Evaluating Hepatitis B vaccination rates and prevalence in Adults from Lagos Nigeria -a facility based World Hepatitis Day awareness study

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The Global Health Sector Strategy on Viral Hepatitis has set goals to eliminate viral hepatitis as a public health threat by 2030. Vaccination is highlighted as a priority action in achieving this goal. The Nigeria Institute of Medical Research (NIMR) conducts annual World Hepatitis Day (WHD) campaigns to educate and raise awareness, while aligning with the global call for viral elimination. This study was done to analyse the impact and uptake of the vaccination exercise carried out in NIMR programmes and proffer strategies for implementing and improving the uptake of adult vaccination in Nigeria. Methods As part of the WHD awareness campaign, a free HBV screening and vaccination programme was established for interested community members. Participants were tested for hepatitis B surface antigen (HBsAg) using the SD Bioline HBsAg Rapid test kit. Participants who tested positive were referred to the institute's clinic for further evaluation. Those who tested negative were vaccinated using a 6-month regimen of 3 doses (0, 1 and 6 month intervals). Participants' demographics and travelling distance to NIMR were obtained and analysed using descriptive and inferential statistics. Variables significant via inferential statistics were subjected to a multivariate analysis. Results A total of 553 participants, with a mean age of 37.8 ± 13.1 years, were screened for HBsAg. Prevalence of HBsAg was 9.0% (50/553), and 402/503 (80%) gave consent for vaccination. Of these 402 participants, 85.5% and 57.7% completed the second and third doses, respectively, with 42.3% being lost to follow-up. Conclusions Economic migration and loss of interest were key factors influencing vaccine uptake. Participants with a farther travel distance/time to NIMR had significantly lesser odds (0.41) of completing vaccination.In conclusion, HBsAg prevalence is high, while vaccination uptake and completion is low. Mobile clinics and a shorter vaccine schedule are innovative strategies that may help improve the uptake of vaccines and reduce loss to follow-up. Health sciences/Diseases Health sciences/Gastroenterology Health sciences/Health care Biological sciences/Immunology Health sciences/Medical research Figures Figure 1 INTRODUCTION World Hepatitis Day (WHD) was launched on July 28th 2010, and is one of 11 official global public health campaigns marked by the World Health Organisation (WHO). 1 It is observed annually every July 28th to raise awareness about viral hepatitis, promote prevention, testing, treatment, and mobilise action towards the WHO 2030 viral elimination goal set by WHO. 2 Various activities globally commemorate the WHD to increase public awareness and strengthen the political will to address the viral hepatitis epidemic. 2 , 3 This is a noteworthy cause since approximately 257 million individuals are living with hepatitis B worldwide. 3 , 4 Hepatitis B virus (HBV) prevalence rates in adult populations in West Africa are estimated to be between 6% and 16%, while in Nigeria, prevalence is estimated at 9.5%. 4,5 Despite the high prevalence of HBV worldwide and ongoing attempts to enhance care and treatment, many infected individuals are unaware of their status until the disease progresses. 6 , 7 This highlights the need for increased awareness, need for more screening opportunities, improved regulations and testing standards at healthcare facilities and more emphasis on vaccination 6 , 8 . The Nigerian Institute of Medical Research (NIMR) celebrates WHD annually and is located in the Yaba area of Lagos, Nigeria. Lagos is a bustling metropolitan city in southwestern Nigeria , with about 20 million inhabitants. 9 NIMR began its community engagement programs and public awareness campaigns for viral hepatitis on July 28th 2013, joining the global community to celebrate WHD towards the WHO global goal of viral elimination by 2030. Scheduled events and activities over the last decade’s commemoration have included medical outreach programs, facility-based HBV testing around Lagos state, community meetings inclusive of testing and focus group discussions, symposiums, free viral hepatitis screening and free HBV vaccine for eligible individuals. Hepatitis B vaccination is vital to preventive healthcare, offering protection against the potentially life-threatening HBV and its long-term serious sequelae. 6 It is the cheapest and most effective measure to control and prevent hepatitis B globally and a priority action in achieving viral elimination by 2030. 3 , 6 , 10 Adult vaccination is targeted at children and adults who were not vaccinated at infancy and is a mop-up vaccination strategy to support infant vaccine programs towards hepatitis B viral elimination. 10 The hepatitis B vaccine is administered in different dosing schedules, with the standard 3-dose vaccine consisting of 2 priming doses administered 1 month apart and a third dose administered 6 months after the first dose. 11 The vaccine has been widely available since the 1980s and has been instrumental in reducing the incidence of HBV infection and its associated complications. This study aimed to evaluate the impact and uptake of vaccination activities implemented through NIMR programme and to propose strategies for enhancing the implementation and uptake of adult vaccination in Nigeria. METHODS Study aim, design and setting The study aimed to evaluate the impact and uptake of vaccination activities implemented through a NIMR programme, and to propose strategies for enhancing the implementation and uptake of adult vaccination in Nigeria. The study design was a prospective cohort design composed of adult males and females who approached the institution for hepatitis B screening, and upon testing negative, requested vaccination. The study setting was NIMR. Characteristics of participants NIMR is located in Yaba, an urban metropolitan area of Lagos State, Nigeria. The presence of universities and colleges in Yaba provide an opportunity to reach young adults, a key demographic for HBV vaccination, and offers convenient access to HBV screening and vaccination services. The district's commercial centres and markets enable outreach to a diverse audience, while its transportation hubs facilitate access for individuals across Lagos. WHD is a platform for governments, healthcare providers, civil society organisations, and individuals to act and collaborate to achieve the 2030 HBV elimination targets. For our response to this WHD clarion call, we established a free viral screening and vaccination program for interested community members. Counselling, Testing and Vaccination Firstly we organized a symposium to train on hepatitis and the importance of vaccination to the general public. A brief overview of the event's goals was provided before training commenced on viral hepatitis, types of hepatitis, phases, and modes of transmission, testing, consequences of infection and importance of vaccination. We then set up two 10 x 15 compact canvas canopy tents at the institute for our walk-in service for testing and vaccination. Registration was done first and information such as name, sex, phone number, residential address and past immunisation history was