Skip to main content
Download PDF
  • Research article
  • Open access
  • Published:

Seroprevalence of Hepatitis B virus surface antigen and factors associated among pregnant women in Dawuro zone, SNNPR, Southwest Ethiopia: a cross sectional study

BMC Research Notes volume 10, Article number: 418 (2017) Cite this article

Abstract

Background

Hepatitis B is the world’s most common serious liver infection. Infection by hepatitis B virus during pregnancy has high rate of vertical transmission and adverse effect on both the mother and child. Data on seroprevalence and associated factors among pregnant women in Dawuro or surrounding was scarce. Therefore, the aim of this study was to assess prevalence of hepatitis B virus and factors associated among pregnant women in Dawuro Zone.

Methods

Institution based cross-sectional study was conducted from 1st April to May 31, 2015 in Dawuro zone. Venous blood was collected, plasma was separated and hepatitis B virus surface antigen was screened using rapid test. Logistic regression was employed with 95% CI and p value of <0.05 was used as statistically significant.

Results

Data were collected on 289 women. The overall prevalence from this study was (p = 3.5%, 95% CI 1.4–5.6%) multivariate analysis using logistic regression showed multiple sexual partner (AOR = 6.923; 95% CI 1.685–28.441), and abortion history (AOR = 4.975; 95% CI 1.21–20.456), were significantly associated with hepatitis B virus surface antigen (HBsAg) infection.

Conclusion

This seroprevalence was categorized as intermediate endemicity according to WHO classification criteria. Health education on sexual transmission of hepatitis B virus and inclusion of screening hepatitis b virus as routine antenatal care service is recommended.

Background

Hepatitis B is the world’s most common serious liver infection caused by a double stranded deoxyribonucleic acid (DNA) virus, whose main routes of transmission are: mother to child, via open wounds, sexual contact, blood transfusion and other blood contact related activities [1]. This virus is 50–100 and 10 times more infectious than human immunodeficiency virus (HIV) and hepatitis C virus (HCV), respectively [2].

Globally about 240 million people are thought to be chronically infected with hepatitis B virus; with the endemicity ranges from high (≥8%) to intermediate (2–7%) and low (<2%) [3]. Hepatitis B during pregnancy is associated with maternal complications, death accompanied by impaired mental and physical health of child because of its vertical transmission [4, 5]. Hepatitis B virus infection in infancy usually followed by liver cirrhosis and hepatocellular carcinoma [6].

Prevalence of hepatitis B virus surface antigen (HBsAg) varied from place to place with 5.49% in China [7], 0.61, 0.9%, in India [8, 9], 32% in South Korea [10], 10.8% in Sana’a, Yemen [11] and 2.1% in northern Turkey [12]. In Africa the prevalence of hepatitis B virus among pregnant women ranges from 3.67–16.5% [13,14,15,16,17,18,19,20,21,22,23,24,25,26] and in Ethiopia ranges from 3.0 to 8.1% [27,28,29,30,31,32,33,34,35]. However, data on prevalence of hepatitis B virus and factors associated among pregnant women in Dawuro zone or surroundings were lacking. Therefore, this study was aimed at estimating prevalence of hepatitis B virus surface antigen and factors associated among pregnant women in Dawuro zone.

Methods

Study design, period and area

Institution based cross-sectional study was conducted from 1st April to May 31, 2015 in Dawuro zone. Dawuro zone, is located Southwest of Ethiopia 500 km from Addis Ababa, 319 km from, regional city, Hawassa and 144 km from Jimma. The Zone has 5 woredas and one city administration. Based on central statistics agency report of 2007, the projected total population in 2014/15 was 619,359. Health institutions in the Zone include: one general hospital, 23 health centers and 175 health posts.

Sample size calculation and sampling procedures

By using single population proportion formula with p = 0.061 from recent study in South Ethiopia [32] with margin of error of 0.04, design effect of 2 and 95% CI the minimum sample size was 276 and adding 10% non-response rate, sample size was 304. However, data were collected on 289 women with 95% response rate.

