{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T06:22:07Z","timestamp":1791872527954,"version":"4.3.4"},"reference-count":94,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2023,10,16]],"date-time":"2023-10-16T00:00:00Z","timestamp":1697414400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["TropicalMed"],"abstract":"<jats:p>The persistent burden of chronic hepatitis B among \u22645-year-old children in Africa suggests missed opportunities for controlling mother-to-child transmission (MTCT) of the hepatitis B virus (HBV). This scoping review maps the evidence base on the risk of HBV MTCT, the status of HBV MTCT mitigation strategies including hepatitis B birth-dose vaccination, and the role of systems complexity on the suboptimal adoption and performance of hepatitis B birth-dose vaccination programs in Africa. Overall, 88 peer-reviewed and grey literature sources published between 2000\u20132022 were included in this review. The growing evidence base consistently argues for a heightened risk of HBV MTCT amidst the HIV co-epidemic in the region. Without universal HBV screening programs integrated within broader antenatal care services, current selective hepatitis B birth-dose vaccination is unlikely to effectively interrupt HBV MTCT. We underscore critical health systems-related barriers to universal adoption and optimal performance of hepatitis B birth-dose vaccination programs in the region. To better conceptualize the role of complexity and system-wide effects on the observed performance of the program, we propose an adapted systems-based logic model. Ultimately, exploring contextualized complex systems approaches to scaling-up universal hepatitis B birth-dose vaccination programs should form an integral part of the regional research agenda.<\/jats:p>","DOI":"10.3390\/tropicalmed8100474","type":"journal-article","created":{"date-parts":[[2023,10,17]],"date-time":"2023-10-17T08:10:19Z","timestamp":1697530219000},"page":"474","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":26,"title":["Weak Adoption and Performance of Hepatitis B Birth-Dose Vaccination Programs in Africa: Time to Consider Systems Complexity?\u2014A Scoping Review"],"prefix":"10.3390","volume":"8","author":[{"given":"Tasneem","family":"Solomon-Rakiep","sequence":"first","affiliation":[{"name":"Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa"},{"name":"Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9155-6896","authenticated-orcid":false,"given":"Jill","family":"Olivier","sequence":"additional","affiliation":[{"name":"Health Policy and Systems Division, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3913-0457","authenticated-orcid":false,"given":"Edina","family":"Amponsah-Dacosta","sequence":"additional","affiliation":[{"name":"Vaccines for Africa Initiative, School of Public Health, Faculty of Health Sciences, University of Cape Town, Observatory, Cape Town 7925, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1255","DOI":"10.1016\/j.clinthera.2018.05.016","article-title":"Elimination of Vertical Transmission of Hepatitis B in Africa: A Review of Available Tools and New Opportunities","volume":"40","author":"Njei","year":"2018","journal-title":"Clin. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.11604\/pamj.supp.2017.27.3.11981","article-title":"The Status of Hepatitis B Control in the African Region","volume":"27","author":"Breakwell","year":"2017","journal-title":"Pan Afr. Med. J."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3141","DOI":"10.1016\/j.vaccine.2021.04.041","article-title":"Prevention of Hepatitis B Mother-to-Child Transmission in Namibia: A Cost-Effectiveness Analysis","volume":"39","author":"Andersson","year":"2021","journal-title":"Vaccine"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"4618","DOI":"10.1016\/j.vaccine.2015.06.076","article-title":"Hepatitis B Virus Infection in HIV-Exposed Infants in the Western Cape, South Africa","volume":"33","author":"Chotun","year":"2015","journal-title":"Vaccine"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1111\/jvh.12263","article-title":"Prevention of Materno-Foetal Transmission of Hepatitis B in Sub-Saharan Africa: The Evidence, Current Practice and Future Challenges","volume":"21","author":"Howell","year":"2014","journal-title":"J. Viral Hepat."