https://orcid.org/0000-0002-0265-1822
Figures
Abstract
Hepatitis B virus (HBV) infection remains major public health concern in Ghana, where prevalence is high despite the availability of an effective vaccine. Informal sector workers represent a large proportion of the national workforce but have limited access to preventive health services. This study assessed hepatitis B vaccination coverage and its predictors among informal sector workers in Kejetia market, Kumasi, Ghana. A cross-sectional analytical study was conducted among 809 market workers selected using stratified random sampling across different occupational groups. Data were collected using structured interviewer-administered questionnaires covering sociodemographic characteristics, HBV awareness and knowledge, and vaccination history. Vaccination uptake was categorized as at least one dose (≥1) and full coverage (≥3 doses). Logistic regression analyses were used to identify predictors of vaccination uptake. Overall, only 137 (16.9%) had completed the three-dose schedule, though 256 (31.6%) of participants reported having received at least one dose of HBV vaccine. While 718 (88.8%) of respondents had heard of HBV infection, 619 (76.5%) reported very little or no knowledge about the disease, and 402 (49.7%) did not know its routes of transmission. Vaccination uptake was significantly higher among those who had received HBV-related health education, 175 (62.7%) compared to those who had not 18 (15.3%, p < 0.001). In the multivariate logistic regression model, ≤ 30 years (aOR = 2.209, 95% CI [1.140–4.282], p = 0.019), secondary education (aOR = 2.426, 95% CI [1.220–4.824], p = 0.012), and tertiary education (aOR = 4.796, 95% CI [2.121–10.845], p < 0.001) were the independent predictors of vaccination status. HBV vaccination coverage among informal sector workers in Kejetia Market is alarmingly low despite high general awareness of the infection. Sociodemographic factors and receipt of HBV-related health education strongly influenced uptake. These findings underscore the urgent need for targeted health education and subsidized vaccination programs tailored to informal sector workers in Ghana to achieve national HBV elimination goals.
Citation: Obeng MA, Okwan DK, Boateng CO, Scott GY, Attah JK, Ahadzie SYN, et al. (2026) Towards hepatitis B elimination in Ghana: vaccination coverage and its predictors among informal sector workers in Kejetia, Kumasi, Ghana. PLoS One 21(4): e0334205. https://doi.org/10.1371/journal.pone.0334205
Editor: Jason T. Blackard, University of Cincinnati College of Medicine, UNITED STATES OF AMERICA
Received: September 23, 2025; Accepted: March 17, 2026; Published: April 2, 2026
Copyright: © 2026 Obeng et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: The data underlying the results presented in the study are available from Dryad at https://doi.org/10.5061/dryad.z8w9ghxsg.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
Introduction
Hepatitis B virus (HBV) infection remains a significant global public health concern, despite the availability of a safe and highly effective vaccine [1–4]. In 2019, an estimated 296 million people were living with chronic HBV infection worldwide, resulting in approximately 820,000 deaths, primarily due to cirrhosis and hepatocellular carcinoma [1,2,5,6]. The African region bears a disproportionately high burden, with prevalence rates of 6–8%, while Ghana is classified as hyperendemic with prevalence estimates ranging from 8% to 15% [1,7].
Vaccination is the cornerstone of HBV prevention. The World Health Organization (WHO) recommends timely infant vaccination, completion of the vaccine series, and catch-up vaccination for unvaccinated adolescents and adults at risk [8,9]. However, in Ghana, despite the integration of HBV vaccination into the Expanded Programme on Immunization (EPI) since 2002, adult coverage remains low, with barriers including limited awareness, high costs, access challenges, and poor vaccine completion rates [10–13].
Informal sector workers are particularly vulnerable because of poor access to workplace health services, irregular income, and limited exposure to health education programs [14–16]. In Ghana, the informal sector represents a large proportion of the national workforce, yet HBV vaccination uptake within this group is poorly characterized [17,18]. The Kejetia Market in Kumasi, one of the largest open-air markets in West Africa, provides a unique setting to study this population. The market accommodates thousands of sellers, traders, and workers from diverse sociodemographic and cultural backgrounds, reflecting a microcosm of Ghana’s informal economy [19]. Given their constant interaction with large numbers of people and limited access to preventive health interventions, market workers are at elevated risk for infectious diseases, including HBV [20].
