Hepatitis B is an infectious disease of viral origin that causes significant morbidity and mortality worldwide. It accounts for over 820,000 deaths annually, and approximately 296 million people live with a chronic form of the disease. As a leading cause of liver disease and primary liver cancer, hepatitis B poses a substantial public health challenge
[1]
. The epidemiology of hepatitis B reveals high endemicity in sub-Saharan Africa, with prevalence rates exceeding 8%
[2]
. Despite the availability of an effective vaccine and its inclusion in vaccination programs in endemic countries
[3]
, several populations, including university students, exhibit high prevalence rates
[4]
[5]
. University students are at increased risk of hepatitis B infection due to certain behaviors such as unprotected sexual intercourse, acquisition of tattoos, piercings, shared use of sharp objects, and occasional use of injectable drugs
[6]
. Effective protection for this population is further limited by the reliance on individual initiatives
[3]
. Given the scarcity of comprehensive data on vaccination coverage among students in sub-Saharan Africa, this systematic review and meta-analysis aim to assess the extent of hepatitis B vaccination coverage in this demographic and provide insights into regional disparities and potential interventions.
2. Study Method2.1. Research Strategy
Based on the guidelines of the Preferred reporting items for systematic reviews and meta-analyses (PRISMA)
[7]
this study is exhaustive and was done in databases such as PubMEd and African journal online (AJO). Key words such as “hepatitis B”, “hepatitis B virus”, “vaccination coverage”, “vaccination”, “students”, “universities”, “Sub-Saharan Africa” were used (
Table 1
). Several combinations of these words were used in French and English. On the Google Scholar search engine a manual search was also used. Furthermore, we verified the references of all eligible articles to find relevant publications. Studies published between January 1st, 2000 and December 31st 2023 were considered. The latest search was conducted on March 31, 2024.
(Hepatitis B or HBV or Hepatitis B Virus or Hepatitis B Antigen or Hepatitis B Antibodies or Anti-HBsAg or viral hepatitis or hepatitis)
2
(Vaccine* or immunization or vaccinat* or immuni* or Viral Hepatitis Vaccines or Viral Hepatitis Vaccines or Hepatitis B Vaccines or Immunotherapy or vaccination coverage*)
3
(Students* or Universities* or Campus* or)
4
“Africa South of the Sahara” [MeSH]
5
1 and 2 and 3 and 4
2.2. Article Eligibility Criteria
Inclusion Criteria
Using the PICOS (Patient, Intervention, Comparison, Outcome, Study type) framework, the inclusion criteria were:
Patients
adult university students regardless of their faculties or specialties;
Interventions
3 doses of vaccine;
Comparison
none;
Outcomes
vaccination coverage rate;
Study type
quantitative studies (observational, randomized or not, prospective or retrospective studies) (English or French).
Exclusion Criteria
We excluded studies that described the following:
Vaccine coverage was not completerly described;
Qualitative studies;
Incomplete outcomes reported.
Mixed cohorts with other populations where data on university students could not be extracted;
Letters to editors, literature reviews, and duplicated studies were also excluded.
2.3. Quality of Items Included
All included documents underwent a quality assessment based on 10 criteria
[8]
with the same rating. As shown in
Table 2
, these criteria are organized into external and internal validation criteria. After assessment, the quality of a document was classified as low, medium or high if it met 1 to 4 criteria, 5 to 7 criteria and 8 to 10 criteria respectively.
<xref ref-type="bibr" rid="scirp.136494-"></xref>Table 2. Criteria used for the assessment of methodological quality <xref ref-type="bibr" rid="scirp.136494-8">
[8]
</xref>.
Internal validity
Description of methods
1. Are important characteristics of the population specified?
2. Is the study period specified?
3. Is there a clear definition of hepatitis B vaccination status?
4. Is the data collection method adequately described?
Collection tool
5. Is the collection tool validated?
Prevalence data
6. Are prevalence data reported for people who have received partial or full vaccination?
7. Are prevalence data reported by demographic category?
External validity
8. Is the participation rate greater than 70% or is the information on non-respondents sufficient to allow conclusions to be drawn on the representativeness of the population studied?
