Deficient knowledge on hepatitis B infection in pregnant women and prevalence of hepatitis B surface antigen carriage in an endemic area: a review

Prevalence, knowledge of and attitude towards hepatitis B virus among pregnant females in Jordan

This observational study was designed to assess the prevalence, knowledge and attitude of pregnant females towards hepatitis B infection, in addition to their perspective of the healthcare practice about HBV in Jordan. A randomly selected group of pregnant females visiting public gynaecology clinics in Jordan were approached to participate in the study. Blood samples were collected from the participants, and HBV markers were detected in their serum using specialized ELISA Kits to assess for the prevalence of infection. Knowledge and attitude of participants was assessed via a developed and validated questionnaire. Statistical analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 24. Blood samples (n = 300) from 330 pregnant females were collected. The prevalence of hepatitis B surface antigen (HBsAg) among the pregnant females was found to be 5%. Anti-HBs and anti-HBc were found to be 33.3% and 7%, respectively. No significant correlation between age, socio-economic status and educational level was found with HBsAg positivity. Limited knowledge regarding HBV was revealed among the pregnant females (9.1%-41.3%, P < .05). The majority had a positive attitude regarding HBV vaccination and antiviral medications in case of infectivity. More than 90% agreed on the present lack of counselling and screening of HBV they obtained during their first perinatal visit to the gynaecology clinics. This study revealed a lack of knowledge on HBV, and low counselling and screening received were reported. Policymakers need to introduce new interventions to improve the current awareness of patients and gynaecologists regarding hepatitis B infection.

Psychiatric Morbidity, Fatigue, Stigma and Quality of Life of Patients With Hepatitis B Infection

AIMS

This study aimed to evaluate the prevalence of psychiatric morbidity, fatigue, stigma and quality of life (QOL) of patients with hepatitis B infection. Additional aim of the study was to evaluate the correlates of psychiatric morbidity and QOL in patients with hepatitis B infection.

METHODS

A total of 150 patients with hepatitis B virus (HBV) infection (75 inactive carriers and 75 patients with chronic hepatitis) were evaluated on Mini International Neuropsychiatric Interview-PLUS, World Health Organization-QOL-BREF scale, Chronic Liver Disease Questionnaire, Toronto Chinese HBV Stigma Scale, HBV knowledge scale and Fatigue Severity scale.

RESULTS

About half of the study participants (49.3%) had at least one lifetime psychiatric morbidity and of these more than one-third (37.3%) fulfilled at least one current psychiatric diagnosis. Generalized anxiety disorder was seen in 19.3% of the participants. Major depressive disorder was the second most common psychiatric diagnosis fulfilled at the time of assessment, with nearly equal prevalence of first episode of depression (8%) and recurrent depressive disorder (7.3%). Compared to those with inactive hepatitis, patients in the chronic hepatitis group had poorer QOL and experienced more fatigue. However, both the groups did not differ in terms of knowledge and stigma. Compared to those without current or lifetime psychiatric diagnosis, those with current or lifetime psychiatric diagnosis had poorer QOL, higher level of stigma and higher fatigue scale.

CONCLUSION

About half of the patients with HBV infection have psychiatric morbidity, which has negative impact on QOL of patients. Hence, it is important to recognize psychiatric morbidity among patients with HBV.

Knowledge, attitudes and practices of hepatitis B prevention and immunization of pregnant women and mothers in northern Vietnam

Background and aim

Infection at birth due to mother-to-child (MTC) transmission is the most common cause of chronic hepatitis B virus (HBV) infection in Vietnam. This study was undertaken to examine the knowledge, attitudes, and practices of pregnant women and mothers in Vietnam concerning HBV prevention and immunization.

Methods

A cross-sectional survey was conducted in Quang Ninh and Hoa Binh provinces in 2017. A standardized questionnaire was administered to women when they received care at primary and tertiary maternal health clinics. Multivariate regression was used to identify predictors of HBV knowledge and practices.

Results

Among the 380 women surveyed, 50.3% were pregnant and 49.7% were postpartum. Despite 70.3% of participants reported having received information about HBV during their pregnancy, only 10.8% provided correct answers to all questions regarding HBV transmission routes and preventive measures. Around half of the participants incorrectly believed that HBV is transmitted through sneezing, contaminated water or sharing foods with chronic HBV patients. Although 86.1% of participants believed that HBV vaccination is necessary for infants, only 66.1% responded they were definitely willing to have their own child vaccinated within 24 hours. More than a third of participants expressed concern about having casual contacts or sharing foods with chronic HBV patients. In multivariate analysis, having received information about HBV during their pregnancy was significantly associated with better HBV knowledge score. Delivery at provincial level clinics was a strong predictor for perinatal HBV screening and hepatitis B birth dose administration.

