Narrative review of conflict and non-conflict influences on hepatitis B prevalence in Sub-Saharan Africa using the socio-ecological model

Hepatitis B remains a significant public health challenge, particularly in sub-Saharan Africa where it is hyper-endemic. This mini-review examines the epidemiological trends of hepatitis B and the socio-ecological factors influencing its prevalence, focusing on conflict and non-conflict settings within Sub-Saharan Africa. The World Health Organization (WHO) estimates that the Sub-Saharan African region has 81 million chronically infected individuals. Despite effective vaccines, hepatitis B prevalence continues to rise due to gaps in vaccination coverage and violent conflicts. Utilizing the socio-ecological model, this review explores multilevel factors affecting hepatitis B prevalence, including individual behaviors, interpersonal relationships, institutional policies, and community and societal influences. Conflict settings exacerbate the risk of Hepatitis B transmission through increased instances of transactional sex, sexual violence, displacement, and destruction of healthcare infrastructure. Non-conflict settings are influenced by cultural practices and healthcare accessibility. Conflicts lead to higher hepatitis B prevalence by disrupting public health systems and increasing risky behaviors. The review assesses the effectiveness of interventions and public health strategies by examining vaccination program implementation and outcomes, particularly in conflict-affected regions. It evaluates healthcare infrastructure, public awareness campaigns, and policy interventions in mitigating the spread of hepatitis B. The review underscores the need for context-specific public health strategies to address challenges posed by conflicts, such as mobile health units and targeted vaccination campaigns in refugee camps. In non-conflict settings, strengthening healthcare infrastructure and enhancing health education are crucial. By understanding the socio-ecological determinants of hepatitis B, this review aims to inform more effective public health interventions and contribute to eliminating hepatitis B by 2030.