Prevalence of hepatitis B infection: Knowledge and practice toward Hepatitis B virus infection among pregnant women attending antenatal care in Adwa town, North Ethiopia

doi:10.21203/rs.3.rs-3291506/v1

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Research Article

Prevalence of hepatitis B infection: Knowledge and practice toward Hepatitis B virus infection among pregnant women attending antenatal care in Adwa town, North Ethiopia

https://doi.org/10.21203/rs.3.rs-3291506/v1

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Background: Hepatitis B virus (HBV) is a major cause of morbidity and mortality worldwide and 100 times contagious than HIV. Mother to child transmission leads to chronic infections and remain as public health threat. There is scarce study about prevalence of HBsAg; knowledge and practice of pregnant women regarding HBV infection in the study area. Therefore, this study aimed to assess prevalence HBsAg; level of knowledge and practice toward HBV infection among pregnant women in Adwa town.

Methods: Facility based cross sectional study was employed among 337 pregnant women attending antenatal care clinics from March 28 to May 4, 2017 in Adwa town. Pregnant mothers were selected consecutively. Data was collected using a pre tested questionnaire. Logistic regression analysis was used to determine association between independent and the outcome variable. P value less than 0.05 at 95% confidence interval were used for statistical significance.

Results: The overall seroprevalence of HBsAg among pregnant mothers was 3.9% (95%CI: 1.8-6.2). Education of Pregnant mothers (secondary school and above) (AOR=2.3, 95%CI: 1.2-4.7) and Occupation of pregnant mothers (employed pregnant mothers) (AOR=2.5, 95%CI: 1.5-4.3) were independently associated with knowledge score of pregnant mother toward HBV infection transmission. Occupation of pregnant mothers (employed pregnant mothers (AOR=4.4:95%:1.5-12.0), age group 31-41years old pregnant mothers (AOR=3.7:95%CI: 1.3-10.7) and knowledge score of pregnant mothers (AOR=1.3, 95%CI: 1.2-1.5) were independently associated with good preventive technique pregnant mothers toward HBV infection.

Conclusion: The seroprevalence of HBsAg among pregnant mothers was intermediate endemic. Education and occupation status of pregnant mothers was factors with the knowledge score of pregnant mothers toward HBV infection transmission. Therefore, sustainable community based health education intervention about HBV transmission and prevention is important to raising awareness among pregnant mothers.

Prevalence

Knowledge

Hepatitis B virus

pregnant women

Adwa

Ethiopia

Hepatitis B virus is a DNA virus and belongs to the family of Hepadnaviridae. The incubation period is 6 weeks to 6 months and found in blood and other body fluids such wound exudates, semen, vaginal secretions, and saliva (1). The genotypes of HBV are A to H(2).HBV infection is 50 to 100 times more contagious than HIV(3). Blood and product, Body fluid such as semen, mother to child, unsafe sex, unsterilized medical equipment and sharing of sharp instruments are among potential source of HBV (4).

Vertical transmission of HBV is common in endemic are such as Asia and sub-Saharan Africa (5) and cause high morbidity and mortality due to cirrhosis and hepatocellular carcinoma (6).Hepatitis B virus transmit from mother to her child (7) and the transmission route are trans placental, natal and postnatal transmission (8).

Lack of data about knowledge and practice of pregnant mothers regarding HBV in our country and low awareness among the populations are challenges to control HBV transmission (9). Study about knowledge and practice is important to collect information about individuals what they know, believe to be a particular disease. Knowledge and practice study is important to plan, implement and identify knowledge gaps and barriers that hinders disease control effort in countries like Ethiopia (10).

Hepatitis B virus (HBV) is one the major source of morbidity and mortality around the world

(11). Internationally at least two billion people has been infected with HBV and around 240 million population of the world are chronically infected with HBV (12).

The prevalence of HBV is different at different part of the world based on this the world classify into three,(≥ 8%) endemic, such as Africa, Asia, and western pacific, (2–7% ) intermediate; southern and Easter Europe and (< 2%) low, western Europe, North America and Australia (9).

