- Research article
- Open Access
Prevalence of hepatitis B and C viruses infection among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia
© Birku et al. 2015
- Received: 26 September 2015
- Accepted: 19 November 2015
- Published: 1 December 2015
Military personnel are high-risk people for parenteral and sexually transmitted diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV). Data regarding HBV and HCV prevalence among military personnel in Ethiopia is limited. Hence, the study aimed to determine sero-prevalence and associated risk factors of HBV and HCV among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.
A cross-sectional study was conducted in a total of 403 military personnel from February to May 2015. Socio-demographic characteristics and risk factors were collected through face to face interview using structured questionnaire. HBV and HCV infection was determined using HBsAg and anti-HCV antibody rapid tests. Logistic regression analysis was employed to assess possible risk factors for HBV and HCV infections.
The sero-prevalence of HBV and HCV infection were 4.2 and 0.2 %, respectively. None of the study subjects were co-infected with HBV and HCV. Higher prevalence of HBV infection (11.3 %) was observed in the age group of 40 and above. Being at the age of 40 years and above (COR 7.6; 95 % CI 2.0–29.0, p = 0.003), history of nose piercing (COA 5.9; 95 % CI 1.2–29.9, p = 0.033) and sexually transmitted infection (COR 4.3; 95 % CI 1.1–16.4, p = 0.03) were significantly associated with these viral hepatitis infections.
Intermediate prevalence of HBV and low prevalence of HCV were observed among military personnel. Strengthening HBV screening strategies among military personal may further reduce these viral diseases.
- Hepatitis B virus
- Hepatitis C virus
- Military personnel
Viral hepatitis is an inflammation of the liver due to viral infections. The most common types of viruses that cause viral hepatitis are hepatitis B virus (HBV) and hepatitis C virus (HCV) . HBV and HCV share some common mode of transmission such as parenteral route and unsafe sexual intercourse. Viral hepatitis is significant public health problem especially in resource-poor settings. Annually about 500,000–700,000 people die as a result of HBV infection and more than 350,000 people from HCV-related liver diseases [2–4]. Worldwide, more than 240 million people are chronically infected with HBV [5, 6] and 150 million people with HCV .
In Ethiopia, although nationwide survey report is lacking, an estimated prevalence of 10–15 % HBV infection and 2–5 % HCV infection were reported. More than 60 % of chronic liver disease and up to 80 % of hepato-cellular carcinoma were caused by HBV and HCV chronic infections [7, 8]. In addition, the prevalence of viral hepatitis showed great variability among different risk groups that should be taken into consideration when designing a more appropriate epidemiological investigation. In this regard, 4.11–6.2 % sero-prevalence of HBV has been reported among blood donors [9–11], 5.6 % among HIV infected individuals , 4.7 % among medical waste handlers , 10.9 % among street dwellers  and 10.4 % among prisoners . The prevalence of HCV infection was reported 0.63–1.7 % among blood donors [9–11], 0.7 % among medical waste handlers  and 5 % among HIV positive individuals .
In most cases, military people live in military camps which may contribute to predispose them to HBV and HCV transmission through some common routes. The risk of sharing utensils such as hair-brushes, combs, razors and toothbrushes is common among people living in groups that can facilitate transmission of the viruses . Moreover, usually soldieries travel from place to place for different professional reasons and stay longer apart from their family. This may force soldiers to have multiple sex partners that can expose them for different sexually transmitted infections (STIs) including HBV and HCV. Although several studies reported the prevalence of HBV and HCV infections among different risk groups, so far there is no published data about viral hepatitis prevalence among military people in the Amhara regional state of Ethiopia. Thus, this study primarily aimed to determine the sero-prevalence of HBV and HCV infections and associated risk factors among military personnel at Bahir Dar Armed Forces General Hospital, Ethiopia.
Study setting and design
The study was conducted at Bahir Dar Armed Forces General Hospital found in Bahir Dar town from the 1st of February to the 30th of May 2015. The town is located 578 km far from Addis Ababa. The hospital currently provides health service for more than 9000 military and military families. It has 5 wards with 200 beds for inpatient service. All military persons attending the hospital were eligible for the study. The sample size was determined using single population proportion formula with the assumption of 95 % confidence interval (CI), 5 % marginal error and 50 % prevalence of HBV and HCV infection because there was no previous similar study and 5 % none response rate. Therefore, the final sample size was determined 403. During the study period, a total of 1320 military patients were attended in the hospital and the study participants were recruited using systematic random sampling method.