9. Is the included population representative of the target/sub-national population?
10. Is the population included representative of the national population?
2.4. Data Collected
The following data were collected: authors’ names, year of publication, country where the study took place, sample size, participation rate, gender of participants and their average ages, and vaccination coverage rate.
2.5. Data Analysis
Statistical analysis was performed using R software. Graphs were created using Microsoft Excel.
For qualitative variables, the absolute and relative frequencies were determined. For quantitative variables, the mean and standard deviation were calculated.
Jamovi software made it possible to estimate the combined vaccination coverage rate with the 95% confidence interval (CI) in sub-Saharan Africa. A meta-analysis estimated the pooled prevalence with the 95% confidence interval (CI) of hepatitis B vaccination coverage in Sub-Saharan Africa. A sub group analysis was done to evaluate the pooled prevalence according to the sub region (west, east and central Africa).
Heterogeneity between studies was tested by the I2 test. A random-effects model was when I2 > 50%; and a fixed-effects model when I2 ≤ 50%.
3. Results3.1. Selection of Studies
Through databases and manual searching, 106 articles were found of which 35 were included for the study. The selection process is illustrated in
Figure 1
.
Figure 1. PRISMA diagram illustrating the study search and selection process.
3.2. Characteristics of Included Studies
All studies were cross-sectional studies involving a total of 20,520 students from universities in 15 countries in sub-Saharan Africa. The F/M sex ratio was 1.05 and the mean age of students was 22.1 ± 5.1 years.
The publications of these studies cover the period from 2005 to 2023. The evolution of the number of publications concerning the subject since 2005 shows a clear increase in the number of publications on the subject between 2018 and 2020. This evolution is illustrated by
Figure 2
.
Figure 2. Evolution of the number of publications on vaccination coverage of students in ASS.
The countries of origin and the number of articles found are illustrated in
Figure 3
.
Figure 3. Number of articles found by country in Sub-Saharan Africa.
The majority of studies (63.9%) were conducted in West Africa. According to the qualitative assessment of the articles, 5.5% were of good quality while 66.7% had moderate quality and 27.8% had low quality.
Table 3
presents the results from the quality assessment of the included articles. The majority of studies (65.7%) had a quality judged to be moderate and most of the works were published in the period 2016-2020.
<xref ref-type="bibr" rid="scirp.136494-"></xref>Table 3. Characteristics of studies following qualitative assessment.
Features
Frequencies n (%)
Number of studies where data were available
Sex
Women
7916 (51, 3)
33/35
Man
7501 (48, 7)
Quality of studies (NOS scale)
Good
2 (5, 7)
35/35
AVERAGE
23 (65, 7)
Weak
10 (28, 6)
Year of publication
2005-2010
4 (11, 4)
35/35
2011-2015
5 (14, 3)
2016-2020
18 (51, 4)
≥2021
8 (22, 9)
Location of the study
West Africa
23 (65, 7)
35/35
East Africa
9 (25, 7)
Central Africa
2 (5, 7)
Southern Africa
1 (2, 9)
All characteristics of the studies are shown in
Table 4
.
<xref ref-type="bibr" rid="scirp.136494-"></xref>Table 4. Characteristics of the studies included in the systematic review.
Author
Year
Country
Type of Study
Effective
Men
Women
Average age (year)
Abdela et al.
[19]
2016
Ethiopia
Transversal
246
187
59
N/A
Adeleye et al.
[20]
2019
Nigeria
Transversal
207
112
95
25.65
Adenlewo et al.
[21]
2017
Nigeria
Transversal
113
71
42
24.97
Ali et al.
[22]
2023
Somalia
Transversal
247
71
176
N/A
Aniaku et al.
[23]
2019
Ghana
Transversal
358
95
263
21.56
Aroke et al.
[24]
2018
Cameroon
Transversal
714
329
385
22.03
Atiba et al.
[25]
2014
Nigeria
Transversal
594
N/A
N/A
N/A
Chingle et al.
