- Systematic Review
- Open access
- Published:
COVID- 19 vaccine uptake and its determinants in Cameroon: a systematic review and meta-analysis (2021–2024)
BMC Infectious Diseases volume 25, Article number: 525 (2025)
Abstract
Background
COVID-19 vaccination is crucial for mitigating the pandemic's impact. However, vaccine hesitancy and access challenges have hindered global vaccination efforts. This meta-analysis aimed to estimate the pooled COVID-19 vaccine uptake proportion and identify associated determinants in Cameroon.
Methods
This review, conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, identified articles through searches of electronic databases, including PubMed, ScienceDirect, and Google Scholar, as well as through gray literature. The search encompassed published and unpublished studies from 2021 to 2024 reporting on COVID-19 vaccine uptake and/or acceptance in Cameroon. Extracted data were compiled in a Microsoft Excel spreadsheet and analyzed using R statistical software (version 4.4.2). A random-effects model was employed when heterogeneity exceeded 50%. Publication bias was assessed using funnel plots, Egger’s and Begg's tests. Meta-regression was used to explore the influence of study characteristics.
Results
Twenty-two studies, encompassing 24,130 participants, were included. The pooled vaccine uptake proportion was 37.14% (95% CI: 29.24–45.05) with substantial heterogeneity (I2 = 98.2%, p < 0.001). Subgroup analyses revealed lower uptake among the general population (23.18%; 95% CI: 10.11–36.25) and in community settings (16.0%; 95% CI: 0.97–31.04) compared with healthcare workers (42.12%; 95% CI: 34.14–50.09). Younger age (OR = 0.53; 95% CI: 0.42–0.67) was inversely associated with vaccine uptake, while being in a partnership (OR = 1.59; 95% CI: 1.11–2.27) was positively associated. Higher levels of education (OR = 1.75; 95% CI: 1.56–1.97), urban residence (OR = 1.66; 95% CI: 1.21–2.29) were positively associated with vaccine acceptance.
Conclusion
This meta-analysis revealed a suboptimal pooled COVID-19 vaccine uptake required to ensure a herd immunity. The results of this meta-analysis underline the crucial need to step up efforts to improve vaccination coverage, particularly among the most vulnerable populations. Identifying and addressing the factors underlying this low coverage is imperative if public health objectives are to be met. Public health interventions should be tailored to address the specific concerns and needs of different age groups and marital statuses.
Background
Since the initial report of a case in Wuhan, China [1], Coronavirus disease 2019 (COVID- 19) has spread rapidly across the globe, subsequently becoming a significant public health challenge [2]. Vaccination has historically played a crucial role in enhancing global public health outcomes, contributing to increased life expectancy and representing a highly cost-effective intervention for disease prevention [3].
During the pandemic, effective vaccine use was imperative to mitigate the associated social and economic burden and for establishing a viable exit strategy from the COVID- 19 pandemic [1]. In this regard, a global analysis estimated that COVID- 19 vaccination would save 2.5 million lives or 15 million life-years during 2020–2024, representing approximately 1% of total global mortality during this period [4]. A study reported that COVID- 19 vaccines reduced deaths by 59% overall, which equates to approximately 1.6 million lives saved in Europe [5].
Cameroon's COVID- 19 vaccination outbreak began after the first confirmed case was reported on March 6, 2020. The government immediately introduced vaccination as part of its preventive measures. [6]. The country's health authorities, led by the National Immunization Technical Advisory Groups and the Scientific Advice for Public Health Emergencies, approved four vaccines against COVID- 19 [7]. However, the vaccination coverage remained relatively low. As of July 22, 2023, approximately 6.8% of the eligible population had been vaccinated, falling far short of the global goal of 70% coverage by the end of that year [8, 9]. The Janssen vaccine was the most widely administered and at that time, notable gender and geographical disparities in vaccine uptake were observed in the country [6, 10].
Despite the availability of various vaccines against COVID- 19, ensuring equitable access for everyone remained a significant challenge [2]. The efficacy of the COVID- 19 vaccines in controlling disease transmission and save lives was contingent upon achieving sufficient vaccine coverage (60–90%) [7]. However, concerns regarding potential adverse events and uncertainties about vaccine effectiveness have contributed to COVID- 19 vaccine hesitancy [7, 10]. Vaccine hesitancy is recognized as one of the top ten leading threats to global health. A distorted perception of disease risk, inadequate knowledge regarding vaccines, apprehension about adverse reactions, proliferation of misinformation and unsubstantiated claims are some of the key elements contributing to this public health problem [11]. Vaccine hesitancy adversely affected the vaccine uptake and impeded efforts to control the pandemic [12]. COVID- 19 vaccine hesitancy is associated with a range of factors, including sociodemographic factors (female gender, younger age, nursing profession, lack of prior influenza vaccination), concerns about vaccine safety and efficacy, and mistrust of government and institutions [6, 10, 13].
