Towards improved maternal health: Navigating non-compliance with integrated viral hepatitis B and malaria interventions among pregnant women in Bono East, Ghana.

Background: Effective management of viral hepatitis B (HBV) and malaria in pregnancy requires compliance with HBV vaccination, long-lasting insecticidal nets (LLINs), and intermittent preventive treatment in pregnancy with sulfadoxine-pyrimethamine (IPTp-SP). Although these interventions have reduced the burden of HBV and malaria in pregnancy, several barriers exist across endemic regions. This study assessed personal barriers to compliance with integrated HBV and malaria interventions among pregnant women in the Bono East Region of Ghana. Method: This multicentre hospital-based cross-sectional study employed the mixed method design to collect data from 1430 pregnant women. Data were collected through serological screening, questionnaires, in-depth interviews, and focus group discussions. Quantitative data were analysed with SPSS version 25. Descriptive statistics were performed to obtain frequencies, percentages, and means with standard deviations for continuous variables. Pearson's chi-square tests were conducted to determine differences in proportions, and logistic regression analyses were also performed to identify barriers significantly associated with HBV and malaria. Likewise, a four-step thematic analysis was used to analyse qualitative data. Result: The study revealed a low vaccination coverage (25.6 %), low utilisation of LLINs (39.7 %), and low uptake of IPTp-SP [≤1 (62.8 %)]. It was further revealed that awareness of HBV and malaria was associated with a lower risk of HBV (AOR = 0.04) and malaria (AOR = 0.42). Non-compliance due to age was associated with increased odds of HBV infection (AOR = 4.24), while occupational commitments increased the risk of malaria (AOR = 3.73). Besides, discomfort was also associated with increased odds of HBV and malaria. Conclusion: The low coverage of HBV vaccination, LLIN usage, and the uptake of IPTp-SP were attributed to barriers such as non-adherence due to age, discomfort, lack of consultation, and occupational commitments, which increased the risk of maternal HBV and malaria. These highlight the need for enhancing health education to strengthen compliance.