[26]
2017
Nigeria
Transversal
1200
559
641
21.2
Chukwkrah et al.
[27]
2020
Nigeria
Transversal
253
112
141
22.9
Balegha et al.
[28]
2021
Ghana
Transversal
402
183
219
23
Déguénonvo et al.
[29]
2019
Senegal
Transversal
318
131
187
23
Ejembi et al.
[30]
2019
Nigeria
Transversal
176
118
58
22
Eward et al.
[31]
2023
Tanzania
Transversal
283
153
130
N/A
Gebremeskel et al.
[32]
2019
Ethiopia
Transversal
200
115
85
N/A
Gyimah et al.
[33]
2021
Ghana
Transversal
2712
1269
1443
N/A
Haile et al.
[34]
2021
Ethiopia
Transversal
417
251
166
22.7
Kachimanga et al.
[35]
2020
Leone Series
Transversal
157
100
57
26
Kana et al.
[36]
2020
Nigeria
Transversal
133
85
48
N/A
Kumah et al.
[37]
2021
Ghana
Transversal
262
180
82
N/A
Lohouès-kouacou et al.
[38]
2013
Ivory Coast
Transversal
2557
859
1698
23.4
Maina et al.
[39]
2020
Kenya
Transversal
487
240
247
22.5
Makan et al.
[40]
2023
South Africa
Transversal
221
68
153
22.5
Ni et al.
[41]
2015
Nigeria
Transversal
316
194
122
N/A
Noubiap et al.
[42]
2013
Cameroon
Transversal
111
57
54
23.04
Odusanyaa et al.
[43]
2006
Nigeria
Transversal
313
164
149
24.3
Okeke et al.
[44]
2008
Nigeria
Transversal
346
228
118
N/A
Osei et al.
[45]
2019
Ghana
Transversal
226
151
75
24.12
Pido et al.
[46]
2005
Uganda
Transversal
182
106
76
N/A
Sake et al.
[47]
2018
Benign
Transversal
265
140
125
18.9
Sawadogo et al.
[48]
2022
Burkina Faso
Transversal
410
128
282
25.71
Sofola et al.
[49]
2008
Nigeria
Transversal
N/A
N/A
N/A
N/A
Sombié et al.
[9]
2015
Burkina Faso
Transversal
507
336
171
24
Tawiah et al.
[50]
2020
Ghana
Transversal
178
139
39
N/A
Umuhoza et al.
[10]
2020
Rwanda
Transversal
140
75
65
25
<xref ref-type="bibr" rid="scirp.136494-"></xref>3.3. Hepatitis B Vaccination Coverage
The vaccination coverage rate of students in sub-Saharan Africa was 28.8% [95% CI: 22.9% - 34.7%]. It was highly variable and ranged from 1.4% in Burkina Faso
[9]
to 90.7% in Rwanda
[10]
. The results of the meta-analysis are presented in
Figure 4
.
Analysis of the sub-regions of the zone showed that the coverage rate was higher in West Africa (29.8% [95% CI: 22.9% - 36.7%]) than in East Africa (23.4% [95% CI: 9.4% - 37.4%]) and Central Africa (17.0% [95% CI: 14.4% - 19.5%]). The results of the meta-analyses are presented in
Figures 5-7
.
Figure 4. Meta-analysis of hepatitis B vaccination coverage among students in sub-Saharan Africa.
Figure 5. Meta-analysis of hepatitis B vaccination coverage among West African students.
Figure 6. Meta-analysis of hepatitis B vaccination coverage among East African students.
Figure 7. Meta-analysis of hepatitis B vaccination coverage among students in Central Africa.
4. Discussion
This systematic review estimates the vaccination coverage of students in sub-Saharan Africa. The coverage rate obtained (28.8% [95% CI: 22.9% - 34.7%]) shows that the majority of students in this geographical area are exposed to contamination by the hepatitis B virus. Auta’s work in 2018 showed that 24.7% of healthcare professionals are protected against this virus
[8]
. It is, therefore, possible to say that students in sub-Saharan Africa are as exposed as healthcare professionals, even if we can agree that the risks are higher for healthcare professionals due to blood exposure accidents (BEAs). Nevertheless, it should not be forgotten that, according to several studies, young people, through risky behaviors to which they are more prone, can be highly exposed to this disease. Additionally, apart from students in health or related fields such as biology, the level of knowledge about this disease is often poor
[11]
-
[13]
.
