Sero-prevalence and risk factors of hepatitis C virus infection among pregnant women in Bahir Dar city, Northwest Ethiopia: Cross sectional study

Pan African Medical Journal, Volume 21, Year 2015

Interpretation

Viral hepatitis during pregnancy is associated with high risk of maternal complications and has become a leading cause of fetal death. So the main objective of this study is to determine the prevalence of hepatitis C viral infections among pregnant women attending the antenatal clinic in Bahir Dar health institutions, Ethiopia. This was institutional based cross-sectional study that included 318 pregnant women who attended the antenatal clinic in Bahir Dar health institutions from January 2013 to June 2013. Appropriate data was gathered from study participants. Sero-prevalence of hepatitis C virus was determined by detecting immunoglobulin of HCV using ELISA kit. Data was entered and analyzed with SPSS version 16 statistical software. The overall prevalence of hepatitis C virus among pregnant women was 0.6%. None of the expected risk factors had significant outcome. In conclusion, prevalence of the Hepatitis C virus among pregnant women attending in Bahir Dar health institutions was low and expected variables were not statistically significant. Institutional based cross sectional study was carried out from January 2013 to June 2013 to assess the sero- prevalence and associated risk factors of Hepatitis C viruses among pregnant women attending antenatal care in Bahir Dar health institutions, Bahir Dar town. Bahir Dar is the capital of the Amhara regional state and situated on the southern shore of Lake Tana, the source of the Blue Nile. It is located approximately 578 km northwest of Addis Ababa, having a latitude and longitude of 11°36’N 37°23’E Coordinates and an elevation of 1840 meters above sea level. Based on the 2007 Census conducted by the Central Statistical Agency of Ethiopia (CSA), Bahir Dar Special Zone has a total population of 221,991, of whom 108,456 are men and 113,535 women; 180,174 or 81.16% are urban inhabitants, the rest of population are living at rural kebeles around Bahir Dar. From the town there is one governmental referral hospital (FelegeHiwot hospital) and 10 governmental health centers. The hospital and 3 randomly selected health centers (Bahir Dar health centers, Han health centers and Tis Abay health centers) were included as our study sites. The source population was all pregnant women who have access to attend antenatal care from Bahir Dar health institutions, whereas the study population was all pregnant women who attended antenatal care from the selected health institutions during the study period. The study subjects were also all pregnant women who attended antenatal care at the selected health institutions during data collection time that fulfill the inclusion criteria and signed the consent form. The single population proportion formula was used to determine the sample size and accordingly 318 study subjects were included in this study. The number of sample size in each of the selected study sites was proportionally allocated and convenient sampling technique was used until the sample size completed. A pretested structured questionnaire was used to collect socio-demographic characteristics and other expected risk factors of the clients. The data collectors were trained laboratory technologist/technician and nurses. About 5ml of whole blood sample was drawn through vein-puncture, and serum was separated and stored in a refrigerator in the study area. The collected samples from the study sites was taken into the place where the laboratory investigation takes place. Sero-prevalence of hepatitis C virus was determined by detecting immunoglobulin of HCV using ELISA kit based on the manufacturer’s instruction. Positive results were retested again with ELISA. The questionnaire was pretested at the health center other than the actual study sites. The collected data was daily checked for consistency and accuracy. Standardized procedures was strictly followed at each of pre-analytical, analytical and post analytical process. Positive and negative controls were run alongside the test. Data was entered and analyzed using SPSS Version 16.0 statistical software. Binary logistic regression was done to determine the presence of a statistically significant association between explanatory variables and the outcome variables. Odds Ratio (OR), p-value and their 95% Confidence Intervals (CI) was calculated. The study was conducted after obtaining institutional ethical clearance from ethical review committee of College of Medicine and Health Sciences, Bahir Dar University. Verbal consent was also obtained from the study participants. Positive results was reported to their physicians for the treatment and any antenatal care. Confidentiality was maintained and the clinical specimen collected during the study period was used for the stated objectives only.

