Peer-reviewed article
Spatial variation and determinants of hepatitis B birth dose vaccination in Nigeria: a population-based study.
Olorunfemi Akinbode Ogundele, Hassan Seun Ogunwemimo, Funmito Omolola Fehintola, Tolulope Ogundele, Tope Olubodun et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed data from 13,064 Nigerian children to understand why hepatitis B birth dose vaccination coverage remains at only 52% nationally, with significant regional variation. Geographic clustering was found, particularly in northern Nigeria, with lower vaccination rates. Children whose mothers had secondary education, attended antenatal care, and delivered in health facilities were more likely to be vaccinated. Household wealth and maternal education were important predictors of vaccination uptake.
Key points
- Overall hepatitis B birth dose vaccination coverage in Nigeria is 52%, below recommended targets
- Children of mothers with secondary or higher education had 1.92 times higher odds of vaccination compared to those with no education
- Children from richest households had 2.46 times higher odds of vaccination than those from poorest households
- Antenatal care attendance was associated with 2.76 times higher odds of vaccination
- Significant geographic clustering identified, with cold spots (low coverage) concentrated in North-East and North-West Nigeria
Limitations
The study uses cross-sectional data from 2018 and cannot establish causation, only associations. The analysis relies on survey data which may be subject to recall bias regarding vaccination status.
Abstract
BACKGROUND: Hepatitis B virus (HBV) infection remains a major public health problem in Nigeria, with an estimated prevalence of 5–10%, with a sub-Saharan African regional average of approximately 6.1%. Timely administration of the hepatitis B birth dose (HepB-BD) is essential for preventing vertical transmission and its long-term complications; however, national coverage remains below recommended targets. Despite its importance, evidence on the geographic distribution and contextual determinants of HepB-BD uptake across Nigerian states is limited. This study examined the spatial variation and determinants of HepB-BD vaccination in Nigeria. METHODOLOGY: A population-based cross-sectional study that analysed data from the 2018 Nigeria Demographic and Health Survey. Spatial analysis using Local Moran’s I was performed to detect clusters of high and low HepB-BD vaccination coverage across Nigeria. Using STATA 14, binary logistic regression was used to analyse data of 13,064 children aged 0–24 months to identify predictors of Hep-B-BD vaccination. RESULTS: Overall, 52% of children received HepB-BD, with significant regional variation. Children of mothers with secondary or higher education, compared with those with no education, had higher odds of vaccination (aOR: 1.92; 95% CI: 1.63–2.27). Similarly, children from the richest households, relative to the poorest, had higher odds of vaccination (aOR: 2.46; 95% CI: 1.88–3.23). Antenatal care attendance, compared with none (aOR: 2.76; 95% CI: 2.39–3.18), and health facility delivery, compared with home delivery (aOR: 2.09; 95% CI: 1.83–2.38), were also associated with higher odds of vaccination. Children in the North-East (aOR: 0.68; 95% CI: 0.55–0.84) and North-West (aOR: 0.64; 95% CI: 0.51–0.80), compared with North Central, had reduced odds. Spatial analysis revealed significant clustering, with cold spots concentrated in northern Nigeria, and global spatial autocorrelation confirmed this (Moran’s I = 0.220, p = 0.001). CONCLUSION: HepB-BD coverage remains suboptimal and geographically clustered, with disparities associated with maternal, socioeconomic, and regional factors. Targeted, context-specific strategies may be required to improve equitable uptake across low-coverage states.