The World Health Organization (WHO) aims to eliminate hepatitis B by 2030 at the latest
[14]
. Reasonable doubts persist regarding this goal since, seven years later, barely a quarter of young people have been vaccinated, and resistance to vaccination is only increasing. Indeed, not only is the rise of anti-vaccine individuals real, but also disinformation campaigns are taking place on certain continents, making populations (especially young people) resistant to accepting vaccines
[15]
[16]
.
The vaccination coverage rate among students is not uniform in sub-Saharan Africa. Our study showed that coverage was higher in West Africa than in other regions. Indeed, while 29.8% [95% CI: 22.9% - 36.7%] of students in West Africa were protected, only 23.4% [95% CI: 9.4% - 37.4%] and 17.0% [95% CI: 14.4% - 19.5%] were protected in East Africa and Central Africa, respectively. This disparity, although it could be due to the political and social realities of each region, may reflect the willingness of different states to combat hepatitis B. The fight against this disease has led to the creation of national programs in many countries. However, health priorities are dynamic, and in the context of developing countries, it is not surprising to see budgets redirected towards other health challenges. Some recent studies mention the impact of COVID-19 on health programs in these countries; this may explain the differences in coverage
[17]
.
The hepatitis B vaccine is effective. Its financial accessibility for certain population groups could increase coverage across the continent. If this vaccine were made free for all students, the number of vaccinated individuals would increase. Additionally, through herd immunity, many other unvaccinated people would gain some protection. Furthermore, making vaccination mandatory upon university enrollment would be an effective way to protect students. In France, this approach is used and yields satisfactory results in the fight against this disease among students entering clinical training
[18]
. Given that most students live in close proximity to one another, vaccinating them all, regardless of their field of study, could be beneficial.
5. Conclusion
This systematic review reveals a low hepatitis B vaccination coverage among university students in sub-Saharan Africa, with significant regional disparities. Despite the World Health Organization’s (WHO) target to eliminate hepatitis B by 2030, our findings suggest that reaching this goal may be challenging, given that only about a quarter of students are currently vaccinated. To enhance coverage, strategies such as providing free vaccines to students and mandating vaccination upon university entry could be considered. These interventions have been successfully implemented in other contexts, such as France, where mandatory vaccination policies have led to increased coverage among students in clinical training programs
[12]
. However, the feasibility of such strategies in sub-Saharan Africa requires careful consideration of factors such as healthcare infrastructure, funding, and public acceptance. Future research should explore context-specific barriers to vaccination and identify practical solutions to enhance hepatitis B vaccine uptake in this vulnerable population.
References
World Health Organization, Global Hepatitis Programme (2017) Global Hepatitis Report, 2017.>https://www.who.int/fr/news-room/fact-sheets/detail/hepatitis-b
Yerbanga, I. (2016) Virus de l’hépatite B: Connaissances et couverture vaccinale en milieu scolaire et estudiantin dans la ville de Bobo-Dioulasso, Burkina Faso. Master’s Thesis, Université Polythechnique de Bobodioulasso Institut Supérieur des Sciences de la Santé.
Togtoga, L., Ndong, A., Bah, M.S., Ndoye, P.D., Niang, K. and Ndiaye, P. (2024) Statut vaccinal contre l’hépatite B chez les étudiants du premier cycle en médecine de l’Université Gaston Berger de Saint-Louis en 2023. Revue africaine de Biologie Médicale, 9, 1543-1554.
Pido, B. and Kagimu, M. (2005) Prevalence of Hepatitis B Virus (HBV) Infection among Makerere University Medical Students. African Health Sciences, 5, 93-98.
