Page 1 of 12
British Journal of Healthcare and Medical Research - Vol. 11, No. 3
Publication Date: June 25, 2024
DOI:10.14738/bjhmr.113.16933.
Asamoah, A., & Saho, P. (2024). Examining Prevalence and Risk Factors of Hepatitis B Virus Among Pregnant Women in the Context
of Prevention of Mother-To-Child Transmission. British Journal of Healthcare and Medical Research, Vol - 11(3). 202-213.
Services for Science and Education – United Kingdom
Examining Prevalence and Risk Factors of Hepatitis B Virus
Among Pregnant Women in the Context of Prevention of Mother- To-Child Transmission
Andrews Asamoah
Ghana Coalition of NGOs in Health, Accra
Prosper Saho
Ghana Health Service, Kumasi
ABSTRACT
Background: Hepatitis B. virus continues to pose threat to human by infecting
millions of people globally through the liver and remains a public health problem
even though there has been the availability of HB vaccine and antiviral agents over
the years. It is estimated that 240 million people worldwide are chronically
infected, particularly in low and middle-income countries (LMICs). The major well- established risk of harm associated with maternal HBV infection is perinatal
transmission to the infant occurring most commonly through the process of
delivery. Objective: The aim of this study is to estimate the prevalence of Hepatitis
B and associated risk factors among pregnant women in Ejura-Sekyedumase
Municipal. Method: The study adopted a cross sectional approach to research
design among pregnant women attending antenatal care. Proportion sampling
method was applied to each facility based on the number of pregnant women
attending ANC clinic to determine the number of pregnant women to be interviewed
from each facility. Statistical analysis was done using STATA and results were
presented in frequencies and percentages while regression analysis results was
report in odds ratio with its associated chi-square and p-values. Results: Three
hundred and thirteen pregnant women participated in the study with a mean age of
30.3 +2.5. A total of 64 pregnant women tested positive for HB virus, giving a
prevalence rate of 20.5%. Factors that were significantly associated with HB virus
infection among pregnant women include age 18-24 and 45+ years, polygamous
marriage, blood transfusion and multiple sexual partners. About 49% of the
pregnant women had adequate knowledge on hepatitis B infection. Knowledge on
hepatitis B infection was significantly associated with age, religion, place of
residence and place of past deliveries. Conclusion: With the high prevalence of
hepatitis B among pregnant women in the district, it is important urgent actions are
taking to address the root causes of the high infection among the pregnant women.
Screening and HBV vaccine introduction should be key on the agenda among policy- makers.
Keywords: pregnant women, hepatitis B, HB transmission, prevalence
BACKGROUND
Hepatitis B (HB) remain one of the major health problems with millions of people getting
infected with the virus which affects the liver. Nearly 240 million people worldwide are living
Page 2 of 12
203
Asamoah, A., & Saho, P. (2024). Examining Prevalence and Risk Factors of Hepatitis B Virus Among Pregnant Women in the Context of Prevention
of Mother-To-Child Transmission. British Journal of Healthcare and Medical Research, Vol - 11(3). 202-213.
URL: http://dx.doi.org/10.14738/bjhmr.113.16933.
with hepatitis B especially in low and middle-income countries (LMICs) including an estimated
65 million women of childbearing age (WHO, 2015). The WHO has explained that hepatitis B
virus that destroys the immunity of a person by destroying the cells in the liver. Hepatitis B
virus has generally been known to belong to hepatotropic deoxyribonucleic acid (DNA) and are
included in the oncogenic group of viruses and may increase the risk of getting hepatocellular
carcinoma (WHO, 2015). In 2017, hepatitis B status report from the World Health Organization
(WHO) shows an estimated 328 million persons globally are infected with hepatitis B and C,
with majority of these incidence coming from sub-Saharan Africa and East Asia (WHO, 2017).
It has been established that hepatitis B and C are both transmitted through the same routes.
Evidence has shown that in most cases hepatitis B and C are transmitted through contaminated
blood, sexual activity or other means including perinatal transmission (WHO, 2015). An
estimated 71 million people were infected with HCV in 2015, globally. In the same year, it was
estimates that about 257 million people were living with chronic hepatitis B infection and this
resulted in over 887,000 deaths through cirrhosis and hepatocellular carcinoma (WHO, 2017).
