THE PREVALENCE OF HEPATITIS B INFECTIONS AND

ASSOCIATED FACTORS AMONG PREGNANT WOMEN

ATTENDING ANTENATAL CARE AT MADDA WALABU
UNIVERSITY, GOBA REFERRAL HOSPITAL 2024

RESEARCH GROUP MEMBERS

1) Emnet Habte………………………………………………………………UGR/21581/13
2) Endashaw Tefera,…………………………………………………………UGR/21587/13
3) Fami Abdella…………………………………………………………..…..UGR/21639/13
4) Fetiya
Mohammed………………………………………………….……..UGR/21676/13
5) Feven Awoke…………………………………………………....……...….UGR/24347/13
6) Fozia Abadir……………………………………………………………....UGR/21707/13
7) Gada Regea……………………………………..…………………………UGR/24365/13
8) Gatjiak Majiok……………………………………………………………UGR/24376/13

MADDA WALLABU UNIVERSITY

Bale Goba Ethiopia, January 2025

 MADDA WALABU UNIVERSITY GOBA REFERRAL HOSPITAL
SCHOOL OF MEDICINE AND HEALTH SCIENCE DEPARTMENT OF
MEDICAL LABORATORY SCIENCE

THE PREVALENCE OF HEPATITIS B INFECTIONS AND

ASSOCIATED FACTORS AMONG PREGNANT WOMEN
ATTENDING ANTENATAL CARE AT MADDA WALABU
UNIVERSITY, GOBA REFERRAL HOSPITAL 2025

RESEARCH GROUP MEMBERS

1) Emnet Habte………………………………………………………………UGR/21581/13
2) Endashaw Tefera,…………………………………………………………UGR/21587/13
3) Fami Abdella…………………………………………………………..…..UGR/21639/13
4) Fetiya
Mohammed………………………………………………….……..UGR/21676/13
5) Feven Awoke…………………………………………………………...….UGR/24347/13
6) Fozia Abadir……………………………………………………………....UGR/21707/13
7) Gada Regea……………………………………..…………………………UGR/24365/13
8) Gatjiak Gat Majiok.………………………………………………………UGR/24376/13

Advisors; Mr.Nagesso D. (MSC) and

Mr. Abdul Malik H. (MSC)

RESEARCH PAPER SUBMITTED TO SCHOOL OF MEDICINE AND HEALTH

SCIENCE DEPARTMENT OF MEDICAL LABORATORY SCIENCE MADDA
WALABU UNIVERSITY AS PARTIAL FULFILMENT FOR THE REQUIREMENT
OF DEGREE OF BACHELOR SCIENCE IN MEDICAL LABORATORY SCIENCE

PREPARED BY GROUP MEMBERS

Bale Goba, Ethiopia, December 2025

 ABSTRACT
Background: Hepatitis B virus is one of the prominent public health problems
globally. The hepatotropic deoxyribonucleic acid virus causes the disease and happens over
the immune-mediate killing of disease liver chambers. Hepatitis B virus is a potentially life-
threatening pathological virus of the liver that leads to critical or prolonged hepatitis.
Hepatitis B infection is one of the world’s most serious public health problems, causing
significant morbidity and mortality. More than 2 billion individuals around the globe are
infected with the hepatitis B virus. Approximately 400 million people are chronically infected
with the virus, with more than a million dying each year from hepatitis B virus-related liver
disease.

Objective: To determine the seroprevalence of Hepatitis B Infection among pregnant

women and identify the possible associated factors in this infection at Madda Walabu
University Goba Referral Hospital from March 2025 to May 2025.

Method: Hospital base cross-sectional study was conducted using a random sampling
technique from March 2025 to May 2025 to find the prevalence and associated factors of
Hepatitis B Infection among 140 pregnant women attending ANC at Madda Walabu
University Goba Referral Hospital Bale, Ethiopia. Data on socio-demography and associated
factors was collected by using structured questionnaires. Laboratory determination of HBsAg
was performed sufficient volume of whole blood (3-5ml) was collected using a clean test tube
and labeled carefully. The blood was centrifuged to separate serum/plasma from whole blood
and using a latex agglutination test to perform the expected result. The data was collected
based on the registration book of laboratory tests. The data was sorted and processed using
Statistical Package for Social Science (SPSS) computer software version 20. The analyzed
data was presented by using tables, and charts. The association between HBV infection and
associated factors was determined by using a chi-square. The obtained data was presented
using tables based on the findings.

Result: - A total of 140 pregnant women were screened for HBsAg. In this study, the overall
prevalence rate of HBsAg was 7.14%(10/140) of the total subjects 37.3%(48) were
secondary school and 42.9%(60) were government employees. Most of the study
participants were found in the age group of 35-39 which were 32.14%(45/140) and most of

i
them were town dwellers which was 86.4%(121/140). Hepatitis B Virus prevalence was most
common on adult ages so it may need more attentions. In our study the age were the
associated factors for this disease. In that study the prevalence was more on adult ages
around rular area so it good for get attension by some governimetal body for various vaccine
to reduces transmition of hepatitis B virus.

Conclusion and recommendation. The overall seroprevalence of HBV infection was

7.14%. None of the factors assessed were statistically associated with HBV infection. The
study showed that the prevalence of HBsAg is moderate (7.14%). Since the study was very
specific to only pregnant women attending ANC, if all these are raised the infection can also
increase. Hence it is still screening of all pregnant women attending ANC at MWUGRH is
required.

ii
 ACKNOWLEDGEMENT
First of all, we would like to thank the almighty God Who assist us to do this proposal
smoothly and successfully.

And foremost we would like to express our deepest gratitude and sincere appreciation to
our advisors Mr.Nagesso D.(MSC) and Mr. Abdulmalik H. (MSC) for their invaluable and un
reserve help throughout this research Paper development.

We would like to acknowledge Madda Wallabu University College of Medicine and the
Medical Science Department of Medical Laboratory Science for giving us this chance to
further our education in the profession we have already engaged in.

We would like to acknowledge Madda Wallabu University Student Research Project(SRP)

for giving us the chance to prepare this research paper.

