Expanded Programme on Immunization 2016 Expanded Programme on Immunization District-Based Immunization Coverage Cluster Survey 1 Expanded Programme on Immunization 2016 Acknowledgment Special acknowledgment goes to the Director General of the Ministry of Public Health, Dr. Walid Ammar for his guidance, and Dr Randa Hamadeh, head of the Primary Health Care department for facilitating the process of the study. Particular thanks goes to Dr. Gabriele Riedner, WHO Representative in Lebanon Country Office, for her unconditional support and Dr. Alissar Rady for her technical guidance all through the design and implementation process, and the country office team as well as the team at WHO Regional Office. The Expanded Programme on Immunization, district-based immunization coverage cluster survey, would not have been possible without the generous financial support of Bill & Melinda Gates Foundation through the World Health Organization. This EPI cluster survey was conducted by the Connecting Research to Development center, contracted by and under the guidance of WHO and with the overall supervision of the MOPH team. 2 Expanded Programme on Immunization 2016 TABLE OF CONTENTS Acronyms and Abbreviations .......................................................................................................... 5 List of Tables ........................................................................................................................................... 6 List of Figures.......................................................................................................................................... 7 List of Appendices ................................................................................................................................. 8 A. INTRODUCTION ............................................................................................... 9 1. Overview of the Expanded Programme on Immunization ................................ 9 2. Factors Affecting under-5 Years Old Immunization ............................................ 10 3. Vaccination Coverage in Lebanon ................................................................................. 11 4. Objectives of the Study ....................................................................................................... 13 B. METHODS ............................................................................................................ 14 1. Study Design ............................................................................................................................ 14 2. Survey Population ................................................................................................................. 14 3. Sampling Technique ............................................................................................................ 14 a. Sample Size ........................................................................................................................... 14 b. Sampling Frame .................................................................................................................. 14 4. Project Implementation ....................................................................................................... 15 5. Training of Fieldworkers ................................................................................................... 15 6. Piloting ......................................................................................................................................... 15 7. Questionnaire ........................................................................................................................... 16 8. Household Tracking Form ................................................................................................. 16 9. Fieldwork .................................................................................................................................... 16 10. Data Collection and Management............................................................................... 17 a. Data Collection Process .................................................................................................... 17 b. Data Management .............................................................................................................. 17 11. Data Analysis…………………………………………………………. ................................. 18 12. Ethical Considerations ...................................................................................................... 18 3 Expanded Programme on Immunization 2016 C. RESULTS ............................................................................................................... 20 I. Results of the Participants Residing in the Lebanese Communities ........... 20 1. Demographic Characteristics of the Surveyed Children ...................................... 20 2. Family Characteristics of Surveyed Children ........................................................... 21 3. Vaccination Behavior ........................................................................................................ 22 4. Vaccination Status as per Received Immunization Cards and Recall ............. 29 a. Polio Vaccination Status ........................................................................................ 33 b. Hepatitis B Vaccination Status ........................................................................... 35 c. DTP Vaccination Status ......................................................................................... 37 d. Hib Vaccination Status .......................................................................................... 39 e. Measles Vaccination Status .................................................................................. 41 f. Mumps and Rubella Vaccination Status .......................................................... 42 II. Results of the Syrian Participants in the Informal Settlements ................... 44 1. Demographic Characteristics of the Surveyed Children ...................................... 44 2. Family Characteristics of Surveyed Children ........................................................... 44 3. Vaccination Behavior ........................................................................................................ 46 4. Vaccination Status as per Received Immunization Cards and Recall ............. 49 a. Polio Vaccination Status ........................................................................................ 53 b. Hepatitis B Vaccination Status ........................................................................... 54 c. DTP Vaccination Status ......................................................................................... 55 d. Hib Vaccination Status .......................................................................................... 56 e. Measles Vaccination Status .................................................................................. 57 f. Mumps and Rubella Vaccination Status .......................................................... 59 Appendices ............................................................................................................................................. 60 4 Expanded Programme on Immunization 2016 Acronyms and Abbreviations CRD Connecting Research to Development DTP Diphtheria, Tetanus and Pertussis EPI Expanded Programme on Immunization GPS Global Positioning System Hib Haemophilus influenzae Type b IPV Inactivated Polio Vaccine IRB Institutional Review Board IS Informal Settlement LPS Lebanese Pediatric Society MCV Measles-Containing Vaccine MDG4 Millennium Development Goal 4 MMR Measles, Mumps and Rubella MoPH Ministry of Public Health NGO Non-Governmental Organization OPV Oral Polio Vaccine PHC Primary Health Care PPS Probability Proportionate to Size PSU Primary Sampling Unit SD Standard Deviation SOP Standard Operating Procedure SPSS Statistical Package for Social Sciences UNHCR United Nations High Commissioner for Refugees UNICEF United Nations Children's Fund WHO World Health Organization 5 Expanded Programme on Immunization 2016 List of Tables I. Results of the Participants Residing in the Lebanese Communities Table 1 Sample Size and Characteristics by Districts (N=9,560). Table 2 Family Characteristics of the Surveyed Children (N=9,560). Table 3 Behaviors Associated with Vaccination of Sampled Children (N=9,560). Table 4 Decisions about Vaccinating the Sampled Children (N=9,560). Table 5 Knowledge of Respondents about Vaccination (N=9,560). Table 6 Place of Last Vaccination by Districts and Nationalities (N=9,329). Table 7 Polio Vaccination Status by Demographic Variables (N=9,560). Table 8 Reported Reasons for not Vaccinating against Polio (N=594). Table 9 Hepatitis B Vaccination at Birth by Demographic Variables (N=9,560). Table 10 Hepatitis B Vaccination Status by Demographic Variables (N=9,560). Table 11 Reported Reasons for not Vaccinating against Hepatitis B (N=797). Table 12 DTP Vaccination Status by Demographic Variables (N=9,560). Table 13 Reported Reasons for not Vaccinating against DTP (N=716). Table 14 Hib Vaccination Status by Demographic Variables (N=9,560). Table 15 Reported Reasons for not Vaccinating against Hib (N=785). Table 16 Measles Vaccination Status by Demographic Variables (N=9,560). Table 17 Reported Reasons for not Vaccinating against Measles (N=1,783). Table 18 Mumps and Rubella Vaccination Status by Demographic Variables (N=9,560). Table 19 Reported Reasons