Abstract
Introduction: Viral hepatitis B (HBV) in pregnancy is a risk for childhood transmission where the majority become chronically infected. In Uganda, HBV is not tested for during antenatal, therefore the number of infected, infectious, immune and none-immune pregnant women is unknown curtailing efforts to prevent mother to child transmission. Methods: We conducted a descriptive cross-sectional study involving 254 pregnant women from four health centers in Mbarara Municipality. HBV status was assessed using an immunochromatographic (COMBO) kit, the type of infection; based on demonstration of anti hepB core IgM (acute infection) and total core IgG antibodies (chronic infection) and infectiousness; based on the presence of HBeAg and/or a quantitative HBV viral load ≥ 20,000 IU/mL. Immunity was determined using the COMBO kit and HBsAb quantification ELISA. One was deemed immune to HBV if HBsAb titers were ≥10 mIU/mL. Results: The prevalence of HBV infection was 1.2%; 33% and 67% with acute and chronic HBV respectively. 33% were infectious based on a high viral load, none had detectable HBeAg. 14% were immune; amongst whom 72% had natural exposure and 18% after vaccination. There was insufficient immunity in 11% with a majority (75%) having acquired immunity following vaccination. Conclusion: The prevalence of HBV is low and most of those are chronically infected. HBeAg and Hepatitis B viral load should be performed when evaluating infectiousness. Further, there is a high transmission of HBV among adults and a low uptake of the HBV vaccine in Mbarara Municipality.
Highlights
Viral hepatitis B (HBV) in pregnancy is a risk for childhood transmission where the majority become chronically infected
Infectiousness of Hepatitis B or risk of transmission depends on replication of the virus which is evidenced by the presence of Hepatitis B envelop antigen (HBeAg) or Hepatitis B viral load ≥20,000 IU/mL [5]
At present observation of the Uganda antenatal integrated register Health management information system (HMIS) form 071 shows that there is no routine testing for Hepatitis B during pregnancy as it is for other infections like HIV and Syphilis, yet routine vaccination against hepatitis was not publically available until 2012 under the Uganda National Extended Program on Immunization (UNEPI) [6]
Summary
Hepatitis B virus causes morbidity and mortality especially among persons that are chronically infected [1]. Data from the Uganda Population-Based HIV Impact Assessment (UPHIA) put the Country’s prevalence of Hepatitis B virus at 4.1% [7]. This surveillance report is silent on the prevalence of Hepatitis B among pregnant women; there is evidence of the infection being higher among pregnant women than in the general population. This study was designed to determine the prevalence of viral Hepatitis B among pregnant women, classify whether the infection was acute or chronic, determine whether the pregnant women were infectious or not and to evaluate immunity among those who were HBV negative. The study was carried out at four (4) public health centers in Mbarara Municipality that were Mbarara Municipal Council Health Centre IV (MMCHCIV), Biharwe Health Centre III (BHCIII), Nyamitanga Health Center III (NHCIII) and Kakoba Health Center (KHCIII)
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