Last but not least thanks to our friends for their important input in the preparation of this
research

iii
Contents
ABSTRACT...............................................................................................................................i
ACKNOWLEDGEMENT..........................................................................................................iii
CHAPTER ONE: - INTRODUCTION.......................................................................................1
1.1 BACKGROUND..............................................................................................................1
1.2 STATEMENT OF THE PROBLEM................................................................................2
1.3 SIGNIFICANCE OF THE STUDY...................................................................................5
CHAPTER TWO: LITERATURE REVIEW...............................................................................6
CHAPTER THREE OBJECTIVES.......................................................................................10
3.1 General objective.....................................................................................................10
3.2 Specific objectives........................................................................................................10
CHAPTER FOUR...................................................................................................................11
4.1 STUDY AREA AND STUDY PERIOD..........................................................................11
4.1.1 Study area..............................................................................................................11
4.1.2. STUDY PERIOD...................................................................................................11
4.2 STUDY DESIGN...........................................................................................................11
4.3. POPULATION.............................................................................................................11
4.3.1. Source of population.............................................................................................11
4.3.2. Study population...................................................................................................11
4.4. Study variables............................................................................................................12
4.4.1. Independent variables...........................................................................................12
4.4.2. Dependent variable...............................................................................................12
4.4. Eligibility criteria...........................................................................................................12
4.4.1. Inclusion criteria....................................................................................................12
4.4.2. Exclusion criteria...................................................................................................12
4.5. Sampling technique and Sample size.........................................................................12
4.6. Materials and instruments...........................................................................................13
4.7. Data collection method................................................................................................13
4.7.1 pretest........................................................................................................................13
4.8. Data processing and analysis......................................................................................13
4.9 Quality control and Quality assurance..........................................................................14
4.10 Sample collection process and criteria.......................................................................14
4.11 Ethical Consideration..................................................................................................14
4.12 Operational definition of terms....................................................................................15
CHAPTER 5: RESULT..........................................................................................................16
CHAPTER: SIX DISCUSSION...............................................................................................22

iv
CHAPTER SEVEN: CONCLUSION AND RECOMMENDATION.........................................24
7.1 limitations and strengths of study.................................................................................24
ANNEX I PROBLEMS ENCOUNTERED DURING THE STUDY PERIOD..........................25
REFERENCE.........................................................................................................................26
ANEXX II QUESTIONNAIRE ENGLISH VERSION.............................................................30
OROMIC VERSION...............................................................................................................32
ANNEX III TEST PROCEDURE FOR HBsAg........................................................................34
ANEXX IV...............................................................................................................................34
DECLARATION FORMAT.....................................................................................................35

v
LIST OF TABLE

Table 1 Prevalence of Hepatitis B serostatus among pregnant women by Occupational Status

characteristics of the participants at MWUGRH, 2025...........................................................18
Table 2 Prevalence of Hepatitis B serostatus among pregnant women by Marital Status
characteristics of the participants at MWUGRH, 2025...........................................................18
Table 3 Prevalence of Hepatitis B serostatus among pregnant women by Residence Area of
the participants at MWUGRH, 2025........................................................................................20
Table 4 Prevalence of Hepatitis B serostatus among pregnant women and associated factors
at MWUGRH, 2025.................................................................................................................21
Table 5 Prevalence of Hepatitis B sero status among pregnant women and associated factors
who have history of liver disease at MWUGRH, 2025...........................................................22

Figure page

Figure 1 CONCEPTUAL FRAMEWORK................................................................................5

Figure 2 Prevalence of Hepatitis B serostatus among pregnant women by Age characteristics
of the participants at MWUGRH, 2025...................................................................................17
Figure 3 Prevalence of Hepatitis B serostatus among pregnant women by Educational Level
of the participants at MWUGRH, 2025...................................................................................19
Figure 4 Prevalence of Hepatitis B sero status among pregnant women associated With their
pregnancy times at MWUGRH, 2025......................................................................................20

vi
ABBREVIATIONS

AIDS Acquired immune deficiency syndrome

ANC Antenatal care

DNA deoxyribonucleic acid

HBcAg Hepatitis B core Antigen

HBeAg Hepatitis B envelope Antigen

HBsAg Hepatitis B Surface Antigen

HBV Hepatitis B virus

HIV Human Immune Virus

TARH tkur anbesa refral hospital

MWU Madda Walabu University

GRH Goba Refferal Hospital

vii
 CHAPTER ONE: - INTRODUCTION

1.1 BACKGROUND.
Hepatitis B virus (HBV) is one of the prominent public health problems globally (Liu.M
2019). The disease is caused by the hepatotropic deoxyribonucleic acid (DNA) virus and
happens over the immune-mediated killing of diseased liver chambers. Hepatitis B virus is a
potentially life-threatening pathological virus of the liver that leads to critical or prolonged
hepatitis (Liang J. WHO, 2021). In childhood, less than 5% of infections result in chronic
hepatitis (Tanaka Y. 2020).

Hepatitis B virus can cause coagulation defects, postpartum hemorrhage, organ failure,
and high maternal mortality, as well as poor newborn outcomes such as stillbirth, neonatal
deaths, and severe, and prolonged liver disease. Early intervention and prevention of these
illnesses is now a priority, with universal screening in antenatal care (ANC) and as part of
reproductive health programs. It has an average incubation period of 75 days and can be
detected in the blood within 30–60 days (C. Ebert, 2021). In light of this, the virus is more
contagious and powerful than the human immunodeficiency virus (HIV) virus (Maynard J,
2019, Kaplan JE, Stone VE 2018). The World Health Organization estimates that
approximately 296 million people had chronic hepatitis B infection in 2019, with 1.5 million
new infections occurring each year. In 2015, 2.7 million people were HIV coinfected.
Furthermore, 5%–15% of populations in developing and poor-income countries are chronic
carriers of hepatitis B infection (Z. Siddiqui 2019). The presence of support groups or
community organizations dedicated to hepatitis B awareness and support can mitigate the
severity of the disease locally. A significant number of individuals infected with hepatitis B
develop chronic infection, Cirrhosis can lead to liver scarring (cirrhosis), which impairs liver
function and can result in severe complications. Liver Cancer is an increased risk of
developing hepatocellular carcinoma (liver cancer)(Sunbul M 2014).

