Pregnant women’s hepatitis B vaccination coverage in Nigeria: a national pilot cross-sectional study

  • Therapeutic Advances in Vaccines and Immunotherapy, Volume 9, Year 2021

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Study Justification:
The study aimed to determine the hepatitis B vaccination coverage among pregnant women in Nigeria and identify factors that affect the uptake of the vaccine. This information is important for public health policymakers and healthcare providers to understand the current situation and develop strategies to improve vaccination rates. Hepatitis B is a serious viral infection that can be transmitted from mother to child during childbirth, and vaccination is an effective preventive measure.
Highlights:
– The study found that only 13.2% of pregnant women in Nigeria had received the hepatitis B vaccine.
– Among those vaccinated, the majority received only one to three doses, indicating poor full-dose coverage.
– Lack of awareness about the vaccine was the most common reason for non-uptake.
– The level of education was initially associated with vaccination uptake, but this association did not remain significant after adjusting for other factors.
Recommendations:
– Improve awareness: Public health campaigns should be implemented to increase awareness about the importance of hepatitis B vaccination among pregnant women.
– Strengthen healthcare access: Efforts should be made to improve access to the vaccine, ensuring that it is readily available in healthcare facilities.
– Target high-risk groups: Special attention should be given to pregnant women who are at higher risk of hepatitis B infection, such as those who are hepatitis B virus positive.
– Enhance education: Health education programs should be developed to provide accurate information about the vaccine, its benefits, and safety to pregnant women and healthcare providers.
Key Role Players:
– Ministry of Health: Responsible for developing and implementing vaccination policies and programs.
– Healthcare Providers: Involved in administering the vaccine and providing education to pregnant women.
– Public Health Agencies: Responsible for conducting awareness campaigns and monitoring vaccination coverage.
– Research Institutions: Conduct further studies to monitor the impact of interventions and evaluate the effectiveness of strategies.
Cost Items for Planning Recommendations:
– Vaccine Procurement: Budget for the purchase and distribution of hepatitis B vaccines to healthcare facilities.
– Training and Education: Allocate funds for training healthcare providers on vaccine administration and education programs for pregnant women.
– Awareness Campaigns: Allocate resources for developing and implementing public health campaigns to increase awareness about hepatitis B vaccination.
– Monitoring and Evaluation: Budget for monitoring vaccination coverage, conducting surveys, and evaluating the impact of interventions.
Please note that the provided cost items are general suggestions and may vary depending on the specific context and resources available in Nigeria.

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is a cross-sectional study, which provides a snapshot of the hepatitis B vaccination coverage among pregnant women in Nigeria. The sample size is relatively small, with 159 pregnant women included in the study. The study used bivariate analysis and conditional logistic regression analysis to determine variables associated with the uptake of the vaccination. However, the statistical significance was only accepted when the p-value was less than 0.05, which may lead to potential false negatives. To improve the strength of the evidence, it would be beneficial to conduct a larger-scale study with a more diverse sample to increase generalizability. Additionally, using a lower threshold for statistical significance, such as p < 0.1, could help identify potential associations that may have been missed. Finally, including qualitative data to explore the reasons for non-uptake of vaccination in more depth would provide valuable insights for developing targeted interventions to improve coverage rates.

Objective: To determine the hepatitis B vaccination coverage, full-dose (⩾3) coverage and the associated factors affecting uptake among pregnant women. Methods: This was a cross-sectional study among pregnant women attending antenatal care in six tertiary hospitals across all the geopolitical zones of Nigeria. Pregnant women who consented to the study completed screening questions about their hepatitis B vaccination status and coverage. The main outcome measures were hepatitis B vaccination coverage rate, dose, and factors affecting uptake. Bivariate analysis was performed by the chi-square test and conditional logistic regression analysis was used to determine variables associated with uptake of the vaccination. Odds ratios (ORs) and adjusted odds ratios (aORs) were calculated and statistical significance was accepted when p-value was < 0.05. Results: Of 159 pregnant women who completed the interview questions, 21 [13.2%, 95% confidence interval (CI) 7.9–18.5%] were vaccinated for hepatitis B for one to three doses. The numbers of doses received were: three doses (8/159, 5.0%), two doses (5/159, 3.1%), and one dose (8/159, 5.0%). The reasons for non-uptake of vaccination included: lack of awareness of the vaccine 83/138 (60.1%), inadequate access to vaccine 11/138 (8.0%), and positivity to hepatitis B virus 10/138 (7.2%). The uptake of hepatitis B vaccination was significantly affected by the level of education (OR 0.284, 95% CI 0.08–1.01, p = 0.041), but in multivariable logistic regression, adjusted for confounders, the association between hepatitis B vaccination and participants’ level of education (aOR 3.09; 95% CI 0.95–10.16; p = 0.061) did not remain significant. Conclusions: In Nigeria, the national hepatitis B vaccination coverage among pregnant women appears poor, with the full-dose coverage even poorer. The level of education was not positively associated with uptake of hepatitis B vaccination, while lack of awareness of the vaccine was the commonest reason for non-uptake. Funding: TETFund National Research Fund 2019 (grant number TETFund/DR&D/CE/NRF/STI/33).

