Evaluation report

Insights from strengthening perinatal hepatitis b prevention in healthcare facilities in Delta State, Nigeria: A prospective, pilot implementation intervention.

Prince Ochuko Okinedo, Catherine Freeland, Ehimario U Igumbor, Samuel Okwuchukwu Ilikannu, Funso Joshua Eniojukan et al. · 3 Feb 2026

Abstract

BACKGROUND: Hepatitis B virus (HBV) infection is a leading cause of chronic liver disease and cancer globally, with perinatal transmission representing the predominant route of new infections in high-burden countries such as Nigeria. Despite significant prevalence, screening, diagnosis, and timely intervention for HBV among pregnant women remain suboptimal in Nigeria, contributing to ongoing morbidity and mortality. OBJECTIVES: This analysis assessed the impact of interventions to reduce perinatal HBV transmission in five pilot health facilities in Delta State, Nigeria. It evaluated HBV and HCV prevalence among pregnant women, timing of antenatal care (ANC) booking, linkage to care for HBV-positive women, and HepB birth dose (HepB-BD) vaccination coverage and timeliness. DESIGN: The project design was a prospective implementation research which involved a cohort of pregnant women registered for ANC in the five pilot healthcare facilities strategically located across the three senatorial districts of Delta State, Nigeria. These facilities were all high-volume public facilities located and were carefully chosen to ensure representation across different regions of Delta State, providing a diverse perspective on the project's implementation and impact. The selected facilities provide secondary and tertiary care services. METHODS: All pregnant women at five health facilities were screened at their first ANC visit for HBV and HCV using rapid testing. HBV-positive women were linked to care and initiated on tenofovir disoproxil fumarate (TDF) prophylaxis. The proportion of newborns receiving timely HepB-BD vaccination (within 24 h of birth) was measured pre- and post-intervention. Statistical analysis was performed using paired t-tests and Chi-squared. RESULTS: A total of 2844 pregnant women were screened for HBV and HCV. The pooled prevalence of HBV infection among the study population was found to be 1.86% (95% CI: 1.35%-2.37%), six times higher than HCV (0.3%). A Chi-squared test for homogeneity was conducted to determine if the proportion of HBV-reactive individuals varied significantly across the five facilities. The test revealed a statistically significant difference in HBV prevalence across facilities (χ2 = 11.49, df = 4, p = 0.021). Most women (53.4%) booked ANC in the second trimester. Prior to intervention, the probability of administering the HepB vaccine to any child, whether newborn or older infants, on any day of the week, including weekends, was 40% because vaccination was not conducted daily in any of the pilot facilities. Post-intervention, this rose to 100% as all pilot facilities adopted daily vaccination practice. In comparison with the previous study of 5.8%, HepB-BD timely uptake within 24 h, post-intervention, was 100% across all pilot facilities. CONCLUSION: Project StopHepB interventions significantly improved early identification, linkage to care, and timely HepB-BD vaccination, effectively closing gaps in HBV prevention of perinatal transmission. These findings support the scale-up of similar interventions to advance HBV elimination goals across other facilities in the state, in Nigeria, and to prevent new HBV infections in the future.