Nigerian Journal of Basic and Clinical Sciences

ORIGINAL ARTICLE
Year
: 2018  |  Volume : 15  |  Issue : 2  |  Page : 114--117

Prevalence of hepatitis B viral infection at paediatric gastroenterology clinic of ABUTH, Zaria


M Mado Sani1, W Idris Hafsat1, M Abdullahi Sakinatu1, Aliyu Ibrahim2, Musa Sani1, M Yakubu Alhassan3,  
1 Department of Paediatrics, ABU/ABUTH Zaria, Jos, Nigeria
2 Department of Paediatrics, AKTH Kano, Jos, Nigeria
3 Department of Paediatrics, Bingham University Teaching Hospital, Jos, Nigeria

Correspondence Address:
Dr. M Mado Sani
Department of Paediatrics, ABU/ABUTH-Zaria
Nigeria

Abstract

Background: Hepatitis B viral (HBV) infection occurs worldwide and is highly endemic in sub-Saharan Africa and southeast Asia. Materials and Methods: This was a retrospective review of cases of childhood HBV infection seen at gastroenterology clinic of ABUTH, Zaria from July 1st 2009 to June 30th 2015. Results: Four hundred and six subjects were seen in the gastroenterology clinic during the 6-year period under review. Ninety-two of these had HBV infection giving a prevalence of 22.7%. Sixty-three (68.5%) were males and 29 (31.5%) females giving a male to female ratio of 2.2:1. The age of the subjects ranged from 1 to 14 years with mean value of 8.0 ± 3.0 years. Use of contaminated sharps was the most common identifiable source of infection. Eighty-five (92.4%) of the cases were not vaccinated against HBV infection. Twenty-seven (64.3%) of the 42 available subjects at 6 months of follow-up were still HBsAg positive. All the 42 subjects that were available for follow-up for 6 months were on Livolin forte (supplement containing phosphatidylcholine and vitamins). Twenty-five of the 92 hepatitis B surface antigen (HBsAg) positive children tested positive for e antigen and 13 (52.0%) of these remained positive at 6 months follow-up. All the 27 subjects with chronic HBV infection were further evaluated for eligibility for antiviral therapy. Fever, abdominal pain, and yellowness of the eyes were the most common complaints whereas joint pain was the least reported. Conclusion: Childhood hepatitis B viral infection is a serious problem affecting more males. Use of sharps is the most common modality of transmission, whereas at the 6th month of follow-up visit, most of the subjects were in the immune clearance phase of chronicity.



How to cite this article:
Sani M M, Hafsat W I, Sakinatu M A, Ibrahim A, Sani M, Alhassan M Y. Prevalence of hepatitis B viral infection at paediatric gastroenterology clinic of ABUTH, Zaria.Niger J Basic Clin Sci 2018;15:114-117


How to cite this URL:
Sani M M, Hafsat W I, Sakinatu M A, Ibrahim A, Sani M, Alhassan M Y. Prevalence of hepatitis B viral infection at paediatric gastroenterology clinic of ABUTH, Zaria. Niger J Basic Clin Sci [serial online] 2018 [cited 2018 Dec 10 ];15:114-117
Available from: http://www.njbcs.net/text.asp?2018/15/2/114/241163


Full Text



 Introduction



Viral hepatitis occurs worldwide and affects all age-groups and The World Health Assembly in 2010 recognized viral hepatitis as a universal health problem with hepatitis B contributing significantly to the global burden.[1],[2] The global burden of hepatitis B viral (HBV) infection varies widely depending on geographical region; with Asia, sub-Saharan Africa, and western Pacific having the highest burden whereas Europe, North America, and Australia have the lowest prevalence.[1] Nigeria belongs to the countries with high transmission rates. The prevalence of hepatitis B surface antigenemia in Nigerian children differs from regions to regions varying from 4.1–13.9%[3],[4],[5],[6] in the southern Nigeria and 9.4–23.3%[7],[8],[9],[10] in northern Nigeria. Majority of children with acute HBV infection are asymptomatic and some may progress to develop chronic infection with attendant risk of chronic liver disease and hepatocellular carcinoma. Mother-to-child transmission perinatally is an important source of infection in childhood and therefore achieving good HBV vaccination coverage of newborns and infants will significantly reduce the prevalence of the infection.

