Introduction: countries in sub-Saharan Africa, including Ghana, are disproportionately affected by hepatitis B viral (HBV) infection. In these areas, mother-to-child transmission (MTCT) is an essential mode of HBV transmission. Evidently, timely hepatitis B birth dose vaccination remains an effective preventive intervention against MTCT of HBV. Considering that midwives and physicians are the primary care providers of newborns in Ghana, we sought to examine their preventive practices toward vertical transmission of HBV in the eastern region of Ghana. Methods: a cross-sectional survey was conducted with 126 healthcare providers (HCP; midwives and physicians). The participants were conveniently recruited from one regional hospital and four district hospitals. Statistical significance was set at 0.05 alpha level. Results: the findings indicate that 42.9% (n = 54) of HCPs’ prevention of mother to child transmission (PMTCT) practices for hepatitis B were good (X2 = 2.57, p > 0.05). Explicitly, 79% indicated screening all pregnant women for hepatitis B as part of antenatal care (X2 = 41.14, p 0.05), whereas one-third (33%) reported routinely administering a birth dose of the hepatitis B vaccine to neonates of mothers with hepatitis B (X2 = 14.00, p < 0.001). However, only 37% reported administering the hepatitis B vaccine to newborns within 12 hours of birth (X2 = 9.18, p < 0.01). The binary logistic regression analyses identified training as the only significant predictor of good practice on PMTCT of hepatitis B at the 5% level (Wald = 3.91, p =0.05). Conclusion: given that more than half of the participants in the study area had incorrect PMTCT practices for hepatitis B, it is imperative that a series of workshops on hepatitis B be done for healthcare providers in Ghana. In addition, hepatitis B birth dose vaccine must be incorporated into the ´Expanded Programme on Immunisation´ to remove the cost that acts as a barrier to access.
Study design: a quantitative approach [11] using a cross-sectional survey was used [12]. Study setting: this study was conducted in the eastern part of Ghana. According to the most recent population and housing census report, about 2,633,154 people reside in the eastern region of Ghana [13]. The region has a regional hospital and a number of districts, and sub-district health facilities owned by the Government of Ghana and the Christian Health Association of Ghana (CHAG). This study was conducted in the only regional hospital and four district hospitals in the region. This study is part of a larger study, but the findings as reported here are about the preventive practices of midwives and physicians [9]. Study participants: participants were included if they were full-time employees of the selected health facilities with at least six (6) months working experience in midwifery or medicine. Additionally, participants were considered eligible if they were providing either maternal or neonatal care in any of the selected health facilities and consented to participate. Midwives and physicians were excluded if they were doing national service or internship respectively. Sampling technique: convenience sampling technique was used to recruit participants who met the inclusion criteria [13]. The physicians were approached in their consulting rooms following a prior notice a week to data collection. Also, the midwives were contacted in their various place of work including the labour ward, antenatal unit, lying-in ward, and post-natal unit. Data collection spanned between March and September, 2017. Outcome measures: the primary outcome of the study was the preventive practices of the midwives and physicians toward vertical transmission of hepatitis B. Data collection: we used a semi-structured self-administered questionnaire to collect participants' response to the research questions. The questionnaire was developed by experts in the field, including gastroenterologist, obstetric and gynaecologist specialist, and a hepatitis researcher. The questionnaire was pre-tested using five physicians and ten midwives. Items reported to be unclear to the participants were revised accordingly. Cronbach´s alpha reliability coefficient was established after the revised questionnaire was administered to 30 participants and found to be 0.74 which was considered acceptable [14]. Six (6) questions were asked on levels of practice on PMTCT of HBV. Practice was categorised into good and bad. This was based on the standard measure of the Ghana Education Service 50% cut off rating for pass or fail in an examination. Sample size determination: Yamane [15] formula for calculating sample size at a precision level of 0.05 was used to estimate the sample size for this study. A total of 120 participants was the minimum sample size required. However, 126 questionnaires were retrieved, out of 130 questionnaires administered, representing a response rate of 97%. Statistical analysis: we analysed the data using the IBM Statistical Product and Service Solutions (IBM-SPSS) version 24.0. Descriptive statistics such as means, standard deviation, and percentages were examined. Inferential statistics, including Chi-square, and binary logistic regression, were performed. A p-value of 0.05 alpha level was considered statistically significant. Informed consent: written informed consent was obtained from every participants after explaining the purpose, confidentiality information, and the right to withdraw from the study. Ethical considerations: ethical approval was obtained from the Ghana Health Service ethical review committee (approval number GHS-ERC 13/07/15). We also obtained permission from the management of the selected facilities.
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