1
|
Gaviola GC, McCarville M, Shendale S, Goodman T, Lomazzi M, Desai S. A review of health worker vaccination programs in low, middle and upper middle-income countries. PUBLIC HEALTH IN PRACTICE 2023; 6:100415. [PMID: 37547811 PMCID: PMC10400463 DOI: 10.1016/j.puhip.2023.100415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 07/24/2023] [Accepted: 07/25/2023] [Indexed: 08/08/2023] Open
Abstract
Objectives Health workers (HW) are at risk of contracting vaccine preventable diseases when caring for patients and communities. This study aims to evaluate the existing literature on the routine vaccination of health workers against a variety of antigens in low and middle income countries, focusing on facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Study design A PubMed Literature search. Methods A PubMed search was conducted to find articles that addressed vaccination programs and policies for HW in low-income countries (LIC), lower middle-income countries (LMIC), and upper middle-income countries (UMIC). Original articles, meta-analyses, and reviews published in English between January 2000 and July 2022 were included in the search. Inductive content analysis was used to identify themes that illustrate facilitators, barriers, and considerations in the implementation of immunization programs and campaigns. Results The search identified 4240 studies, 90 were used for analysis as they provided antigen specific details on immunization policies or programs. Hepatitis B was the most frequently discussed antigen, followed by Influenza, then Measles, Rubella and Mumps. With considerable variability by vaccine and country, in most cases the vaccination was not offered free to HW or included in a regular vaccination schedule. Utilizing existing immunization infrastructure such as the Expanded Programme on Immunization (EPI) and having effective management of vaccination programs were found to be key facilitators to vaccinate HW. Conclusions The low vaccination coverage of health workers in LMIC is of concern; attention towards the key considerations, barriers and facilitators of immunization implementation is central to the advancement of health worker vaccination coverage in LMIC's. The COVID-19 pandemic necessitated the swift vaccination of HW. Many LIC countries lacking established HW immunization infrastructure are now administering COVID-19 vaccines. As we move beyond the pandemic's acute phase, there is a chance for those countries to enhance their immunization initiatives and policies for HW concerning other antigens, even if it is not a standard practice currently.
Collapse
Affiliation(s)
- Gabriel C. Gaviola
- Department of Occupational Medicine, Cambridge Health Alliance, Cambridge, MA, USA
- Harvard Medical School, Cambridge, MA, USA
| | - Maddison McCarville
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
- World Federation of Public Health Associations, Geneva, Switzerland
| | - Stephanie Shendale
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Tracey Goodman
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Marta Lomazzi
- World Federation of Public Health Associations, Geneva, Switzerland
- University of Geneva, Institute of Global Health, Geneva, Switzerland
| | - Shalini Desai
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| |
Collapse
|
2
|
Mboya FO, Daud II, Ondondo R, Onguru D. Hepatitis B virus infection status and associated factors among health care workers in selected hospitals in Kisumu County, Kenya: A cross-sectional study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001535. [PMID: 37729120 PMCID: PMC10511138 DOI: 10.1371/journal.pgph.0001535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/24/2023] [Indexed: 09/22/2023]
Abstract
Poorly managed medical waste produced at the health facilities are potential source of infections including occupational exposure to Hepatitis B Virus (HBV). This study evaluated the prevalence of HBV infection among healthcare workers (HCWs) in Kisumu County. We determined prevalence of HBV infections among 192 HCWs from nine purposively selected high-patient volume public hospitals in Kisumu County. A structured questionnaire was administered, and 4.0 ml of venous blood sample collected for Hepatitis B surface antigen (HBsAg), hepatitis B surface antibody (anti-HBs) and total hepatitis B core antibody (anti-HBc) testing using enzyme immunoassay (EIA). Of 192 HCWs sampled, 52.1% were males and the median participants age was 34.4 years with interquartile range (IQR) of 11 (28-39) years. Most participants (44%) had worked for between 1-5 years. There was low HBV vaccine uptake with 35.9% completing the required 3 doses, while 40.6% had never been vaccinated. HBV prevalence was 18.8% (36/192), prevalence of past resolved infection was 25.5% (49/192), while 37.5% (72/192) of HCW had evidence of vaccine-derived immunity and 17.7% (34/192) were susceptible. HBV prevalence among HCW who had worked for less than one year and those who had never been vaccinated was 37.5% and 35.9% respectively. Significant risk of HBV lifetime exposure was noted among HCWs with one vaccine dose, those with no known exposure, while highest in those with knowledge on HBV transmission (aOR, 7.97; 95% CI, 2.10-153.3, p-value = 0.008). HCWs who had received ≥2 doses of HBV vaccine (aOR, 0.03; 95% CI, 0.01-0.10, p-value = <0.0001) had significant HBV protection. Duration of service was not associated with HBV among HCWs. HBV prevalence was high among HCWs from nine high patient volume public hospitals in Kisumu County. Efforts to strengthen HBV vaccination uptake and dose completion are needed to reduce HBV infections among HCWs.
