Epidemiological and clinical profile of viral hepatitis B and C among adult patients attending Hepatitis clinic at Rwanda Military Referral and Teaching Hospital: a retrospective cross-sectional study

Abstract

Background

This study aims to establish the epidemiological and clinical Profile of viral hepatitis B and C (HBV and HCV) among adult patients attending the hepatitis clinic at Rwanda Military Referral and Teaching Hospital.

Methods

Retrospective data were collected using an online Google Form questionnaire (File Appendix 1). Files were randomly selected from among 557 and 209 files for patients with hepatitis B and C, respectively, attending the Rwanda Military Referral and Teaching Hospital hepatitis clinic. Descriptive statistics of the demographic and clinical characteristics of patients attending the clinic were determined using SPSS statistical software version 29.0.

Results

The majority (75.8%) of the patients with HBV were male, while females were 24.2%. Most (70.1%) of the patients also belong to the Ubudehe category III. Those from Kigali City accounted for 53.1% of all cases. Of all the participants, 51.03% were either military or police officers. Kicukiro district has the highest proportion of patients from the same district of residence (27.3%). The highest number of patients with HBV attending RMRTH’s hepatitis clinic were aged between 30 and 39 years, accounting for 39.7%. Regarding Hepatitis C, the majority of the patients were female (n = 43, 62.3%). Those with a socioeconomic background in category III were the Majority, 65.2% (n = 45). The majority of patients were unemployed (60.9%, n = 42). Those from Kigali City accounted for 55.1% (n = 38). The majority of HCV patients were from the GASABO district (31.88%, n = 22), followed by Kicukiro District (20.3%, n = 14). The highest number of patients with HCV clinic are aged between 70 and 79 years, accounting for 23.2% (n = 16). Most HBV cases were diagnosed between 2015 and 2019, and the first-line treatment used was tenofovir. For the case of HCV, the HCV Antibody test was the primary diagnostic method, and the first-line treatment for HCV was Sofosbuvir and Daclatasvir.

Conclusions

This research has demonstrated some patterns in HBV and HCV infections. Males account for more cases of HBV infection, while females account for more HCV infections.

Clinical trial number

Not applicable.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12879-026-13119-7.

Introduction

Viral hepatitis B (HBV) and C (HCV) infections remain significant global public health challenges due to their potential to cause severe liver complications, including cirrhosis and hepatocellular carcinoma. Worldwide, an estimated 296 million people live with chronic HBV infection, while HCV affects approximately 130 to 150 million individuals [1, 2], with substantial morbidity and mortality attributed to these viruses. Transmission occurs primarily through exposure to infected body fluids, with sexual contact, perinatal transmission, and parenteral routes being the most common pathways [1]. The burden of HBV and HCV is disproportionately high in sub-Saharan Africa and other resource-limited settings, where prevalence rates exceed global averages and healthcare infrastructure may be constrained [3]. HBV and HCV rates remain high, with country-specific variations such as Ghana’s 12% HBV prevalence and South Africa’s lower rates among blood donors. East African countries, including Rwanda, report HBV prevalences around 3.9–8.7%, with risk factors including blood transfusion, scarification, and male sex [4]. while HCV seroprevalence in Rwanda reaches up to 8.86% [5], especially among older populations. High-risk groups such as medical students and healthcare workers show variable HBV and HCV prevalence, emphasising occupational exposure. Risk factors across settings include unsafe injections, traditional surgical practices, and household exposure, underscoring the need for targeted prevention and control measures, including vaccination and screening, especially in high-risk and endemic populations [6].

Despite national screening efforts and the availability of antiviral treatments, there remains limited detailed knowledge about the epidemiological and clinical characteristics of patients attending specialised hepatitis clinics within the country. Rwanda Military Referral and Teaching Hospital (RMRTH), as a tertiary referral center, provides a unique setting to assess these profiles among adult patients diagnosed with HBV and HCV.

