Journal of Clinical and Cellular Immunology
Open Access
ISSN: 2155-9899
ISSN: 2155-9899
Research Article - (2022)Volume 13, Issue 6
Objective: Hepatitis B Virus (HBV) is the world’s most common and highly contagious liver infection and main routes of transmission are: mother to child, via open wounds, sexual contact, blood transfusion and other blood contact related activities. Prevalence of HBV among pregnant women in Africa ranges from 3.67-16.5% and in Ethiopia 2.4 to 7.8%. Hepatitis B infection leads to high morbidity and mortality for mother as well as for their infants due to the vertical transmission.
Methodology: An institution based cross sectional study was conducted with a total of 194 of pregnant women attending antenatal care at Agena health center from May 1-30/2019. The collected data was entered into Epi-data 4.2.0.0 and exported to SPSS (Software Package for Social Science) version 25 for data analysis. Binary and multivariable Logistic regression was performed to determine each factor and to check the association between independent variable and HBV infection.
Results: The prevalence of HBV in Agena health center among pregnant women were 4.1% and it was associated with marital status, history of hospital admission and history of abortion.
Conclusion: The prevalence of HBV in Agena health center among pregnant women was intermediate. Since routine screening and immunization of all pregnant women is mandatory.
Hepatitis B infection; Pregnant women; Agena health center
World Health Organization report that more than 350 million people are infected with HBV since 2017 worldwide [1]. HBV is highly contagious and its main routes of transmission are: mother to child, via open wounds, sexual contact, blood transfusion and other blood contact related activities [2]. The WHO (World Health Organization) has launched a global program against hepatitis in May 2016 which aims to reduce by 90% the number of new cases of hepatitis, reduce by 65% the number of hepatitis related deaths, and treat 80% of eligible people infected with viral hepatitis by 2030 [3].
Even if HBV is the most common and highly contagious diseases for the whole population, it is highly prevalent among pregnant women (9.41% general population versus 11.11% pregnant women) and it has different maternal complications and fetal death due to vertical transmission [4]. There is a high chance of vertical transmission from HBV infected mothers to their infants during delivery and during breast feeding [5,6]. To prevent the vertical transmission of HBV Antiviral therapy for infected pregnant women is very crucial [7]. Hepatitis B vaccination should be given for the infant who is infected with HBV [8].
HBsAg (Hepatitis B surface Antigen) prevalence among pregnant women was 3.1% in Shenyang, China. Only 23.4% and 17.7% of pregnant women knew their HBV status before gestation and before delivery respectively [9]. The prevalence of HBV infections among pregnant women in Africa was 6.8% and child vaccination, routine and universal antenatal hepatitis B virus screening program is very important [10]. The prevalence of HBV infections among pregnant women was 16.5% and 9.2% in Osogbo, Nigeria and Gambia respectively. Studies show that the prevalence was low among pregnant women who were vaccinated for HBV infection but high prevalence was seen among pregnant women who did not vaccinated for HBV infection [11,12].
In Ethiopia the prevalence of hepatitis B virus infection among pregnant women was intermediate (4.7%), with the prevalence of HBSAg positivity ranging from 2.3% to 7.8% [13]. Different studies in Ethiopia shows those pregnant women who have history of multiple sexual partners, history of abortion, and history of surgical procedures, body tattooing and ear/nose piercing have a high chance of infected with HBV [14-18].
Prevention of HBV infection among pregnant women is very important to prevent the transmission of HBV infection from mother-to-child. An effective strategy for reducing the incidence of the infection is identifying and handling the associated factors as well as giving awareness for the pregnant women. However, limited information has been published regarding the prevalence of HBV among pregnant women in Ethiopia as well as in Gurage zone and there is no evidence based interventions. Therefore, the aim of this study was to assess the sero-prevalence and risk factors of positive HBsAg status among pregnant women receiving care at the Agena health center Ante-Natal Care (ANC) clinic.
Study design and area
Institutional based cross-sectional study design was conducted in Agena town, Ezha woreda at Agena health center, Gurage zone SNNPR (South Nation Nationalities People Region) from May 1-30, 2019. Agena is the only urban kebele found in Ezha woreda, Gurage zone, and SNNPR of Ethiopia. Agena is located 198 km from Addis Ababa (south west), 38 km from wolkite (east) and 23.17 km from Wolkite.
Source population
The source populations were all pregnant mothers who were attending ANC in Agena Healt Center.
Study populations
The study populations were pregnant mothers who were attending ANC follow-up and fulfill the inclusion criteria in AHC from May 1-30, 2019.
Exclusion criteria and inclusion criteria
The pregnant women who have at least one ANC visit at AHC were included in the study.
The pregnant women whose HBV status is unknown, who is already in labour, who is seriously ill or admitted in the ICU ward was excluded from the study.