Collapse
Affiliation(s)
| | - Ibrahim I. Daud
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| | - Raphael Ondondo
- Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Daniel Onguru
- Jaramogi Oginga Odinga University of Science and Technology, Bondo, Kenya
| |
Collapse
|
3
|
Ndunguru B, Wilfred D, Kapesa A, Kilonzo SD, Mirambo M, Hyera F, Massaga F. Low uptake of hepatitis B vaccination among healthcare workers in primary health facilities in Mwanza region, North-Western Tanzania. Front Public Health 2023; 11:1152193. [PMID: 37333557 PMCID: PMC10274318 DOI: 10.3389/fpubh.2023.1152193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 05/08/2023] [Indexed: 06/20/2023] Open
Abstract
Background Despite the availability of hepatitis B vaccines (HBV) in Tanzania, their uptake among healthcare workers (HCWs) in high-level facilities, such as tertiary hospitals where the vaccines are available, is low. However, their uptake among HCWs in primary health facilities remains understudied. The lack of this information limits the scaling up of HBV vaccination programs. Methodology A cross-sectional analytical study was conducted between June and July 2022 among HCWs in the Misungwi and Ilemela districts, which were purposefully selected. The sample size was calculated using the Taro Yamane formula, and data were collected using a self-administered questionnaire and analyzed using IBM SPSS® version 25. Results A total of 402 HCWs were recruited, their mean age was 34.9 ± 7.77 years, and only 18% (76/402) reported being fully vaccinated. HCWs in Ilemela showed higher uptake (χ2 = 23.64, df = 1, p = 0.00) of the vaccine than HCWs in Misungwi. Being male (aOR = 2.38, 95% CI 1.28-4.45, p = 0.006), working in an urban setting (aOR = 5.75, 95% CI 2.91-11.35, p = 0.00), and having an employment duration of more than 2 years (aOR = 3.58, 95%CI 1.19-10.74, p = 0.023) were significantly associated with higher odds of vaccination. Moreover, high perceived susceptibility to HBV infection (aOR = 2.20, 95% CI1.02-4.75, p = 0.044) and history of needle prick injuries (aOR = 6.87, 95%CI 3.55-13.26, p = 0.00) were significantly associated with higher odds of HBV vaccination. Conclusion Low uptake of HBV vaccine among HCWs in primary health facilities was observed with a noteworthy difference between rural and urban settings. Therefore, advocacy campaigns and resource mobilization toward the promotion of HBV vaccination in primary health facilities are pivotal.