Furthermore, the World Health Organization reported that hepatitis is responsible for
1.34 million deaths, which is equivalent to deaths due to tuberculosis but higher than deaths
due to HIV in 2015 ((WHO,2021). In addition, 1.8 million children less than 5 years old are
living with hepatitis B virus infection (Duri K. 2023). Due to the high price of the vaccine,
private access is less likely (Aibu T. 2020)). As a part of the sub-Saharan region, Ethiopia
ranked medium to high endemicity for HBV infection. In Ethiopia, even if there is a lack of

1
data representing the spread of HBV infection nationally, according to the findings of some
individual studies, the country is regarded as having a high burden of the disease (Negero A.
Sisay Z. 2019).

Systematic reviews and meta-analyses revealed that the prevalence of HBV in the
general population ranged from 6% to 7.4% (13) whereas 5%–7% of pregnant mothers were
a major source of disease for newborns (Yazie TD. Tebeje MB. 2019).

1.2 STATEMENT OF THE PROBLEM

Hepatitis B is a viral infection that attacks the liver and can cause both acute and
chronic disease. The virus is most commonly transmitted from mother to child during birth
and delivery, in early childhood, as well as through contact with blood or other body fluids
during sex with an infected partner, unsafe injections, or exposures to sharp instruments.
WHO estimates that 254 million people were living with chronic hepatitis B infection in
2022, with 1.2 million new infections each year.

2
 Hepatitis B is a viral infection that primarily affects the liver and can lead to several
complications, particularly if the infection becomes chronic. Approximately 296 million
people worldwide are living with chronic hepatitis B infection, with high prevalence in
regions such as sub-Saharan Africa and East Asia. The World Health Organization (WHO)
estimates that about 1.5 million people are newly infected each year. Hepatitis B is
responsible for approximately 880,000 deaths annually, primarily due to complications such
as cirrhosis and hepatocellular carcinoma (liver cancer)(WHO Global Hepatitis Report,
2017).

There is a significant disparity in access to antiviral treatments and vaccination programs

across different countries, leading to varying severity outcomes. The risk of perinatal
transmission of HBV is related to maternal HBV-DNA levels and HBsAg status of the
mother without immunoprophylaxis, vertical transmission occurs in 70-90% if the mother is
HBsAg positive. This is reduced to 40% if the mother is HBeAg negative. Overall, vertical
transmission was reduced to 5-10% with appropriate active and passive immunoprophylaxis
(hepatitis B vaccination for all plus hepatitis B immunoglobulin if the mother is HBsAg
positive). However, in infants born to mothers with high HBV_DNA levels, despite
immunoprophylaxis 8-32% of infants develop perinatal infection. Local public health
education initiatives can greatly influence community understanding of hepatitis B
transmission and prevention. Liver Cancer is an increased risk of developing hepatocellular
carcinoma (liver cancer) (Sunbul M 2014). Hepatitis B infection is influenced by a variety of
factors that can increase the risk of transmission and infection. Blood exposure sharing
needles or other drug paraphernalia blood transfusions (especially in regions without
screening) and exposure to infected blood. Sexual intercourse with an infected partner can
lead to transmission (Sunbul M 2014). Infected mothers can transmit the virus to their infants
during childbirth (Harrison’s AASLD 2023). A higher prevalence of hepatitis B is found in
certain regions, such as sub-Saharan Africa, East Asia, and the Pacific Islands. (WHO, 2024).

Immunocompromised Individuals People with weakened immune systems (due to

conditions like HIV/AIDS or medications that suppress the immune system) are at increased
risk for hepatitis B infection. Those who have not received the hepatitis B vaccine are at
higher risk of infection, especially if they engage in high-risk behaviors. Certain cultural
practices involving blood (such as scarification or tattooing) can increase the risk of
transmission if proper hygiene is not maintained. Co-infection with Other Viruses Individuals

3
co-infected with other viruses (such as HIV or hepatitis C) may have an altered immune
response that affects susceptibility to hepatitis B( Zhang C. 2022).

Hepatitis B mostly affects the peoples of developing than developed countries as the
above magnitude of prevalence indicates, this information would be revealed not only to the
local health institutions but would also be a vital regional database (Liu Y. 2022). Even
though the disease is endemic in all populations and/or pregnant mothers in the country, there
is not enough research done in the southeastern Ethiopia Bale zone, where the prevalence and
factors associated with HBV infection among pregnant mothers are unknown. Furthermore,
evidence-based information on the prevalence and risk factors for HBV infection in pregnant
women enables effective HBV prevention and management.

4
 Socio-
demographic
characteristics
Sex
Age

body flood side effect of

contact drugs
sexual intercourse Hepatetis B Acoholic toxicity

blood transfussion

Figure 1 CONCEPTUAL FRAMEWORK

5
1.3 SIGNIFICANCE OF THE STUDY
This study provides the current magnitude of HBV infection and its potential factors. Since
HBV is one of the viral diseases that is transmitted through body fluid, blood, and products
therefore this study was useful:-

 To prevent and reduce the transmission of hepatitis during childbirth

 To provide information for healthy pregnant women about hepatitis infection

6
 CHAPTER TWO: LITERATURE REVIEW
According to the World Health Organization, nearly 300 million people are chronically
infected with HBV globally, with 1.5 million new infections each year. In 2019, hepatitis B
resulted in an estimated 820,000 deaths, mostly from decompensated cirrhosis and
hepatocellular carcinoma (HCC); as a result, HBV infection will rank 15th among all causes
of human mortality (Zhang C. Liu Y. 2022). There are regional variations in the prevalence
of chronic HBV infection: 0.1–2.0% in Western Europe and the United States, 2.0–8.0% in
Japan and the Mediterranean region, and 8.0–20.0% in Southeast Asia and Sub-Saharan
Africa (Sagneli E. Coppola E.2014).

