|Year : 2018 | Volume
| Issue : 3 | Page : 167-171
Serological screening of hepatitis B virus and hepatitis C virus among patients attending a tertiary hospital in Jalingo, Taraba state, Nigeria
Victor Omote1, Emmanuel Kashibu1, Isreal Ojumah1, Danjuma Adda2, Johnson Etaghene3, Henry Ukwamedua4
1 Department of Medical Microbiology, Specialist Hospital, Jalingo, Taraba, Nigeria
2 Centre for Initiative and Development, Jalingo, Taraba, Nigeria
3 Department of Public Health, Ministry of Health Asaba, Asaba, Nigeria
4 Department of Laboratory Services, Central Hospital Warri, Delta, Nigeria
|Date of Web Publication||6-Feb-2019|
Department of Medical Microbiology, Specialist Hospital Jalingo, Taraba
Source of Support: None, Conflict of Interest: None
Background: The rising prevalence of hepatitis B and hepatitis C viral infection as single or co-infection among the Nigerian populace and their association with hepatocellular carcinoma is a serious health issue. Aims and Objective: The aim of this study is to determine the prevalence of hepatitis B and C among patients seen in a tertiary health facility in Jalingo. Settings and Design: This is a cross-sectional and prospective study carried out among patients at a tertiary health-care facility in Jalingo, Taraba state of Nigeria. Materials and Methods: A total of 513 patients were screened for both hepatitis B surface antigen (HBsAg) and anti-hepatitis C virus (HCV) using rapid chromatographic immunoassays for their qualitative detection in plasma. Result: Of the 513 patients screened, 70 (13.60%), 85 (16.6%), and 5 (1.0%) were positive of HBsAg, anti-HCV, and co-infection, respectively. About 14.7% and 20.1% were the highest gender-based prevalence recorded for HBsAg and anti-HCV, respectively, and they were recorded for the male gender. Age group 21–40 years had the highest prevalence rate of 19.2% for HBsAg, whereas age-group 61 years and above had a high prevalence of 31.3%. Conclusion: The high prevalence rates obtained from this study for both viral hepatitis calls for augmentation of existing interventions toward the prevention, diagnosis, and treatment of these diseases. Further studies aimed at evaluating the efficacy of the interventions are highly recommended.
Keywords: Age, co-infection, hepatitis B, hepatitis C, prevalence, sex, Taraba
|How to cite this article:|
Omote V, Kashibu E, Ojumah I, Adda D, Etaghene J, Ukwamedua H. Serological screening of hepatitis B virus and hepatitis C virus among patients attending a tertiary hospital in Jalingo, Taraba state, Nigeria. Saudi J Health Sci 2018;7:167-71
|How to cite this URL:|
Omote V, Kashibu E, Ojumah I, Adda D, Etaghene J, Ukwamedua H. Serological screening of hepatitis B virus and hepatitis C virus among patients attending a tertiary hospital in Jalingo, Taraba state, Nigeria. Saudi J Health Sci [serial online] 2018 [cited 2019 Aug 24];7:167-71. Available from: http://www.saudijhealthsci.org/text.asp?2018/7/3/167/251590
| Introduction|| |
Hepatitis (inflammation of liver cells) has been associated with the consumption of alcohol and certain drugs as well as been linked with the presence of infectious microbes. However, a group of unrelated and hepatotropic viruses (hepatitis A, B, C, D, and E) belonging to the family Hepatoviridae have been reported to be the leading cause of viral hepatitis which is estimated to be responsible for about 1.5 million deaths in the year 2013 Bulk of the morbidity and mortality associated with viral hepatitis are caused by hepatitis B and C viruses.
Infections with hepatitis B and C virus are a major global health problem affecting 240 million people who suffer from chronic hepatitis B virus infections and about 150 million who suffer from hepatitis C virus (HCV) infections. In most cases, these viruses cause chronic infections whose natural course leads to liver cirrhosis, liver failure, and/or hepatocellular carcinoma in affected patients.
In Nigeria, several prevalence figures have been reported for hepatitis B viral infection among different study group or population. For the general populace, 10%–15%, among surgeons 25.7%, voluntary blood donors 2.9%, infants 16.3%, and 12.3% for HIV patients. Reports for hepatitis C infections in Nigeria gave the following prevalence rate. About 2.1% for the general population, 12.3% for adult blood donors, 5% for sickle cell anemia patients, and 11% for doctors and dentists.
