Prevalence and factors associated with Hepatitis B Virus infection among pregnant women attending antenatal care clinic in Mulago Hospital

Abstract

Background. Hepatitis B is a viral infection that affects the liver and can cause both acute and chronic disease. Worldwide, about two billion people are exposed to Hepatitis B virus and an estimated 257 million people are living with Hepatitis B virus infection. Babies born to a mother with Hepatitis B have a greater than 90% chance of developing chronic Hepatitis B if they are not properly treated at birth. It is imperative for pregnant women to know their Hepatitis B status.

Objective To determine the prevalence and factors associated with Hepatitis B Virus infection among pregnant women attending antenatal care clinic in Mulago Hospital.

Methods This was a cross sectional study, of pregnant women attending the antenatal care clinic, in Mulago Hospital. Three hundred and forty (340) women were enrolled into the study, and data was collected between December 2018 and February 2019. A blood sample was screened for HBsAg, and the positive samples were taken to an accredited laboratory for HBsAg external quality assurance tests, HBeAg tests, and liver function tests. An interviewer administered questionnaire was also used on the study participants, to establish the factors associated with HBV infection. Double data entry was done using Epidata 3.1 package, followed by cleaning, coding, and audit. HBV prevalence was determined, that is the number of HBsAg positive pregnant women, divided by the number of all women recruited into the study. Data was further analyzed using bivariate and multivariate logistic regression, using STATA version 14.1, to investigate the association of demographic and social factors with HBV infection. Results are presented as Adjusted Odds Ratio of 95% Confidence Interval.

Results A total of 340 participants were recruited into the study, with a mean age of 27±5.7 years, and a median gravidity of 3. The prevalence of Hepatitis B Virus infection among pregnant women attending the antenatal care clinic in Mulago hospital was found to be 2.9% (N=10). (95%CI, 1.58-5.40). The factors that were found to be associated with Hepatitis B virus infection were, marital status, (aOR=11.37, p= 0.002), history of having had a Hepatitis B positive patient at home, (aOR=49.52, p<0.001), and history of having had a blood or body fluid splash to mucous membranes from a Hepatitis B positive patient, (aOR=61.69, p=0.015). Other factors such as age, level of education, socioeconomic status, number of sexual partners, HIV serostatus, piercing of ears, history of abortions, history of blood transfusion, and history of jaundice, were not found to be significantly associated with Hepatitis B virus infection in this study.

Conclusion The prevalence of Hepatitis B virus infection among pregnant women attending antenatal care clinic in Mulago hospital was of intermediate endemicity. The factors associated with Hepatitis B virus infection in this study population were marital status, history of having a Hepatitis B positive patient at home, and history of a blood or body fluid splash to mucous membranes from a Hepatitis B positive patient. Factors such as age, HIV status, history of blood transfusion, piercing of ears, and social status were of limited value in this study.

Reccomendations Testing of all pregnant women for Hepatitis B virus during antenatal care, and a birth dose Hepatitis B vaccine, with or without Hepatitis B Immunoglobulin for all babies born to Hepatitis B positive mothers, followed with two other doses within the first six months of life. Screening and adult vaccination with 3 doses of Hepatitis B vaccine is recommended for high risk groups, such as health workers, people living or taking care of Hepatitis B positive patients, and women without stable partners. Considering the significance of this prevalence among pregnant women, vaccination of pregnant women with the 3 doses of the Hepatitis B vaccine, within 6 months, is recommended, as it is not contraindicated in pregnancy, and yet protective. A multicenter, larger sample size study, with more tests, such as viral load, Anti-Hepatitis B Core Antibody, should be carried out in this same study population, to ascertain the exposure status to Hepatitis B virus, the risk of vertical transmission, and more generalisable associated factors.

Key words: Hepatitis B, prevalence, pregnant women, Mulago hospital, Uganda