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Year : 2019  |  Volume : 22  |  Issue : 7  |  Page : 932-935

Hepatitis B surface antigenemia in two rural communities in Enugu, Nigeria

1 Department of Chemical Pathology, University of Nigeria Teaching Hospital, Enugu, Nigeria
2 Department of Internal Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria

Date of Acceptance25-Mar-2019
Date of Web Publication11-Jul-2019

Correspondence Address:
Dr. I A Meka
Department of Chemical Pathology, College of Medicine/University of Nigeria Teaching Hospital, Ituku/Ozalla, Enugu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/njcp.njcp_108_18

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Background: Hepatitis B virus infection is endemic in Nigeria, yet few data exist about the extent of infection in rural communities. Objective: To determine seroprevalence of hepatitis B surface antigenemia in two rural communities in Nigeria. Methods: A 330-person survey for seroprevalence of hepatitis B surface antigen (HBsAg) was carried out in two rural communities in Enugu State, Nigeria, in January, 2017. All study participants were screened for HBsAg using chromatographic immunoassay. Results: The mean age of participants was 57.2 ± 17.4 years, (range = 10–92 years) with 168 (50.9%) aged 60 years and above. The prevalence of HBsAg was found to be 2.1% with the 18–29 years age group having the highest prevalence. Conclusion: There is need to increase hepatitis B surveillance in rural communities to reduce transmission and institute early treatment.

Keywords: HBsAg, hepatitis, prevalence, rural

How to cite this article:
Meka I A, Onodugo O D, Obienu O, Okite J. Hepatitis B surface antigenemia in two rural communities in Enugu, Nigeria. Niger J Clin Pract 2019;22:932-5

How to cite this URL:
Meka I A, Onodugo O D, Obienu O, Okite J. Hepatitis B surface antigenemia in two rural communities in Enugu, Nigeria. Niger J Clin Pract [serial online] 2019 [cited 2020 May 31];22:932-5. Available from:

   Introduction Top

Hepatitis B infection caused by hepatitis B virus (HBV) is a major disease burden in Nigeria, Africa, and indeed globally. The infection is endemic in Nigeria with a carrier rate of 9.76% (9.59–9.93).[1] It is reported that the highest rates of hepatitis B infection are found in South-East Asia, Sub-Saharan Africa, and parts of the Pacific Basin and Amazon Basin.[2] The virus is hepatotropic and known to cause both acute and chronic infections. The African region has some of the highest prevalence levels for chronic viral hepatitis in the world, with hepatitis B accounting for more than 8%.[3] It contributes significantly to mortality and morbidity as chronic infection may progress to liver cirrhosis and hepatocellular cancer. It is documented that hepatitis B and C infections cause 57% of liver cirrhosis and 78% of primary liver cancer globally.[4]

The incubation period of HBV is 75 days on average but can vary from 30 to 180 days.[5] It may be transmitted from mother to child at birth, through sexual transmission, percutaneous or mucosal exposure to infected blood and other body fluids.[5] Acute infection is marked by the presence of HBsAg and immunoglobulin M antibody to the core antigen (IgM anti-HBc), while chronic infection is characterized by the persistence of HBsAg for at least 6 months.

It is known that rural dwellers hardly have access to optimal healthcare as health facilities in these areas often provide limited services. Ignorance, cost of healthcare services, geographical distance, and cost of transportation are other factors which may hinder rural dwellers from accessing health care in more equipped healthcare facilities especially in developing countries.

Due to the ability of this virus to cause asymptomatic infection, the infectivity of this infection, its high prevalence, and contribution to mortality and morbidity, it is essential for all individuals to know their HBV status. Moreover, much of the available data on prevalence of hepatitis B infection is concentrated around pregnant women, blood donors, and health workers.

Hence, we undertook this study to determine the seroprevalence of hepatitis B surface antigenemia in two rural communities who hardly have access to such screening programs.

   Methods Top

Study area and population

This descriptive cross-sectional study was carried out in January 2017 in Ituku and Ozalla communities in Awgu Local Government Area of Enugu State. Enugu state is a rain forest region situated in the South-East of Nigeria, with a land mass of 7534 km 2 and a population of 3,267,837 as at 2006[6] national population census. The residents of the two communities are mostly of Igbo tribe with farming as their major occupation.

Study design and sample collection

A health outreach program was conducted in the two communities. Advocacy visits were made to the traditional rulers of the two communities and their approval was obtained a week prior to the outreach program. The management of the health center located in the communities where the exercise took place was also contacted and their approval was obtained. The choice of the health centers was essentially due to proximity to the community inhabitants, space, and convenience. Awareness was created through information dissemination in churches and market places.

