Introduction

Hepatitis is an inflammatory liver disease that is mostly caused by viral infection. Hepatitis B and C virus (HBV and HCV) infections are responsible for a significant percentage of liver diseases globally1. Hepatitis B virus (HBV) is a DNA virus that is part of the Hepadnaviridae family, which is made up of a distinct kind of DNA genomic virus. HCV is an RNA virus that is a member of the Flaviviridae family of viruses. The infection with HBV may spontaneously resolve and lead to protective immunity, chronic infection, and, in rare cases, acute liver failure with a high risk of death. An infection with HCV becomes chronic in most cases. People who have a long-term infection with HBV, HCV, or both are still contagious with the risk of developing life-threatening liver conditions including cirrhosis or heptocellular carcinoma (HCC)2,3.

Around one-third of the world's population has been exposed to HBV and an estimated 350–400 million people are chronically infected2,4. Approximately 350 million individuals have been infected with HBV and each year, an estimated 1 million persons die from chronic complications of the disease. Although chronic HBV infection has a worldwide distribution, the vast majority of infected persons reside in Asia, the Middle East, and Africa Globally, cirrhosis, liver cancer, and chronic HBV infection are thought to be the causes of 1.2 million annual deaths5. In Ethiopia, a nation in Africa, hepatitis B surface antigen (HBsAg) prevalence ranges from 6 to 12% in both adults and children. Furthermore, 31% of deaths on medical wards and 12% of hospital admissions are related to liver cirrhosis, hepatocellular carcinoma, acute and chronic viral hepatitis6,7.According to estimates from the World Health Organisation (WHO), 120–170 million persons worldwide are expected to be infected with HCV, representing 3% of the global population8,9.

There is a noticeable regional variance in the frequency and incidence of both HBV and HCV; it may be due to inadequate health facilities, low socioeconomic status, and a lack of public awareness regarding the spread of serious infectious diseases10. Patients with acute or persistent infection have a well-documented phenomenon where HCV suppresses HBV replication. The titer of serum HBsAg was significantly reduced in chimpanzees used in an in vivo study demonstrating acute HCV superinfection in chronic HBV infection11,12. The routes of transmission of HBV and HCV are similar, and co-infection with both viruses is frequent, particularly in regions where HBV infection is endemic and in individuals who are at a high risk of contracting parenteral infection13.

The hepatitis B and hepatitis C viruses have a common mode of transmission that can be spread by the transfusion of contaminated blood, the use of contaminated devices during medical operations, and other risky behaviors. High-efficiency transmission routes for HBV also include perinatal and sexual exposure14. Patients with dual HBV and HCV infection have more severe liver disease and are at increased risk of progression to HCC13. Most persons infected with HBV as adults will recover fully, however, most people infected with HBV as children will develop chronic infection2.

In general, a substantial rate of infection has been repeatedly demonstrated in patients with clinical suspicion of HBV and HCV. Little is known about the prevalence of hepatitis infection in developing countries like Ethiopia. There is a lack of awareness among carers regarding the severity of this disease. Thus this study was conducted to determine the Seroprevalence of HBsAg and anti-HCV antibodies among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia.

Materials and methods

Study design, area, and period

A hospital-based retrospective study was conducted at Guhala Primary Hospital, North-West Ethiopia, from September 1st, 2017 to August 30, 2021. Guhala is the capital town of East Belesa, located northwest of Addis Ababa (the capital city of Ethiopia), which is 718 km away. Guhala town has an estimated total population of 148,758, of whom 75,732 were males and 73,026 were females. The town has only one public primary hospital, one health center, one health post, and four private health facilities. Guhala Primary Hospital is the only public hospital in east Belesa woreda. Today, the hospital is providing health services to a total population of about 148,758. The data collection period was from July to September 2022.

Study population, sample size, and sampling technique

The source populations were all patients who visited Guhala Primary Hospital and their HBV and HCV test results were registered in the serology Laboratory Logbook. The study population was all patients who had been suspected of having HBV and HCV infection and whose HBV and HCV results were registered in the serology Laboratory registration logbook for the last four years. Data showed HBV and HCV statuses, years, ages, and sex were included in this study. Patient information with incomplete socio-demographic characteristics, and test results in the log book was excluded.

