|Year : 2016 | Volume
| Issue : 4 | Page : 188-193
Burden of hepatitis B and C infections among pregnant women in Bauchi, North-eastern Nigeria
Yusuf B Jibrin1, Philip M Kolo2, Alkali Mohammed1, Emmanuel O Sanya2, Labaran D Aliyu3
1 Department of Medicine, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
2 Department of Medicine, University of Ilorin, Ilorin, Nigeria
3 Department of Obstetrics and Gynecology, Abubakar Tafawa Balewa University Teaching Hospital, Bauchi, Nigeria
|Date of Web Publication||11-Jul-2017|
Philip M Kolo
Department of Medicine, University of Ilorin, P.M.B. 1515, Ilorin
Context: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are growing public health concerns and are responsible for most cases of chronic liver disease worldwide.
Aims: This study evaluated the prevalence and associated sociocultural factors in HBV and HCV infections among pregnant women in our hospital.
Settings and Design: Cross-sectional hospital-based study.
Materials and Methods: Two thousand four hundred and sixty-two pregnant women were recruited for the study with a mean age of 26.4 ± 5.6 years. Screening for hepatitis B surface antigen was done using latex rapid agglutination slide tests and samples that were reactive were further confirmed using enzyme linked immunosorbent assay (ELISA, Bio-Rad, France). Anti-HCV antibody was evaluated using a third generation ELISA (DRG International Inc., USA).
Statistical Analysis Used: Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (SPSS Inc., Chicago, Illinois, USA).
Results: Seroprevalence of HBV and HCV infections in this study was 14.6 and 2.0%, respectively. Percentages of pregnant women who were positive for HBV increased progressively with age. Seroprevalence of HBV was significantly higher among participants with below secondary (20%) than those with secondary and tertiary education (13.1%), P = 0.001. Significant positive correlation was observed between HBV and scarifications (P = 0.001), and negative correlation was observed between educational level and HBV (P = 0.001). Significant positive correlation was seen between previous blood transfusion and HCV (P = 0.002).
Conclusion: There is a high prevalence of HBV and HCV infections among the participants. HBV and HCV infections are associated with age, scarifications, blood transfusion, low level of education, and multiple sexual partners among the participants. There is a need for infants of HBV-positive mothers to receive hepatitis B immune globulin in addition to hepatitis B vaccine within 12 h of birth.
Keywords: Burden, hepatitis b and c, liver disease, nigeria, pregnant women
|How to cite this article:|
Jibrin YB, Kolo PM, Mohammed A, Sanya EO, Aliyu LD. Burden of hepatitis B and C infections among pregnant women in Bauchi, North-eastern Nigeria. Sub-Saharan Afr J Med 2016;3:188-93
|How to cite this URL:|
Jibrin YB, Kolo PM, Mohammed A, Sanya EO, Aliyu LD. Burden of hepatitis B and C infections among pregnant women in Bauchi, North-eastern Nigeria. Sub-Saharan Afr J Med [serial online] 2016 [cited 2017 Sep 19];3:188-93. Available from: http://www.ssajm.org/text.asp?2016/3/4/188/210204
| Introduction|| |
Hepatitis B virus (HBV) infection is a growing public health concern, especially in Asian and African countries where transmission rates are very high. HBV and hepatitis C virus (HCV) infections account for most cases of chronic liver disease and hepatocellular cancer (HCC). According to the World Health Organization (WHO), HBV infection affects approximately two billion people globally and more than 240 million have chronic infections. Between 500,000 and 780,000 patients die annually from HBV-related liver disease and most of these deaths occur in developing countries., Similarly, WHO estimates that around 3% of the world’s population have chronic HCV infection, with more than one million new cases annually, the majority of which are occurring in Africa.,, Common routes of transmission of these viruses include: sexual (heterosexual and homosexual) route, transfusion of blood and its derivatives, scarifications, perinatal infections, hemodialysis, and unsterilized needle use for intravenous and intramuscular injections. Of all these routes of transmission of these viruses, sexual contact is very important, especially among pregnant women. Most couples in Northern Nigeria practice polygamy, which exposes the man and his wives to the infection if any member of the family is carrying the virus.
