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Hepatitis B Birth Dose Coverage among Infants in Plateau State,
Nigeria
*Nwosu Simon Onyekachi
Pre-eminent Empowerment and Development Foundation
*Corresponding Author
ABSTRACT
Hepatitis B virus (HBV) infection remains a significant public health challenge in Nigeria, with vertical (mother-
to-child) transmission being a major route of infection. The World Health Organization (WHO) recommends
administering the hepatitis B birth dose (HepB-BD) within 24 hours of birth to prevent perinatal transmission.
However, the level of HepB-BD coverage across different regions of Nigeria remains suboptimal and poorly
documented. This study assesses the coverage of the hepatitis B birth dose among infants in Plateau State,
Nigeria, and identifies the determinants influencing vaccine uptake. Using a cross-sectional study design, data
were collected through structured interviews with caregivers and health workers, as well as reviews of
immunization records from selected health facilities across urban and rural areas of the state. The study evaluated
birth dose administration rates, timing, and associated factors such as maternal education, place of delivery,
awareness of HBV, availability of vaccines, and health system challenges. Preliminary findings reveal a low
overall coverage of HepB-BD, with significant disparities between urban and rural communities, and a high
proportion of infants receiving the vaccine beyond the recommended 24-hour window. Key barriers identified
include inadequate maternal awareness, high rates of home deliveries, poor vaccine logistics, and health worker
shortages. The study underscores the need for targeted health education, improved delivery and immunization
services, and policy interventions to enhance timely administration of the birth dose. Strengthening the
integration of maternal and child health services with immunization programs is critical for reducing HBV
transmission and achieving national and global hepatitis elimination targets.
Keywords: Hepatitis B, HBV transmission, infants, immunization, HepB-BD, vaccine, liver
INTRODUCTION
Hepatitis B is the most common liver infection in the world caused by the Hepatitis B virus. Each year more
than 1 million people die from Hepatitis B worldwide even though it is preventable. Hepatitis is a ‘silent
epidemic’ because symptoms may not appear for months after infection and the infected person can still transmit
the infection to others [1]. Viral hepatitis is inflammation of the liver caused by one or more of the five main
hepatic viruses: A, B, C, D, and E. These viruses show similar symptoms like weakness, fatigue or tiredness,
jaundice (yellowing of the eye and body), joint pain, nausea, vomiting, abdominal pain, dark urine, loss of
appetite, swollen abdomen among others., and have the potential to cause liver disease to varying degrees.
Viral hepatitis is a major global health problem with more than 400 million individuals chronically infected,
causing over 1.4 million deaths per year [2]. The Hepatitis B virus contains an outer envelope and an inner core.
The outer envelope of the virus is composed of a surface protein called the Hepatitis B surface antigen or HBsAg.
The surface antigen can be detected by a simple blood test and a positive test result indicates a person is infected
with the Hepatitis B virus while the inner core of the virus is a protein shell referred to as the Hepatitis B core
antigen or HBcAg which contains the Hepatitis B virus DNA and enzymes used in viral replication. [10]
The Hepatitis B virus is a small DNA virus that belongs to the ‘Hepadnaviridae’ family. Related viruses in this
family are also found in woodchucks, ground squirrels, tree squirrels, pecking ducks and herons [2, 3].
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Conceptual Clarification
Lifecycle of the Hepatitis B Virus
The Hepatitis B virus has a complex life cycle. The virus enters the liver cell and is transported into the nucleus
of the liver cell. Once inside the nucleus, the viral DNA is transformed into the covalently closed circular DNA
(cccDNA) which serves as a template for viral replication (creation of new Hepatitis B virus). New HBV is
packaged and leaves the liver cell, with the stable viral cccDNA remaining in the nucleus where it can integrate
into the DNA of the host liver cell, as well as continue to create new Hepatitis B virus. Although the life cycle
is not completely understood, parts of this replicative process are error prone, which accounts for different
genotypes or genetic codes of the Hepatitis B virus ( 4).
