Systematic review and meta-analysis of HIV, HBV and HCV infection prevalence in Sudan

HIV and hepatitis B virus co-infection in Mozambique: Policy review and health professionals' knowledge and practices

BACKGROUND

Human Immunodeficiency Virus (HIV) and Hepatitis B Virus (HBV) co-infection is a public health problem affecting 2.7 million worldwide. In Mozambique, the prevalence of this co-infection is 9.1%, calling for specific policies on prevention, diagnosis and adequate management in health facilities caring for HIV patients. This study aimed to review the existing policies and to assess the knowledge and practices of health professionals about HIV/HBV co-infection.

METHODS

A document and literature review to describe the existing policies and guidelines on HIV/HBV co-infection in Mozambique was performed. Key informants were contacted to clarify or add information. Health Professionals who care for HIV-positive patients in four health centers in Maputo City, the capital of Mozambique, responded to a questionnaire on knowledge and practices about this co-infection. Qualitative analysis was done to identify main themes using content analysis. Descriptive statistics of socio-demographic, knowledge and practice variables was presented using the SPSS Program version 20 and bivariate analysis was applied to describe the association between variables.

RESULTS

Twenty-one policy documents were found, and five key informants were interviewed. Fifty-two participants answered the questionnaire. Only one policy document explicitly referred to HIV/HBV co-infection treatment. Most Health Professionals (96%) were aware of HIV/HBV co-infection. Although the only existing policy is on the treatment, few (33%) referenced antiretroviral formulations containing Tenofovir and Lamivudine. Only 29% of Health Professionals reported screening HIV patients for HBV and 21% practiced HIV/HBV co-infection counselling. No statistically significant differences were found when relating the socio-demographic variables with knowledge and practices.

CONCLUSION

Policy documents relating to prevention, diagnosis and clinical management of HIV/HBV co-infection were rare or absent. Health Professionals had little knowledge about HIV/HBV co-infection. Defining adequate policies and training of Health Professionals may help increase awareness, increase counselling of patients for disease prevention, diagnosis and proper management of HIV/HBV co-infected patients.

High prevalence of hepatitis B and HIV among women survivors of sexual violence in South Kivu province, eastern Democratic Republic of Congo

INTRODUCTION

Limited data are available on the prevalence rates of hepatitis B and acquired immunodeficiency syndrome (AIDS) among women survivors of sexual violence (WSSV) in South Kivu province, in the eastern part of the Democratic Republic of Congo (DRC), where armed conflicts persist. Here, we aimed to assess the prevalence of these two infections in this vulnerable local population.

METHODS

A total of 1002 WSSV, aged from 18 to 70 years old were enrolled from May 2018 to May 2020 at three healthcare facilities (Panzi, Mulamba and Bulenga hospitals), which are called "The One-Stop Centre Care Model" for the management of sexual violence in South Kivu. Blood samples were collected and tested for hepatitis B virus (HBV) and human immunodeficiency virus (HIV) antigens and antibodies using enzyme-linked immunoassay (ELISA) methods. Subsequently, viral load quantification for HBV and HIV were performed using the GeneXpert. Univariate and multivariate logistic regression models were used to assess factors associated with HIV-positive and HBV-positive status.

RESULTS

For HBV, overall prevalence was 8.9% (95% CI; 7.2-10.8%), 32.1% (95% CI; 29.3-35.0%), and 14.5% (95% CI; 12.3-16.8%) for HBsAg, anti-HBc and anti-HBs antibodies, respectively. Among the 89 HBsAg-positive patients, 17 (19.1%) were HBeAg-positive. The median age of individuals with a positive HBsAg test was higher than those with a negative test (median: 40 years (IQR 30-52) compared to 36 years (IQR 24-48)). Risk factors for HBV infection were age (≥35 years) (AOR = 1.83 [1.02-3.32]; p = 0.041), having no schooling (AOR = 4.14 [1.35-12.62]; p = 0.012) or only primary school-level (AOR = 4.88 [1.61-14.75]; p = 0.005), and multiple aggressors (AOR = 1.76 [1.09-2.84], p = 0.019). The prevalence of HIV was 4.3% [95% CI: 3.1-5.7%]. HIV/HBV co-infection occurred only in 5 individuals (0.5%). The HBV viral load was detectable (> 1 log10 UI/mL) in 61.8% of HBsAg-positive subjects and 64.8% HIV-positive subjects had a high viral load (≥ 3 log10 copies/mL).

CONCLUSION

This study revealed a high prevalence of HBV and HIV infections among WSSV in South Kivu. The results generated highlight the urgent need for systematic screening of HBV and HIV by integrating fourth-generation ELISA tests in HIV and HBV control programs.

Seroprevalence of human immunodeficiency virus in African blood donors: a systematic review and meta-analysis

BACKGROUND

In developing countries, the safety of blood transfusions remains an important public health concern as it is associated with a higher risk of transfusion-transmissible infections (TTIs). In this study, we aimed to estimate the seroprevalence of HIV among blood donors in Africa and assess the temporal trends and regional differences within the continent through a systematic review and meta-analysis.

METHODS

Seven electronic databases (PubMed, Web of Science, Cochrane, Scopus, HINARI, Global Index Medicus and Clinical.

TRIAL

gov) were searched for relevant studies for our research. We included all primary studies that estimated the seroprevalence of HIV among blood donors in Africa with an age population from 16 to 65 years old, without language restrictions, from inception up to March 1st 2024. The pooled seroprevalence was estimated through the DerSimonian-Laird random effects model. The temporal trends and regional differences were assessed through subgroup and meta-regression analysis.

FINDINGS

We obtained 122 studies that met our inclusion criteria, comprising 7,814,996 blood donors tested for HIV. Sixty-six percent of the studies were from Western and Eastern Africa. The pooled seroprevalence of HIV among blood donors in Africa was 2.66% (95% CI: 2.17-3.20%; I2 = 99.80%, p < 0.01). The highest prevalence was observed in the Central African region, 3.28% (95% CI: 2.57%-4.06%), followed by the Eastern 3.21% (95% CI: 2.12%-4.52%), and the Western 2.66% (95% CI: 1.93%-3.49%) regions. Lower prevalences were observed in the Northern region, 0.57% (95% CI: 0.0%-2.10%), followed by the Southern African region with 0.45% (95% CI: 0.16%-0.86%). We observed a temporal decreased trend of HIV prevalence.

INTERPRETATION

The prevalence of HIV infection among African blood donors remains high and is not homogeneous across the continent. Efficient measures to strengthen HIV testing and prevent HIV transmission through blood transfusion are needed in Africa. Systematic review protocol registration: PROSPERO CRD42023395616.

