Abstract
Background
Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in pregnancy, coupled with high viral load, increase the risk of mother-to-child transmission. Additionally, the genotypes of HBV and HCV involved determine the course of infection and response to treatment. The study aimed to determine the prevalence, circulating genotypes, and risk factors associated with HBV and HCV infections among pregnant women attending the antenatal clinic in the Sekondi-Takoradi Metropolis, Western Region, Ghana.
Methods
Questionnaires were administered to obtain socio-demographic data, participants’ knowledge of HBV and HCV, and risk factors associated with HBV and HCV infections. Venous blood was collected from 200 participants to test for HBsAg and anti-HCV IgM and IgG using rapid diagnostic test kits. HBsAg- and anti-HCV-positive samples were confirmed by enzyme-linked immunosorbent assay, and nested PCR and 2% agarose gel electrophoresis were used to detect genotypes.
Results
Overall, 19 (9.5%) were HBsAg/HBV-DNA-positive. The common HBV genotypes detected were A (68.4%), E (10.4%), and D (5.3%). None of the participants tested positive for anti-HCV antibodies (IgM and IgG). Most participants (75.5%) had poor knowledge of HCV, and 46.5% had moderate knowledge of HBV. The results also showed a statistically significant association between HBV infection and multiple sexual partners (p = 0.01; AOR = 2.18; 95% CI = 1.27–3.74) using a multivariate logistic regression analysis.
Conclusion
The study identified a high prevalence of HBV among the pregnant women (9.5%), with genotype A being the most common in the Western part of Ghana.
Supplementary Information
The online version contains supplementary material available at 10.1186/s12879-026-13378-4.
Keywords: Pregnant women, Hepatitis B virus, Hepatitis C virus, Genotype, Ghana
Introduction
The Global Hepatitis Report 2024 by the World Health Organisation (WHO) shows that viral hepatitis is a significant public health challenge, and the world is still far from achieving the viral hepatitis elimination target by 2030. Combined, hepatitis B virus (HBV) and hepatitis C virus (HCV) infections cause about 3500 deaths per day. According to the same report, an estimated 254 million people were living with chronic HBV, and 50 million people with chronic HCV worldwide in 2022. Further, the same report indicated that in the WHO African region, the prevalence of chronic HBV infection in the general population is 5.8%, whereas that of HCV infection is 0.7% [1]. In Ghana, the estimated national prevalence of chronic HBV and HCV infections, based on a systematic review, are 12.3% and 3%, respectively [2, 3].
It is well established that mother-to-child transmission (MTCT) at the time of delivery is a potent means of HBV and HCV transmission worldwide [4, 5]. Serum HBV-DNA and HCV-RNA levels, as well as high maternal HBeAg levels, are identified as essential risk factors for MTCT [6–8]. Other recognised risk factors for MTCT of HBV and HCV infections include threatened premature labour, prolonged actual labour, invasive foetal monitoring procedures and a failure of immunoprophylaxis in siblings of the foetus [9]. Mother-to-child transmission of HBV and HCV can increase the risk of the child becoming a carrier and, consequently, may develop cirrhosis or hepatocellular carcinoma (HCC) in the future [10]. A report further indicates that of children exposed at birth, 90% develop chronic HBV infection unless they are vaccinated at birth, whereas fewer than 10% of patients infected after age five develop chronic HBV infection [11]. Consequently, the possibility of progression from acute to chronic infection inversely relates to the age at which one is exposed to the virus [12].
Based on sequence homology, HCV has eight major genotypes, each with subtypes [13]. So far, ten HBV genotypes (A-J) have been identified, and they all have distinct geographic distributions [14, 15]. Various HBV genotypes and subgenotypes have been shown to impact HBeAg seroconversion, viral load, the development of mutants, disease pathogenesis, response to therapy, and resistance to antiviral treatment and vaccination [16, 17]. Several studies have been carried out in Ghana on HBV and HCV infections, including using pregnant women and blood donors. However, there is still a scarcity of data on the genotypes of HBV and HCV circulating in the country, especially among pregnant women. A meta-analysis of HBV and HCV infections in Ghana found that no data were available for the Western Region [2, 3]. Due to the scanty data on the genotypes of HBV and HCV causing viral hepatitis infection in Ghana, especially among pregnant women, there is a challenge in predicting the clinical course of infection and outcome of treatment. This study, therefore, aimed to determine the prevalence of HBV and HCV infections, circulating genotypes, and risk factors among pregnant women attending the antenatal clinic in the Sekondi-Takoradi Metropolis, Western Region, Ghana.
