Prevalence and risk factors of hepatitis b virus among pregnant women in jazan region kingdom of saudi arabia

Journal of Biology, Agriculture and Healthcare www.iiste.org
ISSN 2224-3208 (Paper) ISSN 2225-093X (Online)
093X
Vol 2, No.7, 2012

Prevalence and risk factors of Hepatitis B Virus among Pregnant
Women in Jazan Region Kingdom of Saudi Arabia
Region-
Ibrahim Bani1, Mohamed S. Mahfouz1, Erwa Maki2 Abdelrahim Gaffar1, Ibrahim Elhassan1, Abu Obaida Yassin2,
Hussein M. Ageely2
1 . Department of Family and Community Medicine -Faculty of Medicine –Jazan, University, KSA.
Jazan,
2. Department of Internal Medicine - Faculty of Medicine - Jazan University, KSA.
Corresponding Author:Dr. Ibrahim Bani
Email: bani1984@gmail.com
Chairperson Family and Community Medicine Department,Faculty of Medicine,P O Box 114,Jizan, KSA
P
966505159210 (cell) 96673217540 (fax)

Abstract:
Background: Hepatitis B virus is one of the major etiological agents for parenterally acquired hepatitis. Viral
hepatitis during pregnancy is associated with high risk of maternal complications. This study was conducted to
associated
determine the prevalence of HBV infection in pregnant women, and to find out its associated risk factors in
Jazan region south KSA.Patients & Methods: A random sample of 537 pregnant females who attended Jazan
Patients
general hospital and randomly selected primary health care centers in Jazan region - before 38 weeks of gestation
- constituted the target population of the present study. All women were screened for HBsAgd by using HBsAg
Rapid Test Device (ACON).Results: The overall prevalence of HBV virus among the women was found to be
Results:
4.1% (95% CI: 2.7 - 6.1). The prevalence of HBV according to age showed that women less than 20 years are
free of HBV, whereas for other age groups HBV prevalence is found to increase with increase in age. Regarding
prevalence
the associated risk factors, women with history of hospitalization, and jaundices showed a significant
association with anti- HBV seropositive. Dental histories, blood transfusion and history of surgery did not prove
significant association with HBV.Conclusion: Prevalence of Hepatitis B virus infection in pregnant ladies was
Conclusion:
4.1%. Past history of hospitalization and jaundices are important risk factors for transmission of infectio The
infection.
study suggests expansion of the Hepatitis B vaccination program to reduce the risk of HBV among pregnant
women.
Key words: Hepatitis B virus, Pregnancy, Prevalence, Risk factors.

Introduction:
Hepatitis B is caused by hepatitis B virus (HBV) which is an envelope virus with double strand DNA that related
to hepadnavirus. HBV is found in highest concentrations in blood and in lower concentrations in other body
.
fluids (e.g., semen, vaginal secretions, and wound exudates). It estimated that about 5% of world populations are
chronic carriers and nearly 25% of them develop serious complications as chronic hepatitis, liver cirrhosis and
hepatocellular cell carcinoma, which result in more than one million death every year [[1].
Hepatitis B virus (HBV) infection is a major public health problem in the Arab Countries. The majority of
infection
the countries in the Middle East have intermediate (2 to <5%) or high (>5%) endemicity of HBV infection [ [2].
Studies in Saudi Arabia indicated that the prevalence of Hepatitis B surface antigen (HBsAg) ranges from 7.4
udi
to 17% denoting high endemicity.[3]. ].
The HBV is a major cause of chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It ranks as an
important pathogen throughout the world[ ]. Transmission occurs mainly from a mother to child at time of
world[4].
parturition, as well as person-to-person (horizontal) transmission among children < 5 years of age.[ Even when
person age.[5]
not infected during the perinatal period, children of HBV infected mothers remain at a high risk of acquiring
HBV-infected
HBV infection by horizontal transmission during the first 5 years of life.[
life.[6]
Viral hepatitis during pregnancy is associated with high risk of maternal complications, has a high rate of
vertical transmission causing fetal and neonatal hepatitis and it has been reported as a leading cause of maternal
sion
mortality in developing countries [7 9]. Previous studies showed that the prevalence of HBsAg among Saudi
[7-9].
pregnant females ranged from 3.9 to 12.7%.[
12.7%.[9–12]
The aim of the present study was to determine the prevalence and risk and its related factors of HBV
infection among pregnant women in Jazan region – Saudi Arabia .

