Seroprevalence of Hepatitis B Virus Infection and Associated Factors Among Pregnant Women Attending Antenatal Care At Public Hospitals in Borena Zone,Southern Ethiopia

Abstract

Background

Hepatitis B virus (HBV) is one of the major threats to global health, affecting millions of people each year and causing morbidity and mortality. The risk of acquiring chronic HVV infection varies with age, with 90% of infections acquired during the perinatal period. Despite many studies, there is little evidence of this virus in the Borena Zone.

Objectives

This study was done to assess seroprevalence HBVinfection and associated factors among pregnant women attending antenatal care at selected Borena Zone public hospitals from June 1 to September 30, 2022.

Methods

A cross-institutional study was conducted on 368 randomly selected pregnant women who received antenatal care at Yabelo General Hospital and Moyale Primary Hospital. Data on sociodemographic and HBV-related factors were collected using a structured questionnaire. A 5 mL blood sample is then taken and tested using a diagnostic method, the enzyme-linked immunosorbent assay. Finally, data were entered using Epidata version 3.1 and exported to SPSS version 25 and Stata version 14 for analysis. Independent predictors were identified using logistic regression analysis and P < .05 was considered statistically significant.

Results

The prevalence of HBV infection was 21 (5.7%) (95% confidence interval [CI], 3.74-8.61). History of hospitalization (adjusted odds ratio [AOR] = 3.44, 95% CI, 1.07-11.09), traditional tonsillectomy (AOR = 4.16, 95% CI, 1.29-13.40), history of sexually transmitted infection (AOR = 5.99, 95% CI, 1.81-19.85), human immunodeficiency virus (HIV) (AOR = 8.28, 95% CI, 1.66-41.41), and alcohol drinking (AOR = 5.08, 95% CI, 1.49-17.31) were independent predictors of HBV infection.

Conclusions

The results of this study indicate a moderate prevalence of HBV in selected public hospitals in the Borena Zone. History of hospitalization, traditional tonsillectomy, sexually transmitted infections, HIV, and alcohol use was significantly associated with HBV infection. Therefore, there is a need to conduct health education and more community-based research on disease transmission routes.

Keywords

hepatitis B virus pregnant women antenatal care Borena Zone Ethiopia

Introduction

Hepatitis B virus (HBV) is a virus that can cause acute or chronic infection. HBV infections in pregnancy are the most common cause of morbidity and mortality for both mother and fetus.^1,2 Presence of HBV infection in early life increases the risk of chronic liver disease, the development of cirrhosis, splenomegaly, and hepatocellular carcinoma.³ Also, it may cause maternal complications and infant death by impaired mental and physical health.^2,4The common transmission way of HBV is generally through vertical or perinatal and horizontal transmission. Vertical transmission is the transfer of the virus from mother to infants and horizontal transmission is generally by mucosal exposure to HBV-contaminated blood and other body fluids such as saliva, vagina, and seminal fluids through unprotected sex, medical and surgical procedures, tattooing, scarification, and sharing of sharps.⁵

Hepatitis B virus is a major global health problem, with 30.4 million people worldwide infected with HBV and nearly 296 million people with chronic hepatitis. Worldwide, approximately 820,000 people die from HBV-related deaths, and 1.5 million people are newly infected with HBV.⁶ Globally, the prevalence of HBV infection in the general population was 3.8%, and the geographical distribution of HBV was highest in the WHO Regions of Africa and the Western Pacific, with prevalences of 7.5% and 5.9%, respectively.⁶ About 65 million women between the ages of 15 and 49 years have been infected with HBV, and 9 of 10 mothers with hepatitis B have the disease in their babies at birth.^7,8

According to the WHO Global Progress Report on human immunodeficiency virus (HIV), Viral Hepatitis and Sexually Transmitted Diseases, the prevalence of hepatitis B in the general population in 2021 will be highest in the WHO Africa Region, with the estimated prevalence of 7.5% (5.7-10. Estimated prevalence is 5.9% (4.9%-7.3%).⁶ In Ethiopia, the prevalence of HBV in children under 5 years of age is 5.7% ⁹ and the prevalence of HBV infection among pregnant women is 5.7%.⁹ The pooled prevalence is 4.75%.¹⁰

In response to the sustainable development goals, WHO developed the first Global Health Sector Strategy on viral hepatitis, due for 2016 to 2021.⁸ Also, HBV screening in all pregnant women, universal Hepatitis B (HB) birth dose within the first day after delivery, and hepatitis vaccination are considered effective methods to reduce mother-to-child transmission by 90%.¹¹ However, most developing countries have not yet adopted HBV vaccine, the birth dose administered to all newborns.^12,13 In Africa, only 11 countries include HBV birth dose as part of their routine Expansion of Program Immunizations (EPIs), and none of the East African countries do so.¹⁴ Despite WHO recommendations, health facilities in Ethiopia lack routine prenatal screening for HBV, vaccination with HBV birth doses, and universal hepatitis B vaccination.¹⁵ Moreover, some privately owned private health facilities offer HBV vaccines at price too high for the majority of the population.^15,16

In previous studies conducted in Ethiopia, the seroprevalence of HBV was 5.5% in Tigray,¹⁷ 6.5% in Oromia,¹⁸ 9.2% in Southern Nation Nationalities and People’s Region (SNNPR),¹⁹ and 3.7% to 9.2% in Addis Ababa.²⁰ The HBV seroprevalence in pregnant women was associated with a history of blood transfusions, surgical history, tooth extraction, hospitalization, abortion, genital mutilation, family history of HBV infection, tattoos, noise, and ear piercings. It has also been reported that multiple sexual partner was associated with HIV positive.^17–20 Another study conducted in Oromia showed no factors significantly associated with HBV seropositivity.²¹

In addition, information from various studies showed that the degree of HBV infection and predictors of HBV infection varied by region. The extent and burden of the pregnant women's HBV infection are unknown, and there is no locally generated information on risk factors associated with pregnant women in the study area. Therefore, this study aims to assess the seroprevalence of HBV infection and associated factors among pregnant women attending antenatal care (ANC) at selected public hospitals in the Borena zone, southern Ethiopia.

