Hepatitis B virus infection among pregnant women in Ethiopia: a systematic review and Meta-analysis of prevalence studies

Prevalence of hepatitis B virus infection among pregnant women in Africa: A systematic review and meta-analysis

INTRODUCTION

Africa exhibits a considerably high prevalence of the hepatitis B virus among pregnant women. Furthermore, there is a discernible lack of a well-established surveillance system to adequately monitor and comprehend the epidemiology of the hepatitis B virus, particularly among pregnant women. The eradication efforts of the virus in Africa have been impeded by the significant disease burden in the region, and there is a lack of evidence regarding the pooled prevalence of the hepatitis B virus in Africa. Consequently, this systematic review and meta-analysis aims to determine the prevalence of hepatitis B virus infection among pregnant women in Africa.

METHODS

We conducted a systematic literature search using reputable databases such as PubMed, Advanced Google Scholar, Scopus, and the Cochrane Library. The search spanned from July 2013 to July 2023 and included all relevant articles published within this period. To identify potentially eligible articles, we conducted a comprehensive manual review of the reference lists of the identified studies. Our review encompassed articles from the African Journal Online. The analysis focused on observational studies published in peer-reviewed journals that reported the prevalence of hepatitis B surface antigen-positive testing among pregnant women. We utilized the Newcastle-Ottawa critical appraisal checklist to assess the methodological quality of each paper. Finally, a meta-analysis was conducted using a random-effects model.

RESULTS

Out of the 774 studies identified, 31 studies involving 33,967 pregnant women were selected for the meta-analysis. According to the random-effects model, the combined prevalence of hepatitis B virus among pregnant women was 6.77% [95% CI: 5.72, 7.83]. The I2 statistic was calculated to be 95.57% (p = 0.00), indicating significant heterogeneity among the studies. The high I2 value of 95.57% suggests a substantial degree of heterogeneity. A subgroup meta-analysis revealed that factors such as time-dependent bias, sample size dependence, or individual variation among study participants contributed to this heterogeneity (p-difference < 0.05).

CONCLUSION

According to the findings of this study, the pooled prevalence of hepatitis B infection among pregnant women in Africa was found to be intermediate-high. It is recommended that policymakers implement hepatitis B virus immunization programs targeting pregnant women and their new-born babies at higher risk of exposure.

Prevalence of Hepatitis B virus infection and its determinants among pregnant women in East Africa: Systematic review and Meta-analysis

INTRODUCTION

Hepatitis B virus (HBV) is one of the major public health problems globally and needs an urgent response. It is one of the most responsible causes of mortality among the five hepatitis viruses, and it affects almost every class of individuals. Different studies were conducted on the prevalence of HBV among pregnant women in East African countries, but none of them showed the pooled prevalence of HBV among the pregnant women. Thus, the main objective of this study was to determine the pooled prevalence and its determinants among pregnant women in East Africa.

METHODS

We searched studies using PubMed, Scopus, Embase, ScienceDirect, Google Scholar and grey literature that were published between January 01/2020 to January 30/2024. The studies were assessed using the Newcastle Ottawa Scale (NOS) quality assessment scale. The random-effect (DerSimonian) model was used to determine the pooled prevalence and associated factors of HBV among pregnant women. Heterogeneity were assessed by I2 statistic, sub-group analysis, and sensitivity analysis. Publication bias was assessed by Egger test, and the analysis was done using STATA version 17.

RESULT

A total of 45 studies with 35639 pregnant women were included in this systematic review and meta-analysis. The overall pooled prevalence of HBV among pregnant women in East Africa was 6.0% (95% CI: 6.0%-7.0%, I2 = 89.7%). The highest prevalence of 8% ((95% CI: 6%, 10%), I2 = 91.08%) was seen in 2021, and the lowest prevalence 5% ((95% CI: 4%, 6%) I2 = 52.52%) was observed in 2022. A pooled meta-analysis showed that history of surgical procedure (OR = 2.14 (95% CI: 1.27, 3.61)), having multiple sexual partners (OR = 3.87 (95% CI: 2.52, 5.95), history of body tattooing (OR = 2.55 (95% CI: 1.62, 4.01)), history of tooth extraction (OR = 2.09 (95% CI: 1.29, 3.39)), abortion history(OR = 2.20(95% CI: 1.38, 3.50)), history of sharing sharp material (OR = 1.88 (95% CI: 1.07, 3.31)), blood transfusion (OR = 2.41 (95% CI: 1.62, 3.57)), family history of HBV (OR = 4.87 (95% CI: 2.95, 8.05)) and history needle injury (OR = 2.62 (95% CI: 1.20, 5.72)) were significant risk factors associated with HBV infection among pregnant women.

CONCLUSIONS

The pooled prevalence of HBV infection among pregnant women in East Africa was an intermediate level and different across countries ranging from 1.5% to 22.2%. The result of this pooled prevalence was an indication of the need for screening, prevention, and control of HBV infection among pregnant women in the region. Therefore, early identification of risk factors, awareness creation on the mode of transmission HBV and implementation of preventive measures are essential in reducing the burden of HBV infection among pregnant women.

Prevalence and associated factors for hepatitis B infection among pregnant women attending antenatal clinic at SOS Hospital in Mogadishu, Somalia

Background

Hepatitis B virus (HBV) remains a leading cause of chronic hepatitis, maternal complications, and neonatal deaths in sub-Saharan Africa. Mother-to-child transmission is a major route of HBV transmission in endemic areas. This study aimed to determine the prevalence of hepatitis B infection and its associated factors among pregnant women attending Antenatal Care clinics at SOS Hospital in Mogadishu, Somalia.