Recent global policy shifts highlight the urgency of improving adult vaccination. In April 2022, the U.S. Advisory Committee on Immunization Practices (ACIP) recommended universal hepatitis B vaccination for all adults aged 19–59 years, removing the need for risk-based eligibility [21,22]. In March 2023, the U.S. Centers for Disease Control and Prevention (CDC) further recommended universal lifetime screening for HBV infection in adults aged ≥18 years using a triple serologic panel [23]. These recommendations remove barriers associated with risk-based eligibility and hold promise for broader vaccine uptake and reduction in HBV cases.
Although these guidelines are U.S.-centric, they emphasize the global need to expand vaccine access to adults, particularly underserved groups. In line with Ghana’s HBV elimination goals, it is essential to generate context-specific evidence on vaccination uptake and determinants among informal sector workers [24–26].
This study, therefore aimed to assess hepatitis B vaccination coverage, dose completion, and predictors among sellers and workers at Kejetia Market in Kumasi, Ghana, to inform targeted interventions for this high-risk and underserved population.
Materials and methods
Study design
This study employed a cross-sectional analytical design to assess the uptake of hepatitis B vaccination and its determinants among informal sector workers in Ghana. The study collected quantitative data from various informal sector workers to determine their vaccination status, knowledge, perceptions, and barriers to vaccination.
Study setting
The study was conducted from 8th June 2024–5th January 2025 at Kejetia, a major commercial centre in Ghana, where a larger proportion of informal sector workers engage in trade, transport, and service-related activities. It is an open-air market place in Kumasi, a city in the Ashanti Region of Ghana, with over 8,000 stores and stalls [19]. This location was chosen due to its diverse informal workforce and potential risk of occupational exposure to HBV infection.
Study population, inclusion and exclusion criteria
The study population was made up of randomly selected participants consisting of informal sector workers who belonged to any of the following occupational groups; butchers and meat sellers, fishmongers, tailors and seamstresses, head porters (kayayei), drivers and mates, food vendors, and general goods storekeepers. Participants were eligible if they were 18 years and above, had worked in Kejetia Market for at least six months, and provided informed consent to participate. Individuals who were mentally challenged were excluded.
Sample size and sampling procedure
The minimum sample size was calculated using Cochran’s formula for single proportions:
Where:
n = required sample size
Z = standard normal deviation at 95% confidence level (1.96)
p = assumed prevalence of hepatitis B vaccination uptake (50%), chosen to maximize sample size since no prior data were available for informal sector workers in Ghana
d = margin of error (0.05)
Substituting:
To account for design effect due to stratified sampling, we doubled the sample size (384 × 2 = 768). An additional 5% was added to adjust for potential non-response (≈41). Thus, the final minimum required sample size was 809 participants, which was achieved in this study.
A stratified sampling technique was employed to ensure representation from different categories of informal sector workers. Participants were grouped into occupational strata (e.g., butchers, food vendors, drivers), and a proportionate random sampling approach was used within each stratum to obtain a representative sample. The sampling frame was developed through collaboration with market leadership and recognized trader associations, which maintain registers of traders and workers across the major market sections. Informal workers were first stratified into predefined subgroups based on the nature of their economic activities (e.g., butchers, food vendors, drivers).
The estimated population size of each subgroup was obtained from these records and validated through consultations with section heads and market executives. Proportional allocation was then applied to determine the number of participants to be selected from each stratum relative to its size within the overall market population. Within each stratum, eligible participants were selected using simple random sampling techniques (See Table 1.). This approach minimized selection bias and ensured that the final sample reflected the occupational composition of informal sector workers at Kejetia Market.
Data collection
Data were collected using a structured, interviewer-administered questionnaire designed to capture knowledge and level of awareness of HBV infection, demographic data, occupational data, occupational hazards, HBV vaccination status, knowledge, perceptions, and barriers to vaccination. Trained research assistants conducted these face-to-face interviews with participants. Questionnaires were administered in English and local languages where necessary. Vaccination status was self-reported and, where possible, verified by vaccination cards.
Vaccination history was primarily based on participants’ self-reporting due to the limited availability of vaccination cards in this informal population. To improve accuracy, participants were probed about the number of doses received, approximate dates, and sites of vaccination. Although recall bias cannot be excluded, self-reporting has been widely used in similar HBV epidemiological studies in Ghana and other African countries [11,27–30]. We also cross-checked available vaccination cards when presented by participants, which helped partially validate the self-reported information. The questionnaire used in this study is presented in the supplementary materials (S1 File).
