This paper reports on a qualitative study on social norms and child marriage in rural Cameroon, a country with high prevalence of child marriage but largely ignored in the literature. Study participants (n = 80) were men and women from four different ethnic groups living in four rural villages (two in the Far-North, two in the East). With the assistance of four local interviewers, we conducted 16 semi-structured focus groups to understand how existing social norms contributed to child marriage in participants' communities. We found great variety in the influence of social norms on people's health-related practices: across these four communities, social norms made compliance with the child marriage practice (respectively) possible, tolerated, appropriate, and obligatory. Effective health promotion interventions should be grounded within sound theoretical understandings of the varying influence of social norms. Using data on child marriage, this paper offers a case study of how that understanding can be developed.
Beniamino Cislaghi, Gerry L. Mackie, Paul Nchoji Nkwi et al.
INTRODUCTION: Parenting programmes are increasingly popular for reducing children's exposure to interpersonal violence in low/middle-income countries, but there is limited evidence on their effectiveness. We investigated the incremental impact of adding a caregiver component to a life skills programme for adolescent girls, assessing girls' exposure to violence (sexual and others) and caregivers' gender attitudes and parenting behaviours. METHODS: In this two-arm, single-blinded, cluster randomised controlled trial, we recruited 869 adolescent girls aged 10-14 and 764 caregivers in South Kivu, Democratic Republic of Congo. Following a baseline survey, participants were divided into 35 clusters based on age, language and location. Eighteen clusters were randomised to the treatment arm and 17 clusters to the wait-list control arm. Adolescent girls in both arms received 32 life skills sessions; caregivers in the treatment arm received 13 complementary caregiver sessions. The primary outcome was girls' self-reported exposure to sexual violence in the last 12 months; secondary outcomes included self-reports of specific forms of sexual violence, physical and emotional violence, transactional sex, child marriage for girls and parenting behaviours for caregivers. Intent-to-treat and per-protocol analyses were conducted. RESULTS: At 12 months of follow-up, the intervention showed no impact on sexual violence (adjusted OR=0.95; 95% CI 0.65 to 1.37) or any secondary outcomes for girls. The intervention was associated with improved supportive parenting behaviours. Protocol adherence was also associated with improvements in these outcomes. CONCLUSION: While the caregiver curriculum improved some parenting outcomes, additional programmatic adaptations may be needed to reduce adolescent girls' violence exposure in humanitarian settings. TRIAL REGISTRATION NUMBER: NCT02384642.
Vaccination of children continues to pose problems, and the vaccination coverage rate is very low in DR Congo. Cultural, social and economic constraints at various levels are thought to be the main causes. Faced with this health emergency, the Congolese government has implemented strategies to increase the level of immunization coverage among children, and to help reduce child morbidity and mortality linked to vaccine-preventable diseases. A household survey was carried out in 2019 in the provinces of Ituri and Haut-Katanga to estimate the level of coverage at grassroots level. A representative cluster sample was used to exhaustively cover 63 health zones (36 in Ituri and 27 in Haut-Katanga). Over 6,300 mothers/caregivers of children aged 10-23 months were interviewed, at a rate of 100 mothers/caregivers per health zone. The results of this survey show that overall, nearly 49% of children aged 10-23 months are fully vaccinated in Ituri, compared with 53.12% in Haut-Katanga. There are still large numbers of zerodose children (those who have never been vaccinated since birth). For all vaccines, results varied: 53.12% of children in Ituri and 46.88% in Haut-Katanga received the bacillus Calmette and Guerin (BCG) vaccine. BCG vaccine was administered at birth to 39.76% of children in Ituri, versus 60.24% in Haut-Katanga. The discrepancies suggest a missed opportunity and therefore unmet needs for several reasons, principally vaccine stock-outs. For other antigens, there is a downward trend in both provinces between input and output doses. This suggests a lack of effective monitoring. Only 49.6% of children in Ituri and 50.33% of children in Haut-Katanga received the entry dose of polio vaccine (OPV0).
Joseph Oyaya Mundala, Joël Fumwakwau Kiniati, Leurby Ikina Bokele et al.
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.
Yauba Saidu, Marius Zambou Vouking, Andreas Ateke Njoh et al.