Methods

The research followed a cross-sectional design, and the participants were chosen through systematic random sampling, including every fifth outpatient. Each participant provided a blood sample for standard testing, and their consent was obtained before conducting Hepatitis B screening using the ELISA method.

Results

In our study of 384 pregnant women, 43 individuals (11.2%) tested positive for HBsAg. The frequency of HBsAg seropositivity was significantly higher in subjects with no education when compared to those with primary education (AOR = 0.1, 95% CI: 0.01-0.96, p = 0.046). Caesarian Section (AOR = 0.02, 95% CI: 0.004-0.0103, p = 0.001), blood transfusion (AOR = 11.6, 95% CI: 3.44-38.08, p = 0.001), previous dental procedures (AOR = 0.1, 95% CI: 0.04-0.38, p = 0.001), and unsafe injections in the past (AOR = 0.3, 95% CI: 0.09-0.91, p = 0.035) were identified as significant risk factors for hepatitis positivity.

Conclusions

The study found a higher prevalence of hepatitis B compared to previous studies. Factors such as blood transfusion, dental procedures, Caesarian Section, and unsafe injections were associated with hepatitis B infection. It is essential to raise awareness, promote preventive measures, and implement routine screening for pregnant women so as to stop the transmission of hepatitis B to their children.

Hepatitis B and hepatitis C virus infections and associated factors among prisoners in Gondar City, Northwest Ethiopia

BACKGROUND

Globally, hepatitis B virus (HBV) and hepatitis C virus (HCV) cause considerable morbidity and mortality from their acute and chronic infections. The transmission of the viruses within the prisons is high due to overcrowding, and other risk behaviors such as drug use, and unsafe sexual practices. This study aimed at determining the prevalence and associated factors of HBV and HCV infections among prisoners in Gondar city, Northwest Ethiopia.

METHODS

A cross-sectional study was conducted in the Gondar City Prison Center from May 1, 2022, to July 30, 2022. A total of 299 prison inmates were selected by using a systematic random sampling technique. A semi-structured questionnaire was used to collect data on sociodemographic, clinical, behavioral and prison related factors. Five milliliters of blood sample were collected, and the serum was separated from the whole blood. The serum was tested for HBV surface antigen (HBsAg) and anti-HCV antibody by using an Enzyme-Linked Immunosorbent Assay (ELISA). Data was entered using EpiData version 4.6.0 and exported to SPSS version 20 for analysis. Logistic regression analysis was done to assess the association between the independent variables and HBV and HCV infections. P-values < 0.05 were considered statistically significant.

RESULTS

The overall seroprevalence of HBV or HCV infections was 10.4%. The seroprevalence of HBV and HCV infections was 7.0% and 4.0%, respectively. It has been demonstrated that having several heterosexual partners, sharing sharp materials in prison, having longer imprisonment, and having a body tattoo are significantly associated with HBV infection. The presence of a body tattoo, a history of surgical procedures, and previous imprisonment are associated risk factors for HCV infection.

CONCLUSION

The prevalence of HBV and HCV were high-intermediate and high, respectively. Therefore, preventative and control initiatives are needed in prisons to decrease the rate of infection and transmission.

Information seeking behavior on hepatitis B virus, and its associated factors among pregnant women at teaching and specialized hospitals, Northwest Ethiopia: A cross-sectional study

INTRODUCTION

Hepatitis B virus (HBV) infection continues to be a major public health issue worldwide. Health information-seeking behavior is critical to obtain information about health, diseases such as the Hepatitis B virus, health risks, and health promotion and it has become a major concern of health policymakers. However, there is little evidence of information-seeking behavior on the Hepatitis B virus in Ethiopia. So, this study aimed to assess Hepatitis B virus information-seeking behavior and its associated factors among pregnant women at teaching and Specialized Hospitals, in Northwest Ethiopia.

METHODS

An institution-based cross-sectional study was conducted among pregnant women at teaching and specialized hospitals, in Northwest Ethiopia from May 01 to June 01, 2022. A total of 423 participants were selected using a systematic random sampling method. The data was collected through an interview-administered questionnaire by kobo-collect software. Then export into SPSS version 20 for analysis. Descriptive statistics, bi-variable, and multivariable logistic regression analyses were done to identify factors associated with Hepatitis B virus information-seeking behavior.

RESULTS

The proportion of information-seeking behavior on the Hepatitis B virus among pregnant women was 40.5% (CI = 35.7, 45.6). Education(diploma and above) [AOR = 3.3, 95% CI (1.31, 8.16)], more than one ANC visit [AOR = 5.99, 95% CI (3.20, 12.31)], smart-phone ownership [AOR = 4.1, 95%CI (1.35, 12.31)], internet access [AOR = 5.1, 95%CI (1.35, 15.60)], perceived susceptibility [AOR = 2.7, 95%CI (1.38, 5.31)], perceived severity [AOR = 3.7, 95%CI (2.06, 6.55)], and self-efficacy [AOR = 1.9, 95%CI (1.03, 3.73)] were factors influencing information seeking on Hepatitis B virus.

CONCLUSION

The overall proportion of information-seeking behavior on HBV among pregnant women was low. To improve information-seeking behavior on HBV among pregnant women we should connect the women to the internet and technology. Creating women's awareness about the Hepatitis B virus severity and their venerability and increasing their antenatal care (ANC) visits, self-efficacy, internet access, and women's education can improve information seeking about the Hepatitis B virus.

Modelling of Hepatitis B Virus vertical transmission dynamics in Ethiopia: a compartmental modelling approach

BACKGROUND

Hepatitis B (HB) is a virus which causes a potentially fatal liver infection. It is a DNA virus belonging to the Hepadnaviridae virus family. Africa, after Asia, has the second highest number of chronic HBV carriers and is considered a high-endemic region. Ethiopia is classified as a country with a high prevalence of viral hepatitis and with nations that lack a systematic strategy for viral hepatitis surveillance.

