Immunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021-2024)

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This study aimed to examine vaccination coverage trends in Afghan children in Iran. Methods This descriptive-analytical cross-sectional study analyzed vaccination data of Afghan nationals from March 2021 to March 2024, extracted from the SINA system (Integrated Health System of Mashhad University of Medical Sciences). Data were analyzed using descriptive statistics, independent t-tests, and ANOVA with SPSS v21. Results Out of 6,106 vaccine doses administered, 50.03% were for boys. The average vaccination coverage in Afghan children from 2021–2024 was 89.9%. Vaccination coverage for children under two years was above 85% for all vaccines, exceeding WHO global averages. The lowest coverage was observed for the second dose of DPT (74.47%) and the fifth dose of oral polio vaccine (74.98%) in six-year-olds. No significant gender differences in vaccination coverage were found. Significant differences in coverage trends were observed across the three-year period for all vaccines (p = 0.000). Conclusion Immunization coverage for vaccine-preventable diseases in Afghan children in Iran is optimal and higher than WHO-recommended levels. Continuous monitoring of subnational data is crucial for tailoring vaccination strategies to address immunization gaps and ensure comprehensive coverage. vaccination vaccination coverage children Afghan nationals refugee Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction immunization has been considered one of the most effective and cost-effective strategies in promoting health within children and preventing infectious diseases [ 1 ]. Being a prime strategy in primary prevention, vaccination protects not only at the individual level but also offers benefits at the level of the community through the reduction of disease transmission [ 2 ]. In response to global health needs, most countries modified national immunization programs, which included routine vaccinations for children against major infectious diseases. The WHO expanded the Program on Immunization in 1977, and Iran launched this program in 1984[ 1 ]. So far, the NITAG of Iran has incorporated all vaccines recommended by the WHO into the national schedule: one dose of BCG against tuberculosis; several doses of OPV against polio; DTP against diphtheria, tetanus, and pertussis; MMR against measles; HepB against hepatitis B; Hib against Haemophilus influenzae type B [ 2 ]. Currently, in 2024, it has added rotavirus and pneumococcal diseases vaccines to extend protection against more diseases[ 3 ]. However, particular attention needs to be given to the vaccination cover for Afghan refugees—a vulnerable population group making up a considerable part of Iran's demographic. Official statistics indicate that about 4.5 million refugees reside in Iran, out of which 97 percent are Afghan nationals. These refugees have settled in Iran due to decades of conflict and instability in Afghanistan, besides the socio-economic problems; recent political upheavals accelerate migration into Iran. These barriers to healthcare access—including immunization—leave Afghan refugees, particularly children, as a challenge for public health and disease prevention in Iran[ 4 ]. Interrupted vaccinations are one of the serious health issues linked with Afghan refugees. Many refugees normally come from regions with weak health infrastructures, and the disruptions in access to routine vaccinations during migration also complicate their health needs[ 5 ]. This continuous threat to public health in Iran, due to the high prevalence of diseases like measles that are preventable by vaccine, could clinically result in undermining the efforts at eradication with fluxes of unvaccinated people into Iran. This is a particular concern on border provinces such as Khorasan-Razavi, hosting one of Iran's largest Afghan populations[ 6 ]. Socio-cultural differences, language barriers, and economic hardships together with limited health literacy have been cited as various barriers to health services for refugees and immigrant populations [ 7 , 8 ]. Afghan refugees, especially, are at a high risk given that many are of uncertain legal status or part of highly mobile populations. For instance, NikFarjam et al. (2014) have indicated that even though the vaccination coverage among Iranian children in marginalized areas of Tehran stood at 98.4%, for non-Iranian children it was 95%, and Afghan children had the lowest vaccination coverage due to mobility and illegal status [ 9 ]. The disparities that exist in the immunization coverage indeed call for urgent targeted interventions to ensure that Afghan refugee children are adequately vaccinated[ 10 ]. Complete immunization of Afghan refugee children in Iran requires attention at both national health priority and strategic levels for global health security[ 11 ]. Most Afghan migrants in Iran are settled in the Province of Khorasan Razavi, with a high concentration in the city of Mashhad. This region has been an important destination for Afghan refugees due to its proximity to Afghanistan, shared cultural and linguistic ties, and religious sites in the area. As one of the biggest urban hubs in Iran, Mashhad provides at least some economic opportunities to Afghan migrants through informal employment and support within the community[ 12 ]. While studies designate Mashhad as hosting one of the major Afghan populations in the country, larger than any other city but Tehran, some refugees also declare this location home. The present study aimed to present Immunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021–2024) . As Khorasan-Razavi is the second province in Iran to have the highest population of Afghans—after Tehran—tracking the immunization progress is thus considered successful for finding out gaps and developing strategies to address the particular challenges this complex population faces. The current study will present evidence-based findings that will contribute to informed policy decision-making for the improvement of health care delivery and prevention of diseases among Afghan refugees in Iran. The study investigates the immunization trends over a period of three years.Ultimately, the findings from this study would not only reflect the progress of vaccination programs but also provide critical guidance regarding how the health needs of Afghan refugee children could be better supported to ensure integration into Iran’s broader public health framework. Through these efforts, Iran can make meaningful strides toward achieving comprehensive immunization coverage and mitigating the risks associated with the