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      Hepatitis B virus infection among pregnant women in Ethiopia: a systematic review and Meta-analysis of prevalence studies

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          Abstract

          Background

          There are several epidemiological studies available on hepatitis B virus among pregnant women in Ethiopia. These individual studies revealed wide variation over time and across geographical areas. The aim of this systematic review and Meta-analysis is to estimate the overall prevalence of hepatitis B virus infection among pregnant women in Ethiopia.

          Methods

          A comprehensive search of electronic databases including PubMed, Popline, Lalicus, Ovid, MedNar, African Journal Online (AJOL) and advanced Google Scholar was conducted regardless of publication year from August 30, 2017 to September 25, 2017. The search was updated on January 02, 2018 to minimize time-lag bias. The methodological qualities of included studies were assessed using Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments.

          Results

          Out of 103 studies, 17 studies with a total of 5629 pregnant women were included in the Meta-analysis. The pooled prevalence of hepatitis B virus infection among pregnant women using random-effect model was 4.7%(95% CI 4.0–5.4%). The I 2 statistics was I 2 = 37.9%( p = 0.0575). Even though significant heterogeneity among studies was not detected, the I 2 = 37.9% suggests medium heterogeneity. A subgroup Meta-analysis showed that study site, region, mean/median sample size, hepatitis B virus screening methods and methodological quality were not source of heterogeneity (p-difference > 0.05).

          Conclusion

          This review shows an intermediate level of hepatitis B virus infection among pregnant women in Ethiopia. In addition to the current practice of child vaccination, routine and universal antenatal hepatitis B virus screening program need to be implemented.

          Electronic supplementary material

          The online version of this article (10.1186/s12879-018-3234-2) contains supplementary material, which is available to authorized users.

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          Most cited references31

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          Hepatitis B in Ghana: a systematic review & meta-analysis of prevalence studies (1995-2015)

          Richard Ofori-Asenso, Akosua Agyeman (2016)
          Background Although, chronic hepatitis B (HBV) is considered to be of significant public health importance in Ghana, not many reviews detailing the burden (prevalence) of the disease have been conducted. This study was aimed at summarizing the available information and to make an accurate estimate of HBV infection prevalence in Ghana over the last two decades (1995–2015). Methods A systematic search was conducted in PubMed, ScienceDirect, Google Scholar and Africa Journals Online (AJOL) databases to retrieve primary studies published between 1st January 1995 and 4th October 2015, assessing the prevalence of HBV among populations in Ghana. This was supplemented by a manual search of retrieved references. Results Thirty (30) studies across all the ten (10) regions of Ghana and involving an overall population size of 105,435 were analyzed. The national prevalence of HBV as determined by HBsAg seropositivity was 12.3 %. HBV prevalence among voluntary blood donors (VBDs), replacement blood donors (RBDs) and pregnant women were 10.8, 12.7 and 13.1 % respectively. HBV infection prevalence was highest among studies published within the period 1995–2002 (17.3 %), followed by those published within 2003–2009 (14.7 %) and the lowest prevalence rate being recorded across studies published in the period 2010–2015 (10.2 %). Regional prevalence were determined for Ashanti, Greater Accra, Eastern, Northern, central and Brong-Ahafo regions as 13.1, 10.6, 13.6, 13.1, 11.5 and 13.7 % respectively. No aggregate data were derived for Volta, Western, Upper East and Upper West regions. Higher prevalence of HBV infection was attained for rural (13.3 %) compared to urban settings (12.2 %). Across the country, highest HBV infection prevalence rates were recorded in persons within the age group 16–39 years. Conclusion Hepatitis B infection is clearly an important public health problem in Ghana. The burden of the disease as dictated by a high prevalence rate calls for urgent public health interventions and strategic policy directions to controlling the disease to avert any potential future explosion.
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            Hepatitis viruses in Ethiopia: a systematic review and meta-analysis