This study aims to characterise the epidemiological and clinical profiles of adult patients with viral hepatitis B and C attending the hepatitis clinic at RMRTH. By examining demographic factors, risk exposures, treatment outcomes, and geographic distribution, the research seeks to inform targeted prevention strategies and optimise clinical management within the Rwandan context. Understanding these patterns is essential to support national efforts to control viral hepatitis and align with global health goals aimed at reducing the burden of these infections.

Methods

The primary objective of this study is to determine the epidemiological and clinical determinants of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections among adult patients.

Study design and setting

Rwanda Military Referral and teaching hospital is a referral and tertiary hospital located in Kigali, primarily serving Rwandan military families. Additionally, RMRTH extends specialised healthcare services to the general population within its defined catchment area, including the Eastern province of Rwanda and other parts of the country. The Hepatitis clinic offers comprehensive services, including screening, diagnosis, treatment, and follow-up care of patients with viral hepatitis. A retrospective descriptive cross-sectional study design was employed to analyse existing patient data. The study was conducted at the hepatitis clinic of RMRHH, a tertiary referral hospital in Rwanda known for specialised care for patients with viral hepatitis. The Hepatitis clinic provides referral care and follow-up for patients diagnosed with Hepatitis.

Participants and sampling techniques

The study identified patients attending the Rwanda Military Referral and Teaching Hospital (RMRTH) Hepatitis Clinic as the study population. A total of 766 patients diagnosed with either HBV (557) or HCV (209) were actively attending the clinic. To ensure statistical robustness, Slovin’s formula was applied with a 5% margin of error, resulting in a minimum required sample size of 263 participants. Patient files were selected using a probability-based sampling approach. Recognising the potential limitations imposed by the alphabetical organisation of patient records, files were stored alphabetically in cubicles, each containing approximately 20 files. These cubicles were numbered, and random draws of cubicle numbers were conducted separately for HBV and HCV files until the target sample size was reached. An independent clinician, blinded to file details, carried out the assignment. Random numbers were generated using a computer-based random number generator to assign files to cubicles of varying sizes. This process minimised systematic biases; nevertheless, the potential limitation of alphabetical organisation is acknowledged and considered in the interpretation of findings. Inclusion criteria encompassed adult patients with a confirmed diagnosis of HBV, HCV, or coinfection who were actively attending the RMRTH Hepatitis Clinic during the study period.

Data collection

Data were retrospectively extracted from patient medical records using a structured questionnaire (see Appendix 1) designed to capture comprehensive socio-demographic and clinical variables. The questionnaire was developed specifically for this study. Content validation was conducted by a clinical expert, a physician, and researchers, and the instrument was piloted with 15 files that were not included in the final sample. Trained data collectors, familiar with the research protocol, Good Clinical Practice (GCP), and data collection procedures, systematically reviewed patient charts and clinical records to complete the questionnaire. The socio-demographic section included variables such as age, sex, education level, occupation, marital status, socioeconomic status (Ubudehe category), and place of residence. These variables facilitated a comprehensive understanding of the study population. The clinical section captured information on symptoms, duration of illness, vaccination history, history of blood transfusion, exposure to risk factors (e.g., scarification, tattoos, intravenous drug use), comorbidities, diagnostic methods, viral load measurements, and treatment regimens. In instances where participants did not provide a response or the information was not available in the source documents, the variable was recorded as ‘Not mentioned.’ All responses were recorded; however, some variables contained these non-specific responses.

Due to the retrospective nature of the study and the use of de-identified data, informed consent was sought and subsequently waived by the Rwanda Military Referral and Teaching Hospital Institutional Review Board (IRB). Nevertheless, confidentiality and data protection protocols were strictly adhered to, in accordance with ethical guidelines from the University of Rwanda (UR) and the Rwanda Military Referral and Teaching Hospital. Data extraction was conducted between March and May 2023, ensuring the capture of contemporaneous and consistent data. To maintain data quality, data collectors underwent study-specific training and supervision, and completed questionnaires were reviewed for completeness and accuracy by the assigned data quality assurance officer. Extracted data were entered electronically into a secure, password-protected Google Drive folder with regular backups to ensure data integrity and confidentiality.