Although the COVID- 19 public health emergency of international concern was declared over in May 2023, current WHO recommendations emphasize the continued need to vaccinate priority populations at highest risk for severe COVID- 19 disease and mortality. These recommendations also advocate for building more sustainable programs by integrating COVID- 19 vaccination into primary health care, strengthening immunization across the life course, and improving pandemic preparedness [14].
The optimal implementation of these recommendations at national level required monitoring of evidence-based data to inform decision-making. In this regard, several studies conducted in Cameroon have assessed COVID- 19 vaccine uptake and associated factors. These reports underscore variable degree of vaccine acceptance and uptake. To the best of our knowledge no previous systematic review and meta-analyses assessing COVID- 19 vaccine uptake and its determinants have been conducted in Cameroon. Beyond simply addressing the gap in research, this meta-analysis seeks to provide actionable data that can directly guide vaccination campaigns and inform health policies specific to Cameroon. By synthesizing existing evidence, this study aims to identify key determinants of vaccine uptake, allowing for targeted interventions to improve coverage and ultimately enhance public health outcomes in the country.
Methods
Study design
This systematic review and meta-analysis were conducted to assess the proportion of vaccine uptake and associated factors. The study results are reported based on the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines [15].
Study setting
Cameroon occupies a total land area of 472,650 km2 and geographically divided into ten administrative regions: Centre, Littoral, Far-North, North, Adamawa, North-West, South-West, West, East and South. Demographic data for 2023 indicate an estimated population of approximately 28.6 million. The nation has a dual capital structure: Yaoundé, located in the Central Region, serves as the designated political capital, while Douala, located in the Littoral Region, serves as the primary economic center driving national economic growth [16].
Eligibility criteria
This systematic review included all existing published and unpublished research documenting the COVID- 19 vaccine uptake and acceptance in Cameroon. Quantitative studies reporting individuals who received at least one dose of a COVID- 19 vaccine were included. Studies lacking clearly defined outcome variables were excluded. Duplicate articles were identified and subsequently removed prior data extraction. The review was restricted to articles published in English or French. No temporal restrictions on publication date were imposed, as there were no prior systematic reviews and meta-analyses investigating vaccine uptake in the country at the time of the search.
Article searching strategy
A systematic search of electronic databases, including PubMed, Google Scholar, Scopus, and ScienceDirect, was performed to identify published studies. The search strategy included analysis of the text within the title and abstract of each study. A combination of keywords and Medical Subject Headings (MeSH) terms was employed, utilizing Boolean logic operators ("AND"and"OR") to refine the search. The keywords and MeSH terms included"coronavirus OR COVID- 19 AND vaccine AND acceptance OR willingness OR hesitancy OR uptake OR intention OR perception AND Cameroon."To ensure a comprehensiveness, a manual search was conducted to identify additional published articles not indexed in electronic databases. Unpublished studies were sought at the University of Yaoundé I library. Furthermore, the reference lists of identified studies were screened to identify further relevant articles. The last search was conducted on November 15, 2024 (Additional files 1, Supplementary Table 1).
Data extraction
Data were extracted from all eligible articles using a predefined Microsoft Excel 2016 form to collect study characteristics. For the first outcome (vaccine uptake assessment), the data extraction checklist included the first author’s name, study year, region, study design, setting, study participants, sample size, reported vaccine uptake. For the secondary outcome (assessment of determinants), extracted data included the crude odds ratios and their corresponding confidence intervals. The natural logarithm of each odds ratio and its corresponding upper and lower limits were calculated based on the results reported in the original studies. Two authors independently assessed each article for relevance and quality. Discrepancies between reviewers were resolved through discussion with a third reviewer to achieve consensus.
Data quality assessment
The quality of the included studies was assessed using the Joanna Briggs Institute (JBI) quality assessment tool for prevalence studies [17]. Nine criteria were employed to assess the risk of bias for each study. These criteria included appropriateness of the sampling frame, use of a suitable sampling technique, adequate sample size, description of study subjects and setting, sufficient data analysis, use of valid methods for identifying conditions, use of valid measurements for all participants, use of appropriate statistical analysis, and an adequate response rate (≥ 60%). Each criterion was scored as 1 (yes) or 0 (no or unclear). The risk of bias was categorized as low (5–9), moderate (3–4), or high (0–2).
Outcome measurement
This systematic review and meta-analysis had two main outcomes. The primary outcome was COVID- 19 vaccine uptake, estimated as the total number of individuals who received the COVID- 19 vaccine divided by the total number of participants who responded to the question, expressed as a percentage. The secondary outcome was the determinants of willingness to accept the COVID- 19 vaccine and actual vaccine uptake. These determinants were assessed using odds ratios calculated from binary outcomes reported in primary studies. The key factors identified through review of the primary articles were age (< 30 vs. ≥ 30 years), sex (female vs. male), educational level (primary vs. none, secondary vs. none/primary, tertiary vs. none/primary), marital status (in a partnership vs. other), religion (other vs. Christian), professional group (other vs. doctor), employment status (unemployed vs. employed), residence (urban vs. rural), number of household members (< 5 vs. ≥ 5), and past history of comorbidity (yes vs. no).
