Determinants of incomplete childhood hepatitis B vaccination in Sierra Leone, Liberia, and Guinea: Analysis of national surveys (2018–2020)

Abstract

Vaccination against hepatitis B virus (HBV) is effective at preventing vertical transmission. Sierra Leone, Liberia, and Guinea are hyperendemic West African countries; yet, childhood vaccination coverage is suboptimal, and the determinants of incomplete vaccination are poorly understood. We analyzed national survey data (2018–2020) of children aged 4–35 months to assess complete HBV vaccination (receiving 3 doses of the pentavalent vaccine) and incomplete vaccination (receiving <3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11,181 mothers were analyzed (4,846 from Sierra Leone, 2,788 from Liberia, and 3,547 from Guinea). Sierra Leone had the highest HBV childhood vaccination coverage (70.3%), followed by Liberia (64.6%) and Guinea (39.3%). Within countries, HBV vaccination coverage varied by socioeconomic characteristics and healthcare access. In multivariate regression analysis, factors that were significantly associated with incomplete vaccination in at least one country included sex of the child, Muslim mothers, lower household wealth index, <4 antenatal visits, home delivery, and distance to health facility vaccination (all p < 0.05). Understanding and addressing modifiable determinants of incomplete vaccination will be essential to help achieve the 2030 viral hepatitis elimination goals.

Understanding COVID-19 Vaccine Uptake and Hesitancy among People with HIV in Freetown, Sierra Leone: A Cross-Sectional Study

“…Furthermore, it was noteworthy that being Muslim was a predictor of COVID-19 vaccine hesitancy in our study. This observation aligns with prior reports both from and outside Sub-Saharan Africa, which document increased levels of vaccine hesitancy among Muslim communities in the context of COVID-19 and other infectious diseases [18,[25][26][27]. For instance, we observed in a recent study that children of Muslim parents had lower odds of completing the hepatitis B vaccination series for infants in Sierra Leone and Guinea, two countries with majority Muslim populations [27].…”

“…This observation aligns with prior reports both from and outside Sub-Saharan Africa, which document increased levels of vaccine hesitancy among Muslim communities in the context of COVID-19 and other infectious diseases [18,[25][26][27]. For instance, we observed in a recent study that children of Muslim parents had lower odds of completing the hepatitis B vaccination series for infants in Sierra Leone and Guinea, two countries with majority Muslim populations [27]. Similarly, a recent systematic review and meta-analysis conducted in the United Kingdom noted that being a Muslim parent was associated with decision making regarding routine childhood vaccinations [28].…”

Key Considerations: Alleviating Chronic Food Insecurity in South Sudan

“…11 Another study looking at childhood vaccination in Sierra Leone, Liberia and Guinea found that children of Muslim mothers were less likely than Christian mothers to complete Hepatitis B vaccination. 9 This is consistent with a recent study on immunisation in Sierra Leone, which saw a higher likelihood of missed vaccination for children with Muslim caregivers compared to children with Christian caregivers. 26 While these findings might not be consistent with all Muslims, it is believed that vaccine hesitancy and rejection among Muslims might be connected to whether vaccines are 'halal' (religiously permissible) or in line with Islamic teachings, particularly during the month of Ramadan.…”