under-vaccinated refugee population. Method Study Design and Setting This study employed a cross-sectional, descriptive-analytical design. The research was conducted on vaccination data from health centers affiliated with Mashhad University of Medical Sciences, covering the period from March 2021 to March 2024. Data Collection Data were extracted from the SINA system (Integrated Health System of Mashhad University of Medical Sciences). The SINA system is an electronic health platform that records and presents data related to vaccination, disease diagnosis, and laboratory results using the International Coding Standards for Diseases (ICD-10). Vaccination data for Afghan nationals were collected based on the following parameters: Index (type of vaccine),Nationality (non-Iranian nationals), Gender (male and female), Year (March 2021-March 2024) Calculation of Vaccination Coverage At the end of each month, vaccination coverage for target groups was calculated online in the SINA system dashboard, following World Health Organization (WHO) standards. The system provides real-time data analysis and includes all national program vaccines such as polio (oral polio), diphtheria, BCG, and MMR. The dashboard embedded in the SINA system allows for the analysis of vaccination indicators and presents trends in vaccination coverage by vaccine type, gender, and year. Data Analysis Statistical analysis was performed using SPSS version 21 softwareMeans and standard deviations were calculated for vaccination coverage. Independent t-test: Used to investigate differences in vaccination coverage between genders. The level of statistical significance was set at p < 0.05 for all analyses. Ethical Considerations This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Ethics code: IR.MUMS.REC.1403.051). Results The findings show that out of a total of 6106 vaccine doses injected in 2021–2024, 3055 vaccine doses (50.03%) were allocated for boys and 3051 vaccine doses (49.97%) for girls (Table 1 ). Table 1 vaccination doses in Afghan children in Iran by sex Sex 21 March 2021- 20 March 2022 21 March 2022- 20 March 2023 21 March 2023- 20 March 2024 Number of vaccine doses percentage Number of vaccine doses percentage Number of vaccine doses percentage Boy 806 47.66 1103 49.89 1146 52 Girl 885 52.34 1108 50.11 1058 48 Table 2 Percentage of vaccination coverage in Afghan children by type of vaccine and year Vaccine Type Vaccine dose Percentage of vaccination coverage(%) 21 March 2021- 20 March 2022 21 March 2022- 20 March 2023 21 March 2023- 20 March 2024 BCG Single dose 96.11 94.7 96.26 DPT First 86.38 90.15 91.15 Second 71.61 73.05 78.76 Pentavalent First 95.20 95.40 96.76 Second 93.56 94.05 95.80 Third 90.86 91.24 92.65 OPV Zero 94.60 93.07 94.81 First 94.76 94.71 95.83 Second 93.43 93.67 95.03 Third 90.42 91.05 92.21 Fourth 86.13 89.59 90.77 Fifth 71.71 73.92 79.32 MMR First 90.28 92.35 92.94 Second 85.16 88.30 86.68 The findings show that the percentage of vaccination coverage in children of Afghan nationals under the age of two in three years is above 85% for all vaccines. Meanwhile, the percentage of vaccination of the second round of three and the fifth round of oral polio in children with the age of 6 years was less than 80%(Table 2 ). Table 3 The difference in the average percentage of vaccination coverage in Afghan children by gender and year Sex Mean ± SD Year P.value male 91.24 ± 11.66 21 March 2021- 20 March 2022 0.46 female 84.55 ± 7.54 male 90.96 ± 10.7 21 March 2022- 20 March 2023 0.67 female 89.40 ± 8.74 male 90.88 ± 7.26 21 March 2023- 20 March 2024 0.66 female 92.24 ± 8.28 The results of the independent t-test showed that there is no significant difference between gender and vaccination coverage in Afghan children in 21 March 2021- 20 March 2022 (p = 0.46), 21 March 2022- 20 March 2023 (p = 0.67), and 21 March 2023- 20 March 2024 (p = 0.66).(Table 3 ) The results of one-way analysis of variance showed that there is a statistically significant difference between the trend of BCG vaccination coverage in March 2021-March 2024 (p = 0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p = 0.000). (Fig. 1 ) The results of one-way analysis of variance showed that there is a statistically significant difference between the trend of MMR vaccination coverage in March 2021-March 2024 (p = 0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p = 0.000).(Fig. 2 ) The results of the one-way analysis of variance test showed that there is a statistically significant difference between the Pentavalent vaccination coverage trends in March 2021-March 2024 (p = 0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p = 0.000).(Fig. 3 ) The results of one-way analysis of variance showed that there is a statistically significant difference between the trend of DPT vaccination coverage in March 2021-March 2024 (p = 0.000). The results of the post hoc test for the first and second dose of the vaccine showed that the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p = 0.000). For the second time, in addition, between 21 March 2022- 20 March 2023 and 21 March 2022- 20 March 2023, the average difference was significant (p < 0.05).(Fig. 4 ) The results of one-way analysis of variance showed that there is a statistically significant difference between the trend of polio vaccination coverage in March 2021-March 2024 (p = 0.000). The results of the post hoc test for each of the vaccine dose showed that the coverage in March 2021-March 2024 (p = 0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p = 0.000). (Fig. 5) Discussion This study aimed to investigate Immunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021–2024).findings reveal that the average vaccination coverage in Afghan children under two years of age exceeded 85% for all vaccines, which is higher than the average global vaccination coverage reported by the World Health Organization in 2023 [ 8 ]. This high coverage rate is particularly noteworthy given the challenges often faced by refugee populations in accessing healthcare services [ 8 , 13 ]. The trend analysis of vaccination coverage from 2021 to 2024 showed significant differences across years for all vaccine types. Notably, the average vaccination coverage in 2021 differed significantly from 2022 and 2024. This finding can be partly attributed to the disruptions caused by the COVID-19 pandemic in the early stages of our study period. The pandemic has been reported to affect vaccination services globally, with a WHO survey finding that outreach services were affected in 70% of the 91 countries surveyed and facility-based disruptions in 61% [ 16 ]. Various studies have identified factors such as lockdowns, parental