Immunisation uptake, services required and government incentives for usersof formal day care

Objectives: To determine immunisation uptake in children attending formal d ay cars prior to the introduction of certificates (state) and parent incent ives (federal), and to document parent and child carers' attitudes to these strategies. Method: In 1997, 60 child care centres and 300 family day carers in suburba n Melbourne were randomly sampled. Immunisation dates, service use and pref erence. and views on government incentives were obtained from parents of ch ildren under three years of age. Results: From 2,454 eligible children, information was obtained for 1,779, of whom 84% (95% CI 82-86) were completely immunised. Low income (OR 1.8, 9 5% CI 1.2-1.9, p less than or equal to 0.001) and larger family size (OR 1. 8, 95% CI 1.2-2.7, p=0.002) and only ever using a doctor (OR 1.6, 95% CI 1. 1-2.3) was associated with incomplete immunisation. Main reasons for delayi ng immunisation were occurrence of minor illness and work commitments. Fami lies would prefer immunisation services at Maternal and Child Health visits (39%), evening sessions (22%) and at day care (22%). Immunisation uptake c ould increase to 94% if those receiving Childcare Assistance (67%) immunise d their children on time but would increase to 87% if this incentive only m otivated those for whom Childcare Assistance was essential (15%). While 98% of day care co-ordinators and 71% of family day care co-ordinators documen ted immunisation status at commencement of child care, only 51% and 33% res pectively regularly updated this information. Conclusion: Providing client-focused, flexible immunisation services and go vernment incentives and legislation may work together to boost immunisation levels for those in formal child care.