**3. Results**

This study included annual DTP-1 and DTP-3 vaccination coverages from all districts in the COVID-19 hotspot regions, representing one-third of districts (56/189) in Cameroon. Based on the DHIS-2 data quality assessment tool, data completeness in the pre-pandemic period was 96% and 100% in the Littoral and Centre regions, respectively. In addition, in the pandemic period, data exhibited 91% and 94% completeness in the Littoral and Centre regions, respectively.

Basing on these assumptions, our results unveiled a significant drop in vaccination coverage of 3.3% and 5.4% in DTP-1 and DTP-3 coverages, respectively. As a result, 8247 children missed DTP-1, and 12,896 children did not receive DTP-3 vaccines in the pandemic period compared to the results for pre-pandemic period in the two hotspot regions. This is contrary to the trend in national data, as shown in Figures 1 and 2. Additionally, most districts reported a decline in childhood immunization access (62.5%) and utilization (71.4%), ranging from a drop of 0.1% to 43.7% in vaccination coverage.

**Figure 1.** Change in DTP-1 and DTP-3 coverage in hotspot regions during the pandemic.

**Figure 2.** Number of children who missed vaccination in hotspot regions and contrasting national gain in children vaccinated during the pandemic.

As presented in Tables 1 and 2, in the Littoral Region, 46% (11/24) of districts experienced a decreased vaccination access, which ranged from 2.6% to 29.4%. Moreover, 58% (14/24) of districts experienced decreased vaccine utilization, which ranged from 0.1% to 28.3%. The adjusted drop in vaccination coverage in the Littoral Region was 0.8% (*p* = 0.0002) and 3.1% (*p* = 0.0003) for DTP-1 and DTP-3 vaccination coverages, respectively. This implies that about 748 children missed DTP-1 vaccines, and 2898 children the Littoral Region did not receive DTP-3 vaccines during the pandemic compared to the pre-pandemic period.


**Table 1.** DTP-1 coverage variations in the pre-pandemic and pandemic period in the Littoral Region.

\* The negative sign (−) shows a drop in coverage after the pandemic compared to before, while a positive sign (+) indicates an increase in coverage.




**Table 2.** *Cont.*

\* The negative sign (−) shows a drop in coverage after the pandemic compared to before, while a positive sign (+) indicates an increase in coverage.

Meanwhile, as shown in Tables 3 and 4, the Centre Region experienced a 5.7% (*p* < 0.0001) drop in DTP-1 and a 7.6% (*p* < 0.0001) drop in DTP-3 coverage, with about 7498 children missing DTP-1 and 9998 others missing DTP-3 during the pandemic compared to the pre-pandemic period. This decrease in DTP-1 vaccination coverage was reported in 75% (24/32) of districts, ranging from a 2.1% to a 31.6% drop in coverage. Likewise, 81% (26/32) of districts showed a decreased DTP-3 vaccination coverage in the pandemic period, with a 2.5% to a 43.7% drop in coverage.

**Table 3.** DTP-1 coverage variations in the pre-pandemic and pandemic period in the Centre Region.


\* The negative sign (−) shows a drop in coverage after the pandemic compared to before, while a positive sign (+) indicates an increase in coverage.


**Table 4.** DTP-3 coverage variations in the pre-pandemic and pandemic period in the Centre Region.

\* The negative sign (−) shows a drop in coverage after the pandemic compared to before, while a positive sign (+) indicates an increase in coverage.
