Impact of Socio-Demographic Characteristics on Acquiring HBV Infection Among Village Midwives in Khartoum State, Sudan, 2014

Background: WHO estimated that 500 000–700 000 people died due to HBV related diseases per year. Objective: To determine the impact of socio demographic characteristics on occurrence of HBV markers among Village Midwifes in Khartoum State, Sudan, 2014.Method:It is a cross-sectional survey. Three hundred thirty five village midwives were studied. Demographic data were collected through a close end questionnaire. Sera were examined, using Eliza, for HBV markers. Statistical package of social sciences (SPSS) version (16) and Chi-Square test were used. Selected level of P value is 0.05Result: Marital status was: married (61.8%), widow (16.4%), divorced (11.3%) and single (4.8%). Level of education: university graduate (0.9%), secondary certificate (9.8%), intermediate (14.2%), primary (50.2%), Quranic School (1.9%) and illiterate (23%). About 65.8% of participants were in age group (30-49), 29.5% in age group of more than 50 years, and 4.6% in age group <30 years. One hundred and thirteen (34%) were positive Anti-HBcore (IgG) reflecting past or on going infection. Fifty seven (57%) of infected respondents were positive HBsAg indicating carrier rate. The overall immunity measured by HBsAb was 8.4%.The tested samples were negative for both HBeAg and Anti-HBcore (lgM).With an exception of the statistical association of duration of work to HBsAb, there is no statistical association between socio-demographic and seroprevalence of HBV markers. Conclusion: Apart from the statistical relation of duration of work to HBsAb, there is no statistical association between seroprevalence of HBV markers and socio-demographic of village midwives in Khartoum State, Sudan.


Background Information
WHO estimated that the cause of death of about 500 000-700 000 people is due to HBV related diseases per year. Ninety four percent of deaths related to chronic HBV infection complications [1,2]. More than 75% of the world's chronic HBsAg carriers are of Asian and African origins [3]. The range of infection rate (positive Anti-HBcore) of HBV in Sudan is 47% to 78%. While carrier rate (positive HBsAg) 6.8% to 26%. So, Sudan considered as one of the countries with a high endemicity [4]. HBV infection is an important occupational hazard for village midwives. They are illiterates and a few of them have basic school education. To our knowledge, in Sudan up to now, there is no published study about seroprevalence of HBV infection specifically among this group. The risk of HBV infection is basically related to the degree of contact with infected blood and body fluids in the workplace and also to the hepatitis B-e antigen (HBeAg) status of the source person. The hepatitis B virus is 50 to 100 times more infectious than HIV. [5]. There is a relationship Village Midwives in Khartoum State, Sudan, 2014 between the endemicity and the age of acquiring HBV infection. About 70-80% occurs perinatally [6].In a study done in Iran, there is no significant statistical association between HBsAg and age, education, place of residency, and duration of work (7). Place of original residency, marital status and age group (30-49) of HCWs are statistically associated with HBV markers. (8). There is a statistical significant relation between hazards of occupation and HBV markers. (9). Duration of work together with sharp instrument injury are occupational hazards (10). In the centre of Sudan 70% of women in the age of child bearing were positive HBsAg [11]. In a study conducted among HCWs in Public Hospitals in Khartoum State, Sudan, prevalence of Anti-Hcore total, HBsAg, and HBeAg in obstetric department is 17.4%, 17.7% and 20.7% respectively. (12)

Objective
To determine the impact of socio demographic characteristics on occurrence of HBV markers among Village Midwifes in Khartoum State, Sudan, 2014.

Study Design
It is a comparative cross-sectional survey.

Study Population
They arevillage midwives who were trained for provision of reproductive health services and licensed their bags in Khartoum State, Sudan, 2013.

Sample Frame
It consists of all village midwives who are providing reproductive health services, for at least the last one year, in Khartoum State, Sudan.

Sampling Technique
Stratified, systematic random sampling

Sample Size
It was calculated using the formula: N=Total number of VMWs in Khartoum State, Sudan d= 5%= 0.05desired margin of error NRR = Non-response rate = 1.8% So, n =329+6 = 335 The sample was distributed among the seven localities proportionately according to the number of village midwives in each of them, as shown in Table 2 below:

Data Analysis
Using Eliza sera of all participants were tested for Anti-HBcore (IgG and IgM), and HBsAb. Positive samples for Anti-HBcore were tested for HBsAg. Positive samples for HBsAg were tested for HBeAg. Data was analyzed using statistical package of social sciences (SPSS) version (16).Chi-square test was used. P value equal or less than 0.05 was considered statistically significant.

Ethical Consideration
Ethically it was approved by the Sudan Medical Specialization Board; then from the Ministry of Health of Khartoum State.At the end each respondent gave a written consent.

Discussion
Hepatitis B virus is one of the blood borne viruses that infect the liver leading to a range of liver damage, ending by cirrhosis and hepatocellular carcinoma. Village Midwives, during their routine work, expose to blood and other body fluids by which HBV can be transmitted. Three hundred and thirty five participants were surveyed in this study. Past or ongoing infection among the study group, measured by Anti-HBcore (IgG), was 34% which was less than that found in other study among Sudanese population [4]. This may be explained by the health education offered to village midwives during their training program. Infection rate of 57% was mentioned among HCWs in Public Teaching Hospitals in Khartoum State, 2011; in a study of a socio-demographic characteristics and hazards analysis within departments and occupations of them showed 73.3% among midwives, such difference may be related to that deliveries at home associated with limited exposure to body fluids. Village Midwives work at home with limited exposure because they only provide services to those live in their catchment's area, in comparison to those working in hospitals where they handle much more clients [8,12]. In this study, with an exception of the statistical relation of duration of work to HBsAb, there is no statistical association between sociodemographic of village midwives and seroprevalence of HBV markers. This does not coincide with a study done among HCWs in Khartoum State, Sudan; where there is a significant statistical association between HBV markers and socio-demographic characteristics [8]. This may be explained by the fact that village midwives are less expose to HBV than HCWs who work in hospitals.

Conclusion
Anti-HBcore (IgG) and HBsAg positively levels are high. The overall immunity measured by HBsAb is low. There is no high infectious or acute infection measured by HBeAg and Anti-HBcore (lgM) respectively among respondents. Apart from the statistical relation of duration of work to HBsAb, there is no statistical association between seroprevalence of HBV markers and socio-demographic of village midwives in Khartoum State, Sudan.