Conclusions

The results highlight the need to prioritize educating pregnant women and mothers in future public health campaigns in order to increase knowledge, reduce misperception, and improve hepatitis B vaccine birth dose coverage in Vietnam.

Knowledge, Preference, and Willingness to Pay for Hepatitis B Vaccination Services among Woman of Reproductive Age in Vietnam

Background

Hepatitis B virus (HBV) vaccine is a critical approach to prevent HBV transmission from mother to child. However, despite high HBV prevalence, evidence about the preference of women of productive age for HBV vaccine in Vietnam was constrained. This study aims to explore the preference and willingness to pay (WTP) for the HBV vaccine in Vietnamese women in productive age.

Methods

A cross-sectional study was conducted in Hanoi in April 2016. A structured questionnaire was used to collect information about respondents' socioeconomic status and knowledge about HBV vaccination. A contingent valuation approach was employed to measure the WTP for the HBV vaccine. Logistic and interval regressions were used to determine the associated factors.

Results

Among 807 women, 80.8% were willing to have the vaccine injected which had the average price of 108,600 VND (95% CI, 97,580 VND-119,570 VND). Participants not suffering any diseases during pregnancy were more likely to be willing to pay for the HBV vaccine (OR = 3.41, 95% CI = 1.73-6.70). Not having the antenatal examination at central hospitals and working as farmers/workers were positively correlated with willingness to pay for this vaccine, while the number of children of respondents had a negative correlation with WTP.

Conclusions

Our sampled women expressed a high willingness to pay for the vaccine. The price people were willing to pay for the vaccine, however, is equal to half of the actual price. These findings implied needs for better targeted public education interventions about HBV and the involvement of local medical staffs and the media in providing information. Efforts to reduce the price of the vaccine should also be warranted for scaling-up the coverage of this vaccine.

Different interventional criteria for chronic hepatitis B pregnant women with HBeAg(+) or HBeAg(-): Epidemiological data from Shaanxi, China

The seroprevalence of hepatitis B virus (HBV) and its impact on pregnancy outcomes of women from Shaanxi Province (China) was assessed. Risk factors for mother-to-child transmission (MTCT) were evaluated based on HBV-related seroprevalence data.Viral markers and biochemical parameters were assessed in HBsAg-positive mothers and their infants out of 13,451 cases recruited. A pretested and structured questionnaire was used to test the general HBV knowledge. Descriptive statistics and logistic regression analysis were done to reveal possible risk factors for MTCT.The overall prevalence of HBsAg in pregnant women was 7.07% (951/13,451), and a rate as high as 9.40% was observed. Among the HBsAg-positive pregnant women, 30.49% (290/951) were HBeAg-positive, 22.08% (210/951) had HBV DNA levels >10 IU/mL and only 16.19% with a high risk of MTCT (34/210) had received antiviral treatment. The overall MTCT rate was 5.21%. Noteworthy, the risk ratio and 95% confidence interval (95% CI) of MTCT in HBeAg-negative mothers with HBV DNA levels >2 × 10 IU/mL and HBsAg >10 IU/mL was 26.062 (2.633-258.024), which was significantly higher than that of HBeAg-positive mothers with HBV DNA level >10 IU/mL. Moreover, the awareness and knowledge about HBV transmission, risk factors, and intervention for MTCT were generally lacking among HBsAg-positive mothers.As a higher HBsAg seroprevalence and a higher MTCT rate among HBeAg-negative mothers with lower HBV DNA level was observed, our study emphasizes different interventional criteria for HBeAg-positive and HBeAg-negative mothers. Extensive health education, routine screening, and immunization against HBV during pregnancy are highly warranted to minimize the possibility of perinatal transmission.

Assessing the knowledge of expectant mothers on mother-to-child transmission of viral hepatitis B in Upper West region of Ghana

Background

Viral Hepatitis B is of a major public health concern globally, especially in developing countries. Expectant mothers’ knowledge of Mother-To-Child Transmission (MTCT) of the disease is significant in preventing the spread from an infected mother to her child. This study sought to assess the expectant mothers’ knowledge of Mother-To-Child Transmission of viral hepatitis B in the Wa Municipality and Lawra District of Upper West Region, Ghana.

Methods

A descriptive cross-sectional study with a multi-stage sampling technique was employed to select a total of 450 study respondents (expectant mothers), and a semi-structured questionnaire was used for the data collection. Respondents were interviewed using face-to-face interview technique.

