Abstract
BackgroundHepatitis B virus (HBV) affects people worldwide but the local burden especially in pregnant women and their new born babies is unknown. In Rwanda HIV-infected individuals who are also infected with HBV are supposed to be initiated on ART immediately. HBV is easily transmitted from mother to child during delivery. We sought to estimate the prevalence of chronic HBV infection among pregnant women attending ante-natal clinic (ANC) in Rwanda and to determine factors associated with HBV and HIV co-infection.MethodsThis study used a cross-sectional survey, targeting pregnant women in sentinel sites. Pregnant women were tested for hepatitis B surface antigen (HBsAg) and HIV infection. A series of tests were done to ensure high sensitivity. Multivariable logistic regression was used to identify independent predictors of HBV-HIV co-infection among those collected during ANC sentinel surveillance, these included: age, marital status, education level, occupation, residence, pregnancy and syphilis infection.ResultsThe prevalence of HBsAg among 13,121 pregnant women was 3.7% (95% CI: 3.4–4.0%) and was similar among different socio-demographic characteristics that were assessed. The proportion of HIV-infection among HBsAg-positive pregnant women was 4.1% [95% CI: 2.5–6.3%]. The prevalence of HBV-HIV co-infection was higher among women aged 15-24 years compared to those women aged 25–49 years [aOR = 6.9 (95% CI: 1.8–27.0)]. Women residing in urban areas seemed having HBV-HIV co-infection compared with women residing in rural areas [aOR = 4.3 (95% CI: 1.2–16.4)]. Women with more than two pregnancies were potentially having the co-infection compared to those with two or less (aOR = 6.9 (95% CI: 1.7–27.8). Women with RPR-positive test were seemed associated with HBV-HIV co-infection (aOR = 24.9 (95% CI: 5.0–122.9).ConclusionChronic HBV infection is a public health problem among pregnant women in Rwanda. Understanding that HBV-HIV co-infection may be more prominent in younger women from urban residences will help inform and strengthen HBV prevention and treatment programmes among HIV-infected pregnant women, which is crucial to this population.
Highlights
Hepatitis B virus (HBV) affects people worldwide but the local burden especially in pregnant women and their new born babies is unknown
Of the 486 women who tested hepatitis B surface antigen (HBsAg)-positive, 20 women (4.1% [95% Confidence Interval (CI): 2.5–6.3%]) were infected with Human Immunodeficiancy Virus (HIV)
There was no observed HBV-HIV co-infection among pregnant women in ‘salaried’ occupation, but this coinfection was 4.3% [95% confidence intervals (95% CI): 2.6–6.5%] among pregnant women in ‘not salaried’ occupation
Summary
Hepatitis B virus (HBV) affects people worldwide but the local burden especially in pregnant women and their new born babies is unknown. We sought to estimate the prevalence of chronic HBV infection among pregnant women attending ante-natal clinic (ANC) in Rwanda and to determine factors associated with HBV and HIV co-infection. Without immuno-prophylaxis, the risk of HBV infection among infants born to women who are both HBsAg-positive and HBeAg-positive (a marker of high virus titers) is approximately 85–100%, and 90–95% of these infants become chronically infected with HBV [9, 10]. Knowledge of the prevalence of chronic HBV infection among pregnant women is critical to understand the epidemiology of the disease. Studies and systematic reviews have found that the prevalence of HBsAg among pregnant women in a collection of African nations varies from 2.4–16% [11]. A study conducted among Sudanese pregnant women found a prevalence of 5.6%; [12] similar studies estimated a prevalence of 8.2% in Nigeria [13], 6.3% in Tanzania [14], 8.0% in Mali [15]
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