Sampling size determination
The sample size was determined by using a single population proportion formula considering the following assumptions: standard normal distribution with confidence interval (CI) of 95% (Za/2=1.96), absolute precision or tolerable margin of error (d=0.05), and the prevalence of HBV infection among pregnant women Attending Antenatal Care in Public Health Facilities, Dire Dawa in 2018 was 8.4% [19]. Assuming a 10 % non-response rate a total sample size of 194 pregnant women was selected from Agena Health Center. A study participant was selected by using systematic random sampling method from the appointment log of May, 2019.
Data collection tool and method
Data was collected by face-to-face interview using structured and pre-tested questionnaire which is adapted from relevant literatures and modified to local context in such a way that all the variables to be assessed were included and HBV status was taken from routine ANC document for each participants. The tool was first prepared in English and translated to Amharic then to the local Guragegna language then back to English again to check for its consistency.
Data processing and analysis
Data was checked for completeness and cleaned before it was entered to a computer. Then it was coded and entered into EpiData version 4.2.0.0 and importing to SPSS version 25 software packages for data analysis. Frequencies and proportions were used to describe the study participants. The data was presented by using tables and graphs.
Bivariate analysis and crude odds ratio with 95% confidence interval (CI) was used to see the association between independent variable and the outcome variable by using binary logistic regression. Independent variables with p- value of =0.25 were included in the multivariate analysis to control confounding factors. Adjusted odds ratio along with 95% CI was estimated to identify the factor associated with HBV infection among pregnant women using multivariable logistic regression analysis. Level of statistical significance was declared at P-value=0.05.
Socio-demographic and economic characteristic
194 pregnant women were included in the analysis, and majority of them 138(71.1%) were urban in residence, 72(37.1%) were between 25-29 years old, 164 (84.5%) were from Gurage ethnic group and most of the study participants 174 (89.7%) were married.
Among the pregnant women 118(60.8) completed their primary education, 91(46.9%) of them were merchant, 85(43.8%) had an average monthly income between 500-1500 ETB and 140(72.2%) were multigravida (Table 1).
| Variables | Frequency | Percentage | |
|---|---|---|---|
| Age | 15-19 | 3 | 1.5 |
| 20-24 | 59 | 30.4 | |
| 25-29 | 72 | 37.1 | |
| 30-34 | 40 | 20.6 | |
| >35 | 20 | 10.3 | |
| Residence | Urban | 138 | 71.1 |
| Rural | 56 | 28.9 | |
| Ethnicity | Gurage | 164 | 84.5 |
| Amhara | 12 | 6.2 | |
| Oromo | 6 | 3.1 | |
| Others | 12 | 6.2 | |
| Marital status | Single | 20 | 10.3 |
| Married | 174 | 89.7 | |
| Educational level | cannot read and write | 26 | 13.4 |
| read and write( informal) | 40 | 20.6 | |
| Primary (1-8) | 118 | 60.8 | |
| high school and above | 30 | 15.5 | |
| Occupation | government employee | 18 | 9.3 |
| Merchant | 91 | 46.9 | |
| house wife | 81 | 41.8 | |
| Others | 4 | 2.1 | |
| Income | <500 | 42 | 21.6 |
| 500-1500 | 85 | 43.8 | |
| 1501-2000 | 50 | 25.8 | |
| >2000 | 17 | 8.8 | |
| Gravidity | Primi | 54 | 27.8 |
| Multi | 140 | 72.2 | |
Table 1: Socio-demographic and economic characteristics of the pregnant women (n=194) attending antenatal care at Agena health center, Gurage zone, Ethiopia, 2019.
Hospital associated factors for HBV infection
Among the total population of the respondents 27(13.9%) had at least one history of hospital admission, 25(12.8%) had history of dental procedure in hospital, 20(10.3%) of them had surgical procedure and blood transfusion or donation each in their previous history (Table 2).
| Variables | Frequency | Percent | |
|---|---|---|---|
| Hospitalization | Yes | 27 | 13.9 |
| No | 167 | 86.1 | |
| Dental procedure | Yes | 25 | 12.8 |
| No | 169 | 87.2 | |
| Blood transfusion | Yes | 20 | 10.3 |
| No | 174 | 89.7 | |
| Surgical procedure | Yes | 20 | 10.3 |
| No | 174 | 89.7 | |
Table 2: Hospital associated factors of the pregnant women attending antenatal care at Agena health center, SNNPR, Gurage zone, Ethiopia, 2019 (n=194).
