Determinants of Under‐Immunization Among Children Between 0 and 59 Months in Buea Municipality, South Western Cameroon: Implications for National Immunization Campaign
Authors: Dinga Jerome Nyhalah , Ngunjoh Fred Ngwa , Tendongfor Nicholas , Mbah Glory Enjong , Qin Haowen , Ahmed Irshad , Muki Synthia Eni , Gamua Stanley Dobgima , Manyam Rameshbabu , Titanji Vincent P. K. 
Published: January 2025

Immunization is a cornerstone of public health, significantly reducing morbidity and mortality from vaccine-preventable diseases like measles, whooping cough and tetanus, particularly among chil-dren. Under-immunization ,defined as the failure to complete a recommended vaccine series on time, remains a major global public health concern. The World Health Organization (WHO) reports that approximately 20 million children globally are not fully vaccinated, with more than half of these children residing in Africa. Africa countries including Cameroon face unique challenges in achieving high vaccination coverage. This study aimed to determine the prevalence and deter-minants of under-immunization among children aged 0-59 months in Buea, Cameroon to con-tribute to effective national immunization policy.
Methods: A cross-sectional survey designed using the World Health Organization Behavioural and Social Determinants (WHO BeSD) of vaccination tool was employed to collect data from 438 caregivers of children aged 0-59 months in urban Buea. The research focused on the urban setting of Buea, which includes Urban Health Areas such as Buea Road, Molyko, Bokwango, and Buea Town, involving 22 communities. Buea, as a major urban center, presents a diverse and densely populated environment with unique healthcare challenges and opportunities. Its urban landscape encompasses a mix of residential, commercial, and healthcare infrastructure, providing a dynamic backdrop for understanding childhood immunization in an urban context. Data were collected on socio-demographics, immunization factors, and health system variables for the study cohort.
Results: It was found that 25.11% of children in urban Buea were under-immunized. Children in Buea Town were three times more likely to be under-immunized than those in Molyko (AOR = 3.0, 95% CI: 1.3 - 7.3, p = 0.013). Children of separated caregivers were 0.2 times less likely to be un-der-immunized than those of widowed caregivers (AOR = 0.2, 95% CI: 0.1 - 0.9, p = 0.036). Children whose caregivers didn&#039;t receive unsolicited advice were 2.1 times more likely to be un-der-immunized (AOR = 2.1, 95% CI: 1.2 - 3.4, p = 0.006). Children living less than 1 mile from health facilities were 2.9 times more likely to be under-immunized than those living more than 10 miles away (AOR = 2.9, 95% CI: 1.1 - 7.5, p = 0.030). Children of caregivers employed in the private sector were 4.3 times more likely to be under-immunized compared to those of unemployed caregivers (AOR = 4.3, 95% CI: 1.1 - 16.2, p = 0.031). Children in non-owned/non-rented houses were 0.3 times less likely to be under-immunized compared to those in rented houses (AOR = 0.3, 95% CI: 0.1 - 0.9, p = 0.030). Children whose caregivers didn&#039;t discuss vaccination concerns with healthcare workers were 0.6 times less likely to have under-immunized children (COR = 0.6, 95% CI: 0.3 - 0.9, p = 0.020). Children of caregivers without positive cultural beliefs about vaccines were 1.9 times more likely to be under-immunized (COR = 1.9, 95% CI: 1.2 - 3.0, p = 0.014).
Conclusion: It is concluded that under-immunization is a significant public health problem in urban Buea, and that there are several factors that contribute to it. Targeted interventions need to consider not only physical proximity to healthcare facilities but also the quality of services, com-munity engagement, and the unique challenges faced by different caregiver groups.