Behavioural determinants of zero-dose and under-immunisation in conflict-affected Northwest and Southwest Cameroon

Findings from a doer/non-doer assessment

Abstract

Background: Conflict in the Northwest and Southwest regions of Cameroon has disrupted routine immunisation, leaving many children without vaccines. To design better interventions, it was important to understand what had shifted in caregivers’ perceptions of vaccines and what influences their decisions to immunise their children.

Purpose: This study was designed to explore behavioural, socio-cultural, and structural determinants of immunisation uptake among doers and non-doers in conflict-affected Northwest and Southwest Cameroon, and to generate evidence to inform the design of specific interventions and service delivery adaptations.

Material and methods: A qualitative Doer/Non-Doer analysis was conducted in four health districts (Konye, Kumba South, Bamenda, Nwa) from March to June 2025. The study included 140 semi-structured interviews with caregivers, healthcare workers, and community leaders, plus six focus group discussions. Thematic analysis was guided by the Social-Ecological Model, COM-B, and Health Belief Model frameworks.

Results: Nine behavioural determinants distinguished doers from non-doers. All doers were confident in immunising their children, versus 67% of non-doers. Doers (70%) perceived their children as vulnerable to vaccine-preventable diseases, compared to 33% of non-doers. Non-doers (71%) incorrectly believed immunisation ended at 9 months. Barriers included vaccine stockouts, poor cold chain, clinic hours conflicting with farm work, security constraints, and misinformation from non-state armed groups.

Conclusions: Increasing immunisation coverage in conflict-affected Cameroon requires addressing individual perceptions, family dynamics, community norms, and health system challenges through family engagement, trust-building, and service adaptations