• Research Article
  • |
  • Open Access
  • |
  • ISSN: 2637-4501

Sero-Prevalence of Hepatitis B Virus Infection Among Patients Attending at Addis Alem Primary Hospital, Bahir Dar, Northwest Ethiopia

    • Mekuanint Geta Alemneh*;
      • Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
    • Endalew Yizengaw;
      • Departments of Microbiology, Immunology and Parasitology, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
    • Zegeye Getaneh;
      • Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
    • Tamyalew Getahun
      • Addis Alem Hospital Laboratory department, Bahir Dar, Ethiopia.

  • Corresponding Author(s): Mekuanint Geta Alemneh

  • Department of Medical Microbiology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, 196, University of Gondar, Ethiopia.

  • yageta23@gmail.com

  • Geta M (2021).

  • This Article is distributed under the terms of Creative Commons Attribution 4.0 International License

Received : Dec 10, 2020
Accepted : Feb 12, 2021
Published Online : Feb 16, 2021
Journal : Annals of Gastroenterology and the Digestive System
Publisher : MedDocs Publishers LLC
Online edition : http://meddocsonline.org

Cite this article: Clerc SL, Ulveling D, Jeanmougin M, Labib T, Spadoni JL et al. Genome-Wide Association Study Reveals Three New Loci Associated with Liver Fibrosis Severity in HIV-HCV Co-Infected Patients. Ann Gastroenterol Dig Syst. 2021; 4(1): 1033.

Keywords: HBV; HBsAg; Addis alem; Bahir dar.

Abbreviation: DNA: Deoxyribonucleic Acid; ELISA: Enzyme Linked Immunosorbent Assay; HBV: Hepatitis B Virus; HCC: Hepatocellular carcinoma; NAAT: Nucleic Acid Amplification Technique; STI: Sexually Transmitted Infection; VCT: Voluntary Counselling and Testing.

Abstract

      Background: Hepatitis B Virus (HBV) causes severe liver disease, such as Hepatocellular Carcinoma (HCC) and life- threatening liver disease. Hepatitis B virus infection is one of the most dominant public health problems these days. Therefore, this study aimed to determine the seropreva- lence of HBV infection among patients attending Addis Alem Hospital, Bahir Dar, Northwest Ethiopia.

      Methods: A retrospective study was conducted from January to February 2019 on HBV registered from January 2016 to December 2018. The presence of HBsAg in serum was detected using the One Step Cassette Style HBsAg test kit. Data were analyzed using SPSS version 20. Descriptive statistics were used to describe the characteristics of par- ticipants with HBV infection. Statistical association of the determinants with HBV infection was determined by the X2 test.

      Results: In this study, a total of 2010 participants of HBsAg rapid test records in the laboratory logbook were included. The median age of women was 25 years. The overall seroprevalence of HBsAg was 78 (3.9%). There was a general increment of HBV infection from 2016 to 2018, X2

      =7.52; P=0.023. Age (X2=8.19; P=0.042) and sex (X2=37.77; P

      <0.001) were associated with HBsAg positivity.

      Conclusion and recommendations: An intermediate se- roprevalence of HBV infection was detected among partici- pants in our study area. This figure raises significant public health concerns. Therefore, implementing strategies for routine screening of women for HBV and hospital atten- dants would be critical.

Background

      Hepatotropic viruses cause most cases of hepatitis world- wide. Hepatitis B Virus (HBV), a Hepadnaviridae [1], is one of these viruses which causes severe liver disease, such as Hepa- tocellular Carcinoma (HCC) and life-threatening liver disease. Hepatitis remains one of the most dominant public health prob- lems these days. Hepatitis B virus infection is the critical cause of diseases and death worldwide [2,3].

      Hepatitis B virus infection is limited to the liver cells of hu- mans and causes cirrhosis and HCC. This infection is still ac- counting for a significant proportion of morbidity and mortality.