Study variables and measurements
The dependent variable was hepatitis B vaccination uptake, defined as receipt of at least one dose of the hepatitis B vaccine, as reported by the participant. For analytical purposes, vaccination uptake was coded as a binary variable (Yes/No). Participants who reported having received one or more doses of the hepatitis B vaccine were classified as having taken up vaccination, whereas those who reported never receiving any dose were classified as unvaccinated.
Information on completion of the full hepatitis B vaccination series (three or more doses) was collected and described separately but was not used as the primary outcome variable for the regression analysis.
The independent variables included socio-demographic factors (age, gender, educational level, etc), knowledge and perception of HBV and vaccination, barriers and facilitators to vaccination (cost, availability, employer support), and willingness to participate in an HBV education program.
Definition of terms
Hepatitis B vaccination coverage refers to the proportion of the study participants who have received at least three shots of the HBV vaccine as recommended by the WHO.
Incomplete vaccination refers to individuals who have taken one or two shots of the HBV vaccine.
Data analysis
Data were entered into Microsoft Excel 2019 and analyzed using SPSS version 26. Descriptive statistics (frequencies, percentages) were used to summarize participant characteristics. Chi-square tests were used to examine associations between independent variables and vaccination status. Logistic regression analysis was performed to identify independent predictors of vaccination uptake. Crude odds ratios (cOR) and adjusted odds ratios (aOR) with 95% confidence intervals (CI) were reported. A p-value < 0.05 was considered statistically significant.
Ethical considerations
Ethical approval for this study was obtained from the Committee on Human Research Publication and Ethics (CHRPE), School of Medical Sciences, KNUST with approval number, CHRPE/AP 180/24. Permission was also obtained from Kejetia market management prior to data collection. All participants provided written informed consent. Data were anonymized to ensure confidentiality, and participation was voluntary with the right to withdraw at any stage without penalty. Written informed consent was obtained from all participants before recruitment.
Results
Sociodemographic and Behavioral Factors Associated with Hepatitis B Vaccination
Most of the participants were ≤ 30 years 322 (39.8%), were female 515 (63.7%), were married 408 (50.4%). The majority of them were Christians 590 (72.9%), from the Ashanti region 445 (55.0%), had basic education 357 (44.1%), and had stayed in urban areas for the greater part of their lives 610 (75.4%). Most of them did not have a close person living with hepatitis B 706 (87.3%). Majority of them stated that testing and vaccinating against Hepatitis B infection is expensive 362 (44.7%). Most of them were general goods storekeepers 201 (24.8%) (Table 2).
There was a significant association between age group (p < 0.001), marital status (p < 0.001), region (p = 0.001), educational level (p = 0.009), residence (p = 0.014), work type (p = 0.016) and vaccination status. However, gender (p = 0.996), religion (p = 0.076), having close person with hepatitis B infection (p = 0.057), perception about the cost of testing and vaccinating against Hepatitis B infection (p = 0.617) and Hepatitis B vaccination status were not statistically significant (Table 2).
Hepatitis B vaccination coverage and influencing factors among the study participants
Fig 1 illustrates the coverage of Hepatitis B vaccination among the study participants, along with the doses of the vaccine that they have taken.
Out of the total participants, most of them 553 (68.4%) had not been vaccinated against Hepatitis B infection, while 256 (31.6%) had received at least one dose of the Hepatitis B vaccine (Fig 1A). Only 137 (16.9%) of them had taken at least 3 doses of the Hepatitis B vaccine, while about 553 (68.4%) had not taken any dose (Fig 1B).
Fig 2 illustrates Hepatitis B vaccination uptake and influencing factors among the participants.
Having prior knowledge about Hepatitis B infection was significantly associated with vaccine uptake (Fig 2A). Among those unvaccinated, the most common reason cited was the cost 326 (59.0%) (Fig 2B), which is further emphasized in (Fig 2C) where 440 (79.6%) of them stated that they would take the Hepatitis B vaccination if given to them for free. Among those vaccinated, 117 (45.7%) of them indicated that they took self-initiative to get vaccinated (Fig 2D).
Awareness and knowledge of hepatitis B among participants
Awareness of Hepatitis B infection was generally high, with 718 (88.8%) indicating they were aware of the infection. When asked which group of people should be encouraged to take the hepatitis B vaccine, majority 507 (62.7%), correctly indicated it should be those who are not infected, however, 175 (21.6%) reported not knowing.
