Arresting vertical transmission of hepatitis B virus (AVERT-HBV) in pregnant women and their neonates in the Democratic Republic of the Congo: a feasibility study (original) (raw)
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International Journal of Community Medicine and Public Health, 2024
Background: Hepatitis B virus (HBV) is a global health threat, affecting millions worldwide and causing severe liver diseases such as cirrhosis and cancer. Low and middle-income countries (LMICs), particularly South Sudan, face challenges like limited healthcare infrastructure and public awareness, leading to high HBV prevalence. Infants born of seropositive women are at heightened risk due to vertical transmission, perpetuating the infection cycle. Methods: This study assessed HBV seroprevalence among pregnant women in Abyei, South Sudan, and evaluated vaccine effectiveness in preventing mother-to-child transmission. A hybrid study of cross-sectional and cohort design included 384 pregnant women and 94 infants. Blood samples were tested for hepatitis B surface antigen (HBsAg), while socio-demographic data and awareness levels were gathered through structured questionnaires. Qualitative insights were also collected via focus group discussions and interviews with healthcare providers. Logistic regression was used to analyze risk factors. Results: The seroprevalence of HBV was 19% among pregnant women. Younger age, lower education levels, and unemployment were associated with higher infection rates. Vertical transmission occurred in 4.3% of infants, despite vaccine availability. Awareness of HBV was notably low among participants, underscoring gaps in public health education. Conclusions: HBV presents a significant health burden in Abyei, South Sudan. Enhancing health education, improving access to preventive strategies, and strengthening healthcare infrastructure are critical to reducing HBV prevalence and transmission. Implementing targeted public health interventions can mitigate the virus’s impact on maternal and child health in the region.
Journal of Medical Microbiology & Diagnosis
Background: According to the WHO report, Ethiopia is regarded as a country with intermediate to hyperendemic viral hepatitis infections, though it has no national strategy for surveillance, prevention and control of viral hepatitis. Without intervention, a mother who is positive for HBsAg and HBeAg has as high as 90% risk of passing the infection to her offspring. Therefore, this study tried to assess the seroprevalence and associated factors of HBV infection among pregnant women attending antenatal care in public health facilities of Dire-Dawa, Eastern Ethiopia. Materials and methods: A facility based cross-sectional study was conducted from January to March 2018 among 334 pregnant mothers. After obtaining a consent forms, data were collected by face to face interview and blood samples were collected to test for HBsAg. Logistic regression analysis was employed to identify factors significantly associated with HBV infection. A p value <0.05 was considered as level of significance. Results: The mean age of participated pregnant mothers was 24.93 years (+2 SD 5.21). The prevalence of HBV infection found to be 8.4% in the study area. On multivariate analysis, being single pregnant mothers (p-0.002), having nose/ear pierce (p-0.018), history of blood transfusion (p-0.008), circumcision (p-0.004), and HIV coinfection (p-0.032)} were factors significantly associated with HBV infection. Conclusion: To halt spread of this virus, increasing awareness on modes of transmission should be considered. Screening all pregnant women for HBV should be made as part of routine antenatal care service. Interventions should be targeted on reduction of circumcision by all concerned bodies.
