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

Abstract

Hepatitis B (HBV) is a major public health threat in Sierra Leone. Pregnant women are disproportionately impacted, yet little is known about the epidemiology of HBV in this group. We conducted a cross-sectional study of pregnant women aged ≥16 years receiving antenatal care across 10 community health centers in Freetown from July to September 2021 to assess the prevalence and associated factors of HBsAg seropositivity. A logistic regression was used to identify the predictors of HBsAg seropositivity. In total, 394 pregnant women were screened. The mean age was 24.4 ± 4.9 years, 78.2% were married, and 47.2% were in the second trimester. Only 1% had received the HBV vaccine. The prevalence of HBsAg was 7.9%, while HIV was 5.8% and HIV/HBV co-infection was 0.3%. Regarding high-risk practices, 76.6% reported female genital circumcision, 41.9% ear piercing, 29.0% endorsed multiple sexual partners, and 23.6% reported sexually transmitted infections. In the logistic regression analysis, having a husband/partner with HBV (adjusted odds ratio (aOR): 6.54; 95% CI: [1.72–24.86]; p = 0.006) and residing in Central Freetown (aOR: 4.00; 95% CI: [1.46–11.00]; p = 0.007) were independently associated with HBsAg seropositivity. Our findings support the scaling up of HBV services to target pregnant women and their partners for screening and vaccination to help reduce mother-to-child transmission rates in Sierra Leone.

Factors Associated with Late Antenatal Care Initiation for Pregnant Women Aged 15-49 Years in Sierra Leone Using the 2019 Demographic Health Survey

“…Some previous studies have also demonstrated the significance of regional differences in the timely start of antenatal care and its utilization [18,19]. This is an unusual finding considering that the Western region of Sierra Leone is the most developed, has the liveliest economy, and has the biggest concentration of trained workers and medical facilities [20]. However, the Western regions are seeing an increase in the number of urban poor, who are unable to get adequate healthcare due to their high level of living and unequal access to social facilities [10].…”

“…However, the Western regions are seeing an increase in the number of urban poor, who are unable to get adequate healthcare due to their high level of living and unequal access to social facilities [10]. Additionally, the established staff issues in metropolitan areas, such as inadequate delegation, favoritism, and a lack of autonomy, may have an impact on the level of service provided by public health facilities, which further reduces the number of people who can access healthcare [20]. The trend observed in the eastern region could be attributed to the established processes for the opening, accreditation and closing of health facilities which were carried out across Sierra Leone as part of the National Health Sector Strategic Plan and the free maternal healthcare (2017-2021) [21].…”

Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale

“…Survey questionnaire and stigma instrument development were informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical, and social aspects of the HBV epidemic in Sierra Leone 11,29–33 and the broad literature on measuring HIV‐related stigma, 34,35 which has been adapted to inform studies in understanding HBV‐related stigma 4,5 …”

Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale

“…Survey questionnaire and stigma instrument development was informed by our experiences gained from interactions with PWHB in the clinical and community settings in Sierra Leone, our preliminary work describing the epidemiological, clinical and social aspects of the HBV epidemic in Sierra Leone [11,[29][30][31][32][33] and the broad literature on measuring HIV-related stigma [34,35], which has been adapted to inform studies in understanding HBV-related stigma [4,5].…”