Impact of a performance monitoring intervention on the timeliness of Hepatitis B birth dose vaccination in the Gambia: a controlled interrupted time series analysis

Abstract

Introduction The Hepatitis B virus that can cause liver cancer is highly prevalent in the Gambia, with one in ten babies at risk of infection from their mothers. Timely hepatitis B birth dose administration to protect babies is very low in The Gambia. Our study assessed whether 1) a timeliness monitoring intervention resulted in hepatitis B birth dose timeliness improvements overall, and 2) the intervention impacted differentially among health facilities with different pre-intervention performances. Methods We used a controlled interrupted time series design including 16 intervention health facilities and 13 matched controls monitored from February 2019 to December 2020. The intervention comprised a monthly hepatitis B timeliness performance indicator sent to health workers via SMS and subsequent performance plotting on a chart. Analysis was done on the total sample and stratified by pre-intervention performance trend. Results Overall, birth dose timeliness improved in the intervention compared to control health facilities. This intervention impact was, however, dependent on pre-intervention health facility performance, with large impact among poorly performing facilities, and with uncertain moderate and weak impacts among moderately and strongly performing facilities, respectively. Conclusion The implementation of a novel hepatitis B vaccination timeliness monitoring system in health facilities led to overall improvements in both immediate timeliness rate and trend, and was especially helpful in poorly performing health facilities. These findings highlight the overall effectiveness of the intervention in a low-income setting, and also its usefulness to aid facilities in greatest need of improvement.

Impact of the COVID-19 pandemic on the coverage and timeliness of routine childhood vaccinations in the Gambia, 2015–2021

“…The EPI programme leveraged the monitoring potential of the solution and, since January 2020 when the system was still being pilot tested, introduced a HepB0 vaccination timeliness indicator which is monitored monthly at the health facility level. 48 Through this solution, facilities throughout the country could monitor timeliness of HepB0 and take data-driven decisions.…”

“…43 Fourth, in January 2021, the Gambian EPI implemented an electronic immunisation register system called 'MyChild Solution' across the country. 48 One of the key features of the MyChild Solution is the ability to autogenerate predefined indicators and send out SMS messages to valid phone numbers of BMJ Global Health parents registered in the system. The EPI programme leveraged the monitoring potential of the solution and, since January 2020 when the system was still being pilot tested, introduced a HepB0 vaccination timeliness indicator which is monitored monthly at the health facility level.…”

Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia

“…Subsequently, these forms are then scanned and transformed into digital records by the smart paper engine. A pilot phase of the smart paper system took place in two of the seven health regions in the country in 2017, and it was officially rolled out nationwide in January 2021 [ 25 ].…”

Prevalence of hepatitis B infection in the Gambian population: A narrative review of recent developments

“…Vaccine efficacy against chronic HBV carriage and infection among 4-year-olds was 94% effective against chronic carriage and 84 % effective against infection. It suggests that vaccination in infancy gives a 94% efficacy in preventing chronic HBV carriage from progressing into liver cancer ( Fortuin et al, 1993 , Mele et al, 2002 , Sowe et al, 2023 ). The main route of transmission appears to have shifted from vertical to horizontal in the Gambia.…”