Barriers to compliance with hepatitis B vaccination: sociocultural and socioeconomic perspectives of pregnant women in the Bono East Region of Ghana

Non-compliance with hepatitis B virus (HBV) vaccination among pregnant women poses a significant challenge to maternal health, particularly due to the risk of vertical transmission. Understanding the factors influencing non-compliance is essential for contextualising patterns of HBV vaccination uptake and the risk of infection. This study, therefore, investigated the sociocultural and socioeconomic barriers to compliance with HBV vaccination among pregnant women in the Bono East Region of Ghana.

This was a hospital-based cross-sectional study that employed the mixed method approach. A serological screening, a closed-ended questionnaire, in-depth interviews (IDIs), and focus group discussions (FGDs) were used to collect data from 1430 pregnant women. Quantitative data were analysed with the Software Package for Social Sciences (SPSS) version 25 (IBM, USA). Logistic regression was performed to compute the odds ratios and identify the barriers that were significantly associated with HBV. Thematic analysis was used to analyse qualitative data, with a focus on four steps: transcription, profiling, coding, and thematic framework.

The prevalence of HBV infection among pregnant women was 1.8% (95% CI: 1.24–2.65). The majority of participants (74.34%) reported not taking the HBV vaccine or not completing the full vaccination regimen. Several sociocultural and socioeconomic factors were qualitatively reported as reasons for non-compliance. These included spiritual beliefs, fear of divine punishment, concerns about becoming a burden to family members, perceived cost of interventions, and time constraints. In the multivariate analysis, pregnant women who cited belief in spiritual poisoning as a reason for non-compliance had significantly higher odds of HBV infection (aOR = 8.79; 95% CI: 3.57–13.63; p < 0.001). Concern about being a burden to family members (aOR = 2.73; 95% CI: 1.03–7.21; p = 0.042) and perceived cost of intervention (aOR = 5.86; 95% CI: 1.13–9.26; p = 0.034) were also associated with increased odds of HBV infection.

This study sheds light on the various sociocultural and socioeconomic barriers to compliance with HBV vaccination. This highlights the complexity involved in promoting essential interventions among pregnant women. Addressing these challenges requires collaborative efforts to promote responsiveness, improve healthcare accessibility, enhance health education, and strengthen community support systems.