FUNDING

This article was supported by National Funds through FCT - Fundação para a Ciência e a Tecnologia,I.P., within CINTESIS, R&D Unit (reference UIDP/4255/2020).

Combined "Test and Treat" Campaigns for Human Immunodeficiency Virus, Hepatitis B, and Hepatitis C: A Systematic Review to Provide Evidence to Support World Health Organization Treatment Guidelines

Background

Worldwide, more than 39 million individuals are living with human immunodeficiency virus (HIV), 296 million with chronic hepatitis B (HBV), and 58 million with chronic hepatitis C (HCV). Despite successful treatments for these blood-borne viruses (BBVs), >1.7 million people die per annum. To combat this, the World Health Organization recommended implementing triple testing for HIV, HBV, and HCV. This systematic review aims to provide evidence for this policy, by identifying the prevalence of these BBVs and discussing the costs of available triple tests.

Methods

Medline, Embase, and Global Health were searched to identify articles published between 1 January and 24 February 2023. Included studies reported the prevalence of HIV (anti-HIV 1/2 antibodies), HBV (hepatitis B surface antigen) and HCV (anti-HCV antibodies). Results were stratified into risk groups: blood donors, general population, healthcare attendees, individuals experiencing homelessness, men who have sex with men, people who use drugs, pregnant people, prisoners, and refugees and immigrants.

Results

One hundred seventy-five studies sampling >14 million individuals were included. The mean prevalence of HIV, HBV, and HCV was 0.22% (standard deviation [SD], 7.71%), 1.09% (SD, 5.80%) and 0.65% (SD, 14.64%) respectively. The mean number of individuals testing positive for at least 1 BBV was 1.90% (SD, 16.82%). Therefore, under triple testing, for every individual diagnosed with HIV, another 5 would be diagnosed with HBV and 3 with HCV. Testing for all 3 viruses is available for US$2.48, marginally more expensive than the lowest-priced isolated HIV test ($1.00).

Conclusions

This article highlights a potential avenue for healthcare improvement by implementing combination testing programs. Hopefully, this will help to achieve the Sustainable Development Goal of elimination of these BBV epidemics by 2030.

Tuberculosis in Sudan: systematic review and meta analysis

Every year, 10 million people fall ill with tuberculosis (TB). Despite being a preventable and curable disease, 1.5 million people die from TB each year -making it the world's top infectious disease. TB is the leading cause of death of people with HIV and also a major contributor to antimicrobial resistance. Its presumed that TB was the cause of 1% of the total deaths among inpatients in Sudan in 2017. The current study is aimed to provide pooled prevalence of Mycobacterium tuberculosis among Sudanese as well as to determine any socio-cultural risk factors associated. A systematic review of the literature was conducted and regulated in accordance with the PRISMA Statement. After abstract and full text screening only twenty-six articles met our inclusion criteria and passed the quality assessment procedure. Pulmonary tuberculosis prevalence was assessed in sixteen included studies among participants from Khartoum, Gezira, Kassala, Blue Nile, River Nile, White Nile, Gadarif, Red sea, North Kordofan, Northern State, Sennar and West Darfur States, representing a total sample size of 11,253 participants of suspected individuals such as febrile outpatients, TB patients' contacts and other groups such as HIV/AIDS patients, hemodialysis patients, School adolescents as well as pregnant women. The pooled prevalence was 30.72% [CI: 30.64, 30.81]. Moreover, Khartoum State recorded the highest pooled prevalence as 41.86% [CI: 14.69, 69.02] based on a total sample size of 2,737 participants. Furthermore, male gender and rural residence were found to be significantly associated with TB infection. Further research with larger sample sizes targeting prevalence and risk factors of TB among Sudanese population is needed to be conducted.

Diarrheal diseases prevalence among children of Sudan and socio cultural risks related; systematic review and meta analysis

It is estimated that more than 4% of the causes of inpatient deaths in 2017 were due to diarrheal diseases. The current study is aimed to provide pooled prevalence of microorganisms causing diarrhea among Sudanese as well as determine any socio-cultural risk factors associated. A systematic review of the literature was conducted and regulated in accordance to PRISMA. After abstract and full text screening Twenty-one research articles were recruited to the study. Among witch eighteen research articles determined prevalence of causative microorganisms of Diarrhea; eight research articles determining prevalence of causative microorganisms of Diarrhea were conducted in Khartoum State, five in Gezira State, two in White Nile State, one in Kordofan State while two studies were conducted in several States. Moreover, majority of studies were concerned of prevalence among children while two studies were toward general population as well as mothers of children. The pooled prevalence of viral diarrhea in less than five years old children was 22.90% [15.37, 30.43] among more than 14 thousands' participants, the pooled prevalence of parasitic diarrhea was 31.40% [19.53, 43.27] among participants from different age groups while the pooled prevalence of bacterial diarrhea was 36.20% [14.00, 58.40]. No associated risk factors were able to be synthesized from included studies.

Knowledge, attitude, and practice towards hepatitis B virus among healthcare workers: a cross-sectional, hospital-based study in Montserrado County, Liberia

Prevention is critical in safeguarding against the spread of hepatitis B virus (HBV) infection. The knowledge, attitudes, and practices of healthcare workers (HCWs) regarding the disease play an important role in its prevention or spread, yet in this regard, data in Liberia remains scarce. Hence, determining the Knowledge, Attitude, and Practices (KAP) level of HCWs toward HBV infection becomes necessary. A descriptive cross-sectional hospital-based study was conducted among 251 HCWs at two major health facilities in Monrovia. KAP regarding HBV was assessed using a standardized structured questionnaire. Results were analyzed using descriptive statistics for demographic characteristics, percentages for categorical variables, and mean ± standard deviation for continuous variables. Kruskal Wallis test, p < 0.05, was used to derive statistical inferences. Complete data from 248 respondents showed a mean age of 36.3 ± 8.9 years with most respondents were within 30-39 age range (45.82%). While poor knowledge was observed in responses to all categories of questions, correct response rates to questions range from 41.93 - 99.19% for transmission of HBV, to 98.79 - 100% for preventive measures of HBV. About 77.8% and 90.32% of study respondents strongly agreed that hepatitis B is a major public health threat and that following infection control guidelines will protect them from being infected with HBV at work respectively. More than half of the participants (60.08%) had a history of needle-stick injury (NSI), and washing the injury site with water and soap, sterilizing the wound, and checking whether the patient has a blood-borne disease was done by 48.79%, 53.62% and 27.01% of the respondents respectively. Findings from this study show that there is an inadequate level of KAP regarding HBV infection among the HCWs. It therefore is expedient to conduct regular awareness campaigns for HCWs on preventive measures against HBV infection in hospitals, in addition to workshops and in-service trainings on infection prevention and control (IPC) best practices.