Results

Majority (54.0%) of the respondents were aged between 25 and 35 years and the results were similar in both districts. Overall, 62.4% (281/450) of the respondents had at least Junior High level education, and 76.2% (343/450) were multigravida. Educational levels among respondents in the two areas were above 50.0% and considered relatively high. Respondents’ general knowledge of hepatitis B infection and disease was 46.0% (208/450). However, there was a slight difference between the two districts (40.1% in Lawra District and 51.6% in Wa Municipality). The overall knowledge level on MTCT of viral hepatitis B among the respondents was 34.7% (156/450): the Wa Municipality recorded higher knowledge (43.3%) compared to 24.8% in Lawra District.

Conclusion

The knowledge level of the expectant mothers on MTCT of viral hepatitis B is relatively low in Upper West Region, Ghana. Majority of the respondents had some form of formal education. The age, marital status, education, occupation, gravity and family setup were found to be associated with knowledge of Hepatitis B infection and MTCT. Thus, there is urgent need to intensify efforts of health staff to educate expectant mothers. In addition, home education and outreach activities should be intensified on HBV infection as well as MTCT. Consequently, planning, implementation and execution of preventive activities, especially in the antenatal clinics should critically consider the social and demographic variations of mothers.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-017-2490-x) contains supplementary material, which is available to authorized users.

Knowledge of and attitudes towards hepatitis B and its transmission from mother to child among pregnant women in Guangdong Province, China

BACKGROUND

Hepatitis B virus (HBV) infection remains a serious public health problem worldwide. Mother-to-child transmission (MTCT) of HBV is the major mode of transmission in HBV-endemic areas, including China, where little is known about pregnant women's knowledge of and attitudes towards HBV infection and MTCT.

METHODS

A cross-sectional survey, conducted in pregnant women in Guangdong Province, China, measured HBV knowledge and attitudes using a questionnaire, at one tertiary and two rural hospitals.

RESULTS

The total response rate was 94.5% (737/780). Of the 11 knowledge questions, the mean score was 6.73 ± 3.04 (mean ± SD). Most pertinent to preventing MTCT, 53.3% of the respondents did not know that HBV can be transmitted through unprotected sexual intercourse and nearly 20% did not know that HBV can be transmitted from mother to infant. The results of the four attitude questions was better with 83% and 85% being willing to be screened for HBV and let their baby receive HBV vaccine and HBIg, respectively. However, only 16.5% of respondents agreed that they would be willing to take drugs that are known not to harm the fetus to prevent MTCT of HBV. In multivariable analysis, higher education level was associated with better knowledge and attitude scores.

CONCLUSIONS

Knowledge about HBV among pregnant women was poor and needs to be improved to prevent MTCT of HBV. Health education needs to be directed towards pregnant mothers, particularly less educated mothers, in high HBV endemicity settings.

Prevalence, awareness and risk factors associated with Hepatitis B infection among pregnant women attending the antenatal clinic at Mbagathi District Hospital in Nairobi, Kenya

INTRODUCTION

Hepatitis B Viral Infection (HBV) remains one of the leading cause of morbidity and mortality globally accounting for 38-53% of chronic liver diseases and about 686,000 deaths annually. The prevalence of HBV is 9-20% in Sub-Saharan Africa, and in Kenya it is 5-30% among the general population and 9.4% among pregnant women. This study was aimed at identifying the prevalence, awareness and risk factors associated with HBV infections among pregnant women attending Antenatal clinic (ANC) at Mbagathi District hospital, Nairobi.

METHODS

This was a cross-sectional study involving 287 pregnant women enrolled for three months (September to December 2014) from Nairobi and neighbouring counties. A structured questionnaire that captured social, demographic and explanatory variables was administered to the study participants. Blood samples were also drawn from the participants and tested for HBV using Enzyme-Linked Immunosorbent Assay (ELISA) system.

RESULTS

The study established that the prevalence of HBV infections among pregnant women attending antenatal clinic at Mbagathi District Hospital was 3.8% with highest infection rate among the 20-24 years age group. Seventy six (60.8 %) of the participants reported sexual encounters in less than a month before the interview of which 5 (7.6%) reported encounters involving other partners apart from their spouses. HBV awareness among the study participants was 12.2%. Before the interview, those with at least tertiary education (Mean =1.33, SD = 1.131), were more informed about HBV infection as compared to those with primary and secondary education (Mean = 0.63, SD = 0.722; (Mean =0.31, SD= 0.664). In regards to assessment of the risk factors; type of family (χ^² =19.753 df2 p<0.01), parity (χ^² =7.128 df2 p<0.01), History of abortions (χ^²=9.094 df1 p<0.01), early age (11-15 years) at first sexual encounter (χ^² =8.185 df1 p<0.01) were significantly associated with HBV positivity.

