The faces behind vaccination: unpacking the attitudes, knowledge, and practices of staff of Cameroon's Expanded program on Immunization.

BACKGROUND: Immunization is regarded as one of the most cost-effective public health interventions in global health. However, its cost-effectiveness depends greatly on the knowledge and skills of vaccinators. With the growing complexity of immunization programs, the need for a well-trained vaccination workforce cannot be overemphasized. In this study, we assessed the knowledge, attitudes, and practices among vaccination staff in Cameroon. METHODS: Through a descriptive cross-sectional design, we used structured questionnaires and observation guides to collect data from vaccination staff in health facilities that were selected by a multistage sampling method. Data were analyzed using STATA 13 software. RESULTS: Overall, we collected data from Expanded Program on Immunization focal staff in 265 health facilities across 68 health districts. Over half (53%) of the surveyed facilities were found in rural areas. Nearly two-thirds of health facilities had immunization focal staff with knowledge gaps for each of the four basic immunization indicators assessed. In other words, only 37% of staff knew how to estimate coverages, 36% knew how to inteprete the EPI monitoring curve, 35% knew how to prepare vaccine orders, and 37% knew how to estimate vaccine wastage. In terms of practices, staff waited for more than ten children to be present before opening a 20-dose vaccine vial in 63% of health facilities, and more than five children to be present before opening a 10-dose vaccine vial in 80% of surveyed facilities. Provision of vaccine-specific information (informing caregiver about vaccine received, explanation of benefits and potential side effects) during immunization sessions was suboptimal for the most part. CONCLUSION: This study suggests marked deficits in immunization knowledge among vaccination staff and exposes common attitudes and practices that could contribute to missed opportunities for vaccination and hinder vaccination coverage and equity in Cameroon. Our findings highlight the urgent need to invest in comprehensive capacity building of vaccination staff in Cameroon, especially now that the immunization program is becoming increasingly complex.

Assessment of immunization data management practices in Cameroon: unveiling potential barriers to immunization data quality.

BACKGROUND: One crucial obstacle to attaining universal immunization coverage in Sub-Saharan Africa is the paucity of timely and high-quality data. This challenge, in part, stems from the fact that many frontline immunization staff in this part of the world are commonly overburdened with multiple data-related responsibilities that often compete with their clinical tasks, which in turn could affect their data collection practices. This study assessed the data management practices of immunization staff and unveiled potential barriers impacting immunization data quality in Cameroon. METHODS: A descriptive cross-sectional study was conducted, involving health districts and health facilities in all 10 regions in Cameroon selected by a multi-stage sampling scheme. Structured questionnaires and observation checklists were used to collect data from Expanded Program of Immunization (EPI) staff, and data were analyzed using STATA VERSION 13.0 (StataCorp LP. 2015. College Station, TX). RESULTS: A total of 265 facilities in 68 health districts were assessed. There was limited availability of some data recording tools like vaccination cards (43%), maintenance registers (8%), and stock cards (57%) in most health facilities. Core data collection tools were incompletely filled in a significant proportion of facilities (37% for registers and 81% for tally sheets). Almost every health facility (89%) did not adhere to the recommendation of filling tally sheets during vaccination; the filling was instead done either before (51% of facilities) or after (25% of facilities) vaccinating several children. Moreso, about 8% of facilities did not collect data on vaccine administration. About a third of facilities did not collect data on stock levels (35%), vaccine storage temperatures (21%), and vaccine wastage (39%). CONCLUSION: Our findings unveil important gaps in data collection practices at the facility level that could adversely affect Cameroon's immunization data quality. It highlights the urgent need for systematic capacity building of frontline immunization staff on data management capacity, standardizing data management processes, and building systems that ensure constant availability of data recording tools at the facility level.

Anticipating and strategizing to address potential bottlenecks during clinical research projects in sub-Saharan Africa: a case for adapting approaches and tools used in the entrepreneurial and development sectors.

Many research funders have invested billions of US dollars in building research capacity in sub-Saharan Africa (SSA). Despite these colossal investments, many well-intentioned and designed clinical research projects have either failed to kick off or ended abruptly. Although obstacles to clinical research in SSA are well known, there is limited information on frameworks and tools that can be used to anticipate and avert these systemic bottlenecks, particularly those related to socio-politics. In this paper, we leveraged lessons from entrepreneurs and development experts in harsh and uncertain business environments to develop a framework for anticipating and addressing potential bottlenecks to clinical research in SSA. More so, to illustrate and build a case for this framework, we shared our experience in supporting clinicians and regulators to adopt a point-of-use care tool, the "chemoPAD," to screen for the quality of anticancer medications rapidly and systematically in Cameroon despite resistance from some stakeholders. The critical steps in this framework involve identifying stakeholders, categorizing them based on their potential reactions to the study (adversary, supporters, and indifferents), and developing critical strategies to engage or deal with each stakeholder's reactions, starting with adversaries. This approach may be useful in complex research projects, especially clinical trials, which often involve many stakeholders with different interests and perceptions.