Collapse
Affiliation(s)
- Bernada Ndunguru
- School of Public Health, The Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Diana Wilfred
- Department of Pediatrics and Child Health, Bugando Teaching and Consultant Hospital, Mwanza, Tanzania
| | - Anthony Kapesa
- Department of Community Medicine, School of Public Health, The Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Semvua D. Kilonzo
- Department of Internal Medicine, The Catholic University of Health and Allied Sciences-Bugando, Mwanza, Tanzania
| | - Mariam Mirambo
- Department of Microbiology and Immunology, The Catholic University of Health and Allied Sciences- Bugando, Mwanza, Tanzania
| | - Fred Hyera
- Department of Research and Consultancy, Bugando Teaching and Consultant Hospital, Mwanza, Tanzania
| | - Fabian Massaga
- Department of General Surgery, Bugando Teaching and Consultant Hospital, Directorate of Surgical Services, Mwanza, Tanzania
| |
Collapse
|
4
|
Sikakulya FK, Munyambalu DK, Mambo SB, Mutsunga AK, Djuma SF, Djuna PA, Ndiwelubula E, Ngavo WA, Sahika SM, Kumbakulu PK, Adelard KN, Shindano TA. Level of screening for and vaccination against hepatitis B among healthcare workers in the Eastern Democratic Republic of the Congo: a public health concern. Infect Prev Pract 2022; 4:100226. [PMID: 35898603 PMCID: PMC9310114 DOI: 10.1016/j.infpip.2022.100226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Accepted: 06/13/2022] [Indexed: 11/30/2022] Open
Abstract
Background In low resource settings in sub-Saharan Africa healthcare workers (HCW) have a high risk of contracting hepatitis B infection. Vaccination of HCWs is to protect them from acquisition of hepatitis B from patients. Objective To evaluate the hepatitis B virus (HBV) serological and vaccination status of HCWs in the Butembo Antenna in the Eastern Democratic Republic of Congo (DR Congo) and to investigate the factors influencing hepatitis screening and vaccination. Methods A cross-sectional study using a structured questionnaire was carried out from 1st to 30th April 2021 among consenting HCWs in Butembo (≥18 years of age). Data was analysed using SPSS version 23. Results Of 373 participants, 178 (47.7%) had already been screened for HBV. Screening was more likely for HCWs in a rural or publicly owned facility (P<0.05). A total of 25 (6.7%) HCWs were fully vaccinated against HBV; the factors associated with full vaccination were: prior screening for HBV (odds ratio: 9.03 (2.51–38.61), P<0.0001), prior knowledge of the value of post-exposure prophylaxis (odds ratio 12.9 (2.89–80.44), P=0.0004), prior knowledge of hepatitis B vaccine benefits (adjusted odds ratio: 4.54 (1.66–13.05), P=0.002) and prior exposure to hepatitis B infection (adjusted odds ratio: 2.61 (1.08–6.39), P=0.039). Conclusion Screening and vaccination rates of HCWs for HBV are extremely low, and not high enough to prevent the spread of this serious illness and its complications. There is a dire need to increase vaccination rates among HCWs in Eastern DR Congo. The DRC government should issue vaccination against HBV as a recommendation at the national level.
Collapse
Affiliation(s)
- F K Sikakulya
- Department of General Surgery, Kampala International University, Western Campus, Bushenyi, Uganda.,Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - D K Munyambalu
- Department of Internal Medicine, Kampala International University, Western Campus, Bushenyi, Uganda
| | - S B Mambo
- Youth Alliance for Reproductive Health, Goma, Democratic Republic of the Congo.,Department of Public Health, School of Allied Health Sciences, Kampala International University, Western Campus, Bushenyi, Uganda
| | - A K Mutsunga
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - S F Djuma
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - P A Djuna
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - E Ndiwelubula
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - W A Ngavo
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - S M Sahika
- Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo
| | - Patrick Kumbowi Kumbakulu
- Department of Paediatrics and Child Health, Kampala International University, Western Campus, Bushenyi, Uganda
| | - Kalima Nzanzu Adelard
- Department of General Surgery, Kampala International University, Western Campus, Bushenyi, Uganda
| | - T A Shindano
- Department of Internal Medicine, Hôpital Provincial Général de Référence de Bukavu (HPGRB), Bukavu, Democratic Republic of the Congo.,Faculty of Medicine, Université Catholique de Bukavu (UCB), Bukavu, Democratic Republic of the Congo.,University of Kindu, Kindu, Maniema, Democratic Republic of the Congo
| |
Collapse
|
5
|
