Prevalence of chronic hepatitis B virus infection and associated factors among pregnant women attending antenatal care at Felege Hiwot Comprehensive Specialized Hospital Ethiopia

Abstract

Chronic hepatitis B is a serious liver infection, caused by the hepatitis B virus. Chronic hepatitis B further leads for the risk of liver function failure, liver cancer and serious scarring of the liver called cirrhosis. The objective of the current study was to investigate the prevalence of chronic hepatitis b virus infection and associated factors among pregnant women attending antenatal care at Felege Hiwot Comprehensive Specialized Hospital Ethiopia. Institutional based retrospective cross sectional study design was conducted at Felege Hiwot Comprehensive Specialized Hospital. To measure the prevalence of hepatitis B infection in the study area, testing of hepatitis B surface antigen (HBsAg) was conducted over time. The study was conducted among 221 pregnant women who have attended antenatal care. Systematic random sampling technique was conducted for the selection of participants in the current study. The overall prevalence of hepatitis B virus among pregnant women in the current study was 4.55%. Among 221 pregnant women taken as study participants, 49 of them who had history of medical illness were screened for hepatitis B surface antigen and among these 25 had positive result, yielding a sensitivity (95% confidence interval) of 80% (70 − 88.5) and a specificity of 96.8% (93.7 − 98.4) for Healgen and Determine; 91.6 − 96.5 for Advanced Quality). Among the predictors, history of blood transfusion [AOR = 11.5; 95%, CI: (8.67, 17.5), history of abortion (AOR = 3.47, 95% (1.29, 7.40), history of genital mutilation (AOR = 12.2, 95% CI: (9.30, 18.4)), history of tattoo (AOR = 6.04, 95% CI: (1.20, 10.0)), drinking alcohol (AOR = 1.52, 95% CI: (1.19, 4.36)), multiple sexual partner (AOR = 1.35, 95% CI: (1.09, 4.82)) and History of contamination with individuals with liver disease (AOR = 1,45; 95% CI: (1.23, 7.84)). The prevalence of hepatitis B virus was significantly affected by history of blood transfusion, history of alcohol consuming, history of contact an individual with liver disease, having multiple sexual partners, body tattoo and history of genital mutilation. The first step during ANC shall be screening of HBV infection for pregnant women under the follow up period to take remedial action. The current study recommends conducting health education campaigns to make awareness about HBV transmission and prevention among pregnant women.

Introduction

Hepatitis B infection is one of the leading public health problems globally¹. According to the World Health Organization (WHO) estimate, approximately 360 million people in the world have a chronic HBV infection, and almost half of these individuals live in the Western Pacific Region, which takes a share of 28% of the global population². In 2015, the global prevalence of HBV infection in the general population was 3.5%³. Hence, about 257 million people were living with HBV infection in the world¹ and of these, an estimate of 25.3% of women of reproductive age and 65 million women of childbearing age who are chronically infected with HBV can potentially transmit HBV to their babies⁴. Globally almost two billion people have been exposed to HBV at some stage of their lives and about 780,000 patients die from advanced liver disease caused by chronic hepatitis B virus infection each year¹.

Hepatitis B virus infection remains a serious public health problem in the endemic regions like Sub-Saharan Africa⁵. Africa has the second largest number of chronic carriers and considered as a widespread of an infectious disease over a whole region for HBV⁶ and is a significant public health concern⁷. Studies indicate that despite the fact that the exact burden of HBV in Africa is difficult to assess due to inaccurate records and under-reporting, it is estimated that between 70 and 95% of the adult population show evidence of the past exposure to HBV infection⁸. Approximately 82 million people in Africa are living with chronic HBV infection⁷.

In Ethiopia, the prevalence of Hepatitis B virus (HBV) infection is unexpectedly very high. Studies indicate that the pooled prevalence of chronic HBV in 2016 was 7.4% and 6% in 2019 across the country⁹ and it contributes significantly to hospital admissions and mortality¹⁰. Its prevalence varies across different regions and populations within Ethiopia, ranging from 1% to 36% and previous studies recommended for further investigation in identifying predictors for the prevalence of HBV¹¹.

