Missed Opportunities for Vaccination and Associated Factors among Children Aged 12 - 23 Months in Cameroon: Further Analyses of 2018 Cameroon Demographic and Health Survey

Background: Low vaccination coverage has been attributed to missed opportunities for vaccination (MOV). This study examines the prevalence of MOV, and its associated factors among children in Cameroon. Methods: Data from the 2018 Demographic and Health Survey (DHS) was analyzed for children with at least one vaccination date in the home-based record (HBR). Immunization performances such as accessibility, drop-out, and timeliness, were assessed. Service quality was assessed using MOV. Multiple logistic regression examined the effect of DHS variables on MOV outcomes, and a decision tree approach was used to study their interaction. Results: Overall, 1824 children aged 12 to 23 months were surveyed;1285 (70.45%) had cards seen with vaccination dates leading to 85.03% of immunization activities. A proportion of 46.5% of children were not completely vaccinated. There was 27% of drop-out between BCG and MCV1, and less than 10% with the specific antigens. Vaccination timeliness proportions ranged from 42.18% for BGC to less than 70% for PENTA1-3. The national prevalence of MOV for simultaneous vaccines was 75.1% (95% confidence interval (CI) = 72;79). Among those who experienced MOV, 67.4% (95% CI = 60 - 73) were uncorrected MOV. MOV was an issue in all regions and comparable in rural areas that urban areas (p = 0.2). Dose-specific MOV ranged from 2.66% (for the third dose of the pneumococcal conjugate vaccine) to 91.12 (for the yellow fever vaccine). Second birth order children experienced more MOV than first born children (adjusted odds ratio (aOR) = 1.67, 95% CI: 1.11 - 2.47). Children born to non-educated/primary level mothers had increased odds of experiencing a MOV than those born to educated mothers (aOR = 1.48, 95% CI = 1.007 - 2.19/aOR = 1.55, 95% CI = 1.12 - 2.09). Children from poorest households were at high risk of experiencing MOV for any vaccine than richest households (aOR = 2.04, 95% CI = 1.11 - 3.76). Conclusion: There is a burden of MOV and under immunized children in the population. Direct interventions that target rural poor and focus on equity gaps that relate to maternal education, socio-economic status, and family planning, should be implemented. Such strategies should aim at reducing MOV for the achievement of the immunization agenda 2030 goals.