BMC Infectious Diseases, 2023
Background Despite the availability of an effective vaccine, chronic hepatitis B virus (HBV) infections remain a major cause of liver cirrhosis and hepatocellular carcinoma. HBV burden in pregnancy, risk factors and the timing of mother to child transmission remain poorly described especially during this era of lifelong use of Tenofovir/Lamivudine/ Efavirenz as firstline for HIV treatment. We aimed to determine the burden of HBV in pregnancy and infants receiving their first dose of HBV vaccine 6 weeks after birth in a high HIV-prevalence setting. Methods Pregnant women ≥ 20 weeks' gestational age were enrolled and followed up as mother-infant dyads from delivery, 6, 24 and 96 weeks after birth. HBV surface antigen (HBsAg) was tested (fresh plasma, immunochromatography) in pregnancy. Women testing HBsAg-seropositive were further evaluated for other four HBV-biomarkers. Maternally HBV exposed babies were tested for HBsAg from birth and HBs-antibodies from 6 months of age. Maternalinfant factors were tested in univariable and multivariable analyses for predictors of HBsAg-seropositivity. Results Six hundred HIV-uninfected and 608 HIV-infected women on Tenofovir/Lamivudine/Efavirenz-regimen with median (interquartile range) 350: (87-1477) days of therapy use were enrolled. The overall HBsAg-seroprevalence was 32/1208: 2.65%, 95% confidence interval (CI) [1.74, 3.55]; being 7/600: 1.17%, 95% CI [0.37, 1.97] and 25/608: 4.11%, 95% CI [2.52, 5.68] in HBsAg-monoinfected and HBsAg/HIV-coinfected respectively, disproportionately detected in 31/32: 96.9%, 95% CI [90.8, 100] women presumably HBV-unvaccinated in infancy. HBV exposed babies tended to be born prematurely (< 37 weeks); 15.2% versus 9.9% in the HBV-unexposed, p = 0.009. In multivariate logistic regression-models with variable elimination, HIV-infection and reported tooth extractions predicted antenatal HBsAg-seropositivity; odds ratios (
Burden of HBV Infection among Pregnant Women in a Low Income City of Ibadan, Nigeria
World Journal of Medical Sciences, 2019
Mother to child HBV transmission has been a prominent cause of ailment among children which progresses to chronic hepatitis, cirrhosis of the liver and hepatocellular carcinoma. About a million die annually as a result of these complications. This study focused on the evaluation of HBsAg prevalence among pregnant women in a secondary health institution in Ibadan, Oyo State. Seven hundred and ninety nine(799) pregnant women who attended antenatal between March and December, 2017 were recruited into this cross sectional study. Blood samples were aseptically withdrawn from each of the women after informed consent was obtained. Samples were centrifuged, sera separated and kept at-20°C. Analysis was thereafter carried out following the manufacturers' guideline using conventional method. Out of the 799 pregnant women tested in total, 54 (6.8%) were HBsAg positive. The age groups with the highest prevalence rate were 35-39 (31.5%) and 30-34 years (24.1%). The least educated had the lowest prevalence of 14.8%(p>0.05).Free hospital screening and vaccination of all pregnant women together with their babies should be included in the antenatal and postnatal programmes of hospitals to prevent mother to child transmission. Other serological markers like anti-HBs, anti-HBe and anti-HBc are advocated for to be also included in the antenatal programme nationwide for pregnant women and those negative should be vaccinated to confer protection against HBV infection.
International Journal of Women’s Health, 2022
Background: While hepatitis B virus infection may be seen as a global threat within the medical and scientific community, primary prevention via vaccination remains the most effective approach towards breaking the chain of transmission of HBV infection. However, vaccination uptake in Uganda has been modest despite a very endemic national figure resulting from the vertical transmission of this infection. This study assessed the predictors of HBV vaccine hesitancy among pregnant women attending Antenatal clinic in Central Uganda. Methodology: A hospital-based cross-sectional study employing a five-sectioned pretested interviewer-administered questionnaire was conducted to obtain data from 385 consenting pregnant women. Responses for the antecedent variables were transformed into weighted aggregate scores using SPSS version 26. Multivariable logistic regression analysis was employed to ascertain the predictors of HBV vaccine hesitancy with the cutoff for hypotheses set at 5% level of significance. Results: The majority of the respondents (59%) were between the ages of 18 and 28 years. Women with secondary educational attainment were predominant (42.3%). The respondents had mean scores of 5.97±6.61, 17.10±18.31, and 12.39±13.37, respectively, computed for knowledge of HBV infection, perception, and behavioral skills towards HBV prevention. Regarding vaccine hesitancy, three-quarters of the women (74%) hesitated to uptake HBV vaccine. While negative significant associations exist between marital status (AOR = 0.47, 95% CI = 0.22-1.01), knowledge (AOR = 0.79, 95% CI = 0.70-0.89), behavioral skills (AOR = 0.88, 95% CI = 0.81-0.95) and vaccine hesitancy, level of education (AOR = 1.88, 95% CI = 1.08-3.27) and perception (AOR = 1.11, 95% CI = 1.05-1.18) on the other hand, positively predicted vaccine hesitancy. Conclusion: The findings reported an extremely high degree of HBV vaccine hesitancy among the expectant mothers discovered to be linked with marital status, educational attainment, HBV-specific knowledge, perception and behavioral skills. This necessitates targeted health education for married women with lower educational attainment to improve their knowledge which will in turn shape their perception and behavioral skills towards satisfactory uptake of HBV vaccine.