      Globally, 2 billion people are infected with HBV, 350 million people are estimated to be chronically infected [4,5], and 50 million people are newly infected with hepatitis B every year [6]. The prevalence of chronic HBV infection is variable through- out the world, ranging from < 1% in areas of low endemicity to over 30% in highly endemic areas. Africa has the second largest number of chronic carriers of HBsAg (>8%) next to Asia, which is considered a region of high endemicity [5,7,8]. Ethiopia, being part of this region, is ranked as an area with medium to high endemicity for HBV infection [9-10]. Worldwide, HBV infection is estimated to be the cause of 50% of reported cases of cirrho- sis and 30% of liver cancer, and over 500,000 people die from them each year [11]. Cirrhosis, liver failure, and hepatocellular carcinoma develop in 15–40% of chronically HBV infected indi- viduals [2,12].

      In highly endemic settings, perinatal, and horizontal (Expo- sure to chronically infected household members) routes are re- sponsible for most disease transmission [13]. But in low preva- lence countries, the Hepatitis B virus is transmitted parenterally [14]. Adults infected with HBV usually develop acute hepatitis and recover. Infected children rarely develop the acute disease, but 25 to 90% become chronic carriers [15]. Infection with HBV is highest among developing countries. Ethiopia is among the high burden countries for HBV infection [16], 7.4% in the gen- eral population [17]. Therefore, this study aimed to determine the seroprevalence of HBV for the last three years using labora- tory recorded data (log book) to fill the existing epidemiologic gap in the area.

Methods

Study area, period and design

      From January to February 2019, a retrospective cross-sec- tional study was conducted on HBsAg registered from January 2016 to December 2018. The research was done in Northwest Ethiopia, in Bahir Dar. Bahir Dar is situated 556 kilometers from Addis Ababa, Ethiopia’s capital city. It is one of the tourist des- tinations places in Ethiopia, which contains the largest lake in Ethiopia: Lake Tana, which gives birth to the Blue Nile. Some twenty of these shelter churches and monasteries of immense historical and cultural interest, decorated with beautiful paint- ings and housing innumerable treasures. The study was con- ducted at Addis Alem Primary Hospital found in this town.

Population

      The study population consisted of all clients who gave blood, were screened for HBV, and reported in the laboratory logbook at the Addis Alem Hospital from January 2016 to December 2018.

Data collection tool

      The checklist was used to obtain information on HBV status, gender, age, and the department that requested the exam. Fur- ther data on different factors associated with HBV infection was problematic because the logbook contained small variables.

Laboratory investigation

      The hepatitis B surface antigen (HBsAg) was requested as part of the antenatal care panel and for clinical suspicion of liver disease. The presence of HBsAg in serum was detected using a One Step Cassette Style HBsAg test kit (Nantog genes Biotech Co. Ltd, China) by following the Manufacturer’s instructions.

Quality control

      To ensure the consistency of the data, the necessary data were obtained from the laboratory logbook and reviewed thor- oughly every day for completeness and accuracy. Software data has been tested carefully for errors, implausible values, and discrepancies that may be due to encoding, input, typing, and other errors. HBsAg positive clients’ serum was double-checked using ELISA in the referral laboratory located in the city.

Data processing, analysis and interpretation

      Data were entered and analyzed using version 20 of the Sta- tistical Package for Social Sciences (SPSS). Descriptive statistics (frequency, median, percentage) were used to define the char- acteristics of HBV participants. The Pearson Chi-squire (X2) test was used to determine the relationship between categorical variables. The Chi-square trend test was used to analyze year- by-year changes in patterns.

Ethical consideration

      Ethical approval was received from the Ethical Committee of the University of Gondar, College of Medicine and Health Sci- ence, Biomedical School and Laboratory Sciences Research. The study used data previously obtained from patients. The Addis Alem Hospital Administration and clinical management com- mittee have waived the requirement to seek approval from cus- tomers.

