Predictors of Hepatitis B Virus Vaccine Uptake Among Women of Reproductive Age, in South Sudan: Conceptualising Health Belief Model

Abstract

Background: Hepatitis B virus (HBV) remains a public health problem in South Sudan. Vaccination is currently the most
effective means of protection against HBV infection. However, there is limited evidence regarding the uptake of the
vaccine among women of reproductive age (WRA) in South Sudan. This study aimed to examine the predictors of HBV
vaccine uptake among WRA in Juba City, South Sudan.
Methods: This study adopted a mixed methods cross-sectional design with quantitative and qualitative components
among WRA accessing health services at seven health facilities in Juba, South Sudan from May to July 2024. A validated
semi-structured questionnaire was used to collect data related to HBV vaccine uptake, women characteristics, health
behaviour factors from the 1808 randomly selected women. The study used Stata version 15 and ATLAS.ti version 7 for
analyses. Chi squared tests and regression model were performed to determine associations and likelihood, respectively.
Results: Among the 1,808 women, 37.7% received HBV vaccine as observed uptake and 65.8% as model’s predicted
uptake. Of those who received the vaccine, 56.9% had full dose. The demographic factors associated with uptake
of HBV vaccine were; residential area (p<.001), level of education (p<.001), employment status (p<.001). Similarly,
health behaviours associated with uptake of vaccine were; blood transfusion (p<.001), and surgical operation (p<.001).
The women who attended formal education were two times more likely to receive HBV vaccine compared to those who
did not (OR 1.988, 95% CI: 1.508 - 2.621). Employed women of reproductive age were two times more likely to
receive HBV vaccine than the unemployed (OR 1.676, 95 CI: 1.339 - 2.097). Women who had close contact with
a case of hepatitis B were two times more likely to receive the vaccine than those who had not had close contact with
a case of hepatitis B (OR 1.509, 95% CI:1.13 - 2.016). The study identified these themes: benefits of HBV vaccine
uptake (prevention of HBV and its complications, prevention of vertical transmission and social benefit (herd immunity)).
Furthermore, the results of major theme of barriers to HBV vaccine uptake included lack of vaccine information, limited
access to vaccination, fear of adverse reactions, and financial constraints.
Conclusion: HBV vaccine uptake among women of reproductive age in Juba city remains suboptimal. Uptake was
associated with residential area, level of education, employment status, blood transfusion history, and surgical operation
history. The study recommends strengthening tailored health promotion interventions, addressing identified barriers,
expanding antenatal HBV screening, and providing continuous in-service training for health workers