Infection with HBV is by the entry of the virus through the skin or mucous membrane into
the blood or body fluid. In tropical countries the main routes of transmission are transfusion
of blood or blood products containing HBV, use of HBV-contaminated sprinklers, needles, or
syringes, close contact with a person with HBV contact with blood which contains HBV,
indicated mother to infant, and sexual contact. In regions like East Asia, prevalence rates can
exceed 10%, while in North America and Western Europe, prevalence is often below 1%(Lok
A. S. McMahon B. J. (2009)). Public health campaigns tailored to regional cultural contexts
can improve awareness and treatment uptake. Within a specific community, the prevalence of
hepatitis B can vary based on factors such as demographics, socioeconomic status, and
migration patterns. The over-prevalence rate of hepatitis B virus infection among individuals
visiting Goba Referral Hospitals was 7.4% (Negero E. Benti T. 2020). Mother to infant
(vertical) transmission from an HBV-infected mother is the commonest mode of transmission
worldwide and accounts for 50-60% of chronically infected patients. It is estimated that up to
25% of these patients die prematurely from the complication of chronic HBV infection in
later-life cirrhosis, liver failure, and liver cancer.

A significant public health concern in the majority of nations is hepatitis B virus (HBV)
infection, with an estimated 2 billion persons globally expressing viral exposure, and 360
million people have a chronic infection that is susceptible to liver disorders caused by HBV
(Roper K. Lidbary BA. 2022). The hepatitis B virus (HBV) is responsible for acute and
chronic hepatitis, cirrhosis, liver failure, and hepatocellular carcinoma (HCC) (Liang TJ.
2019). Significant death rates from this malignancy (HCC) are found in regions with a high
endemicity of chronic HBV infection (Glynn C. London WT. 2015).

7
 It represents the sixth most prevalent type of cancer worldwide and the third leading cause
of cancer-related deaths (MC Gylnn KA Clinics in Liver Disease. 2015). The Hepatitis B
virus was initially named serum hepatitis to differentiate it from the hepatitis A virus, which
was responsible for fecal-oral hepatitis (Plotkin S, Orenstein W, Elsevier; 2018). HBV is the
common form of viral hepatitis with parenteral transmission that causes acute and chronic
hepatitis, some with progression to liver failure (Schillie S. MMWR 2018).

The clinical manifestations of acute infection resemble those of other viral hepatitis, and the
incubation period varies between 1 and 6 months (Jonas MM Murad MH 2016). HBV
hepatitis becomes chronic more frequently when the virus is contracted at a young age, 90%
of infected infants and up to 30% of children. The later the infection is contracted, during
adulthood, the risk of chronicity decreases to 5–10%, with most having a complete recovery
but with a serological scar, meaning the presence of anti-HBc antibodies in the blood (Kwon
SY, 2021)Fulminant hepatitis occurs in rare cases, less than 1% of cases, and especially in
immunocompromised people (Lee CH. 2019).

In terms of the way the virus is transmitted, there is vertical transmission (perinatal) and
horizontal transmission. The first category appears during childbirth, from infected mothers
who transmit it to their children (Belyhan M. 2016) The second way is horizontal
transmission, which is divided into sexual and parenteral transmission through skin continuity
solutions, blood transfusions, nosocomial infections, drug injections, and tattoos (Intech
Open; 2021). Sexual transmission of hepatitis B is an important source of infection in all
areas of the world, but especially in areas of low endemicity (North America), but is
increasingly important in areas of high endemicity as young people adopt a style of
“Western” life (Nolan M. 2021). Hepatitis B is considered a sexually transmitted disease
(STD), and for a long time, gay men were considered to be at the highest risk of infection
through sexual contact (Meheus A. 2018).

Reduction of HBV-related chronic liver damage and chronic HBV infection is the primary
goal of hepatitis B prevention initiatives (Alter MJ. 2023;23(1) ). Many effective hepatitis B
prevention measures have been partially or fully implement. Three strategies are available to
prevent HBV infection: prevention through behavioral changes, passive immunoprophylaxis,
and active immunization (vaccination) (Chen D-S. 2015).

The 8th “H,” described last, is found in Central America. Genotype E is found in sub-
Saharan Africa, and genotype F is seen in Native Americans (Sunbul M 2014;20(18)). All

8
genotype classes have a common immune dominant region on the HBs antigen which is
called “a determinant” (Intech Open; 2021). This determinant comprises amino acids 124–
147 and is hydrophilic (Intech Open; 2021). It is taught to be a form of two major and one
minor loop with cysteine disulfide bonds. The “a” determinant primarily targets vaccine-
induced neutralizing antibodies, which achieves a common major immunization response to
the “a” determinant, with subsequent protection against all HBV subtypes (Seo Y, Yano Y.
2020)

The response to treatment depends on the genotype, subgroup, and recombination, which
can influence the biological characteristics of the virus (IntechOpen, 2023). A correlation
between HBV genotypes and HBsAg clearance, liver damage, and response to IFN treatment
has been reported (Seo Y, Yano Y. 2020). The prevalence of HBsAg seems higher in patients
with genotype C than with genotype B, also, patients with genotype B have lower histological
activity scores and genotype C is more prevalent in patients with cirrhosis.