Socio-demographic characteristics and associated risk factors for HBV and HCV infections were collected using structured questionnaire by trained health officer. The study variables included in this study were age, sex, marital status, work experience, history of hospitalization, blood transfusion, surgical procedure, ear/nose piercing, dental extraction, tattooing, STI, multiple sexual partner, family history of liver disease, sharing of shaving blade or nail cutter. Three milliliters of venous blood was collected from each study participant by trained laboratory technologist. Serum was separated by centrifugation at 3000 rpm for 5 min. Each serum was subjected to HBsAg and anti-HCV antibody rapid tests (Shanghai Eugene Biotech co., Ltd) following the manufacturer’s instruction. To ensure the quality of data positive and negative control sera were run following the manufacturer recommendation of the kit.
Data was checked and cleared before entry. Data was entered and analyzed using SPSS version-20 computer software. Descriptive statistics were used to analyze socio-demographic characteristics, prevalence of HBV and HCV infections. Logistic regression analysis was employed to assess the possible associated factors of HBV and HCV infections. Odds ratio (OR), confidence interval (CI) and p value were computed to assess the presence and degree of association between dependent and independent variables. P-value < 0.05 was considered statistically significant for all cases.
Ethical approval was obtained from School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar ethical review committee. Official permission was obtained from Bahir Dar Armed Forces General Hospital higher management. Written informed consent was taken from each study participant and confidentiality was maintained at each level of the study. Individuals found HBV and/or HCV positive were linked to physician for appropriate management.
Socio-demographic characteristics of military personnel and sero-prevalence of HBV and HCV at Bahir Dar armed force general hospital, 2015
Total n (%)
Positive n (%)
Negative n (%)
Positive n (%)
Negative n (%)
Work experience (year)
Sero-prevalence of HBV and HCV infection
The overall sero-prevalence of HBV and HCV infections was 18/403 (4.5 %) of which 17 (4.2 %) was positive for HBV and only one individual was positive for HCV. The point prevalence of HBV infection was 318.2/100,000 but that of HCV was 15.2/100,000. However, none of the soldiers were co-infected by HBV and HCV. Higher prevalence of HBV infection 8/71 (11.3 %) was found among soldiers with age ≥40 years. Moreover, the sero-prevalence of HBV infection was relatively higher among rural dwellers 5/84 (6 %) and married soldiers 12/215 (5.6 %) (Table 1).
Risk factor analysis for hepatitis virus infection
Bivariate regression analysis of risk factors association with hepatitis virus infection among military patients at Bahir Dar armed force general hospital, 2015
COR (95 % CI)
Up to 12
College and above
Muslim + others
Number of sexual partner
7.41 (0 .95–57.64)
Family history of liver disease
War related injury
The result of the present study showed that the sero-prevalence of HBV infection among the military personnel was 4.2 %. The sero-prevalence of HBV infection was reported 3.0 % among delivering women in Ethiopian . Another report showed a 4.11 and 4.7 % prevalence of HBV infection among blood donors and medical waste handlers . On the other hand, higher prevalence of HBV infection was reported from Gondar town street dwellers (10.9 %)  and Woldia prisoners (10.4 %) . Higher prevalence of HBV infections was also observed in some other African countries among different population groups. For instance, a prevalence of 8.2 % was reported in Sudan among healthy people , 23 % in Nigeria among prisoners  and 11.9 % among HIV positive patients in Nigeria . The discrepancies in the prevalence of HBV infection among different study groups might be explained by the variation in predisposing conditions. Military people and street dwellers have higher opportunity to be exposed to infections transmitted through sexual intercourse and parenteral routes. In-contrast, the prevalence of HBV infection found in the current study was relatively higher than the findings reported from Pakistan 2.9 %  and Greece 0.32 % among military groups .