requested. Doctors, nurses and other healthcare workers from NIMR were in attendance to offer pre- and post-vaccination counselling, and give vaccinations to those who qualified and consented. Following a pre-test counselling session, 4 ml of venous blood was drawn using a single use blood collection kit of needle and sterile EDTA vacutainer tubes. The SD Bioline HBsAg (Abbott), a rapid immunoassay, was used to determine the HBsAg status of the participants. The blood sample was added to the prelabeled RDT sample channel, which was unique to each participant for traceability. The assay buffer was added, and the results were read visually after incubation, according to the manufacturer's instructions. Participants who tested positive for HBsAg had post-counseling session and were referred to the institute's clinic for treatment. Those who tested negative for HBsAg and consented were vaccinated, using a 6-month regimen of 3 doses, administered in a time series of 0-1-6. Revac (Bharat Biotech, Shamirpet Mandal India) and Genevac B (Serum Institute of India Pvt. Ltd) were the vaccines administered. The first two doses were free, and dose three was charged at a subsidised cost of ₦1,000.00 (≈ $ 4). A well structured follow-up schedule of telephone calls and text messages weekly before vaccine due dates and on-the-day reminders to all eligible participants for the second and the third doses was planned and follow up calls for appointment defaulters were also arranged. The vaccination exercise commenced with dose one administered on July 28 th, 2015, and last dose administered from January 28th 2016 through the first two weeks of February 2016. Data analysis Statistical analysis was conducted using SPSS version 27. Descriptive statistics were summarized and presented with means (SD), median and IQR, frequencies and percentages. Bivariate analysis was conducted using Pearson’s Chi-square test to know the association between participants’ demographic characteristics (age, sex, occupation and distance from NIMR), and vaccination status. Statistically significant covariates were subjected to a binary logistic regression with the adjusted odds ratio (AOR) and it’s confident interval reported. Results are considered statistically significant when the p value is </= 0.05. RESULTS Of a sum total of 553 persons involved in the screening programme, 402 (72.6%) persons presented for the first vaccination dose and were included in the study. Most of the study participants were adults, with the age range 21 to 40 years having the highest proportion of participants (48.5%). The age group closely following this range was 41 to 60 (37.3%) years. The mean age was 37.8 years, with a standard deviation of 13.1 years. More participants were males (51%) in skilled occupations (44.3%). The median distance of participants' residence to NIMR was 6.49 km with an IQR of 12.1 km. Table 1 provides a summary of the participants' characteristics. Table 1 The socio-demographic characteristics of the study participants Variables (n = 402) Frequency Percentage Age Group (Years) 0–20 45 11.2 21–40 195 48.5 41–60 150 37.3 61–80 12 3.0 Mean (SD) 37.8 (13.1) Sex Female 197 49.0 Male 205 51.0 Occupation Retired 6 1.5 Skilled 178 44.3 Student 53 13.2 Unemployed 11 2.7 Unskilled 77 19.2 Missing 77 19.2 Distance to NIMR (km) 0-6.49 138 34.3 6.50-73.15 137 34.1 Missing 127 31.6 Median (IQR) 6.49 (12.01) Figure 1 summarises the vaccination information, the prevalence of HBsAg positivity of the study participants, and the reasons for not completing the vaccination by participants who defaulted. Most participants (85.5%) completed the second dose of the vaccination, while 57.7% completed the third dose of the vaccine. Key reasons for not completing the vaccination included participants being unreachable by telephone (51.8%), out-of-town (28.6%), and lack of contact telephone number in participant data (19.0%). Using the Chi-square test, the relationship between the socio-demographic characteristics of the study participants and their vaccination status are summarised in Table 2 . Age and distance travelled to NIMR from the participants' residence were statistically significant, with p-values of 0.019 and 0.007, respectively. Table 2 The association between socio-demographic characteristics of study participants and their vaccination status. Vaccination status Variables (n = 402) Missing (%) Completed (%) Not completed (%) p-value Age Group (Years) 0–20 4 (8.9) 25 (55.6) 16 (35.6) 0.019 a 21–40 21(10.8) 108 (55.4) 66 (33.8) 41–60 11 (7.3) 97 (64.7) 42 (28.0) 61–80 4 (33.3) 2 (16.7) 6 (50.0) Sex Female 18 (9.1) 120 (60.9) 59 (29.9) 0.444 Male 22 (10.7) 112 (54.6) 71 (34.6) Occupation Retired 0 (0.0) 4 (66.7) 2 (33.3) 0.121 Skilled 5 (2.8) 117 (65.7) 56 (31.5) Student 0 (0.0) 30 (56.6) 23 (43.4) unemployed 0 (0.0) 4 (36.4) 7 (63.6) Unskilled 7 (9.1) 41 (53.2) 29 (37.7) Distance to NIMR (km) 0-6.49 7 (5.1) 78 (56.5) 53 (38.4) 0.007 a 6.50-73.15 7 (5.1) 101 (73.7) 29 (21.2) a Statistically significant p-values. Missing values were excluded from the analysis. The summary of the multivariable analysis using binary logistic regression is provided in Table 3 . The participants aged 21 to 40 years and 61–80 years have 1.19 and 1.86 odds of completing their vaccination compared to those aged 0 to 20 years. However, the odds were not statistically significant. (0.76 AOR 1.185, 95% CI 0.398–3.527, p-value 0.76 and AOR 1.859 95% CI 0.091–38.175, p-value 0.688 respectively). The participants living further from NIMR had 0.41 odds of completing the vaccination compared to those living closer to NIMR (AOR 0.412, 95% CI 0.237–0.716, p-value 0.002). Table 3 Logistic regression showing factors associated with vaccination completion among the study participants. Variables P-value Adjusted Odds ratio (AOR) 95% C.I. for adjusted Odds ratio Lower Upper Age Group (years) 0–20 21–40 0.76 1.185 0.398 3.527 41–60 0.55 0.693 0.209 2.304 61–80 0.688 1.859 0.091 38.175 Sex Female Male 0.248 1.386 0.796 2.414 Distance from NIMR (km) 0–6.49 6.50–73.15 0.002* 0.412 0.237 0.716 Occupation group retired skilled 0.749 0.852 0.319 2.276 student 0.609 1.386 0.397 4.845 unemployed 0.674 1.547 0.203 11.813 unskilled 0.664 1.27 0.432 3.738 *Statistically significant p-value DISCUSSION The hepatitis B vaccine is an essential and veritable tool for preventing hepatitis B infection. It is also safe, effective, and inexpensive. WHO endorsed the "Global Health Sector Strategy on Viral Hepatitis" in 2016, aiming to eliminate viral hepatitis as a public health threat by 2030. Vaccination is emphasised as a priority action in achieving this goal 12 . This study addresses the prevalence of HBV infection, the uptake and completion of adult hepatitis B vaccination, and the social and economic hurdles that may hamper the uptake and effectiveness of the vaccine in Nigeria. The prevalence of HBV infection seen in our study was 9.0%. This is similar to the prevalence of 8–14% found in the Southwest region of Nigeria. 5 However, our study had a higher prevalence than Lagos state (2.1%), where our facility is located. 5 , 13 Studies in Nigeria have reported varying prevalence rates of HBV for communities, health facilities, states, regions, and populations. 5 Facility-based testing usually has a higher prevalence of positive cases compared to community-based testing, as observed in our study. 