Operational definition
Vaccine uptake was defined as having received at least one dose of any COVID- 19 vaccine approved in Cameroon [7]. Vaccine acceptance refers to the intention or willingness to receive the vaccine, not the actual administration (uptake) of the vaccine itself [12]. It was defined as a"yes"response to the question,"Will you accept COVID- 19 vaccination if it was available?".
Statistical analysis and synthesis
Heterogeneity between studies was assessed using the I2 statistic. Heterogeneity was then categorized as low (< 25%), moderate (25–75%), and high (> 75%). Subgroup analysis was performed for study year, region, setting, and type of participants enrolled. A random-effects model was employed when heterogeneity exceeded 50%. Meta-regression was performed to investigate whether study characteristics could explain the variability in results across studies. The examined study characteristics included the year the study was conducted (≤ 2022 or > 2022), region (other Regions vs. Centre), setting (other settings, including online- and community vs. hospital-based), sample size (< 300 and ≥ 300), study participant type (healthcare workers vs. general population), and sampling method (probabilistic vs. non-probabilistic). Only study variables with meaningful and practical categories were considered. All the studies assessing each selected explanatory variables were included in the meta-regression analysis. Univariate and multivariate meta-regression models were used to assess whether vaccination uptake varied according to the selected explanatory variable categories. A p-value < 0.05 was considered statistically significant. The “meta” package was used to perform analysis using R Statistics version 4.4.2 [18].
Publication bias and sensitivity test
Publication bias was assessed visually using the funnel plot. A funnel plot displaying a symmetrical, inverted funnel shapes suggested the absence of publication bias. To further investigate potential publication bias, Egger's linear regression and Begg’s rank correlation tests were performed, with a significance level of p < 0.05. Sensitivity analysis was conducted by iteratively excluding one study at a time to explore the robustness of the findings.
Results
A total of 1603 records were retrieved from the database search (n = 1599) and from unpublished research studies (gray literature; n = 4). After removing 167 duplicate records, 1436 records remained. Titles/abstracts, followed by full text articles were then screened for eligibility. Ultimately, 22 study reports met the eligibility criteria and were included in this systematic review and meta-analysis (Fig. 1).
Selection of studies
Characteristic of reports included
A comprehensive analysis included 22 studies encompassing a total 24,130 participants. These studies, conducted between 2021 and 2024, involved both general population and healthcare workers in healthcare settings across the country and provided estimates of COVID- 19 vaccine uptake and determinants of acceptance and uptake. All included studies employed a cross-sectional design (Table 1).
COVID- 19 vaccine uptake
The overall pooled vaccine coverage was 37.14% (95% CI: 29.24–45.05); I2 = 98.2% with p < 0.001 (Fig. 2).
The lowest pooled estimates of COVID- 19 vaccine uptake were observed in studies conducted within communities (16.0%; 95% CI: 0.97–31.04, n = 2 studies) and among general population (23.18%; 95% CI: 10.11–36.25, n = 4 studies). Regarding geographical trends, with the exception of the North-west Region (which contributed only one study), the lowest coverage was observed in the South-west Region (35.82%; 95% CI: 18.91–52.73, n = 2 studies). The most recent pooled estimate (2024) was 34.57% (95% CI: 16.84–52.30, n = 2 studies). The highest pooled estimate was observed among healthcare workers 42.12% (95% CI: 34.14–50.09, n = 11 studies) (Figs. 3 and 4).
Meta-regression analysis
Univariate analysis showed that the study participant characteristic demonstrated a positive influence on the heterogeneity of vaccine uptake (β = 0.9747; p = 0.008), but this effect was not robust when other characteristics were considered in the multivariate meta-regression analysis (Table 2).
Publication bias and sensitivity test analysis
A large and almost symmetrical distribution of data points was observed in the funnel plot suggesting a low risk of publication bias. In addition, the Egger's linear regression (p = 0.287) and Begg’s rank correlation (p = 0.217) tests confirmed the absence of statistically significant publication bias (Fig. 5).
Sensitivity analysis, assessing the impact of individual studies and outliers on the overall results, demonstrated that no single study exerted a significant impact on the overall pooled estimate (Fig. 6).
Determinant of vaccine uptake
Participant age and marital status were significantly associated with the vaccine uptake. Individuals under 30 years of age were 47% less likely to receive the vaccine compared with those 30 years and older (OR = 0.53; 95% CI: 0.42–0.67). Individuals in partnership in the country were 59% more likely to be vaccinated than those in other marital status categories (OR = 1.59; 95% CI: 1.11–2.27). Although non statistically significant, the presence of comorbidity showed a moderate positive association with COVID- 19 vaccine uptake (OR = 2.77; 95% CI: 0.39–19.57) (Fig. 7, Table 3).