Pamatika, C.M., Mossoro-Kpindé, C.D., Dieme, A.H., Kongo, G.N., Kongo, G.N., Kodia, R.E.L., et al. (2022) Prévalence de l’hépatite virale B chronique à Bangui et Bimbo en République Centrafricaine: cas des donneurs bénévoles réguliers non éligibles pour les dons de sang [Prevalence of Chronic Viral Hepatitis B in Bangui and Bimbo in the Central African Republic: Cases of Regular Voluntary Donors Not Eligible for Blood Donations]. Annales Africaines de Medecine, 15, e4810-e4817. >https://doi.org/10.4314/aamed.v15i4.7
Attinsounon, C., Akonakpo, A., Adoukonou, T. and Dovonou, C. (2023) Facteurs de risque d’infections sexuellement transmissibles et utilisation du préservatif en milieu estudiantin en 2022. Médecine et Maladies Infectieuses Formation, 2, S110-S111. >https://doi.org/10.1016/j.mmifmc.2023.03.260
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al. (2021) The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ, 372, n71. >https://doi.org/10.1136/bmj.n71
Auta, A., Adewuyi, E.O., Kureh, G.T., Onoviran, N. and Adeloye, D. (2018) Hepatitis B Vaccination Coverage among Health-Care Workers in Africa: A Systematic Review and Meta-Analysis. Vaccine, 36, 4851-4860. >https://doi.org/10.1016/j.vaccine.2018.06.043
Sombié, R., Ouédraogo, R.P.G., Guingané, A. and Bougouma, A. (2015) Connaissance et couverture vaccinale contre le virus de l’hépatite B, des étudiants de l’université de Ouagadougou. Journal Africain d’Hépato-Gastroentérologie, 10, 21-24. >https://doi.org/10.1007/s12157-015-0635-3
Umuhoza, A., Nkurunziza, A., Mukashema, J., Mukarugenga, M.C., Ndayisenga, J.P. and Rugema, J. (2021) Knowledge, Attitudes, and Practices Towards Hepatitis B Virus Prevention among Nursing Students at a Selected Campus in Rwanda. Research Journal of Health Sciences, 9, 44-51. >https://doi.org/10.4314/rejhs.v9i1.5
Dab, W., Beltzer, N. and Moatti, J. (1993) Les modèles d’analyse des comportements à risque face à l’infection à VIH: Une conception trop étroite de la rationalité. Population, 48, 1505-1534. >https://doi.org/10.3917/popu.p1993.48n5.1534
Raia-Barjat, T., Gannard, I., Virieux, D., Del Aguila-Berthelot, C., Nekaa, M., Chauvin, F., et al. (2020) Health Students’ Knowledge of Sexually Transmitted Infections and Risky Behaviors before Participation to the Health Promotion Program. Médecine et Maladies Infectieuses, 50, 368-371. >https://doi.org/10.1016/j.medmal.2020.01.015
Nguyen, T.T.L., Pham, T.T.H., So, S., Hoang, T.H.V., Nguyen, T.T.U., Ngo, T.B., et al. (2021) Knowledge, Attitudes and Practices toward Hepatitis B Virus Infection among Students of Medicine in Vietnam. International Journal of Environmental Research and Public Health, 18, Article 7081. >https://doi.org/10.3390/ijerph18137081
Pruss-Ustun, A., Rapiti, E. and Hutin, Y. (2003) Blessures par objets tranchants: charge mondiale de morbidité due aux blessures par objets tranchants et tranchants chez les agents de santé. Série Charge environnementale des maladies n˚ 3. Organisation mondiale de la santé.
