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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 4  |  Page : 847-852

Seroprevalence of hepatitis B among pregnant women attending maternal and child health centres in Shebin El-Kom district (Menoufia governorate)


1 Department of Public Health and Community Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Clinical Pathology, Menoufia University, Menoufia, Egypt
3 Department of Public Health, National Liver Institute, Menoufia University, Menoufia, Egypt

Date of Submission24-Dec-2013
Date of Acceptance22-Jun-2014
Date of Web Publication22-Jan-2015

Correspondence Address:
Sania Ali Soliman Yehia
Shebin El-Kom, Menoufia
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.149805

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  Abstract 

Objectives
This work aimed to determine the seroprevalence and the risk factors for acquiring hepatitis B virus (HBV) among pregnant women in Shebin El-Kom district, Menoufia governorate.
Background
HBV infection is a major global health problem. Egypt is among the countries with an intermediate endemicity of hepatitis B surface antigen (HBsAg) (range 2-8%). In areas with high/intermediate endemicity, the most common route of infection is still the vertical transmission from mother to child. Passive immunoprophylaxis with hepatitis B immunoglobulin and active immunoprophylaxis with hepatitis B vaccine in the infants of HBV-positive carrier mothers are necessary for the protection of newborns.
Participants and methods
A cross-sectional study was carried out on 397 pregnant women, who were randomly selected from pregnant women attending maternal and child health centres in Shebin El-Kom district, Menoufia governorate, and were subjected to a personal interview with a predesigned questionnaire and screened for HBsAg in the serum using enzyme-linked immunosorbent assay.
Results
The seroprevalence of HBV among pregnant women in Shebin El-Kom district, Menoufia governorate, was 2.3%, and the main risk factors for acquiring infection were the habit of one-syringe multiple use [odds ratio (OR) = 12.03], a family history of HBV infection (OR = 8.73), and HBV infection in the husband (OR = 96.5).
Conclusion
HBV is of intermediate endemicity among pregnant women in Shebin El-Kom district, Menoufia governorate, and the Ministry of Health and Population should adopt a program for the screening of all pregnant women for HBsAg at maternal and child health centres and for health education of the public about the modes of transmission of HBV and the application of infection control measures at health facilities to control the spread of HBV.

Keywords: Hepatitis B virus, pregnant women, seroprevalence, vertical transmission


How to cite this article:
Abo-Salem ME, Mahrous OA, El-Shaarawy AA, Mohamed HM, Yehia SA. Seroprevalence of hepatitis B among pregnant women attending maternal and child health centres in Shebin El-Kom district (Menoufia governorate). Menoufia Med J 2014;27:847-52

How to cite this URL:
Abo-Salem ME, Mahrous OA, El-Shaarawy AA, Mohamed HM, Yehia SA. Seroprevalence of hepatitis B among pregnant women attending maternal and child health centres in Shebin El-Kom district (Menoufia governorate). Menoufia Med J [serial online] 2014 [cited 2020 Feb 22];27:847-52. Available from: http://www.mmj.eg.net/text.asp?2014/27/4/847/149805


  Introduction Top


Hepatitis B virus (HBV) infection is a major global health problem. Approximately two billion people are infected with HBV worldwide. Over 20 million people are infected annually with this virus globally, and there are 350-400 million chronic carriers of HBV [1].

HBV is a small, double-shelled virus in the family Hepadnavirida. The virus has a small circular DNA genome that is partially double-stranded. HBV contains numerous antigenic components, including hepatitis B surface antigen (HBsAg), hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg). Humans are the only known hosts for HBV [2].

The virus is transmitted by parenteral or mucosal exposure to HBsAg-positive body fluids from persons who have acute or chronic HBV infection. The highest concentrations of the virus are in the blood and serous fluids; lower titers are found in other fluids, such as saliva and semen [2].

The most prominent clinical symptoms of hepatitis are right upper quadrant discomfort, nausea, jaundice, and other unspecific constitutional symptoms, and less than 30% of the patients will develop icteric hepatitis [3].

The frequency of infection and patterns of transmission vary in different parts of the world, with a high prevalence of chronic HBV infection [2]

Egypt is among the countries with an intermediate endemicity of HBsAg (range 2-8%) [4].

In the last few years, a large amount of data have been produced in developing countries and areas with high/intermediate endemicity, where the most common route of infection is still vertical transmission from the mother to the child [5].

Perinatal transmission from the mother to the infant at birth is very efficient. If the mother is positive for both HBsAg and HBeAg, in 70-90% of the cases, infants will become infected in the absence of postexposure prophylaxis; the risk of perinatal transmission is ~10% if the mother is positive only for HBsAg. As many as 90% of these infected infants will become chronically infected with HBV [2].

Passive immunoprophylaxis with hepatitis B immunoglobulin (HBIG) and active immunoprophylaxis with hepatitis B vaccine in the infants of HBV carrier mothers offers high levels of protection against the disease. As a result, maternal screening is necessary for the protection of newborns.