Methods

Study Area, Design, and Period

The study was conducted on pregnant women who received ANC at a selected hospital in the Borena zone, Oromia region, southern Ethiopia. Borena zone has 13 districts and 1 municipality, bordered by the region of Somali to the east, West Guji to the north, Guji to the northeast, Kenya to the south, and the SNNPR to the west. It is one of the hotspot areas in the Oromia region. According to the Central Bureau of Statistics in 2019, the population of the zone is estimated to about 503,877. About 89% of the population lives in the zone's 134 rural pastoralist kebeles. The zone altitude is <1500 m above sea level. The average annual temperature is 27°C to 29°C.^22,23 In terms of medical facilities, Borena zone has 4 primary hospitals, 1 general public hospital, and 44 health centers.²⁴ A facility-based cross-sectional study design was conducted at Yabelo General Hospital and Moyale Primary Hospital from June 1 to September 30, 2022.

Study Population and Selection Criteria

All randomly selected pregnant women who visited the ANC during the data collection period and who had their first ANC follow up at selected public hospitals during the study period were included in the study, while the pregnant women who are critically sick and unable to answer were excluded from the study.

Sample Size Determination

The sample size for this study was determined using the single-population ratio formula. When the HBV proportion (9.2%) is taken from a previous study conducted in the Gedeo zone,¹⁹ there is an error rate of 3%, a confidence interval (CI) of 95%, and a nonresponse rate of 5% was assumed.

n = Z^{2} α / 2 \frac{p (1 - p)}{d^{2}}

where n denotes the sample size, Z the value corresponding to 95% level of significance = 1.96, p the proportion of prevalence of HBV in pregnant women = 9.2%, d the marginal error assumed to be 3%, q = (1−p) = (1−0.092) = 0.908, and n = (1.96)² (0.092) (0.908)/ (0.03)² = 356.57 = 357.

Adding a 5% nonresponse rate, which is 18, the final sample size was 375.

Sampling Techniques

From 5 public hospitals, 2 hospitals in Borena zone were selected using the lottery method. According to the previous data obtained from the past 3 months ANC follow up from registration, an estimated 543 and 836 pregnant women visit Yaballo and Moyale hospitals respectively. The total number of ANC attendants in 2 hospitals counted from ANC registration was 1379. The total sample size of pregnant mothers at each facility is then proportional to the population size based on previously enrolled ANC followers. Eligible pregnant women participating in ANC at the time of data collection were carefully selected using a systematic randomization procedure. To set the interval (k), divide the estimated total number of ANC attendants to the assigned study sample size. H·K = N/n, where N = sum of ANC attendants, n = desired sample size, K = sampling interval, K = 1379/ 375 = 3.7 ≈ 4, so every fourth suitable pregnant woman is included and interviewed until the required sample size is reached (Figure 1).

Figure 1.

Schematic representation of the sampling procedure for prevalence and associated risk factors among pregnant women attending ANC of public hospitals in the Borena zone. Abbreviation: ANC, antenatal care.

Data Collection Method

Three midwives and 3 senior laboratory staff were recruited from the ANC office and laboratory. Data were collected using a structured questionnaire. The questionnaire was originally written in English and then translated into Afaan Oromo. The language version of Afaan Oromoo was reformulated into English to check for any contradictions or distortions in the meaning of words and concepts. The data collector introduced herself, explained the purpose of the study, and emphasized the benefits of having tested for HBV during pregnancy. The questionnaire was used to collect sociodemographic characteristics, previous healthcare-related risk behaviors, and practice-related information at ANC wards and 5 mL of venous blood samples were collected in laboratory for HBV screening.

Blood Collection

Five milliliters of venous blood were drawn from each study participant by an experienced laboratory technician. Regular standard operating procedures for sample collection were strictly followed. Serum was separated by centrifugation at 3000 rpm for 15 min.^25,26 Each serum was subjected to a rapid hepatitis B surface antigen (HBsAg) test. The remaining serum samples were stored frozen until shipment from each medical facility. Positive results were confirmed by enzyme-linked immunosorbent assay (ELISA) testing by transportation to the Awassa Regional Blood Bank using refrigerated boxes. Data were collected by structured questionnaire through participants’ personal questions after verbal and written consent.

Data Quality Control

Data collectors and laboratory technicians responsible for sample processing were trained. The questionnaire was pre-tested on 5% of pregnant women sampled at Arero Hospital before the actual study and necessary changes were made to the study tool. Data collectors were supervised by the principal investigator, and data validity and completeness were checked by the principal investigator. Specimen collection, labeling, processing, storage, and testing were performed according to the laboratory standard operating procedures (SOPs) and manufacturer's recommendations. HBsAg Rapid Test performance has its own internal quality control and is evaluated using known positive and negative controls derived from ELISA test samples. Additionally, all positive and 10% negative samples were retested by ELISA.

