Weighted analysis of prevalence and risk factors of hepatitis B infection among antenatal mothers in Ipoh

[Guest guest]

Singapore Med J 2010; 51(10) : 800

Department of

Community Health,

Faculty of Medicine,

Universiti Kebangsaan

Malaysia,

Cheras,

Kuala Lumpur 56000,

Malaysia

Shamsuddin K, MBBCh,

MPH, DrPH

Professor

Marmuji LZ, MBBS,

FRACGP, MMed

Postgraduate Student

Correspondence to:

Dr Khadijah Shamsuddin

Tel: (603) 9145 5894

Fax: (603) 9145 6670

Email: khadijah@

ppukm.ukm.my

Weighted analysis of prevalence and risk

factors of hepatitis B infection among

antenatal mothers in Ipoh

Shamsuddin K, Marmuji L Z

ABSTRACT

Introduction: Several strategies have been

developed to reduce hepatitis B infections. These

include antenatal screening, universal immunisation

of newborns and immunoglobulin therapy for babies

who are at risk. Antenatal screening for hepatitis B is

not routinely performed, but all newborns in Malaysia

are immunised against hepatitis B. We assessed the

prevalence of hepatitis B and the factors associated

with it among antenatal mothers in Ipoh. This

information is useful in decision-making for future

hepatitis B screening programmes for antenatal

mothers, allowing for immunoglobulin therapies for

newborns if their mother’s hepatitis B virus (HBV)

status is known.

Methods: A cross-sectional study of 1,105 antenatal

mothers who attended government health clinics in

Ipoh was conducted between July 2008 and October

2008. The participants were asked to complete a

self-administered questionnaire, and their hepatitis

B surface antigen status was ascertained.

Results: A total of 7,172 registered births and 97

HBV carriers were included in the weighted analysis.

It revealed that none of the high-risk behaviours

explored was significantly associated with HBV

infection. Multivariate analysis showed age 35

years and above, multigravida (having two or more

pregnancies), a positive history of blood transfusion

and a family history of HBV to be significant factors

associated with HBV infections.

Conclusion: The weighted prevalence of HBV

infection among antenatal mothers in Ipoh was 1.35

percent. A risk-based screening programme related

to past medical and family history may be useful since

these two factors are associated with HBV infection.

Keywords: antenatal screening, hepatitis B,

prevalence, risk factors, weighted analysis

Singapore Med J 2010; 51(10): 800-805

INTRODUCTION

The World Health Organization (WHO) has reported

that there were more than two billion carriers and 350

million chronic carriers of the hepatitis B virus (HBV)

worldwide in 2002.(1) The Malaysian Liver Foundation

noted that in 1998, there were about 1.1 million people

with chronic HBV infection in Malaysia.(2) In endemic

areas like East Asia, Southeast Asia, the Pacific Isles

and Africa, the commonest mode of infection is vertical

transmission from mother to child.(3) If no preventive

actions are taken, the risk of vertical HBV transmission

is as high as 90%.(4) A study by Wonke et al also found

that about 80%–90% of HBV carrier mothers would

infect their newborns.(5)

Viral transmission during delivery is evident

because of the direct relationship between hepatitis B

surface antigen (HBsAg) titre in the mother’s blood

and the incidence of antigenaemia in the newborn.(6)

There is also a strong correlation between the presence

of hepatitis B e-antigen (HBeAg) in the mother’s blood

and HBsAg in the newborn. All newborns of HBeAg

carrier mothers will become chronic HBV carriers

in the future.(4,6) A national universal immunisation

programme for newborns was implemented in Taiwan

in 1984. This programme succeeded in reducing the

prevalence of HBV among children below the age of 15

years, from 9.8% in 1984 to 1.3% in 1994.(7) The success

of this antenatal screening programme also contributed

to the decrease in the prevalence rate of HBV. Taiwanese

mothers who are identified as HBsAg or HBeAg carriers

now have their babies immunised and administered with

immunoglobulin treatment immediately after birth.(8)

The risk of chronic HBV infection for these babies has

reduced from 90% to 10%–15%.(9)

The prevalence of HBV infection in Malaysia is

4.7%.(2) A descriptive study investigating the prevalence

of HBV infection among antenatal mothers was

conducted by the Hospital Tengku Ampuan Rahimah

Kelang in 1987. This study assessed the specific hepatitis

B viral markers as well as age, ethnicity and locality

differences among antenatal mothers who were found

to be HBV carriers. The study involved 2,000 healthy

asymptomatic antenatal mothers attending both rural

and urban antenatal clinics in coastal Selangor. The

results showed a prevalence of 3.9% of HBV carriers in

the study population.(10) Our study aimed to determine

the prevalence of HBV and to specifically examine

the association of sociodemographic and reproductive

factors, family and medical history, as well as high-risk

behaviours with hepatitis B infection among antenatal

mothers in Ipoh.

