Even when overall childhood vaccination rates look strong on paper, the fine-grained picture often reveals structural fault lines that aggregate statistics obscure. Understanding precisely which caregiver and community characteristics predict incomplete vaccination — rather than simply measuring population-level coverage — is what enables public health systems to protect the children most at risk of falling through the gaps.
A cross-sectional survey conducted across Cape Town's metropolitan health district between August 2024 and February 2025 enrolled 250 caregivers of children aged zero to two years, stratified across high-, mixed-, and low-density subdistricts. The headline figures were reassuring: 93% of children were fully vaccinated for their age and 99% had received at least one dose. Caregiver intent was nearly universal, with 97% expressing strong willingness to complete the recommended schedule. However, binomial regression analysis grounded in the WHO Behavioural and Social Drivers (BeSD) framework revealed meaningful demographic gradients. Married caregiver status was independently associated with a 7% higher relative risk of full vaccination completion, and residence in the lower-density Tygerberg subdistrict conferred a 9% relative risk advantage over the higher-density Mitchells Plain area.
These findings sit within a well-established global pattern: vaccination uptake is rarely a pure product of attitudes or intent, and this study's near-universal willingness scores confirm that hesitancy is not the dominant barrier in this population. Instead, the structural determinants — household stability, geographic access, and neighborhood resource density — emerge as the operative mechanisms, a picture consistent with prior South African and sub-Saharan African literature. The BeSD framework's application here is methodologically notable, offering a replicable analytical scaffold for comparable low- and middle-income urban settings. Key limitations include the modest sample size of 250, cross-sectional design precluding causal inference, and possible volunteer bias in recruitment. The excerpt's truncation also prevents full assessment of the negative predictors identified. As an incremental confirmatory study, its primary value lies in providing locally granular evidence to inform targeted outreach in underserved Cape Town subdistricts rather than revising broader immunization doctrine.