Prevalence And Risk Factors Of Hepatitis B Among Pregnant Women Attending Antenatal Clinic In Ondo State

Project and Seminar Material for Nursing (Science)

Prevalence And Risk Factors Of Hepatitis B Among Pregnant Women Attending Antenatal Clinic In Ondo State


Abstract


Hepatitis B is the inflammation of the liver caused by the Hepatitis B virus. The risk of maternal transmission of Hepatitis B infection in pregnancy and a peri-natal period is dependent on maternal Hepatitis B envelop antigen (HbeAg). A positive HbeAg mother has between 70-90% chances of transmitting the virus to the unborn child. This study sought to determine the prevalence of and predictors of Hepatitis B among pregnant women in the Ondo state. The study also assessed pregnant women’s awareness about Hepatitis B transmission and prevention. A cross-sectional study was undertaken. Pregnant women were evaluated using a structured questionnaire to collect information on their socio-demographic characteristics and awareness of Hepatitis B virus (HBV) transmission and prevention. Pregnant women were screened for Hepatitis B virus sero-markers, using a commercial rapid diagnostic test, with three milliliters of blood for Hepatitis B profile. Assessment of awareness was done using a Hepatitis B basic awareness summary score. Of the 183 pregnant women screened 20.22% (37/183) tested positive for HbsAg, 7.10% (13/183) for HbeAg, 18.58% (34/183) for HbcAb, 1.64%(3/183) for HbsAb and 10.38% (19/183) for HbeAb. They type of marital relationship was significantly associated with HbsAg positivity and HbeAg positivity. Majority of pregnant women 78.7% are aware of Hepatitis B transmission and prevention. This study has demonstrated a high prevalence of HbsAg and HbeAg and majority 78.14% (143/183) are not aware of mother to unborn child transmission of Hepatitis B among pregnant women. Pregnant women should be a screen for HbeAg before delivery and vaccines should be affordable and available. More educational programs on the mode of HBV transmission and methods of prevention should be introduced at the antenatal care (ANC) level.


Chapter One


Introduction

1.1 Background to the Study

The inflammation of the liver caused by Hepatitis B virus can lead to Hepatitis B disease which can be life threatening to the person infected. Cirrhosis and liver cancer are the cause of death of a person suffering from chronic Hepatitis B infection thereby making it a public health issue(World Health Organization, 2017). Sexual contact is the major transmission route for Hepatitis B infection in low endemicity areas amongst high-risk adults while perinatal transmission account for the transmission of Hepatitis B virus (HBV) in high endemicity areas (Hou et al., 2005).

The most effective way to prevent Hepatitis B Virus transmission to newborn is through effective identification of HBV positive pregnant women (Borgia et al., 2012). Screening asymptomatic people is an important instrument in disease detection, prompt diagnosis and intervention, particularly at an early stage of the disease. This may improve the health outcome as well as better understanding of the transmission pattern of the disease(Parveen et al., 2012).
It is very common for infants to develop chronic Hepatitis B if it is transmitted from an infected mother and usually this occurs before the age of 5 years (WHO, 2017). Chronic HBV infection goes through three to four phases depending on the immunity of the individual. The immune-tolerant phase is the first phase followed by the immune clearance or immunoactive phase, then no replicative inactive phase which may lead to a rebirth of the phases. About 87-90% of patients infected with HBV may either develop immunity or become chronic carriers, which may lead to the risk of developing liver cirrhosis or liver cancer (Ott et al., 2012).

In order to prevent mother to child transmission, a child born to a mother positive for Hepatitis B surface antigen should receive the Hepatitis B vaccine and the Hepatitis B immune globulin within 12 hours of birth, that child will be 85-95% protected from Hepatitis B virus(Center for Disease control and Prevention, 2015). Those who acquire HBV infection at birth or during childhood do not usually experience symptoms. Therefore it is necessary to target the risk group of people who are likely to acquire the infection for screening (Sarin et al., 2016).

Chronic Hepatitis B is endemic in Sub-Saharan Africa and Asia with an estimated prevalence of 5% and 10% respectively in the adult population (WHO, 2017). Ghana has been categorized among the areas of the world with a high prevalence (≥8 %) of chronic HBV The rates of chronic Hepatitis B virus infection in 2013 was 12.92 %, but some experts also put it at 10 to 15% (Schweitzer et al., 2015).Women in their reproductive age with chronic HBV infection remain a major source for continued spread of the virus. Therefore there is the need for screening of pregnant women to detect the virus in prenatal care to enable early intervention (Abdi, 2015).

