Hepatitis E Virus Infection Among Antenatal Attendees in Ekiti State, Nigeria: Awareness and Prevalence

Abstract

Background: Hepatitis E virus (HEV) infection is an enteric viral infection and a global problem of increasing threats among pregnant women with an estimated annual burden of 20 million cases, 70,000 deaths, and 3,000 stillbirths. This study aims to determine the level of awareness of HEV infection, its prevalence, pregnancy risks, and transmission mode among antenatal attendees in Ekiti State.

Methods: This is a dual-center study performed at the antenatal clinics of the study sites over a period of fifteen months following ethical approval. Socio-demographic, pregnancy-related, and HEV awareness data of 300 antenatal attendees were collected during counseling sessions at the clinics. A Biopanda rapid test device was used to test for HEV antibodies. Data were analyzed using the descriptive statistics of the SPSS version 21 software, and the association between hospital and HEV awareness and HEV mode of transmission variables was tested with Chi-square analysis.

Results: The 300 enrollees had a mean age of 31.2 ± 0.3 years and consisted of 161 (53.7%) and 139 (46.3%) from study sites 1 and 2, respectively. Nearly 90% (89.3%) were in their second to third trimesters, and 89% had a hematocrit of 31-39%. The prevalence of HEV antibodies reported in this study was 2.0% and consisted of anti-HEV IgM (0.3%), anti-HEV IgG (1.0%), and anti-HEV antibody total (0.7%). Irrespective of HEV awareness variables or associated health facility, HEV level of awareness was poor, with only awareness of mode of transmission showing a statistically significant difference between hospitals (P =0.025, γ2 = 5.027, OR = 2.371; 95 CI=1.096-5.131). Acute liver disease (50.0%), feto-maternal death (15.8%), and death of a live baby soon after birth (15.8%) were the three most reported HEV infection risks in pregnancy.  

Conclusion:  Low level of awareness of HEV infection despite counselling at clinics reflected the gaps in current national policy on hepatitis and the need for urgent review and update of the same to include result-oriented and all-inclusive antenatal patients’ education on HEV infection, its risk to pregnancy and routine testing for HEV to prevent inherent dangers of risks of acute liver failure, feto-maternal death and still birth