The total population projected from the 1994 census within the catchment area of Debre
Tabor Hospital was 28,248. Out of this, 13,223 were women in the age group of 15-49 years
of which 661 mothers were expected to be pregnant. A cross-sectional study will conducted
from January to March 200 in a total of 209 pregnant women aged 16-40 years attending the
antenatal clinic, at Debre-Tabor Hospital. Hepatitis surface antigen was detected by enzyme-
linked immunosorbent assay (ELISA) method. Data was collected using a pre-tested
structured questionnaire and analyzed using SPSS version 20. A cross-sectional study was
undertaken from January to March 2004 in a total of 209 pregnant women, in Debre Tabor
Hospital, northwest Ethiopia, showing that the overall prevalence of HBsAg among pregnant
women was 5.3%. The majority of the study participants 6(75.9%) belonged to the age group
of 16_22 years. History of use of sharp materials, hypodermic needles, and tattoos for
cosmetics had a statically significant association with HBsAg seropositivity (P<0.05). There
was an intermediate endemicity of HBV infection in pregnant women attending antenatal
care services at Debre Tabor Hospital. According to this research out of 212 mothers
intended to be included in the study, 209 will enrolle in the study giving a response rate of
98.6%. The mean (±sd) age of the mothers was 25.4 (± 6) with range. The majority of the
pregnant women 143 (68.4%) were between the age group of 16 and 28 years. Two hundred
six (98.6%) of the study subjects were married. Of the 209 pregnant women, 122 (58.4%)
were from urban, and the remaining 87 (41.6%) were from rural areas. Almost all the study

9
participants reported exposure to at least one HBV infection risk factor. Exposure to risk
factors such as the use of sharp materials, hypodermic needles for injectable medications, the
practice of tattoos for cosmetics, history of multiple sexual practices, and blood transfusion
was observed in 195 (93.3%), 13 (6.2%), 15 (7.2%), 4 (1.9%) and 2 (1%) of pregnant
women, respectively (Gelaw, Mengistu Y;2017).

10
 CHAPTER THREE OBJECTIVES

3.1 General objective

 To assess the prevalence of Hepatitis B infections and associated factors among
pregnant women attending ANC at Madda Walabu University Goba Referral
Hospital from March 2025 to May 2025.

3.2 Specific objectives

 To determine the prevalence of Hepatitis B Infections among pregnant women
attending ANC at Goba Referral Hospital from March 2025 to May 2025.

 To assess the possible factors that increase Hepatitis B infection among pregnant
women attending ANC at Madda Walabu University Goba Referral Hospital from
March 2025 to May 2025.

11
 CHAPTER FOUR

4.1 STUDY AREA AND STUDY PERIOD

4.1.1 Study area

The study was conducted at Goba Referral Hospital, which is found in Bale Zone. The
Bale zone is located in South-East Ethiopia. Bale, one of the largest Oromia National
Regional States zone was divided into two zonal states; Bale zone and East Bale zone. Robe
is the capital city of Bale zone 442 km away from Addis Ababa, the capital city of Ethiopia.
Robe has high land climate conditions, heavy rainfall, warm temperatures, and long wet
periods. Based on the 2007 census conducted, by the CSA, the total population of the zone is
2,486,155 of whom 1,250,527 are men and 1,235, 628 are women study area; Goba Referral
Hospital, one of the biggest hospitals which is located in Goba sub-city, one sub-city of the
robe.

4.1.2. STUDY PERIOD

The study was conducted from March 2025 to May 2025 at Madda Walabu University Goba
Referral Hospital.

4.2 STUDY DESIGN

A hospital-based cross-sectional study was conducted to assess seroprevalence and
associated factors of pregnant women.

4.3. POPULATION

4.3.1. Source of population

The study population was all pregnant women Attending ANC at Madda Wallabu University
Goba Referral Hospital during the study period.

4.3.2. Study population

A total of pregnant mothers who were attending ANC at Madda Walabu University pregnant
women who attended ANC and volunteered to participate in the study.

12
4.4. Study variables

4.4.1. Independent variables

Sex, Age, Education, Occupation, History of blood transfusion, History of liver
disease, History of previous abortions, history of drinking alcohol, tattoo, History of dental
procedure, History of chronic alcohol consumption, Fear of vaccine side effects, needle stick
injury, history of HBsAg, having multiple sexual partners, health service factors, History of
medical injection, History of surgical procedure, Residence(town or village dwellers),
History of multiple sexual partners

4.4.2. Dependent variable

HbsAg seroprevalence

4.4. Eligibility criteria

4.4.1. Inclusion criteria

Pregnant women who visit Goba Referral Hospital during the study period, are willing to
participate in the study.

4.4.2. Exclusion criteria

Pregnant women who have severe sick medical conditions and those who take a Follow-
up treatment for hepatitis.

4.5. Sampling technique and Sample size

Margin of error(D)=5%

A 95%confidence interval (Za/2)=1.96

Prevalence rate (p) taken from research at Wolaita Sodo University =9.2%

( Z ) ² xp(q)
n=
d²

( 1.96 ) ² x (0. o 92)(0.908)

=
(0.05)²

Where Z=the standard normal variable

α/2 =confidence level

13
p= prevalence rate of HBsAg

d=margin of error

Hence Za/2=1.96

P=9.2%=0.092 (from research done in Wolaita Soddo University)

D= 0.05

n= ((1.96)2 0.092(1-0.092))/(0.05)2

n= 128

by adding 10 % of no response rate our sample size was 128+12.8=140

So based on this were collected questionaries from 140 pregnant women who follow
ANC at MWUGRH by structured questionaries and oral informed consent

4.6. Materials and instruments

Gloves, Centrifuge, HBsAg kit, Marker or pencil, Questionnaire, Test tube and pasture
pipette

4.7. Data collection method

The questionnaire was prepared based on the objective of the study and a review of
pertinent literature. It includes a socio-demographic study and information related to
acquiring the infection. The questionnaire was prepared in English and the concept of the
questionnaire was translated into Oromic language.

4.7.1 pretest
A pretest was done a week before actual data collection to determine any change or revision
in the process appropriateness of the questionnaires and the quality of HBsAg kits and
equipment as well as the materials carried out before the actual study.

4.8. Data processing and analysis

The data was sorted and processed using Statistical Package for Social Science (SPSS)
computer software version 20. The data was presented by using tables, and charts.

14
4.9 Quality control and Quality assurance
Quality control measures were undertaken in pre-analytical, analytical, and post-analytical
phases to obtain reliable and valid results.

-The sale pouches that contain the test dipstick and the desiccant pouch were arranged.

-Materials like test tubes centrifuge and test tube rack was arranged and the expiration date of
the sealed pouch was checked.

-A sufficient volume of whole blood (3-5ml) was collected using a clean test tube and labeled
carefully. The blood was centrifuged for 15 minutes to separate serum from plasma.

-The sale pouch was opened to room temperature and used immediately.

