Prevalence and geo-clinicodemographic factors associated with hepatitis B vaccination among healthcare workers in five developing countries

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Study Justification:
– Healthcare workers (HCWs) have a higher risk of hepatitis B infection compared to the general population.
– Limited access to diagnosis and treatment of hepatitis B in resource-constrained settings may result in low screening and treatment rates among HCWs.
– There is a lack of studies on hepatitis B vaccination among HCWs in developing countries, which hinders intervention and support efforts.
Study Highlights:
– The study aimed to estimate the prevalence of hepatitis B vaccination among HCWs in five developing countries using nationally representative data.
– The study found that the proportion of HCWs who received the required doses of hepatitis B vaccine varied across the countries: Afghanistan (69.1%), Haiti (11.3%), Malawi (15.4%), Nepal (46.5%), and Senegal (17.6%).
– Gender, occupational qualification, and years of education were significant factors associated with receiving the required doses of hepatitis B among HCWs.
– The study highlights the need for intensified education campaigns among HCWs and suggests making hepatitis B vaccination compulsory for employment, especially for those who regularly encounter bodily fluids of patients.
Recommendations for Lay Reader:
– Healthcare workers in developing countries should be educated about the importance of hepatitis B vaccination.
– Policymakers should consider making hepatitis B vaccination mandatory for healthcare workers, particularly those who come into contact with bodily fluids of patients.
Recommendations for Policy Maker:
– Intensify education campaigns among healthcare workers to increase awareness and uptake of hepatitis B vaccination.
– Consider implementing policies that make hepatitis B vaccination a requirement for employment in healthcare settings, especially for workers who have regular contact with patients’ bodily fluids.
Key Role Players:
– Policymakers in developing countries
– National health agencies
– Healthcare facility administrators
– Healthcare worker associations or unions
– Public health organizations
Cost Items for Planning Recommendations:
– Development and implementation of education campaigns
– Training programs for healthcare workers on hepatitis B vaccination
– Vaccine procurement and distribution
– Monitoring and evaluation of vaccination coverage
– Administrative costs for policy implementation and enforcement

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 used nationally representative data from the Demographic and Health Surveys Program’s Service Provision Assessment Survey, which adds credibility to the findings. The study also conducted logistic regressions to analyze the data and reported statistical significance. However, the abstract does not provide information on the sample size or the specific methodology used in the analysis. To improve the evidence, the abstract should include details on the sample size, sampling method, and any potential limitations of the study. Additionally, providing more information on the statistical analysis, such as the model used and any adjustments made, would enhance the strength of the evidence.

Background: There is a four-fold risk for hepatitis B infection among healthcare workers compared to the general population. Due to limited access to diagnosis and treatment of hepatitis B in many resource-constrained settings, there is a real risk that only few healthcare workers with viral hepatitis may get screened or diagnosed and treated. Studies on hepatitis B vaccination among healthcare workers in developing countries are sparse and this bodes ill for intervention and support. The aim of the study was to estimate the prevalence and explored the associated factors that predicted the uptake of the required, full dosage of hepatitis B vaccination among healthcare workers (HCWs) in five developing countries using nationally representative data. Methods: We used recent datasets from the Demographic and Health Surveys Program’s Service Provision Assessment Survey. Descriptive summary statistics and logistic regressions were used to produce the results. Statistical significance was pegged at p < 0.05. Results: The proportion of HCWs who received the required doses of hepatitis B vaccine in Afghanistan, Haiti, Malawi, Nepal, and Senegal were 69.1%, 11.3%, 15.4%, 46.5%, and 17.6%, respectively. Gender, occupational qualification, and years of education were significant correlates of receiving the required doses of hepatitis B among HCWs. Conclusions: Given the increased risk of hepatitis B infection among healthcare workers, policymakers in developing countries should intensify education campaigns among HCWs and, perhaps, must take it a step further by making hepatitis B vaccination compulsory and a key requirement for employment, especially among those workers who regularly encounter bodily fluids of patients.