 Materials and Methods



It was a retrospective review of cases of childhood HBV infection seen in gastroenterology clinic of ABUTH, Zaria from July 1st 2009 to June 30th 2015. Approval of the Health Research Ethical Committee of Ahmadu Bello University Teaching Hospital, Zaria was obtained before commencement of the study. Informed verbal consent from the parent or care givers was also obtained. All records of cases within the study period were retrieved. Relevant information such as their age, sex, clinical presentation, and hepatitis B surface and e antigen status, maternal hepatitis B surface antigen status, hepatitis B vaccination status of the children, and treatment received were obtained and entered into a proforma designed specifically for the study. Patients were followed-up monthly for the first 3 months, and then every 3 months. Liver functions tests were done at the point of diagnosis and then at 1 month and subsequently at every 3–6 months interval.

Data analysis

The information obtained from the records was analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (SPSS Inc. 233 South Wacker Drive, 11th Floor Chicago, Illinois 60606-6412). Quantitative variables were summarized using means and standard deviations whereas qualitative variables were summarized using frequencies and percentages, and categorical variables were compared using Chi square or Fishers exact tests of significance and P < 0.05 was considered as being statistically significant.

 Results



Four hundred and six subjects were recorded in the gastroenterology clinic during the 6-year period under review. Ninety-two of these had HBV infection giving a prevalence of 22.7%. Sixty-three (68.5%) were males and 29 (31.5%) females giving a male to female ratio of 2.2:1. The age of the subjects ranged from 1 to 14 years with mean value of 8.0 ± 3.0 years. The ages were further subclassified into the following age groups: 1 year (1; 1.1%), 2–5 years (19; 20.7%), 6–10 years (51; 55.4%), and more than 10 years (21; 22.8%).

Most of the cases, 77 (84.8%) had no family history of hepatitis viral infection in first degree relatives; similarly majority of the cases (72%) had no documented previous contact with suspected cases of HBV infection. Fifty-one (55.4%) of the cases had no identifiable mode of transmission, but 41 (44.6%) had identifiable probable mode of transmission. Among them, use of contaminated sharps 22 (23.9%) via grouped circumcision, uvelectomy, and sharing of razor blades was the most common identifiable possible source of infection whereas blood transfusion 5 (5.4%) was the least identifiable probable mode of transmission. Furthermore 92.4% of the cases were not vaccinated against HBV infection as shown in [Table 1].{Table 1}

The 92 cases all tested positive for hepatitis B surface antigen (HBsAg) and 25 were positive for e antigen at presentation. At the 6th month follow-up visits, only 42 subjects were available and 27 (64.3%) of these were still HBsAg positive, and only 13 (52.0%) of the 25 e antigen remained positive. The liver enzymes were elevated at presentation, 1 month and 3 months, respectively but, at the 6th month of follow-up, alanine and aspartate aminotransaminases and the alkaline phosphatase returned to normal values in 51.9%, 44.4%, and 55.6% of the cases, respectively as in [Table 2].{Table 2}

Fever, abdominal pain, and jaundice were the most common complaints whereas joint pains were the least reported. Physical examination revealed right upper quadrant tenderness in 13.0% of the cases and hepatomegaly was present in 52.2% ranging from 1 to 7 cm below the right costal margin with a mean of 2.0 + 1.0 cm whereas the liver span ranged from 8 to 15 cm. Within the study period, 15 (35.7%) of the subjects fully recovered from their illness, however majority of the subjects 50 (54.3%) were lost to follow-up at the end of 6 months clinic visit as in [Table 3].{Table 3}

