Seroprevalence of HBsAg among Female Patients Seeking Healthcare in Bo Government Hospital, Southern Sierra Leone: 14-Months Database Study

Background: Chronic hepatitis B virus (HBV) seroprevalence varies globally but is positively correlated with the prevalence of HIV since both have the same route of transmission-contact with infected body fluids. Sierra Leone has a nascent hepatitis B epidemic and there is a paucity of research data and public health awareness about the infection. Bo where this research is done is the second largest city of Sierra Leone and is the regional headquarters of southern Sierra Leone.
Aim: To determine the seroprevalence of hepatitis B surface antigen (HBsAg) among female healthcare seekers who used the main government referral hospital in Bo, southern Sierra Leone.
Methodology: We retrospectively analysed the serological diagnostic results of HBsAg for female healthcare seekers at the Bo Government Hospital. We later determined the HBsAg seroprevalence for various categories of the study subjects; pregnant women, lactating mothers, girls 5-18years and adults >18years for the period under review.
Place and Duration of Study: This study is a multicenter investigation conducted at the Bo Government Hospital laboratory, the Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University in Bo southern Sierra Leone. All laboratory diagnostic tests for HBsAg diagnosis were conducted at the Bo Government Hospital laboratories from May 2012 to June 2013. Literature review and data analysis were done at Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University
Study Subjects: A total of 2,218 female subjects took part in this investigation; girls 5-18yrs (15.2%), adults females >18yrs (48.9%), pregnant women (17.4%), and lactating women (18.3%). Study subjects were between 5-45yrs; mean age 26yrs; HBsAg+ mean age was 24yrs; HBsAg- mean age was 29yrs.
Results: One thousand and fifty four (47.5%) of all females who sought healthcare service at the Bo Government Hospital laboratory during the period under review were tested positive for HBsAg; 159(7.1%) pregnant women, 168 (7.5%) lactating mothers, 154 (6.9%) were girls 5-18yrs and 573 (25.8%) were >18yrs. Forty-five percent (154/339) of all girls between 5-18years who took part in this study were HBV seropositive.
Discussions: Few independent investigations in Sierra Leone have estimated the national HBsAg seroprevalence at 2.6%-5.1%. One import of this study is the high 154/2218(6.9%) HBsAg seroprevalence rate among girls 5-18 years which can be attributed to multiple sex partners, unsafe sex practice and other socioeconomic and behavioral factors that might have been prevailing during the period under review. The generally high HBsAg seroprevalence rate in our study can also be as a result of our large cohort size and the low sensitivity and specificity of the Rapid Determine diagnostic test kits used in our study compared to previous similar studies conducted in Sierra Leone.
Conclusions: The high seroprevalence rate of HBsAg among girl between 5-18years in this study emphasizes the need for a robust public health preventive and control measures for HBsAg including HBsAg vaccination, routine blood screening, and safe sex practice as a means of reducing the spread and prevalence of HBV infection in Bo.