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The hepatitis B virus is a public health threat, chronically infecting over 240 million persons worldwide. The hepatitis B vaccine is 90% effective in preventing perinatal transmission if the first dose is given within the first 24 h of life, followed by a minimum of two subsequent doses. Antigua and Barbuda instituted a hospital-based birth dose vaccination policy in October 2021. Data were extracted from hospital logbooks from November 2021 to October 2022, and a database was created. Frequency distributions of the hepatitis B birth dose, barriers to administration, and maternal and healthcare system factors were analyzed. The positive maternal HBsAg prevalence rate was 0.6%. The timely and total birth dose coverage was 72% and 81%, respectively. In total, 10.5% of parents refused the vaccine, of which 76% either felt uncomfortable or preferred to wait. Moreover, 100% of hepatitis B-exposed babies were vaccinated, with 83% of them receiving the Hepatitis B Immunoglobulin. Barriers to vaccine administration included vaccination hesitancy, gaps in knowledge of medical staff, and the inconsistent vaccination supply. Instituting a quality improvement team, health information system, robust educational efforts, and addressing barriers will make achieving the WHO programmatic targets of eliminating mother-to-child transmission of hepatitis B by 2030 possible.

The prevalence of Sickle Cell Disease (SCD) within the Caribbean region remains second only to that of West Africa. The Newborn Screening (NBS) Program in Antigua and Barbuda remains heavily dependent on grants, therefore ultimately facing sustainability challenges. Early intervention and implementation of preventative measures post-NBS result in significant improvements in morbidity, quality of life, and survival. This audit reviewed the pilot SCD NBS Program in Antigua and Barbuda from September 2020 to December 2021. A conclusive result was received by 99% of babies eligible for screening, 84.3% of which were HbFA, whilst 9.6% and 4.6% were HbFAS and HbFAC, respectively. This was comparable to other Caribbean countries. Sickle Cell Disease was noted in 0.5% of babies screened, which translates to 1 in 222 live births. Eighty-two percent of mothers were aware of their sickle cell status, compared to 3% of fathers. The importance of instituting a quality improvement team post the initiation of a screening program and the need for a robust public education program have been demonstrated by this audit.