PREVALENCE OF HEPATITIS B AND C COINFECTION VIRUS AMONG PREGNANT WOMEN

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PREVALENCE OF HEPATITIS B AND C COINFECTION VIRUS AMONG PREGNANT WOMEN

A CASE STUDY OF MODEL HOSPITAL NASARAWA

ABSTRACT

The study investigated the prevalence of hepatitis B and C coinfection virus among pregnant women, a case study of General Hospital Nasarawa with the specific objective to determine the prevalence of Hepatitis B and C co-infection among pregnant women and to determine the prevalence of HBV and HCV co-infection in relation to some socio-demographic and risk factors, namely, sex, age, marital status and occupation. The population of the study were pregnant women attending antenatal in general hospitalNasarawa. The results of this study showed that the prevalence of HBsAg and HCsAg among pregnant women attending antenatal in general hospital was 11% which according to the WHO classification for Hepatitis B and C endemicity, Nasarawa is a hyper-endemic area for hepatitis B and C virus infection. This prevalence is identical to the study at the Ahmadu Bello University Teaching Hospital Zaria (ABUTH), Nigeria 11% respectively (Eke et al., 2011). Finally, it is recommended that pregnant woman should be mandatorily and routinely screened for hepatitis B and C virus infection as part of antenatal care services in their booking; also infants and new borns must be systematically immunized against hepatitis B and C virus infection. Public awareness, complete immunization against viral hepatitis, better sanitation facilities, safe drinking water, increased availability of antenatal care for early detection and well equipped hospitals for intensive care will go long way in the reduction of viral hepatitis in pregnancy and also its associated maternal and per-natal mortality and morbidity.

CHAPTER ONE

            INTRODUCTION

Hepatitis B and C are one of the major and common infectious diseases of the liver worldwide caused by a small enveloped DNA virus, the hepatitis B and C virus (HBV and HCV). Nigeria is classified among the group of countries endemic for HBV and HCV infection ((Sirisenaet al, 2002). Currently about 18 million Nigerians are infected. Many of these people may not be aware of the infection and hence fail to seek appropriate medical attention therefore progressing to chronic liver disease, cirrhosis and hepatocellular carcinoma. Similarly when pregnant women are involved, they constitute a serious health risk not only to their unborn child but also the society at large (Jomboet al, 2005).

Hepatitis B is an infectious illness of the liver caused by the hepatitis B virus (HBV) that affects apes, including humans (Chang, 2007; Barker et al.,1996). The virus was first discovered as “Australia antigen”, later named hepatitis B surface antigen (HBsAg), in patient blood. Hepatitis Be antigen (HBeAg) was identified several years later as a marker for patients at high risk for transmission of the disease (Tong et al, 2005). The acute illness causes liver inflammation, vomiting, jaundice, and rarely, death. Chronic hepatitis B may eventually cause cirrhosis and liver cancer – a disease with poor response to all but a few current therapies (Tong et al, 2005).

The virus is transmitted by exposure to infectious blood or body fluids such as semen and vaginal fluids, while viral DNA has been detected in the saliva, tears, and urine of chronic carriers. Prenatal infection is a major route of infection in areas of the world where the disease is common (Chang, 2007). Other risk factors for developing HBV infection include working in a healthcare setting, transfusions, dialysis, sharing razors or toothbrushes with an infected person, travel in countries where it is common, and living in an institution. Tattooing and acupuncture led to a significant number of cases in the 1980s; however, this has become less common with improved sterility. The hepatitis B viruses cannot be spread by holding hands, sharing eating utensils or drinking glasses, kissing, hugging, coughing, sneezing, or breastfeeding(Chang, 2007).

Hepatitis B and C virus are  hepadnavirus-hepa from hepatotropic (attracted to the liver) and DNA because it is a DNA virus – and it has a circular genome of partially double-stranded DNA. The viruses replicate through an RNA intermediate form by reverse transcription, which in practice relates them to retroviruses. Although replication takes place in the liver, the virus spreads to the blood where viral proteins and antibodies against them are found in infected people. The hepatitis B virus is 50 to 100 times more infectious than HIV (Hiuet al., 2005)

The prevalence of HBV and HCV in a population is related to risk factors associated with the transmission, such as blood transfusion and blood products, dental and surgical procedures, use of tattoos, accidents with biological material, use of injectable substances, besides the sexual and vertical routes (Bruggmann, et al., 2014).

Maternal-fetal transmission is of great importance in the epi­demiology of viral hepatitis. In children of HBV infected mothers, vertical transmission carries a risk of progression to chronicity in 70%–90% of the cases(14,15). The present study had as objectives: to determine the seropreva­lence of hepatitis B and C in the prenatal patients of the Hospital HospitalUniversitárioAntônio Pedro, Niterói, Rio de Janeiro; to compare the data found with the regional data and those described in the specific literature and to provide demographic, clinical and epidemiological data to the literature that may be used for the formulation of policies in the area (Andrade et al., 2015).

There are few studies in national and international literature addressing the prevalence of the coinfection of hepatitis B and C in pregnant women. As this is still a worldwide worrying and the early detection in prenatal care can avoid a series of deleterious outcomes for the pregnant woman and its child, the concern of deepening the study in this area arose with a more accurate evaluation of the epidemiological profile of pregnant women from the Nigeria and Nasarawa in particular. Thus, prenatal exams provide a great opportunity for screening and identifying these viruses in this population that could serve as a natural reservoir for future generations.

1.0       STATEMENT OF PROBLEM

Hepatitis B and C are life-threatening liver disease, caused by hepatitis B and C virus, and is a major public health problem, particularly in developing countries like Nigeria(Andrade et al., 2015). The prevalence of HBV and HCV in a population can be predicted by risk factors associated with the transmission of infection such as injections, blood products transfusion, surgical procedures, body tattooing, occupational injury, sexual and vertical transmission (Akbar et al., 2017) many infected individuals deny history of any of these risks so that the likely source remains unidentified in some subjects however, the prevalence varies from area to area and population to population due to variability in ethnicity and socioeconomic conditions (Haider et al., 2018). Viral hepatitis during pregnancy is associated with high risk of maternal complications. Infections with the Hepatitis B virus (HBV) or the Hepatitis C virus (HCV) are public health problems and are highly endemic in the sub-Saharan Africa (Haider et al., 2018). HBV and HCV infections are a major cause of morbidity and mortality. The virus is transmitted through infected blood, sexually and vertically (mother to child) in the perinatal period. Perinatal transmission is the most common mode of HBV transmission worldwide (Kuru, 2016).

Although, studies have been carried out on HBV and HCV in other parts of the country, information is very scarce on the prevalence of the coinfection of HBV and HCV among pregnant women attending antenatal in General Hospital Nasarawa. As a result guidelines and other adequate information on the prevention and control strategies are lacking. This is because effective public health policy and awareness campaign for the need to know one’s hepatitis B and C status is lacking. Are people even aware of this hepatitis B and C virus? How can it be transmitted? What are the signs, symptoms and prevention and control?These questions give rise to the need to carry out this study on the prevalence of Hepatitis B and C coinfection virus among pregnant women attending General Hospital Nasarawa.

1.1       Aim and Objectives ofthe Study

1.2       Aim

The aim of this study is to investigate the prevalence of hepatitis B and C coinfection virus among pregnant women, a case study of Model Hospital Nasarawa

Objectives

To determine the prevalence of Hepatitis B and C co-infection among pregnant women

To determine the prevalence of HBV and HCV co-infection in relation to some socio-

demographic and risk factors, namely, sex, age, marital status and occupation

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