Uptake of Hepatitis B vaccines still low among refugees and host communities in West Nile

Last Updated on: 14th April 2023, 04:54 pm

Uptake of Hepatitis B vaccines still low among refugees and host communities in West Nile

West Nile, April 14, 2023: Mr. Samuel Ladu, not his real name is a refugee aged 24 years. He is a senior six student at Alhaji Bezza secondary school and on Hepatitis B medication.

Ladu said he was helpless when he received the result of his test and thought it was the end of his life for him.

He is a refugee from Ayilo II refugee settlement in the Adjumani district who fled South Sudan in 2014 and took a refugee in Uganda due to the unrest back home.

Ladu who is a complete orphan lives with his elder brother. They lost both parents; their father died in 2011 while they were still in South Sudan, and one month after, he lost a mother.

He said he was guided by his elder brother when they were escaping the war in South Juba until when they were settled in Ayilo II refugee settlement.

“I started to know about my status when I tested positive on July 2018, I was stressed to see my results positive,” Ladu recalled.

He had no idea how he could be tested positive for Hepatitis B since he was yet very young and a student, the boy wondered.  Since he was not involved in risky behaviors, Ladu can’t tell what could have exposed him to contracting the disease.

In 2021, he started medications after undergoing all the necessary tests to ascertain the level of the viral load.

“The health workers counseled me until I accepted my situation, now I am on medication, I take one tablet a day for 30 days, and they normally give me for 3 months,” Ladu told TND News.

Ladu observed that access to vaccine and testing services is not available to many refugees but only a few have access, adding that even the few who have access have got negative attitude towards the vaccine because they assume that once you start the first does and misses, the second day they will be tested positive.

Data from the Ministry of Health on the national status

A progress report of July 2022 by the Ministry of Health in Uganda indicated that the government of Uganda through the Ministry of Health introduced the mass adolescent and adult testing and vaccination campaign that was rolled out in the Financial Year 2015/2016.

The Ministry aimed at reaching people aged 14 years and above targeting the population of 17,130,883 representing 49% of the phased approach over the past 7 years. Currently, the implementation is taking place in 61 districts.

According to the Ministry of Health, in the first phase, the target was to reach out to 5,109,280, while in the second phase, the target was to reach 4,389,156 people and, in the third phase to reach out to 7,632,447 people.

Out of the 17,130,883 targeted populations, 5,436,896 people were tested representing 33.6%. Meanwhile, 5,107,490 representing 94% tested negative, and 329,406 (6%) of the tested population were confirmed positive.

In the seven years, 77% of the population got the first dose of the vaccination, 51% got the second dose and only 30% managed to complete the 3rd dose.

The regional situation on Hepatitis B vaccine uptake  

In the West Nile sub-region, out of the population targeted to get vaccinated, 88% got the first dose of Hepatitis B vaccination, 60% got the second dose and only 36% completed the last dose.

Adjumani district local government launched a program for Covid-19 and hepatitis B vaccinations among women, girls, boys, and men in the refugee and host communities in the district.

The district secured funding from UN-Women to the tune of shs132 million targeting 100,000 (both refugees and host communities) as the disease burden of Covid-19 and Hepatitis B is anticipated to rest on women who are the guardians of children and most families.

The project also aims at promoting and increasing vaccine uptake in the district, especially among women, girls, boys, and men to achieve community protection against Covid-19 and hepatitis B.

Assistant district health officer (ADHO) Mr. Lulu Henry Leku regretfully notes that the vaccination success rate among the refugee population during the 2022 mass vaccination exercise was very slow

Mr. Lulu Henry Leku said out of the 273,380 targeted populations for Covid-19 vaccination in the Adjumani district, 158.592 were vaccinated representing 58% while for the refugee population, only 24% of the refugees were vaccinated.

“Last financial year, 253 people died in the district and 45 died of Hepatitis B accounting for 14.8 percent which is second to malaria,” Lulu said.

He said to ensure maximum protection against Covid-19, and Hepatitis B, the vaccination coverage should hit the 95% mark which is when the community will achieve hard immunity which is a recommended standard in Public health.

The district health office has designated 40 Covid-19 vaccination points and 37 Hepatitis B screening centers, covering all the sub-counties and all health facilities in the district and the exercise has been programmed to last six days.

Mr. Wilfred Saka, the district chairperson of Terego district which is hosting 171,179 refugees and more than 233,300 nationals, said out of 27 samples collected and taken to Zombo Industrial Hub last month, 3 tested positive for Hepatitis B.

The LC5 chairperson described it as “a high number”.

These were just randomly picked and they did not present any sign, this means so many other people are infected and have not been noticed, he added.

“We must develop robust and mass testing to involve refugees and nationals so that appropriate approaches can be taken by the government,” Saka is demanding.

 Hepatitis B
A refugee woman in Nyumanzi refugee settlement in Adjumani getting her dose of the Hepatitis B vaccine. Photo by Marko Taibot.

Mr. Zubairi Ojo the acting district health officer of Yumbe district noted that Hepatitis B is still a big challenge in the district, disclosing that the prevalence was 8% between 2020/2021 and dropped from 6.2% in 2021/2022, as a result of the interventions together in with the Ministry of Health.

From 2020 to 2022, according to the acting district health officer, of the 13,000 people tested in Yumbe, 67 people tested positive for Hepatitis B and all were enrolled in care and treatment.

Although the number of refugees vaccinated and tested is unclear, the district has embarked on mass tests and vaccination that includes refugees.

Ojo added that from 2020-2022, 14,000 people got vaccinated in the Yumbe district and 4,000 of the people vaccinated were refugees from the Bidibidi refugee settlement.

The district lost 80 to Hepatitis B between 2020 2022, the deaths, according to the acting district health officer, are attributed to late diagnoses and poor health-seeking behaviors, and negative myths associating the disease with witchcraft.

The uptake of the vaccination is still law among refugee adults and even among the host communities because of their attitudes towards the diseases. The mobile community of the refugees who often move back to South Sudan and Uganda


Mr. Paul Onzubo, the district health officer of Maracha district, however, noticed that the prevalence of Hepatitis B is still high in the region.

He highlighted some of the challenges facing the fight against Hepatitis B as limited advocacy and mobilization in communities, misconceptions, myths, and anxiety about the disease.

Recommendations and priority action areas

Dr. Onzubo proposed the need to scale up testing among pregnant mothers with adopted WHO guidelines on PMTCT.

He also proposed the need to increase awareness of viral Hepatitis, by working with community groups and civil society organizations (CSOs), and religious, cultural, and opinion leaders to increase opportunities, to educate about viral Hepatitis. Strengthen capacity building of health workers’ data and focal persons at the district levels.

Dr. Onzubo proposes that stakeholders must be involved, including all development and implementing partners for resource mobilization, and implementation support at the district level.

Strengthen the referral mechanism of those identified as positive with a clear viral Hepatitis cascade from testing, linkage, and treatment. Adoption of good practices from HIV-patient management.

This story was produced with financial support from the Aga Khan University Graduate School of Media and Communication.

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