In all, there were 13 developing countries who participated in the Service Provision Assessment (SPA) surveys under the Demographic and Health Survey (DHS) program. Only formal facilities are included in the SPA survey hence pharmacies and individual doctors’ offices are often excluded from the SPA. For the purposes of our study, we selected countries with recently conducted SPA surveys from 2013 up till now and having questions on hepatitis B screening for HCWs. The countries that met the criteria were Afghanistan (2018–2019), Haiti (2017–2018), Malawi (2013–2014), Nepal (2015), and Senegal (2019), and these SPA surveys were conducted by the countries’ respective national agencies with technical support from the Demographic and Health Surveys (DHS). Besides the standard DHS, the Service Provision Assessment survey is undertaken to evaluate the health system readiness to provide quality care, amongst others. The surveys used generic questionnaires to assess the availability of essential services and assessed the presence of standard facilities and equipment required to provide these essential services. These services included child welfare clinics, and immediate newborn care, maternal and child health, antenatal services, birth control, treatment for sexuality transmitted diseases, tuberculosis, malaria, and non-communicable diseases amongst other essential health care services. These generic questionnaires included “facility inventory questionnaire”, “health provider interview questionnaire”, “observation protocols for antenatal care, family planning, services for sick children, and normal obstetric delivery and immediate newborn care” and “exit Interview questionnaires for antenatal care and family planning clients and for caretakers of sick children whose consultations were observed”. The survey also assessed health system readiness to ensure infection prevention in the health environment. The healthcare facilities included governmental, private, and quasi-governmental facilities in both rural and urban areas. Along with data on health system preparedness, data on vaccination history of health care providers were obtained. The unit of measurement included both the health facility and individual health care providers. Computer-Assisted Personal Interviews (CAPI) were used to collect data from HCWs who were working in sampled healthcare facilities. For Afghanistan, the 1038 HCWs selected were all interviewed, representing 100% response rate [39]. For Haiti, 4461 HCWs were interviewed out of 4680; this represents 95.32% response rate [40]. For Malawi, the selected 2660.0 HCWs were all interviewed, representing 100% response rate [41]. For Nepal, 4057 HCWs were interviewed out of the selected sample of 4216; this represents 96.23% response rate [42]. For Senegal, 1353 HCWs were interviewed out of 1355; this represents 99.99% response rate [43]. The following demographic characteristics of the HCWs were collected: years of education, sex, and qualification. The following were the weighted analytic sample sizes for each of the countries included in the study: Afghanistan, N = 1038.0; Haiti, N = 4461.0; Malawi, N = 2660.0; Nepal, N = 4057.0; Senegal, N = 1353.0. There were no missing cases in the datasets. The outcome variable is complete dosing of hepatitis B vaccination among healthcare providers. The HCWs were asked the following ‘Yes/No’ question to know their hepatitis B vaccination status: “Have you received any dose of Hepatitis B vaccine?” Those who answered “YES” were further asked the following to determine complete vaccination status: IF YES, how many doses have you received so far? The forgoing question has the following response scale: 1 dose, 2 doses, 3 or more doses. HCWs who had received at least 3 doses were classified as those who have received complete hepatitis B vaccination. Explanatory variables under investigation included gender, occupation, and years of training. Data was analyzed using STATA version 14 software. Each of the selected countries was analyzed separately. Analysis was mainly in two stages. The first stage involved descriptive analysis during which weighted estimates of the outcome and associated 95% confidence intervals were provided. Weighting was done due to the unequal probability of inclusion of cases from certain subgroups in the DHS sample. All included health care facilities were selected from a sample frame of listed health care facilities stratified by facility type, regional location, and management type (i.e., public vs. private facilities). Hospital facilities are usually oversampled because of their relative numbers in each country. Sample weight is a function of the selection probability of health facility and the selection probability within the subgroup of the individual. Sample weights were normalized and estimated in six decimals but often presented in the DHS data without the decimals. Therefore, prior to applying the sample weights during analysis, the sample weight for each case was divided by 1,000,000. All weighting adjustments were done in STATA-14. Thus, sample weights were applied to adjust for representation and ensure accurate estimates of the outcome. Given that the outcome variable is binary, we used binary logistic regression to build the multivariable model showing estimates of the predictors of complete dosing of hepatitis B vaccination among healthcare providers. In the multivariable model, we reported odds ratios and its associated 95% confidence intervals. Data used for the present study is freely available after online request at https://dhsprogram.com/data/dataset_admin/index.cfm. Ethical clearance to undertake the survey was granted by the respective national authorizing bodies. Informed consent was obtained from the health care providers prior to being interviewed. Owing to the use of secondary data, no further consents were sought.

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Based on the provided information, here are some potential innovations that could improve access to maternal health:

1. Mobile Health (mHealth) Solutions: Develop mobile applications or text messaging services to provide information and reminders about maternal health, including vaccination schedules and availability of healthcare services.