fear, social distancing, and reluctance to open multi-dose vials for few beneficiaries as contributors to reduced vaccination coverage during the pandemic [ 14 – 16 ]. Despite these challenges, our study found that vaccination coverage improved over the three-year period. This improvement may be attributed to increased access to vaccination services, mobile visits, and concerted efforts to reach marginalized populations [ 17 ]. The high coverage rates observed in our study align with the findings of a systematic review in Iran from 2011 to 2021, which reported overall immunization coverage ranging from 96.8–98.6% [ 11 ]. However, our study identified lower coverage rates for specific vaccine doses, particularly the second dose of DPT (74.47%) and the fifth dose of oral polio vaccine (74.98%) in six-year-old children. This finding is consistent with the study by Nik Farjam et al. (2014), which reported lower coverage for the second reminder of the triad and polio vaccines in children aged 24 months to 6 years in urban and marginal areas of Tehran [ 9 ]. These lower rates for later doses highlight the importance of maintaining parental awareness about the benefits of completing the full vaccination schedule and ensuring the proper functioning of vaccination service systems, including suitable working hours, appropriate staff-client interactions, and availability of required vaccines [ 18 ]. Importantly, our study found no statistically significant relationship between gender and vaccination coverage. This finding aligns with several previous studies [ 19 – 21 ] and suggests that Iran, in line with other WHO member countries, has successfully implemented universal immunization strategies that provide equitable access regardless of gender [ 3 ]. The high vaccination coverage observed in our study among Afghan children is particularly significant given the challenges often faced by refugee populations. Various studies have highlighted factors such as socio-cultural differences, access barriers to health services, economic issues, language limitations, and inadequate medical information as potential obstacles to vaccination among refugee communities [ 22 ]. Our findings suggest that the Iranian health system has been largely successful in overcoming these barriers for the Afghan population in Mashhad. However, it's important to note some limitations of our study. The data were collected from health centers affiliated with Mashhad Faculty of Medical Sciences, which may not fully represent the entire Afghan population in Iran. Additionally, the mobile nature of some Afghan populations and the potential presence of undocumented refugees may have affected our coverage estimates . In conclusion, our study demonstrates that the immunization coverage for vaccine-preventable diseases in Afghan children in Iran is optimal and even higher than the level recommended by the WHO. This achievement reflects the strength of Iran's primary health care network in responding to the needs of vulnerable populations [ 1 ]. However, the lower coverage rates for certain vaccine doses in older children highlight the need for continued efforts to ensure complete vaccination schedules. Future research should focus on identifying and addressing the specific barriers to full vaccination coverage, particularly for later doses in the schedule. Additionally, continued monitoring of vaccination data at subnational levels remains critical for tailoring vaccination strategies to address immunization gaps and reach every child with life-saving vaccines. Declarations Ethics approval and consent to participate : this research is approved by Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.REC.1403.051) Transparency Statement All methods and materials used in this research are described in detail in the methods section of this article to allow for replication. Funding this research is supported by Mashhad University of medical sciences. (Gant NO. 4022203) Author Contribution Conceptualization and methodology:Ali vafaee Najar,Elaheh HooshmandData collection:Mahin Esmaeili-Darmian,Data analysis and interpretation:Ehsan Mousa-FarkhaniDrafting the article:Fatemeh Kokabi-SaghiRevising and final approval of the manuscript: Ali vafaee Najar,Elaheh Hooshmand Acknowledgements The authors would like to express their gratitude to all the individuals who helped conduct this study. Competing interests : The authors declare that they have no competing interests. Consent for publication : The authors declare their Consent for publication Availability of data and material: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. References MacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161–4. Feldstein LR. Global routine vaccination coverage, 2016. MMWR. Morbidity and mortality weekly report; 2017. p. 66. Moradi-Lakeh M, Esteghamati A. National Immunization Program in Iran: whys and why nots. Hum Vaccin Immunother. 2013;9(1):112–4. Salmani I, Seddighi H, Nikfard M. Access to Health Care Services for Afghan Refugees in Iran in the COVID-19 Pandemic. Disaster Med Public Health Prep. 2020;14(4):e13–4. Bloom DE, Canning D, Weston M. The value of vaccination. Fighting the diseases of poverty. Routledge; 2017. pp. 214–38. Publications Office of the European Union. Iran -Situation of AfghanRefugees . 2022. Morris MD, et al. Healthcare barriers of refugees post-resettlement. J Community Health. 2009;34:529–38. Paxton GA, et al. East African immigrant children in Australia have poor immunisation coverage. J Paediatr Child Health. 2011;47(12):888–92. Nikfarjam A et al. Status of vaccination coverage in children 24 months to 6 years in urban and high risk areas covered by Tehran University of Medical Sciences. 2016. Ahmed N, et al. Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox’s Bazar. Bangladesh Plos one. 2023;18(4):e0283881. Derakhshani M, et al. Immunization Coverage for Vaccine-Preventable Diseases in Iran from 2011 to 2021 Compared to the Level Recommended by the World Health Organization. Volume 16. Qom University of Medical Sciences Journal; 2022. pp. 250–61. 3. Afghanistan Research and Evaluation Unit (AREU), R.t.A.A.S.o.A.L.i.M., Islamic Republic of Iran. October 2005, https://www.refworld.org/reference/countryrep/areu/2005/en/55296 [accessed 09 October 2024]. Odusanya OO, et al. Determinants of vaccination coverage in rural Nigeria. BMC Public Health. 2008;8:1–8. Khoubfekr H, Ershad Sarabi DH, Vahdatimanesh R. The Impact of Reminder Text Messages on Timely Completion of Routine Vaccination among Infants under One Year in IranShahr during the COVID-19 Pandemic: A Quasi-Experimental Study. Health Res Dev J. 2024;1(2):24–33. Alsuhaibani M, Alaqeel A. Impact of the COVID-19 pandemic on routine childhood immunization in Saudi Arabia. Vaccines. 