What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Incomplete vaccination status (n=502). Intervention: Routine vaccination program. Primary outcome: Complete immunization coverage (by card plus parents' recall) (95% CI 82.4-89.3).

July 9, 2015Open Access

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

Key Result

Complete immunization coverage among children aged 12-23 months in Dschang, Cameroon was 85.9%, with incomplete vaccination strongly associated with being the ≥3rd born child and younger maternal age.

Study Design

Type

Cross-Sectional (n=502)

Multicenter

Structured PICO

What is the immunization coverage and what are the determinants of incomplete vaccination in children aged 12-23 months in Dschang, Cameroon?

Population

502 children aged 12-23 months in Dschang, West Region, Cameroon

Outcome

Immunization coverage and determinants for incomplete vaccination status

While vaccination coverage in this region of Cameroon is relatively high, targeted interventions are needed for younger parents, larger families, and those with poor access to antenatal care to reduce incomplete vaccination.

Limitations

Potential for parents over-reporting vaccine doses for complacency without the possibility to check the information
Conducted during a polio-outbreak situation with supplementary immunization activities, which could introduce biases in OPV coverage evaluation
Algorithm for household economic status was based only on family type and parents' occupation, excluding housing conditions and other economic activities
Sampling procedure was susceptible to selection bias
Lack of qualitative methods to investigate the reasons for partial or delayed vaccination

Abstract

BACKGROUND: Inadequate 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. METHODS: A 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 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 ≥ 3(rd) 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). CONCLUSION: Vaccination 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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