Determinant of vaccine acceptance
Individuals with a secondary level of education were significantly 75% more willing to receive the COVID- 19 vaccine than those with no formal education or a primary level of education (OR = 1.75; 95% CI: 1.56–1.97). Those residing in urban areas were 66% more likely to accept the vaccine than those residing in rural areas (OR = 1.66; 95% CI: 1.21–2.29). The odds of accepting the vaccine were almost four times higher among individuals living with one or more chronic conditions than those without comorbidity, although this association was not statistically significant (OR = 3.56; 95% CI: 0.34–37.14) (Table 4, Additional files 2, Supplementary Fig. 1 to 12).
Discussion
This study was conducted to determine the proportion of vaccine uptake and identify associated factors. A total of 22 reports were retrieved from online platforms and gray literature. The inclusion of gray literature enabled the incorporation of unpublished findings and reduced the potential for publication bias arising from the non-publication of negative results.
Vaccination coverage
The overall pooled vaccination coverage was 37.14% (95% CI: 29.24–45.05), with a high level of heterogeneity. This vaccination coverage was significantly lower than the 70% target set by global health authorities for the end of 2022 [9]. The vaccination uptake rate was also lower the global uptake rate trend situated around 42.3% (95% CI: 38.2–46.5) [38].Our study demonstrates relatively stable vaccination coverage across study (30–40%) across the study period (2021–2024) reflecting persistent vaccine barriers (including hesitancy) and the mitigating effect of efforts to increase vaccine uptake. The country has conducted several rounds of vaccination against the COVID- 19 since the vaccination campaign launch in March 2021, with the most recent occurring in November 2022 [7]. Despite national efforts to achieve herd immunity within the community by achieving at least 60% vaccination coverage, vaccine hesitancy remained of critical obstacle to achieving this goal [6, 39]. Studies have identified several barriers to vaccination, including concerns about vaccine-related adverse events, doubts about the composition of the vaccine, and blood-injection-injury fears, which may explain approximately 10% of cases of COVID- 19 vaccine hesitancy [10, 40].
A meta-analysis from Ethiopia in 2024 reported a pooled vaccination coverage (29.6%; 95% CI: 28.7–30.6), a finding not significantly different from our results. Our findings corroborate observations from a weekly report of April 2024, which indicated that 38% of the African Region’s population had received ≥ 1 dose of COVID- 19 vaccine [14].
Regarding geographical trends, with the exception of the North-West Region, the lowest pooled vaccination coverage was observed in the South-West Region (35.82%; 95% CI: 18.91–52.73). They represent Regions where several armed groups steer security challenges for almost a decade in Cameroon [41, 42]. Studies have highlighted the adverse impact of the crisis on the health system in general and on the immunization service in particular, which may explain the observed COVID- 19 vaccination coverage [41,42,43]. Beyond security challenges, limitations in healthcare facilities, staffing, and logistical capabilities likely impacted vaccine distribution and administration should be considered. Furthermore, vaccine access, including transportation, vaccination site availability, and effective communication strategies, requires thorough evaluation [44]. The low pooled vaccination coverage in the South-West Region might also reflect disparities in public health education, cultural beliefs, and trust in healthcare institutions [12]. A nuanced analysis of these multifaceted factors is crucial for developing targeted interventions to improve vaccine uptake in these regions and across Cameroon.
Healthcare workforce is one of the six pillars of the healthcare system [45, 46]. Their contribution to the pandemic response was essential during the implementation of the response strategy and has been recognized by global health authorities [47, 48]. This population had the highest pooled estimate of vaccine uptake in Cameroon (42.12%; 95% CI: 34.14–50.09). This is significant because they are at the forefront of the pandemic management and their compliance with vaccination is critical not only to prevent their own infection by this life-threatening disease but also to limit the disease transmission within healthcare settings [48, 49]. Our findings, however, were significantly lower than the reported vaccine uptake among healthcare workers in Africa (65.6%) and worldwide (77.3%) [13]. This suggests that efforts are still needed to improve vaccination coverage among this professional group, which is particularly vulnerable during pandemics.
Vaccination determinant
Individuals under 30 years of age were 47% significantly less likely to receive the vaccine compared with those aged 30 years and older. Several factors could explain these findings. Risk perception may be lower among younger adults, who generally perceive themselves to be at lower risk for severe COVID- 19 than older adults. This lower perceived risk may translate into a lower perceived need for vaccination. Misinformation and social media influence may have a greater impact among younger adults who are often more active on social media platforms where misinformation and vaccine hesitancy narratives may proliferate rapidly. This exposure may negatively influence their attitudes toward vaccination. The prioritization of older age groups and those with comorbidities during initial vaccine rollouts in many countries may have contributed to the perception among younger adults that vaccination was less urgent for them. A meta-analysis in Ethiopia found that younger adult exhibited lower acceptance of the COVID- 19 vaccine [50].