Afolabi IB, Aremu AB, Maidoki LA, Atulomah NO. Predictors of Hepatitis B Virus Infection Vaccine Hesitancy Among Pregnant Women Attending Antenatal Care at Lubaga Hospital, Kampala, Uganda. Int J Womens Health 2022; 14:1093-1104. [PMID: 35999868 PMCID: PMC9393032 DOI: 10.2147/ijwh.s378000] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/08/2022] [Indexed: 11/23/2022] Open
Abstract
Background While hepatitis B virus infection may be seen as a global threat within the medical and scientific community, primary prevention via vaccination remains the most effective approach towards breaking the chain of transmission of HBV infection. However, vaccination uptake in Uganda has been modest despite a very endemic national figure resulting from the vertical transmission of this infection. This study assessed the predictors of HBV vaccine hesitancy among pregnant women attending Antenatal clinic in Central Uganda. Methodology A hospital-based cross-sectional study employing a five-sectioned pretested interviewer-administered questionnaire was conducted to obtain data from 385 consenting pregnant women. Responses for the antecedent variables were transformed into weighted aggregate scores using SPSS version 26. Multivariable logistic regression analysis was employed to ascertain the predictors of HBV vaccine hesitancy with the cut-off for hypotheses set at 5% level of significance. Results The majority of the respondents (59%) were between the ages of 18 and 28 years. Women with secondary educational attainment were predominant (42.3%). The respondents had mean scores of 5.97±6.61, 17.10±18.31, and 12.39±13.37, respectively, computed for knowledge of HBV infection, perception, and behavioral skills towards HBV prevention. Regarding vaccine hesitancy, three-quarters of the women (74%) hesitated to uptake HBV vaccine. While negative significant associations exist between marital status (AOR = 0.47, 95% CI = 0.22-1.01), knowledge (AOR = 0.79, 95% CI = 0.70-0.89), behavioral skills (AOR = 0.88, 95% CI = 0.81-0.95) and vaccine hesitancy, level of education (AOR = 1.88, 95% CI = 1.08-3.27) and perception (AOR = 1.11, 95% CI = 1.05-1.18) on the other hand, positively predicted vaccine hesitancy. Conclusion The findings reported an extremely high degree of HBV vaccine hesitancy among the expectant mothers discovered to be linked with marital status, educational attainment, HBV-specific knowledge, perception and behavioral skills. This necessitates targeted health education for married women with lower educational attainment to improve their knowledge which will in turn shape their perception and behavioral skills towards satisfactory uptake of HBV vaccine.
Collapse
Affiliation(s)
- Ismail Bamidele Afolabi
- Faculty of Science and Technology, Department of Public Health, Cavendish University, Kampala, Uganda
| | - Abdulmujeeb Babatunde Aremu
- Faculty of Health Sciences, Department of Human Anatomy, Islamic University in Uganda, Kampala Campus, Kampala, Uganda
| | - Lawal Abdurraheem Maidoki
- Faculty of Science and Technology, Department of Public Health, Cavendish University, Kampala, Uganda
| | | |
Collapse
|
6
|
Burnett RJ, Dramowski A, Amponsah-Dacosta E, Meyer JC. Increasing hepatitis B vaccination coverage of healthcare workers - global lessons for South Africa. Curr Opin Immunol 2021; 71:6-12. [PMID: 33819774 DOI: 10.1016/j.coi.2021.03.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Healthcare workers (HCWs) are at high risk of contracting hepatitis B (HB), a severe blood-borne vaccine-preventable disease, caused by HB virus (HBV) infection. Low HB vaccine (HepB) coverage has resulted in suboptimal protection and high HBV infection rates in South African HCWs. Studies from Africa have identified cost; unavailability/lack of access to HepB; and lack of awareness/knowledge of HB and HepB, as barriers to HCW uptake. Studies from Europe show little difference in HepB coverage between countries mandating versus recommending HepB. Providing easy and sustained access to free HepB to student HCWs, together with education about HB and HepB, are recommended to create demand for HepB. Only if this fails should mandatory vaccination be considered.
Collapse
Affiliation(s)
- Rosemary Joyce Burnett
- Department of Virology, Sefako Makgatho Health Sciences University, Pretoria, South Africa; South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa.
| | - Angela Dramowski
- Division of Health Systems and Public Health, Department of Global Health, Stellenbosch University, Cape Town, South Africa
| | - Edina Amponsah-Dacosta
- Vaccines for Africa Initiative, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Johanna Catharina Meyer
- South African Vaccination and Immunisation Centre, Sefako Makgatho Health Sciences University, Pretoria, South Africa; Division of Public Health Pharmacy and Management, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| |
Collapse
|