Determinants of childhood vaccination differ between conflict-affected and non-conflict regions in Cameroon

Childhood vaccination remains one of the most effective public health interventions, yet coverage is often lowest in settings affected by conflict and structural disadvantage. Cameroon has faced overlapping humanitarian crises in its Far North, North-West, and South-West regions, but evidence comparing determinants of full vaccination between conflict-affected and non-conflict regions remains limited. This study explores determinants of full vaccination status in 12-23 months children in Cameroon, stratified by conflict regions.

We conducted a secondary analysis of the 2018 Cameroon Demographic and Health Survey, including 1,824 living children aged 12-23 months. Full basic vaccination was defined as receipt of one dose of BCG, three doses of pentavalent vaccine, three doses of polio vaccine, and one dose of measles vaccine. Survey-weighted logistic regression was used to identify factors associated with full vaccination overall and by conflict status.

Overall, 53.08% of children were fully vaccinated. Coverage was lower in conflict-affected than in non-conflict regions (45.29% versus 55.97%). In unadjusted analysis, conflict status was associated with lower odds of full vaccination, but this association was no longer significant in the adjusted model. At the national level, higher odds of full vaccination were associated with richer household wealth, maternal secondary or higher education, antenatal care attendance, and postnatal care. In conflict-affected regions, maternal secondary or higher education, postnatal care, and facility delivery remained significant predictors of full vaccination.

Full vaccination coverage in Cameroon remains below desirable levels, with lower crude coverage in conflict-affected regions. However, after adjustment, conflict status was not independently associated with full vaccination, suggesting that socioeconomic conditions and contact with maternal health services are more important determinants. Strengthening antenatal and postnatal care and reducing socioeconomic barriers may improve vaccination coverage, especially in fragile settings.