High burden of hepatitis B infection in Northern Uganda: results of a population-based survey

Abstract

BackgroundWorldwide 2 billion people are exposed to hepatitis B infection, 350 million have chronic infection, 65 million in sub-Saharan Africa. Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the southwest and 25% in the Northeast. Childhood vaccination was rolled out in 2002, the effect of which on the burden of hepatitis B has not been examined. We determined the prevalence and risk factors for hepatitis B infection in the Northern Uganda Municipality of Gulu.MethodsWe carried out a cross-sectional, population-based survey. The study population included those found at home at the time of recruitment. Data on demographics, wealth index, cultural and behavioral factors, vaccination and health education on hepatitis B were collected. Hepatitis B infection (Hepatitis B surface antigen positive) and lifetime exposure (anti-hepatitis B core antibody positive) were measured. Analysis was done in 2 age groups, 1–14 years, 14 years and more. Associations between predictors and HBV infection were assessed.ResultsInformation on 790 respondents were analyzed. Overall, 139/790 (17.6%) had hepatitis B infection and 572/790 (72.4%) lifetime exposure. In the younger age group 16/73 (21.9%) had hepatitis B infection and 35/73 (48%) lifetime exposure. Increasing wealth was protective for infection (OR 0.46 per quartile, 95% CI=0.26-0.82, p=0.009), while older age was protective for lifetime exposure (OR 2.70 per age group, 95% CI 1.03-7.07, p=0.043). In the older age group, overall hepatitis B infection was seen in 123/717 (17.2%) and lifetime exposure in 537/717 (74.9%). The female sex (OR 0.63, 95% CI=0.42-0.98, p=0.032) and increasing age (OR 0.76 per age group, 95% CI=0.64-0.91, p=0.003) were factors associated with infection. For lifetime exposure, increasing number of lifetime sexual partners was a risk factor (OR 1.19 per partner category, 95% CI=1.04-1.38, p=0.012).ConclusionsWe found a high prevalence of hepatitis B infection and lifetime exposures to hepatitis B in this northern Uganda Municipality. Targeted vaccination of susceptible adults and improving existing childhood vaccinations and provision of treatment for those with infection will play roles in reducing the high prevalence rates seen in the population.

Human immunodeficiency virus and hepatitis B virus (HIV/HBV) co-infection in people living with HIV/AIDs identified in Yaound Central Hospital, Cameroon: Seroprevalence and impact on the disease progression

“…The prevalence in the present study is comparable to 16.8% obtained in studies from Senegal (Diop-Ndiaye), and from Uganda ** Significant correlation at the threshold 0.01; * Significant correlation at the threshold 0.05; ALT: Alanine amino transaminase; AST: Aspartate amino transaminase; ALP: Alkaline Phosphatase CB = conjugated Bilirubin; CD4 = Cluster of differentiation 4. (Ochola et al, 2013). It is however lower, compared to 19% reported in Northwest Ethiopia (Yoannes et al, 2014) and 20.4% reported in Malawi (Nyirenda et al, 2008).…”

“…Previous studies in sub-Saharan Africa showed that HBV infection prevalence among HIV positive people varies from one region to another: from 17.5% in a hospital setting in Dar Es Salaam, Tanzania (Nagu et al, 2008), 17% in Northern Uganda (Ochola et al, 2013), 12.8% in the North-Eastern Nigeria (Obi et al, 2012), 12.6% in the North-West region of Cameroon (Zoufaly et al, 2012), to 12.2% in The Gambia (Jobarteh et al, 2010). However, in many setting, the dual infection HIV and Hepatitis B virus still goes unnoticed due to the lack of diagnostic means: The spread of this co-infection is rapid while diagnostics means are still deficient.…”

Prevalence of the Surface Antigen of Hepatitis B Virus among Youth Aged 15 to 24 in TOGO in 2010

“…It is also one of the few studies in African sub Saharan region that includes sexually active youth and young adolescent groups. 60 years [22] and is lower than the 23.9% found by Emmanuel et al in 2013 in northern Uganda among the same age group as ours [23]. These high prevalence rates are probably due to difficult living conditions in rural areas and to the non-inclusion of hepatitis B vaccination programs in these countries before these studies [24,25].…”

“…Emmanuel et al [23] have not found any significant difference according to age (p=0.575) either. Other studies have, on the other hand, reported that having an education which is less than A'level was a risk factor for the presence of serological markers of HBV [35,36].…”

“…Deng et al in China found that celibacy and sexual multi-partnership (p=0.049) were associated with high prevalence of HBs Ag [23]. Persons living in undefined marital status are likely to display more at risk behaviors such as sexual multipartnership because the risk of infection increases with the number of sexual partners, the number of years of sexual activity and the presence or absence of other sexually transmitted diseases [33].…”