Childhood Hepatitis B Immunization Coverage and Barriers in Sierra Leone, Liberia, and Guinea: Analysis of National Surveys (2018-2020)

ABSTRACT Vaccination against hepatitis B virus (HBV) is effective at preventing mother-to-child transmission. Sierra Leone, Liberia and Guinea are hyperendemic West African countries; yet childhood immunization coverage is suboptimal and barriers to immunization are poorly understood. We analyzed national survey data (2018-2020) of children aged 4-35 months to assess full HBV immunization (receiving 3 doses of the pentavalent vaccine) and incomplete immunization (receiving < 3 doses). Statistical analysis was conducted using the complex sample command in SPSS (version 28). Multivariate logistic regression was used to identify determinants of incomplete immunization. Overall, 11181 mothers were analyzed (4846 from Sierra Leone, 2788 from Liberia and 3547 from Guinea). Sierra Leone had the highest HBV childhood immunization coverage (70.3%), followed by Liberia (64.5%) and Guinea (40.0%). Within countries, immunization coverage varied by sociodemographic characteristics (education, religion, household wealth index, access to mass media) and healthcare access (antenatal visits, place of delivery and health facility proximity). In multivariate regression analysis, Muslim mothers, lower household wealth index, < 4 antenatal visits, home delivery and distance to health facility were predictors of incomplete immunization (all p < 0.05). Addressing these socioeconomic and healthcare access barriers will be essential to help achieve the 2030 viral hepatitis elimination goals.