Complications of Hepatitis B
Chronic hepatitis B can lead to cirrhosis, liver cancer, liver failure and premature death, and the most common
route of hepatitis B transmission globally is perinatal transmission which occurs during the labor and delivery
process. Unvaccinated infants can also become infected shortly after birth or through horizontal transmission in
early childhood from infected blood. Such perinatal infections lead to a high rate of chronicity.{5} The risk of
developing chronic hepatitis B increases to 90% of those infected as neonates and 30% to 50 % among children
infected between one and five years old and 5% to 10% among those infected as adults. The prevalence of
HBsAg among children aged five years is a proxy for new hepatitis B infections from vertical and/or early
horizontal transmission {5, 6}.
WHO’s global health sector strategy impact target for eliminating Viral hepatitis includes a HBsAg prevalence
target for children of ≤ 1% by 2020 and ≥ 0.1 % by 2030. {6}. Considerable progress has been made towards
eliminating the perinatal transmission of HBV and reducing new infections among children through universal
infant HBV immunization, including a timely hepatitis B birth dose. Following birth dose, it is recommended
that universal infant immunization with at least three of the hepatitis B vaccine (HepB3), each separated by least
four weeks commonly referred to as the pentavalent vaccination series. {7}. The first dose of hepatitis B vaccine
should be administered to all newborns as soon as possible after birth, preferably within 24 hours. .If the birth
dose is administered as soon as possible following delivery (within 24 hours) in addition to the pentavalent
vaccination, the infant has a greater than 90% chance of a hepatitis B free future. {8}
Nigeria is among the countries with a hepatitis B virus, prevalence of 11%. {8} Knowledge of viral hepatitis is
relatively low among Nigerians despite being a leading infectious cause of much death each year. {8,9} It is
estimated that over 20 million Nigerians living with viral hepatitis B are undiagnosed, increasing the likelihood
of future transmission to others and placing them at greater risk for severe, even fatal health complications such
as liver cirrhosis and liver cancer (hepatocellular carcinoma). {10}. Hepatitis B Vaccination at birth is critical
to protecting all babies from hepatitis B and liver disease, as newborns exposed to hepatitis B virus are at a high
risk of developing chronic hepatitis B, which can lead to serious liver disease in adulthood.
In Nigeria hepatitis B birth dose has been offered since 2004, however implementation and uptake has been
variable with researchers identifying barriers to timely administration of birth dose including poor knowledge
among health care workers or common misconceptions about administration. Hepatocellular carcinoma (HCC)
is a disease of public health concern in Nigeria, with chronic hepatitis B infections contributing most to the
disease burden. Despite the increasing incidence of HCC, surveillance practices for early diagnosis and possible
cure are not deeply rooted in the country. (11)
According to FO Baba, in Nigeria, only 33% received timely birth dose which is key to preventing MTCT of
HBV. The availability of daily child vaccination services seems to be an obvious requirement for improving
access to the birth dose of HBV vaccine. {15,16} Where is not possible, there should be rapid linkage to the
nearest facility where HBV vaccination is immediately available.
Key facilitators across multiple zones in Nigeria are health literacy, maternal education, and community leader
influence. However, unique regional differences were existed in Nigeria, where North-West zone perceived
vaccine benefits, fear of non-immunization consequences, urban residence, health literacy, and antenatal care
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visits were reported as crucial. Perceived benefits of vaccines and trust in healthcare providers were identified
as predominant factors in the North-Central were Plateau State belong. Tailored approaches that consider the
social-economic, cultural, and logistical challenges specific to the region essential to bridge the immunization
gap, were HepB-BD is included. (12)
The HBV vaccination remains the cornerstone of public health policy to prevent chronic hepatitis B and its
related complications. It serves as a crucial element in the global effort to eliminate HBV, as established by
World Health Organization (WHO), with an ambitious 90% vaccination target by 2030. However, reports on
global birth dose coverage reveal substantial variability, with an overall coverage rate of only 46 %.( 13). This
comprehensive review thoroughly examines global trends in HBV vaccination coverage. Additionally, the
review addresses the essential formidable challenges and facilitating factors for achieving WHO’s HBV
vaccination coverage objectives and elimination strategies in the coming decade and beyond(3,14)
In Plateau State, most pregnant women confirmed having knowledge of hepatitis B birth-dose, but do not know
the actual period HepB-BD supposed to have been given after birth, while some do not have idea what HepB-
BD is all about, and further said that, their baby will be protected by God, as he/she is in the hands of God,
during oral interview at one Local Government. It is against these backdrops that the study examine hepatitis B
infection, mode of transmission, associated risks, control and prevention in Plateau State to serve as document
for implementation all of the country.
