Summary

A secondary analysis of Nigeria’s 2023–24 Demographic and Health Survey found that 72% of mothers attended antenatal care, but only 12.3% were tested for hepatitis B there. Infant birth-dose coverage was 55%.

A medRxiv preprint has mapped Nigeria’s national hepatitis B mother-to-child prevention cascade and found a large gap between antenatal-care attendance and hepatitis B testing. Although 72% of mothers in the analysis attended antenatal care, only 12.3% were tested for hepatitis B during those visits. The hepatitis B birth dose reached 55.0% of infants.

The study was a secondary analysis of the 2023–24 Nigeria Demographic and Health Survey, using complex-survey methods. It included 13,341 women whose most recent live birth occurred within the preceding three years; each woman was linked to that child’s immunisation record. The work is a preprint rather than a peer-reviewed journal article.

Contents

A wide gap after antenatal attendance

Hepatitis B is a preventable cause of liver cancer, and in high-burden settings chronic infection is commonly acquired around the time of birth. Preventing transmission from mother to child requires several linked steps: contact with antenatal care, hepatitis B testing, receipt of the result and protection of the newborn.

The analysis found that the largest loss occurred at the testing stage. Only 12.3% of mothers were recorded as having hepatitis B testing in antenatal care, with a 95% confidence interval of 11.4% to 13.2%. Among the small group who were tested, almost all received their result. This placed the main breakdown before result-return, rather than after testing.

The researchers describe this as a missed opportunity: antenatal care already reaches most mothers, but that contact is rarely being used to identify hepatitis B infection and guide prevention.

Newborn vaccination followed a separate pathway

The hepatitis B birth dose reached 55.0% of infants, with a 95% confidence interval of 53.1% to 56.9%. The study reports this as 35 percentage points below the relevant World Health Organization target.

Infant birth-dose coverage showed no relationship with whether the mother had been tested during antenatal care. The authors say this pattern is consistent with universal, non-targeted delivery rather than a vaccination process linked to maternal testing. Place of delivery was the dominant correlate of whether an infant received the birth dose.

This means the two protective steps were not operating as a single connected cascade. Antenatal testing was uncommon, while infant vaccination depended more strongly on where delivery took place than on information gathered during pregnancy.

Where the prevention gap was widest

Coverage differed sharply by socioeconomic status and region. Antenatal testing ranged from 2.6% in the poorest wealth quintile to 32.4% in the richest. It was lowest in Nigeria’s North-West, which the researchers identify as the zone with the country’s highest hepatitis B prevalence.

The authors propose integrating free hepatitis B testing into antenatal care and giving greater attention to the highest-burden northern areas. That recommendation follows from the survey’s coverage findings; the study did not test a new testing or vaccination programme.

The analysis provides a national measurement of where the prevention cascade is losing mothers and infants, but it is based on existing survey data rather than an intervention trial. Its description of the birth-dose pattern identifies a separation between maternal testing and newborn vaccination, while the operational reasons for that separation would require further investigation.

Sources