Epidemiology of hepatitis B and C viruses among pregnant women at Queen Elizabeth Central Hospital (QECH), Blantyre Malawi

Charles Bijjah Nkhata^1,2, Alexander J. Stockdale^2,4, Memory N. Mvula^1,2, Milton M. Kalongonda¹,
Martha Masamba^1,3, Isaac Thom Shawa^1,5 *

1. Kamuzu University of Health Sciences, Private Bag 360, Blantyre3, Malawi
2. Malawi-Liverpool Wellcome Programme, Queen Elizabeth Central Hospital, Blantyre Malawi
3. Queen Elizabeth Central Hospital, Obstetrics and Gynaecology Department, P.O. Box 95, Blantyre Malawi
4. Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, United Kingdom
5. University of Derby, Department of Biomedical and Forensic Sciences, Kedleston Road, DE22 1GB, United Kingdom
   *Corresponding Author: Isaac Thom Shawa; E-mail: i.shawa@derby.ac.uk

Abstract
Background
Viral Hepatitis is a serious public health concern globally with an estimated 1.3 million deaths annually due to hepatitis B and C viruses. Prevention of mother to child transmission is a critical step toward elimination of hepatitis B and C. The main aim of this study was to assess the prevalence of HBV and HCV among pregnant women at Queen Elizabeth Central Hospital in Blantyre.
Method
A descriptive cross-sectional study was conducted among consecutive pregnant women attending routine antenatal care, and/or admitted at QECH in last quarter of 2021. Of the 114 pregnant women, 84 women consented to participate. Serum was tested for HBsAg and Anti-HCV markers using rapid diagnostic tests (RDT) and compared to Enzyme Linked Immunosorbent Assay (ELISA).
Results
Of the 84 consenting pregnant women, the median age was 25.0 years (IQR: 21.0, 33.0). Hepatitis B surface antigen (HBsAg) was detected in 6.0% (n=5/84, 95% CI: 0.03–6.4) of participants using ELISA and in 1.2% (0.2-6.4; n=1/84), using RDTs, while none tested positive for anti-HCV antibodies. There were no significant associations between HBV infection and any of the socio demographic characteristics or assessed risk factors.
Conclusion
The prevalence of HBV (6%) and HCV (0%) in this population was lower than reported in previous studies of the general Malawian population, where HBV seroprevalence was estimated at 8.1% and HCV below 1%. We highlight potential underdiagnosis using RDTs for HBV, an ongoing significant rate of HBV infection, and a very low prevalence of HCV. Accessible screening and treatment for all positive pregnant women remains essential to eliminate vertical transmission.
Key words: Viral hepatitis, Pentavalent, Triple-test, Pregnant women, Hepatitis B vaccine.