The prevalence of HBV and HCV infection found in the current study can be graded intermediate and low according to WHO criteria . The prevalence of HBV infection can be graded high when the prevalence is >8 %, intermediate when the prevalence is between 2 and 8 % and low when the prevalence is <2 % . Hepatitis C virus infection can be also graded high, moderate or low when the prevalence is >3.5, 1.5–3.5 % and <1.5 % respectively . In the current study, only one study subject (0.2 %) was positive for HCV infection. This prevalence is nearly similar to previous reports among medical waste handlers (0.7 %) in Gondar, Ethiopia , among apparently health people in Nigeria (0.8 %), and Morocco (0.62 %), and among blood donors in Jordan (0.8 %) and in Pakistan (0.89 %) [26–29]. Lower prevalence of HCV infection was also reported (0.82 %) among military groups in Kabul military training center . On the other hand, relatively higher prevalence of HCV infection (1.7 %) was reported in Pakistan among military groups .
The current study showed significantly higher (11.3 %) prevalence of HBV infection among solders within the age group of ≥40 years. Similarly, in China significantly different HBV clinical and virological characteristics among patients with chronic HBV infection at different age groups was reported. Among patients at the age of ≥40 years, there were markedly more reactivation cases than in any other groups . Moreover, it was also observed that by the age of 40 years, 87 % of the Nigerian population has at least one HBV serologic markers .
In the current study, history of hospitalization, tattooing, dental extraction, ear piercing, war related injury, and sharing of shaving blade or nail cutter were not significantly associated with hepatitis virus infections. Contrary to this finding, a significant association between histories of blood transfusion, body tattooing, surgery and unsafe injection for HBV infections was reported among pregnant women at Bahir Dar, Ethiopia . A similar study, which was conducted in Egypt, identified these variables as significant risk factors for HBV infection. Study participants with body tattoo on any part of their body were 5.7 times more likely to be HBsAg positive . Furthermore, reports from Bamako, Mali indicated that body tattooing was a significant risk factor for HBV infection . However, in this study history of STI showed significant association with HBV infection. Evidences demonstrate that military people are considered to be a gateway group for STIs . Absence of HBV and HCV co-infection in this study is supported by a study conducted among blood donors in the Amhara and Tigray national state of Ethiopian . A report from Nigeria among prisoners was found also only 0.07 % HBV and HCV co-infected individuals . Therefore, HCV infection is uncommon among HBV positive patients and some authors describe mutual inhibition .
The prevalence of HBV and HCV infection among soldiers at Bahir Dar Armed Forces General Hospital was intermediate and low respectively. Higher prevalence of HBV infection was observed among soldiers with an age of ≥40 years. Moreover, older age, history of STI and nose piercing were significantly associated with HBV and HCV infections. Strengthening HBV screening strategies among military personal may further reduce these viral diseases.
This work was carried out in collaboration of all authors. TB proposed the initial idea for the study. All authors contributed to the study design. TB, BG and FM collected all the data. All authors analyzed and interpreted the data and prepared the manuscript for publication. All authors read and approved the final manuscript.
We would like to acknowledge the University of Gondar for all the support given for us to conduct the research. We would also like to extend our deepest thanks to Bahir Dar Armed Forces General Hospital manager for all the help and support given for us during data collection. We also thank all the study participants for their participation in the study.
The authors declare that they have no competing interests.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Gunn RA, Murray PJ, Ackers ML, Hardison WG, Margolis HS. Screening for chronic hepatitis B and C virus infections in an urban sexually transmitted disease clinic: rationale for integrating services. Sex Transm Dis. 2001;28(3):166–70.View ArticlePubMedGoogle Scholar
- WHO. Prevention and control of viral hepatitis infection. Framework for global action.” http://www.who.int/csr/disease/hepatitis/GHP_framework.pdf. 2014.
- Lai CL, Ratziu V, Yuen MF, Poynard T. Viral hepatitis B. Lancet. 2003;362(9401):2089–94.View ArticlePubMedGoogle Scholar
- Pachiadakis I, Pollara G, Chain BM, Naoumov NV. Is hepatitis C virus infection of dendritic cells a mechanism facilitating viral persistence? Lancet Infect Dis. 2005;5(5):296–304.View ArticlePubMedGoogle Scholar
- Tran TT, Hepatitis B. Virus in Pregnancy. Clin Liver Dis. 2013;1(2):29–33.View ArticleGoogle Scholar
- WHO. Guidelines for the screening, care and treatment of person hepatitis C infection. www.who.int/hiv/pub/hepatitis/hepatitis-c-guidelines/en/. 2014.