Materials and methods
Study design, study sites and study participants
This hospital-based cross-sectional study was conducted in two conveniently selected health facilities in the Sekondi-Takoradi Metropolis, Western Region, Ghana. The metropolis consists of the twin cities of Sekondi and Takoradi and serves as the capital of the Sekondi-Takoradi Metropolitan Assembly. The health facilities were the Takoradi Government Hospital and the Essikado Government Hospital in Sekondi. According to the Ghana Statistical Service 2021 population and housing census, Sekondi-Takoradi has a population of 245,382 and a population density of 3,693/km2. Sekondi-Takoradi is located in the southeast of the Western Region. The Sekondi-Takoradi Metropolitan Assembly shares the border with the Effia-Kwesimintsim Municipal Assembly to the West, the Shama District to the East, the Mpohor District to the North, and the Gulf of Guinea to the South. The Sekondi-Takoradi Metropolitan Assembly has a total land area of 66.44 km2. Further, it lies within latitude 4⁰ 54’ 59.99” N and longitude − 1⁰45’ 59.99” W. Consenting pregnant women attending the antenatal clinic for the first time were recruited at the two hospitals from November 2020 to September 2021.
Ethics approval and consent to participate
Permission was sought from the management of the two selected health facilities. The study protocol was reviewed and approved by the Committee on Human Research, Publication and Ethics (CHRPE) of the School of Medical Sciences, Kwame Nkrumah University of Science and Technology (KNUST), Kumasi, Ghana (reference number: CHRPE/AP/443/20), before the commencement of the study. Verbal informed consent was also obtained from the participants after the study’s purpose was explained in a language they understood. All experiments were performed in accordance with the guidelines and regulations of the Declaration of Helsinki.
Sampling technique and sample size estimation
The participants were selected using a typical convenience sampling method, with their ad hoc availability during the study period to achieve the required sample size. The Cochrane formula was used to determine the sample size, as shown below. The study’s power, however, was bolstered by increasing the sample size from 166 to 200 participants.
 |
Where n = the study’s minimal sample size, z = the z-score corresponding to the 95% confidence interval (1.96), d = the margin of error (5%), and p = 12.3%, the sero-prevalence of chronic HBV infection reported in Ghana [2].
Data and blood sample collection
Study participants who fulfilled the eligibility criteria were interviewed to gather relevant information using a structured questionnaire (Supplementary Material 1). The questionnaire comprised socio-demographic characteristics, participants’ knowledge of HBV and HCV, and information on potential risk factors for HBV and HCV transmission. Questions about the causes of HBV (13 questions) and/or HCV infections (13 questions), modes of transmission, treatment, and management were used to gauge the study participants’ knowledge levels. Each correct response to the questions on knowledge was awarded a mark of one (1), scoring 13 points. Participants with a score of 9 or higher were considered to have adequate knowledge. Those with a score of 5 to 8 were considered to have a moderate level of knowledge, and those with a score of 0 to 4 were considered to have a poor level of knowledge about HBV and HCV infections. Five millilitres (5 mL) of venous blood were collected from each participant into ethylenediamine tetraacetic acid (EDTA) tubes. The blood samples were centrifuged, and the plasma was separated. The plasma samples were stored at -20 °C until analysis.