Data Processing and Analysis

All completed checklists were checked for completeness and consistency and data were entered using Epidata version 3.1 software. Data were then exported to SPSS version 25 and Stata version 14 for further analysis. For univariate analysis, descriptive statistics were performed to examine the frequency distribution, central tendency, variability, and overall distribution of the independent variables. A bivariate logistic regression analysis was performed to select candidate variables for multivariate analysis. Variables with P values <.25 in the bivariate analysis were included in the multivariate logistic regression model. Multivariate logistic regression was performed to control possible confounding and identify the true effects of the selected predictors. Multicollinearity between independent variables was checked using variance expansion coefficients. Model fit was performed using Hosmer and Lemeshow statistics, Pearson's chi-square (χ² = 9.31, P = .90), and was found to be nonsignificant, demonstrating model fit. The strength of the association between outcomes and determinants was assessed using adjusted odds ratios (AOR) with 95% CIs, and the significance of the association was reported at P values <.05.

Ethical Approval and Consent Participate

The ethical approval of this study was reviewed and approved by the Bule Hora University Ethical Review Board with reference number 09/2014. Official letters were written to Moyale and Yaballo hospitals, and the Borena zone Health Department wrote the letters of support to selected hospitals. Informed, voluntary, written, and signed consent was obtained from study participants and selected medical facilities. Participation in the study was voluntary and participants were informed that they had the right to withdraw/refuse to participate at any time during the study if they did not wish to participate. To ensure the confidentiality of participant information, a code was used and no participant identifiers were written on questionnaires and test tubes. Participants were interviewed alone to protect their privacy. Testing is free. Blood samples were used for study purposes only. Test results were sent to healthcare providers working in the ANC wards at the hospital for further diagnosis and treatment.

Results

Sociodemographic Characteristics of Study Participants

A total of 368 pregnant women were enrolled, with a response rate of 98.1%. The mean age of the participant was 24.74 with a standard deviation of ±4.71 years. About 129 (35.1%) of pregnant women were in the age range of 21 to 25 years. About 326 (88.6%) of women were housewives and only 5.2% were divorced and widowed. Concerning the place of residence, around 210 (57.1%) were urban residents. In terms of educational status, 159 (43.2%) of women were unable to read and write and only 20 (5.4%) attained above grade 12 and 275 (74.7%) of them were multigravida (Table 1).

Table 1.

Sociodemographic Characteristics of Pregnant Women Who Attended ANC at Selected Hospitals of Borena Zone, Southern Ethiopia, 2022.

Variables	Categories	Frequency (n)
Variables	Categories	Frequency (n)	Percentage
Age (years)	< 21	92	25
	21-25	129	35.1
	26-30	105	28.5
	>30	42	11.4
Marital status	Single	23	6.2
	Married	326	88.6
	Divorce and widowed	19	5.2
Residence	Urban	210	57.1
Residence	Rural	158	42.9
Educational level	Unable to read and write	159	43.2
	Able to read and write	95	25.8
	Primary	71	19.3
	Secondary	23	6.3
	Above grade 12	20	5.4
Religion	Muslim	164	44.6
	Orthodox	68	18.5
	Protestant	116	31.5
	Others	20	5.4
Ethnicity	Oromo	231	62.8
	Gurage	48	13
	Burji	35	9.5
	Somali	31	8.4
	Amhara and others	23	6.3
Occupation	Employee	22	6
	Housewife	235	63.9
	Merchant	63	17
	Daily labors	30	8.2
	Others	18	4.9
Income	<1000	75	20.4
	1000-2000	226	61.4
	>2000	67	18.2
Gravidity	Primgravida	93	25.3
Gravidity	Multigravida	275	74.7

Abbreviation: ANC, antenatal care.

Health-Related and Risky Behavior of Study Participants

Among the 368 women in the study, only 7 (1.9%) had a history of working in a health institution. Around 210 (57.1%) had an ear-piercing history, while only 48 (13%) women had a history of nose piercing. The majority, 212 (57.6%) of mothers, had a history of female genital mutilation. Of the total participants, 70 (19%) had a history of multiple sexual partners and 49 (13.3%) had a history of alcohol drinking (Table 2).

Table 2.

Health-Related and Risky Behavior Among Pregnant Women Who Attended ANC at Selected Hospitals of Borena Zone, Southern Ethiopia, 2022.

Variables	Categories	Frequency (n)	Percentage
History of blood transfusion	Yes	38	10.3
History of blood transfusion	No	330	89.7
History of surgical procedure	Yes	23	6.3
History of surgical procedure	No	345	93.7
History of working in a health institution	Yes	7	1.9
History of working in a health institution	No	361	98.1
Tooth extraction	Yes	37	10.1
Tooth extraction	No	331	89.9
Hospital admission	Yes	60	16.3
Hospital admission	No	308	83.7
Traditional tonsillectomy	Yes	52	14.1
Traditional tonsillectomy	No	316	85.9
History of sexually transmitted infection	Yes	41	11.1
History of sexually transmitted infection	No	327	88.9
HIV/AIDS status	Yes	14	3.8
HIV/AIDS status	No	354	96.2
Abortion	Yes	32	8.7
Abortion	No	336	91.3
Circumcision	Yes	212	57.6
Circumcision	No	156	42.4
Family history of hepatitis B virus infection	Yes	23	6.3
Family history of hepatitis B virus infection	No	345	93.7
Body tattooing	Yes	20	5.4
Body tattooing	No	348	94.6
Nose piercing	Yes	48	13
Nose piercing	No	320	87
Ear piercing	Yes	210	57.1
Ear piercing	No	158	42.9
Share sharps	Yes	31	8.4
Share sharps	No	337	91.6
Multiple sexual partners	Yes	70	19
Multiple sexual partners	No	298	81
Alcohol drinking	Yes	49	13.3
Alcohol drinking	No	319	86.7

Abbreviations: AIDS, acquired immunodeficiency syndrome; ANC, antenatal care; HIV, human immunodeficiency virus.

