Impact of the Socio-political Crisis in the North West and South West Regions of Cameroon on the Expanded Vaccination Program for Children From 0 to 23 Months

Abstract

Socio-political crises have long been recognized as major obstacles in the fight against vaccine-preventable diseases in many parts of the world. However, in Cameroon, the impact of the ongoing socio-political crisis on the Expanded Program on Immunization (EPI) in the North West (NW) and South West (SW) regions has not been fully examined. The objective of this study was to examine the impact of this crisis on the performances of the EPI. This was a secondary data analysis. The data were obtained from the standard EPI data collection tools, from all the health districts in the two regions. The Z-test statistic was used to estimate the differences between our coverage, including BCG (Bacille Calmette-Guérin vaccine), PENTA (pentavalent vaccine), and Measles-rubella (RR) coverage, according to the time periods for each region, i.e., between the years 2014 to 2016 (pre-conflict), and 2017 to 2019 (during the conflict). In both regions, reported immunization coverage rates for key antigens, including BCG, PENTA-3 and RR1, showed a statistically significant decline except for BCG coverage in the NW region. There was a decline in vaccine coverage between the 3 years before the crisis and the first 3 years of the crisis of 7% (Z=3.40; P=0.003) in PENTA-3; 8% (Z=4.14; P<0.001) in RR1 with an increase in the overall drop-out rate of 3% (Z=3.87; P<0.001) in the NW region. In the SW, mean vaccination coverage had declined by 22% (Z=16.81; P<0.001) for BCG, 33% (Z=17.92; P<0.001) for PENTA 3, 36% (Z=12.99; P<0.001) for RR1 with an increase in the mean general dropout rate of 16% (Z=8.10; P<0.001) between the pre-crisis and early crisis years. The results found suggest that the decline in immunization performance in the conflict zone of Cameroon may be due to disruption of health services and increased insecurity limiting access to immunization services. Significant increases in vaccination strategies can improve performance in these areas, although other factors not considered in our study may contribute to the decline in vaccination performance.