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"104","DOI":"10.4314\/njp.v41i2.5","article-title":"Does Nigeria Need the Birth Dose of the Hepatitis B Vaccine?","volume":"41","author":"Sadoh","year":"2014","journal-title":"Niger. J. Paediatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"69","DOI":"10.21106\/ijma.174","article-title":"Prevalence and Identification of Serum Markers Associated with Vertical Transmission of Hepatitis B in Pregnant Women in Yaounde, Cameroon","volume":"6","author":"Sone","year":"2017","journal-title":"Int. J. MCH AIDS"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bittaye, M., Idoko, P., Ekele, B.A., Obed, S.A., and Nyan, O. (2019). Hepatitis B Virus Sero-Prevalence amongst Pregnant Women in the Gambia. BMC Infect. Dis., 19.","DOI":"10.1186\/s12879-019-3883-9"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Umare, A., Seyoum, B., Gobena, T., and Haile Mariyam, T. (2016). Hepatitis B Virus Infections and Associated Factors among Pregnant Women Attending Antenatal Care Clinic at Deder Hospital, Eastern Ethiopia. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0166936"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e005889","DOI":"10.1136\/bmjopen-2014-005889","article-title":"High Prevalence of Hepatitis B Virus Infection among Pregnant Women Attending Antenatal Care: A Cross-Sectional Study in Two Hospitals in Northern Uganda","volume":"4","author":"Bayo","year":"2014","journal-title":"BMJ Open"},{"key":"ref_11","first-page":"72","article-title":"Sero-Prevalence for Hepatitis B Virus among Pregnant Women Attending Antenatal Clinic in Juba Teaching Hospital, Republic of South Sudan","volume":"26","author":"Kirbak","year":"2017","journal-title":"Pan Afr. Med. J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4314\/thrb.v16i1.2","article-title":"Seroprevalence of Hepatitis B Virus Infection among Antenatal Clinic Attendees at a Tertiary Hospital in Dar Es Salaam, Tanzania","volume":"16","author":"Rashid","year":"2014","journal-title":"Tanzan. J. Health Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2367","DOI":"10.1111\/liv.14592","article-title":"Identifying Gaps across the Cascade of Care for the Prevention of HBV Mother-to-child Transmission in Burkina Faso: Findings from the Real World","volume":"40","author":"Bougouma","year":"2020","journal-title":"Liver Int."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e1600","DOI":"10.1016\/S2214-109X(21)00304-1","article-title":"Arresting Vertical Transmission of Hepatitis B Virus (AVERT-HBV) in Pregnant Women and Their Neonates in the Democratic Republic of the Congo: A Feasibility Study","volume":"9","author":"Thompson","year":"2021","journal-title":"Lancet Glob. Health"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Chotun, N., Preiser, W., van Rensburg, C.J., Fernandez, P., Theron, G.B., Glebe, D., and Andersson, M.I. (2017). Point-of-Care Screening for Hepatitis B Virus Infection in Pregnant Women at an Antenatal Clinic: A South African Experience. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0181267"},{"key":"ref_16","unstructured":"World Health Organization (2021). Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2021. Accountability for the Global Health Sector Strategies 2016\u20132021: Actions for Impact, World Health Organization."},{"key":"ref_17","unstructured":"World Health Organization, and Annex, W. (2021). Global Progress Report on HIV, Viral Hepatitis and Sexually Transmitted Infections, 2021. Accountability for the Global Health Sector Strategies 2016\u20132021: Actions for Impact, World Health Organization."},{"key":"ref_18","unstructured":"(2023, August 15). United Nations Children\u2019s Fund Global and Regional Trends. Available online: https:\/\/data.unicef.org\/topic\/hivaids\/global-regional-trends\/."