- Karoney MJ, Siika AM. Hepatitis C virus (HCV) infection in Africa: a review. Pan Afr Med J. 2013;14:44.PubMed CentralPubMedGoogle Scholar
- Bane A, Patil A, Khatib M. Healthcare cost and access to care for viral hepatitis in Ethiopia. IJIAS. 2014;9(4):1718–23.Google Scholar
- Assefa A, Mathewos B, Alemu A, Addis Z, Alem M, Gizachew M. Hepatitis B and C viral infections among blood donors at Bahir Dar, Ethiopia. IJMRHS. 2013;2(3):624–30.Google Scholar
- Tessema B, Yismaw G, Kassu A, Amsalu A, Mulu A, Emmrich F, Sack U. Seroprevalence of HIV, HBV, HCV and syphilis infections among blood donors at Gondar University Teaching Hospital, Northwest Ethiopia: declining trends over a period of five years. BMC Infect Dis. 2010;10(1):111.PubMed CentralView ArticlePubMedGoogle Scholar
- Gelaw B, Mengistu Y. Prevalence of HBV, HCV and malaria parasiets among blood donors in Amhara and tigray regional states. Ethiop J Health Dev. 2007;2(22):3–7.Google Scholar
- Wondimeneh Y, Alem M, Asfaw F, Belyhun Y. HBV and HCV seroprevalence and their correlation with CD4 cells and liver enzymes among HIV positive individuals at University of Gondar Teaching Hospital, Northwest Ethiopia. Virol J. 2013;10:171.PubMed CentralView ArticlePubMedGoogle Scholar
- Anagaw B, Shiferaw Y, Anagaw B, Belyhun Y, Erku W, Biadgelegn F, Moges B, Alemu A, Moges F, Mulu A. Seroprevalence of hepatitis B and C viruses among medical waste handlers at Gondar town Health institutions, Northwest Ethiopia. BMC Res Notes. 2012;5:55.PubMed CentralView ArticlePubMedGoogle Scholar
- Moges F, Kebede Y, Kassu A, Mulu A, Tiruneh M, Degu G, Adugna S, Alem A, Wale F. Sero-prevalence of HIV, hepatitis B infections and syphilis among street dwellers in Gondar city. Ethiop J Health Dev. 2006;3(20):160–5.Google Scholar
- Berhe H, Yismaw G, Addis Z, H/slassie H, Anagawm B, Unakal C. Seroprevalence and associated risk factors of human immunodeficiency virus and hepatitis B virus infections among prison inmates. J Pharm Biomed Sci. 2012;30(30):1035–45.Google Scholar
- Alavian SM. Military personals should be vaccinated against hepatitis B infection. J Arch Mil Med. 2013;2(1):e16450.Google Scholar
- Tegegne D, Desta K, Tegbaru B, Tilahun T. Seroprevalence and transmission of Hepatitis B virus among delivering women and their new born in selected health facilities, Addis Ababa, Ethiopia: a cross sectional study. BMC Res Notes. 2014;7:239.PubMed CentralView ArticlePubMedGoogle Scholar
- Abdallah MT, Mohamed HM, Ali AA. Seroprevalence and epidemiological factors of hepatitis B virus (HBV) infection in Eastern Sudan. Int J Med Med Sci. 2011;3(7):239–41.Google Scholar
- Adoga MP, Banwat EB, Forbi JC, Nimzing L, Pam CR, Gyar SD, Agabi YA, Agwale SM. Human immunonodeficiency virus, hepatitis B virus and hepatitis C virus: sero-prevalence, co-infection and risk factors among prison inmates in Nasarawa State, Nigeria. J Infect Dev Ctries. 2009;3(7):539–47.View ArticlePubMedGoogle Scholar
- Otegbayo JA, Taiwo BO, Akingbola TS, Odaibo GN, Adedapo KS, Penugonda S, Adewole IF, Olaleye DO, Murphy R, Kanki P. Prevalence of hepatitis B and C seropositivity in a Nigerian cohort of HIV-infected patients. Ann Hepatol. 2008;7(2):152–6.PubMedGoogle Scholar
- Butt T, Amin MS. Seroprevalence of hepatitis B and C infections among young adult males in Pakistan. East Mediterr Health J. 2008;14(4):791–7.PubMedGoogle Scholar