The concern of mother-to-child HBV Transmission is its severity and chronicity, 25% of HBV-infected newborns became chronic and died of cirrhosis, liver failure or liver cancer (13). HBV positive pregnant women suffer from coagulation defects, organ failure, high maternal mortality and complications such stillbirths and neonatal death (14).

As to the studies conducted in Ethiopia the prevalence of HBV among pregnant women ranges from 3.8 to 7.8%(15–19).In addition, a three years retrospective study indicated that the prevalence of HBV in the general population was 21.2% (11). This implicates that HBV is still evident in the general population as well as pregnant mothers and Ethiopia is found in the category of high endemic. However, Knowledge and Practice of pregnant mothers toward HBV infection prevention was not studied in Ethiopia and there scarcity of scientific study on prevalence of HBV among pregnant mothers in the study area. Therefore, this study aimed to assess prevalence HBsAg; a factor affecting knowledge and practice toward HBV infection among pregnant women in Adwa town.

Study design, period and area:

Facility based cross sectional study was conducted among pregnant mothers attending ANC clinics in Adwa town from 28 March to 4 May 2017. Adwa town is, Located 1006 km North of Addis Ababa at longitude and latitude o14°15′N, 38°54′E in coordination with an elevation of 1907 meters above sea level. In the town there is a total population of 114,589, of these 74,989 male, 39,600 female and 18, 992 reproductive age women. Concerning the health facilities, there are one general hospital, three health centers and one private ANC clinic in the town (Adwa town Health office report, 2017). Adwa town was selected because of the highest flow of pregnant population to the healthcare facilities of the town as compared to the other districts in the central zone of Tigray.

Sample size determination and sampling procedure

Study population was all pregnant mothers attending ANC clinics at the selected health facility. Pregnant women living in the area for more than six month were included in the study and those unable to communicate due to mental or physical illness were excluded.

In order to determine the sample size we considered the relatively recent prevalence of HBV and the prominent predictor variables from the previous studies in Ethiopia. After all, the single proportion formula gave us the highest sample size s by considering the prevalence of hepatitis B virus among pregnant women 7.8%(16), 95% CI and 3% margin of error. So the sample size was 337. Based on the flow of pregnant mothers to each health care facility, the 337 pregnant mothers were proportionally allocated to each selected health facility (Adwa general Hospital, a private clinic and a selected health center).After the quota allocation, the study participants who were attending in each study sites were consecutively included in the study.

Operational definition

Hepatitis B status (Reactive, non-reactive)

Reactive: presences of two red test band in the test and control region

Non-reactive: presences of one red test band in the control region

Adequate knowledge: if the respondents answered ≥ 70% of the knowledge questions.

Inadequate knowledge: if the respondents answered < 70% of the knowledge questions.

Good practice: when the study participants answered > 70% of practice questions.

Bad practice: when the participants answered < 70% of practice questions(20).

Measurement and data collection:

Data were collected using serological tests and interview administered questionnaires. The questionnaire was adopted from a similar study done in Addis Ababa (20). Knowledge towards HBV infection transmission was measured with 20 questions related HBV etiology, symptoms and route of transmission.

Practices towards HBV infection preventive technique was measured by asking eight questions, what the respondents actually do for self-protection from HBV infection. Each question has yes or no answer. The cutoff point value was taken from a similar study in Addis Ababa (20).

Specimen collection and processing

Five to 3ml venous blood samples were taken by trained laboratory Technologists. Blood was centrifuged at 3000 RPM for 5 minutes after clotting to separate the serum from red blood cells. Presence of HBsAg was detected using 98.89%% sensitivity and 98.87% specificity rapid test kits (Advanced quality ^TM one step HBsAg test Cast, China). Invalid test results were retested and accepted one the control line appears clearly in the allocated time set by the manufacturer directions. All the necessary precautions were taken in handling the samples, as these are capable of transmitting etiological agents(21).

Quality assurance

Questionnaire was translated to local language (Tigrigna) and back by legal translators to maintain consistency and Pretested in 5% of the sample size prior to the study in other health facilities. Data collectors were trained for one day on how to conduct the interview and process the sample. Known positive and negative controls were used to check the quality of the test kits. Clean pipette tips were used for every sample to prevent cross contamination and ensure confidentiality. Hemolyzed and clotted was cheeked. Completeness and accuracy of collected data was cheeked by the principal investigator daily.

