The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka Health Districts of the South West region of Cameroon: a three-year retrospective study

Introduction hepatitis B infection is caused by the hepatitis B virus (HBV). HBV is transmitted through sexual intercourse, by exchange of saliva during kissing and also to newborns of infected mothers. In the Global Burden of Diseases 2010, 786,000 deaths were attributed to HBV. Studies in Cameroon, reported the prevalence of HBV as high as 10.1% and 12% among blood donors in hospital blood banks. This study therefore, aims at determining the prevalence of HBsAg, knowledge and practices of pregnant women on HBV prevention and transmission in the Limbe Health District (LHD) and Muyuka Health District (MHD). Methods ANC registers were exploited from the health centers for a period of three years (2014-2016) in order to determine the prevalence of HBV infection. 270 women attending ANC were selected by exhaustive sampling. Knowledge and practices of participants on HBV prevention and transmission was assessed using a structured questionnaire. Results the prevalence of HBV in the LHD and MHD were 5.7% and 7.5% respectively. Pregnant women in the LHD demonstrated good knowledge but adopted poor practices whereas in the MHD, pregnant women demonstrated poor knowledge and adopted poor practices regarding the mode of transmission and prevention of HBV infection. There was a significant association between the prevalence of HBsAg and marital status (p = 0.000) in the LHD and age (p = 0.022) in the MHD. Conclusion this study indicated a high prevalence of HBV among pregnant women in the LHD and MHD, knowledge and practices were identified as potential risk factors.


Introduction
Hepatitis B infection is caused by the hepatitis B virus (HBV), an enveloped DNA virus that infects the human liver and causes hepatocellular necrosis and inflammation. It is transmitted through sexual intercourse with an infected person, by exchange of saliva during kissing with an infected person and also from infected mothers to their babies: during childbirth, breastfeeding and through the placenta [1]. HBV is a potentially life-threatening cause of liver diseases in the world. Liver injury occurs through immune-mediated killing of infected liver cells [2]. This infection can either be acute or chronic and may range from asymptomatic infection or mild disease to severe or rarely fulminant hepatitis. Acute hepatitis B infection is usually a self-limiting disease marked by acute inflammation and hepatocellular necrosis, with a case fatality rate of 0.5-1% [3].
Chronic hepatitis B infection encompasses a spectrum of disease and is defined as persistent HBV infection that is the presence of detectable hepatitis B surface antigen (HBsAg) in the blood or serum for longer than six months, with or without associated active viral replication and evidence of hepatocellular injury and inflammation [4]. Chronicity is common following acute infection in neonates and in young children under the age of 5 years, but occurs rarely when infection is acquired in adulthood [5]. Globally, WHO estimates that, more than 2 billion people are still living with HBV infection and over 350 million people are believed to be at risk of developing complications of chronic hepatitis such as cirrhosis and primary hepatocellular carcinoma [6,7]. In the Global Burden of Disease 2010, the total number of deaths attributable to hepatitis B was 786,000 deaths, of which 132,200 (17%) were estimated to be caused by acute hepatitis B, 341,400 (43%) were caused by liver cancer and 312,400 (40%) were caused by cirrhosis [8].
In Africa and Asia, the prevalence of HBV is > 8% and 2 billion people have markers of current or past infection with HBV [9]. Approximately 65 million of all chronically infected individuals live in Africa [10]. In Cameroon, the prevalence of HBV ranges from 6-16% [11,12].
Recent studies report the prevalence of HBV to be as high as 10.1% and 12% among blood donors in hospital blood banks in Cameroon [13,14]. Frambo [11]  Data collection: all participants who consented were interviewed using a structured questionnaire adapted from the questionnaire formulated by Mohammed [18]. Prior to its use in this study, a total of 12 questionnaires were pretested at the Regional Hospital Buea  and 97 (7.5%) were positive for HBsAg in the Limbe and Muyuka health districts respectively. It was observed that there was a significant association between the prevalence of HBV and the health district (p=0.00) (Figure 1).  (Table 3). However, the prevalence rate in this study is lower than the 9.7% in Buea health district [11] and 7.7% in the North West region of Cameroon [21]. The prevalence rate in this study is higher than the was however similar to that of Abongwa and Kenneth [21] where there was no difference in the prevalence (p = 0.29) of hepatitis B infection among the age groups in the North West region of Cameroon. There was also a significant difference between marital status and the prevalence of HBsAg (p = 0.000) in the Limbe health district. HBV prevalence was however high among women between the age group 25-34 years (3.1%). This age group is sexually very active, suggesting the role of sexual intercourse in the transmission of HBV. However, it was contrary to studies carried out by [23,27] who stated that the prevalence was high among women in the age group 21-25 years.
Results of our study, shows that pregnant women in the Limbe health district demonstrated a good to excellent knowledge but adopted virus infection seen in this study is similar to studies reported in Egypt [28] and in Japan [29]. On the contrary, studies from Egypt showed good practices regarding hepatitis B [28].  We are grateful to all the pregnant women who participated in this research.        Page number not for citation purposes 11