Figures & Tables
Figures
- FIGURE
Choropleth Map Demonstrating Hepatitis B Birth-Dose Vaccine Coverage and Hepatitis B Surface Antigen Prevalence in sub-Saharan Africaa
Abbreviations: HepB-BD, hepatitis B birth dose; Hep B, hepatitis B; BD, birth dose.
a This figure presents the countries in sub-Saharan Africa (SSA) that have introduced the birth dose of HBV vaccine (HepB-BD) and estimates of HepB antigen surface prevalence by country. SSA islands not depicted in the map include Cabo Verde, Comoros, Mauritania, Mauritius, São Tomé and Principe, and Seychelles. The table lists the year of HepB-BD introduction for all SSA countries offering the vaccine by 2021. All classification intervals are left closed and right open. Geographical boundaries obtained from Global Administrative Areas version 3.6.
Source: Razavi-Shearer et al.; Njuguna.
Tables
- TABLE 1.
Hepatitis B Birth Dose Vaccine Uptake Themes Discussed in the Empirical Literature (N=39)
Sub-Saharan Africa Specific Policy-Level Facility-Level Community-Level Breakwell et al., 20174 X X X X Reardon et al., 20199 X X X Spearmen et al., 201710 X X X Dionne-Odom et al., 201811 X X X X Nelson et al., 201612 X X X Boa et al., 201715 X X Chang et al., 201916 X Ginzberg et al., 201817 X X Hambridge et al., 201918 X X Howell et al., 2014. 19 X X X Jourdain et al., 201920 X X Kolwaite et al., 201621 X Mak et al., 201822 Miyahara et al., 201623 X X X Nayagam et al., 201624 X X Nayagam et al., 201625 X X Nguyen et al., 201926 X Pham et al., 201827 X Scott et al., 201828 X Sobel et al., 201129 X X Spearman, 201830 X X Wiesen, et al., 201631 X World Health Organization, 201932 X X X Okenwa et al., 201933 X X X X Breakwell et al., 201734 X X Moturi et al., 201835 X X X Awuku and Yeboah-Afihene, 201836 X X X Tamandjou et al., 201737 X X X X Hagan et al., 201939 X X Anderson et al., 201840 X X X Beigi et al., 201447 X Li et al., 201752 X X Lemoine, Thursz, 201756 X X Centers for Disease Control and Prevention, 201357 X X Pham et al., 201959 X Giao et al., 201960 X Woodring et al., 201962 X X Xeuatvongsa et al., 201664 X Wiesen et al., 201668 X X - TABLE 2
Potential Barriers to and Solutions to Hepatitis B Birth-Dose Vaccine Uptake in Sub-Saharan Africa Countries
Intervention Level Determinant Potential Barriers Potential Solutions Policy Lack of political willingness: advocacy Lack of awareness of importance of vaccine Engage relevant stakeholders, decision makers, and effective in-country advocacy groups Lack of vaccine advocacy Establish national-level policy mandates for the timely delivery of HepB-BD Lack of political willingness: affordability Lack of available resources Provide cost-effective examples in sub-Saharan Africa Lack of awareness of quantitative impact of vaccine Draw on drug manufacturer or other donors for distribution cost support Need for effective recommendations Lack of consensus recommendations for vaccine implementation Develop site-specific recommendations that draw upon research and literature, international guidelines, and feedback from diverse stakeholders Facility and Logistics Knowledge and training of health workers Lack of awareness of vaccine benefits, stigma, and gaps in knowledge among CHWs Educate facility staff on the HepB-BD vaccine and administration protocol Cultivate champions Comprehensive training Completion of checklist form by staff before discharge of newborn Couple immunization with BCG and oral polio vaccine Variable vial size and concern for wastage Make available vial size combinations Short window for administering vaccine 24-hour administration window Keep mothers in delivery ward at least 24 hours after delivery Mother's hesitancy to vaccinate infant Administer vaccine in delivery ward Mitigate cost burden Cost burden User fees for vaccines Subsidize or reduce costs associated with regular immunization Tracking systems Lack of adequate reporting infrastructure Standardize all Hep B-BD immunization-reporting tools Faltering vaccine recording buy-in by facility staff Vaccine storage and stockouts Limited storage space and stock-out determinants Store the vaccine in existing cold chains and/or in labor wards Allow private providers to obtain the vaccine free-of-charge Poor communication between the immunization and maternity wards Establish standing orders for the vaccine Reaching remote rural villages with vaccines Cultivate partnerships with vaccine distributor Community Maternal involvement At-home births Leverage post-home birth visit to administer vaccine Raise vaccine awareness within the community Geographic distance inhibiting timely delivery of newborn to health facility Educate mothers during antenatal care visits Families to keep home-based records Community health worker involvement Poor communication channels between CHWs and mothers Perform home visits in rural communities to educate mothers, track pregnancies, and refer mother-infant pair to nearby facilities Provide at-home immunization for infants Strengthen ties between CHWs and facilities Engage community leaders and members Provide incentives for CHWs Evidence-based innovations to reach communities Vaccine refrigeration requirements Use of out-of-cold-chain or controlled temperature chains Mobile-based devices to track pregnancies in rural areas Abbreviations: BCG, Bacillus Calmette-Guerin; CHW, community health worker; HepB-BD, hepatitis B birth dose.
Supplemental material
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