Maternal knowledge and infant uptake of valid hepatitis B vaccine birth dose at routine immunization clinics in Enugu State - Nigeria.

BACKGROUND: World Health Organization recommends hepatitis B vaccine birth dose for all infants within 24 hours of birth as the most cost-effective measure to prevent perinatal hepatitis B virus infection (HBV). We assessed and identified the predictors of maternal knowledge and infants' uptake of valid hepatitis B vaccine birth dose (HepB-BD). METHODS: We conducted a hospital-based cross-sectional survey among 366 mother-infant attendees of routine immunization clinics selected by multi-stage sampling technique in Enugu State, Nigeria. We collected data on socio-demographic characteristics, delivery history, maternal knowledge and infant's receipt of valid HepB-BD with interviewer-administered questionnaire. Maternal knowledge was assessed using nine domain questions. Overall, good knowledge was defined as a score of ≥50%. Only infants who received first hepatitis B dose within 24 hours were considered to have received valid BD. We calculated frequencies, performed Chi square test and logistic regression. RESULTS: One hundred and two (29.7%) mothers knew HBV can be transmitted from mother to child; 119 (34.6%) and 156 (45.3%) knew their infant should receive valid HepB-BD and four doses for full immunization of HepB respectively. Overall, 114 (31.1%) mothers had good knowledge of HBV and 88 (26.9%) of 327 who delivered at the health facilities had valid HepB-BD. Predictors of maternal knowledge were attainment of tertiary education (adjusted Odds Ratio (aOR): 2.1, 95%CI: 1.3-3.5) and living in rural areas (aOR: 0.5, 95%CI: 0.3-0.9). Predictors of valid HepB-BD uptake were maternal knowledge (aOR: 2.4, 95%CI: 1.4-4.0) and delivery at facilities offering routine immunization services (aOR: 5.4, 95%CI: 2.5-11.9). CONCLUSION: Knowledge and uptake of valid HepB-BD were low. Health education on benefits of valid HepB-BD was given to mothers after administration of questionnaires. We disseminated findings to the State Ministry of Health and recommended integration of child delivery and immunization services for birth dose vaccines especially valid HepB-BD.

Maternal reasons for non-receipt of valid Hepatitis B birth dose among mother-infant pairs attending routine immunization clinics, South-east, Nigeria.

BACKGROUND: Hepatitis B vaccine (HepB) is an effective tool in prevention of hepatitis B virus (HBV) infection. When administered at birth, it prevents mother-to-child transmission of acute and chronic HBV infection. However, despite a decade and half of implementation of HepB birth dose (HepB-BD), uptake has remained persistently low in Enugu State, Nigeria. We assessed the uptake of valid HepB-BD and the reasons given by mothers of infants for not receiving the HepB-BD in Enugu State, South-east Nigeria. METHODS: An hospital-based cross-sectional survey was conducted among mother-infant pairs attending immunization clinics at randomly selected health facilities in Enugu State, Nigeria. Overall, 344 mothers and their infant children in this study were interviewed using structured questionnaire. Data on maternal reasons for non-receipt of valid HepB-BD by their infants and their recommendations on ways to improve valid HepB-BD uptake, were collected. We defined valid birth dose as the receipt of first dose of HepB within 24 h of birth. RESULTS: Overall, 254 (73.8%) infants did not receive valid HepB-BD. Major reasons for its non-receipt were vaccine not available at place of delivery (91.3%, n = 232), delivery did not take place on immunization day (75.6%, n = 192), lack of awareness on timing of valid HepB-BD (72.8%, n = 185), long distance from the health facility (5.1%, n = 13) and fee payment for immunization (6.3%, n = 16). Of the 384 maternal recommendations, 143 (37.2%) emphasized female literacy while 87 (22.7%) indicated pre-positioning the vaccines at labor rooms to improve valid HepB-BD uptake. CONCLUSION: The low receipt of valid HepB-BD among infants attending routine immunization clinics, found in this study were attributed to lack of maternal awareness on timing of HepB-BD and poor integration of child delivery and immunization services. We recommend educating mothers on benefits of a timely HepB-BD and pre-positioning the vaccines at the labor rooms.