Data entry and Analysis

Data was entered into Epi info version 7 and exported to SPSS v.21 software for analysis. Descriptive statistics was used to estimate prevalence of HBV in pregnant mothers and Hosmer and Lemshow goodness-of-fit-test statistics was used to check model Logistic regression analysis was used to determine level of association between independent and outcome variable (score of knowledge and practice) and control confounding variable. Adjusted odd ratio (AOR), P value ≤ 0.05 and the 95% confidence interval was used to declare statistical significance in the multivariate logistic regression analysis.

Socio demographic characteristic of pregnant mothers in Adwa town, 2017

A total of 337 pregnant mothers were participated in the study with response rate of 100%. From a total of 337 pregnant mothers, 229 (67.9%) were from Adwa General Hospital, 57 (16.9%) were from Adwa Health center and 51(15.1%) were from Senay special private clinic.

The mean age of the pregnant mothers was 26.8 year (± 5.7 S.D). Two hundred and sixty five of the pregnant mothers (78.5%) were within the age range of 20–30 years and 287 (82.5%) were married. One hundred and eighty six of the pregnant mothers (55.2%) were completed secondary school and above. One hundred and eighty two of the pregnant mothers (54.0%) were unemployed. From a total of 337 pregnant mothers 247 (73.3%) were urban resident (Table 1).

Table 1

socio demographic information of pregnant mothers attending selected health facility at Adwa town, northern Ethiopia, 2017(n = 337)
Variables	Number	Proportion
Age
20–30	265	78.5
31–41	72	21.4
Marital status
Single	31	9.2
Married	278	82.5
Divorced/widowed	28	8.3
Educational status
No formal education	79	23.4
Primary school	72	21.4
Secondary school and above	186	55.2
Occupational status
Unemployed	182	54.0
Employed	155	46.0
Gravidity
Primigravida	104	30.9
Multigravida	233	69.1
Residency
Urban	247	73.3
Rural	90	26.7

Seroprevalence of HBsAg among pregnant mother attending selected health facility

The overall seroprevalence of HBsAg of the pregnant mothers were 3.9% (95% CI: 1.8–6.2). The Positivity rate of HBsAg was more frequent in age group of 20-30years old12 (4.5%) than age group31-41 years old (1.4%). According to marital status high seroprevalence HBsAg was observed in unmarried participant 3 (9.7%) followed by divorced/widowed 2 (7.7%). High HBsAg prevalence was observed among urban resident pregnant mothers 10 (4.0%) (Table 2).

Table 2

socio demographic and serological finding of pregnant mothers attending selected health facility at Adwa town, Northern Ethiopia, 2017(n = 337)
Variables	serological finding		P value
Variables	Non-reactive N (%)	Reactive N (%)	P value
Age group(year)
20–30	253 (95.5)	12(4.5)	0.378
31–41	71 (98.6)	1(1.4)	0.378
Marital status
Single	28 (90.3)	3 (9.7)	0.113
Married	270 (97.1)	8 (2.9)
Divorced/widowed	26 (92.9)	2 (7.1)
Educational status
No formal education	75 (94.9)	4(5.1)	0.768
Primary school	69 (95.8.3)	3 (4.2.1)
secondary and above	180 (55.6)	6 (3.2)
Occupational status
Unemployed	175 (95.2)	7 (3.8)	0.64
Employed	149 (96.1)	6 (3.9)	0.64
Gravidity
Primigravida	101 (97.1)	3 (2.9)	0.39
Multigravida	223 (95.7)	10 (4.3)	0.39
Residency
Urban	237(96.0)	10(4.0)	0.763
Rural	87(96.7)	3(3.3)	0.763

Assessment of knowledge of pregnant mothers towards HBV infection

From a total 337 pregnant mothers 96 (28.5%:95%CI: 23.7–33.5) had adequate knowledge.

A total of 173 (51.3%) pregnant mothers had information about a disease termed as Hepatitis. According to the etiology and cause of the virus, 91(27%), 109 (32%) and 100(29.7%) were informed as a viral disease, affects liver function and cause liver cancer respectively. Based on the sign and symptom of the HBV infection, 143(42.4) were recognize as Jaundice is the common symptom of HBV and 82(24.3%) were recognize that Hepatitis B cannot show sign and symptom in some of the HBV infected patients.

