STUDY CONTEXT

background

In 1998, Senegal became the first country in Sub-Saharan Africa to establish a National Viral Hepatitis Program. In the following years, the Ministry of Health collaborated with civil society stakeholders (e.g., the Saafara Hépatites Patients Association) to introduce immunization programs and decentralize CHB management to expand accessibility in rural regions. Despite the country’s early response, Senegal is one of the only African countries to have seen an increase in estimated CHB prevalence between the 1950s and 2000s. An estimated 8-10% of the Senegalese population currently lives with CHB, which remains one of the leading causes of cancer.

Our study was conducted in the Niakhar Health and Demographic Survey System (HDSS) in rural Senegal, with approximately 45,000 total inhabitants. In the 1970s, the Niakhar HDSS hosted the first hepatitis B vaccine trials in Sub-Saharan Africa and has remained closely linked to the Senegalese hepatitis B response as a pilot region for the decentralization of CHB management. The AmBASS Survey on the burden of CHB infection recruited over 3,000 participants between October 2018 and July 2019, which included socioeconomic questionnaires used for our study.