Peer-reviewed article
Contact without protection: high antenatal attendance, minimal hepatitis B testing in Nigeria’s mother-to-child prevention cascade — how far from elimination?
Samson Ikenna Abanni, Bifom Melwin Ekure, Jean Omotosho ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study looked at how well Nigeria prevents mothers from passing hepatitis B to their babies. Using a large national survey, researchers tracked each step: whether mothers attended antenatal care, got tested for hepatitis B, received their test result, and whether their newborn got the hepatitis B birth-dose vaccine. Most mothers attended antenatal care, but very few were actually tested for hepatitis B there. Only about half of newborns received the protective birth-dose vaccine, and testing rates were much lower among poorer families and in the northern region where the disease is most common.
Key points
- 72% of mothers attended antenatal care, but only 12.3% were tested for hepatitis B there
- Among those tested, almost all received their result, showing the main gap is in testing, not follow-up
- Only 55.0% of infants received the hepatitis B birth-dose vaccine, 35 points below the target
- Antenatal testing ranged from 2.6% in the poorest wealth quintile to 32.4% in the richest
- Testing was lowest in the North-West, the region with Nigeria's highest hepatitis B prevalence
Limitations
The study is based on survey data and shows patterns and gaps in service coverage, but it does not test or evaluate any specific program or intervention to fix these gaps.
Abstract
Hepatitis B is a leading preventable cause of liver cancer, and in high-burden settings most chronic infection is acquired around birth. Nigeria carries Africa’s largest hepatitis B burden. Preventing mother-to-child transmission requires a chain of antenatal steps: testing pregnant women, acting on the result, and vaccinating the newborn. No nationally representative study has assembled these into a single prevention cascade. We built the first national hepatitis B mother-to-child prevention cascade for Nigeria and measured how far it falls from the World Health Organization’s triple-elimination targets. We analysed the 2023-24 Nigeria Demographic and Health Survey, the first Nigerian survey to carry both a maternal hepatitis B module and infant birth-dose records. Among 13,341 women with a most recent live birth in the preceding three years, each linked to that child’s immunisation record, we estimated coverage at each cascade step (antenatal attendance, hepatitis B testing in antenatal care, result received, and the infant birth dose) using complex-survey methods, and examined patterning by wealth, education, residence, travel time, and region. Although 72% of mothers attended antenatal care, only 12.3% (95% CI 11.4-13.2) were tested for hepatitis B there, and among the few tested almost all received a result: the loss fell at testing, not at result-return. The infant birth dose reached 55.0% (53.1-56.9), 35 points below target, and ran at a level unrelated to maternal testing, consistent with universal, non-targeted delivery; place of delivery, not maternal testing, was the dominant correlate of an infant receiving it. Both steps were steeply patterned: antenatal testing ranged from 2.6% in the poorest wealth quintile to 32.4% in the richest, and was lowest in the North-West, the zone with Nigeria’s highest prevalence. Nigeria already reaches most mothers through antenatal care but rarely uses that contact to test for hepatitis B, and the universal birth dose is only half delivered. The country is far from elimination, and furthest where the virus is commonest. Integrating hepatitis B testing into antenatal care, made free and weighted toward the highest-burden north, would convert contact already achieved into protection.