Knowledge and observance of vaccination norms and standards among vaccine managers in an urban health district of Yaoundé, Cameroon, during the COVID-19 pandemic

Annual reports have indicated a progressive decline in immunization coverage in Yaoundé. This study aimed to identify knowledge gaps and organizational deficiencies in the implementation of routine immunization in health facilities (HFs) in the Efoulan health district (HD) of Yaoundé. A descriptive cross-sectional study was conducted in Efoulan, an urban HD of Yaoundé, the capital of Cameroon, in May 2022. A self-administered questionnaire and an observation grid were used to collect knowledge-related data. A total of 46 healthcare workers (HCWs) providing vaccinations in the nine health areas of the HD were enrolled in the study. Almost all participants (93.5%) were unable to name all the diseases that the pentavalent vaccine protects against. More than half of the respondents (59%) were aware of the 15-month booster dose of the measles-rubella (MR) vaccine included in the Expanded Program on Immunization (EPI). Half of the respondents were aware of the type of antigen contained in the Bacillus Calmette–Guérin vaccine (52%). More than two-thirds of the respondents (72%) had not identified the 6-month MR vaccine as recommended for HIV-positive children. Almost all the respondents (87%) had poor knowledge of vaccination norms and standards. Most of the visited HFs did not follow the monthly EPI monitoring curve (87%), did not store vaccines according to standards (80%), or lacked an EPI case reporting form (93%). There are still significant deficiencies in the implementation of routine immunization in most HFs in Efoulan HD, which correlate with the staff’s lack of knowledge of EPI norms and standards. Strengthening the capacity of HCWs through ongoing training and supervision is necessary.
Adidja, A., Nchinjoh, S.C., Gu, J., Cheuyem, F.Z.L., Edwige, N.N., Vouking, M., et al. (2023). Immunization staff training needs assessment: An overview of findings from Cameroon. medRxiv. p. 2023.09.19.23295815. https://doi.org/10.1101/2023.09.19.23295815
Amani, A., Mboussou, F., Impouma, B., Cabore, J., & Moeti, M.R. (2024). Introduction and rollout of malaria vaccines in Cameroon and Burkina Faso: Early lessons learned. The Lancet Global Health, 12(5):e740-e741. https://doi.org/10.1016/S2214-109X(24)00101-3
Amani, A., Mossus, T., Cheuyem, F.Z.L., Bilounga, C., Mikamb, P., Basseguin Atchou, J., et al. (2022). Gender and COVID-19 vaccine disparities in Cameroon. COVID, 2(12):1715-1730. https://doi.org/10.3390/covid2120123
Amani, A., Nzouankeu, A., Kamguia, F., Ngo Bama, S., Nouko, A., Cheuyem Lekeumo, F.Z., et al. (2022). Meningitis in Cameroon: Estimation of morbidity from 2004 to 2020 and the impact of MenAfriVac® mass vaccination campaigns. Médecine d’Afrique Noire, 69(11):553-565
Amani, A., Saidu, Y., Asaah, C.T., Cheuyem, F.Z.L., Njoh, A.A., Kabir, H.A., et al. (2023). Immunization in Cameroon: Uncovering progress, confronting challenges, and paving the path towards achieving sustainable development goal 2030 targets. Journal of Vaccines and Vaccination, 14(3):520. https://doi.org/10.35248/2157-7560.23.14.520
Ateudjieu, J., Kenfack, B., Nkontchou, B.W., & Demanou, M. (2013). Program on immunization and cold chain monitoring: The status in eight health districts in Cameroon. BMC Research Notes, 6(1):101. https://doi.org/10.1186/1756-0500-6-101
Baguune, B., Ndago, J.A., & Adokiya, M.N. (2017). Immunization dropout rate and data quality among children 12-23 months of age in Ghana. Archives of Public Health, 75(1):18. https://doi.org/10.1186/s13690-017-0186-8
