Strategies for Improving Hepatitis B Birth Dose in Nigeria

Abstract

Chronic hepatitis B virus (HBV) is a significant global health concern, with 296 million individuals affected worldwide. HBV is transmitted through direct contact with infected blood, unprotected sex with an infected individual, use of contaminated or unsterile medical or injection equipment, and most commonly, from an infected mother to her newborn during childbirth. To prevent mother-to-child (MTC) transmission of HBV during birth, the World Health Organization recommends that all countries include at minimum the three doses of hepatitis B vaccine within the routine immunization schedule, with the first dose given within 24 hours of birth (hepatitis B vaccine birth dose, HepB-BD). If HepB-BD is implemented in a timely manner, there is a significant chance of preventing MTC transmission of HBV. Literature from Nigeria, although limited, has demonstrated an inadequate emphasis on timely HepB-BD administration. To better understand the uptake of HepB-BD and improve its use, this study aimed 1) to identify barriers to and facilitators for implementing the HepB-BD for children born to pregnant women participating in antenatal care in the Adamawa and Enugu states of Nigeria; 2) to evaluate the impact of provider-based training for health care professionals involved in labor and delivery and routine immunization related to hepatitis B and the importance of timely HepB-BD administration; and 3) to disseminate study findings, including lessons learned, methods, and proof of concept to work toward expanding this program and improving the timely administration of HepB-BD beyond the context of this study. Findings from the qualitative analysis demonstrate major barriers to acquiring knowledge of HBV among health care workers, misconceptions related to vaccination contraindications, a lack of understanding of the implications of the timeliness of HepB-BD administration, and vaccination wastage concerns. Pregnant women had little overall knowledge of hepatitis B disease but were willing to have the vaccination if it was recommended by health care workers. After confirming these significant knowledge gaps, training for health care workers was designed to emphasize the importance of timely HepB-BD. To assess the uptake of timely HepB-BD vaccination administration change before and after the intervention, I performed a generalized linear mixed model. Results show that the rate of timely HepB-BD administration grew by 90% in the intervention group compared with the control group over selected time points during the intervention and adjusting for the state (Enugu and Adamawa). The intervention package and resources provided to pregnant women during antenatal care improved the uptake of timely HepB-BD after the intervention. To sustain improvements, the Nigerian government should continue to support capacity building of health care staff, generate vaccine demand by educating communities on the importance of routine immunization, and support outreach immunization services targeting hard-to-reach communities.