Durmaz, N. and Hengirmen, E. (2022) The Dramatic Increase in Anti-Vaccine Discourses during the COVID-19 Pandemic: A Social Network Analysis of Twitter. Human Vaccines&Immunotherapeutics, 18, Article ID: 2025008. >https://doi.org/10.1080/21645515.2021.2025008
Lee, S.K., Sun, J., Jang, S. and Connelly, S. (2022) Misinformation of COVID-19 Vaccines and Vaccine Hesitancy. Scientific Reports, 12, Article No. 13681. >https://doi.org/10.1038/s41598-022-17430-6
Hacker, K.A., Briss, P.A., Richardson, L., Wright, J. and Petersen, R. (2021) COVID-19 and Chronic Disease: The Impact Now and in the Future. Preventing Chronic Disease, 18. >https://doi.org/10.5888/pcd18.210086
Loulergue, P. and Launay, O. (2014) Vaccinations among Medical and Nursing Students: Coverage and Opportunities. Vaccine, 32, 4855-4859. >https://doi.org/10.1016/j.vaccine.2014.01.014
Abdela, A., Woldu, B., Haile, K., Mathewos, B. and Deressa, T. (2016) Assessment of Knowledge, Attitudes and Practices toward Prevention of Hepatitis B Virus Infection among Students of Medicine and Health Sciences in Northwest Ethiopia. BMC Research Notes, 9, Article No. 410. >https://doi.org/10.1186/s13104-016-2216-y
Adeleye, O.O., Oyelekan, A.A., Ale, A.O., Olaitan, A.O. and Ayanwale, A. (2019) The Knowledge and Reported Vaccination Status of Hepatitis B Virus Amongst Medical Students in a Nigerian Tertiary Teaching Hospital. Research Journal of Health Sciences, 7, 109-116. >https://doi.org/10.4314/rejhs.v7i2.5
Adenlewo, O.J., Adeosun, P.O. and Fatusi, O.A. (2017) Medical and Dental Students’ Attitude and Practice of Prevention Strategies against Hepatitis B Virus Infection in a Nigerian University. Pan African Medical Journal, 28, Article 83. >https://doi.org/10.11604/pamj.2017.28.33.11662
Ali, A.S., Hussein, N.A., Elmi, E.O.H., Ismail, A.M. and Abdi, M.M. (2023) Hepatitis B Vaccination Coverage and Associated Factors among Medical Students: A Cross-Sectional Study in Bosaso, Somalia, 2021. BMC Public Health, 23, Article No. 1060. >https://doi.org/10.1186/s12889-023-15992-2
Aniaku, J.K., Amedonu, E.K. and Fusheini, A. (2019) Assessment of Knowledge, Attitude and Vaccination Status of Hepatitis B among Nursing Training Students in Ho, Ghana. Annals of Global Health, 85, 18. >https://doi.org/10.5334/aogh.750
Aroke, D., Kadia, B.M., Anutebeh, E.N., Belanquale, C.A., Misori, G.M., Awa, A., et al. (2018) Awareness and Vaccine Coverage of Hepatitis B among Cameroonian Medical Students. BioMed Research International, 2018, Article ID: 3673289. >https://doi.org/10.1155/2018/3673289
Atiba, B.P., Ajao, K.O., Babalola, R.N., Awosusi, A.E., Ayeni, O.O. and Ijadunola, K.T. (2014) Hepatitis B Virus Infection and Its Modes of Prevention among Clinical Students of Obafemi Awolowo University (OAU), Ile-Ife, Nigeria. African Journal of Medicine and Medical Sciences, 43, 31-37.