Bogale, H.A., Amhare, A.F., & Bogale, A.A. (2019). Assessment of factors affecting vaccine cold chain management practice in public health institutions in east Gojam zone of Amhara region. BMC Public Health, 19(1):1433. https://doi.org/10.1186/s12889-019-7786-x
Cheuyem, F.Z.L., Ajong, B.N., Amani, A., Boukeng, L.B.K., Ngos, C.S., Nkongo, F.K., et al. (2024). Sustainable development goals and health sector strategic indicators assessment in Cameroon: A retrospective analysis at regional and national levels. medRxiv. p: 2024.11.25.24317921 https://doi.org/10.1101/2024.11.25.24317921
Cheuyem, F.Z.L., Amani, A., Ajong, B.N., Boukeng, L.B.K., Mouangue, C., Tsafack, M.G.M., et al. (2024). Humanization of care: A geospatial analysis of key indicators of quality and safety of health care and service in the Centre region, Cameroon. medRxiv. p. 2024.11.11.24317125. https://doi.org/10.1101/2024.11.11.24317125
Cheuyem, F.Z.L., Amani, A., Nkodo, I.C.A., Boukeng, L.B.K., Edzamba, M.F., Nouko, A., et al. (2025). COVID-19 vaccine acceptance and hesitancy in Cameroon: A systematic review and meta-analysis. BMC Public Health, 25(1):1035. https://doi.org/10.1186/s12889-025-22195-4
Cheuyem, F.Z.L., Asahngwa, C.T., Dabou, S., Ajong, B.N., Nloga, G.S., Goupeyou-Youmsi, J., et al. (2025). Healthcare coverage and associated factors in Cameroon: Analyses from a national survey. medRxiv. p. 2025.06.22.25330087. https://doi.org/10.1101/2025.06.22.25330087
Chiabi, A., Nguefack, F.D., Njapndounke, F., Kobela, M., Kenfack, K., Nguefack, S., et al. (2017). Vaccination of infants aged 0 to 11 months at the Yaounde Gynaeco-obstetric and pediatric hospital in Cameroon: How complete and how timely? BMC Pediatrics, 17(1):206. https://doi.org/10.1186/s12887-017-0954-1
Dodds, D., Kindt, J.W Jr., Da Costa, C., Kazi, N., Mahoney, J.T., & Rupassara, S.I. (2023). Supply chain logistics and business ecosystems needed for the development of natural vaccines with novel, safer, and noninvasive delivery mechanisms. In: New Topics in Vaccine Development. London: IntechOpen. https://doi.org/10.5772/intechopen.113953
Domoina Ratovozanany. (2021). Thanks to Advanced Strategies, Parents Waste Less Time Immunizing Their Children. New York: UNICEF. Available from: https://www.unicef. org/madagascar/en/stories/thanks-advanced-strategies-parents-waste-less-time-immunizing-their-children [Last accessed on 2024 Nov 04].
Ebile Akoh, W., Ateudjieu, J., Nouetchognou, J.S., Yakum, M.N., Djouma Nembot, F., Nafack Sonkeng, S., et al. (2016). The expanded program on immunization service delivery in the Dschang health district, west region of Cameroon: A cross sectional survey. BMC Public Health, 16(1):801.https://doi.org/10.1186/s12889-016-3429-7
Ewang, B.F., Eyong, M.E., Cumber, S.N., Nkfusai, C.N., Yankam, B.M., Anye, C.S., et al. (2020). Vaccination coverage under the expanded program on immunization in south west Cameroon. International Journal of Maternal and Child Health and AIDS, 9(2):242. https://doi.org/10.21106/ijma.308
Félicitée, N.D., Christiane, T., Roger, D., Sandra, T., Stève, F.W.D., Andreas, C., et al. (2016). Factors influencing routine vaccination of children of mothers live-stock retailers in the markets of Yaoundé. World Journal of Vaccines, 6(2):23-33. https://doi.org/10.4236/wjv.2016.62004
Geomatic Strategy. (2019). Analyse Géographique De La Couverture Sanitaire Au Cameroun Répartition des Formations Sanitaires Et De La Charge Du Personnel De Santé. Geomatic Strategy, Yaoundé. Available from: https:// www.geostrategies.net/wp-content/uploads/2024/10/strategies-spatiales-002-mars-avril-2019.pdf [Last accessed on 2021 Sep 11].
