Childhood Vaccination Coverage
Vaccine
|
Case
|
Percentage
|
DHS (2011)
|
WHO (2014)
|
Present study
|
Present study
|
West Region, Cameroon
|
Woldwide
|
Africa
|
(n=160)
|
(n=160)
|
|
|
|
%
|
Cameroon
|
|
|
|
|
(n=2265)
|
(n=272)
|
|
|
|
|
%
|
%
|
%
|
%
|
BCG
|
158
|
98.8
|
87.1
|
95.9
|
91
|
84
|
Polio 0
|
158
|
98.8
|
71.7
|
84.4
|
|
|
DPT 1
|
144
|
90
|
85.5
|
94.4
|
|
|
DPT 2
|
134
|
83.8
|
78.3
|
87
|
|
|
DPT 3
|
125
|
78.1
|
68.4
|
75.5
|
86
|
77
|
OPV 1
|
143
|
89.4
|
93.3
|
92.5
|
|
|
OPV 2
|
134
|
83.8
|
85.5
|
87.5
|
|
|
OPV 3
|
124
|
77.5
|
69.8
|
76.6
|
86
|
77
|
VAA (Yellow Fever)
|
101
|
63.1
|
69.3
|
77.7
|
|
|
VAR (Measles)
|
101
|
63.1
|
70.6
|
79.8
|
56
|
11
|
Not vaccinated
|
2
|
1.25
|
4.5
|
2.3
|
|
|
Completely vaccinated
|
96
|
60
|
52.1
|
62.9
|
|
|
Table 1: Vaccination coverage from Foumbot district for each antigen compared to latest data for Cameroon from WHO and Sociodemographic Health Survey (DHS)
Health facilities
|
Number of professional in charge of the vaccination
|
CSI Kwen Baigom
|
3
|
Hôpital EEC Baigom
|
1
|
CSI Mbanjou
|
2
|
CSI Mbantou
|
3
|
CSP St blaise
|
1
|
Hôpital district foumbot
|
4
|
Table 2: Vaccination staff in the Foumbot district, 2014
The vaccination status of the child was established by the records in the vaccination booklet, the records in the EPI registration or by the presence of scar in the case of BCG. In the 5 clusters, a total of 160 households were surveyed. It was found that 96 (60%) children had received complete vaccination by the age of two. On the other hand, 62 (38.75%) had received partial vaccination and 2 (1.25%) had not received any vaccine. The dropout rate between the initial vaccine BCG or OPV 0 and the final vaccine measles is quite high with 36%; that means, over one third of the children were unable to complete the vaccination program [Table 1].
Factors
|
Categorical variables / characteristics of the mother and child
|
Complete Vaccination
|
|
Binary logistic
|
|
Yes
|
No
|
Total
|
OR (95% CI)
|
P. Value
|
|
|
N=96 (%)
|
N=64 (%)
|
N=160 (%)
|
|
|
Maternal Age
|
<25
|
Yes
|
53 (60.9 )
|
34 (39.1 )
|
87 (54.4 )
|
1.09 ( 0.57 - 2.05)
|
0.461
|
No
|
43 (58.9 )
|
30 (41.1 )
|
73 (45.6 )
|
|
|
25 to 34
|
Yes
|
33 (60)
|
22 (40)
|
55 (34.4 )
|
1 (0.51 - 1.94)
|
0.566
|
No
|
63 (60)
|
42 (40)
|
105 (65.6 )
|
|
|
> 34
|
Yes
|
10 (55.6 )
|
8 (44.4 )
|
18 (11.3 )
|
0.81 (0.30 - 2.18)
|
0.434
|
No
|
86 (60.6 )
|
56 (39.4 )
|
142 (88.8 )
|
|
|
Education
|
No school
|
Yes
|
0 (0)
|
2 (100)
|
2 (1.3 )
|
0
|
0.158
|
No
|
96 (60.8 )
|
62 (39.2 )
|
158 (98.8 )
|
|
|
Primary
|
Yes
|
37 (54.4 )
|
31 (45.6 )
|
68 (42.5 )
|
0.67 (0.35 - 1.26)
|
0.141
|
No
|
59 (64.1 )
|
33 (35.9 )
|
92 (57.5 )
|
|
|
Secondary
|
Yes
|
57 (64.8 )
|
31 (35.2 )
|
88 (55)
|
1.55 (0.82 - 2.94)
|
0.115
|
No
|
39 (54.2 )
|
33 (45.8 )
|
72 (45)
|
|
|
University
|
Yes
|
2 (100)
|
0
|
2( 1.3 )
|
|
0.36
|
No
|
94 (59.5 )
|
64 (40.5 )
|
15 (98.8 )
|
|
|
Child Birth order
|
1st
|
Yes
|
27 (67.5 )
|
13 (32.5)
|
40 (25)
|
1.53 (0.72 - 3.26)
|
0.176
|
No
|
69 (57.5 )
|
51 (42.5 )
|
120 (75)
|
|
|
2nd
|
Yes
|
32 (68.1 )
|
15 (31.9 )
|
47 (29.4 )
|
1.63 (0.79 - 3.34)
|
0.121
|
No
|
64 (56.6)
|
49 (43.4 )
|
113 (70.6 )
|
|
|
3rd
|
Yes
|
14 (50)
|
14 (50)
|
28 (17.5 )
|
0.61 (0.26 - 1.38)
|
0.164
|
No
|
82 (62.1 )
|
50 (37.9 )
|
132 ( 82.5 )
|
|
|
>3
|
Yes
|
23 (51.1 )