Prevalence of HBV Among Pregnant Women Who Attended ANC Services

The overall prevalence of HBsAg was 21 (5.7%) with (95% CI, 3.74-8.61) in the prevalence among study participants at Yaballo and Moyale hospitals was 8 (5.4%) and 13 (5.9%), respectively (Figure 2). All 21 (5.7%) serum samples positive for HBsAg were confirmed positive by ELISA. The highest seroprevalence of HBsAg 7 of 104 (6.7%) was observed in the age group of 26 to 30 years and the lowest 4 of 92 (4.3%) in <21 years categories. The prevalence of HBsAg was highest in rural residents, 12 of 158 (7.6%), whereas 9 of 210 (4.3%) in urban residents. Concerning educational status, the prevalence of HBV was highest at 2 to 20 (10%) among those who attended above grade 12 and lowest at 2 of 95 (2.1%) among those able to read and write. About 1 to 93 (1.1%) and 20 to 275 (7.3%) were positive for primigravida and multigravida, respectively. The details are presented in Table 3.

Figure 2.

Prevalence of HBV among pregnant women attending ANC at selected hospitals in Borena zone, southern Ethiopia, 2022. Abbreviations: ANC, antenatal care; HBV, hepatitis B virus.

Table 3.

Prevalence of HBV With Sociodemographic Characteristics Among Pregnant Women Who Attended ANC at Selected Hospitals of Borena Zone, Southern Ethiopia, 2022.

Variables	Categories	Frequency (n)	Percentage
Age (years)	< 21	4	4.3
	21-25	8	6.3
	26-30	7	6.7
	>30	2	4.8
Marital status	Single	1	4.3
	Married	18	5.5
	Divorce and widowed	2	10.5
Residence	Urban	9	4.3
Residence	Rural	12	7.6
Educational level	Unable to read and write	13	8.2
	Able to read and write	2	2.1
	Primary	3	4.2
	Secondary	1	4.3
	Above grade 12	2	10
Religion	Muslim	9	5.5
	Orthodox	2	2.9
	Protestant	10	8.6
	Others	0	0
Ethnicity	Oromo	12	5.2
	Gurage	3	6.3
	Burji	3	8.6
	Somali	2	6.5
	Amhara and others	1	4.3
Occupation	Employee	1	4.5
	Housewife	10	4.3
	Merchant	5	7.9
	Daily labors	3	10
	Others	2	11.1
Income	<1000	5	6.7
	1000-2000	12	5.3
	>2000	4	6
Gravidity	Primgravida	1	1.1
Gravidity	Multigravida	20	7.3

Abbreviations: ANC, antenatal care; HBV, hepatitis B virus.

Factors Associated With the Prevalence of HBV

A logistic regression analysis showed that pregnant mothers who had been hospitalized were approximately 3 times more likely to have HBV infection than women who had not been hospitalized (AOR = 3.44, 95% CI, 1.07-11.09). Traditional tonsillectomy was 4 times more likely to be HBsAg seropositive compared to its counterpart (AOR = 4.16, 95% CI, 1.29−13.40). Pregnant women with a history of sexually transmitted infections were 6 times more likely to be infected with HBV than those without a history of sexually transmitted infections (AOR = 5.99, 95% CI, 1.81-19.85).

HIV infection was highly significantly associated with HBV infection, where HIV-infected pregnant women were around 8 times more likely infected by HBV than HIV-non-infected pregnant women (AOR = 8.28, 95% CI, 1.66-41.41). Pregnant women who had a history of alcohol drinking were about 5 times at higher risk when compared with those who had no history of alcohol drinking (AOR = 5.08, 95% CI, 1.49-17.31) (Table 4).

Table 4.

Bivariable and Multivariable Analysis of Associated Factors With HBV Infection Among Pregnant Women Who Attended ANC at Selected Public Hospitals of Borena Zone, Southern Ethiopia, 2022.

