Peer-reviewed article

Factors contributing to low uptake of vaccination in underserved communities: a mixed-method diagnostic design in Southwest Region of Cameroon.

Edgar Mandeng Ma Linwa, Pamela Oben Besong, Nelson Sontsa Njedock, Jamin Ghangha, Ismail Shifu et al. · 11 Mar 2026

Abstract

INTRODUCTION: in Cameroon, the Southwest Region (SWR) has a high zero-dose (ZD) prevalence (31% in 2021), undermining global immunization goals. This region also experiences sociopolitical unrest, which contributes to low vaccination uptake in underserved communities. This study aimed to quantify the prevalence, identify associated factors, explore barriers and facilitators, and elucidate socio-cultural drivers of zero-dose. METHODS: a convergent parallel mixed-method design integrated a cross-sectional survey (parents of children <2 years) and two focused group discussions (FGDs, n=17) in Tombel and Eyumojock, two health districts with the lowest DTP3 coverage in the SWR. Multistage sampling targeted six community types: remote, conflict-affected, religious, displaced, urban slums, and ethnic minorities. Surveys, based on WHO Demographic and Health Survey modules and the Health Belief Model, assessed zero-dose status, demographics, and vaccine acceptance. Focused group discussions probed barriers, beliefs, and influencers. Quantitative data were analysed using univariable and multivariable logistic regression while qualitative data underwent thematic coding (NVivo 12). Meta-inferences combined findings to inform future interventions. RESULTS: the prevalence of ZD children was 9.2% (39/424). Despite this, vaccine willingness was high (98.1% overall; 89.7% among parents of ZD children). Multivariable analysis identified disagreement that vaccines are a major advancement for humanity (aOR = 2.35, 95% CI: 1.08-5.10; p= 0.031) and lower self-efficacy/confidence in ensuring vaccination (aOR = 0.50, 95% CI: 0.25-1.00; p= 0.049 for high confidence) as significant predictors of ZD status. Perceiving diseases as not serious was marginally associated (aOR = 1.86, 95% CI: 0.93-3.72; p= 0.079). Qualitative themes highlighted access barriers (distance, stockouts, insecurity), misinformation (e.g., population control myths), and fears of poor administration. Trusted community leaders were key facilitators. CONCLUSION: the primary barrier to vaccination in this conflict-affected region is not willingness but access and logistical efficacy, compounded by misinformation. High acceptance rates provide a foundation for interventions. Tailored strategies must prioritize mobile outreach, supply chain resilience, and deploying trusted community leaders for education to reduce ZD prevalence and advance the Immunization Agenda 2030.