**Factors Associated with Zero-Dose Childhood Vaccination Status in a Remote Fishing Community in Cameroon: A Cross-Sectional Analytical Study**

**Sangwe Clovis Nchinjoh 1,2,\*, Yauba Saidu 1,3, Valirie Ndip Agbor 1,4, Clarence Mvalo Mbanga 1, Nkwain Jude Muteh 5, Andreas Ateke Njoh 6,7, Shalom Tchofke Ndoula 6, Bernard Nsah 1, Nnang Nadege Edwige 1, Sveta Roberman 2,8 and Chen Stein Zamir <sup>2</sup>**

	- <sup>3</sup> Institute for Global Health, University of Siena, 53100 Siena, Italy
	- <sup>4</sup> Nuffield Department of Population Health, University of Oxford, Oxford OX1 2JD, UK
	- <sup>5</sup> Gavi, The Vaccine Alliance, 1202 Geneva, Switzerland
	- <sup>6</sup> Expanded Program on Immunization, Cameroon Ministry of Public Health,
		- Yaoundé P.O. Box 2084, Cameroon
	- <sup>7</sup> School of Global Health and Bioethics, Euclid University, Bangui BP 157, Central African Republic
	- <sup>8</sup> The Gordon Academic College of Education, Haifa 3570503, Israel
	- **\*** Correspondence: sangweclovis@gmail.com; Tel.: +237-678-687-939

**Abstract: Background**: Cameroon's suboptimal access to childhood vaccinations poses a significant challenge to achieving the Immunization Agenda 2030 goal—ranking among the top 15 countries with a high proportion of zero-dose (unvaccinated) children worldwide. There are clusters of zero-dose children in pockets of communities that traditionally miss essential healthcare services, including vaccination. The Manoka Health District (MHD) is home to such settlements with consistently low vaccination coverages (DPT-HepB-Hib-1: 19.8% in 2021) and frequent outbreaks of vaccinepreventable diseases (VPD). Therefore, the absence of literature on zero-dose children in this context was a clarion call to characterize zero-dose children in fragile settings to inform policy and intervention design. **Methodology**: This cross-sectional analytical study involved 278 children, 0–24 months of age, selected from a 2020 door-to-door survey conducted in the two most populous health areas in an archipelago rural district, MHD (Cap-Cameroon and Toube). We used R Statistical Software (v4.1.2; R Core Team 2021) to run a multivariable logistic regression to determine zero-dose associated factors. **Results**: The survey revealed a zero-dose proportion of 91.7% (255) in MHD. Children who were delivered in health facilities were less likely to be zero-dose than those born at home (AOR: 0.07, 95% CI: 0.02–0.30, *p* = 0.0003). Compared to children born of Christian mothers, children born to minority non-Christian mothers had higher odds of being zero-dose (AOR: 6.55, 95% CI: 1.04–41.25, *p* = 0.0453). Children born to fathers who are immigrants were more likely to be zero-dose children than Cameroonians (AOR: 2.60, 95% CI = 0.65–10.35, *p* = 0.0016). Younger children were likely to be unvaccinated compared to older peers (AOR: 0.90, 95% CI: 0.82–1.00, *p* = 0.0401). **Conclusions**: In the spirit of "leaving no child behind," the study highlights the need to develop context-specific approaches that consider minority religious groups, immigrants, and younger children, including newborns, often missed during vaccination campaigns and outreaches

**Keywords:** zero-dose; childhood vaccination; Cameroon