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"5579","DOI":"10.1016\/j.vaccine.2013.08.028","article-title":"The Epidemiology of Hepatitis B Virus Infection in HIV-Infected and HIV-Uninfected Pregnant Women in the Western Cape, South Africa","volume":"31","author":"Andersson","year":"2013","journal-title":"Vaccine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s41124-017-0025-0","article-title":"Highlights from the 3rd International HIV\/Viral Hepatitis Co-Infection Meeting-HIV\/Viral Hepatitis: Improving Diagnosis, Antiviral Therapy and Access","volume":"2","author":"Maponga","year":"2017","journal-title":"Hepatol. Med. Policy"},{"key":"ref_21","unstructured":"(2023, August 15). United Nations Children\u2019s Fund Immunization Coverage Estimates Data Visualization. Available online: https:\/\/data.unicef.org\/resources\/immunization-coverage-estimates-data-visualization\/."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1002\/ijgo.12434","article-title":"A Decision Analytic Model for Prevention of Hepatitis B Virus Infection in Sub-Saharan Africa Using Birth-Dose Vaccination","volume":"141","author":"Anderson","year":"2018","journal-title":"Int. J. Gynecol. Obstet."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"97","DOI":"10.7196\/SAMJ.2016.v106i1.9932","article-title":"Antenatal Screening for Hepatitis B Virus in HIV-Infected and Uninfected Pregnant Women in the Tshwane District of South Africa","volume":"106","author":"Diale","year":"2016","journal-title":"S. Afr. Med. J."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"World Health Organization (2019). Hepatitis B Vaccines: WHO Position Paper, July 2017\u2014Recommendations. Vaccine, 37, 223\u2013225.","DOI":"10.1016\/j.vaccine.2017.07.046"},{"key":"ref_25","unstructured":"World Health Organization (2016). Global Health Sector Strategy on Viral Hepatitis 2016\u20132021. Towards Ending Viral Hepatitis, World Health Organization."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"6223","DOI":"10.1038\/s41467-021-26475-6","article-title":"The Impact of the Timely Birth Dose Vaccine on the Global Elimination of Hepatitis B","volume":"12","author":"Nayagam","year":"2021","journal-title":"Nat. Commun."},{"key":"ref_27","unstructured":"World Health Organization (2022, August 15). Immunization Coverage. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/immunization-coverage."},{"key":"ref_28","unstructured":"World Health Organization Regional Office for Africa (2017). Prevention, Care and Treatment of Viral Hepatitis in the African Region: Framework for Action, 2016\u20132020, World Health Organization."},{"key":"ref_29","unstructured":"Kabore, J. (2021, January 17\u201318). Hepatitis B Birth Dose (HepB BD) Vaccination in the WHO African Region. Proceedings of the Building a Community of Practice to Assist hepB Birth Dose Introduction in African Countries, Online."},{"key":"ref_30","unstructured":"Njuguna, H. (2022, January 22). HepB-BD and Infant HepB3 Coverage Status in Africa. Proceedings of the Hepatitis B Birth Dose in the African Region: Bridging Ccience and Advocacy to Eliminate Mother-to-Child Transmission of HBV, Online."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Mounier-Jack, S., Griffiths, U.K., Closser, S., Burchett, H., and Marchal, B. (2014). Measuring the Health Systems Impact of Disease Control Programmes: A Critical Reflection on the WHO Building Blocks Framework. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-278"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1016\/S0140-6736(04)16987-0","article-title":"Overcoming Health-Systems Constraints to Achieve the Millenium Development Goals","volume":"364","author":"Travis","year":"2004","journal-title":"Lancet"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1136\/bmj.39569.510521.AD","article-title":"Complex Interventions or Complex Systems? Implications for Health Economic Evaluation","volume":"336","author":"Shiell","year":"2008","journal-title":"BMJ"},{"key":"ref_34","unstructured":"de Savigny, D., and Adam, T. (2009). Systems Thinking for Health Systems Strengthening, World Health Organization."},{"key":"ref_35","unstructured":"Langlois, E.V., Daniels, K., and Akl, E.A. (2018). Evidence Synthesis for Health Policy and System: A Method Guide, World Health Organization."