Work

Prevalence and determinants of hepatitis B vaccination uptake among pregnant women in sub-Saharan Africa: a systematic review and meta-analysis

Year: 2026

Type: review

Study designs: Systematic Review, Meta-Analysis

Abstract: Objective Despite more than two decades of hepatitis B vaccination implementation across sub-Saharan Africa (SSA), hepatitis B virus (HBV) remains hyperendemic in the region, with vertical transmission an important route of infection. However, there is a lack of regional evidence on HBV vaccination uptake among pregnant women, a priority population in HBV prevention. This systematic review and meta-analysis aimed to estimate the prevalence of HBV vaccination uptake and identify its determinants among pregnant women in SSA. Design Systematic review and random-effects meta-analysis conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data sources Following prospective registration (PROSPERO), we searched MEDLINE, Embase, Web of Science and Scopus for peer-reviewed studies published up to August 2026, supplemented by African Journals Online and Google Scholar. Eligibility criteria for selecting studies Observational studies reporting HBV vaccination uptake among pregnant women in SSA countries were included. Data extraction and synthesis Two reviewers independently screened studies, extracted data and assessed methodological quality using the Joanna Briggs Institute checklist for analytical cross-sectional studies. A random-effects meta-analysis was performed to estimate pooled prevalence. Subgroup and meta-regression sensitivity analyses explored sources of heterogeneity and robustness of findings. Determinants of vaccination uptake were synthesised narratively. Results Of 1041 records screened, 21 studies involving 15 804 pregnant women from seven SSA countries were included. The pooled prevalence of HBV vaccination uptake was 18% (95% CI 14% to 21%) with substantial heterogeneity (I²=99.2%) observed. Studies from West Africa (12; n=8062) reported higher vaccine uptake (24%, 95% CI 17% to 31%; p<0.001). Available studies identified socioeconomic, behavioural and healthcare-related factors associated with uptake, though evidence was limited. Evidence of small-study effects or potential publication bias was observed (Egger’s test, p<0.001). The overall certainty of evidence was considered very low using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, reflecting serious concerns regarding inconsistency, risk of bias and small-study effects. Conclusions HBV vaccination uptake among pregnant women in SSA remains suboptimal and represents an important unmet need for preventing vertical transmission. Targeted, context-specific interventions to improve awareness, access and integration of vaccination into antenatal care services are needed to enhance uptake. Future research should examine barriers and evaluate interventions to increase vaccination coverage in this priority population. PROSPERO registration number CRD420251120357.

Source: BMJ Open

DOI: 10.1136/bmjopen-2026-123877

Authors: Ismail Bamidele Afolabi, J Craig Phillips, Darine El-Chaâr, Shannon A Bainbridge, Karen P Phillips

Institutions: University of Ottawa, Ottawa Hospital, Ottawa Hospital Research Institute

Language: English

Topic: Vaccine Coverage and Hesitancy

Subfield: Health

Field: Social Sciences

Domain: Social Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $1,839