Laboratory analysis of samples
Plasma samples were screened for HBsAg and anti-HCV (total IgM and IgG). The One STEP HBsAg and anti-HCV Test Kits (SD Bioline, South Korea) were used to detect HBsAg and anti-HCV (IgM and IgG) antibodies according to the manufacturer’s protocol. The sensitivity and specificity of the One STEP HBsAg Test Kit were 98.89% and 98.87%, respectively, whereas the sensitivity and specificity of the One STEP anti-HCV Test Kit were 93.3% and 99.5%, respectively. None of the samples tested positive for anti-HCV (total IgM and IgG) using the rapid diagnostic test kit. The plasma samples that tested positive for HBsAg with the rapid diagnostic test kit were sent to the Virology Laboratory at the Department of Clinical Microbiology, KNUST, and stored at -80 °C until confirmation using the HBsAg ELISA Kit (Fortress Diagnostics, UK) according to the manufacturer’s protocol.
The HBV genotypes were determined by nested PCR. Briefly, a Universal HBV-DNA Extraction Kit (Genekam Biotechnology AG, Germany) was used to extract HBV-DNA from all HBsAg-positive plasma samples per the manufacturer’s instructions. The quantity and purity of the isolated DNA were assessed using the NanoDrop 1000 (version 3.8.1, Thermo Scientific, USA). The extracted HBV-DNA was amplified by nested PCR using the HBV Genotyping Kit (Genekam Biotechnology AG, Germany) according to the manufacturer’s protocol. Briefly, the first PCR step was performed in a 20 µL reaction mixture containing 8 µL of the first primers, 10 µL of water, buffer, dNTPs, Taq polymerase mix, and 2 µL of the isolated DNA template. The second PCR step enabled the detection of HBV genotypes A, B, C, D, E, and F. Using primers specific to each genotype, the PCR reactions for genotypes A, B, and C were multiplexed, as were those for genotypes D, E, and F. In all the PCR steps, positive and negative controls supplied by the manufacturers were included. The cycling conditions for the first and second PCR steps were those provided by the manufacturers. The final PCR products were resolved on a 2% agarose gel containing ethidium bromide at 120 volts for 50 min. The gel was visualised under ultraviolet light (Supplementary Material 2). The expected band sizes for the different genotypes were as follows: genotype A: 68 bp; genotype B: 281 bp; genotype C: 122 bp; genotype D: 119 bp; genotype E: 167 bp; and genotype F: 97 bp [18].
Statistical analysis
The data were analysed using the Statistical Package for the Social Sciences (SPSS) software version 24.0 (IBM Corp., Armonk, NY, USA). All the data are presented as frequencies and proportions. Fisher’s exact test was used to assess an association between socio-demographic characteristics and the prevalence of HBV infection. Moreover, multivariate logistic regression analysis was used to predict the participants’ risk factors for HBV infection. A p-value less than 0.05 was considered statistically significant in all comparisons.
Results
Socio-demographic characteristics of participants and their association with HBV status
Out of the 200 participants, 19 (9.5%) were HBsAg/HBV-DNA-positive. However, none of the participants tested positive for anti-HCV antibodies (IgM and IgG) (Fig. 1). Further, most participants (63.2%) who tested positive for HBsAg/HBV-DNA were 21–30 years old; 52.6% were married; 42.1% had basic education; 47.4% were self-employed; and 68.4% lived in rural areas. However, none of the participants’ socio-demographic characteristics was statistically associated with HBsAg/HBV-DNA positivity, as assessed using Fisher’s exact test (Table 1).
Fig. 1.
Prevalence of HBV and HCV infections among the participants
Table 1.