The first Helicobacter pylori-induced Guillain-Barré syndrome in Sudan

Key Clinical Message

This case report highlights the role of Helicobacter pylori infection in the development of GBS. Healthcare providers should consider H. pylori in their differential diagnosis for patients with neurological syndromes.

Astract

We report the first known case of Guillain-Barré syndrome (GBS) associated with Helicobacter pylori infection in Sudan. This case highlights the role of H. pylori infection in the development of GBS. It also emphasizes the importance of wide screening of different endemic infections for patients with neurological syndromes for early detection and improves the case management in resource-limited settings like Sudan. Further research is needed to better understand the underlying mechanisms of H. pylori-inducing neurological disorders.

Pneumonia in Sudan: Systematic and Scoping Review of the Literature and Meta-Analysis

In addition to excessive burden of non-communicable diseases, natural and manmade disasters, and internal conflicts, Sudan is predominantly susceptible to communicable diseases, such as malaria, tuberculosis, and pneumonia, which bring about an extra burden of demand for high-quality healthcare. According to the WHO and the Sudan Health Observatory, pneumonia is one of the leading causes of death in Sudan. This study therefore aimed to illustrate pneumonia literature in Sudan, estimate infection prevalence regardless of the cause among Sudanese children and adults, and demonstrate its related risk factors. A systematic and scoping review of the literature was conducted and regulated in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After abstract and full-text screening, only 15 articles met our inclusion criteria and passed the quality assessment procedure. Seven included studies determined prevalence of pneumonia; the overall pooled prevalence was around 30%. Furthermore, 12 research articles investigated risk factors related to pneumonia among Sudanese population. Further research with larger sample sizes targeting risk factors of pneumonia among Sudanese population is needed to be conducted.

Uptake of hepatitis B vaccination and associated factors among health sciences students, Mogadishu, Somalia

Background

Hepatitis B is a potentially fatal liver infection caused by the hepatitis B virus (HBV). It is a serious issue for global health. It considerably raises the risk of cirrhosis and liver cancer-related death and can result in chronic infection. The risk of infection is high among health sciences students due to the risk of occupational contact with fluids of infected patients and the risk of needle stick injury. The most effective way of preventing HBV infection is the vaccination of students prior to their posting to healthcare settings. There is no data available about HBV vaccination uptake among Health Sciences students in Somalia. Therefore, this study aimed to determine HBV vaccination uptake and associated factors toward HBV among health science students in Somalia.

Methods

A cross-sectional study was undertaken among health sciences students from August to October 2022. Data were gathered using Kobo Toolbox using a standardized questionnaire with questions on characteristics, knowledge attitude, and HBV prevention practices. A total of 569 students were involved in the study. Stata version 15 was utilized for the analysis. Bivariate and multivariate logistic regression analysis, as well as descriptive statistics, were performed. In order to assess the existence and significance of the relationship between the outcome and risk factors, an adjusted odds ratio with a 95% confidence interval (CI) was used. Statistical significance was considered as a p-value ≤0.05.

Results

Of the 569 study participants, 33.4% (95%CI: 29.6-37.4) received a full dose of the HBV vaccine in this study. Participants had good HBV prevention knowledge, attitudes, and practices at 69.6, 37.96, and 50.6%, respectively. The lack of access and the high cost of the vaccine were the reasons for not taking the vaccine. Second-year [AOR: 0.22 (0.12-0.43)]. Positive attitude [AOR: 0.54 (0.31-0.93)], and good practice [AOR: 6.99 (3.62-13.5)].

Discussion

The study indicated that 33.4% of health sciences students had received the required HBV vaccination doses, academic year, attitude, and practice were significantly associated with full-dose vaccination status. The unavailability of the vaccine and the high cost of vaccination were the most common reasons for not taking the vaccine. It is recommended that students receive vaccinations before beginning clinical rotations, and give instruction on infection prevention strategies and general precautions, particularly regarding HBV infection.

Seroprevalence and trends of hepatitis B virus, hepatitis C virus and human immunodeficiency virus in Syrian blood donors at Damascus University Blood Center between 2004 and 2021

Introduction

Seroprevalence of transfusion-transmitted viral infections (TTVIs) is a valuable indicator for assessing blood safety, population health and health system performance in the times of peace and conflicts. Only scarce information is available on the impact of the decade-long violent conflict on the prevalence of TTVIs in Syria. Moreover, hepatitis B vaccine was introduced to the national vaccination program in 1993; however, no data is available on the vaccine effectiveness.

Methods

In this retrospective cross-sectional study, we compiled the screening results for major TTVIs, namely hepatitis B virus (HBV), hepatitis C virus (HCV), and human immuno-deficiency virus (HIV), of volunteer donors at Damascus University Blood Center from May 2004 to October 2021. Prevalence was expressed in percentages for the entire study group and subgroups. Chi-square test and linear regression were used to examine the differences and describe trends in prevalence, respectively, based on demographic characteristics (i.e., age and gender) and time. P-value of <0.005 was considered statistically significant.

Results

Of the total 307,774 donors (82.27% males, median age 27 years), 5,929 (1.93%) had serological evidence of at least one TTVI, and 26 (0.0085%) had multiple infections. The lowest prevalence (1.09%) was detected in donors aged 18-25 years old, and a higher prevalence (2.05%) was evident in males in comparison with females (1.38%). The seroprevalence of HBV, HCV, and HIV was 1.18, 0.52, and 0.23%, respectively. Trend analyses revealed a significant regression in HBV and HIV prevalence from 2011 to 2021. HBV seropositivity depicted a temporal decline by ~80%, from 0.79% in 2011 to 0.16% in 2021 in those born in 1993 and thereafter.

Discussion

The seroprevalence of HBV, HIV, and to a lesser extent HCV dropped over the study 18-year period. Possible explanations may include implementation of the HBV vaccine, robust national health system, conservative sociocultural values, and isolation.