Results

      Among 2010 screened patients, 616 (30.6%), 1151 (57.3%) and 243 (12.1%) patients were screened for HBV in 2016, 2017 and 2018 respectively. Among the screened patients, 1893 (94.2%) were females, and 117 (5.8%) were males with a me- dian age of 25 years (Table 1). Within the year 2016, 2017, and 2018 screened patients, 591 (95.9%), 1068 (92.8%), and 234 (96.3%) were females, respectively. The majority of participants 427 (69.3%), 735 (63.9), and 168 (69.1%) patients were in the age group of 21-30 years screened in 2016, 2017, and 2018 respectively. Most of the participants (95%) in this study were from urban residency (Table 2).

table 1 Table 1

Table 1: Socio-demographic characteristics of study participants screened for HBV from 2016-2018, (n=2010), Northwest Ethiopia, 2019.

table 2 Table 2

Table 2: The distribution of participants characteristics within consecutive three years, (n = 2010), Northwest Ethiopia, 2019.

      EOPD- Emergency outpatient department, ANC- Antenatal care unit, OPD-Outpatient department

      From all patients screened, the total prevalence of HBsAg in this study was 78/2010 (3.9% with 95% CI 3.1, 4.8). The serop- revalence of HBV infection in each consecutive year was 16/616 (2.6%), 46/1151 (4.0%), and 16/243 (6.6%), respectively (Figure 1). The trend of HBV infection was increasing and statistically significant change in seropositivity from the year 2016 to 2018  Table 3). The positivity rate was higher in females 61/2010 (3.0%) than males 17/2010 (0.8%). This difference was statisti- cally significant with HBV infection, X2=37.7; P< 0.001.

...

Figure 1: Trends of HBsAg positivity from 2016-2018 at Addis Alem Hospital, Northwest Ethiopia, 2019.

      From the total patients requested for HBV screening in the hospital, 76 (3.8%) were positive for HBsAg in urban patients, whereas 2 (0.1%) were positive in rural patients. The seroprev- alence of HBV infection was higher in the age group of 21-30 years, 48/2010 (2.4%) than their counterparts. This was statis- tically significant with HBsAg seropositivity, X2 = 8.2; P=0.042. Among the requested patients from different examination de- partments, the highest prevalence reported from the antenatal care unit 44/2010 (2.2%) followed by the emergency outpatient department accounts for 22/2010 (1.1%). This was statistically significant with X2 =73.9; P < 0.001 (Table 3).

table 3 Table 3

Table 3: Sero-prevalence of HBV infection with respect to sociodemographic characteristics and different years of screening (n=2010), Northwest Ethiopia, 2019.

Discussion

      The cases selected for our study were all patients who seek screening for HBV infection. The lab tests employed were all standard and reliable. It is easy to compare our findings with other hospital-based similar studies where the cases selected are the clinically suspected ones coming to the hospital seeking treatment.

      Sexually transmitted infections (STIs) including HBV are widespread in developing countries and constitute a major pub- lic health problem in sub-Saharan Africa [18]. Hepatitis B sur- face antigen (HBsAg) is the main marker indicating endemicity of HBV infection in the general population of a particular geo- graphical area [19]. The classification of low, intermediate, and high endemicity for HBV infection has been defined as HBsAg less than 2%, 2 to 7%, and greater than 7% in an adult popula- tion respectively [20].

      In the present study, we found 3.9% (95% CI, 3.0-4.7%) of the overall seroprevalence of HBsAg among patients screened for HBV infection in Addis Alem primary Hospital. Based on the WHO classification, the prevalence of HBV infection in this study was classified as “Intermediate”. This figure is still high if we compute the general population of Ethiopia as these days it is close to 100, million. In addition, it is assumed that the rate might be increased more if this study is done in different geo- graphical areas. Therefore, HBV infection was a particular prob- lem might be due to the possibility of all the population infected with HBV.

