Coverage of and Influences on Timely Administration of Hepatitis B Vaccine Birth Dose in Remote Rural Areas of the People’s Republic of China

A survey was conducted in 2006 to assess the coverage and timeliness of the birth dose of hepatitis B vaccine (HepB 1 ) and related influences among children in rural areas of Guangxi, Guizhou, Tibet, and Shaanxi provinces, People's Republic of China. A total of 3,390 children born in 2004 were surveyed in four counties in each province, where a proj- ect to strengthen routine immunization is being implemented by the China Ministry of Health, supported by the United National Children's Fund. Two-stage stratified cluster sampling was undertaken to select those surveyed. A question- naire was administered to parents or guardians and vaccination records were assessed. HepB 1 administration was timely for 31.6% of the sample. Timeliness of HepB 1 for children delivered at home (13%) was lower than for children born at county-level or higher facilities (54%) (odds ratio (OR) = 6.52, (95% confidence interval (CI) = 5.29-8.04, P < 10 �3 ), at township hospitals (49%, OR = 7.14, 95% CI = 5.68-8.98, P < 10 �3 ), or private clinics (59%, OR = 5.64, 95% CI = 3.68-8.64, P < 10 �3 ). Children of Tibetan (24.8%, OR = 0.16, 95% CI = 0.12-0.21, P < 10 �4 ), Zhuang (27.8%, OR = 0.73, 95% CI = 0.57-0.94, P < 0.02) or Meng, Miao, and Hui ethnicity (14.2%, OR = 0.36, 95% CI = 0.29-0.45, P < 10 �4 ) were less likely than children of Han ethnicity (33.2%) to have received a timely birth dose. Children lacking vaccination registration cards (OR = 0.64, 95% CI = 0.51-0.80, P < 10 �4 ) and children whose parents or guardians did not know the importance of timely HepB immunization (OR = 0.62, 95% CI = 0.46-0.84, P < 10 �2 ) were also less likely to have received a timely birth dose. Parental knowledge and prioritization of birth-dosing was low among children who did not receive it. The timeliness of HepB 1 should improve with increasing rates of hospital delivery, training of birth attendants, increasing staff and com- munity awareness of the importance of the birth dose, and by focusing on vulnerable groups.