Regarding transmission of HBV infection, a total of 137 (40.7%) of the pregnant mothers knew the risk of transmission from infected mother to her child. Around 115(34.1%) and 98(29.1%) were knew the risk of transmission of HBV by contaminated blood and unsafe sex respectively. One hundred and fifty (44.5%) knew the availability of vaccine for HBV infection (Table 3).

Table 3

Knowledge response toward HBV infection among pregnant mother attending antenatal care in the selected health facility in Adwa town, Northern Ethiopia, 2017(n = 337)
Response of pregnant Mothers To knowledge questions	Yes, N (%)	No, N (%)
Heard of a disease termed as Hepatitis?	173 (51.3)	164 (48.7)
Heard of a disease termed as Hepatitis B?	130 (38.6)	207 (61.4)
Hepatitis B is a viral disease	91 (27.0)	246 (73.0)
Hepatitis B affects liver function	109 (32.3)	227 (67.7)
Hepatitis B cause liver cancer	100 (29.7)	237 (70.3)
Hepatitis B affects any age group	139 (41.2)	198 (58.8)
early symptoms of Hepatitis B are like fever, running nose, and cough	95 (28.2)	242 (71.8)
Jaundice is one of the common symptoms of Hepatitis B	143 (42.4)	194 (57.6)
Nausea, vomiting & loss of appetite common symptom of hepatitis B	100 (29.7)	237 (70.3)
There no symptom of the Hepatitis B in some of the patients	82 (24.3)	257 (75.7)
Hepatitis B transmitted by un sterilized syringe needle & surgical instrument	107 (31.8)	230 (68.2)
Hepatitis B transmitted by contaminated Blood &blood product	115 (34.1)	222 (65.9)
Hepatitis B transmitted by blades of the barber, ear pierces or body tattoo	120 (35.6)	217 (64.4)
Hepatitis B transmitted by unsafe sex	98 (29.1)	239 (70.9)
Hepatitis B transmitted from infect mother to her child	137 (40.7)	200 (59.3)
Hepatitis B transmitted by contaminated water/food prepared by person suffering with the infections	71 (21.1)	266 (78.9)
Hepatitis B curable / treatable	88 (26.1)	249 (73.9)
Hepatitis B self-cured by body	62 (18.4)	275 (81.6)
Vaccine available for Hepatitis B	150 (44.5)	187 (55.5)
specific diet required for treatment of Hepatitis B	66 (19.6)	271 (80.4)
Overall knowledge score of respondents	96 (28.5)	241 (71.5)

Factor affecting knowledge of pregnant mother toward HBV infection

Both bivariate and multivariable analyses were done to identify factors associated with knowledge score of pregnant mother toward HBV infection transmission. In a multi variable logistic regression analysis, the model identified educational and occupational status as independently associated with knowledge score of pregnant mother toward HBV infection transmission. Those pregnant mothers that completed secondary school and above level were 2.3 times more knowledgeable as compare to those no formal education(AOR = 2.3, 95%CI: 1.2–4.7) about HBV transmission. Employed pregnant mothers were 2.5 times more knowledgeable than their counterpart (AOR = 2.5, 95%CI: 1.5–4.3) about HBV transmission