[Guest guest]

Singapore Med J 2010; 51(10) : 800

Department of

Community Health,

Faculty of Medicine,

Universiti Kebangsaan

Malaysia,

Cheras,

Kuala Lumpur 56000,

Malaysia

Shamsuddin K, MBBCh,

MPH, DrPH

Professor

Marmuji LZ, MBBS,

FRACGP, MMed

Postgraduate Student

Correspondence to:

Dr Khadijah Shamsuddin

Tel: (603) 9145 5894

Fax: (603) 9145 6670

Email: khadijah@

ppukm.ukm.my

Weighted analysis of prevalence and risk

factors of hepatitis B infection among

antenatal mothers in Ipoh

Shamsuddin K, Marmuji L Z

ABSTRACT

Introduction: Several strategies have been

developed to reduce hepatitis B infections. These

include antenatal screening, universal immunisation

of newborns and immunoglobulin therapy for babies

who are at risk. Antenatal screening for hepatitis B is

not routinely performed, but all newborns in Malaysia

are immunised against hepatitis B. We assessed the

prevalence of hepatitis B and the factors associated

with it among antenatal mothers in Ipoh. This

information is useful in decision-making for future

hepatitis B screening programmes for antenatal

mothers, allowing for immunoglobulin therapies for

newborns if their mother’s hepatitis B virus (HBV)

status is known.

Methods: A cross-sectional study of 1,105 antenatal

mothers who attended government health clinics in

Ipoh was conducted between July 2008 and October

2008. The participants were asked to complete a

self-administered questionnaire, and their hepatitis

B surface antigen status was ascertained.

Results: A total of 7,172 registered births and 97

HBV carriers were included in the weighted analysis.

It revealed that none of the high-risk behaviours

explored was significantly associated with HBV

infection. Multivariate analysis showed age 35

years and above, multigravida (having two or more

pregnancies), a positive history of blood transfusion

and a family history of HBV to be significant factors

associated with HBV infections.

Conclusion: The weighted prevalence of HBV

infection among antenatal mothers in Ipoh was 1.35

percent. A risk-based screening programme related

to past medical and family history may be useful since

these two factors are associated with HBV infection.

Keywords: antenatal screening, hepatitis B,

prevalence, risk factors, weighted analysis

Singapore Med J 2010; 51(10): 800-805

INTRODUCTION

The World Health Organization (WHO) has reported

that there were more than two billion carriers and 350

million chronic carriers of the hepatitis B virus (HBV)

worldwide in 2002.(1) The Malaysian Liver Foundation

noted that in 1998, there were about 1.1 million people

with chronic HBV infection in Malaysia.(2) In endemic

areas like East Asia, Southeast Asia, the Pacific Isles

and Africa, the commonest mode of infection is vertical

transmission from mother to child.(3) If no preventive

actions are taken, the risk of vertical HBV transmission

is as high as 90%.(4) A study by Wonke et al also found

that about 80%–90% of HBV carrier mothers would

infect their newborns.(5)

Viral transmission during delivery is evident

because of the direct relationship between hepatitis B

surface antigen (HBsAg) titre in the mother’s blood

and the incidence of antigenaemia in the newborn.(6)

There is also a strong correlation between the presence

of hepatitis B e-antigen (HBeAg) in the mother’s blood

and HBsAg in the newborn. All newborns of HBeAg

carrier mothers will become chronic HBV carriers

in the future.(4,6) A national universal immunisation

programme for newborns was implemented in Taiwan

in 1984. This programme succeeded in reducing the

prevalence of HBV among children below the age of 15

years, from 9.8% in 1984 to 1.3% in 1994.(7) The success

of this antenatal screening programme also contributed

to the decrease in the prevalence rate of HBV. Taiwanese

mothers who are identified as HBsAg or HBeAg carriers

now have their babies immunised and administered with

immunoglobulin treatment immediately after birth.(8)

The risk of chronic HBV infection for these babies has

reduced from 90% to 10%–15%.(9)

The prevalence of HBV infection in Malaysia is

4.7%.(2) A descriptive study investigating the prevalence

of HBV infection among antenatal mothers was

conducted by the Hospital Tengku Ampuan Rahimah

Kelang in 1987. This study assessed the specific hepatitis

B viral markers as well as age, ethnicity and locality

differences among antenatal mothers who were found

to be HBV carriers. The study involved 2,000 healthy

asymptomatic antenatal mothers attending both rural

and urban antenatal clinics in coastal Selangor. The

results showed a prevalence of 3.9% of HBV carriers in

the study population.(10) Our study aimed to determine

the prevalence of HBV and to specifically examine

the association of sociodemographic and reproductive

factors, family and medical history, as well as high-risk

behaviours with hepatitis B infection among antenatal

mothers in Ipoh.