Prevalence of hepatitis B virus infection and associated factors at Negele Arsi General Hospital and Medical College, South-East Ethiopia: A cross-sectional study.

Objectives: Hepatitis B virus infection is a serious causes of liver disease affecting millions of people worldwide. It is transmitted through exposure to infective blood, and other body fluids. The objective is to assess the prevalence of hepatitis B surface antigen and associated factors.

Methods: Face to face interview method was conducted among clients screened for Hepatitis B surface antigen from July 01 to August 30,2020. A total of 300 patients were included in the study. All consecutive patients screened for hepatitis B surface antigen and enrolled during the data collection period were included. Data was entered into Epidata 3.1 software and the analysis was done using SPSS version 25. Bivariable and multivariable binary logistic regression analysis with 95 % CI was carried out.

Results: The seroprevalence of hepatitis B surface antigen in this study was 13%. Participants between the age of 21-30 years were three times riskier to hepatitis B virus infection than participants in the age of greater than 41 years (AOR = 3.0, 95% CI: 1.27, 7.11). and those who have a family history of hepatitis B virus were three times riskier to hepatitis B virus as compared to those who have no family history of hepatitis B virus (AOR = 2.67, 95% CI: 1.16, 6.17).

Conclusion: The prevalence of hepatitis B surface antigen was high in the study hospital. Family history of hepatitis B virus infection and age between 21-30 years old were significantly associated. Therefore, health education on transmission and prevention method should be prepared.

Keywords: Hepatitis B surface antigen; Hepatitis B virus; Prevalence; associated factors, Negele Arsi; Ethiopia.

Hepatitis is defined as an inflammation of the liver, usually initiated by a viral infection. Viral hepatitis is a foremost health problem worldwide and causes acute and/or chronic hepatitis which can lead to the development of extensive liver cirrhosis, liver failure, liver cancer, and death. The most common types are hepatitis B virus (HBV) and hepatitis C virus (HCV) infections [1].

The virus is commonly present in the blood, semen, and vaginal secretion and lesser amounts in breast milk, tears and urine of the infected individuals. It is transmitted through exposure to infective blood, semen, and other body fluids, or from infected mothers to infants at the time of birth [2, 3].

Hepatitis B virus infection is the most common contagious infection. The clinical manifestations of hepatitis B and C virus infection commonly include abdominal pain, malaise, and the appearance of jaundice. The complications of hepatitis B and C virus can be portal hypertension, cirrhosis, ascites and esophageal varices [4].

According to the 2017 global hepatitis report, about two billion people worldwide have been infected with hepatitis B virus and 350 million patients develop HBV chronic infection. Hepatitis is the tenth leading cause of death worldwide, and nearly 686,000 deaths/year are caused by chronic hepatitis and hepatocellular carcinoma [5].

World Health Organization (WHO) estimates that the average prevalence of HBV infection in Africa is on average in excess of 10% [1]. Asia is the first which has largest number of chronic carriers and Africa is the second largest number of chronic carriers (> 8%) [7]. Ethiopia is considered to have medium to high HBV infection rate [8].

The prevalence of Hepatitis B virus infection varies from different studies in different countries. Although, there is a presence of high burden of viral hepatitis in NAGHMC, till date, there is no study conducted on this topic in this Hospital and Negelle Arsi town.

The study aims to fill the information gap on the seroprevalence of Hepatitis B virus on inpatient and outpatient undergoing serology tests in Negelle Arsi General Hospital and Medical College Laboratory department.

Study setting: Negele Arsi General Hospital and medical college is located in Oromia regional state in the west Arsi zone, Negele Arsi town, 250km from Addis Ababa, the capital city of Ethiopia. This is the only private hospital in the town. The facility provides medical education training in addition to medical services. The Hospital provide services for different clients who comes from Bale, East Arsi, Guji, West Arsi, and other zones of the Oromia regional state and the Sidama regional state. The hospital has different departments that provide services in outpatient and inpatient with three operation theatres and ICU services. There were different fields of health care workers and supporting staff in the hospital. These staffs have a high risk of exposure to various infectious agents like HBV and a high possibility of transmitting the infection to each other’s and their families. HBV screening was given for some patients ordered by physicians as preoperative screening or diagnostic purposes, but no vaccination. The average of clients screened for HBsAg was 280 per month.

