Epidemiology of HBV and HCV among pregnant women at QECH
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Date
16-06-21
Journal Title
Journal ISSN
Volume Title
Publisher
Kamuzu University of Health Sciencies
Abstract
Type of study
This will be a descriptive cross sectional study.
The problem to be studied
Viral Hepatitis is a predominant cause of liver damage worldwide with approximately 1.4million
deaths annually. HBV and HCV are common causes of high morbidity and mortality rates
worldwide. It is estimated that approximately, 248million people are living with chronic HBV
infection and that 110million people are HCV antibody positive.
This disease is neglected in developing countries due to lack of proper treatment and screening
programs. Unfortunately, infected pregnant women pose a high risk to neonates before or during
delivery.
Very little is known about the prevalence of these viruses among pregnant women in Malawi.
The objectives
Broad objective
• To assess the epidemiology of Hepatitis B Virus and Hepatitis C Virus among pregnant
women at Queen Elizabeth Central Hospital.
Specific objectives
1. To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at Queen
Elizabeth Central Hospital
2. To assess risk factors associated with HBV and HCV infection in pregnant women.
3. To determine distribution of HBsAg and Anti-HCV among pregnant women.
Methodology
The study will be conducted at the antenatal clinic and antenatal ward at Queen Elizabeth Central
Hospital. We plan to recruit pregnant women who are willing to take part in the research. Simple
random sampling will be used for the women who provide consent to participate in the study. We
will the collect blood sample which will be sent to the COM lab for ELISA for HBsAg and Anti-
HCV
The data will be analyzed using Epi info and SPSS version 22. Association between serological
results variables (risk factors) will be established using Chi-square and association will be
measured using odds ratio.
Expected findings and their dissemination.
The study results are expected to uncover the epidemiology of HBV and HCV among pregnant
women of different age groups at QECH. We expect to detect low to undetectable levels of HCV
as opposed to HBV makers.
The results of the study will be disseminated to COMREC, QECH and at the COM Research
dissemination conference. A manuscript will also be submitted for publication in peer reviewed
journals.
1. INTRODUCTION
Viral hepatitis is the predominant cause of liver diseases such as liver fibrosis, cirrhosis and
hepatocellular carcinoma in the world (1). There are five types of hepatitis virus(A-E) that cause
infection but Hepatitis B virus (HBV) and Hepatitis C virus (HCV) are the most common causes
of acute and chronic liver infections. Globally, every year about 1.4 million people die of viral
hepatitis (2). Despite its deadliness, the disease is neglected in developing countries due to lack of
screening programs and treatment. Therefore, viral hepatitis has become one of the major leading
causes of high viral associated mortality and morbidity rates (3). The burden of chronic HBV and
HCV remains disproportionately high in Sub-Saharan Africa and 5-15% of the population is
chronically infected with HBV followed by HCV. HBV and HCV have common modes of
transmission and rarely these viruses can exist together (4). In 2018, HBV sero-prevalence was
estimated to be about 8.1% among the Malawian general population and HCV was below 1% (3).
HBV is manly contracted at birth from infected mothers and during early childhood whereby those
infected develop chronic infections. 90 percent of infants born to infected mothers with chronic
hepatitis are at risk of developing chronic HBV later in life. In contrast when HBV is contracted
during adulthood, 5-10 percent of adults develop persistent chronic HBV infections (5).
HBV is a partially double stranded DNA virus with an icosahedral capsid and envelope. HBV is
classified as an ortho-hepadnavirus in the family of hepadnaviridae. HBV resembles a retrovirus
replication mode by using an intermediate RNA stage. HBV contains several antigens that can be
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used as disease makers these include; Hepatitis B surface antigen (HBsAg), Hepatitis B core
antigen (HBcAg), Hepatitis B e-antigen (HBeAg) (6).
Hepatitis C is a positive sense single stranded RNA virus (+ssRNA) that belong to the genus
hepacivirus and is a member of flaviviridae family.
In acute infections, HBV invade hepatocytes by binding to the host cellular receptors to enter and
replicate in the cells. During incubation period high copies of the virus are present before the host
immune response develops and controls the virus. As the virus replicates, HBcAg and HBeAg get
expressed on the cytoplasmic membrane which trigger B and T cell response. Damage to
hepatocytes is due to antibody dependent, Natural Killer, and Cytotoxic T cell action. HCV
pathogenesis is regulated by host immunity and metabolic responses that influence liver function.