Goga, A.E., & Muhe, L.M. (2011). Global challenges with scale-up of the integrated management of childhood illness strategy: Results of a multi-country survey. BMC Public Health, 11(1):503. https://doi.org/10.1186/1471-2458-11-503
Guttman, M. (2023). Adapting Strategies to Realities in Togo for Catch-Up Vaccination. Washington, D.C: Sabin Vaccine Institute. Available from: https://www.sabin.org/resources/ adapting-strategies-to-realities-in-togo-for-catch-up-vaccination [Last accessed on 2024 Nov 04].
Hamid, H., Mallhi, T.H., Naseer, M.S., Younas, I., Rashid, M.A., Pervaiz, A., et al. (2020). The COVID-19 pandemic threatens the expanded program on immunization: Recommendations for sustaining vaccination goals. Drugs and Therapy Perspectives, 36(11):523-525. https://doi.org/10.1007/s40267-020-00774-2
Kufe, N.C., Metekoua, C., Nelly, M., Tumasang, F., & Mbu, E.R. (2019). Retention of health care workers at health facility, trends in the retention of knowledge and correlates at 3rd year following training of health care workers on the prevention of mother-to-child transmission (PMTCT) of HIV-national assessment. BMC Health Services Research, 19(1):78. https://doi.org/10.1186/s12913-019-3925-4
Murhabazi Bashombwa, A., Tchio-Nighie, K.H., Nanfak, A., Buh Nkum, C., Nguemnang, W.A., Kami, R.F., et al. (2025). Determinants of access to the pentavalent 3 vaccine among children aged 0-23 months in Cameroon based on the demographic and health survey 2018. Pediatric Health Medicine and Therapeutics, 16:35-45. https://doi.org/10.2147/PHMT.S497787
Ndoula, S.T., Mboussou, F., Njoh, A.A., Nembot, R., Baonga, S.F., Njinkeu, A., et al. (2024). Malaria vaccine introduction in Cameroon: Early results 30 days into rollout. Vaccines (Basel), 12(4):346. https://doi.org/10.3390/vaccines12040346
Ngwa, C.H., Doungtsop, B.C.K., Bihnwi, R., Ngo, N.V., & Yang, N.M. (2022). Burden of vaccine-preventable diseases, trends in vaccine coverage and current challenges in the implementation of the expanded program on immunization: A situation analysis of Cameroon. Human Vaccines and Immunotherapeutics, 18(1):1939620. https://doi.org/10.1080/21645515.2021.1939620
Njoh, A.A., Dinga, J.N., Kongnyuy, E.J., Ndoula, T.S., Amani, A., Madaina, I., et al. (2025). Malaria vaccine acceptance and associated factors in Cameroon: A nationwide cross-sectional survey. Vaccine, 60:127323. https://doi.org/10.1016/j.vaccine.2025.127323
Njoh, A.A., Josue Kedakse, T.S.N., Eric Mboke, E., Nembot, R., Collins, L.Y.P., Amani, A., et al. (2023). Polio outbreaks in Cameroon following the COVID-19 pandemic. The Pan African Medical Journal, 45:90. https://doi.org/10.11604/pamj.2023.45.90.35332
Ntenda, P.A.M., Sixpence, A., Mwenyenkulu, T.E., Mmanga, K., Chirambo, A.C., Bauleni, A., et al. (2022). Determinants of pentavalent and measles vaccination dropouts among children aged 12-23 months in the Gambia. BMC Public Health, 22(1):520. https://doi.org/10.1186/s12889-022-12914-6
Scott, G.Y., Aborode, A.T., Adesola, R.O., Khan, M., Elebesunu, E.E., Oluwaseun, A.A., et al. (2025). Enhancing vaccine quality and accessibility: Strategies for efficient storage and distribution in resource-constrained environment. Outbreak Management and Response, 1(1):2443439. https://doi.org/10.1080/29947677.2024.2443439
Shattock, A.J., Johnson, H.C., Sim, S.Y., Carter, A., Lambach, P., Hutubessy, R.C.W., et al. (2024). Contribution of vaccination to improved survival and health: Modelling 50 years of the expanded programme on immunization. The Lancet, 403(10441):2307-2316. https://doi.org/10.1016/S0140-6736(24)00850-X
Starr, K. (2024, September 10). Malaria Vaccine Introduction in Cameroon. Sabin Vaccine Institute. Available from: https:// www.sabin.org/resources/malaria-vaccine-introduction-in-cameroon [Last accessed on 2024 Jun 27].
