ABSTRACT

Introduction: Immunization remains one of the most effective public health interventions for reducing childhood morbidity and mortality. However, pentavalent vaccine dropout continues to be a major challenge in many developing countries, including Cameroon, limiting the effectiveness of immunization programs. Understanding the factors contributing to vaccine dropout is essential for improving child health outcomes.

Aim: This study aimed to assess the pentavalent vaccine dropout rate and its associated socio-demographic, economic, and health service-related factors among children aged 0–5 years at the CMA de Kotto.

Methodology: A descriptive cross-sectional study design was used. Data were collected from 50 caregivers of children aged 0–5 years using a structured questionnaire. A simple random sampling technique was employed to select participants. Data were analyzed using statistical software, and chi-square tests were used to determine associations between variables, with significance set at p < 0.05.

Results: The findings revealed a high pentavalent vaccine dropout rate of 45.0%. Socio-demographic and economic factors such as maternal age (p = 0.047), level of education (p = 0.042), and monthly income (p = 0.027) were significantly associated with vaccine dropout. Additionally, health service and access-related factors including vaccine availability (p = 0.001), transportation cost (p = 0.015), waiting time (p = 0.007), reminder systems (p = 0.009), and cost of transport (p = 0.012) showed significant associations.

Conclusion: The study concludes that pentavalent vaccine dropout in the CMA de Kotto is influenced by both caregiver-related and health system-related factors. Strengthening health service delivery, improving caregiver awareness, and addressing socio-economic barriers are essential to reduce dropout rates and improve immunization coverage.

Keywords: Pentavalent vaccine, dropout rate, immunization, socio-demographic factors, health service factors, Cameroon.

CHAPTER ONE

INTRODUCTION

• Background of the Study

Vaccination is one of the most successful and cost-effective public health interventions for reducing child mortality and morbidity across the globe. It has led to the eradication of smallpox, the near-elimination of polio, and a significant decline in deaths from diseases like measles and tetanus (World Health Organization [WHO], 2022). Despite this progress, the full benefit of vaccines is only realized when children receive all recommended doses. A major challenge in immunization programs is the phenomenon of “dropout,” where children who receive the first dose of a multi-dose vaccine fail to complete the subsequent doses. This leaves them vulnerable to preventable diseases and undermines the collective immunity of the community.

Globally, ensuring high vaccination completion rates remains a struggle. According to WHO and UNICEF (2023), global coverage for the third dose of the diphtheria-tetanus-pertussis containing vaccine (DTP3) a key indicator of program performance was stuck at 84% in 2022, meaning 20.5 million children missed out on one or more doses. The dropout rate between the first and third dose of the pentavalent vaccine, which includes DTP, is a critical metric for assessing the effectiveness and accessibility of an immunization program. A high dropout rate signals that barriers are preventing families from completing the vaccination series, even after they have initiated it.

The situation in Africa is particularly concerning (UNICEF (2021). The African Region of the WHO has consistently had some of the lowest vaccination coverage rates in the world. In 2022, the region’s DTP3 coverage was estimated at 77%, and nearly half of the world’s zero-dose children (those who never receive any vaccination) live in Africa (WHO, 2023). A study analyzing data from several African countries found significant pentavalent dropout rates, with factors like long distances to health facilities, poor maternal education, and missed opportunities for vaccination being major contributors (Wiysonge et al., 2017). This indicates that while getting children to start vaccination is a success, keeping them in the system is a persistent challenge.

In Cameroon, childhood immunization is a priority within the national health strategy, yet performance has been suboptimal. The 2018 Demographic and Health Survey (DHS) revealed that while 88% of children aged 12-23 months had received the first dose of the pentavalent vaccine, only 76% had received the third dose, indicating a notable dropout rate of 12% (Institute for National Statistics [INS] & ICF, 2020). More recent data suggests that the COVID-19 pandemic further disrupted routine immunization services, exacerbating these gaps (Gideon, 2023). In urban settings like Douala, which face unique challenges including high population density, socioeconomic disparities, and a heavy burden on health facilities, these dropout rates can be even more pronounced.

The reasons for vaccine dropout are complex and multifaceted. They are often categorized into three main groups. First, socio-demographic and economic factors play a crucial role. A mother’s level of education significantly influences her health-seeking behavior; those with lower education may not fully grasp the importance of completing the vaccine schedule (Mbengue et al., 2017). Similarly, low family income can make the indirect costs of vaccination, such as transport to the clinic, prohibitive. Second, child-related factors, such as the experience of a mild side effect (like fever) after a previous dose, can frighten a caregiver and deter them from returning for subsequent doses. Finally, health service and access-related factors are critical. Long waiting times at crowded clinics, frequent stock-outs of vaccines, and unfriendly attitudes from healthcare workers can frustrate caregivers and lead to dropout (Shenton et al., 2022).

• Statement of Problem

Immunization is a cornerstone of child health, yet globally, millions of children do not complete their vaccination schedules. In 2021, a record 25 million children were left under-protected, significantly increasing the risk of disease outbreaks (WHO, 2023). This challenge is acute in Africa, where nearly one in five children does not receive all recommended vaccines (WHO Regional Office for Africa, 2022).

Cameroon reflects this troubling trend. Despite government efforts, national coverage for the third dose of the Pentavalent vaccine remains suboptimal, leaving thousands of children vulnerable (UNICEF, 2023). This problem of vaccine dropout is particularly relevant in urban settings like the Centre Médical d’Arrondissement (CMA) de Kotto, where many children receive the first Pentavalent dose but fail to complete the series.

The reasons for this dropout are multifaceted. Socioeconomic barriers, such as financial constraints that make transportation costs prohibitive and low maternal education which can limit understanding of the vaccination schedule, often prevent families from returning (Mbengue et al., 2017). Concurrently, health system factors including frequent vaccine stock-outs, discouragingly long waiting times at clinics, and sometimes poor communication from health workers further deter caregivers.

Consequently, a significant number of children in the Centre Médical d’Arrondissement (CMA) de Kotto ..are left exposed to deadly diseases like diphtheria, pertussis, and hepatitis B. While the dropout is observable, its exact rate and the dominant contributing factors within this specific community are not clearly defined.

Therefore, the problem this study seeks to address is the frequent dropout of children aged 0–5 years from the Pentavalent vaccination program in the Centre Médical d’Arrondissement (CMA) de Kotto ..

• Research Question
  • Main Research Question

What is the frequency of dropout rates for the Pentavalent vaccine among children aged 0-5 years in the Centre Médical d’Arrondissement (CMA) de Kotto.?

• Specific Research Questions

1. What is the dropout rate of the Pentavalent vaccine among children aged 0-5 years in the CMA de Kotto?
2. How do socio-demographic and economic factors influence the dropout rate of the Pentavalent vaccine in the CMA de Kotto?
3. What health service and access-related factors are associated with Pentavalent vaccine dropout in the CMA de Kotto?

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