Prevalence and associated factors of hepatitis B and hepatitis C among patients with liver disease in Mulago Hospital

Abstract

INTRODUCTION: Both hepatitis B and hepatitis C viral infections are endemic in Uganda and are a known cause of liver disease, including acute hepatitis, chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Liver disease is one of the leading causes of mordidity and mortality on the gastroenterology ward in Mulago hospital. Patients with liver disease may benefit from identification and treatment of both HBV and HCV because the treatment of these viruses may halt or slow the progression of the liver disease and avert mortality. It is possible that hepatitis B and C contribute to the etiology of liver disease among patients in Mulago hospital but we do not know by how much. The study was conducted with the aim of determining the possible contribution of HBV and HCV to the aetiology of liver disease in Mulago hospital. OBJECTIVES: The main objective of this study was to determine the prevalence of HBV and HCV among patients with liver disease in the gastroenterology ward and clinic of Mulago hospital The other objective was to determine the factors associated with hepatitis B and hepatitis C among patients with liver disease in Mulago hospital. STUDY DESIGN: This was a cross sectional study STUDY SETTING: Gastroenterology ward and Clinic, Mulago hospital Kampala. METHODS: All patients with a provisional diagnosis of liver disease on the GE ward or clinic were informed about this study and requested to participate in ti. Those patients who agreed to participate in the study were screened for liver disease using a brief history, liver function test, abdominal ultra sound and for those with liver masses, serum alpha feto protein or liver biopsy was also done. Those patients that fulfilled the study definitions for acute hepatitis, chronic hepatitis, liver cirrhosis or HCC and met the inclusion criteria were asked to give a written and informed conscent and recruited into the study. For each patient recruited, history was taken, a physical examination done, blood taken off for HBsAg and Hepatitis C antibodies testing. Aquestionnaire was administered to each patient to assess for selected sociodemographic and behavioural factors and record patient data. RESULTS: One hundred and twenty patients were recruited into the study. The prevalence of hbv among patients with liver disease was 45% while that of possible HCV infection was 4.2%. There was no HBV/HCV co-infection. Younger patients and patients from the northern part of Uganda were more likely to have HBV (p=0.01 and 0.001 respectively). History of blood transfusion and therapeutic cuts were significantly associated with HBV (p=0.047 and 0.009 respectively) Elevated AST was significantly associated with HBV infection (p=0.037). CONCLUSIONS: There is a high prevalence of HBV among patients with liver disease especially in the younger patients and in patients from the northern part of Uganda. HCV is a much less common infection. Blood transfusion and therapeutic cuts are the risk factors that are significantly associated with HBV among patients with liver disease in Mulago hospital. RECOMMENDATIONS: All patients with liver disease should be routinely tested for HBV infection and drugs for HBV should be availed to the gastroenterology ward and clinic to treat this infection. All medical staff working on the gastroenterology ward should be immunized against HBV. In view of the limited resources, it is not cost effective for now to routinely screen patients with liver disease for HCV infection. However, facilities for testing for markers of active HCV and HBV infections should be made available to improve patient diagnosis and treatment in the national referral hospital.