<= /p>

3D"Text <= /td>

<= /p>

Hepatitis B Virus Seroprevalence and Poten= tial Perinatal

Transmission Among Pregnant Women in Abakaliki, Nigeria.

&nb= sp;

*Joseph Agboeze¹, Nwali Matthew Igwe¹, Chukwuemeka Ikechi Ukaegbe¹⁼

⁼

¹Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teac= hing Hospital, Abakaliki, Ebonyi State, Nigeria.

<= /p>

Background: Hepatitis B = Virus Hepatitis B Virus (HBV) infection is a global public health problem. It is highly endemic in Nigeria and it is estimated th= at about 9-12% of the total population of Nigeria are chronic carriers of hepatitis B surface antigen. Epidemiological data on (HBV)infection among pregnant women in Niger= ia are very scarce, especially in rural areas. The purpose of this study was t= o determine the prevalence and potential perinatal transmission among rural pregnant wo= men in Abakaliki Nigeria.<= /span>

Methods= : A cross-sectional study was conducted among pregnant wom= en accessing antenatal care at the Federal Teaching Hospital, Abaka= liki. We consecutively recruited 300 pregnant women attending antenatal consultations. A pretested questionnaire= was used to collect socio-demographic data and factors associated with HBV infection. The presence of hepatitis B surface antigen (HBsAg), hepatitis B= e antigen (HBeAg), and human immunodeficiency virus (HIV)= were determined using commercial test strips. A chi-square t= est was used for the analysis.

Results: The mean age= was 31.8 (SD6.2) years. All women were married and (23.4%) were farmers while (47.0%) had secondary education. Sixteen women (5.3%) were HBsAg-positive, = of whom (6.3%) were positive for HBsAg. The prevalence of HIV infection was (0.3%). Overall, (6.3%) women were co-infected with HIV and HBV. Independent correlates of HBV infection included a history of Jaundice (p =3D 0.046) history of sexually transmitted infections (p=3D0= .005) and concurrent infection by HIV (p < 0.0001).

Conclusion: The prevalence of HBV infection among pregnant women in Abakaliki was intermediate. T= he relatively high rate of women positive to both HBsAg and HBeAg suggests that perinatal transmission of HBV might be the prevailing mode of= HBV transmission in this area.

Keywords: Hepatitis B = virus HBsAg, HBeAg Pregnancy Nigeria

*Correspondence: Dr Joseph Agboeze Department of Obstetrics and Gynaecology, Alex Ekwueme Federal University Teaching Hospital, Aba= kaliki, Ebonyi State, Nigeria. = E-mail: jagboeze2@gmail.com=

This is an open access journal, and articles are distributed und= er the terms of the Creative Commons Attribution-Non-Commercial-Share Alike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit = is given, and the new creations are licensed under the identical terms.

How to cite this article<= span lang=3DEN-GB style=3D'font-size:9.0pt;font-family:"Times New Roman",serif; mso-ansi-language:EN-GB'>: Agboeze J, Nwali MI,= Ukaegbe CI. Hepatitis B Virus Seroprevalence and Pote= ntial Perinatal Transmission Among Pregnant Women in Abakali= ki, Nigeria. Niger Med J 2023;64(4):582-590. Accepted: September 5, 2023. Published: September 21, 2023.

&sh= y;

Background

Hepatitis B = Virus infection is a global public health problem. More than one-third of the wor= ld population has been reported to have serological evidence of past or present hepatitis B virus (HBV) infection^1,2,3. It is estimated that 350 million people globally are chronic carriers of hepatitis B virus of whom 1= 70 million reside in Africa ^2,3. Areas of particularly high endemic= ity are in Sub-Saharan Africa and Asia ^4-8. It is highly endemic in Nigeria and about 9-12% of the total population of Nigeria are chronic carr= iers of hepatitis B surface antigen^4,6,9. Hepatitis B Virus (HBV) infection is an important cause of liver disease in pregnancy. The seroprevalence of hepatitis B surface antigen (HBsAg) in pregnant women ran= ges from 0.67% in Spain¹⁰ to 37% in Papua New Guinea¹¹. In Port Harcourt, Nigeria, the seroprevalence of hepatitis B surface marker in pregnant women is 4.3% ⁴ whereas, in Ghana and Kenya, the hepati= tis B surface antigen (HBsAg) seroprevalence in pregnant women is 6.4%^{12
and 9.3% ² respectively.}