The Hepatitis B screening is among the routine tests recommended for all pregnant women when they visit the antenatal clinic in Ghana. The risks of maternal complications of Hepatitis B virus are inducing premature labor, intra-ventricular, intrapartum and postpartum hemorrhages. In the case of infants, they are usually poor outcomes like stillbirths and neonatal deaths, jaundice, anorexia, malaise, acute and chronic liver disease, impaired mental and physical health (Abongwa, et al., 2016).


1.2 Statement of the Problem

There are several mechanisms in place to check the Hepatitis B status of women who are attending antenatal clinics in order to identify Positive HbsAg mothers so that measures can be put in place to prevent transmission of Hepatitis B virus to the unborn child (Kiyshi et al., 2015). Hepatitis B virus is often acquired in adolescence or adulthood through sexual contact or drug use by injection in the United States and Western Europe. This is different in Nigeria and Africa where a majority of HBV is acquired through vertical transmission from mother to child and horizontal transmission from child to a child usually in pre-schools (Luuse et al., 2017). In Africa where there is scare scarcity of health resources, lack of education, and data, making a diagnosis and monitoring the infection is a major problem. Furthermore, stigma and discrimination are also invisible challenges in helping in the interventions for prevention and treatment of HBV (O’Hara et al., 2017).

Hepatitis B virus can persist in room temperature for at least seven (7) days with viral replication occurring. Hepatitis B virus can be spread from one person to another through an infected person’s sore that shed the virus into the environment. Contact with the contaminated environment/surface while having an open lesion makes a person susceptible to infection with the virus(Nelson, Easterbrook, & Brian, 2017). Hepatitis B virus comes second to tobacco as the most common carcinogenic agent and a major cause of liver cirrhosis and liver cancer. Moreover, they usually have poor outcomes in terms of morbidity and mortality (Okonkwo et al., 2017).

According to WHO (2015), less than 5% of people with chronic Hepatitis infections know their status. Women may know their status only when they are pregnant and this makes it a major public health challenge. Maternal Hepatitis B envelop antigen (HbeAg) is an important factor in the maternal transmission of HBV infection during pregnancy. A positive HbeAg mother has a 70-90% rate of transmission and less than 10% if she is HbeAg negative (Eke et al., 2016). It is necessary to differentiate between a low replicative patient and a risk of progressive disease. A Hepatitis B virus deoxyribonucleic acid (DNA) more than 2000 IU/ml is considered as a risk of progression to disease. According to Sarin et al. (2016), patients who are positive to HbsAg and with DNA≥1000 IU/ml are at a high risk of reactivation of the virus.

The World Health Organization has made Hepatitis a major community health consent, by drafting strategies to deal with viral Hepatitis globally, with strategies to eliminate viral Hepatitis by 2030 (WHO, 2017). The Upper West Region has the highest prevalence of 18% within the West Africa sub-region (GNA, 2006).

Hepatitis B immune globulin (HBIG) which is used to prevent mother to child transmission is very expensive and therefore, rarely available and more over the logistics of storage is a major challenge in most health facilities. Antivirals should be considered for HBV infected mothers to reduce the perinatal transmission(Chotun et al., 2017). In 2015, only 9% of Hepatitis B virus-infected individuals had been tested where sub-Saharan Africa and out of that, only 8% were on treatment. Treatment for Hepatitis B infection should be made easily available and accessible to the general population (Aberra et al., 2017).


1.3 Objective of the Study

The general objective of this study was to determine the prevalence and risk factors of hepatitis b among pregnant women attending antenatal clinic in Ondo state.

Specific Objectives

  1. To determine the prevalence of HbsAg among pregnant women in Ondo state.
  2. To assess the awareness of Hepatitis B transmission and prevention among pregnant women in Ondo state.
  3. To determine the prevalence HbeAg among pregnant women in Ondo state.
  4. To determine, HBcAb (Anti- HBc) HbeAb and HbsAb among pregnant women in Ondo state.