METHODS

S-I-C-R deterministic model was developed and the numerical simulations were done in "R" statistical and programming software. Fixed population assumption was considered so as to develop a simple model which could predict the HBV vertical transmission for the next 5 decades.

RESULTS

The model revealed that significant number of populations will be infected and become carrier till the end the next 49 years even though it has decreasing trend. It was predicted that 271,719 people will die of HBV complications if no intervention will be made on its vertical transmission. The sensitivity analysis result showed that the force of infection has the most important parameter in the vertical transmission dynamics of hepatitis B. Provision of hepatitis B immunoglobulin (HBVIG) and vaccines at the time of delivery could decrease the force of infection by more than half and 51,892 lives will be saved if the intervention is offered for 50% of deliveries in Ethiopia.

CONCLUSION

Despite the fact that the incidence of HBV vertical transmission is substantial, it is expected to decline during the next five decades. However, the situation necessitates immediate attention, since it results in thousands of deaths if no action is taken. Offering HBVIG and vaccinations to the 50% of infants can save many lives and reduces the force of infection by more than a half.

Seroprevalence and Risk Factors of Sexually Transmitted Blood-Borne Infections among Pregnant Women Attending Antenatal Care in Jirapa, Upper West Region of Ghana

Background

Sexually transmitted blood-borne infections (STBBIs) contribute to negative outcomes of pregnancy. Hepatitis B virus (HBV), hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis infections in pregnancy contribute significantly to maternal and child morbidities and mortalities. This study assessed the prevalence, knowledge, and risk factors of STBBIs (HBV, HCV, HIV, and syphilis) among pregnant women attending antenatal clinics in Jirapa.

Methods

A cross-sectional study design involving 246 pregnant women was employed for the study. A structured questionnaire was used to solicit information about the knowledge, prevalence, and risk factors of STBBIs.

Results

The overall prevalence of STBBIs was 11.4%; HBV prevalence was 9.8% and 0.8% each for HCV, HIV, and syphilis. About 66% of mothers were aware of mother-to-child transmission of infections during pregnancy. Knowledge of transmission of HIV (93.9%), hepatitis (67.1%), and syphilis (53.7%) in pregnancy was relatively high. Knowledge of risk factors for HIV, hepatitis, and syphilis was 97.6%, 74.4%, and 76.0%, respectively. More than 98% of respondents knew about the prevention of HIV, hepatitis, and syphilis. Significant risk factors associated with and predictive of STBBIs were female genital mutilation (FGM) and gravidity.

Conclusion

The occurrence of STBBIs among pregnant women was strongly associated with FGM and gravidity. Public health education should be directed at stopping the practice of FGM and improving reproductive health in the study area.

Sero-prevalence and associated factors of hepatitis B virus among pregnant women in Hawassa city public hospitals, Southern Ethiopia: Cross-sectional study design

Objective

This study aimed to determine the prevalence and identify associated factors of hepatitis B virus infection among pregnant women attending antenatal care (ANC) follow-up.

Methods

An institution-based cross-sectional study was conducted from March 04 to April 03, 2020. A total of 381 women were selected using systematic random sampling after every two consecutive women. Structured and interviewer administered questionnaire was used to collect the data. A 2 ml of venous blood sample was drawn from each participant. The plasma was separated from the collected blood samples and was analyzed using a rapid hepatitis B surface antigen (HBsAg) kit to determine hepatitis sero status. Data were entered into the EPI-Data version 3.1, then exported to the statistical package for social sciences version 25 software and analyzed. Multivariable logistic regression was performed to identify independent predictors of HBsAg B seroprevalence at a p-value <0.05.

Results

The prevalence of HBsAg sero-positivity among pregnant women was 6.6%, 95% CI (4.2, 8.9). History of hosptal admission (adjusted odds ratio (AOR) = 4.11; 95% CI = 1.33-12.71), surgical history (AOR = 6.8; 95% CI = 1.93-23.93), history dental procedures (AOR = 4.93; 95% CI = 1.31-18.53), and body tatoo practices (AOR = 6.822; 95% CI = 1.89-24.69) were found to be associated with HBsAg sero-positivity.

Conclusion

This study found that HBsAg sero positivity among pregnant women in the study area was in intermediate edemicity. Factors such as history of hospital admission, history of surgery, history of dental procedures, and body tattoo practices were found to be associated with HBsAg sero-positivity. The government of Ethiopia should strengthen screening of all pregnant women for HBV as a part of routine ANC in ANC clinics and treating if they are positive to prevent mother to child transmission.

Preconception care utilization and associated factors among reproductive age women in Mizan-Aman town, Bench Sheko zone, Southwest Ethiopia, 2020. A content analysis

Background

Preconception care is highly important in reducing a number of adverse pregnancy outcomes and helps to improve maternal health. Preconception care optimizes women’s health and improves pregnancy outcomes. It is a cost-effective first-line preventive strategy for birth defects. However, preconception care utilization in Ethiopia was very low. Studies on these issues are limited in Ethiopia in general and in Mizan-Aman town in particular.

Objective

To assess preconception care utilization and associated factors among reproductive age women in Mizan-Aman town, Bench-Sheko Zone, Southwest Ethiopia.

Methods

A community based cross-sectional study design was employed from April 16 to May 26, 2020 in Mizan-Aman town. The total study participants were 624 reproductive age women. Data were collected by using pre-tested interviewer administered questionnaires and entered into Epi-data version 3.1 then exported to STATA version 14 and analyzed accordingly. Univeriate and Bivariable analysis was done by analysis of variance (ANOVA) and independent t-test. Multivariable statistical analysis using generalized linear regression model (GLM) approach was used to classify factors of preconception care utilization. Since our response variable is measured in terms of count variable, we used a Poisson regression model with a log link function. Finally, Statistical significance between dependent and independent variables were assessed by odds ratios and 95% confidence intervals.

