ArticleBMC public health2026
Spatial variation and determinants of hepatitis B birth dose vaccination in Nigeria: a population-based study.
Article in BMC public health, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundHepatitis B virus (HBV) infection remains a major public health problem in Nigeria, with an estimated prevalence of 5–10%, with a sub-Saharan African regional average of approximately 6.1%. Timely administration of the hepatitis B birth dose (HepB-BD) is essential for preventing vertical transmission and its long-term complications; however, national coverage remains below recommended targets. Despite its importance, evidence on the geographic distribution and contextual determinants of HepB-BD uptake across Nigerian states is limited. This study examined the spatial variation and determinants of HepB-BD vaccination in Nigeria. METHODOLOGY: A population-based cross-sectional study that analysed data from the 2018 Nigeria Demographic and Health Survey. Spatial analysis using Local Moran’s I was performed to detect clusters of high and low HepB-BD vaccination coverage across Nigeria. Using STATA 14, binary logistic regression was used to analyse data of 13,064 children aged 0–24 months to identify predictors of Hep-B-BD vaccination.
resultsOverall, 52% of children received HepB-BD, with significant regional variation. Children of mothers with secondary or higher education, compared with those with no education, had higher odds of vaccination (aOR: 1.92; 95% CI: 1.63–2.27). Similarly, children from the richest households, relative to the poorest, had higher odds of vaccination (aOR: 2.46; 95% CI: 1.88–3.23). Antenatal care attendance, compared with none (aOR: 2.76; 95% CI: 2.39–3.18), and health facility delivery, compared with home delivery (aOR: 2.09; 95% CI: 1.83–2.38), were also associated with higher odds of vaccination. Children in the North-East (aOR: 0.68; 95% CI: 0.55–0.84) and North-West (aOR: 0.64; 95% CI: 0.51–0.80), compared with North Central, had reduced odds. Spatial analysis revealed significant clustering, with cold spots concentrated in northern Nigeria, and global spatial autocorrelation confirmed this (Moran’s I = 0.220, p = 0.001).
conclusionHepB-BD coverage remains suboptimal and geographically clustered, with disparities associated with maternal, socioeconomic, and regional factors. Targeted, context-specific strategies may be required to improve equitable uptake across low-coverage states.
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