Hepatitis B vaccination coverage among health-care workers in Africa: A systematic review and meta-analysis

To estimate full hepatitis B vaccination coverage (uptake of ≥3 doses of vaccine) among health-care workers (HCWs) in Africa.

We systematically searched the PubMed®, Embase®, CINAHL and Psych-Info databases for studies published from January 2010 to October 2017 that reported full hepatitis B vaccination coverage among HCWs in Africa. A random effects meta-analysis was conducted to determine pooled estimates of full vaccination coverage.

Of the 331 articles identified, 35 studies from 15 African countries met the inclusion criteria and were included in the review. The estimated full hepatitis B vaccination coverage was 24.7% (95% CI: 17.3-32.0). Regional coverage was highest in northern Africa (62.1%, 95% CI: 42.5-81.7) and lowest in central Africa (13.4%, 95% CI: 4.5-22.3). Doctors were more likely (OR: 2.6, 95% CI: 1.8-3.7) to be fully vaccinated than Nurses with estimated pooled estimates of 52.4% (95% CI: 31.1-73.8) and 26.3% (95% CI: 9.7-42.9), respectively. Also, HCWs with 10 or more years of experience were more likely to be vaccinated than those with less than 10 years of experience (OR: 2.2, 95% CI: 1.5-3.3). The common reasons identified for non-vaccination of HCWs were unavailability of vaccine 50.5% (95% CI: 26.5-74.4), busy work schedule 37.5% (95% CI: 12.6-62.4) and cost of vaccination 18.4% (95% CI: 7.1-29.7).

The evidence available suggests that many HCWs in Africa are at risk of Hepatitis B infection as only a quarter of them were fully vaccinated against Hepatitis B virus. This study highlights the need for all African governments to establish and implement hepatitis B vaccination policies for HCWs.