TY - JOUR
T1 - Challenges in estimating vaccine coverage in refugee and displaced populations
T2 - Results from household surveys in Jordan and Lebanon
AU - The Jordan Health Access Study Team
AU - The Lebanon Health Access Study Team
AU - Roberton, Timothy
AU - Weiss, William
AU - Oweis, Arwa
AU - Zaheya, Laila Akhu
AU - Lyles, Emily
AU - Burnham, Gilbert
AU - Hanquart, Baptiste
AU - Chela, Lara
AU - Aridi, Nour
AU - Kassab, Nour
AU - Keyrouz, Aline
AU - Fouad, Fouad
AU - Sibai, Abla
AU - Al-Shatti, Deena
AU - de la Roche, Francois
AU - Woodman, Michael
AU - Doocy, Shannon
N1 - Funding Information:
Acknowledgments: Both studies were implemented by The Center for Humanitarian Health (formerly The Center for Refugee and Disaster Response) at the Johns Hopkins Bloomberg School of Public Health (JHSPH). The Jordan study was also implemented by The School of Nursing at Jordan University for Science and Technology (JUST) and the Lebanon study by Médecins du Monde (MdM). Technical support for the Jordan study was provided by The World Health Organization (WHO), and The Ministry of Health (MoH) of the Hashemite Kingdom of Jordan. Administrative and technical support for the Lebanon study was provided by International Medical Corps, The American University of Beirut Faculty of Health Sciences. The UN Refugee Agency (UNHCR) provided technical support for both studies. We would like to acknowledge Rick Brennan, Claudine Prudhon, Altaf Musani, Basel Al-Yousfi, and Said Aden from WHO and Marian Schilperoord, Ann Burton, Michael Woodman, and Frank Tyler from the UN Refugee Agency for their support and efforts to facilitate the surveys. The Jordan study was funded by The World Health Organization and the Lebanon study was funded by The European Commission Humanitarian Aid and Civil Protection Department with additional support from the UN Refugee Agency. The Jordan Health Access Study Team includes Arwa Oweis, Laila-Akhu Zaheya, Emily Lyles and Gilbert Burnham; The Lebanon Health Access Study Team includes Emily Lyles, Baptiste Hanquart, Lara Chela, Nour Aridi, Nour Kassab, Aline Keyrouz, Fouad Fouad, Abla Sibai, Deena Al-Shatti, Francois de La Roche and Michael Woodman.
Publisher Copyright:
© 2017 by the authors.
PY - 2017/9
Y1 - 2017/9
N2 - Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12-23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1-3, and DPT 1-3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations.
AB - Ensuring the sustained immunization of displaced persons is a key objective in humanitarian emergencies. Typically, humanitarian actors measure coverage of single vaccines following an immunization campaign; few measure routine coverage of all vaccines. We undertook household surveys of Syrian refugees in Jordan and Lebanon, outside of camps, using a mix of random and respondent-driven sampling, to measure coverage of all vaccinations included in the host country’s vaccine schedule. We analyzed the results with a critical eye to data limitations and implications for similar studies. Among households with a child aged 12-23 months, 55.1% of respondents in Jordan and 46.6% in Lebanon were able to produce the child’s EPI card. Only 24.5% of Syrian refugee children in Jordan and 12.5% in Lebanon were fully immunized through routine vaccination services (having received from non-campaign sources: measles, polio 1-3, and DPT 1-3 in Jordan and Lebanon, and BCG in Jordan). Respondents in Jordan (33.5%) and Lebanon (40.1%) reported difficulties obtaining child vaccinations. Our estimated immunization rates were lower than expected and raise serious concerns about gaps in vaccine coverage among Syrian refugees. Although our estimates likely under-represent true coverage, given the additional benefit of campaigns (not captured in our surveys), there is a clear need to increase awareness, accessibility, and uptake of immunization services. Current methods to measure vaccine coverage in refugee and displaced populations have limitations. To better understand health needs in such groups, we need research on: validity of recall methods, links between campaigns and routine immunization programs, and improved sampling of hard-to-reach populations.
KW - Displaced populations
KW - Humanitarian assistance
KW - Jordan
KW - Lebanon
KW - Refugee
KW - Syria
KW - Vaccination
KW - Vaccination coverage
UR - http://www.scopus.com/inward/record.url?scp=85028775860&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85028775860&partnerID=8YFLogxK
U2 - 10.3390/vaccines5030022
DO - 10.3390/vaccines5030022
M3 - Article
C2 - 28805672
AN - SCOPUS:85028775860
SN - 2076-393X
VL - 5
JO - Vaccines
JF - Vaccines
IS - 3
M1 - 22
ER -