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*Corresponding Author: Behre Dari Mosa, Worabe Comprehensive Specialized Hospital, Worabe Silte Zone, Ethiopia.
Citation: Behre Dari Mosa, Tewfik Nesro, Teketel Memiru and Admasu Haile, (2022). sero - Prevalence and Associated Factors of Hepatitis B Virus among Pregnant Women at Wolkite Health Center. Archives of Medical Case Reports and Case Study, 6(5); DOI:10.31579/2692-9392/152
Copyright: ©2022 Behre Dari Mosa, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Received: 03 October 2022 | Accepted: 14 October 2022 | Published: 31 October 2022
Keywords: Hepatitis B virus; associated factors; pregnant women; Wolkite Ethiopia
Introduction: Hepatitis B virus (HBV) is a public health problem worldwide. It is highly endemic in Asia and Sub-Saharan Africa. Even though there was an introduction of universal infants HBV immunization in 2007, distribution of HBV remains a public health problem in Ethiopia.
Objective: To determine the sero-prevalence of HBsAg among pregnant women and to identify Factors associated with the infection.
Methods: A cross-sectional study was conducted from June 1-August 1, 2021 among pregnant women attending the antenatal clinic (ANC) of Wolkite Health Center. After obtaining written and informed consent, blood sample was collected from 270 pregnant women using consecutive non- duplicative sampling method. Serum was separated from whole blood and tested for using Bioline strip test. Data was collected using pre-structured questionnaire and analyzed using SPSS version 20. Multiple logistic regression analysis was used to determine the association between explanatory variables and the outcome variables. The result was considered statistically significant at p < 0.05.
Result:In this study, 270 pregnant women were participated. The overall prevalence of sero-positive HBS Ag among pregnant women was 15(5.6%). The study participants having history of abortion [AOR=0.024; 95%CI (.003-.165), p=0.000] and multiple sexual practice [AOR=0.013, 95%Cl (.001-.154), p=0.001] significantly predictor of Hepatitis B virus infection.
Conclusion: The seroprevalence of hepatitis B virus infection was increased among study participants. From assessed associated factor history of abortion and multiple sexual practice were significantly associated with sero-prevalence of HBV infection. Do to these reason routine screening of women for HBV infection during pregnancy and ANC follow up.
Hepatitis B virus (HBV) is an envelope virus with a viral genome of partially double stranded circular DNA which belongs to the family Hepadnaviridae[1, 2]. HBV causes acute and chronic infections of the liver. It is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. Due to its largely asymptomatic nature, viral hepatitis is a silent epidemic; most people are unaware of their infection [3]. Infections by HBV in pregnancy come with its attendant effect on both mother and child [4].
It has been reported that 10-20% of HBsAg positive pregnant women transmit the virus to their babies and women, who are positive for both HBsAg and HBeAg, have a chance of transmitting HBV to their newborns at birth nearly 100%. Up to 90% of the newborns born to these mothers go on to develop chronic hepatitis B if they do not receive hepatitis B immune globulin and hepatitis B vaccine at birth [5]. Although this means of transmission has not been reported to be teratogenic, a higher incidence of low birth weight, low intelligence quotient, liver cirrhosis and hepatocellular carcinoma in young adulthood may result [2].
HBV is not directly cytotoxic to hepatocytes but severity of hepatocellular injury is modulated by the strength of host immune responses [6, 7]. The dynamic balance between viral replication and host immune response plays a key role in the pathogenesis of liver disease from HBV infection [8]. There are three possible routes of transmission of HBV from infected mothers to infants: transplacental transmission of HBV in utero, natal transmission during delivery or postnatal transmission during care of infant or through breast milk. In patients with acute hepatitis B infection vertical transmission occurs in up to 10% of neonates when infection occurs in the first trimester and in 80 -90% of neonates when acute infection occurs in the third trimester [9].
