Investigating predictors and barriers to vaccine uptake in children at Konye Health District, South West region Cameroon

Abstract

INTRODUCTION: Global immunization initiatives aim for ≥ 90% national and ≥ 80% district-level vaccine coverage; however, uptake remains low in crisis-affected settings like Konye Health District, where only 31.5% of children are completely vaccinated. This study examined socio-demographic, health service, and contextual determinants of vaccination uptake, highlighting the importance of understanding context-specific barriers in settings affected by sociopolitical instability. METHODS: A community-based cross-sectional mixed-methods study was conducted from March to May 2023 among 412 caregivers of children aged 0-59 months. Quantitative data were collected on sociodemographic characteristics, vaccination status, while qualitative data provided in-depth insights into caregiver experiences and contextual challenges. Four health areas were selected through multistage sampling, with caregivers systematically recruited. Community health workers (CHWs), healthcare providers, and facility leaders were purposively selected for qualitative interviews. Multivariable logistic regression identified independent factors associated with vaccination complete vaccination status. Qualitative data from three focus group discussions were transcribed and analyzed thematically to explain and complement quantitative findings. RESULTS: From 412 participants, 58% were fully immunized. Vaccination completion was significantly associated with respecting all vaccination appointments (AOR = 20.37, 95% CI: 8.63-48.12), Higher household income (AOR = 3.38, 95% CI: 1.57-7.30) and recognizing vaccine side effects (AOR = 4.54, 95% CI: 2.23-9.25). Qualitative findings explained these patterns by highlighting the role of CHW engagement, reminders, and outreach services, alongside barriers such as long travel distances, transportation difficulties, fear of side effects, and conflict-related disruptions. CONCLUSION: Vaccination uptake in the Konye Health District remains low due to a complex interplay of caregiver behaviors, socioeconomic conditions, and health system factors. Addressing these interconnected challenges through strengthened community-based approaches, improved service accessibility, and resilient health system strategies is essential for enhancing immunization coverage in the district.