Coverage, inequity and predictors of hepatitis B birth vaccination in Myanmar from 2011-2016: results from a national survey

Uptake of combined immunoprophylaxis for newborns exposed to hepatitis B virus in a high hepatitis B endemic rural setting in Northern Ghana

BACKGROUND

Mother-to-Child Transmission (MTCT) is a major route of Hepatitis B Virus (HBV) transmission, accounting for a substantial proportion of new infections, particularly in highly endemic areas. The timely administration of combined immunoprophylaxis of Hepatitis B Immunoglobulin (HBIG) and hepatitis B vaccine to newborns exposed to hepatitis B virus is a crucial strategy for preventing MTCT. This study investigated the determinants of hepatitis B virus immunoprophylaxis utilization for newborns of HBV-seropositive mothers in the North-East region of Ghana.

METHODS

A cross-sectional survey design was employed, involving 213 HBV seropositive mothers who had given birth in four selected study sites. Systematic random sampling was used to select mothers from the selected health facilities. Data was collected using a structured questionnaire. Data was coded entered and analyzed using SPSS version 26. Bivariate and multivariate analyses were undertaken, and the level of significance was set at 0.05.

RESULTS

Key findings revealed that mothers aged 30-39 were less likely to ensure their newborns received both hepatitis B immunoglobulin and vaccine compared to younger mothers (aOR = 0.24, 95% CI [0.09, 0.65], p = 0.005). Employment status significantly influenced utilization, with salaried workers (aOR = 6.78, 95% CI [1.34, 34.46], p = 0.021) and self-employed mothers (aOR = 3.38, 95% CI [1.39, 8.22], p = 0.007) more likely to utilize immunoprophylaxis compared to unemployed mothers. Higher monthly income (501-1000 currency units) was associated with increased utilization (aOR = 4.70, 95% CI [1.28, 17.32], p = 0.020). Mothers with good knowledge of hepatitis B were more likely to ensure immunoprophylaxis for their newborns (aOR = 3.60, 95% CI [1.72, 7.54], p = 0.001).

CONCLUSION

This study found 63.4% HBV immunoprophylaxis uptake among newborns in rural Ghana, influenced by maternal age, employment, income, and knowledge. It recommends integrating immunoprophylaxis into the National Health Insurance Scheme to reduce financial barriers. Strengthening health education for mothers on HBV transmission is also crucial. Policy reforms and improved healthcare are needed to eliminate mother-to-child HBV transmission and achieve the global goal of eliminating viral hepatitis by 2030.

CLINICAL TRIAL REGISTRATION NUMBER

Not applicable.

Progress towards elimination of viral hepatitis: a Lancet Gastroenterology & Hepatology Commission update

The top 20 highest burdened countries (in disability-adjusted life years) account for more than 75% of the global burden of viral hepatitis. An effective response in these 20 countries is crucial if global elimination targets are to be achieved. In this update of the Lancet Gastroenterology & Hepatology Commission on accelerating the elimination of viral hepatitis, we convene national experts from each of the top 20 highest burdened countries to provide an update on progress. Although the global burden of diseases is falling, progress towards elimination varies greatly by country. By use of a hepatitis elimination policy index conceived as part of the 2019 Commission, we measure countries' progress towards elimination. Progress in elimination policy has been made in 14 of 20 countries with the highest burden since 2018, with the most substantial gains observed in Bangladesh, India, Indonesia, Japan, and Russia. Most improvements are attributable to the publication of formalised national action plans for the elimination of viral hepatitis, provision of publicly funded screening programmes, and government subsidisation of antiviral treatments. Key themes that emerged from discussion between national commissioners from the highest burdened countries build on the original recommendations to accelerate the global elimination of viral hepatitis. These themes include the need for simplified models of care, improved access to appropriate diagnostics, financing initiatives, and rapid implementation of lessons from the COVID-19 pandemic.

Introduction of the Hepatitis B Vaccine-Birth Dose: Methods of Improving Rates in a Milieu of Vaccine Hesitancy

The hepatitis B virus is a public health threat, chronically infecting over 240 million persons worldwide. The hepatitis B vaccine is 90% effective in preventing perinatal transmission if the first dose is given within the first 24 h of life, followed by a minimum of two subsequent doses. Antigua and Barbuda instituted a hospital-based birth dose vaccination policy in October 2021. Data were extracted from hospital logbooks from November 2021 to October 2022, and a database was created. Frequency distributions of the hepatitis B birth dose, barriers to administration, and maternal and healthcare system factors were analyzed. The positive maternal HBsAg prevalence rate was 0.6%. The timely and total birth dose coverage was 72% and 81%, respectively. In total, 10.5% of parents refused the vaccine, of which 76% either felt uncomfortable or preferred to wait. Moreover, 100% of hepatitis B-exposed babies were vaccinated, with 83% of them receiving the Hepatitis B Immunoglobulin. Barriers to vaccine administration included vaccination hesitancy, gaps in knowledge of medical staff, and the inconsistent vaccination supply. Instituting a quality improvement team, health information system, robust educational efforts, and addressing barriers will make achieving the WHO programmatic targets of eliminating mother-to-child transmission of hepatitis B by 2030 possible.