The United Republic of Cameroon is a Central African country that covers an area of 475,440 square km. Due to its location, Cameroon receives many refugees and experiences major migratory movements.
Cameroon’s predominant disease pattern is often attributed to its equatorial climate and geographical features, which include coastal plains, isolated volcanic heights, mountain chains and plateaus. Cameroon’s 2005 population census showed a young population, with more than 50% of Cameroon’s people younger than 25. In early 2010, the population was estimated at 19.4 million, and the annual average population growth rate is estimated at 2.6%. Cameroon’s varied geography hinders access to services in many places and isolates some communities. Population movements associated with lifestyle (e.g., among pygmy populations, the Bororo, and herders), and/or broader socioeconomic and political dynamics (immigration, refugee flows, and border crossings), can undermine immunization programs and preventive services, especially if they are not integrated into existing systems.
UNICEF figures recorded an under-five child mortality rate in 2009 of 154%. The same year, the mortality rate in children under one-year-old was 95%, while the neonatal mortality rate was 36%. Reported coverage of delivery by skilled health personnel during the period 2005–2009 was 63%. The UNDP’S Human Development Index considers Cameroon, where 33% of the population lives below the poverty threshold (1994–2008), a country with a low average income.
During the economic crisis of the 1980s–1990s, which led to the adoption of the World Bank and the International Monetary Fund (IMF) structural adjustment programs, Cameroon’s social service budget was reduced. Ten years later, Cameroon was admitted to the World Bank-IMF Highly Indebted Poor Countries Initiative, which made additional resources available between 2001 and 2003, and helped strengthen the education and health sectors. Between 1998 and 2008, health comprised 3% of central government expenditure.
The health system consists of three components: Public services, private services, and traditional healers, who are often people’s first choice for health care. The Ministry of Public Health has offices in each of the country’s ten administrative regions. The operational/administrative focal point of the health system is the health district, which is divided into health areas or smaller operational units for implementation of outreach strategies, follow-up of dropouts, and social mobilization.
According to experts in this field, immunization statistics in Cameroon are considered generally reliable. EPI data underwent quality audits in 2001 and 2004. For most of the districts, the 2010 coverage estimates were based on population figures from the 2005 census (published in June 2010), with the application of an annual demographic growth rate of 2.6%. In most cases, immunization coverage rates are not derived from empirical investigations but from administrative data. Thus they may presumably bear biases due to local population dynamics (immigration, population displacement, variations in fertility rates, and infant mortality) that may affect the denominators.
Immunization coverage in Cameroon has grown steadily since 1980. The clearest advances were made during the 1980s. Universal childhood immunization (UCI) played a key role in the last five years of the 80s, with Cameroon receiving UNICEF technical and financial support for the immunization system. Nevertheless, UCI was not achieved in Cameroon and a drop was recorded in this increased coverage between the late 1980s and mid-1990s. Since then, consistent coverage increases have been recorded through 2010, with a decrease in 2009.