The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon

Abstract

Background: Civil strife has long been recognized as a significant barrier in the fight against vaccine preventable diseases in several parts of the world. However, little is known about the impact of the ongoing civil strife on the immunisation system in the Northwest (NW) and Southwest (SW) regions of Cameroon, which erupted in late 2016. In this paper, we assessed the effect of the conflict on key immunisation outcomes in the North West and South West regions of Cameroon.

Methods: Data were obtained from the standard EPI data reporting tool, the District Vaccine and Data Management Tool (DVDMT), from all the districts in the two regions. Completed forms were then reviewed for accuracy prior to data entry at central level. Summary statistics were used to estimate the variables of interest for each region for the years 2016 (pre-conflict) and 2019 (during conflict).

Results: In the two regions, the security situation has deteriorated in almost all districts, which in turn has disrupted basic healthcare delivery in those areas. A total of 26 facilities were destroyed and 11 healthcare workers killed in both regions. Reported immunisation coverage rates for key antigens including, BCG, DPT-3 and MR, witnessed a dramatic decline between 2016 and 2019, ranging from 22% points decline for BCG in the NW and to 42% points decline for DPT-3 in the SW. Similarly, the proportion of districts with DPT-3 coverage of at least 80% dropped from 75% in 2016 to 11% in 2019 in the NW. In the SW this proportion dropped from 16% in 2016 to 0 % in 2019.

Conclusion: Our data demonstrates the marked negative impact of the ongoing civil strife on key immunisation outcomes in the two regions and the country at large. This decline could amplify the risk of vaccine preventable diseases vaccine preventable diseases outbreaks in the two regions. Besides the ongoing actions to contain the crises, effective strategies for reaching children in the conflict zones as well as the internally displaced population are needed. There is also the need to rebuild destroyed facilities as well as to protect health facilities and staff from targeted violence.

Keywords: Anglophone crises; Cameroon; Civil strife; Conflict; Immunisation coverage.

Fig. 1

Evolution of the security situation in health districts in North West and South West Regions. A schematic representation of the evolution of the security profile of the northwest and southwest regions of Cameroon from 2016 to December, 2019. For the respective years, zones in green represent health districts considered not to experience armed violence. Zones in yellow represent health districts with periodic armed violence associated with some accessibility challenges. Red illustrates health districts with full blown armed conflict and zones are completely inaccessible

Fig. 2

Evolution of vaccination coverage in the two regions with civil strife. a Shows the percentage of the total vaccination coverage for each of the vaccines (BCG, DTC-3 and MR) for the North West region in 2016 and 2019. The bars color corresponds to the year whose coverage is represented for each of the vaccines presented. The gap whose value is represented in red indicates the absolute difference between the 2016 and 2019 vaccination coverages for each of the vaccines. b Shows the percentage of the total vaccination coverage for each of the vaccines (BCG, DTC-3 and MR) for the South West region in 2016 and 2019. The bars color corresponds to the year whose coverage is represented for each of the vaccines presented. The gap whose value is represented in red indicates the absolute difference between the 2016 and 2019 vaccination coverages for each of the vaccines

Fig. 3

Effect of crises on vaccinating health facilities. The drop in the total number of vaccinating health facilities in the north west region and south west region between 2016 and 2019. The color of each bar corresponds to the year whose number of functional health facilities are represented by the bar. The gap whose value is represented in red indicates the percentage drop in the number of functional health facilities for the respective regions between 2016 and 2019. This gap is obtained by dividing the number of vaccinating health facilities that were no longer functional after 2016 by the number of functional vaccinating health facilities in the respective regions in 2016