2020;8(4):581. Sharma M, et al. Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries. J family Med Prim care. 2021;10(11):3991–7. Ekezie W et al. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel), 2022. 10(7). Oyo-Ita A et al. Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev, 2023. 12(12): p. Cd008145. Shenton LM, et al. Vaccination status of children aged 1–4 years in Afghanistan and associated factors, 2015. Vaccine. 2018;36(34):5141–9. Mellou K, et al. Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018. Eurosurveillance. 2019;24(27):1800326. Gooya M, et al. Vaccination Coverage among Nomads’ under 6 Years Children in Kermanshah Province, 2012–2013. Hakim J. 2015;17(4):337–42. Daniels D, et al. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother. 2022;18(6):2131168. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5309598","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":371055305,"identity":"e86d8522-83c3-43c0-bf3b-d8ceab7b03dd","order_by":0,"name":"Mahin Esmaeili-Darmian","email":"","orcid":"","institution":"Mashhad University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Mahin","middleName":"","lastName":"Esmaeili-Darmian","suffix":""},{"id":371055306,"identity":"958fb8f1-4232-48e3-909b-2d288456ec38","order_by":1,"name":"Elaheh Hooshmand","email":"","orcid":"","institution":"Mashhad University of Medical 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[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Being a prime strategy in primary prevention, vaccination protects not only at the individual level but also offers benefits at the level of the community through the reduction of disease transmission [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In response to global health needs, most countries modified national immunization programs, which included routine vaccinations for children against major infectious diseases. The WHO expanded the Program on Immunization in 1977, and Iran launched this program in 1984[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. So far, the NITAG of Iran has incorporated all vaccines recommended by the WHO into the national schedule: one dose of BCG against tuberculosis; several doses of OPV against polio; DTP against diphtheria, tetanus, and pertussis; MMR against measles; HepB against hepatitis B; Hib against \u003cem\u003eHaemophilus influenzae\u003c/em\u003e type B [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Currently, in 2024, it has added rotavirus and pneumococcal diseases vaccines to extend protection against more diseases[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, particular attention needs to be given to the vaccination cover for Afghan refugees\u0026mdash;a vulnerable population group making up a considerable part of Iran's demographic. Official statistics indicate that about 4.5\u0026nbsp;million refugees reside in Iran, out of which 97 percent are Afghan nationals. These refugees have settled in Iran due to decades of conflict and instability in Afghanistan, besides the socio-economic problems; recent political upheavals accelerate migration into Iran. These barriers to healthcare access\u0026mdash;including immunization\u0026mdash;leave Afghan refugees, particularly children, as a challenge for public health and disease prevention in Iran[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInterrupted vaccinations are one of the serious health issues linked with Afghan refugees. Many refugees normally come from regions with weak health infrastructures, and the disruptions in access to routine vaccinations during migration also complicate their health needs[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. This continuous threat to public health in Iran, due to the high prevalence of diseases like measles that are preventable by vaccine, could clinically result in undermining the efforts at eradication with fluxes of unvaccinated people into Iran. This is a particular concern on border provinces such as Khorasan-Razavi, hosting one of Iran's largest Afghan populations[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSocio-cultural differences, language barriers, and economic hardships together with limited health literacy have been cited as various barriers to health services for refugees and immigrant populations [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Afghan refugees, especially, are at a high risk given that many are of uncertain legal status or part of highly mobile populations. For instance, NikFarjam et al. (2014) have indicated that even though the vaccination coverage among Iranian children in marginalized areas of Tehran stood at 98.4%, for non-Iranian children it was 95%, and Afghan children had the lowest vaccination coverage due to mobility and illegal status [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The disparities that exist in the immunization coverage indeed call for urgent targeted interventions to ensure that Afghan refugee children are adequately vaccinated[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eComplete immunization of Afghan refugee children in Iran requires attention at both national health priority and strategic levels for global health security[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Most Afghan migrants in Iran are settled in the Province of Khorasan Razavi, with a high concentration in the city of Mashhad. This region has been an important destination for Afghan refugees due to its proximity to Afghanistan, shared cultural and linguistic ties, and religious sites in the area. As one of the biggest urban hubs in Iran, Mashhad provides at least some economic opportunities to Afghan migrants through informal employment and support within the community[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. While studies designate Mashhad as hosting one of the major Afghan populations in the country, larger than any other city but Tehran, some refugees also declare this location home. The present study aimed to present \u003cb\u003eImmunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021\u0026ndash;2024)\u003c/b\u003e. As Khorasan-Razavi is the second province in Iran to have the highest population of Afghans\u0026mdash;after Tehran\u0026mdash;tracking the immunization progress is thus considered successful for finding out gaps and developing strategies to address the particular challenges this complex population faces. The current study will present evidence-based findings that will contribute to informed policy decision-making for the improvement of health care delivery and prevention of diseases among Afghan refugees in Iran. The study investigates the immunization trends over a period of three years.Ultimately, the findings from this study would not only reflect the progress of vaccination programs but also provide critical guidance regarding how the health needs of Afghan refugee children could be better supported to ensure integration into Iran\u0026rsquo;s broader public health framework. Through these efforts, Iran can make meaningful strides toward achieving comprehensive immunization coverage and mitigating the risks associated with the under-vaccinated refugee population.