Multistage sampling technique was used. The Zone has five woredas and one city administration, comprising 23 health centers and one hospital. Three woredas were randomly selected using lottery method from five woredas and the city administration was by purposive technique. One health center from each woreda was selected by lottery method and Tarch’a general hospital from city administration was included in the study purposively. All pregnant women came for ANC during the study period in selected health institutions were included in the study.

Data collection procedures

Data collection was performed by one mid wife and one laboratory professional per health institution by using structured questionnaire. Interview was done by mid wife and 3 ml of venous blood was collected with ethylene diamine tetra acetate (EDTA) anticoagulated tube following standard operating procedure (SOP) by laboratory professional. Two supervisors controlled data collection process. Plasma was separated after centrifugation and transported to Tarch’a hospital laboratory for screening. Testing for surface antigen was performed by senior laboratory technologist at Tarch’a general hospital laboratory.

Data quality, processing and analysis

Questionnaire prepared in English language was translated into Dawuro language and back to English to keep consistency. Daily supervision was made to check completeness of data. Known positive and negative samples were run to control the quality of HBsAg kit as external quality assurance. Standard operating procedure (SOP) from Tarch’a hospital with manufacturers’ instruction was used for testing. Manufacturer: Shangai Eugene Biotech co., Ltd. Email: info@eugenebio.com.

Data were entered into EpiInfo 7.1.4 and exported to SPSS 20 for analysis. Descriptive analyses, using means, percentage and frequency, were calculated. Logistic regression was employed to assess association of factors with hepatitis B virus infection. Findings were taken as statistically significant at p value of less than 0.05.

Results

Socio demographic characteristics of study participants

Data were obtained on 289 study participants making the response rate 95%. The mean ± SD age of subjects was 26.23 ± 6.05 years old. Of whom, 129 (44.6%) and 121 (41.9%) were found in the age group of 25–34 and 15–24 years old respectively. One hundred and forty-four (49.8%) of women attended primary school and 103 (35.7%) attended no formal education (Table 1).

Table 1 Socio demographic characteristics of pregnant women attending ANC in selected health institutions in Dawuro Zone, SNNPR, Ethiopia 2015 (n = 289)
Full size table

Prevalence and factors associated with HBsAg

Ten women were positive for HBsAg out of 289 and the overall prevalence was 3.5% (p = 3.5%, 95% CI 1.4–5.6%).

In multivariable analysis, abortion history (AOR = 4.98, 95% CI 1.21–20.46) and multiple sexual partner (AOR = 6.92, 95% CI 1.69–28.44) were significantly associated with HBV infection among pregnant mothers (Table 2).

Table 2 Multivariate analysis of variables with HBV (HBsAg) infection among pregnant women attending antenatal care in selected health institutions in Dawuro Zone, SNNPR, Ethiopia 2015 (n = 289)
Full size table

Discussion

The overall prevalence of hepatitis B virus surface antigen (HBsAg) among pregnant women in this study (3.5%) was categorized as intermediately endemic prevalence according to WHO classification criteria [36]. This prevalence agrees with recent studies from Addis Ababa [27], Bahir Dar [29], in Arba Minch [35] Jimma town, southwest Ethiopia [28], Nigeria [18],Tanzania [23, 37]. In contrary, other studies in Ethiopia depicted higher prevalence in Debre Tabor, South Gondar [31], in Gondar Health center [33] and the highest prevalence of 8.1% was seen in Mekele [34]. Here the discrepancy might be on account of difference in sample size used, cultural and behavioral differences of women. On the other hand, lower prevalence was shown in India [8, 9]. This might be owing to previous awareness creation made regarding hepatitis B transmission.

In multivariate logistic regression analysis women with multiple sexual partners were about seven times at higher risk of HBV infection compared to those with no multiple sexual partners (AOR = 6.92, 95% CI 1.69–28.44) (Table 2). This is consistent with study done at Dessie referral Hospital, Ethiopia [30] and hospital based study in Nigeria [16]. This could be because of sexual transmission of HBV. Women with more than one partner could have had more sexual contacts.