A substantial 402 (49.7%) indicated they did not know the transmission route of Hepatitis B virus. Most 508 (62.8%) of them indicated that they were aware of vaccine availability against Hepatitis B infection. When asked about how much they know about Hepatitis B infection, most 323 (39.9%) of them indicated that they know very little about it (Table 3).
Predictors of hepatitis B vaccination.
In the univariate logistic regression model, age group, marital status, region, educational level, and residence were predictors of hepatitis B vaccination. In the multivariate logistic regression model, respondents aged ≤ 30 years (aOR = 2.209, 95% CI [1.140–4.282], p = 0.019), had 2.21 times higher odds of being vaccinated against hepatitis B compared with those aged ≥ 51 years. Participants with secondary education (aOR = 2.426, 95% CI [1.220–4.824], p = 0.012), were approximately 2.4 times more likely to be vaccinated compared to those with no education. Similarly, respondents with tertiary education (aOR = 4.796, 95% CI [2.121–10.845], p < 0.001) had nearly five times higher odds of hepatitis B vaccination compared with those of no education (Table 4).
Discussion
Vaccination coverage among informal sector workers
This study assessed hepatitis B vaccination coverage and its predictors among informal sector workers at Kejetia market in Kumasi, Ghana. The overall vaccination coverage (≥3 doses) was 137 (16.9%) (Fig 1B), though 256 (31.6%) reported having taken at least one shot of the vaccine (≥1 dose). For adults, adequate protection against hepatitis B is obtained through a three-dose vaccination schedule [31]. This means that less than one in five of the study population is likely to remain protected against future HBV exposure. This low vaccination uptake is a serious public health challenge for a country with high HBV prevalence like Ghana and thus increased transmission risk [32]. These findings indicate critically low vaccination coverage, highlighting the urgent need for targeted public health interventions by policymakers to improve HBV vaccination coverage. These results highlight a significant gap in adult HBV prevention among this population, despite the availability of an effective vaccine. Findings from this study are consistent with the 18% vaccination coverage from Tanzania [29] and comparable to the 20.04% vaccination coverage (≥3 doses) reported from a systematic review among health care workers in Ethiopia [33]. Still, the HBV vaccination coverage recorded in this study is higher than the 11.4% reported among healthcare workers (HCWs) in Cameroon [34], 6.7% among HCWs in the Eastern Democratic Republic of the Congo [35] and the 5.4% among HCWs in Northwest Ethiopia [36]. Vaccination coverage in this study is lower than what has been reported among HCWs in Ghana (43.6%), HCWs in Nigeria (36.2%), HCWs in South Africa (49.0%), general adult population in Uganda (26.7%) and nurses Ethiopia (36.9%) [11,37–40]
The higher vaccination coverage reported among healthcare workers compared with the informal sector workers in this study may be explained by several factors. Healthcare workers often receive occupational health training that increases awareness of blood-borne infections and the importance of vaccination. In many healthcare facilities, hepatitis B vaccination is recommended or facilitated through workplace policies, occupational health programs, or infection prevention initiatives. In contrast, informal sector workers typically lack structured workplace health programs and may face financial and logistical barriers to accessing vaccination services. These structural differences likely contribute to the lower vaccination coverage observed in informal sector populations.
Hepatitis B vaccination uptake and influencing factors among the participants
The study revealed that age group, marital status, education level, residence and work type are the statistically significant variables influencing HBV vaccination uptake (Table 1). Our finding aligns with other African studies, though different populations, a similar trend exists. For example, among Ghanaian health facility staff, age group, marital status, and profession were all significantly associated with vaccination (p < 0.001) [11]. In Kampala, Uganda, lower education, age and marital status predicted greater vaccine hesitancy [41]. These concordant findings underscore the consistent influence of sociodemographic factors on adult HBV vaccine uptake across diverse African settings [40,42,43]. Vaccination coverage increased with increasing age group and increasing educational level. This study demonstrated that participants who had lived more in urban centers having higher odds of HBV vaccine coverage than their rural counterparts. This could be due to increased health educational programs and access to health facilities among urban dwellers compared to rural dwellers.