Analysis

Data analysis was conducted using the Statistical Package for the Social Sciences (SPSS) version 29. Descriptive statistics, including frequencies, proportions, means, and standard deviations, were calculated to summarise socio-demographic and clinical characteristics. The study was descriptive in nature; therefore, no inferential statistical tests were performed. Analyses were conducted using available-case data where variables had missing values. All questionnaires were completed; however, certain variables included responses categorised as “Not mentioned”. These responses were treated as missing data in the analysis. The extent of missing data was evaluated for each variable before conducting statistical analyses, which were performed using available-case (complete-case) data.

Ethical considerations

The study was conducted in accordance with the principles of the Declaration of Helsinki. Ethical approval was obtained from the Institutional Review Board (IRB) of the University of Rwanda, with reference number CMHS/IRB/154/2023, and from the Rwanda Military Referral and Teaching Hospital Institutional Review Board (IRB)before the initiation of data collection. Patient confidentiality was rigorously maintained by anonymising data and restricting access to authorised research personnel only.

Results

Baseline characteristics of participants

We collected a total of 263 patients’ files enrolled in RMRTH’s hepatitis Unit, among which 194 patients were enrolled in HBV treatment follow-up, and 69 were enrolled in HCV treatment follow-up. Rwanda Military Referral and Teaching Hospital is a referral hospital with a catchment area of eastern province district hospitals, implying that most of the referred patients are from the east, and it also extends its service specifically to people working for security organs in Rwanda.

Demographic variables of HBV and HCV

Data collection was done from a total of 194 files, with all patients having an HBV diagnosis. Table 1 shows the demographic characteristics of the patients from our study setting. The majority of patients were male (n = 147, 75.8%), while females accounted for 24.2% (n = 47). The highest number of patients with HBV are aged 30–39 years, accounting for 39.7% (n = 77), followed by those aged 40–49 (n = 57, 29.4%), while those aged 60 + were the minority (n = 4, 2%). Regarding the marital status, 64.9% of the patients are married (n = 126), 28.4% single (n = 55), 3.6% widowed (n = 7), 2.6% divorced (n = 5), while one patient’s marital status was unknown, accounting for 0.5%. The majority of the patients with hepatitis B attending the hepatitis clinic at RMRHH have medical insurance (93.3%, n = 181). The majority of the patients also come from above-average socioeconomic backgrounds; those from Ubudehe category III were 70.1% (n = 136), category II (10.3%, n = 20), and category I (2.6%, n = 5). However, no socioeconomic status was mentioned for 17% of the patient files (n = 33). Most patients (30.4%, n = 59) had attained tertiary education, while those without any formal education accounted for 2.1% (n = 4). Equally, Variation was observed in the province of residence of patients of the patients attending the clinic. Those from Kigali City accounted for 53.1% (n = 103).

Table 1.

Demographic characteristics of patients attending HBV and HCV clinic at RMRTH

Variable	HBV (n = 194)	HCV (n = 69)
Gender	Male: 147 (75.8%)	Female: 43 (62.3%)
	Female: 47 (24.2%)	Male: 26 (37.7%)
Age Group	20–29: 27 (13.9%)	20–29: 1 (1.4%)
	30–39: 77 (39.7%)	30–39: 5 (7.2%)
	40–49: 57 (29.4%)	40–49: 10 (14.5%)
	50–59: 29 (14.9%)	50–59: 12 (17.4%)
	60–69: 2 (1.0%)	60–69: 14 (20.3%)
	70–79: 2 (1.0%)	70–79: 16 (23.2%)
Marital Status	Married: 126 (64.9%)	Married: 34 (49.3%)
	Single: 55 (28.4%)	Widowed: 28 (40.6%)
	Widowed: 7 (3.6%)	Single: 3 (4.3%)
	Divorced: 5 (2.6%)	Divorced: 3 (4.3%)
Insurance	Insured: 181 (93.3%)	Insured: 66 (95.7%)
	Non-insured: 8 (4.1%)	Non-insured: 3 (4.3%)
Ubudehe Category	III: 136 (70.1%)	III: 45 (65.2%)
	II: 20 (10.3%)	II: 16 (23.2%)
	I: 5 (2.6%)	I: 4 (5.8%)
Education Level	Tertiary: 59 (30.4%)	Primary: 18 (26.1%)
	No formal education: 4 (2.1%)	No formal education: 16 (23.2%)
Province of Residence	Kigali City: 103 (53.1%)	Kigali City: 38 (55.1%)
	East: 46 (23.7%)	East: 15 (21.7%)
	West: 27 (13.9%)	West: 8 (11.6%)
	South: 13 (6.7%)	South: 5 (7.2%)
	North: 5 (2.6%)	North: 3 (4.3%)