14 , 15 Facility testing presents a promising avenue for increased screening and diagnosis opportunities due to the high walk-in potential. This aligns with WHO’s goal to eliminate viral hepatitis as a major public health threat by the year 2030 through an increase in screening and diagnosis by 90%. 12 Leveraging existing platforms and structures in established health facilities can increase testing and provide faster, cheaper and synergistic approaches to HBV diagnosis and monitoring. This integration and linkage to care is a positive force multiplier, being quicker and immediate. The study evaluated the uptake of the vaccination exercise carried out at NIMR. At study closeout, 57.7% were fully vaccinated, receiving three standard doses, and 85.5% received the first and second doses only. From the initial study population of 402 participants, we observed that 170 participants (42.3%) were lost to follow-up. The significant finding associated with the loss-to-follow-up was the commute distance to the vaccination centre and economic migration. Vaccination rates in this study (57.7%) were higher than the 42.0% and 43.9% reported by Issa and Akabuike, respectively, in Nigerian studies. Other studies in Nigeria also reported low rates indicating poor uptake even among healthcare workers, a key population with a significant risk for HBV infection. 16 , 17 , 18 Reports from other African countries show different rates across regions, with a pooled average vaccination rate of 24% for the continent. 19 The African continent has one of the highest burdens of Hepatitis B, with 6.1% -16% of the adult population living with the infection – this shows the burden of disease is high and vaccination rates and acceptance is low. 4 , 5 , 19 , 20 Improving vaccine uptake is vital to achieving the global goal of viral elimination, calling for increased action and policies towards vaccination. Awareness campaigns on vaccination and screening are essential to drive vaccination knowledge and acceptability, thereby improving uptake. Loss to follow-up in adult vaccination programs has various barriers that limit the efficacy of vaccine campaigns and immunisation success. Transportation and apathy are barriers identified as severe limitations, as further observed in our study. 21 , 16 At the study's inception, 20% of eligible vaccine beneficiaries declined participation despite the low financial cost of the exercise, indicating disinterest and poor knowledge of associated risks and benefits. Implementing mobile or community-based vaccination and awareness campaigns using diverse media to sensitise the public on HBV vaccination must be explored to increase uptake, especially among adults. 22 The average vaccination rate in Nigerian children is as high as 76% compared to 57.7% seen among adults in this study. 22 , 23 The findings revealed that distance/travel time to the facility was significant in the success of the vaccination exercise- the farther the commute, the lesser the participation. At dose two, vaccination rates were approximately 86%, compared to 57% who completed the exercise. This outcome was similar to other Nigerian studies that reported severe loss to follow-up after doses 2 and 3 16,17,24 . Follow-up reminders and phone calls were made to participants about why they were absent for follow-up appointments. Some participants said they had travelled out of town, and some of these calls were truncated or uncompleted with no signal tone. Others had phone numbers which were no longer connecting or reachable. This may be due to economic migration or relocation to out-of-reach areas. Despite this drawback, the intensive follow-up phone calls yielded positive results as we recorded a 57% vaccine completion rate, a higher rate than the outcome of other vaccination studies done in-country. 16 , 17 , 18 , 24 Mobile or community-based vaccination units stationed close to vaccine recipients have been explored and studied as a significant factor that improves participation and completing doses in vaccine time series. 22 , 25 , 26 Implementing a different dosing regimen, e.g. accelerated dosing schedules (with a shorter time to completion), has been reported to help communities where time series compliance is poor and retaining interest is a challenge. 27 It is recommended as a means to combat forgetfulness, retain interest and prevent economic migration as the vaccine is administered within a one-month cycle; several studies have also indicated that immune responses and protection rates were similar when the two dosing schedules (six months versus one month) were compared. 27 , 28 This may be useful to ensure higher participation and better vaccine uptake. The accelerated dosing schedule aims to provide faster protection by completing the primary vaccination course within a shorter period. Some vaccine types may require a booster dose at 12 months. CONCLUSIONS In conclusion this study underscores the need to improve adult vaccination against HBV. Individuals protect themselves and others contributing to the overall goal of controlling and eliminating HBV infection by 2030. Our findings highlight the high prevalence of hepatitis B in Nigeria, contrasted with low vaccination rates. Incomplete vaccination schedules, long commutes to the facility, economic migration and disinterest emerged as significant hurdles, raising the pressing need for improved follow-up systems for vaccination time series and policy reviews. Innovative strategies such as mobile or community-based vaccination units and initiating shorter vaccine dosing regimes are recommended to improve vaccine uptake. Abbreviations HBV - Hepatitis B Virus, WHD - World Hepatits Day, NIMR - Nigerian Institute of Medical Research, IRB - Institutional Review Board, WHO -World Health Organisation Declarations Ethics approval and consent to participate The study received ethical clearance from the Nigerian Institute of Medical Research Institutional Review Board (NIMRIRB). All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants, and they were assured of voluntary participation, confidentiality, and data protection throughout and after the study. The research was in accordance with the Declaration of Helsinki. Consent for publication All authors gave their consent for this publication to be made. Availability of data and material All available data is provided within the manuscript. Addition requests can be made to the first author, Dr. Fehintola A. Ige at [email protected] Competing interests Authors declare that they have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper. Funding No funding was received for this study. Authors' contributions The study concept and design was by FAI and RAA. Acquisition of data was performed by FAI, APO, PME, DO, JCI and OOO. FAI, SON, IRA, OOO, CLO, COO, and EOO performed the laboratory investigation. Analysis and interpretation of data was carried out by OOO and FAI. Statistical analysis was done by OOO. Initial draft of the manuscript was done by SON, FAI and IRA. FAI, APO, PME, OOO, CLO did the data curation. FAI, SON and IRA performed the formal analysis. AGO and RAA performed funding acquisition. FAI, DO, EOO, PME and DA performed the methodology. FAI, CKO, JCI and RAA were responsible for project administration. Resources were obtained by AGO and RAA. All authors read and the final version of the manuscript. 