WHO and UNICEF. (2024). WHO/UNICEF Estimates of National Immunization Coverage. Geneva: WHO. Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage /who-unicef-estimates-of-national-immunization-coverage [Last accessed on 2024 Jun 27].
WHO. (2017). Reaching Every District (RED). WHO Regional Office for Africa. Available from: https://www.who.int/ teams/immunization-vaccines-and-biologicals/essential-programme-on-immunization/implementation/reaching-every-district-(red) [Last accessed on 2024 Jun 27].
WHO. (2024a). Global Immunization Efforts Have Saved at Least 154 Million Lives over the Past 50 Years. Geneva: WHO. Available from: https://www.who.int/news/item/24-04- 2024-global-immunization-efforts-have-saved-at-least-154-million-lives-over-the-past-50-years [Last accessed on 2024 Jun 27].
WHO. (2024b). Cameroon Kicks off Malaria Vaccine Rollout. WHO Regional Office for Africa. Available from: https://www.afro.who.int/countries/cameroon/news/cameroon-kicks-malaria-vaccine-rollout [Last accessed on 2024 Jun 27].
WHO. (2025). Le Cameroun Vaccine Contre Le Paludisme. WHO Regional Office for Africa. Available from: https://www.afro.who.int/fr/photo-story/le-cameroun-vaccine-contre-le-paludisme [Last accessed on 2024 Jun 27].
Wie, S.H., Jung, J., & Kim, W.J. (2023). Effective vaccination and education strategies for emerging infectious diseases such as COVID-19. Journal of Korean Medical Science, 38(44):e371. https://doi.org/10.3346/jkms.2023.38.e371
Yakum, M.N., Ateudjieu, J., Walter, E.A., & Watcho, P. (2015). Vaccine storage and cold chain monitoring in the North West region of Cameroon: A cross sectional study. BMC Research Notes, 8(1):145. https://doi.org/10.1186/s13104-015-1109-9
Yakum, M.N., Funwie, A.D., Ajong, A.B., Tsafack, M., Ze, L.E.E., & Shah, Z. (2022). The burden of vaccine hesitancy for routine immunization in Yaounde-Cameroon: A cross-sectional study. PLOS Global Public Health, 2(9):e0001012. https://doi.org/10.1371/journal.pgph.0001012
Yoo, K.J., Lee, Y., Lee, S., Friebel, R., Shin, S., Lee, T., & Bishai, D. (2023). The road to recovery: Impact of COVID-19 on healthcare utilization in South Korea in 2016-2022 using an interrupted time-series analysis. The Lancet Regional Health Western Pacific, 41:100904. https://doi.org/10.1016/j.lanwpc.2023.100904
Zhou, F., Jatlaoui, T.C., Leidner, A.J., Carter, R.J., Dong, X., Santoli, J.M., et al. (2024). Health and economic benefits of routine childhood immunizations in the Era of the vaccines for children program-United States, 1994-2023. MMWR. Morbidity and Mortality Weekly Report, 73:682-685. https://doi.org/10.15585/mmwr.mm7331a2
Zia, I., Cheema, S.S., Sheikh, N.S., & Ashraf, H. (2022). Hand hygiene knowledge, attitudes, and self-reported practices among medical and nursing staff of a tertiary-care military hospital: A cross-sectional study. International Journal of Infection Control, 18. https://doi.org/10.3396/ijic.v18.21469