|Year : 2013 | Volume
| Issue : 2 | Page : 113-117
Prevalence of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Benin City, Nigeria
Bankole Henry Oladeinde1, Richard Omoregie2, Oladapo Babatunde Oladeinde3
1 Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo State, Nigeria
2 Department of Medical Microbiology, School of Medical Laboratory Sciences, University of Benin Teaching Hospital, Benin City, Edo State, Nigeria
3 Department of Obstetrics and Gyneocology, Irrua Specialist Hospital, Irrua, Edo State, Nigeria
|Date of Web Publication||10-Sep-2013|
Bankole Henry Oladeinde
Department of Medical Microbiology, College of Health Sciences, Igbinedion University, Okada, Edo State
Source of Support: None, Conflict of Interest: None
Background: Data on prevalence of human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV) infections among pregnant women in non-institutionalized health facilities in Nigeria are missing. Aim: This study aimed at determining the prevalence and associated risk factors of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Nigeria. Setting and Design: This was a cross-sectional study conducted in a traditional birth home. Materials and Methods: Blood and sera samples obtained from 360 pregnant women were tested for the presence of HIV, HBV, and HCV antibodies and hemoglobin concentration determined using standard technique. Questionnaires were used to obtain demographic information. Statistical Analysis: INSTAT ® statistical software. Results: The prevalence of HIV infection was significantly higher among pregnant women with no formal education and among those with multiple marriages (P = 0.008 and P = <0.0001 respectively). Only HIV infection was associated with anemia (OR = 4.154, 95% CI = 1.699, 10.157, P = 0.002). Age, gravidity, parity, marital status, history of blood transfusion, and educational status did not significantly affect the prevalence of HBV and HCV infections. Conclusions: The prevalence of HIV, HBV, and HCV infections were 7.2%, 2.2%, and 0.8%, respectively. Anemia was significantly associated with HIV infection only. Intervention effort at reducing HIV, HBV, and HCV infections and associated sequelae among pregnant women receiving antenatal care in traditional birth homes is strongly advocated.
Keywords: Hepatitis C virus, hepatitis B virus, human immunodefi ciency virus, pregnant women, traditional birth home
|How to cite this article:|
Oladeinde BH, Omoregie R, Oladeinde OB. Prevalence of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Benin City, Nigeria. Saudi J Health Sci 2013;2:113-7
|How to cite this URL:|
Oladeinde BH, Omoregie R, Oladeinde OB. Prevalence of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Benin City, Nigeria. Saudi J Health Sci [serial online] 2013 [cited 2020 Jul 2];2:113-7. Available from: http://www.saudijhealthsci.org/text.asp?2013/2/2/113/117916
| Introduction|| |
The human immunodeficiency virus (HIV) is a teething global health problem. Sub-Saharan Africa remains by far the most affected region, with 24.5 million people living with HIV, representing a little below two-thirds of all people living with HIV.  HIV epidemic affects females severely in the sub-region, and women of reproductive age make up 57% of adults living with HIV.  HIV infection in pregnancy is associated with adverse maternal and fetal outcome,  the effect of which includes among others infectious morbidity, vertical transmission, and severe anemia. ,
Infections with hepatitis B and C viruses (HBV and HCV) are global public health problems. , HBV infection affects over 350 million people worldwide,  reaching endemic proportions in sub-Saharan Africa.  Available data show that about 3% of the world population is infected with HCV, with the highest prevalence rate recorded in Africa.  Viral hepatitis in pregnancy is associated with high risk of maternal, fetal, and neonatal complications.  Acute hepatitis in pregnancy has been shown to induce premature labor and prematurity with its attendant effects.  Unlike in developed countries of the world where HBV infection occurs predominantly in adults, in resource-poor settings, a high number of infants and children are infected, approximately 90% of whom were infected at birth. 