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Comparison of the accelerated and standard vaccination schedules against hepatitis B in healthcare workers. Journal of Research in Medical Sciences ;17(10):934-7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7512840","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":519494303,"identity":"344d85e7-8a7b-4a03-91a8-0fd1c62aaa17","order_by":0,"name":"Fehintola Anthonia Ige","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAyElEQVRIiWNgGAWjYBAC9gYehgNAmoefgYGNOC08B8BaDHgkG0jRAgQGDAYHiNbC3nvwcAHDHxnjG8nPHnyoYJDnFztAQAvPuYTDM4AOM7uRZm444wyD4czZCfi12EvkGBzmAWtJMJPmbWNIMLhNQAuP/BuIFuMZ6d+I1CLBA9FiIJFDrC08YIcZ80iceVMmOeOMBGG/8LCfMf7MwyBnz9+evk3iQ4WNPL80AS1gwPgPSAiAVUoQoRwO+A+QonoUjIJRMApGEgAAYDY5Lrp+zE0AAAAASUVORK5CYII=","orcid":"","institution":"Nigerian Institute of Medical Research","correspondingAuthor":true,"prefix":"","firstName":"Fehintola","middleName":"Anthonia","lastName":"Ige","suffix":""},{"id":519494304,"identity":"c8fbf3b7-879c-4d6b-8ce9-fcddb7e0c447","order_by":1,"name":"Azuka Patrick Okwuraiwe","email":"","orcid":"","institution":"Nigerian Institute of Medical 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15:36:56","extension":"html","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":101655,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7512840/v1/d86f9384cb29c068c0f4affc.html"},{"id":92193717,"identity":"d1ea8d5d-8f70-4504-9531-4056fa4a1658","added_by":"auto","created_at":"2025-09-25 15:36:56","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":347306,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eVaccination information of the study participants.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7512840/v1/656e376cddbec133ff86b0a3.png"},{"id":97664725,"identity":"b6a639bf-8740-4ceb-ab94-889ef9f424de","added_by":"auto","created_at":"2025-12-08 09:13:30","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1217147,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7512840/v1/c9c04b47-7dfb-4b56-8413-4e908aa52656.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Evaluating Hepatitis B vaccination rates and prevalence in Adults from Lagos Nigeria -a facility based World Hepatitis Day awareness study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eWorld Hepatitis Day (WHD) was launched on July 28th 2010, and is one of 11 official \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eglobal public health\u003c/span\u003e campaigns marked by the \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eWorld Health Organisation\u003c/span\u003e (WHO).\u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e It is observed annually every July 28th to raise awareness about viral hepatitis, promote prevention, testing, treatment, and mobilise action towards the WHO 2030 viral elimination goal set by WHO.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e Various activities globally commemorate the WHD to increase public awareness and strengthen the political will to address the viral hepatitis epidemic.\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e,\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e This is a noteworthy cause since approximately 257\u0026nbsp;million individuals are living with hepatitis B worldwide.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e Hepatitis B virus (HBV) prevalence rates in adult populations in West Africa are estimated to be between 6% and 16%, while in Nigeria, prevalence is estimated at 9.5%.\u003csup\u003e4,5\u003c/sup\u003e Despite the high prevalence of HBV worldwide and ongoing attempts to enhance care and treatment, many infected individuals are unaware of their status until the disease progresses.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e This highlights the need for increased awareness, need for more screening opportunities, improved regulations and testing standards at healthcare facilities and more emphasis on vaccination\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe Nigerian Institute of Medical Research (NIMR) celebrates WHD annually and is located in the Yaba area of Lagos, Nigeria. Lagos is a bustling metropolitan city in southwestern \u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eNigeria\u003c/span\u003e, with about 20\u0026nbsp;million inhabitants.\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e NIMR began its community engagement programs and public awareness campaigns for viral hepatitis on July 28th 2013, joining the global community to celebrate WHD towards the WHO global goal of viral elimination by 2030. Scheduled events and activities over the last decade\u0026rsquo;s commemoration have included medical outreach programs, facility-based HBV testing around Lagos state, community meetings inclusive of testing and focus group discussions, symposiums, free viral hepatitis screening and free HBV vaccine for eligible individuals.\u003c/p\u003e\u003cp\u003eHepatitis B vaccination is vital to preventive healthcare, offering protection against the potentially life-threatening HBV and its long-term serious sequelae.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e It is the cheapest and most effective measure to control and prevent hepatitis B globally and a priority action in achieving viral elimination by 2030.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e,\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e Adult vaccination is targeted at children and adults who were not vaccinated at infancy and is a mop-up vaccination strategy to support infant vaccine programs towards hepatitis B viral elimination.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e The hepatitis B vaccine is administered in different dosing schedules, with the standard 3-dose vaccine consisting of 2 priming doses administered 1 month apart and a third dose administered 6 months after the first dose.\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e The vaccine has been widely available since the 1980s and has been instrumental in reducing the incidence of HBV infection and its associated complications. This study aimed to evaluate the impact and uptake of vaccination activities implemented through NIMR programme and to propose strategies for enhancing the implementation and uptake of adult vaccination in Nigeria.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy aim, design and setting\u003c/h2\u003e\u003cp\u003eThe study aimed to evaluate the impact and uptake of vaccination activities implemented through a NIMR programme, and to propose strategies for enhancing the implementation and uptake of adult vaccination in Nigeria. The study design was a prospective cohort design composed of adult males and females who approached the institution for hepatitis B screening, and upon testing negative, requested vaccination. The study setting was NIMR.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eCharacteristics of participants\u003c/h3\u003e\n\u003cp\u003eNIMR is located in Yaba, an urban metropolitan area of Lagos State, Nigeria. The presence of universities and colleges in Yaba provide an opportunity to reach young adults, a key demographic for HBV vaccination, and offers convenient access to HBV screening and vaccination services. The district's commercial centres and markets enable outreach to a diverse audience, while its transportation hubs facilitate access for individuals across Lagos. WHD is a platform for governments, healthcare providers, civil society organisations, and individuals to act and collaborate to achieve the 2030 HBV elimination targets. For our response to this WHD clarion call, we established a free viral screening and vaccination program for interested community members.