Several risk factors have been associated with the acquisition of both viruses. These include multiple sexual partners, sharing of sharps and drawing tattoos, unscreened blood transfusion, undertaking health procedures that require invasive techniques and several other sociocultural practices. Some of these risk factors tend to be age and gender dependent. Although viral hepatitis is a serious health issue, little attention is allocated to it because it is difficult to quantifying disease morbidity and mortality since liver cirrhosis, hepatocellular carcinoma, and eventual death which are usually its endpoint effect takes decades to develop. Thus, this study aims to evaluate the prevalence rate of hepatitis B and C viral infections as both single and/or co-infection in relation to age and gender among patients attended to at GOPD in a bid to determine the level of endemicity of both viral infection for the study region as well as add to the burden of knowledge available for viral hepatitis.
| Materials and Methods|| |
Study region and population
This is a cross-sectional descriptive study carried out at the medical microbiology unit of the laboratory service department of Taraba State Specialist Hospital, Jalingo (a tertiary health-care facility and a referral center). Jalingo is the capital city of Taraba state. Its coordinates are 80 54'N and 110 22'E and have an estimated population of 118,000 people.
Patients of all age grade and sex with pyrexia of unknown origin and have reported a case of possible exposure seeking medical care at General Out Patient Department in a tertiary health care facility were eligible for the study. Five hundred and thirteen patients comprising 259 males and 254 females with complete demographic information were enrolled for the study that took place from February to November 2017.
Sample collection and analysis
Three to five milliliters of blood were collected from adults and 2 ml from children under the age of 5 years by aseptic technique via venipuncture into ethylenediaminetetraacetic acid bottles. The sample bottle was labeled with patient's identification number and was crosschecked to ensure it corresponds with the patient's form that contains the demographic information (age and sex) after which they were taken to the serology sub-unit for centrifugation and separation of the required plasma.
Hepatitis B surface antigen (HBsAg) was detected using Egenes rapid diagnostic kit (Nantomy Egens Biotechnology Co., Ltd. Xinghu China) following the manufacturer's instructions. HCV-specific antibody rapid detection kit Agary (Nantomy Egen Biotechnology Co., Ltd. Xinghu China) was used to determine hepatitis C infection according to the manufacturer's directive. Fifty microliter of plasma was placed on the sample region on test trip. A drop (50 μl) of test buffer was added to aid the lateral flow, and the test result read after 15 min. A pink or red band on the control column only is indicative of a negative result while two bands (one each on test and control column) is indicative of a positive result. A test is said to be invalid and repeated when there is only one band on the test region or no band at all.
Result obtained was expressed in simple frequency and percentages after analysis using SPSS 23 (SPSS Inc., Chicago, IL, USA). Test for statistical significance was done using Pearson's Chi-square and Fisher's exact test at a confidence limit of 95% and the values of P < 0.05 were considered to have a significant association.
The study was approved by the ethical committee of Taraba State Specialist Hospital Jalingo. All the participants gave consent and confidentiality of data recorded was assured and kept.
| Results|| |
The study population was accounted for by 259 males (50.5%) and 254 (49.5%) females. Age-group 21–40 years accounted for 48.5% (249) of the study population while those within the age-group of 61 and above accounted for just 9.4% of the study population. [Table 1] summarizes the age and sex distribution of the studied population.
Seventy patients (13.6%) tested positive to HbsAg, 85 (16.6%) reacted to anti-HCV, whereas 5 (1.0%) gave dual-infection for HbsAg and HCV [Table 2].
Age-based prevalence gave 19.2% for those within 21–40 years as its highest age-based HbsAg prevalence while those in the age group of 61 and above recorded no case of infection. Analysis for the association between age and HbsAg prevalence gave a value of P = 0.006 indicating a strong association between age and HBV infection [Table 3]. HbsAg prevalence in relation to sex gave a 14.7% to 12.6% in favor of the males but lack statistical association (P = 0.481) [Table 3].
Age-based prevalence for HCV revealed an increasing trend as age increases with those within the 61 and above age group recording the highest prevalence of 31.3%. HCV incidence to age relation gave a P = 0.002 indicating a very strong association between HCV acquisition and age [Table 3]. Males had an HCV prevalence of 20.16% (52 out of 259), whereas females had an HCV prevalence of 12.9% (33 out of 254). Statistical analysis also gave a statistically significant P = 0.02 [Table 3].
The general co-infection rate was 1.0% but age grade 21–40, 41–60, male and female recorded 1.2%, 1.6%, 1.2%, and 1.8%, respectively. There was no association between co-infection and age and gender (P = 0.559 and 0.509).
| Discussion|| |
The prevalence of 13.6% for HBsAg recorded in the study, agrees with the average prevalence for Nigeria (10%–15%), but is lower than the figure reported by Elkanah et al. who recorded a prevalence of 26.37% for blood donors in Jalingo. The prevalence for HBsAg (13.6%) obtained in this study when compared with other reports on Taraba state may be as a result of the difference in population studied, variation in methodology and sensitivity of diagnostic kits and gains made along the four-prong strategy developed by the World Health Organization which has ensured the registration of hepatitis-related cancer cases, creating national guidelines for prevention of infection in health-care workers, adopting universal vaccination, public awareness creation and screening all donated blood.
