Factors Associated with Zero-Dose Childhood Vaccination Status in a Remote Fishing Community in Cameroon: A Cross-Sectional Analytical Study

Abstract

Background: Cameroon’s suboptimal access to childhood vaccinations poses a significant challenge to achieving the Immunization Agenda 2030 goal—ranking among the top 15 countries with a high proportion of zero-dose (unvaccinated) children worldwide. There are clusters of zero-dose children in pockets of communities that traditionally miss essential healthcare services, including vaccination. The Manoka Health District (MHD) is home to such settlements with consistently low vaccination coverages (DPT-HepB-Hib-1: 19.8% in 2021) and frequent outbreaks of vaccine-preventable diseases (VPD). Therefore, the absence of literature on zero-dose children in this context was a clarion call to characterize zero-dose children in fragile settings to inform policy and intervention design. Methodology: This cross-sectional analytical study involved 278 children, 0–24 months of age, selected from a 2020 door-to-door survey conducted in the two most populous health areas in an archipelago rural district, MHD (Cap-Cameroon and Toube). We used R Statistical Software (v4.1.2; R Core Team 2021) to run a multivariable logistic regression to determine zero-dose associated factors. Results: The survey revealed a zero-dose proportion of 91.7% (255) in MHD. Children who were delivered in health facilities were less likely to be zero-dose than those born at home (AOR: 0.07, 95% CI: 0.02–0.30, p = 0.0003). Compared to children born of Christian mothers, children born to minority non-Christian mothers had higher odds of being zero-dose (AOR: 6.55, 95% CI: 1.04–41.25, p = 0.0453). Children born to fathers who are immigrants were more likely to be zero-dose children than Cameroonians (AOR: 2.60, 95% CI = 0.65–10.35, p = 0.0016). Younger children were likely to be unvaccinated compared to older peers (AOR: 0.90, 95% CI: 0.82–1.00, p = 0.0401). Conclusions: In the spirit of “leaving no child behind,” the study highlights the need to develop context-specific approaches that consider minority religious groups, immigrants, and younger children, including newborns, often missed during vaccination campaigns and outreaches

In-Depth Reasons for the High Proportion of Zero-Dose Children in a Remote Rural District in Cameroon: A Qualitative Study

“…Manoka Health District (MHD) in the Littoral Region of Cameroon is one of such hard-toreach communities with a high proportion of zero-dose children, low vaccination coverage (DPT-1 coverage of 19.8% in 2021), and several outbreaks of VPDs reported by the district health team. Indeed, in a previous study, we showed that over 90% of children in this district's most populous health area had not received a single dose of any vaccine [11]. Despite this high proportion, there is a paucity of data on the reasons why children in this district or other similar settings have not received a single dose of basic pediatric vaccines [10,[12][13][14][15].…”

“…Despite this high proportion, there is a paucity of data on the reasons why children in this district or other similar settings have not received a single dose of basic pediatric vaccines [10,[12][13][14][15]. In a previous study in this setting, quantitative data was used to characterize zero-dose children, which revealed that children born at home, children born to minority non-Christian and immigrant parents, and younger children had higher odds of being zerodose children [11]. This was quite useful in zero-dose identification and vaccination.…”

Inequality in Immunization: Holding on to Equity as We ‘Catch Up’

“…The Special Issue features research, reviews, and commentaries that span a range of immunization topics and populations. While there is an emphasis on childhood vaccinations [ 15 , 16 , 17 , 18 ]—exploring inequalities in DTP and measles-containing vaccine (MCV) coverage [ 19 , 20 , 21 , 22 , 23 ] and patterns of inequality in unvaccinated or zero-dose children [ 24 , 25 , 26 , 27 , 28 , 29 ]—contributions also cover inequalities in adult immunization [ 30 ], including protection of pregnant women and their newborns against tetanus [ 31 ] and COVID-19 vaccination [ 32 , 33 ].…”

“…An encouraging observation while putting together this Special Issue has been the use of a variety of data sources to assess immunization inequalities. Studies have made use of traditional sources of immunization data like administrative data [ 19 , 23 , 32 ] and population surveys [ 18 , 21 , 22 , 27 , 29 , 30 ] (including Demographic and Health Surveys and/or Multiple Indicator Cluster Surveys [ 15 , 20 , 31 ]), while several other studies explored the potential of novel sources such as geospatial data [ 24 , 25 ], electronic immunization registries [ 34 ], dialogues [ 16 ], country appraisals and reports [ 35 ], and funding proposals [ 26 ]. Three review studies relied on synthesis and structured analyses drawing from a multitude of existing studies [ 17 , 33 , 36 ].…”

“…As dimensions of inequality present themselves and intersect in dynamic ways, our modes of understanding must keep up. Several studies in this Special Issue examined multiple dimensions of immunization inequality [ 18 , 19 , 21 , 27 , 29 , 31 , 33 , 36 ], while others focused on specific dimensions, such as gender barriers [ 20 , 34 ] or socioeconomic status [ 15 , 30 , 32 ].…”