In the Amhara region of Ethiopia, the prevalence of Hepatitis B Virus (HBV) infection varies with studies showing rates ranging from 1% to 8.68%¹². A systematic review and meta-analysis study conducted in 2019 declared that about 6% of the overall country’s pooled prevalence belongs to Amhara region¹³. A study focusing on pregnant women in Amhara region indicates that there is a 4.6% sero prevalence of HBsAg (Hepatitis B surface antigen)¹⁴.

Hepatitis B virus is caused by hepatotoxic deoxyribonucleic acid (DNA) virus and occurs through the immune-mediated killing of the infected liver cells^15,16. In developing countries, high or intermediate route of infection such as vertical transmission from mother to child and horizontal transmission between children, particularly siblings and from the community are very common¹⁷. Different risk factors may play a significant role for its prevalence. Hence, studies indicate that there’s a need for more comprehensive study on HBV prevalence and associated factors in the study area to identify the intervention areas¹⁸.The disease is one of the major blood borne and sexually transmitted infectious agent of mankind and causes a serious global public health problem¹⁹. HBV can be transmitted to a pregnant woman through various routes, such as sexual contact, blood transfusions, and contaminated needles¹⁹. However, the most significant concern during pregnancy is the transmission of the virus from mother to child during pregnancy, childbirth, or shortly after birth²⁰. Hepatitis B surface Antigen was identified several years later as a marker for patients at high risk for transmission of the disease²¹.

Babies born from a mother having hepatitis B virus have a greater chance of developing chronic hepatitis B virus, if they are not properly treated at birth²². It is very important that pregnant mothers know their hepatitis B status in order to prevent passing the virus to their newborn baby during delivery²². If the doctor is aware that the pregnant mother has hepatitis B virus, he or she can ensure that HBV transmission to her baby is prevented by taking the right steps based on blood test results. In such conditions, the proper medications in the delivery room is important to prevent her baby from infection of HBV virus²³.

The virus is a major cause of liver disease, cirrhosis, and liver cancer, leading to substantial morbidity and mortality¹⁵. The primary goal is to establish how widespread of the Hepatitis B virus among pregnant women be prevented in the specific hospital setting. Pregnant mothers with seriously abnormal liver function are prone to postpartum hemorrhage, puerperal infection, low body weight infants, fetal distress, premature birth, fetal death and neonatal asphyxia and can have adverse birth outcomes²⁴. Neonates born from chronically infected mothers have a 70–90% more likely to be infected with the virus²⁵. Systematic reviews and meta-analyses study revealed that the prevalence of HBV in the general population ranged from 6% to 7.4% whereas 5%–7% of pregnant mothers were a major source of disease for newborns.

Despite the high prevalence of HBV in the study area, there is a scarcity of research which declares its threat as a critical public issue, and there is a need for increase of awareness and resources for prevention and control. Therefore, the objective of the current study was to investigate the prevalence of chronic hepatitis b virus infection and associated factors among pregnant women attending antenatal care at Felege Hiwot Comprehensive Specialized Hospital Ethiopia. The findings obtained in the current study will help to fill a knowledge gap regarding HBV epidemiology in a specific regional setting. The result in the current study is also crucial for understanding the local public health burden of the disease. The result obtained in this study would highlight the potential risk factors for the prevalence and associated predictor of HBV in the study area. The findings of the study are also intended to provide evidence-based recommendations for the regional health system.

Methods and materials

Study area and populations

The research was conducted at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar city administration from June, 2022- July 224. Bahir Dar is the regional city of Amhara nation, which is 565 km northwest of Addis Ababa. Based on the 2021 Health and Health Related indicators report by Bahir Dar city administration health office, there are 3 Hospitals and 8 Health Centers (HCs) in Bahir Dar city. Felege Hiwot is one of the compressive referral hospitals in Bahir Dar city. It gives services for the western part of Amhara region as a referral hospital. Felege Hiwot referral hospital was established in 1953 E.C. The hospital has different departments that provide specialized services for outpatients, inpatients and operation theatre departments. It provides services for about more than 10 million people from the surrounding area. In the hospital, two follow ups and one ultrasound class’s give a service for 5200 pregnant mothers. HBV screening is one of routine investigations for all pregnant mothers who had ANC follow ups.

Source of population

The source of population for the current study was all pregnant women who had antenatal care follow ups at Felege Hiwot Comprehensive Specialized Hospital in Bahir Dar city.

Inclusion criterion

All pregnant women who were attended with at least two follow-ups for the ANC care at Felege Hiwot Comprehensive Specialized Hospital during the study period were included under study.