Public Health in Practice, 2021
Approximately 257 million people are infected with hepatitis B virus (HBV) especially in the middle and low-income countries, despite the Global Health Sector Strategy on viral hepatitis 2016-2021 which aims to eliminate viral hepatitis as a public health threat by 2030. Hepatitis B virus (HBV) remains a common public health problem in Cameroon with a high prevalence among pregnant women. Therefore, this study was designed to assess risk factors associated with hepatitis B virus infection among pregnant women attending the antenatal care unit of the Bamenda Regional Hospital. Study design: The study was a health facility-based cross-sectional study carried out from March to May 2020. The inclusion criteria were all pregnant women who came for their first visit. Methods: A well-structured questionnaire and laboratory test methods were used to collect data from 221 pregnant women who were consecutively enrolled in the study. The OnSite HBsAg Rapid Test (source: CTK Biotech, Inc. REF: R0040), was used to detect HBsAg in serum. Both descriptive statistics and Chi-square (and Fisher's exact) test were used for data analysis. Results: The prevalence of HBV infection among pregnant women was 4.98% (11/221). Although knowledge, attitude and practice towards HBV by pregnant women were not significantly associated with the risk of infection, there were higher odds of poor practice (P = 0.0152) and attitudes (P = 0.0016) among those without knowledge on HBV infection. Conclusions: Free of charge vaccination for those with negative HBsAg test results and extensive health education campaigns against HBV is recommended among pregnant women attending the antenatal care unit of the Bamenda Regional Hospital.
BMC Public Health, 2015
Background: Epidemiological data on hepatitis B virus (HBV) infection among pregnant women in Cameroon are very scarce, especially in the rural milieu. The purpose of this study was 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: A cross-sectional study was conducted in three rural health facilities of the Guidiguis health district between December 2013 and March 2014. We consecutively recruited 325 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. Regression analyses were used to assess correlates of HBV infection. Results: The mean age was 24.4 (SD5.6) years. Most women were married (97.2%) and housewives (96.4%), with less than secondary education level (80%). Only 4 women (1.2%) had been vaccinated against HBV. Thirty-three women (10.2%) were HBsAg-positive, of whom 4 (12.1%) were positive to HBeAg. The prevalence of HIV infection was 2.5% (8/325). Overall, 5 (1.5%) women were co-infected with HIV and HBV. Independent correlates of HBV infection included history of blood transfusion (adjusted odd ratio 12.59, 95% CI 1.46-108.89; p = 0.021) and concurrent infection by HIV (adjusted odd ratio 22.53, 95% CI 4.76-106.71; p < 0.0001). Conclusion: The prevalence of HBV infection among pregnant women in this rural milieu is high. History of blood transfusion and HIV infection are highly associated with HBV infection. The relative low rate of women positive to both HBsAg and HBeAg suggests that perinatal transmission of HBV might not be the prevailing mode of HBV transmission in this area.
Open Journal of Gastroenterology, 2017
The aim of this study was to identify the risk factors of mother-to-child transmission of HBV in positive Ag Hbs pregnant women in Cote d'Ivoire. Methods: This was a transversal prospective study that took place over a period of 7 months (from February 2016 to August 2016) in 2 university hospital and 2 private clinics. We consecutively recruited 91 pregnant women who were positive for HBs Ag in prenatal consultations. For each pregnant woman record included in the study, we provided Socio-demographic (Age, marital status, education level, social rank, gravidity, parity) and biological data (HBs Ag, Anti-HBc Total Ac, Hbe Ag, Ac anti-Hbe Ac, DNA-VHB, Ac anti-HCV Ac, retroviral serology, transaminases). All of these data were collected using a survey sheet developed for the study. Results: The age of our pregnant women HBs positive ranged from 18 years to 44 years with a mean age of 30.10 years. The age group from 20 to 39 years was the most represented with a frequency of 92.31%. Almost of all positive HBs Ag pregnant women was HBe Ag negative, only 3.3% was HBe Ag positive. The viral load above 2000 IU/ml was found in 21 (23.03%) patients. There were 4 co-infected patients, which 3 HBV-HIV and 1 HBV-HCV. Only 19 (20.88%) pregnant HBs Ag positive women were able to bring back the supplementary virological assessment within a period less than one month. Conclusion: According to our work the virologic profile of positive HBs Ag in pregnant women in Cote d'Ivoire is characterized by an important viral replication objectified by a high viral load in about 23% pregnant women, a negativity of HBe antigen in 96.6% of them.