A few reports from Southern part of Nigeria have documented prevalence of HBV and HCV infections among pregnant women to be between 6.78–16.3 and 1.39–3.6%, respectively., Similar studies in the Northern part of Nigeria, but with small sample sizes, reported prevalence of these infections among pregnant women to be between 8.2 and 9.5% for HBV and 0.5% for HCV., Current guidelines recommend immunization of newborns with hepatitis B vaccine for management of at risk babies to prevent infection. However, high viral load in affected mothers may still predispose to perinatal transmission of the viruses to their babies. This study aimed at finding prevalence of HBV and HCV seropositivity among pregnant women attending Antenatal Clinic at our hospital and to determine the association of the infections with sociocultural factors.
| Subjects and Methods|| |
This prospective study was conducted over a 1-year period between January and December 2012 at the Antenatal Clinic of our hospital. Consecutive patients aged 18 years and above who attended antenatal care were recruited to participate in the study. Consent was obtained from each participant, and the research protocol for the study was approved by the Ethics and Review Committee of the hospital. A detailed medical and obstetric history was obtained from each participant including marital status, number of times of divorce, remarriage, and position among the wives for those in polygamous setting. The level of education of the mothers was also obtained. History of multiple sexual partners, sharing of sharps and needles, and previous blood transfusion were elicited from each participant. All the subjects were examined for scarifications, yellowness of the eyes, and liver enlargement or reduction of liver span. Serum samples (5 ml of blood) were obtained from the participants for viral serology (hepatitis B surface antigen (HBsAg) and anti-HCV). Screening for HBsAg was done using latex rapid agglutination slide tests, and samples that were reactive were further tested using enzyme linked immunosorbent assay (ELISA) for confirmation (Bio-Rad, France). Anti-HCV antibody was evaluated using a third generation ELISA (DRG International Inc., USA).
| Data Analysis|| |
Statistical analysis was performed using the Statistical Package for the Social Sciences version 20 software (SPSS Inc., Chicago, Illinois, USA), and the mean age is presented as mean ± standard deviation. Frequencies of risk factors are presented as number and simple percentages. Proportions (percentages) are compared using chi-square test. Associations between risk factors and serological markers of HBV and HCV were determined by Spearman’s Rank correlation method. A statistically significant association was set at P < 0.05.
| Results|| |
Two thousand four hundred and sixty-two pregnant women were recruited for the study with a mean age of 26.4 ± 5.6 years. Age distribution of the participants and seropositivity for HBV and HCV are presented in [Table 1]. Overall prevalence of seropositivity among the participants was 14.6% for HBV and 2.0% for HCV, respectively. Eight participants (0.32%) were positive for both HBV and HCV infections. Majority of the participants (55%) were in the age group of 21–30 years, and 441 (17.9%) patients were above 40 years. Percentages of pregnant women who were positive for HBV (seroprevalence) increased progressively with advancing age (14.2% in subjects aged ≤30 years and 16.1% in those above ≥31 years, P = 0.17, respectively). The same pattern was observed with HCV seropositivity (1.9% in subjects ≤30 years and 2.3% in those ≥31 years, P = 0.68, respectively). However, the difference in the prevalence of HBV and HCV in various age groups did not reach statistical significance. Selected risk factors and frequencies of HBV and HCV positivity are shown in [Table 2]. More patients who had caesarean section, scarification, blood transfusion, contact with jaundiced patient, and family history of liver disease were positive for HBV than those who did not have these risk factors. However, only the difference among those who had scarifications reached statistical significance. In addition, a similar pattern was observed for above risk factors with HCV infection. More importantly, the difference between those who were exposed and those not exposed to cesarean section, blood transfusion, and family history of liver disease reached statistical significance.
|Table 1: Age distribution of participants with HBV and HCV infections (n = 2462)|
Click here to view
|Table 2: Risk factors for hepatitis B and C infections among the participants (n = 2462)|
Click here to view
Educational level of subjects is shown in [Table 3]. The most common educational level among the participants was secondary school which was documented in 42.4%, 30.4% had tertiary education, and 26.8% had less than secondary education. Seroprevalence of HBV was significantly higher among participants with lower educational levels (20% in those below secondary school) than those with higher level of education (13.1% for those with secondary and above), P = 0.001. Similarly, respondents without formal education had the highest seropositivity for HCV (3.1%) compared with primary school and above education but the difference was not statistically significant.
