The Missed Dose: Determinants of Zero-Dose Vaccination in Urban Refugee Children
Anna Petrova¹ Ivan Markov² Anna Dimitrova³ Simeon georgiev⁴ Kristina Nikolova⁵
Keywords:
vaccination, zero-dose children, refugees, urban health, immunization accessAbstract
Abstract:
Background: Zero-dose children — those who have not received even a single vaccine — remain a major public health concern. This study assesses the prevalence and determinants of zero-dose status among urban refugee populations in East Mediterranean settings.
Methods: A cross-sectional household survey was conducted among 1,128 refugee families in urban centers across Jordan and Lebanon in 2023. Data included demographics, health access, legal status, maternal education, and immunization records. Multivariate logistic regression was used to identify predictors of zero-dose status.
Results: Zero-dose prevalence was 18.6%. Lack of legal documentation (OR = 3.41, p < 0.001), maternal illiteracy (OR = 2.15, p = 0.004), and absence of primary health center within 5 km (OR = 2.62, p = 0.003) were the strongest predictors. Households with prior displacement ≥3 times had significantly higher odds (OR = 2.91, p = 0.001).
Conclusion: Structural barriers including legal status, maternal education, and healthcare proximity significantly influence zero-dose vaccination in refugee children. Targeted outreach and mobile clinics are urgently needed in high-risk urban areas.
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