Guan T Hugh, Htut Hnin Nandar, Davison Colleen M, Sebastian Shruti, Bartels Susan Andrea, Aung Soe Moe, Purkey Eva
Department of Family Medicine, Queen's University, Kingston, Ontario, Canada.
B.K.Kee Foundation, University Avenue Road, Bahan Township, Yangon, Myanmar.
PLoS One. 2021 Dec 20;16(12):e0261470. doi: 10.1371/journal.pone.0261470. eCollection 2021.
Hepatitis B infection is a major health concern in Myanmar. Hepatitis B birth dose vaccination to prevent mother-to-child transmission is not universal, especially in births outside of health care facilities. Little is documented about delivery of immunization programs in rural Myanmar or in conflict-affected regions. To address this gap, this study describes the implementation of a novel community delivered neonatal hepatitis B immunization program in rural Karenni State, Myanmar.
A mixed-methods study assessed the effectiveness and feasibility of hepatitis B birth dose immunization program. 1000 pregnant women were screened for hepatitis B virus (HBV) infection using point of care testing. Neonates of HBV positive mothers were immunized with a three dose HBV vaccine schedule at birth, 1, and 6 months of age. HBV testing was completed for children at 9 months to assess for infection. Descriptive statistics were collected including demographic data of mothers, neonatal vaccination schedule completion, and child HBV positivity at 9 months. Qualitative data examining barriers to implementation were collected through semi-structured interviews, participant-observation, and analysis of program documents. Themes were codified and mapped onto the Consolidated Framework for Implementation Research.
46 pregnant women tested HBV positive leading to 40 live births. 39 women-child dyads were followed until the 9-month age mark. With the exception of two neonates who received their birth dose past 24 hours, all children received their vaccines on time. None of the 39 children tested positive for HBV at nine months. Themes regarding barriers included adaptability of the program to the rural setting, friction with other stakeholders and not meeting all needs of the community. Identified strengths included good communication and leadership within the implementing ethnic health organization.
A community delivered neonatal HBV vaccination program by ethnic health organizations is feasible and effective in rural Myanmar.
乙型肝炎感染是缅甸的一个主要健康问题。预防母婴传播的乙型肝炎出生剂量疫苗接种并不普及，尤其是在医疗机构以外的分娩中。关于缅甸农村地区或受冲突影响地区免疫规划实施情况的记录很少。为了填补这一空白，本研究描述了在缅甸克伦尼邦农村实施的一项新型社区提供的新生儿乙型肝炎免疫规划。
一项混合方法研究评估了乙型肝炎出生剂量免疫规划的有效性和可行性。使用即时检测对1000名孕妇进行乙型肝炎病毒（HBV）感染筛查。HBV阳性母亲的新生儿在出生时、1个月和6个月龄时按照三剂HBV疫苗接种程序进行免疫接种。在9个月时对儿童进行HBV检测以评估感染情况。收集描述性统计数据，包括母亲的人口统计学数据、新生儿疫苗接种程序完成情况以及9个月时儿童的HBV阳性情况。通过半结构化访谈、参与观察和项目文件分析收集了关于实施障碍的定性数据。对主题进行编码并映射到实施研究综合框架上。
46名孕妇HBV检测呈阳性，导致40例活产。39对母婴组合被随访至9个月龄。除了两名在24小时后才接种出生剂量疫苗的新生儿外，所有儿童都按时接种了疫苗。39名儿童在9个月时HBV检测均为阴性。关于障碍的主题包括该项目对农村环境的适应性、与其他利益相关者的摩擦以及未满足社区的所有需求。确定的优势包括实施民族卫生组织内部良好的沟通和领导能力。
民族卫生组织在缅甸农村实施的社区提供的新生儿HBV疫苗接种项目是可行且有效的。
