Trends and challenges in vaccination coverage among children aged 0–11 months in Nkambe health district, north–west region, Cameroon

Abstract

Vaccination remains an effective and affordable disease-prevention measure, yet sociopolitical unrest in Cameroon’s North West Region hampers vaccine uptake. In Nkambe Health District, there is a dearth in data regarding coverage and challenges to vaccination. We aimed to determine the trends in vaccination coverage among children aged 0–11 months and identify the challenges faced by caregivers and healthcare providers in the uptake of vaccination in Nkambe Health District, North West Region, Cameroon. Review of hospital records was done to determine the trend of vaccination coverage between 2013 and 2019. A survey was conducted among caregivers of 385 children aged 0–11 months in the Nkambe Health District from January to July 2020 to determine the vaccination status of children, the coverage, challenges and associated factors using a structured questionnaire. We conducted in-depth interviews among healthcare providers to explore challenges of vaccination coverage. Quantitative data was analysed using Statistical Package for Social Sciences (SPSS) version 25 and qualitative data was analysed using NVivo version 15. Logistic regression analysis was used to identify the predictors of complete vaccination and triangulated with thematic analysis results. From 2013 to 2019, vaccination coverage increased to a peak of 82.0% in 2017 before declining sharply to 40.0% in 2019. Among the 385 children included in the 2020 survey, 330 (85.7%) had completed the recommended vaccination. Complete vaccination was significantly associated with living less than 5 km from a vaccination site (aOR = 3.2, 95% CI 1.81–5.82), antenatal care attendance (aOR = 5.25, 95% CI 1.52–18.34) and being married (aOR = 5.23, 95% CI 2.54–10.29). Awareness of the vaccination schedule was also associated with complete vaccination in the crude analysis (cOR = 2.57, 95% CI 1.43–4.60). Challenges included staff shortages, lack of cold chain, and socio-political unrest. Vaccination coverage in Nkambe Health District has sharply declined in recent years due to the ongoing crisis and other challenges; improving coverage will require stronger community engagement, sensitization, and expanded outreach services. Vaccination coverage declined from 82% in 2017 to 40% in 2019 amid sociopolitical unrest. Complete vaccination was strongly linked to proximity to vaccination sites and caregiver marital status. Coverage gaps were driven by staff shortages, weak cold chain, and socio-political unrest.