  Participants and methods Top


The type of study

A cross-sectional study.

The target population

Pregnant women attending maternal and child health (M.C.H) centers in Shebin El-Kom district, Menoufia governorate.

Sampling

Shebin El-Kom district was chosen by simple random sampling from Menoufia governorate districts. Shebin El-Kom district was divided into urban and rural parts. From the urban part, the Shebin El-Kom city M.C.H center at the south of Shebin El-Kom city was chosen randomly. From the rural part, the Kafr Tanbedy family health unit was chosen randomly.

A representative sample from pregnant women attending these centers was chosen randomly: it included 397 pregnant women; the sample size estimated using Epi-info at confidence interval 95% was 322 pregnant women. Because of the available kits, 397 pregnant women participated in this study. Samples from urban and rural areas were chosen by the proportional allocation method: 140 from the urban area and 257 from the rural area.

Ethical points

An approval was obtained from the ethical committee. During the interview, the participant women were informed simply about the aims of this study and the fact that it is conducted to improve the health status of the population. Oral consent was obtained from each woman before participating in the research.

Each participant was subjected to the following:

(1) Personal interview and filling of a predesigned questionnaire, which included an inquiry about the following:

  1. Demographic data such as their age, residence, educational level, and employment.
  2. History of hospitalization, blood transfusion, surgical or dental procedures, immunization for hepatitis B, family history, infection in the husband, sharing of private instruments such as nail clipper and scissors, one-syringe multiple use, contact with hepatitis-infected patients, a history of jaundice, fever, and right upper quadrant pain.
  3. Obstetric data such as the gestational age and the history of previous pregnancies.


(2) Laboratory investigations: Three milliliters of venous blood were withdrawn from each participant for the detection of HBsAg in the serum by enzyme-linked immunosorbent assay.

(a) Data management: Data were collected, tabulated, and statistically analyzed by an IBM-compatible personal computer with SPSS statistical package, version 16. Qualitative data were expressed as number and percentage. Quantitative data were expressed as mean and SD. The Student t-test is a test used for comparison between groups having normally distributed quantitative variables. The c2 -test was used to study the association between two qualitative variables. The Fischer exact test was used to study the association between qualitative variables when one or more cells were less than 5. The odds ratio (OR) was used to determine the risk in the exposed group. The level of significance was set at a level of 0.05. A P value of less than 0.05 was considered statistically significant.


  Results Top


[Figure 1] shows that 2.3% of the studied group of pregnant women were HBV positive.
Figure 1: The seroprevalence of HBV in the studied group of pregnant women. HBV, hepatitis B virus.

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[Table 1] shows no significant association between the HBV status of the studied group of pregnant women and their sociodemographic factors (P > 0.05).
Table 1: The number and the percent distribution of HBV-seropositive and HBV-negative pregnant women regarding their sociodemographic data

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[Table 2] shows a highly significant association between the habit of multiple use of a syringe and the HBV status of the studied group of pregnant women (P < 0.001). Multiple use of a syringe was more risky by 12.03 times than single use (OR = 12.03).
Table 2: The number and the percent distribution of HBV-seropositive and HBV-negative pregnant women regarding health care-related risk factors

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No significant association was found between the history of hospitalization, blood transfusion, surgical operation, and tooth manipulation and the HBV status of the studied group of pregnant women (P > 0.05).

[Table 3] shows the presence of a highly significant association between a family history of HBV infection and the HBV status of the studied group of pregnant women (P < 0.001), and the presence of a highly significant association between HBV infection in the husband and the HBV status of the studied group of pregnant women (P < 0.001). The presence of a family history of HBV infection was about 8.73 times more risky than a negative family history (OR = 8.73) (P < 0.001). The presence of HBV infection in the husband was about 96.5 times more risky than the presence of a HBV-negative husband (OR = 96.5) (P < 0.001). No significant association was found between the occurrence of the previous pregnancy and the duration of the present pregnancy and the HBV status in the studied group of pregnant women (P > 0.05).
Table 3: The number and the percent distribution of HBV-seropositive and HBV-negative pregnant women regarding the family history, infection in the husband, the duration of the current pregnancy, the history of previous pregnancies, and sharing of private instruments with family members

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  Discussion Top


HBV infection is a major public health problem in the Arab countries The majority of the countries in the Middle East have intermediate (2 to <8%) or high (>8%) endemicity of HBV infection [6].

Egypt is considered as an area of intermediate endemicity for the virus [7].

This study was carried out on 397 pregnant women as a representative sample of pregnant women attending maternal and child health centers in Shebin El-Kom district, Menoufia governorate. Our results showed that 9 (2.3%) out of the 397 pregnant women were HBV positive, whereas 388 (97.7%) were negative for HBV. The prevalence of HBV in Shebin El-Kom district, Menoufia governorate, was of intermediate level. The observed low seroprevalence might be attributed to the lower mean age of the study population compared with the adult population.