Variable	Category	HBV status		COR (95% CI)	P value	AOR (95% CI)	P value
Variable	Category	Positive (%)	Negative (%)	COR (95% CI)	P value	AOR (95% CI)	P value
Residence	Urban	9 (4.3)	201 (95.7)	0.55 (0.22-1.33)	0.18	0.66 (0.16-2.73)	0.57
Residence	Rural	12 (7.6)	146 (92.4)	1		1
Educational level	unable to read and write	13 ((8.2)	146 (91.8)	0.80 (0.17-3.48)	0.78	0.61 (0.08-4.74)	0.63
	Able to read and write	2 (2.1)	93 (97.9)	0.19 (0.03-1.47)	0.11	0.14 (0.01-1.67)	0.12
	Primary	3 (4.2)	68 (95.8)	0.40 (0.06-2.56)	0.33	0.18 (0.01-2.68)	0.21
	Secondary	1 (4.3)	22 (95.7)	0.41 (0.03-4.89)	0.48	0.10 (0.01-2.23)	0.15
	>Grade 12	2 (10)	18 (90)	1		1
Gravidity	Primgravida	1 (1.1)	92 (98.9)	0.14 (0.02-1.05)	0.06	0.18 (0.02-1.52)	0.12
Gravidity	Multigravida	20 (7.3)	255 (92.7)	1		1
Blood transfusion	Yes	7 (18.4)	31 (81.6)	5.10 (1.91-13.57)	0.00	2.14 (0.50-9.24)	0.31
Blood transfusion	No	14 (4.2)	316 (95.8)	1		1
Previous surgery	Yes	5 (21.7)	18 (78.3)	5.71 (1.88-17.34)	0.00	0.69 (0.08-6.15)	0.74
Previous surgery	No	16 (4.6)	329 (95.4)	1		1
Tooth extraction	Yes	7 (18.9)	30 (81.1)	5.28 (1.98-14.10)	0.00	2.59 (0.61-11.06)	0.20
Tooth extraction	No	14 (4.2)	317 (95.8)	1		1
Hospital admission	Yes	10 (16.7)	50 (83.3)	5.40 (2.18-13.38)	0.00	3.44 (1.07-11.09)	0.04**
Hospital admission	No	11 (3.6)	297 (96.4)	1		1
Traditional tonsillectomy	Yes	10 (19.2)	42 (80.8)	6.60 (2.64-16.49)	0.00	4.16 (1.29-13.40)	0.02**
Traditional tonsillectomy	No	11 (3.5)	305 (96.5)	1		1
Sexually transmitted infection	Yes	11 (26.8)	30 (73.2)	11.62 (4.57-29.60)	0.00	5.99 (1.81-19.85)	0.00***
Sexually transmitted infection	No	10 (3.1)	317 (96.9)	1		1
HIV/AIDS status	Yes	6 (42.9)	8 (57.1)	16.95 (5.22-55.06)	0.00	8.28 (1.66-41.41)	0.01**
HIV/AIDS status	No	15 (4.2)	339 (95.8)	1		1
Family history of HBV	Yes	5 (21.7)	18 (78.3)	5.71 (1.88-17.34)	0.00	2.83 (0.50-16.11)	0.24
Family history of HBV	No	16 (4.6)	329 (95.4)	1		1
Body tattooing	Yes	4 (20)	16 (80)	4.87 (1.47-16.15)	0.01	1.52 (0.15-15.83)	0.73
	No	17 (4.9)	331 (95.1)	1		1
Nose piercing	Yes	5 (10.4)	43 (89.6)	2.21 (0.77-6.34)	0.14	0.52 (0.08-3.20)	0.48
Nose piercing	No	16 (5)	304 (95)	1		1
Share sharps	yes	5 (16.1)	26 (83.9)	3.86 (1.31-11.37)	0.01	2.79 (0.63-12.35)	0.18
Share sharps	No	16 (4.7)	321 (95.3)	1		1
Multiple sexual partners	Yes	11 (15.7)	59 (84.3)	5.37 (2.18-13.22)	0.00	0.86 (0.21-3.56)	0.84
Multiple sexual partners	No	10 (3.4)	288 (96.6)	1		1
Alcohol drinking	Yes	9 (18.4)	40 (81.6)	5.76 (2.28-14.52)	0.00	5.08 (1.49-17.31)	0.01***
Alcohol drinking	No	12 (3.8)	307 (96.2)	1		1

Note: Statistically significant at ***P < .01, **P < .05, Reference = 1.

Abbreviations: AIDS, acquired immunodeficiency syndrome; ANC, antenatal care; AOR, adjusted odds ratio; CI, confidence interval; COR, Crude odd ratio; HBV, hepatitis B virus; HIV, human immunodeficiency virus.

Discussion

In this study, the overall prevalence of HBV infection among pregnant women attending ANC services in the study area was 5.7% with (95% CI, 3.74-8.61). The prevalence of HBV infection was nearly similar to results reported in Shone, Nekemte, Bishoftu, and Felegehiwot referral hospitals 4.9%,²⁷ 5.8%,²⁸ 6.5%,¹⁸ and 4.7% ²⁹, respectively.

The result of this study was relatively high when compared to the result reported from Addis Ababa at 3.7%,²⁰ 7.8% Southern Ethiopia,³⁰ Gandhi memorial hospital at 2.3%,³¹ Agena health center in the Gurage zone at 4.1%,³² Uganda at 2.1% ³³, and Rwanda 3.1%.³⁴ The variation might be due to the differences in cultural practices and strategies used for infection prevention and risky behavior practices. In comparison with other studies done outside African region, the result of the study was higher than the result reported by Pakistan at 2.78%,³⁵ Turkey at 2.1%,³⁶ and India at 1.6%.³⁷ This variation might be due to regular screening and vaccination provided in those countries.

However, the result of this study was lower than the result reported from Gedeo zone at 9.2%,¹⁹ Jigjiga town at 8.5%,³⁸ Gambella at 7.9%,³⁹ Yirgalem hospital at 7.2%,⁴⁰ Ghana at 7.7%,⁴¹ South Darfur state, Sudan at 8.5%⁴², and Gambia at 9.2%.⁴³ The variation might be due to the differences in geographical regions, sociodemographic variations, differences in cultural practices, and risky behavior toward the risk of HBV infection.

The odds of HBV infection were about 3 times higher among pregnant mothers who had a history of hospital admission when compared to those who had no history of hospital admission. This result is in line with the study reported from Ambo town,⁴⁴ Desie,⁴⁵ Gedeo zone,¹⁹ Agena health center, Gurage zone,³² West Hararghe public hospitals,⁴⁶ and Egyptian.⁴⁷ This might be due to that the hospitalized women might easily acquire the infection during a different procedure than the pregnant women who had no history of hospital admission.

In this study, pregnant women with traditional tonsillectomy have 4 fold chance to have HBsAg seropositivity compared with their counterparts. The finding of this report is similar to the study conducted in Felegehiwot referral hospital ²⁹and West Hararghe Public Hospital.⁴⁶ This study revealed the traditional surgery of tonsillectomy was done in an area where appropriate sterilization was not followed. Therefore, the virus easily transferred from a career to a healthy woman.

