Identifying the reasons for low immunization coverage. A case study of Yaounde (United Republic of Cameroon)

Among the problems encountered today in Expanded Programmes on Immunization (EPI) is the failure to reach an acceptable level of immunization coverage in rapidly growing urban areas. This paper describes a checklist to identify the reasons for such low coverage. The checklist was first used in Yaounde, United Republic of Cameroon. There the low coverage is found to be associated with certain neighborhoods, one ethnic group, low socio-economic status, and newly-arrived families. Publicity about immunizations is not reaching Yaounde residents in those categories. Furthermore, health lessons (given only in French) seem to be confusing the parents rather than educating them. Finally, previous ineffective immunization programmes have made Yaounde residents mistrustful of the current programme. The authors recommend solutions to each of these Yaounde problems. The checklist, and the methods used for answering it in Yaounde, should prove useful to other immunization programmes.