Hepatitis B virus seroprevalence among parturients in Accra, Ghana

Abstract

Hepatitis B virus (HBV) infection is a major health problem, with 5% of the world population being chronic carriers, and parts of Africa and the Middle and Far East have a disproportionately higher carrier rate of 10% to 15%. Persistent HBV infection is an important risk factor for hepatocellular cancer, one of the most common cancers in adults in Ghana [1]. Perinatal transmission has remained the most important means of spreading of HBV worldwide [2]. This study was conducted to determine HBV seroprevalence among parturients at the Korle-Bu teaching hospital (KBTH) in Accra, Ghana, and whether selected medical and socio-demographic characteristics are associated with HBV seropositivity. Women delivered at KBTH were randomly selected, and medical and socio-demographic characteristics were recorded using a standardised questionnaire. Maternal sera were tested for HBV surface antigen (HBsAg), HIV I and HIV II antibodies, and hepatitis B e-antigen (HBeAg) if the participant tested positive for HBsAg. The data were analysed using Centers for Disease Control and Prevention—issued software Epi Info 2000. Associations between hepatitis B seropositivity and the selected characteristics were examined. P < 0.05 was considered significant. Of the 638 women tested, 67 (10.5%) tested positive for HBsAg, and 5 (7.5%) of these 67 also tested positive for HBeAg. The overall rate of HIV-positive women was 2.7%, but it was 4.5% in the HbsAg-positive group. The socio-demographic and medical characteristics, which included slum residence, duration of schooling, age below 20 or above 35 years, nulliparity, marriage, history of jaundice, and HIV seropositivity, showed no significant association with HBV seropositivity (Table 1). In 1991, in an attempt to reduce the global impact of HBV infection, the World Health Organization recommended that Hepatitis B vaccination be integrated into immunisation programmes worldwide [3]. A decade after this recommendation, this study demonstrates a marked increase in HBV seroprevalence (10.5%) compared with the 6.4 % seroprevalence in pregnant women studied at the same hospital in 1994 [4]. There is no definitive treatment for HBV infection, but passive and/or active immunization of neonates before exposure to carriers would be protective, and it would prevent the high carrier rate (90%) associated with neonatal infection. The high and rising HBV seroprevalence in pregnant women in Ghana reinforces the need to examine the preventive measures for reducing perinatal transmission. Antenatal screening for HBV carriers would be crucial for an effective prophylaxis, but this is not yet routine practice in KBTH or nationally. Targeting for screening pregnant women at high risk could be a cost-effective option, but the selected medical and socio-demographic characteristics in this study would not be useful in identifying high-risk pregnant women. In many antenatal clinics in high-prevalence communities, the trend is to test all pregnant women for HBV infection and to institute effective interventions for reducing vertical transmission. This is a policy worth considering at KBTH. The recently initiated newborn vaccination should go hand in hand with identifying HbsAg and HbeAg-positive pregnant women for specific management to reduce perinatal transmission.