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Helou M, Mouawad Y, El Ters F, Husni R. Measles Outbreak in Lebanon: July 2023. Disaster Med Public Health Prep 2024; 18:e49. [PMID: 38525826 DOI: 10.1017/dmp.2024.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Abstract
After the beginning of the Syrian crisis, increased rates of infectious diseases were reported. Lebanon, a neighboring country with a major socioeconomic crisis, witnessed a measles outbreak since July 2023, with 519 reported suspected cases. Half of the cases were under 5 y of age, most of them were unvaccinated. The mass displacement of refugees from conflict areas in Syria to Lebanon and the low vaccination coverage have made the situation more challenging. Further efforts are required in Lebanon to address identified gaps to prevent or at least better control future outbreaks.
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Affiliation(s)
- Mariana Helou
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Yara Mouawad
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Fadi El Ters
- Division of Emergency, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
| | - Rola Husni
- Division of Infectious Diseases, Department of Internal Medicine, Lebanese American University, School of Medicine, Beirut, Lebanon
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Mehtar S, AlMhawish N, Shobak K, Reingold A, Guha-Sapir D, Haar RJ. Measles in conflict-affected northern Syria: results from an ongoing outbreak surveillance program. Confl Health 2021; 15:95. [PMID: 34933672 PMCID: PMC8689574 DOI: 10.1186/s13031-021-00430-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/29/2021] [Indexed: 01/02/2023] Open
Abstract
Background The Syrian conflict has dramatically changed the public health landscape of Syria since its onset in March of 2011. Depleted resources, fractured health systems, and increased security risks have disrupted many routine services, including vaccinations, across several regions in Syria. Improving our understanding of infectious disease transmission in conflict-affected communities is imperative, particularly in the Syrian conflict. We utilize surveillance data from the Early Warning Alert and Response Network (EWARN) database managed by the Assistance Coordination Unit (ACU) to explore trends in the incidence of measles in conflict-affected northern Syria and analyze two consecutive epidemics in 2017 and 2018. Methods We conducted a retrospective time-series analysis of the incidence of clinically suspected cases of measles using EWARN data between January 2015 and June 2019. We compared regional and temporal trends to assess differences between geographic areas and across time. Results Between January 2015 and June 2019, there were 30,241 clinically suspected cases of measles reported, compared to 3193 cases reported across the whole country in the decade leading up to the conflict. There were 960 regional events that met the measles outbreak threshold and significant differences in the medians of measles incidence across all years (p-value < 0.001) and in each pairwise comparison of years as well as across all geographic regions (p-value < 0.001). Although most governorates faced an elevated burden of cases in every year of the study, the measles epidemics of 2017 and 2018 in the governorates of Ar-Raqqa, Deir-Ez-Zor, and Idlib accounted for over 71% of the total suspected cases over the entire study period. Conclusions The 2017 and 2018 measles epidemics were the largest since Syria eliminated the disease in 1999. The regions most affected by these outbreaks were areas of intense conflict and displacement between 2014 and 2018, including districts in Ar-Raqqa, Deir-Ez-Zor, and Idlib. The spread of measles in northern Syria serves as an indicator of low immunization coverage and limited access to care and highlights the Syrian peoples’ vulnerability to infectious diseases and vaccine preventable diseases in the setting of the current conflict. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00430-0.
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Affiliation(s)
- Sammy Mehtar
- UC Berkeley - UCSF Joint Medical Program, Berkeley, USA
| | | | | | - Art Reingold
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94705, USA
| | - Debarati Guha-Sapir
- Centre for Research on the Epidemiology of Disasters, University of Louvain School of Public Health, Leuven, Belgium
| | - Rohini J Haar
- Division of Epidemiology and Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, CA, 94705, USA.
