Risk Factors for Horizontal Transmission of Hepatitis B Virus in a Rural District in Ghana

• Published in: American journal of epidemiology 1998-03, Vol.147 (5), p.478-487
• Main Authors: Martinson, Francis E. A., Weigle, Kristen A., Royce, Rachel A., Weber, David J., Suchindran, Chirayath M., Lemon, Stanley M.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Africa; Aged; Biological and medical sciences; Child; Child Welfare; Child, Preschool; disease transmission; Disease Transmission, Infectious; Family Characteristics; Female; Ghana - epidemiology; Hepatitis Antibodies - analysis; Hepatitis B - transmission; hepatitis B surface antigen; Hepatitis B virus; Hepatitis B virus - immunology; horizontal; Human viral diseases; Humans; Infant; Infectious diseases; Male; Medical sciences; Middle Aged; Population; Prevalence; Risk Factors; Rural Health; Tropical medicine; Viral diseases; Viral hepatitis
• ISSN: 0002-9262; 1476-6256
• DOI: 10.1093/oxfordjournals.aje.a009474

Most hepatitis B virus (HBV) infections in sub-Saharan African infants and children are acquired through horizontal transmission, but the exact mechanisms of spread have not been documented. The authors conducted a study in rural Ghana which determined seroprevalence in a probability sample of 1.385 individuals of all ages, and evaluated risk factors for horizontal transmission of HBV in a subsample of 547 children aged 1–16 years who were not hepatitis B surface antigen (HBsAg) carriers. Most residents in this district live in compounds which typically contain 2–4 households each. Overall prevalence of HBV seropositives (any HBV marker) was 74.7% (95% confidence interval (CI) 72.5%-76.9%). Prevalence of HBsAg was 20.9% (95% CI 18.8%-23.1%). The data suggest a continous nonuniform acquisition of HBV infection with advancing age predominantly through horizontal transmission in childhood, with the household, rather that the domestic compound, being the primary place for transmission. The behaviours most strongly associated with prevalence of HBV were sharing of bath towels (OR = 3.1, 95% CI 2.10-4.5), sharing of chewing gum of partially eaten candies (OR = 3.4, 95% CI 2.3-5.0), sharing of dental cleaning materials (OR = 2.5, 95% CI 1.3-4.6), and biting of fingemails in conjuction with scratching the backs of carriers (OR = 2.5, 95% CI 1.6-4.3) Am J Epidemiol 1998; 147:478–87.