\u003c/p\u003e"},{"header":"Method","content":"\u003cp\u003e \u003cb\u003eStudy Design and Setting\u003c/b\u003e This study employed a cross-sectional, descriptive-analytical design. The research was conducted on vaccination data from health centers affiliated with Mashhad University of Medical Sciences, covering the period from March 2021 to March 2024.\u003c/p\u003e \u003cp\u003eData Collection Data were extracted from the SINA system (Integrated Health System of Mashhad University of Medical Sciences). The SINA system is an electronic health platform that records and presents data related to vaccination, disease diagnosis, and laboratory results using the International Coding Standards for Diseases (ICD-10).\u003c/p\u003e \u003cp\u003eVaccination data for Afghan nationals were collected based on the following parameters:\u003c/p\u003e \u003cp\u003eIndex (type of vaccine),Nationality (non-Iranian nationals), Gender (male and female), Year (March 2021-March 2024)\u003c/p\u003e \u003cp\u003eCalculation of Vaccination Coverage At the end of each month, vaccination coverage for target groups was calculated online in the SINA system dashboard, following World Health Organization (WHO) standards. The system provides real-time data analysis and includes all national program vaccines such as polio (oral polio), diphtheria, BCG, and MMR. The dashboard embedded in the SINA system allows for the analysis of vaccination indicators and presents trends in vaccination coverage by vaccine type, gender, and year.\u003c/p\u003e \u003cp\u003eData Analysis Statistical analysis was performed using SPSS version 21 softwareMeans and standard deviations were calculated for vaccination coverage. Independent t-test: Used to investigate differences in vaccination coverage between genders. The level of statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 for all analyses.\u003c/p\u003e \u003cp\u003eEthical Considerations This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (Ethics code: IR.MUMS.REC.1403.051).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe findings show that out of a total of 6106 vaccine doses injected in 2021\u0026ndash;2024, 3055 vaccine doses (50.03%) were allocated for boys and 3051 vaccine doses (49.97%) for girls (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003evaccination doses in Afghan children in Iran by sex\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e21 March 2021- 20 March 2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e21 March 2022- 20 March 2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c7\" namest=\"c6\"\u003e \u003cp\u003e21 March 2023- 20 March 2024\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of vaccine doses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNumber of vaccine doses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eNumber of vaccine doses\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003epercentage\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBoy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e806\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e49.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGirl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e885\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e52.34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e1058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c7\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePercentage of vaccination coverage in Afghan children by type of vaccine and year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVaccine Type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVaccine dose\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003ePercentage of vaccination coverage(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 March 2021- 20 March 2022\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21 March 2022- 20 March 2023\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21 March 2023- 20 March 2024\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBCG\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSingle dose\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e96.11\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e94.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e96.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eDPT\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFirst\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e86.38\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e90.15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e91.15\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSecond\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e71.61\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e73.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e78.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003ePentavalent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFirst\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e95.20\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e95.40\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e96.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSecond\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e93.56\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e94.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e95.80\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eThird\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e90.86\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e91.24\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e92.65\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003eOPV\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eZero\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e94.60\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e93.07\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e94.81\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFirst\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e94.76\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e94.