Women with abortion history were about five times at higher risk of HBV infection (AOR = 4.98, 95% CI 1.21–20.46) compared to those with no abortion history. This finding was in agreement with findings from Jimma, Southwest Ethiopia [28], Arba Minch, South Ethiopia [35] and Nigeria [16, 26]. Abortion is directly related to sexually active women, and one of the most known modes of transmission for HBV is exposure to sexual intercourse. Deliberate termination of pregnancy is the result of unwanted pregnancy which in turn could be because of unwanted sexual contact. Therefore, abortion significance could be because of sexual transmission of hepatitis B virus. Besides this, instrumentation during abortion procedure could also contribute to HBV transmission.

Women attending ANC service in health posts and private health institutions were not included in the study. Significant variables were with a little bit wide confidence interval. These could be limitations of this study.

Conclusion

From this study, considering all limitations, it can be concluded that the prevalence of HBsAg was 3.5%. Multiple sexual partners and abortion history were factors significantly associated with HBV seroprevalence.

To lessen the seroprevalence of HBV infection, health education on the risk of sexual transmission is needed at zonal level. At national level, screening all pregnant women for hepatitis B virus should be made as part of routine antenatal care service. Community awareness on unsafe abortion is needed too.

Abbreviations

AOR:

adjusted odds ratio

ANC:

antenatal care

CDC:

centers for disease control and prevention

CI:

confidence interval

COR:

crude odds ratio

HBV:

hepatitis B virus

HCV:

hepatitis C virus

OR:

odds ratio

SNNPR:

South Nations Nationalities and Peoples’ Region

SPSS:

statistical package for social science

WHO:

World Health Organization

MPH:

master of public health

References

  1. Cheesbrough M. District laboratory practice in tropical countries. 2nd ed. Cambridge: Cambridge University; 2006.

    Book  Google Scholar 

  2. Hepatitis B Foundation Cause for a Cure. Understanding Hepatitis B Blood Tests. http://www.hepb.org. Accessed 18 Oct 2015.

  3. WHO. Global policy report on the prevention and control of viral hepatitis. Geneva: WHO; 2013.

  4. 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(7):2.

    Google Scholar 

  5. Ugbebor O, Aigbirior M, Osazuwa F, Enabudoso E, Zabayo O. The prevalence of hepatitis B and C viral infections among pregnant women. North Am J Med Sci. 2011;3(5):238.

    Article  Google Scholar 

  6. Negero A, Sisay Z, Medhin G. Prevalence of hepatitis B surface antigen (HBsAg) among visitors of Shashemene general hospital voluntary counseling and testing center. BMC Res Notes. 2011;4(1):35.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Ding Y, Sheng Q, Ma L. Dou. Chronic HBV infection among pregnant women and their infants in Shenyang, China. Virol J. 2013;10(1):17.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dwivedi M, et al. Seroprevalence of hepatitis B infection during pregnancy and risk of perinatal transmission. Indian J Gastroenterol. 2007;30:66–71.

    Article  Google Scholar 

  9. Shazia Parveen S, Shyamala R, Janardhan Rao R, Rama Rao MV. Sero-prevalence of hepatitis B surface antigen among pregnant women attending antenatal clinic in a teaching hospital, India. J Microbiol Biotechnol Res. 2012;2:343–5.

    Google Scholar 

  10. Kim JH, Kim JS, Lee JJ, et al. Survey of perinatal hepatitis B virus transmission after Korean national prevention program in a tertiary hospital. Korean J Intern Med. 2014;29:307–14.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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(1):127.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Yavuz U, Cevat C, Balci A. Seroprevalence of hepatitis B virus among pregnant women in Northern Turkey. Hepat Mon. 2009;9:146–9.

    Google Scholar 

  13. Mbaawuaga EM, Enenebeaku MNO, Okopi JA, Damen JG. Hepatitis B virus (HBV) infection among pregnant women in Makurdi. Nigeria. Afr J Biomed Res. 2008;11:155–9.

    Google Scholar 

  14. Oladele OO, Saheed S, Familua F, et al. Seroprevalence of hepatitis B surface antigen and antibody among pregnant women attending a tertiary health institution in Southwestern Nigeria. IOSR J Dent Med Sci. 2014;13(3):67–71.