Seroprevalence and effect of HBV and HCV co-infections on the immuno-virologic responses of adult HIV-infected persons on anti-retroviral therapy

Chronic hepatitis negatively affects persons living with HIV. While varying in their transmission efficiency, HIV, HBV, and HCV have shared routes of transmission. Available data suggest widely variable rates of HBV and HCV infections in HIV-infected populations across sub-Saharan Africa. With prolonged survival rates due to increased accessibility to antiretroviral drugs, HBV and HCV have the potential to complicate the prognosis of HIV co-infected patients by contributing significantly to continued morbidity and mortality. The study sought to determine the seroprevalence of HIV/HBV and HIV/HCV co-infections among HIV patients on antiretroviral therapy and to evaluate the effect of HIV/HBV and HIV/HCV co-infections on the immunologic and virologic responses of patients. A cross-sectional study in which samples were taken from 500 people living with HIV and attending ART clinic at the Fevers unit of the Korle Bu Teaching Hospital and tested for Hepatitis B Surface Antigen (HBsAg) and Hepatitis C virus antibody (HCV). CD4 cell counts and HIV-1 RNA levels were estimated as well. Data generated were analysed using IBM SPSS version 22. The seroprevalence of HIV/HBV and HIV/HCV co-infections among people living with HIV was 8.4% and 0.2% respectively. HIV/HBV coinfection included 15/42 (35.7%) males and 27/42 (64.3%) females out of which the majority (97.6%) were in the 21-60 years old bracket. HIV/HBV and HIV/HCV co-infections have varied effects on the immunological and virological response of HIV patients on ART. The mean CD cell count was 361.0 ± 284.0 in HIV/HBV co-infected patients and 473.8 ± 326.7 in HIV mono-infected patients. The mean HIV-1 RNA level was not significantly different (X2 [df] = .057 [1]; P = .811) among HIV/HBV co-infected patients (Log102.9±2.0 copies/mL), compared to that of HIV mono-infected patients (Log102.8±2.1 copies/mL) although HIV mono-infected patients had lower viral load levels. One-third (14/42) of HIV/HBV co-infected patients had virologic failure and the only HIV/HCV co-infected patient showed viral suppression. 336/500 (67.2%) patients had HIV-1 viral suppression (females [66.1%]; males [33.9%]) while 164/500 (32.8%) had virologic failure (females [67.7%]; males [32.3%]). The mean CD4 count of patients with viral suppression and patients with virologic failure was 541.2 cells/μL (95% CI 508.5-573.8) and 309.9 cell/μL (95% CI 261.9-357.9) respectively.The study concludes that, HIV/HBV and HIV/HCV coinfections do not significantly affect the immunologic and virologic responses of patients who have initiated highly active antiretroviral therapy, and treatment outcomes were better in females than in males. There was no HBV/HCV co-infection among patients.

Psychosocial beliefs of health providers' intention and behavior of offering HIV testing and counseling services: Estimating their relevance for intervention

Background

Diagnosis of people with HIV is vital in achieving the 95-95-95 global targets. The proportion of people with HIV who know they have HIV in Sudan is low. Promoting engagement of healthcare providers (HCPs) in offering HIV Testing and Counseling (HTC) services would improve the percentage of diagnosed people with HIV in the country. This study aims to assess the psychosocial beliefs associated with HCPs' intention and behavior to offer HTC services and their relevance for intervention.

Methods

This institutional cross-sectional study was conducted in Kassala State, from July 2019 to February 2020, among 438 healthcare providers from public health facilities. A self-administered questionnaire was used to assess behavior and intention to offer HTC services and related behavioral, normative, and control beliefs. Data were analyzed using R software. Confidence Interval Based Estimation of Relevance (CIBER) was used to estimate the relevance of the beliefs to interventions.

Results

The CIBER analysis showed that the belief "It causes many worries for patients if I offer or counsel them about HIV test" was negatively associated with HCPs' intention and behavior to offer HTC services and a highly relevant belief for intervention. The belief "My manager thinks I should offer or counsel patients about HIV test" was positively associated with the behavior and intention to offer HTC services and was a relatively highly relevant belief. The control belief "Patients are at low risk of HIV and do not need offering or counseling about HIV test" was negatively associated with HCPs' intention and behavior and was relevant for intervention. The control belief "If I offered or counseled patients about HIV test, I would spend more time with them" was negatively associated with the intention and behavior of HCPs toward HTC services, with high relevance to target with intervention. The belief "My colleagues think I should offer or counsel patients about HIV test" was weakly associated with behavior and intention, and it is a low relevant belief for intervention.

Conclusion

Different psychosocial beliefs among healthcare providers can influence their intention and behavior to offer HTC services to patients. More relevant beliefs are required to be targeted with interventions to promote the intention and behavior of providing HTC services among health care providers.

Socioeconomic Inequalities and HIV Testing During Antenatal Care in High- Medium- and Low-Conflict Intensity Countries in Sub-Saharan Africa

Understanding HIV testing determinants in different settings is vital to reducing new infections. This study assessed HIV testing rates during antenatal care (ANC) in seven sub-Saharan African countries designated as high, medium, low or no conflict intensity settings. We ranked and plotted concentration curves for HIV testing by socioeconomic inequality and determined their concentration indices (CCI). Testing for HIV during ANC was highest in Zimbabwe (95.7%) and lowest in Sudan (3.6%). Countries with medium and high conflict intensity experienced higher HIV testing inequality (CCI = 0.38) than countries with low or no conflict (CCI = 0.15). Low HIV testing rates were associated with no education, rural areas, poorest wealth index quintiles and home birth, which demonstrate that determinants of HIV testing during ANC in conflict-affected areas are complex and context-based. Programme implementation and policymakers must acknowledge these complexities and local contexts in their program designs and planning.

Seroprevalence of the Serological Markers of Transfusion-Transmissible Infections among Volunteer Blood Donors of Kosti Obstetrics and Gynecology Hospital