Relationship between multiple marriages and seroprevalence of infection with HBV and HCV is shown in [Table 4]. The percentage of HBV infection among participants who had multiple marriages (divorced and remarried) was 16.1% compared with 14.6% in those who were in their first marriages, P = 0.37. HCV seroprevalence in those with multiple marriages was 2.42% compared with 1.86% found in those in their first marriages, P = 0.39. HBV and HCV seropositivity and order of marriage are shown in [Table 5]. Prevalence of HBV seropositivity was higher in those who were married as first wives than those who were married as second and third wives (15.2, 13.2 and 11.5%, respectively, P = 0.35). Similar pattern was observed with HCV seropositivity and order of marriage (2.1% for those married as first wives and 1.35% for second wives, P = 0.35).
|Table 4: Multiple marriages among participants with HBV and HCV infections|
Click here to view
|Table 5: Order of marriage of participants and positivity for HBV and HCV infections|
Click here to view
Correlation between HBV and HCV seropositivity with some risk factors is shown in [Table 6]. Significant negative association was observed between level of education and HBV seropositivity (P = 0.001). Previous scarification in the participants was positively correlated (P = 0.02) with HBV positivity. On the other hand, significant positive correlation was seen between previous blood transfusion and HCV positivity (P = 0.002).
| Discussion|| |
HBV and HCV infections during pregnancy are associated with high risk of transmission to the babies and this may predispose them to neonatal hepatitis. Neonatal hepatitis often results in chronic viral hepatitis because of the immaturity of the immune system, which may increase the risk of liver cirrhosis and HCC in young adults. The prevalence of HBV and HCV varies widely all over the world, often reflecting the level of basic health services available in these countries. The results of our study showed that the prevalence of HBV and HCV was 14.6 and 2.0%, respectively. These indicate that the transmission rate of HBV and HCV among the study participants was very high (one of the highest in Nigeria). The pattern of HBV and HCV transmission in our study is similar to that reported in many African and Asian countries where standards of basic health care services and implementation of health guidelines are still poor. Sidibe et al. in a study of hepatitis B infection among pregnant women in Bamako, Mali, reported HBsAg seroprevalence of 15.5%, Rouet et al. 8.5% in Cote d’Ivorire, Collenberg et al. 17.3% in Burkina Faso, and Murad et al. 10.8% among Yemeni pregnant women. Our findings are in sharp contrast with the reports from the United Kingdom, United States of America, and Canada, where the rate of the infection ranges between 0.2 and 2.0%.,
One major factor that determines chronicity of HBV infection is the age at acquisition of the infection. The rate of progression from acute to chronic HBV infection is approximately 90% in perinatal, 20–50% for infections between 1 and 5 years, and <5% for infections acquired during adulthood. The risk of transmission of HBV from mother to baby is also very high during the perinatal period. Therefore, strategies aimed at preventing maternal to child transmission of HBV should be instituted early and with all seriousness. Perinatal HBV transmission can be prevented by identifying HBV-infected (i.e., HBsAg-positive) pregnant women and providing hepatitis B immune globulin and hepatitis B vaccine to their infants within 12 h of birth. Presently in Nigeria, only hepatitis B vaccine is given at birth, and this may be one of the reasons for high prevalence rate of HBV infection in our population.Analysis of factors associated with high prevalence of HBV and HCV infections showed that advancing age is associated with higher infection rates as 16.1 and 2.3% of participants ≥31 years were positive for HBV and HCV, respectively, while only 14.2 and 1.9% of those ≤30 years were positive for HBV and HCV, respectively. Age as a factor in the rate of HBV infection has been documented in previous studies and may be a reflection of accumulation of risk factors for this infection over the years and for the fact that older women might not have been vaccinated.
Similarly, low level of education was found to be associated with higher risk of HBV infection among the study participants (20% for below secondary and 13.1% in those with secondary and above education), P = 0.001. In addition, the pattern with HCV infection was similar to that seen with HBV seropositivity (2.1 versus 1.9% in those below secondary and those with secondary and above education, respectively), P = 0.32. The level of education may determine knowledge and practice of preventive measures against HBV and HCV infections. Educational level may also determine the level of economic power and access to good quality health care. Individuals with low level of education are more likely to undergo scarifications and injections with unsterilized instruments than those with higher level of education.
Another major factor that has been identified as a risk factor for HBV and HCV infections is the marital indices of the mothers. Participants who had multiple marriages (divorced and remarried) had higher percentage with HBV and HCV than those in their first marriages. However, the difference in the infection rates with these viruses did not reach statistical significance. Having multiple sexual partners is a risk factor for both HBV and HCV infections. In addition, the rate of infection with HBV and HCV in this study was higher in those who were first than in those who were second or third wife. Being the first wife means cumulatively longer exposure time to HBV and HCV risk factors, especially through the sexual route of transmission.
