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ORIGINAL ARTICLE
Year : 2016  |  Volume : 10  |  Issue : 2  |  Page : 58-62

Seroprevalence of hepatitis B virus among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria


1 Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria
2 Department of Microbiology, University of Abuja Teaching Hospital, Gwagwalada, Abuja, Nigeria

Date of Web Publication15-May-2017

Correspondence Address:
Benjamin Howe Nongo
Department of Obstetrics and Gynaecology, University of Abuja Teaching Hospital, Abuja
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0331-3131.206213

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   Abstract 

Background: Pregnant women infected with hepatitis B virus(HBV) can transmit the infection to their fetuses and newborns. Despite the above, screening of antenatal attendees is not yet done as a routine in many Nigerian Hospitals that offer antenatal services, inclusive of University of Abuja Teaching Hospital.
Aim: The aim of the study was to determine the seroprevalence of HBV infection among antenatal attendees at the University of Abuja Teaching Hospital.
Materials and Methods: This was a cross-sectional study of 200 consecutive antenatal attendees at the University of Abuja Teaching Hospital. Rapid Test; Quick profile™; by Lumiquick Diagnostics: Santa Clara, California, USA, was used. All materials and specimen(plasma) were brought to room temperature.
Results: The seroprevalence of HBV among antenatal attendee was 7.0%.
Conclusion: The prevalence of HBV among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria, is on the high side. It is hereby recommended that routine screening for hepatitis B surface antigen should be offered to all antenatal clinic attendees.

Keywords: Abuja, hepatitis B, Nigeria, pregnancy, seroprevalence


How to cite this article:
Nongo BH, Agida TE, Oghenebuk U, Yunusa T. Seroprevalence of hepatitis B virus among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria. Ann Nigerian Med 2016;10:58-62

How to cite this URL:
Nongo BH, Agida TE, Oghenebuk U, Yunusa T. Seroprevalence of hepatitis B virus among antenatal attendees at the University of Abuja Teaching Hospital, Nigeria. Ann Nigerian Med [serial online] 2016 [cited 2017 Aug 17];10:58-62. Available from: http://www.anmjournal.com/text.asp?2016/10/2/58/206213




   Introduction Top


A combination of two Greek words “hepatos”(liver) and “itis”(inflammation) gave rise to the current word hepatitis. Hepatitis is usually caused by drugs, toxic agents, or viral infections, but it may also arise as a result of an autoimmune response.[1] The recognition of hepatitis B virus(HBV) infection as a disease of public health importance came into existence when it appeared as an adverse event associated with a vaccination program.[2] HBV infection is a serious disease of humanity and constitutes a global public health problem.[3] HBV can be transmitted by several routes which include vertical transmission, early life horizontal transmission, and adult horizontal transmission.[4]

HBV infection in Nigeria is still a public health issue.[5] It remains a major cause of mortality, especially in underdeveloped countries. In this low-resource setting, vertical transmission of HBV infection is thought to be a major route of transmission. Despite the above, routine antenatal screening for Hepatitis B infection is not practiced in many Nigerian hospitals.[6] HBV infection is still a serious global health issue.[7],[8],[9] In the continents of Africa and Asia, it remains a major cause of morbidity and mortality.[7],[8],[9] Every year, as much as 1 million of the infected population die from the sequelae of the infection such as liver cirrhosis and hepatocellular carcinoma.[10]

Although there is a safe and effective vaccine for HBV infection, Nigeria is yet to move away from being counted among the hyperendemic area for HBV infection. An estimated 12% of the population are documented to be chronic carriers of this virus.[11] New cases of HBV are still being reported annually.[12],[13]

Seroprevalence studies on HBV in Nigeria have shown that the prevalence of the infection in pregnant women ranges from 2% to 15%.[14],[15],[16],[17] In other parts of West African sub region, seroprevalence of 8%–16.2% has been reported.[18],[19],[20]

In Taiwan, a HBV-positive rate of 15.5% was reported.[20] In developed countries such as the United States and Western Europe, less than 2% of the population is chronically infected.[21] A regression analysis in a study done in Birmingham, UK, showed that there was a significant increase in the number of cases of hepatitis B being identified through antenatal screening from 106cases in 2005 to 161cases in 2008. This represents a 52% increase in cases in 2008 compared to 2005 with an average increase of 13.7cases per year.[22] HBV prevalence rate in the general population can be obtained by determining how many women in an antenatal population have the infection.