Individuals in partnership in the country were 59% more likely to be vaccinated than those in other marital status categories. Shared decision-making and social influence within the household may explain this finding. Indeed, individuals in partnerships may discuss health decisions, including vaccination, with their partners. This shared decision-making process could lead to increased vaccine uptake if one partner is inclined to be vaccinated. Furthermore, if one partner is vaccinated, the other may be more likely to follow suit because of concerns about protecting their partner and maintaining a healthy household [51].
Although not statistically significant, the presence of comorbidity showed a positive association with COVID- 19 vaccine uptake (OR = 2.77; 95% CI: 0.39–19.57). This observation aligns with the understanding that individuals with underlying health conditions are at higher risk of severe COVID- 19, making vaccination more important for them. Further research with larger sample sizes is warranted to confirm this association.
While our analysis revealed that vaccine acceptance is significantly influenced by education level and urban residence, vaccine uptake was more strongly associated with age, marital status, and comorbidities. This divergence suggests that factors influencing the willingness to be vaccinated (acceptance) may differ substantially from those affecting the actual act of receiving the vaccine (uptake). For instance, the finding that younger individuals exhibit lower uptake despite age not being a significant barrier to acceptance raises critical questions about the nature of these barriers. This suggests that while young people may express a willingness to be vaccinated, logistical or structural factors, such as access to vaccination sites, flexible scheduling, or targeted communication strategies, might be hindering their actual uptake.
Similarly, the association between education level and acceptance, without a corresponding impact on uptake, points to the potential existence of structural barriers that transcend individual willingness. This could include issues related to vaccine availability, healthcare infrastructure limitations, or a lack of trust in healthcare systems, particularly among less educated populations [44]. These discrepancies highlight the necessity of distinguishing between attitudinal and logistical barriers when designing interventions to improve vaccination rates. Interventions targeting vaccine acceptance, such as educational campaigns and community engagement initiatives, may not be sufficient to address the structural obstacles that impede actual uptake [2]. A more nuanced approach is required, one that addresses both attitudinal and logistical challenges.
Furthermore, within the context of Cameroon, the observed differences may reflect underlying socioeconomic disparities, cultural norms, and specific healthcare challenges. Future research should investigate these factors in greater detail, employing qualitative methodologies to provide a more in-depth understanding of the barriers to vaccine uptake.
Strength and limitations
The use of local unpublished research data (grey literature) helped to address potential publication bias. The lack of association assessment of vaccine uptake and acceptance in some studies have reduced the number of studies included in the pooled odds ratio assessment and should be considered when interpreting the results related to vaccination determinants. The model selection for each determinant was based on the heterogeneity index. This study did not include an in-depth analysis of vaccine acceptance. Additionally, the use of cross-sectional study designs to assess associated factors limits our ability to establish temporal relationships between exposures and outcomes. The study relied on self-reported data, which may be susceptible to social desirability bias, potentially leading to overreporting of vaccine acceptance or uptake. Because we used crude odds ratios to assess determinants, the observed associations may be influenced by unmeasured confounding factors not accounted for in the analysis. The findings should be interpreted in the context of the specific time period and geographical location of the included studies.
Conclusions
In conclusion, this meta-analysis revealed a suboptimal pooled COVID- 19 vaccine uptake proportion of 37.14% in Cameroon from 2021 to 2024, significantly lower than the global target of 70% required to ensure herd immunity. Subgroup analyses identified lower uptake among the general population and in community settings, whereas healthcare workers demonstrated the highest uptake. Geographically, the two Regions experiencing armed conflicts (North-West and South-West Regions) exhibited the lowest uptake. Factors such as younger age and not being in a partnership were significantly associated with lower vaccine uptake. Besides, the level of education and area of residency were significantly associate with vaccine acceptance. These findings underscore the crucial need to scale up efforts to improve vaccination coverage, especially among the most vulnerable populations. To overcome the suboptimal COVID- 19 vaccine uptake in Cameroon, multifaceted strategies encompassing targeted public health campaigns, enhanced community-based access, context-specific interventions in conflict regions, leveraging healthcare worker advocacy, and educational initiatives to combat misinformation are essential for improving vaccination coverage. These findings may also inform decision-making during response to future emerging and re-emerging disease epidemics.
Data availability
The sources of data supporting this systematic review are available in the reference. All data generated or analyzed during this study are included in this published article and supplemental material.