|
22 (48.9 )
|
45 (28.1 )
|
0.6 (0.29 - 1.20)
|
0.105
|
No
|
73 (63.5 )
|
42 (36.5 )
|
115 (71.9 )
|
|
|
Marital Status
|
Single
|
Yes
|
17 (81)
|
4 (19)
|
21 (13.1 )
|
3.23 (1.03 - 10.09)
|
0.028
|
No
|
79( 56.8 )
|
60 (43.2)
|
139 (86.9 )
|
|
|
Married
|
Yes
|
79 (57.2 )
|
59 (42.8 )
|
138 (86.3 )
|
0.393 (0.13 - 1.12)
|
0.06
|
No
|
17 (77.3 )
|
5 (22.7 )
|
22 (13.8 )
|
|
|
Widow
|
Yes
|
0
|
1 (100)
|
1 (0.6 )
|
0
|
0.4
|
No
|
96 (60.4 )
|
63 (39.6 )
|
159 (99.4 )
|
|
|
Divorced
|
No
|
96 (60)
|
64 (40)
|
160 (100)
|
|
|
Religion
|
Catholic
|
Yes
|
12 (75)
|
4 (25)
|
16 (10)
|
2.14 (0.65 - 6.96)
|
0.1533
|
No
|
84 (58.3 )
|
60 (41.7)
|
144 (90)
|
|
|
Protestant
|
Yes
|
24 (82.8 )
|
5 (17.2 )
|
29 (18.1 )
|
3.93 (1.41 - 10.94)
|
0.004
|
No
|
72 (55)
|
59 (45)
|
131 (81.9 )
|
|
|
Muslim
|
Yes
|
60 (52.2 )
|
55 (47.8 )
|
115 (71.9 )
|
0.27 (0.12 - 0.61)
|
0.001
|
No
|
36 (80)
|
9 (20)
|
45 (28.1 )
|
|
|
Animist
|
No
|
96 (60)
|
64 (40)
|
160 (100)
|
|
|
Occupations
|
Formal sector
|
Yes
|
8 (66.7 )
|
4 (33.3 )
|
12 (7.5 )
|
1.36 (0.39 - 4.73)
|
0.434
|
No
|
88 (59.5 )
|
60 (40.5 )
|
148 (92.5 )
|
|
|
Informal Sector
|
Yes
|
88 (59.5 )
|
60 (40.5 )
|
148 (92.5 )
|
0.73 (0.21 - 2.54)
|
0.434
|
No
|
8 (66.7 )
|
4 (33.3 )
|
12 (7.5 )
|
|
|
Reason for vaccinating
|
Prevent the occurrence of diseases
|
Yes
|
64 (58.7 )
|
45 (41.3 )
|
109 (68.1 )
|
0.84 (0.42 - 1.67)
|
0.379
|
No
|
32 (62.7 )
|
19 (37.3 )
|
51 (31.9 )
|
|
|
Decrease the severity of diseases
|
Yes
|
1 (50)
|
1 (50)
|
2 (1.2 )
|
0.66 (0.04 - 10.79)
|
0.641
|
No
|
95 (60.1 )
|
63 (39.9 )
|
158 (98.8 )
|
|
|
No idea
|
Yes
|
31 (63.3)
|
18 (36.7)
|
49 ( 30.6 )
|
1.2 (0.61 - 2.4)
|
0.35
|
No
|
65 (58.6 )
|
46 (41.4 )
|
111 (69.4 )
|
|
|
Knowledge of VDP and infectious diseases
|
Good knowledge
|
Yes
|
88 (63.7)
|
50 (36.2)
|
138 (86.2)
|
3.08 (1.21-7.85)
|
0.01
|
No
|
8 (36.3 )
|
14 (63.6)
|
22 (13.8)
|
|
|
Poor knowledge
|
Yes
|
8 (36.4)
|
14 (63.6)
|
22 (13.8)
|
0.32 (0.12-0.82)
|
0.014
|
No
|
88 (63.8)
|
50 (36.2)
|
138 (86.3)
|
|
|
Age-appropriate vaccination
|
At Birth
|
Yes
|
83 (64.3 )
|
46 (35.7 )
|
129 (80.6 )
|
2.5 (1.12 - 5.55)
|
0.02
|
No
|
13 (41.9 )
|
18 (58.1 )
|
31 (19.4 )
|
|
|
No idea
|
Yes
|
11 (44)
|
14 (56)
|
25 (15.6 )
|
0.4 (0.19 – 1.09)
|
0.06
|
No
|
85 (63 )
|
50 ( 37 )
|
135 (84.3 )
|
|
|
Other date
|
Yes
|
2 (33.3)
|
4 (66.6)
|
6 (3.7 )
|
0.32 (0.06 – 1.79)
|
0.17
|
No
|
94 (60 )
|
60 (40 )
|
154 (96.9 )
|
|
|
Mastering of the vaccination schedule
|
Master
|
Yes
|
29 (80.6 )
|
7 (19.4 )
|
36 (22.5 )
|
3.52 (1.43 - 8.65)
|
0.002
|
No
|
67 (54)
|
57 (46)
|
124 (77.5 )
|
|
|
Retention of the vaccination booklet
|
Keep
|
Yes
|
88 (62)
|
54 (38)
|
142 (88.8 )
|
2.04 (0.76 - 5.48)
|
0.121
|
No
|
8 (44.4 )
|
10 (55.6 )
|
18 (11.3 )
|
|
|
Table 3: Sociodemographic characteristics and complete childhood vaccination in Foumbot district, 2014
The child was not completely vaccinated because of:
|
cases
|
Percentage
|
Missing Information
|
Ignores the necessity for vaccination
|
6
|
17%
|
Ignores the necessity of the 2nd and 3rd dose
|
3
|
Fear of adverse effects
|
2
|
No interest
|
Discouraged by the entourage
|
2
|
6.25%
|
Does not trust vaccination
|
2
|
Lack of flexibility and resource
|
Absence of the vaccination personal
|
1
|
76.5%
|
Lack of financial means
|
1
|
Vaccines not available
|
4
|
Long waiting time
|