When HBV infection occurs in the trimester, about 10% of the neonates are affected by vertical transmission, and when it does occurs in the third trimester, a higher percentage of 60–90% of the children may have the infection by vertical transmission.[23]

In most developed countries of the world, screening for HBV infection is a routine. Routine screening of antenatal attendees all over the world is a recommendation of most of the 122 colleges of obstetrics and gynecology.[24] This same approach is recommended by the Royal College of Obstetrics and Gynaecology.[24] This routine screening of all antenatal attendees is not yet the practice in Nigeria. Vaccination of newborns is also not yet widely available in most low-resource settings. Hepatitis B vaccine only became widely available in 2004, even though its approval for inclusion in the National Program on Immunization was given in 1995.[25]

Coverage for hepatitis B immunization is still not adequate in Nigeria; this is despite its availability. Currently, hepatitis B vaccine coverage in Nigeria is about 41%.[26] As a result of the poor screening and low vaccination rate, the vertical transmission of HBV has become a major route of transmission of the virus in Nigeria. This leaves the children born at risk of developing chronic liver disease later in life.

When a fetus comes into contact with the hepatitis B antigen early in embryonic development, it becomes immunologically tolerant to the antigen as a result of the inability to eliminate the virus and a chronic HBV infection state supervenes.[27]

The consequences of an acute hepatitis in pregnancy may include premature labor with the resultant sequelae of prematurity.[24],[27] An increase in the incidence of prematurity over that seen in the general population has being demonstrated in some studies.[24],[27],[28] Other sequelae of HBV infection may include a higher risk of intraventricular hemorrhage and low Apgar scores.

When coagulation failure occurs due to lack of production of Vitamin K-dependent clothing factors, it could lead to intra-and post-partum hemorrhage. This happens more so if the prothrombin time is prolonged, as it may happen in fulminant hepatic failure. The above are possible sequelae that may arise when there is chronic HBV infection.[28]

Antenatal clinic attendees who tested positive to HBV infection screening were counseled. Mothers were referred to the gastroenterology unit for further management.

The children(of mothers who could afford) were given Hepatitis B immunoglobulin before commencement of breastfeeding and they also had four doses of hepatitis B vaccine given at 0, 4, 6, and 14weeks of life as in the National Programme of Immunization Schedule(NPI) in our NPI unit located within the hospital.

Since HBV infection has serious consequences, there is a need to examine its epidemiology, especially in low-resource settings such as Nigeria. The prevalence of HBV infection has not being determined before in the Federal Capital Territory of Nigeria.

The aim of this study, therefore, is to determine the seroprevalence of hepatitis B surface antigen(HbsAg) positivity among antenatal clinic attendees at the University of Abuja Teaching Hospital, Abuja, FCT, Nigeria.


   Materials And Methods Top


This was a cross-sectional study carried out in the antenatal clinic of the University of Abuja Teaching Hospital, Abuja, FCT, Nigeria. The University of Abuja Teaching Hospital is a 350-bed hospital located in Gwagwalada, a suburb of the FCT. It receives patients from the neighboring states of Nasarawa, Kogi, Niger, and Kaduna. The study population comprised 200 consecutive antenatal clinic attendees at the University of Abuja Teaching Hospital between March and June 2012. Whole blood was collected from the patients' veins and separated into plasma which was eventually used for the screening of HBV infection.


   Sampling And Data Collection Top


After acquiring ethical approval and obtaining written consents from the patients, 200 consecutive consenting pregnant women were recruited into the study. Sociodemographic factors(age and parity) were recorded on the pro forma.


   Hepatitis B Virus Test Top


Procedure

Rapid test: Quick profile™; by Lumiquick Diagnostics; Santa Clara, California, USA.

The sample used was plasma. All materials and specimen(plasma) were brought to room temperature, and the test device was removed from the sealed foil pouch. The test device was placed on a flat horizontal surface and was labeled with specimen identity. Transfer pipette was used to draw up the sample and dispensed 2–3 drops(80-100 μl) of sample in a vertical position into each sample well individually. The result was read at 20min after adding the sample. Two colored bands appeared within 20min. One colored band appears in the control zone(C) and another colored band appeared in the test zone(T), which was considered positive. One colored band appeared in the control zone(C) within 20min. No colored band appeared in the test zone(T), which was considered negative. No colored band appeared in the control zone(C) within 20min, which was considered invalid.