Exclusion criterion

Women who had ANC visit at Felege Hiwot Comprehensive Specialized Hospital during data collection period but had incomplete and missed medical records for pregnant woman and those pregnant women who had been vaccinated for HBV before their pregnancy were excluded under study. Such vaccinated women are less likely to be infected by the HBV virus as compared to non-vaccinated women.

Study design and period

Institutional based retrospective study design was conducted for the current study. The study was done for those pregnant mothers whose ANC follow-ups were from June, 2022- July 2024.

Study variables

Dependent variable

The dependent variable for the current study was test result of hepatitis B surface antigen (HBsAg). It is either positive or negative and considered as binary/dichotomous in nature. For the representative sample, prevalence is the ratio of number of pregnant mothers having chronic HBV and total number of pregnant mothers considered under the given study.

Independent variables

For the current study, age of participants, occupation of the participants, marital status, gravidity, parity, history of abortion, history of surgical procedure, working history at health facility, history of blood transfusion, history of having multiple sexual partner, genital mutilation, drinking alcohol and body tattoo were considered as potential predictor variables for the variable of study.

Sensitivity and specificity of HBsAg

The VITROS HBsAg test was performed using the VITROS HBsAg reagent pack and VITROS immunodiagnostic products. HBV screening was conducted to those pregnant mothers with history of medical illness using HBsAg, Point of Care for Rapid Diagnostic of Tests (POC-RDTs). In this study, HBsAg has shown high sensitivity, specificity, and accuracy for the hepatitis B virus. However, despite HBsAg measurement, there remains a residual risk of transfusion-transmitted infection with HBV through the transfusion of infected blood or blood components, due mainly to a relatively long preseroconversion window period following HBV infection.

Sample size determination and its procedures

Sample size was calculated with desired precision of 4%, a 95% confidence level and 10% for non-response rate. The sample size was determined based on a single-population proportion formula. Hence, among the pregnant mothers who fulfilled the inclusion, about 221 were randomly selected using systematic random sampling technique. First sampling frames were listed from antenatal care registration log book. Then by using systematic random sampling technique, study units were selected. ANC registration log book was used for sources of data for those selected women receiving prenatal care at Felege Hiwot referral hospital. The information obtained in the sample population was used to estimate the whole pregnant mothers attended at the ANC clinic in the hospital and the three month’s average was calculated to be 625. The sampling interval K was calculated as N/n = study population/sample size = 625/221 ≈ 3. Then the first pregnant mother was selected randomly and the rest was done in the pre design patter. Hence, the charts of pregnant mothers attended at ANC which was ordered based on their chart number were selected at every 3 intervals for data analysis.

Data collection procedure and tools

After receiving permission letter from GAMBY Medical and Business College, The data were gathered using chart reviews, which were previously interviewed by health staff while pregnant mother came for ANC medical checkups and recorded on the chart of each ANC visits. Socio-demographic data, health-related factors, health-related behavioral and cultural factors and practices were properly recorded in each visit on charts each pregnant mother. Data collection tools were prepared in reviewing related literature and were pre-test for sake of completeness and amendments were conducted after pilot test.

Awareness creation was conducted for data collectors (health staff) with one day training about the variables needed for the current study and their categories (measures of scaling). To ensure its reliability, the English version of the questionnaire was translated into local language (Amharic) and then back to English by language experts. The data collection process was overseen and the data collected were examined and verified by the principal investigator. Successive data collection was verified to ensure reliability and accuracy.

Data processing and analysis

After checking for completeness and consistency of the data, the data were entered into SPSS version 27 statistical software for data cleaning, coded and analysis. Binary logistic regression analysis was conducted after dichotomized the dependent variables. After checking association of the variables, those with p value less than 0.25 were proceed to multi-variable logistic regression analysis to control confounding factors. Finally, P value of < 0.05 was used to express the statistical significance of the variables.

Binary logistic regression for assessing the HBV status of pregnant mothers

In binary logistic regression, proportions and probabilities are bounded by 0 and 1. This means that we cannot assume normality for a proportion, and we must recognize that proportions have a binomial distribution. It is known that mean and variance of the Binomial distribution are not independent. Hence, mean and variance are related to each other²⁶.

