Hepatitis B virus (HBV) infection is a serious public health problem in sub-Saharan Africa. The risk of vertical transmission increases if the mother is hepatitis B surface antigen (HBsAg) positive and more so when she is also hepatitis B envelope antigen (HBeAg) positive. Since 2000, the World Health Organization recommends screening of pregnant women for HBV infection. However, this is not currently practiced in Tanzania. The objective of this study was to determine seroprevalence and associated factors of HBV infection among pregnant women attending antenatal clinic at the Muhimbili National Hospital, in Dar es Salaam, Tanzania. This cross-sectional study was conducted from August-September 2010. Data on sociodemographic characteristics, obstetric and risk factors such as history of blood transfusion, and risky sexual practices was collected. Blood samples were tested for HBsAg, HBeAg, antibodies to HBsAg (AntiHBs), IgM antibodies to hepatitis B core antigen (Anti-HBc) and anti-HIV antibodies. A total of 310 pregnant women (28.5±5.4 years) were enrolled in the study. Thirty-one percent (96) of the women were primigravidae. Most of studied women were of low educational status and married. The seroprevalence of HBsAg was 3.9% (12/310) and none had detectable anti-HBs. None had IgM HBcAb, thus excluding acute HBV infection. All women tested negative for HBeAg. The overall seroprevalence of HIV infection was 9.7%. Three of 12 (25%) women had HBV-HIV co-infection. None of the assessed associated factors were significantly related to HBV infection. In conclusion, the seroprevalence of HBsAg among women attending antenatal care at Muhimbili National Hospital is moderate. It is recommended to introduce routine antenatal screening for HBV and "at birth dose" vaccination to new born babies of mothers found to be HBsAg positive.

Background The decision to implement new vaccines should be supported by public health and economic evaluations. Therefore, this study was primarily designed to evaluate the economic impact of switching from partially combined vaccine (Pentaxim® plus hepatitis B) to fully combined vaccine (Hexaxim®) in the Malaysian National Immunization Program (NIP) and to investigate healthcare professionals (HCPs)’ and parents’/caregivers’ perceptions. Methods In this economic evaluation study, 22 primary healthcare centers were randomly selected in Malaysia between December 2019 and July 2020. The baseline immunization schedule includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses), whereas the alternative scheme includes switching from Pentaxim® (four doses) and hepatitis B (three doses) to Hexaxim® (four doses) and hepatitis B (one dose) administered at birth. Direct medical costs were extracted using a costing questionnaire and an observational time and motion chart. Direct non-medical (cost for transportation) and indirect costs (loss of productivity) were derived from parents’/caregivers’ questionnaire. Also, HCPs’ and parent’s/caregivers’ perceptions were investigated using structured questionnaires. Results The cost per dose of Pentaxim® plus hepatitis B vs. Hexaxim® for the baseline scheme was Malaysian ringgit (RM) 31.90 (7.7 United States dollar [USD]) vs. 17.10 (4.1 USD) for direct medical cost, RM 54.40 (13.1 USD) vs. RM 27.20 (6.6 USD) for direct non-medical cost, RM 221.33 (53.3 USD) vs. RM 110.66 (26.7 USD) for indirect cost, and RM 307.63 (74.2 USD) vs. RM 155.00 (37.4 USD) for societal (total) cost. A similar trend was observed for the alternative scheme. Compared with Pentaxim® plus hepatitis B, total cost savings per dose of Hexaxim® were RM 137.20 (33.1 USD) and RM 104.70 (25.2 USD) in the baseline and alternative scheme, respectively. Eighty-four percent of physicians and 95% of nurses supported the use of Hexaxim® in the NIP. The majority of parents/caregivers had a positive perception regarding Hexaxim® vaccine in various aspects. Conclusions Incorporation of Hexaxim® within Malaysian NIP is highly recommended because the use of Hexaxim® has demonstrated substantial direct and indirect cost savings for healthcare providers and parents/caregivers with a high percentage of positive perceptions, compared with Pentaxim® plus hepatitis B. Trial registration Not applicable.