Socio-demographic characteristics of participants in relation to HBV status
| Variable | Total N (%) |
HBV status | p-value | |
|---|---|---|---|---|
| Positive n (%) |
Negative n (%) |
|||
| Age | 0.51 | |||
| ≤ 20 | 26 (13.0) | 3 (15.8) | 23 (12.7) | |
| 21–25 | 63 (31.5) | 6 (31.6) | 57 (31.5) | |
| 26–30 | 86 (43.0) | 6 (31.6) | 80 (44.2) | |
| 31–35 | 19 (9.5) | 4 (21.0 | 15 (8.3) | |
| 36–40 | 5 (2.5) | 0 (0.0) | 5 (2.8) | |
| > 40 | 1 (0.5) | 0 (0.0) | 1 (0.6) | |
| Marital status | 0.82 | |||
| Single | 59 (29.5) | 7 (36.8) | 52 (28.7) | |
| Married | 122 (61.0) | 10 (52.6) | 112 (61.9) | |
| Divorced | 16 (8.0) | 2 (10.6) | 14 (7.7) | |
| Widow | 3 (1.5) | 0 (0.0) | 3 (1.7) | |
| Educational status | 0.62 | |||
| No formal education | 15 (7.5) | 3 (15.7) | 12 (6.6) | |
| Basic education | 84 (42.0) | 8 (42.1) | 76 (42.0) | |
| Secondary education | 58 (29.0) | 5 (26.3) | 53 (29.3) | |
| Tertiary education | 43 (21.5) | 3 (15.7) | 40 (22.1) | |
| Employment status | 0.36 | |||
| Unemployed | 55 (27.5) | 8 (42.1) | 47 (26.0) | |
| Formally employed | 18 (9.0) | 2 (10.5) | 16 (8.8) | |
| Self-employed | 127 (63.5) | 9 (47.4) | 118 (65.2) | |
| Religion | 0.70 | |||
| Christian | 129 (64.5) | 11 (58.0) | 118 (65.2) | |
| Muslim | 47 (23.5) | 4 (21.0) | 43 (23.8) | |
| Traditionalist | 14 (7.0) | 2 (10.5) | 12 (6.6) | |
| Others | 10 (5.0) | 2 (10.5) | 8 (4.4) | |
| Residence | 0.06 | |||
| Rural | 172 (86.0) | 13 (68.4) | 159 (87.8) | |
| Peri-urban | 18 (9.0) | 5 (26.3) | 13 (7.2) | |
| Urban | 10 (5.0) | 1 (5.3) | 9 (5.0) | |
No statistical difference at p < 0.05 as assessed using Fisher’s exact test
Distribution of HBV genotypes among study participants
The predominant HBV genotype identified in the study was A (68.4%; 13/19), followed by E (10.4%; 2/19). However, one sample could not be genotyped (Fig. 2).
Fig. 2.
Percentage distribution of the HBV genotypes among study participants. RT: unable to type
Participants’ knowledge level of HBV and HCV infections
Participants’ knowledge of HBV and HCV infections was assessed based on their responses. In all, 13 questions were asked. Of the 200 participants, most (83.5%) had heard of HBV infection, whilst 67.5% had not heard of HCV infection (Table 2). The majority of the participants (64.5%) correctly stated that the causative agent of hepatitis B is a virus, whereas 68.0% did not know the aetiologic agent of hepatitis C. The majority of the participants (52.5%) were aware that hepatitis B is an infection of the liver, whereas 67.5% did not know that hepatitis C is an infection of the liver. Most participants (46.0%; 83.5%) did not know that HBV and HCV infections could be spread by someone who looks healthy. Similarly, 53.0% did not know that an HBV vaccine exists, whilst 88.0% correctly indicated that there is no vaccine for HCV. Overall, some participants (46.5%) had moderate knowledge of HBV infection. In contrast, 75.5% had poor knowledge of HCV infection (Table 2).
Table 2.