Results

Overall, 28.6% of the women receipt atleast one item of preconception care while only 1.5% were taken the whole recommended components of preconception care services. The most common item received in the study area was taking micronutrient supplementation (18.5%). Age of women, educational status, husbands educational status, husbands occupation, wealth status, distance from the health facility, waiting time to get services, planning to pregnancy, age at first pregnancy, previous ANC use, Previous PNC use, adverse pregnancy experience, women’s knowledge of preconception care, and attitude on preconception care were determinants of preconception service utilization.

Conclusions

Preconception care component utilization was lower as compare with recommended service with different disparities. Multipurpose tailored strategies which incorporate a woman with no formal education, poor knwledge on preconception care,never take maternal services previously and distant from health facility could improve preconception care service utilization. Advocative strategies on preconception care component and planning pregnancy may elicite more women to use the services of preconception care.

Magnitudes and Correlates of Human Immunodeficiency Virus, Hepatitis B Virus, and Syphilis among Pregnant Mothers Attending Antenatal Care in Addis Ababa, Ethiopia

BACKGROUND

Human immunodeficiency virus (HIV), hepatitis B virus (HBV), and syphilis are major sexually transmitted infections (STIs) among the general population in Ethiopia, which in turn result in a wide range of adverse pregnancy outcomes. Hence, it is important to determine the seroprevalence and risk factors of HIV, HBV, and syphilis infection among pregnant mothers attending antenatal care in Addis Ababa, Ethiopia.

METHOD

A cross-sectional study was conducted among 286 pregnant women from February 1, 2021, to March 30, 2021, in four selected public hospitals in Addis Ababa. Sociodemographic, risky sociocultural, behavioral, and hospital-related factors were collected using an interview-administered questionnaire. Detection of anti-HIV antibodies, hepatitis B surface antigen (HBsAg), and rapid plasma reagin (RPR) for syphilis was conducted. A binary logistic regression analysis was used to determine predictors of STIs using SPSS version 25.

RESULT

A total of 281 pregnant mothers with a mean age of 27.5 (SD 4.6) completed the study. Among the participants, the seroprevalence rates of HIV, HBV, and syphilis were 15 (5.3%), 9 (3.2%), and 5 (1.8%), respectively. Twenty six (9.3%) of the participants tested positive for any one of the STIs, and 3 (1.1%) of the women had HIV and syphilis coinfections. History of multiple sexual partners (AOR 3.42, 95% CI: 1.6-11.63) and STIs (AOR 3.7; 95% CI: 1.70-13.45) were significantly associated with HIV infection. Likewise, history of abortion (AOR 7.65, 95% CI: 1.17-49.74), tattooing (AOR 9.72, 95% CI: 1.41-66.73), and rape (AOR 9.72, 95% CI: 1.41-66.73) were significantly associated with hepatitis B virus infection. Husband history of multiple sexual partners (AOR 20.9, 95% CI: 1.8-241.8) was significantly associated with syphilis infection. The educational level of participants, history of tattooing (AOR 6.24, 95% CI: 1.79-21.7), and history of multiple sexual partners (AOR 5.15, 95% CI: 1.68-15.7) were independent predictors of infection with any one of the STIs.

CONCLUSION

There is still a high burden of HIV, HBV, and syphilis among pregnant mothers in Ethiopia. History of multiple sexual partners, abortion, rape, and tattooing was a significant predictor of STIs.

Seroprevalence of Hepatitis B Virus and Associated Factors among Pregnant Women Attending Antenatal Care Services at Public Health Facilities in Nekemte Town

Background

Viral hepatitis is an emerging global health problem. A pregnant mother infected with the hepatitis B virus has a high rate of vertical transmission, causing adverse fetal and neonatal outcomes. Understanding the magnitude of the problem and associated factors has paramount importance to avert such adverse fetal and neonatal outcomes. Therefore, the main aim of this study was to assess the seroprevalence of hepatitis B virus and associated factors among pregnant women attending antenatal care clinics at public health facilities in Nekemte town.

Methods

An institutional-based cross-sectional study was conducted among 277 pregnant women attending antenatal care at public health facilities in Nekemte town from June 1 to July 30, 2020. All public health institutions in Nekemte town (two hospitals and one health center) were recruited, and study participants were selected by using a systematic sampling method. The data were collected using pretested and structured questionnaires using a face-to-face interview, and a blood sample was collected to test for hepatitis B surface antigen. Logistic regression analysis was employed to identify factors significantly associated with hepatitis B virus infection. Variables with a p value < 0.05 were considered statistically significant predictors of the outcome variable.

Result

The overall seroprevalence of hepatitis B virus infection was 16 (5.8%) [95% CI: 3.2-8.7], which indicates intermediate endemicity. History of abortion (AOR =6.155; 95% CI: 1.780, 21.291), history of contact with hepatitis patient (AOR =7.178; 95% CI: 1.702, 30.279), and having multiple sexual partners (AOR =6.788; 95% CI: 1.701, 27.086) had a statistically significant association with hepatitis B surface antigen seropositivity.

Conclusion

Hepatitis B virus seroprevalence among pregnant women in this study shows intermediate endemicity. Therefore, health professionals should provide health information on the risk of having multiple sexual partners, risk factors of unprotected contact with hepatitis patients, and abortion for pregnant women during their antenatal care visits.

