Prevalence and behavioural risk factors for hepatitis B in Upper Dolpo, Nepal

  • Anna Sofia MennerEmail author
  • Hans-Tilmann Kinkel
  • Sameer Dixit
  • Audry Morrison
  • Burkhard Rieke
  • Thomas Küpper
Original Article



Nepal is a country of low endemicity for chronic hepatitis B, with a prevalence of 0.9%. However, in Dolpo District, a higher prevalence of hepatitis B virus (HBV) was reported in small samples, anecdotal reports and, recently, among pregnant women. We determined data on HBV endemicity and risk factors among people from Dolpo (Dolpopa).


We conducted a cross-sectional HBV prevalence study among two separate convenience samples of overall 524 Dolpopa, assessing HBV serology on a medical supply tour to Upper Dolpo (Group 1, n = 223) and assessing detailed HBV serology, markers for hepatitis D virus (HDV) and human immunodeficiency virus (HIV) coinfection, as well as a questionnaire-based survey of risk behaviour and alcohol consumption patterns in Dolpopa visiting the Dolpali “Winter Clinic” in Kathmandu (Group 2, n = 301).


The overall prevalence of hepatitis B surface antigen (HBsAg) was 18.7% [95% confidence interval (CI) 15.6–22.3%]. HBsAg prevalence was independent of age group and gender, but was significantly higher in the settlements lining the trading route between Nepal and China. From the HBsAg-positive participants, 68.8% (95% CI 56.6–78.8%) also tested positive for hepatitis B e antigen (HBeAg). Viral load among HBeAg-positive samples ranged from 3.12 × 107 to 1.42 × 109 IU/mL. HDV and HIV coinfection was not found. Questionnaires confirmed that 92% had never used a condom and 27.6% showed a risky alcohol consumption pattern.


HBV prevalence in Dolpo is significantly higher than in the rest of Nepal. Targeted interventions are recommended to address liver and sexual health education, including the introduction of birth dose HBV vaccinations, HBV screening and HBV vaccinations for pregnant women in Dolpo.


Hepatitis B Dolpo Nepal HIV Hepatitis D 



We would like to thank the patients and contributors from the Winter Clinic of the Dolpo Tulku Charitable Foundation for making this research project possible. Special thanks go to the Dolpo Tulku Lhama. We are also grateful for the assistance of Chime Lhamo, P.J. Neiger and Kevin Kopp from the medical supply tour to Upper Dolpo.

This study was privately funded by the authors.

On behalf of all authors, the corresponding author states that all persons gave their informed verbal and written consent prior to their inclusion in the study.

Compliance with ethical standards

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the national research committee [National Health Research Council (NHRC) of Nepal with the study code 196/2013] and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Diabetology and EndocrinologyMedicover Berlin-MitteBerlinGermany
  2. 2.Department for Occupational and Social MedicineRWTH Aachen UniversityAachenGermany
  3. 3.Dolpo Tulku Charitable FoundationKathmanduNepal
  4. 4.Center for Molecular Dynamics NepalKathmanduNepal
  5. 5.Royal Free London NHS Foundation TrustLondonUK

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