Age group 21–40 years had the highest age based HbsAg prevalence of 19.2% (48/201). This finding is in consonance with Adoga et al. but in contrast to the report of Tula and lyoha. This study reported a strong association between HbsAg seroprevalence and age (P = 0.006) a notion supported by Khan et al. The highest prevalence of HbsAg recorded for the subjects within the 21–40 years group may be attributed to the sexual active nature of this group, illicit drug uses, tattooing, body piercing, etc., which are risk factors associated with HBV transmission and are prevalent among this age group. Age grade 61 and above had no case of HBV infection. This may be explained by the fact that most HBV complications occur within this age group and bulk of them may be dead. The ability of older HBV carriers to achieve viral clearance may also account for this finding.
Sex-based HbsAg prevalence gave 14.7%–12.6% in favor of the males but lack significant association (P = 0.481). This finding agrees with Adoga et al. and Tula and lyoha, but disagrees with Bwogi et al. and Sule et al., Multiple sexual partnership and polygamy, men having sex with men, and the care-free nature of men that allows for the sharing of sharps such as nail cutters and barbing clippers may be responsible for the sex-based prevalence recorded. Injectable drug usage is also more prevalent in males than in females. This may also be a contributing factor.
Prevalence of HCV recorded in this study gave an alarming 16.6% which is far higher than several other reports of HCV prevalence for Nigeria. Imoru et al. reported 0.4% in Kano, Odenigbo et al. reported 2.0% for Anambra, Jeremiah et al. gave 5.0% for Port-Harcourt, and 12.0% was reported by Halima and Ajayi for blood donors in Benin City Edo state. The lower prevalence reported in other studies may be a product of the study population (blood donors) whom are mostly commercial donors that have been educated on the preventive and protective measures of HCV infection. The asymptomatic and chronic nature (75%–85%) of most HCV infections may also account for the increasing prevalence because chronic carriers serve as a source of infection without knowing.
HCV age-based prevalence recorded a rising trend as age increases with its peak recorded within the 61 and above age grade. Similar pattern of rising prevalence has been reported by Gacche and Al-Mohani. Increasing exposure to risk factors of HCV (hemodialysis, ocular and dental procedures, and other invasive techniques) as life progress may be responsible for the HCV age-based prevalence recorded in this study.
Gender-based HCV prevalence recorded a 20.1%–12.9% rate in favor of the males. Both age and sex reported a significant association with HCV prevalence with P = 0.002 and 0.02, respectively, a notion supported by the work of Gacche and Al-Mohani. Level of estrogen plays a vital role in HCV clearance. This may account for the lower incidence recorded for females.
A co-infection rate of 1.0% (5 of 513) reported in this study agrees with the 1.1% obtained by Baseke et al. among HIV patients in Kampala Uganda but disagrees with Alter who reported a co-infection rate of 10% among HIV patients. Age and sex lacked significant association with co-infection (P = 0.559 and 0.509).
The reducing prevalence for HBsAg and increasing prevalence of HCV obtained in this study when compared with previous studies within the study location may be attributed to the fact that there is no vaccine for HCV, reduced public awareness of HCV, and the rural nature of most parts of Taraba State encouraging unsafe blood transfusion. The age-grade prevalence disparity between HBV and HCV (age 21–40 years for HBV and 61 and above for HCV) may be attributed to the fact that only 5% of HCV infection are sexually transmitted. Thus, fewer transmission of HCV occurs within the sexually active age grade of 21–40, but the reverse is the case for HBV. Patients between 0 and 20 years had HBsAg and HCV incidence of 8.6% and 7.5%, respectively, an indication of significant mother to child transmission of both viruses.
| Conclusion|| |
The prevalence recorded by this study (13.6%) for HBsAg and (16.6.86%) for HCV tags this zone as a region of hyperendemicity. Our findings associate infection acquisition to certain age-groups and gender. Routine screening of the general populace for both viral infections in a bid to enhance early diagnosis, confirm treatment eligibility, provide prompt treatment as well as education and awareness on preventive measures is recommended.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I, et al.
The global burden of viral hepatitis from 1990 to 2013: Findings from the global burden of disease study 2013. Lancet 2016;388:1081-8.
Shepard CW, Finelli L, Alter MJ. Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 2005;5:558-67.
Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
Emechebe GO, Emodi IJ, Ikefuna AN, Ikechukwu GC, Igwe WC, Ejiofor OS. Hepatitis B virus infection in Nigeria. A review. Niger Med J 2009;50:18-22. [Full text]
Belo AC. Prevalence of hepatitis B virus markers in surgeons in Lagos, Nigeria. East Afr Med J 2000;77:283-5.
Olokoba AB, Salawu FK, Danburan A, Desalu OO, Olokoba LB, Wahab KW, et al
. Viral hepatitides in voluntary blood donors in Yola, Nigeria. Eur J Sci Res 2009;31:329-34.
Sadoh AE, Sadoh WE. Serological markers of hepatitis B infection in infants presenting for their first immunization. Niger J Pediatr 2013;40:248-53.
Hamza M, Samaila AA, Yakasai AM, Musa B, Musa MB, A Abdukazaq GH. Prevalence of hepatitis B and C virus infection among HIV infections in a tertiary hospital in North – Western Nigeria. Niger J Basic Clin Sci 2013;10:76-81. [Full text]
Karoney MJ, Siika AM. Hepatitis C virus (HCV) infection in Africa: A review. Pan Afr Med J 2013;14:44.
Halim NK, Ajayi OI. Risk factors and sero-prevalence of hepatitis C antibodies in blood donors in Nigeria. East Afr Med J 2000;77:410-12.
Lesi OA, Kehinde MO. Hepatitis C virus infection in patients with sickle cell anaemia at the Lagos university hospital. Niger Postgrad Med J 2003;10:79-83. [Full text]
Ejiofor OS, Emechede GO, Igure WC, Ifeadike CO, Ubajaka CH. Hepatitis C virus infection in Nigerians. Niger Med J 2010;51:173-6. [Full text]
Musa BM, Bussell S, Borodo MM, Samaila AA, Femi OL. Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis. Niger J Clin Pract 2015;18:163-72.
] [Full text]
Elkanah OS, Okoye AH, Debby-Sambo OE. Prevalence of hepatitis B surface antigen among blood donors in Jalingo, Taraba state, Nigeria. Niger J Parasitol 2010;34:138-42.
Adoga MP, Gyar SO, Pechulono S, Bashayi OO, Emiaseyen SE, Zungure T, et al
. Hepatitis B virus Infection in apparently health urban Nigerians: Data from pre-vaccination tests. J Infect Dis 2010;4:397-400.
Tula MY, lyoha O. A cross sectional study on the sero-prevalence of hepatitis B surface antigen (HBsAg) among apparently health student of a tertiary institution in North – Eastern Nigeria. Int J Trop Dis Health 2015;7:102-8.
Khan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, et al.
Hepatitis B virus infection among different sex and age groups in Pakistani Punjab. Virol J 2011;8:225.
Bwogi J, Braka F, Makumbi I, Mishra V, Bakamutumaho B, Nanyunja M, et al.
Hepatitis B infection is highly endemic in Uganda: Findings from a national serosurvey. Afr Health Sci 2009;9:98-108.
Sule WF, Okonko IO, Yunusa IP, Odu NN, Frank-Peterside N. Detection of HBsAg and risk factors of transmission among patients attending universal hospital, Ankpa, Kogi state, Nigeria. Nat Sci 2011;9:37-44.
Imoru M, Eke C, Adeyoke A. Prevalence of hepatitis B surface antigen (HBsAg), hepatitis C virus (HCV) and human immuno-deficiency virus HIV) among blood donors in Kano state, Nigeria. Niger J Med Lab Sci 2003;12:59-63.
Odenigbo C, Oguejiofor C, Okonkwo U, Afomuyha A, Ezeh T, Okocha E. Prevalence of antibody to hepatitis C virus in blood donors in Nnewi South-Eastern Nigeria. In association with blood groups. Int J Gend Entrep 2010;10:1-6.
Jeremiah ZA, Koate B, Buseri F, Emelike F. Prevalence of antibodies to hepatitis C virus in apparently healthy Port Harcourt blood donors and association with blood groups and other risk indicators. Blood Transfus 2008;6:150-5.
Gacche RN, Al-Mohani SK. Seroprevalence and risk factors for hepatitis C virus infection among general population in central region of Yemen. Hepat Res Treat 2012;2012:689726.
Alric L, Fort M, Izopet J, Vinel JP, Bureau C, Sandre K, et al.
Study of host- and virus-related factors associated with spontaneous hepatitis C virus clearance. Tissue Antigens 2000;56:154-8.
Baseke J, Musenero M, Mayanja-Kizza H. Prevalence of hepatitis B and C and relationship to liver damage in HIV infected patients attending joint clinical research centre clinic (JCRC), Kampala, Uganda. Afr Health Sci 2015;15:322-7.
Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44:S6-9.
[Table 1], [Table 2], [Table 3]