Analysis of our data showed significant positive correlation between history of scarifications and HBV seropositivity. However, negative correlation was observed between level of education and HBV infection. This is not surprising because less educated persons are more likely to receive treatment from traditional health practitioners who often use unsterilized instruments. On the other hand, history of blood transfusion was significantly correlated with HCV infection. HCV is one of the blood transfusion-associated infections, which often may not be screened before patient receives blood transfusion. This is because HCV screening is just beginning to be available, especially in rural areas and may explain this association.
| Conclusion|| |
There is a high prevalence of HBV and HCV infection among our study participants. Factors associated with higher rate of HBV and HCV infections include advancing age, low level of education, scarification, blood transfusion, and multiple sexual partners. We recommend regular health education on safe use of blood and blood products, safe use of sharp instruments such as razor blades and needles as well as healthy sexual behavior in our population. There is also the need for inclusion of hepatitis B immune globulin in addition to hepatitis B vaccine given to infants of HBV-positive mothers within 12 h of birth. This will go a long way in reducing HBV transmission from mother to child and in the long run reduce the incidence of complications associated with these infections in Nigeria.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Merican I, Guan R, Amarapuka D, Alexander MJ, Chutaputti A, Chien RN et al.
Chronic hepatitis B virus infection in Asian countries. J Gastroenterol Hepatol 2000;15:1356-61.
World Health Organization. Global surveillance and control of hepatitis C: Report of a WHO consultation organized in collaboration with the Viral Hepatitis Prevention Board, Antwerp, Belgium. J Viral Hepat 1999;6:35-47.
Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 2005;5:558-67.
Messina JP, Humphreys I, Flaxman A, Brown A, Cooke GS, Pybus OG et al.
Global distribution and prevalence of hepatitis C virus genotypes. Hepatology 2015;61:77-87.
Esan AJ, Omisakin CT, Ojo-Bola T, Owoseni MF, Fasakin KA, Ogunleye AA. Sero-prevalence of hepatitis B and hepatitis C virue co-infection among pregnant women in Nigeria. Am J Biomed Res 2014;2:11-5.
Adeyemi AB, Enabor OO, Ugwu IA, Abraham OA, Bello FA, Olayemi O. Prevalence of antenatal hepatitis B infection in tertiary and non-tertiary health facilities in Ibadan, Nigeria. Niger J Med 2014;23:248-53.
Olokoba AB, Salawu FK, Danburam A, Olokoba LB, Midala JK, Badung LH et al.
Hepatitis B virus infection amongst pregnant women in North-eastern Nigeria − A call for action. Niger J Clin Pract 2011;14:10-3.
] [Full text]
Olaitan AO, Zamani LG. Prevalence of hepatitis B virus and hepatitis C virus in ante-natal patients in Gwagwalada-Abuja, Nigeria. Rep Opin 2010;2:48-50.
Trehanpati N, Hissar S, Shrivastav S, Sarin SK. Immunological mechanisms of hepatitis B virus persistence in newborns. Indian J Med Res 2013;138:700-10.
] [Full text]
Sidibe S, Sacko BY, Traoré I. Prevalence of serologic markers of the hepatitis B virus in pregnant women of Bamako, Mali. Bull Soc Pathol Exot 2001;94:339-41.
Rouet F, Chaix ML, Inwoley A, Msellati P, Viho I, Combe P et al.
HBV and HCV prevalence and viraemia in HIV-positive and HIV-negative pregnant women in Abidjan, Côte d’Ivoire: The ANRS 1236 study. J Med Virol 2004;74:34-40.
Collenberg E, Ouedraogo T, Ganamé J, Fickenscher H, Kynast-Wolf G, Becher H et al.
Seroprevalence of six different viruses among pregnant women and blood donors in rural and urban Burkina Faso: A comparative analysis. J Med Virol 2006;78:683-92.
Murad EA, Babiker SM, Gasim GI, Rayis DA, Adam I. Epidemiology of hepatitis B and hepatitis C virus infections in pregnant women in Sana’a, Yemen. BMC Pregnancy Childbirth 2013;13:127.
Hwang EW, Cheung R. Global epidemiology of hepatitis B virus (HBV) infection. North Am J Med Sci 2011;4:7-13.
Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H. Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 2014;61:S45-57.
Heiberg IL, Pallett LJ, Winther TN, Høgh B, Maini MK, Peppa D. Defective natural killer cell anti-viral capacity in paediatric HBV infection. Clin Exp Immunol 2015;179:466-76.
Center for Disease Control (CDC). Guidelines and recommendations: Hepatitis B vaccination recommendations for infants, children, and adolescents. MMWR 2005;54.
Suen SS, Lao TT, Chan OK, Lau TK, Leung TY, Chan PK. Relationship between age and prevalence of hepatitis B infection in first-year university students in Hong Kong. Infection 2013;41:529-35.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]