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1093\/eurpub\/ckr084","article-title":"When Are Complex Interventions \u201cComplex\u201d? When Are Simple Interventions \u201cSimple\u201d?","volume":"21","author":"Petticrew","year":"2011","journal-title":"Eur. J. Public Health"},{"key":"ref_37","first-page":"979","article-title":"Developing and Evaluating Complex Interventions: The New Medical Research Council Guidance","volume":"337","author":"Craig","year":"2008","journal-title":"BMJ"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1209","DOI":"10.1016\/j.jclinepi.2013.06.004","article-title":"Complex Interventions and Their Implications for Systematic Reviews: A Pragmatic Approach","volume":"66","author":"Petticrew","year":"2013","journal-title":"J. Clin. Epidemiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s10464-009-9229-9","article-title":"Theorising Interventions as Events in Systems","volume":"43","author":"Hawe","year":"2009","journal-title":"Am. J. Community Psychol."},{"key":"ref_40","unstructured":"Aromataris, E., and Munn, Z. (2020). JBI Manual for Evidence Synthesis, JBI."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"467","DOI":"10.7326\/M18-0850","article-title":"PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation","volume":"169","author":"Tricco","year":"2018","journal-title":"Ann. Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"193","DOI":"10.3163\/1536-5050.98.2.021","article-title":"Mendeley","volume":"98","author":"Reiswig","year":"2010","journal-title":"J. Med. Libr. Assoc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan\u2014A Web and Mobile App for Systematic Reviews","volume":"5","author":"Ouzzani","year":"2016","journal-title":"Syst. Rev."},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Shimakawa, Y., Bottomley, C., Njie, R., and Mendy, M. (2014). The Association between Maternal Hepatitis B e Antigen Status, as a Proxy for Perinatal Transmission, and the Risk of Hepatitis B e Antigenaemia in Gambian Children. BMC Public Health, 14.","DOI":"10.1186\/1471-2458-14-532"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1111\/apt.13795","article-title":"Systematic Review with Meta-Analysis: The Risk of Mother-to-Child Transmission of Hepatitis B Virus Infection in Sub-Saharan Africa","volume":"44","author":"Keane","year":"2016","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"2753","DOI":"10.1016\/j.vaccine.2008.03.018","article-title":"A Non-Randomized Vaccine Effectiveness Trial of Accelerated Infant Hepatitis B Immunization Schedules with a First Dose at Birth or Age 6 Weeks in C\u00f4te d\u2019Ivoire","volume":"26","author":"Ekra","year":"2008","journal-title":"Vaccine"},{"key":"ref_47","first-page":"18","article-title":"Is Hepatitis B Birth Dose Vaccine Needed in Africa?","volume":"27","author":"Maponga","year":"2017","journal-title":"Pan Afr. Med. J."},{"key":"ref_48","unstructured":"World Health Organization (2016). Global Compliance with Hepatitis B Vaccine Birth Dose and Factors Related to Timely Schedule. A Review, World Health Organization."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"2937","DOI":"10.1016\/j.vaccine.2017.04.020","article-title":"Early Childhood Transmission of Hepatitis B Prior to the First Hepatitis B Vaccine Dose Is Rare among Babies Born to HIV-Infected and Non-HIV Infected Mothers in Gulu, Uganda","volume":"35","author":"Seremba","year":"2017","journal-title":"Vaccine"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2212","DOI":"10.1016\/j.vaccine.2011.12.116","article-title":"Global Epidemiology of Hepatitis B Virus Infection: New Estimates of Age-Specific HBsAg Seroprevalence and Endemicity","volume":"30","author":"Ott","year":"2012","journal-title":"Vaccine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105906","DOI":"10.1016\/j.ijsu.2021.105906","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews","volume":"88","author":"Page","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/jvh.13217","article-title":"Prevalence and Burden of HBV Co-infection among People Living with HIV: A Global Systematic Review and Meta-analysis","volume":"27","author":"Platt","year":"2020","journal-title":"J. Viral Hepat."