MATERIALS AND METHODS
Study Population:
This study is a secondary data analysis from 1,236 Primary Healthcare Centers in 17 Local Government Area of
Plateau State, Nigeria from 2020 to 2024 on vaccination at birth-does of Infants within 24 hours of birth.
Plateau State is located in the North-central zone out of the Six geopolitical zone of Nigeria, with an Area of
26,899 square kilometers (10,386 sqmi), the State is located between latitude 8
0
24’E and 10
0
30’N and longitude
8
0
32’E and 10
0
38’E. The population projection of Plateau State in 2025 is approximately 5.07 million people,
while in 2022, the estimated population of 4.7 million. However, the growth rate is based on an annual increase
of 2.4% which has been consistent over the years [Cirddoc.org Plateau State ]
The seventeen (17) Local Government of the State comprises of Barkin Ladi, Bassa, Bokkos, Jos East, Jos North,
Jos South, Kanam, Kanke, Langtang North, Langtang South, Mangu, Mikang, Pankshin, Qua’an Pan, Riyom,
Shendam, and Wase. Each of the Local Government Area has their unique cultural, linguistic, and weather
differences.
This study employed a cross-sectional descriptive design, suitable for assessing the prevalence of hepatitis B
birth dose (HepB-BD) administration and identifying associated factors within a defined population at a single
point in time (Ghobadmoradi et al., 2021).
Primary respondents: Mothers or caregivers of infants aged 011 months.
Secondary respondents: Health care workers (HCWs) at primary health centers offering immunization
services.
A multistage sampling method was adopted:
1. First stage: Stratified selection of 3 urban and 3 rural LGAs from the 17 LGAs in Plateau State.
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2. Second stage: Random selection of primary health care facilities offering immunization services within
each LGA.
3. Third stage: Systematic sampling of eligible mother-infant pairs attending immunization clinics or
located through health records and home visits.
Random and stratified sampling techniques were employed where the researcher selected and interviewed 152
people across the 17 Local Governments of the Plateau State which has One Thousand two hundred and thirty
six (1236) Primary health care centers, and some Private Hospitals. These comprises 32 Health workers
provider, 96 pregnant women and 24 nursing Mothers on the availability and accessibility of the vaccines in
labor ward, giving vaccines on HepB-BD within 24 hours , and as well obtained data from the 1,236 Primary
health Centers in the State. Furthermore, cell phone conversations were made to access the first hand information
on the ground across the State Healthcare facilities, to ascertain perceptions and attitudes of parents and
healthcare providers towards HepB-BD vaccination, barriers and facilitators to HepB-BD vaccination in
different contexts. This was done to know if a cultural, social and environmental context has influence on HepB-
BD vaccination.
All the secondary data was collected through the Plateau State Primary health Care Board, using documentary
evidence, oral interview was done at the primary healthcare facilities (PHC) and some Private Hospital (HCWs),
Pregnant Women and Nursing Mothers as well were interviewed in English.
Data were collected using pre-tested, interviewer-administered structured questionnaires and health facility
record checklists.