In data analysis, both bi-variate and multivariate regression models were conducted. First, the bi-variate logistic regression model was conducted and from this analysis variables with p-values < 0.25 were significant to be considered in the multivariate logistic regression model analysis.

Ethics approval and consent to participate

Ethical approval certificate had been obtained from Gambi Medical College, Bahir Dar, Ethiopia Ethical approval committee with reference number GMC/122/2021. Hence, due to the retrospective nature of the study, Gambi Medical College review board waived the need for obtaining informed consent from participants.

Results

Socio-demographic characteristics of study participants

A total of 221 pregnant women who were at ANC at Felege Hiwot Comprehensive Specialized Hospital were considered as participants for the current study. The mean age of the women was 29.12 years (range from 24 to 34 years) with a SD of 5.11 years. The majority, 146 (66.1%) of the participants were under age group (18–30). A total of 195 (88.2%) respondents were in urban areas, 33(14.9%) have no formal education and only 63(28.5%) had college or university education. Regarding marital status and occupation of the study participants, a total of 217(98.2%) are married, 100(45.2%) are housewife and 47(21.3%) were governmental employee (See Table 1).

Table 1.

Socio- demographics characteristics of participants (n = 221).

Characteristics	Category	Frequency	Percent
Age of the respondent	18–30	146	66.1
	31–40	70	31.7
	> 40	5	2.3
Residence	Rural	26	11.8
	Urban	195	88.2
Occupation	House wife	100	45.2
	G. Employee	47	21.3
	Farmer	12	5.4
	Merchant	38	17.2
	Student	8	3.6
	Daily laborer	16	7.2
educational status	No formal education	33	14.9
	Primary school	67	30.3
	Secondary school	58	26.2
	College/university	63	28.5
Marital status	Married	217	98.2
	Divorced	4	1.8

Risky socio-cultural behavioral health related factors

A total of 61 (27.6%) participants had been history of body tattooing, 3 (1.4%) had multiple sexual partners. Among participants, 87(39.4%) had history of genital mutilation, 46 (20.8%) of participants were alcohol consumers, while 14 (6.3%) participants had a history of blood transfusion. Among the participants, 3(1.4%) had history of contacting with a person having liver disease, while 58 (28.2%) had history of abortion. Among the participants, 64 (29.0%) had surgical history, 17 (7.7%) had history of working at health facilities. For the participants in the current study, husband HBV screening was conducted for 54 (24.4%) and among the screened husbands, only one was HBV positive and the rest were HBV negative. A total of 49 (22.2%) had history of medical illness and among the study participants, 15 (6.8%) were HIV positive (Refer to Table 2).

Table 2.

A risky cultural, behavior and health related characteristics of study participants (n = 221).

Characteristics	Category	Frequency	Percent
Gestational age	1 st trimester	47	21.3%
	2nd trimester	77	34.8%
	3rd trimester	97	43.9%
Number of gravida	primi gravida	66	29.9%
	multi gravida	155	70.1%
Number of parity	primi para	69	31.2%
	multi para	91	41.2%
	no birth	61	27.6%
History of abortion	Yes	58	26.2%
	No	163	73.8%
Place of birth	no birth	70	31.7%
	at health facilities	140	63.3%
	at home	11	5%
Previous surgical history	Yes	64	29%
	No	157	71%
History of blood transfusion	Yes	14	6.3%
	No	207	93.7%
History of alcohol consuming	Yes	46	20.8%
	No	175	79.2%
Health service follow up at other health facilities	Yes	29	13.1
	No	192	86.9
HBsAg test result	Negative	211	95.5
	Positive	10	4.5
History of medical illness	Yes	49	22.2
	No	172	77.8
Husband tested for HBV status	Yes	54	24.4
	No	167	75.6
If she said yes in husband screen, what was the result	non response	168	76
	Positive	1	0.5
	Negative	52	23.5
history of contact with a person with liver disease	Yes	3	1.4
	No	218	98.6
history of genital mutilation	Yes	87	39.4
	No	134	60.6
history of having multiple sexual partner	Yes	3	1.4
	No	218	98.6
history of working at health facilities	Yes	17	7.7
	No	204	92.3
history of tattooing	Yes	61	27.6
	No	160	72.4

