The Effect of the Ongoing Civil Strife on Key
Total Page：16
File Type：pdf, Size：1020Kb
Saidu et al. Conflict and Health (2021) 15:8 https://doi.org/10.1186/s13031-021-00341-0 RESEARCH Open Access The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon Yauba Saidu1,2* , Marius Vouking3,4, Andreas Ateke Njoh5,6, Hassan Ben Bachire3, Calvin Tonga3, Roberts Mofor7, Christain Bayiha3, Leonard Ewane3, Chebo Cornelius7, Ndi Daniel Daddy Mbida5, Messang Blandine Abizou8, Victor Mbome Njie8,9 and Divine Nzuobontane1 Abstract Background: Civil strife has long been recognized as a significant barrier in the fight against vaccine preventable diseases in several parts of the world. However, little is known about the impact of the ongoing civil strife on the immunisation system in the Northwest (NW) and Southwest (SW) regions of Cameroon, which erupted in late 2016. In this paper, we assessed the effect of the conflict on key immunisation outcomes in the North West and South West regions of Cameroon. Methods: Data were obtained from the standard EPI data reporting tool, the District Vaccine and Data Management Tool (DVDMT), from all the districts in the two regions. Completed forms were then reviewed for accuracy prior to data entry at central level. Summary statistics were used to estimate the variables of interest for each region for the years 2016 (pre-conflict) and 2019 (during conflict). Results: In the two regions, the security situation has deteriorated in almost all districts, which in turn has disrupted basic healthcare delivery in those areas. A total of 26 facilities were destroyed and 11 healthcare workers killed in both regions. Reported immunisation coverage rates for key antigens including, BCG, DPT-3 and MR, witnessed a dramatic decline between 2016 and 2019, ranging from 22% points decline for BCG in the NW and to 42% points decline for DPT-3 in the SW. Similarly, the proportion of districts with DPT-3 coverage of at least 80% dropped from 75% in 2016 to 11% in 2019 in the NW. In the SW this proportion dropped from 16% in 2016 to 0 % in 2019. Conclusion: Our data demonstrates the marked negative impact of the ongoing civil strife on key immunisation outcomes in the two regions and the country at large. This decline could amplify the risk of vaccine preventable diseases vaccine preventable diseases outbreaks in the two regions. Besides the ongoing actions to contain the crises, effective strategies for reaching children in the conflict zones as well as the internally displaced population are needed. There is also the need to rebuild destroyed facilities as well as to protect health facilities and staff from targeted violence. Keywords: Immunisation coverage, Civil strife, Conflict, Anglophone crises, Cameroon * Correspondence: [email protected]; [email protected] 1Clinton Health Access Initiative, Cameroon Country Office, Third floor, Y-building, Rue 1775, Nouvelle Route Bastos, Yaoundé, Cameroon 2Institute for Global Health, University of Siena, Siena, Italy Full list of author information is available at the end of the article © The Author(s). 2021 Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Saidu et al. Conflict and Health (2021) 15:8 Page 2 of 8 Introduction Methods There is increasing recognition from the global health Study settings community that the goal of equitably extending the ben- The study was conducted in Cameroon, which is politic- efits of immunisation to all infants is far from being ally divided into ten regions: eight of which are French achieved [1]. One underlying reason for this is that a siz- speaking and the remaining two are English speaking. able proportion of infants reside in areas with civil strife. This dichotomy can be traced back to World War I, In 2017, for instance, nearly 8 million unimmunized in- when France and Britain joined forces to attack and fants resided in areas with civil strife [2], where a sizable seize Cameroon, which until then was a German colony. number of them died from diseases that could have been Following the seizure, the German colony was split into easily and affordably prevented by vaccines [3, 4]. two entities and 83% of the territory was awarded to The death toll is often high because civil strife habit- France by the League of Nation and the remaining 17% ually creates conditions that increase susceptibility to to Britain [20]. Each of these countries then influenced VPDs, while also damaging immunization systems. Civil its mandated territory with its