Hepatitis B virus infection in Nigeria: a systematic review and meta-analysis of data published between 2010 and 2019

Background

Hepatitis B virus (HBV) is an infectious disease of global significance, causing a significant health burden in Africa due to complications associated with infection, such as cirrhosis and liver cancer. In Nigeria, which is considered a high prevalence country, estimates of HBV cases are inconsistent, and therefore additional clarity is required to manage HBV-associated public health challenges.

Methods

A systematic review of the literature (via PubMed, Advanced Google Scholar, African Index Medicus) was conducted to retrieve primary studies published between 1 January 2010 and 31 December 2019, with a random-effects model based on proportions used to estimate the population-based prevalence of HBV in the Nigerian population.

Results

The final analyses included 47 studies with 21,702 participants that revealed a pooled prevalence of 9.5%. A prevalence estimate above 8% in a population is classified as high. Sub-group analyses revealed the highest HBV prevalence in rural settings (10.7%). The North West region had the highest prevalence (12.1%) among Nigeria’s six geopolitical zones/regions. The estimate of total variation between studies indicated substantial heterogeneity. These variations could be explained by setting and geographical region. The statistical test for Egger’s regression showed no evidence of publication bias (p = 0.879).

Conclusions

We present an up-to-date review on the prevalence of HBV in Nigeria, which will provide critical data to optimise and assess the impact of current prevention and control strategies, including disease surveillance and diagnoses, vaccination policies and management for those infected.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-021-06800-6.

A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria

Background

Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria.

Methods

Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg.

Results

From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I² = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I² = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant.

Conclusions

There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Hepatitis B surface antigen and associated factors among mothers who had antenatal care contact in Attat Hospital, southern Ethiopia

Introduction:

Hepatitis B virus is a viral infection which can cause both acute and chronic liver disease. Predominately, this virus transmitted through the mother-to-child route. It is an endemic disease in low-resource setting countries like Ethiopia.

Objective:

Therefore, this study was used to assess magnitude and associated factors of hepatitis B surface antigen among pregnant mothers, who had antenatal care in Attat Hospital.

Method:

The cross-sectional study was conducted from 1 September 2019 to 30 January 2020. The data were collected from serological testing in laboratory and interview in antenatal care on 422 pregnant mothers. The data were entered into Epi Data version 3.1 and exported to SPSS version 24.0 for further analysis. Variables on bivariate analysis at p < 0.25 were taken to multivariate analysis. A p value of less than 0.05 on multivariate analysis was considered significant.

Result:

From 438 total samples, 422 respondents were participated and the mean age of the participants was 25.4 years (standard deviation ± 4.85). Magnitude of hepatitis B surface antigen was 10.9% (95% confidence interval: 8.3, 14.0). Respondents whose occupation was in government or self-employed were 67% (adjusted odds ratio = 0.33, 95% confidence interval: 0.12, 0.91) and whose number of gravidity was 3 and below were 79% (adjusted odds ratio = 0.21, 95% confidence interval: 0.04, 0.68) less likely to have hepatitis B surface antigen. Respondents who respond that hepatitis B surface antigen has cured were 1.52 times (adjusted odds ratio = 1.52, 95% confidence interval: 1.7, 9.4) more likely to have hepatitis B surface antigen. Respondents who answered hepatitis B surface antigen has vaccine were 57% (adjusted odds ratio = 0.43, 95% confidence interval: 0.05, 0.75) less likely to have hepatitis B surface antigen.

Conclusion:

Magnitude of hepatitis B surface antigen among mothers who were on antenatal care in Attat Hospital was high compared to other studies. Being employed in government or self-employed, gravida 3 and below, those who think that the disease has vaccine and those who think hepatitis B surface antigen was curable were statistically significant factors. Health promotion should be an important recommendation to be done by the hospital.

Prevalence of Hepatitis B Virus Infection and Factors Associated with Hepatitis B Virus Infection Among Pregnant Women Presented to Antenatal Care Clinics at Adigrat General Hospital in Northern Ethiopia

Background

Hepatitis B infection is among the most common public health concerns globally, particularly in low- and middle-income countries. The prevalence of hepatitis B infection is more common among most vulnerable populations, including pregnant women. However, there are limited studies on hepatitis B virus infection among pregnant women in low-income countries, including Ethiopia, and the previous studies focused on the general population rather than the pregnant women. The purpose of this study was to estimate the prevalence and examine factors associated with hepatitis B virus infection among pregnant women in the Northern Ethiopia.

Methods

nstitution-based cross-sectional study design and a structured face-to-face interview were used to collect data from the study participants. Simple random sampling method was used to select eligible study participants. Data were entered using EpiData version 3.1, and SPSS version 20 was used for the data analysis. We analyzed the data to examine factors associated with hepatitis B virus infection using binary and multivariable logistic regression models.

Results

The overall prevalence of hepatitis B virus infection among the study participants was 9.2%. The majority (46.7%) of the study participants infected by hepatitis B were in the age group 25-34 years. The study found that married study participants were more likely to be infected by hepatitis B when compared to the unmarried study participants. Having history of abortion [OR = 0.12 (95% CI: 0.03, 0.47), P < 0.01] and having history of tattooing [OR = 0.21 (95% CI: 0.07, 0.62), P < 0.01] were found to be statistically significantly associated with the prevalence of hepatitis B virus infection among pregnant women.

Conclusion

A significant number of pregnant women participating in the study were infected by the hepatitis B virus which needs efficient intervention to reduce the infection rate. Further, educational status, having history of surgery, dental procedure, ear piercing, abortion and tattooing were found statistically to be significant before controlling for confounders. But, after controlling for confounders, only having history of tattooing and having history of abortion were found to be independent factors affecting the prevalence of the infection.