Participants’ level of knowledge on HBV and HCV infections
| Parameter | HCV N (%) |
HBV status | p-value | ||
|---|---|---|---|---|---|
| Total N (%) |
Positive n (%) |
Negative n (%) |
|||
| Have you heard of hepatitis B or C? | 0.02* | ||||
| Yes | 65 (32.5) | 167 (83.5) | 12 (63.2) | 155 (85.6) | |
| No | 135 (67.5 | 33 (16.5) | 7 (36.8) | 26 (14.4) | |
| What causes hepatitis B? | 0.05 | ||||
| Virus | 49 (24.5) | 134 (67.0) | 8 (42.1) | 126 (69.6) | |
| Evil spirit | 9 (4.5) | 7 (3.5) | 2 (10.5) | 5 (2.8) | |
| Drugs | 4 (2.0) | 9 (4.5) | 1 (5.3) | 8 (4.4) | |
| Food | 2 (1.0) | 10 (5.0) | 1 (5.3) | 9 (5.0) | |
| I do not know | 136 (68.0) | 40 (20.0) | 7 (36.8) | 33 (18.2) | |
| Which organ in the body is affected by HBV or HCV? | 0.01* | ||||
| Brain | 2 (1.0) | 4 (2.0) | 1 (5.3) | 3 (1.7) | |
| Heart | 1 (0.5) | 2 (1.0) | 2 (10.5) | 0 (0.0) | |
| Kidney | 6 (3.0) | 9 (4.5) | 2 (10.5) | 7 (3.9) | |
| Liver | 43 (21.5) | 110 (55.0) | 8 (42.1) | 102 (46.4) | |
| Blood | 13 (6.5) | 35 (17.5) | 2 (10.5) | 33 (18.2) | |
| I do not know | 135 (67.5) | 40 (20.0) | 4 (21.1) | 36 (19.9) | |
| Have you been tested for HBV or HCV before? | |||||
| Yes | 30 (15.0) | 107 (53.5) | 6 (31.6) | 101 (55.8) | 0.01* |
| No | 27 (13.5) | 57 (28.5) | 4 (21.1) | 53 (29.3) | |
| I do not know | 143 (71.5) | 36 (18.0) | 9 (47.4) | 27 (14.9) | |
| Can HBV or HCV be spread through sexual contact? | 0.07 | ||||
| Yes | 53 (26.5) | 156 (78.0) | 11 (57.9) | 145 (80.1) | |
| No | 1 (0.5) | 5 (2.5) | 1 (5.3) | 4 (2.2) | |
| I do not know | 146 (73.0) | 39 (19.5) | 7 (36.8) | 32 (17.7) | |
| Can HBV or HCV be spread through a mosquito bite? | 0.27 | ||||
| Yes | 25 (12.5) | 18 (9.0) | 3 (15.8) | 15 (8.3) | |
| No | 11 (5.5) | 80 (40.0) | 5 (26.3) | 75 (41.4) | |
| I do not know | 164 (82.0) | 102 (51.0) | 11 (57.9) | 91 (50.3) | |
| Can you get HBV or HCV through tattoos or piercings? | 0.76 | ||||
| Yes | 32 (16.0) | 62 (31.0) | 6 (31.6) | 56 (30.9) | |
| No | 7 (3.5) | 36 (18.0) | 2 (10.5) | 34 (18.8) | |
| I do not know | 161 (80.5) | 102 (51.0) | 11 (57.9) | 91 (50.3) | |
| Can HBV or HCV be spread through childbirth? | 0.54 | ||||
| Yes | 41 (20.5) | 116 (58.0) | 10 (52.6) | 106 (58.6) | |
| No | 5 (2.5) | 18 (9.0) | 3 (15.8) | 15 (8.3) | |
| I do not know | 154 (77.0) | 66 (33.0) | 6 (31.6) | 60 (33.1) | |
| Can HBV or HCV be spread through blood transfusion? | 0.18 | ||||
| Yes | 44 (22.0) | 142 (71.0) | 11 (57.9) | 131 (72.4) | |
| No | 1 (0.5) | 9 (4.5) | 2 (10.5) | 7 (3.9) | |
| I do not know | 154 (77.0) | 49 (24.5) | 6 (31.6) | 43 (23.8) | |
| Can HBV or HCV be spread through kissing? | 0.79 | ||||
| Yes | 31 (15.5) | 73 (36.5) | 6 (31.6) | 67 (37.0) | |
| No | 7 (3.5) | 25 (12.5) | 3 (15.8) | 22 (12.2) | |
| I do not know | 162 (81.0) | 102 (51.0) | 10 (52.6) | 92 (50.8) | |
| Can a healthy person spread HBV or HCV? | 1.00 | ||||
| Yes | 31 (15.5) | 82 (41.0) | 8 (42.1) | 74 (40.9) | |
| No | 2 (1.0) | 26 (13.0) | 2 (10.5) | 24 (13.3) | |
| I do not know | 167 (83.5) | 92 (46.0) | 9 (47.4) | 83 (45.9) | |
| Is there a vaccine for HBV or HCV? | 0.65 | ||||
| Yes | 9 (4.5) | 79 (39.5) | 6 (31.6) | 73 (40.3) | |
| No | 15 (7.5) | 15 (7.5) | 2 (10.5) | 13 (7.2) | |
