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Effect of Prevention of Mother-to-Child Transmission of Hepatitis B Services on Hepatitis B Birth-Dose Vaccination in Nigeria

Abstract

Hepatitis B virus (HBV) infection remains an important public health concern in Nigeria, particularly because infection acquired during the perinatal and early childhood periods carries a substantial risk of progressing to chronic liver disease, cirrhosis, and hepatocellular carcinoma. Prevention of mother-to-child transmission (PMTCT) of hepatitis B requires timely identification of pregnant women with HBV infection, appropriate maternal management, birth planning, and prompt administration of the hepatitis B vaccine to newborns. The hepatitis B birth dose is a critical intervention because administration soon after birth can substantially reduce the risk of perinatal transmission. However, implementation of hepatitis B PMTCT services in Nigeria may be affected by limited antenatal screening, inadequate linkage between maternal and newborn services, insufficient healthcare worker knowledge, vaccine availability challenges, home deliveries, delayed newborn presentation, and weak coordination between maternity and immunization services. Strengthening PMTCT services may therefore improve timely hepatitis B birth-dose vaccination among newborns. Against this background, this study investigates the effect of Prevention of Mother-to-Child Transmission of Hepatitis B services on hepatitis B birth-dose vaccination in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Donabedian Model of Healthcare Quality. The Health Belief Model explains how mothers' perceptions of hepatitis B susceptibility and severity, perceived benefits of screening and vaccination, perceived barriers, and cues to action may influence acceptance and uptake of hepatitis B prevention services. The Social Ecological Model emphasizes the interaction of individual, household, healthcare facility, community, and health-system factors in determining access to PMTCT and newborn vaccination services. The Donabedian Model explains healthcare quality through structure, process, and outcome, with PMTCT services representing important structural and process components and hepatitis B birth-dose vaccination serving as a measurable outcome. Collectively, these theoretical perspectives provide a suitable framework for explaining how hepatitis B PMTCT services may influence birth-dose vaccination in Nigeria. The study will adopt a quantitative quasi-experimental or analytical comparative research design. The study population will comprise pregnant women receiving antenatal care and their newborns in selected public and private healthcare facilities across Nigeria, as well as healthcare workers involved in antenatal, maternity, immunization, and hepatitis B PMTCT services. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, maternity units, immunization clinics, pregnant women, and eligible newborns. Hepatitis B PMTCT services will be assessed using indicators such as antenatal hepatitis B screening, availability of hepatitis B testing, documentation of maternal HBV status, counselling, linkage to appropriate maternal care, birth planning, communication between antenatal and maternity services, healthcare worker training, availability of hepatitis B vaccines, newborn vaccination protocols, referral arrangements, and follow-up systems. Hepatitis B birth-dose vaccination will be assessed using indicators such as receipt of the hepatitis B vaccine at birth, timeliness of administration, vaccination before discharge, documentation of vaccination, availability of vaccination records, and completion of subsequent recommended hepatitis B vaccine doses. Data will be collected using structured questionnaires, antenatal care records, maternity registers, laboratory records, immunization registers, newborn records, vaccination cards, PMTCT programme records, and healthcare worker interviews. Descriptive statistics will be used to summarize maternal and newborn characteristics, hepatitis B screening patterns, PMTCT service availability, and birth-dose vaccination coverage. Inferential statistical techniques, including chi-square tests, t-tests, correlation analysis, and logistic or multiple regression analysis where appropriate, will be used to determine the effect of hepatitis B PMTCT services on birth-dose vaccination. Where a quasi-experimental design is adopted, birth-dose vaccination outcomes before and after implementation of strengthened PMTCT services may be compared, or facilities with comprehensive PMTCT services may be compared with similar facilities with limited services. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that effective hepatitis B PMTCT services have a significant positive effect on hepatitis B birth-dose vaccination in Nigeria. Newborns whose mothers receive appropriate antenatal hepatitis B screening, counselling, birth planning, and coordinated maternity and immunization services are expected to have a higher likelihood of receiving the hepatitis B vaccine promptly after birth than newborns whose mothers have limited access to PMTCT services. Early identification of maternal HBV infection may increase awareness among healthcare providers and families and facilitate advance planning for newborn vaccination. Strong coordination between antenatal, maternity, laboratory, and immunization services may also reduce missed opportunities for birth-dose vaccination. However, vaccine stock-outs, inadequate screening, limited healthcare worker training, poor documentation, weak referral systems, home deliveries, delayed presentation, financial barriers, and inadequate coordination between services may reduce vaccination uptake. The study therefore expects accessible, coordinated, adequately resourced, and consistently implemented hepatitis B PMTCT services to contribute significantly to improved and timely hepatitis B birth-dose vaccination in Nigeria. The study is expected to contribute to the literature on prevention of mother-to-child transmission of hepatitis B, hepatitis B birth-dose vaccination, maternal and newborn health, antenatal screening, immunization, vaccine-preventable diseases, PMTCT services, and public health in Nigeria. The findings will provide useful information to the Federal Ministry of Health and Social Welfare, National Primary Health Care Development Agency, Nigeria Centre for Disease Control and Prevention, state ministries of health, hospitals, primary healthcare facilities, antenatal and maternity units, immunization programme managers, laboratory personnel, healthcare workers, development partners, and policymakers regarding strategies for strengthening hepatitis B prevention. The study will also provide evidence-based recommendations for expanding antenatal hepatitis B screening, improving linkage between maternal and newborn services, ensuring continuous availability of hepatitis B vaccines, strengthening healthcare worker training, improving birth-dose vaccination documentation, strengthening coordination between PMTCT and immunization programmes, increasing maternal awareness, and reducing missed opportunities for hepatitis B birth-dose vaccination across Nigeria.

Keywords: Prevention of mother-to-child transmission, hepatitis B, hepatitis B birth-dose vaccination, HBV, maternal health, newborn health, antenatal screening, immunization, vaccine-preventable diseases, PMTCT services, Nigeria, public health.