In sub-Saharan Africa, and South Asia, which together account for over half (57%) of deliveries in the developing world, up to 65% of births occur outside hospitals and are predominantly delivered by traditional birth attendants (TBAs).  The TBAs, apart from being known to provide care for women during pregnancy, , presently deliver the majority of women in Nigeria.  HIV, HBV, and HCV infections are known to be transmitted through unprotected sexual contact, unsafe blood transfusion, scarification with contaminated needles and instruments, and vertical transmission, amongst others. ,, Antenatal education has been reported to promote better pregnancy outcome and care for neonates.  While this is readily available to most pregnant women receiving antenatal care in institutionalized health facilities in Nigeria, it is obviously lacking in traditional birth homes (TBHs) as most TBAs are largely uneducated  and unable to prevent and treat most life-threatening obstetric complications.  This may put the pregnant women receiving care in a TBH at increased risk of acquiring preventable infections. Intervention strategies in preventing mother to child transmission of HIV can only be applied to a pregnant woman whose HIV status is known.  Consequently, children born to pregnant women in TBHs with no knowledge of their HIV status may be at increased risk of being infected with HIV. Indeed, prevention of mother-to-child transmission (PMTCT) programs are not extended to TBHs.
Poverty and low educational status have been linked with patronage and delivery of pregnant women by TBAs. , These factors have also been reported to be driving forces for acquiring HIV infection.  Although data exist on prevalence of HIV, HBV, and HCV among pregnant women in Nigeria, none have focused on pregnant women receiving antenatal care in TBHs. Against this background, this study was aimed at determining the prevalence of HIV, HBV, and HCV infections among pregnant women receiving antenatal care at a TBH in Benin City, Nigeria.
| Materials and Methods|| |
This study was conducted from November 2010 to June 2012 among pregnant women receiving antenatal care at a TBH in Benin City. A total of 360 pregnant women of age ranging from 14 to 40 years were recruited for this study. Selection criteria included being registered in the center for at least 1 month and non-attendance of orthodox health facility. A structured questionnaire was administered to obtain demographic information.
The study proposal was examined, approved, and permission for commencement of work granted by the ethical committee of Edo State Ministry of Health, Benin City, Edo State, Nigeria. Pregnant women and their spouses, where applicable, were educated on the purpose of conducting the research. Verbal informed consent was obtained from all participating pregnant women and their spouses.
Collection and processing of specimen
Ten milliliters of blood was collected from each pregnant woman and 5 ml was dispensed into a container having ethylene diamine tetra-acetic acid (EDTA) and the remaining 5 ml was placed in a plain container and allowed to clot. The sera obtained were used for serological diagnosis of HIV using a previously described method.  Briefly, each patient's serum was screened for the presence of HIV antibodies using Determine (Abbott Laboratories, Tokyo, Japan) and HIV 1/2 Stat-Pak (Chembio Diagnostic Systems, New York, NY, USA).When both kits showed positivity, the patient was regarded as positive for HIV infection and vice versa. However, when test results were discordant, a third kit Genie II HIV-1/HIV-2 (Biorad, Marne-la-Coquette, France) was used. The HIV serostatus of the patient was taken as the result of either of the first two kits that agree with that of the third kit. Antibodies to HBV and HCV were detected using immunochromatographic methods (Clinotech Diagnostics, Richmond, Canada) according to the manufacturer's instruction. Hemoglobin concentration was determined using an autoanalyzer, Sysmex KX-21 (Sysmex Corporation, Kobe, Japan). Anemia was defined as hemoglobin concentration <11 g/dl. 
The data obtained were analyzed using Chi-square (χ2 ) and odd ratio analysis was done using the statistical software INSTAT ® . An association was established between two variables when an OR value ≥1.00 was obtained. Statistical significance was set at P < 0.05.
| Results|| |
A total of 26 (7.2%) out of the 360 pregnant women studied were infected with HIV. The prevalence of HIV was significantly higher among pregnant women with no formal education (21.2%; P = 0.008) and those with multiple marriages (20.0%; P < 0.0001) [Table 1].
|Table 1: Prevalence of HIV infection among pregnant women receiving antenatal care in traditional birth home|
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The prevalence of HBV and HCV were 2.2% and 0.8%, respectively. Maternal age, gravidity, parity, history of blood transfusion, marital and educational status did not significantly affect the prevalence of HBV and HCV infection among pregnant women (P > 0.05) [Table 2] and [Table 3].