Abbreviations
- CI:
-
Confidence Interval
- COVID- 19:
-
New Coronavirus Disease
- CS:
-
Cross Sectional Study
- HCW:
-
Healthcare worker
- MeSH:
-
Medical Subject Headings
- OR:
-
Odds Ratio
- PRISMA:
-
Preferred Reporting Items for Systematic Reviews and Meta-Analysis
- VA:
-
Vaccine Acceptance
- VU:
-
Vaccine Uptake
References
Mengistu DA, Demmu YM, Asefa YA. Global COVID-19 vaccine acceptance rate: systematic review and meta-analysis. Front Public Health. 2022;10:1044193.
Tchiasso D, Mendjime P, Fai KN, Wandji BSN, Yuya F, Youm É, et al. Dynamic factors associated with COVID-19 vaccine uptake in Cameroon between 2021 and 2022. J Public Health Afr. 2024;15(1):8.
Shattock AJ, Johnson HC, Sim SY, Carter A, Lambach P, Hutubessy RCW, et al. Contribution of vaccination to improved survival and health: modelling 50 years of the expanded programme on immunization. The Lancet. 2024;403(10441):2307–16.
Ioannidis JPA, Pezzullo AM, Cristiano A, Boccia S. Global estimates of lives and life-years saved by COVID-19 vaccination during 2020–2024. medRxiv; 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2024.11.03.24316673v2
Meslé MMI, Brown J, Mook P, Katz MA, Hagan J, Pastore R, et al. Estimated number of lives directly saved by COVID-19 vaccination programmes in the WHO European Region from December, 2020, to March, 2023: a retrospective surveillance study. Lancet Respir Med. 2024;12(9):714–27.
Amani A, Mossus T, Cheuyem FZL, Bilounga C, Mikamb P, BasseguinAtchou J, et al. Gender and COVID-19 Vaccine Disparities in Cameroon. COVID. 2022;2(12):1715–30.
Amani A, Njoh AA, Mouangue C, Zobel CLF, Mossus T. Vaccination coverage and safety in Cameroon; descriptive assessment of COVID-19 Infection in Vaccinated Individuals. Health Sci Dis. 2022;23(8):1–8.
EzieKengo N, Ghislain FS, Zolo Y, Saidu Musa S, Musa Shallangwa M, Haruna UA, et al. Towards Addressing COVID-19 Vaccine Wastage in Cameroon: Challenges and Way Forward. Public Health Chall. 2024;3(2):e200.
Cameroon steps up vaccination efforts with support from WHO, UNICEF, WB and other partners. WHO, Geneva. 2022. https://www.who.int/news/item/11-12-2022-cameroon-steps-up-vaccination-efforts-with-support-from-who--unicef--wb-and-other-partners. Accessed 2025 Jan 7.
Takougang I, Cheuyem FZL, Lyonga EE, Ndungo JH, Mbopi-Keou FX. Observance of standard precautions for infection prevention in the Covid-19 Era: a cross sectional study in six district hospitals in Yaounde. Cameroon Am J Biomed Sci Res. 2023;19(5):590–8.
Baghani M, Fathalizade F, Loghman AH, Samieefar N, Ghobadinezhad F, Rashedi R, et al. COVID-19 vaccine hesitancy worldwide and its associated factors: a systematic review and meta-analysis. Sci One Health. 2023;2:100048.
Cheuyem FZL, Amani A, Nkodo ICA, Boukeng LBK, Edzamba MF, Nouko A, et al. COVID-19 vaccine acceptance and hesitancy in Cameroon: a systematic review and meta-analysis. BMC Public Health. 2025;25(1):1035.
Galanis P, Vraka I, Katsiroumpa A, Siskou O, Konstantakopoulou O, Katsoulas T, et al. COVID-19 Vaccine Uptake among Healthcare Workers: a systematic review and meta-analysis. Vaccines. 2022;10(10):1637.
Doshi RH. COVID-19 Vaccination Coverage — World Health Organization African Region, 2021–2023. MMWR Morb Mortal Wkly Rep. 2024;73(14):307–11.
Moher D, Liberati A, Tetzlaff J, Altman DG, Group TP. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLOS Med. 2009;6(7):e1000097.
Cheuyem FZL, Mouangue C, Ajong BN, Edzamba MF, Hamadama DCM, Achangwa C, et al. Occupational Exposures to Blood and other Body Fluids among Healthcare Workers in Cameroon: A Systematic Review and Meta-analysis Accessed. medRxiv; 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2024.12.05.24318564v2
JBI Critical Appraisal Tools. The Joanna Briggs Institute, Adelaide. 2017. https://jbi.global/critical-appraisal-tools. Accessed 2024 Dec 3.
R Core Team. R: A Language and Environment for Statistical Computing Accessed. R Foundation for Statistical Computing, Vienna, Austria. 2024. https://www.R-project.org/. Accessed 2024 Dec 19.
Abongwa LE, Sumo L, Ngum NH, Muhammed NN, Njiwale MS, Nakuh NM, et al. A Survey on Factors Influencing COVID-19 Vaccine Hesitancy in Bamenda-Cameroon. J Adv Microbiol. 2022;1–14.
