Bahir Dar town is located in Amhara region, 565km north-west of Addis Ababa. According to 2007 Ethiopian central statistical agency report, the total populations of Bahir Dar town administration is 221, 991.Of them 108,456 are males and 113,535 females. The hospital has different departments that provide specialized services in outpatient, inpatient and operation theatre departments. It provides services for approximately for more than 7 million people from the surrounding area. It has more than 415 beds and gives services for the western part of Amhara region as a referral hospital. There are more than 600 members of staff employed by the hospital and a further 200 employed by Bahir Dar university. Felegehiwot referral hospital provides care for the pregnant mothers widely in ANC, Intrapartum and Postpartum period.
All pregnant women who had antenatal care follow up at Felegehiwot referral hospital.
All pregnant women who were visited the antenatal care clinic during the first visit at Felegehiwot referral hospital
Women who had first antenatal care follow up at Felegehiwot hospital during the study period
Women whose antenatal care follow up were in another health institutions
Women who referred from other health institutions
Study design and Sample size determination
We designed an institutional based cross-sectional with serological supplemented study to estimate magnitude of hepatitis B virus infection. The sample size was estimated using Epi Info 7 software using sample size determination for cross sectional studies. The parameters that were used to estimate the sample size were: confidence level of 95%, 5% margin of error and prevalence of outcome was 7.8%. It was estimated based on one study in Ethiopia prevalence of hepatitis B in Hawassa hospital. Adding a 10% loss rate, the final sample size required for the study were a total of 338 women.
Sampling techniques and Procedures
Systematic random sampling technique was applied to select the study participants. We took 3 months’ average sampled population from registration book which was done at ANC clinic which is 626.So as to get kthinterval = (source population) N/sample size (n0) =626/338 2. Then the first pregnant mother was randomly selected by lottery method. Then study participants were interviewed every two interval until the sample size was completed through systematic random sampling technique.
Data collection tools and procedures
Data collection was implemented both face to face interview through pretested structured questionnaire and chart review. A pre-tested structured questionnaire was consisting of socio-demographic and socioeconomic characteristics, risky socio cultural and behavioral factors, institution related factors and blood sample test was designed to collect patient serum hepatitis B surface antigen virus status by requesting laboratory investigation. One-day training was given for the supervisor and data collectors about data collection and sampling technique. There were two trained diploma midwives for data collection and one BSc midwife supervisor. Pre testing of questionnaire on 17 (5%) pregnant women was done to assess the questionnaire content and face validity. The investigator and supervisor made spot checking and reviewing the completed questionnaires on daily basis to ensure completeness and consistency of the information collected. Privacy of the participants was kept.
Blood sample was obtained from 338 pregnant women. A standard procedure was used to collect blood and process them for testing. All sera were screened for hepatitis B surface antigen (HBsAg) using Enzyme Linked Immunosorbent Assay (ELISA) (Hepanostika test kit; Biomerieux, Boxtel, Netherlands) in central laboratory which is found in Felegehiwot specialized Hospital compound
Traditional tonsillectomy: Any traditional malpractice which was attempted to remove the tonsil by the community and cultural malpractice workers especially in the school age group without attending and evaluating in health institutions.
Risky socio cultural and behavior: Is behaviors which are endangers the life of the mother, children, family and the community consisting of unsafe sexual intercourse, multiple sexual partner, tattooing, unsafe injection of drugs without health professionals permission, traditional tonsillectomy, different types of piercing either in the ear or eye any factors which increases healthy mothers prone by acquiring of through different procedures in the health facility as well as in the community.
Data processing and analysis
After declaring for completeness and consistency of the data, the data were entered into Epi Info version-7 and exported in to SPSS version 23 statistical software for data cleaning, coded and analysis respectively. Bivariate logistic regression analysis was done after dichotomizing the dependent variables. After checking associations of the variables, those with p<0.2 in bivariate analysis was processed to multi-variable logistic regression analysis to control confounding factors. P-value of < 0.05 was used to express the statistical significance of the variables.