Global Immunization: Childhood Vaccine Coverage in Botswana

Botswana is a country of remarkable natural beauty, political stability and economic prosperity. Located in southern Africa and about the size of Texas, Botswana has a population of about 2 million people. Since its independence in 1966, Botswana has made investing in health, including childhood immunizations, a priority. Although it has one of the region’s highest rates of HIV/AIDS, it boasts one of the most comprehensive national responses to the disease, and the rates of new infections have decreased dramatically over the past few years. In Botswana, routine pediatric vaccination rates are very high; in fact, national immunization rates surpass many of the World Health Organization’s goals.

Karata

In health posts and clinics all across the delta and rolling plains of Botswana, mothers can be found holding their child’s personal health record in their hand. Called the karata, which means “Under-5 card” in Setswana, the local language of Botswana, these cards are given to children at birth and contain valuable health information, including their growth charts and vaccine history. Many mothers store the cards in plastic or decorate them with stickers, highlighting the importance of these “traveling medical records.”

These are especially important because, although health centers have records of all of their patients, sometimes they are not readily available when a child visits a clinic, and oftentimes children visit different clinics. The karata travels with children as they grow; and, in fact, many adults also carry their own karata tucked into their current health record, so their medical history is always at hand.

Herd immunity and HIV/AIDS

Pediatric immunizations are an important part of the health strategy for the Botswana Ministry of Health, the governing body of public healthcare in the country. In fact, vaccines are provided free of charge to all children through the public sector at health posts throughout the country. Typically, children get their vaccinations at a local clinic, such as a rural outpost or larger community clinics.

Ensuring that all children are vaccinated becomes more important with the prevalence of HIV/AIDS in the general and pediatric populations. According to Elizabeth Lowenthal, MD, a CHOP pediatrician and HIV specialist who spent years living and working in Botswana: “The high prevalence of HIV in countries such as Botswana makes herd immunity for vaccine-preventable diseases of particular importance since sometimes children with HIV won’t mount sufficient immunity from vaccinations, particularly if they are given before the child’s HIV is well-controlled.” Herd immunity refers to the concept that a disease cannot spread as easily throughout a community in which most people have been immunized against it, therefore, protecting individuals who have not developed immunity, especially children and those with weakened immunity, such as people suffering from HIV and AIDS.

More vaccines in Botswana

Because diarrhea and pneumonia are very common in the pediatric population, the Ministry of Health in Botswana hopes to introduce the rotavirus and pneumococcal vaccines into their immunization program. Clinicians in Botswana are excited about these additional ways to keep their patients healthy. According to Matt Kelly, MD, the CHOP David N. Pincus Global Health Fellow who currently lives and works in Botswana, "Pneumonia and diarrheal illnesses are the most common reasons for children in Botswana to be admitted to the hospital. The addition of pneumococcal and rotavirus vaccines to the national immunization schedule will undoubtedly save lives and improve the health of children throughout the country."

As health officials in Botswana continue to focus on improving the health of their citizens, progress against HIV/AIDS and vaccine-preventable diseases is likely to remain among their top priorities.

To learn more about pediatric vaccines in the developing world, visit the UNICEF immunization website.