Vaccination status of children aged 12-23 months in the Northern Transvaal Health Region.

A vaccination coverage survey was done between October and December 1989 in the Northern Transvaal Health Region, as the first phase in the region's contribution to the National Measles Strategy. The aim of the study was to evaluate the vaccination status of children in this region aged 12-23 months. The study population was divided into four strata, a black and a white urban stratum and two rural black strata, one in the north-western and the other in the south-eastern part of the region (self-governing and independent territories excluded). The Expanded Programme on Immunisation (EPI)-recommended cluster sampling technique was used in each stratum. The data were collected by nursing staff working in the area, after they had received special training. A questionnaire was used to obtain data from randomly selected households. The following conclusions can be made from the results: (i) in all strata percentages of fully vaccinated children were well below the EPI-recommended target of 60-70% to be reached by the developing countries by 1990; (ii) a danger of measles outbreaks exists in most communities, because the levels of measles vaccination were less than 70% in three out of the four strata; (iii) the children with the highest risk of developing measles complications were not being vaccinated early enough; and (iv) the very high drop-out rates for subsequent vaccinations in the rural areas warrant urgent attention.

Mass immunisation campaigns--do they solve the problem?

Mass immunisation campaigns have been successfully used for vaccine delivery in countries such as Brazil and Turkey as well as in a number of instances locally. Although in some circumstances mass campaigns have been advantageous, they are not recommended as a basic policy for South Africa. Immunisation services should be incorporated into routine primary health care delivery as part of maternal and child services. If these services are adequately delivered there would be no need for mass campaigns.

The 'Road to Health' card and immunisation records.

The 'Road to Health' card (RTHC) is a useful medical record summary of a child's health in the first 5 years of life. More than 40 different types are in use in southern Africa at present, creating confusion among health workers. RTHCs allow effective recording of the vaccination status of children and, in contrast to cards that allow the recording of vaccinations only, emphasise the place of vaccination within the context of comprehensive child care.

Provision of immunisation--the Gazankulu experience.

Following the outbreak of poliomyelitis in Gazankulu in 1982, the immunisation services in Gazankulu were thoroughly examined. As a result of this, a comprehensive immunisation policy for Gazankulu was accepted in November 1986. The broad aim of the policy is to provide effective immunisation to all Gazankulu residents against tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis and measles. A specific objective is that by the end of 1987, 85% of under-5s should have been vaccinated against these six diseases and by the end of 1990 this percentage should be 97%. The detailed strategies to reach these objectives are highlighted. Within the framework of the objectives, the policy allows different areas to formulate individual strategies. Programme monitoring and community involvement are two crucial aspects of the policy and these are discussed in detail. The early successes and difficulities in implementing this policy are discussed.