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ABSTRACT
Introduction. Routine vaccination coverage in Kousseri health district shows persistent disparities, with significant numbers of “zero-dose” children. This study evaluates an integrated intervention involving traditional birth attendants (TBAs) and community health workers (CHWs) to promote routine immunization. Patients and Methods. This was a mixed-methods, pre-post evaluation that assessed the effect of involving TBA and CHW in the promotion of routine immunization in eight health areas from July to October 2025 of the Kousseri health district. Results. After the intervention, vaccination coverage improved for majority of assessed antigens: Penta 1 (+3.0%), Penta 3 (+1.1%), BCG (+2.3%) and OPV 0 (+0.4%). Regarding zero-dose cases, 176 (97.8%) zero-dose children out of 180 identified were referred for vaccination. The most commonly used awareness-raising methods were home visits (46.5%) and educational talks (33.7%). The qualitative analysis revealed high participant satisfaction (90%) and identified weather related obstacles as flooding as main operational challenges. Conclusion. Combined TBA and CHW involvement effectively improves vaccination coverage and reduces zero-dose children in hard-to-reach areas. Success depends on tailored training, structured monitoring, and rigorous referral. Institutionalizing this integrated model is recommended to sustainably strengthen vaccination equity in similar contexts.
RÉSUMÉ
Introduction. La couverture vaccinale systématique dans le district sanitaire de Kousseri présente des disparités persistantes, avec un nombre important d’enfants n’ayant reçu aucune dose. Cette étude évalue une intervention intégrée impliquant des accoucheuses traditionnelles (AT) et des agents de santé communautaires (ASC) visant à promouvoir la vaccination systématique. Patients et méthodes. Il s'agissait d'une évaluation pré-post utilisant des méthodes mixtes, qui a évalué l'effet de l'implication des ACC et des ASC dans la promotion de la vaccination systématique dans huit zones sanitaires du district sanitaire de Kousseri, de juillet à octobre 2025. Résultats. À l'issue de l'intervention, la couverture vaccinale s'est améliorée pour la majorité des antigènes évalués : Penta 1 (+3,0 %), Penta 3 (+1,1 %), BCG (+2,3 %) et OPV 0 (+0,4 %). Concernant les cas n'ayant reçu aucune dose, 176 (97,8 %) des 180 enfants identifiés comme n'ayant reçu aucune dose ont été orientés vers un centre de vaccination. Les méthodes de sensibilisation les plus couramment utilisées étaient les visites à domicile (46,5 %) et les séances d'information (33,7 %). L'analyse qualitative a révélé un niveau élevé de satisfaction des participants (90 %) et a identifié les obstacles liés aux conditions météorologiques, tels que les inondations, comme les principaux défis opérationnels. Conclusion. L'implication combinée des accoucheuses traditionnelles et des agents de santé communautaires améliore efficacement la couverture vaccinale et réduit le nombre d'enfants n'ayant reçu aucune dose dans les zones difficiles d'accès. Le succès dépend d'une formation sur mesure, d'un suivi structuré et d'un système d'orientation rigoureux. Il est recommandé d'institutionnaliser ce modèle intégré afin de renforcer durablement l'équité en matière de vaccination dans des contextes similaires.
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References
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References
1. Immunization coverage [Internet]. [cité 25 nov 2025]. Disponible sur: https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
2. outcomes--gavi-vaccine-investment-strategy.pdf [Internet]. [cité 25 nov 2025]. Disponible sur: https://cdn.who.int/media/docs/default-source/immunization/pdvac/pdvac-2024/day-1/outcomes--gavi-vaccine-investment-strategy.pdf?sfvrsn=5a41cf31_1
3. Enquête Démographique de Santé -V_ 2018_0.pdf [Internet]. [cité 26 janv 2023]. Disponible sur: https://www.minsante.cm/site/sites/default/files/Enqu%C3%AAte%20D%C3%A9mographique%20de%20Sant%C3%A9%20-V_%202018_0.pdf
4. Jalloh MF, Sengeh P, Ibrahim N, Kulkarni S, Sesay T, Eboh V, et al. Association of community engagement with vaccination confidence and uptake: A cross-sectional survey in Sierra Leone, 2019. J Glob Health. 2022;12:04006.
5. Ingle EA, Shrestha P, Seth A, Lalika MS, Azie JI, Patel RC. Interventions to Vaccinate Zero-Dose Children: A Narrative Review and Synthesis. Viruses. 14 oct 2023;15(10):2092.
6. Alban R, Gibson E, Payne J, Chihana T. Leveraging community health workers as vaccinators: a case study exploring the role of Malawi’s Health Surveillance Assistants in delivering routine immunization services. Hum Resour Health. 31 mai 2023;21(1):42.