AI Digest

Study Justification:

– Viral hepatitis during pregnancy is associated with high risk of maternal complications and fetal death.
– The prevalence of hepatitis C virus among pregnant women in Bahir Dar city, Northwest Ethiopia is unknown.
– Understanding the prevalence and risk factors of hepatitis C virus infection among pregnant women is important for developing appropriate prevention and control strategies.

Study Highlights:

– The study was conducted in Bahir Dar city, Northwest Ethiopia.
– A total of 318 pregnant women attending antenatal clinics in Bahir Dar health institutions were included in the study.
– The sero-prevalence of hepatitis C virus among pregnant women was found to be 0.6%.
– None of the expected risk factors had a significant outcome.

Recommendations for Lay Reader:

– Pregnant women in Bahir Dar city have a low prevalence of hepatitis C virus infection.
– The study did not find any significant risk factors for hepatitis C virus infection among pregnant women.
– Pregnant women should continue to receive routine antenatal care to ensure their health and the health of their babies.

Recommendations for Policy Maker:

– Continue to prioritize and invest in antenatal care services in Bahir Dar city.
– Strengthen surveillance and monitoring of hepatitis C virus infection among pregnant women.
– Consider implementing targeted interventions to prevent and control hepatitis C virus infection among pregnant women, if necessary.

Key Role Players:

– Researchers and scientists involved in viral hepatitis research and prevention.
– Health professionals and policymakers in Bahir Dar city.
– Ethical review committees and regulatory bodies overseeing research and public health initiatives.

Cost Items for Planning Recommendations:

– Training and capacity building for healthcare providers on hepatitis C virus prevention and control.
– Laboratory equipment and supplies for testing and diagnosing hepatitis C virus infection.
– Public awareness campaigns and educational materials for pregnant women.
– Monitoring and surveillance systems for tracking hepatitis C virus infection rates among pregnant women.
– Research and data analysis to inform evidence-based interventions and policies.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong, but there are some areas for improvement. The study design is clearly stated as an institutional-based cross-sectional study, which provides a snapshot of the prevalence of hepatitis C virus among pregnant women in Bahir Dar city. The sample size of 318 pregnant women is adequate for a cross-sectional study. The sero-prevalence of hepatitis C virus among pregnant women is reported as 0.6%, which is a useful finding. However, the abstract does not provide information on the representativeness of the sample or the generalizability of the results to the broader population. Additionally, the abstract does not mention any limitations of the study or potential biases that may have influenced the results. To improve the evidence, the abstract should include information on the sampling method used to select the study participants and any potential limitations or biases that may have affected the findings.

