A systematic review and meta-analysis of the prevalence of hepatitis B virus infection among pregnant women in Nigeria

Abstract

Background Nigeria has a high burden of hepatitis B virus (HBV) infection, commonly acquired through vertical transmission. However, there is a lack of an efficient surveillance system for monitoring and understanding the epidemiology of HBV among pregnant women. Building on a previous review on the prevalence of HBV in Nigeria (2000–2013), we conducted a systematic review and meta-analysis of HBV prevalence among pregnant women in Nigeria. Methods Four electronic databases PubMed, Embase, Global Health, and Scopus were systematically searched from January 2014 to February 2021. We also searched the African Journal Online and manually scanned the reference lists of the identified studies for potentially eligible articles. Observational studies that reported the prevalence of HBsAg and/or HBeAg among pregnant women in peer-reviewed journals were included in the study. We performed a meta-analysis using a random-effects model. We defined HBV infection as a positive test to HBsAg. Results From the 158 studies identified, 20 studies with a total sample size of 26, 548 were included in the meta-analysis. The pooled prevalence of HBV infection among pregnant women across the studies was 6.49% (95% confidence interval [CI] = 4.75–8.46%; I2 = 96.7%, p = 0.001; n = 20). The prevalence of HBV was significantly lower among pregnant women with at least secondary education compared with those with no education or primary education (prevalence ratio = 0.7, 95% CI = 0.58–0.87; n = 10). However, the prevalence of HBV was not significantly different by age, religion, marital status, or tribe. The prevalence of HBV was not significantly different among pregnant women with previous surgery, blood transfusion, multiple lifetime sex partners, tribal marks, tattoos, scarification, or sexually transmitted infections, compared with those without these risk factors. From a total sample size of 128 (n = 7), the pooled prevalence of HBeAg among HBV-infected pregnant women was 14.59% (95% CI = 4.58–27.99%; I2 = 65.5%, p = 0.01). Subgroup analyses of HBV infection by study region and screening method, and meta-regression analysis of the study year, sample size, and quality rating were not statistically significant. Conclusions There is an intermediate endemicity of HBV infection among pregnant women in Nigeria. Interventions, such as routine antenatal HBV screening, antiviral prophylaxis for eligible pregnant women, and infant HBV vaccination should be scaled up for the prevention of perinatal transmission of HBV infection in Nigeria.

Factors Associated with HBsAg Seropositivity among Pregnant Women Receiving Antenatal Care at 10 Community Health Centers in Freetown, Sierra Leone: A Cross-Sectional Study

“…This figure is consistent with estimates from previous studies among non-HIV-infected pregnant women from Sierra Leone (i.e., 6% to 11%) [11,12] and approximates to the criterion for high endemicity (≥8%) [1,4]. Our findings are in agreement with multiple studies conducted in the antenatal care setting in West Africa, which have consistently reported significantly higher HBsAg seroprevalence rates than studies from other regions across SSA [17][18][19].…”

“…Over three-quarters of participants reported a history of female genital circumcision, while substantially large proportions of study participants also endorsed a history of ear piercing, multiple sexual partners, sexually transmitted infections, body tattooing and surgical procedures. We found that the risk of HBsAg seropositive status did not significantly increase with any of the above-mentioned factors, which are typically associated with the horizontal transmission of HBV, nor with socio-demographic variables such as age, gender, socio-economic status, or educational attainment as previously described by studies from SSA [17][18][19]. It has been amply established that in endemic settings such as in SSA, HBV is predominantly acquired vertically through MTCT or early in life [1,3], which supports the findings of risk factor analysis in our cohort of pregnant women.…”

The burden of Hepatitis B virus infection in Kenya: A systematic review and meta-analysis

“…The studies in pregnant women showed a pooled prevalence of 6.5%, exactly the same as that reported by a recent meta-analysis in the West African country of Nigeria ( 89 ). This rate is, however, high compared to rates reported from the neighboring countries of Ethiopia at 4.8% ( 90 ), Rwanda at 3.7% ( 91 ), and Tanzania at 5.2% ( 92 ).…”

Seroprevalence of Hepatitis B Virus Among Pregnant Women in India: A Systematic Review and Meta-Analysis

“…Accordingly, the seroprevalence of HBV in women who were illiterate or had primary education was 3.8% (1.2 -6.5), and in those with secondary level or higher education, it was 1.5% (0.9 -2.0) with a significantly higher odds of HBV seroprevalence in those with education less than secondary level (OR 2.29, 95%CI 1.24 -4.23). Previous two other meta-analyses have also shown that illiteracy was the only significant demographic factor associated with increased risk of HBsAg positivity [62,63].…”