Table 4

Bivariable and multivariable logistic regression analysis for factor associated with knowledge score of pregnant mothers towards HBV infection in Adwa town, 2017(n = 337)
Explanatory variables		knowledge towards HBV				COR(95%CI)		AOR(95%CI			P value
Explanatory variables		Inadequate		Adequate		COR(95%CI)		AOR(95%CI			P value
Age group
20–30		191(72.1%)	74(27.9%)			1		1
31–41		50(69.4%)	22(30.6%)			1.33 (0.64-2.0)		1.2(0.66–2.4)			0.475
Marital status
Single		25(80.6%)	6 (19.4%)			1		1
Married		197(70.9%)	81 (29.1%)			1.7 (0.67–4.3)		1.5(0.56–3.9)			0.411
Divorced / widowed		19 (67.9%)	9 (32.1%)			1.9(0.59–6.5)		1.8(0.50–6.5)			0.36
Educational status
No formal education		66 (83.5%)	13 (16.5%)			1	1
Primary school		61(84.7%)	11(15.3%)			0.91(0.38–2.2)	0.86(0.35–2.1)				0.74
secondary and above		114(61.3%)	72(38.7%)			3.2 (1.6–6.2)	2.3(1.2–4.7)				0.014
Occupational
unemployed	150(82.4%)		32(17.6%)			1	1
Employed	91(58.7%)		64(41.3%)			3.3(2.004-5.4)	2.5(1.5–4.3)			0.0001
Gravidity
Primigravida	74(71.2%)		30(28.8%)			1			1
Multigravida	167(71.7%)		66(28.3%)			0.97(0.58–1.62)			0.93(.52 − 1.6)	0.82
Residence
Urban	166(67.2%)				81(32.8)	2.4(1.3–4.5)			1.6(0.85–3.20	0.134
Rural	72(83.3%)				15(16.7%)	1			1
AOR: Adjusted odds ratio; COR: Crude odds ratio

Assessment of practice of pregnant mothers towards HBV infection prevention

From a total of 337 pregnant mothers, 264 (78.3%) were not screened for Hepatitis B virus infection previously. Out of the total pregnant mothers150 (44.4%) were asked for a new syringe before use and 184(54.6%) were asked for safe equipment for ear piercing or body tattoo. Around 212(62.9%) were seek further investigation and treatment if diagnosed with Hepatitis B. Practice score of the pregnant mothers were determined by adding each scores. From a total of 337 pregnant mothers 43 (12.8%:95%CI: 9.2–16.9) had good preventive technique towards HBV infection prevention.

Table 5

response of study subject to practice questions toward HBV infection
Response pregnant mothers to practice questions	Yes, N (%)	No, N (%)
Previously screening for Hepatitis BV	73 (21.7)	264 (78.3)
vaccinated against Hepatitis BV	35 (10.4)	302 (89.6)
ask for a new syringe before use	150 (44.4)	187 (55.5)
Ask for screening of blood before transfusion?	65 (19.3)	272 (80.7)
ask for safe equipment for ear piercing or body tattoo	184 (54.6)	153 (45.4)
seek further investigation and treatment if diagnosed with Hepatitis B	212 (62.9)	125 (37.1)
avoid meeting Hepatitis B patients	27 (8.0)	310 (92.0)
participated in health education program related to Hepatitis B	55 (16.3)	282 (83.7)
Overall practice score of respondent	43 (12.8)	294 (87.2)

Factor affecting practice of pregnant mother towards HBV infection

Both bivariate and multivariable analyses were done to identify the factors associated with practice score of pregnant mother toward HBV infection prevention technique. In a multi variable logistic regression analysis, the model identified occupational status, knowledge sum score and age as independently associated with practice score of pregnant mother toward HBV infection prevention.

Employed Pregnant mothers were 4.4 times more likely to have good practice on preventive technique towards HBV infection prevention as compare to those unemployed (AOR = 4.4:95%:1.5–12.0). Pregnant mothers within the age group 31–41 years old were 3.7 times more likely to have good practice on preventive technique toward HBV infection as compared to their counterpart(AOR = 3.7:95%,1.3–10.7). For every knowledge score increase preventive technique of pregnant mothers improved by 1.3 times (AOR = 1.3:95%CI: 1.2–1.5).

