Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

Hussein Mukasa Kafeero; Dorothy Ndagire; Ponsiano Ocama; Ali Kudamba; Abdul Walusansa; Hakim Sendagire

doi:10.1186/s13690-021-00686-1

Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

Arch Public Health. 2021 Sep 18;79(1):167. doi: 10.1186/s13690-021-00686-1.

Authors

Hussein Mukasa Kafeero^{1

2}, Dorothy Ndagire³, Ponsiano Ocama⁴, Ali Kudamba⁵, Abdul Walusansa⁶, Hakim Sendagire^{6

7}

Affiliations

¹ Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda. [email protected].
² Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda. [email protected].
³ Department of Plant Sciences, Microbiology and Biotechnology, College of Natural Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
⁴ Department of Medicine, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.
⁵ Department of Human Physiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
⁶ Department of Medical Microbiology, Faculty of Health Sciences, Habib Medical School, Islamic University in Uganda, P.O. Box 7689, Kampala, Uganda.
⁷ Department of Medical Microbiology, College of Health Sciences, Makerere University, P.O. Box 7062, Kampala, Uganda.

Abstract

Background: The epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region.

Methods: We examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I² statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg's tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and sub-group analysis at 95% CI. P < 0.05 was considered significant for all analyses.

Results: The prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg's test showed no evidence of publication bias for overall meta-analysis (p > 0.05).

Conclusion: The burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.

Keywords: East Africa; HBsAg; Hepatitis B; Predictors; Prevalence.