|Table 2: Prevalence of HBV infection among pregnant women receiving antenatal care in traditional birth home|
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|Table 3: Prevalence of HCV infection among pregnant women receiving antenatal care in traditional birth home|
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The prevalence of anemia among pregnant women was 41.9%. Only HIV infection was significantly associated with anemia (OR = 4.154, 95% CI = 1.699, 10.157, P = 0.002) [Table 4].
|Table 4: Effect of HIV, HBV, and HCV infections on prevalence of anemia among pregnant women receiving antenatal care in traditional birth home|
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No co-infection between HIV, HBV, and HCV was observed.
| Discussion|| |
Infections with HIV, HBV, and HCV are global health concerns. Data on the prevalence of HIV, HBV, and HCV among pregnant women attending non-institutionalized health facilities in Nigeria are missing. Against this background, this study was aimed at determining the prevalence of HIV, HBV, and HCV infections and associated risk factors among pregnant women attending a TBH in Benin City.
The prevalence of HIV in this study was 7.2%. This is higher than the Nigerian national overall average prevalence of 4.6% reported among pregnant women.  It is also higher than the reported figures in a number of Nigerian studies. ,, It is, however, lower than a finding in a rural community of Nigeria.  Poverty and low educational status have been linked with patronage and delivery of pregnant women by TBAs. , These factors have also been reported to be driving forces for acquiring HIV infection,  and may account for this observed variation. It is important to note that PMTCT programs are not extended to TBHs and this may result in adverse maternal-fetal outcomes and attendant sequelae.
The prevalence of HIV was significantly associated with marital status. Pregnant women with multiple marriages were found to be at increased risk of acquiring HIV. This agrees with a previous finding.  Exposure to multiple sex partners has been associated with increased risk of acquiring HIV infection.  This may explain the high prevalence of HIV among pregnant women with multiple marriages in this study. The finding that pregnant women with no formal education had a higher prevalence of HIV compared to pregnant women of other educational status had previously been reported.  Messages on HIV prevention in Nigeria are often passed in English language and through the electronic and print media. Pregnant women with no formal education may not be able to read and/or appreciate English language efficiently, resulting in impaired understanding of preventive measures for HIV infection. Nigeria is the most populous black nation of the world, with vast ethnic diversity. There is, therefore, an urgent need for an increased community-based approach to HIV prevention and awareness campaign, so as to stem the spread of HIV amongst the poor and uneducated which forms the bulk of her population.
HBV and HCV infections were recorded in 8 (2.2%) and 3 (0.8%) of pregnant women studied, respectively. These values are lower than the reported figures in a recent Benin City study.  Pregnant women with a history of blood transfusion had higher prevalence of HBV and HCV infection, albeit the difference was not statistically significant. This is consistent with a previous finding.  A similar picture was observed for HIV. Maternal age, gravidity, parity, marital and educational status of pregnant women did not significantly affect the prevalence of HBV and HCV infection.
Generally, among pregnant women, the prevalence of anemia was 41.9%. Non-use of insecticide-treated bed nets, as well as high prevalence of malaria among pregnant women attending TBHs in Nigeria has previously been reported. , In this study, the prevalence of anemia was significantly associated with HIV infection only. The association of anemia and HIV infection among pregnant women has previously been reported.  Bone marrow suppression by HIV has been reported as a possible mechanism for anemia. 
Conclusively, the prevalence rates of HIV, HBV, and HCV were 7.2% 2.2%, and 0.8%, respectively. The prevalence of HIV was significantly affected by marital and educational status and HIV infection was associated with anemia. Intervention effort by relevant agencies at reducing HIV, HBV, and HCV infections and associated sequelae among pregnant women receiving antenatal care in TBHs is strongly advocated.
| Acknowledgment|| |
Authors acknowledge with thanks all the pregnant women who participated in this study.
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[Table 1], [Table 2], [Table 3], [Table 4]
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