Abstract

Institutional based cross sectional study was carried out from January 2013 to June 2013 to assess the sero- prevalence and associated risk factors of Hepatitis C viruses among pregnant women attending antenatal care in Bahir Dar health institutions, Bahir Dar town. Bahir Dar is the capital of the Amhara regional state and situated on the southern shore of Lake Tana, the source of the Blue Nile. It is located approximately 578 km northwest of Addis Ababa, having a latitude and longitude of 11°36’N 37°23’E Coordinates and an elevation of 1840 meters above sea level. Based on the 2007 Census conducted by the Central Statistical Agency of Ethiopia (CSA), Bahir Dar Special Zone has a total population of 221,991, of whom 108,456 are men and 113,535 women; 180,174 or 81.16% are urban inhabitants, the rest of population are living at rural kebeles around Bahir Dar. From the town there is one governmental referral hospital (FelegeHiwot hospital) and 10 governmental health centers. The hospital and 3 randomly selected health centers (Bahir Dar health centers, Han health centers and Tis Abay health centers) were included as our study sites. The source population was all pregnant women who have access to attend antenatal care from Bahir Dar health institutions, whereas the study population was all pregnant women who attended antenatal care from the selected health institutions during the study period. The study subjects were also all pregnant women who attended antenatal care at the selected health institutions during data collection time that fulfill the inclusion criteria and signed the consent form. The single population proportion formula was used to determine the sample size and accordingly 318 study subjects were included in this study. The number of sample size in each of the selected study sites was proportionally allocated and convenient sampling technique was used until the sample size completed. A pretested structured questionnaire was used to collect socio-demographic characteristics and other expected risk factors of the clients. The data collectors were trained laboratory technologist/technician and nurses. About 5ml of whole blood sample was drawn through vein-puncture, and serum was separated and stored in a refrigerator in the study area. The collected samples from the study sites was taken into the place where the laboratory investigation takes place. Sero-prevalence of hepatitis C virus was determined by detecting immunoglobulin of HCV using ELISA kit based on the manufacturer’s instruction. Positive results were retested again with ELISA. The questionnaire was pretested at the health center other than the actual study sites. The collected data was daily checked for consistency and accuracy. Standardized procedures was strictly followed at each of pre-analytical, analytical and post analytical process. Positive and negative controls were run alongside the test. Data was entered and analyzed using SPSS Version 16.0 statistical software. Binary logistic regression was done to determine the presence of a statistically significant association between explanatory variables and the outcome variables. Odds Ratio (OR), p-value and their 95% Confidence Intervals (CI) was calculated. The study was conducted after obtaining institutional ethical clearance from ethical review committee of College of Medicine and Health Sciences, Bahir Dar University. Verbal consent was also obtained from the study participants. Positive results was reported to their physicians for the treatment and any antenatal care. Confidentiality was maintained and the clinical specimen collected during the study period was used for the stated objectives only.

Materials

N/A

Innovations

Based on the information provided, here are some potential innovations that could be recommended to improve access to maternal health:

1. Telemedicine: Implementing telemedicine services can allow pregnant women in remote areas to access healthcare professionals and receive prenatal care through virtual consultations. This can help overcome geographical barriers and ensure that pregnant women receive the necessary medical attention.

2. Mobile health (mHealth) applications: Developing mobile applications that provide educational resources, appointment reminders, and personalized health information can empower pregnant women to take control of their own health and access important maternal health services.

3. Community health workers: Training and deploying community health workers who can provide basic prenatal care, health education, and referrals to pregnant women in underserved areas can improve access to maternal health services, especially in areas where healthcare facilities are limited.

4. Transportation support: Providing transportation support, such as subsidized or free transportation services, can help pregnant women overcome transportation barriers and ensure they can access prenatal care and deliver their babies in healthcare facilities.

5. Health education programs: Implementing comprehensive health education programs that focus on prenatal care, nutrition, hygiene, and other important aspects of maternal health can empower pregnant women with knowledge and help them make informed decisions about their health.

6. Strengthening healthcare infrastructure: Investing in the improvement and expansion of healthcare facilities, particularly in underserved areas, can increase access to maternal health services and ensure that pregnant women have access to quality care during pregnancy, childbirth, and postpartum.

7. Public-private partnerships: Collaborating with private healthcare providers and organizations can help increase the availability and accessibility of maternal health services, particularly in areas where public healthcare facilities are limited.

8. Maternal health insurance schemes: Implementing affordable and accessible health insurance schemes specifically for maternal health can help reduce financial barriers and ensure that pregnant women can afford the necessary healthcare services.

9. Maternal health awareness campaigns: Conducting targeted awareness campaigns to educate communities about the importance of maternal health, the available services, and the benefits of seeking prenatal care can help increase demand for maternal health services and encourage pregnant women to access them.

10. Integration of maternal health services: Integrating maternal health services with other healthcare services, such as family planning, HIV/AIDS prevention and treatment, and immunization programs, can improve overall access to comprehensive healthcare for pregnant women.