| I do not know | 176 (88.0) | 106 (53.0) | 11 (57.9) | 95 (52.5) | |
| Can HBV affect any age group? | 0.19 | ||||
| Yes | 43 (21.5) | 152 (76.0) | 12 (63.2) | 140 (77.3) | |
| No | 13 (6.5) | 10 (5.0) | 2 (10.5) | 8 (4.4) | |
| I do not know | 144 (72.0) | 38 (19.0) | 5 (26.3) | 33 (18.2) | |
| Overall knowledge level | 0.86 | ||||
| Excellent | 22 (11.0) | 61 (30.5) | 6 (31.6) | 55 (30.4) | |
| Moderate | 27 (13.5) | 93 (46.5) | 8 (42.1) | 85 (47.0) | |
| Poor | 151 (75.5) | 46 (23.0) | 5 (26.3) | 41 (22.7) | |
*Statistical difference at p < 0.05 as assessed using Fisher’s exact test
Participants’ responses on risk and confounding factors for HBV and HCV infections
Most participants have multiple partners (72.5%), do not use condoms during sexual intercourse (53.5%), do not share sharps when trimming their nails (83.5%), have never been diagnosed with liver problems (86.0), have never received blood products (84.5%), and has no history of sexually-transmitted diseases (78.0%), as presented in Table 3. Among these risk factors, the participants with multiple sexual partners were at a higher risk of contracting HBV infection (p = 0.01; AOR = 2.18; 95% CI = 1.27–3.74) from the multivariate analysis (Table 4).
Table 3.
Participants’ responses on risk and confounding factors stratified by HBV status
| Parameter | Total N (%) |
HBV status | p-value | |
|---|---|---|---|---|
| Positive n (%) |
Negative n (%) |
|||
| How many sex partners have you had? | 0.02* | |||
| 1 | 55 (27.5) | 3 (15.8) | 52 (28.7) | |
| 2 | 70 (35.0) | 5 (26.3) | 65 (35.9) | |
| 3–5 | 63 (31.5) | 8 (42.1) | 55 (30.4) | |
| 6–10 | 10 (5.0) | 1 (5.3) | 9 (5.0) | |
| >10 | 2 (1.0) | 2 (10.6) | 0 (0.0) | |
| Do you use condoms during sexual intercourse? | 0.12 | |||
| Yes | 24 (12.0) | 0 (0.0) | 24 (13.3) | |
| No | 107 (53.5) | 14 (73.7) | 93 (51.4) | |
| Sometimes | 69 (34.5) | 5 (36.3) | 64 (35.4) | |
| Which of the following do you associate with? | 0.01* | |||
| Alcohol | 56 (28.0) | 5 (26.3) | 51 (28.2) | |
| Smoking | 9 (4.5) | 3 (15.8) | 6 (3.3) | |
| Narcotics | 18 (9.0) | 4 (21.1) | 14 (7.7) | |
| None of the above | 117 (58.5) | 7 (36.8) | 110 (60.8) | |
| Do you share sharps when you trim your nails? | 0.01* | |||
| Yes | 5 (2.5) | 2 (10.5) | 3 (1.7) | |
| No | 167 (83.5) | 12 (63.2) | 155 (85.6) | |
| Sometimes | 28 (14.0) | 5 (26.3) | 23 (12.7) | |
| Have you ever been diagnosed with any liver problems? | 0.01* | |||
| Yes | 11 (5.5) | 3 (15.8) | 8 (4.4) | |
| No | 172 (86.0) | 12 (63.2) | 160 (88.4) | |
| I do not know | 17 (8.5) | 4 (21.1) | 13 (7.2) | |
| Have you received blood products during your hospital admission? | 0.01* | |||
| Yes | 31 (15.5) | 7 (36.8) | 24 (13.3) | |
| No | 169 (84.5) | 12 (63.2) | 157 (86.7) | |
| Do you have any tribal marks/piercings/tattoos on your body? | 0.08 | |||
| Yes | 26 (13.0) | 5 (26.3) | 21 (11.6) | |
| No | 174 (87.0) | 14 (73.7) | 160 (88.4) | |
| Do you have any history of STDs? | 0.44 | |||
| Yes | 41 (20.5) | 6 (31.6) | 35 (19.3) | |
| No | 156 (78.0) | 13 (68.4) | 143 (79.0) | |
| I do not know | 3 (1.5) | 0 (0.0) | 3 (1.7) | |
*Statistical difference at p < 0.05 as assessed using Fisher’s exact test
Table 4.