Background: Transfusion-transmissible infections are well-known global health challenges. The present study is proposed to investigate the seropositivity of anti-HIV1/2, anti-HCV, HBsAg, and anti-T.pallidum among volunteer blood donors of Kosti Obstetrics and Gynecology Hospital. Methods: Our study was conducted in a cross-sectional retrospective manner. The data of donors who attended Kosti Obstetrics and Gynecology Hospital throughout 2016 to 2018 were reviewed and retrieved manually from blood bank records. Results: Out of 8139 donors, 22.52% were seropositive for serological markers of TTIs and 1.67% were seropositive for at least two serological markers of TTIs. The overall seropositivity rate of anti-HIV1/2, HBsAg, anti-HCV, and anti-T.pallidum was 1.77%, 6.07%, 1.14%, and 11.87%, respectively (p < 0.000). Anti-T.pallidum was the most frequently detected (p < 0.05) marker across all study variables. TTIs seroprevalence was significantly (p < 0.05) varied according to the age, residence, occupations, and blood groups. Notably, there was a rising trend in the rate of anti-HIV1/2 and seropositivity for more than one marker with age (p < 0.000). Regionally, rural area residents had a higher rate of anti-HIV1/2 (2.20%), HBsAg (6.31%), anti-HCV (1.42%), anti-T.pallidum (18.38%), and multiple markers seropositivity (2.28%) compared to urban areas. Between occupations, the highest rate of anti-HIV1/2 (p = 0.483), HBsAg (p = 0.003), anti-HCV (p = 0.408), anti-T.pallidum (p < 0.000), and multiple markers seropositivity (p < 0.000) were detected in farmers. Regarding the screening, we also found that the frequency of anti-T.pallidum was significantly (p = 0.003) higher in donors who carry the AB+ve blood group, whereas anti-HCV (1.83%) was more frequent in donors carry O−ve blood group (p = 0.255). As seen, anti-T.pallidum+HBsAg was the most frequently (1.22%) co-occurring markers. In contrast, anti-T.pallidum+anti-HIV1/2+HBsAg was the lowest frequency one (p < 0.000). Conclusions: The study showed an alarming rate of TTIs, which suggests the requirement for comprehensive surveillance and health education programs.

Prevalence of infertility in Sudan: A systematic review and meta-analysis

BACKGROUND/AIM

Infertility is defined as the inability of heterosexual couples to achieve a successful clinically recognizable pregnancy after 12 months or more of regular, unprotected sexual intercourse. Infertility estimations are very important to inform the healthcare policymakers and governments to implement appropriate social and economic policies. Thus, this study aimed to estimate the pooled prevalence of infertility (primary and secondary) and its etiologic factors in Sudan.

METHODS

This study included all published and unpublished studies written in Arabic or English. Electronic sources (namely, PubMed, MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov) and nonelectronic sources (direct Google search, Google Scholar, OpenGrey, OATD, WorldCat log, and university websites) were used from their inception to May 16, 2021. A total of 1955 studies were reviewed, of which only 20 studies were eligible for the meta-analysis. Studies were eligible if they provided the prevalence of infertility in Sudan. The Joanna Briggs Institute Quality Assessment Tool was used to evaluate each study. Data synthesis and statistical analysis were conducted using Jeffrey's Amazing Statistics Program version 0.14.1.0.

RESULTS

The pooled prevalence of overall infertility, primary infertility, and secondary infertility in Sudan were 13% (I² = 96.45, p < 0.001), 65% (I² = 98.5, p < 0.001), and 35% (I² = 98.5, p < 0.001), respectively, and the prevalence of infertility factors were 41%, 27%, 16%, and 17% for female, male, combined factors, and unexplained factors, respectively. Women with infertility were mainly present because of ovulatory disorders (ovulatory factors, 36%; polycystic ovary syndrome, 38%). By contrast, spermatic disorders such as azoospermia (37%), oligozoospermia (30%), and asthenozoospermia (30%) were the main causes of male infertility.

CONCLUSION

In Sudan, the prevalence of primary infertility is higher than that of secondary infertility. Female factors were the most common causes of infertility in Sudan, and this study found a high prevalence of unexplained factors. Polycystic ovary syndrome and azoospermia were the most common causes of female and male infertility in Sudan, respectively. The interpretation of these findings should take into consideration the presence of substantial heterogeneity between the included studies.

Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

BACKGROUND

The epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region.

METHODS

We examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I2 statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg's tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and sub-group analysis at 95% CI. P < 0.05 was considered significant for all analyses.

RESULTS

The prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg's test showed no evidence of publication bias for overall meta-analysis (p > 0.05).

CONCLUSION

The burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.

Seroprevalence of Hepatitis C Viral Infection in Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Hepatitis C virus is a highly genetically heterogenous bloodborne pathogen that is responsible for acute and chronic hepatitis. Globally, an estimated 71 million population is chronically infected with this virus from which 399,000 people die every year. Its prevalence is high in Ethiopia and varies from region to region, even among different studies within a region.

METHODS

Electronic databases, including Science Direct, Medline, HINARI, African Journals Online, TRIP database, African Index Medicus, and Directory of Open Access Journals, searched from 2010 to 2020 and published articles were included. Due to evidence of considerable heterogeneity, the pooled prevalence of anti-HCV was analyzed using the random-effects model. The possible sources of heterogeneity were analyzed through subgroup analysis, sensitivity analysis, and meta-regression. Funnel plots and Egger's test statistics were used to determine the presence of publication bias.

RESULTS

The analysis of 56 articles showed that the prevalence of anti-HCV in Ethiopia ranged from 0% to 22%. The pooled prevalence estimated was 2% (95% CI 2.0-3.0), and the meta-regression statistics indicated that the diagnostic method (p=0.037), study group (p=0.005), and level of bias (p=0.035) showed statistically significant association with the outcome variable. The sensitivity analysis claims no influence on the overall effect estimate while removing a single study from the analysis at a time. Egger's test statistics (p ≤ 0.001) declare the presence of publication bias that is handled using time and fill analysis.

CONCLUSIONS

The pooled prevalence of anti-HCV in Ethiopia was high. Predictor variables, including the diagnostic method, study group, and level of bias, showed a statistically significant relationship with the outcome variable. Strengthening the scope of existing prevention and control programs and implementing novel approaches, including screen-and-treat, could significantly help to tackle this critical public health issue. The study provides a current estimate which is valuable for policymakers and other responsible bodies.

Knowledge, Attitude, and Practice Regarding HIV, HBV, and HCV Among Medical Students of Syrian Private University, Damascus, Syria

BACKGROUND

Hepatitis B, Hepatitis C, and HIV/AIDS are infections that constitute major health concerns impacting national health systems worldwide. This is the first study to determine Syrian medical students' attitudes, awareness and knowledge of HIV/HBV/HCV, regarding general knowledge about, clinical features, transmission, and prevention.

METHODS

This cross-sectional study was conducted at Syrian Private University on World AIDs Day (1/12/2019), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys which targeted social demographic information, general knowledge, attitude, towards HBV, HCV, HIV. Data were divided and analysed according to the source of information, study year, marital status, and GPA using one-way analysis of variance to assess the level of knowledge.

RESULTS

Of 317 respondents, the majority (59.8%) were males with age ranging from 18 to 30 years of age. . The majority of students 188(59.3%) showed an average level of knowledge, 73(23%) showed a good level of knowledge. This study revealed adequate knowledge. However there were misconceptions regarding transmission pathways. The majority 173(54.6%) had a positive attitude, and 144(45.4%) had a neutral attitude, while none had a negative attitude towards HIV/HBV/HCV infected individuals. Clinical year students (mean 73.0%, SD ± 10.0%) demonstrated higher levels of awareness compared to pre-clinical students (mean 39.7%, SD ± 13.0%).