Chingle, M., Osagie, I., Adams, H., Gwomson, D., Emeribe, N. and Zoakah, A. (2017) Risk Perception of Hepatitis B Infection and Uptake of Hepatitis B Vaccine among Students of Tertiary Institution in Jos. Annals of African Medicine, 16, 59-64. >https://doi.org/10.4103/aam.aam_49_16
Chukwurah, S.N., Nonyelum, N.J. and Paul, O.N. (2020) Knowledge, Attitude and Practice towards Hepatitis Virus Infection Prevention Among Healthcare Interns and Medical Students in A Tertiary Hospital, South-East Nigeria. Orient Journal of Medicine, 32, 1-9. >https://www.ajol.info/index.php/ojm/issue/view/18965
Balegha, A.N., Yidana, A. and Abiiro, G.A. (2021) Connaissance, attitude et pratique de la prévention de l’infection par l’hépatite B chez les étudiants en soins infirmiers dans la région du Haut Ghana occidental: Une étude transversale [Knowledge, Attitude and Practice of Hepatitis B Infection Prevention among Nursing Students in the Upper West Region of Ghana: A Cross-Sectional Study]. PLOS ONE, 16, e0258757. >https://doi.org/10.1371/journal.pone.0258757
Fortes Déguénonvo, L., Massaly, A., Ngom Gueye, N., Diallo Mbaye, K., Cisse Diallo, V., Lakhe, N., et al. (2019) Assessment of Knowledge, Attitudes and Practices of Medical Students Regarding Hepatitis B Infection at a Private University of Medicine in Senegal. Journal of Infectious Diseases and Epidemiology, 5, Article No. 103. >https://doi.org/10.23937/2474-3658/1510103
Ejembi, J., Muktar, H., Jimoh, O., Ibrahim, M.S., Ibrahim, A., Giwa, F., et al. (2020) Hepatitis B Vaccination Status among Medical Students at a Tertiary Institution in North-East Nigeria. International Journal of Infectious Diseases, 101, 526-527. >https://doi.org/10.1016/j.ijid.2020.09.1366
Mirambo, M.M., Mkumbo, E., Selega, H., Msemwa, B., Mushi, M.F., Silago, V., et al. (2020) Hepatitis B Virus Infections among Health Professional Students in Mwanza City, Tanzania in 2016. Archives of Public Health, 78, Article No. 76. >https://doi.org/10.1186/s13690-020-00459-2
Gebremeskel, T., Beshah, T., Tesfaye, M., Beletew, B., Mengesha, A. and Getie, A. (2020) Assessment of Knowledge and Practice on Hepatitis B Infection Prevention and Associated Factors among Health Science Students in Woldia University, Northeast Ethiopia. Advances in Preventive Medicine, 2020, Article ID: 9421964. >https://doi.org/10.1155/2020/9421964
Adjei Gyimah, A., Peprah, P., Agyemang-Duah, W., Frimpong, E., Kwegyir Tsiboe, A. and Aboagye Darkwa, M. (2021) Hepatitis B Vaccination Status and Associated Factors among University Students in Ghana: A Cross-Sectional Survey. Cogent Medicine, 8, Article ID: 2005226. >https://doi.org/10.1080/2331205x.2021.2005226
Haile, K., Timerga, A., Mose, A. and Mekonnen, Z. (2021) Hepatitis B Vaccination Status and Associated Factors among Students of Medicine and Health Sciences in Wolkite University, Southwest Ethiopia: A Cross-Sectional Study. PLOS ONE, 16, e0257621. >https://doi.org/10.1371/journal.pone.0257621
Kachimanga, C., Bangura, M., Nyama, E., Mhango, M., Reed, V., Rodriguez, M.P., et al. (2020) Screening and Linkage to Care for Medical Students with Hepatitis B Virus Infection in Sierra Leone. Heliyon, 6, e04673. >https://doi.org/10.1016/j.heliyon.2020.e04673
Kana, M., Omole, N., Nmadu, A., Joshua, I. and Muhammad-Idris, Z. (2020) Hepatitis B and C: An Assessment of Risk Exposure and Prevalence among Preclinical Medical Students in Northwestern Nigeria. Nigerian Journal of Medicine, 29, 62-68. >https://doi.org/10.4103/1115-2613.284897
Kumah, A., Tormeti, E., Dzando, G., Nutakor, H.S., Amenuvor, W.A.Y., Anagblah, C.K., et al. (2021) Knowledge, Attitude and Practices Towards Hepatitis B Infection and Vaccination among Public Health Students in Ghana. Open Journal of Preventive Medicine, 11, 43-53. >https://doi.org/10.4236/ojpm.2021.111004