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e95.83\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSecond\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e93.43\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e93.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e95.03\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eThird\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e90.42\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e91.05\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e92.21\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFourth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e86.13\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e89.59\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e90.77\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFifth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e71.71\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e73.92\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e79.32\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eMMR\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFirst\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e90.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e92.35\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e92.94\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSecond\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e85.16\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e88.30\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e86.68\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe findings show that the percentage of vaccination coverage in children of Afghan nationals under the age of two in three years is above 85% for all vaccines. Meanwhile, the percentage of vaccination of the second round of three and the fifth round of oral polio in children with the age of 6 years was less than 80%(Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe difference in the average percentage of vaccination coverage in Afghan children by gender and year\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYear\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP.value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e91.24\u0026thinsp;\u0026plusmn;\u0026thinsp;11.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21 March 2021- 20 March 2022\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.46\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003efemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e84.55\u0026thinsp;\u0026plusmn;\u0026thinsp;7.54\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e90.96\u0026thinsp;\u0026plusmn;\u0026thinsp;10.7\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21 March 2022- 20 March 2023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.67\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003efemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e89.40\u0026thinsp;\u0026plusmn;\u0026thinsp;8.74\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003emale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e90.88\u0026thinsp;\u0026plusmn;\u0026thinsp;7.26\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e21 March 2023- 20 March 2024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.66\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003efemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e92.24\u0026thinsp;\u0026plusmn;\u0026thinsp;8.28\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe results of the independent t-test showed that there is no significant difference between gender and vaccination coverage in Afghan children in 21 March 2021- 20 March 2022 (p\u0026thinsp;=\u0026thinsp;0.46), 21 March 2022- 20 March 2023 (p\u0026thinsp;=\u0026thinsp;0.67), and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.66).(Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of one-way analysis of variance showed that there is a statistically significant difference between the trend of BCG vaccination coverage in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of one-way analysis of variance showed that there is a statistically significant difference between the trend of MMR vaccination coverage in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.000).(Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of the one-way analysis of variance test showed that there is a statistically significant difference between the Pentavalent vaccination coverage trends in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.000).(Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of one-way analysis of variance showed that there is a statistically significant difference between the trend of DPT vaccination coverage in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test for the first and second dose of the vaccine showed that the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). For the second time, in addition, between 21 March 2022- 20 March 2023 and 21 March 2022- 20 March 2023, the average difference was significant (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).(Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe results of one-way analysis of variance showed that there is a statistically significant difference between the trend of polio vaccination coverage in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test for each of the vaccine dose showed that the coverage in March 2021-March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). The results of the post hoc test showed the average difference in 21 March 2021- 20 March 2022 is significantly different from 21 March 2022- 20 March 2023 and 21 March 2023- 20 March 2024 (p\u0026thinsp;=\u0026thinsp;0.000). (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5)\u003c/span\u003e\u003c/p\u003e\n\n"},{"header":"Discussion","content":"\u003cp\u003eThis study aimed to investigate Immunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021\u0026ndash;2024).findings reveal that the average vaccination coverage in Afghan children under two years of age exceeded 85% for all vaccines, which is higher than the average global vaccination coverage reported by the World Health Organization in 2023 [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. This high coverage rate is particularly noteworthy given the challenges often faced by refugee populations in accessing healthcare services [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe trend analysis of vaccination coverage from 2021 to 2024 showed significant differences across years for all vaccine types. Notably, the average vaccination coverage in 2021 differed significantly from 2022 and 2024. This finding can be partly attributed to the disruptions caused by the