CONCLUSIONS

This study revealed that medical students have adequate knowledge regarding HIV/HBV/HCV. Medical students play a pivotal role in raising awareness and disseminating knowledge among the community, thus more effort should be concentrated on developing educational programs to limit the risks of such infections.

Epidemiological characterization and geographic distribution of human immunodeficiency virus/acquired immunodeficiency syndrome infection in North African countries

BACKGROUND

Human immunodeficiency virus (HIV) infection is a major global public health concern. North African countries carry a disproportionate burden of HIV representing one of the highest rates in Africa.

AIM

To characterize the epidemiological and spatial trends of HIV infection in this region.

METHODS

A systematic review was carried out on all the published data regarding HIV/acquired immunodeficiency syndrome in North African countries over ten years (2008-2017) following the PRISMA guidelines. We performed a comprehensive literature search using Medline PubMed, Embase, regional and international databases, and country-level reports with no language restriction. The quality, quantity, and geographic coverage of the data were assessed at both the national and regional levels. We used random-effects methods, spatial variables, and stratified results by demographic factors. Only original data on the prevalence of HIV infection were included and independently evaluated by professional epidemiologists.

RESULTS

A total of 721 records were identified but only 41 that met the criteria were included in the meta-analysis. There was considerable variability in the prevalence estimates of HIV within the countries of the region. The overall prevalence of HIV ranged from 0.9% [95% confidence interval (CI) 0.8-1.27] to 3.8% (95%CI 1.17-6.53). The highest prevalence was associated with vulnerable groups and particularly drug abusers and sexually promiscuous individuals. The dense HIV clustering noted varied from one country to another. At least 13 HIV subtypes and recombinant forms were prevalent in the region. Subtype B was the most common variant, followed by CRF02_AG.

CONCLUSION

This comprehensive review indicates that HIV infection in North African countries is an increasing threat. Effective national and regional strategies are needed to improve monitoring and control of HIV transmission, with particular emphasis on geographic variability and HIV clustering.

Transfusion transmitted infections among male blood donors of White Nile State, Sudan: Screening of the current seroprevalence and distribution

Objective

Our study planned to investigate the current positivity rate and distribution of the serologic markers of TTIs among male blood donors of the White Nile state, Sudan.

Results

The overall reported seropositive cases of TTIs was 15.91%, and percentages of anti-Human immunodeficiency virus 1/2 (anti-HIV1/2), Hepatitis B virus surface antigen (HBVsAg), anti-Hepatitis C virus (anti-HCV), and anti-Treponema palladium (anti-T. palladium) were 2.61%, 5.57%, 1.40%, and 5.72%, respectively. Out of 10897 donors examined, 0.59% had a serological sign of multiple infections. Furthermore, the odds of testing positive for TTIs were higher in the 28–37 age group (OR: 2.620, 95% CI: 2.324–2.955) and lower in the 38–47 age group (OR: 0.671, 95% CI: 0.567–0.794) compared to individuals of 18–27 years old. Likewise, it is more in individuals of Kosti (OR: 1.122, 95% CI: 0.987–1.277) and Rabak (OR: 1.354, 95% CI: 1.188-1.543) localities compared to Al Douiem locality. Anti-HIV/anti-T. palladium (27.70%) and anti-HIV/HBVsAg (23.07%) were the most frequently detected serologic markers of co-infections, P = 0.002.

Seroprevalence and genotypic characterization of HBV among low risk voluntary blood donors in Nairobi, Kenya

Background

Hepatitis B virus (HBV) causes significant morbidity and mortality globally primarily due to its ability to cause hepatitis, liver cirrhosis and hepatocellular carcinoma. The Kenya National Blood Transfusion Services screens for Hepatitis B antibodies using the chemiluminescent microparticle immunoassay method. This test does not inform on the genotypic characteristics of the virus or the actual presence of the virus in blood. This study therefore sought to determine the serologic and genotypic profiles of HBV circulating among the voluntary blood donors in Nairobi.

Methods

Blood samples were collected in plain and EDTA vacutainers and tested for the Hepatitis B surface antigen (HBsAg). HBV DNA was then extracted from plasma, its overlapping P/S gene amplified and sequenced. The resulting sequences were used to analyze for the circulating genotypes and mutations within the P and S genes. Bivariate statistical analysis was used to determine the association between demographic factors and HBV infection.

Results

A seroprevalence of 2.3% (n = 7) was reported. The age group 19–28 years was significantly associated with HBV infection. Nine samples were positive for HBV DNA; these included 2 HBsAg positive samples and 7 HBsAg negative samples. Genotype A, sub genotype A1 was found to be exclusively prevalent while a number of mutations were reported in the “a” determinant segment of the major hydrophilic region of the S gene associated with antibody escape. RT mutations including mutation rt181T in the P gene conferring resistance against Lamivudine and other ʟ-nucleoside drugs were detected.

Conclusion

There is a high prevalence of occult HBV infections among these blood donors and therefore the testing platform currently in use requires revision.

Prevalence of human immunodeficiency virus among pulmonary tuberculosis patients: A cross-sectional study

Tuberculosis (TB) is caused by Mycobacterium tuberculosis and is an endemic disease in Sudan, where it has rapidly become the major complication of human immunodeficiency virus (HIV) infection. Thus, this study aimed to determine the prevalence of HIV among TB patients and evaluate the co-infection rate. The association of HIV prevalence with gender, age, and duration of treatment as risk factors was also determined. A descriptive cross-sectional study was performed in Omdurman Abu Anga Hospital, Khartoum, Sudan, from October 2018 to March 2019. A total of 281 blood samples were obtained randomly from pulmonary TB patients. The plasma was examined for the presence of HIV antibodies using sandwich ELISA. A structured questionnaire was used during data collection. A noticeable marker for HIV immunoglobulin M/immunoglobulin G was found in 12 patients (4.3%), of which five patients (41.7%) were diagnosed as new TB cases. Moreover, the relationship between age, sex, and duration of TB treatment and the prevalence of HIV was not significantly different (P > 0.05). In conclusion, the prevalence of HIV antibodies among TB pulmonary patients is high. Therefore, all TB patients should be examined for HIV risk factors and advised to undergo HIV testing. Further studies are essential to provide more insights into the epidemiology of the co-infection to better report the double burden of HIV and TB among TB patients in Sudan.

