HEPATITIS B AND C INFECTION IN PREGNANT WOMEN ATTENDING ANTENATAL CLINIC AT THE CATHOLIC HOSPITAL, BATTOR IN THE VOLTA REGION, GHANA

ABSTRACT
Viral hepatitis is caused by hepatotrophic viruses with Hepatitis B and Hepatitis C being the frequent viruses affecting humans. Infections with HBV and HCV in pregnancy results in complications to the neonate and mother. Determination of the infection in pregnant women as well as the associated risk factors helps to identify neonates at risk of mother to child transmission and hence appropriate measures taken to help prevent the infection. A cross sectional study was carried out at the Catholic Hospital, Battor, to investigate the seroprevalence of HBV and HCV virus infections and associated risk factors among pregnant women attending the antenatal clinic. Structured questionnaire were administered to obtain the socio demographic data and Enzyme Linked Immunosorbent Assay, ELISA from Human diagnostic worldwide, Germany) was used to investigate the presence HBsAg, anti-HBc and anti HCV. One hundred and thirty five (135) pregnant women were enrolled in the study. HBsAg was detected in 37 of these women, giving an overall prevalence of 27.4%. Among these women 5 (13.5%) tested positive for HBeAg indicating that this proportion of patients was highly infectious and therefore likely to transmit the virus to their offspring. The prevalence of hepatitis C in the study population was 8.8% and 60.7% tested positive for anti HBc. Parity, educational background and the use of protection during sex were factors that did not have any statistically significant association in the acquisition of these infection but the age of the subjects had a significant association with the acquisition of both HBV and HCV. Among the associated risk factors analyzed, having multiple sexual partners was the only significant factor in the acquisition of HBV infection whiles history of previous blood transfusion was associated to the acquisition of HCV infection. The results from this study reveals a high prevalence of HBV and HCV among pregnant women in the area.


CHAPTER ONE
INTRODUCTION
1.0 Background to the study
Hepatitis is inflammation of the liver characterized by the existence of inflammatory cells in the tissue of the organ principally caused by viral infections. There are five hepatotrophic viruses Hepatitis A B C D and E that are recognized to cause hepatitis and of these, Hepatitis B virus and Hepatitis C virus are amongst the most regular viral infections in human beings (Eke et al., 2011; El-Serag, 2012). Hepatitis can also be caused by toxins (some drugs, plants and alcohol), other infections and certain autoimmune diseases (Ahmedin et al., 2004).The major public health problem, particularly in developing countries among the liver diseases are the one caused by hepatitis B and C (Haider et al., 1994; Santiago-Munoz et al., 2005) and are extremely prevalent in the sub-Saharan Africa (Kwan et al., 1997; Kramvis and Kew, 2007). Hepatitis is called acute when infection lasts for less than six months and chronic when infection continues longer. Most infection occur with limited or no symptoms, but often leads to vomiting, jaundice, malaise, fatigue anorexia (low appetite) and abdominal pain. (Ryder and Beckingham, 2001).

The mode of Hepatitis B virus transmission is through infected blood, by sexual means and mother to child (vertically) in the perinatal duration. Perinatal transmission is the principal mode of hepatitis B virus (HBV) transmission globally (Tran, 2009). Most people are infected by vertical transmission, or in the early-childhood in endemic areas, (Wright, 2006). Without immunization of the pregnant women, up to 90% of newborns born to mothers will become chronic carriers of the infection (McMahon et al., 1985; Chang, 2000; Sandesh et al., 2005).

Parenteral routes such as intravenous drug use or blood product transfusion, sexually and vertically during delivery is mainly the mode in which hepatitis C is transmitted (Dienstag, 1983; Melbye et al., 1990; Wejstål et al., 1992). Mother to child transmission of hepatitis C virus occurs in 3%-10% of pregnancies complicated by hepatitis C virus infections (Berkley et al., 2008). The World Health Organization (WHO) approximated that 3.0% of the world's populaces are infected with hepatitis C virus chronically where most of these cases are coming from Africa which is reported to have the highest prevalence rate of hepatitis C virus infection (Lavanchy, 1999; Madhava et al., 2002).