Socio cultural behavioral associated factors of HBV infection
Based on this study among the total respondents 31(15.9%) of them had history of abortion, 185(95.3%) had history of circumcision, 192(98.9%) were had ear piercing, 61(31.4%) had history of alcohol consumption, 5(2.6%) had history of chat chewing, and 15(6.7%) had tattoo on their body (Table 3).
| Variables | Frequency | Percent | |
|---|---|---|---|
| Abortion | Yes | 31 | 15.9 |
| No | 163 | 84.1 | |
| Circumcision | Yes | 185 | 95.3 |
| No | 9 | 4.7 | |
| Ear piercing | Yes | 192 | 99 |
| No | 2 | 1 | |
| Alcohol | Yes | 61 | 31.4 |
| No | 133 | 68.6 | |
| Chat | Yes | 5 | 2.6 |
| No | 189 | 97.4 | |
| Tattoo | Yes | 15 | 6.7 |
| No | 179 | 93.3 | |
Table 3: Socio-cultural and behavioral associated factors of the pregnant women attending antenatal care at Agena health center, SNNPR, Gurage zone, Ethiopia, 2019 (n=194).
Prevalence of hepatitis B virus
Based on this study, the prevalence of HBV in Agena health center among pregnant women were 4.1% which categorized as intermediate according to WHO classification 2%-7% (Figure 1).
Figure 1: Prevalence of HBV infection among pregnant women attending antenatal care at Agena health center, South Nation Nationalities People Region (SNNPR), Gurage zone, Ethiopia, 2019 (n=194).
Factors associated with HBV infection among pregnant women
Those variables with a P-value of ≤ 0.25 in the Binary logistic analysis was entered to multivariable logistic analysis using enter method to identify the independent factors associated with hepatitis B virus among pregnant women.
In bivariate analysis the independent variables: marital status, history of hospitalization, blood transfusion or donation, abortion, circumcision, alcohol drinking, chat chewing, were associated with hepatitis B virus among pregnant women. In multiple logistic regression analysis, the independent variables: marital status, history of hospital admission, and abortion were statistically significant at 5% level and were found to be the associated factors of hepatitis B virus infection among pregnant women (Table 4).
| Variables | HBV | COR (95%CI) | AOR (95%CI) | ||
|---|---|---|---|---|---|
| YES | NO | ||||
| Marital status | Single | 4(20.0%) | 16(80.0%) | 1 | 1 |
| Married | 4(2.3%) | 170(97.7%) | 0.094(0.021-0.412) | 0.66(0.004-0.985)** | |
| Admitted to hospitalization | yes | 5(18.5%) | 22(81.5%) | 1 | 1 |
| No | 3(1.8) | 164(97.2%) | 0.080(0.08-0.360) | 0.03(0.002-0.377)*** | |
| Abortion | Yes | 3(9.7%) | 28(90.3%) | 3.343(0.756-14.785) | 10.331(1.161-92.926)** |
| No | 5(3.07%) | 158(96.93%) | 1 | 1 | |
Note: P<0.05**, P<0.01***
Table 4: Factors associated with HBV among pregnant women at Agena health center, Ethiopia, 2019, n=194.
According to this study married pregnant women were 66% times less likely to be reactive to HBV infection than single pregnant women [AOR=0.66(0.004-0.985)]. Those pregnant women with history of hospitalization were 97% times more likely to be reactive to HBV infection than pregnant women who had no history of hospitalization [AOR=0.030(0.002-0.377)], and those pregnant women who had history of abortion were 10 times more likely to be reactive to HBV infection than pregnant women who had no history of abortion [AOR=10.331(1.161-92.926)].
Prevalence of Hepatitis B virus in pregnant women
In this study the prevalence of HBV infection among pregnant women in Agena health center was 4.1%. This finding was relatively comparable with study reported from Dawuro Zone, south Ethiopia, Arba Minch Hospital, Bahir Dar city, West Ethiopia and Kinshasa, DR Congo in which prevalence of HBV infection among pregnant women were 3.5%, 4.3%, 3.8% and 4.7% respectively [15,17,18,20].
This prevalence was higher than the studies reported from Shenyang, China, East Wollega Zone, Ethiopia and Addis Ababa, Ethiopia in which prevalence of HBV infection among pregnant women were 3.1%, 2.4% and 4.3% respectively [9,21,22]. The difference might be occurred due to the variation in socio-economic status of the population, sample size, design, and study setting.
This prevalence was lower than the studies reported from Osogbo, Nigeria, Gambia, Yirgalem Hospital, Ethiopia, Deder Hospital, Eastern Ethiopia, Hawassa University referral hospital, Southwestern Nigeria, Yaounde-Cameroon, Eastern Region of Ghana, Buea Health District, Cameroon, Juba Teaching Hospital, Republic of South Sudan, Myanmar-Thailand Border and Shaanxi, China in which the prevalence of HBV infection among pregnant women were 16.5%, 9.20%, 7.2%, 6.9%, 7.8%, 8.3%, 7.7%, 10%, 9.7, 11%,6.2% and 7.07% respectively [11,12,14,16,23-30]. The difference might be occurred due to the variation in duration, because currently there is a great modification regarding to health care service for HBV infection.