Deployment of vaccine cold chain equipment in resource-limited settings: lessons from the Gavi Cold Chain Optimization Platform in Cameroon.

BACKGROUND: Lack of or use of suboptimal cold chain equipment (CCE) is a major barrier to optimal immunization coverage and equity. Gavi established the CCE optimization platform (CCEOP) in 2015 to help eligible countries modernize their cold chain systems. However, there are limited data on CCE deployment at country level. We present lessons learnt from deploying CCE from the Gavi CCEOP in Cameroon. METHODS: This cross-sectional study collected data on the number of days items of CCE spent at each point on their trajectory from the entry port to 62 randomly selected health facilities in Cameroon. RESULTS: Once equipment arrived at the entry port, it took 10 d for customs clearance, 2 d from customs clearance to warehousing and 257 d (>9 mo) from the warehouse to facilities. Upon arrival at the facilities, it took a median of 53 (range 0-395) d from installation to final commissioning: most of the days (median=210) were spent between installation and final commissioning. The major causes of delays included insufficient coordination and communication across all levels, poor documentation and final commissioning. CONCLUSION: Early engagement on customs clearance, strengthening coordination and communication, ensuring proper documentation, as well as eliminating final commissioning, could significantly improve implementation of the program.

The Hidden Impact of the COVID-19 Pandemic on Routine Childhood Immunization Coverage in Cameroon.

Background: The third round of the global pulse survey demonstrated that the abrupt and rapid progression of the COVID-19 pandemic significantly disrupted childhood immunization in many countries. Although Cameroon has reported over 120,000 COVID-19 cases, the reported national childhood vaccination coverage during the pandemic seems to have increased compared to that during the pre-COVID-19 period. Indeed, the first dose of the diphtheria, tetanus, and pertussis-containing vaccine (DTP-1) coverage increased from 85.4% in 2019 to 87.7% in 2020, and DTP-3 coverage increased from 79.5% in 2019 to 81.2% in 2020. The paucity of literature on the impact of COVID-19 on childhood vaccination in COVID-19 hotspot regions poses a challenge in developing a context-specific immunization recovery plan, hence the need to conduct this study. Methodology: We conducted a cross-sectional study using 2019 (pre-pandemic period) and 2020 (pandemic period) district childhood immunization data from the DHIS-2 database, weighted using completeness for each data entry against regional data completeness in 2020. Based on COVID-19 incidence, two hotspot regions were selected, with all districts (56/56) included in the final analysis. The Chi-square test was used to compare DTP-1 and DTP-3 coverage during the pre-pandemic and pandemic periods. Results: In the two hotspot regions, 8247 children missed DTP-1, and 12,896 children did not receive DTP-3 vaccines in the pandemic period compared to the results from the pre-pandemic period. Indeed, there was a significant drop in DTP-1 and DTP-3 coverage of 0.8% (p = 0.0002) and 3.1% (p = 0.0003), respectively, in the Littoral Region. Moreover, the Centre Region reported a 5.7% (p < 0.0001) and 7.6% (p < 0.0001) drop in DTP-1 and DTP-3 coverage, respectively. Most districts in the hotspot regions reported a decline in childhood immunization access (62.5%) and utilization (71.4%). Indeed, in the Littoral Region, 46% (11/24) and 58% (14/24) of districts experienced decreased vaccination access and utilization, respectively. Meanwhile, 75% (24/32) and 81% (26/32) of districts in the Centre Region experienced a drop in vaccination access and utilization, respectively. Conclusion: This study reported a situation where the national immunization indicators mask the impact of COVID-19 on childhood immunization in heavily hit regions. Therefore, this study presents valuable information for ensuring continuous vaccination service delivery during public health emergencies. The findings could also contribute to developing an immunization recovery plan and informing policy on future pandemic preparedness and response.

Vaccination coverage and safety in Cameroon: descriptive assessment of COVID-19 infection in vaccinated individuals

Objective. Toassess national vaccination coverage, adverse events following immunization (AEFI) and evaluate the vaccination status in COVID infected patients. Methods. Sociodemographic data on vaccination and clinical characteristics of Covid-19 cases were extracted from the national COVID-19databases of the Public Health Emergency Center and the Expanded Program on Immunization. Result. A total number of 808229 out of 27 869965 (2.9%) were fully immunized on 13 February 2022 in the Cameroon. The most requested vaccine was Janssen with 48.24% of total doses administered. Women were less vaccinated than men and with a remarkable disparity in northern regions of the country. The Adamawa region presented the best performance 11.3% of adults fully immunized. Despite vaccinal coverage still insufficient among health care worker, they were the most vaccinated among priority groups (43.4%). Only 8% COVID-19 cases were vaccinated and 0.22 % of all vaccinated still developed COVID-19. Tolerability assessment identified 1.83 non-serious AEFI and 0.1 serious AEFI per 1000 doses administered. Only 7% of vaccinated individual still developed laboratory-confirmed COVID-19. Conclusion. COVID-19vaccination coverage is still low in Cameroon compared to the target of 60%. Although data completeness is still an issue, the protection against severe forms of the disease provided by the vaccines currently used is quite satisfactory. There is however a need to intensify all strategies to make people adhere to vaccination in order to protectthem against severe form of the disease.

