title: Assessment of the hepatitis B birth dose vaccination program, Papua New Guinea, 2014.
abstract: BACKGROUND
  Papua New Guinea (PNG) implemented hepatitis B birth dose (BD) vaccination in 2005 yet since that time coverage has remained low, allowing mother-to-child transmission to occur. We conducted a field assessment of the BD vaccination program to develop strategies for improving the BD coverage.
  
  
  METHODS
  We selected five provinces with higher hepatitis B prevalence and five with lower prevalence based on the results of a 2013 hepatitis B serological survey. Within each province, we interviewed district and provincial health officers, health workers, village volunteers, and caregivers from ten randomly selected health facilities. Data were collected on knowledge, practice, vaccine management and data recording/reporting. To identify enabling factors and barriers, we compared health facilities with higher BD coverage with those with lower coverage, and compared caregivers whose children received BD with those whose children did not.
  
  
  RESULTS
  Overall timely BD coverage was 31% and BD vaccination was taking place in 81% of sampled health facilities. Lack of cold chain and vaccine were the major reasons for not providing the BD. Insufficiencies in supervision, vaccine management, community outreach, and data management were identified as obstacles to achieving high timely hepatitis B BD coverage. Good supervision, knowledge of hepatitis B and hepatitis B vaccination, antenatal care including information about the hepatitis B BD, provision of vaccine refrigerators in maternity wards, and outreach vaccination for home deliveries were associated with higher timely BD coverage.
  
  
  CONCLUSIONS
  Several steps will likely be effective in improving BD coverage: strengthening training and supervision among health workers and officers, educating caregivers on the benefits of the BD and delivery in health facilities, improving vaccine management, and improving data quality. Considerable effort and leadership will be needed to achieve these steps.
authors.affiliation: Expanded Program on Immunization Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
authors.forename: Eric
authors.initials: E
authors.lastname: Wiesen
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: William
authors.initials: W
authors.lastname: Lagani
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Gerard
authors.initials: G
authors.lastname: Sui
authors.affiliation: National Department of Health, Port Moresby, Papua New Guinea.
authors.forename: Johnnie
authors.initials: J
authors.lastname: Arava
authors.affiliation: Expanded Program on Immunization Unit, World Health Organization, Port Moresby, Papua New Guinea.
authors.forename: Salim
authors.initials: S
authors.lastname: Reza
authors.affiliation: Expanded Program on Immunization Unit, World Health Organization Regional Office for the Western Pacific, Manila, Philippines.
authors.forename: Sergey
authors.initials: S
authors.lastname: Diorditsa
authors.affiliation: The European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Stockholm, Sweden. Electronic address: yungching.lin@gmail.com.
authors.forename: Yung-Ching
authors.initials: YC
authors.lastname: Lin
mesh_terms: D001521:Behavior Therapy; D005260:Female; D006266:Health Education; D006302:Health Services Research; D006509:Hepatitis B / Q000276:immunology / Q000517:prevention & control*; D017325:Hepatitis B Vaccines / Q000008:administration & dosage* / Q000276:immunology*; D006801:Humans; D017589:Immunization Programs; D007223:Infant; D007231:Infant, Newborn; D007407:Interviews as Topic; D010219:Papua New Guinea / Q000453:epidemiology; D011247:Pregnancy; D014611:Vaccination / Q000706:statistics & numerical data
chemical_list: D017325:Hepatitis B Vaccines
keywords: Caregivers; Health facilities; Health knowledge, attitudes, practice; Hepatitis B vaccines; Home childbirth; Immunization program; Papua New Guinea