Factors influencing vaccination coverage for the birth dose of hepatitis B vaccine in Kabadougou, Côte d’Ivoire, 2025: Analytical cross-sectional study

Introduction: The hepatitis B birth dose (HepB-BD) vaccine prevents mother-to-child transmission of the virus. The World Health Organization recommends its administration within 24 hours after birth, targeting 90% vaccination coverage (VC). In the Kabadougou region, administrative VC ranged from 49% to 71% between 2020 and 2023, remaining below national targets. This study aimed to identify the factors associated with this low coverage. Methods: A cross-sectional analytical study was conducted in August 2025 on 450 children born between 2020 and 2025 in Kabadougou, selected by two-stage cluster sampling. Sociodemographic and vaccination data were collected using a KoboCollect questionnaire through interviews, observations, and document review. The outcome variable was non-vaccination with the HepB-BD within three days after birth. Data were analyzed using binary logistic regression in SPSS-27 with α= 5% (p<0.05). Results: HepB-BD vaccination coverage was 68.4% (95% CI: 64.1%-72.7%). No vaccine stockout was reported. On average, five trained health workers were available per health centre (standard deviation: four). Factors significantly associated with non-vaccination were: home birth (adjusted odds ratio [aOR]=5.7; 95% confidence interval [95% CI]:2.3-14.6), each one-year increase in the child’s age (aOR=1.4; 95% CI: 1.2-1.7), unfavourable local beliefs regarding the birth dose (aOR = 4.7; 95% CI: 2.3-9.7), receipt of a vaccination record (aOR=0.1; 95% CI: 0.04-0.5), and maternal counselling on the HepB-BD received during antenatal care (aOR =0.3; 95% CI: 0.2-0.5). Conclusion: The HepB-BD coverage in Kabadougou remains low, driven by home births. Improvement requires promoting facility-based deliveries, community sensitization, and systematic provision of vaccination records.