Regarding the history of sexually transmitted infection, women who had a history of sexually transmitted infection were 6 times more likely to have an infection with HBV than those who had no history of sexually transmitted infection. This finding was similar to the study conducted in Jinka Hospital⁴⁸ and Harar city.⁴⁹ A possible explanation for this occurrence is that HBV and other Sexual Transmit Infection (STI) co-infections can occur since STI and HBV share the same modes of transmission.

The finding of this study revealed that HIV co-infection was highly significantly associated with HBV infection, with HIV-infected women being around 8 times more likely infected by HBV than HIV-non-infected women. The result of this report agreed with the study done in the Gedeo zone,¹⁹ Amhara national regional state hospitals,⁵⁰ Dire Dawa,⁵¹ Yirgalem Hospital,⁴⁰ and Harar city.⁴⁹ The major justification might be explained by their nature of sharing similar modes of transmission.

Pregnant women who had a history of alcohol drinking were about 5 times at higher risk when compared with those who had no history of alcohol drinking. The finding of this report was consistent with the result of a study conducted in Ambo town,⁴⁴ Nigeria,²⁵ and Kenya.⁵² The possible explanation for this occurrence might be alcohol intake is associated with risky sexual behavior and chronic alcohol intake has adverse effects on the liver.

Strength and Limitations

The strength of the study was data were collected from clients and it was primary data which increase the completeness and consistency of data. The limitation of this study was due to time and budget constraints, limited to assessing the only prevalence and associated factors. In addition, markers of HBV like hepatitis B envelope antigen (HBeAg), hepatitis B core antigen (HBcAg), anti-Hepatitis B surface (HBs), anti-Hepatitis B envelope (HBe), anti-Hepatitis B core (HBc) nor viral load were detected, due to resource constraints and a wide CI in associated factors due course of a small sample of HBV positive cases.

Conclusion

The prevalence of HBV infection among pregnant women in the study area was intermediate endemic according to WHO classification criteria. Factors such as hospitalization history, previous traditional tonsillectomy, history of sexually transmitted infections, HIV infection status, and alcohol consumption were associated with HBV infection among pregnant women. Healthcare providers have to make effort to implement the infection prevention strategy during admission at the health facility to prevent HBV infection trasmission. The health extension workers should creat awareness on the risk of contact with sexually transmitted infection person, traditional tonsillectomy, and alcohol consumption. The government should provide routine HBV screening for people living with HIV.

Footnotes

Abbreviations and Acronyms

Acknowledgements

First, we would like to acknowledge Bule Hora University for giving us this chance to prepare a research report. Further, we extend our sincere gratitude to the Medical Laboratory Science staff for their timely support and positive approach. We also like to express our thanks to our study participants, Yaballo and Moyale hospital, and Borena Zone Health Office for their cooperation.

Availability of Data and Materials

Data essential to the conclusion are included in this manuscript. Additional data are available upon reasonable request from the corresponding author.

Authors’ Contributions

AK performed conceptualization, developed proposals, resources, project management, research and monitoring, data analysis, and interpretation. MKA, DT, and DD were involved in supervision, performed document preparation and interpretation, and writing. AA, WD, and AE was involved in manuscript preparation. All authors read and approved the final manuscript.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article

Funding

The author(s) received no financial support for the research, authorship, and/or publication of this article.

ORCID iD

Alqeer Aliyo

Author Biographies

Abdo Kampe is a lecturer at the department of medical laboratory science, institute of Health, Bule hora University, Ethiopia.

Dr. Moorthy Kannaiyan Abbai is a professor of medical microbiology at the department of medical laboratory science, institute of Health, Bule hora University, Ethiopia.

Dagnamyelew Tilahun is a lecturer at the department of medical laboratory science, institute of Health, Bule hora University, Ethiopia

Deresse Daka is an associate professor in medical microbiology and immunology at Hawassa University, Ethiopia. Currently, he is a Ph.D. candidate at the University of Gonder and an adjunct staff of Bule hora University.

Alqeer Aliyo is a lecturer and currently serving as a clinical coordinator at the Institute of Health, Bule hora University, Ethiopia.

Wako Dedecha is a lecturer and currently serving as head of the medical laboratory science department at an institute of Health, Bule hora University, Ethiopia.

Alo Edin is a lecturer at the school of public health and currently serving as a post-graduate coordinator at the institute of Health, Bule hora University, Ethiopia.

References

Mauss

Rockstroh

Wedemeyer

Hepatology a Clinical Textbook. 7th ed. Druckerei Heinrich GmbH, 2016.

Singhal

Naswa

Marfatia

. Pregnancy and sexually transmitted viral infections. Indian Sex Transm Dis AIDS. 2009;30(2):71.

Aliyo

Ashenafi

Adem

Evaluation of transfusion transmissible infections prevalence and trend among blood donors attended at Bule Hora Blood Bank, West Guji, South Ethiopia. Health Serv Res Manag Epidemiol. 2022; 2022:1–7. DOI:10.1177/23333928221136717

Chernet

Yesuf

, 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. 2017;10(1):418. https://doi.org/10.1186/s13104-017-2702-x.

Hutin

Bulterys

, Hirnschall GO. How far are we from viral hepatitis elimination service coverage targets? J Int AIDS Soc. 2018;21 (Suppl 2):e25050. https://doi.org/10.1002/jia2.25050

WHO. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021 Accountability for the global health sector strategies 2016–2021: actions for impact. 2021

WHO. Global Hepatitis Report .World Health Organization. World Health Organizazation. 2017b.

WHO. Global health sector strategy on viral hepatitis 2016–2021: towards ending viral hepatitis.: World Health Organization. Available at: http://www.who.int/hepatitis/2017a.