Often about 15-40% with the infection progress to cirrhosis, liver failure and hepatocellular
carcinoma (WHO, 2017)
Hepatitis B infection remains an important global public health concern despite the existence
of an effective vaccine and antiviral agents. Chronic HBV in pregnancy is associated with
mother-to-child transmission (WHO, 2017). The major well-established risk of harm associated
with maternal HBV infection is perinatal transmission to the infant occurring most commonly
through the process of delivery (Al-Mandeel et al., 2015). Higher risk of maternal and foetal
complications have been associated with pregnancies with chronic infection. Children born to
mothers with chronic hepatitis B infection are more likely to develop hepatitis B infection
before the age of 5 years (WHO, 2016). Globally, screening has been identified as an effective
mechanism in HBV detection, prompt diagnosis and intervention, especially at an early stage of
the infection to prevent MTCT. Hepatitis B viral screening has very high accuracy (sensitivity
and specificity >98%) as established in studies by the WHO in the 1980s and 1990s when the
tests were developed (Alavian et al., 2016). A WHO report in 2016 shows that 10.5% of the
world population are aware of their hepatitis B status with only 16.7% of those who are infected
are able to have access to treatment (WHO, 2016). Recent statistics indicate that 1.1 million
people were newly infected with hepatitis B in 2017 (CDC, 2019; WHO, 2019).
Ghana has been categorized among the endemic areas with a high prevalence of chronic HBV
(WHO, 2016). Owusu-Ansah (2015) indicated that HBV is one of the public health concerns
identified in Ghana and requiring more attention. Different studies and reports put the
prevalence at different levels for the country. For instance, Howell, Lemoine, & Thursz, (2014)
and Kumar et al. (2015) estimates the prevalence of chronic HB infection as higher than 8%
while Schweitzer et al, (2015)in an analysis of the burden of chronic HB prevalence in the world
put the prevalence for Ghana at 12.9%. Teye (2015) also estimates the prevalence in Ghana as
10-15%. Issahaku et al. (2017) estimates that the prevalence of HB among pregnant women
was 14.3%. Regional level data on HB prevalence among pregnant women is mostly limited.
The level of knowledge on hepatitis B infection among pregnant women is another key
determinant of hepatitis B prevalence, but not many people are aware of their status and
therefore unable to seek appropriate and timely care. In such cases, the viral infection develops
to chronic state. This ignorance of the status especially among pregnant women has the
Page 3 of 12
204
British Journal of Healthcare and Medical Research (BJHMR) Vol 11, Issue 03, June-2024
Services for Science and Education – United Kingdom
potential of affecting the unborn child, if early diagnosis is not done. There are other associated
risks factors that may lead to HBV infection among pregnant women. This study seeks to
provide empirical evidence regarding the prevalence of HB viral infection among pregnant
women in Ejura Sekyedumase Municipal. The study further sought to ascertain the risk factors
associated with HBV virus infection among pregnant women within the district in the context
of preventing vertical transmission from mothers to their foetuses.
METHOD
Study Setting
The study was conducted in Ejura-Sekyedumase Municipality of Ashanti region of Ghana Data
for the study was collected from the two main hospitals of the municipality: Ejura Sekyedumase
Municipal Hospital and St. Luke Hospital, Kasei.
Study Design
The study adopted an analytical cross-sectional design of research focusing on hepatitis B
prevalence among pregnant women who utilise antenatal care services in the two main
hospitals in the municipality. The study adopted a quantitative method of research to gather
data. The quantitative approach of the research was to help estimate the prevalence of hepatitis
B infection among pregnant women as well as determine the knowledge levels of the pregnant
women. The quantitative method further helped to predict the risk factors that were
significantly associated with hepatitis B infection among pregnant women.
Study Population
The study population included all pregnant women attending antenatal care clinic at the Ejura
municipal hospital and St. Luke hospital Kasei in the Ashanti Region of Ghana and were willing
to participate in the study were included in this study. However, pregnant women who were on
admission with one or two pregnancy complications were excluded from the study.
Sample Size and Sampling Method
The minimum sample size for this study was determined by Yamane formula for sample size
determination (Yamane, 1967) using single population proportion formula (n0 =
N
1+Ne
2
). The
sample size was determined based on the following assumptions: 95% level of confidence at
standard value of 1.96; 5% margin of error; N = 1820; i.e., total number of pregnant women
attending antenatal care at both Ejura Sekyedumase Municipal hospital and St. Luke Hospital,
Kasei. This was obtained from the Hospitals’ records for 2019 (GHS/Ejura Sekyedumase Annual
Report, 2019).
Inputting the above into Yamane’s formula, the minimum sample size required for this study
was given by: n0 =
1820
1+1820(0.05)2 = 327.
Proportion sampling method was applied to determine the sample size for each of the two
facilities based on the number of pregnant women attending ANC clinic. With the number of
participants per facility determined, the names and details of pregnant women attending
antenatal care at both hospitals were acquired from the antenatal care unit of these hospitals.
From this list, simple random sampling was used to select participants. For each facility, pieces
of papers were numbered 1 to 100 and participants on each day were asked to select one of the