Barriers to Timely Administration of Hepatitis B Birth Dose Vaccine to Neonates of Mothers With Hepatitis B in Ghana: Midwives’ Perspectives

Abstract

Background The global health sector strategy on viral hepatitis aims to reduce new hepatitis B infections by 90% by 2030. Yet, hepatitis B birth dose (HepB-BD) vaccination, which is effective in preventing mother-to-child transmission of hepatitis B, remains low in sub-Saharan Africa. Given the essential role that midwives play in infants’ birth dose immunisation, we explore their perspectives on the reasons for delays and non-administration of HepB-BD to eligible neonates in Ghana. Methods We conducted interviews with 18 midwives, stratified by region (Greater Accra and Northern regions). Participants were selected purposively. The data were transcribed, coded, and analysed following the Braun and Clarke data analysis procedure. Results The participants conveyed a broad range of barriers to HepB-BD vaccination in Ghana. These include the mother's denial of hepatitis B seropositivity; the mother's ignorance of the impact of hepatitis B on their newborn; partners’ non-involvement in post-test counselling; and the high cost of hepatitis B immunoglobulin and hepatitis B monovalent vaccine. Other reasons included vaccine unavailability and midwives’ oversight and documentation lapses. Conclusion We recommend educating expectant mothers on the importance and effectiveness of HepB-BD vaccination during antenatal care (ANC) visits, as well as educating midwives on HepB-BD vaccination procedures. In addition, ensuring sufficient supplies and administering hepatitis B vaccines in the delivery ward should be done to guarantee that babies receive the vaccines on time. Importantly, Ghana needs policies that require HepB-BD vaccination as part of the Expanded Programme on Immunisation (EPI) to ensure the investments and funding it needs.

‘We are willing, but we have challenges’: Qualitative enquiry on midwives’ views on factors influencing the prevention of mother-to-child transmission of hepatitis B program

“…These challenges may prevent pregnant women from being screened for HBV and their exposed newborns from receiving appropriate postexposure prophylaxis. These findings agree with previous studies, which revealed that the high cost of hepatitis B screening and vaccination is detrimental to HBV prevention strategies ( Adjei et al, 2023 ; Djaogol et al, 2019 ; Olakunde et al, 2023 ; Paul, Marie & Bechem, 2017 ). The high cost of HBV testing and vaccination with HepB-BD may negatively impact the successful implementation of the PMTCT program in the facility.…”

“…These issues can affect the successful implementation of the PMTCT program. These findings agree with reports that indicate that the unavailability of vaccines, limited vaccination hours, lack of institutional mechanisms available to deliver vaccines at birth, vaccine stockouts, and high cost of vaccines hinder the PMTCT program ( Adjei et al, 2023 ; Gera et al, 2019 ). The difficulties in obtaining HepB-BD and HBIG may affect the timely administration of the vaccine to HBV-exposed newborns, and this defeats the overall goal of the PMTCT program.…”

“…Again, at the facility level, the scarcity of HBIG and the absence of national directives or programs to prevent HBV have all negatively impacted PMTCT programs ( Chabrol et al, 2019 ; Djaogol et al, 2019 ; Ntsime, Makhado & Sehularo, 2022 ; Olakunde et al, 2023 ). At the client and family level, the mother's denial of her hepatitis B seropositivity, her ignorance of the effects of hepatitis B on her infant and her entire family, and her partner's lack of participation in posttest counseling have all been reported as barriers affecting PMTCT program implementation ( Adjei, Suglo, Ahenkorah, MacDonald & Richter, 2023 ; Paul, Marie & Bechem, 2017 ).…”

Midwives’s Knowledge and Practice in Preventing Mother-to-Child Transmission on Hepatitis B Virus in Brazzaville in 2023

“…However, in Africa, anti-HBV serotherapy is often unavailable, and early treatment could minimize the risk of contamination. Generally speaking, midwives have a poor knowledge of the HBV vaccine [12] Ghana, the factors limiting the vaccination of newborns from birth were: the mother's denial of her seropositivity, the mother's ignorance of the consequences of hepatitis B for the newborn, the costs associated with monovalent vaccines [21]. Finally, the sample size of our study may have been a limitation.…”

Introduction of the Hepatitis B Vaccine—Birth Dose: Methods of Improving Rates in a Milieu of Vaccine Hesitancy

“…These are factors that can be reviewed locally in the future. Lack of parental health literacy regarding the impact of hepatitis B on the newborn, maternal denial of her positive hepatitis B status, cost of the birth dose and the HBIG, and the partners’ noninvolvement post-testing were additional factors identified in Ghana [ 32 ]. Although the HepB-BD is free of cost in Antigua and Barbuda, there is a cost associated with receiving the HBIG, which is an out-of-pocket cost covered by the client.…”