Key components:
Demographic data (age, education, parity, income)
Infant’s birth details (place of delivery, birth attendant)
Knowledge and awareness of HBV and HepB-BD
Vaccination status (verified from vaccination cards or facility registers)
Facility-level data (vaccine availability, cold chain status)
Data Collection Tools
Structured questionnaires administered to caregivers/mothers to collect data on:
o Socio-demographic characteristics
o Birth history and vaccination status of the infant
o Awareness and knowledge of HBV
o Accessibility of health services
Health facility records were reviewed to verify HepB-BD administration.
Key informant interviews were conducted with health workers to gather qualitative insights.
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Data Analysis
Statistical analysis was done using SPSS or similar statistical software. Descriptive statistics (frequencies,
proportions) described the coverage where results were presented the table and percentages, and the second
method of the data analysis was the use of Bar Chart, and Pie Chart, for data visualization. The relative risks
were estimated by fitting unvariate and multivariable log-binomial regression models. The adjusted model
included all the independent variables regardless of their significance level in the univariate analysis.
A chi-square (χ²) test was employed and examined associations between the environmental sustainability of
healthcare facilities at government and private healthcare centres in Kaduna metropolis variables. It is to show
weather there are variations between the responses the government and private health facilities. Eleven (11)
independent variables were used for the comparative analysis of the HCF numbered a – k.
The formula for the Chi-Square:
𝑥
2
= ∑ (0
i
– E
i
)
2
E
i
…………………………… Equation (2.3)
Where 𝑥
2
= Chi-Square
0
i
= Observed frequency (table of the Likert Scale responses),
E
i
= Expected Count.
RESULT AND DISCUSSION
Hepatitis B Transmission, risk factors, symptoms and preventions
Hepatitis B is a viral infection that can be transmitted through blood or other bodily fluids, including semen and
vaginal secretions. Common modes of transmission include having unprotected sex with an infected person,
sharing personal items such as toothbrushes or sharp objects like razors, clippers, and nail cutters contaminated
with infected blood, receiving tattoos or body piercings with unsterilized equipment, mother-to-child
transmission during childbirth, transfusion of infected blood, and sharing of needles, syringes, or other
unsterilized equipment. Certain factors increase the risk of contracting the virus, such as having multiple sexual
partners, working in healthcare, being an infant born to an infected mother, being a man who has sex with men,
injecting drugs, living with an infected person, having hepatitis C infection or a history of it, and being on
immunosuppressive therapy. Many people with hepatitis B do not initially show symptoms; however, when
symptoms occur, they may include fever, fatigue, muscle or joint pain, nausea, vomiting, abdominal discomfort,
dark urine, weakness, loss of appetite, yellowing of the eyes and skin (jaundice), and a bloated or swollen
abdomen. Hepatitis B is preventable through vaccination, which is safe, effective, and recommended for all
infants within 12–24 hours of birth, as well as for children, adolescents, and unvaccinated adults. Additional
preventive measures include avoiding contact with contaminated blood, not sharing sharp objects or using
unsterilized equipment, limiting sexual partners, practicing safe sex, and ensuring that infected pregnant women
are identified early and treated to prevent mother-to-child transmission.
Knowledge of Hepatitis B and its vaccines
The interviews with the local population, the nursing mothers, hospital workers showed that many of them
confirmed that there are limited vaccines available in their area, while some said; they are not properly informed
about the 24hrs HepB-BD vaccine. Few of them attributed the barrier as experience and perceptions of mothers,
healthcare providers, and community members regarding HepB-BD vaccination. One woman told me about the
stigma associated with HBV, and traditional practices that impact HepB-BD uptake. Could these be the factors
influencing uptake of the HepB-BD.? This is a call for enhancing public awareness campaigns to educate
communities about HepB-BD. Some Healthcare workers also complained about non availability of the vaccines
to private hospitals as it is in the Primary Health Centers, owing to the fact that, they do not actually care more
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about the HepB-BD. This posture does not work in line with stipulated WHO guidelines 2024, and National
guideline for the prevention, care and treatment of viral Hepatitis B and C in Nigeria.
