Hepatitis B vaccination uptake and associated factors among communities targeted for mass vaccination in Gulu.

Abstract

Background: Hepatitis B virus (HBV) is associated with several acute and long-term complications and vaccination is the cornerstone of prevention. A recent outbreak in Gulu, Uganda, one of the districts covered by a mass vaccination campaign, suggests low uptake of HBV vaccination. Objective: To determine uptake and completion of HBV vaccination and associated factors among residents of Gulu, Uganda. Methods: This was a cross-sectional study among residents of Gulu in Northern Uganda; Gulu city representing urban Gulu and Gulu District representing rural Gulu. A total of 434 adults (>18 years) that had been residents of this area for at least 5 years at the time of study were recruited. A pretested study questionnaire was used to obtain data for socio-demographics, perceptions, and knowledge on HBV vaccination as well as measure uptake and completion. Additionally, 10 key informant interviews were conducted. The uptake, completion and factors associated to HBV vaccination were determined. Thematic analysis was used for qualitative data. Results: The median age of participants was 33 (IQR: 26-44) years; 246/434 (56.7%) were females. Out of 434 respondents, 182 (41.9%), 141 (32.5%), 87 (20%) had ever received at least one dose, at least 2 doses and all the 3 doses of the hepatitis B vaccine. Overall, 47.8% of those vaccinated went on to complete the 3 doses. Reasons for non-uptake included; not being aware of the vaccination campaign, myths about the vaccine, inaccessibility of the vaccine and fear. Those for incompletion: lack of awareness of need to complete, poor access to vaccination points or sites and myths. Factors associated with uptake of hepatitis B vaccine were being female, Adj. PR: 1.33 (1.09 – 1.61), urban residence, Adj. PR: 1.49(1.19-1.88), low perceived risk Adj. PR: 1.58(1.31-1.91), perceived lack of safety of Vaccine-Adj. PR: 2.83(1.27-6.32) and awareness about the mass vaccination campaign, Adj. PR: 2.36(1.52-3.67). Factors associated with completion of the hepatitis B vaccination schedule were urban residence, Adj. PR: 2.67(1.58-4.49) and low perceived risk PR: 2.94(1.98-4.37). Health facility factors that influenced uptake and completion were: inadequate mobilization and low sensitization; stock outs; inadequate facilitation for health workers; VHTs Distance from facility; health worker knowledge gaps; poor attitude towards none routine vaccination by some health workers; mistrust of the government; myths and fear of side effects. Conclusion: The uptake and completion of Hepatitis B vaccine were low in Gulu. Sex, residence, perceived risk to Hepatitis B, perceived safety of the vaccine and awareness of the mass vaccination campaign independent influenced the uptake of the vaccination. Residence and perceived risk to Hepatitis B were independently associated with completion of vaccination. Recommendations: To improve vaccination coverage, future campaigns have to invest efforts in creating awareness and sensitizing the masses aimed at improving knowledge on the disease, perceptions of risk to the disease and safety of the vaccines as well as dispelling myths around vaccination. The government should invest in training the health workers especially in the community to raise awareness among them as a gate way to the masses.