Socio-economic and demographic factors influencing immunisation access in children of self-settled Mozambican refugees and South African children in the Agincourt sub-district, Mpumalanga, South Africa.

Abstract

Immunisations are one of the most important interventions to decrease mortality and provide a foundation for a successful health system. Eliminating disparities in immunisation access is needed to meet immunisation coverage goals. Although migrants have been identified as influencing recent measles outbreaks in South Africa, research on access to immunisations is lacking for migrants in the country. Numerous barriers to accessing health care have been reported for international migrants in South Africa despite official policies of equal access. Children of Mozambican refugees may be a vulnerable group and not being immunised because of their migration status or other socio-economic and demographic factors. This study aims to determine immunisation rates in rural South Africa and identify socioeconomic and demographic factors influencing immunisation access including being a child of a refugee. All children under 5 years during 2003 and 2006 censuses in the Agincourt subdistrict, Mpumalanga, South Africa (N=17,532) are included in this retrospective, nested cross-sectional multivariate analysis of immunisation access community level data. Immunisation rates are approximately 85% for the first immunisation but rates for subsequent dosing decreased and only 5% of children of appropriate age obtained all immunisations on the South African immunisation schedule. Children of former Mozambican refugees were significantly more likely to be immunised than South African children (OR=1.59, p=0.018) controlling for other socio-economic and demographic characteristics. Children who lived in a village with a clinic (OR=1.43, p=0.015), children with older mothers (OR=1.02, p=0.028), and children in households with higher wealth (OR=1.13, p=0.033) were also more likely to be immunised. Strategies for increasing immunisation access should focus on delivery of services to villages without health care facilities, providing support and outreach to poorer and younger mothers, and ensuring continuing engagement with the immunisation programme. This study adds to the sparse existing research on predictors of immunisation access in South Africa as well as health care access for refugees in South Africa. This research shows that health care access can be higher for international migrants than the host population. Policymakers can use this research to target vulnerable groups to decrease disparities.