The coverage of the second dose of the measles-containing vaccine: A cross-sectional survey in a rural health district of Cameroon
Measles remains a significant public health challenge in sub-Saharan Africa, including Cameroon, where vaccination coverage (77%) falls below the World Health Organization target of 95%. This study assessed the coverage of the second dose of measles-containing vaccine (MCV2) and identified factors influencing vaccination uptake in Ngog-Mapubi Health District (HD), Cameroon. A community-based cross-sectional survey was conducted in this rural HD in March 2024, involving 140 parents or guardians of children aged 15–23 months. Data were collected using a pre-tested questionnaire, covering sociodemographic characteristics, vaccination status, and barriers to uptake. Determinants of MCV2 vaccination were identified through logistic regression. Data were analyzed using R statistics version 4.4.2. p<0.05 was considered statistically significant. The study revealed a MCV2 vaccination coverage of 46.4% (95% confidence interval [CI]: 38.0–55.0). Among unvaccinated children, 85.3% (95% CI: 75.3–92.4) of caregivers expressed willingness to vaccinate, indicating high acceptance but persistent barriers. Distance to health facilities (43%), lack of information about vaccine availability (37%), and missed opportunities during health visits (25%) were the most cited obstacles. Awareness of MCV2 was high (89%), but knowledge gaps persisted, with 61% of respondents demonstrating poor understanding of vaccination schedules. Multivariate analysis identified the absence of advanced vaccination strategies (e.g., outreach programs) as the strongest predictor of non-vaccination (adjusted odds ratio = 7.15; 95% CI: 3.19–17.2; p<0.001). Despite a high MCV2 acceptance rate, low MCV2 coverage in this rural district underscores the need for improved access through advanced vaccination strategies and targeted community education. Addressing structural and informational barriers is essential to achieving equitable immunization coverage.
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):12. https://doi.org/10.3390/covid2120123
Anderson, E.L. (2014). Recommended solutions to the barriers to immunization in children and adults. Missouri Medicine, 111(4):344-348.
Annick, S.T.A., Dominique, E., Diomède, N., Christine, A.E.M., Haoua, A.P., Jeannette, E.N., et al. (2024). Epidemiological, clinical aspects and outcome of measles in a low-income country in 2023. Open Journal of Pediatrics, 14(1):139-148. https://doi.org/10.4236/ojped.2024.141015
Bangura, J.B., Xiao, S., Qiu, D., Ouyang, F., & Chen, L. (2020). Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health, 20:1108. https://doi.org/10.1186/s12889-020-09169-4
Cheuyem, F.Z.L., Ajong, B.N., Amani, A., Boukeng, L.B.K., Ngos, C.S., Nkongo, F.K., et al. (2024a). Sustainable Development Goals and Health Sector Strategic Indicators Assessment in Cameroon: A Retrospective Analysis at Regional and National Levels. [medRxiv Preprint]. https://doi.org/10.1101/2024.11.25.24317921
Cheuyem, F.Z.L., Amani, A., Achangwa, C., Ajong, B.N., Minkandi, C.A., Zeh, M.M.M.K., et al. (2025d). COVID- 19 vaccine uptake and its determinants in Cameroon: A systematic review and meta-analysis (2021-2024). BMC Infectious Diseases, 25(1):525. https://doi.org/10.1186/s12879-025-10946-y
Cheuyem, F.Z.L., Amani, A., Ajong, B.N., Boukeng, L.B.K., Mouangue, C., Tsafack, M.G.M., et al. (2024b). Humanization of Care: A Geospatial Analysis of Key Indicators of Quality and Safety of Health Care and Service in the Centre Region, Cameroon. [medRxiv Preprint]. https://doi.org/10.1101/2024.11.11.24317125
Cheuyem, F.Z.L., Amani, A., Ajong, B.N., Otsali, R.K.N., Nouko, A., Guissana, E.O., et al. (2025a). Knowledge and observance of vaccination norms and standards amongvaccine managers in an urban health district of Yaoundé, Cameroon, during the COVID-19 pandemic. Global Health Economics and Sustainability, 2025:025250046. https://doi.org/10.36922/GHES025250046
Cheuyem, F.Z.L., Amani, A., Nkodo, I.C.A., Boukeng, L.B.K., Edzamba, M.F., Nouko, A., et al. (2025c). 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., Edzamba, M.F., Amani, A., & Mossus, T. (2025b). Factors associated with alcohol, smoking, and illicit drug use among university students in Yaoundé, Cameroon. Discover Public Health, 22(1):11. https://doi.org/10.1186/s12982-025-00388-x