Data collection and tools

We collected data from hepatitis B and C suspected clients' serology Laboratory registration logbooks using a structured checklist. Patient information, including age, sex, laboratory results, and year of diagnosis, was obtained from the serology laboratory registration logbooks.

Quality control

We used different methods to ensure that the collected data had the required quality. For instance, we used a structured data collection checklist and regular communication with the hospital staff working at the serology laboratory. HBsAg and anti HCV positive clients’ serum was rechecked using ELISA by Amhara Public Health Institute referral laboratory in Bahir Dar. Finally, we checked the collected data, cleaned it manually, and entered SPSS version 2 for analysis.

Laboratory methods

About 5 ml of venous blood was collected from each study participant. Then, the serum was separated by centrifugation at 5000 RPM for 15 min and tested for HBsAg and anti-HCV using a one-step HBsAg test strip (Nantong Diagnosis Technology Co., Ltd., China) and a one-step HCV test strip (Nantong Diagnosis Technology Co., Ltd., China), respectively by following the manufacturer instructions. The sensitivity and specificity of rapid test kits of HBsAg and one-step HCV test strips were 99.1% and 99.6%, respectively.

Data processing and analysis

All participants’ information and laboratory data were entered and then analyzed using SPSS version 26 (IBM Corp., Armonk, NY). Descriptive analysis was used to describe and calculate the frequencies and percentages of variables. A chi-square test of proportions was used to identify a significant difference between variables, and a p-value < 0.05 was considered statistically significant.

Ethics approval and consent to participate

Ethical approval was obtained ethical clearance from the University of Gondar; School of Biomedical and Laboratory Sciences ethical review committee with reference number SBMLS/2934/2022. We conducted the study by following the Declaration of Helsinki. Before data collection, we explained the study objectives to the heads of the hospital director and the serology laboratory personnel. Due to the nature of this retrospective study and the preserved anonymity of patients, a waiver of informed consent was obtained. The waivers of informed consent were the University of Gondar; School of Biomedical and Laboratory Sciences and Guhala primary hospital. To ensure the confidentiality of information from the participant’s records, we didn’t record any personal identifiers on the data collection sheet, and secured data from participant records were not available to anyone except for the investigators15.

Results

Socio-demographic characteristics of study participants

In the past four years (2017–2021), a total of 883 study participants were suspected of HBV, and all of them were given blood samples at the Guhala Primary Hospital serology laboratory. Most of them, 473 (53.6%) were females. The age of patients ranges from one to eighty-five years and the mean age of the patients was 30.7 years (± 14.6 SD). Most of the samples were tested in 2019 (41.7%), followed by 2021 (28.7%) and 2018 (20.5%). The majority of the samples came from patients between the ages of 21 and 30 (38.8%), followed by those the age between 1 and 20 (24.5%), and those the ages of over 40 (19.9%). On the other hand in the past 5 years (2017–2021), a total of 366 blood samples were collected and tested from HCV-suspected study participants at the Guhala Primary Hospital serology laboratory. Most of them, 221 (60.4%) were males (Table 1).

Table 1 Socio-demographic characteristics of study participants screened for HBV and HCVat Guhala Primary Hospital, North-West Ethiopia from 2017 to 2021.
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Sero-prevalence of HBV and HCV infections

In this study, the overall prevalence of HBsAg and anti-HCV were 124/883 (14%) and 73/366 (19.9%), respectively. Among the study participants, the positivity rate of HBsAg was 17.1% (70/410) among males and 54/473 (11.4%) females. Additionally, Out of the total HCV screening samples, 53/366 (14.4%) males, and 20/366 (5.5%) females were positive for hepatitis C, respectively. The prevalence of Hepatitis B virus was higher among individuals aged between 31 to 40 years old 33/148 (22.3%) followed by individuals aged > 40 years old 29/176(3.3%). On the other hand, the prevalence of hepatitis C virus was high among the age group > 40 years old 25/93(6.8%) followed by 31–40 years old 14/70 (3.8%). Of HBV and HCV mixed-infected 14 (3.8%) study participants, 3% were males and 0.8% were females. The majority of Coinfected study participants were 31–40 years old 7 (1.9%). Moreover, the highest prevalence of HBV was seen by the year of 2019, and also the highest prevalence of HCV was seen by the year of 2018, While, the lowest prevalence of HBV and HCV was seen in the year of 2020 (Table 2, Fig. 1).