CONCLUSION

The prevalence of HBV infection among pregnant women attending Antenatal clinic (ANC) at Mbagathi District hospital, Nairobi was lower (3.8%) than the prevalence among pregnant women nationally (9.4%). These women also showed a low level of HBV awareness (12.2%.).

Mother-to-child transmission of hepatitis B: extent of knowledge of physicians and midwives in Eastern region of Ghana

Background

Mother -to -Child transmission of hepatitis B infection remains a major public health concern particularly in Africa. Adequate knowledge of physicians and midwives is crucial in averting most of the hepatitis B viral transmissions from mothers to their new-borns. However, there is a dearth of evidence on extent of knowledge of physicians and midwives in Ghana inspite of the increasing incidence of hepatitis B infection in the country. This study therefore assessed the knowledge level of physicians and midwives regarding Mother-to-Child transmission of hepatitis B in the Eastern region of Ghana.

Methods

A Cross sectional survey was conducted between August to November, 2015 using semi-structured self-administered questionnaire. Study participants were recruited from five health facilities and their level of awareness and knowledge about Mother-to-Child transmission of hepatitis B were assessed. The level of statistical significance was set at 0.05 alpha level.

Results

The findings showed that both physicians and midwives had good knowledge on Mother-to-Child transmission of hepatitis B infection. However, there were some knowledge gaps regarding effective hepatitis B prevention from mother to their newborns such as the use of hepatitis B vaccine and immunoglobulin. Additionally, 49.2 % (n = 62) of the participants had never attended any workshop on Mother-to-Child transmission of hepatitis B since completion of formal training.

Conclusions

Developing appropriate periodic training programmes on current issues of hepatitis B for physicians and midwives in Eastern region will further enhance their knowledge. It is recommended that, further study examine if the knowledge of the respondents is translated into practice.

A Survey Study of Pregnant Women and Healthcare Practitioners Assessing the Knowledge of Attitudes and Practices of Hepatitis B Management at a Teaching Hospital in Kumasi, Ghana, West Africa

Hepatitis B virus (HBV) infection is a major global health problem, with sub-Saharan Africa (SSA), including West Africa, bearing a large proportion of cases. Mother-to-child and early childhood horizontal transmission, the most common mechanisms of disease spread in West Africa, lead to a high rate of chronic infection. Although these transmission mechanisms are preventable through vaccine and hepatitis B immunoglobulin, they are not routinely used due to limited resources. Antiviral therapy in pregnant women who are HBV positive is another option to reduce transmission. We conducted a survey study of pregnant women and clinicians at a teaching hospital in West Africa to determine the knowledge base about HBV and willingness to implement measures to reduce HBV transmission. Pregnant women had limited knowledge about HBV and the common transmission mechanisms. Clinicians identified cost and time as the major barriers to implementation of HBV prevention measures. Both pregnant women and clinicians were largely willing to implement and use measures, including antivirals, to help reduce HBV transmission.

Assessment of Growth and Development in Children With Hepatitis B Positivity

Background

Chronic infections and liver diseases may influence the growth and development of children by leading to malnutrition. In this study, demographic characteristics, anthropometric measurements and laboratory findings for children with hepatitis B positivity were analyzed.

Methods

A total of 43 cases were admitted to our clinic between January 2012 and February 2013 and detected to have HBsAg positivity.

Results

Malnutrition was detected in 11 cases (25.6%) and obesity in three cases (6.9%). Aspartate aminotransferase (AST) levels were significantly higher in malnourished patients compared to those without malnutrition. The weight to height was significantly higher in patients with positive HBeAg compared to children with negative HBeAg. We found that the weight standard deviation scores (SDS) ratios dropped as alanine aminotransferase (ALT) and AST levels increased and height SDS ratios decreased. In addition, body mass index (BMI) decreased as AST and alpha feto protein (AFP) values increased. While a significant relationship was not detected between insulin-like growth factor binding protein-3 (IGFBP-3) and insulin-like growth factor-1 (IGF-1) and ALT, a significantly negative correlation was detected between IGFBP-3 and IGF-1 and AST. We found a malnutrition rate of 25.6% in children with HBsAg positivity. We also found that weight and height SDS rates decreased as ALT and AST levels increased. In addition, we detected that BMI decreased as AST and AFP values increased.

Conclusion

We consider that hepatic inflammation is the factor that affects growth. Monitoring of growth and development during follow-up of children who are detected to have HBsAg positivity would be beneficial to determine the mechanism and causes of growth retardation.