Regarding HCV, Data were collected from 69 patient files with an HCV diagnosis, the majority being female (62.3%), and most patients were aged 60–79 years. Nearly half were married (49.3%), widowed (40.6%), and almost all were on medical insurance (95.7%). Most patients were from higher socioeconomic categories (Ubudehe III and II) and primarily resided in Kigali City (55.1%). Educational attainment was generally low, with most having only primary education or none at all (Table 1).

Factors promoting possible exposure to infection

The risk factor profile of patients at the HCV clinic at RMRTH indicates multiple potential exposures to HBV and HCV. Household contact with HBV and HCV cases was reported by 26.3% and 4.1% of patients, respectively. Sexual risk factors included a history of sexually transmitted infections (5.7%), condomless intercourse (25.8%), and sexual assault (1.5%). Most patients were nonsmokers (85.5%) and not sexually active (60.9%) at data collection. Liver disease varied, with 2.9% having steatosis, 10.1% liver cirrhosis, and 87% normal liver findings. (Table 2).

Table 2.

Factors promoting possible exposure to infection for HBV and HCV

Exposure Factor	HBV (n = 194)	HCV (n = 69)
Household member with HBV	Yes: 51 (26.3%)	Yes: 4 (5.8%)
	No: 143 (73.7%)	No: 65 (94.2%)
Household member with HCV	Yes: 8 (4.1%)	Yes: 5 (7.2%)
	No: 183 (94.3%)	No: 64 (92.8%)
Prior history of sexually transmitted infection	Yes: 11 (5.7%)	Yes: 4 (5.8%)
	No: 180 (92.8%)	No: 65 (94.2%)
Sex without a condom	Yes: 50 (25.8%)	Yes: 10 (14.5%)
	No: 143 (73.7%)	No: 59 (85.5%)
Victim of sexual assault	Yes: 1 (0.5%)	Not reported
Traded sexual favours	Not reported	Yes: 1 (1.4%)
Paid for sexual favours	Not reported	Yes: 2 (2.9%)

Exposure to body fluids and invasive procedures

The exposure and procedure history among patients at the Rwanda Military Referral and Teaching Hospital hepatitis clinic shows that a small proportion reported blood transfusion or body fluid contact, with 2.6% (n = 5) of HBV patients and 7.2% (n = 5) of HCV patients affected. Tattooing was reported by 3.1% (n = 6) of HBV patients but none among HCV patients. Scarification was more common, affecting 19.6% (n = 38) of HBV and 34.8% (n = 24) of HCV patients. A history of imprisonment was reported by 4.1% (n = 8) of HBV and 5.8% (n = 4) of HCV patients. Intravenous drug use was low, at 3.1% (n = 6) for HBV and 1.4% (n = 1) for HCV patients. Exposure to unhygienic medical practices (e.g., lasers, razors, dental, and surgical procedures) was reported by 17.5% (n = 34) of HBV and 18.8% (n = 13) of HCV patients (Table 3).

Table 3.

Exposure to body fluids and invasive procedures for HBV and HCV

Exposure / Procedure	HBV (n = 194)	HCV (n = 69)
History of blood transfusion or body fluid contact	Yes: 5 (2.6%)	Yes: 5 (7.2%)
	No: 189 (97.4%)	No: 64 (92.8%)
Tattoos	Yes: 6 (3.1%)	Yes: 0 (0%)
	No: 188 (96.9%)	No: 69 (100%)
Scarification	Yes: 38 (19.6%)	Yes: 24 (34.8%)
	No: 155 (79.9%)	No: 45 (65.2%)
Previously in prison	Yes: 8 (4.1%)	Yes: 4 (5.8%)
	No: 186 (95.9%)	No: 65 (94.2%)
Intravenous injection of drugs	Yes: 6 (3.1%)	Yes: 1 (1.4%)
	No: 187 (96.4%)	No: 68 (98.6%)
Unhygienic medical practice (lasers, razors, dental, and surgical procedures)	Yes: 34 (17.5%)	Yes: 13 (18.8%)
	No: 159 (82.0%)	No: 56 (81.2%)

