Abstract

Hepatitis B infection is a viral infection causes by hepatitis B virus. It poses a global threat affecting 257 to 350 million people globally. In 2015, it caused 887,000 deaths. 65 million of people carry this infection in Africa and a mortality risk of 25%; with a prevalence of 9 to 20%.

Hepatitis B infection is transmitted vertically from mother to fetus, and it is associated with high risk maternal complications leading to preterm births, intrauterine restrictions and low birth weight. The aim of this study was to assess the seroprevalence and associated risk factors of hepatitis B infection among pregnant women attending the Baptist Hospital Mutengene, Cameroon.

The study employed a descriptive cross sectional design in which 65 pregnant women were sampled. A total of 56.9% of the pregnant women were aged 16-25 years and 61.5% were married. The overall prevalence of hepatitis B obtained via rapid diagnostic testing was 7.7%. The prevalence was high (8.1%) among those aged 16-25 years, among singled compared to those who were married and among those with ordinary level education.

The associated risk factors of hepatitis B infection included having a history of blood transfusion, used or injected drugs and having been treated for a sexually transmitted disease. It is therefore recommended (reiterated) to integrate routine hepatitis B screening with ANC services at health facilities to facilitate early diagnosis and prompt treatment and to improve maternal and child health.

CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Hepatitis B is a systemic infection caused by the hepatotropic virus, Hepatitis B virus (HBV) (Cacoub et al., 2022). Hepatitis is a common cause of serious liver inflammation in the world (Uneke et al., 2005).

The virus is transmitted through contact with blood or other body fluids from infected person globally.  Globally, an estimated 257 to 350 million people are living with Hepatitis B virus infection (defined as hepatitis B surface antigen HBsAg).

In 2015 hepatitis B resulted in 887000 deaths mostly from complications (including cirrhosis and hepatocellular carcinoma). Hepatitis B virus have similar transmission route with human immunodeficiency virus (HIV); thus, co-infection with these two viruses is common and both are Serious global public health problems.

An estimated two billion people around the globe have been infected with hepatitis B virus. Persons with HIV infections are easily affected by viral hepatitis. Among the estimated 40 million persons infected with HIV worldwide, an estimated 2 – 4 million (5% – 15%) have chronic HBV (Soi et al., 2019).

There are about 65million individuals who carry HBV in Africa, with a 25% mortality risk. In sub-Saharan Africa, the prevalence of HBV infection ranges from 9 to 20% (Kiire, 1996 and Kramvis, 2007). As reported by world health organization (WHO) the prevalence of Hepatitis B virus infection among pregnant women in Africa countries ranges from 6% to 25% (WHO,2007).

Hepatitis is an inflammation of the liver characterized by the presence of inflammatory cells in the tissues of the organ. It may occur with limited or no symptoms but often leads to Jaundice, anorexia (poor appetite) and malaise. Hepatitis B is acute and chronic when it persists longer (Ryder et al., 2001).

A group of viruses know as hepatitis virus cause most of Hepatitis worldwide, but it can also be due to toxins (notably alcohol, certain medications and plants), other infection and autoimmune diseases (Ahmedin et al., 2004). The hepatitis is found in blood and other body fluids and is transmitted from person to person, the most common routes of infections include blood transfusions and blood products where there is no screening for blood-borne viruses, medical or dental interventions in countries where equipment’s are not adequately sterilized, mother to infant during childbirth, sexual transmission (in case of Hepatitis B), sharing equipment for injecting drugs, sharing straws notes etc. (for snorting cocaine is particularly alkaline and corrosive), sharing razors, toothbrush or other house hold articles, tattooing and body piercing if done using unsterilized equipment (Redmond, 2007).

The hepatitis is spread through contact with the blood or other body fluids (that is semen, vaginal fluids and saliva). Viral hepatitis during pregnancy is associated with high risk of maternal complications. There is a high rate of vertical transmission causing fetal and neonatal hepatitis which can have serious effects on neonates, leading to impaired mental and physical health later in life. Hepatitis B is a leading cause of maternal mortality (Elinav et al., 2006). It is said to be the most familiar cause of jaundice in pregnancy (Sheffield et al., 2002).

1.2 Problem Statment

Despite the availability of a safe and effective vaccine, hepatitis B remains a major global health problem, especially in low- and middle-income countries, where the burden of infection is highest. One of the challenges in eliminating hepatitis B is the lack of access to diagnosis and treatment for people living with the infection.

Many people are unaware of their status and do not receive the appropriate care and support they need. Moreover, current treatments for chronic hepatitis B are not curative and require long-term use, which can be costly and have side effects.

World Health Organization adopted resolution asking Countries to develop Comprehensive National Hepatitis B Strategies and also countries require reliable data. Furthermore, Strategies or several efforts have been made to promote and expand the infection prevention and Control Program beyond ministry of public.

Health, Society/community, and most importantly the hospital, to Fight Hepatitis B in pregnancy by raising the awareness of the public, and educating the public on the various method of prevention. In general Hepatitis B continues to be among health conditions with high burden. While understanding the risk factors of Hepatitis B and potential mechanisms are crucial to the ability to intervene to reduce this burden, more information about the risk factors is necessary in developing countries including Cameroon for innovation and evidence-based interventions.

WHO also strongly recommends that all regions and associated Countries develop goals for Hepatitis B control appropriate to their epidemiology situation (WHO, 2017). In May 2016, the world health organization assembly endorsed the global Health sector strategy (GHSS) on viral hepatitis 2016 to 2021. The GHSS calls for the elimination of viral hepatitis a public health threats by 2030 (reducing new infections by 90% and mortality by 65%), (WHO, 2017). The information is important in relation to the adoption of recommendations made by WHO on Screening of Pregnant women and offering the at-birth-dose of Hepatitis B virus vaccines to prevent perinatal transmission for those mothers who test Positive.

Therefore, there is an urgent need for innovative and affordable solutions to improve the prevention, diagnosis, and treatment of hepatitis B, especially in resource-limited settings. However, there exist scared data or few articles have been published on the prevalence of Hepatitis B in pregnancy in Cameroon (Fomulu et al., 2013) and this defines the purpose of this study. Therefore, the aim of this study is to create data on the prevalence and associated risk factors of Hepatitis B in pregnancy in sub-Sahara Africa and Cameroon in particular to assist in the design of public health intervention to mitigate the challenge

1.3 Research Questions

1. What is the prevalence of Hepatitis B amongst pregnant women attending ANC at Baptist hospital Mutengene?
2. What are the associated Risk factors of Hepatitis B amongst pregnant women attending ANC at Baptist hospital Mutengene?

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