VITROS HBsAg screening was conducted to those pregnant mothers with history of medical illness using HBsAg) POC-RDTs (Healgen, Advanced Quality and Determine) and among the 49 pregnant who screened for HBV, 25 (51%) of them had positive HBV result with the gold standard. All the three POC-RDTs were positive in 20 of the 25 positive samples, yielding a sensitivity (95% confidence interval) of 80% (70 − 88.5) and a specificity of 96.8% (93.7 − 98.4) for Healgen and Determine; 91.6 − 96.5 for Advanced Quality). False negatives were observed in 15 pregnant mothers associated with low levels of HBsAg (median 1.7 IU/mL). All the three POC-RDTs had reasonably high sensitivity and excellent specificity, but false negative results were observed in patients with moderately low titres of HBsAg. Thus, these POC-RDTs might be helpful to identify pregnant mothers in need of HBV treatment.

Prevalence of hepatitis B surface antigen (HBsAg)

Among the participants in the current study, a total of 4.55% of the study participants were positive for hepatitis B surface antigen, while the rest were negative. Among the pregnant women, 97(43.9%) were 3rd trimester, the majority of them (155 (70%)), were multi gravida and 58(26.2%) has abortion history. Among the participants, a total of 140 (63.3%) delivered at health facility, 64 (29%) had a history of previous surgical and 14(6.3%) of them had history of blood transfusion. Among the pregnant mothers, 46(20.8%) were alcohol consumers, 29 (13.1%) had followed at other health facilities. Of the participants, 49 (22.2%) had a history of medical illness, the majority of husbands of the pregnant mothers (167(75.6%)) did not test their HBV status and 3(1.4%) had a history of contacting with HBV positive individuals. Among the participants in the current study, 87(39.4%) had genital mutilation, 3(1.4%) of them had multiple sexual partners and 61(27.6%) had history of tattooing (Refer to Table 2).

Factors associated with the prevalence of hepatitis B virus infection

In order to measure association of variables with dependent variable, prevalence of hepatitis B virus infection, binary logistic regression with significance level of 0.25 was conducted, then multivariable logistic regression analysis with significance level of 0.05 was also conducted to get the significant predictors. Both univariate and multivariable logistic regression analyses were done as shown in Table 3 to assess socio-demographic and other predictable variables in relation to the prevalence of hepatitis B virus infection among the pregnant women. Table 3 indicates that, number of gravida, previous history of abortion, history of blood transfusion, women who had medical illness, contact history with liver disease person, history of genital mutilation, and history of body tattooing were significant at 0.25 level of significance. The multivariable logistic regression analysis shows that, among the predictors, history of abortion, history of blood transfusion, history of genital mutilation, history of tattoo, history of alcohol consuming, history of having multiple sexual partner and history of contact with HBV infected person were significantly affected the prevalence of chronic HBV among the pregnant mothers.

Table 3.

Multivariate logistic regression parameter estimates of HBsAg test status of pregnant mothers attended at ANC at Felege hiwote referral hospital (n = 221).

Predictors	COR	95% CI for COR	AOR	95%CI for AOR	P-value
Number of gravida(Ref.=Primi gravida)
Multigravida	0.25	(0.31–2.01)	0.61	(0.59,6.31)	0.231
History of Abortion (Ref.= No)
Yes	4.98	(1.83,10.7)	3.47	(1.29,7.40)	0.030**
History of Blood transfusion (Ref.=No)
Yes	7.79	(1.76,34.31)	11.5	(8.67, 17.5)	0.013**
History of Medical illness (Ref.=No)
Yes	2.45	(0.66,9.09)	1.9	(0.36,9.6)	0.44
History of genital mutilation (Ref.=No)
Yes	15.34	(1.90,123.4)	12.2	(9.30,18.4)	0.028**
History of tattoo (Ref.=No)
Yes	6.78	(1.69,27.1)	6.04	(1.20,10.0)	0.028**
History of alcohol consuming (Ref.=No)
Yes	1.62	(1.08, 4.45)	1.52	(1.19, 4.36)	0.041**
History of multiple sexual partner (Ref.=No)
Yes	1.45	(1.05,4.58)	1.35	(1.09, 4.82)	0.023**
History of contact with person infected level (Ref.=No)
Yes	1.28	(1.08, 5.64)	1.45	(1.03,3.84)	0.002**

Note that: ** stands for significant predictors at 95% CI.