AI Innovations Description

Based on the description provided, the study aimed to determine the prevalence of hepatitis C virus (HCV) infections among pregnant women attending antenatal clinics in Bahir Dar health institutions, Ethiopia. The study found that the overall prevalence of HCV among pregnant women was 0.6%, and none of the expected risk factors had a significant outcome.

To improve access to maternal health, the following recommendations can be developed from the study:

1. Increase awareness: Develop educational campaigns and programs to increase awareness among pregnant women about the risks and prevention of HCV infection. This can be done through community outreach programs, antenatal care sessions, and media campaigns.

2. Routine screening: Implement routine screening for HCV infection during antenatal care visits. This will help identify infected pregnant women early and provide appropriate treatment and care.

3. Training healthcare providers: Provide training to healthcare providers on the detection, management, and prevention of HCV infection in pregnant women. This will ensure that healthcare providers are equipped with the necessary knowledge and skills to provide quality care.

4. Integration of services: Integrate HCV screening and management services into existing antenatal care programs. This will ensure that pregnant women have easy access to HCV testing and treatment without the need for additional visits or referrals.

5. Collaboration with stakeholders: Collaborate with relevant stakeholders such as government agencies, non-governmental organizations, and community-based organizations to strengthen efforts in improving access to maternal health. This can include resource sharing, joint awareness campaigns, and advocacy for policy changes.

By implementing these recommendations, access to maternal health can be improved by addressing the prevalence of HCV infection among pregnant women and providing appropriate care and support.

AI Innovations Methodology

To improve access to maternal health, here are some potential recommendations:

1. Mobile clinics: Implementing mobile clinics that travel to remote areas or underserved communities can provide essential maternal health services, including prenatal care, vaccinations, and health education.

2. Telemedicine: Utilizing telemedicine technology can connect pregnant women in remote areas with healthcare professionals, allowing them to receive virtual consultations, monitoring, and guidance throughout their pregnancy.

3. Community health workers: Training and deploying community health workers can help bridge the gap between healthcare facilities and pregnant women in rural or marginalized communities. These workers can provide education, support, and referrals for maternal health services.

4. Transportation support: Establishing transportation services or subsidies can help pregnant women overcome geographical barriers and ensure they can access healthcare facilities for prenatal care, delivery, and postnatal care.

5. Health education programs: Implementing comprehensive health education programs that target pregnant women and their families can increase awareness about the importance of maternal health, nutrition, hygiene, and early detection of complications.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the study population: Determine the target population for the simulation, such as pregnant women in a specific region or community.

2. Collect baseline data: Gather data on the current access to maternal health services, including the number of pregnant women receiving care, distance to healthcare facilities, and any existing barriers.

3. Define the intervention: Specify the details of the recommended intervention, such as the number of mobile clinics, the coverage area, the availability of telemedicine services, or the number of community health workers.

4. Simulate the intervention: Use modeling techniques to simulate the impact of the intervention on improving access to maternal health. This could involve estimating the number of additional pregnant women reached, the reduction in travel distance, or the increase in utilization of maternal health services.

5. Analyze the results: Evaluate the simulated impact of the intervention on access to maternal health by comparing the baseline data with the simulated outcomes. Assess the effectiveness of each recommendation and identify any potential limitations or challenges.

6. Refine and iterate: Based on the analysis, refine the recommendations and simulation methodology as needed. Consider additional factors such as cost-effectiveness, scalability, and sustainability.

7. Implement and monitor: Once the recommendations have been refined, implement the interventions and closely monitor their impact on improving access to maternal health. Continuously evaluate and adjust the interventions based on real-world data and feedback from pregnant women and healthcare providers.

By following this methodology, policymakers and healthcare professionals can make informed decisions about which innovations to prioritize and implement to improve access to maternal health.

Author

Dima Health

Statistics:

Citations: 12

Identifiers:

DOI: 10.11604/pamj.2015.21.158.6367

Research Areas:

Disparities, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Male & Female