Materials and Methods:
This study was part of a large cross-sectional survey conducted on volunteer blood donors, and attendants of GI ,
-sectional

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Vol 2, No.7, 2012

Premarital screening clinics and Antenatal Clinics ( in randomly selected PHCCs and General Hospitals) in Jazan
Clinics
Region, Kingdom of Saudi Arabia (KSA).
All pregnant females who attended the antenatal clinic - before 38 weeks of gestation - constituted the
subjects of the present study. Serology screening for HBsAg, Hepatitis B core antigen (HBcAb), and Hepatitis B
screening
antibody (HBsAb) is requested in every first booking visit. Random samples of 537 women were tested for HBV
serologic markers by using HBsAg Rapid Test Device ( (ACON).
The questionnaire administered to the women consisted of questions related to demography, level of
tered
education, marital status, sexual behaviors, and injection risk behaviors. Sexual behavior questions included the
kind of relationship the subject has ever had. Injection risk behavior questions determined whether if the study
behavior
subject used or shared syringe, the duration of injection addiction, type of drug and history of blood transfusion,
surgery, dental procedure, cupping and jaundice. Standardized, face to face interviews were con
face-to conducted by the
physician. The ethical approval for the current study was obtained from the faculty of Medicine, Jazan
University and the local health authorities.
The overall prevalence of HBV among pregnant women was calculated with a 95% confidence interval
(CI). The chi-square test (or Fisher exact test where applicable) was used to evaluate the prevalence of an HBV
square
infection among different sub-groups. The crude odds ratios (OR) were estimated by univariate analys to
groups. analysis
observe the association of each variable with the presence of HBV. All statistical tests were two two-sided; and a
level of P<0.05 was used to indicate statistical significance. Statistical analyses were performed using the SPSS
0.05
(Version 17.0) software.

Results:
Table 1 illustrates some background characteristics of the studied women. The table shows that 53.8 % of the
women are of age group (20-29) while 22.7% are of (30 39) years, only 5.4% of them are 40 and above years.
29) (30-39)
The table further suggest the majority of them are coming from rural area (56.2%). The educational level of the
women showed that 25.7 % of them are of high of secondary educational level, 20.9 % are primary school.
Regarding the nationality the majority of them are Saudi (92.2 %). Regarding the employment status of the
%).
women, the majority of them (69.3%) are housewives, while 8.8% are government employees.

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Vol 2, No.7, 2012

Table 1 : Demographical Characteristics of Studied Women

Characteristics No %
Age group
< 20 year 46 8.8
20 – 29 year 289 53.8
30 – 39 year 122 22.7
> 40 30 5.6
Missing 50 9.3

Residence type
Rural 302 56.2
Urban 235 42.8
Education
Illiterate 75 14.0
Primary 112 20.9
Intermediate 90 16.8
High secondary 138 25.7
University and above 76 14.2

Nationality
Saudi 496 92.4
Non-Saudi 41 7.6
Employment
Government 47 8.8
Private work 12 2.3
House wife 372 69.3
Unemployed 38 7.1
Students 14 2.6
Other 54 10.0
Total 537 100 %

The prevalence of HBV infection according to some demographic characteristics of the women is shown in
Table 2. The prevalence of HBV according to age showed that women less than 20 years are free of HBV and
greater than 40 years were with the highest HBV prevalence 13.8% with confidence interval (95% C.I.
%
5.5-30.5). The age specific prevalence rate showed a general increase of HBV with age with significant
).
difference between the different age groups. The prevalence of HBV according to the mode of living showed that
4.6 % of the urban women are HBV positive (95% C 2.7-7.6) compared with 3.4 % in Rural areas (95% C.I.
C.I. )
1.7-6.6). According to the nationality, Saudi pregnant with women HBV positive were 4.0% (95% C.I.
).
2.28-5.70). The overall prevalence of HBV virus among the women was found to be 2.4% (95% CI: 0.10-14.4).
5.70).
The table further suggests there is a no significant difference between HBV infections in women according to
different education level, between patients according to nationality and mode of living.

