Factors Associated with Hepatitis B Surface Antigen Seropositivity among Pregnant Women in Kigali, Rwanda: A Cross Sectional Study

Abstract

Background: Hepatitis B virus (HBV) is the commonest cause of chronic viral hepatitis which is responsible for up to 80% of primary liver cancers. Pregnant women who are carriers of the virus pose a significant risk to their health and unborn babies. Majority of countries in developing world have not yet adopted universal screening for pregnant women. Therefore, this study aimed at determining the prevalence and associated risk factors of hepatitis B surface antigen (HBsAg) among pregnant women in Kigali. Methods: A multicenter, facility based cross-sectional study was conducted on 385 pregnant women visiting antenatal care between May and August 2013. Data on socio-demographic information and possible risk factors of HBV were collected using a pretested structured questionnaire. Blood samples were collected for the detection of HBsAg using a standard diagnostics INC Bioline HBsAg test device followed by confirmatory ELISA for the positive samples. The results were analyzed using descriptive statistics and binary logistic regression. Crude and adjusted odds ratios with corresponding 95% confidence interval (CI) were calculated. A p-value of less than 0.05 was considered significant. Results: Of the 385 pregnant women enrolled in this study, 3.1% (95% CI=1.4% to 4.8%) were found to be seropositive for HBsAg. Pregnant women who ever worked in hospital (AOR=12.7; 95% CI=2.21-72.57; P=0.004) and had history of gestational diabetes (AOR=10.9; 95% CI=1.87-63.52; P=0.008) were independently associated with HBsAg seropositivity. Though, history of HBV infection in family member was significantly associated during bivariate analysis, it was insignificant in multivariable analysis. Conclusion: This study indicates that Kigali has intermediate endemicity of HBV among pregnant women. Considering the severity of the infection, HBV is important public health issue in the study area that needs to be addressed. Universal and free ante-natal screening and/or vaccination should be adopted. Moreover, awareness and vaccination coverage to be expanded for healthcare staff, gestational diabetes and family contacts of infected individuals.