This was a cross-sectional pilot baseline finding from a Nigerian longitudinal cohort study, designed to explore the vaccination coverage rate and factors affecting such interventions among pregnant women. Pregnant women 18 years or over and registered for their antenatal care (ANC) were eligible to participate in the study. The questions (screening survey) asked their hepatitis B vaccination status, and those who were previously or recently vaccinated. Consent was obtained from all participants before recruitment into the study. The study was conducted among pregnant women attending ANC in the six geopolitical zones of Nigeria. The study was conducted in Nigeria, a country made up of the federal capital territory and 36 states which are partitioned into contiguous six geopolitical zones. Participants were recruited from one randomly selected tertiary level facility in each of the five geopolitical zones in Nigeria apart from the south-east zone where the lead institution for the TETFund National Research Fund 2019 was selected. The sites randomly selected are: University of Maiduguri Teaching Hospital, Maiduguri (north-east zone); University of Abuja Teaching Hospital, Gwagwalada (north-central zone); Aminu Kano Teaching Hospital, Kano (north-west zone); Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife (south-west zone); and University of Port Harcourt Teaching Hospital, Port Harcourt (south-south zone) in addition to the lead Institution, Nnamdi Azikiwe University Teaching Hospital, Nnewi (south-east zone). We employed purposive non-probability sampling by selecting six tertiary hospitals across the six geopolitical zones in Nigeria. The research assistants were adequately trained in recruiting and screening pregnant women in the survey. We recruited pregnant women from various antenatal clinics at each hospital between June and July 2020. Trained research assistants systematically handed out a screening survey to all pregnant women attending antenatal clinics in those sites. The screening survey contained questions asking women whether they had received hepatitis B vaccination before, among others, and if they had not received hepatitis B vaccination before, they were then excluded from answering any further full survey questions. Each hospital was asked to recruit approximately 25 pregnant women into the pilot phase. Pregnant women who completed the full survey were asked for their contact details and given a unique identifier; a member of the research team cross-checked these details to ensure each woman completed the full survey questions. No formal sample size calculations were made because of the pilot nature of the study. Ethical clearance for this study was obtained from the National Health Research Ethics Committee, with registration number: NHREC/01/01/2007–23/01/2020 (approval date: 23 January 2020). Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidance was used for reporting. Full details of the study are in the protocol. 12 The survey was divided into two parts: the screening survey and the full survey. The women were asked their gestational age (in weeks), age, marital status, level of education, occupation, income available to the woman for ANC, ownership of housing and type of accommodation and whether they had completed the survey previously. They were then asked whether they have heard of hepatitis B infection, hepatitis B vaccination as well as their current and past hepatitis B vaccination status. For those who had received HBV vaccination, they were asked their age when they received the vaccination, and the number of doses they received: (one dose, two doses, three doses or more than three doses), and when they received the last dose prior to pregnancy (less than one month, between one month and 3 months, between 4 months and 6 months or more than 6 months). We defined HBV vaccination status as: (i) no vaccination when no dose was received; (ii) partial vaccination when one or two doses were received; and (iii) full vaccination when three or four doses were received. 13 The main outcome measure was hepatitis B vaccination and hepatitis B vaccine knowledge status collected from the screening and full survey. The Statistical Package for the Social Sciences (SPSS) version 22.0 (IBM Corp., Armonk, NY, USA) was used to perform the statistical analyses in this study. Screening survey responses were used to estimate the prevalence of hepatitis B vaccination and knowledge of hepatitis B vaccine for all pregnant women with 95% confidence intervals (CIs). The estimates of the proportions, in the following categories: dose of hepatitis B vaccine, and reasons for non-uptake of the hepatitis B vaccine were evaluated and the prevalence of hepatitis B vaccination by level of education, maternal age, religion, marital status, occupation, income availability for ANC, ownership of living apartment/house and type of accommodation were compared using chi-square statistics. For those who were eligible and completed the full survey, maternal characteristics, hepatitis B vaccination coverage and other factors among all participants were described. These latter independent variables were then used to conduct chi-square tests, to determine differences between women who received hepatitis B vaccination and those who did not receive hepatitis B vaccination and the differences between them. Conditional logistic regression was employed in the multiple regression analysis to determine variables associated with the uptake of hepatitis B vaccination, while controlling for other confounding variables (such as: age, religion, marital status, occupation status, income availability and ownership of housing). In this analysis, the odds ratios (ORs), adjusted odds ratios (aORs) and CI was set at 95% and p < 0.05 was considered significant.