[Table 4] shows that HBsAg negative serology at 6 months is closely related to the clinical outcome; all those who recovered fully were already HBsAg negative. This relation was observed to be statistically significant (P = 0.005).{Table 4}

 Discussion



The prevalence of HBV infection has remained unacceptably high in the tropics as seen in this study with a prevalence of 22.7% reflecting high endemicity. The prevalence rate obtained in this study is higher than the ones reported by Ashir, Ndako, Jibril et al.[7],[8],[9] in northern Nigeria and most studies from the southern Nigeria [3],[4],[5],[6] but lower than the one from Katsina.[10] The high prevalence rate in the current study may be attributable to the low hepatitis B vaccination among the study population as 85 (92.4%) were unvaccinated. Our study showed more males were affected with HBV infection; this observation is similar to that reported by Ashir and Habib et al.[7],[10] and another study from Sudan.[11] Females were said to elaborate more antibodies to HBsAg than males as indicated in the findings of Vierucci et al.[12] in their study among thalassemia patients in Italy. However this contrasted with the findings of Ikobah et al.;[13] who reported more infection in females (1.8%) than in males (0.8%). Their study focused on children of the prevaccination era (before the introduction of HBV vaccine into the National Immunization Programme); therefore with the current immunization program, females may possibly elaborate more antibodies and hence better protected. The mean age of our study subjects was similar with that of Dar et al.;[14] but higher than that reported by Alam et al.[15] This study also support the notion that prevalence rate of infection increases with age. Vertical transmission is reported to account for more than 50% of all infection.[16] Male/female circumcision, use of unsterilized sharps for traditional scarifications are common practice in some localities in developing countries. These practices increase the risk of HBV infection.[16] Our study showed that use of contaminated sharps via circumcision, uvelectomy, and sharing of razor blades was the most probable common identifiable mode of infection transmission accounting for 23.9% of the cases and reflected common use of unsterilized sharps in our environment as observed by Adewole et al.;[17] whereas vertical transmission accounted for 15.3% as suggested by the presence of HBsAg in their maternal sera. The exact reasons for the low rates of possible vertical transmission and high rates (55.4%) of cases where their possible mode of transmissions could not be identified in this study were not completely clear.

Blood transfusion history was obtained in 5.4% of the subjects that may indicate the source of infection and all the five subjects were transfused at peripheral hospitals where proper screening of blood may be lacking. This observation is lower than the 6.1% reported by Aba et al.[18]

Nigeria included routine immunization against HBV as far back as 2004;[13] however the coverage has been poor. Our study showed that 92.4% of the subjects were not vaccinated against HBV; this is worrisome considering efforts by successive government in making the vaccine available. Our finding contrasted with that reported by Sadoh et al.[19] who reported a high rate of HBV infection despite an age appropriate vaccination against HBV of 83%.

More than 50% of the 42 patients who were still on follow-up for 6 months following the diagnosis were still infected with the liver enzymes such as the AST, and ALT elevated at 6th month after diagnosis. This is indicative of the immune clearance phase of chronicity.

Fever, abdominal pain, and jaundice were the most common complaints reported among the subjects. Furthermore, all the subjects who seroconverted by the 6th month follow-up visit; had complete resolution of clinical symptoms and signs. All the subjects who seroconverted as well as those with persistence of HBsAg were on the same supportive treatment. Though absence of hepatitis B surface antigenemia and clinical symptoms does not translate to complete cure; because cases of hepatitis B surface and e antigen negativity with persistence of HBV DNA have been documented and therefore reactivation of this inactive carrier state may reoccur.