-The red area of the dipstick was submerged in the serum.

-The result was read according to the color of the band on the dipstick.

-The result was reported either positive or negative.

4.10 Sample collection process and criteria

Ensure that all necessary materials are available, including sterile blood collection tubes
(usually red-top), needles, alcohol swabs, gloves, and labels. Verify that the patient has been
informed about the procedure and has provided consent. Confirm the patient's identity using
two identifiers (e.g., name and date of birth) to ensure accurate sample labeling. Select an
appropriate venipuncture site (commonly the ant cubital fossa). Clean the site with an alcohol
swab or antiseptic solution in a circular motion, starting from the center and moving outward.
Put on gloves and perform the venipuncture using a sterile needle and syringe or a vacationer
system. Collect the required volume of blood into the appropriate collection tube(s). After
blood collection, apply pressure to the puncture site with a clean cotton ball or gauze until the
bleeding stops. Label the specimen immediately with the patient's information, date, time of
collection, and type of test being performed. If not tested immediately, store the samples
according to laboratory guidelines (usually refrigerated) and transport them to the laboratory
as soon as possible.

15
4.11 Ethical Consideration
An official letter of permission was obtained from the faculty of Health Sciences and was
given to the administrator of Madda Wallabu University office, Goba, South Eastern
Ethiopia. Before any attempt to collect data, the protocol was approved by the Department of
Medical Laboratory Sciences, College of Public Health and Medical Sciences, Madda
Wallabu University. Official permission was obtained from Goba Referral Hospital Official.
Each participant was notified about the purpose of the study, the right to refuse or participate
in the study, and the anonymity and confidentiality of the information that was gathered.
They was assured that they were penalized for not participating if they wish not to participate
and that their responses to the questions had no effect on their care. The participant's result
was communicated to the concerned physician or caregiver. informed consent was obtained
from each study subject. the results obtained from the study were kept confidential

4.12 Operational definition of terms

Blood borne disease: a disease that can be transmitted by blood contamination

Tattoo: endogenous work by making color on the body by using sharp material

Hepatitis B; Viral infection that attacks the liver and can cause both acute and chronic
disease.

Immunocompromised; A person whose immune body is below normal

DNA; Substance that carries genetic information in the cells

Vaccination; Substance that is usually injected into a person or animal to protect against a
particular disease

16
 CHAPTER 5: RESULT
Of the total of 140 screened pregnant mothers 105 of them were attending ANC
previously and the rest 35 were not followed ANC of which 33 were in their first pregnancy.
Among these, only 1 individual was positive for HBsAg. The different variables such as
Dental procedure, surgical procedure, operative delivery, liver disease, blood transfusion, and
previous abortion (p>0.05 i.e.P=0.999) with HBsAg, Age (p=0.985>0.05).

Socio-demographic characteristics of the participants: during the study period 140

consenting pregnant women were selected using a systematic random sampling method. The
mean age of the 140 participants finally enrolled was 31 years. The youngest was 18 years
and the oldest was 44 years and almost all the women 128 (91.4%) were married.

3.57
%

13.6
15.7%
%

23.6%

32.4%

12.14%

Figure 2 Pregnant women by Age characteristics of the participants at MWUGRH, 2025

In this study the overall prevalence rate of HbsAg was 7.14%(10/140) from the total
subjects studied most of them found in the age gap between 25-29 which were
23.6%(33/140) and the least found in 15-19 which were 3.57%(5/140) shown by the table

17
below. From this socio demographic characteristics the association of age with the prevalence
of hepatitis was depend on p value (p=0,005 so 0.00016<0.005) so age has association factor
with this infection of pregnant womens. But other p value was greater than 0.005 so were
they have not association with the infections among pregnant womens.

Table 1 Pregnant women by Occupational Status characteristics of the participants at

MWUGRH, 2025

Occupational Positive negative total percentage

status
Housewife 1 19 20 14.3

Government 2 58 60 42.9
employ
Student 0 0 0 0
Merchant 1 29 30 21.4
Daily labor 0 0 0 0
Farmer 6 24 30 21.4
Total 10 130 140 100

140 consenting pregnant women were selected using a systematic random sampling
method. Were 42.9%(60) are governmental employ that participate on the study. From that
population 3.3%(2) are hepatitis B virus positive. And 21.4%(30) are farmers from there
20%(6) are hepatitis b virus positive. And that 21.4%(30) of participants are merchants.

Table 2 Pregnant women by Marital Status characteristics of the participants at MWUGRH,

2025

Marital status Positive negative total percentage

Single 0 1 1 0.7
Married 10 118 128 91.4
Divorced 0 5 5 3.6
Widowed 0 6 6 4.3
Total 10 130 140 100

18
 140 consenting pregnant women were selected using a systematic random sampling
method. Were 91.4%(128) are married from them all hepatitis b virus are married. So the
prevalence of hepatitis b virus was prevalent on married population on our study.

Figure 3 Pregnant women by Educational Level of the participants at MWUGRH, 2025

Except few all participants had some level of education, most study participants were in their
second trimester. According to the above table, the educational status of study subjects
showed that most study subjects were in primary school and illiterate 26.5 %( 37), followed
by secondary school 37.3%(52 ), university10.7%(15), and the last one was college
25.7%(36)

19
Table 3 Prevalence of Hepatitis B serostatus among pregnant women by Residence Area of
the participants at MWUGRH, 2025

Residence HBsAg serostatus total %

Positive Negative

Town 6 115 121 86.4

Rural 4 15 19 13.6

Total 10 130 140 100

140 consenting pregnant women were selected using a systematic random sampling
method. The population participate on the study 86.4%(121) are urban residents. And
13.6%(15) are rural residents from the hepatitis b sero-prevalence positive 5.2%(6) are from
urban area. And the others are come from rural area.

Table 4 Pregnant women who attend ANC at MWGRH

percentage
ANC Follow up Yes 105 75
No 35 25
total 140 100

Figure 4 Prevalence of Hepatitis B sero status among pregnant women associated With their
pregnancy times at MWUGRH, 2025.