Pattern of risk factors among participants

The risk factor profile of patients attending the Hepatitis clinic at RMRTH, as detailed in Table 4, shows a low prevalence of smoking, with 96.4% (n = 187) identified as nonsmokers, 2.6% (n = 5) as former smokers, and smoking status not reported for 6.2% (n = 12) of participants. Sexual activity was reported by 85.1% (n = 165) of patients, while 39.1% (n = 27) of HCV patients were sexually active. The vaccination rate was low, with only 22.7% (n = 44) having received at least one dose. The study found that 72.2% (n = 140) had not been vaccinated, while the status of 5.2% (n = 10) was unknown. Those with liver changes such as cirrhosis, fibrosis, and fatty liver were 4.6% (n = 9, 2.6% (n = 5), and 0.5% (n = 1), respectively (Table 4).

Table 4.

Behavioural risk factors and liver conditions in HBV and HCV patients

Variable	HBV (n = 194)	HCV (n = 69)
Smoking status	Non-smoker: 187 (96.4%)	Non-smoker: 59 (85.5%)
	Former smoker: 5 (2.6%)	Former smoker: 4 (5.8%)
	Not mentioned: 12 (6.2%)	Not mentioned: 2 (2.9%)
Sexually active	Yes: 165 (85.1%)	Yes: 27 (39.1%)
	No: 24 (12.4%)	No: 42 (60.9%)
Vaccination (HBV only)	Yes: 44 (22.7%)	Not applicable
	No: 140 (72.2%)
Liver cirrhosis	Yes: 9 (4.6%)	Yes: 7 (10.1%)
Liver fibrosis	Yes: 5 (2.6%)	Not reported
Fatty liver / Steatosis	Fatty liver: 1 (0.5%)	Steatosis: 2 (2.9%)
Normal liver	Not reported	60 (87.0%)

Demographic variables of participants with HCV

Alcohol consumption frequency among HCV patients

The Pie chart below shows the level of alcohol consumption among HCV patients attending RMRTH’s hepatitis clinic. The majority, 73.9% (n = 51), reported having never taken alcohol in the past 12 months, while 3 patients (4.3%) reported drinking more than 4 times per week (see Chart 1).

Chart 1.

Alcohol consumption among HCV patients

Clinical profile of patients with HBV

The clinical profile and viral load data of patients attending the HBV and HCV clinics at RMRTH, as presented in Table 5, indicate the distribution of initial positive test dates and viral load categories before treatment. For HBV patients, the majority (56.2%) received their initial positive test between 2015 and 2019, followed by 20.6% tested between 2020 and 2023. Smaller proportions were diagnosed in earlier periods: 14.9% (2010–2014), 4.6% (2005–2009), 3.1% (2000–2004), and 0.5% (2015–2018). Regarding viral load before treatment, 24.7% had 1,000–9,999 copies, 14.4% had 100,000-999,999 copies, 10.3% had 10,000–19,999 copies, 8.2% had 0-999 copies, and 2.1% had over 100 million copies.

Table 5.

