Factors Affecting HBV Vaccination in a Medical Training College in Kenya: A Mixed Methods Study

Abstract Background: Hepatitis B Virus (HBV) is highly endemic in Sub-Saharan Africa with 70 to 90% of the population becoming infected before the age of 40 years. Healthcare workers (HCWs) including healthcare students (HCSs) are at an increased risk of contracting HBV due to occupational exposure. HCS are especially at a high risk because of their inexperience with infection control procedures and insufficient knowledge about the level of risk when dealing with patients. Despite the availability of an effective vaccine, and its recommendation by Kenya’s Ministry of Health, few HCW and students are vaccinated. The aim of this study was to evaluate the influence of awareness, attitude, practices, and access factors on hepatitis B vaccination uptake by HCS at Kenya Medical Training College (KMTC). Methods: This was a concurrent mixed methods study. For the qualitative arm, a structured questionnaire was used to assess the awareness, knowledge, attitudes and practices towards HBV disease and vaccination. Accessibility of the HBV vaccine in the participating campuses was also assessed. Two FGDs were carried out: one comprised of members of the participating campuses while the second comprised members of staff. Quantitative data was analysed using STATA (version 15) while NVIVO (version 11) was used for qualitative data. Results: Out of 634 students invited to participate in the study, 487 participated (response rate 76.81%). HBV vaccine uptake rate was 76.18% while the non-vaccination rate was 19.10%. Full vaccination was reported by only 21.78% of respondents. The major reason for not receiving the recommended doses was that the vaccine was not available when the students went for it. The qualitative study revealed challenges in the implementation of the vaccination program at KMTC. Conclusions: A clear policy on mandatory vaccination of students and staff is required. In addition, the HBV vaccine should be readily available, affordable and accessible at all times. Regular review of the curricula in medical colleges to include current vaccination recommendations could aid in improving the vaccination status of healthcare workers in particular and the larger community in general.