Despite the availability and free access to basic vaccines under the Expanded Program on Immunization (EPI), the mortality rate among children aged 0–5 years remains relatively high worldwide due to vaccine-preventable diseases. Sub-Saharan Africa is particularly affected due to the low immunization coverage recorded. This study examines the effect of birth order on the vaccination status of children under 5 in Cameroon, considering the influence of cultural, economic and community factors.
To achieve this, a multinomial probit model was applied to the Demographic and Health Surveys (DHS) conducted in 1991, 1998, 2004, 2011 and 2018 by the National Institute of Statistics (INS). The EPI vaccination module was administered to 3,350, 2,317, 8,125, 11,732 and 9,733 children under 5 years old in 1991, 1998, 2004, 2011 and 2018 respectively. Vaccination was categorized into three groups: (1) zero vaccine, (2) partial immunization and (3) complete immunization.
The results reveal that birth order has a negative and significant effect on timely complete vaccination for children under 5, with the impact increasing with birth rank. Furthermore, the effect is more pronounced after adjusting for cultural factors, suggesting that cultural influences are at the root of biases that lead to vaccine rejection. Considering children under 2 years of age and vaccines administered within the first 4 months, the observed effect of birth rank emphasizes the contributions of routine vaccination, catch-up immunization and response campaigns in promoting vaccination for children under 5 years old.
The uniqueness of this study lies in its consideration of adherence to the vaccination schedule and the analysis of socio-cultural, socio-economic and community factors.