COVID-19 pandemic in the early stages of our study period. The pandemic has been reported to affect vaccination services globally, with a WHO survey finding that outreach services were affected in 70% of the 91 countries surveyed and facility-based disruptions in 61% [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Various studies have identified factors such as lockdowns, parental fear, social distancing, and reluctance to open multi-dose vials for few beneficiaries as contributors to reduced vaccination coverage during the pandemic [\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these challenges, our study found that vaccination coverage improved over the three-year period. This improvement may be attributed to increased access to vaccination services, mobile visits, and concerted efforts to reach marginalized populations [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The high coverage rates observed in our study align with the findings of a systematic review in Iran from 2011 to 2021, which reported overall immunization coverage ranging from 96.8\u0026ndash;98.6% [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, our study identified lower coverage rates for specific vaccine doses, particularly the second dose of DPT (74.47%) and the fifth dose of oral polio vaccine (74.98%) in six-year-old children. This finding is consistent with the study by Nik Farjam et al. (2014), which reported lower coverage for the second reminder of the triad and polio vaccines in children aged 24 months to 6 years in urban and marginal areas of Tehran [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These lower rates for later doses highlight the importance of maintaining parental awareness about the benefits of completing the full vaccination schedule and ensuring the proper functioning of vaccination service systems, including suitable working hours, appropriate staff-client interactions, and availability of required vaccines [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImportantly, our study found no statistically significant relationship between gender and vaccination coverage. This finding aligns with several previous studies [\u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and suggests that Iran, in line with other WHO member countries, has successfully implemented universal immunization strategies that provide equitable access regardless of gender [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe high vaccination coverage observed in our study among Afghan children is particularly significant given the challenges often faced by refugee populations. Various studies have highlighted factors such as socio-cultural differences, access barriers to health services, economic issues, language limitations, and inadequate medical information as potential obstacles to vaccination among refugee communities [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Our findings suggest that the Iranian health system has been largely successful in overcoming these barriers for the Afghan population in Mashhad.\u003c/p\u003e \u003cp\u003eHowever, it's important to note some limitations of our study. The data were collected from health centers affiliated with Mashhad Faculty of Medical Sciences, which may not fully represent the entire Afghan population in Iran. Additionally, the mobile nature of some Afghan populations and the potential presence of undocumented refugees may have affected our coverage estimates .\u003c/p\u003e \u003cp\u003eIn conclusion, our study demonstrates that the immunization coverage for vaccine-preventable diseases in Afghan children in Iran is optimal and even higher than the level recommended by the WHO. This achievement reflects the strength of Iran's primary health care network in responding to the needs of vulnerable populations [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. However, the lower coverage rates for certain vaccine doses in older children highlight the need for continued efforts to ensure complete vaccination schedules. Future research should focus on identifying and addressing the specific barriers to full vaccination coverage, particularly for later doses in the schedule. Additionally, continued monitoring of vaccination data at subnational levels remains critical for tailoring vaccination strategies to address immunization gaps and reach every child with life-saving vaccines.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cu\u003eEthics approval and consent to participate\u003c/u\u003e\u003cspan dir=\"RTL\"\u003e:\u003c/span\u003e this research is approved by Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.REC.1403.051)\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eTransparency Statement\u0026nbsp;\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eAll methods and materials used in this research are described in detail in the methods section of this article to allow for replication.\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003ethis research is supported by Mashhad University of medical sciences. (Gant NO. 4022203)\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eConceptualization and methodology:Ali vafaee Najar,Elaheh HooshmandData collection:Mahin Esmaeili-Darmian,Data analysis and interpretation:Ehsan Mousa-FarkhaniDrafting the article:Fatemeh Kokabi-SaghiRevising and final approval of the manuscript: Ali vafaee Najar,Elaheh Hooshmand\u003c/p\u003e\u003ch2\u003eAcknowledgements\u003c/h2\u003e \u003cp\u003eThe authors would like to express their gratitude to all the individuals who helped conduct this study.\u003c/p\u003e \u003ch2\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eCompeting interests\u003c/span\u003e:\u003c/strong\u003e \u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e \u003ch2\u003e \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eConsent for publication\u003c/span\u003e:\u003c/strong\u003e \u003cp\u003eThe authors declare their Consent for publication\u003c/p\u003e\u003ch2\u003eAvailability of data and material:\u003c/h2\u003e \u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMacDonald NE. Vaccine hesitancy: Definition, scope and determinants. Vaccine. 2015;33(34):4161\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFeldstein LR. Global routine vaccination coverage, 2016. MMWR. Morbidity and mortality weekly report; 2017. p. 66.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoradi-Lakeh M, Esteghamati A. National Immunization Program in Iran: whys and why nots. Hum Vaccin Immunother. 