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Helou M, Van Berlaer G, Yammine K. Factors influencing the occurrence of infectious disease outbreaks in Lebanon since the Syrian crisis. Pathog Glob Health 2021; 116:13-21. [PMID: 34313580 DOI: 10.1080/20477724.2021.1957192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Since the beginning of the Syrian crisis in 2011, the region has witnessed a major population displacement. Lebanon, a country with a population of 4.2 million, has welcomed around one million refugees. A rise in the incidence of Measles, Hepatitis A and Leishmaniosis was noted. This paper aims to document the incidence of outbreaks along with the factors that contributed to their emergence in Lebanon. A comprehensive literature review was conducted using electronic databases and (non) governmental reports, including studies reporting the state of Syrian refugees in Lebanon and those reporting on infectious outbreaks in Lebanon and Syria. Primary outcomes were defined as incidence or prevalence of Measles, Hepatitis A, and Leishmaniosis in both populations. Secondary outcomes were set to be the risk factors for the outbreaks. As of February 2016, Lebanon registered a total of 1.067.785 refugees. Infectious outbreaks were reported in Lebanon just after initiation of Syrian migration, with 1760 new measles cases, 1551 hepatitis A cases, and 1033 Leishmania cases in 2013. Local factors probably contributing to the emergence and dissemination of the outbreaks include living conditions, water and sanitation, nutritional state, and immunization. The outbreaks were not only reported in regions with higher refugee concentration, but also within other Lebanese regions. This was attributed to deficiencies in immunization of measles, low socioeconomic status and poor living conditions. The Syrian crisis has led to considerable impact on the demographic, economic, and political systems in Lebanon, next to an important burden on the healthcare system.
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Affiliation(s)
- Mariana Helou
- Department of Emergency Medicine, Lebanese American University Medical Center, Beirut, Lebanon
| | - Gerlant Van Berlaer
- Department of Emergency Medicine and Research Group on Emergency and Disaster Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kaissar Yammine
- Department of Orthopedic Surgery, Lebanese American University Medical Center, Beirut, Lebanon
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Korave J, Bawa S, Ageda B, Ucho A, Bem-Bura DM, Onimisi A, Dieng B, Nsubuga P, Oteri J, Fiona B, Shuaib F. Internal displacement; an impediment to the successful implementation of planned measles supplemental activities in Nigeria, a case study of Benue State. Vaccine 2021; 39 Suppl 3:C76-C81. [PMID: 33461836 DOI: 10.1016/j.vaccine.2020.12.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 11/12/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Measles is a highly infectious disease with great burden and implication on a displaced population with low immunity status. The disease can cause up to 140,000 deaths annually. Internal displacement during supplemental immunization activities often affects optimal reach and coverage of the campaign as people move and implementation and logistic plans are usually disrupted with attendant missed children. This study documented the process of extension of the measles vaccination campaign (MVC) 2018 for five internally displaced persons (IDPs) camps in Benue state, not previously in the microplan, to increase population herd immunity. METHODS We obtained population figures and disease surveillance data for five IDPs camps and used it to conduct detailed microplanning to determine the requirement for the conduct of additional days of measles vaccination. Vaccination teams used fixed posts in the camps and temporary posts strategy in designated locations in the host communities. RESULTS The estimated total population of the IDPs was 170,000 with MVC target population of 9374 which was not earlier planned for. There was reported measles outbreaks in IDP camps in both Guma and Makurdi Local Government areas (LGAs) during period of displacement. Microplans requirement determined 10,421 bundled measles vaccine, 30 health workers, 5 vehicles and 15 motorcycles. A total of 7679 out of 9374 (81.9%) of the eligible children aged 9-59 months were vaccinated during the 3 days of the campaign. CONCLUSION Non-inclusion of plans on internally displaced population in supplemental immunization activities (SIAs) microplans have a potential risk of vaccine preventable diseases (VPDs) outbreak. Future Measles Vaccination campaigns should take cognizance of internal displacement due to insecurity and other humanitarian emergencies.
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Affiliation(s)
- Joseph Korave
- Primary Health Care Development Board, Benue State, Nigeria
| | - Samuel Bawa
- World Health Organization, Country Office, Abuja, Nigeria.
