Factors Associated with Hepatitis B Surface Antigen Seroprevalence amongst Pregnant Women in Kenya

Background: Knowledge of factors associated with seroprevalenceof Hepatitis B in pregnancy is important in informing policiestowards prevention of vertical transmission of Hepatitis B Virus (HBV) infection, since in-utero and perinatal infectionlead to chronic carrier state with severe long-term sequela. In addition, adequate and timely immunization plays a major role in the prevention of transmission. Objective: To determine the factors associated with HBs Ag seroprevalencein pregnant women from various geographical regions in Kenya. Methods and Subjects: This was a cross-sectional survey amongst all pregnant women attending antenatal clinics in Kenyatta National Hospital and 8 other hospitals from different regions of Kenya in their third trimester of pregnancy among June 2001 to June 2002. For each pregnant woman, age, history of intravenous drug use, sexually transmitted disease(STD), liver diseases, alcohol intake, blood transfusion(BT) and presence of traditional scarificationwere documented. HBs Ag serology was assayed at the Kenya Medical Research Institute (KEMRI) laboratory. Results: A total of 2241 pregnant women were enrolled in the study, 2196 consented, of whom 205 (9.3%) tested positive for HBs Ag. A significant association was found between HBs Ag seroprevalenceand traditional scarification(p = 0.029), history of blood transfusion(p = 0.0024) and alcohol intake (p = 0.05). There was no significant association between Hbs Ag seroprevalenceand sexually transmitted disease(p = 0.64). It was not possible to evaluate the association of HBs Ag seroprevalencewith history of hospitalization for any liver disease including Hepatitis A, B or C, history of intravenous drug use or contact with sex partners previously hospitalised for any liver disease including Hepatitis A, B or C as the numbers with these attributes were small. Conclusions: We found 9.3% of pregnant women were HBs Ag positive, significantly higher than previously observed. The high seropositivity was associated with traditional scarification, history of blood transfusionand alcohol intake. Proper screening of blood transfusionproducts, immunization and control of scarificationand alcohol use should be considered by health policy experts.