Married participants had significantly higher vaccination coverage compared to singles or those cohabiting. This may reflect the role of spousal and family influence in health-seeking behaviors, where partners encourage one another to pursue preventive health measures. Married individuals are also more likely to access healthcare services during antenatal or family planning visits, creating opportunities for HBV screening and vaccination [44]. Conversely, singles or cohabiting individuals may perceive themselves at lower risk or may lack the social support and motivation to prioritize preventive measures such as vaccination [45]. These findings indicate that family and social dynamics are important considerations in designing HBV vaccination campaigns.
Participants who had received hepatitis B–related health education demonstrated substantially higher vaccination uptake compared with those without prior health education, highlighting the importance of targeted health education in improving vaccine coverage (Fig 2A). The difference was statistically significant consistent with other studies [13,40,46]. Our study emphasizes that, public education can be one of the key ways to increase the vaccination coverage and encourage HBV preventive practices which will contribute to the 2030 HBV elimination goal as set by WHO.
Cost-related barriers emerged as the dominant reason for non-vaccination among unvaccinated participants, alongside time constraints, lack of specific reasons, and limited awareness of the hepatitis B vaccine. Notably, a substantial majority of unvaccinated participants indicated willingness to receive the vaccine if it were provided free of charge, underscoring the critical role of affordability in hepatitis B vaccination uptake (Fig 2C). Our findings show that, subsidizing the HBV vaccination and or probably making it free of charge to be covered under the national health insurance scheme can improve vaccination coverage among adults in Ghana.
Awareness and knowledge of Hepatitis B among participants
While 717 (88.8%) cited having heard of HBV infection before, 619 (76.5%) reported either very little knowledge or no knowledge about hepatitis B infection. Again, when asked the route of transmission of HBV, almost half of them 402 (49.7%) said they do not know (Table 2). This pattern – high general awareness but low specific knowledge – has been observed in multiple Ghanaian studies. For example, barbers in Obuasi reported high awareness (~90%) yet poor understanding of transmission and prevention [20]. Similarly, a community study of young adults found widespread awareness but low knowledge and low testing/vaccination uptake [47], while a mixed-methods survey of street beauticians and barbers reported ~88% awareness but two-thirds with poor knowledge [48]. Low knowledge has also been linked with reduced testing and preventive behaviors in national surveys, underscoring the need for targeted education interventions among market populations [49].
Strengths and limitations
Vaccination history was mainly based on participant recall due to limited availability of vaccination cards, which may have introduced recall bias. The proportion of participants who presented vaccination cards were 224 (82.1%) of those who reported having taken the shot. This reduces the chances of recall bias. Also, factors such as previous HBV testing, perceptions of stigma, or cultural beliefs around vaccination were not deeply explored, which might also influence uptake. Other limitations include the absence of serologic testing to confirm vaccine-induced immunity (e.g., anti-HBs antibody levels), which limits our ability to distinguish between vaccination and actual immunologic protection. Also, the single-site nature of the study conducted at Kejetia Market in Kumasi, which may limit the generalizability of findings to other informal sector populations or geographic settings in Ghana. Notwithstanding, our study has several strengths. This is the first study, to our knowledge, that specifically assessed hepatitis B vaccination coverage and its determinants among informal sector workers in Kejetia market, one of the largest open-air markets in West Africa. The findings therefore provide context-specific evidence for a high-risk but under-researched population. Again, with 809 participants across diverse occupational groups (e.g., traders, food vendors, porters, butchers, seamstresses), the study achieved broad representation of informal workers, enhancing the generalizability of the findings to similar market settings in Ghana. Lastly, the study provides timely evidence to inform Ghana’s HBV elimination efforts and highlights actionable areas such as health education and subsidized vaccination, which can guide interventions within informal sector populations.
Conclusion
This study demonstrated that hepatitis B vaccination coverage among informal sector workers in Kejetia market, Kumasi, remains alarmingly low, with fewer than one in five participants completing the recommended three-dose schedule. Despite high awareness of hepatitis B, detailed knowledge about the infection and its transmission was poor, and uptake was strongly influenced by sociodemographic factors such as age, marital status, education level, residence, and work type. Importantly, receipt of HBV-related health education was associated with markedly higher vaccine uptake, underscoring the value of targeted educational interventions.
The findings highlight the urgent need to scale up accessible and affordable HBV vaccination programs tailored to informal sector workers, including integration into workplace and market-based health outreach initiatives. Policies such as subsidizing or covering vaccination under the National Health Insurance Scheme could address financial barriers, while structured health education campaigns may help close persistent knowledge gaps. Strengthening these efforts will be critical for Ghana to meet its HBV elimination targets and to protect vulnerable populations within the informal economy.
