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Impact of Maternal Hepatitis B Vaccination on Hepatitis B Prevention among Newborns in Nigeria

Abstract

Hepatitis B remains an important public health concern in Nigeria, particularly because infection acquired during the perinatal and early childhood periods carries a high risk of progressing to chronic hepatitis B infection, cirrhosis, and hepatocellular carcinoma. Newborns exposed to hepatitis B virus through an infected mother are particularly vulnerable to infection during childbirth. Effective maternal hepatitis B prevention and appropriate newborn interventions are therefore essential for reducing mother-to-child transmission. Maternal hepatitis B vaccination may contribute to prevention by protecting susceptible pregnant women from hepatitis B infection and reducing the risk of maternal infection during pregnancy and subsequent perinatal transmission. However, limited awareness, inadequate antenatal care attendance, incomplete vaccination, poor access to vaccination services, and insufficient integration of hepatitis B prevention into maternal healthcare may affect the effectiveness of preventive programmes in Nigeria. Against this background, this study investigates the impact of maternal hepatitis B vaccination on hepatitis B prevention among newborns in Nigeria. The study will be anchored on the Health Belief Model, Social Ecological Model, and Health Systems Framework. The Health Belief Model explains how pregnant women's perceptions of susceptibility to hepatitis B, perceived severity of infection, perceived benefits of vaccination, perceived barriers, and cues to action may influence maternal hepatitis B vaccination uptake. The Social Ecological Model emphasizes the influence of individual, family, healthcare, community, and policy factors on maternal vaccination and newborn health. The Health Systems Framework emphasizes antenatal service delivery, health workforce, vaccine availability, health information, financing, governance, and accessibility as essential components of effective hepatitis B prevention programmes. Collectively, these theoretical perspectives provide a suitable framework for explaining how maternal hepatitis B vaccination may influence hepatitis B prevention among newborns in Nigeria. The study will adopt a quantitative analytical cohort or quasi-experimental research design. The study population will comprise pregnant women receiving antenatal care in selected healthcare facilities in Nigeria and their newborns. A multistage sampling technique will be used to select states, local government areas, healthcare facilities, antenatal clinics, pregnant women, and eligible mother-newborn pairs. Maternal hepatitis B vaccination will be assessed using indicators such as maternal vaccination status, number of vaccine doses received, completion of the recommended vaccination schedule, gestational age at vaccination, timing of vaccination, and documentation of vaccination. Hepatitis B prevention among newborns will be assessed using indicators such as maternal hepatitis B surface antigen status, newborn hepatitis B infection status where testing is available, receipt and timing of the hepatitis B birth dose, receipt of hepatitis B immunoglobulin where indicated and available, completion of the infant vaccination schedule, and evidence of mother-to-child transmission. Data will be collected using structured questionnaires, antenatal care records, maternal immunization registers, vaccination cards, hepatitis B screening records, delivery records, newborn medical records, laboratory reports, and immunization registers. Descriptive statistics will be used to summarize maternal and newborn characteristics, maternal vaccination coverage, hepatitis B screening patterns, newborn preventive interventions, and infection outcomes. 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 impact of maternal hepatitis B vaccination on hepatitis B prevention among newborns. Where a cohort design is adopted, hepatitis B-related outcomes among newborns of vaccinated mothers may be compared with those of unvaccinated mothers, with relevant maternal and newborn factors appropriately controlled. Diagnostic tests will also be conducted to assess the reliability, validity, and robustness of the findings. The study is expected to find that maternal hepatitis B vaccination has a significant positive impact on hepatitis B prevention among newborns in Nigeria. Newborns whose mothers received appropriate hepatitis B vaccination before or during pregnancy are expected to have a lower risk of maternal hepatitis B infection and perinatal transmission when compared with newborns whose mothers were not vaccinated, particularly when maternal vaccination is combined with appropriate antenatal screening and timely newborn preventive interventions. Maternal vaccination may reduce the number of susceptible pregnant women and consequently reduce the risk of acquiring hepatitis B infection during pregnancy. However, maternal vaccination alone may not be sufficient to prevent perinatal transmission from mothers who are already infected. Therefore, maternal hepatitis B screening, timely newborn hepatitis B vaccination, administration of hepatitis B immunoglobulin to eligible exposed newborns, and appropriate follow-up remain important components of comprehensive prevention. Limited vaccine availability, inadequate maternal screening, incomplete vaccination, delayed birth-dose vaccination, poor access to immunoglobulin, and weak follow-up systems may reduce the effectiveness of prevention programmes. The study therefore expects integrated maternal and newborn hepatitis B prevention services to contribute significantly to reducing hepatitis B transmission in Nigeria. The study is expected to contribute to the literature on maternal hepatitis B vaccination, hepatitis B prevention, mother-to-child transmission, newborn health, maternal immunization, antenatal care, hepatitis B screening, birth-dose vaccination, 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, healthcare facilities, maternal and child health programmes, immunization programme managers, obstetricians, midwives, paediatricians, development partners, and policymakers regarding strategies for strengthening hepatitis B prevention. The study will also provide evidence-based recommendations for improving maternal hepatitis B vaccination, integrating hepatitis B screening into antenatal care, strengthening timely newborn birth-dose vaccination, improving access to hepatitis B immunoglobulin for eligible newborns, enhancing vaccination documentation and follow-up, increasing maternal awareness, and strengthening comprehensive programmes for preventing mother-to-child transmission of hepatitis B across Nigeria.

Keywords: Maternal hepatitis B vaccination, hepatitis B prevention, newborns, hepatitis B virus, mother-to-child transmission, maternal immunization, antenatal care, hepatitis B screening, birth-dose vaccination, hepatitis B immunoglobulin, Nigeria, public health.