Clinical profile and viral load for HBV and HCV patients

Variable	HBV (n = 194)	HCV (n = 69)
Date of initial positive test
− 2000–2004	6 (3.1%)	Not applicable
− 2005–2009	9 (4.6%)
− 2010–2014	29 (14.9%)
− 2015–2018	1 (0.5%)
− 2015–2019	109 (56.2%)
− 2020–2023	40 (20.6%)
Viral load before treatment (copies)
− 0-999	16 (8.2%)
− 1,000–9,999	48 (24.7%)
− 10,000–19,999	20 (10.3%)
− 100,000-999,999	28 (14.4%)
- >100 million	4 (2.1%)
HCV viral load before treatment
− 0.9-1 million	Not applicable	2 (15.4%)
− 1–2 million		1 (7.7%)
− 2–3 million		3 (23.0%)
- >10 million		1 (7.7%)
Method of diagnosis	HBsAg test (implied)	HCV Antibody test: 69 (100%)

For HCV patients, all were diagnosed via HCV antibody testing. Viral load categories before treatment showed variability, with 23.0% having 2–3 million copies, 15.4% with 0.9-1 million copies, 7.7% with 1–2 million copies, and another 7.7% with over 10 million copies (Table 5).

Treatment duration, status, and medication for HBV

Most patients (44.3%, n = 86) had treatment durations between 1 and 5 years. The second most common treatment duration was in the range of 6 to 10 years, accounting for 39.7% (n = 77) of the cases. A small percentage of patients (0.5%, n = 1) had a treatment duration of less than 1 year. The majority of patients (85.1%, n = 165) were currently undergoing treatment. Some patients (4.6%, n = 9) were lost to follow-up, while 10.3% (n = 20) did not have their treatment status mentioned. In regard to treatment, tenofovir was the most commonly prescribed treatment, with 86.1% (n = 167) of the patients receiving it. Other treatments, such as Lamivudine, Entecavir, and those not mentioned, accounted for smaller percentages (Table 6).

Table 6.

Treatment duration, status, and medication for HBV

		Frequency	Percentage
Treatment duration (Years)	<1 year	1	0.5%
	21–25 years	3	1.5%
	16–20 years	8	4.1%
	11–15 years	19	9.8%
	6–10 years	77	39.7%
	1–5 years	86	44.3%
Treatment status	Lost to follow-up	9	4.6%
	Not Mentioned	20	10.3%
	Currently in treatment	165	85.1%
Treatment	Lamivudine	1	0.5%
	Entecavir	5	2.6%
	Not mentioned	21	10.8%
	Tenofovir	167	86.1%

Clinical profile of patients with HCV

Pregnancy status for HCV patients

Pregnancy status from all 43 female participants was collected. Only 2.3% (n = 1) reported being pregnant at the time they started attending the HCV clinic (Chart 2). The majority of the patients were not pregnant (n = 41, 95.4%), while one participant’s pregnancy status was not reported (n = 1, 2.3%).

Chart 2.

Pregnancy status for HCV patients

Liver changes among HCV patients

Among the participants, various liver changes were observed. Six participants (8.7%) had cirrhosis, making it the most prevalent liver condition. Cholelithiasis and Choledocholithiasis were less common, with two participants (2.9%) and one participant (1.4%), respectively, experiencing these conditions. Decompensated liver cirrhosis was identified in one participant (1.4%). In Chart 3, a significant number of participants, 57 (82.6%), did not exhibit any liver changes. The occurrence of Steatosis grade 1 and Steatosis grade 2 was low, with each accounting for only one participant (1.4%).

Chart 3.

Liver Changes among HCV patients

Method of diagnosis, viral load, and previous HCV status

The diagnosis of Hepatitis C Virus was established using the HCV Antibody test for all participants (n = 69, 100.0%). Before the initiation of treatment, the HCV RNA viral load (copies) was determined. Most participants had a viral load between 1 million and 2 million, accounting for 13 participants (18.8%). Another most common range was between 3 million and 4 million, with 13 participants (18.8%).

The majority of participants had no previous history of HCV infection (n = 60, 87.0%), while 9 participants (13.0%) reported a previous HCV infection. Among those with previous HCV infection, only 8 had undergone previous HCV treatment (chart 4).

Chart 4.

Methods of diagnosis, viral and previous HCV status

Although all patient files were retrieved and reviewed, some variables had incomplete documentation in the medical records. Missing data were observed for socioeconomic status (17%, n = 33), smoking status (6.2%, n = 12), vaccination status (5.2%, n = 10), treatment status (10.3%, n = 20), and marital status (0.5%, n = 1). Analyses for each variable were conducted using available data.