\u003c/p\u003e\n\u003ch3\u003eCounselling, Testing and Vaccination\u003c/h3\u003e\n\u003cp\u003eFirstly we organized a symposium to train on hepatitis and the importance of vaccination to the general public. A brief overview of the event's goals was provided before training commenced on viral hepatitis, types of hepatitis, phases, and modes of transmission, testing, consequences of infection and importance of vaccination. We then set up two 10 x 15 compact canvas canopy tents at the institute for our walk-in service for testing and vaccination. Registration was done first and information such as name, sex, phone number, residential address and past immunisation history was requested. Doctors, nurses and other healthcare workers from NIMR were in attendance to offer pre- and post-vaccination counselling, and give vaccinations to those who qualified and consented.\u003c/p\u003e\u003cp\u003eFollowing a pre-test counselling session, 4 ml of venous blood was drawn using a single use blood collection kit of needle and sterile EDTA vacutainer tubes. The SD Bioline HBsAg (Abbott), a rapid immunoassay, was used to determine the HBsAg status of the participants. The blood sample was added to the prelabeled RDT sample channel, which was unique to each participant for traceability. The assay buffer was added, and the results were read visually after incubation, according to the manufacturer's instructions.\u003c/p\u003e\u003cp\u003eParticipants who tested positive for HBsAg had post-counseling session and were referred to the institute's clinic for treatment. Those who tested negative for HBsAg and consented were vaccinated, using a 6-month regimen of 3 doses, administered in a time series of 0-1-6. Revac (Bharat Biotech, Shamirpet Mandal India) and Genevac B (Serum Institute of India Pvt. Ltd) were the vaccines administered. The first two doses were free, and dose three was charged at a subsidised cost of ₦1,000.00 (\u0026asymp; \u003cspan\u003e$\u003c/span\u003e4). A well structured follow-up schedule of telephone calls and text messages weekly before vaccine due dates and on-the-day reminders to all eligible participants for the second and the third doses was planned and follow up calls for appointment defaulters were also arranged. The vaccination exercise commenced with dose one administered on July 28\u003csup\u003eth,\u003c/sup\u003e 2015, and last dose administered from January 28th 2016 through the first two weeks of February 2016.\u003c/p\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eStatistical analysis was conducted using SPSS version 27. Descriptive statistics were summarized and presented with means (SD), median and IQR, frequencies and percentages. Bivariate analysis was conducted using Pearson\u0026rsquo;s Chi-square test to know the association between participants\u0026rsquo; demographic characteristics (age, sex, occupation and distance from NIMR), and vaccination status. Statistically significant covariates were subjected to a binary logistic regression with the adjusted odds ratio (AOR) and it\u0026rsquo;s confident interval reported. Results are considered statistically significant when the \u003cem\u003ep\u003c/em\u003e value is \u0026lt;/= 0.05.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003eOf a sum total of 553 persons involved in the screening programme, 402 (72.6%) persons presented for the first vaccination dose and were included in the study. Most of the study participants were adults, with the age range 21 to 40 years having the highest proportion of participants (48.5%). The age group closely following this range was 41 to 60 (37.3%) years. The mean age was 37.8 years, with a standard deviation of 13.1 years. More participants were males (51%) in skilled occupations (44.3%). The median distance of participants' residence to NIMR was 6.49 km with an IQR of 12.1 km. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e provides a summary of the participants' characteristics.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe socio-demographic characteristics of the study participants\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;402)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercentage\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e45\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e195\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e48.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e37.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e61\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMean (SD)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37.8 (13.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e197\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e49.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e205\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e51.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e178\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e44.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnskilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e77\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to NIMR (km)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e138\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.50-73.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e137\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e34.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMissing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e31.6\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMedian (IQR)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6.49 (12.01)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eFigure \u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e summarises the vaccination information, the prevalence of HBsAg positivity of the study participants, and the reasons for not completing the vaccination by participants who defaulted. Most participants (85.5%) completed the second dose of the vaccination, while 57.7% completed the third dose of the vaccine. Key reasons for not completing the vaccination included participants being unreachable by telephone (51.8%), out-of-town (28.6%), and lack of contact telephone number in participant data (19.0%).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cp\u003eUsing the Chi-square test, the relationship between the socio-demographic characteristics of the study participants and their vaccination status are summarised in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Age and distance travelled to NIMR from the participants' residence were statistically significant, with p-values of 0.019 and 0.007, respectively.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eThe association between socio-demographic characteristics of study participants and their vaccination status.