Ekezie, W., Igein, B., Varughese, J., Butt, A., Ukoha-Kalu, B.O., Ikhile, I., et al. (2024). Vaccination communication strategies and uptake in Africa: A systematic review. Vaccines, 12(12):12. https://doi.org/10.3390/vaccines12121333
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 MCH and AIDS, 9(2):242-251. https://doi.org/10.21106/ijma.308
Eyong, E.M., Njoh, A.A., Etutu, S.J.M., Bachir, H.B., Ndoula, S.T., Saidou, Y., et al. (2023). Factors associated with measles outbreak in three health districts of Cameroon in 2019: A cross-sectional study. The Pan African Medical Journal, 46(41):41. https://doi.org/10.11604/pamj.2023.46.41.35832
Gbeminiyi, O.T., & Oyeneye, A.I. (2025). Evaluation of immunization service delivery in primary healthcare centers in Akinyele and Lagelu local government areas, Oyo State, Nigeria. SAGE Open Medicine, 13:20503121251352974. https://doi.org/10.1177/20503121251352974
Ibrahim, H.A., Wariyo, A., Asefa, E.M., Cheru, A., Abebe Lonsako, A., & Dirirsa, G. (2024). Measles second dose vaccine uptake and associated factors among under-five children in Jigjiga City, Somali Region, Eastern Ethiopia: A community-based cross-sectional study. Frontiers in Public Health, 12:1395802. https://doi.org/10.3389/fpubh.2024.1395802
Jalloh, M.F., Patel, P., Sutton, R., Kulkarni, S., Toure, M., Wiley, K., et al. (2022). Qualitative assessment of caregiver experiences when navigating childhood immunisation in urban communities in Sierra Leone. BMJ Open, 12(5):e058203. https://doi.org/10.1136/bmjopen-2021-058203
Kamani, N.L.N., Bassong, O.Y.M., Fossi, C.T., & Alexandre, N.B. (2020). Facteurs associés à la non observance du calendrier vaccinal des Enfants de 0 à 11 mois dans le District de sante de djoungolo-cameroun [Factors associated with non-adherence to the vaccination schedule of children aged 0-11 months in the Djoungolo Health District, Cameroon]. Health Sciences and Disease, 21(2):2. https://doi.org/10.5281/hsd.v21i2.1827
Kaufman, J., Tuckerman, J., Bonner, C., Durrheim, D.N., Costa, D., Trevena, L., et al. (2021). Parent-level barriers to uptake of childhood vaccination: A global overview of systematic reviews. BMJ Global Health, 6(9):e006860. https://doi.org/10.1136/bmjgh-2021-006860
Legesse, E., & Dechasa, W. (2015). An assessment of child immunization coverage and its determinants in Sinana District, Southeast Ethiopia. BMC Pediatrics, 15(1):31. https://doi.org/10.1186/s12887-015-0345-4
Liu, H., Nowak, G.R., Wang, J., & Luo, Z. (2023). A national study of marital status differences in early uptake of COVID-19 vaccine among older Americans. Geriatrics, 8(4):69. https://doi.org/10.3390/geriatrics8040069
Mamuti, S., Tabu, C., Marete, I., Opili, D., Jalang’o, R., & Abade, A. (2022). Measles containing vaccine coverage and factors associated with its uptake among children aged 24-59 months in Cherangany Sub County, Trans Nzoia County, Kenya. PLoS One, 17(2):e0263780. https://doi.org/10.1371/journal.pone.0263780
Mukhtar, A.F., Abdul Kadir, A., Mohd Noor, N., & Mohammad, A.H. (2022). Knowledge and attitude on childhood vaccination among healthcare workers in Hospital Universiti Sains Malaysia. Vaccines, 10(7):1017. https://doi.org/10.3390/vaccines10071017
Nah, S., Williamson, L.D., Kahlor, L.A., Atkinson, L., Ntang- Beb, J.L., & Upshaw, S.J. (2023). COVID-19 Vaccine hesitancy in cameroon: the role of medical mistrust and social media use. Journal of Health Communication, 28(9):619-632. https://doi.org/10.1080/10810730.2023.2250287
Nchasi, G., Paul, I.K., Sospeter, S.B., Mallya, M.R., Ruaichi, J., & Malunga, J. (2022). Measles outbreak in sub-Saharan Africa amidst COVID-19: A rising concern, efforts, challenges, and future recommendations. Annals of Medicine and Surgery, 81:104264. https://doi.org/10.1016/j.amsu.2022.104264
Parpia, A.S., Skrip, L.A., Nsoesie, E.O., Ngwa, M.C., Abah Abah, A.S., Galvani, A.P., et al. (2020). Spatio-temporal dynamics of measles outbreaks in Cameroon. Annals of Epidemiology, 42:64-72.e3. https://doi.org/10.1016/j.annepidem.2019.10.007
Parsekar, S.S., Vadrevu, L., Jain, M., Menon, S., & Taneja, G. (2024). Interventions addressing routine childhood immunization and its behavioral and social drivers. Frontiers in Public Health, 12:1364798. https://doi.org/10.3389/fpubh.2024.1364798
R Core Team. (2024). R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing, Vienna, Austria. Available from: https://www.r-project.org [Last accessed on 2025 May 30].
