Date of Award

January 2020

Document Type


Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Kaveh Khoshnood



With the large influx of Syrian refugees into Lebanon, the burden on primary health care centers has significantly increased. Most of this refugee population is made up of children (53.3%) which emphasizes the importance of vaccination coverage and access since it has been proven as the most cost-effective way to prevent the outbreak of vaccine preventable infectious diseases. The risk of infectious disease outbreaks is high in Lebanon where it has already seen measles outbreaks that prompted the response of vaccination campaigns. In our study we assessed vaccine coverage and perceived barrier to vaccinations among Syrian refugee children aged 1-59 months.


A survey was administered in 22 primary healthcare centers across 5 regions (Beirut/Mount Lebanon, Tripoli, Akkar, South, and Beqaa). The survey was adapted from the Lebanese Ministry of Public Health, the Lebanon country office of the WHO and the United Nations Children’s Fund (UNICEF) combined with the SAGE Working Group on Vaccine Hesitancy surveys.


Among surveyed children aged 1–59 months, 74.1% had complete vaccinations including those that had been drop-outs and recovered while 25.9% of the children included in the study were dropouts or had delayed vaccines. Vaccination completion was higher among children with mothers who had a university level education, had knowledge of the vaccine schedule, and who trusted the quality of the vaccines. The most commonly reported barrier to vaccination was shown to be child was sick followed by not trusting the quality of the vaccine.


From the results, we need to address reported barriers particularly lack of trust in vaccine quality. An increased commitment is needed to ensure compliance of the national vaccine schedule and retention of vaccination cards Additionally, efforts to increase awareness include more outreach and assessment of the specific needs in each region.


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