Abstract
BackgroundLittle current information is available for prevalence of vertically-transmitted infections among the Afghan population. The purpose of this study is to determine prevalence and correlates of human immunodeficiency virus (HIV), syphilis, and hepatitis B and C infection among obstetric patients and model hepatitis B vaccination approaches in Kabul, Afghanistan.MethodsThis cross-sectional study was conducted at three government maternity hospitals in Kabul, Afghanistan from June through September, 2006. Consecutively-enrolled participants completed an interviewer-administered survey and whole blood rapid testing with serum confirmation for antibodies to HIV, T. pallidum, and HCV, and HBsAg. Descriptive data and prevalence of infection were calculated, with logistic regression used to identify correlates of HBV infection. Modeling was performed to determine impact of current and birth dose vaccination strategies on HBV morbidity and mortality.ResultsAmong 4452 women, prevalence of HBsAg was 1.53% (95% CI: 1.18 – 1.94) and anti-HCV was 0.31% (95% CI: 0.17 – 0.53). No cases of HIV or syphilis were detected. In univariate analysis, HBsAg was associated with husband's level of education (OR = 1.13, 95% CI: 1.01 – 1.26). Modeling indicated that introduction of birth dose vaccination would not significantly reduce hepatitis-related morbidity or mortality for the measured HBsAg prevalence.ConclusionIntrapartum whole blood rapid testing for HIV, syphilis, HBV, and HCV was acceptable to patients in Afghanistan. Though HBsAg prevalence is relatively low, periodic assessments should be performed to determine birth dose vaccination recommendations for this setting.
Highlights
Recommendations for birth dose vaccination are determined by antenatal prevalence of hepatitis B e antigen (HBeAg) and to some degree by hepatitis B surface antigen (HBsAg) in settings where HBeAg prevalence is unknown [6]
Prevalence of both HBsAg and hepatitis C virus (HCV) were lower than those detected through the Central Blood Bank for Kabul province or among Afghan populations in refugee camps in Balochistan or in southwest Iran [[8] – see additional file 1; [10,11]]
A study assessing HBsAg seroprevalence among blood donors in Pakistan noted males were more likely to be infected than females; both this study and a study exclusively looking at first-time male blood donors noted that hepatitis B transmission likely occurred through unclean medical or shaving supplies [27,28]
Summary
Testing for human immunodeficiency virus (HIV), syphilis, and hepatitis B surface antigen (HBsAg) in pregnancy and labor is medically indicated to prevent vertical transmission. Prevalence of these infections among the antenatal population may be a reliable indicator of general population prevalence and determinant of vaccination policy [1,2,3]. Successful interventions to prevent vertical transmission linked to intrapartum rapid testing have been demonstrated in a variety of limited resource settings [4,5] One such intervention is birth dose hepatitis B vaccine. Resources do not exist to assess HBeAg prevalence so vaccination policy may be made on HBsAg prevalence alone
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