title: One year of campaigns in Cameroon: effects on routine health services.
abstract: BACKGROUND
  Targeted campaigns have been reported to disrupt routine health services in low- and middle-income countries. The objective of this study was to evaluate the average effect of public health campaigns over 1 year on routine services such as antenatal care, routine vaccination and outpatient services.
  
  
  METHODS
  We collected daily activity data in 60 health facilities in two regions of Cameroon that traditionally undergo different intensities of campaign activity, the Centre region (low) and the Far North (high), to ascertain effects on routine services. For each outcome, we restricted our analysis to the public health centres for which good data were available and excluded private health facilities given their small number. We used segment-linear regression to account for the longitudinal nature of the data, and assessed whether the number of routine activities decreased in health facilities during periods when campaigns occurred. The analysis controlled for secular trends and serial correlation.
  
  
  RESULTS
  We found evidence that vaccination campaigns had a negative impact on routine activities, decreasing outpatient visits when they occurred (Centre: -9.9%, P = 0.079; Far North: -11.6%, P = 0.025). The average negative effect on routine services [outpatient visits -18% (P = 0.02) and antenatal consultations -70% [P = 0.001]) was most pronounced in the Far North during 'intensive' campaigns that usually require high mobilization of staff.
  
  
  CONCLUSIONS
  With an increasing number of interventions delivered by campaigns and in the context of elimination and eradication targets, these are important results for countries and agencies to consider. Achieving disease control targets hinges on ensuring high uptake of routine services. Therefore, we suggest that campaigns should systematically monitor 'impact on routine services', while also devising concrete strategies to mitigate potential adverse effects.
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK sandra.mounier-jack@lshtm.ac.uk.
authors.forename: Sandra
authors.initials: S
authors.lastname: Mounier-Jack
authors.affiliation: Ministry of Health, Yaoundé, Cameroon.
authors.forename: Jean Marie
authors.initials: JM
authors.lastname: Edengue
authors.affiliation: London School of Hygiene & Tropical Medicine, London, UK.
authors.forename: Mylene
authors.initials: M
authors.lastname: Lagarde
authors.affiliation: Ministry of Health, Yaoundé, Cameroon.
authors.forename: Simon Franky
authors.initials: SF
authors.lastname: Baonga
authors.affiliation: Central Hospital, Yaoundé, Centre for Development of Best Practices in Health, Yaoundé, Cameroon.
authors.forename: Pierre
authors.initials: P
authors.lastname: Ongolo-Zogo
mesh_terms: D002163:Cameroon; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D003906:Developing Countries; D006268:Health Facilities / Q000706:statistics & numerical data; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data*; D007114:Immunization / Q000706:statistics & numerical data; D011295:Prenatal Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data
keywords: Evaluation; health services; health systems; immunization