Lohouès-Kouacou, M.J., Assi, C., Nigué, L., Biékré, A.R., Ouattara, A., Koné, S., et al. (2013) Connaissance et couverture vaccinale contre l’hépatite virale B (HVB): Étude transversale parmi les étudiants de l’université de Cocody, Côte d’Ivoire. Revue d’Épidémiologie et de Santé Publique, 61, 494-498. >https://doi.org/10.1016/j.respe.2013.04.007
Maina, A.N. and Bii, L.C. (2020) Factors Affecting HBV Vaccination in a Medical Training College in Kenya: A Mixed Methods Study. BMC Public Health, 20, Article No. 48. >https://doi.org/10.1186/s12889-020-8158-2
Makan, N., Song, E., Kinge, C.W. and Kramvis, A. (2023) Hepatitis B Virus Immunity Prior to and after Administration of a ‘booster’ Dose of Vaccine among Health-Care Students at a South African University. Vaccine: X, 14, Article ID: 100284. >https://doi.org/10.1016/j.jvacx.2023.100284
Paul, N. and Peterside, O. (2015) Hepatitis B Vaccination Rate among Medical Students at the University of Port Harcourt Teaching Hospital (Upth). World Journal of Vaccines, 5, 1-7. >https://doi.org/10.4236/wjv.2015.51001
Noubiap, J.J.N., Nansseu, J.R.N., Kengne, K.K., Tchokfe Ndoula, S. and Agyingi, L.A. (2013) Occupational Exposure to Blood, Hepatitis B Vaccine Knowledge and Uptake among Medical Students in Cameroon. BMC Medical Education, 13, Article No. 148. >https://doi.org/10.1186/1472-6920-13-148
Odusanya, O.O., Meurice, F.P. and Hoet, B. (2007) Nigerian Medical Students Are at Risk for Hepatitis B Infection. Transactions of the Royal Society of Tropical Medicine and Hygiene, 101, 465-468. >https://doi.org/10.1016/j.trstmh.2006.08.001
Okeke, E., Ladep, N., Agaba, E. and Malu, A. (2008) Hepatitis B Vaccination Status and Needle Stick Injuries among Medical Students in a Nigerian University. Nigerian Journal of Medicine, 17, 330-332. >https://doi.org/10.4314/njm.v17i3.37404
Osei, E., Niyilapah, J. and Kofi Amenuvegbe, G. (2019) Hepatitis B Knowledge, Testing, and Vaccination History among Undergraduate Public Health Students in Ghana. BioMed Research International, 2019, Article ID: 7645106. >https://doi.org/10.1155/2019/7645106
Pido, B. and Kagimu, M. (2005) Prevalence of Hepatitis B Virus (HBV) Infection among Makerere University Medical Students. African Health Sciences, 5, 93-98. >https://www.ajol.info/index.php/ahs/article/view/6877
Saké, K., Alassani, C.A., Adè, S., Kouessi, P., Kiki, M., Akanni, D.M., Attinsounon, C.A., Dovonou, C.A., Fanou, C.D., Mama Cissé, I., Kpangon, A., Amidou A.S. and Savi De Tovè, S.M. (2021) Séroprevalence de infection par le virus de l’hépatite b et les facteurs associes chez les étudiants en prémiere année de médecine générale à l’université de Parakou en république du Bénin, en 2018. Annales de l’Université de Parakou, Série “Sciences de la Santé”, 11, 24-27.
Sawadogo, P.M., et al. (2022) L’hépatite virale B en milieu de soins: Facteurs associés à la vaccination chez les élèves professionnels de santé de l’Ecole nationale de santé publique de Ouagadougou, Burkina Faso. Pan African Medical Journal, 42, Article 227.
Sofola, O.O. and Uti, O.G. (2008) Hepatitis B Virus Infection and Prevention in the Dental Clinic: Knowledge and Factors Determining Vaccine Uptake in a Nigerian Dental Teaching Hospital. Nigerian Quarterly Journal of Hospital Medicine, 18, 145-148. >https://europepmc.org/article/med/19062478
Tawiah, P.A., Abaka-Yawson, A., Effah, E.S., Arhin-Wiredu, K. and Oppong, K. (2021) Prevalence and Risk Factors of Hepatitis B Virus Infection among Medical Laboratory Science Students in a Ghanaian Tertiary Institution. Journal of Health Research, 36, 442-452. >https://doi.org/10.1108/jhr-06-2020-0191