Apparently healthy consenting individuals who presented for the outreach exercise were recruited after the purpose of the study was explained to them and confidentiality of data assured. Screening was done by trained personnel drawn from the University of Nigeria Teaching Hospital (UNTH), Enugu. Sample collection was carried out by aseptically collecting 4 mL of venous blood by venipuncture into EDTA bottles. This was to allow for repeat testing in case of invalid results. Clear plasma separated from the red cells on standing was then extracted using Pasteur pipette and presence of hepatitis B surface antigen (HBsAg) determined using HBsAg chromatographic immunoassay rapid test strips (Biotest, China). This test was carried out according to the manufacturer's instructions. This test strip has analytical sensitivity of 1 ng/mL of HBsAg, relative sensitivity of 99.2% (95% confidence interval 98.3%–99.7%), and relative specificity of 99.4% (95% confidence interval 98.9%–99.7%). Participants with reactive samples were referred to the gastroenterology unit of UNTH for follow-up while those with nonreactive samples were counseled.

Ethical review

The study proposal was reviewed and approved by the Health Research Ethics Committee of the UNTH. Informed consent was also obtained from prospective participants after explaining the purpose of the study in English or native language. For minors <18 years, consent was obtained from the parents or guardians.

Statistical analysis

Collected data were entered into a Microsoft Excel spreadsheet and analyzed using EpiInfo 3.5.1 (CDC, Atlanta, GA, USA). Continuous variables were summarized as means (±standard deviation) and categorical variables as counts and percentages. Chi-square test was used to compare categorical data. Exact P values are reported as test of statistical significance.

   Results Top

A total of 330 individuals participated in the study with a mean age of 57.2 ± 17.4 years (range = 10–92 years). Majority of the participants 168 (50.9%) were aged 60 years and above. There was a preponderance of female participants with M: F ratio of 1:4.5. Sex and age distribution is as shown in [Table 1].
Table 1: Sex and age distribution of participants

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The prevalence of HBsAg was found to be 7 (2.1%). Prevalence was higher in females [6 (2.2%)] than in males [1 (1.7%)] though this difference was not statistically significant, χ2 = 0.07 (1, N = 330), P = 0.79. The 18–29 years age group had the highest prevalence of 3 (12.0%) as shown in [Table 2].
Table 2: Distribution of prevalence according to age groups

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   Discussion Top

Rural settings in Nigeria are not spared of hepatitis B infections with Nigeria being an endemic country. We recorded a HBsAg prevalence of 2.1% in this study which is comparable to 2.33%[7] and 2.45%[8] recorded in India and Pakistan, respectively. It, however, differs from the prevalence of 8.8%, 7.6%, and 10.6% recorded in rural Vietnam,[9] northern Gabon in Central Africa,[10] and Central African Republic,[11] respectively.

The age distribution showed that the age group 18–29 years had the highest prevalence in this study. This correlates with the study in Lome [12] which recorded the highest prevalence in the age ranges of 20–29 years and lowest prevalence in people more than 50 years of age. It also correlates with a study in Pakistan [13] which noted that the HBV infection rate increased from 13.4% among individuals age 11–20 years to 34.9% among those age 21–30 years. The high prevalence seen in this age group may not be unrelated to the active sexual life and unprotected sexual intercourse frequently engaged in by many individuals in this age group due to peer pressure and youthful exuberance. HIV infection may also be a contributing factor as 3.2 million Nigerians are documented to be living with HIV.[14] Among these, it was reported in 2016 that young people recorded the most prevalence of HIV/AIDs in the country.[15] Coinfection of hepatitis B with HIV has been reported by various researchers.[16],[17]

As seen in our study, 50.9% of the participants were aged 60 years and above. This is in sharp contrast to the 2006 National Census data [18] which recorded that the population of those age 65+ years in Enugu State constituted only 4.5% of the state population. This concentration of elderly people could be attributed to rural–urban migration of younger people and also urban–rural migration of old retirees as common among the indigenes. Hence, rural settings in Nigeria are usually typified by a demographically unbalanced population of women, younger children, and older people.[19],[20]

This remarkably elderly population could contribute to the low prevalence seen in our study as the age group with the highest prevalence forms less than 10% of study participants. Again, in elderly people, death due to hepatitis B cannot be overlooked as it may contribute to the low prevalence. Spontaneous clearance of HBsAg which represents a favorable clinical condition with good prognosis is another important factor as it has been documented that spontaneous clearance of HBsAg is associated with age older than 40 years.[21]

   Conclusion Top

A majority of existing data on hepatitis B infection are hospital-based and concentrated around blood donors, health workers, and pregnant women. Our study throws light on the existence of hepatitis B infection in the rural areas which hardly have access to such surveillance programs. Hence, there is need for government, policy makers, health agencies, and all stakeholders to increase hepatitis B surveillance in rural communities. This is essential to reduce transmission rates, institute early treatment, and prevent disease progression.