The estimated odds of being positive HBV for those pregnant women who had history of blood transfusion was 11.5 times more likely than those who had no history of blood transfusion, given the other covariates constant [AOR = 11.5; 95%, CI: (8.67,17.5) and P-value = 0.013].

History of abortion was another significant variable for the HBV prevalence. Hence, the estimated odds of being HBsAg positive for those pregnant women who had abortion history was 3.47 times more likely as compared to those pregnant mothers without abortion history, given the other conditions constant (AOR = 3.47, 95% (1.29, 7.40) and p-value = 0.030).

History of genital mutilation was also another significant variable for the variable of interest. The estimated odds of being positive HBsAg surface antigen for those pregnant mothers who had history of genital mutilations was 12.2 times more likely as compared to pregnant mothers without history of genital mutilations, given the other covariates constant (AOR = 12.2, 95% CI: (9.30, 18.4), p-value = 0.028) (Refer to Table 3).

Another variable significantly affected the prevalence of HBV among the pregnant mothers was history of tattoo. Hence, the estimated odds of being positive HBsAg for pregnant mothers with history of tattoo was 6.04 times more likely than those pregnant mothers without history of tattoo, assume that the other covariates constant (AOR = 6.04, 95% CI: (1.20,10.0), p-value = 0.028).

The association of light-to-moderate alcohol consumption with clinical outcomes in patients with chronic hepatitis B virus (HBV) infection appears modest. The estimated odds of being positive HBsAg surface antigen for those pregnant mothers with history of drinking alcohol was 1.52 time higher than those mothers without history of drinking alcohol, given the other conditions constant (AOR = 1.52, 95% CI: (1.19, 4.36), p-value = 0.041).

Having sex with multiple partners emerged as another significant association with the HBsAg positive status. Hence, the estimated odds of being positive HBsAg for those pregnant mothers who had multiple sexual partners was 1.35 times more likely than those mothers without multiple partners, given the other conditions constant (AOR = 1.35, 95% CI: (1.09, 4.82), p-value = 0.023).

History of contamination with individuals with liver disease had also significant effect for getting HBsAg positive result. The estimated odds of getting HBsAg positive result for pregnant women who had contacted with person with liver disease was increased by 45% as compared to those pregnant mothers with no history of contacting individuals with liver disease, keeping the other covariates constant (AOR = 1,45; 95% CI: (1.23, 7.84) and p-value = 0.002).

Discussion

In the current study, it is found that the prevalence of HBV infection was 4.5% which was investigated using the test of HBsAg surface antigen. Hence, according to established criterion, Potential predictors for this result have been identified in the current study. This result is consistent with one of the previous study, conducted at Della University referral hospital 5/1%²⁷ and at Jimma university 3.7%²⁸. The findings obtained in the two hospitals are closer to the current result general hospital. However, this result is contradicted with another studies conducted at Adigrat general hospital with result of 9.2% and conducted in Ghana with result of 7.7%²⁹. The potential reason for the contradicted result might be the study area/geographical location, study time and number of participants in the different studies and sampling techniques used. Hence, further investigation is needed for the consistency of the result.

In this study having a history of blood transfusion significantly affects the possibility being positive HBsAg. Hence, a pregnant mother who had a history of blood transfusion have a more chance of getting positive HBsAg result as compared to those pregnant mothers without history of blood transfusion. This finding is supported by many of the previously conducted researches³⁰. The reason for this might be the fact that a residual risk of transfusion-transmitted infection with HBV through the transfusion of infected blood or blood components, due mainly to a relatively long preseroconversion window period following HBV infection or occult HBV infection.

History of abortion is one another variable significantly affects for the possibility being positive HBsAg. The possibility of getting positive HBsAg for those mothers with previous abortion history is greater than that of mothers without abortion history³¹. The potential reason for this might be Prior abortions elevated a pregnant woman’s risk of contracting the hepatitis B virus.

History of genital mutilation also significantly affects the possibility of getting positive HBsAg. Hence, the possibility of getting positive HBsAg for pregnant mothers with history of genital mutilation is higher than those pregnant mothers without genital mutilation^31,32. The potential reason for this is that it is carried out by a traditional cutter using a blade or any other sharpens materials. It is usually initiated and carried out by unskilled women such daughters may expose to HBV. Adverse health effects depend on the type of procedure; they can include recurrent infections like HBV.