Treatment options, duration and outcomes

The primary treatment for HCV patients at RMH was Sofosbuvir and Daclatasvir, used by 95.7% of participants, with a few receiving alternative regimens. Treatment duration varied, with most patients undergoing 6 months (43.5%), followed by 24 months (33.3%) and 3 months (23.2%). The majority (62.3%) completed treatment and achieved a cure, while 17.4% did not complete treatment and were lost to follow-up. Resistance to first-line treatment occurred in 18.8% of cases, leading to second-line therapy with Sofosbuvir, Velpatasvir, and Ribavirin.

Among those with resistance, reasons were mostly unreported, though poor adherence was suspected in some cases. Of patients on second-line treatment, 30.8% achieved a cure, 46.1% were still undergoing therapy, and a minority experienced treatment failure, with some requiring a third-line regimen. Viral loads before second-line treatment varied widely, reflecting diverse disease burdens within this group.

Discussions

The present study aimed to investigate the epidemiological and clinical determinants of HBV and HCV infection among patients attending the hepatitis clinic at Rwanda Military Referral and Teaching Hospital. The findings revealed several important insights into the demographics, socioeconomic backgrounds, and risk factors among these patient populations.

The study’s demographic analysis showed that the Majority of HBV patients were male (75.8%), while females accounted for 24.2% of the participants. This gender distribution aligns with existing research, which indicates that males are more susceptible to HBV infection than females [7]. In terms of marital status, a significant proportion of the patients were married (64.9%), followed by single individuals (28.4%). These findings suggest that being married might be associated with a higher risk of HBV transmission, possibly due to sexual contact with infected partners or shared household exposure [8].

In our study, we believe that our sample choice likely depicts a true version of the clinical realities. For instance, research from Nigeria reported males constituting approximately 65% of HBV cases [9], while a study in Egypt documented a 70% male predominance (El-Zanaty & Way, 2018), both reflecting behavioural and biological susceptibility factors similar to those observed in Rwanda. However, the higher proportion of married individuals affected by HBV in the Rwandan cohort contrasts with findings from a South African study, where younger, unmarried populations showed higher HBV prevalence, suggesting regional variation in transmission dynamics, possibly influenced by cultural and sexual behaviour patterns [10].

Regarding HCV, the Rwanda study’s higher female prevalence diverges from data reported in Ethiopia and Cameroon, where males accounted for 60–65% of HCV infections [11]. The observed association between widowed status and HCV infection in Rwanda may be partially explained by factors such as prior exposure to health-related risk, including historical medical practices like unsafe injections, although this was not established with certainty. These patterns differ from reports in West African settings such as Ghana, where intravenous drug use is more identified as a major risk factor [7]. These variations highlight the importance of context-specific assessments of HCV risk factors.

Socioeconomic and educational disparities observed in Rwanda, with higher healthcare access among tertiary-educated groups, align with findings from Kenya and Uganda, where education significantly correlates with awareness and treatment uptake [12].

Behavioural risk factors emphasise sexual transmission for HBV, consistent with studies from West Africa reporting sexual activity as the primary transmission route in 45–55% of cases [13]. The study notes that transactional sex is included in transmission dynamics where (2.9%, n = 2) represents a distinct subgroup of paid-for sexual favours. Conversely, the lower prominence of smoking and alcohol consumption in Rwanda contrasts with South African cohorts, where these factors significantly exacerbate liver disease progression in HCV patients [10].

Clinically, the predominance of tenofovir treatment for HBV in Rwanda complies with WHO recommendations and reflects treatment patterns in East African countries such as Tanzania and Uganda, where tenofovir use exceeds 75% among HBV patients [14]. The use of Sofosbuvir-Daclatasvir for HCV aligns with cure rates above 90% reported in clinical trials across Africa. Nonetheless, the challenge of treatment adherence to prevent resistance, noted in Rwanda, echoes concerns from Egypt and Nigeria, where non-adherence rates range from 15 to 25%, impacting sustained virologic response [15].

These contrasts underscore the crucial importance of tailoring public health interventions to Rwanda’s distinct epidemiological profile, while leveraging regional data to inform effective strategies. The findings underscore the need to expand rural healthcare access, enhance education on transmission risks, and strengthen treatment adherence programs to effectively mitigate the viral hepatitis burden.

