level of education, employment status and immunization coverage of the child. However, participants aged 40 years and older, less educated and unemployed were likely to have missed immunization of their children. Mother and/or caregivers with a tertiary education were 3.46 times more likely to get their children immunized than those with none/primary education [OR = 3.46, (95% CI:0.75;15.9), p<0.2)]. The employed mother and/or caregivers were 2.01 times more likely to get their children immunized than the unemployed mother and/or caregivers [OR = 2.01, (95% CI: 0.82; 4.89), p<0.20]. In the multivariate model, level of education and employment status were found not to be significantly associated with immunization of the child. Conclusion: The overall immunization coverage in the present study was relatively high and significantly decreased with age. At 6 weeks, all age groups between 0-6 weeks were immunized, while at 10 weeks, with exception of children in the age group 10 -13 weeks and 18 months – 5 years. At 6 months, the young children (age 9-11 months) were likely to default or missed measles vaccination. At 6 and 12 years, the Td vaccination coverage was relatively low. Mothers and/ or caregivers who missed child immunization were likely to experience shortage of vaccines at health facility and said it takes the whole day to immunize a child but the result were not significant. Mother and/or caregivers with a tertiary education and employed were more likely to immunize their children than mothers and/or caregivers with primary, secondary education and the unemployed.

Introduction This research was a descriptive study into the cold chain management of childhood vaccines by nurses in Primary Health Care Clinics in the uMgungundlovu District. It is imperative for health professionals to follow the procedures and policies set out by the immunisation and health manuals by of the World Health Organization. The success of any childhood vaccination programme depends on how well nurses and health professionals are able to adhere to the laws, regulations and procedures. There is also a need for clinics and health institutions to be flexible enough to deal with certain constraints so that the vaccination programmes are not interrupted for extended periods of time but rather run efficiently and benefit the intended population. As a result pandemics are easily avoided and a healthy generation of children will bring about a better society. Methodology The study was carried out in two phases i.e. an observational study and a self-administered questionnaire. In the first phase, the observational study was carried out at 14 different clinics in the uMgungundlovu District. In the second phase, the cold chain management of vaccines by nurses was explored by means of a self-administered questionnaire. Results The key findings of the observational study include that on most occasions policy was not being implemented. Furthermore there were no contingency plans to deal with equipment and electricity issues, no monitoring and evaluation systems, poor recording keeping, poor management of the cold box, access to stock and the actual management of the cold chain for vaccines. The self-administered questionnaire was completed by 276 nurses via a simple random sample from the different clinics. The most salient aspects of the research in this phase of the study revealed that education and experience of the nurses are crucial to the sustainability of the childhood immunisation programme. Not surprisingly, some of the findings were similar to that of the observational study. Issues surrounding equipment and electricity, monitoring and evaluation systems, poor recording keeping, poor access to stock and ordering of stock were prevalent in this phase of the research as well. Conclusion Recommendations have been made for ongoing communication between the Department of Health, the District Office of Health and clinics so that the short and long term problems identified are solved.

Thesis (MEng)-- Stellenbosch University, 2013. / ENGLISH ABSTRACT: South Africa’s health sector has not yet shown enough improvement to reach the Millennium Development Goals related to health. One of the problem areas is the low infant and child vaccination coverage in certain areas of South Africa. The use of mobile phones in health care (mHealth) has the potential to strengthen the primary health care system through improved information management. A mobile health solution for vaccination (MHSV) can be used to improve information management of vaccinations, which in turn can improve vaccination coverage. However, the feasibility of implementing such an MHSV in the South African context is unknown. This study therefore investigates the feasibility of using mobile phones to improve information management for child vaccinations in South Africa. Feasibility is determined by using a feasibility framework together with business model development. The feasibility framework, which is informed by a literature study, surveys and a case study, determines the feasibility of an MHSV in terms of human factors, technical feasibility, information management, policies and ethics, and economics. It is found that an MHSV is feasible in South Africa, although certain areas pose challenges that will have to be considered. Complementing the feasibility framework, business models are developed to suggest possible ways in which an MHSV can be deployed in South Africa. These models build on the results from the feasibility framework and are developed using Osterwalder’s business model canvas. The effect of the National Health Insurance (NHI) on these business models is also examined. In order to validate the feasibility framework and business models, interviews were held with experts in health care and mobile phone solutions. These interviews show that the research is valid and that the feasibility framework and business models can be generalised to the wider field of mHealth solutions. / AFRIKAANSE OPSOMMING: Suid-Afrika se gesondheidsektor het nog nie genoeg verbetering getoon om die gesondheidsverwante Millenium Ontwikkelingsdoelwitte te bereik nie. Een van die probleemareas is die besondere lae inentingsdekking van babas en kinders in sekere gebiede van Suid-Afrika. Die gebruik van selfone vir gesondheidsorg hou die potensiaal in om die primêre gesondheidsorgstelsel te versterk deur inligtingsbestuur te verbeter. ’n Inentingsoplossing wat gebruik maak van selfone, bekend as ‘n “mobile health solution for vaccination” (MHSV), kan inligtingsbestuur van inentings verbeter, wat hoër inentingsdekking tot gevolg kan hê. Die haalbaarheid van die implementering van so ’n MHSV in die konteks van Suid-Afrika is egter onbekend. Hierdie studie ondersoek dus die haalbaarheid daarvan om selfone te gebruik vir beter inligtingsbestuur van kinder-inenting in Suid-Afrika. Haalbaarheid word vasgestel deur ’n haalbaarheidsraamwerk en die ontwikkeling van besigheidsmodelle te gebruik. Die haalbaarheidsraamwerk, wat toegelig word deur ’n literatuurstudie, vraelyste en ’n gevallestudie, bepaal die haalbaarheid van ’n MHSV in terme van menslike faktore, tegniese haalbaarheid, inligtingbestuur, beleid en etiek, en ekonomie. Daar word gevind dat ’n MHSV haalbaar is in Suid-Afrika, alhoewel sekere areas uitdagings inhou. Die haalbaarheidsraamwerk word aangevul deur die ontwikkeling van besigheidsmodelle wat moontlike maniere voorstel waarop ’n MHSV in Suid-Afrika ontplooi kan word. Hierdie modelle word geskoei op die resultate van die haalbaarheidsraamwerk en word ontwikkel met behulp van Osterwalder se besigheidsmodelskema (“business model canvas”). Die effek van die nasionale gesondheidversekering op hierdie modelle word ook ondersoek. Onderhoude met kundiges in die veld van selfoonoplossings vir gesondheidsorg word gebruik om die haalbaarheidsraamwerk en die besigheidsmodelle te valideer. Die onderhoude toon dat die navorsing geldig is en dat die haalbaarheidsraamwerk en besigheidsmodelle veralgemeen kan word na die wyer veld van selfoonoplossings vir gesondheidsorg.