3
|
Not suitable time schedule
|
1
|
Impediment (travel, sickness, mourning)
|
33
|
Lack of time
|
6
|
Total
|
64
|
100%
|
Table 4: Reasons given by parents for missing the vaccination
Parental Perception
Defaulting factors
The parents whose children had not completed the EPI mentioned missing information (17%), Lack of interest (6.2%), and lack of flexibility and resource (76.5) [Table 4].
The association of the sociodemographic factors with completion of child vaccination were assessed by this study. The results showed that 52% and 80% of those who are Muslim and Non-Muslim, respectively, had children with complete vaccination status, whereas 48% and 20% of those who are Muslim and non- Muslim, respectively, had children with partial vaccination status. From all the variables, religious belonging (Muslim) showed significant association with incompletion of vaccination in bivariate analysis. The likelihood of vaccination completion among parents in Muslim communities was about 27% (OR=0.27; p-value <0.05) when compared with parents in other religious communities [Table 3].
Furthermore, the results showed that 36% and 64% of those with poor knowledge of VPDs and good knowledge of VPDs, respectively, had their children with complete vaccination status, whereas 54% and 36% of those with poor knowledge of VPDs and good knowledge of VPDs, respectively had their children with partial vaccination status or no vaccination status. The statistics showed that there was significant association between poor knowledge of VPDs and the childhood vaccination status [OR=0.32] at p-value < 0.0 5 [Table 3].
Parents’ decision making
Of all parents whose children had complete vaccination status, 64:3% were assigned to the group of parents who started the vaccination at birth, 63.7% were assigned to the group of parents with good knowledge of VPDs, and 80% were assigned to the group of parents who mastered the vaccination schedule. The statistics showed that starting vaccination at birth [OR=2.5], knowledge of VPDs [OR=3.08], and mastering the vaccination schedule [OR=3.52] were significantly positive associated with complete childhood vaccination. The result of the logistic regression analysis are showed in Table 5. The final model (step 3) shows the smallest value of the AIC, the BIC, and the – 2 Log Likelihood statistics [Table 5]. This model (step 3) is better suited to explain the decision of parents about childhood vaccination status. After the adjustment of all variables that were found significant, poor knowledge of VPDs was found as a significant negative predictor of the intention to complete the EPI. That is, poor knowledge of VPDs significantly predicted a lower likelihood for parents to complete the EPI.
Model
|
Action
|
Effect(s)
|
Model Fitting Criteria
|
Effect Selection Tests
|
AIC
|
BIC
|
-2Log-Likelihood
|
Chi-squarea
|
degree of freedom
|
Significance
|
Step 0
|
Entered
|
Constant
|
85.70
|
88.78
|
83.70
|
.
|
|
|
Step 1
|
Entered
|
Muslim
|
76.58
|
82.73
|
72.58
|
11.12
|
1
|
0.001
|
Step 2
|
Entered
|
Start at birth
|
67.74
|
76.97
|
61.74
|
10.84
|
1
|
0.001
|
Step 3
|
Entered
|
Poor Knowledge of VPDs
|
64.16
|
76.46
|
56.14
|
5.58
|
1
|
0.018
|
Stepwise Method: Forward Selection
- The Chi-Square for entry is based on the Likelihood-Ratio-Test
Table 5: Step Summary – Information criteria