Multivariate logistic regression analysis of risk factors of HBV status
| Variable | AOR | 95%CI | p-value |
|---|---|---|---|
| Multiple sexual partners | 2.18 | 1.27–3.74 | 0.01* |
| Condom usage | 1.13 | 0.65–1.97 | 0.61 |
| Alcohol use, smoking and narcotics | 0.99 | 0.39–2.51 | 0.98 |
| Sharing of sharps for trimming nails | 0.43 | 0.14–1.32 | 0.12 |
| Ever diagnosed with a liver problem | 1.03 | 0.40–2.73 | 0.94 |
| Transfusion of blood products | 2.83 | 0.60-13.55 | 0.19 |
| Tribal marks, piercings and tattoos | 0.33 | 0.05–2.35 | 0.28 |
| History of sexually transmitted infection | 1.5 | 0.49–4.61 | 0.48 |
*Statistically significant at p < 0.05. AOR (adjusted odds ratio); CI (confidence interval)
Discussion
Chronic infections like HCV and or HBV are a substantial public health concern worldwide, especially in underdeveloped nations [19]. This study reports a prevalence of HBV infection among participants as 9.5%, with none of the participants testing positive for HCV. The prevalence reported in this study is consistent with the ≥ 8% reported in other studies [12]. Still, it is higher than the overall prevalence rate of 5.8% reported in the WHO African Region [1]. Moreover, the prevalence reported in this study was higher than the 4%, 8.36% and 8.8% previously reported in Ghana [20–22]. Other studies worldwide have also reported lower HBV prevalence, including less than 0.27% in the United States, 2.14% in Iran, and 4.2% in Kosovo [23–25]. However, the prevalence in the current study was lower than that reported in other studies, such as the 10.2% reported among parturient women in peri-urban Ghana [26] and the 12.3% reported in a systematic review by Ofori-Asenso and Agyeman in Ghana [2]. The differences in prevalence across these studies could be attributed to geographical differences, cultural practices, methods used to detect the virus, and the sexual behaviour of study participants in relation to the risk of HBV infection. None of the participants tested positive for HCV. This finding agrees with a previous study among beauticians in Ghana, which found none tested positive for HCV [22]. Moreover, this study’s findings are consistent with the reported national HCV prevalence of 1.7% in Ghana [27]. A systematic review also reported a 3% HCV prevalence in Ghana [3], supporting the low prevalence of HCV in the Ghanaian population.
HBV genotype distribution varies geographically. This study identified genotypes A (68.4%) and E (10.4%) as the most prevalent in the Sekondi-Takoradi Metropolis, Western Region, Ghana. The results of this study agree with the previous reports on genotypes A, D, and E circulating in some parts of Ghana [18, 28, 29]. The difference in the dominant genotype could be due to differences in geographic location, the study population (pregnant women with multiple sex partners in this study), and the massive migration of people from various parts of the world into the Sekondi-Takoradi Metropolis, driven by the discovery of oil and mining activities in the Western Region of Ghana. The predominant genotype A in this study aligns with findings that it is widespread in sub-Saharan and West Africa [30, 31]. The prevalence of genotype A in the current research is further supported by a systematic review, which reported that genotype A is highly prevalent in sub-Saharan Africa (subtype A1), Northern Europe (subtype A2), and Western Africa (subtype A3) [32].