Background: Immunization is an effective intervention for preventing morbidity and complications associated with infectious diseases in children. Objectives were to contribute to improving vaccination coverage among children aged 1-59 months admitted to hospitals in Brazzaville. Methods: A cross-sectional study on childhood vaccination coverage was conducted between January and October 2021 in four health facilities in Brazzaville. Children aged 1-59 months who were hospitalized and whose parents provided consent were included. Study variables included sociodemographic characteristics, parental knowledge of immunization, and children’s vaccination status. Statistical tests used were chi-square and odds ratio with a significance level of p<0.05. Results: A total of 217 children were included, 53% of whom were boys (sex ratio=1.1). Children older than 2 years accounted for 36.4% (n=79). The rate of vaccination card ownership was 48.4% (n=105). Among these, 75.2% (n=79) were up to date with their vaccines up to the age of 9 months. The dropout rate between BCG and measles vaccine (VAR) was 53.3%, and the lowest coverage was observed for measles and yellow fever vaccines at 46.7% (n=49). Gender, maternal education level, and mothers’ knowledge of target diseases significantly influenced vaccination coverage (p<0.05). Conclusions: Improving the low vaccination coverage among children aged 1-59 months requires revitalizing the expanded program on immunization (EPI).
Judicaël Kambourou, Herling Houando, Aymar Pierre Gildas Oko et al.
Adolescent girls in Cameroon face substantial sexual and reproductive health vulnerabilities that heighten their risk of HIV exposure. Using data from 2,586 adolescent girls aged 15-19 years from the 2017-18 Cameroon Population-based HIV Impact Assessment, we examined factors associated with multiple sexual partnerships, age-disparate sex, inconsistent condom use, transactional sex, and a composite measure of high-risk sex. Overall, 4.31% reported multiple partners, 25.18% engaged in age-disparate sex, 27.06% reported inconsistent condom use, 3.91% engaged in transactional sex, and 19.61% exhibited high-risk sexual behaviours. In multivariable analyses, marriage or cohabitation was strongly associated with age-disparate sex (aOR = 8.57, 95% CI = 5.84-12.56; p < 0.001) and inconsistent condom use (aOR = 10.07, 95% CI = 6.98-14.53; p < 0.001). Adolescent motherhood was associated with high-risk sex (aOR = 1.71, 95% CI = 1.14-2.55; p = 0.011). School non-enrolment was associated with inconsistent condom use (aOR = 1.76, 95% CI = 1.31-2.37; p = 0.001). Predicted probabilities showed that unmarried, non-mothers who initiated sex later had the lowest probability of high-risk sex (8%), whereas married adolescent mothers with early sexual debut had the highest (72%). These findings underscore the need for combination HIV prevention programming that prioritises married adolescents, adolescent mothers, out-of-school girls, and those initiating sex early. Delaying sexual debut, preventing adolescent motherhood and child marriage, and strengthening age-appropriate, context-specific interventions may substantially reduce HIV exposure among adolescent girls in Cameroon.
Ololade Julius Baruwa, Elona Toska, Boladé Hamed Banougnin et al.
The Expanded Programme on Immunization (EPI) is a public health intervention aimed at reducing child morbidity and mortality caused by vaccine-preventable infectious diseases, particularly in low-income countries. The Democratic Republic of Congo (DRC) is a country that introduced the national EPI program in 1978. Different ways exist to implement the EPI. The DRC opted for an initiative taken by the family. The coverage is however low, because the country did not conduct a research that identifies factors that constrain optimal vaccine implementation when the decision is at the household level. To get support for a project that investigates that knowledge, a survey was conducted among immunization experts to assess whether exploring the determinants of vaccination coverage in the city of Lubumbashi is worthwhile. Experts were purposively selected through a multidisciplinary approach, targeting individuals with substantial national and international experience in vaccine program implementation, both globally, locally in Africa, and in the DRC. An open-ended questionnaire was developed to explore expert perspectives on optimal vaccine delivery strategies that was conceived in the locally developed SCAVA / VACCIN+CONNECT- OS project (Adaptive Strategy for the Control of Vaccination Activities). Responses were analyzed using mixed quantitative and qualitative methods to identify expert consensus on the need for a local determinants study to enhance vaccine delivery. A total of 167 experts were contacted, and 111 responded (66%). Respondents represented a diverse sample in terms of gender (64% male), age (>50 y: 43%), experience (<10 y: 43%), and professional scope (local/global: 75%). Eighty percent (90/111) supported the initiation of the SCAVA / VACCIN+CONNECT- OS study, followed by the development of an actionable plan to address the identified barriers. They specified multiple reasons and causes of vaccine hesitancy at the household level. Twenty percent (21/111) held a different opinion, citing the immediate need for financial, logistical, and material resources to strengthen vaccination services. The survey demonstrates strong expert support for launching a determinant-focused study like SCAVA / VACCIN+CONNECT- OS as a prerequisite to successful and sustainable vaccination implementation in the DRC. The majority advocated for socio-anthropological and communication-centered public health models, addressing local economic, cultural, and behavioral factors, as an essential foundation for improving childhood immunization coverage.
