Uptake of the Birth Dose HBV Vaccine and Associated Factors Among Children in Sub‐Saharan Africa: An Analysis Using Recent Demographic and Health Survey Data

The hepatitis B virus birth dose vaccine (HepB-BD) is administered within the first 24 h after birth. When given during this period, along with at least two additional doses, it effectively prevents perinatal HBV infection and induces immunity. Hepatitis B virus (HBV) infection is a significant public health problem that can cause substantial mortality and morbidity worldwide. The uptake of the HepB-BD vaccine varies across different regions, with more than 70% birth dose coverage observed only in the Americas and the Western Pacific regions. In contrast, coverage in the African Region is generally low, and sub-Saharan Africa (SSA) experiences even lower coverage than the region as a whole. Despite its importance, there is a lack of evidence regarding the uptake of the HepB-BD in SSA. Therefore, this study aimed to assess the prevalence and factors associated with the uptake of the birth dose HBV vaccine among children in SSA. In this study, we used the recent Demographic and Health Survey (DHS) dataset from 2015 to 2023 for seven SSA countries. STATA version 17 software was used for data analysis. After assessing the Intraclass Correlation Coefficient (ICC) and performing the Likelihood Ratio (LR) test, we determined that applying multilevel analysis to account for the hierarchical or nested structure of the DHS data did not provide a significantly better fit than the simpler logistic regression model. As a result, we used the rare-event logistic regression model in our analysis. A Hosmer-Lemeshow test was conducted (Prob > χ² = 0.4763), which suggested that the logistic regression model fit the data well. Variables with a p-value of less than 0.25 in the bivariate rare-event logistic regression model were included in the multivariable rare-event logistic regression analysis. Variables with p-values less than 0.05 were considered to be significantly associated with the uptake of the birth dose HBV vaccine. The prevalence of birth-dose HBV vaccine uptake in SSA was 2.76% (95% CI: 0.021-0.036). Children whose mothers were aged 35-39 years (AOR = 4.21, 95% CI: 1.11-5.95) and 40-44 years (AOR = 5.36, 95% CI: 1.15-6.13) had higher odds of receiving the birth-dose HBV vaccine compared with those whose mothers were aged 15-19 years. The odds of receiving the birth-dose HBV vaccine were higher among children whose fathers had higher education (AOR = 2.88, 95% CI: 1.20-8.63) as well as those whose fathers' education level was unknown (AOR = 2.61, 95% CI: 1.25-5.46) compared with children whose fathers had no formal education. Furthermore, children from households in the middle wealth index (AOR = 1.86, 95% CI: 1.23-3.51) had higher odds of receiving the birth-dose HBV vaccine than those from the poorest households. Our study revealed that only about three out of every one hundred children in SSA countries received the birth dose of the HBV vaccine within the first 24 h of delivery. Increased maternal age, higher or unknown paternal education level, and belonging to the middle household wealth index were factors that significantly increased the odds of receiving the HBV birth-dose vaccine among children in SSA countries. Targeted strategies are needed to improve HepB birth-dose coverage, including integrating counselling into maternal health care, involving fathers, ensuring timely facility-based and outreach delivery, targeting younger mothers, improving vaccination record-keeping, and training midwives.