 Conclusion



Childhood hepatitis B viral infection is a serious problem affecting more males. Use of sharps is the most common possible modality of transmission, whereas at the 6th month of follow-up visit, most of the subjects were in the immune clearance phase of chronicity.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. Recommendations on Viral hepatitis 2010. Available from: http://www.apps.who.int/gb/ebwha/pdf _files/EB126/B126_ R16-en.pdf. [Last accessed on 2016 Dec 31].
2Elizabeth WH, Ramsey C. Global epidemiology of hepatitis B virus (HBV) infection. N J Med Sci 2011;4:7-13.
3Alikor EA, Erhabor ON. Seroprevalence of hepatitis B surface antigenaemia in children in a tertiary health institution in the Niger delta of Nigeria. Niger J Med 2007;16:250-1.
4Uleanya ND, Obidike EO. Prevalence and risk factors of hepatitis B virus transmission among children in Enugu, Nigeria. Niger J Paediatr 2015;42:199-203.
5Donbraye E, Japhet MO, Adesina AO, Abayomi OA. Prevalence of asymptomatic hepatitis B virus surface antigenemia in children in llesha, Osun state, south-Western Nigeria. Afr J Micro Res 2014;8:2329-31.
6Sadoh AE, Ofili AN. Risk factors and clinical correlates of hepatitis B seroprevalence in Nigerian children. Niger J Paediatr 2015;42:303-8.
7Ashir GM, Rabasa AI, Gofama MM. Seroprevalence of hepatitis B surface antigenaemia in children attending the University of Maiduguri Teaching Hospital. Niger J Paediatr 2007;34:85-9.
8Ndako JA, Echeonwu GO, Atanda OO, Nwankiti OO, Aimakhu SO, Onovo EM,et al. Seroprevalence of hepatitis B surface antigen (HBsAg) among children of primary school age in a community, north-central Nigeria. Sierra Leone J Biomed Res 2010;2:32.
9Jibrin B, Jiya NM, Ahmed H. Prevalence of Hepatitis B surface Antigen in children with sickle cell anemia. Sahel Med J 2014;17:15-8.
10Habibu B, Belonwu R, Ibrahim M. Seroprevalence of hepatitis B surface antigen among apparently healthy primary school pupils in Batagarawa Local Government area of Katsina State, Nigeria. Niger J Paediatr 2017;44:136-9.
11Sabir OM, Ali AB, Algemaabi O. Pattern of liver diseases in Sudanese children. Sudan J Med Sci 2010;5:285-8.
12Vierucci A, London WT, Blumberg BS, Sutnick AI, Ragazzini F. Australia antigen and antibody in transfused children with thalassemia. Arch Dis Childhood 1972;47:760-5.
13Ikobah J, Okpara H, Elemi I, Ogarepe Y, Udoh E, Ekanem E. The prevalence of hepatitis B virus infection in Nigerian children prior to vaccine introduction into the National Programme on Immunization schedule. Pan Afr Med J 2016;23:128.
14Dar GA, Zarger SA, Jan K, Malik MI, Mir TA, Dar MA. Spectrum of Liver Diseases among Children in Kashmir Valley. Academic Med J India 2014;2:80-6.
15Alam MJ, Ahmed F, Mobarak R, Arefin S, Tayab A, Tahera A, et al. Pattern of liver diseases in children admitted in Dhaka Shishu Hospital. Int J Hepatol 2010;1:18-24.
16Musa B, Bussel S, Borodo MM, Samaila AA, Femi OL. Prevalence of hepatitis B viral infection in Nigeria, 2000-2013: A systematic review and meta-analysis. Niger J Clin Pract 2015;18:163-72.
17Adewole OO, Anteyi E, Ajuwon Z, Wada I, Elegba F, Ahmed P, et al. Hepatitis B and C virus co-infection in Nigerian patients with HIV infection. J Infect Dev Ctries 2009;3:369-75.
18Aba HO, Aminu M. Seroprevalence of Hepatitis B viral serological markers among Nigerian pregnant women. Ann Afr Med 2016;15:20-7.
19Sadoh AE, Sadoh WE. Serological markers of hepatitis B infection in infants presenting for their first immunization. Niger J Paeadiatr 2013;40:248-53.