7. Community Health Workers Capacitated on Vaccination in Practice and ZDC Tracking Log – CBC Health Services [Internet]. [cité 25 nov 2025]. Disponible sur: https://cbchealthservices.org/community-health-workers-capacitated-on-vaccination-in-practice-and-zdc-tracking-log/
8. Tchio-Nighie KH, Njimbia Chebe A, Murhabazi Bashombwa A, Ngu Nembo P, Ateudjieu J. Improving Access to PMTCT Through the Involvement of Traditional Birth Attendants in Program Activities in the Far North Region of Cameroon: A Retrospective Cohort Study. HIVAIDS Auckl NZ. 5 nov 2024;16:423‑31.
9. Bodwell G. Rebuilding Trust in Vaccination through Community Health Workers in Cameroon [Internet]. Sabin Vaccine Institute. 2023 [cité 25 nov 2025]. Disponible sur: https://www.sabin.org/resources/rebuilding-trust-in-vaccination-through-community-health-workers-in-cameroon/
10. Marefiaw TA, Yenesew MA, Mihirete KM. Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: A community-based cross-sectional study. PLOS ONE. 16 août 2019;14(8):e0218470.
11. Community health worker programmes in the WHO African region Policy brief | WHO | Regional Office for Africa [Internet]. 2025 [cité 25 nov 2025]. Disponible sur: https://www.afro.who.int/publications/community-health-worker-programmes-who-african-region-policy-brief
12. Ateudjieu J, Tchio-Nighie KH, Goura AP, Ndinakie MY, Dieffi Tchifou M, Amada L, et al. Tracking Demographic Movements and Immunization Status to Improve Children’s Access to Immunization: Field-Based Randomized Controlled Trial. JMIR Public Health Surveill. 1 mars 2022;8(3):e32213.
13. Nsongola RDM, Ndziessi G, Niama AC, Ngatse JA, Massala J, Matangelo GE, et al. Evidence on the Impact of Community Health Workers on Health Indicators in Congo: A Quasi-Experimental Temporal Study. Open J Epidemiol. 26 août 2025;15(3):712‑26.
14. Reyal HP, Perera MN, Guruge GND. Effectiveness of a community-based participatory health promotion intervention to address knowledge, attitudes and practices related to intimate partner violence: a quasi-experimental study. BMC Public Health. 27 mai 2024;24(1):1417.
15. Bosch‐Capblanch X, Liaqat S, Garner P. Managerial supervision to improve primary health care in low‐ and middle‐income countries. Cochrane Database Syst Rev. 7 sept 2011;2011(9):CD006413.
16. Haddad S, Bicaba A, Feletto M, Taminy E, Kabore M, Ouédraogo B, et al. System-level determinants of immunization coverage disparities among health districts in Burkina Faso: a multiple case study. BMC Int Health Hum Rights. 14 oct 2009;9(1):S15.
17. Zero-dose children and missed communities [Internet]. 2025 [cité 25 nov 2025]. Disponible sur: https://www.gavi.org/our-alliance/strategy/phase-5-2021-2025/equity-goal/zero-dose-children-missed-communities
18. Perry HB, Zulliger R, Rogers MM. Community Health Workers in Low-, Middle-, and High-Income Countries: An Overview of Their History, Recent Evolution, and Current Effectiveness. Annu Rev Public Health. 18 mars 2014;35(Volume 35, 2014):399‑421.
19. Gopalan SS, Mutasa R, Friedman J, Das A. Health sector demand-side financial incentives in low- and middle-income countries: a systematic review on demand- and supply-side effects. Soc Sci Med 1982. janv 2014;100:72‑83.
20. Singh KD, Alagarajan M, Ladusingh L. What Explains Child Malnutrition of Indigenous People of Northeast India? PLOS ONE. 29 juin 2015;10(6):e0130567.
21. A77/32 - Mises à jour et rapports futurs : renforcement des services de santé intégrés centrés sur la personne [Internet]. [cité 25 nov 2025]. Disponible sur: https://apps.who.int/gb/ebwha/pdf_files/WHA77/A77_32-fr.pdf
22. Habicht JP, Victora CG, Vaughan JP. Evaluation designs for adequacy, plausibility and probability of public health programme performance and impact. Int J Epidemiol. févr 1999;28(1):10‑8.
23. Sweeney S, Vassall A, Foster N, Simms V, Ilboudo P, Kimaro G, et al. Methodological Issues to Consider When Collecting Data to Estimate Poverty Impact in Economic Evaluations in Low-income and Middle-income Countries. Health Econ. févr 2016;25 Suppl 1(Suppl Suppl 1):42‑52.
24. Lewin S, Munabi-Babigumira S, Glenton C, Daniels K, Bosch-Capblanch X, van Wyk BE, et al. Lay health workers in primary and community health care for maternal and child health and the management of infectious diseases. Cochrane Database Syst Rev. 17 mars 2010;2010(3):CD004015.
25. Schneider H, Lehmann U. From Community Health Workers to Community Health Systems: Time to Widen the Horizon? Health Syst Reform. 2 avr 2016;2(2):112‑8.