The role of social mobilization activities implemented by the Syria Immunization Group in increasing vaccination demand in Northwest Syria

Background: Conflict-affected settings such as Northwest Syria face severe disruptions to health services, resulting in reduced vaccination coverage and increased risk of outbreaks of vaccine-preventable diseases (VPDs). This study assessed vaccination coverage among children under five years of age and examined factors associated with incomplete immunization, with particular attention to social mobilization and communication. Methods: A community-based cross-sectional survey was conducted from June 3 to June 7, 2024, across nine districts in the Aleppo and Idlib governorates using a two-stage cluster sampling approach in line with WHO Expanded Programme on Immunization (EPI) survey guidance. Face-to-face interviews were conducted with caregivers of children under five years using a structured questionnaire. Vaccination status was defined based on age-appropriate completion of the recommended schedule. Descriptive analyses and chi-square tests were used to examine associations between vaccination status and sociodemographic, geographic, and communication-related factors. Results: A total of 1,244 households were surveyed, including 1,114 households with children under five years of age. Overall, 61.3% of children were fully vaccinated, 35.5% were partially vaccinated, and 3.2% had received no vaccines. Full vaccination coverage was significantly higher among children of mothers with secondary or diploma education compared with illiterate mothers (72.3% vs. 58.3%, p < 0.001). Higher coverage was also observed in households where income exceeded expenditure (69% vs. 60%, p = 0.036). Caregivers reporting WhatsApp as a source of vaccine information showed higher full vaccination coverage (p < 0.001). Coverage varied by district and housing type, with lower rates among displaced populations living in tents. Commonly reported barriers included misinformation, fear of side effects, and limited access to services. Conclusions: Vaccination coverage in Northwest Syria remains uneven, reflecting social, economic, and geographic disparities. Digital communication platforms, particularly messaging applications, may complement community-based outreach efforts. However, communication strategies should be integrated with interventions addressing service accessibility and structural barriers.