Seroprevalence of hepatitis b and vaccine effectiveness in vertical transmission prevention among pregnant women attending antenatal clinics in Abyei, south Sudan

Abstract

The transmission of hepatitis B from mother to child continues to be a significant mode of transmission in many regions around the globe. The absence of timely prenatal screening and the delay in administering vaccinations to newborns are contributing factors to the increased prevalence of Hepatitis B among babies delivered to Hepatitis B- positive mothers. The prevalence of Hepatitis B in South Sudan is 55.5% among babies who are born to women who test positive for HBsAg. The primary objective of this study was to investigate the seroprevalence of hepatitis B and analyze the efficacy of vaccination in preventing mother-to-child transmission. The study focused on a specific set of primary health care facilities, including Abyei Primary Health Care Centre (PHCC) and Ganga Primary Health Care Unit (PHCU). The attendance report for the ANC in Abyei during the last three years documented the participation of 8,135 women. These individuals were evaluated within a hybrid research design that combined elements of both cross-sectional and cohort studies. The process of selecting health facilities for participation was purposeful, considering factors such as distance and the coverage of antenatal care (ANC) services in the area. A representative sample included 384 individuals. The research used a systematic recruitment approach to enroll pregnant mothers who visited ANC clinics. Structured questionnaires were used to gather quantitative data. The collection of qualitative data included conducting Key Informant Interviews and focus group discussions. The collection of quantitative data was facilitated via the use of the Open Data Kit (ODK), while the subsequent analysis was conducted using SPSS version 29.0. Descriptive statistics were used to provide a concise summary of the key features shown by a given dataset. Chi-square analysis was conducted to ascertain the seroprevalence of Hepatitis B across various age cohorts. A multilinear logistic regression analysis was used to assess the risk factors associated with Hepatitis B and their potential correlations with other variables. The theme analysis method was used to examine the qualitative data and to identify and emphasize significant viewpoints, ideas, and quotes expressed by the participants. Results indicated that 19% of the study participants were diagnosed with viral hepatitis B. The results also revealed that all study participants were not aware of the hepatitis B virus. The results also showed that the age of first sexual life (χ2 =6.1212 (1), p= 0.013), having an incident of STI (χ2 =154.6550, (df=2), p = 0.000), use of drugs χ2 =54.7617, (df=1) p= 0.000), and piercing of the nose (χ2 =18.4305 (df=1) p= 0.000) were significantly associated with hepatitis B seroprevalence. Logistic regression illustrated that having an STI and use of IV drugs were predictors of testing positive for hepatitis B. Among the cohort followed 2 out of 47 of the children born of Hepatitis B positive mothers tested positive for hepatitis B. There was also no significant association between child vaccination and hepatitis B seroprevalence (RR: 0.719 (C.I 0.179-2.893) fisher’s exact p = 0.5241). The prevalence of hepatitis B in this study (19%) surpasses the global rates and targeted interventions are required to prevent vertical transmission. There is also a concerning lack of awareness among all participants necessitating comprehensive awareness campaigns in Abyei. The South Sudanese Government should implement practices promoting early and regular antenatal care attendance. Policy efforts should focus on improving testing infrastructure in Abyei South Sudan. Further studies should be conducted to investigate the factors contributing to the relatively higher number of vaccinated children testing positive for HBV.