Nchinjoh Sangwe Clovis, Saidu Yauba, Agbor Valirie Ndip, Mbanga Clarence Mvalo, Jude Muteh Nkwain, Njoh Andreas Ateke, Ndoula Shalom Tchofke, Nsah Bernard, Edwige Nnang Nadege, Roberman Sveta, Zamir Chen Stein
Clinton Health Access Initiative Inc., Yaounde P.O. Box 2664, Cameroon.
Faculty of Medicine, The Hebrew University-Hadassah Braun School of Public Health and Community Medicine, Jerusalem 91120, Israel.
Vaccines (Basel). 2022 Nov 30;10(12):2052. doi: 10.3390/vaccines10122052.
: Cameroon's suboptimal access to childhood vaccinations poses a significant challenge to achieving the Immunization Agenda 2030 goal-ranking among the top 15 countries with a high proportion of zero-dose (unvaccinated) children worldwide. There are clusters of zero-dose children in pockets of communities that traditionally miss essential healthcare services, including vaccination. The Manoka Health District (MHD) is home to such settlements with consistently low vaccination coverages (DPT-HepB-Hib-1: 19.8% in 2021) and frequent outbreaks of vaccine-preventable diseases (VPD). Therefore, the absence of literature on zero-dose children in this context was a clarion call to characterize zero-dose children in fragile settings to inform policy and intervention design. : This cross-sectional analytical study involved 278 children, 0-24 months of age, selected from a 2020 door-to-door survey conducted in the two most populous health areas in an archipelago rural district, MHD (Cap-Cameroon and Toube). We used R Statistical Software (v4.1.2; R Core Team 2021) to run a multivariable logistic regression to determine zero-dose associated factors. : The survey revealed a zero-dose proportion of 91.7% (255) in MHD. Children who were delivered in health facilities were less likely to be zero-dose than those born at home (AOR: 0.07, 95% CI: 0.02-0.30, = 0.0003). Compared to children born of Christian mothers, children born to minority non-Christian mothers had higher odds of being zero-dose (AOR: 6.55, 95% CI: 1.04-41.25, = 0.0453). Children born to fathers who are immigrants were more likely to be zero-dose children than Cameroonians (AOR: 2.60, 95% CI = 0.65-10.35, = 0.0016). Younger children were likely to be unvaccinated compared to older peers (AOR: 0.90, 95% CI: 0.82-1.00, = 0.0401). : In the spirit of "leaving no child behind," the study highlights the need to develop context-specific approaches that consider minority religious groups, immigrants, and younger children, including newborns, often missed during vaccination campaigns and outreaches.
喀麦隆儿童疫苗接种情况不理想，这对实现《2030年免疫议程》目标构成了重大挑战——喀麦隆在全球零剂量（未接种疫苗）儿童比例较高的国家中排名前15。在一些传统上错过包括疫苗接种在内的基本医疗服务的社区中，存在零剂量儿童聚集的情况。马诺卡健康区（MHD）就有这样一些定居点，其疫苗接种覆盖率一直很低（2021年白喉、百日咳、破伤风、乙肝、b型流感嗜血杆菌联合疫苗第一剂接种率为19.8%），且疫苗可预防疾病（VPD）经常爆发。因此，在这种背景下缺乏关于零剂量儿童的文献，这是一个明确的信号，即需要对脆弱环境中的零剂量儿童进行特征描述，以为政策和干预措施设计提供信息。
这项横断面分析研究涉及278名0至24个月大的儿童，他们选自2020年在一个群岛农村地区MHD（喀麦隆角和图贝）人口最多的两个健康区进行的挨家挨户调查。我们使用R统计软件（v4.1.2；R核心团队，2021年）进行多变量逻辑回归，以确定与零剂量相关的因素。
调查显示，MHD的零剂量比例为91.7%（255名）。在医疗机构出生的儿童比在家中出生的儿童更不容易成为零剂量儿童（调整后比值比：0.07，95%置信区间：0.02 - 0.30，P = 0.0003）。与基督教母亲所生的儿童相比，少数非基督教母亲所生的儿童成为零剂量儿童的几率更高（调整后比值比：6.55，95%置信区间：1.04 - 41.25，P = 0.0453）。父亲是移民的儿童比喀麦隆人所生的儿童更有可能成为零剂量儿童（调整后比值比：2.60，95%置信区间 = 0.65 - 10.35，P = 0.0016）。与年龄较大的同龄人相比，年龄较小的儿童更有可能未接种疫苗（调整后比值比：0.90，95%置信区间：0.82 - 1.00，P = 0.0401）。
本着“不让任何一个儿童掉队”的精神，该研究强调需要制定针对具体情况的方法，这些方法要考虑到少数宗教群体、移民以及年龄较小的儿童，包括新生儿，这些群体在疫苗接种活动和外展工作中常常被忽视。