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eVaccination status\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables (n\u0026thinsp;=\u0026thinsp;402)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMissing (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCompleted (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNot completed (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003ep-value\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group (Years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (8.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e25 (55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e16 (35.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.019\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e21(10.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e108 (55.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e66 (33.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e11 (7.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e97 (64.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42 (28.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e61\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e4 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2 (16.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e6 (50.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e18 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e120 (60.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e59 (29.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.444\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e22 (10.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e112 (54.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e71 (34.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRetired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (66.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e2 (33.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.121\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSkilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e5 (2.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e117 (65.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e56 (31.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eStudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e30 (56.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e23 (43.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0 (0.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4 (36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e7 (63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUnskilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (9.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e41 (53.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29 (37.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance to NIMR (km)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0-6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e78 (56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e53 (38.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003e0.007\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.50-73.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e7 (5.1)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e101 (73.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e29 (21.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cb\u003ea\u003c/b\u003e\u003c/sup\u003e Statistically significant p-values. Missing values were excluded from the analysis.\u003c/p\u003e\u003cp\u003eThe summary of the multivariable analysis using binary logistic regression is provided in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The participants aged 21 to 40 years and 61\u0026ndash;80 years have 1.19 and 1.86 odds of completing their vaccination compared to those aged 0 to 20 years. However, the odds were not statistically significant. (0.76 AOR 1.185, 95% CI 0.398\u0026ndash;3.527, p-value 0.76 and AOR 1.859 95% CI 0.091\u0026ndash;38.175, p-value 0.688 respectively). The participants living further from NIMR had 0.41 odds of completing the vaccination compared to those living closer to NIMR (AOR 0.412, 95% CI 0.237\u0026ndash;0.716, p-value 0.002).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eLogistic regression showing factors associated with vaccination completion among the study participants.\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eP-value\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAdjusted Odds ratio (AOR)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u003cp\u003e95% C.I. for adjusted Odds ratio\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eLower\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eUpper\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAge Group (years)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u0026ndash;40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.76\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.185\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.398\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.527\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e41\u0026ndash;60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.693\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.209\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.304\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e61\u0026ndash;80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.688\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.859\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.091\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e38.175\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.248\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.796\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.414\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance from NIMR (km)\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e0\u0026ndash;6.49\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.50\u0026ndash;73.15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.002*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.412\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.716\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation group\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eretired\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eskilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.749\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.852\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.319\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.276\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003estudent\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.609\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.386\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.397\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e4.845\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunemployed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.674\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.547\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e11.813\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eunskilled\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.664\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1.27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.432\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e3.738\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"5\"\u003e*Statistically significant p-value\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe hepatitis B vaccine is an essential and veritable tool for preventing hepatitis B infection. It is also safe, effective, and inexpensive. WHO endorsed the \"Global Health Sector Strategy on Viral Hepatitis\" in 2016, aiming to eliminate viral hepatitis as a public health threat by 2030. Vaccination is emphasised as a priority action in achieving this goal\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. This study addresses the prevalence of HBV infection, the uptake and completion of adult hepatitis B vaccination, and the social and economic hurdles that may hamper the uptake and effectiveness of the vaccine in Nigeria.