The authors thank the Ituku and Ozalla communities, staff of Ituku and Ozalla health centers, and staff of Chemical Pathology of UNTH Enugu for their support and cooperation.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

   References Top

Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013. Lancet 2015;386:1546-55.  Back to cited text no. 1
Lavanchy D. Hepatitis B virus epidemiology, disease burden, treatment, and current and emerging prevention and control measures. J Viral Hepat 2004;11:97-107.  Back to cited text no. 2
Tapko JB, Mainuka P, Diarra-Nama A. Status of blood safety in the WHO African region: Report of the 2004 survey. Brazzaville: World Health Organization Regional Office for Africa; 2009.  Back to cited text no. 3
Perz JF, Armstrong G, Farrington L, Hutin Y, Bell B. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.  Back to cited text no. 4
WHO Hepatitis B Fact Sheet, 2017. Available from: [Last assessed on 2017 Dec 11].  Back to cited text no. 5
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Chaudhary IA, Samiullah, Khan SS, Masood R, Sardar MA, Mallhi AA. Seroprevalence of Hepatitis B and C among the healthy blood donors at Fauji Foundation Hospital, Rawalpindi. Pak J Med Sci 2007;23:64-7.  Back to cited text no. 8
Duong TH, Nguyen PH, Henley K, PetersM. Risk factors for hepatitis B infection in rural Vietnam. Asian Pac J Cancer Prev 2009;10:97-102.  Back to cited text no. 9
Makuwa M, Mintsa-Ndong A, Souquière S, Nkoghé D, Leroy EM, Kazanji M. Prevalence and molecular diversity of hepatitis B virus and hepatitis delta virus in urban and rural populations in Northern Gabon in Central Africa. J Clin Microbiol 2009;47:2265-8.  Back to cited text no. 10
Komas NP, Vickos U, Hubschen JM, Bere A, Manirakiza A, Muller CP, et al. Cross-sectional study of hepatitis B virus infection in rural communities, Central African Republic. BMC Infect Dis 2013;13:286.  Back to cited text no. 11
Kolou M, Katawa G, Salou M, Gozo-Akakpo KS, Dossim S, Kwarteng A, et al. High prevalence of hepatitis B virus infection in the age range of 20 – 39 years old individuals in Lome. Open Virol J 2017;11:1-7.  Back to cited text no. 12
Khan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, et al. Hepatitis B virus infection among different sex and age groups in Pakistani Punjab. Virol J 2011;8:225-9.  Back to cited text no. 13
HIV testing and treatment cascade. Country factsheets Nigeria 2016. Available from: [Last assessed on 2018 Jan 5].  Back to cited text no. 14
Awofala AA, Ogundele OE. HIV epidemiology in Nigeria. Saudi J Biol Sci 2018;25:697-703.  Back to cited text no. 15
Balogun TM, Emmanuel S, Ojerinde EF. HIV, hepatitis B and C viruses' coinfection among patients in a Nigerian tertiary hospital. Pan Afr Med J 2012;12:100.  Back to cited text no. 16
Owolabi LF, Ibrahim A, Musa BM, Gwaram BA, Dutse AI, Hamza M et al. Prevalence and burden of human immunodeficiency virus and hepatitis B virus co-infection in Nigeria: A systematic review and meta-analysis. J AIDS Clin Res 2014;5:308.  Back to cited text no. 17
Enugu (State, Nigeria) – Population Statistics, Charts, Map and Location. Available from: [Last assessed on 2017 Dec 22].  Back to cited text no. 18
Nigeria Rural-Urban Linkages. Available from: [Last assessed on 2017 Jul 27].  Back to cited text no. 19
Osita-Njoku A, Chikere P. Rural-urban migration and the underdevelopment in selected rural communities in Imo State, Nigeria. Br J Educ Soc Behav Sci 2015;10:1-10.  Back to cited text no. 20
Ferreira SC, Chachá SG, Souza FF, Teixeira AC, Santana RC, Villanova MG, et al. Factors associated with spontaneous HBsAg clearance in chronic hepatitis B patients followed at a university hospital. Ann Hepatol 2014;13:762-70.  Back to cited text no. 21


  [Table 1], [Table 2]


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