- German V, Giannakos G, Kopterides P, Liaskonis K, Falagas ME. Serologic indices of hepatitis B virus infection in military recruits in Greece (2004–2005). BMC Infect Dis. 2006;6(1):163.PubMed CentralView ArticlePubMedGoogle Scholar
- Hou J, Liu Z, Gu F. Epidemiology and prevention of hepatitis B virus infection. Int J Med Sci. 2005;2(1):50–7.PubMed CentralView ArticlePubMedGoogle Scholar
- Mahoney FJ. M. K. Hepatitis B vaccine. In: Plotkin SA, Orenstein WA, editors. Vaccines. 3rd ed. Philadelphia: WB Saunders Company; 1999. p. 158–82.Google Scholar
- Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST. Global epidemiology of hepatitis C virus infection: New estimates of age-specific antibody to HCV seroprevalence. Hepatology. 2013;57(4):1333–42.View ArticlePubMedGoogle Scholar
- Balogun TM, Emmanuel S, Ojerinde EF. HIV, hepatitis B and C viruses’ coinfection among patients in a Nigerian tertiary hospital. Pan Afr Med J. 2012;12:100.PubMed CentralPubMedGoogle Scholar
- Baha W, Foullous A, Dersi N, They-they TP, El alaoui K, Nourichafi N, Oukkache B, Lazar F, Benjelloun S, Ennaji MM, Elmalki A, Mifdal H, Bennani A. Prevalence and risk factors of hepatitis B and C virus infections among the general population and blood donors in Morocco. BMC Public Health. 2013;13(1):50.PubMed CentralView ArticlePubMedGoogle Scholar
- Al-Gani FA. Prevalence of HBV, HCV and HIV-1, 2 infections among blood donors in Prince Rashed Ben Al-Hassan Hospital in North Region of Jordan. IIBMR. 2011;2(4):912–6.Google Scholar
- Khan A, Bukhari SS, Alvi MI, Qazi A. Seroprevalence of hepatitis B, hepatitis C and HIV in blood donors of Peshawar. GJMS. 2010;9(1):46–50.Google Scholar
- Todd CS, Nasir A, Mansoor GF, Sahibzada SM, Jagodzinski LL, Salimi F, Khateri MN, Hale BR, Barthel RV, Scott PT. Cross-sectional assessment of prevalence and correlates of blood-borne and sexually-transmitted infections among Afghan National Army recruits. BMC Infect Dis. 2012;12(1):196.PubMed CentralView ArticlePubMedGoogle Scholar
- Wu D, Xu G, Lu S, Ma B, Miao N, Liu X, et al. Age versus clinical virological characteristics in chronic hepatitis B virus infection: a case series study in China. Eur J Gastroenterol Hepatol. 2012;24(4):406–13.PubMedGoogle Scholar
- Amazigo UO, Chime AB. Hepatitis-B virus infection in rural and urban populations of eastern Nigeria: prevalence of serological markers. East Afr Med J. 1990;67(8):539–44.PubMedGoogle Scholar
- Zenebe Y, Mulu W, Yimer M, Abera B. Sero-prevalence and risk factors of hepatitis B virus and human immunodeficiency virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: a cross sectional study. BMC Infect Dis. 2014;14:118.PubMed CentralView ArticlePubMedGoogle Scholar
- Zahran KM, Badary MS, Agban MN, Aziz NHA. Pattern of hepatitis virus infection among pregnant women and their newborns at the women’s health Center of Assiut university, Upper Egypt. Int J Gynecol Obste. 2010;111:171–4.View ArticleGoogle Scholar
- 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(4):339–41.PubMedGoogle Scholar
- Ndiaye AA, Fall IS, Lo G, Seck SM, Tall AB, Gueye B, Mbodj AB, Tal-Dia A. HBsAg seroprevalence among Senegalese militaries. Mil Med Res. 2015;2:5.PubMed CentralView ArticlePubMedGoogle Scholar
- Tsega E, Mengesha B, Nordenfelt E, Hansson BG, Lindberg J. Prevalence of hepatitis B virus markers among Ethiopian blood donors: is HBsAg screening necessary? Trop Geogr Med. 1987;39(4):336–40.PubMedGoogle Scholar