Evaluation of Iraq’s national plan for hepatitis B control: identifying gaps and strategies for improvement

Hepatitis B virus (HBV) remains a significant public health challenge in Iraq, necessitating a comprehensive evaluation of the national hepatitis B control plan. This study aimed to assess the epidemiological trends of HBV in Iraq from 2015 to 2022 and evaluate the implementation and effectiveness of the national control plan. A descriptive cross-sectional study was conducted using national HBV surveillance data from all available Iraqi governorates between 2015 and 2022. The program evaluation component was performed in Wasit Governorate and included 24 randomly selected primary health care centers (PHCCs). Descriptive statistics, Mann–Whitney U, Kruskal–Wallis, and chi-square tests were performed using SPSS version 25 and Microsoft Excel. The annual HBV incidence rate declined from 8.3 to 3.5 per 100,000 population between 2015 and 2022, with consistently higher incidence rates among males and marked geographic variation across governorates. The highest incidence rates were observed among individuals aged 15–45 years and those aged > 45 years. Childhood hepatitis B vaccination coverage exceeded the national target by 2022; however, prevention of mother-to-child transmission and HBV diagnosis coverage remained below target levels. Evaluation of PHCC performance showed that 88% achieved acceptable evaluation scores, although substantial variability in performance was observed across facilities. This study provides a comprehensive evaluation of Iraq’s national hepatitis B control plan, demonstrating declining incidence rates alongside important demographic and geographic disparities. Although vaccination coverage has improved substantially, important gaps remain in HBV diagnosis, prevention of mother-to-child transmission, and PHCC performance. These findings provide evidence to guide targeted interventions, strengthen health service delivery, and inform future policy decisions aimed at advancing hepatitis B control in Iraq.