Seroprevalence of Hepatitis B Virus and Associated Factors Among Pregnant Women Attending Antenatal Care in Public Health Facilities in Jigjiga Town, Eastern Ethiopia

Background

Hepatitis B virus (HBV) remains a major global public health problem affecting millions of people across the world. The risk of developing a chronic hepatitis B virus infection is affected by the age at the time of acquiring infection. For instance, around 95% of these infections are acquired during the perinatal period. Although evidences indicate the wider effects of hepatitis B virus and its negative consequences, there are limited studies and a scarcity of data in Eastern Ethiopia. Therefore, this study was aimed at determining seroprevalence of HBV and associated factors among pregnant women attending antenatal care in the public health facilities of Jigjiga town, Eastern Ethiopia, from March 4 to April 4, 2019.

Methods

A facility-based cross-sectional study was employed among pregnant women in the public health facilities of Jigjiga town, Eastern Ethiopia. A total of 589 pregnant women were enrolled in the study using a systematic sampling technique. Data were collected using a pretested interviewer administered questionnaire. Five milliliters of venous blood samples was collected and tested for HBV using ELISA diagnostic test. The collected data were entered in to Epidata version 3.1 and exported to SPSS version 20 for statistical analysis. Descriptive statistics was carried out using frequency tables and summary measures. Multivariable analysis was done to identify the true effects of the selected predictor variables on the outcome variable after controlling for possible confounders. Statistical significance was declared at p-value <0.05.

Results

Overall, 8.5% (95% CI: 6.5–10.7) of the study participants were seropositive for HBsAg. Having any surgical history [AOR = 3.41, 95% CI (1.26–9.24)], family history of HBV [AOR = 4.96, 95% CI (2.11–10.60)], history of sharing sharps [AOR = 2.78, 95% CI (1.13–6.83)] and having multiple sexual partners [AOR = 6.12, 95% CI (2.12–17.64)] were significant predictors of HBV infection.

Conclusion

The seroprevalence of HBV was relatively high in this study area. Having a history of surgery, family history of hepatitis, history of sharing sharps and multiple sexual partners were significantly associated with HBV infection. Therefore, health information dissemination and awareness creation on mode of transmission of HBV are very crucial.

Knowledge, Attitude, and Associated Factors Towards Vertical Transmission of Hepatitis B Virus Among Pregnant Women Attending Antenatal Care in Tertiary Hospitals in Amhara Region, Northwest Ethiopia: A Cross-Sectional Study

PURPOSE

Hepatitis B virus (HBV) infection is a major public health problem globally. Mother-to-child transmission (MTCT) of HBV is high in endemic countries; however, little is known about pregnant women`s knowledge and attitudes regarding MTCT and prevention methods in Ethiopia. Therefore, this study aimed to assess the knowledge, attitude and associated factors of pregnant women towards MTCT of HBV and its prevention in three tertiary hospitals in the Amhara region, northwestern Ethiopia.

MATERIALS AND METHODS

A cross-sectional study was conducted from May 1, 2018 to September 30, 2019. A total of 1121 pregnant women participated in the study. A structured questionnaire was used to collect the sociodemographic, knowledge, and attitudes of pregnant women towards MTCT of HBV and its prevention. Data were analyzed using SPPS version 20. χ 2-test, multivariate logistic regression, Spearman correlation, and analysis of variance (ANOVA) were used for data analysis.

RESULTS

The majority of 89.6%; 95% CI (87.9-91.3%) pregnant women had poor knowledge of MTCT of HBV and its prevention. However, more than half of the study participants had favorable attitudes. Only 141 (12.6%) of the pregnant women knew that HBV transmitted from mother-to-child and 169 (15.1%) knew that HBV had a vaccine. There was a significant difference in attitude between the three hospitals (P<0.001). In multivariable analysis, education, gravida and vaccination history were independent factors significantly associated with good knowledge and favorable attitudes while income and residence significantly associated only to knowledge and attitude, respectively. There was a significant positive correlation between the knowledge and attitude of pregnant women (P<0.001).

CONCLUSION

The knowledge of pregnant women was found to be poor and their attitude was also limited to MTCT of HBV infection and its prevention. Educational status and vaccination history were predictors of knowledge and attitude, but income and residence only to knowledge and attitude, respectively. This study revealed a lack of knowledge in pregnant women for the prevention and control of MTCT of HBV. This calls for the Amhara Health Bureau and Ministry of Health to promote health education programs for pregnant women attending antenatal care on MTCT of HBV and its prevention methods to improve knowledge and attitudes.

Post exposure prophylaxis coverage, vertical transmission and associated factors among hepatitis B exposed newborns delivered at Arsi zone health institutions, 2019

INTRODUCTION

One third of the world population has been exposed to hepatitis B virus and an estimated 257 million people are chronically infected. The main route of hepatitis B virus (HBV) infection is vertical transmission. Post exposure prophylaxis is recommended by world health organization to have free Hepatitis B infection by 2030.

OBJECTIVE

The main purpose of this research project was to assess Hepatitis B virus post exposure prophylaxis coverage, rate of vertical transmission and factors among exposed newborns delivered at Arsi zone health institution.

METHODS

A cross-sectional study was conducted in Arsi zone health institutions among hepatitis B virus exposed newborns delivered at Arsi zone health institutions from January 2018 to September 2019. Systematic sampling technique was used to select 422 exposed newborns into the study. A pre-tested structured questionnaire and checklist were used to collect relevant data. Data was entered and cleaned using epidata7 & analyzed using SPSS version 25 software package. Both bivariate and multivariate analyses was carried out to identify associations. Odds ratio with 95% CI and P-value <0.05 was considered statistically significant.