Acknowledgments
We express our greatest appreciation to the management of Kejetia market and all the study participants who willingly took part in this study.
References
- 1. Sepanlou SG, Safiri S, Bisignano C, Ikuta KS, Merat S, Saberifiroozi M, et al. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5.
- 2. Jefferies M, Rauff B, Rashid H, Lam T, Rafiq S. Update on global epidemiology of viral hepatitis and preventive strategies. World J Clin Cases. 2018;6(13):589–99. pmid:30430114
- 3. Hsu Y-C, Huang DQ, Nguyen MH. Global burden of hepatitis B virus: current status, missed opportunities and a call for action. Nat Rev Gastroenterol Hepatol. 2023;20(8):524–37. pmid:37024566
- 4. Das S, Ramakrishnan K, Behera SK, Ganesapandian M, Xavier AS, Selvarajan S. Hepatitis B Vaccine and Immunoglobulin: Key Concepts. J Clin Transl Hepatol. 2019;7(2):165–71. pmid:31293917
- 5. World Health Organization RWP. Viral hepatitis B and C policies in countries and burden of disease in WHO regions. World Heal Organ. 2023.
- 6.
World Health Organization. Global hepatitis report 2024: action for access in low- and middle-income countries. Geneva: World Health Organization; 2024.
- 7. Schmit N, Nayagam S, Thursz MR, Hallett TB. The global burden of chronic hepatitis B virus infection: comparison of country-level prevalence estimates from four research groups. Int J Epidemiol. 2021;50(2):560–9. pmid:33367672
- 8. Nayagam S, Thursz M. Strategies for Global Elimination of Chronic HBV Infection: 2019 Update. Curr Hepatology Rep. 2019;18(3):300–9.
- 9. Al-busafi SA. Global perspectives on the hepatitis B vaccination: challenges, achievements, and the road to elimination by 2030. 2024.
- 10. Dodoo ANO, Renner L, van Grootheest AC, Labadie J, Antwi-Agyei KO, Hayibor S, et al. Safety monitoring of a new pentavalent vaccine in the expanded programme on immunisation in Ghana. Drug Saf. 2007;30(4):347–56. pmid:17408311
- 11. Okwan DK, Scott GY, Takyi P, Boateng CO, Antwi PB, Abrampah AA, et al. A Multicentre Cross-Sectional Study on Hepatitis B Vaccination Coverage and Associated Factors Among Personnel Working in Health Facilities in Kumasi, Ghana. Biomed Res Int. 2024;2024:8899638. pmid:39534102
- 12. Kusi KA, van der Puije W, Asandem DA, Baba-Adam R, Agbevey H, Asare B, et al. World Hepatitis day 2021 -screening and vaccination against Hepatitis B virus in Accra, Ghana. BMC Public Health. 2023;23(1):1164. pmid:37328849
- 13. Senoo-Dogbey VE, Anto F, Quansah R, Danso-Appiah A. Completion of three-dose hepatitis B vaccination cycle and associated factors among health care workers in the Greater Accra Region of Ghana. PLoS One. 2024;19(4):e0298771. pmid:38626000
- 14. Adei D, Agyemang-Duah W, Mensah AA. Predictors of enrollment in a health protection scheme among informal sector workers in Kumasi Metropolis of Ghana. BMC Res Notes. 2019;12(1):758. pmid:31752971
- 15. Alfers L. The Ghana National Health Insurance Scheme: Barriers to Access for Informal Workers. WIEGO. 2023. Cited [2025 September 6]. https://www.wiego.org/research-library-publications/ghana-national-health-insurance-scheme-barriers-access-informal-workers/?utm_source=chatgpt.com
- 16. Adei D, Braimah I, Mensah JV, Acquah Mensah A, Agyemang-Duah W. Improving upon the working environment of informal sector workers in Ghana: The role of planning. Cogent Medicine. 2021;8(1).
- 17. Akazili J, Chatio S, Ataguba JE-O, Agorinya I, Kanmiki EW, Sankoh O, et al. Informal workers’ access to health care services: findings from a qualitative study in the Kassena-Nankana districts of Northern Ghana. BMC Int Health Hum Rights. 2018;18(1):20. pmid:29769071
- 18. Solomon-Ayeh B, Adams I, Decardi-Nelson I, Farhan S. Informal commerce: aspects of congestion in Kumasi central market, Ghana. Int J Environ Ecol Fam Urban Stud. 2016;6:11–22.