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"10","DOI":"10.55320\/mjz.46.1.217","article-title":"Prevalence of Hepatitis B Virus, HIV and HBV Coinfection and Associated Factors in Pregnant Women Attending Antenatal Care at the University Teaching Hospital, Lusaka, Zambia","volume":"46","author":"Sichone","year":"2019","journal-title":"Med. J. Zamb."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"815","DOI":"10.1002\/jmv.24409","article-title":"HBV Carriage in Children Born From HIV-Seropositive Mothers in Senegal: The Need of Birth-Dose HBV Vaccination","volume":"88","author":"Gueye","year":"2016","journal-title":"J. Med. Virol."},{"key":"ref_55","unstructured":"(2020). World Health Organization Prevention of Mother-to-Child Transmission of Hepatitis B Virus: Guidelines on Antiviral Prophylaxis in Pregnancy, World Health Organization."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1002\/hep.28156","article-title":"AASLD Guidelines for Treatment of Chronic Hepatitis B","volume":"63","author":"Terrault","year":"2016","journal-title":"Hepatology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1016\/j.jhep.2017.03.021","article-title":"EASL 2017 Clinical Practice Guidelines on the Management of Hepatitis B Virus Infection","volume":"67","author":"Lampertico","year":"2017","journal-title":"J. Hepatol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.jcv.2016.10.017","article-title":"Screening, Characterisation and Prevention of Hepatitis B Virus (HBV) Co-Infection in HIV-Positive Children in South Africa","volume":"85","author":"Jooste","year":"2016","journal-title":"J. Clin. Virol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"65","DOI":"10.2471\/BLT.04.017426","article-title":"Improving Birth Dose Coverage of Hepatitis B Vaccine","volume":"84","author":"Hipgrave","year":"2006","journal-title":"Bull. World Health Organ."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"4004","DOI":"10.7189\/jogh.11.04004","article-title":"How the Use of Vaccines Outside the Cold Chain or in Controlled Temperature Chain Contributes to Improving Immunization Coverage in Low- and Middle-Income Countries (LMICs): A Scoping Review of the Literature","volume":"11","author":"Dadari","year":"2021","journal-title":"J. Glob. Health"},{"key":"ref_61","doi-asserted-by":"crossref","unstructured":"Bassoum, O., Kimura, M., Dia, A.T., Lemoine, M., and Shimakawa, Y. (2020). Coverage and Timeliness of Birth Dose Vaccination in Sub-Saharan Africa: A Systematic Review and Meta-Analysis. Vaccines, 8.","DOI":"10.3390\/vaccines8020301"},{"key":"ref_62","unstructured":"World Health Organization (2023, August 15). Hepatitis B Vaccination Coverage. Available online: https:\/\/immunizationdata.who.int\/pages\/coverage\/HEPB.html."},{"key":"ref_63","unstructured":"World Health Organization (2017). Global Hepatitis Report 2017, World Health Organization."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"1002","DOI":"10.3855\/jidc.10433","article-title":"Hepatitis B Vaccination in Burkina Faso: Prevalence of HBsAg Carriage and Immune Response in Children in the Western Region","volume":"12","author":"Sanou","year":"2018","journal-title":"J. Infect. Dev. Ctries."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"13","DOI":"10.4314\/gmj.v51i1.3","article-title":"Hepatitis B Virus Surface Antigen and Antibody Markers in Children at a Major Paediatric Hospital after the Pentavalent DTP-HBV-Hib Vaccination","volume":"51","author":"Apiung","year":"2017","journal-title":"Ghana Med. J."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1179\/146532810X12703902516167","article-title":"Immunity to Hepatitis B Vaccine in Tanzanian Under-5 Children","volume":"30","author":"Metodi","year":"2010","journal-title":"Ann. Trop. Paediatr."