The cell phone interview reported that some of the Matrons /Nurses said “vaccines are not kept in labor ward,
and are not accessible at all time, because most of the Primary Health centers has a particular day in a week for
immunization. If the birth of infant happened on the day that is not immunization, the HepB-BD vaccines will
be difficult to be administered within 24hours of birth while face to face interview with the selected respondents
reveled that most of the pregnant women confirmed having knowledge of hepatitis B birth-dose, but do not know
the actual period HepB-BD supposed to have been given after birth, while some do not have idea what HepB-
BD is all about, and further said that, their baby will be protected by God, as he/she is in the hands of God.
Table 1, 2, 3, 4 and 5 discuss the number of infants born, vaccinated, born at private hospital/ home delivery,
completed second and third doses of the vaccines against HBV at PHC in Plateau State from 2020 – 2024
respectively.
Table 1: The number of infants born at PHC in Plateau State from 2020 to 2024:
LGA
2020
2021
2022
2023
2024
BARKIN LADI
2345
164
131
238
227
BASSA
1577
655
709
987
1028
BOKKOS
902
390
301
238
277
JOS EAST
1063
267
337
321
330
JOS NORTH
2638
861
2210
3935
3582
JOS SOUTH
2928
886
843
818
3040
KANAM
610
287
445
564
417
KANKE
939
373
447
69
143
LANGTANG NORTH
896
203
345
322
507
LANGTANG SOUTH
817
187
201
123
186
MANGU
6198
2016
2110
1402
1459
MIKANG
461
183
259
98
127
PANKSHIN
1329
363
1049
886
592
QUA’AN PAN
2349
512
645
515
633
RIYOM
938
639
650
492
752
SHENDAM
2435
736
820
465
410
WASE
502
76
28
37
23
TOTAL
28927
8798
11532
11510
13733
Source Field Survey (2025)
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Table 2: The number of infants vaccinated in Plateau State from 2020 t0 2024.
LGA
2020
2021
2022
2023
2024
BARKIN LADI
5328
5092
7595
6674
7130
BASSA
6638
5496
7030
7936
8657
BOKKOS
5082
4902
6016
4780
5245
JOS EAST
2181
2221
2124
1935
2589
JOS NORTH
18300
12789
17849
17518
18886
JOS SOUTH
9203
9651
12400
10056
12122
KANAM
3631
6294
8150
7147
8739
KANKE
2900
3042
3532
2882
3180
LANGTANG NORTH
4616
3686
4241
3905
6017
LANGTANG SOUTH
3513
3856
3953
3471
3640
MANGU
9053
8059
11165
8609
8644
MIKANG
2882
2390
2482
2069
2682
PANKSHIN
4023
4357
4083
4304
4406
QUA’AN PAN
6810
5788
7267
8306
7679
RIYOM
3350
3517
4075
3452
3538
SHENDAM
7362
6255
6788
9040
9016
WASE
3922
3730
5075
5703
7011
TOTAL
98794
91125
113825
107787
119181
Source Field Survey (2025)
Table 3: The number of Infants born at Private Hospital/ Home Delivery in Plateau State.