RESULTS

The study revealed that among 401 exposed newborns only 83(20.7%), have been administered post exposure prophylaxis. But vertical transmission of hepatitis B virus (HBV) was observed in 32.4% (27.9%-36.9%) exposed newborns. Antenatal (ANC) attendance (AOR = .40, 95%CI = .23-.69), Instrumental delivery (AOR = 4.18, 95%CI = 2.05-8.51) HIV coinfection (AOR = 9.7, 95%CI = 4.37-21.34), Post exposure Prophylaxis (AOR = .20, 95%CI = .08-.50) and Knowledge on HBV (AOR = .27, 95%CI = .14-.53) are significant predictors of HBV vertical transmission.

CONCLUSION

Magnitude of HBV post exposure prophylaxis coverage is very low while Rate of vertical transmission is high. Antenatal attendance, Instrumental delivery, Post exposure Prophylaxis and Knowledge on hepatitis B virus transmission are significant predictors of HBV vertical transmission.

Seroprevalence of Hepatitis B Virus Infection, Mother-To-Child Transmission, and Associated Risk Factors Among Delivering Mothers in Tigray Region, Northern Ethiopia: a Cross-Sectional Study

Introduction

High prevalence of hepatitis B virus (HBV) infection among pregnant women is the primary source of infection for their children and the general population. Mother-to-child transmission (MTCT) is the primary mode of transmission in endemic areas like Ethiopia. The aim of this study was to determine the prevalence of HBV infection, rate of MTCT, and associated risk factors among delivering mothers.

Methods

This health facility-based cross-sectional study was conducted in four public hospitals of the Eastern zone of Tigray among 473 delivering mothers. Structured questionnaires and laboratory results were used to collect the data. The data were checked for completeness and entered into EpiData manager version 4.6.0.0. Then the data were exported to Statistical Package for Social Sciences (SPSS) version 23. The odds ratio, along with a 95% confidence interval, was estimated to identify predictors of HBV infection using multivariable logistic regression analysis. Significant association was considered at p < 0.05.

Results

A total of 473 mothers were enrolled, and the response rate was 100%. The prevalence of HBV infection among the mothers and the rate of MTCT of the infection were 11.6% and 30.9%, respectively. History of home delivery [adjusted odds ratio (AOR) = 4.5, 95% confidence interval (CI) (2, 10.6)], history of hospital admission [AOR = 5, 95% CI (2.2, 11.5)], working at health facility [AOR = 5.4, 95% CI (1.4, 20.7)], body tattoos [AOR = 5.8, 95% CI (2.4, 13.6)], sharing personal care materials [AOR = 3.8, 95% CI (1.4, 9.9)], insufficient knowledge [AOR = 5.6, 95% CI (1.6, 19)], and having human immunodeficiency virus (HIV) [AOR = 5.1, 95% CI (1, 26.2)] were significantly associated with HBV infection.

Conclusion

HBV infection among delivering women is becoming highly endemic, and the rate of MTCT was high. Therefore, administering hepatitis B vaccine to all neonates within 24 h of birth is mandatory to prevent MTCT of HBV infection and related complications. Furthermore, health education and dissemination of information about HBV for the pregnant mothers are needed to reduce HBV infection and vertical transmission in Ethiopia.

Introduction of birth dose of hepatitis B virus vaccine to the immunization program in Ethiopia: an economic evaluation

BACKGROUND

Hepatitis B virus (HBV) infection is an important cause of morbidity and mortality with a very high burden in Africa. The risk of developing chronic infection is marked if the infection is acquired perinatally, which is largely preventable through a birth dose of HBV vaccine. We examined the cost-effectiveness of a birth dose of HBV vaccine in a medical setting in Ethiopia.

METHODS

We constructed a decision analytic model with a Markov process to estimate the costs and effects of a birth dose of HBV vaccine (the intervention), compared with current practices in Ethiopia. Current practice is pentavalent vaccination (DPT-HiB-HepB) administered at 6, 10 and 14 weeks after birth. We used disability-adjusted life years (DALYs) averted to quantify the health benefits while the costs of the intervention were expressed in 2018 USD. Analyses were based on Ethiopian epidemiological, demographic and cost data when available; otherwise we used a thorough literature review, in particular for assigning transition probabilities.

RESULTS

In Ethiopia, where the prevalence of HBV among pregnant women is 5%, adding a birth dose of HBV vaccine would present an incremental cost-effectiveness ratio (ICER) of USD 110 per DALY averted. The estimated ICER compares very favorably with a willingness-to-pay level of 0.31 times gross domestic product per capita (about USD 240 in 2018) in Ethiopia. Our ICER estimates were robust over a wide range of epidemiologic, vaccine effectiveness, vaccine coverage and cost parameter inputs.

CONCLUSIONS

Based on our cost-effectiveness findings, introducing a birth dose of HBV vaccine in Ethiopia would likely be highly cost-effective. Such evidence could help guide policymakers in considering including HBV vaccine into Ethiopia's essential health services package.

Hepatitis B Virus Infection and Its Determinants among Pregnant Women in Ethiopia: A Systematic Review and Meta-Analysis

Background

Hepatitis B virus (HBV) is an infectious and a global public health problem. The prevalence of HBV infection among pregnant women is between 2.3% and 7.9%. HBV infection during pregnancy is associated with prenatal transmission to the fetus. HBV has an effective vaccine which reduces up to 96% of the transmission. Although different studies were conducted in Ethiopia, none of them showed the national prevalence of HBV infection among pregnant women. Therefore, this study was conducted to determine the pooled prevalence of HBV and its associated factors in Ethiopia.

Methods

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for articles. All observational published studies were retrieved using relevant search terms in Google Scholar, African Online Journal, CINAHL, and PubMed databases. Newcastle-Ottawa assessment checklist for observational studies was used for critical appraisal of the included articles. The meta-analysis was done with STATA version 14 software. The I ² statistics were used to test heterogeneity whereas Begg's and Egger's tests were used to assess publication bias. Odds ratio (OR) with a 95% confidence interval (CI) was presented using the forest plot.