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Based on the provided information, here are some potential innovations that can be used to improve access to maternal health, specifically in relation to hepatitis B vaccination coverage:

1. Mobile Health (mHealth) Interventions: Develop mobile applications or text messaging services to provide pregnant women with information about hepatitis B vaccination, including reminders for vaccination appointments and educational materials.

2. Community Health Workers: Train and deploy community health workers to educate pregnant women about the importance of hepatitis B vaccination, address misconceptions, and provide access to vaccination services in remote or underserved areas.

3. Telemedicine: Implement telemedicine services to enable pregnant women in rural or remote areas to consult with healthcare providers and receive guidance on hepatitis B vaccination, reducing the need for travel and improving access to healthcare.

4. Public Awareness Campaigns: Launch targeted public awareness campaigns to increase knowledge and awareness about hepatitis B vaccination among pregnant women, their families, and communities, addressing common misconceptions and promoting the benefits of vaccination.

5. Integration of Services: Integrate hepatitis B vaccination services with existing maternal health programs, such as antenatal care visits, to ensure that pregnant women have easy access to vaccination during routine healthcare visits.

6. Improving Vaccine Supply Chain: Strengthen the vaccine supply chain to ensure an adequate and consistent availability of hepatitis B vaccines in healthcare facilities, reducing barriers to access and increasing vaccination coverage.

7. Training Healthcare Providers: Provide training and education to healthcare providers on the importance of hepatitis B vaccination during pregnancy, ensuring they have the knowledge and skills to effectively counsel and administer vaccines to pregnant women.

8. Collaboration and Partnerships: Foster collaboration and partnerships between government agencies, healthcare providers, non-governmental organizations, and community-based organizations to collectively address barriers to hepatitis B vaccination access and improve coverage rates.

These innovations can help improve access to hepatitis B vaccination for pregnant women, ultimately reducing the risk of transmission to newborns and improving maternal and child health outcomes.
AI Innovations Description
The study mentioned is a cross-sectional pilot baseline finding from a Nigerian longitudinal cohort study that aimed to explore the vaccination coverage rate and factors affecting the uptake of hepatitis B vaccination among pregnant women. The study was conducted in six tertiary hospitals across all the geopolitical zones of Nigeria.

The main objective of the study was to determine the hepatitis B vaccination coverage, full-dose coverage (≥3 doses), and the factors influencing the uptake of the vaccine among pregnant women. The study collected data through a screening survey completed by pregnant women attending antenatal care. The survey included questions about their hepatitis B vaccination status and coverage.

The findings of the study showed that among the 159 pregnant women who completed the interview questions, only 13.2% (21 women) were vaccinated for hepatitis B, with varying numbers of doses received (three doses: 5.0%, two doses: 3.1%, one dose: 5.0%). The reasons for non-uptake of vaccination included lack of awareness of the vaccine (60.1%), inadequate access to the vaccine (8.0%), and positivity to hepatitis B virus (7.2%).

The study also analyzed the factors associated with the uptake of hepatitis B vaccination. Initially, the level of education was found to have a significant association with vaccination uptake. However, after adjusting for confounders, the association did not remain significant.

