The coverage of hepatitis B birth dose vaccination in Nigeria: Does the place of delivery matter?

Abstract

Background Hepatitis B birth dose (HepB-BD) vaccination coverage remains suboptimal in Nigeria. While evidence suggests that institutional delivery is associated with the uptake of HepB-BD vaccine, little is known about how the uptake differs by facility ownership (public or private). This study examined the HepB-BD vaccination coverage by place of delivery in Nigeria. Methods This study is a secondary analysis of data on 6143 children aged 12–23 mo obtained from the 2018 Nigeria Demographic and Health Survey. We assessed the association between HepB-BD vaccination and the place of delivery using logistic regression models. Results About 53% of the children received the HepB-BD vaccine. Approximately 77, 83 and 33% of those delivered at a public health facility, private health facility and at home received the HepB-BD vaccine, respectively. After controlling for child- and maternal-level factors, the odds of receiving HepB-BD vaccine were significantly lower in children delivered at a private health facility (adjusted OR [aOR]=0.77, 95% CI 0.59 to 0.99) or at home (aOR=0.48, 95% CI 0.36 to 0.63). Wealth index and region of residence were significantly associated with the receipt of HepB-BD vaccination in all three places of delivery. Conclusions Children are less likely to receive the HepB-BD vaccine if they are delivered at a private health facility or at home. There is a need for private health sector engagement for immunization service delivery and innovative community-based interventions to reach the children delivered at home.

Determinants of timely administration of the birth dose of hepatitis B vaccine in Senegal in 2019: Secondary analysis of the demographic and health survey

“…The latter are better off in terms of health infrastructure and human resources in health [23] . In Nigeria, a similar result was found [34] . Overall, this study highlights the existence of inequity in timely vaccination because coverage varies significantly in terms of social and geographic characteristics.…”

Weak Adoption and Performance of Hepatitis B Birth-Dose Vaccination Programs in Africa: Time to Consider Systems Complexity?—A Scoping Review

“…Several studies have investigated the programmatic barriers to optimal uptake of the hepatitis B birth-dose vaccine in Africa, using both quantitative and qualitative research approaches. Some of the barriers reported across the literature include the lack of relevant policies at both national and health-facility levels [73,74], lack of funding or out-of-pocket payment requirements [75], poor monitoring and evaluation systems [73,74], lack of integration with the maternal and child health package [14,74], lack of awareness about HBV infection and hepatitis B birth-dose vaccination among pregnant women [75,76], geographical inaccessibility of immunization clinics [75,77], inaccessibility due to allotted vaccination days [74,75], frequent stockouts [75,78], home births [79,80], lack of outreach services [74], mistrust of HCWs handling newborns [76], birth doses administered on discharge only [74], poor knowledge of contraindications among HCWs, and absence of delineated staff [74]. In 2017, Breakwell et al published a MEDLINE literature review citing (i) timely administration, (ii) the high prevalence of home births, (iii) the lack of services available to reach infants born at home, and (iv) unreliable vaccine supplies as challenges limiting improved adoption and coverage of the hepatitis B birth-dose vaccination program [2].…”

“…Of the four, only one publication described programmatic barriers, which suggested that living in rural areas was the most weighted risk factor limiting access to the hepatitis B birth-dose vaccine post-delivery [48,77]. despite integration with the national immunization schedule [80,82]. While calls for improved institutional delivery are valid [1,2,81], it remains important that national health systems become more responsive to cultural contexts where home births and isolation periods post-birth are concerned [2,76,77].…”

“…In a previous systematic review addressing Nigeria's position on vertical transmission of hepatitis B, the rate of institutional delivery was reported to be only 35% and of those attending antenatal care, 58% [6]. Consequently, hepatitis B birthdose vaccine coverage in Nigeria remains suboptimal (52%) despite integration with the national immunization schedule [80,82]. While calls for improved institutional delivery are valid [1,2,81], it remains important that national health systems become more responsive to cultural contexts where home births and isolation periods post-birth are concerned [2,76,77].…”

Awareness of Hepatitis B Virus Infection and Vaccination Rate Among Adults Attending the Out-Patient Clinic of General Hospital, Ilorin, Nigeria

“…Also, high cost of diagnostic testing and out of pocket expenses for viral hepatitis treatment, low capacity of health care providers, and the proliferation of sub-standard treatment centers across Nigeria constitute a challenge to the elimination goal of hepatitis in the country [14]. All these factors could account for poor birth-dose HBV vaccination in Nigeria, which has a 51-53% coverage rate [15,16].…”