Table 6

Multivariable logistic regression analysis for factor associated with practice score of pregnant mothers toward HBV infection in Adwa town, 2017(n = 337)
Explanatory variables	Level practice					COR 95%Cl)	AOR (95%Cl)	P value
Explanatory variables	bad practice		good practice			COR 95%Cl)	AOR (95%Cl)	P value
Age
20–30	238 (89.8%)			27 (10.2%)		1	1
31–41	56 (77.8%)			16 (22.2%)		2.5(1.3–4.9)	3.7 (1.3–10.7)	0.013
marital status
Single	28 (90.3%)			3 (9.7%)		1	1
Married	244 (87.8%)			34(12.2%)		1.3 (0.37–4.5)	0.7(0.10–5.3)	0.75
Divorced/widowed	22 (78.6%)			6 (21.4%)		2.5 (0.57–11.3)	1.7(0.17-17)	0.64
educational status
No formal education	73(92.4%)			6(7.6%)		1	1
Primary school	66 (91.7%)			6 (8.3%)		1.1 (0.34–3.5)	1.5(0.30–7.5)	0.60
secondary and above	155 (83.3%)			31 (16.7%)		2.4 (0.9-6.0)	0.70(0.17–2.9)	0.65
Occupational
Unemployed	175(96.2%)				7(3.8%)	1	1
Employed	119 (76.8%)				36 (23.2%)	7.5 (3.2–17.5)	4.4(1.5–12.0)	0.004
Gravidity
Primigravida		97(93.3%)			7(6.7%)	1	1
Multigravida		197(84.5%)			36(15.5%)	2.5(1.0-5.8)	2.6(0.92–7.5)	0.072
Residency
Urban		197 (79.8%)			50 (20.2%)	2.0 (0.86–4.7)	1.1(0.32–3.8)	0.89
Rural		82 (91.1%)			8 (8.9%)	1	1
Knowledge sum score						1.4(1.27–1.56)	1.3(1.23–1.50)	0.0001
AOR: Adjusted odds ratio; COR: Crude odds ratio

In this study, the seroprevalence of HBV is 3.9% (95%CI: 1.8–6.2). The seroprevalence of HBsAg among the pregnant mothers in this study has dissimilarity with the study conducted in different part of Ethiopia. The current finding is lower than the findings from the study done in (Deder Hospital) Easter Ethiopia 6.9% (1), Hawasa 7.8% (16), and Dessie Referral Hospital l4.9% (4).This difference might be due to socio-cultural or history of exposure to the risk factor of HBV or due to the method used for HBsAg screening. On the other hand, this finding is almost comparable with the studies conducted in Addis Ababa 6% (15), Bahir Dar Referral Hospital 4.4% (17), Bahir Dar city 3.8%(19) and Arba Minch 4.3% (18).

This findings is also comparable with study done in India 3.9% (22). However smaller than the study conducted from Cameroon 7.7% (23) and Indonesia 6.8%(6). This difference may be due to socio cultural, geographic or risk behavior of the study participant. This study indicates that Ethiopia is intermediate endemic for HBV prevalence as per the WHO criteria (9). This indicates that the possible mother to child transmission of HBV in the study area.

From a total of 337 pregnant mothers participating in the study, 28.5% had adequate knowledge toward HBV. This finding is also in line with the study conduct in Addis Ababa (20). The finding also comparable with a study conducted in Pakistan(24) and in Cameroon among two rural communities (25). The possible reason for low knowledge of the study participant toward HBV might be due to poor health education programs in those areas about HBV transmission route and prevention methods.

Educational status was identified as a factor associated with the knowledge score of pregnant mothers. Pregnant mothers who complete secondary school and above were 3.2 times more knowledgeable about HBV transmission route, sign and symptom as compared to those with no formal education. The finding was supported by study conduct in Addis Ababa among pregnant mothers (20). In addition, our finding is consistent with the study conducted in Cameron (25) and Nigeria (26)

Out of 337 pregnant mothers, (87.8%) were with bad preventive technique toward HBV infection. The finding is consistent with the study conduct in Cameroon (25).

In this study, occupational status was significantly associated with practice of pregnant mothers towards HBV. Those Governmental employees were 4.4 times more likely to have good practice towards HBV infection prevention as compared to those unemployed. This is consistent with the finding from Ethiopia (20) and Cameron (25). The reason for this might be employed pregnant mothers have the opportunity of exposure about HBV information.

In this finding, residence was not associated with the practice score of pregnant mothers. In contrast to this finding, residence was significantly associated with study conduct in Cameron(25)and Pakistan(24). This might be due to most of our study participants were urban residence, they may have the same degree of prevention against HBV infection or different in the study population. The study was facility based and may not represent all pregnant mothers in the general population. Therefore, further community based study is needed to identify the level of knowledge and practice toward HBV and seroprevalence of HBsAg.

The seroprevalence of HBsAg among pregnant mothers attending antenatal care in Adwa town was intermediate endemic. It indicates the possibility of vertical transmission in the area.