Sonderup

Spearman

. Global disparities in hepatitis B elimination—a focus on Africa. Viruses. 2022;14:82.

10.

Alemu

Zeleke

, Aynalem BY, Kassa GM. Hepatitis B virus infection and its determinants among pregnant women in Ethiopia: a systematic review and meta-analysis. Infect Dis Obstet Gynecol. 2020;2020:9418475 https://doi.org/10.1155/2020/9418475.

11.

CDC. Working Together to Eliminate the Threat of Hepatitis Available at: www.cdc.gov/getce. 2018.

12.

UNDP. Sustainable development goals booklet. http://www.undp.org/content/undp. 2015.

13.

Bodo

Malande

OO.

Delayed introduction of the birth dose of hepatitis B vaccine in EPI programs in east Africa: a missed opportunity for combating vertical transmission of hepatitis B. Pan Afr Med J. 2017;27(Suppl 3):19.

14.

UNICEF WHO. WHO/UNICEF coverage estimates 2014 revision. 2015. Available at: http://apps.who.int/immunization_monitoring/globalsummary/timeseries/tswucoveragebcg.html. 2015.

15.

Shiferaw

Letebo

, Bane A. Chronic viral hepatitis: policy, regulation, and strategies for its control and elimination in Ethiopia. BMC Public Health. 2016;16(1):769. https://doi.org/10.1186/s12889-016-3459-1.

16.

Biset Ayalew

Adugna Horsa

Hepatitis B vaccination status among health care workers in a tertiary hospital in Ethiopia. Hepat Res Treat. 2017;2017:6470658.

17.

Araya Mezgebo

Niguse

, Gebrekidan Kahsay A, Hepatitis B virus infection and associated risk factors among pregnant women attending antenatal care in health facilities of Tigray, northern Ethiopia. J Med Virol. 2018;90(3):503–509 https://doi.org/10.1002/jmv.24987.

18.

Kenea

Lemessa

. Assessment of hepatitis B virus infection and associated factors among pregnant women attending antenatal care service in Bishoftu Town, south east, Ethiopia. Am J Health Res. 2020;8(2):11–17.

19.

Tadiwos

Kanno

, Areba AS, et al. Sero-prevalence of hepatitis B virus infection and associated factors among pregnant women attending antenatal care services in Gedeo Zone, Southern Ethiopia. J Prim Care Community Health. 2021;12:2150132721993628. https://doi.org/10.1177/2150132721993628

20.

Ayele

. Seroprevalence and associated factor of HBV infection among pregnant woman attending ANC at Hidase Health Center Addis Ababa, Ethiopia 2021. Health Sci J. 2021;15(7):6–14.

21.

Tumsa

Degefu

, Belay Z. Assessment of hepatitis B virus and associated risk factors among pregnant women attending antenatal care at Arsi University Asella Referral and Teaching Hospital, Ethiopia. Ethiop J Sci Sustain Dev. 2018;5(1):81–101. https://doi.org/10.20372/ejssdastu:v5.i1.2018.68

22.

Fenetahun

Fentahun

. Socio-economic profile of arid and semi-arid agropastoral region of Borana Rangeland Southern, Ethiopia. MOJ Eco Environ Sci Rep. 2020;5(3):113–122.

23.

Aliyo

Geleto

Trends of intestinal parasites among the patients attended at Yabelo General Hospital, Borena Zone. SAGE Open Med. 2022;10:1–8, The Author(s) 2022.

24.

Aliyo

Golicha

Fikrie

. Pastoral community malaria prevention practice and associated factors among households in three districts of the Borena Zone, southern Ethiopia. Health Serv Res Manag Epidemiol. 2022;9:1–9.

25.

Wondfo. One step HBsAg serum/plasm test. In: Guangzhou Wondfo Biothech CL. www.wondfo.com.cn; 2008.

26.

WANTAI. AiDTM HBsAg ELISA. In: Beijing Wantai Biological Pharmacy Enterprise Co. L (ed) Wantai hepatitis B virus diagnostic. 7th ed. 2018.

27.

Firde

Mosa

, Ahmed R, Demelash M, Endale F. Sero-prevalence and risk factors associated with hepatitis B virus infections among pregnant women at Shone Hospital, southern Ethiopia: a cross-sectional study. J Midwifery Reproduct Health. 2022;10(1):1–9. https://doi.org/10.22038/jmrh.2021.56706.1688.

28.

Eba

Kejela

, Tamiru A. Seroprevalence of hepatitis B virus and associated factors among pregnant women attending antenatal care services at public health facilities in Nekemte Town. Int J Reprod Med. 2021;9572235. https://doi.org/10.1155/2021/9572235.

29.

Gedefaw

Waltengus

, Akililu A, Gelaye K. Risk factors associated with hepatitis B virus infection among pregnant women attending antenatal clinic at Felegehiwot referral hospital, northwest Ethiopia, 2018: an institution based cross sectional study. BMC Res Notes. 2019;12(1):509. https://doi.org/10.1186/s13104-019-4561-0.

30.

Metaferia

Dessie

, Ali I, Amsalu A. Seroprevalence and associated risk factors of hepatitis B virus among pregnant women in southern Ethiopia: a hospital-based cross-sectional study. Epidemiol Health. 2016:38 :e2016027. https://doi.org/10.4178/epih.e2016027.

31.

Zemenu

Daniel

. Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women in Gandhi Memorial Hospital, Addis Ababa. J Public Health Epidemiol. 2019;11(6):123–129.

32.

