-->

Timeliness and Completion of Routine Childhood Vaccination and Associated Factors among Children Aged 0–59 Months in Tiko Health District, Southwest Region, Cameroon

Download Article

DOI: 10.21522/TIJAR.2014.13.04.Art014

Authors : Ngo Billong Christiane Peggy, Ojong-Ebot Ayukndip, Talongwa Roberto, Adiogo Dieudonnee

Abstract:

Childhood vaccination remains a major public health challenge; global third-dose coverage of the combined diphtheria, tetanus, and pertussis (DTP3) vaccine reached 85% in 2025, yet 13.5 million children remained zero-dose. In Cameroon, national third-dose coverage of the combined diphtheria, tetanus and pertussis vaccine (DTP3) rose to 82.5% in 2024, but sub-national performance remains undocumented: a South-West Region study reported only 47.7% coverage. Whether the Tiko Health District follows this national pattern of declining coverage between initial and subsequent doses had not previously been documented. This cross-sectional study assessed vaccination coverage, timeliness, and associated factors in the Tiko Health District, combining a review of 800 vaccination records and a survey of 604 caregivers of children aged 0–59 months. Age-appropriate vaccination completion was 30.3% (242/800). Coverage declined markedly from 98.6% for Bacillus Calmette-Guerin (BCG) and 76.0% for Pentavalent 1 (Penta1) to 48.1% for Pentavalent 3 (Penta3) and 9.0% for the first measles-rubella (MR) dose. Timeliness remained high for later doses (95.3% for Penta3) despite low coverage. Untimely vaccination was significantly associated with caregivers' lack of schedule knowledge adjusted odds ratio [aOR] = 4.3; 95% confidence interval [CI]: 2.41–7.92), absence of reminders (aOR = 2.2; 95% CI: 1.30–3.66), and age of child under 5 years in the household (aOR = 3.22; 95% CI: 1.26–8.26). Routine immunisation in Tiko shows high initial access but substantial attrition across subsequent doses, indicating that retention, rather than initial uptake, is Tiko's principal challenge. Caregiver knowledge and reminders emerged as the strongest modifiable determinants of timeliness, pointing to clear priorities for improving retention and equity in the district.

References:

[1].   United Nations Children's Fund (UNICEF). Health & HIV: Cameroon [Internet]. Yaoundé: UNICEF Cameroon; 2025 [cited 2026 Aug 14]. Available from: UNICEF Cameroon website.

[2].   World Health Organization, United Nations Children's Fund. Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated [Internet]. Geneva: WHO; 2025 Jul 15 [cited 2026 Aug 14]. Available from: World Health Organization website.

[3].   Janusz CB, Frye M, Mutua MK, Wagner AL, Banerjee M, Boulton ML. Vaccine delay and its association with undervaccination in children in sub-Saharan Africa. Am J Prev Med. 2021;60(1 Suppl 1):S72–S79. doi:10.1016/j.amepre.2020.10.003.

[4].   Zeufack AGD, Njinkui DN, Youdom SW, Ateudjieu J. Timeliness and missed opportunities for vaccination among children aged 0 to 23 months in Dschang Health District, West Region, Cameroon: a cross-sectional survey. PLOS Glob Public Health. 2023;3(6):e0001721. doi:10.1371/journal.pgph.0001721.

[5].   United Nations Children's Fund (UNICEF). Humanitarian Action for Children 2024: Cameroon [Internet]. Yaoundé: UNICEF Cameroon; 2024 [cited 2026 Aug 14]. Available from: UNICEF Cameroon website.

[6].   World Health Organization, United Nations Children's Fund. Cameroon: WHO and UNICEF estimates of immunization coverage: 2023 revision [Internet]. Geneva: World Health Organization; 2024 [cited 2026 Aug 14]. Available from: World Health Organization.

[7].   Institut National de la Statistique (INS), ICF. Enquête Démographique et de Santé du Cameroun 2018. Yaoundé, Cameroon and Rockville (MD): INS and ICF; 2020.

