Modeling a BCG Birth Dose-based Vaccination Program for Improved Hepatitis B Control in Uganda: Mixed-methods study

Background: Hepatitis B virus (HBV) is mainly transmitted perinatally. Delaying the first dose of HBV vaccine to 6 weeks of age as is the current practice in Uganda may increase the risk of perinatal transmission. In this study, we aimed to assess the uptake of BCG vaccine within 24 hours after birth and to assess the feasibility of BCG/HBV vaccine co-administration in Uganda. Methods: This was a mixed-methods study. We retrospectively collected data on BCG vaccine uptake, the timing of vaccination, and reasons for missed/delayed vaccination, at two hospitals: capital city-based St. Francis Hospital Nsambya (SFHN), and upcountry-based Mbarara Regional Referral hospital. We also conducted a cross-sectional study at SFHN to explore factors associated with delayed or missed BCG vaccination within 24 hours after birth. Results: : Of the 2,002 newborn babies randomly sampled, 1,534 (76.5%) received BCG vaccine within 24 hours. On chart review, 140 participants had identifiable reasons for delayed BCG vaccination as follows: admission to neonatal unit with birth asphyxia (56.2%, n= 73), and birth weight <2.5kg (30.8%, n=40). On interviewing 73 mothers at vaccination clinics, admission to a neonatal unit for prematurity (n= 42, 57.5%), birth asphyxia (n= 73, 56.2%) or birth weight < 2.5kg (n=40, 30.2%) were the reasons for missed/delayed vaccination. The median human cost for the BCG vaccination process was $0.14. Conclusions: : Over three-fourth of neonates received their BCG vaccine within 24 hours after birth, providing a convincing basis for co-administration of BCG and HBV vaccines.