Agazhu

Robele

, Ayele IT, Mohammed AA. Prevalence and associated factors of hepatitis B virus infection among pregnant women attending antenatal care at Agena health center, South Ethiopia, 2019: a cross sectional study. 2019.

33.

Mugabiirwe

Kalyetsi

, Ayella R, Obote J, Ssedyabane F. Hepatitis B virus infection and HBeAg positivity among pregnant women in south west Uganda. Afr J Lab Med. 2022;11(1):1784. https://doi.org/10.4102/ajlm.v11i1.1784.

34.

Nyamusi

Imunya

, Muvunyi CM, Habtu M. Factors associated with hepatitis B surface antigen seropositivity among pregnant women in Kigali, Rwanda: a cross sectional study. J Community Public Health Nurs. 2017;3:4.

35.

Jamil

Hamid

, Aziz Q. Prevalence of hepatitis B among pregnant women. J Islamabad Med Dental College. 2018;7(2):128–131.

36.

Cetin

, Turhan E, Dolapcioglu K. Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women. J Infect Dev Countries. 2018;12(10):904–909. https://doi.org/10.3855/jidc.10018.

37.

Giri

Sahoo

, Angadi S, Seroprevalence of hepatitis B virus among pregnant women in India: a systematic review and meta-analysis. J Clin Exp Hepatol. 2022;12(6):1408–1419. DOI:10.1016/j.ceh.2022.08.2005

38.

Roble

Roba

, Mengistie B, Abdurke Kure M. Seroprevalence of hepatitis B virus and associated factors among pregnant women attending antenatal care in public health facilities in Jigjiga Town, eastern Ethiopia. Int J Womens Health. 2020;12:1299. https://doi.org/10.2147/IJWH.S276526.

39.

Tanga

Teshome

, Hiko D, Fikru C, Jilo, GK. Sero-prevalence of hepatitis B virus and associated factors among pregnant women in Gambella Hospital, south western Ethiopia: facility based cross-sectional study. BMC Infect Dis. 2019;19(1):602. https://doi.org/10.1186/s12879-019-4220-z.

40.

Amsalu

Ferede

, Eshetie S, Tadewos A, Assegu D. Prevalence, infectivity, and associated risk factors of hepatitis B virus among pregnant women in Yirgalem Hospital, Ethiopia: implication of screening to control mother-to-child transmission. J Pregnancy. 2018;8435910. https://doi.org/10.1155/2018/8435910.

41.

Dortey

Anaba

, Lassey AT, Damale NKR, Maya ET. Seroprevalence of hepatitis B virus infection and associated factors among pregnant women at Korle-Bu Teaching Hospital, Ghana. PLoS One. 2020;15(4):e0232208. https://doi.org/10.1371/journal.pone.0232208.

42.

Mudardum

Mohammed

. Prevalence and risk factors for hepatitis B infection among pregnant women attending antenatal clinic in UM dafog area, South Darfur state, Sudan. Sudan J Medical Sci. 2019;14(3):116–125.

43.

Bittaye

Idoko

, Ekele BA, Obed SA, Nyan O. Hepatitis B virus sero-prevalence among pregnant women in the Gambia. BMC Infect Dis. 2019;19(1): 259. https://doi.org/10.1186/s12879-019-3883-9.

44.

Wakjira

Darega

, Oljira H, Tura MR. Prevalence of hepatitis B virus and its associated factors among pregnant women attending antenatal care in Ambo town, central Ethiopia: a cross-sectional study. Clin Epidemiol Glob Health. 2022;15:101054.

45.

Gebretsadik

Assefa

, Fenta GM, High seroprevalence of hepatitis B and C virus infections among pregnant women attending antenatal clinic in Borumeda General Hospital, northeast Ethiopia. Biomed Res Int. 2022(1395238). DOI:10.1155/2022/1395238

46.

Mamuye

Gobena

, Oljira L. Hepatitis B virus infection and associated factors among pregnant women attending antenatal clinics in West Hararghe public hospitals, Oromia region, Ethiopia. Pan Afr Med J. 2020;35:128. https://doi.org/10.11604/pamj.2020.35.128.17645.

47.

Mortada

Mohamed

, Hamdi MS. Prevalence of hepatitis B virus infection among Egyptian pregnant women—a single center study. Int J Trop Dis Health. 2013;3(2):157–168.

48.

Marama

Shegaze

, Fikadu K, et al. Burden of hepatitis B surface antigen sero-prevalence and associated factors among pregnant women receiving antenatal care at a public health institution, southern Ethiopia, 2018: implications for public health prevention. Medical Studies/Studia Medyczne. 2018;36(4):290–297.

49.

Tiruye

Shiferaw

, Tadesse F. Seroprevalence of hepatitis B virus infection and associated factors among pregnant women attended antenatal care services in Harar City, eastern Ethiopia. J Womens Health Care. 2018;7(3):3–10.

50.

Dagnew

Million

, Gizachew M, Hepatitis B and C viruses’ infection and associated factors among pregnant women attending antenatal care in hospitals in the Amhara national regional state, Ethiopia. Int J Microbiol. 2020(8848561). DOI:10.1155/2020/8848561

51.

Mekonnen

Admasu

, Belete M. Sero-prevalence of hepatitis B virus and associated factors among pregnant mothers attending antenatal care in Public Health Facilities, Dire Dawa. J Med Microb Diagn. 2018;7(281):2161-07031.000281.

52.

Gatheru

Murila

, Mbuthia J, et al. Factors associated with hepatitis B surface antigen seroprevalence among pregnant women in Kenya. Open J Obstet Gynecol. 2018;8:456–467. https://doi.org/10.4236/ojog.2018.85052.