Djuikoue CI, KamgaWouambo R, Pahane MM, DemanouFenkeng B, Seugnou Nana C, DjamfaNzenya J, et al. Epidemiology of the Acceptance of Anti COVID-19 Vaccine in Urban and Rural Settings in Cameroon. Vaccines. 2023;11(3):625.
Gunawardhana N, Baecher K, Boutwell A, Pekwarake S, Kifem M, Ngong MG, et al. COVID-19 vaccine acceptance and perceived risk among pregnant and non-pregnant adults in Cameroon, Africa. Sallam M,editor. PLOS One. 2022;17(9):e0274541.
Ngasa NC, Ngasa SN, Tchouda LAS, Tanisso E, Abanda C, Dingana TN. Spirituality and other factors associated with COVID-19 Vaccine Acceptance amongst Healthcare Workers in Cameroon Accessed. Research Square; 2021. https://doiorg.publicaciones.saludcastillayleon.es/10.21203/rs.3.rs-712354/v1.
Tambo E, Tsague CL, Ebong SB, Tchuendem I, Ngazoue EF, Fankep B, et al. Acceptability Of Covid-19 Vaccines And Vaccination In Cameroon: Challenges And Way Forward Accessed. Research Square; 2022. https://doiorg.publicaciones.saludcastillayleon.es/10.21203/rs.3.rs-1369012/v1.
Ambe NC, Akum AE, Binwi NF, Ngunde PJ. Prevalence, perceptions and factors influencing covid-19 vaccines’ uptake among nurses in fako division, cameroon Accessed. medRxiv; 2023. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2023.01.25.23284999
Dinga JN, Njoh AA, Gamua SD, Muki SE, Titanji VPK. Factors Driving COVID-19 vaccine hesitancy in Cameroon and their implications for Africa: a comparison of two cross-sectional studies conducted 19 months apart in 2020 and 2022. Vaccines. 2022;10(9):1401.
Elit L, Ngalla C, Afungchwi G, Tum E, Fokom-Domgue J, Nouvet E. Perceptions of COVID 19 Vaccine in Rural Cameroon. Med Discoveries. 2023;2(1):1007.
Fotzo NNC, Takougang I, Nokam A. Needle Stick Injuries: Prevalence and Reporting Patterns Among Bucco Dental And Medical Health Workers In Two Reference Hospitals In Yaoundé [Thesis]. [Yaoundé]: Université de Yaoundé 1; 2022.
Christelle KNE, Ngha KJ, Regine EE, Olga B. Factors associated with covid-19 vaccines acceptance among health care professionals in the west region of Cameroon. Health Res Afr. 2024;2(8):35–42.
Lowe JM, Nokam ME, Nseme E, Voundi EV, Songue E, Voundi JV, et al. COVID-19: comparison of vaccination coverage between oral health care practitioners and other health care personnel in Yaounde. Immunome Res. 2022;18(2):156.
MoguemSoubgui AF, Foko LPK, EmboloEnyegue EL, Mboussi WSN, KoangaMogtomo ML. Prevalence, clinical profile and determinants of COVID-19 Vaccination and SARS-CoV-2 Breakthrough Infection in Douala. Cameroon Trends Med Res. 2023;18(1):122–35.
Tetsatsi ACM, Nguena AA, Deutou AL, Talom AT, Metchum BT, Tiotsia AT, et al. Factors Associated with COVID-19 Vaccine Refusal: A Community-Based Study in the Menoua Division in Cameroon. Trop Med Infect Dis. 2023;8(9):424.
Tsamoh FF, Takougang I. Organisational determinants of the observance of infection prevention measures within bucco-dental health services in the Mifi and Dschang Health Districts [Thesis]. [Yaoundé]: Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1; 2022.
Ukah EC, Tambe J, Tanue AE, Ngeha NC, Shei MC, Tabe OBV, et al. COVID-19 vaccine uptake among healthcare workers in the Limbe Health district of Cameroon. J Public Health Epidemiol. 2024;16(1):28–40.
Voundi-Voundi E, Songue E, Voundi-Voundi J, Nseme EG, Abba-Kabir H, Kamgno J. Factors Associated with COVID-19 Vaccine Hesitancy Among Health Personnel in Yaounde. Cameroon Health Sci Dis. 2023;24(2 Suppl 1):23–7.
Aka TK, Atanga SN, Esemu SN, Ndip LMA. Attitudes, and perceptions of COVID-19 vaccines and Acceptance to receive COVID-19 vaccine among healthcare workers in Yaounde. Cameroon OALib. 2024;11(04):1–23.
Cheuyem FZL, Takougang I, Lyonga EE, Kwabong E. Compliance with standard precautions and microbial profile of media in the gynecology-obstetrics department of the University Teaching Hospital of Yaoundé [Thesis]. [Yaoundé]: Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1; 2024.
