Abstract：
BACKGROUND: Cameroon, a country in sub-Saharan Africa, ranks among the top 15 countries worldwide with the highest number of zero-dose (unvaccinated) children. Among other reasons, pockets of hard-to-reach communities that traditionally miss essential healthcare services, including childhood immunization, largely contribute to this sub-optimal vaccination coverage. This is the case of Manoka Health District (MHD), an archipelago district with a zero-dose proportion of 91.7%. High disease burdens such as malaria and water-borne diseases have forced the population to depend on herbalists and roadside drug vendors, eroding trust in the primary healthcare system and worsening vaccine hesitancy. This study, therefore, aims to describe how a project optimized vaccine demand generation in these hard-to-reach settlements using an integrated community health worker service delivery package developed using the Community-oriented primary healthcare (COPC) model.
METHODS: This cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis.
RESULTS: Over 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention.
CONCLUSIONS: The use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.
METHODS: This cross-sectional descriptive study was based on data collected from November 2021 to August 2022 in three project-implementing health areas (Kombo Moukoko, Kooh, and Toube) in the Manoka health district. Data was collected on the integrated health packages offered by Community Health Workers (CHWs). It comprised health education on malaria and water-borne diseases, screening for malaria using Rapid Diagnostic Test (RDT), treatment of under-5 for uncomplicated malaria and diarrhea, conduct of essential Antenatal Care (ANC) services, and vaccination counseling and referral in the three health areas. Microsoft Excel 2013 was used to analyze descriptive data and expressed results as percentages, with tables and column charts used for data visualization. All missing data were considered in the final analysis.
RESULTS: Over 550 under-5 children and 187 pregnant women were identified to be in need of curative and preventive care services during the project period. About 81% of pregnant women received a minimum ANC package by CHWs, and 47% adhered to referrals to health facilities for continuous ANC and delivery. Half of the children under 5 with health issues were diagnosed and managed for uncomplicated malaria. Also, during home visits, 617 under-immunized and zero-dose children less than two years of age were identified, referred, and vaccinated either during an outreach program or at the nearest health post in a neighboring health area, representing about 64% (617/964) of under-2 children identified in these communities. There was a gradual increase from 0% vaccine acceptance post-referral in the first month to 47% after six months and 64% at one year of intervention.
CONCLUSIONS: The use of the COPC model to co-develop integrated essential health service packages that meet the needs of communities showed value in building trust and increasing childhood immunization uptake in hard-to-reach communities.
摘要：
背景：喀麦隆，撒哈拉以南非洲的一个国家，在全球零剂量（未接种疫苗）儿童数量最多的15个国家中排名第一。除其他原因外，传统上错过基本医疗服务的难以到达的社区，包括儿童免疫,在很大程度上导致了这种次优的疫苗接种覆盖率。这是Manoka卫生区（MHD）的情况，零剂量比例为91.7%的群岛区。疟疾和水传播疾病等高疾病负担迫使民众不得不依赖中医和路边的毒贩,侵蚀对初级医疗保健系统的信任，恶化疫苗的犹豫。这项研究,因此,旨在描述一个项目如何在这些难以到达的定居点中优化疫苗需求生成，该项目使用了使用面向社区的初级医疗保健（COPC）模型开发的综合社区卫生工作者服务提供包。
方法：这项横断面描述性研究基于2021年11月至2022年8月在三个项目实施卫生领域收集的数据（KomboMoukoko，Kooh,和Toube）在Manoka卫生区。收集了社区卫生工作者（CHW）提供的综合卫生包的数据。它包括关于疟疾和水传播疾病的健康教育，使用快速诊断测试（RDT）筛查疟疾，5岁以下儿童治疗无并发症的疟疾和腹泻，开展基本的产前保健(ANC)服务，以及三个卫生领域的疫苗接种咨询和转诊。MicrosoftExcel2013用于分析描述性数据，并以百分比表示结果，用于数据可视化的表和柱状图。在最终分析中考虑所有缺失的数据。
结果：在项目期间，超过550名5岁以下儿童和187名孕妇需要治疗和预防保健服务。约81％的孕妇接受CHWs的最低ANC包装，47%的人坚持转诊到医疗机构进行持续的ANC和分娩。有健康问题的5岁以下儿童中有一半被诊断和管理为简单的疟疾。此外，在家访期间,确定了617名免疫不足和零剂量的2岁以下儿童，引用,并在外展计划期间或在邻近卫生区最近的卫生站接种疫苗，代表这些社区中确定的2岁以下儿童中约有64％（617/964）。从转诊后的第一个月的0％疫苗接受度逐渐增加到六个月后的47％和干预一年时的64％。
结论：使用COPC模式共同开发满足社区需求的综合基本卫生服务包显示出在难以到达的社区中建立信任和增加儿童免疫接种的价值。
方法：这项横断面描述性研究基于2021年11月至2022年8月在三个项目实施卫生领域收集的数据（KomboMoukoko，Kooh,和Toube）在Manoka卫生区。收集了社区卫生工作者（CHW）提供的综合卫生包的数据。它包括关于疟疾和水传播疾病的健康教育，使用快速诊断测试（RDT）筛查疟疾，5岁以下儿童治疗无并发症的疟疾和腹泻，开展基本的产前保健(ANC)服务，以及三个卫生领域的疫苗接种咨询和转诊。MicrosoftExcel2013用于分析描述性数据，并以百分比表示结果，用于数据可视化的表和柱状图。在最终分析中考虑所有缺失的数据。
结果：在项目期间，超过550名5岁以下儿童和187名孕妇需要治疗和预防保健服务。约81％的孕妇接受CHWs的最低ANC包装，47%的人坚持转诊到医疗机构进行持续的ANC和分娩。有健康问题的5岁以下儿童中有一半被诊断和管理为简单的疟疾。此外，在家访期间,确定了617名免疫不足和零剂量的2岁以下儿童，引用,并在外展计划期间或在邻近卫生区最近的卫生站接种疫苗，代表这些社区中确定的2岁以下儿童中约有64％（617/964）。从转诊后的第一个月的0％疫苗接受度逐渐增加到六个月后的47％和干预一年时的64％。
结论：使用COPC模式共同开发满足社区需求的综合基本卫生服务包显示出在难以到达的社区中建立信任和增加儿童免疫接种的价值。