Knowledge, attitudes, practices and epidemiological profile of Muslim faithful receiving Covid-19 vaccines in Yaounde, Cameroon

In the response strategy against the Covid-19 pandemic, Cameroon has used to date, two types of vaccine namely: Sinopharm, Covishield/AstraZeneca. The objective of this study is to determine the KAP and the epidemiological profile of Muslim faithful receiving the Covid-19 vaccine at Mosque Biyem-Assi, Yaounde-Cameroon. Data on COVID-19, vaccination, and clinical characteristics were collected. A total of 58 participants took part in the first survey and equally received their first dose of the COVID-19 vaccine of their choice. The majority of the participants were females (n =32, 55.2%), 37.9% were 50 years and over and 43.1% had a university degree. Overall score was 78.41% for knowledge, 92.8% for perceptions and 48.3% for practices. Despite the availability and gratuity only half of the Participants reported to have carried out their COVID-19 test ever since the pandemic started. Out of 40 (69.0) participants who have heard stories concerning the vaccines, 39.7% suggested that they COVID-19 vaccines can protect us from the disease. Also, out of the 58 participants who received their first dose of the anti-COVID-19 vaccine, 36 of them came for their second shot amounting for a 62% complete vaccination rate. Headache, pain and heaviness of the injected arm were the most frequently reported side effects following participants first shot. The mobile based strategy could be the best solution to increase vaccine uptake in Cameroon.

Gender and COVID-19 Vaccine disparities in Cameroon

Six months following the national launch of COVID-19 vaccination in Cameroon, only 1.1% of the target population was fully vaccinated with women representing less than one-third of the vaccinated population regardless of their age, profession or comorbidities. Hence, the aim of this study was to understand the low COVID-19 vaccination rate of women in order to enhance vaccine uptake. A cross-sectional study was conducted between July and October 2021 through an online survey. Also, a retrospective analysis of the Cameroon Ministry of Public Health (MINSANTE) database of the pandemic (COVID-19), for the period of March 2020 to October 2021 was equally carried out. Our sample consisted of 249 responders aged between 18 and 50 years enrolled in the 10 regions of Cameroon, with 142 (57%) who were female. We assessed factors related to having been vaccinated against Covid-19 and predictors to Covid-19 vaccination among non-vaccinated people. Concerning Covid-19 vaccination, 39.2% were not vaccinated. Non-vaccination was statistically associated with being female, being a healthcare worker, fear of adverse effects, and not believing in the vaccine. In the qualitative analysis, women identified themselves as being anti-COVID vaccine for several reasons, including doubts about the quality or safety of the vaccine; the perception that anti-COVID-19 vaccines are presented as being an obligation; including the multitude of vaccines on the market, the believe that there are "more local" effective alternatives to the vaccine. The implementation of the gender approach to COVID vaccination is a condition for the effectiveness and sustainability of actions.

A Systematic Review on COVID-19 Vaccine preferences using Discrete Choice Experiments

ObjectiveTo determine the attributes of COVID-19 vaccines that influence vaccine acceptance using a DCE through a systematic review. MethodsA systematic search was carried out for articles published up to November 2021 in the PubMed, Psycinfo, Embase, Web of Science, and Global Index Medicus databases. The electronic search algorithm consisted of the terms (Covid-19) AND (Vaccine) AND (discrete choice experiment). FindingsA total of 39 records were retrieved of which 18 duplicates were identified and removed. Of the remaining 21 records, 10 were excluded because they did not use a DCE approach. 11 studies were included in the meta-analyses with a total of 42 795 participants from three WHO regions. We examined 13 attributes of COVID-19 vaccine that influenced acceptance; cost, vaccine efficacy, number of doses, risk of side effects, proof of vaccination, vaccination setting, duration of immunity, doctors recommendation, proportion of acquaintances vaccinated, region of vaccine manufacture, background knowledge of herd immunity, life attenuated or mRNA, speed of vaccination development. The four attributes reported to influence COVID-19 vaccine preferences most worldwide were; high vaccine efficacy, low risk of side effects, long duration of immunity and low number of doses of the vaccine. ConclusionThe most preferred COVID-19 vaccine attributes should be taken into account by vaccine manufacturers and public health policy makers for better introduction and acceptance of COVID-19 vaccine to the world.