26.3%

73.7%

20
 So repetition of the pregnancy has no association (P=0.746>0.05) with infection of
HBsAg. The above table showed that from the total of 140 screened pregnant mothers 33 of
them were in their 1st pregnancy and the rest 107 were 2nd and above. First Vs second and
above pregnancy(p=0.785>0.05)haven’t any association with HBsAg infection

Table 5 Prevalence of Hepatitis B serostatus among pregnant women and associated factors
at MWUGRH, 2025

Factors HBsAg –serostatus percentage

Positive Negative
dental procedure yes 2 16 12.9
no 8 114 87.1
total 10 130 100
Surgical procedure yes 0 14 10
no 1 125 90
total 10 140 100
Operative delivery yes 0 98 70
no 2 40 30
total 2 138 100
Liver diseases yes 1 10 7.9
no 0 129 92.1
total 1 139 100
Blood transfusion yes 0 9 6.4
no 0 131 93.6
total 0 140 100
Previous abortion yes 0 16 11.4
no 0 124 88.6
total 0 140 100

The different risk factors such as Dental, surgical procedure operative delivery, liver
disease, blood transfusion and previous abortion haven’t any association (p>0.05 i.e.
P=0.205) with HBsAg. In order to calculate probability there must be at least two positive
individual. From the above table the only positive individual was undergo dental procedure,
therefore the only variable that had p-value was dental procedure.

21
Table 6 Prevalence of Hepatitis B sero status among pregnant women and associated factors
who have history of liver disease at MWUGRH, 2025

HISTORY OF LIVER DISEASES

Frequency Percent Valid Percent

Valid YES 1 .7 .7

NO 139 99.3 99.3

Total 140 100 100.0

From our study only one participant has history of liver disease.

22
 CHAPTER: SIX DISCUSSION
A hospital-based cross-sectional study was carried out at the ante-natal care of Madda
Walabu University Goba Referral Hospital, south east Ethiopia. 140 Pregnant women were
recruited, and their serum was analyzed for Hepatitis B virus, while socio-demographic
characteristics and associated factors for HBV infection were assessed with pretested
questionnaires. We found an HBsAg seroprevalence rate of 7.142% among the pregnant
women tested, indicating that HBV Prevalence is low.

As we see from the above tables, the distribution of HBsAg among pregnant women by
different variables, those who are illiterate 3.6% (1/5) were positive for HBsAg, married
7.142%(10/118), no previously ANC attendants 105, those with first pregnancy 0.71%(1/33),
individuals who have had dental procedure 12.9%(2/18) and among the different age groups,
the 25-29 age group 23.6%(6/33) have been found infected more comparing to their relative
corresponding variables and were positive for HBsAg.However, the rest of the group of
variables were found negative for HBsAg.

This prevalence is an approach to the research done in India, of 400 women tested for
HBsAg, 37 (0.9%) were HBsAg positive, of these 37 women,6(16%) presented with acute
hepatitis and 31 (84%) were asymptomatic the highest HBsAg positivity rate was in the age
group of 21 - 25 years (1.15%) followed by 26 - 30 years(0.86%)( Murad MH, 2016). But
7.14% prevalence is relatively low when compared to research done in Saudi Arabia, a total
of 755 pregnant females who attended the antenatal care from June 2019 -June 2020 for the
first time before 38 weeks of gestation shows an overall prevalence of seropositive HBsAg is
1.6%, in Tunisia (5.4%), Greek ranged from 3-4 % and Jimma and Debretawer with 3.7%
and 5.3% respectively(WHO, 2022) According to WHO criteria this prevalence of HBsAg
among pregnant women is low prevalence(,2%) this is because the Ethiopian government
aimed "all mothers to deliver in Health institution" as the goal of the Millennium this helped
to prevent risk of infection during delivery also pregnant women become informed and aware
of how to prevent from such infections by the health staffs and it may also be due to their
geographical location. In this research most study subjects 121 out of 140 were urban
dwellers, therefore they got current information about HBV on television, and radio and
attended ANC during their pregnancy period better than the rural one. The other reason for

23
the low result may be time, this means that all the research was done almost four years. At
that time there was no sufficient information about HBV infection as compared to today.

Even the study showed that the prevalence of HBsAg is modarate(7.12), since the
study period is short(one months) as compared to the reference researches done in at least
two months(60days) and the study was very specific to only pregnant women attending
ANC.

24
 CHAPTER SEVEN: CONCLUSION AND RECOMMENDATION

In this study, the overall sero-prevalence of the HBV marker was 7.14%. The majority of the
subjects were found in the age group 25-29 years. Most of them were urban duelers and had
attended antenatal care previously. If pregnant women are left undiagnosed and unmanaged,
the future burden of the disease on healthcare resources and society were substantial. To
reduce the prevalence below 7.14%, give information to the general population on the
prevalence of HBV infection. We were recommend a population-based study for the
assessment of HBV prevalence as a first step to implementing control measures and
increasing the coverage of hepatitis B vaccination to reduce the rate of HBV infection. We
were recommended health institutions give health education for mothers to attend ANC
during their pregnancy.

Introduce and sustain nationwide vaccination programs for newborns. To prevent mother-to-
child transmission, screen pregnant women and provide appropriate interventions. Monitor
infection rates and vaccination coverage. Vaccinate high-risk groups (e.g., healthcare
workers, high-risk adults). Implement continual screening for pregnant women and high-risk
populations. Provide access to antiviral therapy for chronic carriers. Continue infant and
high-risk group vaccination efforts. Monitor trends to detect any increase in prevalence.
Promote safe behaviors and infection control. Aim for ≥90% coverage to achieve herd
immunity. Focus on underserved populations and areas with rising infection rates.

7.1 limitations and strengths of study

Limitations;

 Lack of time for more investigations

 more clients were refused as in case that the problem occurred with our sample
techniques.
 Overlapping of some schedules with other study program makes as unavailable with
in time of study periods at place.

Strength;
 material for laboratory diagnosis was available at hospital so in guidance when lab
investigation request paper sent to lab no need of any payment is confortable for our
study to support and readiness to engage to the program group members.