| | - Bem Ageda
- Primary Health Care Development Board, Benue State, Nigeria
| | | | | | | | - Boubacar Dieng
- Technical Assistance Consultant, Global Alliance for Vaccines and Immunizations, United States
| | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, United States
| | - Joseph Oteri
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Braka Fiona
- World Health Organization, Country Office, Abuja, Nigeria
| | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Leresche E, Truppa C, Martin C, Marnicio A, Rossi R, Zmeter C, Harb H, Hamadeh RS, Leaning J. Conducting operational research in humanitarian settings: is there a shared path for humanitarians, national public health authorities and academics? Confl Health 2020; 14:25. [PMID: 32435274 PMCID: PMC7222467 DOI: 10.1186/s13031-020-00280-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 05/05/2020] [Indexed: 11/10/2022] Open
Abstract
In humanitarian contexts, it is a difficult and multi-faceted task to enlist academics, humanitarian actors and health authorities in a collaborative research effort. The lack of research in such settings has been widely described in the past decade, but few have analysed the challenges in building strong and balanced research partnerships. The major issues include considering operational priorities, ethical imperatives and power differentials. This paper analyses in two steps a collaborative empirical endeavour to assess health service utilization by Syrian refugee and Lebanese women undertaken by the International Committee of the Red Cross (ICRC), the Lebanese Ministry of Public Health (MoPH) and the Harvard François-Xavier Bagnoud (FXB) Center. First, based on challenges documented in the literature, we shed light on how we negotiated appropriate research questions, methodologies, bias analyses, resource availability, population specificities, security, logistics, funding, ethical issues and organizational cultures throughout the partnership. Second, we describe how the negotiations required each partner to go outside their comfort zones. For the academics, the drivers to engage included the intellectual value of the collaboration, the readiness of the operational partners to conduct an empirical investigation and the possibility that such work might lead to a better understanding in public health terms of how the response met population needs. For actors responding to the humanitarian crisis (the ICRC and the MOPH), participating in a technical collaboration permitted methodological issues to be worked through in the context of deliberations within the wider epistemic community. We find that when they collaborate, academics, humanitarian actors and health authorities deploy their respective complementarities to build a more comprehensive approach. Barriers such as the lack of uptake of research results or weak links to the existing literature were overcome by giving space to define research questions and develop a longer-term collaboration involving individual and institutional learning. There is the need ahead of time to create balanced decision-making mechanisms, allow for relative financial autonomy, and define organizational responsibilities. Ultimately, mutual respect, trust and the recognition of each other's expertise formed the basis of an initiative that served to better understand populations affected by conflict and meet their needs.
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Affiliation(s)
- Enrica Leresche
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Christophe Martin
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | | | - Rodolfo Rossi
- International Committee of the Red Cross, Geneva, Switzerland
| | - Carla Zmeter
- International Committee of the Red Cross Delegation, Beirut, Lebanon
| | - Hilda Harb
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health 2019; 13:31. [PMID: 31297141 PMCID: PMC6598365 DOI: 10.1186/s13031-019-0211-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health needs of displaced Syrians in refugee hosting countries have become increasingly complex in light of the protracted Syrian conflict. The primary aim of this study was to identify the primary health needs of displaced Syrians in Iraq, Jordan, Lebanon, Turkey, and Syria. Methods A systematic review was performed using 6 electronic databases, and multiple grey literature sources. Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was Syrian individuals displaced due to conflict in Syria and its neighboring countries. The outcomes of interest were health needs (i.e. health problems that can be addressed by health services), gaps in health services, training, and workforce. Studies on mixed refugee populations and Syrians displaced prior to the conflict were excluded. Results The Lebanon-specific results of the review were validated through two stakeholder roundtable discussions conducted with representatives from primary healthcare centers, non-governmental organizations and humanitarian aid agencies. A total of 63 articles were included in the analysis. Mental health and women's health were identified as the greatest health needs in the region. The most common health problems were Non-communicable diseases in Jordan, women's health in Lebanon and mental health in Turkey. Studies addressing gaps in services found the highest gap in general healthcare services, followed by women's health, mental health, and vaccinations. Sub-optimal training and availability of health workers was also noted particularly in Syria.Results from the stakeholders' discussions in Lebanon showed communicable diseases, women's health and mental health as the main health needs of Syrian refugees in Lebanon. Reported barriers to accessing health services included geographical barriers and lack of necessary awareness and education. Conclusion There is a need for an enhanced synchronized approach in Syria's refugee hosting neighboring countries to reduce the existing gaps in responding to the needs of Syrian refugees, especially in regards to women's health, mental health, and communicable diseases. This mainly includes training of healthcare workers to ensure a skilled workforce and community-based efforts to overcome barriers to access, including lack of knowledge and awareness about highly prevalent health conditions.