Results

A total of twenty-three studies were included in this systematic review and meta-analysis. The pooled prevalence of HBV in Ethiopia was 4.75% (95% CI: 4.06, 5.44). The subgroup analysis showed a higher prevalence of HBV infection among pregnant women in Gambella (7.9%) and the lowest in Southern Nations, Nationalities, and Peoples' Region (SNNPR) (2.3%). Associated factors with HBV infection include history of multiple sexual partner (OR = 6.02 (95%CI = 3.86, 9.36)), blood transfusion history (OR = 5.71 (95%CI = 3.25, 10.04)), abortion history (OR = 3.58 (95%CI = 2.10, 6.09)), and history of body tattoo (OR = 2.83 (95%CI = 1.55, 5.17)).

Conclusions

HBV infection among pregnant women is a common public health problem in Ethiopia. Multiple sexual partners, abortion history, blood transfusion history, and body tattoo were significantly associated with HBV infection. Policies and strategies should focus on factors identified in this study to improve the prevention of HBV among pregnant women.

Hepatitis B in sub-Saharan Africa-How many patients need therapy?

Hepatitis B is endemic in sub-Saharan Africa with ~60 million people chronically infected. While prevention, through vaccination, is central to elimination strategies, only 11 countries have birth dose vaccination and full vaccine coverage remains at suboptimal levels. Furthermore, to fully realize elimination, those chronically infected need to be identified, assessed for therapy and then linked to care. Given current treatment criteria, the precise quantum of people warranting therapy, according to criteria, is essentially unknown. The issue is further complicated by data to suggest differences in the numbers of people requiring treatment when applying WHO as compared to European Association for the Study of the Liver, EASL, criteria. Optimal determination of treatment eligibility is further hindered by the lack of available tools to adequately assess individual patients. It is conceivable that accurately determining the number of those requiring treatment, given the heterogeneity of hepatitis B in Africa, is difficult. Better studies and data are required. More signifcantly, improved access and availability to the diagnostic tools needed to assess patients in additon to access to drugs are as, if not more important, to achieve elimination.

Seroprevalence of Hepatitis B virus infection and associated factors among pregnant women at Korle-Bu Teaching Hospital, Ghana

INTRODUCTION

Hepatitis B virus infection is a global public health problem. Though, the disease is endemic in sub-Saharan Africa, little is known about its epidemiology among pregnant women in Ghana. This study sought to determine the seroprevalence of Hepatitis B virus infection and associated factors among pregnant women attending antenatal care at Korle-Bu Teaching Hospital; Ghana's largest hospital.

METHODS

We conducted a facility-based cross-sectional survey among 232 antenatal attendants. Participants were recruited using systematic random sampling technique and screened with HBsAg Rapid Test. Data was analyzed with the aid of Statistical Package for Social Sciences (SPSS), version 23.0. Results were presented using descriptive statistics, Fisher's Exact test and Logistic Regression analysis.

RESULTS

Two hundred and twenty-one (221) of the total sample (n = 232) agreed to participate in this study; representing a response rate of 95%. The mean age of the participants was 31 years and standard deviation of 5.3. The mean gestational period at recruitment was 28 weeks and standard deviation of 6.8. Majority of the participants were married (83.3%), parous (69.6%), educated (91.4%) and employed (90.5%). The prevalence of HBsAg was 7.7%. We found no significant association between socio-demographic characteristics of the participants and HBV infection.

CONCLUSION

Seroprevalence of 7.7% indicates moderate endemicity. Socio-demographic characteristics did not influence HBV infection among pregnant women attending antenatal care at Korle-Bu Teaching Hospital. The findings provide empirical evidence that will contribute to knowledge of HBV epidemiology in Ghana.

Seroepidemiology of Hepatitis B and C Virus Infections among Pregnant Women Attending Antenatal Clinic in Selected Health Facilities in East Wollega Zone, West Oromia, Ethiopia

Background

Hepatitis B virus and hepatitis C virus infections are a public health problem worldwide. It is highly endemic in Asia and Sub-Saharan Africa. Horizontal and perinatal transmissions are thought to be the major modes of transmission in these countries. Objective. This study aimed to investigate the seroepidemiology and possible risk factors for hepatitis B virus and hepatitis C virus infection among pregnant women attending antenatal care clinics.

Methods

A cross-sectional study design was conducted from July to September 2014 among 421 pregnant women attending antenatal care services in randomly selected health facilities, East Wollega Zone, West Oromia, Ethiopia. Blood sample was collected from each woman and separated serum was tested for the presence of markers. A prestructured questionnaire was used to collect sociodemographic data and risk factors. The collected data was analyzed using SPSS 20.0 statistical software. Odds ratio and 95% confidence interval were used as measures of the strength of association.

Result

The overall prevalence of HBsAg was 2.4% ranging from 0.0% to 5.2%. It was the highest in Sire Health Center and the lowest/nil in others. The prevalence of HCV ranged from 6.7% to 20% with an average of 8.07% in this study area where it was highest in the Getema Health Center Antenatal Care Attendants. Only address (p=0.020) and area of the health institution (p=0.021) are significantly the associated factors for HBsAg and serostatus of HCV, respectively.

Conclusion

The prevalence of HBsAg carrier rate of pregnant women in the study area falls within the medium endemic prevalence and HCV prevalence was higher than HBsAg. Study participants who were from urban areas were significantly affected with HBV while study institution affects the prevalence of HCV infection so that initiating screening tests during follow up period for antenatal care services is mandatory.