Chronic HBV infection during pregnancy is usually mild but may flare after delivery or with discontinuing therapy [10]. The sero-markers and bio-markers associated with HBV infection include HBsAg, anti-HBs, HBeAg, anti-HBc, IgM-anti- HBc and IgG-anti- HBc. At least one serologic marker is present during the different phases of HBV infection. The presence of a confirmed HBsAg result is indicative of ongoing HBV infection, so all HBsAgpositive persons should be considered infectious. In newly infected persons, HBsAg is the only serologic marker detected during the first 3–5 weeks after infection, and it persists for variable periods at very low levels. The average time from exposure to detection of HBsAg is 30 days (range: 6–60 days). Chronic HBV infection occurs when HBsAg persists for > 6th months in the presence of HBeAg or anti-HBc or detection of IgG-anti- HBc, whereas acute HBV infection occurs within 6th months of infection (detection of IgM-anti- HBc) [11].
Management of chronic HBV infection in pregnancy is mostly supportive with antiviral medications indicated in a small subset of HBV infected women with rapidly progressive chronic liver disease. Because of the high risk of developing chronic HBV among infant born to HBsAg positive mother, administration of Hepatitis B Immunoglobulin (HBIG) in combination with hepatitis B vaccines as post exposure prophylaxis is very important [12].
Study setting
Study was conducted at WHC, which is located in Wolkite city administration, Gurage Zone, SNNPR, Ethiopia. Wolkite has a total of an estimated population of 28,279 out of those 13,886 male and 14,393 female. It is found 158 Km southeast from the capital city, Addis Ababa.
Study design and period
Cross sectional study was conducted among pregnant women who attending WHC ANC clinic from June 1 - August 1, 2021.G.C
Source population
All pregnant women who were visiting ANC clinic at WHC during the study period.
Study population
All pregnant women who were signed on informed a consent form.
Eligibility criteria
Inclusion criteria: - All pregnant women those who were in any gestational age, and those who were willing to participate in the study were included in the study.
Exclusion criteria: - pregnant women who were critically sick, unable to answer the questionnaire and on active labor during the study were excluded from the study.
Variable of the study
Dependent Variables: -Sero-prevalence of Hepatitis B virus
Independent Variables: - Socio demographic data and related factors such as age, Occupation, Residence, Educational status , surgical procedure ,Place of previous delivery , Gestational age , Body tattooing ,Genital mutilation , History of blood transfusion, History of abortion, multiple sexual practices.
Sample size determination and sampling technique
The sample size was determined using a single population proportion formula with the following
Assumptions: estimate prevalence rate (6.1Percentage) taken from a previous study conducted in a rural hospital in Southern Ethiopia [18], with 95Percentage confidence level, and 3Percentage degree of precision. After considering 10Percentage for the non-response rate, the final sample size was 270. To recruit study participants convenient sampling technique was useduntil the required sample size was obtained.
Data collection
Socio-demographic data and related factors were collected using a pre-structured questionnaire by the trained BSC nursethrough a face-to-face interview.
Specimen Collection and Processing
After written informed consent was obtained approximately 5 ml venous blood samples were collected from each study participant. The collected blood samples were centrifuge at 2000-3000 rpm for 5 minutes to separate the serum part of the whole blood. The separated serum was tested for the presence of HBs Ag by using Rapid Test Cassette.
Laboratory Testing Methods
Rapid HBsAg screening test is a laboratory testing methods biolinerapid strip test has sensitivity of 99.7Percentage and specificity of greater than 99.6 Percentage.It is a qualitative, solid phase, two-site sandwich immunoassay for the detection of HBsAg in serum or plasma. The membrane is pre-coated with anti-HBsAg antibodies on the test band region and anti-mouse antibodies on the control band region. During testing, the serum sample reacts with the dye conjugate (mouse anti HBsAg antibody colloidal gold conjugate) that will be coated in the test strip. The mixture then by capillary action reacts with anti-HBsAg antibodies on the membrane and generates a red band. Presence of this red band indicates a positive result while its absence indicates a negative result.
Data quality control
To ensure the quality of data, training was given for data collectors before starting data collection. Pre-tested was conducted on 5Percentage of the sample size at WolkiteUniversity Hospital to check its consistency, appropriateness,completenessandreliability of the questionnaire.
Data processing and analysis
Data were coded,entered and analyzedby using SPSS version 21 software. Descriptive statistics were used to determine the prevalence of HBS AGE. The association between explanatory variables and the outcome variables was checked by usingbinary logistic regression model; Variables with a p-value of less than 0.05 were considered as statistically significant.
