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This was a cross-sectional study carried out among the pregnant population in five healthcare facilities in Jos, between November 1, 2017 and April 30, 2018. Informed consent was obtained, and data on sociodemographic and risk factors for hepatitis B virus (HBV) infection were collected. Hepatitis B viral infection was assessed using the in vitro HBsAg diagnostic rapid kit (Acon Laboratories, USA). Descriptive statistics, Chi-square test, and logistic regression were performed to identify predictors of HBV infection in the study population. All statistical analyses were carried out on STATA version.


Globally, estimates suggest that over 250 million people are living with chronic Hepatitis B Virus (HBV) infection, with 4.5 million new HBV infections, and 880,000 HBV-related deaths occurring yearly.[1] The highest prevalence of HBV disease of over 8% is reported in Central Asia, Southeast Asia, sub-Saharan Africa, and the Amazon basin; followed by an intermediate prevalence of 2%–8% reported in the Middle-East, South Asia, some Eastern European countries, and the Mediterranean basin; and the lowest prevalence of < 1% is reported in the United States, Western Europe, Australia, and parts of South America. In HBV endemic regions, the lifetime risk of HBV exposure is universal and 5%–10% of the adults have chronic HBV infection.[2,3]
The differences in the HBV burden across regions are reflected in the modes of transmission and the burden of pediatric HBV infection. In high prevalence regions, HBV is predominantly transmitted in the perinatal period or early childhood, accounting for over 50% of chronic HBV infection in the adult population.[4,5,6] The risk for the development of chronic hepatitis B infection varies inversely with the age at which acute hepatitis B infection occurs.[7,8] The risk for chronic HBV infection is about 90% if infected at birth or infancy, 30%–50% in children aged 1–6 years, and 5%–10% in children above the age of 6 years to adulthood.[9] Chronic HBV infection acquired in childhood carries a 25% risk of death resulting from complications of chronic liver disease, cirrhosis, or hepatocellular carcinoma.[10]
Although a higher prevalence of HBV infection is reported among surgeons (25.7%), voluntary blood donors (23.4%), and infants (25.7%), Hepatitis B surface antigenemia (HBsAg) studies of pregnant women in Nigeria have revealed HBV prevalence of between 2% and 15.2%.[11,12] In Zaria and Ilorin both in Northern-central Nigeria, studies showed HBV prevalence in pregnancy to be 8.2% and 5.7%, respectively.[13,14] Previous studies on risk factors for HBV infection in pregnancy have shown that high parity, history of blood transfusion, HBV infection in family members, tattooing, and previous surgeries are known risk factors for HBV infection in pregnancy.[15] However, other studies showed no association with a history of multiple sexual partners, previous surgeries, blood transfusion, and circumcision.[16]
There is a paucity of studies on the prevalence and risk factors of HBV in pregnancy, a window of opportunity in the global strategies to reduce HBV prevalence.[17] HBV infection in pregnancy is not only a determinant for vertical transmission, but also has the potential for horizontal transmission to close contacts and remains a significant source of HBV infection. A better understanding of the HBV epidemiology in pregnancy is crucial to developing or adopting strategies to reduce pediatric HBV infection and ultimately reduce its socioeconomic burden. In this study, we sought to determine the prevalence of HBV infection and associated risk factors among pregnant women in Jos, Nigeria.
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This cross-sectional study was conducted in five health facilities in Jos, North-Central Nigeria: Jos University Teaching Hospital (JUTH), Plateau State Specialist Hospital (PSSH), Bingham University Teaching Hospital (BHUTH), Faith Alive Foundation Hospital (FAF), and Our Lady of Apostles Hospital (OLA), together with caring for about 40% of pregnant women in this area.[18] Ethical approvals were obtained from the five Institutional Health Committees on ethics and research.
This study sampled antenatal clinic attendees between November 1, 2017 and April 30, 2018, at their first or second visit after obtaining informed written consent.
Data on socio-demographics, obstetric, and sexual risk factors for HBV infection were collected. HBV was tested using the in vitro diagnostic assay for HBsAg manufactured by Wondfo Biotech Co. Ltd, USA. The test kit (dipsticks) was a rapid immune-chromatographic assay designed for the qualitative determination of the HBsAg in plasma. Twenty-five microliters of blood were placed into the specimen pot of the cassette and a drop of the buffer solution was added. A single red or pink band in the control region indicated a negative result, while two bands each at the control and the test region indicated a positive result. The test was deemed invalid if a single band appeared at the test region and thus was repeated. The study participants who were found to be positive for HBsAg were referred to the Gastro-Intestinal unit for further clinical evaluation and care. In addition, blood samples were tested for HIV-1 and HIV-2 antibodies according to the National HIV testing algorithm.
All statistical analyses were performed on STATA 15 (Corp LP, USA). We performed descriptive statistics and relevant tests of hypotheses to identify risk factors for HBV infection in the study population. We further built a multivariable logistic regression model for risk factors that were associated with HBV (P < 0.05) to identify independent predictors of HBV infection among pregnant women. The results were presented as adjusted odds ratio (aOR), with a 95% confidence interval (CI). A value of P < 0.05 was considered statistically significant.
We thank the participants, midwives, counselors, and laboratory staff in the five study sites for their commitments to the study. We equally thank the data assistant, who ensured that all the data was captured for the analysis.


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