Mother-to-child transmission (MTCT) of HBV is responsible for m= ore than one-third of chronic HBV infections globally ¹³. Indeed, perinatal transmission seems to be predominant in high-prevalence areas suc= h as sub-Saharan African countries ¹⁴. Children born to mothers posit= ive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) have a 70-90% likelihood of perinatal acquisit= ion of HBV infection, and up to 90% of perinatal infections evolve towards chronic= ity compared to nearly 5% of adult infections ¹⁵. Prevention of perinatal transmission of HBV is therefore crucial to tackling the burden of the disease in high-endemic sub-Saharan African areas. Effective strategies= for reducing the incidence of chronic infections include maternal screening combined with post-exposure prophylaxis consisting of HBV vaccination immediately after delivery in all children born to HBsAg-positive mothers, ideally with immunoglobulin prophylaxis ¹⁶. This study aimed to determine the prevalence and factors associated with HBV infection and the infectivity of rural pregnant women in the Far North region of Cameroon.

Methods, Questionnaire administration, Laboratory testing, Statistical analysis, and finally Ethical considerations.

Study design

This was a cross-sectional study conducted among pregnant women accessing antena= tal care or delivery services at the Federal Teaching Hospital, Abakaliki.

Study setting and population.

The hospital is located in the = Abakaliki Metropolis, the capital of Ebonyi State of Nigeria. The inhabitants are mai= nly the Igbos. The majority of<= /span> the population dwells in rural areas with farming as= their major occupation¹⁷. The study population comprised all pregnant women who attended antenatal care at the Federal Teaching Hospital during the study period.

Sampling technique and sample size

The prevalence rate of Hepatitis B surface antigen (HBsAg) in pregnant women in Enugu is 4.5%¹. This prevalence rate of 4.5% has been chosen to calculate the minimum sample size of this study. This is because Enugu and = Abakaliki fall under the same South-East Geopolitical= zone of Nigeria with similar socio-cultural and demographic characteristics and = no such studies have been done in Ebonyi state.

The minimum sample size for this study therefore will be calculated using the following equation¹⁸.

n =3D Z²PQ/d²

n =3D The minimum sample size

z =3D The standard normal deviate =3D 1.96

p =3D The proportion in the target population estimated to have a particular characteristic with a prevalence rate of 4.5%¹(0.045) in this instance

q =3D 1.0 – p =3D which is 1.0 – 0.045 =3D 0.955

d =3D Degree of accuracy desired which is 2.5% (0.025) in this case.

Consequently, by applying the formula as follows:

n =3D (1.96)² x 0.045 x 0.957 =3D 3.8416 x 0.045 x 0.955 =3D 0.165= 0928 =3D 264.15

        &= nbsp;           &nbs= p;   (0.025)²        &= nbsp;           &nbs= p;            &= nbsp; 0.000625        &= nbsp;

The minimum sample size was 264, allowing for a 20% attrition rate, the sample = size for this study was 300.

Data collection and laboratory investigation.