Study design: Hospital- based cross- sectional study.

Population: all patients who visited Negelle Arsi General Hospital and Medical College from July 01 to August 2020, South-East Ethiopia. Hospital staff and critically ill patients were excluded from the study.

Sample size determination and Sampling procedure: The sample size was calculated using the single population proportion formula, based on the prevalence from the previous study conducted in Yirgalem Hospital using 7.2% (18) using 95% confidence interval level (Zα/2=1.96) and margin of error to be 3% (d = 0.03). So, n= (1.96)²x 0.072 x (1-0.072)/ (0.03)²= 285. So, after adding 5% non-response, the final sample size was determined to be 300. Considering the laboratory request for hepatitis B surface antigen screening random, we included all patients whose samples were sent to the laboratory department for hepatitis B surface antigen screening until the required sample size was achieved.

Data collection technique and procedure: Face to- face interview using a pre-tested and structured questionnaire was used to collect data. The result for hepatitis B surface antigen was taken from the record. Training was given for supervisor and data collectors about data collection and sampling techniques. Data were collected by two Nurses and supervised by one Anesthetist.

Data processing and Analyzing: The data was cleaned and checked for completeness. Data was entered into Epi Data 3.1 and SPSS version 25 was used to analyze data. Descriptive statistics were computed and the result was presented in text and tables. Bivariable and multivariable logistic regressions was used to identify different associated factors of HBV infection. Odds ratio (OR) and 95% confidence interval (CI) were used to measure the strength of association between dependent and independent variables. In multivariable logistic regression P-value ≤ 0.05 was considered for statistical significance.

Ethical Consideration: Ethical clearance was obtained from the Ethical Review Committee of Negele Arsi General Hospital and Medical College. Verbal consent was acquired from all study participants, after they had been informed about the objective of the study. Confidentiality of the participants’ information was kept throughout the research processes.

Socio-demographic characteristics of respondents: All the 300 participants responded to the questionnaire, with a response rate of 100.0%. Among the participant, 104(34.7%) were age > 41 years, and 154(51.3%) of them were males. Three-fourth (76.0%) of the participants was married. Nearly a third of the study participants cannot read and write and housewife by occupation (Table 1).

Table 1: Distribution of socio-demographic characteristics of patients in Negele Arsi General Hospital and Medical College, February 2021 (n=300).

¹shows those divorced and widowed, ²shows Adventist and Catholic religion, ³shows driver and private employees.

Behavioral factors that affect seroprevalence of Hepatitis B virus infection: Among the responsents,  63(21.0%) have multi- sexual partner history. Having a tattoo, a habit of alcohol and sharing of sharp materials were 22.3%, 11.3%, and 41.0% respectively (Table-2).

Table 2: Behavioral factors that may affect seroprevalence of Hepatitis B virus infection, February (n=300).

Previous history that may affect seroprevalence of Hepatitis B virus infection: Among the responsents, 16(5.3%) have a history of blood transfusion. 253(84.3%) have a history of circumcision. Family history of HBV, history of dental extraction and

sexually transmitted disease were 14.0%, 44.0% and 18.3% respectively (Table-3).

Table 3: Previous history that may affect seroprevalence of Hepatitis B virus infection, February (n=300).

Seroprevalence of HBsAg

Among the patients screened for HBsAg for HBV infection, 39(13.0%) (95%CI: 9.5-17.2%) of them were positive for HBsAg result (Figure-1).

Figure 1: Laboratory result for HBsAg among patients screened for HBV in NAGHMC; south east Ethiopia, 2021.