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Vol 2, No.7, 2012

Table 2: Prevalence of HBV Infection among 517 pregnant women- Jazan Region by Age groups,
Residence and Nationality

Characteristics N-positive/
N HBV % 95% CI P. Value
N-tested
Age groups
Less than 20 years (0/45) 0 - 0.005*
20 – 29 year (9/338) 2.7 1.4-4.9
30 – 39 year (9/125) 7.2 1.5-7.9
> 40 (4/29) 13.8 5.5-30.5
Level of education
Illiterate (8/75) 10.6 5.5-19.6 0.096
Primary (3/112) 2.6 0.40-6.2
Intermediate (4/90) 4.4 1.7-10.9
High secondary (4/138) 2.9 1.1-7.2
University and above (2/76) 2.6 0.70-9.0
Residence type
Urban (14/302 ) 4.6 2.7-7.6 0.312
Rural (8/235 ) 3.4 1.7-6.6
Nationality
Saudi (20/496) 4.0 2.6-6.1 0.502
Non-Saudi (1/ 41) 2.4 0.10-14.4
Overall prevalence (22/537) 4.1 2.7-6.1

Table 3 illustrates the prevalence of HBV according to some risk related variables. According to the table women
with history of hospitalization and jaundices showed a significant association with anti HBV seropositive.
anti-
Other risk factors like dental histories, blood transfusion and history of surgery did not prove association with
HBV.

Table 3. Prevalence of HBV Infection among pregnant women in Jazan Region According to
Risk-Related Variables

Variables (Exposure to Potential Yes No P. Value
Risks) OR
95% CI
Dental procedures 7.2(6/83) 3.4(14/411) 0.107
Blood transfusion 6.1(2/33) 4.2(19/457) 0.600
Hemodialysis 50(1/2) 4.3(12/485) 0.088
History of Surgery 8.1(5/62) 3.7(16/431) 0.110
Hospitalization 7.2(10/138) 3.3(12/364) 0.050* 2.2 (.96-5.433)
Jaundices 28.6(2/7) 4.0(19/480) 0.001* 9.7 (1.76-53.27)

Discussion:
The present study shows that the sero prevalence of HB was 4.1 %, which is slightly greater than 2.6% which
sero-prevalence
was reported by Al-Mazrou and colleagues in 2004[ ] and far higher from the estimate of Alrowaily etal.
Mazrou 2004[13]
Which was 1.6% in 2008[14]. This result generally reflects the high prevalence of hepatitis B virus in Jazan
].
region, which is documented in a number of studies conducted previously in kingdom of Saudi Arabia[
Arabia[15-18].
The findings of this study further suggest that mothers below 20 years are free of HBV, who perhaps were
exposed to the mass HBV vaccination for children that took place in 1989 in all parts Kingdom of Saudi
Arabia.[15]. This finding suggests the efficiency of the Hepatitis B vaccination program among children.
]. the
Regarding the risk factors hospitalization, showed a significant association with anti- HBV seropositive and
hence is the most important risk factor for its transmission in the context of this study. HospHospitalization
association with HBV infection was reported in many other studies [19] .
Dental procedures were not associated with HBV infection in Jazan, this finding is similar to the situation in
Brazil and some other developing countries [19] and it could be explained by the improvement in sterilization

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Vol 2, No.7, 2012

and hygienic practice in dental clinics. Blood transfusion and history of surgery, although they constitute an
important risk factors in many studies in KSA and the Arabian region, they also were not associated with
high risk of HBV in this study[20-21]. Finally the results of this study should be interpreted with care, since it
21].
involved only small sample size of pregnant women and based on cross sectional study design.

Conclusion and Recommendation:
Prevalence of Hepatitis B virus in healthy pregnant women is 4.1%. Hospitalization, and jaundices showed a
significant association with anti- HBV seropositive and hence are important risk factors for its transmission.
Finally the study suggests the expansion of the Hepatitis B vaccination program to reduce the risk of HBV
ggests
among pregnant women.

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Prevalence and risk factors of hepatitis b virus among pregnant women in jazan region kingdom of saudi arabia

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