25
  Have good relationship within the concerned institutions.

ANNEX I PROBLEMS ENCOUNTERED DURING THE STUDY

PERIOD
At the very beginning of the study the amount of requests for HbsAg was not as
satisfactory as I wish, because The ANC staff send the request only for those who invite
ANC for the first time. I have solved the problem by contacting with medicine and HO intern
students working in ANC and informed them to order the test for any pregnant woman who
came to ANC for attending.

There was a great difficulty when the data was collected through questionnaires:

Some clients were not happy when the were asked, but responded to the question. When I
am collecting the data through questioner some pregnant go without being screened for
HBsAg and when I was Performing the HBsAg test, some pregnant went without being asked
for the questionnaire, but later I offered help from my friend and the staff in the laboratory
hence everything was corrected properly. Language barrier, some clients cannot speak
Amharic.

26
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 ANEXX II QUESTIONNAIRE ENGLISH VERSION

DATE FEBRUARY 2025

Madda Walabu University School Of Medicine and Medical Science And Department Of
Medical Laboratory Science Questionnaire on the prevalence of HBsAg among pregnant
women attending ANC at MWU GRH Southwest Ethiopia.

1) Identification
1. Age………..Code no……………..
2) Adders; urban………….woreda……………kebele………….
Rullar (specify)…………..
3) Socio-demographic
I. Education status
A. Illiterate
B. Read and write
C. Primary school
D. High school
E. College graduate or above

4) Marital status

A) Married B) divorced…… C) Widowed …….D) Single

5) Occupation
A) Government employee……B) student…..C) housewife……D) merchant….E)
farmer………F) no work……..G) other specify……..

6) Have you attended ANC previously

A) Yes……B) no……….

7) Is this pregnancy your first time?

A) Yes…… B) No……..

31
8) Have you ever been exposed for
A) Dental procedure………
A) Yes…… B) No……..
B) Operative delivery……..
A) Yes…… B) No……..
C) Surgical procedure…….
A) Yes…… B) No……..
D) Previous abortion …..
A) Yes…… B) No……..
E) Unsafe injection……..
A) Yes…… B) No……..
F) Alcoholic drinks………….
A) Yes…… B) No……..
G) History of abortion………..
A) Yes…… B) No……..
H) Needle injury…………..
A) Yes…… B) No……..
9) Is there any history of liver disease?
A) Yes…….
B) No……
10) Is there any history of transfusion?
A) Yes…….B) no………
11) Have you had many sexual partners?
A) Yes B) NO
12) Have you vaccinated Hepatitis B Vaccine?
A) Yes B) NO
13) Why you have not been vaccinated?
A) Fear of vaccine B) fear of needle injection
C) Fear of drug side effects

32
OROMIC VERSION
1) Adda baasuu

1. Umurii.........Koodii lakk.................

2. Adders; magaalaa.................woreda..................kebele.................

Rullar (ibsi).

2) Hawaasummaa dimogiraafii

1. Haala barnootaa

A. Dubbisuu fi barreessuu kan hin dandeenye

B. Dubbisee barrels

C. Mana barumsaa sadarkaa tokkoffaa

D. Mana barumsaa sadarkaa lammaffaa

E. Kolleejjii irraa eebbifame you Asia ol

3) Haala gamelan

A) Kan fuudhe B) kan wal hiikan...... C) Dubartii abbaan manaa irraa du'e .......D) Qofa hin
qabne

4) Hojii

A) Hojjetaa mootummaa......B) barattuu.....C) haadha manaa......D) daldalaa....E) qonnaan

bulaa.........F) hojii hin qabu........G) kan biroo ibsi........

5) Kanaan dura ANC irratti hirmaachaa turtaniittuu

A) Eeyyee......B) lakki..........

6) Ulfi kun yeroo jalqabaati?

A) Eeyyee...... B) Lakki........

8) Saxiltee beektaa

33
A) Adeemsa ilkaan........

B) Kenniinsa hojii (operative delivery)........

C) Adeemsa baqaqsanii hodhuu.......

D) Ulfa baasuu kanaan dura .....

E) Lilmoo nageenya hin qabne........

9) Seenaan dhukkuba kalee ni jiraa?

A) Eeyyee.......

B) Lakki......

10) Seenaan dhiiga namaa dabarsuu ni jiraa?

A) Eeyyee.......B) lakki........

34
 ANNEX III TEST PROCEDURE FOR HBsAg
3-5 ml of blood was taken and centrifuged for five minutes to get plasma.

The sealed pouch was bought to room temperature and opened and the device was removed.

Two drops of plasma or serum specimen will be dispensed to the device using the dropper
provided.

The result will read at the end of 15 minutes as follows:-Negative :

Only one pink _purple band appears on the control region “c” Positive:

In addition to the control bar, pink and Purple also appear on the test region "T",

The test should be considered invalid if neither the Test band nor the control band appears.

ANEXX IV
Laboratory test results for the procedure

Positive…………… Total……
Negative……………

35
 DECLARATION FORMAT

THE PREVALENCE OF HEPATITIS B INFECTIONS AND ASSOCIATED

FACTORS AMONG PREGNANT WOMEN ATTENDING ANTENATAL
CARE AT MADDA WALABU UNIVERSITY, GOBA REFERRAL HOSPITAL
2025

The study was conducted at Goba Referral Hospital, which is found in Bale Zone. The Bale
zone is located in South-East Ethiopia. Bale, one of the largest Oromia National Regional
States zone was divided into two zonal states; Bale zone and East Bale zone. Goba Woreda
The undersigned declares the proposal entitled " the prevalence of hepatitis b infections
and associated factors among pregnant women attending antenatal care "is our work.
We have only used the sources indicated and have not made unauthorized use of sources of
the 3rd part. When the work of others has been quoted or reproduced, the sources are always
given. I further declare that the electronic version of the submitted paper is congruent with
the printed version both in content and format.

Principal Investigator

Name of advisors Signature Date

Mr.Nagesso D.(MSC)
Mr. Abdul Malik H.(MSC)

Principal Investigator Director…………………..

36