1.4 Research Question

  1. What is the level of the prevalence of HbsAg among pregnant women in Ondo state.
  2. What is the level of awareness of Hepatitis B transmission and prevention among pregnant women in Ondo state.
  3. What is the prevalence HbeAg among pregnant women in Ondo state.
  4. How is HBcAb (Anti- HBc) HbeAb and HbsAb among pregnant women in Ondo state.

1.5 Significance of the Study

Studies (Seyed, Azar, Kourosh, Mohammad, Hamid and Mohammad, 2011) have been done on Hepatitis B Viral infection in different parts of the world but information regarding the prevalence of HBV infection in pregnant women using two serological markers (HBsAg and HBcoreAb) is very scanty particularly in Nigeria.

Studies (Pomper, Wu and Snyder, 2003) have revealed that steady increase in the transmission of the disease is attributed to improper screening of the blood; also the virus can be transmitted by blood donors and organ donors who are positive for antibody to HBV core antigen (anti-HBc) but negative for all other HBV markers. This occult infection is one of the reasons for high risk of HBV infection. There may be possibility of missing out one marker when the other is negative among pregnant women posing a risk to their babies. The findings from this study will improve the management protocol of pregnant women when screened, hence the need for this study.


1.6 Scope of the Study

This study involved pregnant women visiting three hospitals in Ondo state for ante-natal care. Blood samples were collected from the pregnant women and screened for Hepatitis B virus using two serological markers (HBsAg and HBcoreAb). Methodology employed for the study includes collection of Demographic information and the screening of the blood samples using rapid HBV panel kit.


1.8 Limitation of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, language barriers, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.


1.9 Definition of Terms

Level of Education

Can be no formal education, primary, middle/Junior High School, Senior High School/Vocational, or Training College/University.

Gestation

Can be first trimester, second trimester or third trimester

Area of Residence

Can be Urban or Rural

Occupation

Can be civil servant, jobless, self- employed or student

Marital Status

Can be single, married or divorced

Level of Awareness

Can be limited, average or adequate.


1.10 Organization of the Study

This research work is organized in five chapters, for easy understanding, as follows.

  • Chapter one is concern with the introduction, which consist of the (overview, of the study), historical background, statement of problem, objectives of the study, research hypotheses, significance of the study, scope and limitation of the study, definition of terms and historical background of the study.
  • Chapter two highlights the theoretical framework on which the study is based, thus the review of related literature.
  • Chapter three deals on the research design and methodology adopted in the study.
  • Chapter four concentrate on the data collection and analysis and presentation of finding.
  • Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five


Conclusion and Recommendation

5.1. Conclusion

The HbsAg, HbeAg, and HBcAb prevalence rate among pregnant women in this study was high. A 20.22% prevalence of HbsAg, 7.10% for HbeAg and 18.58% for HbcAb in a population of pregnant women attending ANC were recorded in this study.

There was lower HbsAg positive among age below 20 years; means the introduction of the vaccination program by Ghana Health Service has really reduced Hepatitis B in this age group. The occurrence of HBV infection in the type of marital (polygamous) is four times more likely than a monogamous marital relationship.

Furthermore, the study indicates that risk factors were not significant to Hepatitis B virus infection.

More importantly, this study indicates an association between age and positive HbeAg which increases the risk of mother to child transmission of the disease to the unborn child. Therefore babies becoming chronic carriers of HBV infection which will further lead to an increase in the virus among the general population.


5.2. Recommendation

This study recommends that for future studies the sample size should be large and that other serological markers such as viral load and liver function test should be done to know the stage of the liver and to quantify virus in the Liver.

  1. Furthermore, Nigeria Health Service should make a recommendation to the National Health Insurance Scheme to include Hepatitis B profile for all pregnant women who are attending antenatal care.
  2. More importantly, the study recommends that there should be at least three- time screening of pregnant women during pregnancy to identify HbsAg positive mother for immediately administering the birth dose and Hepatitis B immunoglobulin to children born to these women.
  3. Moreover, Nigeria Health Service should make Hepatitis B immunoglobulin available and accessible in health facilities for immediately administrating after birth, in order that infected mothers will not transmit HBV to their children.
  4. Finally, the study recommends that the mode of transmission and methods of prevention of HBV should be included in the daily health talk at antenatal care clinics and at durbars to raise the awareness of mothers and fathers to prevent the spread of Hepatitis B in the Municipality

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