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Background: Approximately 240 million people worldwide are chronically infected with hepatitis B virus (HBV), with Egypt
being an area of intermediate endemicity. Children born to hepatitis B surface antigen (HBsAg) and envelope antigen (HBeAg)
positive mothers have a 70-90% chance of HBV perinatal acquisition; 85-90% of these infections become chronic. HBV
vaccination in conjunction with gamma globulin at birth reduces perinatal transmission rates by 90%. Chronic HBV carriers
have an increased lifetime risk of dying from hepatocellular carcinoma and liver cirrhosis and are the main reservoir for HBV
transmission. Routine HBV antenatal screening is not practiced in Egypt.
Aim of the study: To assess the prevalence and risk factors for HBsAg positivity among pregnant women in three rural
Egyptian villages.
Design/Methods: Pregnant women attending the rural health unit antenatal clinics in three villages in the Nile Delta, enrolled
in this perinatal cohort studying hepatitis transmission from 1997- 2005. After obtaining informed consent, serum samples
were tested for HBsAg and liver function tests (ALT, AST, total and direct bilirubin). Demographic characteristics and risk
factors for infection were assessed using questionnaires. All infants born to HBsAg positive women in the study were given
HBV vaccine after delivery.
Results: Forty-two (1.2%) of 3408 screened pregnant women were HBsAg positive. The median age of recruited women was
24 years (range: 16-48). Age, parity, working in a health care facility, and history of jaundice, liver disease or viral hepatitis
were not significantly associated with HBsAg positivity. Women with primary/preparatory school had 2.3 times greater risk
to be HBsAg positive than those with a higher level of education (p=0.012). There were no significant differences in levels
of ALT, AST, total and direct bilirubin between those with and without HBsAg. However, when asked about their health
perceptions, HBsAg positive women were 2.5 times more likely to perceive their health as very bad (p=0.003). No parenteral
risk factors (surgery, blood transfusion, needle stick injury, sutures, injections, IV lines, endoscopy, renal dialysis, dental
procedures, injection treatment for schistosomiasis, abortion, stillbirth, cesarean section, episiotomy or hospital admission)
were significantly associated with HBsAg. Having hepatitis C antibodies or RNA was not associated with HBsAg seropositivity.
Conclusions: Antenatal screening for HBV showed risk-based screening alone would have missed all the positive HBsAg
positive pregnant women. Thus, diagnosis of HBV-infected pregnant women would allow the application of the appropriate
preventive measures thereby reducing potential perinatal transmission and liver-related complications.
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