\u003c/p\u003e\u003cp\u003eThe prevalence of HBV infection seen in our study was 9.0%. This is similar to the prevalence of 8\u0026ndash;14% found in the Southwest region of Nigeria.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e However, our study had a higher prevalence than Lagos state (2.1%), where our facility is located.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e Studies in Nigeria have reported varying prevalence rates of HBV for communities, health facilities, states, regions, and populations.\u003csup\u003e\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e Facility-based testing usually has a higher prevalence of positive cases compared to community-based testing, as observed in our study.\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e,\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Facility testing presents a promising avenue for increased screening and diagnosis opportunities due to the high walk-in potential. This aligns with WHO\u0026rsquo;s goal to eliminate viral hepatitis as a major public health threat by the year 2030 through an increase in screening and diagnosis by 90%.\u003csup\u003e12\u003c/sup\u003e Leveraging existing platforms and structures in established health facilities can increase testing and provide faster, cheaper and synergistic approaches to HBV diagnosis and monitoring. This integration and linkage to care is a positive force multiplier, being quicker and immediate.\u003c/p\u003e\u003cp\u003eThe study evaluated the uptake of the vaccination exercise carried out at NIMR. At study closeout, 57.7% were fully vaccinated, receiving three standard doses, and 85.5% received the first and second doses only. From the initial study population of 402 participants, we observed that 170 participants (42.3%) were lost to follow-up. The significant finding associated with the loss-to-follow-up was the commute distance to the vaccination centre and economic migration.\u003c/p\u003e\u003cp\u003eVaccination rates in this study (57.7%) were higher than the 42.0% and 43.9% reported by Issa and Akabuike, respectively, in Nigerian studies. Other studies in Nigeria also reported low rates indicating poor uptake even among healthcare workers, a key population with a significant risk for HBV infection.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Reports from other African countries show different rates across regions, with a pooled average vaccination rate of 24% for the continent.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e The African continent has one of the highest burdens of Hepatitis B, with 6.1% -16% of the adult population living with the infection \u0026ndash; this shows the burden of disease is high and vaccination rates and acceptance is low.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e,\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Improving vaccine uptake is vital to achieving the global goal of viral elimination, calling for increased action and policies towards vaccination. Awareness campaigns on vaccination and screening are essential to drive vaccination knowledge and acceptability, thereby improving uptake.\u003c/p\u003e\u003cp\u003eLoss to follow-up in adult vaccination programs has various barriers that limit the efficacy of vaccine campaigns and immunisation success. Transportation and apathy are barriers identified as severe limitations, as further observed in our study.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e At the study's inception, 20% of eligible vaccine beneficiaries declined participation despite the low financial cost of the exercise, indicating disinterest and poor knowledge of associated risks and benefits. Implementing mobile or community-based vaccination and awareness campaigns using diverse media to sensitise the public on HBV vaccination must be explored to increase uptake, especially among adults.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e The average vaccination rate in Nigerian children is as high as 76% compared to 57.7% seen among adults in this study.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe findings revealed that distance/travel time to the facility was significant in the success of the vaccination exercise- the farther the commute, the lesser the participation. At dose two, vaccination rates were approximately 86%, compared to 57% who completed the exercise. This outcome was similar to other Nigerian studies that reported severe loss to follow-up after doses 2 and 3\u003csup\u003e16,17,24\u003c/sup\u003e. Follow-up reminders and phone calls were made to participants about why they were absent for follow-up appointments. Some participants said they had travelled out of town, and some of these calls were truncated or uncompleted with no signal tone. Others had phone numbers which were no longer connecting or reachable. This may be due to economic migration or relocation to out-of-reach areas. Despite this drawback, the intensive follow-up phone calls yielded positive results as we recorded a 57% vaccine completion rate, a higher rate than the outcome of other vaccination studies done in-country.\u003csup\u003e\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e,\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e Mobile or community-based vaccination units stationed close to vaccine recipients have been explored and studied as a significant factor that improves participation and completing doses in vaccine time series.\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e,\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eImplementing a different dosing regimen, e.g. accelerated dosing schedules (with a shorter time to completion), has been reported to help communities where time series compliance is poor and retaining interest is a challenge.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e It is recommended as a means to combat forgetfulness, retain interest and prevent economic migration as the vaccine is administered within a one-month cycle; several studies have also indicated that immune responses and protection rates were similar when the two dosing schedules (six months versus one month) were compared.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e This may be useful to ensure higher participation and better vaccine uptake. The accelerated dosing schedule aims to provide faster protection by completing the primary vaccination course within a shorter period. Some vaccine types may require a booster dose at 12 months.