Freeland Catherine, Kanu Florence, Mohammed Yahaya, Nwokoro Ugochukwu Uzoechina, Sandhu Hardeep, Ikwe Hadley, Uba Belinda, Asekun Adeyelu, Akataobi Charles, Adewole Adefisoye, Fadahunsi Rhoda, Wisdom Margeret, Akudo Okeke Lilian, Ugbenyo Gideon, Simple Edwin, Waziri Ndadilnasiya, Vasumu James Jacob, Bahuli Abubakar Umar, Bashir Suleiman Saidu, Isa Abdullahi, Ugwu George Onyemachi, Obi Emmanuel Ikechukwu, Binta Haj, Bassey Bassey Okposen, Shuaib Faisal, Bolu Omotayo, Tohme Rania A
Hepatitis B Foundation, Doylestown, Pennsylvania, United States of America.
Global Immunization Division, United States, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
PLOS Glob Public Health. 2023 Jun 8;3(6):e0001332. doi: 10.1371/journal.pgph.0001332. eCollection 2023.
Nigeria is estimated to have the largest number of children worldwide, living with chronic hepatitis B virus (HBV) infection, the leading cause of liver cancer. Up to 90% of children infected at birth develop chronic HBV infection. A birth dose of the hepatitis B vaccine (HepB-BD) followed by at least two additional vaccine doses is recommended for prevention. This study assessed barriers and facilitators of HepB-BD administration and uptake, using structured interviews with healthcare providers and pregnant women in Adamawa and Enugu States, Nigeria. The Consolidated Framework for Implementation Sciences Research (CFIR) guided data collection and analysis. We interviewed 87 key informants (40 healthcare providers and 47 pregnant women) and created a codebook for data analysis. Codes were developed by reviewing the literature and reading a subsample of queries line-by-line. The overarching themes identified as barriers among healthcare providers were: the lack of hepatitis B knowledge, limited availability of HepB-BD to vaccination days only, misconceptions about HepB-BD vaccination, challenges in health facility staffing capacity, costs associated with vaccine transportation, and concerns related to vaccine wastage. Facilitators of timely HepB-BD vaccination included: vaccine availability, storage, and hospital births occurring during immunization days. Overarching themes identified as barriers among pregnant women were lack of hepatitis B knowledge, limited understanding of HepB-BD importance, and limited access to vaccines for births occurring outside of a health facility. Facilitators were high vaccine acceptance and willingness for their infants to receive HepB-BD if recommended by providers. Findings indicate the need for enhanced HepB-BD vaccination training for HCWs, educating pregnant women on HBV and the importance of timely HepB-BD, updating policies to enable HepB-BD administration within 24 hours of birth, expanding HepB-BD availability in public and private hospital maternity wards for all facility births, and outreach activities to reach home births.
据估计，尼日利亚是全球感染慢性乙型肝炎病毒（HBV）儿童数量最多的国家，慢性乙型肝炎病毒感染是肝癌的主要病因。高达90%的出生时感染的儿童会发展为慢性HBV感染。建议接种一剂乙肝疫苗（HepB-BD），随后至少再接种两剂疫苗以预防感染。本研究通过对尼日利亚阿达马瓦州和埃努古州的医疗服务提供者和孕妇进行结构化访谈，评估了HepB-BD接种和使用的障碍与促进因素。实施科学研究综合框架（CFIR）指导了数据收集和分析。我们采访了87名关键信息提供者（40名医疗服务提供者和47名孕妇），并创建了一个用于数据分析的编码手册。通过查阅文献和逐行阅读部分查询样本制定了编码。在医疗服务提供者中确定的主要障碍主题包括：缺乏乙肝知识、HepB-BD仅在接种日有限供应、对HepB-BD疫苗接种的误解、医疗机构人员配备能力方面的挑战、疫苗运输相关成本以及与疫苗浪费相关的担忧。及时接种HepB-BD疫苗的促进因素包括：疫苗供应、储存以及免疫日期间的医院分娩。在孕妇中确定的主要障碍主题包括缺乏乙肝知识、对HepB-BD重要性的理解有限以及在医疗机构外分娩时难以获得疫苗。促进因素是疫苗接受度高以及如果提供者建议，愿意让其婴儿接种HepB-BD。研究结果表明，需要加强对医护人员的HepB-BD疫苗接种培训，向孕妇宣传乙肝病毒以及及时接种HepB-BD的重要性，更新政策以实现在出生后24小时内接种HepB-BD，在公立和私立医院产科病房扩大HepB-BD对所有机构分娩的供应，并开展外展活动以覆盖在家分娩的情况。
