Saudi Journal of Gastroenterology
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ORIGINAL ARTICLE Table of Contents   
Year : 2007  |  Volume : 13  |  Issue : 2  |  Page : 81-83
Prevalence of hepatitis B virus infection in the Gezira State of Central Sudan


1 Department of Internal Medicine, University of Khartoum, Khartoum, Sudan
2 Institute of Liver Studies, Kings College Hospital, London, United Kingdom
3 Department of Internal Medicine, University of Gezira, Gezira, Sudan

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   Abstract 

Aim: This is a cross-sectional study to determine the prevalence and risk factors for transmission of hepatitis B virus (HBV) infection in the Gezira state of central Sudan prior to the introduction of blood screening and vaccination against HBV. Materials and Methods: The study was carried out on the population of Um Zukra village in Gezira state of Central Sudan. The village was surveyed on five consecutive days in Dec 2000. Epidemiological characteristics were recorded and participants were interviewed for risk factors of viral hepatitis. Blood samples were then collected and tested for HBsAg and HBcAb. Results: A total of 404 subjects were screened with a mean age of 35 years; 54.9% were females, HBsAg and HBcAb were reactive in 6.9% and 47.5% of the studied population, respectively. Exposure to HBV increased with increasing age. The only significant risk factor for transmission of infection was a history of parenteral antischistosomal therapy. Conclusion: This study shows that prevalence of HBV infection is high in the studied population and it is hoped that introduction of blood screening and vaccination against HBV would decrease the carrier pool in the next few years.

Keywords: Hepatitis B virus, risk factors, vaccination.

How to cite this article:
Mudawi H, Smith H M, Rahoud S A, Fletcher I A, Saeed O K, Fedail S S. Prevalence of hepatitis B virus infection in the Gezira State of Central Sudan. Saudi J Gastroenterol 2007;13:81-3

How to cite this URL:
Mudawi H, Smith H M, Rahoud S A, Fletcher I A, Saeed O K, Fedail S S. Prevalence of hepatitis B virus infection in the Gezira State of Central Sudan. Saudi J Gastroenterol [serial online] 2007 [cited 2019 Feb 19];13:81-3. Available from: http://www.saudijgastro.com/text.asp?2007/13/2/81/32182


Hepatitis B virus (HBV) infection is a major health problem causing considerable morbidity and mortality from both acute infection and chronic sequelae including chronic hepatitis, cirrhosis and hepatocellular cancer. More than 2 billion people show evidence of past or current HBV infection and over 350 million people are chronic carriers worldwide. Three quarters of the world's population lives in areas with high levels of infection. Sudan is classified among the countries with high HBV endemicity. [1] Screening of blood and blood products for HBV was only introduced to blood banks throughout the country in 2002, before which, screening was only performed in a very few centers in the capital, Khartoum. Vaccination for HBV was included as part of the extended program of immunization in 2005. Our study objectives were to determine the prevalence and risk factors for transmission of HBV infection prior to the introduction of blood screening and HBV vaccination in a village in the Gezira state of central Sudan, an area endemic for schistosomiasis and malaria.


   Materials and Methods Top


Study area

This study was carried out in the population of Um Zukra village in the Managil province, Gezira state of Central Sudan. The village is about 350 km south of Khartoum, the capital and 110 km west of Wad Medani town. The Gezira and Managil irrigation system is spread over an area of about two million acres cultivated with cotton and other crops, populated by approximately 1.5 million individuals and is an area highly endemic for schistosomiasis and malaria. [2] The study area was selected due to the high prevalence of S. mansoni infection. Random stool samples were taken from different villages in the Gezira state and examined for S. mansoni eggs. The highest prevalence (70%) was found in Um Zukra village. According to a census performed in 1999, the population of Um Zukra is approximately 4000 individuals.

The village is surrounded by a cultivated area and the canal is at a distance of only 450 meters from the center of the village. There are two water pumps (wells) used for drinking water, the other water source for washing and bathing is the canal. The village was surveyed on five consecutive days in December 2000 when all the villagers appearing in the study site were enrolled after individual informed consent was obtained. Three physicians interviewed the participants and completed a questionnaire with basic demographic data including age, gender and potential risk factors for the transmission of HBV infection such as previous personal history of jaundice, surgery, dental treatment, parenteral antischistosomal therapy and blood transfusion. Patients were also examined for the presence of tattoos / scarification. The study was approved by the medical research board of the University of Khartoum.

Serological analysis

10 ml blood samples were drawn from each subject; sera were separated, aliquoted, labeled within 6 h of collection and stored at -70șC. The sera were analyzed at the Institute of Liver Studies, Kings College Hospital in London where all samples were tested for HBsAg and HBcAb using ELISA tests (IMX HBsAg (V2) and AxSYM HBV core antigen recombinant, Abbott).

