Sierra Leone caregivers anticipate hepatitis B birth-dose vaccine acceptance

Sierra Leone is preparing to introduce the Hepatitis B birth-dose (HepB-BD) vaccine nationally, a critical step in addressing mother-to-child transmission, which remains a major contributor to hepatitis B virus (HBV) infection in sub-Saharan Africa. To inform this rollout, a qualitative study explored the knowledge, attitudes, and perceptions of caregivers regarding the vaccine before its implementation. The research aimed to understand the social and informational landscape that would influence acceptance, recognizing that successful vaccination programs depend heavily on community trust and clear communication.

The study was conducted across six districts in Sierra Leone, providing a broad perspective on caregiver perspectives in the lead-up to the national introduction. The research team employed a qualitative descriptive method, utilizing 20 focus group discussions (FGDs) with a total of 125 caregivers. These discussions were audio-recorded, transcribed verbatim, and translated where necessary to ensure accurate representation of local viewpoints.

The data were analyzed using Braun and Clarke’s reflexive thematic analysis within the NVivo 14 software environment. This approach allowed the researchers to identify recurring patterns and themes in the caregivers' responses, offering a nuanced understanding of their perceptions. The study did not rely on a predefined saturation endpoint; instead, data collection concluded after 20 FGDs when the research team judged that the dataset possessed sufficient information power to address the study's aim.

Analysis of the focus group discussions revealed six distinct themes that shaped caregiver perspectives. The first theme highlighted limited health literacy regarding hepatitis B, indicating that many caregivers had a basic understanding of the disease. The second theme addressed misconceptions and uncertainty surrounding transmission, suggesting that while caregivers were aware of the virus, their understanding of how it spreads was often incomplete or inaccurate.

Institutional trust emerged as a central theme, serving as the foundation for vaccine acceptance. Caregivers expressed a general confidence in healthcare workers and the healthcare system, which was a significant factor in their anticipated willingness to accept the HepB-BD vaccine. The study found that acceptance was conditional upon effective communication, meaning that caregivers were more likely to accept the vaccine if it was clearly explained and recommended by trusted sources.

Positive perceptions of routine childhood vaccination also facilitated birth-dose acceptance. Caregivers generally viewed the existing immunization schedule favorably, which created a receptive environment for the introduction of the new birth-dose vaccine. Additionally, community information networks were identified as a key factor in shaping health decisions.

Caregivers relied heavily on information shared within their communities, indicating that peer influence and local networks play a significant role in determining vaccination behaviors. Despite the identified gaps in knowledge about hepatitis B and its prevention, caregivers expressed an anticipated willingness to accept the HepB-BD vaccine. This willingness was closely tied to their trust in healthcare workers and their confidence in the routine immunization process.

Participants frequently requested clear education and reassurance about the vaccine's safety and benefits before implementation. The findings indicate that strengthening caregiver education, healthcare-worker communication, and community engagement before the national introduction may support successful implementation. Future research should determine whether these anticipated perceptions translate into timely birth-dose vaccination uptake.

Subject of Research: Caregiver perspectives on hepatitis B birth-dose vaccination in Sierra Leone

Article Title: Exploring caregivers’ perspectives and anticipated acceptance of hepatitis B birth-dose vaccination before the national introduction in Sierra Leone: a qualitative study

Article References: Sesay, E. N., Jones, M., Kemoh, A. K., Kargbo, N. M., Clemens-Kangbai, N., Clemens, A., Kangbai, M. M., Lansana, S., Samuels, E. G., Barrie, U., Jimmy, A. A. N., Kallay, M. T. M., & Kangbai, D. M. (2026). Exploring caregivers’ perspectives and anticipated acceptance of hepatitis B birth-dose vaccination before the national introduction in Sierra Leone: a qualitative study. BMC Public Health. https://doi.org/10.1186/s12889-026-30107-3

Image Credits: AI Generated

DOI: 10.1186/s12889-026-30107-3

Keywords: hepatitis B, birth-dose vaccine, Sierra Leone, qualitative study, caregiver perspectives, vaccine acceptance, public health, mother-to-child transmission, Exploring, caregivers, perspectives, anticipated