language and culture and strife can lead to mass displacement of people, over- eventually, these territories evolved into Francophone crowding, and limited access to food, water, hygiene and and Anglophone zones. Currently, there are two Anglo- sanitation services [5], which invariably amplify the phone regions - the NW and SW regions - which are spread of, and mortality from, vaccine preventable home to nearly 5 million people, with diverse cultural diseases (VPD) [6, 7]. For example, overcrowding may and traditional backgrounds. Over 44% percent of this increase the risk of measles and pneumonia while re- population reside in rural areas [20], where the main stricted food access can result in malnutrition, which in economic activities are farming and fishing [20]. turn may increase susceptibility to VPD [8] as well as limit the generation of robust immune responses after vaccination [9]. In addition, civil strife can also cripple Organisation of immunisation system in the North West immunisation systems through the destruction of build- and South West regions ings, decimation of staff, and disruption of supply lines Both regions are divided into Health Districts (HD), and service delivery, which in turn can lead to a sizable which in turn are divided into health areas. Each health decline in immunisation programme performance [10]. area has a leading health facility, which is generally pub- In Afghanistan, for instance, a marked deterioration of lic, but can be private in some health areas. The leading immunisation system was noted following the onset of facility coordinates the distribution of vaccines and sup- armed conflict in 2001 [4]. Similar deteriorations, which plies and reports coverage rates for all facilities, both eventually triggered outbreaks of polio, have been re- public and private, within the health area. Prior to the ported from Chad [11], Central African Republic [12], crises, the SW had 18 functional health districts, and Pakistan [13], South Sudan [14], Somalia [15] and 308 health facilities, of which 255 (83%) were offering Ukraine [16] amongst others. In almost all of these immunisation services [21]. The North West region, on countries, onset of armed conflicts resulted into a sud- the other hand, had 19 functional districts, and 400 den drop in vaccination coverage, with some countries health facilities, of which 351 (88%) were offering im- registering national coverages below 50% [17]. munisation. These facilities obtain vaccines and other Although the devastating effect of conflicts on the im- immunisation supplies from the districts on a monthly munisation system has been documented in many basis via a pull mechanism and deliver them to the tar- countries, little is known about the influence of the on- get population according to the following schedule: going civil strife on Cameroon’s immunisation system. One dose of Bacillus Calmette-Guerin (BCG) at Cameroon has enjoyed decades of peace until late 2016 birth or on first contact by a health worker, three when armed violence erupted in the NW and SW regions doses of diphtheria, pertussis and tetanus containing [18]. The conflict is characterized by fierce fighting be- vaccines (DPT1, DPT2 and DPT3) and 13- tween several separatist militia groups and government pneumococal conjugate vaccine (PCV-13) at 6, 10 and forces [19]. The security situation in almost all health dis- 14 week, four doses of oral polio vaccine (OPV0, tricts in these regions has been extremely delicate and ac- OPV1,OPV2andOPV3)atbirth,6,10and14weeks, cess to healthcare services has become a major concern. two doses of rotavirus vaccine at 6 and 10 weeks, one The protracted nature of the conflict has adversely af- dose of inactivated polio vaccine (IPV) at 14 weeks, fected the immunisation programme and despite efforts at and one dose of yellow fever and combined measles various levels, provision of immunisation services to those and rubella vaccine (MR) at 9 months (Table 1). Ac- who need it has become extremely challenging. In this cording to national guidelines, these vaccines are ad- paper, we assess the impact of this conflict on various im- ministered to all eligible infants at the facility on munisation outcomes in the two regions. daily basis and in outreach sites, where feasible [22]. Saidu et al. Conflict and Health (2021) 15:8 Page 3 of 8 Table 1 Immunization schedule in Cameroon. Illustrates the vaccination calendar of Cameroon. Each color is assigned to a particular vaccine.