The result indicates a gap in knowledge and preventive technique among pregnant mothers to infection control measures. Education and occupation status were independently associated with the knowledge score of pregnant mother toward HBV infection transmission. Occupational status and knowledge score of pregnant mothers toward HBV were independently associated with practice score of pregnant mother toward HBV infection preventive technique. Therefore, Community and facility based health education programs should be designed to improve knowledge and practice of pregnant mothers toward HBV infection transmission and prevention.

ANC

Antenatal Care

DNA

Deoxyribonucleic acid

ELISA

Enzyme Linked Immuno-sorbent Assay

HBsAg

Hepatitis B surface Antigen

HBV

Hepatitis B Virus

HIV

Human Immunodeficiency Virus

NND

Neonatal Death

RNA

Ribonucleic acid, RPM:Revolution Per Minute

VCT

Voluntary Counseling and Testing

WHO

World Health Organization

Acknowledgments

I would like to acknowledge Tigray Regional state health bureau for financial support in conducting this work. I am grateful to the study participants who kindly volunteered in this study

Authors’ contributions

Conceived and designed the study: BT, DN, BF, SH, MTS and HG; coordinated the field work and performed the experiments; BT, DN, BF, GW, TG and SH. Analyzed the data and wrote the manuscript: BT, DN, BF, HG, MTS, TG and GW. All authors also read and approve the final manuscript.

Funding: This work was supported by Aksum University College of Health Sciences.

Availability of data and materials

The datasets on which conclusion was made is available in the form of Microsoft Excel. It is available on reasonable request.

Ethics approval and consent to participate

Ethical clearance was obtained from the Research and Ethics Review board of Aksum University. Permission letter was obtained from Tigray regional state Health bureau. Written informed consent was obtained from each study participant and their parents/guardians (for those under 18 years) after clear explanation about the purpose, benefit, risk, confidentiality of the information and voluntary nature of participation in the study. All of the study participants were reassured that they will be anonymous. Names or any personal identifiers were not recorded.

Consent for publication: Not applicable

Competing Interests

This is to confirm that all authors have reviewed the submitted the research article and approved the paper for submission. All authors also declare that they have no financial or non-financial competing interests.

Author details

BT (MPH, Department of field epidemiology, Tenbyen-Abyadi district, Tenbyen-Abyadi Ethiopia)

HG (MPH, Assistant professor, Department of Public Health, College of Health Science, Aksum University, Aksum Ethiopia)

TG (MPH, Department of Public Health, College of Health Science, Aksum University, Aksum Ethiopia)

MTS (M.Sc., Assistant professor, Department of Medical Laboratory Sciences, College of Health Science, Aksum University, Aksum Ethiopia)

SH (M.Sc., Department of Health Biomedical sciences, College of Health Science, Aksum University, Aksum Ethiopia)

GW (M.Sc, Assistant professor, Department of Midwifery, College of Health Science, Aksum University, Aksum Ethiopia)

DN (MPH, Assistant professor, Department of Reproductive Health, College of Health Sciences, Bahrdar University, Bahrdar, Ethiopia)

BF (MPH, Assistant professor, Department of Biostatics and Epidemiology, College of Health Sciences, Bahrdar University, Bahrdar, Ethiopia)

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No competing interests reported.

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Prevalence of hepatitis B infection: Knowledge and practice toward Hepatitis B virus infection among pregnant women attending antenatal care in Adwa town, North Ethiopia

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Version 1

Abstract

Introduction

Methods and materials

Study design, period and area:

Sample size determination and sampling procedure

Operational definition

Measurement and data collection:

Specimen collection and processing

Quality assurance

Data entry and Analysis

Results

Socio demographic characteristic of pregnant mothers in Adwa town, 2017

Seroprevalence of HBsAg among pregnant mother attending selected health facility

Assessment of knowledge of pregnant mothers towards HBV infection

Factor affecting knowledge of pregnant mother toward HBV infection

Assessment of practice of pregnant mothers towards HBV infection prevention

Factor affecting practice of pregnant mother towards HBV infection

Discussion

Conclusion

Abbreviations

Declarations

References

Additional Declarations

Status:

Version 1