Factors associated with seroprevalence of HBsAg in NAGHMC: Those variables that have P- value of ≤ 0.25 in binary logistic regression were transferred to multivariable logistic regression. Among the variables, the age of the respondent and family history of Hepatitis B virus was significantly associated with seroprevalence of HBsAg. Accordingly, participants in the age of 21-30 years were three

times more likely to have hepatitis B virus infection than participants in the age greater than 41 years (AOR = 3.0, 95% CI: 1.27, 7.11). and those who have a family history of Hepatitis B virus were three times riskier to hepatitis B virus as compared to those who have no family history of hepatitis B virus (AOR = 2.67, 95% CI: 1.16, 6.17) (Table 4).

Table 4: Factors associated with seroprevalence of HBsAg among patients in Negele Arsi General Hospital and Medical College, Ethiopia, 2021.

In this study, we found that the seroprevalence of hepatitis B virus infection was 13% (95% CI: 9.5-17.2%).  The variables significantly associated with seroprevalence of HBsAg among patients were the age of the patients from 21-30 years and family history of hepatitis B surface antigen.

Depending on the endemicity of Hepatitis B virus infection, countries are classified into high incidence countries (greater than 7%) like South- East Asia, China etc; intermediate incidence countries (2-7%) like Eastern Europe; or low (less than 2%) incidence countries like USA, Australia [8].

The seroprevalence of Hepatitis B virus infection in our study is similar with the study conducted in Ghana (10.8%) [9], and Wolaita Sodo University Teaching Referral Hospital 9.5% [10] and seroprevalence of HBV infection among pregnant women in Cameroon 10.2% [11].

However, our study finding is higher than a study conducted in Bahir dar which showed a seroprevalence of HBV infection among pregnant women was 3.8% [12] and study done among pregnant mothers attending antenatal care services in Harar health institutions, the overall seroprevalence of HBV positivity were 6.3% [13]. This may be because of our study involved all population.

Current findings were lower than the study conducted in Bale zone, Bale Robe town at Bereka Medical Center among patients with chronic hepatitis, the overall prevalence of Hepatitis B virus was 22.3 percent [14]. This may be because their study was performed on chronic hepatitis patients.

Africa is considered as a region of high endemicity as it is the second- largest number of chronic Hepatitis B virus carriers after the Asia continent. The overall prevalence of Hepatitis B virus and HCV in Ethiopia among the general population was 7.4% and 3.1% respectively [15]. But, the prevalence in our study area (13%) was somehow higher than even the study done in Ethiopia among the general population. This high prevalence may be because of the reason that our study focused on patients who visited our hospital for other diseases.

In this study, family history of HBV was one of the risk factors and this finding is supported by the study conducted in the general population in China that identified family history of Hepatitis B virus as risk factors [16]. Also, a study conducted in Sao Paulo, Brazil showed as a family history of hepatitis B virus was reported as the main risk factors associated with hepatitis B virus infection [17].

Overall, among patients who visited Negelle Arsi General Hospital and Medical College, the Seroprevalence of HBsAg was high. Age of the participants from 21-30 years and family history of hepatitis B virus were significantly associated with seroprevalence of hepatitis B surface antigen. Therefore, health education on transmission and prevention method should be prepared.

Data Availability: The data sets used and/or analyzed during this study are available from the corresponding author on reasonable request.

Funding: Not funded

Abbreviation: AOR – Adjusted Odds Ration; CI – Confidence Interval; COR – Crude Odds Ration; HBV – Hepatitis B virus; HBsAg – Hepatitis B surface antigen; NAGHMC – Negele Arsi General Hospital and Medical College.

Competing interests: None to declare

Authors’ contributions: All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Acknowledgements: Our heartfelt thanks go to all study participants and data collectors who participated in the study.  The authors would like to thank NAGHMC for the provision of facilities to conduct the study.