Other

Factors Associated with Uptake of Hepatitis B Birth Dose Vaccine among Newborns at Mubende Regional Referral Hospital, Mubende District

Atuhaire R, Ssebagereka A, Kamuhanda S, Nankabirwa V · 25 Sept 2026

Abstract

Abstract Background Hepatitis B virus (HBV) infection remains a global public health challenge, with mother-to-child transmission (MTCT) accounting for the majority of chronic infections in high-endemic settings. The hepatitis B birth dose (HepB-BD) vaccine, administered within 24 hours of birth, is the most effective intervention against MTCT, offering over 95% protection. Despite Uganda's introduction of the HepB-BD into its national immunisation schedule in November 2022, national coverage remains low at 38%, with Mubende District recording only 22%, well below the WHO-recommended target of 90%. This study assessed HepB-BD vaccine uptake among newborns at Mubende Regional Referral Hospital (MRRH), associated factors, and the barriers and facilitators influencing vaccine delivery at the facility. Methods A mixed-methods study was conducted at MRRH between March 2024 and February 2025. A structured questionnaire was administered to 294 caretakers of newborns, selected through proportional stratified and systematic random sampling. Four key informant interviews were conducted with healthcare workers, and two focus group discussions were held with 16 caretakers. Quantitative data were analysed using modified Poisson regression in STATA 15 to estimate adjusted prevalence ratios (aPRs). Qualitative data were analysed thematically using ATLAS.ti version 9 and triangulated with quantitative findings. Results Of 294 caretakers surveyed, 252 (85.7%) reported that their newborns received general immunisation services at MRRH, of whom 175 (69.4%) had documented HepB-BD vaccination, exceeding national and district averages but below the WHO target. The only independent predictor of uptake in multivariable analysis was caretakers' awareness of vaccine availability: those unaware had an 84% lower probability of vaccination (aPR 0.16, 95% CI: 0.10–0.25, p < 0.001). Qualitative findings identified vaccine stockouts, healthcare worker communication gaps, and sociocultural misconceptions as key barriers, while health education and supportive healthcare worker attitudes were facilitators. Conclusions HepB-BD vaccine uptake at MRRH, while exceeding district and national averages, remains below the WHO target. Caretaker awareness of vaccine availability is the critical modifiable determinant. Improving health worker communication and ensuring consistent vaccine supply are essential to achieving the 90% coverage target and advancing Uganda's HBV elimination goals.