LGA
2020
2021
2022
2023
2024
TOTAL
BARKIN LADI
2983
4928
7464
6436
6903
28714
BASSA
5061
4841
6321
6949
7629
30801
BOKKOS
4180
4512
5715
4542
4968
23917
JOS EAST
1118
1954
1787
1614
2259
8732
JOS NORH
15662
11928
15639
13583
15304
72116
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JOS SOUTH
6275
8765
11557
9238
9082
44917
KANAM
3021
6007
7705
6583
8322
31638
KANKE
1961
2669
3083
2813
3037
13563
LANGTANG NORTH
3720
3483
3896
3583
5510
20192
LANGTANG SOUTH
2696
3669
3752
3348
3454
16919
MANGU
2855
6043
9055
7207
7185
32345
MIKANG
2421
2207
2223
1971
2555
11377
PANKSHIN
2694
3994
3034
3418
3814
16954
QUA’AN PAN
4461
5276
6622
7791
7046
31196
RIYOM
2412
2878
3425
2960
2786
14461
SHENDAM
4927
1111
5968
8575
8606
29187
WASE
3420
3654
5047
5666
6988
24775
TOTAL
69,867
77,919
102,293
96,277
105,448
451,804
Source Field Survey (2025)
Table 4: The Newborns that completed second dose vaccines against HBV
LGA
2020
2021
2022
2023
2024
TOTAL
BARKIN LADI
4
-
-
-
-
4
BASSA
38
-
-
-
-
38
BOKKOS
16
-
-
-
-
16
JOS EAST
6
-
-
-
-
6
JOS NORTH
120
-
-
-
-
120
JOS SOUTH
17
-
-
-
-
17
KANAM
19
-
-
-
-
19
KANKE
61
-
-
-
-
61
LANGTANG NORTH
126
-
-
-
-
126
LANGTANG SOUTH
-
-
-
-
-
-
MANGU
24
-
-
-
-
24
MIKANG
15
-
-
-
-
15
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PANKSHIN
6
-
-
-
-
6
QUA’AN PAN
23
-
-
-
-
23
RIYOM
-
-
-
-
-
-
SHEMDAM
-
-
-
-
-
-
WASE
173
-
-
-
-
173
TOTAL
648
0
0
0
0
648
Source Field Survey (2025)
Table 5: The Newborns that completed third dose vaccines against HBV
LGA
2020
2021
2022
2023
2024
TOTAL
BARKIN LADI
31
-
-
-
-
31
BASSA
36
-
-
-
-
36
BOKKOS
-
6
-
-
-
6
JOS EAST
12
-
-
-
-
12
JOIS NORTH
10
-
-
-
-
10
JOS SOUTH
108
17
-
-
-
125
KANAM
12
-
-
-
-
12
KANKE
-
-
-
-
-
-
LANGTANG NORTH
92
54
-
-
-
146
LANGTANG SOUTH
1
-
-
-
-
1
MANGU
68
-
-
-
-
68
MIKANG
53
-
-
-
-
53
PANKSHIN
32
-
-
-
-
32
QUA’AN PAN
22
-
-
-
-
22
RIYOM
-
-
-
-
-
-
SHENDAM
48
-
-
-
-
48
WASE
190
-
-
--
-
190
TOTAL
715
77
0
0
0
792
Source Field Survey (2025)
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Considering the facts that many families from the rural areas in Plateau State come from poor background, and
most of them prefer having their babies at home without recourse to consequences of complications that may
arise.
Comparing Table 1, 3, in 2020, 61.17% of newborns was delivered at Home delivery/private Hospitals while
only 38.83% was delivered at Primary Health care centers in the State. 2021, 88.19% was delivered at Home
delivery/Private Hospitals while only 11.81% was delivered at PHC in Plateau State. In 2022 too, 84.52% was
also delivered at Home delivery/Private Hospitals while only 15.45% was at Primary Health care Centers. 2023,
84.55% was through Home delivery/ private hospitals, and 15.48% was through Primary healthcare centers.
And 2024, 81.58% was Home delivery/Private Hospitals while 18.42% was Primary Healthcare Centers.
The number of Newborns that was delivered at Home delivery/Private Hospitals is far higher than the number
of Newborns delivered at Primary Healthcare Centers in the State from the period under review. This is an
indication that many Women preferred having their Babies born at Private Hospitals than the Primary Heath care
Centers that is being managed by government.
Though, the Private Hospitals do refer the Newborns to Primary Healthcare Centers for HepB-BD vaccines,
because non availability of vaccines at private hospitals, or because at PHC, it is less cost of total free as
Government subsidized the cost. The problem with this arrangement from Private Clinics is that, in most cases,
the 24hours stipulated for the vaccines to Newborns are not always maintained, therefore creating gap for HBV
to infect the Newborns at will. This should be followed with proper orientation and training to Private Clinics
Health workers, as well the Primary Healthcare workers to be on the same slate for preventing spread of the
HBV.