    Article  Google Scholar 

  15. Kolawole OM, Wahab AA, Adekanle DA, Sibanda T, Okoh AI. Seroprevalence of hepatitis B surface antigenemia and its effects on hematological parameters in pregnant women in Osogbo, Nigeria. Virol J. 2012;9(1):317.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Alegbeleye JO, Nyengidiki TK, Ikimalo JI. Maternal and neonatal seroprevalence of hepatitis B surface antigen in a hospital based population in South–South, Nigeria. Int J Med Med Sci. 2013;5:241–6.

    Google Scholar 

  17. Onwuakor CE, Eze VC, Nwankwo IU, Iwu JO. Sero-prevalence of hepatitis B surface antigen (HBsAg) amongst pregnant women attending antenatal clinic at the federal medical centre Umuahia, Abia State, Nigeria. Am J Public Health Res. 2014;2:255–9.

    Article  Google Scholar 

  18. Pondei K, Isa I. The sero-prevalence of hepatitis B surface antigen and anti-hepatitis C antibody among women attending antenatal clinic at a tertiary health facility in the Niger Delta of Nigeria. Glob Adv Res J Med Med Sci. 2013;2(1):006–12.

    Google Scholar 

  19. Bankole Henry, Oladeinde BH, Omoregie R, Olley M, Anunibe JA, Oladeinde OB. Hepatitis B and C viral infections among pregnant women in a rural community of Nigeria. Int J Basic Appl Virol. 2012;1:01–5.

    Article  Google Scholar 

  20. Oladimeji AA, Pius AOI, Adekunle AE, et al. Seroprevalence of hepatitis B infection in pregnant women at the Ekiti State University Teaching Hospital, Ado-Ekiti, Southwest Nigeria. Afr J Intern Med. 2013;2(4):23–5.

    Google Scholar 

  21. MacLean B, Hess RF, Bonvillain E, Kamate J, Dao D, Cosimano A, Hoy S. Seroprevalence of hepatitis B surface antigen among pregnant women attending the Hospital for Women & Children in Koutiala, Mali. SAMJ. 2012;102(1):47–9.

    Google Scholar 

  22. Fomulu NJ, Morfaw FLI, Torimiro JN, Nana P, Koh MV, William T. Prevalence, correlates and pattern of Hepatitis B among antenatal clinic attenders in Yaounde–Cameroon: is perinatal transmission of HBV neglected in Cameroon. BMC Pregnancy Childbirth. 2013;13(1):158.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Rashid S, Kilewo C, Abound S. Seroprevalence of hepatitis B virus infection among antenatal clinic attendees at a tertiary hospital in Dar es Salaam. Tanzania. Tanzan J Health Res. 2014;16(1):9–15.

    PubMed  Google Scholar 

  24. Elsheikh RM, Daak AA, Elsheikh MA, Karsany MS, Adam I. Hepatitis B virus and hepatitis C virus in pregnant Sudanese women. Virol J. 2007;4(1):104.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Gasim GI, Murad IA, Adam I. Hepatitis B and C virus infections among pregnant women in Arab and African countries. J Infect Dev Ctries. 2013;7:566–78.

    Article  PubMed  Google Scholar 

  26. Yakasai IA, Ayyuba R, Abubakar IS, Ibrahim SA. Sero-prevalence of hepatitis B virus infection and its risk factors among pregnant women attending antenatal clinic at Aminu Kano Teaching Hospital, Kano, Nigeria. J Basic Clin Reprod Sci. 2012;1(1–2):49–55.

    Article  Google Scholar 

  27. 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. BMC Res Notes. 2014;7(1):239.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Awole M, Gebre-Selassie S. Seroprevalence of HBsAg and its risk factors among pregnant women in Jimma. Southwest Ethiopia. Ethiop J Health Dev. 2005;19(1):45–50.

    Google Scholar 

  29. Zenebe Y, Mulu W, Yimer Y, 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. BMC Infect Dis. 2014;14:118.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Seid M, Gelaw B, Assefa A. Sero-prevalence of HBV and HCV infections among pregnant women attending antenatal care clinic at dessie referral hospital. Ethiopia. Adv Life Sci Health. 2014;1(2):109–20.