Israël Badypwyla, Marc Raes, Jean Marie Dikanga Kazadi et al.
Background: Humanitarian crises have a significant negative impact on global health initiatives. Humanitarian crises, driven by conflict and natural disasters, result in population displacement, and significantly affect healthcare and routine immunisation services. Problem: Vaccination and immunisation efforts in crisis-affected areas are hindered by broken logistics and supply chain systems, resulting in delayed deliveries, and weakened health infrastructure. Population displacement leads to overcrowding, and increased transmission of Vaccine-Preventable Diseases (VPDs). The resultant fragile governance limits coordination between government and humanitarian partners, leading to an increase in zero-dose and under-immunised children. Aim: This article analyses the mechanisms by which humanitarian crises disrupt vaccines supply chains and coverage, using the Cameroon conflict as a case study, and proposes integrated response strategies. Method: We conducted a narrative review of peer-reviewed and institutional literature published between 2015 and 2025 on vaccination in humanitarian and conflict-affected settings. We complemented this review with a qualitative case study using routine immunisation reports, outbreak investigation summaries, program monitoring data, and stakeholder field experiences from the Northwest and Southwest regions of Cameroon between 2019 and 2025. We synthesized findings thematically, focusing on health system disruptions, supply chain constraints, service delivery barriers, and surveillance breakdowns. Results: We observe broken health systems from armed conflict, leading to compromised delivery of health commodities, a preponderance in unimmunised and under immunised children in conflict laden areas of the world. The direct result is outbreaks, and increased under-5 morbidity and mortality. Impact: In Cameroon, VPDs have resurged over the past four years, including poliomyelitis, measles, yellow fever, and neonatal tetanus, especially in the crisis-hit regions, such as the Wabane and Eyumodjock health districts in the Southwest Region. This resurgence is not unique to Cameroon. Other conflictaffected countries report similar findings regarding VPDs. These trends illustrate how insecurity and logistical challenges compromise vaccine delivery and handling, as well as vaccination coverage, thereby threatening immunisation goals. Conclusion: The interplay between humanitarian crises and immunisation underscores the urgent need to integrate resilience and emergency response into vaccination strategies. Strengthening these systems is critical to improving coverage, protecting vulnerable populations, and advancing progress toward Sustainable Development Goal 3, with vaccination remaining central to health equity
Julius Kenkoh Nkiese, Marilyn Yentoh Bantar, Stephanie Kininla Wirba
In complex humanitarian emergencies, infants and young children are exposed to a higher risk of malnutrition, morbidity, delayed development and mortality. As shown by earlier research, maternal mental health and capacity for nurturing are of fundamental importance in child health and development. Since 2006, the international nongovernmental organisation, Action Contre la Faim, has been implementing a holistic approach to interventions for pregnant and lactating women and their young children to prevent child mortality and developmental delay in contexts affected by war and natural disasters. The experience presented here of ‘Baby Friendly Spaces’ refers to a programme in Cameroon, implemented with Central African refugees. The activities comprised in this model are focused on maternal mental health, parental skills, early child stimulation and infant and young child feeding practices. Results show a positive and significant (p < 0.01) impact on maternal wellbeing, breastfeeding practices and mother–child relationships. These findings reinforce previous evidence highlighting the necessity of implementing programmes, within complex humanitarian contexts, to reinforce the mother’s psychological wellbeing and increase capacity to provide nurturing care to guarantee the child’s health status and development.
Elisabetta Dozio, Karine Le Roch, Cécile Bizouerne
Abstract The objective of this article is to analyze the effect of fiscal decentralization on early childhood education in Cameroon. Using a methodological framework based on econometric modeling by ordinary least squares (OLS), generalized least squares (GLS), and the generalized method of moments (GMM), it emerges that fiscal decentralization positively and significantly affects early childhood education in Cameroon. The results obtained by OLS and GLS reveal that Fiscal decentralization has a significant and positive effect on the number of desks per student. The Global Monitoring Mechanisms (GMM) demonstrate that fiscal decentralization leads to a significant and positive increase in both the number of classrooms per student and the number of desks per student. The investigations revealed that fiscal decentralization has a positive effect on early childhood education in Cameroon.These results suggest implementing financing mechanisms for local authorities to stimulate local development through the provision of sustainable socioeconomic infrastructure that can ensure equal and equitable access to education for children. Keywords: Cameroon, schooling, early childhood, fiscal decentralization
Martin Christy ABIAYA'A, Tati Gaelle TIMBA, Jean Hugues NLOM et al.