Russo, G., Miglietta, A., Pezzotti, P., Biguioh, R.M., Bouting Mayaka, G., Sobze, M.S., et al. (2015). Vaccine coverage and determinants of incomplete vaccination in children aged 12-23 months in Dschang, West Region, Cameroon: A cross-sectional survey during a polio outbreak. BMC Public Health, 15(1):630. https://doi.org/10.1186/s12889-015-2000-2
Saidu, Y., Gu, J., Ngenge, B.M., Nchinjoh, S.C., Adidja, A., Nnang, N.E., et al. (2023). The faces behind vaccination: Unpacking the attitudes, knowledge, and practices of staff of Cameroon’s expanded program on immunization. Human Resources for Health, 21(1):88. https://doi.org/10.1186/s12960-023-00869-7
Sharrow, D., Hug, L., You, D., Alkema, L., Black, R., Cousens, S., et al. (2022). Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: A systematic analysis by the UN Inter-agency Group for child mortality estimation. The Lancet Global Health, 10(2):e195-e206. https://doi.org/10.1016/S2214-109X(21)00515-5
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
Singh, S., Sahu, D., Agrawal, A., & Vashi, M.D. (2019). Barriers and opportunities for improving childhood immunization coverage in slums: A qualitative study. Preventive Medicine Reports, 14:100858. https://doi.org/10.1016/j.pmedr.2019.100858
Szalast, K., Nowicki, G.J., Pietrzak, M., Mastalerz-Migas, A., Biesiada, A., Grochans, E., et al. (2025). Parental attitudes, motivators and barriers toward children’s vaccination in Poland: A scoping review. Vaccines, 13(1):1. https://doi.org/10.3390/vaccines13010041
WHO. (2009). Measles Vaccines: WHO Position Paper. Releve Epidemiologique Hebdomadaire, Vol. 84. p349-360. Available from: https://iris.who.int/handle/10665/241405 [Last accessed on 2025 May 30].
WHO. (2019). Measles vaccines: WHO position paper, April 2017-recommendations. Vaccine, 37(2):219-222.
WHO. (2024). Measles. Geneva: WHO. Available from: https:// www.who.int/news-room/fact-sheets/detail/measles
WHO. (2025a). Improving Health Security by Removing Barriers to Vaccination - Progress at the Local Level in the European Region. WHO, Geneva. Available from: https://www.who. int/europe/news/item/30-04-2025-improving-health-security-by-removing-barriers-to-vaccination---progress-at-the-local-level-in-the-european-region [Last accessed on 2025 May 30].
WHO. (2025b). Measles. WHO, Regional Office for Africa. Available from: https://www.afro.who.int/health-topics/ measles
WHO. (2025c). Vaccines and Immunization. Geneva: WHO. Available from: https://www.who.int/health-topics/ vaccines-and-immunization
Woyessa, A.B., Shah, M.P., Azmeraye, B.M., Pan, J., Lisanwork, L., Yimer, G., et al. (2024). Factors associated with uptake of routine measles-containing vaccine doses among young children, Oromia regional State, Ethiopia, 2021. Vaccines, 12(7):762. https://doi.org/10.3390/vaccines12070762
Yakum, M.N., Atanga, F.D., Ajong, A.B., Eba Ze, L.E., & Shah, Z. (2023). Factors associated with full vaccination and zero vaccine dose in children aged 12-59 months in 6 health districts of Cameroon. BMC Public Health, 23(1):1693. https://doi.org/10.1186/s12889-023-16609-4