Prevalence and factors associated with Hepatitis B and Hepatitis C among patients with liver disease in Mulago Hospital

Abstract

Introduction: Both Hepatitis B and Hepatitis C virus and endemic in Uganda and are known cause of liver disease, including acute hepatitis, chronic hepatitis, liver cirrhosis and hepatocellular carcinoma. Liver disease in one of the leading causes of morbidity and mortality in gastroenterology ward in Mulago Hospital. Patients with liver disease may benefit from identification and treatment of both HBV and HCV because the treatment of these viruses may halt or slow down the progression ot the liver disease and avert mortality. It is possible that hepatitis B and C contribute to etiology of liver disease among patients in Mulago Hospital but we do not know by how much. This study was conducted with the aim of determining the possible contribution of HBV and HCV to etiology of liver disease in Mulago Hospital. Objectives: The main objective of this study to determine the prevalence of HBV and HCV among patients with liver disease on gastroenterology ward and clinic of Mulago Hospital. The other objective was to determine the factor associated with hepatitis B and hepatitis C among patients with liver disease in Mulago Hospital. Study design: This was cross sectional study. Study setting: Gastroenterology and clinic Mulago Hospital Kampala. Methods: All patients with a provisional diagnosis of liver disease on the GE ward or clinic were informed about this study and requested to participate in it. Those patients who agreed to participate in the study were screened for liver disease using a brief history, liver function tests, and abdominal ultra sound and for those with liver masses; serum alpha feto protein or liver biopsy was also done. Those patients that fulfilled the study definitions for acute hepatitis, chronic hepatitis, liver cirrhosis or HCC and met the inclusion criteria were asked to give a written and infonned consent and recruited into the study. For each patient recruited, history was taken, a physical examination done, blood taken off for HBsAg and Hepatitis C antibodies testing. A questionnaire was administered to each patient to assess for selected sociodemographic and behavioral factors and record patient data. Results: One hundred and twenty patients were recruited into the study. The prevalence of HBV among patients with liver disease was 45% while that of possible HCV infection was 4.2%. There was no HBV/HCV co-infection. Younger patients and patients from the northern part of Uganda were more likely to have HBV (p=0.0l and 0.001 respectively). History of blood transfusion and therapeutic cuts were significantly associated with HBV (p=0.047 and 0.009 respectively). Elevated AST was significantly associated with HBV infection (p=0.037). Conclusion: There is a high prevalence of HBV among patients with liver disease especially in the younger patients and in patients from northern part of Uganda. HCV is a much less common infection. Blood transfusion and therapeutic cuts are risk factors that are significantly associated with HBV among patients with liver disease in Mulago Hospital. Recommendation: All patients with liver disease should be routinely tested for HBV and drugs for HBV should be availed to gastroenterology ward and clinic to treat infection. All staff working on gastroenterology should be immunized against HBV. In view of the limited resources, it is not cost effective for now to routinely screen patients with liver disease for HCV infection. However, facilities for testing for markers of active HCV and HCV infections should be made available to improve patient diagnosis and treatment in the national referral Hospital.