A structured pretested questionnaire was used to collect socio-demographic information and data on risk factors for HBV infection among participants. = Upon completion of the questionnaire, 5 ml of venous blood was aseptically collected by venipuncture into an Ethylene Di-amine Tetra-acetic Acid (EDTA) tube. The plasma obtained from each sample was tested for the presence of H= BsAg using a commercial test strip, the Clinotech Diagnostics HBsAg detection test according to the manufacturer’s instructions. All samples tested positive were retested for confirmation us= ing the same kit. There were no discordant results. Samples confirmed positive = for HBsAg were further tested for HBeAg using a commercial test strip, the Clinotech Diagnostic= s HBeAg detection test. We also tested all blood sample= s for HIV according to the national screening algorithm. Accordingly, samples were first screened with an anti-HIV antibody rapid test, the Determine HIV-1/2 (Abbott Laboratories, IL, USA).

Data analysis

Data were entered and analyzed using Epi info for Windows, version 7. (Atlant= a, GA 30329-4027 USA). Results are presented as counts (proportions) and mean with standard deviations (SD). The influence of vari= ous factors on the occurrence of HBV infection was calculated by both univariate and bivariate analyses. A p-value < 0.05 was set as statistically significant.

Ethical consideration

Formal approval was obtained from the Research and Ethics Committee of the Federal Teaching Hospital, Abakaliki with reference no FMC/AI/AD/05/227. The participation of any pregnant woman in this study was voluntary and only after written informed consent had been obtained. Those recruited were free to withdraw from the study = at any point in this study without any influence on their continued management in = the hospital. An arrangement was made for those who had positive HBeAg to obtain treatment at the Federal Teaching Hos= pital Abakaliki at no cost to them.

Results

A total of 300 pregnant women receiving antenatal care at Federal Teaching Hospital Abakaliki were serially recruited into= this study.

The age ranged from 20 to 48 years with a mean age of 31.9 ± 6.3 years. = The majority of the women were in the age group 21-30 = years 149 (49.7%). Most of our respondents 141 (47%) had secondary school educati= on and 83 (27.7%) women were Farmers. (Table 1)

<= /o:p>

Table 1 Demographics= of pregnant women attending antenatal care in the Federal Teaching Hospital Abakaliki, Ebonyi state. Nigeria.2014

Variables

Number (N=3D300)

Percentage (%)

Age

≤ 20

5

     1.7=

21-30

149

    49.7

31-40

115

    38.3

41-50

31

   10.3

Educational level

None

35

11.7

Primary

51

17

Secondary

141

47

Tertiary

73

24.3

Marital Status

Married

300

100

Occupation

Farmer

83

27.7

Civil servants

72

24

Students

69

23

Traders

62

20.6

Unemployed

14

4.7

Risk factors for HBV infection are presented in Table 2 The main factors reported were: previous history of sexually transmitted infection (68.0%), previous history of jaundice (35.3%), and family history of known HBV infec= tion (6.5%).

Table: Risk factors of HBV infectio= n and markers of HBV infectivity among pregnant women attending antenatal care in= Federal Teaching Hospital Abakaliki, Ebonyi State. Nigeria.2014

Characteristics

NO

Percentage (%)

Yes

Percentage (%)

Risk factors

Previous history of Jaundice;

194

64.7

106

35.3

    History of tattoo; <= o:p>

297

99

3

1

    History of Sexually<= span style=3D'mso-spacerun:yes'>     transmitted infection;

96

32

204

68

Family history of hepatitis

252

84

48

16

Past history of abortion

280

93.3

20

6.7

Number of pregnancies < 4

83

27.7

217

72.3

HIV serology test

299 (Negative).

99.67

1

(Positive)

0.33

The prevalence of HBV infection was 5%.

Factors independently associated with HBV infection included previous history of Jaundice (p =3D 0.046) History of sexually transmitted infectio= ns (p =3D 0.005) and co-infection with HIV (p < 0.001). The other factors assessed did not influence the occurrence of HBV infection among our participants (Table 3).

