{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T19:37:05Z","timestamp":1793216225350,"version":"4.5.0"},"reference-count":27,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2022,8,4]],"date-time":"2022-08-04T00:00:00Z","timestamp":1659571200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100007265","name":"school of medicine, boston university","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100007265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001322","name":"south african medical research council","doi-asserted-by":"publisher","award":["Bill and Melinda Gates Foundation (INV-GC2019)"],"award-info":[{"award-number":["Bill and Melinda Gates Foundation (INV-GC2019)"]}],"id":[{"id":"10.13039\/501100001322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Glob Health Promot"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:p>Many low- and middle-income countries face challenges in attaining adequate levels of vaccination coverage, and the factors driving this under-coverage have not been completely elucidated. In this cross-sectional study, we investigated factors associated with vaccination coverage in Mopani District, Limpopo Province, South Africa. Between July and October 2017, we surveyed 317 caregivers (83% of whom were mothers) of seven-month-old infants in Mopani District about barriers faced when attaining vaccines and attitudes towards vaccination, and reviewed the infants\u2019 documented vaccination history. Caregiver and child demographic data were collected shortly after birth. We described the coverage for vaccines that should be received by age seven months, according to South Africa\u2019s Expanded Programme on Immunization schedule, and explored the relationship between coverage and caregiver characteristics, behavioral factors (e.g. attitudes towards vaccination), and structural factors (e.g. vaccination stock-outs at clinics). We found that caregivers reported positive attitudes towards vaccination, based on a seven-question survey of vaccination attitudes. Although coverage was high for most recommended vaccines, it was low for pneumococcal conjugate vaccine (PCV), with just 36% of children having received it by age seven months. This appears to have been due to PCV stock-outs at government clinics. For vaccines other than PCV, children were more likely to be up-to-date on vaccinations if a community health worker (CHW) had visited their home in the past month (adjusted odds ratio (OR) 1.24, confidence interval (CI) (1.10\u20131.41); p\u2009&lt;\u20090.001) and if the caregiver had more years of schooling (adjusted OR 1.03 (CI 1.01\u20131.05); p\u2009=\u20090.012). We conclude that addressing PCV stock-outs at government clinics in Mopani District is necessary to ensure coverage reaches adequate levels. Additionally, supporting CHW programs may be a productive avenue for improving vaccination coverage.<\/jats:p>","DOI":"10.1177\/17579759221107037","type":"journal-article","created":{"date-parts":[[2022,8,5]],"date-time":"2022-08-05T01:02:16Z","timestamp":1659661336000},"page":"42-52","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Vaccination coverage at seven months of age in Limpopo Province, South Africa: a cross-sectional survey"],"prefix":"10.1177","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2454-8129","authenticated-orcid":false,"given":"John P.","family":"Killion","sequence":"first","affiliation":[{"name":"Boston University School of Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David T.","family":"Silverman","sequence":"additional","affiliation":[{"name":"Boston University School of Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Evans","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lezanie","family":"Coetzee","sequence":"additional","affiliation":[{"name":"Health Economics and Epidemiology Research Office, University of Witwatersrand, Johannesburg, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amanda R.","family":"Tarullo","sequence":"additional","affiliation":[{"name":"Department of Psychological and Brain Sciences, Boston University, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davidson H.","family":"Hamer","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, USA"},{"name":"Infectious Disease Section, Department of Medicine, Boston University School of Medicine, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter C.","family":"Rockers","sequence":"additional","affiliation":[{"name":"Department of Global Health, Boston University School of Public Health, Boston, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2022,8,4]]},"reference":[{"key":"bibr1-17579759221107037","unstructured":"World Health Organization [Internet]. Immunization coverage fact sheet; 2018[Internet] [cited 2019 Aug 3]. Available from: http:\/\/www.who.int\/mediacentre\/factsheets\/fs378\/en\/."},{"key":"bibr2-17579759221107037","unstructured":"Africa Centres for Disease Control and Prevention [Internet]. COVID-19 vaccine perceptions: A 15-country study; 2021[Internet] [cited 2021 Jun 17]. Available from: https:\/\/africacdc.org\/download\/covid-19-vaccine-perceptions-a-15-country-study\/."},{"key":"bibr3-17579759221107037","unstructured":"UNICEF [Internet]. South Africa: WHO and UNICEF estimates of immunization coverage: 2016 revision; 2016[Internet] [cited 2019 Aug 3]. Available from: https:\/\/data.unicef.org\/wp-content\/uploads\/country_profiles\/South%20Africa\/immunization_country_profiles\/immunization_zaf.pdf"},{"key":"bibr4-17579759221107037","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0150131"},{"key":"bibr5-17579759221107037","doi-asserted-by":"publisher","DOI":"10.4314\/thrb.v12i3.51112"},{"key":"bibr6-17579759221107037","doi-asserted-by":"publisher","DOI":"10.4102\/phcfm.v8i2.923"},{"key":"bibr7-17579759221107037","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2017.28.21.11255"},{"key":"bibr8-17579759221107037","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.supp.2017.27.3.12083"},{"key":"bibr9-17579759221107037","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0212270"},{"key":"bibr10-17579759221107037","doi-asserted-by":"publisher","DOI":"10.3390\/vaccines6020022"},{"key":"bibr11-17579759221107037","unstructured":"Mopani District Municipal Government [Internet]. Demographics; 2014 [cited 2019 Aug 3]. Available from: http:\/\/www.mopani.gov.za\/about\/demographics.php"},{"key":"bibr12-17579759221107037","unstructured":"Statistics South Africa [Internet]. Greater Tzaneen; 2011[Internet] [cited 2021 Jun 22]. Available from: http:\/\/www.statssa.gov.za\/?page_id=993&id=greater-tzaneen-municipality"},{"key":"bibr13-17579759221107037","volume-title":"Poster presented at: Grand Challenges Annual Meeting 2019","author":"Evans D"},{"key":"bibr14-17579759221107037","unstructured":"National Institute for Communicable Diseases [Internet]. Vaccine information for parents & caregivers (1st ed.); Nov 2016[Internet] [cited 2021 Jun 18]. Available from: https:\/\/www.nicd.ac.za\/wp-content\/uploads\/2017\/08\/NICD_Vaccine_Booklet_D132_FINAL.pdf"},{"key":"bibr15-17579759221107037","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2015.04.037"},{"key":"bibr16-17579759221107037","unstructured":"SAGE Working Group. 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