Introduction
Hepatitis B virus (HBV) remains a critical global public health challenge, with an estimated 254 million people living with HBV infection as of 2022. In sub-Saharan Africa, HBV prevalence among pregnant women varies widely, prompting urgent calls for routine antenatal screening and strengthened prevention of mother-to-child transmission (PMTCT). This article summarizes a study conducted in Babile district, Oromia, Eastern Ethiopia, which measured HBV sero-prevalence among pregnant women attending antenatal care (ANC) and explored associated risk factors that can guide local health policy and practice.
Study overview
A health facility-based cross-sectional study was carried out from February 26 to March 20, 2018, involving 293 pregnant women attending ANC at public health facilities in Babile district. Data collection combined a WHO-adapted questionnaire with blood sampling. HBsAg status was determined using a rapid diagnostic test (RDT) kit, with positive results confirmed by Enzyme-Linked Immunosorbent Assay (ELISA) to minimize false positives. Descriptive analyses and logistic regression identified factors linked to HBV infection.
Key findings
The study found an overall HBV sero-prevalence of 7.85% among pregnant women (23/293). This places the district in the high-intermediate endemicity category per WHO criteria, signaling a notable public health concern for maternal and child health programs in Babile.
Demographic and behavioral patterns showed higher positivity among younger women and those with lower educational attainment, with rural residents experiencing higher infection rates than urban counterparts. 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 or incision (AOR 5.21; 95% CI: 1.48–18.35)
– Traditional cutting of tonsil/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 underscore the role of unsafe medical practices, traditional procedures, and familial exposure in driving HBV transmission within this community.
Implications for PMTCT and policy
The findings highlight an urgent need to strengthen HBV screening within ANC services, enable timely birth-dose vaccination, and consider antiviral interventions for pregnant women with high viral loads. Integrating HBV testing into existing HIV/syphilis screening frameworks aligns with the WHO’s triple elimination initiative and Ethiopia’s goal to eliminate mother-to-child transmission by 2030.
Given resource constraints and regional variability, targeted public health actions in Babile should emphasize: routine HBsAg screening for all pregnant women during ANC, counseling and linkage to care for those who test positive, and ensuring birth-dose HBV vaccination within 24 hours of delivery where feasible. Community education about safe medical and traditional practices can further reduce transmission risk.
Comparison with other settings
HBV prevalence in this study (7.85%) is consistent with several Ethiopian and neighboring-country studies but higher than in some low-endemic regions. Differences may reflect variations in healthcare access, diagnostic methodologies, cultural practices, and exposure to unsafe medical procedures. Understanding local context is essential for tailoring interventions that reduce MTCT and improve maternal health outcomes.
Limitations and strengths
The study relied on HBsAg testing, which identifies current infections but not prior or resolved infections. As a cross-sectional snapshot, temporal relationships between risk factors and infection cannot be established. Exclusion of private facilities could bias results toward lower-income populations. Additionally, not all RDT-positive results were confirmed by ELISA in this study, which may affect prevalence estimates. Despite these limitations, the study provides actionable insights into HBV transmission dynamics in a rural Ethiopian district.
Conclusions
HBV infection among pregnant women in Babile district is at a high-intermediate level, with substantial implications for maternal and child health strategies. Independent risk factors—blood transfusion history, past surgical procedures, traditional tonsil/uvula cutting, and family history of hepatitis B—offer clear targets for strengthening antenatal screening, PMTCT efforts, and community education. Implementing routine HBV testing in ANC and ensuring birth-dose vaccination could contribute to Ethiopia’s broader HBV elimination goals and the WHO triple elimination framework.
Recommendations
- Integrate HBV screening into all ANC visits in Babile district public health facilities.
- Strengthen safety protocols for medical and traditional procedures to reduce transmission risk.
- Establish robust referral pathways for HBV-positive pregnant women and ensure access to birth-dose vaccination
- Educate communities about HBV transmission, prevention, and the importance of routine prenatal screening.