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"2741","DOI":"10.1016\/j.vaccine.2022.03.049","article-title":"Assessing the Impact of the Routine Childhood Hepatitis B Immunization Program and the Need for Hepatitis B Vaccine Birth Dose in Sierra Leone, 2018","volume":"40","author":"Breakwell","year":"2022","journal-title":"Vaccine"},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.vaccine.2012.08.007","article-title":"Cost-Effectiveness Analysis of an Additional Birth Dose of Hepatitis B Vaccine to Prevent Perinatal Transmission in a Medical Setting in Mozambique","volume":"31","author":"Klingler","year":"2012","journal-title":"Vaccine"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1007\/s40274-021-7892-8","article-title":"Introducing Birth-Dose Hepatitis B Vaccination Would Be Cost Effective in Burkina Faso","volume":"883","author":"Gosset","year":"2021","journal-title":"PharmacoEcon Outcomes News"},{"key":"ref_70","doi-asserted-by":"crossref","unstructured":"Gosset, A., Nishimwe, M.L., Diallo, M.Y., Deroo, L., Diallo, A., Ba, E.H., Carrieri, P.M., Sokhna, C., Vray, M., and Shimakawa, Y. (2021). The Costs of Introducing the Hepatitis B Birth Dose Vaccine into the National Immunization Programme in Senegal (N\u00e9oVac Study). Vaccines, 9.","DOI":"10.3390\/vaccines9050521"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s12962-020-00219-7","article-title":"Introduction of Birth Dose of Hepatitis B Virus Vaccine to the Immunization Program in Ethiopia: An Economic Evaluation","volume":"18","author":"Memirie","year":"2020","journal-title":"Cost Eff. Resour. Alloc."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s13031-019-0188-y","article-title":"Cost-Effectiveness of Birth-Dose Hepatitis B Vaccination among Refugee Populations in the African Region: A Series of Case Studies","volume":"13","author":"Reardon","year":"2019","journal-title":"Confl. Health"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"891","DOI":"10.4269\/ajtmh.18-0926","article-title":"Selective Hepatitis B Birth-Dose Vaccination in S\u00e3o Tom\u00e9 and Pr\u00edncipe: A Program Assessment and Cost-Effectiveness Study","volume":"101","author":"Hagan","year":"2019","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"31","DOI":"10.29245\/2578-3009\/2018\/si.1104","article-title":"Implementing a Birth Dose of Hepatitis B Vaccine in Africa: Findings from Assessments in 5 Countries","volume":"5","author":"Moturi","year":"2018","journal-title":"J. Immunol. Sci."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"6894","DOI":"10.1016\/j.vaccine.2019.09.056","article-title":"Maternal Reasons for Non-Receipt of Valid Hepatitis B Birth Dose among Mother-Infant Pairs Attending Routine Immunization Clinics, South-East, Nigeria","volume":"37","author":"Okenwa","year":"2019","journal-title":"Vaccine"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"100039","DOI":"10.1016\/j.jve.2021.100039","article-title":"Hepatitis B Birth Dose Vaccination for Newborns in Uganda: A Qualitative Inquiry on Pregnant Women\u2019s Perceptions, Barriers and Preferences","volume":"7","author":"Surkan","year":"2021","journal-title":"J. Virus Erad."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"3335","DOI":"10.1016\/j.vaccine.2016.05.017","article-title":"Barriers to Timely Administration of Birth Dose Vaccines in The Gambia, West Africa","volume":"34","author":"Miyahara","year":"2016","journal-title":"Vaccine"},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"e2100277","DOI":"10.9745\/GHSP-D-21-00277","article-title":"Implementation Approaches for Introducing and Overcoming Barriers to Hepatitis B Birth-Dose Vaccine in Sub-Saharan Africa","volume":"10","author":"Boisson","year":"2022","journal-title":"Glob. Health Sci. Pract."},{"key":"ref_79","doi-asserted-by":"crossref","unstructured":"P\u00e9ri\u00e8res, L., Marcellin, F., Lo, G., Protopopescu, C., Ba, E.H., Coste, M., Kane, C.T., Maradan, G., Diallo, A., and Sokhna, C. (2021). Hepatitis B Vaccination in Senegalese Children: Coverage, Timeliness, and Sociodemographic Determinants of Non-Adherence to Immunisation Schedules (ANRS 12356 AmBASS Survey). Vaccines, 9.","DOI":"10.3390\/vaccines9050510"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1093\/trstmh\/trab129","article-title":"The Coverage of Hepatitis B Birth Dose Vaccination in Nigeria: Does the Place of Delivery Matter?","volume":"116","author":"Olakunde","year":"2021","journal-title":"Trans. R. Soc. Trop. Med. Hyg."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"4094","DOI":"10.1016\/j.vaccine.2017.06.051","article-title":"Hepatitis B Vaccine Birth Dose Coverage Correlates Worldwide with Rates of Institutional Deliveries and Skilled Attendance at Birth","volume":"35","author":"Allison","year":"2017","journal-title":"Vaccine"},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"199","DOI":"10.2471\/BLT.16.178822","article-title":"Hepatitis B Vaccination Timing: Results from Demographic Health Surveys in 47 Countries","volume":"95","author":"Schweitzer","year":"2017","journal-title":"Bull. World Health Organ."