The State Government should liaise with the Private Hospital on the need to supply these vaccines to them so
that the life of the Newborn can be saved from HBV.
Using Bar Chart To Analyse The Table 1,2 And 3.
The percentage of HepB-BD from 2020 to 2024 shows a rise and fall of the activities which ought to have been
on increased considering the facts that, the population in the State is increasing.
In 2020 = 18.62%
2021 = 17.17%
2022 = 21.45%
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2923= 20.31 %
2024 = 22.45 %
The Jos North Local Government Area has the highest number of Women who delivered their Babies and was
given HepB-BD vaccines, while Jos East Local Government Area has the lowest number of Infants given HepB-
BD vaccines in the State. The Wase Local Government Area has the lowest number of delivery among women
the State. Jos North Local Government seems to understand the policy on HepB-BD than other Local
Government Areas.
Table 4, shows the second dose of HepB-second dose at 6 week after delivery, the researcher found out that in
year 2020, the records for the activities on vaccines shown that only 648 infants received vaccines , and from
2021 to 2024, no records or proof of Infants reviewed the second dose vaccines. Questions were asked on why
there are no records, and the answers from Primary Healthcare Workers were that, “many Women do not bring
their Infants to Clinic for second dose vaccination after the first dose”. From the record, only 0.2% of Infants
received second dose vaccines in 2020, and from 2021 to 2024 is 0%, which is too poor. This is also a proof
that many Women need sensitization on the needs to get their Infants complete HepB vaccination.
The table 5, shown the level of vaccinations of Infants within 10 weeks after birth as third dose from 2020 t0o
2024 in Plateau State of Nigeria.
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In 2020 and 2021 have 715 and 77 Infants which represent 0.13% and 0.014% respectively, while from 2022 to
2024 have 0%.
There are a lot of gap between the knowledge of second and third dose Hepatitis B vaccines among the Women
in Plateau State that needs urgent attention. This could be attributed to access barriers limitation on vaccines
broad use, not well informed about the second and third does, limited cold chain storage, lack of adequate trained
community health workers, unearth attitude of some women towards vaccines and financial constraint
Chi-Square Test of Independence Variables of the PHC and Private/Home births across LGAs (2020 -
2024)
The study further subjected the data between PHC and Private/Home births across LGAs (2020 - 2024) to show
relationship of the two variables. The combined results showed Chi-square statistic (χ²) = 16,633.54, Degrees of
freedom (df) = 16 and p-value = 0.000… (≈ 0). This was done on LGA bases as shown in Table …
This means that since the p-value < 0.05, there is a highly significant difference in the distribution of births
between PHC deliveries and Private/Home deliveries across LGAs in Plateau State as well as the uptake of
PHC vs. Private/Home delivery is not uniform across LGAs. It indicates that some LGAs rely much more on
PHC, while others rely heavily on private/home births as shown the chi-sqaure standardized residuals which
show where the biggest differences lie between PHC vs. Private/Home births across LGAs (see Table)
Table: Chi-square Test of Independence by LGA, Plateau State (2020–2024)
LGA
χ² Value
df
p-value
Interpretation
Barkin Ladi
8543.64
4
<0.0001
Significant
Bassa
687.90
4
<0.0001
Significant
Bokkos
831.79
4
<0.0001
Significant
Jos East
1283.25
4
<0.0001
Significant
Jos North
1721.44
4
<0.0001
Significant
Jos South
4047.11
4
<0.0001
Significant
Kanam
712.00
4
<0.0001
Significant
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Kanke
1483.77
4
<0.0001
Significant
Langtang North
576.81
4
<0.0001
Significant
Langtang South
1310.60
4
<0.0001
Significant
Mangu
8762.96
4
<0.0001
Significant
Mikang
288.61
4
<0.0001
Significant
Pankshin
1002.93
4
<0.0001
Significant
3476.49
4
<0.0001
Significant
Riyom
259.57
4
<0.0001
Significant
Shendam
4449.53
4
<0.0001
Significant
Wase
1915.74
4
<0.0001
Significant
Source: Field Survey (2025)
Chi-Square Standardized Residuals Variables of the PHC and Private/Home births across LGAs (2020 -
2024)
LGA
PHC
Residual
Private
Residual
Interpretation
Barkin Ladi
-20.85
+8.46
Far fewer PHC births than expected; strong preference for
private/home births.
