Factors Associated with HBsAg Seropositivity among Pregnant Women Receiving Antenatal Care at 10 Community Health Centers in Freetown, Sierra Leone: A Cross-Sectional Study.

Manal Ghazzawi,Peter B James,Sahr A Yendewa,Samuel P Massaquoi,Robert A Salata,George A Yendewa

doi:10.3390/pathogens11020243

Abstract

Hepatitis B (HBV) is a major public health threat in Sierra Leone. Pregnant women are disproportionately impacted, yet little is known about the epidemiology of HBV in this group. We conducted a cross-sectional study of pregnant women aged ≥16 years receiving antenatal care across 10 community health centers in Freetown from July to September 2021 to assess the prevalence and associated factors of HBsAg seropositivity. Logistic regression was used to identify the predictors of HBsAg seropositivity. In total, 394 pregnant women were screened. The mean age was 24.4 ± 4.9 years, 78.2% were married, and 47.2% were in the second trimester. Only 1% had received the HBV vaccine. The prevalence of HBsAg was 7.9%, while HIV was 5.8% and HIV/HBV co-infection was 0.3%. Regarding high-risk practices, 76.6% reported female genital circumcision, 41.9% ear piercing, 29.0% endorsed multiple sexual partners, and 23.6% reported sexually transmitted infections. In the logistic regression analysis, having a husband/partner with HBV (adjusted odds ratio (aOR): 6.54; 95% CI: [1.72–24.86]; p = 0.006) and residing in Central Freetown (aOR: 4.00; 95% CI: [1.46–11.00]; p = 0.007) were independently associated with HBsAg seropositivity. Our findings support the scaling up of HBV services to target pregnant women and their partners for screening and vaccination to help reduce mother-to-child transmission rates in Sierra Leone.

Highlights

Hepatitis B virus (HBV) poses a major public health threat globally
The low human immunodeficiency virus (HIV)/HBV prevalence among our study participants was reassuring, as current evidence suggests that HIV/HBV co-infection is associated with a high morbidity and mortality, resulting from the early onset of the acquired immune deficiency syndrome (AIDS) [20] and accelerated progression to cirrhosis, end-stage liver disease and hepatocellular carcinoma [21]
Our study provides a comprehensive analysis of the prevalence and associated risk factors of HBV among pregnant women that could help inform the formulation of a comprehensive national policy towards eliminating viral hepatitis as a public health threat by 2030

Summary

Introduction

Hepatitis B virus (HBV) poses a major public health threat globally. Recent reports have indicated that there are an estimated 296 million people chronically infected with HBV (CHB) [1]. In 2015, the World Health Organization (WHO) launched an ambitious global agenda aiming to eliminate HBV and the other hepatitis viruses as a public health threat by the year 2030 [2]. In hyperendemic regions (defined as HBsAg prevalence ≥ 8% in the general population [1,4]), HBV is most frequently acquired through MTCT or through close contact during the early years of life [1,3]. Infection acquired during the early years of life is associated with accelerated progression to cirrhosis, hepatic decompensation and hepatocellular carcinoma, underscoring the critical importance of the prevention of vertical transmission through universal antenatal screening programs [6]

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Discussion

Conclusion