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Contextualised strategies to increase childhood and adolescent vaccination coverage in South Africa: a mixed-methods study
  1. Charles Shey Wiysonge1,
  2. Phetole Walter Mahasha1,
  3. Duduzile Edith Ndwandwe1,
  4. Ntombenhle Ngcobo2,
  5. Karen Grimmer3,
  6. Janine Dizon4,
  7. Rosemary J Burnett5,
  8. Sara Cooper1
  1. 1Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
  2. 2Independent Consultant, Pretoria, South Africa
  3. 3Department of Physiotherapy, Stellenbosch University, Cape Town, South Africa
  4. 4International Centre for Allied Health Evidence, University of South Australia - City East Campus, Adelaide, South Australia, Australia
  5. 5South African Vaccination and Immunisation Centre, Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, UK
  1. Correspondence to Dr Sara Cooper; sara.cooper{at}


Introduction Despite the unparalleled success of immunisation in the control of vaccine preventable diseases, immunisation coverage in South Africa remains suboptimal. While many evidence-based interventions have successfully improved vaccination coverage in other countries, they are not necessarily appropriate to the immunisation needs, barriers and facilitators of South Africa. The aim of this research is to investigate barriers and facilitators to optimal vaccination uptake, and develop contextualised strategies and implementation plans to increase childhood and adolescent vaccination coverage in South Africa.

Methods The study will employ a mixed-methods research design. It will be conducted over three iterative phases and use the Adopt, Contextualise or Adapt (ACA) model as an overarching conceptual framework. Phase 1 will identify, and develop a sampling frame of, immunisation stakeholders involved in the design, planning and implementation of childhood and human papillomavirus immunisation programmes in South Africa. Phase 2 will identify the main barriers and facilitators to, and solutions for, increasing vaccination coverage. This phase will comprise exploratory qualitative research with stakeholders and a review of existing systematic reviews on interventions for improving vaccination coverage. Using the findings from Phase 2 and the ACA model, Phase 3 will develop a set of proposed interventions and implementation action plans for improving immunisation coverage in South Africa. These plans will be discussed, revised and finalised through a series of participatory stakeholder workshops and an online questionnaire, conducted as part of Phase 3.

Ethics Ethical approval was obtained from the South African Medical Research Council (EC018-11/2018). No risks to participants are expected. Various steps will be taken to ensure the anonymity and confidentiality of participants.

Dissemination The study findings will be shared at stakeholder workshops, the website of Cochrane South Africa and academic publications and conferences.

  • paediatric infectious disease & immunisation
  • public health
  • qualitative research

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Twitter @CharlesShey, @PhetoleMahasha

  • Contributors The study was conceived by CW. SC led the design of the qualitative components of the study. KD and JD developed the overarching conceptual framework and the sampling approach. NN and DN developed the list of stakeholder groups, with input from PM and RB; NN, DN, PM and RB worked together to develop the methodology for phase 3 of the study. The manuscript was drafted by CW and SC. All authors reviewed and provided critical input to manuscript drafts and provided final approval.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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