Table 2 Prevalence of HBsAg and anti-HCV antibodies among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia, from 2017 to 2021.
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Fig. 1
figure 1

The trends of HBsAg and anti-HCV antibodies among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia, from 2017 to 2021.

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Factors associated with hepatitis B virus infections

Multivariate logistic regression was performed to account for possible confounding variables and all variables with a P-value < 0.2 in the bivariate analysis were included in the multivariate logistic regression analysis. Accordingly, the adjusted odds ratio was calculated between different age groups and sex and HBV infection. According to bivariate analysis being female and age showed an association with hepatitis B virus infection and transported to multivariate analysis. Based on the multivariable logistic regression model, females were 1.53 times more likely (AOR 1.53; 95% CI 1.03, 2.27) to be infected with HBV than males. furthermore, participants who were in the age group of 31–40 years were two times more likely (AOR 2.85; 95% CI 1.56, 5.17) to be infected with HBV than those who were in the age group 21–30 years (Table 3).

Table 3 Factors associated with HBsAg and anti-HCV antibodies among clinically suspected cases of viral hepatitis visiting Guhalla Primary Hospital, Northwest Ethiopia, from 2017 to 2021.
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Factors associated with HCV infection

In the multivariable logistic regression analysis, females were around two times more likely (AOR 1.97; 95% CI 1.10, 3.53, p = 0.02) to be infected with HCV than males. Additionally, study participants who were in the age group of 21–30 years were 2.7 times more likely (AOR 2.71; 95% CI 1.15, 6.40, p = 0.02) and age group of greater than 40 years were three times more likely (AOR 3.13; 95% CI 1.31, 7.44, p = 0.01) to be infected with HCV than those who were in the age group less than 20 years (Table 4).

Table 4 Factors associated with HCV among viral hepatitis suspected patients visiting Guhala Primary Hospital North West Ethiopia, From 2017 to 2021.
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Discussion

HBV and HCV are two common sexually transmitted infections (STIs) that represent a significant public health concern in sub-Saharan Africa and are common in developing countries16. The primary indicators of the endemicity of HBV and HCV infection in the general population in a given geographic area are hepatitis B surface antigen (HBsAg) and anti-HCV17. According to WHO criteria18, The prevalence of HBV infection can be graded high when the prevalence is > 8%, intermediate when the prevalence is between 2 and 8%, and low when the prevalence is < 2%19. Hepatitis C virus infection can be also graded high, moderate, or low when the prevalence is > 3.5, 1.5–3.5%, and ˂ 0.1.5%20.

In the present study, we found that 14% and 19.9% of the overall Sero-prevalence of HBsAg and Anti-HCV among patients screened for HBV and HCV infection in Guhala Primary Hospital, respectively. Based on the WHO classification, the prevalence of HBV infection in this study was classified as "High". This figure is still high if we compute the general population of Ethiopia as these days it is close to 117 million. In addition, it is assumed that the rate might be increased more if this study is done in different geographical areas. Therefore, HBV and HCV infection was a particular problem that might be due to the possibility all the populations are at risk for HBV and HCV infection21.