- 19. Mensah F, Shi G, Yu Q, Boadi EB, Andam FA, Bofah NA. The impact of resettlement in urban market redevelopment on income inequality, its determinants, and implications for the resettled population: applying the Kejetia new market exemplar, Ghana. Sustain. 2022;14:16682.
- 20. Adoba P, Boadu SK, Agbodzakey H, Somuah D, Ephraim RKD, Odame EA. High prevalence of hepatitis B and poor knowledge on hepatitis B and C viral infections among barbers: a cross-sectional study of the Obuasi municipality, Ghana. BMC Public Health. 2015;15:1041. pmid:26456626
- 21. Weng MK, Doshani M, Khan MA, Frey S, Ault K, Moore KL, et al. Universal hepatitis B vaccination in adults aged 19-59 years: Updated recommendations of the advisory committee on immunization practices-United States, 2022. Am J Transplant. 2022;22(6):1714–20. pmid:35674154
- 22.
CDC. ACIP Recommendations: Hepatitis B Vaccine. [Cited 2025 September 7]. https://www.cdc.gov/acip-recs/hcp/vaccine-specific/hepatitis-b.html?utm_source=chatgpt.com
- 23. Conners EE, Panagiotakopoulos L, Hofmeister MG, Spradling PR, Hagan LM, Harris AM, et al. MMWR Recomm Rep. 2023;72:1–25.
- 24.
GHS. National Viral Hepatitis Control Programme (NVHCP) – Ghana Health Service. [Cited 2025 September 7]. https://ghs.premiercaregh.org/national-viral-hepatitis-control-programme-nvhcp/?utm_source=chatgpt.com
- 25.
Ghana faces significant challenges in eliminating viral hepatitis. 2024. [Cited 2025 September 7]. https://nationalcourrier.com/2024/11/09/ghana-faces-significant-challenges-in-eliminating-viral-hepatitis-by-2030/?utm_source=chatgpt.com
- 26. Nartey YA, Okine R, Seake-Kwawu A, Ghartey G, Asamoah YK, Senya K. A nationwide cross-sectional review of in-hospital hepatitis B virus testing and disease burden estimation in Ghana, 2016 - 2021. BMC Public Health. 2022;22.
- 27. Dayyab FM, Iliyasu G, Ahmad BG, Bako AT, Ngamariju SS, Habib AG. Hepatitis B vaccine knowledge and self-reported vaccination status among healthcare workers in a conflict region in northeastern Nigeria. Ther Adv Vaccines Immunother. 2020;8:2515135519900743. pmid:32002499
- 28. Rashid N, Ddamulira JB, Ndugwa SK, Juliana N, Julius S, Daama A, et al. Self-Reported Hepatitis B Vaccination Uptake and Associated Factors Among Adults Attending Budwale Health Center in Mbale District Uganda. East Afr Health Res J. 2023;7(2):257–66. pmid:39219647
- 29. Ndunguru B, Wilfred D, Kapesa A, Kilonzo SD, Mirambo M, Hyera F, et al. Low uptake of hepatitis B vaccination among healthcare workers in primary health facilities in Mwanza region, North-Western Tanzania. Front Public Health. 2023;11:1152193. pmid:37333557
- 30. Obeng MA, Okwan DK, Adankwah E, Owusu PK, Gyamerah SA, Duah KB, et al. Seroconversion and Prevalence of Hepatitis B Surface Antigen among Vaccinated Health Care Workers in Ashanti Region, Ghana. Adv Med. 2023;2023:2487837. pmid:38149294
- 31. Junewicz A, Brateanu A, Nielsen C. Q: Do patients who received only two doses of hepatitis B vaccine need a booster?. Cleve Clin J Med. 2014;81(6):346–8. pmid:24891535
- 32. Abesig J, Chen Y, Wang H, Sompo FM, Wu IXY. Prevalence of viral hepatitis B in Ghana between 2015 and 2019: A systematic review and meta-analysis. PLoS One. 2020;15(6):e0234348. pmid:32530945
- 33. Awoke N, Mulgeta H, Lolaso T, Tekalign T, Samuel S, Obsa MS, et al. Full-dose hepatitis B virus vaccination coverage and associated factors among health care workers in Ethiopia: A systematic review and meta-analysis. PLoS One. 2020;15(10):e0241226. pmid:33108365
- 34. Bilounga Ndongo C, Eteki L, Siedner M, Mbaye R, Chen J, Ntone R, et al. Prevalence and vaccination coverage of Hepatitis B among healthcare workers in Cameroon: A national seroprevalence survey. J Viral Hepat. 2018;25(12):1582–7. pmid:30047565
- 35. Sikakulya FK, Munyambalu DK, Mambo SB, Mutsunga AK, Djuma SF, Djuna PA, et al. Level of screening for and vaccination against hepatitis B among healthcare workers in the Eastern Democratic Republic of the Congo: a public health concern. Infect Prev Pract. 2022;4(3):100226. pmid:35898603
- 36. Abeje G, Azage M. Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar City Administration, Northwest Ethiopia: a cross sectional study. BMC Infect Dis. 2015;15:30. pmid:25637342
- 37. Ogoina D, Pondei K, Adetunji B, Chima G, Isichei C, Gidado S. Prevalence of Hepatitis B Vaccination among Health Care Workers in Nigeria in 2011–12. Int J Occup Environ Med. 2014;5:51.
