Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis

Abstract

Background: Depending on the epidemiological context of each country, three vaccines are recommended by the World Health Organization (WHO) to be administered as soon as possible after birth (birth vaccines); namely, BCG, zero dose of oral polio vaccine (OPV0), and birth dose of hepatitis B vaccine (HepB-BD). The timely administration of these vaccines immediately after birth might pose significant challenges in sub-Saharan Africa, where about half of childbirths occur outside health facilities. We therefore conducted a systematic review and meta-analysis to estimate the coverage rate of these vaccines at a specific timing in neonates in sub-Saharan Africa. Methods: We searched PubMed, Embase, CINAHL, and Web of Science for studies conducted in sub-Saharan Africa and published up to March 31, 2017, which provided a coverage rate of the birth vaccines at any specific time points within 28 days after birth. Two investigators independently screened the titles and abstracts and extracted data from the eligible full-text articles. This study was registered in PROSPERO (CRD42017071269). Results: Of 7283 articles identified, we finally included 31 studies with 204,111 infants in the meta-analysis. The pooled coverage rates at day 0–1 after birth were 14.2% (95% CI: 10.1–18.9) for BCG and 1.3% (0.0–4.5) for HepB-BD. No data were available for OPV0 at day 0–1. The coverage at day 28 was 71.7% (63.7–79.2) for BCG, 60.8% (45.8–74.7) for HepB-BD, and 76.1% (67.1–84.0) for OPV0. No significant difference in the vaccine coverage was observed between infants born in healthcare facilities and those born outside facilities. Conclusions: The rates of vaccine coverage immediately after birth were very low for BCG and HepB-BD, and no data for OPV0. We need additional data to better define barriers and facilitators for the timely administration of the birth vaccines in sub-Saharan Africa, since the delay in its provision may increase the burden of these vaccine-preventable diseases.

Hepatitis B Vaccination in Senegalese Children: Coverage, Timeliness, and Sociodemographic Determinants of Non-Adherence to Immunisation Schedules (ANRS 12356 AmBASS Survey)

“…By measuring the timeliness of HBV vaccination in Senegal, this study is one of the first to assess not only the coverage but also the effectiveness of a HBV vaccination programme in sub-Saharan Africa [ 27 ]. It is also the first study in Senegal, and one of the few in sub-Saharan Africa to date, to identify barriers to both BD timeliness and complete HBV vaccination.…”

“…Compared with other countries in the region, the proportion of children with timely BD vaccination is high in Senegal. According to a recent systematic review, only 1.3% (95% CI, 0.0–4.5%) and 21.5% (95% CI, 9.4–36.8%) of children in sub-Saharan African countries that have introduced the BD received it within 24 h and seven days of birth, respectively [ 27 ].…”

The Costs of Introducing the Hepatitis B Birth Dose Vaccine into the National Immunization Programme in Senegal (NéoVac Study)

“…Even after the introduction of HepB-BD into a country’s EPI, considerable challenges remain to reach a high level of coverage in the resource-limited African context. First, a recent meta-analysis of HepB-BD coverage in Sub-Saharan African countries where the dose is scheduled in the EPI reported that only 0.3% of babies born in healthcare facilities received the dose within 24 h of birth [ 11 ]. This highlights the importance of both providing clear guidelines for timely HepB-BD administration in healthcare facilities and ensuring the availability of the HepB-BD at all levels of the healthcare system [ 12 , 23 ].…”

“…These countries also face continued challenges to prioritize resource allocation for HepB-BD and advocate for action and investment in this vaccination strategy because of the lack of reliable information on the economic and financial costs required to integrate HepB-BD into their current EPI. Second, even in countries that have already introduced the HepB-BD into their EPI, coverage of timely HepB-BD administration remains low because of the logistical difficulties in administering the dose as scheduled (i.e., within 24 h of birth) to children born at home [ 10 , 11 , 12 ].…”

Epidemiological projections of viral‐induced hepatocellular carcinoma in the perspective of WHO global hepatitis elimination

“…696 This is because (a) only a few African countries have integrated HepB-BD in the national vaccination program; and (b) its timely administration is not sufficiently made even in countries that have integrated HepB-BD in their national program due to high rate of child birth at home. 97 Furthermore, HepB-BD is not perfect to prevent mother-to-child transmission from a high-risk mother. HBeAg-positive mothers exhibit a 20% risk of transmission to their offspring, despite neonatal immunoprophylaxis using HepB-BD.…”