Epidemiology of hepatitis B and C virus infections among patients who booked for surgical procedures at Felegehiwot referral hospital, Northwest Ethiopia

Background

Hepatitis B virus(HBV) and hepatitis C virus(HCV) are the main causes of cirrhosis, liver cancer, and death. This study aimed to determine the seroprevalence and associated factors of HBV surface antigen(HBsAg) and anti-HCV among patients screened for surgery at Felegehiwot referral hospital, Northwest Ethiopia.

Methods

A hospital-based cross-sectional study was conducted among 433 patients in 2018. Data on socio-demographic and risk factors were collected by an exit interview using a pretested structured questionnaire. A venous blood sample of 5ml was collected from each participant, and serum was tested for HBsAg and anti-HCV using one-step rapid test kits and enzyme-linked immunosorbent assay. Multivariable logistic regression analysis was computed to identify factors associated with HBV and HCV infections. The odds ratio with 95%CI was used to describe the strength of association and statistical significance.

Results

A total of 422 patients gave data and included in the analysis. The mean age of patients was 36±5 years. About two-thirds, 269(64%) and 274(65%) patients were males, and from rural areas, respectively. The seroprevalence of HBsAg was 34(8%) followed by 18(4.3%) anti-HCV and 4(0.9%) co-infections. Being single(AOR = 1.96, 95%CI = 1.12–3.10), rural residence (AOR = 2.68, 95%CI = 1.28–5.61), ever heard about HBV (AOR = 2.41, 95%CI = 1.18–5.20), having multiple sexual partners(AOR = 2.85, 95%CI = 1.30–5.58), HIV positive(AOR = 3.14, 95%CI = 1.31–7.61), history of tooth extraction(AOR = 3.0, 95%CI = 1.40–6.56), hospitalization history(AOR = 2.95, 95%CI = 1.26–5.81), sharing of sharp instruments (AOR = 3.86, 95%CI = 1.82–8.79), and had blood contact(AOR = 2.64, 95%CI = 1.14–5.42) were statistically significant factors to HBV infection. Similarly, sharing of sharp instruments(AOR = 4.65, 95%CI = 1.32–15.1), tooth extraction practice(AOR = 2.81, 95%CI = 1.12–6.56), surgical history (AOR = 3.68, 95%CI = 1.64–9.82), hospitalization history(AOR = 4.51, 95%CI = 1.62–8.35) and had blood contact(AOR = 3.2, 95%CI = 1.56–8.51) were significant factors to HCV infection.

Conclusion

The seroprevalence of HBsAg and ant-HCV was high compared to WHO and previous study findings. Giving special attention to awareness creation, rural settings, improving personal behaviors, infection prevention activities of health facilities, quality of healthcare procedures is crucial to prevent viral hepatitis infection.

Prevalence and associated risk factors for Hepatitis B and C viruses among refugees in Gambella, Ethiopia

BACKGROUND

Currently, there is an increased flow of refugees into Ethiopia from neighboring countries. However, there are no post-arrival screening mechanisms for hepatitis B and C viruses which could be an additional burden for the local population. Hence, this study aimed to determine the prevalence and associated risk factors for hepatitis B and C viruses among refugees in Gambella, Ethiopia. It also aimed to determine the knowledge, attitude, and practice concerning hepatitis B and C viruses among participants.

METHODS

A cross-sectional study was conducted among 453 refugees in Gambella, Ethiopia from January until May 2018. A questionnaire was used to collect data on refugees' socio-demographic, risk factors, and KAP of hepatitis B and C infections. Five milliliters of blood sample were collected from each participant and the serum was used for HBsAg and anti-HCV antibody screening rapid tests. Positive samples were further tested by ELISA method. Data were performed using SPSS version 20, and a p-value less than 0.05 was considered statistically significant.

RESULTS

The overall prevalence of HBsAg and anti-HCV among refugees was 7.3% (33/453) and 2.0% (9/453) respectively. Of these, 6.8% (25/370) and 1.4% (5/370) of females were positive for HBsAg and anti-HCV, whereas 9.6% (8/83) and 4.8% (4/83) of males were positive for HBsAg and anti-HCV. The age group of 18-29 and 30-41 years old were related to HCV infection (P = 0.003 and P = 0.020). However, proposed risk factors were not related to HBV and HCV infections. Knowledge assessment showed that 86.5% (392/453) did not know how HBV and HCV infections are transmitted, and 86.8% (393/453) had no information about the availability of HBV vaccine.

CONCLUSION

This study showed intermediate prevalence of hepatitis B and hepatitis C virus in a large refugee camp in Ethiopia. The prevalence of hepatitis C virus was found to increase with age, but no other risk factor for either virus identified as significant. Refugees' understanding of hepatitis B and C was very limited. This indicates the need for screening policy to be implemented and integrated with other health services and awareness creation about the infection in all refugee camps of Gambella.

Severe childhood anemia and emergency blood transfusion in Gadarif Hospital, eastern Sudan

BACKGROUND

Anemia is a major cause of global morbidity and mortality, particularly among children. Management of anemia depends on causes and severity of anemia. However blood transfusion is a lifesaving intervention in severe and life-threatening anemia. There are no published data on blood transfusion for anemia in Sudan.

METHODS

A descriptive study was conducted in Gadarif Hospital in eastern Sudan during 1 August, 2017 to 31 March, 2018. Consecutive children who presented at the emergency room with an indication for blood transfusion were enrolled in the study. A detailed history was gathered from all patients. Physical examinations, including vital signs, were performed. The World Health Organization guidelines for blood transfusion were followed.

RESULTS

During the study period, a total of 1800 children were admitted to the emergency pediatric ward in Gadarif Hospital and were assessed for anemia, 513 (28.5%) were anemic and 141 (7.8%) had severe anemia. Three hundred anemic children received blood transfusion. The median (interquartile) of the age of the 300 children who received blood transfusion was 4.2 4.2(2.0-9.0) years. A total of 148 (49.3%) of the children were boys and 151 (50.3%) were younger than 5 years. The diagnoses associated with the order for blood transfusion were sickle cell disease (129, 43.0%), active bleeding (58, 19.3%), malaria (50, 16.7%), visceral leishmaniasis (25, 8.3%), severe acute malnutrition (16, 5.30%), snake bite (11, 3.7%), sepsis (5, 1.7%), and others. Two hundred eighty-five (95.0%) children improved, nine children were discharged against medical advice, and six (2.0%) children died.

CONCLUSION

There is a high burden of anemia in eastern Sudan. Sickle cell disease, malaria, and visceral leishmaniasis are the main causes of anemia in this region. Further research on blood transfusion is needed.