2013;9(1):112\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSalmani I, Seddighi H, Nikfard M. Access to Health Care Services for Afghan Refugees in Iran in the COVID-19 Pandemic. Disaster Med Public Health Prep. 2020;14(4):e13\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBloom DE, Canning D, Weston M. The value of vaccination. Fighting the diseases of poverty. Routledge; 2017. pp. 214\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePublications Office of the European Union. \u003cem\u003eIran -Situation of AfghanRefugees\u003c/em\u003e. 2022.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMorris MD, et al. Healthcare barriers of refugees post-resettlement. J Community Health. 2009;34:529\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaxton GA, et al. East African immigrant children in Australia have poor immunisation coverage. J Paediatr Child Health. 2011;47(12):888\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNikfarjam A et al. \u003cem\u003eStatus of vaccination coverage in children 24 months to 6 years in urban and high risk areas covered by Tehran University of Medical Sciences.\u003c/em\u003e 2016.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAhmed N, et al. Factors associated with low childhood immunization coverage among Rohingya refugee parents in Cox\u0026rsquo;s Bazar. Bangladesh Plos one. 2023;18(4):e0283881.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDerakhshani M, et al. Immunization Coverage for Vaccine-Preventable Diseases in Iran from 2011 to 2021 Compared to the Level Recommended by the World Health Organization. Volume 16. Qom University of Medical Sciences Journal; 2022. pp. 250\u0026ndash;61. 3.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAfghanistan Research and Evaluation Unit (AREU), R.t.A.A.S.o.A.L.i.M., Islamic Republic of Iran. October 2005, \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.refworld.org/reference/countryrep/areu/2005/en/55296\u003c/span\u003e\u003cspan address=\"https://www.refworld.org/reference/countryrep/areu/2005/en/55296\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [accessed 09 October 2024].\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOdusanya OO, et al. Determinants of vaccination coverage in rural Nigeria. BMC Public Health. 2008;8:1\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhoubfekr H, Ershad Sarabi DH, Vahdatimanesh R. The Impact of Reminder Text Messages on Timely Completion of Routine Vaccination among Infants under One Year in IranShahr during the COVID-19 Pandemic: A Quasi-Experimental Study. Health Res Dev J. 2024;1(2):24\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlsuhaibani M, Alaqeel A. Impact of the COVID-19 pandemic on routine childhood immunization in Saudi Arabia. Vaccines. 2020;8(4):581.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharma M, et al. Magnitude and causes of routine immunization disruptions during COVID-19 pandemic in developing countries. J family Med Prim care. 2021;10(11):3991\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEkezie W et al. Access to Vaccination among Disadvantaged, Isolated and Difficult-to-Reach Communities in the WHO European Region: A Systematic Review. Vaccines (Basel), 2022. 10(7).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOyo-Ita A et al. Interventions for improving coverage of childhood immunisation in low- and middle-income countries. Cochrane Database Syst Rev, 2023. 12(12): p. Cd008145.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShenton LM, et al. Vaccination status of children aged 1\u0026ndash;4 years in Afghanistan and associated factors, 2015. Vaccine. 2018;36(34):5141\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMellou K, et al. Increasing childhood vaccination coverage of the refugee and migrant population in Greece through the European programme PHILOS, April 2017 to April 2018. Eurosurveillance. 2019;24(27):1800326.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGooya M, et al. Vaccination Coverage among Nomads\u0026rsquo; under 6 Years Children in Kermanshah Province, 2012\u0026ndash;2013. Hakim J. 2015;17(4):337\u0026ndash;42.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaniels D, et al. Vaccine hesitancy in the refugee, immigrant, and migrant population in the United States: A systematic review and meta-analysis. Hum Vaccin Immunother. 2022;18(6):2131168.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"vaccination, vaccination coverage, children, Afghan nationals, refugee","lastPublishedDoi":"10.21203/rs.3.rs-5309598/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5309598/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eImmunization is crucial for improving child health, especially among refugee populations. This study aimed to examine vaccination coverage trends in Afghan children in Iran.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis descriptive-analytical cross-sectional study analyzed vaccination data of Afghan nationals from March 2021 to March 2024, extracted from the SINA system (Integrated Health System of Mashhad University of Medical Sciences). Data were analyzed using descriptive statistics, independent t-tests, and ANOVA with SPSS v21.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOut of 6,106 vaccine doses administered, 50.03% were for boys. The average vaccination coverage in Afghan children from 2021\u0026ndash;2024 was 89.9%. Vaccination coverage for children under two years was above 85% for all vaccines, exceeding WHO global averages. The lowest coverage was observed for the second dose of DPT (74.47%) and the fifth dose of oral polio vaccine (74.98%) in six-year-olds. No significant gender differences in vaccination coverage were found. Significant differences in coverage trends were observed across the three-year period for all vaccines (p\u0026thinsp;=\u0026thinsp;0.000).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eImmunization coverage for vaccine-preventable diseases in Afghan children in Iran is optimal and higher than WHO-recommended levels. Continuous monitoring of subnational data is crucial for tailoring vaccination strategies to address immunization gaps and ensure comprehensive coverage.\u003c/p\u003e","manuscriptTitle":"Immunization Insights: Trends and Coverage Among Afghan Children refugee in Iran (2021-2024)","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 12:27:36","doi":"10.21203/rs.3.rs-5309598/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9049ea0c-6bb6-4bcf-9602-095c52a1da59","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-29T10:12:05+00:00","versionOfRecord":[],"versionCreatedAt":"2024-11-15 12:27:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5309598","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5309598","identity":"rs-5309598","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}