This result was in agreement with EL-Shabrawi [8], who conducted a single-center study to determine the prevalence of HBV infection among Egyptian pregnant women, and found it to be 1.6%.

Also, Araz and Dikensoy [9] studied the seroprevalence of hepatitis B among pregnant women in southern Turkey, and HBsAg was detected in 2.1% of the studied pregnant women. In addition, El-Magrahe et al. [10], who studied maternal and neonatal seroprevalence of HBsAg in Tripoli, Libya, found a prevalence of 1.5%.

However, our result was in contrast to the study by Taseer et al. [11], who studied the frequency of HBSAg and related risk factors in pregnant women in Nishtar hospital, Pakistan, where 4.6% of the participants were positive for HBsAg.

Fawzy et al. [12] studied the screening of HBV in Shatby maternity university hospital and found that in the overall sample, 5.2% of the cases tested positive for HBSAg.

In this study, no significant association was found between the sociodemographic data (age, residence, educational level, and occupation) of the studied group of pregnant women and their HBV status (P > 0.05). This brings to light the need for focused education on the prevention of high-risk behaviors among all community sectors regardless of their age, residence, education, and occupation.

This result was in agreement with the study by Eke et al. [13], who found that there was no statistically significant relationship between maternal age, educational level, and HBV infection. There were statistically significant relationships between HBV infection and the occupation of the woman. Alegbeleye et al. [14] noted that educational attainment did not reduce the risk factors for transmission of the infection.

However, Yang [15] found that the prevalence of HBsAg among pregnant women older than 20 years of age was significantly different compared with pregnant women younger than 20 years of age. Alrowaily et al. [16] found that as the age increased, the prevalence of seropositive HBsAg increased significantly (P < 0.001).

In this study, there was a highly significant association between the habit of one-syringe multiple use and the HBV status of the studied group (P < 0.001); this may be due to economic factors and a lack of awareness among the study participants. There was no significant association between a history of hospitalization, blood transfusion, surgical operation, and tooth manipulations and the HBV status of the studied group (P > 0.05); this may be due to the application of infection control measures in health facilities or the low age group of the study participants.

Ibrahim et al. [6] found that the dental history, blood transfusion, and a history of surgery did not have a significant association with HBV, but a history of hospitalization and jaundice were important risk factors for the transmission of infection.

Eke et al. [13] found that blood transfusion, dental manipulations, and sharing of sharps/needles were not significant modes of transmission.

According to the study by Taseer et al. [11], a history of surgery, multiple injection therapy, and blood transfusion were observed as risk factors among HBsAg-positive pregnant women.

EL-Shabrawi et al. [8] found that a family history of HBV, hospital admission, and surgeries were the risk factors for acquiring HBV infection.

This study showed a highly significant association between the presence of a family history, which exposes the pregnant woman to household contact with a HBV patient, and the HBV status of the study participant (P < 0.001), a highly significant association between the presence of infection in the husband and the HBV status of the study participants (P < 0.001), and a nonsignificant association with sharing of private instruments with other members in the family (P > 0.05%).

Results are in accordance with the study by EL-Shabrawi et al. [8], who found that there was a significant association between a family history of HBV and the HBV status (P = 0.001), and Eke et al. [13], who found that there were statistically significant relationships between HBV infection and a history of contact with previously infected HBV patients (P = 0.001).

In this study, no significant association was found between the duration of the present pregnancy, the history of previous pregnancies, and the HBV status of the studied group of pregnant women (P > 0.05).

This was in agreement with the study by Zahran et al. [17], who postulated that there were no significant differences with regard to the parity and the gestational age. However, this was in contrast to the study by Ndako et al. [18], who found that women in their second trimester of pregnancy recorded a higher prevalence of HBV (P < 0.05). Alegbeleye et al. [14] found that the HBV prevalence was significantly higher in nulliparous women.


  Conclusion and recommendations Top


This study concluded that hepatitis B infection is of intermediate endemicity among pregnant women in Shebin El-Kom district, Menoufia governorate, and that the presence of a family history of HBV infection, HBV infection in the husband, and the habit of multiple use of syringes are the main risk factors for acquiring HBV infection in pregnant women.

Hence, this study recommends the following:

  1. The Ministry of health and population should adopt a program for the screening of all pregnant women for HBsAg at maternal and child health centers and for ensuring the administration of HBIG in combination with hepatitis B vaccine as postexposure prophylaxis for infants born to HBsAg-positive mothers in addition to the implementation of infection control practices in all health facilities to control the spread of hepatitis B.
  2. Close family contacts of HBV-positive pregnant women must be tested for HBsAg, and if negative, must be vaccinated.
  3. Premarital screening might be useful to identify at-risk spouses to propose targeted immunization.
  4. Health education about the risk factors and modes of transmission of HBV should be provided to the public through various media, for example print and electronic.



  Acknowledgements Top


Conflicts of interest

There are no conflicts of interest.

 
  References Top

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    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]


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