|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 2021 Apr 11];2:113-7. Available from: https://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.
| References|| |
|1.||Uneka CJ, Duhlinska DD, Igbinedion EB. Prevalence and public health significance of HIV infection and anaemia among pregnant women attending antenatal clinics in Southern Nigeria. J Health Popul Nutr 2007;25:328-35. |
|2.||Oladeinde BH, Omoregie R, Olley M, Anunibe JA. Prevalence of HIV and anemia among pregnant women. North Am J Med Sci 2011;3:548-51. |
|3.||Behets FI, Matendo R, Vaz ME, Kilese N, Nanlele D, Kokolomami J, et al. Preventing vertical transmission of HIV in Kinshasa, Democratic Republic of the Congo: A baseline survey of 18 antenatal clinics. Bull World Health Organ 2008;24:969-75. |
|4.||Eke AC, Eke UA, Okafor CI, Ezebielu IU, Ogbuagu C. Prevalence correlates and pattern of hepatitis B surface antigen in a low resource setting. Virol J 2011;8:12. |
|5.||Elsheikh RM, Daak AA, Elsheikh MA, Karsany MS, Adams I. Hepatitis B virus and hepatitis C virus in pregnant Sudanese women. Virol J 2007;4:104. |
|6.||Ijoema UN, Nwokediuko SC, Onyemekwe B, Ijoma CK. Low prevalence of hepatitis B `E` antigen in asymptomatic adult subjects with hepatitis B virus infection Enugu, South East Nigeria. Internet J Gastroenterol 2010;10:1. |
|7.||Shaikh F, Qaiser H, Naqvi H, Jilani K, Allah R, Memon D. Prevalence and risk factors for hepatitis C virus during pregnancy. Gomal J Med Sci 2009;7:86-8. |
|8.||Mbamar SU, Obiechina NJA. Seroprevalence of hepatitis B surface antigen among antenatal clinic attendees in a private specialist hospital in Onitsha, South East Nigeria. Niger Med J 2010;15:152-4. |
|9.||Olusanya BO, Inem VA, Abosede OA. Infants delivered in maternity home run by traditional birth attendants in Urban Nigeria: A community - based study. Health Care Women Int 2011;32:474-91. |
|10.||Ofili AN, Okojie L. Assessment of the role of traditional birth attendants in maternal health care in Oredo Local Government Area, Edo-State Nigeria. J Comm Med Prim Health Care 2005;17:55-6. |
|11.||Nyanzi S, Mannah H, Walraven G. Traditional birth attendants in rural Gambia: Beyond health to social cohesion. Afr J Reprod Health 2007;11:43-56. |
|12.||Olokoba AB, Tidi SK, Salawu FK, Danburam A, Desalu OO, Abdurrahman MB, et al. Human immunodeficiency virus infection in voluntary blood donors in North-Eastern Nigeria. Am J Sci Indian Res 2010;1:435-8. |
|13.||Adekanle O, Ndububa DA, Ayodeji OO, Paul-Odo B, Folorunso TA. Sexual transmission of the hepatitis B virus among blood donors in a tertiary hospital in Nigeria. Singapore Med J 2010;51:944-7. |
|14.||Lassey AT, Damale NK, Bekoe V, Klufio CA. Hepatitis C sero- prevalence among mothers delivering at the Korle - Bu Teaching hospital, Ghana. East Afr Med J 2004;8:198-201. |
|15.||Renkert S, Nutbeam D. Opportunities to improve maternal health literacy through antenatal education: An exploratory study. Health Promot Int 2001;16:381-8. |
|16.||Sadoh AE, Ogungbe RO. Multiple fractures and latrogenic burns in a newborn due to unskilled delivery: A case Report. Afr J Reprod Health 2008;12:197-206. |
|17.||Fatmai Z, Gulzar AZ, Kazi A. Maternal and newborn care: Practices and beliefs of traditional birth attendants in Sindh, Pakistan. East Mediterr Health J 2005;11:226-34. |
|18.||Imade P, Ibadin K, Eghafona N, Enabulele O, Ophori E. HIV Seroprevalence among pregnant women attending antenatal clinic in a tertiary health institution in Benin City, Nigeria. Maced J Med Sci 2010;15:43-5. |
|19.||Opiah MM, Osayi TA, Afolayan JA, Adeyanju AB, Ute AF. Factors influencing patronage of traditional birth attendants for delivery and newborn care in Amassoma community, Southern Ijaw local government area. Bayelsa State. Bull Sci Assoc Nigeria 2010;29:27-32. |
|20.||Siziya S, Muula AS, Rudatsikira E. Socio-economic factors associated with delivery assisted by traditional birth attendants in Iraq, 2000. BMC Int Health Hum Rights 2009;9:7. |
|21.||Lerato ST. Poverty and HIV/AIDS in South Africa: An empirical contribution. J Soc Aspects HIV/AIDS 2006;3:365-81. |
|22.||Omoregie R, Efam MO, Ihongbe JC, Ogefere HO, Omokaro EU. Seroprevalence of HIV infection among psychiatric patients in Benin City, Nigeria. Neurosciences 2009;14:100-1. |
|23.||Federal Ministry of Health, Nigeria. Technical report on the 2008 National HIV seroprevalence sentinel survey among pregnant women attending antenatal clinics in Nigeria. Department of Public Health, National AIDS/STI Control Programme, Abuja. Nigeria 2010. |
|24.||Obi RK, Iroagba II, Ojiako OA. Prevalence of human immunodeficiency virus infection among pregnant women in an antenatal clinic in Port-Harcourt, Nigeria. Afr J Biotechnol 2007;6:263-6. |
|25.||Sagaya AS, Kapiga SH, Imade GE, Sankale JL, Idoko J. HIV infection among pregnant women in Nigeria. Int J Gynaecol Obstet 2005;90:61-7. |
|26.||Chen L, Jha P, Stirling B, Sgaier SK, Daid T, Kaul R, et al. Sexual risk factors for HIV infection in early and advanced HIV epidemics in Sub-saharan Africa: Systematic overview of 68 epidemiological studies. PLoS One 2007;2:e1001. |
|27.||Frank-Peterside N, Okonko IO, Okerentugba PO, Jaja N. Detection of HIV 1 and 2 antibodies among pregnant women in Port Harcourt, Rivers State, Nigeria. World Appl Sci J 2012;16:589-98. |
|28.||Ugbebor D, Aigbirior M, Osazuwa F, Enabudosu E, Zabayo O. The prevalence of hepatitis B and C viral infection among pregnant women.North Am J Med Sci 2011;3:238-41. |
|29.||Idowu OA, Mafiana CF, Sotiloye D. Traditional birth home attendance and its implications for malaria control during pregnancy in Nigeria. Trans R Soc Trop Med Hyg 2008;102:679-84. |
|30.||Oladeinde BH, Omoregie R, Odia I, Oladeinde OB. Malaria and anemia among pregnant women attending a traditional birth home in Nigeria. Oman Med J 2012;27:232-6. |
|31.||Akinbo FO, Okaka CE, Omoregie R, Mordi R, Igbinuwen O. Prevalence of malaria and anemia among HIV infected patients in Benin City, Nigeria. N Z J Med Lab Sci 2009;63 : 78-80. |
[Table 1], [Table 2], [Table 3], [Table 4]
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