Prevention and care of hepatitis B in the rural region of Fatick in Senegal : a healthcare workers’ perspective using a mixed methods approach

Tchadine Djaogol (1) , Marion Coste (1) , Fabienne Marcellin (1) , Antoine Jaquet (2) , Fanny Chabrol (3) , Tamara Giles-Vernick (4) , Aldiouma Diallo (5) , Maria Patrizia Carrieri (1) , Sylvie Boyer (1)

1 SESSTIM - U1252 INSERM - Aix Marseille Univ - UMR 259 IRD - Sciences Economiques et Sociales de la Santé & Traitement de l'Information Médicale
2 BPH - Bordeaux population health
3 CEPED - UMR_D 196 - Centre population et développement
4 Epidémiologie des Maladies Emergentes - Emerging Diseases Epidemiology
5 VITROME - Vecteurs - Infections tropicales et méditerranéennes

Background: In countries where hepatitis B virus (HBV) is endemic, including Senegal, the World Health Organization recommends systematic HBV screening of pregnant women and vaccination at birth to prevent mother-to-child transmission (MTCT). This study investigated healthcare workers' (HCW) knowledge and practices regarding HBV prevention and care in the rural region of Fatick in Senegal, as well as challenges they faced in implementing prevention activities related to HBV MTCT. Methods: A mixed-methods survey was conducted between May-July 2017 among 112 HCW working in 15 healthcare facilities in two districts of the Fatick region using face-to-face questionnaires and semi-structured interviews. Descriptive statistics and chi-square/Mann-Whitney tests were used to analyze quantitative data, while qualitative data were analyzed thematically. Results: The study population included 87 HCW in the quantitative component (83% women, median age [interquartile range, IQR] = 35 [31-40] years) and 11 in the qualitative component. A knowledge gap was observed in key areas of HBV infection: only 24, 51 and 38%, respectively, correctly reported that early HBV acquisition is associated with a high risk of developing chronic infection, that perinatal transmission is one of the main modes of HBV transmission in Senegal, and that three to four doses of HBV vaccine are required to ensure immunization in children. Despite good acceptability of systematic screening of pregnant women and vaccination at birth, only 48% of HCW mainly involved in prenatal care and 71% of those involved exclusively in vaccination routinely performed these two key interventions. HCW reported several structural barriers that may hinder their implementation: a lack of training in HBV and in counseling, poor availability of rapid diagnostic tests (RDT), high costs of both screening and treatment, a lack of adequate information on treatment options and missed opportunities for vaccination at birth.

Mots clés: HBV; Mixed-methods; Healthcare workers; Vaccination at birth; Senegal; Decentralized care; Prevention; Vertical transmission; Mother-to-child transmission; Africa; Hepatitis B

Domaines: Sciences du Vivant [q-bio]

Tchadine Djaogol, Marion Coste, Fabienne Marcellin, Antoine Jaquet, Fanny Chabrol, et al.. Prevention and care of hepatitis B in the rural region of Fatick in Senegal : a healthcare workers’ perspective using a mixed methods approach. BMC Health Services Research, 2019, 19 (1), ⟨10.1186/s12913-019-4416-3⟩. ⟨hal-02279641⟩