Maternal and child health indicators in a rural South African health district

Objective. To measure important maternal and child health indicators in a rural health district as part of the process of developing a comprehensive district health information system. Design. A modified Expanded Programme on Immunisation cluster sample survey. Setting. Hlabisa health district, KwaZulu-Natal. Participants. 480 mothers (or carers) of children aged 12-35 months surveyed in 32 clusters. Interventions. A questionnaire was administered and Road-to-Health cards were examined. Main outcome measures. Proportion of women receiving antenatal care and delivering in a health facility; knowledge and understanding of vaccination; and recall of vaccination history. Proportion of children with a Road-to-Health card, overall coverage of each vaccine, coverage at 12 months of age and proportion receiving an immunogenic dose. Results. Most mothers (91%) had attended antenatal care, 77% had received tetanus toxoid and 83% delivered in a health facility. Only 14 children (3%) had never received a Road-to-Health card and 73% had one available at the time of the survey Overall immunisation coverage was high (80-98%), as was the proportion receiving an immunogenic dose of each vaccine (78-98%). However, only 76% had received all the vaccines due to a 12-month-old child, and only 88% of these had received all doses by 12 months of age. Conclusions. While the key maternal health indicators measured here are reassuring, there is still room for improvement in the child health indicators. The proportion of women receiving antenatal care and delivering in a health facility is very high, but the proportion of children receiving all vaccines can be improved upon, as can the timing of immunisation. The results of this survey are being used to strengthen further the primary health care services in the district.