Table 3. Correlates o= f HBV infection among pregnant women attending antenatal in the Federal Teaching Hospital Abakaliki, Ebonyi State. Nigeria. 2014

Variables

Hepatitis B Negative

Hepatitis B Positive

P-value

Age

≤31

144 (50.7%)

10 (62.5%)

0.508

≥32

140 (49..3%)

6 (37.5%)

Educational Level

Below Secondary

77(72.89%)

6(37.5%)

0.537

Secondary & above

207(27.77%)

10(62.5%)

Parity

≤4

236(83.10%)

13(81.25%)

0.880

≥5

48(16.90%)

3(18.75%)

History of tattoo

Yes

2(0.7%)

1(6.25%)

0.380

No

282(99.3%)

15(93.75%)

HIV status

positive

0(0.00)

1(6.25%)

0.046

Negative

284(100%)

15(93.75%)

History of jaundice

Yes

106(37.32%)

0(0.00%)

0.005

No

178(62.68%)

16(100%)

History of hepatitis

Yes

48(16.90%)

0(.0.00%)

0.148

No

236(83.10%)

16(100.0%)

History of STI

Yes

200(70.42%)

4(25.0%)

0.001

No

84(29.58%)

12(75.0%)

History of miscarriage

Yes

35

1

0.768

No

265

15

Discussion

We investigated the seroprevalence and factors associated with HBV infection i= n Abakaliki Nigeria. The information gathered by this w= ork may contribute to improving knowledge of HBV infection epidemiology in preg= nant women in that region and inform local and national antenatal HBV screening = and infant immunization policies.

In this study seroprevalence of HBV infection among pregnant women attending t= he antenatal clinic at the Federal Teaching Hospital, Aba= kaliki Nigeria was 5%. The prevalence reported in our study is consistent with data reported among pregnant women in Nigeria: 4.5% in Enugu¹,4.3% reported in Port Harcourt ⁴,2.19 % reported in Benin City,^1=
9 and 5.7% reported in Ilorin²⁰. However, the prevalence rate was lower,11.6% in Maiduguri²¹, 8.3% in Zaria²²and 11% in Makurdi²³ in Nigeria. The various data reported among pregnant w= omen in sub-Saharan African countries: 6.5% in Congo ²⁴, 9.3% in Keny= a ²⁵, 9.5% in Gabon ²⁶, 10.7% in Burkina Faso ²⁷, 10.9 % in Mauritania ²⁸, 12.6% in Ghana ²⁹, 13.8% in Senegal 30, and 25% in Zimbabwe ³¹. The seroprevalence of HBV in Nigeria is higher in northern Nigeria than in the southern part of the country where t= his study was done. Reasons deduced for this difference include poor awareness = of the infection and misconception about the safety of immunization which is a common finding in Northern Nigeria. Also, the common practice of Polygamy a= nd widespread practice of native scarification in Northern Nigeria could contribute to the high prevalence in Northern Nigeria^1,4,8. The practice of scarification and tattooing has been reported to play a role in hepatitis B Virus infection.¹⁹

The age group of 21-30 years had the highest prevalence of 49.7% in this study = This agrees with the findings in Port Harcourt⁴ but is in contrast to= the observations in the Middle East and Indonesia where most of the subjects we= re between 30 and 40 years of age ¹⁹.The preponderance of HBsAg–positive pregnant women in this age bracket could be due to the fact that women within this age bracket constitute the majority of our obstetric population.

Mother-to-child transmission (MTCT) of HBV is reported to be responsible for more than one-third of chronic HBV infections globally 13, and prenatal infection is assumed to be a major mode of transmission in high-prevalence areas like most sub-Saharan African countries¹⁴= . HBeAg positivity is associated with a high risk of perinatal transmission of HBV as children born to mothers positive to both HBsAg and HBeAg have a 70-90% chance of perinat= al acquisition of HBV infection ¹⁵. The HBsAg seroprevalence rate in this study was 6.3%. This finding is higher than 3.3% in Makurdi^{23
and 1.36% in Maiduguri⁸. The prevalence rate from this study is =
also
significantly higher than 0.8%²¹ reported in Zimbabwe. In studies
done at Port Harcourt and Enugu, HBsAg seropositive subjects were not tested
for HBeAg. HBeAg an=
d viral
DNA level determine the level of mother-to-child transmission of HBV.^3=
3
Hence for those reactive to HBeAg, the possibil=
ity of
mother-to-child transmission is high^.The overall prevalence of =
HBeAg in our sample was 0.33%. This suggests that the
probability of HBV MTCT was high in our study
population.}