Socio-demographic data
In this study, 270 pregnant women were participated in the study with response rate of 100%. From the total study participants (53.7%) were in the age category of 24–28 years. One hundred ninety three (71.5%) were rural in residence. More than half of the study participants were (56.7%)educational level from 1-8 grades. The majority of the study participants were (54.8) housewife. (57%) of the study participants were gestational age under 2nd tri-minister, (85.6%) therePlace of previous delivery at hospital. (Table 1).
Table 1: Socio-demographic data and related factor of pregnant women attending antenatal care at WHC, from June 1-August 1, 2021 (N=270).
Sero-prevalence and associated factors
In the current study a total of 270 study participantsinvolved. The overall Sero prevalence of HBV infection was15/270(5.6%). From associated factors assessed, in the current study history of abortion and multiple sexual practice were significantly associated with prevalence of HBV infection. (Tables 2).
COR: crude odds ratio, AOR: adjusted odds ratio, CI: confidence interval, N: number, 1: reference
Table 2: Seroprevalence of HBsAginfection and Possible risk factors among pregnant women attending antenatal care at WHC June 1-August 1, 2021(N=270).
HBV infection during pregnancy can cause serious problems among the newborns. Several efforts have been made in Ethiopia to reduce transmission of HBV to newborns before and during birth. In the current study, the overall sero-prevalence of HBsAge in pregnant women was 5.6%. This shows almost intermediate of HBV infection according to WHO criteria [14].The current study finding was lower compared to the previous studies done in different region of Ethiopia in rural hospital in Southern Ethiopia (6.1%)[18],Mali (8.0%) [34],Nigeria ( 8.3%) [45] and Sierra Leone (6.2%) [46]andHong Kong (10%) [47].The finding of the current study was higher than study reported in Addis Ababa; central Ethiopia (3%)[20],Jimma; South west Ethiopia (3.7%)[21],Debre-Tabor Hospital (5.3%)[17] and Bahir Dar (3.8%) [19]. The finding was in agreement to similar study findings were reported in Sudan (5.6%) [37]. The difference in prevalence might be due to the difference in hepatitis epidemiology in the general population, study design, sample size and traditional practice.
In the current study regarding socio-demographic status and related factors of the study participants revealed that HBV infection was higher among pregnant women havehistory of abortion and multiple sexual practice and had significant association with HBV infection. The odds of having HBsAge was 0.024 times higher risk among pregnant women who had a history of abortion compared to pregnant women who had no a history of abortion. The odds of having HBs Age was 0.013times higher risk among pregnant women who had multiple sexual practice compared to pregnant women who had no multiple sexual practice. The finding was comparable tostudy reported from Nigeria [4], Addis Abeba [20],Bahir Dar [19],Jimma[21] and Debretabor[17].The possible reason may be due to HBV might be found in blood and all body fluids that were transmitted during blood transfusion, unsafe any hospital procedure and unsafe sexual practice.
Almost intermediate prevalence of hepatitis B infection was detected among pregnant women attending ANC at WHC. From associated factors assessed, in the current study history of abortion and multiple sexual practice were significantly associated with prevalence of HBV infection. So routine screening of pregnant women for HBV irrespective of basis of risk factor and intensified prevention targeting this group may reduce mother to child transmission of HBV infection.
Abbreviations
WHC-Wolkite Health Center, HBSAGE -Hepatitis B Surface Antigen, HBV-Hepatitis B Virus, ANC-Antenatal Care
Acknowledgment
We would like to thank all health care workers of WHC who assisted us during data collection
Authors‘contribution
BDM Conceived and designed the protocol, data analysis, writing the original draft, Manuscript preparation and review, TNConceived and designed the protocol, Laboratory work, data collection, data analysis, writing the original draft,.TM designed the protocol, Laboratory work, data collection, data analysis, writing the original draft, AHConceived and designed the protocol, data analysis, writing the original draft
Funding
No funding was received for this study.
Ethical Consideration
The study was approved by the institutional review board of Worksite University, College of Medicine and health sciences (Ref No IRB/101/13). Permission letter was obtained from the WHC Administration office. Before data collection, informed consent was obtained from study participants.
Consent for publication
Not applicable.
Data availability
All relevant data are available within the paper.
Competing Interests
The authors have declared that no competing interests exist
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