Vaccine, 2017
Background-Hepatitis B (HBV) in sub-Saharan Africa is believed to be horizontally acquired. However, because of the high HBV prevalence in northern Uganda, no hepatitis B vaccination at birth and no access to HBV immunoglobulin, we hypothesize that vertical transmission also could also play an important role. We therefore investigated the incidence of HBV among babies presenting for their first HBV vaccine dose in Gulu, Uganda. Methods-We recruited mothers and their babies (at least 6-week old) presenting for their postnatal care and first HBV vaccine dose respectively. Socio-demographic and risk factors for HBV transmission were recorded. Mothers were tested for Hepatitis B core antibody (anti-HBc-IgG) and hepatitis B surface antigen (HBsAg). HBsAg-positive sera were tested for hepatitis B e antigen (HBeAg) and HBV viral load (HBVDNA). Babies were tested for HBsAg at presentation and at the last immunization visit. A sample of HBsAg-negative babies were tested for HBVDNA. Incident HBV infection was defined by either a positive HBsAg or HBVDNA test. Chi-square or fisher's exact tests were utilized to investigate associations and t-tests or Wilcoxon rank-sum test for continuous differences. Results-We recruited 612 mothers, median age 23 years (IQR 20-28). 53 (8.7%) were HBsAgpositive and 339 (61.5%) were anti-HBc-IgG-positive. Ten (18.9%) of the HBsAg-positive mothers were HBeAg-positive. Median HBVDNA levels of HBV-infected mothers was 5.7log (IQR 4.6-7.0) IU/mL with 9 (17.6%) having levels ≥10 5 IU/mL. Eighty (13.3%) mothers were HIV-infected of whom 9 (11.5%) were co-infected with HBV. No baby tested HBsAg or HBVDNA positive.
Gastroenterology, 2012
BACKGROUND & AIMS: Mother-to-infant transmission is the major cause of hepatitis B virus (HBV) infection among immunized children. There has been much debate about screening pregnant women and administering hepatitis B immunoglobulin (HBIG) to newborns. We analyzed the rate of HBV infection among children born to hepatitis B surface antigen (HBsAg)-positive mothers and whether HBIG administration reduces transmission. METHODS: We analyzed data from 2356 children born to HBsAg-positive mothers, identified through prenatal maternal screens. In addition to HBV vaccines, HBIG was given to all 583 children with hepatitis B e antigen (HBeAg)-positive mothers and to 723 of 1773 children with HBeAgnegative mothers. Serology tests for HBV were performed from 2007 to 2009, when children were 0.5-10 years old. RESULTS: A significantly greater percentage of children with HBeAg-positive mothers tested positive for antibodies against the hepatitis B core protein (16.76%) and HBsAg (9.26%) than children with HBeAgnegative mothers (1.58% and 0.29%, respectively; P Ͻ .0001 and Ͻ.001). Among the HBV-infected children, the rate of chronicity also was higher among children with HBeAg-positive mothers than children with HBeAg-negative mothers (54% vs 17%; P ϭ .002). Similar rates of antibodies against the hepatitis B core protein (0.99% and 1.88%; P ϭ .19) and HBsAg (0.14% and 0.29%; P ϭ .65) were noted in children born to HBeAg-negative mothers who were or were not given HBIG. Infantile fulminant hepatitis developed in 1 of 1050 children who did not receive HBIG (.095%). CONCLUSIONS: Children born to HBeAg-positive mothers are at greatest risk for chronic HBV infection (9.26%), despite immunization. Administration of HBIG to infants born to HBeAg-negative mothers did not appear to reduce the rate of chronic HBV infection, but might prevent infantile fulminant hepatitis. Screening pregnant women for HBsAg and HBeAg might control mother-to-infant transmission of HBV.