The purpose of this study was to determine the progress of the immunization program for Contagious Diseases in the City Schools of Dallas, Texas, over a period of ten years, dating from September 1928, to September 1938. An endeavor was made to determine how the Health Works Program of the Dallas Public Schools developed, and the protection it gave the public children.

This project examines the role of immunization registries and their effect on a health care delivery system. Recent efforts to attain coverage of child populations by recommended vaccines have included initiatives by federal and state agencies, as well as private foundations, to develop and implement statewide community-based childhood immunization registries.

MPH / Department of Public Health

The aim of the study was to gain an in-depth understanding of the girl children’s parents perceptions regarding the papillomavirus vaccine roll-out programme at schools in Tshwane District, Gauteng Province. The researcher used a qualitative exploratory research design to address the research objective of the study as the qualitative method enables the researcher to explore and describe the study phenomenon. Data were collected from 12 parents of girl children who received the papillomavirus vaccine at one of the schools in Soshanguve township, which is one of the biggest townships in the Tshwane District. Data was analysed manually using content analysis. The following four superordinate themes emerged from data analysis: a) Communication of the programme, b) Motivation for allowing their children to be immunized. c) Response to immunisation, d) Suggested ways of enhancing the programme. These themes were discussed in relation to existing literature. Recommendations were made based on the findings to enhance the papillomavirus vaccination programme and for future research. / Health Studies / M.A. (Nursing Science)

Measles is a highly contagious virus that can affect the entire population if an effective immunisation programme is not in place. This study was aimed at determining the measles immunisation coverage and the dropout rate among children aged between 6 months and 14 years and at assessing factors associated with caregivers’ knowledge and perception of, and attitude towards the measles immunisation programme. Between 14 May 2018 and 31 July 2018, a descriptive, cross-sectional study design was conducted using simple random sampling to sample 381 caregivers of children at nine public health facilities at Tshwane Sub-district 2, Hammanskraal town. Data were collected by means of a structured questionnaire and observational checklist, and analysed using IBM SPSS version 23.0. Overall, the measles immunization coverage was 95.8% (365/381) and the MCV1-MCV2 dropout rate was 4.1%. The association between educational level and employment status (correlation coefficient=0.157**, p=0.0002), measles knowledge (correlation coefficient=-0.244**, p=0.000), immunization importance (correlation coefficient=-0.194**, p=0.000) and measles vaccine schedule (correlation coefficient=-0.138**, p=0.007) were found to be significant at p<0.05. The findings in this study revealed that caregivers’ positive attitude towards, and knowledge of measles immunisation programme resulted in high measles immunisation coverage and low dropout rate. It is recommended that continuous positive immunisation education about the benefits and importance be emphasized in order to increase immunisation uptake. / Health Studies / M. P. H.

Indiana University-Purdue University Indianapolis (IUPUI) / Vaccinations are an important step in preventing childhood illnesses and disease outbreaks in the community. Complete immunizations before school assure eligibility for enrollment and protect children against severe illness. The fact that foreign-born children of Latino immigrants face health disparities in receiving vaccinations is well documented. However, there is little information in the literature about the actual experience of immigrants facing the complexities of the health system, and through their eyes, which factors ultimately affect vaccination rates of immigrant Latino children. The purpose of this study is to give voice to Latino immigrant families who have recently immigrated to the United States, in terms of the issues they encountered when engaging the health care system for vaccinations.