Knowledge, attitudes and practices regarding prevention of hepatitis B virus mother-to-child transmission among health professionals in a semi-rural health district of Cameroon: a cross-sectional study
Although health professionals in Cameroon's Obala Health District possess acceptable knowledge and favorable attitudes regarding hepatitis B virus mother-to-child transmission prevention, their clinical practices are frequently inadequate or harmful due to structural barriers like vaccine shortages and insufficient training, highlighting an urgent need for supply chain improvements and targeted retraining to achieve elimination goals.
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In many parts of the world, a virus that attacks the liver can be passed from a mother to her baby during birth. This is not just a temporary illness; for a newborn, catching this virus often means living with a lifelong infection that can lead to severe liver damage decades later. The good news is that science has found a way to stop this transmission almost entirely. If a baby receives a specific vaccine shot within the first day of life, and sometimes an extra protective injection, the risk of infection drops dramatically. However, knowing the solution is different from delivering it. In places where the virus is common, the success of this protection depends entirely on the people working in clinics and hospitals. They must know the rules, believe in them, and actually follow the steps every single time a mother gives birth.
Researchers in Cameroon recently set out to understand exactly how well this system is working in a semi-rural area called the Obala Health District. They wanted to see if the local health workers knew the correct steps, if they felt confident about them, and most importantly, if they were actually doing them. They surveyed nearly every doctor, nurse, midwife, and assistant who works with mothers and babies in that district. What they found was a story of a team that knows the theory and wants to help, but is being stopped by a broken supply chain and a lack of recent training.
The study took place over three months in 2026, covering thirty-three different health facilities across the district. The researchers spoke directly to one hundred and eighteen health workers, asking them detailed questions about how they handle hepatitis B. They wanted to measure three things: what the staff knew, how they felt about the work, and what they actually did in their daily routines. The results painted a picture of a workforce that is largely young and female, with nurses making up the largest group. While the team had a solid grasp of the medical facts, the reality of their daily work told a different story.
When it came to knowledge, the staff performed reasonably well. About thirty-six percent of them demonstrated a strong understanding of the virus and how to prevent it. They knew that screening mothers during pregnancy was vital and that a vaccine shot within twenty-four hours of birth was crucial. However, gaps remained. Nearly half of the workers did not realize that the newborn needed a special, single-dose vaccine right at birth, separate from the standard shots given later. This is a critical detail because the first few weeks of life are the most dangerous time for the baby to catch the virus. The study also found that knowledge was not spread evenly; workers in the most remote, rural parts of the district knew significantly less than those closer to the main town.
Attitudes were even more encouraging. The vast majority of the health workers believed that preventing this virus was important and that they should be teaching mothers about it. They agreed that screening pregnant women and vaccinating newborns were effective strategies. In fact, having good knowledge made a worker much more likely to have the right attitude. Experience also mattered; those who had been working for more than five years tended to feel more confident in their role. There was, however, one persistent misunderstanding: a significant portion of the staff still believed that mothers with the virus should not breastfeed their babies. Medical guidelines say they can, as long as the baby gets the vaccine and protective injection, but this old belief lingered, potentially depriving infants of the benefits of breastfeeding.
The most striking finding, and the most concerning, was the gap between what the staff knew and what they actually did. While knowledge was acceptable and attitudes were positive, the actual practice of preventing the virus was poor. Only about one in five workers reported that they consistently followed all the correct steps to protect a newborn. Even worse, about one in five reported practices that were actively harmful, such as delaying the vaccine until the next day or sending the mother away to find the medicine elsewhere. This happened most often among general practitioners and nursing aides, the very people who might be expected to lead the effort.
The researchers discovered that this failure was not because the workers were unmotivated. Instead, they were blocked by things outside their control. The most common reason they gave for not following the rules was that the vaccines or the protective injections simply were not available in the clinic. When the supplies ran out, the workers had no choice but to postpone the care or send the family away, putting the baby at risk. The study also found that recent training made a huge difference. Workers who had attended a specific training session on this topic within the last three years were three times more likely to follow the correct procedures than those who had not.
The conclusion is clear: the people on the ground in Obala are ready and willing to stop this virus, but they cannot do it without the right tools and up-to-date guidance. The knowledge is there, and the will is there, but the system is failing to deliver the vaccines and the training needed to turn that potential into action. To protect the next generation, the focus must shift from just teaching the staff to ensuring that the vaccines are always in stock and that every worker, from the newest aide to the most experienced doctor, receives regular, practical training. Without fixing these supply and training gaps, the best intentions will remain just that, and the goal of eliminating this virus will stay out of reach.
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