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eIn conclusion this study underscores the need to improve adult vaccination against HBV. Individuals protect themselves and others contributing to the overall goal of controlling and eliminating HBV infection by 2030. Our findings highlight the high prevalence of hepatitis B in Nigeria, contrasted with low vaccination rates. Incomplete vaccination schedules, long commutes to the facility, economic migration and disinterest emerged as significant hurdles, raising the pressing need for improved follow-up systems for vaccination time series and policy reviews. Innovative strategies such as mobile or community-based vaccination units and initiating shorter vaccine dosing regimes are recommended to improve vaccine uptake.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eHBV\u003c/strong\u003e- Hepatitis B Virus, \u003cstrong\u003eWHD\u003c/strong\u003e- World Hepatits Day,\u0026nbsp;\u003cstrong\u003eNIMR\u003c/strong\u003e-\u0026nbsp;Nigerian Institute of Medical Research, \u003cstrong\u003eIRB\u003c/strong\u003e- Institutional Review Board, WHO -World Health Organisation\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received ethical clearance from the Nigerian Institute of Medical Research Institutional Review Board (NIMRIRB). All methods were performed in accordance with the relevant guidelines and regulations. Informed consent was obtained from all participants, and they were assured of voluntary participation, confidentiality, and data protection throughout and after the study. The research was in accordance with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors gave their consent for this publication to be made.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll available data is provided within the manuscript. Addition requests can be made to the first author, Dr. Fehintola A. Ige at [email protected] \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors declare that they have no competing interests, or other interests that might be perceived to influence the results and/or discussion reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study concept and design was by FAI and RAA. Acquisition of data was performed by FAI, APO, PME, DO, JCI and OOO. FAI, SON, IRA, OOO, CLO, COO, and EOO performed the laboratory investigation. Analysis and interpretation of data was carried out by OOO and FAI. Statistical analysis was done by OOO. Initial draft of the manuscript was done by SON, FAI and IRA. FAI, APO, PME, OOO, CLO did the data curation. FAI, SON and IRA performed the formal analysis. AGO and RAA performed funding acquisition. FAI, DO, EOO, PME and DA performed the methodology. FAI, CKO, JCI and RAA were responsible for project administration. Resources were obtained by AGO and RAA. All authors read and the final version of the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank all the various persons that participated in the drive to propagate the knowledge of hepatitis.\u0026nbsp;\u003cbr\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003e World Health Organization. (2019). \u003cem\u003eWorld Hepatitis Day 2019.Retrieved in February10th 2025\u003c/em\u003e.\u003c/li\u003e\n\u003cli\u003e Ward JW, Averhoff FM, Koh HK. (2011). 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Using mobile clinics to deliver care to difficult-to-reach populations: a COVID-19 practice we should keep. \u003cem\u003ePreventive medicine reports\u003c/em\u003e, \u003cem\u003e24\u003c/em\u003e, 101551.\u003c/li\u003e\n\u003cli\u003e Zadsar M, Moghaddam ES, Alavian SM, Seighali F (2020). Accelerated Hepatitis B Vaccination: Efficacy in Young, Regular Blood Donors. \u003cem\u003eGlobal Journal of Transfusion Medicine\u003c/em\u003e 5(2):p 135-138. DOI: 10.4103/GJTM.GJTM_46_19\u003c/li\u003e\n\u003cli\u003e Ghadiri K, Vaziri S, Afsharian M, Jahanbaksh A, Mansouri F, Sayad M, Najafi F, Souri B. (2012). Comparison of the accelerated and standard vaccination schedules against hepatitis B in healthcare workers. \u003cem\u003eJournal of Research in Medical Sciences\u003c/em\u003e;17(10):934-7.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7512840/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7512840/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eHepatitis B virus (HBV) is a vaccine-preventable disease. The Global Health Sector Strategy on Viral Hepatitis has set goals to eliminate viral hepatitis as a public health threat by 2030. Vaccination is highlighted as a priority action in achieving this goal. The Nigeria Institute of Medical Research (NIMR) conducts annual World Hepatitis Day (WHD) campaigns to educate and raise awareness, while aligning with the global call for viral elimination. This study was done to analyse the impact and uptake of the vaccination exercise carried out in NIMR programmes and proffer strategies for implementing and improving the uptake of adult vaccination in Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAs part of the WHD awareness campaign, a free HBV screening and vaccination programme was established for interested community members. Participants were tested for hepatitis B surface antigen (HBsAg) using the SD Bioline HBsAg Rapid test kit. Participants who tested positive were referred to the institute's clinic for further evaluation. Those who tested negative were vaccinated using a 6-month regimen of 3 doses (0, 1 and 6 month intervals). Participants' demographics and travelling distance to NIMR were obtained and analysed using descriptive and inferential statistics. Variables significant via inferential statistics were subjected to a multivariate analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 553 participants, with a mean age of 37.8\u0026thinsp;\u0026plusmn;\u0026thinsp;13.1 years, were screened for HBsAg. Prevalence of HBsAg was 9.0% (50/553), and 402/503 (80%) gave consent for vaccination. Of these 402 participants, 85.5% and 57.7% completed the second and third doses, respectively, with 42.3% being lost to follow-up.\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e\u003cp\u003eEconomic migration and loss of interest were key factors influencing vaccine uptake. Participants with a farther travel distance/time to NIMR had significantly lesser odds (0.41) of completing vaccination.In conclusion, HBsAg prevalence is high, while vaccination uptake and completion is low. Mobile clinics and a shorter vaccine schedule are innovative strategies that may help improve the uptake of vaccines and reduce loss to follow-up.\u003c/p\u003e","manuscriptTitle":"Evaluating Hepatitis B vaccination rates and prevalence in Adults from Lagos Nigeria -a facility based World Hepatitis Day awareness study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-25 15:36:52","doi":"10.21203/rs.3.rs-7512840/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1cf3c58d-d493-496d-aadf-2013da0a9f0b","owner":[],"postedDate":"September 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":55211070,"name":"Health sciences/Diseases"},{"id":55211071,"name":"Health sciences/Gastroenterology"},{"id":55211072,"name":"Health sciences/Health care"},{"id":55211073,"name":"Biological sciences/Immunology"},{"id":55211074,"name":"Health sciences/Medical research"}],"tags":[],"updatedAt":"2025-12-03T09:39:24+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-25 15:36:52","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7512840","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7512840","identity":"rs-7512840","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}