The prevalence of HIV/HBV co-infection was 6.3%. This co-infection rate was hig= her than the 4.2% rate reported in a study in Nigeria ³⁴. We found t= hat HIV infection was highly associated with HBV infection in our study populat= ion, this can be explained by the fact that HBV and HIV share common modes of transmission. Moreover, it has been reported that HIV/HBV co-infection facilitates HBV replication and reactivation leading to higher HBV-DNA leve= ls and a reduced spontaneous clearance of the virus³⁵.

This study was limited by certain factors. First, we used rapid diagnostic tests which are less sensitive than ELISA or PCR tests, leading to possible underestimation of the prevalence of assessed markers. Furthermore, we investigated HBV infectivity based only on HBeAg, and we did not look for HBV viral load which is an important determinant of HBV transmission. Despite these shortcomings, this study provides relevant information in the context of very limited epidemiological data on HBV infection in Nigeria, especially among pregnant women.

Conclusion and Recommendation

The seroprevalence of HBsAg among pregnant women in our setting is intermediate. History of jaundice, History of sexually transmitted infection, and HIV infection are independently associated with the occurrence of HBV infection= in this setting. In view of this, routine testing of all pregnant women for HB= sAg is necessary. Routine vaccination of all infants, irrespective of maternal = HBV carrier status, as it is currently practiced, is also an effective approach= to HBV prevention and control in Abakaliki, Nigeri= a and this practice should be continued and enforced.

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Variables	Number (N=3D300)	Percentage (%)
Age
≤ 20	5	1.7=
21-30	149	49.7
31-40	115	38.3
41-50	31	10.3
Educational level
None	35	11.7
Primary	51	17
Secondary	141	47
Tertiary	73	24.3
Marital Status
Married	300	100
Occupation
Farmer	83	27.7
Civil servants	72	24
Students	69	23
Traders	62	20.6
Unemployed	14	4.7

Characteristics	NO	Percentage (%)	Yes	Percentage (%)
Risk factors
Previous history of Jaundice;	194	64.7	106	35.3
History of tattoo; <= o:p>	297	99	3	1
History of Sexually<= span style=3D'mso-spacerun:yes'> transmitted infection;	96	32	204	68
Family history of hepatitis	252	84	48	16
Past history of abortion	280	93.3	20	6.7
Number of pregnancies < 4	83	27.7	217	72.3
HIV serology test	299 (Negative).	99.67	1 (Positive)	0.33

Variables	Hepatitis B Negative	Hepatitis B Positive	P-value
Age
≤31	144 (50.7%)	10 (62.5%)	0.508
≥32	140 (49..3%)	6 (37.5%)
Educational Level
Below Secondary	77(72.89%)	6(37.5%)	0.537
Secondary & above	207(27.77%)	10(62.5%)
Parity
≤4	236(83.10%)	13(81.25%)	0.880
≥5	48(16.90%)	3(18.75%)
History of tattoo
Yes	2(0.7%)	1(6.25%)	0.380
No	282(99.3%)	15(93.75%)
HIV status
positive	0(0.00)	1(6.25%)	0.046
Negative	284(100%)	15(93.75%)
History of jaundice
Yes	106(37.32%)	0(0.00%)	0.005
No	178(62.68%)	16(100%)
History of hepatitis
Yes	48(16.90%)	0(.0.00%)	0.148
No	236(83.10%)	16(100.0%)
History of STI
Yes	200(70.42%)	4(25.0%)	0.001
No	84(29.58%)	12(75.0%)
History of miscarriage
Yes	35	1	0.768
No	265	15