Associated factors of HBV among pregnant women
In this study only marital status, history of hospitalization and history of abortion were significantly associated with HBV infection among pregnant women. Married pregnant women were 66% times less likely to be reactive to HBV infection than single pregnant women [AOR=0.66(0.004-0.985)]. This finding was inconsistent with studies conducted at Gambia, Yirgalem Hospital, Ethiopia, Dawuro zone, SNNPR, Southwest Ethiopia, Bahir Dar city, Northwest Ethiopia, Health Facilities in East Wollega Zone, West Oromia, Ethiopia, Addis Ababa, Ethiopia and Buea Health District, Cameroon [12,14,15,18,21,22,27]. Generally being single exposes for HBV infection because single women might have multiple sexual partners. But in those studies there might be a wrong generalization due to increased prevalence as a result of married women might be more diagnosed than single during ANC follow up and during the delivery procedure.
Those pregnant women with history of hospitalization were 97% times more likely to be reactive to HBV infection than pregnant women who had no history of hospitalization [AOR=0.030(0.002-0.377)]. This finding was consistent with study conducted at Arba Minch Hospital [17].
Those pregnant women who had history of abortion were 10 times more likely to be reactive to HBV infection than pregnant women who had no history of abortion [AOR=10.331(1.161-92.926)]. This finding was consistent with studies conducted at Dawuro zone, SNNPR, Southwest Ethiopia, at Deder Hospital, Eastern Ethiopia and Bahir Dar city, Northwest Ethiopia [15,16,18]. It might be occurred due to the abortion might be unsafe so it expose for HBV infection. However, no significant association between previous history of abortion and HBsAg positivity was observed at the studies conducted at Yirgalem Hospital, Arba Minch Hospital, and Hawassa university referral hospital [14,17,23]. This may be due to the implementation of policies aimed at reducing the incidence of unsafe abortions and health education related to unsafe abortions.
This study has found that the prevalence of HBV infection among pregnant women were intermediate (based on WHO classification with prevalence of 2%-8%). Pregnant women who were married, who had previous history of hospitalization and who had history of abortion were more likely to be infected with Hepatitis B Virus. So more concern should be given for pregnant mothers; who are married, who were hospitalized previously and who have history of abortion regarding to screening and management of Hepatitis B Virus.
Based on this finding the following recommendations were forwarded;
• To Regional health bureau and health facilities; Effort should be made to improve the quality of service in health facilities especially on improving the aseptic technique in different procedures to reduce HBV transmission. Routine screening and immunization of all pregnant women and their infants should be incorporated in the antenatal and postnatal follow up in health facilities to reduce vertical transmission of HBV from infected mothers to their infants.
• For Agena health office and health center; Routinely screening and treatment should be performed to the pregnant women on follow up and awareness creation should be performed on the transmission and prevention of HBV infection.
• For researchers; large epidemiological studies that cover large study population and experimental studies that can show the real cause- effect relationship.
The associated factors were assessed by interview so there might be a recall bias and social desirability and since the study was crosssectional; it did not show the real cause-effect relationship.
Competing Interest
There is no competing of interests
Firstly we would like to acknowledge the study participants for their participation.
Finally, our grateful appreciation extends for Wolkite University for providing fund to conduct this study and for Gurage Zone Health office and Agena Health center staffs for their support during the study.
The ethical clearance was obtained from Wolkite University Institution Research Board. Letter was submitted to Gurage zone health office and Agena Health center then permission was obtained from those bodies. Prior to data collection; written informed consent was received from all participants since all participants are above 16 years old. Respondents were insured about the confidentiality of information obtained and the respondents did not ask to tell their names.
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request
It is not applicable for this study
Haile Workye conceived the study and developed the study design, analysis, report writing and drafted the manuscript. Melese Niguse, Ijigu Tadesse and Amin A/Karim were involved in data collection, data entry analysis and report writing. Both authors read and approved the final manuscript.
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Citation: Workye H, Niguse M, Tadesse I, Karim A (2022) Prevalence and Associated Factors of Hepatitis B Virus Infection among Pregnant Women Attending Antenatal Care in Agena Health Center, South Ethiopia: A Cross-Sectional Study. J Clin Cell Immunol.13:674.
Received: 21-Nov-2022, Manuscript No. JCCI-22-20277; Editor assigned: 23-Nov-2022, Pre QC No. JCCI-22-20277 (PQ); Reviewed: 08-Dec-2022, QC No. JCCI-22-20277; Revised: 16-Dec-2022, Manuscript No. JCCI-22-20277 (R); Published: 23-Dec-2022 , DOI: 10.35248/2155-9899.22.13.674
Copyright: © 2022 Workye H, et al. 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.