Knowledge, attitude, and practice towards Hepatitis B infection among nurses and midwives in two maternity hospitals in Khartoum, Sudan

Background

Hepatitis B virus (HBV) infection creates a global health burden with significant morbidity and mortality. Healthcare workers, including nurses and midwives, are at higher risk of acquiring the disease. While health-related behaviours are affected by different aspects of knowledge, attitude, and practices (KAP), there are few studies examining the KAP level of healthcare workers towards HBV infection in Sudan. The purpose of this study was to examine the KAP level of nurses and midwives towards HBV virus infection in Khartoum, Sudan.

Methods

A cross-sectional descriptive hospital-based study was conducted in two public maternity hospitals (Saudi and Saad Abul-Eleella hospitals) in Khartoum state of, Sudan. A pre-tested structured questionnaire was constructed and implemented to examine KAP towards HBV infection. Statistical Package for Social Sciences (SPSS) version of 21 was utilized to conduct statistical analysis and examine the data at hand. Chi-square test was used implemented to determine the relationship between categorical variables.

Results

A total of 110 nurses and midwives from the both hospitals participated in this study. More than half of the respondents (58.2%) had an average level of knowledge, two-third of the respondents had a safe practice, and the majority of the respondents had a favourable attitude towards HBV preventive measures. Approximately half of the participants (51.8%) had a history of needle stick injuries. Half of the participants had inaccurate concepts about post exposure prophylaxis to HBV infection, while more than half of the nurses and midwives didn’t complete the vaccination schedule for HBV.

Conclusion

Most of the nurses and midwives in Saudi and Saad Abul-Eleella hospitals were aware of HBV infection. However, a significant proportion of the participants lack the requisite knowledge about post exposure management. The study revealed a low level of HBV vaccination coverage rate and a high rate of needle stick injuries. Further strategies for preventing workplace exposure, training programs on HBV infection, including post exposure prophylaxis, and increasing vaccination coverage rate of all HCWS are highly recommended.

An updated systematic review and meta-analysis of the prevalence of hepatitis B virus in Ethiopia

Background

Hepatitis B virus is one of the major public health concerns globally. It is highly infectious and can be transmitted from person to person through vertically or horizontally via contaminated body fluids. Despite the provision of an effective vaccine, it remains a major problem worldwide, particularly among the developing countries.

Methods

Online electronic databases including PubMed, Google Scholar, Science Direct, African Index Medicus, African Journals Online, and WHO Afro Library were searched and published articles from 2010 to June 8, 2019, were considered. Both authors independently screened articles and extracted the data. Funnel-Plots and Egger’s test statistics were used to determine the presence of small-study effects and publication bias. The pooled prevalence of HBV was analyzed using the random-effects model. The possible sources of heterogeneity was analyzed through subgroup analysis, sensitivity analysis, and meta-regression.

Results

The overall pooled prevalence of HBV was 6% and among subgroups, pregnant women, healthcare workers, and HIV positive patients accounted for 5% for each group. Relatively low prevalence (4%) was obtained among blood donors. The Egger’s test statistics (p = 0.747) indicated the absence of publication bias. In addition, from the sensitivity analysis, there was no influence on the overall effect estimate while removing a single study at a time. The level of heterogeneity was reduced among pregnant women, HIV positive and studies with unknown sampling techniques. After conducting meta-regression, province, study group, screening method, and quality of papers were identified as sources of heterogeneity.

Conclusions

The overall pooled prevalence of HBV in Ethiopia was high. Strengthening and scaling up of the scope of the existing vaccination program and implementing novel approaches including screen-and-treat could be implemented to reduce the burden of the disease. Generally, the study can provide current prevalence estimate of HBV that could vital for intervention to tackle the disease.

Knowledge gaps of STIs in Africa; Systematic review

Sexually Transmitted Infections (STIs) are ambiguous burden of tremendous health, social and economic consequences. The current systematic review was conducted in order to determine awareness and knowledge of Africans toward sexually transmitted infections, not only concerning HIV/AIDS, but also other STIs such as gonorrhea, syphilis, HBV, HCV and HPV. A systematic review of literature was conducted, studies were retrieved and selected after fulfilling the inclusion criteria as well as passing the assessment procedure. Related data was extracted, quantitative analysis was conducted among participants who responded to questions related to HIV, HBV, HCV, HPV or STIs knowledge, sensitivity analysis as well as subgroup analysis were also conducted. Seventy four articles addressing knowledge among 35 African countries were included and 136 questions were analyzed and synthesized. The question "does using condom reduces HIV transmission?" was answered by 1,316,873 Africans in 35 countries, 66.8% [95% Cl; 62.6, 70.9] answered yes. While the question "is sexual contact a possible route of HBV transmission?" was answered by 7,490 participants in 5 countries; 42.5% [95% Cl; 20.4, 64.7] answered yes. The differences observed among populations are highlighting the possibility for improvement by directing light toward specific populations as well as addressing specific awareness knowledge to ensure that the general as well as the related specific preventive knowledge is improved.

The realities of HIV prevention. A closer look at facilitators and challenges faced by HIV prevention programmes in Sudan and Yemen

Background: HIV/AIDS prevention has historically encountered many obstacles. Understanding the factors affecting HIV/AIDS prevention is central to designing and implementing suitable context-specific interventions. Research relating to HIV prevention in the Middle East and North African region is required to address the gradually increasing HIV epidemic. Objective: This study aimed to explore the perspectives of employees/health care professionals who are working or have worked within HIV prevention in Sudan and Yemen on the challenges and facilitating factors facing HIV prevention. Methods: A qualitative approach was employed using an open-ended questionnaire. Sixteen stakeholders from governmental and non-governmental agencies participated in the study. The questionnaire focused on the various challenges and facilitating factors facing HIV prevention as well as proposed possible solutions from the perspectives of the participants. The data were analysed using thematic analysis. Results: The study illustrated the similarities in context and HIV prevention systems between Sudan and Yemen. Thematic analysis resulted in three main themes: I) much is achieved despite difficulties; II) a programme left to be paralysed; this theme addressed the main obstacles facing HIV prevention in Sudan and Yemen generating a total of six sub-themes; III) comprehensive change is needed. The participants drew focus and attention to vital changes required to improve the delivery of HIV prevention services. Conclusion: Increased financial support for HIV prevention in Sudan and Yemen is urgently needed. De-stigmatisation and increased political support, advocacy and improved legislation for people living with HIV (PLHIV) are required for the sustainability and effectiveness of HIV prevention programmes in Sudan and Yemen. Civil society organisations must be aided and supported in their role in engaging key populations.