Epidemiology of hepatitis B, C and D in Malawi: systematic review

Abstract

BackgroundViral hepatitis is an important public health issue in sub-Saharan Africa. Due to rising mortality from cirrhosis and hepatocellular carcinoma and limited implementation of screening and treatment programmes, it has been characterised as a neglected tropical disease. Synthesis of the existing evidence on the epidemiology of viral hepatitis B, C and D in Malawi is required to inform policy and identify research gaps.MethodsWe searched Pubmed, EMBASE and Scopus for studies reporting the epidemiology of viral hepatitis B, C and D in Malawi from 1990 to 2018. Articles reporting prevalence estimates were included provided they described details of participant selection, inclusion criteria and laboratory methods (detection of HBsAg, anti-HCV or anti-HDV antibody, HCV antigen or HCV RNA or HDV RNA). We assessed study quality using a prevalence assessment tool. Where appropriate, a pooled prevalence was calculated using a DerSimonian Laird random effects model.ResultsSearches identified 199 studies, 95 full text articles were reviewed and 19 articles were included. Hepatitis B surface antigen (HBsAg) seroprevalence was assessed in 14 general population cohorts. The pooled prevalence among adults was 8.1% (95% CI 6.1, 10.3). In 3 studies where HBsAg was stratified by HIV status, no effect of HIV on HBsAg prevalence was observed (OR 1.2 (95% CI: 0.8, 1.6, p = 0.80)). In a single study of HIV/HBV infected individuals, anti-hepatitis D antibody (anti-HDV) prevalence was low (1.5%). HCV antibody prevalence (anti-HCV) ranged from 0.7 to 18.0% among 12 cohorts in general populations. Among three studies which used PCR to confirm current infection, the pooled rate of HCV RNA confirmation among anti-HCV positive individuals was only 7.3% (95% CI: 0.0, 24.3).ConclusionsHepatitis B is highly prevalent in Malawi. There is a paucity of epidemiological data from rural areas where 85% of the population reside, and the Northern region. Priority research needs include large-scale representative community studies of HBV, HDV and HCV seroprevalence, assessment of children following introduction of the HBV vaccine in 2002, prevalence estimates of viral hepatitis among individuals with cirrhosis and HCC and data on HCV prevalence using PCR confirmation, to support a viral hepatitis strategy for Malawi.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3428-7) contains supplementary material, which is available to authorized users.

Incidence and Determinants of Transfusion-Transmissible Infections in Voluntary Blood Donors in Malawi, 2005-2015

“…In SSA, HBV among blood donors in high and this has been attributed to the generally high prevalence (8%) and endemicity of this pathogen in the region (30). These results support the fact that HBV in the general population is high (32). Remarkably, incident HBV exhibited a statistically significant association with age groups 20-24 and 30-34, male sex, region of residence and syphilis co-infection.…”

“…(associated with a 2.14-fold increased odds of incident HBV; 95% CI= 1.01 -4.53) and [30][31][32][33][34] (associated with a 2.26-fold increased odds of incident HBV; 95% CI= 1.02 -5.01), male sex (associated with a 1.53-fold increased odds of incident HBV; 95% CI= 1.27 -1.84) and syphilis coinfection (1.71-fold increased odds of incident HBV; 95% CI= 1.01 -2.89) ( Table 7). Table 7: Predictors of HIV, HCV and HBV in blood donors: multivariate model* 15 per 10,000 in HBV-infected donors followed by HIV with 10 per 10,000 and HCV with 7 per 10,000.…”

Ecological study of viral hepatitis in Brazil: A geographical and temporal analysis

“…A geographical analysis of Map 1, which reveals the pattern of HBV endemic regions in the country, indicates the northern and southern borders as the most affected areas. The involvement of border areas could be explained by the fact that they are less developed and have difficulties in consolidating control measures, such as vaccination and prenatal care 6,23,25 . In the northern border, Acre, Amazonas, Rondônia and Mato Grosso states have high birth rates; thus, the virus can be transmitted from mother to child, which has been frequently described in endemic areas such as East Asia and Sub-Saharan Africa 25 .…”

Epidemiology of Liver Cancer in Africa: Current and Future Trends

“…52 There has been a growing concern and controversy about an apparent unexpected increase in the number of HCC cases The prevalence of hepatitis B as a risk factor for hepatocellular carcinoma (HCC) in 9 African countries: Egypt, 39 Uganda, 40 Cameroon, 41 Ghana, 42 Nigeria, 43 Kenya, 44 South Africa, 45 and Malawi. 46 developing following direct acting antiviral (DAA) therapy for HCV, as well as higher than expected rates of recurrence following surgical resection in patients receiving DAA treatment. A multicenter study in Spain showed a surprisingly high 27% recurrence rate of HCC in patients who received DAA.…”

“…The impact of the HBV vaccine in Africa against the spread of hepatitis has been demonstrated in a small community-based HBV prevalence study in Malawi with no documented HBV infections in children under the age of 5 in a community-based study of the prevalence of hepatitis B and also in Gamba. 46,122 The PROLIFICA project had shown that a large-scale test-and-treat approach is feasible and cost-effective in SSA if a high coverage of community-based screening and good linkage into care is present. 2 Use of nucleoside analogues has been shown to reduce fibrosis and progression to HCC.…”