            Yeshambel Belyhun, Melanie Maier, Andargachew Mulu … (2016)
            Background The existing seroepidemiological data on viral hepatitis in Ethiopia showed a wide variation in prevalence pattern and the clinical and public health burden have been underestimated. The aim of this systematic review and meta-analysis was to provide a clear and comprehensive estimation of viral hepatitis epidemiology and the potential clinical burdens in Ethiopia. Methods A comprehensive literature search was carried out from five decades (1968–2015) published studies from biomedical databases; PubMed, Google scholar, Medline and Web of Science. Results The overall pooled prevalence of hepatitis B virus (HBV) was 7.4% (95%CI: 6.5–8.4). The pooled prevalence among subgroups showed 5.2% (95%CI: 3.7–7.4) in human immunodeficiency virus (HIV) infected individuals, 8.0% (95%CI: 5.9–10.7) in community based studies, 8.4% (95%CI: 5.4–12.7) in blood donors, 11.0% (95%CI: 7.5–15.9) in immigrants and 6.9% (95%CI: 5.6–8.5) in other groups. Among study parameters considered during meta-regression analysis, only study years were associated with a decreasing HBV prevalence rate over time. The overall pooled prevalence of anti-hepatitis C virus antibody (anti-HCV) was 3.1% (95%CI: 2.2–4.4). Unlike HBV, the anti-HCV prevalence in HIV infected individuals was higher (5.5%, 95%CI: 3.8–7.8%, p = 0.01) than the prevalence observed in the other subgroup of study population. Although relatively few data were available, hepatitis virus A (HAV), D (HDV) and E (HEV) were also circulated in Ethiopia. Conclusions This review indicates that all types of viral hepatitis origins are endemic in Ethiopia. Adapting a recommended diagnostic and treatment algorithm of viral hepatitis in the routine healthcare systems and implementing prevention and control policies in the general population needs an urgent attention. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-2090-1) contains supplementary material, which is available to authorized users.
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              Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: a systematic review and meta-analysis.

              B Musa, Jennifer S Bussell, M M Borodo … (2015)
              Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.
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                Author and article information

                Contributors
                Kindie Mitiku Kebede:
                ORCID: http://orcid.org/0000-0002-0568-8962
                +251917742402 , mitikukindie@gmail.com
                Dejene Derseh Abateneh: dejenieh@gmail.com
                Alemayehu Sayih Belay: Alex.sayihalem2012@gmail.com
                Journal
                Journal ID (nlm-ta): BMC Infect Dis
                Journal ID (iso-abbrev): BMC Infect. Dis
                Title: BMC Infectious Diseases
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1471-2334
                Publication date (Electronic): 11 July 2018
                Publication date PMC-release: 11 July 2018
                Publication date Collection: 2018
                Volume: 18
                Electronic Location Identifier: 322
                Affiliations
                [1 ]GRID grid.449142.e, Department of Public Health, College of Health Sciences, , Mizan -Tepi University, ; PO.box 260, Mizan-Teferi, Ethiopia
                [2 ]GRID grid.449142.e, Department of Medical Laboratory Sciences, College of Health Sciences, , Mizan -Tepi University, ; Mizan-Teferi, Ethiopia
                [3 ]GRID grid.449142.e, Department of Nursing, College of Health Sciences, , Mizan -Tepi University, ; Mizan-Teferi, Ethiopia
                Author information
                http://orcid.org/0000-0002-0568-8962
                Article
                Publisher ID: 3234
                DOI: 10.1186/s12879-018-3234-2
                PMC ID: 6042274
                PubMed ID: 29996785
                SO-VID: d02ab07d-751d-47c6-a24b-b0effa45bef4
                Copyright © © The Author(s). 2018
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 8 February 2018
                Date accepted : 3 July 2018
                Categories
                Subject: Database
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                issue-copyright-statement © The Author(s) 2018

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: prevalence,seroprevalence,hepatitis b,pregnant women,ethiopia,systematic review,and meta-analysis
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: prevalence, seroprevalence, hepatitis b, pregnant women, ethiopia, systematic review, and meta-analysis

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