[8].   Yakum MN, Atanga FD, Ajong AB, Eba Ze LE, Shah Z. Factors associated with full vaccination and zero vaccine dose in children aged 12–59 months in 6 health districts of Cameroon. BMC Public Health. 2023;23:1693. doi:10.1186/s12889-023-16609-4.

[9].   Chiabi A, Nguefack FD, Njapndounke F, Kobela M, Kenfack K, Nguefack S, et al. Vaccination of infants aged 0 to 11 months at the Yaoundé Gynaeco-Obstetric and Pediatric Hospital in Cameroon: how complete and how timely? BMC Pediatr. 2017;17:206. doi:10.1186/s12887-017-0954-1.

[10].  Ngandjon JK, Ostermann T, Kenmoe V, Laengler A. Insights into predictors of vaccine hesitancy and promoting factors in childhood immunization programs—a cross-sectional survey in Cameroon. Int J Environ Res Public Health. 2022;19(5):2721. doi:10.3390/ijerph19052721.

[11].  World Health Organization, United Nations Children's Fund. WHO and UNICEF estimates of national immunization coverage (WUENIC): 2024 revision [Internet]. Geneva: World Health Organization; 2025 [cited 2026 Aug 14]. Available from: World Health Organization.

[12].  World Health Organization, United Nations Children's Fund. Global childhood immunization coverage inches forward despite conflict and hesitancy [Internet]. Geneva: World Health Organization; 2026 Jul 15 [cited 2026 Aug 14]. Available from: World Health Organization.

[13].  World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191–2194. doi:10.1001/jama.2013.281053.

[14].  von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP; STROBE Initiative. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–1457. doi:10.1016/S0140-6736(07)61602-X.

[15].  International Council for Harmonisation of Technical Requirements for Pharmaceuticals for Human Use. ICH harmonised guideline E6(R3): Guideline for Good Clinical Practice. Geneva: ICH; 2025.

[16].  Modi RN, King C, Bar-Zeev N, Colbourn T. Caregiver recall in childhood vaccination surveys: systematic review of recall quality and use in low- and middle-income settings. Vaccine. 2018;36(29):4161–4170. https://doi.org/10.1016/j.vaccine.2018.05.089.

[17].  Eze P, Lawani LO, Acharya Y. Short message service (SMS) reminders for childhood immunisation in low-income and middle-income countries: a systematic review and meta-analysis. BMJ Glob Health. 2021;6(7):e005035. https://doi.org/10.1136/bmjgh-2021-005035.

[18].  Ateudjieu J, Yakum MN, Goura AP, Tembei AM, Ingrid DK, Bita'a Landry B, et al. EPI immunization coverage, timeliness and dropout rate among children in a West Cameroon health district: a cross sectional study. BMC Public Health. 2020;20(1):228. https://doi.org/10.1186/s12889-020-8340-6.

[19].  Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, et al. Timeliness of routine childhood vaccination in 103 low- and middle-income countries, 1978–2021: a scoping review to map measurement and methodological gaps. PLOS Glob Public Health. 2022;2(7):e0000325. https://doi.org/10.1371/journal.pgph.0000325.

[20].  Harvey H, Reissland N, Mason J. Parental reminder, recall and educational interventions to improve early childhood immunisation uptake: a systematic review and meta-analysis. Vaccine. 2015;33(25):2862–2880. https://doi.org/10.1016/j.vaccine.2015.04.085.

[21].  Yunusa U, Garba SN, Umar AB, Idris SH, Bello UL, Abdulrashid I, et al. Mobile phone reminders for enhancing uptake, completeness and timeliness of routine childhood immunization in low- and middle-income countries: a systematic review and meta-analysis. Vaccine. 2021;39(2):209–221. https://doi.org/10.1016/j.vaccine.2020.11.043.

[22].  Ewang BF, Eyong ME, Cumber SN, Nkfusai CN, Yankam BM, Anye CS, et al. Vaccination coverage under the Expanded Program on Immunization in South West Cameroon. Int J Matern Child Health AIDS. 2020;9(2):164–173.