High burden of hepatitis B infection in Northern Uganda: results of a population-based survey

BMC Public Health, Aug 2013

Background Worldwide 2 billion people are exposed to hepatitis B infection, 350 million have chronic infection, 65 million in sub-Saharan Africa. Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the southwest and 25% in the Northeast. Childhood vaccination was rolled out in 2002, the effect of which on the burden of hepatitis B has not been examined. We determined the prevalence and risk factors for hepatitis B infection in the Northern Uganda Municipality of Gulu. Methods We carried out a cross-sectional, population-based survey. The study population included those found at home at the time of recruitment. Data on demographics, wealth index, cultural and behavioral factors, vaccination and health education on hepatitis B were collected. Hepatitis B infection (Hepatitis B surface antigen positive) and lifetime exposure (anti-hepatitis B core antibody positive) were measured. Analysis was done in 2 age groups, 1–14 years, 14 years and more. Associations between predictors and HBV infection were assessed. Results Information on 790 respondents were analyzed. Overall, 139/790 (17.6%) had hepatitis B infection and 572/790 (72.4%) lifetime exposure. In the younger age group 16/73 (21.9%) had hepatitis B infection and 35/73 (48%) lifetime exposure. Increasing wealth was protective for infection (OR 0.46 per quartile, 95% CI=0.26-0.82, p=0.009), while older age was protective for lifetime exposure (OR 2.70 per age group, 95% CI 1.03-7.07, p=0.043). In the older age group, overall hepatitis B infection was seen in 123/717 (17.2%) and lifetime exposure in 537/717 (74.9%). The female sex (OR 0.63, 95% CI=0.42-0.98, p=0.032) and increasing age (OR 0.76 per age group, 95% CI=0.64-0.91, p=0.003) were factors associated with infection. For lifetime exposure, increasing number of lifetime sexual partners was a risk factor (OR 1.19 per partner category, 95% CI=1.04-1.38, p=0.012). Conclusions We found a high prevalence of hepatitis B infection and lifetime exposures to hepatitis B in this northern Uganda Municipality. Targeted vaccination of susceptible adults and improving existing childhood vaccinations and provision of treatment for those with infection will play roles in reducing the high prevalence rates seen in the population.

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High burden of hepatitis B infection in Northern Uganda: results of a population-based survey

BMC Public Health High burden of hepatitis B infection in Northern Uganda: results of a population-based survey Emmanuel Ochola 1 2 Ponsiano Ocama 0 Christopher G Orach 4 Ziadah K Nankinga 2 Joan N Kalyango 2 Willi McFarland 3 Charles Karamagi 2 0 Department of Medicine, Makerere University College of Health Sciences , Kampala , Uganda 1 St. Mary's Hospital Lacor , Gulu , Uganda 2 Clinical epidemiology unit, School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda 3 University of California , San Francisco , USA 4 School of Public Health, Makerere University College of Health Sciences , Kampala , Uganda Background: Worldwide 2 billion people are exposed to hepatitis B infection, 350 million have chronic infection, 65 million in sub-Saharan Africa. Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the southwest and 25% in the Northeast. Childhood vaccination was rolled out in 2002, the effect of which on the burden of hepatitis B has not been examined. We determined the prevalence and risk factors for hepatitis B infection in the Northern Uganda Municipality of Gulu. Methods: We carried out a cross-sectional, population-based survey. The study population included those found at home at the time of recruitment. Data on demographics, wealth index, cultural and behavioral factors, vaccination and health education on hepatitis B were collected. Hepatitis B infection (Hepatitis B surface antigen positive) and lifetime exposure (anti-hepatitis B core antibody positive) were measured. Analysis was done in 2 age groups, 1-14 years, 14 years and more. Associations between predictors and HBV infection were assessed. Results: Information on 790 respondents were analyzed. Overall, 139/790 (17.6%) had hepatitis B infection and 572/790 (72.4%) lifetime exposure. In the younger age group 16/73 (21.9%) had hepatitis B infection and 35/73 (48%) lifetime exposure. Increasing wealth was protective for infection (OR 0.46 per quartile, 95% CI=0.26-0.82, p=0.009), while older age was protective for lifetime exposure (OR 2.70 per age group, 95% CI 1.03-7.07, p=0.043). In the older age group, overall hepatitis B infection was seen in 123/717 (17.2%) and lifetime exposure in 537/717 (74.9%). The female sex (OR 0.63, 95% CI=0.42-0.98, p=0.032) and increasing age (OR 0.76 per age group, 95% CI=0.64-0.91, p=0.003) were factors associated with infection. For lifetime exposure, increasing number of lifetime sexual partners was a risk factor (OR 1.19 per partner category, 95% CI=1.04-1.38, p=0.012). Conclusions: We found a high prevalence of hepatitis B infection and lifetime exposures to hepatitis B in this northern Uganda Municipality. Targeted vaccination of susceptible adults and improving existing childhood vaccinations and provision of treatment for those with infection will play roles in reducing the high prevalence rates seen in the population. - Background Hepatitis B viral infection (HBV) causes significant global burden of disease with 2 billion people exposed to the virus, more than 350 million of whom are chronic carriers. It is a cause of more than 600,000 deaths annually. Africa shares 25% of the total HBV burden, with 65 million chronic carriers [1,2]. Infection is highly endemic in Uganda with a national prevalence estimate of 10% in a study carried out in 2004. The in-country distribution of the virus however varies from region to region. The highest prevalence is found in the Northern part of the country ranging from 19% in North west to 25% in the North east [3]. The explanation for this variation in distribution is not well established. Hepatitis B transmission occurs through blood and blood product exposures. While sexual and needle stick exposures are common modes of transmission in the low endemic areas, transmission in high endemic regions tends to occur in early childhood either perinatally or through child-to-child horizontal methods [2]. Scarifications, shown to be an important mode of HBV transmission in South Africa [4] is also a common practice in northern Uganda but its contribution to transmission of infectious diseases is not studied [5,6]. Control of hepatitis B is done through immunization. Where this has been done the prevalence of infection and chronic liver diseases have been significantly reduced [7]. The Uganda National Expanded Program on Immunizations (UNEPI) successfully helped scale-up childhood immunizations including hepatitis B which was included in the program in the year 2002. However the program strategy incorporates the hepatitis B vaccine into a combination vaccine whose first dose is administered at 6 weeks of age. This was a strategy of World Health Organization and is still being used in many African Countries. However, this delay both limits the efficacy of the vaccine in the prevention of vertical transmission and allows for the potential transmission of hepatitis B throug (...truncated)


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Emmanuel Ochola, Ponsiano Ocama, Christopher G Orach, Ziadah K Nankinga, Joan N Kalyango, Willi McFarland, Charles Karamagi. High burden of hepatitis B infection in Northern Uganda: results of a population-based survey, BMC Public Health, 2013, pp. 727, 13, DOI: 10.1186/1471-2458-13-727