Bassa
-1.48
+0.60
Small deviation, not significant.
Bokkos
-25.96
+10.54
Strong underuse of PHC, overuse of private/home.
Jos East
+19.06
-7.74
Much higher PHC reliance than expected.
Jos North
+10.43
-4.23
More PHC births than expected.
Jos South
+10.94
-4.44
More PHC births than expected.
Kanam
-35.83
+14.55
Heavy reliance on private/home deliveries.
Kanke
-4.86
+1.97
Mildly fewer PHC births.
Langtang North
-16.08
+6.53
Strong private/home preference.
Langtang South
-21.44
+8.71
Strong private/home preference.
Mangu
+83.96
-34.09
Extremely strong reliance on PHC (the biggest positive deviation).
Mikang
-15.26
+6.20
Private/home preference.
Pankshin
+22.32
-9.06
Strong PHC preference.
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-5.90
+2.40
Slight private/home preference.
Riyom
+18.51
-7.52
Strong PHC reliance.
Shendam
+0.66
-0.27
No meaningful deviation.
Wase
-48.91
+19.86
Very strong private/home reliance.
Source: Field Survey, (20
The PHC and Private residuals show that Mangu is the biggest outlier with far more PHC births than expected,
Wase and Kanam stand out for very strong reliance on private/home deliveries while Bokkos, Barkin Ladi,
Langtang South, and Mikang also lean heavily toward private/home births. Jos East, Jos North, Jos South,
Pankshin, and Riyom on the other hand show significantly higher PHC use.
Findings:
a. Many women do not know more about Hepatitis B, mode of transmission, preventive measures, and
HepB-BD vaccines.
b. A lot of Health Workers (Matrons, Nurse) does not know the period to be given HepB-BD. Some said
within 72hrs, some said within the same week, while others said for few days. Only few of them
confirmed that is within 24hrs of birth, as some do not know the Nigerian guideline for viral Hepatitis B
and C vaccination.
c. Those who give birth at Private Hospitals and at Home are 10 times more than those who give birth at
Primary Health care facilities.
d. Many Primary Health care Centers do not have qualified personnel, and some who have needs more
manpower to carter for the number of patients.
e. Many Private Hospitals do not give vaccines; rather they refer the Newborns to Government facilities
for vaccination.
f. There was not adequate information or record concerning the second dose and third dose vaccines given
to Infants within 6 weeks and 10 weeks after birth.
g. The HepB-BD vaccines are not available at the delivery ward rooms, in almost all the facilities, and many
Private Hospitals where over 80% of women delivered do not have the HepB-BD vaccines.
h. Most Health workers lack basic knowledge on Hepatitis viruses.
RECOMMENDATIONS
a. There should be refreshers training among the Health workers at least 2 persons from each Primary
Healthcare Centers (1236) across the State.
b. The Private Hospitals should also be sensitized and trained on HepB-BD vaccines within the State.
c. There should be aggressive awareness campaign within the Seventeen (17) Local Government of the
State, so that those Women in the rural Areas will be acquainted with HepB-BD vaccines.
d. The HepB-BD vaccines should be placed in every delivery ward, so that the vaccines will always be at
hands for vaccination.
e. The Private Hospital should be giving subsidies vaccines so that it will also be available at their facilities.
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