Inter-genotypic recombination occurs in geographic regions where multiple HBV genotypes co-circulate within the population, facilitating diversification within and between individuals. Novel variants generated by recombination between different HBV genotypes have been documented worldwide [32–34]. In this study, genotypes A/E and A/B were identified, in agreement with studies conducted in other parts of West Africa that also identified genotypes A/B, A/C, A/E, C/E, D/E, and D/E/A recombinants [28, 35–39]. Hepatitis B virus genotype recombination is an integral component of HBV genetic variability [40]. The knowledge of HBV circulating genotypes and population-level recombination would enable clinicians to predict treatment response and disease progression. Thus, the presence of these genotypes (A/E and A/B) in the participants has significant implications for disease progression and therapy.
The study assessed participants’ knowledge of HBV and HCV. Most participants had poor and moderate knowledge levels of HCV and HBV infections, respectively. These findings align with other studies conducted in Ghana, which reported low levels of knowledge about HCV and HBV infections. Among 200 barbers in Kumasi, Ghana, none (0%) could describe the common HCV transmission pathways, and only 7% were aware that sharing razor blades or hair trimmers could transmit viral pathogens such as HCV and HBV [41]. Also, low levels of knowledge among pregnant women in Kumasi have been reported [42], which aligns with the current findings. The low level of knowledge and awareness of HBV and HCV is probably because of the low level of education of the study participants [22, 43], which calls for an urgent need to intensify the public health education of citizens, especially pregnant women, on HBV and HCV infections, given that infected pregnant women stand the chance of transmitting the virus to their babies. A statistically significant association was established between HBV infection and the number of sexual partners (p = 0.01). Participants having a history of multiple sexual partners were 2.18 times at elevated risk of contracting HBV infection (AOR = 2.18, 95% CI = 1.27–3.74). This finding is consistent with a study conducted in Ethiopia, which reported a statistically significant association between HBV infection and multiple sexual partners [44]. This finding is not surprising since HBV is commonly transmitted through sexual intercourse.
Conclusion
The prevalence of HBV infection among the pregnant women in the current study was 9.5%, and that of HCV infection was 0%. The study revealed that the most predominant circulating HBV genotype in the study area was A. The overall knowledge of HBV and HCV was moderate and poor among the pregnant women, respectively. The study also showed that pregnant women with multiple sexual partners were at a higher risk of contracting HBV infection.
Recommendation
It is recommended that public education on the mode of HBV/HCV transmission should be intensified in Ghana to create awareness for pregnant women and the general public to reduce the spread of these viruses, since they are frequently spread through sexual contact. Further studies in other parts of Ghana are recommended to determine the circulating HBV and HCV genotypes, which would help improve patient management and control these viral infections.
Limitations
The study was conducted at two health facilities in the Western Region of Ghana, which may not fully reflect the diversity of HBV/HCV infection across the region. Further, sampling from only two health facilities limits the generalisability of the study’s findings, as other areas may exhibit different HBV/HCV infection rates and genotypes. Despite these limitations, the study provides valuable preliminary insights. Particularly, this study underscores the need for more extensive education on the mode of transmission of HBV/HCV infection, especially among pregnant women with a higher risk of transmitting the infection to their babies.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
The authors thank the Management of the Takoradi Government Hospital and the Essikado Government Hospital in Sekondi, and the antenatal clinic staff who helped in participant recruitment. We also thank the laboratory staff at these health facilities for their help with blood sample collection. Finally, we are grateful to the study participants.
Author contributions
PWN, MM and FA discussed the idea and designed the experiment. FA and SAD performed the experiments and analysed the data. PWN wrote the manuscript, which MM, SAD and FA reviewed. All authors approved the final manuscript.
Funding
The authors received no financial support for the research, authorship or publication.
Data availability
The corresponding author would make the datasets available upon a reasonable request.
Declarations
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
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Supplementary Materials
Data Availability Statement
The corresponding author would make the datasets available upon a reasonable request.