This study provides valuable insights into the epidemiological and clinical characteristics of HBV and HCV infections at the Rwanda Military Referral and Teaching Hospital, revealing patterns largely consistent with regional African data but with distinct demographic and behavioural nuances. The observed gender disparities, marital status associations, and urban predominance emphasise the need for context-specific public health strategies. Aligning treatment protocols with international guidelines while addressing local challenges such as treatment adherence and healthcare accessibility will be vital. Future efforts should prioritise comprehensive rural outreach, targeted vaccination campaigns, and culturally sensitive education programs to reduce transmission and improve clinical outcomes in Rwanda.

Strengths and limitations of this study

It is important to acknowledge both the strengths and limitations of this study. One strength is the comprehensive analysis of various demographic factors, including gender, marital status, socioeconomic status, education levels, and geographic distribution. This multidimensional approach enables a more nuanced understanding of the patient population. Additionally, the study’s focus on risk factors, such as smoking, sexual activity, vaccination rates, and alcohol consumption, provides important information for the development of targeted prevention strategies. On the other hand, this research has mentioned two limitations. First, as the study was conducted in a single hospital setting, the findings may not fully represent the broader population of patients with HBV and HCV in Rwanda. Second, while the random selection of cubicles reduces systematic bias, the alphabetical filing of patient records may still introduce residual risks of selection bias. These potential limitations are acknowledged and were carefully considered when interpreting the study findings.

Furthermore, the study sampling method. Random selection of cubicle numbers continued until 263 participants were reached without stratified sampling, possibly leading to a sample ratio that does not reflect the actual population distribution of HBV to HCV cases (557 HBV vs. 209 HCV). Additionally, the study relies on self-reported data, which may be subject to recall bias or social desirability bias. Despite these limitations, the study contributes valuable insights into HBV and HCV infections and underscores the need for further research in this area.

Conclusion

The study examined demographic characteristics and risk factors among patients with HBV and HCV attending the Hepatitis Clinic at RMRTH. It found that HBV patients were predominantly male, mostly married, insured, and from higher socioeconomic backgrounds, with many residing in Kigali City. Risk factors included low smoking rates, high sexual activity, and low vaccination coverage. HCV patients were more often female, widowed, insured, and from similar socioeconomic backgrounds, with alcohol consumption generally low, but sexual behaviour was identified as a potential transmission route. Limitations included missing data and possible biases in patient records.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

HBV

Hepatitis B virus

HCV

Hepatitis C virus

RMRTH

Rwanda Military Referral and Teaching Hospital

IRB

Institutional Review Board

HBsAg

Hepatitis B surface antigen

HCC

Hepatocellular carcinoma

UR

University of Rwanda

GCP

Good Clinical Practice

SPPS

Statistical Package for the Social Sciences

WHO

World Health Organisation

RNA

Ribonucleic acid

HCV Ab

Hepatitis C Virus Antibody

ART

Antiretroviral Therapy

DAAs

Direct-Acting Antivirals

Author contributions

D.N. and D.S.: Conceptualisation, study design, drafting of study protocol for ethical approval, data analysis, writing of manuscript. N.N & F: Conceptualisation, study design, drafting of study protocol for ethical approval, data collection, data analysis, and review. E.S: Study design, reviewing, supervision. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no funding.

Data availability

Study data can be shared upon reasonable request to the corresponding author via email at [nsdidierdesha@gmail.com].

Declarations

Institutional review board

The study was conducted in accordance with the Declaration of Helsinki and approved by the University of Rwanda Ethics Committee and the Rwanda Military Referral and Teaching Hospital Institutional Review Board (IRB) (RMRTH/IRB).

Informed consent

The requirement for informed consent was waived by the University of Rwanda Institutional Review Committee (IRB) and the Rwanda Military Referral and Teaching Hospital Institutional Review Committee (RMRTH/IRB), RB, due to the retrospective nature of the study and the use of anonymised data.

Competing interests

The authors declare no competing interests.