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Affiliation(s)
- Nour El Arnaout
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Spencer Rutherford
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Thurayya Zreik
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Dana Nabulsi
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Nasser Yassin
- 2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,3Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
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Kmeid M, Azouri H, Aaraj R, Bechara E, Antonios D. Vaccine coverage for Lebanese citizens and Syrian refugees in Lebanon. Int Health 2019; 11:568-579. [DOI: 10.1093/inthealth/ihz023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 03/06/2019] [Accepted: 03/26/2019] [Indexed: 01/03/2023] Open
Abstract
Abstract
Article History
Following the refugee crisis in Lebanon, the on-going inflow of Syrian refugees presented new challenges to optimal immunization coverage for all the children living in the country. Healthcare facilities have been overburdened during this period and the country witnessed outbreaks of many infectious diseases. Thus, the evaluation of vaccine compliance for mandatory and non-mandatory vaccines as well as the factors affecting the vaccination rate among Lebanese residents and Syrian refugees is fundamental.
Background
Since 2012, Lebanon has hosted around 1.2 million Syrian refugees, a high number in a country whose population does not exceed 4.4 million. Healthcare facilities have been overburdened during this period, which has led to the spread of many infectious diseases, including outbreaks of measles, mumps and hepatitis. At the appearance of such outbreaks, it becomes essential to evaluate vaccine compliance and the factors influencing the vaccination rate among Lebanese residents and Syrian refugees in infants and children up to 15 y of age.
Methods
A total of 571 infants and children were recruited in Beirut and Mount Lebanon, two governorates that together host half of the Lebanese population.
Results
A very high rate of vaccine compliance was seen for mandatory vaccines, whereas an intermediate to very low rate of compliance was found for non-mandatory vaccines. Both bivariate and multiple regression analyses indicated that age group and regular consultation of a pediatrician were independently associated with immunization coverage. Bivariate analysis indicated that parental age, occupational and educational status of parents, family size and vaccine price were also independently associated with immunization coverage. Incomplete vaccination coverage was associated with socioeconomic factors.
Conclusions
From these results, it becomes apparent that it may be necessary to reassess vaccination priorities considering the current socioeconomic situation.
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Affiliation(s)
- Maria Kmeid
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Hayat Azouri
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Racha Aaraj
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Elissa Bechara
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
| | - Diane Antonios
- Toxicology Laboratory and Poison Control Center, Faculty of Pharmacy, Campus of Medical Sciences, Saint Joseph University, Damascus Road, Beirut, Lebanon. P.O. Box: 11-5076—Riad El Solh, Beirut 1107 2180, Lebanon
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Truppa C, Leresche E, Fuller AF, Marnicio AS, Abisaab J, El Hayek N, Zmeter C, Toma WS, Harb H, Hamadeh RS, Leaning J. Utilization of primary health care services among Syrian refugee and Lebanese women targeted by the ICRC program in Lebanon: a cross-sectional study. Confl Health 2019; 13:7. [PMID: 30923560 PMCID: PMC6420751 DOI: 10.1186/s13031-019-0190-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Accepted: 02/28/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The Syrian crisis has put tremendous strain on the Lebanese health system, particularly in the historically underserved border region. The ICRC Primary Health Care program has focused on refugee and host communities in these areas. This study objectives were: 1) to determine whether the ICRC program was reaching the most vulnerable populations; 2) to understand the key perceived health needs in the catchment areas of the ICRC supported facilities; and 3) to identify barriers to utilization of health care services. METHODS Between July and September 2017 we conducted two cross-sectional studies - one randomized household survey and one clinic-based - in the catchment areas of three ICRC-supported facilities, targeting women of reproductive age and caretakers of children under five. Differences between groups were analysed with t-test or chi-squared test. RESULTS In the household survey, similar socio-demographic profiles were observed between Syrian refugee women and vulnerable Lebanese hosts. With regard to the study objectives:The most vulnerable populations were those seen in the ICRC-supported facilities.For both populations, the most common reasons for seeking care were non-communicable diseases (40.6%) and sexual and reproductive health issues (28.6%). Yet the people reaching the ICRC supported facilities were more likely to seek care for communicable diseases affecting their children (37.8%), rather than for the most common reasons expressed in the household survey.In the catchment areas, reported gaps included low immunization coverage and low levels of antenatal care and family planning both for Syrian and Lebanese. Dental care also emerged as an issue. Out of pocket expenditures was reported as a critical barrier for utilization of primary health care services for both populations, while the most important barrier for utilization of ICRC-supported services was lack of awareness. CONCLUSIONS Despite the ICRC reaching the most vulnerable Syrian and Lebanese communities, the population-based survey revealed that important gaps exist in terms of utilization of health care services among women of reproductive age and their children. A stronger outreach component is needed to address lack of awareness. Innovative solutions are also needed to address cost barriers at the levels of both facility and individual user.