2. Telemedicine: Implement telemedicine programs to connect healthcare providers with pregnant women in remote or underserved areas, allowing them to receive prenatal care and consultations without having to travel long distances.

3. Community Health Workers: Train and deploy community health workers to provide education, support, and basic healthcare services to pregnant women in their communities, including promoting the importance of vaccination and facilitating access to healthcare facilities.

4. Integrated Maternal Health Clinics: Establish integrated clinics that offer comprehensive maternal health services, including vaccinations, prenatal care, family planning, and postnatal care, to ensure that women receive all necessary care in one location.

5. Public-Private Partnerships: Foster collaborations between public and private sectors to improve access to maternal health services, including vaccination programs. This could involve leveraging private healthcare providers and facilities to expand service coverage.

6. Supply Chain Management: Implement efficient supply chain management systems to ensure the availability and accessibility of vaccines and other essential maternal health commodities in healthcare facilities, particularly in resource-constrained settings.

7. Health Education Campaigns: Conduct targeted health education campaigns to raise awareness about the importance of maternal health, including the benefits of vaccination, among pregnant women, their families, and healthcare providers.

8. Policy and Regulatory Changes: Advocate for policy and regulatory changes that prioritize and support maternal health, including mandating hepatitis B vaccination for healthcare workers and ensuring adequate funding for maternal health programs.

It is important to note that these recommendations are general and may need to be tailored to the specific context and needs of each country or region.
AI Innovations Description
Based on the description provided, the recommendation to improve access to maternal health would be to intensify education campaigns among healthcare workers (HCWs) and make hepatitis B vaccination compulsory and a key requirement for employment, especially among those workers who regularly encounter bodily fluids of patients. This recommendation is based on the increased risk of hepatitis B infection among healthcare workers and the low prevalence of hepatitis B vaccination among HCWs in developing countries. By implementing this recommendation, it would help protect healthcare workers from hepatitis B infection and ensure safer maternal health practices.
AI Innovations Methodology
Based on the provided description, the study focuses on the prevalence and factors associated with hepatitis B vaccination among healthcare workers in five developing countries. To improve access to maternal health, the following innovations and recommendations can be considered:

1. Education Campaigns: Intensify education campaigns among healthcare workers (HCWs) to raise awareness about the importance of hepatitis B vaccination. This can include training programs, workshops, and informational materials to ensure HCWs understand the risks and benefits of vaccination.

2. Mandatory Vaccination: Make hepatitis B vaccination compulsory and a key requirement for employment, especially among healthcare workers who regularly encounter bodily fluids of patients. This can help ensure that all HCWs are protected against hepatitis B and reduce the risk of transmission.

3. Improved Screening and Diagnosis: Enhance access to diagnosis and treatment of hepatitis B in resource-constrained settings. This can involve improving the availability of diagnostic tests, training healthcare providers on screening protocols, and ensuring affordable treatment options are accessible.

Methodology to Simulate the Impact of Recommendations:

To simulate the impact of these recommendations on improving access to maternal health, the following methodology can be employed:

1. Data Collection: Collect data on the current prevalence of hepatitis B vaccination among healthcare workers in the selected countries. This can be done through surveys, interviews, or existing datasets.

2. Define Variables: Identify and define variables that will be used to measure the impact of the recommendations. This can include variables such as vaccination rates, healthcare worker demographics, and access to screening and treatment.

3. Baseline Assessment: Conduct a baseline assessment to determine the current status of access to maternal health and hepatitis B vaccination among healthcare workers in the selected countries. This will serve as a reference point for comparison.

4. Model Development: Develop a simulation model that incorporates the recommendations mentioned above. This model should consider factors such as the effectiveness of education campaigns, the compliance rate with mandatory vaccination, and the impact of improved screening and diagnosis on vaccination rates.

5. Data Analysis: Analyze the data collected and simulate the impact of the recommendations on improving access to maternal health. This can be done by comparing the baseline assessment with the simulated outcomes, such as changes in vaccination rates and healthcare worker behavior.

6. Evaluation: Evaluate the results of the simulation to assess the effectiveness of the recommendations in improving access to maternal health. This can involve comparing the simulated outcomes with predefined targets or benchmarks.

7. Iterative Process: Refine the simulation model based on the evaluation results and repeat the process to further optimize the recommendations and improve access to maternal health.

By following this methodology, policymakers and healthcare stakeholders can gain insights into the potential impact of the recommendations and make informed decisions to improve access to maternal health and hepatitis B vaccination among healthcare workers in developing countries.

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