In our study, the prevalence rate of HBsAg 14% was comparable with a study conducted in Gondar among patients attending serology laboratory of Gondar University Hospital 14.4%3. However, this finding is higher than another study conducted in Gondar among blood donors 4.7%22, a study done in Gondar among street dwellers 10.9%23 and medical waste handlers 6%24, Bahirdar among military personnel 4.2%25 and among patients Attending at Addis Alem Primary Hospital 3.9%26, Mekele among blood donors 6.2%27, Addis Ababa among blood donors 3.0%28, in Addis Ababa, Ethiopia among medical waste handlers 6.3%29, in Addis Ababa among general population 7%30, southern Ethiopia among VCT clients 5.7%31, Jigjiga among blood donors 10.9%32, in Eretria on blood donors 2.6%33, and 2.0%34, and Northern Nigeria among blood donors 10.9%35, and the study reported Japan 0.8%36. Furthermore, our study was lower than the study conducted among donors at Bahir Dar, Ethiopia 25%37, in southeast Ethiopia among patients with chronic hepatitis 22.3%38, in Addis Ababa among Chronic liver disease patients 57.5%39, and in Nigeria among blood donors 18.6%40. These variations may be attributed to variances in sample size, geographic variance, detection technique, cultural practices, and behavioral divergences for the risk factors. Additionally, the degree of HBV endemicity is frequently correlated with the major mode of transmission. Moreover, the variation may also result from various research designs and techniques for the HBV infection assay.

In the current study, the overall prevalence of anti-HCV was 19.9%. This study was higher than the study conducted Gondar among patients attending serology laboratory of Gondar University Hospital 12.4%3, southeast Ethiopia among patients with chronic hepatitis 3.6%25, in Nigeria among Patients with Suspected Liver Diseases 4.4%41, in southeastern Nigeria among the outpatients attending the general hospital 4.39%42, and 12.9% in Nigeria among urban and rural communities 12.9%43, and in Pakistan among the patients reporting in surgical OPD 10.8%44, in contrast this study lower than study conducted in Addis Ababa among CLD patients 57.5%39, and in Pakistan among patients seeking hospital care 23.5%45.

In this study, the highest prevalence was recorded among the age group between 31 and 40 years 33 (22.3%) which was higher than the seroprevalence of all other age groups 0–20 years 20 (9.3%), 21–30 years 42 (12.24%), and > 40 years 29 (3.3%). This study is in agreement with studies conducted in Ghana on blood donors, revealing that the highest seroprevalence was among the 30–39 years age group 8.9%46. However, our study is not in agreement where the highest prevalence was recorded among the age group between 21 and 30 years 48 (2.4%)26.

In the present study, Among the study participants, the positivity rate of HBsAg was higher in males (17.1%) than females. Our study is in disagreement with studies done in Bahir Dar, Ethiopia where the positivity rate of HBsAg was higher in females (3.0%) compared to males 17 (0.8%)26 And a study done in Ghana where the positivity rate of HBsAg was higher in females (14.3%) compared to males 17 (6.7%)46. This vibration may be brought on by cultural activities like tattooing, bloodletting, and circumcisions that put a person at risk for HBV infection, as well as vaccination status47. Similarly, the positivity rate of HCV was higher in males (14.4%) compared to females. However, This finding is inconsistent with a study conducted in Gondar where the positivity rate of HCV was higher in males (7.6%) compared to females (4.13%)3, and in Pakistan where the positivity rate of HCV was higher in males (2.5%) compared to females (0.9%)45. This inconsistency might be due to variations in the study population,-screening methods, and study design.

In the current study, the prevalence of HBV-HCV co-infection was 3.8%. This finding is consistent with studies conducted in Gondar 2%3 and in Burkina Faso 2.2%48. However, this finding is inconsistent with the study conducted in Nigeria 8.3%49. We attempted to shed light on the hepatitis virus prevalence in our study because it hasn't been well investigated in this area.

Limitations of this study

Due to the study's reliance on secondary data, its limitations included incomplete data and an inadequate document-keeping system. Another drawback is that, because of budgetary constraints, laboratory testing has been restricted to detecting HBsAg and anti-HCV alone. ELISA and the Nucleic Acid Amplification Technique (NAAT) as a screening method were not done.h

Conclusion and recommendation

In our study, a high prevalence of HBV and HCV infection was found in clinically suspected patients. This study is female and the age group between 31 to 40 years more affected by HBV and HCV. This figure raises major issues regarding public health because hospital attendant clients are among the most vulnerable populations. Thus, it would be essential to establish protocols for routinely screening all hospital attendant clients for HBV and HCV infection.