- 38. Razwiedani LL, Mogale NM, Mawela MPB. Hepatitis B vaccination coverage amongst healthcare workers in a tertiary academic hospital in Gauteng province, South Africa. S Afr J Infect Dis. 2022;37(1):393. pmid:35935169
- 39. Bayissa L, Gela D, Boka A, Ararsa T. Hepatitis B vaccination coverage and associated factors among nurses working at health centers in Addis Ababa, Ethiopia: a cross-sectional study. BMC Nurs. 2024;23(1):600. pmid:39198790
- 40. Aber JO, Bongomin F, Opio SL, Ochola E. Hepatitis B vaccine uptake and associated factors among adults of Gulu city in Northern Uganda: A community-based cross-sectional study. PLoS One. 2024;19(3):e0297617. pmid:38427654
- 41. Afolabi IB, Aremu AB, Maidoki LA, Atulomah NO. Predictors of Hepatitis B Virus Infection Vaccine Hesitancy Among Pregnant Women Attending Antenatal Care at Lubaga Hospital, Kampala, Uganda. Int J Womens Health. 2022;14:1093–104.
- 42. Duodu PA, Darkwah E, Agbadi P, Duah HO, Nutor JJ. Prevalence and geo-clinicodemographic factors associated with hepatitis B vaccination among healthcare workers in five developing countries. BMC Infect Dis. 2022;22(1):599. pmid:35799107
- 43. Omotowo IB, Meka IA, Ijoma UN, Okoli VE, Obienu O, Nwagha T, et al. Uptake of hepatitis B vaccination and its determinants among health care workers in a tertiary health facility in Enugu, South-East, Nigeria. BMC Infect Dis. 2018;18(1):288. pmid:29954344
- 44. Homish GG, Leonard KE. Spousal influence on general health behaviors in a community sample. Am J Health Behav. 2008;32(6):754–63. pmid:18442354
- 45. Chingle MP, Osagie IA, Adams H, Gwomson D, Emeribe N, Zoakah AI. Risk perception of hepatitis B infection and uptake of hepatitis B vaccine among students of tertiary institution in Jos. Ann Afr Med. 2017;16(2):59–64. pmid:28469118
- 46. Zacharias T, Wang W, Dao D, Wojciechowski H, Lee WM, Do S, et al. HBV Outreach Programs Significantly Increase Knowledge and Vaccination Rates Among Asian Pacific Islanders. J Community Health. 2015;40(4):619–24. pmid:25476035
- 47. Adam A, Fusheini A. Knowledge, risk of infection, and vaccination status of hepatitis B virus among rural high school students in Nanumba North and South Districts of Ghana. PLoS One. 2020;15(4):e0231930. pmid:32320446
- 48. Adjei-Gyamfi S, Asirifi A, Asobuno C, Korang FK. Knowledge and occupational practices of beauticians and barbers in the transmission of viral hepatitis: A mixed-methods study in Volta Region of Ghana. PLoS One. 2025;20(1):e0306961. pmid:39821157
- 49. Adjei CA, Stutterheim SE, Bram F, Naab F, Ruiter RAC. Correlates of hepatitis B testing in Ghana: The role of knowledge, stigma endorsement and knowing someone with hepatitis B. Health Soc Care Community. 2022;30(6):e4564–73. pmid:35701984