It is known that alcohol has its own effect for the occurrence of liver disease. Pregnant mothers who drink alcohol have a higher chance of getting positive HBsAg result as compared to those pregnant mothers without history of drinking alcohol³³. Hence, the result in the current study showed an increased concurrence of HBsAg in alcoholic patients when compared with controls as well as an increased incidence of severe chronic liver disease in HBV- positive groups when compared with HBV- negative groups. The association of light-to-moderate alcohol consumption with clinical outcomes in patients with chronic hepatitis B virus (HBV) infection appears modest³³.

Having sex with different partners facilitates for the positive HBsAg for the pregnant mothers. It is known that one of the methods of transmitting HBV is sexual intercourse and for a woman who have sexual intercourse with multiple partners, the chance of getting positive HBsAg is by far greater than that of the woman without multiple partners³⁴. The potential reason for this might be having a history of STDs, particularly those that increase the likelihood of ulcerative lesions, can increase the odds of HBV transmission during sexual contact.

History of contamination with individuals infected by liver disease significantly affects for the chance of being positive HBsAg as compared to those pregnant mothers who do not contact with individuals with HBV infection. The expected odds of getting positive HBsAg for pregnant women who contacted with person with liver disease have a greater chance of getting positive HBsAg³⁵. The increased risk may be attributed to the sharing of personal and Household items contaminated with HBV, specifically toothbrushes, razors, nail clippers, or sharp materials, which could facilitate the transmission of the virus from infected individuals to other family members.

History of tattoo significantly affects the chance of getting positive HBsAg. Hence, the expected odds of getting positive HBsAg for pregnant mothers with history of tattoo is higher than those pregnant mothers without history of tattoo³⁶. A review of the literature has been conducted previously to examine the risk of transmission of hepatitis B virus (HBV) from tattooing and body piercing and the result indicates that there is a high risk of transmission of HBV from tattooing and body piercing³⁶.

Conclusion and recommendation

The overall prevalence of HBV among pregnant mothers under ANC for the current study was 4.5% which was investigated using the test of HBsAg surface antigen at laboratory test. Different factors played significantly for the current prevalence of HBV. Among the significant predictors, history of blood transfusion, drinking alcohol, having multiple sexual partners, history of contamination with individuals with HBV, history of body tattoo and history of genital mutilation significantly affected for the prevalence of HBV in the current study.

Intervention should be taken for those pregnant mothers with positive results, screening of blood at donation. Screening should be the first step in identifying infected mothers and preventing transmission to their infants. All newborns should receive the hepatitis B vaccine as soon as possible after birth to prevent mother-to-child transmission (MTCT). This is especially important for infants born to HBV -positive mothers. Health related education should be conducted for pregnant mothers while coming ANC to raise awareness about HBV transmission and prevention. This should include a focus on risky cultural behaviors and the importance of using sterile equipment during medical and traditional procedures.

Limitation of the current study

This study was not without limitation. The study has been conducted in a single institute, Felege Hiwot Comprehensive Specialized Hospital. Having more health institutes may give additional information and as the data was secondary collected by the health staff for ANC service provision, only those recorded covariates in the charts of each pregnant mother were included in the current study. The regional characteristic included in the current study, may not easily reflect the national epidemiology and risk factors. Further research with more treatment site and additional covariates is recommended by this research.

Abbreviations

Ag

Antigen

ANC

Antenatal care

DNA

Deoxyri bonucleic acid

HBsAg

Hepatitis B surface antigen

HBV

Hepatitis B virus

HIV

Human immune virus

WHO

World health organization

Author contributions

AAW wrote the proposal, developed data collection format, supervised the data collection process, AST and NSM participated in data analysis, writing the manuscript and finally edited the whole document for the current study.

Data availability

The datasets generated and/or analyzed during the current study are not publicly available to protect the privacy of participants but are available from the corresponding author on reasonable request.

Declarations

Competing interests

The authors declare no competing interests.

Ethics approval and consent to participate

Ethical approval certificate had been obtained from Gambi Medical College, Bahir Dar, Ethiopia Ethical approval committee with reference number GMC/122/2021. To keep the confidentiality and compliance with the declaration of Helsinki within the manuscript of patient related data, the names of patients were not given to investigators; rather patients MRN and important variables from patients’ chart related to the current study were given to researchers. Hence, due to the retrospective nature of the study, Gambi Medical College review board waived the need of obtaining informed consent from participants.