CHAPTER ONE

INTRODUCTION

1.1       Background of the study

Infections due to Hepatitis C viruses (HCV) is significant health problems around the globe. Worldwide, viral hepatitis is the commonest cause of hepatic dysfunction in pregnancy. In our study, the frequency of Hepatitis C virus infections among pregnant women attending antenatal care in Bahir Dar health institutions was 0.6%. This was similar to the study which was conducted from Sudan, (0.6%). All of the HCV positive pregnant women were among secondary trimesters and orthodox religion followers (Elsheikh, Daak, Elsheikh, Karsany, Adam, 2017).

In contrast the prevalence of HCV in our finding was less than the studies conducted from Nigeria (3.6%) (Ugbebor, Aigbirior, Osazuwa, Enabudoso, Zabayo, Ewing, 2011), Cameron (1.9%) (6.4%) (Njouom, Pasquier, Ayouba, Sandres-Saune, Mfoupouendoun, Lobe, Tene, Thonnon, Izopet, Nerrienet, 2013), Egypt (Kamal, Zahran, Mohamad, Badary, Michael, Agban, Nafesa and Abdel, 2012) and Gondar, Ethiopia (1.3%) (Tiruneh, 2016). These discrepancies might not be disparate with the fact that some of the studies were not from the same risk group and some of the them were done with the detection of both hepatitis C virus RNA and anti HCV antibody, which was Anti HCV antibody detection only in case of our study. This may loss the acute infections before antibody production (Kesson, 2015). None of the expected risk factors (history of blood transfusion, sugery, dental manipulations, tattooing circumcision etc. and other socio-demographic factors) for sero-positivity of HCV had been identified in the study. This might be due to the small sample size we used. Moreover in similar studies reported at Nigeria and Sudan, these expected risk factors were not associated for the positivity of HCV. The explanations for such observations need to be addressed in the future (Ugbebor, Aigbirior, Osazuwa, Enabudoso, Zabayo, Ewing, 2011).

Onwere, Kamanu, Chigbu, Okoro, Ndukwe, Akwuruoha, Ndukwe and Onwere, (2011) and found out that twelve (1.5%) of the 820 antenatal clinic attendees were found to be HCV positive and asymptomatic. History of having received blood transfusion in the past was associated with HCV seropositivity (p<0.05). Maternal age, parity, educational level attained, marital status. Intravenous drug use, tattooing or jaundice in the past and Human Immunodeficiency Virus positivity did not show any association with HCV seropositivity. Onwere, Kamanu, Chigbu, Okoro, Ndukwe, Akwuruoha, Ndukwe and Onwere, (2011) concluded that HCV seropositive pregnant women in the study were asymptomatic and showed no association with the medical and sociodemographic characteristics examined except with a history of having received blood transfusion in the past. This strengthens the case for routine HCV screening in pregnancy in our setting.

Clement, Andy, Eni and Jewell, (2010) worked on the prevalence, sociodemographic characterestics and risk factors for hepatitis C infection among pregnant women in Calabar municipality and the results showed that a total of 6.1% (22/360) of pregnant women were HCV seropositive; of them only 45% (9/20) had viraemia. Risk factors were their age, the age of their husband and the presence of chronic liver disease in the husband.  Clement, Andy, Eni and Jewell, (2010) concluded that the rate of HCV infection in pregnant women in Nigeria appears to be lower than previously reported. The detected risk factors are old age of the pregnant women and their husbands, and chronic liver disease in the husbands. None of the other known risk factors was found to be significantly associated with HCV infection in pregnant women.

1.2       Statement of the problem

The global prevalence of hepatitis C virus (HCV) infection was estimated between 1.2 and 3.8% according to World Health Organization (WHO) Global Burden Disease (GBD), with more than 185 million people infected worldwide ( Khayriyyah, Groeger and  Flaxman, 2013). A study conducted in specific sub-Saharan African countries estimated a high prevalence of HCV (6.0%) in central African countries. In North Africa, Egypt has the highest HCV prevalence (17.5%) followed by Morocco (7.7%) (Madhava, Burgess and Drucker, 2002).

More disturbingly, the prevalence of HIV among pregnant women in Botswana remains at 45%, while in Nigeria, the most populous country in Africa, the HIV prevalence among pregnant women is 5.6% as at 2004 sentinel report (Federal Ministry of Health Nigeria, 2014). However, while prevalence of either HIV or HCV has been chronicled among pregnant women in different parts of the world, little information exist for the prevalence of HIV and HCV co-infection among pregnant women in Nigeria. Therefore we hypothesize that HIV and HCV co-infection may be present in pregnant women seeking antenatal care in Benin City.

1.3       Objective of the study

The general objective of this study is to determine the prevalence of hepatitis c virus among pregnant women people living with HIV/AIDs attending clinic in UNTH Ituku-ozalla.

The specific objectives are:

    To determine the prevalence of hepatitis C virus in pregnant women attending ante-natal in UNTH Ituku-ozalla

    To determine the age distribution where the infection occurs most

    To determine the prevalence of hepatitis virus in people living with HIV and AIDS attending UNTH Ituku-ozalla

    To determine hepatitis C Virus infection associated factors among pregnant women attending ante-natal clinics in UNTH Ituku-ozalla

    HEPATITIS C VIRUS AMONG PREGNANT WOMEN/PEOPLE LIVING WITH HIV/AIDS (CASE STUDY OF CLINIC AT UNTH ITUKUOZALLA)