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Affiliation(s)
- Claudia Truppa
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Enrica Leresche
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Arlan F. Fuller
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Ariana S. Marnicio
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Josyann Abisaab
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
| | - Nicole El Hayek
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Carla Zmeter
- The International Committee of the Red Cross, Beirut Delegation, Beirut, Lebanon
| | - Warda S. Toma
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
- Department of Paediatrics, The University of British Columbia, Vancouver, Canada
| | - Hilda Harb
- Lebanese Ministry of Public Health, Beirut, Lebanon
| | | | - Jennifer Leaning
- Harvard François Xavier Bagnoud Center for Health and Human Rights, Boston, USA
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Mansour Z, Hamadeh R, Rady A, Danovaro-Holliday MC, Fahmy K, Said R, Brandt L, Warrak R, Ammar W. Vaccination coverage in Lebanon following the Syrian crisis: results from the district-based immunization coverage evaluation survey 2016. BMC Public Health 2019; 19:58. [PMID: 30642314 PMCID: PMC6332691 DOI: 10.1186/s12889-019-6418-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/09/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Following the Syrian crisis, a substantial influx of Syrian refugees into Lebanon posed new challenges to optimal vaccination coverage for all children residing in the country. In 2016, the district-based immunization coverage evaluation survey (CES) assessed routine immunization coverage at the district level in Lebanon among children aged 12-59 months. METHODS A cross-sectional multistage cluster survey was conducted in all of Lebanon (with the exception of the Nabatieh district) using the World Health Organization (WHO) recommended Expanded Programme on Immunization (EPI) methodology adapted to the local context. A survey questionnaire consisting of closed and open-ended questions concerning demographic information and the child's immunization status was administered to collect immunization status information. RESULTS Among surveyed children aged 12-59 months, irrespective of nationality, vaccination coverage at the national level for any recommended last dose was below the targeted 95%. Generally, vaccination coverage levels increased with age and were higher among Lebanese than Syrian children. However, large variations were revealed when coverage rates were analyzed at the district level. Vaccination was significantly associated with nationality, age, mother's educational status and the place of vaccination. Common reasons for undervaccination included the child's illness at the time of vaccine administration, vaccination fees, lack of awareness or a doctor's advice not to vaccinate during campaigns. CONCLUSIONS Substantial variability exists in vaccination coverage among children aged 12-59 months residing in different districts in Lebanon. Immunization coverage reached 90% or above only for the first doses of polio and pentavalent vaccines. A considerable dropout rate from the first dose of any vaccine is observed. Efforts to optimize coverage levels should include increased vaccination initiatives targeting both refugee children and children from vulnerable host communities, increased cooperation between public and private vaccine providers, improved training for vaccine providers to adhere to complete vaccine administration recommendations, and increased awareness among caregivers.
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Affiliation(s)
- Ziad Mansour
- Connecting Research to Development, Beirut, Lebanon
| | | | - Alissar Rady
- World Health Organization Lebanon Country Office, Beirut, Lebanon
| | | | - Kamal Fahmy
- World Health Organization Eastern Mediterranean Region Office, Cairo, Egypt
| | - Racha Said
- Connecting Research to Development, Beirut, Lebanon
| | - Lina Brandt
- Connecting Research to Development, Beirut, Lebanon
| | - Ramy Warrak
- Connecting Research to Development, Beirut, Lebanon
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