Abstract
BackgroundTo fully understand the burden of hepatitis C (HCV) infection in Ghana towards informing appropriate preventive measures, accurate prevalence estimates are needed. In this study, we estimate the prevalence of chronic HCV infection by systematically reviewing primary studies published between 1995 and 2015.MethodsA systematic review and meta-analysis was conducted as per the PRISMA guidelines. Comprehensive searches for hepatitis C prevalence studies for the years 1995–2015 were conducted in PubMed, ScienceDirect, Google Scholar, Africa Journals Online (AJOL) and the WHO African Index Medicus databases. We also searched the websites of the ministry of health and Ghana Health service for non-indexed studies or reports on the subject. Further systematic reference screening of published reviews and retrieved studies were also conducted to identify additional publications not captured through the online searches.ResultsTwenty-Four (24) studies from nine regions of Ghana with a combined sample size of 100,782 were analyzed. No study involving participants from Upper West region was retrieved. The national prevalence of chronic HCV was estimated as 3.0 % (95 % CI = 2.6 % to 3.5 %; I2 = 97.61 %, p < 0. 001). Prevalence rates of chronic HCV infection among blood donors was 2.6 % (95 % CI = 2.1 % to 3.1 %; I2 = 98.33 %, p < 0.001) with higher prevalence rate estimated for replacement blood donors (RBDs) than voluntary blood donors (RBDs). Among pregnant women and parturients, anti-HCV seroprevalence was estimated as 4.6 % (95 % CI = 1.8 % to 7.5 %; I2 = 75.74 %, p = 0.016). The national prevalence of HIV/HCV co-infection was also estimated as 2.8 % (95 % CI = 0.4-6 %; I2 = 65.86 %, p = 0.0053). Regional prevalence of chronic HCV infection were determined for Ashanti (1.5 %, 95 % CI = 1.2 % to 1.9 %; I2 = 96.24 %, p < 0.001) and Greater Accra (6.4 %, 95 % CI = 4.2 % to 8.6 %; I2 = I2 = 88.5 %, P < 0. 001) regions but no estimates were available for the other eight regions. The ascending order of HCV prevalence rates according to years in which studies were conducted was 2006–2010 < 2011–2015 < 1995–2002 < 2001–2005. Higher prevalence of chronic HCV infection was estimated for rural (5.7; 95 % CI 5.0–6.3 %; I2 = 0, p = 0.804) than urban (2.6 %, 95 % CI = 2.1 % to 3.0 %; I2 = 97.3 %, p = 0.0001) settings.ConclusionOur study demonstrates a high prevalence of chronic hepatitis C infection in Ghana. This highlights the urgent need for stronger commitments from government and all stakeholders within the country to outline efficient preventive and curative measures towards reducing the overall burden of the disease.
Highlights
To fully understand the burden of hepatitis C (HCV) infection in Ghana towards informing appropriate preventive measures, accurate prevalence estimates are needed
Our study demonstrates a high prevalence of chronic hepatitis C infection in Ghana
The observation of higher prevalence rate in this study may be in alignment with the observation by Layden et al [10] that Hepatitis C virus (HCV) prevalence rates for sub-Saharan Africa have generally been underestimated in the past
Summary
To fully understand the burden of hepatitis C (HCV) infection in Ghana towards informing appropriate preventive measures, accurate prevalence estimates are needed. About 10–20 % of chronic HCV sufferers develop liver cirrhosis within 20–30 years of onset of infection, 1–5 % of these are likely to progress into liver cancer [4, 5]. Over 25 % of the global cases of liver cirrhosis and HCC are attributable to chronic HCV infection, with rates higher in endemic regions [7]. There are variations in the burden of HCV across the globe as depicted by prevalence rates of 1.5 %, 2.3 % and 3.2 % for the World Health Organization (WHO)’s Americas, Europe and Africa regions, respectively [1]. Madhava et al [8] estimated the HCV prevalence in 2002 in Sub-Saharan Africa to be 3.0 % with a prevalence rate of 2.4 % for the West African region where Ghana is located. Recent estimate by Rao et al [9] presents a slightly lower prevalence of 2.65 % for the Sub-Saharan Africa region
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