HCV does not cause cytopathic effect to the hepatocytes rather during replication it causes cell
necrosis by several mechanisms including immune mediated cytolysis and other contributing
factors such as hepatic steatosis, oxidative stress and insulin resistance (7).
Viral hepatitis is caused by different subtypes of Hepatitis viruses for example, HBV and HCV
which are considered to be blood borne pathogens. HBV and HCV cause acute hepatitis which can
clear spontaneously or progress to chronic hepatitis (8). Chronic hepatitis is also a predominant
cause of liver damage, cirrhosis and hepatocellular carcinoma (HCC) in general population
globally (3),(9).
There are several risk factors that are associated with viral hepatitis transmission, and these
include; reuse of needles among individuals and needle stick injuries, blood transfusion, local
barbers (10). In other literatures the following have also been known to be risk factors; multiple
sexual partners, family history of hepatitis or any other liver diseases, surgery, IV infusion, tooth
brush sharing (11).
Individuals who are at a high risk of contracting these blood borne infections include; individuals
from countries with high prevalence of HBV and HCV or international travelers, recipients of
blood and blood products, injecting drug users, patients with liver diseases, health care workers
and hemodialysis patients.
Several measures have been put in place to control blood borne viral hepatic infections. Treatment
against acute hepatitis B has not been developed but limited and non-curative treatment for chronic hepatitis B is available, a combination of lamivudine and alpha-interferon is given to suppress
HBV viral load (12).
Unlike hepatitis C there is a vaccine for hepatitis B. The vaccine was discovered in 1965 by Dr.
Baruch Blumberg and his team (13). The vaccine is administered as an active prophylaxis in three
doses; after the first dose, the second dose is given after a month and the third (booster) is
administered after six months. In infants, the first dose is administered within 24 hours and the two
remaining doses follow a similar pattern as in adults (14).
In an exposed individual a passive prophylaxis in form of an intra-muscular injection that contains
Hepatitis B immunoglobulin is given within seven days of exposure to offer short-term protection.
Other preventive measures like civic education have been put in place by the WHO to minimize
risk behaviors among infected population and sensitize risk groups on how to prevent spreading
of hepatitis (8). At present it is thought that giving the hepatitis B vaccine to pregnant women is
relatively safe(15) in addition, current vaccines contain noninfectious HBsAg and should cause no
risk to the fetus(16).
2. JUSTIFICATION
Several studies have been conducted in various countries around the world on the epidemiology
of HBV and HCV in the general population as well as in pregnant women. Literature shows that
viral hepatitis during pregnancy is associated with a high risk of maternal complications, has a
high rate of vertical transmission causing fetal and neonatal hepatitis and has been reported as a
leading cause of maternal deaths (7). For these reasons, screening antenatal women for hepatitis B
surface antigen and Hepatitis C antibody can give a reliable prevalence of these diseases in a
population and provide an avenue for preventing mother to child transmission of the viruses.
Despite the importance of Hepatitis B and C infections in pregnancy, there is paucity of data on
the prevalence of Hepatitis B and C viruses in the pregnant women in Malawi. We therefore feel
that this study will contribute to the body of knowledge to bridge this gap 3. OBJECTIVES OF THE STUDY
3.1. BROAD
To assess the epidemiology of Hepatitis B Virus and Hepatitis C Virus among pregnant women at
Queen Elizabeth Central Hospital.
3.2. SPECIFIC OBJECTIVES
1. To determine sero-prevalence of HBsAg and Anti-HCV in pregnant women at Queen
Elizabeth Central Hospital.
2. To assess risk factors associated with HBV and HCV infection in pregnant women.
3. To determine the distribution of HBsAg and Anti-HCV infection among pregnant women
of different age groups.
4. METHODOLOGY
4.1. TYPE OF STUDY
The study will use prospective and descriptive cross-section study. Prospective analysis will be
conducted whereby blood samples will be collected from the pregnant women and tested for HBV
and HCV. Descriptive cross sectional study will be used to characterize lab results by looking at
their qualitative and quantitative nature.
4.2. STUDY SITE
The study will be conducted at QECH in Blantyre and College of Medicine Hematology
laboratory. Participants will be recruited at the antenatal clinic and antenatal ward at QECH. Blood
samples will be processed at COM Hematology Lab.
4.3. STUDY POPULATION
This study will target pregnant women at QECH.
4.4. STUDY PERIOD
The study will be conducted within a period of four weeks after approval from COMREC. The
planned activities are indicated in the Gantt chart as follows;