Introduction
Hepatitis B virus (HBV) remains a major global public health challenge, with an estimated 254 million people living with chronic HBV infection worldwide as of 2022. Mother-to-child transmission (MTCT) is a key driver of chronic HBV cases, particularly in high-endemic regions. In sub-Saharan Africa, prevalence among pregnant women varies widely, underscoring the need for local data to guide prevention strategies. This article synthesizes findings from a facility-based study conducted in public health facilities in Babile district, Oromia, Eastern Ethiopia, to determine the sero-prevalence of HBV among pregnant women attending antenatal care (ANC) and identify associated factors that could inform targeted interventions at the district and national levels.
Study overview and methods
The research used a cross-sectional design conducted from February 26 to March 20, 2018, enrolling 293 pregnant women attending ANC across five public facilities in Babile district. Participants provided socio-demographic and obstetric history data via WHO-adapted questionnaires. Blood samples were screened for HBsAg using rapid diagnostic tests (RDTs), with positive results confirmed by Enzyme-Linked Immunosorbent Assay (ELISA). Data analysis involved descriptive statistics and both bivariate and multivariable logistic regression to identify independent predictors of HBsAg positivity, with a significance threshold of P ≤ 0.05.
Key findings: HBV prevalence among pregnant women
The study found an overall HBsAg seroprevalence of 7.85% (23/293) among pregnant women in Babile, placing the district in the high-intermediate endemic category according to World Health Organization (WHO) criteria. Notably, prevalence tended to be higher among younger women and those residing in rural areas, though the confidence intervals reflect statistical uncertainty due to sample size.
Independent risk factors for HBV infection
Multivariable analysis identified four independent predictors of HBsAg positivity:
– History of blood transfusion (AOR 4.75; 95% CI: 1.19–18.92)
– Previous history of any surgical procedure/incision (AOR 5.21; 95% CI: 1.48–18.35)
– Traditional cutting of the tonsils/uvula (AOR 5.82; 95% CI: 1.63–20.75)
– Family history of hepatitis B infection (AOR 5.82; 95% CI: 1.63–20.75)
These associations suggest that unsafe medical practices and close contact with infected household members may contribute to HBV transmission in this setting. Other variables (e.g., nose piercing, tooth extraction, STI history) showed weaker or non-significant associations after adjustment.
Interpretation and public health implications
The 7.85% prevalence indicates that pregnant women in Babile face a substantial burden of HBV infection. This finding has several implications for maternal and child health policies:
– Integrate routine HBV screening into ANC services to identify positive cases early.
– Ensure timely birth-dose vaccination (within 24 hours of delivery) and completion of the HBV vaccine series for newborns to prevent MTCT as part of broader elimination goals.
– Strengthen infection prevention in health facilities and community settings to minimize transmission through unsafe medical practices and traditional procedures.
– Establish linkage-to-care pathways for HBsAg-positive mothers, including evaluation for antiviral therapy where indicated by viral load and liver status.
Limitations and context for interpretation
Limitations include testing only for HBsAg (capturing current infection but not past exposure) and potential selection bias from excluding private facilities. The cross-sectional design precludes causal inferences, and some associations had wide confidence intervals due to limited events. Nonetheless, the study provides crucial local evidence to guide ANC programming in Babile and similar districts.
Recommendations for action
- Formalize HBV screening as part of ANC in Babile, with consented testing and counseling for all pregnant women.
- Coordinate with immunization programs to ensure the hepatitis B birth dose and recommended vaccination schedule are available and affordable for newborns.
- Enhance infection prevention training for healthcare workers and address culturally rooted practices involving non-sterile equipment.
- Promote community education on HBV transmission, emphasizing the importance of safe medical procedures and family risk awareness.
Conclusion
The HBV seroprevalence of 7.85% among pregnant women in Babile indicates a high-intermediate endemicity with significant implications for MTCT prevention and ANC policies. By integrating systematic HBV screening, ensuring timely neonatal vaccination, and reinforcing safe medical and traditional practices, health authorities can advance Ethiopia’s 2030 goal of eliminating MTCT and reducing the HBV disease burden in vulnerable populations.
