According to the surveillance system for hepatitis B in Iraq, there were 1,279 reported cases of hepatitis B in 2022. Table 1 provides information on the annual incidence rates of hepatitis B per 100,000 people in Iraq over different years, as well as baseline characteristics such as sex, age groups, and governorates. The data show that approximately 60% of the cases occurred among males. The highest incidence rates were observed among individuals aged 15-45 years and those aged >45 years. Among the governorates, Duhok and Sulaymaniyah had the highest incidence rates, while governorates such as Al-Anbar, Al-Muthanna, and Kerbela had the lowest incidence rates.
In the baseline year of 2015, the incidence rate of hepatitis B was 8.3 per 100,000 population, falling into the "high" category, indicating a significant level of endemicity. From 2016 to 2018, the incidence rates ranged from 5.2 per 100,000 population, falling into the "high-intermediate" category, suggesting a slightly lower but still significant level of endemicity. From 2019 to 2022, the incidence rates ranged from 4.2 to 3.5 per 100,000 population, falling into the "low-intermediate" category according to the WHO classification.
During this period, the incidence rates continued to decrease, indicating a reduction in the prevalence or incidence of hepatitis B. The lowest incidence rate was observed in 2020 at 2.6 per 100,000 population. However, there was a slight increase in the incidence rate in 2021 and 2022.
Figure 3 shows a greater number of cases and a greater annual incidence rate among males, highlighting a gender disparity in the prevalence of confirmed HBsAg.
The evaluation of the national plan to control hepatitis B virus (HBV) in Iraq from 2015 to 2022 indicates both success and areas for improvement. The hepatitis B vaccination coverage for the third dose has consistently increased and surpassed the target of 90%. However, the prevention of mother-to-child transmission (MTCT) of hepatitis B remains below the target of 75%. Blood safety measures have consistently met the target of 100% donations screened with quality assurance. Viral hepatitis B diagnosis coverage has slightly declined and falls short of the target of 50%. Viral hepatitis B treatment coverage data are not available. The incidence of new HBV infections has generally decreased, with the goal of reducing infections by 2030. The incidence of HBsAg in children aged ≤5 years remains below the target. Overall, there was a reduction in mortality from viral hepatitis B, as shown in Table 2
The of the evaluation of the national plan to control Hepatitis B in the Wasit Governorate included a study sample and are presented in Table 3. The sample comprises 24 primary health care centers (PHCCs) distributed across 6 health districts. The Al-Kut second district had the highest representation with 7 PHCCs (29.2%), followed closely by the Al-Kut first district with 5 PHCCs (20.8%). Other districts, namely AL-Numaniya, Al-Hayee, AL-Azizia, and Al Suwaira, also contributed to the overall distribution.
The sample is further divided into different classes. Class A had the highest percentage, with 19 PHCCs (79.2%), while class B and class C had lower percentages, with 2 PHCCs (8.3%) and 3 PHCCs (12.5%), respectively. In terms of residence, most PHCCs are located in urban areas, comprising 22 PHCCs (91.7%), while a smaller percentage, 2 PHCCs (8.3%), are located in rural areas.
The evaluation score of the national plan to control HBV in (PHCCs) are presented in Table 4 and Figure 5. The highest evaluation score falls within the acceptable range, while the lowest scores are in the poor and good ranges. The mean score for the evaluation of PHCCs was 61.01.
Among the PHCCs, the Al-Mazak Health Center in the Al-Kut 2 district had the lowest score of 47.76, indicating the lowest evaluation score. On the other hand, the Al-Numaniyah Health Center had the highest score of 85.07, representing the highest evaluation score among the PHCCs.
Table 4 and Figure 5 provide a comprehensive overview of the evaluation scores of PHCCs in the national plan to control HBV.
The evaluation scores of (PHCCs) in the national plan to control HBV are presented in the study. The scores are categorized as acceptable or poor, and their distribution is analyzed based on districts, class, and residence area.
In terms of districts, the Al-Kut First district has no PHCCs categorized as poor, while 20.8% are classified as acceptable. In the Al-Kut second district, 8.3% of PHCCs are considered poor, and 20.8% are acceptable. Other districts do not have any PHCCs in the poor category, except for one in the good category in AL-Numaniya.
An analysis of the scores by PHCCs class, revealed that among the class A PHCCs, 8.3% were categorized as poor, and 66.7% were deemed acceptable. Classes B and C do not have any PHCCs in the poor category.
Regarding the residence area, in urban areas, 4.17% of PHCCs are considered poor, while 83.3% are classified as acceptable. In rural areas, 4.17% are categorized as poor, and 4.17% are acceptable.
The statistical analysis indicated no significant association between the evaluating score and the districts or the type of residence.
Table 5, Figure 4, and Figure 5 provide a comprehensive overview of the distribution and analysis of evaluating scores based on districts, class, and residence area.
The evaluation scores in communicable disease, dental, and laboratory units vary across districts, PHCC classes, and types of residence. In the Al-Kut districts, there were differences in the mean scores for communicable disease, dental units, and laboratory units. However, these. Nevertheless, these differences are not statistically significant, except for in the laboratory units. Among PHCC classes, there were slight variations in the mean scores for communicable disease, dental units, and laboratory units, but these differences were not statistically significant. When comparing urban and rural PHCCs, there were variations in the mean scores for communicable diseases, dental units, and laboratory units. The difference in communicable disease scores was statistically significant, while the differences in dental and laboratory scores were not significant, as shown in Table 6.