    Google Scholar 

  31. Walle F, Asrat D, Alem A, Tadesse E, Desta K. Prevalence of hepatitis B surface antigen among pregnant women attending antenatal care service at Debre-Tabor hospital, Northwest Ethiopia. Ethiop J Health Sci. 2008;17:13–21.

    Google Scholar 

  32. Ramos JM, Toro C, Reyes F, Amor A, Gutiérrez F. Seroprevalence of HIV-1, HBV, HTLV-1 and Treponema pallidum among pregnant women in a rural hospital in southern Ethiopia. J Clin Virol. 2011;51:83–5.

    Article  PubMed  Google Scholar 

  33. Tiruneh M. Seroprevalence of multiple sexually transmitted infections among antenatal clinic attendees in Gondar Health Center, northwest Ethiopia. Ethiop Med J. 2008;46:359–66.

    PubMed  Google Scholar 

  34. Semaw A, Awet H, Yohannes M. Sero-Prevalence of hepatitis B surface antigen and associated factors among pregnant mothers attending antenatal care service, Mekelle, Ethiopia: evidence from institutional based quantitative cross-sectional study. Int J Med Health Sci. 2015;2(9).

  35. Yohanes T, Zerdo Z, Chufamo N. Seroprevalence and predictors of hepatitis B virus infection among pregnant women attending routine antenatal care in Arba Minch Hospital, South Ethiopia. Hepat Res Treat. 2016;2016(2):1–7.

    Google Scholar 

  36. 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;57:1333–42.

    Article  PubMed  Google Scholar 

  37. Mirambo MM, Mbena PB, Mushi MF, Mtebe M, Seni J, Mshana SE. Prevalence of hepatitis B surface antigen among pregnant women attending antenatal clinic at Nyamagana District Hospital Mwanza, Tanzania. Tanzan J Health Res. 2016;18(1). doi:10.4314/thrb.v18i1.10.

Download references

Authors’ contributions

AC was involved in proposal writing, designing, and recruitment and training of supervisors and data collectors, analysis and write-up and in all stages of the project implementation. He did most of the analysis and write up of the paper. AY contributed in the designing of the methodology, reviewing the proposal and paper and in the final approval of the paper. AA involved in designing of project proposal, design of questionnaires and in the final approval of the paper. All authors read and approved the final manuscript.

Acknowledgements

We would like to acknowledge Arba Minch University; College of Medicine and Health Science for the approval of the ethical clearance. Our gratitude goes to Tarcha hospital for granting the fund to undertake this study and laboratory professionals for their diligence during laboratory analysis. At last we are thankful to data collectors and women who participated in this study.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

Data are available in PDF based file from corresponding author.

Consent for publication

Not applicable.

Ethics approval and consent to participate

Ethical rules were approved and clearances were obtained from Ethical Review Board (ERB) of Arba Minch University College of Medicine and Health Sciences. Written informed consent was obtained from the study participants and parents, for participants’ age below 16 years old, by explaining the purpose of the study. Reactive cases were linked to clinicians for further follow up and management. Blood samples were not used for another purpose.

Funding

Tarcha General Hospital funded for full conduct of this research excluding publication fee.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Author information

Authors and Affiliations

  1. Epidemiology and Biostatistics, Public Health Emergency Management Officer, Dawuro Zone Health Department, SNNPR, PO Box: 20, Dawuro, Ethiopia

    Asrat Chernet

  2. Department of Public Health, College of Medicine and Health Sciences, Arba Minch University, PO Box: 21, Arba Minch, Ethiopia

    Aman Yesuf & Amsalu Alagaw

Authors
  1. Asrat Chernet
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aman Yesuf
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Amsalu Alagaw
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Asrat Chernet.

Rights and permissions

Open Access This 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.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Chernet, A., Yesuf, A. & Alagaw, A. Seroprevalence of Hepatitis B virus surface antigen and factors associated among pregnant women in Dawuro zone, SNNPR, Southwest Ethiopia: a cross sectional study. BMC Res Notes 10, 418 (2017). https://doi.org/10.1186/s13104-017-2702-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13104-017-2702-x

Keywords

BMC Research Notes

ISSN: 1756-0500

Contact us