COMPLIANCE TO, AND PERCEPTION OF HEALTH STAFF ON THE EFFECTIVENESS OF THE MALARIA EXPANDED PROGRAMME ON IMMUNIZATION IN BAMENDA III HEALTH DISTRICT

Dr. Lukong Hubert Shalanyuy, *, Kahbit Doris Sama, Alindoh Godlives Ngangsi, Pr Samje Moses, Dr. Tanlaka Lucas Mengnjo and Dr. Ngwainbi Genesis

ABSTRACT

Background: Malaria remains a leading cause of death and illness, especially among children under five in sub-Saharan Africa. In 2021 alone, 247 million cases and 619,000 deaths were reported globally, with Africa bearing 95% of the burden. In Cameroon, malaria accounts for 40% of childhood mortality and remains the top cause of morbidity. Despite interventions like insecticide-treated nets and indoor spraying, drug and insecticide resistance persist. The introduction of the RTS,S (Mosquirix) vaccine offers a promising addition to control efforts. The Expanded Programme on Immunization (EPI) plays a vital role in reducing malaria-related morbidity and mortality. However, its success depends on the compliance and perceptions of frontline health workers. Studies show that gaps exist in vaccine administration and record-keeping. In Bamenda III Health District, malaria remains endemic, with unique challenges like poor infrastructure and sociocultural factors. This research provides a first baseline assessment for Bamenda III. It aims to guide strategies to enhance EPI effectiveness and reduce malaria deaths in the region. Methods: A community based descriptive cross-sectional study design was used to assess the compliance to, and perception of 293 freely consented health staff on the effectiveness of the malaria EPI in the Bamenda III Health District, from the month of March - June 2024. The study respondents were sampled using a 3-stage sampling technique. Data was collected using a well-structured questionnaire divided into 4 sections, depending on the specific objectives of the study. Data was analysed using SPSS version 21. The Chi square (X2) test and logistic regression analyses were used for inferential statistics. The tests were carried out at the sole probability of 0.05 and statistically significance differences were considered if p value was less than or equal to 0.05. Results: The study involved 293 health workers in Bamenda III Health District, predominantly female (77.5%) and nurses (73.4%), with 41.6% having less than one year of experience with the malaria EPI. About 71% of respondents strongly agreed that factors such as education, knowledge, in-service training, supervision, job aids, experience, and job satisfaction influence EPI compliance. Significant associations were found between work experience and education level affecting EPI understanding (p=0.031), and a positive correlation (r=+0.181, p=0.002) was observed between the variables. Job satisfaction’s effect on compliance was significantly associated with gender (p=0.032), age (p=0.0001), work experience (p=0.0001), and religion (p=0.0001). Most respondents (71.7%) believed in the need for child vaccination, and 93.2% believed EPI reduces infections. Younger staff (18–22 years) were 0.43 times more likely (p=0.014) to support child vaccination, and those with less than 1-year experience were 3.23 times more likely (p=0.040). Up to 88.1% supported RTS,S vaccination. Challenges strongly agreed upon included poor logistics (63.5%), cold chain issues (62.8%), and insufficient infrastructure (60.4%). Conclusion: The study shows strong health staff agreement on key factors influencing compliance with malaria EPI guidelines. Significant associations between demographic factors and perceptions highlight the need for targeted staff support. Younger and less experienced staff were more likely to value child vaccination and EPI effectiveness. Major implementation challenges include poor logistics, cold chain failures, and limited infrastructure. Strengthening training, resources, and system support could enhance EPI impact in Bamenda III.

Keywords: Compliance, Perception, Health Staff, EPI, Bamenda III Health District.