Nouko A, Takougang I, Nguefack F. Determinants of compliance to vaccination as a means of infection prevention among healthcare workers in the health districts of Yaoundé [Thesis]. [Yaoundé]: Faculty of Medicine and Biomedical Sciences, The University of Yaounde 1; 2024.
Wang Q, Hu S, Du F, Zang S, Xing Y, Qu Z, et al. Mapping global acceptance and uptake of COVID-19 vaccination: A systematic review and meta-analysis. Commun Med. 2022;2(1):113.
Cheuyem FZL, Amani A, Nkodo ICA, Boukeng LBK, Edzamba MF, Nouko A, et al. COVID-19 vaccine acceptance and hesitancy in Cameroon: a systematic review and meta-analysis accessed. medRxiv; 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2024.12.12.24318938v1.
Freeman D, Lambe S, Yu LM, Freeman J, Chadwick A, Vaccari C, et al. Injection fears and COVID-19 vaccine hesitancy. Psychol Med. 2023;53(4):1185–95.
Njoh AA, Saidu Y, Bachir HB, Ndoula ST, Mboke E, Nembot R, et al. Impact of periodic intensification of routine immunization within an armed conflict setting and COVID-19 outbreak in Cameroon in 2020. Confl Health. 2022;16(1):29.
Takougang I, Cheuyem FZL, Changeh BA, Nyonga ND, Moneboulou HM. Accidental exposure to body fluids among healthcare workers in a Referral Hospital in the Security-Challenged Region of South West Cameroon. J Nurs Healthc. 2024;9(2):1–13.
Saidu Y, Vouking M, Njoh AA, Bachire HB, Tonga C, Mofor R, et al. The effect of the ongoing civil strife on key immunisation outcomes in the North West and South West regions of Cameroon. Confl Health. 2021;15(1):8.
Nabia S, Wonodi CB, Vilajeliu A, Sussman S, Olson K, Cooke R, et al. Experiences, enablers, and challenges in service delivery and integration of COVID-19 Vaccines: a rapid systematic review. Vaccines. 2023;11(5):974.
Cheuyem FZL, Ajong BN, Amani A, Boukeng LBK, Ngos CS, Nkongo FK, et al. Sustainable development goals and health sector strategic indicators assessment in Cameroon: a retrospective analysis at regional and national levels accessed. medRxiv; 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2024.11.25.24317921v1.
Cheuyem FZL, Amani A, Ajong BN, Boukeng LBK, Mouangue C, Tsafack MGM, et al. Humanization of Care: a geospatial analysis of key indicators of quality and safety of health care and service in the centre region, Cameroon accessed. medRxiv; 2024. https://doiorg.publicaciones.saludcastillayleon.es/10.1101/2024.11.11.24317125v1.
Almaghrabi RH, Alfaradi H, Hebshi WAA, Albaadani MM. Healthcare workers experience in dealing with Coronavirus (COVID-19) pandemic. Saudi Med J. 2020;41(6):657–60.
Chemali S, Mari-Sáez A, El Bcheraoui C, Weishaar H. Health care workers’ experiences during the COVID-19 pandemic: a scoping review. Hum Resour Health. 2022;20(1):27.
Takougang I, Cheuyem FZL, Ze BRS, Tsamoh FF, Moneboulou HM. Awareness of standard precautions, circumstances of occurrence and management of occupational exposures to body fluids among healthcare workers in a regional level referral hospital (Bertoua, Cameroon). BMC Health Serv Res. 2024;24(1):424.
Tolossa T, Fetensa G, Feyisa BR, Wakuma B, Lema M. Willingness to accept COVID-19 vaccine and its determinants in Ethiopia: a systematic review and meta-analysis. Front Virol. 2023;3:1065991.
Deng JS, Ying CQ, Lin XQ, Huang CL, Zhang MX, Tung TH, et al. Impact of household decision makers’ hesitancy to vaccinate children against COVID-19 on other household members: a family-based study in Taizhou. China SSM - Popul Health. 2023;24:101517.
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F.Z.L.C. conceived the original idea of the study. F.Z.L.C. and C.A. conducted the literature search. F.Z.L.C., C.A. and C.D. selected the studies, extracted the relevant information, and synthesized the data. F.Z.L.C. performed the analyses and wrote the first draft of the manuscript. All authors critically reviewed and revised successive drafts of the manuscript. All authors read and approved the final manuscript.
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Cheuyem, F.Z.L., Amani, A., Achangwa, C. et al. COVID- 19 vaccine uptake and its determinants in Cameroon: a systematic review and meta-analysis (2021–2024). BMC Infect Dis 25, 525 (2025). https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12879-025-10946-y
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DOI: https://doiorg.publicaciones.saludcastillayleon.es/10.1186/s12879-025-10946-y