},{"key":"ref_83","first-page":"15","article-title":"Sustainable Development Goals for HBV Elimination in South Africa: Challenges, Progress, and the Road Ahead","volume":"17","author":"Maponga","year":"2019","journal-title":"S. Afr. Gastroenterol. Rev."},{"key":"ref_84","unstructured":"Immunization Vaccines and Biologicals (2017). Practices to Improve Coverage of the Hepatitis B Birth Dose Vaccine, World Health Organization."},{"key":"ref_85","unstructured":"Cheung, C.K. (2017). Proportion of Children Born to Infected Mothers at Risk of Contracting Hepatitis B, and Associated Risk Factors for Inadequate Hepatitis B Timely Birth Dose Vaccination: Analysis of the S\u00e3o Tom\u00e9 and Pr\u00edncipe Demographic Health Survey Program Data, 2008\u20132009, Uppsala Universitet."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.healthpol.2007.09.003","article-title":"Assessing Health System Performance in Developing Countries: A Review of the Literature","volume":"85","author":"Kruk","year":"2008","journal-title":"Health Policy"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"2137","DOI":"10.1016\/S0140-6736(09)60919-3","article-title":"An Assessment of Interactions between Global Health Initiatives and Country Health Systems","volume":"373","author":"Samb","year":"2009","journal-title":"Lancet"},{"key":"ref_88","unstructured":"World Health Organization (2007). Everybody\u2019s Business: Strengthening Health Systems to Improve Health Outcomes: WHO\u2019s Framework for Action, World Health Organization."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1093\/intqhc\/mzg049","article-title":"Conceptual Frameworks for Health Systems Performance: A Quest for Effectiveness, Quality, and Improvement","volume":"15","author":"Arah","year":"2003","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_90","first-page":"717","article-title":"A Framework for Assessing the Performance of Health Systems","volume":"78","author":"Murray","year":"2000","journal-title":"Bull. World Health Organ."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"1","DOI":"10.5195\/HCS.2012.71","article-title":"The Health System Dynamics Framework: The Introduction of an Analytical Model for Health System Analysis and Its Application to Two Case-Studies","volume":"2","author":"Criel","year":"2012","journal-title":"Health Cult. Soc."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1016\/j.jclinepi.2016.06.012","article-title":"Series: Clinical Epidemiology in South Africa. Paper 3: Logic Models Help Make Sense of Complexity in Systematic Reviews and Health Technology Assessments","volume":"83","author":"Rohwer","year":"2017","journal-title":"J. Clin. Epidemiol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"701","DOI":"10.1093\/heapol\/czaa017","article-title":"Health Systems Constraints and Facilitators of Human Papillomavirus Immunization Programmes in Sub-Saharan Africa: A Systematic Review","volume":"35","author":"Kagina","year":"2020","journal-title":"Health Policy Plan."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"381","DOI":"10.9745\/GHSP-D-14-00137","article-title":"The Future of Routine Immunization in the Developing World: Challenges and Opportunities","volume":"2","author":"Shen","year":"2014","journal-title":"Glob. Health Sci. Pract."}],"container-title":["Tropical Medicine and Infectious Disease"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/10\/474\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:07:58Z","timestamp":1760130478000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2414-6366\/8\/10\/474"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,16]]},"references-count":94,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["tropicalmed8100474"],"URL":"https:\/\/doi.org\/10.3390\/tropicalmed8100474","relation":{},"ISSN":["2414-6366"],"issn-type":[{"value":"2414-6366","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,16]]}}}