      In our study, the prevalence rate of HBsAg was comparable with a study conducted in Gondar University Teaching Hospital on blood donors 4.7% [21] and Addis Ababa 3.0% [22]. How- ever, our study finding was lower than when compared to study done in Gondar, Ethiopia among street dwellers 10.9% [23] and among medical waste handlers 6% [24], on donors at Bahir Dar, Ethiopia 25% [25], among blood donors in Amhara and Tigray regional states, Ethiopia 6.2% [26], among patients with chronic hepatitis, southeast Ethiopia 22.3% [27], among VCT clients, southern Ethiopia 5.7% [28], in Addis Ababa, Ethiopia among medical waste handlers 6.3% [29] and among general popula- tion higher than 7% [9], and Jigjiga, Ethiopia (10.9) [30], in Nigeria among blood donors 10.9% [31] and 18.6% [32]. In contrast, our study was higher than a study conducted in Eretria on blood donors 2.6% [33] and 2.0% [34], and the study reported Japan 0.8% [5].

      These differences might be suggested to sample size dif- ference, geographical variation, method of detection, cultural practice difference, and behavioural divergences for the risk factors, and the degree of HBV endemicity often correlates with the predominant mode of transmission. Furthermore, the vari- ation might be also due to different study designs and methods for the assay of HBV infection used.

      In this study, the highest prevalence was recorded among the age group between 21-30 years 48/2010 (2.4%), which was higher than all other age groups 1.5%. The infectivity of HBV seems to be skewed towards persons younger than 30 years of age as the majority of the clients in this age group were HBsAg positive. In our opinion, the reason behind the high rate of HBV in this age group is most probably the high infectivity potential of the virus, immunization status, cultural practices which could expose to HBV infection like circumcisions, tattooing, bloodlet- ting exercises to treat different diseases. But a study conducted  in Ghana on blood donors, revealed that the highest seropreva- lence was among the 30–39 years age group 8.9% [35] which was not in agreement with our study. Sixty-one (3.0%) females were tested positive as compared to 17 (0.8%) males. This was supported by another study done by Walana W et al. (14.3%) of females as compared to (6.7%) males [35]. Almost all, 76/78 (97.4) of all HBsAg positives were from urban.

      The trend analysis performed showed that HBV infection significantly increased from 16 (2.6%), 46(4.0%), and 16 (6.6%) for the last three consecutive years. This might be due to an increased focus and frequent HBV screening for all suspected attendants in the hospital. The limitation of our study is the method that we employed. HBsAg detection method can also be questioned because it used a rapid chromatographic immu- noassay for the first 3 years. Another limitation is that labora- tory tests have been limited to the detection of HBsAg, without checking the markers of viral replication, as HBeAg or HBV DNA, for economic reasons. So, our results would have been more genuine if we had been able to perform ELISA and Nucleic Acid Amplification Technique (NAAT).

Conclusions

      An intermediate prevalence of HBV infection was detected among study participants in our study area. Because hospital attendant clients are among vulnerable population groups, the figure raises serious public health concerns. Therefore, imple- menting strategies for routine screening of all patients attend- ing Hospitals for HBV would be critical.

Declarations

Ethical considerations

      Ethical clearance was first obtained from the ethical review committee of school of Biomedical and Laboratory Sciences, University of Gondar.

Availability of data and materials

      The original data used for this study are available at the cor- responding author, so that interested reader can get the data from the corresponding author with reasonable request.

Competing interests

      The authors declared that we have no competing interests regarding the publication of this article.

Authors' contributions

      MG: Primary researcher conceived the idea for this study. MG, TG, ZG, and EY participated in data collection, conducted data analysis, drafted and finalized the manuscript for publica- tion. All authors read and approved the final manuscript

Acknowledgments

      We have a great appreciation to University of Gondar for giv- ing the technical support during analysis and write up of this article. We would also like to acknowledge Addis Alem Hospital

      Laboratory staffs who actively participated in the collection of this data.

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