In conclusion, the study revealed that the national hepatitis B vaccination coverage among pregnant women in Nigeria is poor, with even lower coverage for full-dose vaccination. Lack of awareness of the vaccine was identified as the most common reason for non-uptake. The level of education did not show a significant association with vaccination uptake.

Based on these findings, a recommendation to improve access to maternal health, specifically hepatitis B vaccination, could include:

1. Increasing awareness: Implementing targeted awareness campaigns to educate pregnant women about the importance of hepatitis B vaccination during antenatal care visits. This can be done through various channels such as community health workers, healthcare providers, and mass media.

2. Strengthening healthcare infrastructure: Ensuring adequate availability and accessibility of hepatitis B vaccines in healthcare facilities, especially in remote areas. This may involve improving supply chains, storage facilities, and distribution systems.

3. Training healthcare providers: Providing comprehensive training to healthcare providers on the importance of hepatitis B vaccination, its administration, and addressing common concerns or misconceptions among pregnant women.

4. Collaboration and partnerships: Engaging with relevant stakeholders, including government agencies, non-governmental organizations, and international partners, to mobilize resources and support for improving access to maternal health services, including hepatitis B vaccination.

5. Monitoring and evaluation: Establishing a robust monitoring and evaluation system to track vaccination coverage rates, identify barriers, and measure the impact of interventions. This can help in identifying areas for improvement and ensuring accountability.

By implementing these recommendations, it is expected that access to maternal health, specifically hepatitis B vaccination, can be improved, leading to better health outcomes for pregnant women and their infants.
AI Innovations Methodology
Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Increase awareness: Develop and implement comprehensive awareness campaigns to educate pregnant women about the importance of hepatitis B vaccination during pregnancy. This can be done through various channels such as community outreach programs, social media campaigns, and educational materials in healthcare facilities.

2. Strengthen healthcare infrastructure: Improve access to hepatitis B vaccination by ensuring that healthcare facilities have adequate and consistent supplies of the vaccine. This can be achieved by strengthening the supply chain management system and addressing any logistical challenges that may hinder the availability of the vaccine.

3. Training and capacity building: Provide training and capacity building programs for healthcare providers to enhance their knowledge and skills in administering hepatitis B vaccinations. This can help improve the quality of antenatal care services and increase the confidence of healthcare providers in recommending and administering the vaccine.

4. Collaboration and partnerships: Foster collaboration and partnerships between government agencies, healthcare providers, non-governmental organizations, and community leaders to collectively address the barriers to hepatitis B vaccination uptake. This can involve joint advocacy efforts, resource sharing, and coordinated outreach programs.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could be developed as follows:

1. Define the indicators: Identify key indicators that reflect access to maternal health, such as vaccination coverage rate, dose coverage, and factors affecting uptake.

2. Data collection: Collect data on the selected indicators before implementing the recommendations. This can be done through surveys, interviews, and analysis of existing data sources.

3. Intervention implementation: Implement the recommended interventions, such as awareness campaigns, infrastructure improvements, training programs, and collaboration initiatives.

4. Post-intervention data collection: Collect data on the same indicators after implementing the interventions. This can be done using the same methods as in the pre-intervention phase.

5. Data analysis: Analyze the pre- and post-intervention data to assess the impact of the recommendations on improving access to maternal health. This can involve comparing the vaccination coverage rates, dose coverage, and factors affecting uptake before and after the interventions.

6. Evaluation and interpretation: Evaluate the results of the data analysis and interpret the findings to determine the effectiveness of the recommendations in improving access to maternal health. This can involve calculating the changes in vaccination coverage rates, identifying any significant differences in dose coverage, and assessing the impact of the interventions on the factors affecting uptake.

7. Recommendations and future steps: Based on the evaluation findings, make recommendations for further improvements and identify potential future steps to sustain and enhance the impact of the interventions on access to maternal health.

It is important to note that the methodology described above is a general framework and can be adapted and customized based on the specific context and resources available for the study.

Statistics:
Citations: 4
Authors: 41
Identifiers:
DOI: 10.1177/25151355211032595
ISSN: 25151355
Research Areas:
Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants
Study Countries:
Nigeria
Study Design:
Cohort Study, Cross Sectional Study
Study Approach:
Quantitative
Participants Gender:
Female
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