Statistical analysis

The χ2 test with Yates' correction was used to compare proportions. Odds ratios (OR) with 95% confidence intervals (95% CI) were calculated either directly or by the Mantel-Haenszel method for stratified OR.


   Results Top


A total of 404 subjects were included in the study, the mean age being 35 years with an age range of 8-90 years. 54.9% of the subjects were female, 51.2% had a history of jaundice, 30.7% had dental treatment, 18.8% received parenteral antischistosomal therapy, 11.2% had a previous history of surgery, 5.1% received a blood transfusion and 2.7% had a tattoo / scarification on examination [Table - 1]. HBsAg was reactive in 6.9% of subjects; there was no statistically significant difference regarding infection rate in different age groups [Table - 2]. HBcAb was reactive in 47.5%. Exposure to HBV infection was highest in those over the age of 50 years (68%) and lowest in those under the age of 10 years (12.5%) [Table - 3]. The only significant risk factors for HBV exposure were a previous history of parenteral antischistosomal therapy and increasing age [Table - 1],[Table - 3].


   Discussion Top


The prevalence of HBV infection in this study is less than that reported in previous studies from Sudan where HBsAg and all HBV markers were reactive in 14% and 68% of cases respectively. [3],[4] The risk of acquiring chronic HBV infection were not statistically significant among different age groups. This is different from results from countries such as Saudi Arabia [5] and countries in South East Asia where a large percentage of chronic carriers were noted to be children and which had resulted from perinatal transmission. [6] Almost half the population screened had evidence of exposure to HBV in concordance with previous studies from Sudan. [3],[4] A significant risk factor for infection in this study as well as in a previous study conducted in Sudan [3] was prior exposure to parenteral antischistosomal therapy; a practice abandoned in 1980 after introduction of oral antischistosomal therapy. Introduction of HBV vaccination in children and screening of blood and blood products should reduce the rate of HBV infection in this country. Mass vaccination programs for HBV in infants and school children in Saudi Arabia have resulted in significant rates of drop in overall HBsAg seroprevalence from 6.7% to 0.7% and of HBcAb seroprevalence from 4.2% to 0.46% over a period of eight years. [7]


   Conclusion Top


It can be concluded that prevalence of HBV infection is high in the studied population. Hopefully, introduction of blood screening and vaccination of infants against HBV should reduce the HBV infection carrier pool and eventually prevent infection in both children and adults over the next few years. A repetition of a similar survey after 10 years should be made in order to measure such a reduction and monitor the effectiveness of the screening and vaccination program.

 
   References Top

1.Expanded program on immunization, hepatitis B vaccine, making global progress. EPI update, WHO: October 1996.  Back to cited text no. 1    
2.el Gaddal AA. The Blue Nile Health Project: A comprehensive approach to the prevention and control of water-associated diseases in irrigated schemes of the Sudan. J Trop Med Hyg 1985;88:47-56.  Back to cited text no. 2  [PUBMED]  
3.McCarthy MC, Burnas JP, Constantine NT, el Hag AA, el Tayeb ME, el Dabi MA, et al . Hepatits B and HIV in Sudan: A serosurvey for hepatits B and HIV antibodies among sexually active heterosexuals. Am J Trop Med Hyg 1989;41:726-31.  Back to cited text no. 3    
4.Hyams KC, al Arabi MA, al Tagani AA, Messiter JF, al Gaali AA, George JF. Epidemiology of hepatitis B in the Gezira region of Sudan. Am J Trop Med Hyg 1989;40:200-6.  Back to cited text no. 4    
5.al-Faleh FZ, Ayoola EA, Arif M, Ramia S, al-Rashed R, al-Jeffry M, et al . Seroepidemiology of hepatitis B virus infection in Saudi Arabian children: A baseline survey for mass vaccination against hepatitis B. J Infect 1992;24:197-206.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]
6.Stevens CE, Beasley RP, Tsui J, Lee WC. Vertical transmission of hepatitis B antigen in Taiwan. N Engl J Med 1975;292:771-4.  Back to cited text no. 6  [PUBMED]  
7.Al-Faleh FZ, Al-Jeffri M, Ramia S, Al-Rashed R, Arif M, Rezeig M, et al . Seroepidemiology of hepatitis B virus infection in Saudi children 8 years after a mass hepatitis B vaccination programme. J Infect 1999;38:167-70.  Back to cited text no. 7  [PUBMED]  

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Correspondence Address:
HMY Mudawi
P. O. Box 2245, Khartoum
Sudan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1319-3767.32182

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    Tables

  [Table - 1], [Table - 2], [Table - 3]

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