The prevalence of hepatitis B virus amongst women who are pregnant globally is about 5.0% ranging from 0.6% in low endemic regions to greater than 20.0% in high endemic areas in the Far East and Africa whiles the occurrence of hepatitis C virus amongst women who are pregnant globally is between 1.0% and 8.0% (Petrova and Kamburov, 2010; Arshad et al., 2011). In Southern African countries, the occurrence of hepatitis B virus among pregnant women is 2.0% to 2.9% except South Africa which has a prevalence of 4.6% (Alter, 2007; Sinha and Kumar, 2010), whiles the prevalence of HCV in these same countries is reported to be 0.1% (Njouom et al., 2011). In Central Africa, the prevalence of hepatitis B virus among women who are pregnant ranges from 6% to 9.5% whiles the prevalence of HCV is 4.3% (Ugbebor et al., 2011; Kfutwah et al., 2012). HBV prevalence in Western Africa is high varying between 6.2% and 16% whereas the prevalence of HCV ranges from 2.2% to 3% (MacLean et al., 2012; Okusanya et al., 2013).

Chronic infection with hepatitis B virus and hepatitis C virus are frequently asymptomatic but there is a high vertical transmission rate which can proceed to cirrhosis of the liver and hepatocellular carcinoma. During pregnancy, infections with viral hepatitis are related with high maternal risk, neonatal and foetal problems (Ali and Adam, 2011). Foetal and neonatal hepatitis may lead to chronic virus carriage, which might result to impaired physical and mental health in the future. Chronic virus carriage is usually caused by neonatal hepatitis, which in turn may lead to liver cirrhosis and hepatocellular carcinoma among young adults (Sookoian, 2006; Wright, 2006; Shukla et al., 2011). In addition, inducement of premature labor, poor outcomes of infants such as still births, neonatal deaths (NND) and high maternal mortality have been reported to be caused by acute hepatitis in pregnancy (Bohidar, 2004; Gambarin-Gelwan, 2007). The mother is also at risk of postpartum hemorrhage and high incidence of hypertensive disorders. If the pregnant woman has had acute hepatitis B infection during late pregnancy perinatal transmission of this disease happens, in the first post-partum or if the pregnant woman is a long-lasting HBsAg carrier (Levy and Gagnadoux, 1996).

However, early diagnosis of hepatitis B and hepatitis C infections in women who are pregnant can aid in treatment and management of the disease much more efficiently. A preventive measure includes immunization with hepatitis B virus (HBV) vaccine which is the most effective mode of hepatitis B virus infection prevention. Hepatitis B immune globulin (HBIG) also safeguards the infant by passive immunization if given just before or soon after exposure to hepatitis B virus. In addition, screening of pregnant women for HBV infection and routine screening of blood donors for HBsAg, strict surveillance, good personal hygiene and proper measures to control the environmental factors should be practiced to reduce transmission.

Treatment regimen following a positive diagnosis of the infection involves the use of interferon alpha 2b, P EG-interferon alpha 2a, , lamivudine, adefovir, entecavir, telbivudine and tenofovir (Tran, 2009).

There is no vaccination for HCV infections on the other hand but the infection can be prevented avoiding contact with infected blood, avoid sharing of razor blades, toothbrushes, shavers and needles and avoidance of alcohol intake (CDC, 1998a; Wiley et al., 1998). Treatment regimen is the use of pegylated interferon (I FN) alpha and ribavirin (Fried et al., 2002; Hadziyannis et al., 2004). Early detection of HCV infection ensures early administration of antiviral treatment which is the most effective than beginning at a later stage (Alter et al., 1990). Moreover, early identification together with counselling and life style modification reduces the transmission of the infection to other people. In Ghana, particularly in Battor which is a rural area where the level of education is low and also the level of teenage pregnancy being high, it is expected that some of the sexually transmitted diseases like hepatitis B and hepatitis C will be prevalent among the youth. Despite the inclusion of Hepatitis B in the routine antenatal care screening, some newborns are still at risk of vertical transmission of the disease. The study therefore, was to determine the prevalence of these viruses among healthy pregnant women.

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Item Type: Ghanaian Project Material  |  Attribute: 90 pages  |  Chapters: 1-5
Format: MS Word  |  Price: GH50  |  Delivery: Within 30Mins.
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