Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: a cross-sectional survey during a polio outbreak

Abstract

BackgroundInadequate immunization coverage with increased risk of vaccine preventable diseases outbreaks remains a problem in Africa. Moreover, different factors contribute to incomplete vaccination status. This study was performed in Dschang (West Region, Cameroon), during the polio outbreak occurred in October 2013, in order to estimate the immunization coverage among children aged 12–23 months, to identify determinants for incomplete vaccination status and to assess the risk of poliovirus spread in the study population.MethodsA cross-sectional household survey was conducted in November-December 2013, using the WHO two-stage sampling design. An interviewer-administered questionnaire was used to obtain information from consenting parents of children aged 12–23 months. Vaccination coverage was assessed by vaccination card and parents’ recall. Chi-square test and multilevel logistic regression model were used to identify the determinants of incomplete immunization status. Statistical significance was set at p < 0.05.ResultsOverall, 3248 households were visited and 502 children were enrolled. Complete immunization coverage was 85.9 % and 84.5 %, according to card plus parents’ recall and card only, respectively. All children had received at least one routine vaccination, the OPV-3 (Oral Polio Vaccine) coverage was >90 %, and 73.4 % children completed the recommended vaccinations before 1-year of age. In the final multilevel logistic regression model, factors significantly associated with incomplete immunization status were: retention of immunization card (AOR: 7.89; 95 % CI: 1.08–57.37), lower mothers’ utilization of antenatal care (ANC) services (AOR:1.25; 95 % CI: 1.07–63.75), being the ≥3rd born child in the family (AOR: 425.4; 95 % CI: 9.6–18,808), younger mothers’ age (AOR: 49.55; 95 % CI: 1.59–1544), parents’ negative attitude towards immunization (AOR: 20.2; 95 % CI: 1.46–278.9), and poorer parents’ exposure to information on vaccination (AOR: 28.07; 95 % CI: 2.26–348.1). Longer distance from the vaccination centers was marginally significant (p = 0.05).ConclusionVaccination coverage was high; however, 1 out of 7 children was partially vaccinated, and 1 out of 4 did not complete timely the recommended vaccinations. In order to improve the immunization coverage, it is necessary to strengthen ANC services, and to improve parents’ information and attitude towards immunization, targeting younger parents and families living far away from vaccination centers, using appropriate communication strategies. Finally, the estimated OPV-3 coverage is reassuring in relation to the ongoing polio outbreak.

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“…Thus aging mothers might have gained enough experience from past births concerning the importance of such vaccines to the survival of children and therefore would be more inclined to utilise them for children. This concurs with the findings of Russo et al [5] in Cameroon who found younger mother's age to affect incomplete immunization for children as well as Otieno et al [9] who found older maternal age to be linked with the likelihood that a child was given Influenza vaccination in Kenya.…”

“…On the empirical front, Russo et al [5], Cockcroft et al [6], Lakew et al [7], Ibnouf et al [8], and Otieno et al [9] have conducted studies on the factors that influence the utilisation of immunisation for children in Cameroon, Nigeria, Ethiopia, Sudan, and Kenya, respectively. In Ghana, Immurana and Urma [10], Immurana and Urma [11], Dwumoh et al [12], Matthews and Diamond [13], Bosu et al [14], McGlynn [15], and Duah-Owusu [16] have also conducted studies on factors that influence immunization utilisation.…”

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“…Far from this assertion are studies that have shown that remunerated maternity leave permitted the increase in vaccination coverage [13]. However, maternal occupation was not the only factor influencing vaccination irregularity; others included socio-demographic factors, and perception which negatively influenced children's vaccination [12]. It is therefore desirable that health personnel, instead of limiting themselves to the transmission of information, also incite parents to appreciate the necessity of vaccination [14].…”

“…However, low financial status of the woman is one of the obstacles to the access of health services of children [5]- [8]. In developing countries, paid-jobs of mothers have proven to be detrimental to the health of their children [9]- [12]. Mothers' involvements in these income generating activities, coupled with the workload, inhibit them from taking care of their children's health, and from respecting vaccination schedules [8].…”

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“…El riesgo de enfermarse por demora en la vacunación depende del tipo de vacuna, grado de transmisibilidad, circulación y gravedad de la enfermedad, además de la presencia de casos importados (12)(13)(14)(15) .…”