Principle

When the sample was added, it migrated by capillary diffusion. Presence of HbsAg reacted with gold conjugate-forming particles.

Data analysis

Data were analyzed using frequency distribution tables. Each entry in the table contains the frequency or count of the occurrences of values within a particular group or interval, and in this way, the table summarizes the distribution of values in the sample.


   Results Top


During the study period, a total of 200 consecutive consenting antenatal clinic attendees at University of Abuja Teaching Hospital were enrolled.

The results showed that 14 of them tested positive for HBV infection, thus giving a HBV seroprevalence rate of 7%.

[Table1] shows that in the age distribution of the patients, majority (44%) of the patients were within the age range of 25–29. This was followed by those in the age range of 30–34 (27.5%). Majority of those who tested positive were in the age range of 25–29. This range had the highest rate of HBV infection of 57.1% followed by age group20–24 (21.4%).
Table 1: Age distribution and parity of patients who tested both negative and positive for hepatitis B virus screening

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[Table1] also shows the distribution of HBV infection among the patients on the basis of parity. The highest seroprevalence of 78.6% was seen in the Para 1–4 followed by the least(21.4%) in the Po+0. There was no HBsAg positivity in the grand multipara. This shows that increasing parity appears to be a risk factor for HBV infection.


   Discussion Top


The result of this study revealed that the seroprevalence of HBV infection among antenatal attendee was 7%. This falls within the range of 2–15% found in similar studies in Nigeria.[14],[15],[16],[17] This finding is similar to that found in Minna, North-Central Nigeria(6.5%).[29] It is, however, lower than the World Health Organization reported prevalence rate of hepatitis B, where between 5% and 10% of the adult population is chronically affected in Sub-Saharan Africa and East Asia. Indeed, this prevalence is said to be the highest.[30] Our findings, thus, show that Gwagwalada, Abuja, FCT, like other areas in Nigeria, is endemic for HBV infection.

The HBV seroprevalence of 7.0% in this study is<11.5% found among pregnant women in Ibadan, Oyo State, Nigeria.[31] In Northeastern Nigeria, a slightly higher HBV seroprevalence rate of 8.2% was found among antenatal attendees.[32] In Nnewi, Nigeria, a HBV seroprevalence rate of 8.3% was found among antennal clinic attendees.[33] This was slightly higher than the seroprevalence rate of 7.0% found in this study. In Kano, Nigeria, a HBV seroprevalence rate of 7.9% was found among antenatal clinic attendees.[34]

The HBV seroprevalence rate of 7.0% in this study is slightly less than that found in another West African country(8.0%)[16] and much<16.0% found in a neighboring country, Nigeria.[19] The rate in Taiwan, an Asian country, was 15.5% which is much higher than that in this study. However, the HBV seroprevalence rate of 7.0% is much higher than that quoted for the developed world such as United States of America and Western Europe of 2%.[21] The wide difference in the HBV seroprevalence rate of HBV infection between the developing and developed countries may be because of the widespread usage of the hepatitis B vaccine both in children and the adult population in developed countries.

Sociodemographic factors considered in this study were age and parity of the patients. The age group of 25–29 had the highest HBV seroprevalence rate of 57.1%. This agreed with the highest hepatitis seroprevalence rate which occurred in the 25–29years' age group in a similar study in Ibadan, Nigeria.[35] This may be so because this age range falls within the sexually active age bracket and thus are more at risk of having a sexual contact with an infected person.[36]

Multiparous patients(Para 1–4) constitute the majority with 118(59.0%) of the patients and those who tested positive to HBV infection(78.6%). This finding also agrees with similar results in Ibadan, Nigeria.[35] This could be because since they are multiparous, they are also sexually active [35] and thus more at risk of having a sexual contact with an infected person.[36]


   Conclusion Top


The findings in this study correlates well with the findings of earlier studies and report by the World Health Organization that HBV infection is endemic in Nigeria and developing countries. This justifies our aim/objective of finding out the seroprevalence of HBV infection among antenatal clinic attendees at University of Abuja Teaching Hospital.

It is hereby recommended that HBV screening must be incorporated into the routine antenatal clinical investigations for all women attending the antenatal clinic except where a woman has already being documented to be HBV positive. Awareness campaign of the disease and widespread coverage of the HBV immunization of the population should be encouraged.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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