Prevalence and predictors of hepatitis B virus (HBV) infection in east Africa: evidence from a systematic review and meta-analysis of epidemiological studies published from 2005 to 2020

Abstract

Background: The epidemiology of hepatitis B virus (HBV) in the general population in east Africa is not well documented. In this meta-analysis, we examined 37 full published research articles to synthesise up-to-date data on the prevalence and predictors of the HBV burden for the effective prevention and management of the virus in our region.

Methods: We examined 37 full published research articles found using PubMed, Scopus, African Journal Online (AJOL), and Google Scholar between May and October 2020. Dichotomous data on HBV prevalence and predictors of infection were extracted from the individual studies. The HBV prevalence, test of proportion, relative risk, and I² statistics for heterogeneity were calculated using MedCalc software version 19.1.3. Begg's tests was used to test for publication bias. Sources of heterogeneity were analysed through sensitivity analysis, meta-regression, and sub-group analysis at 95% CI. P < 0.05 was considered significant for all analyses.

Results: The prevalence of HBV was generally high (6.025%), with publications from Kenya (8.54%), Uganda (8.454%) and those from between 2011 and 2015 (8.759%) reporting the highest prevalence (P < 0.05). Blood transfusion, scarification, promiscuity, HIV seropositivity, and being male were independent predictors significantly associated with HBV infection (P < 0.05), with the male sex being the most strongly associated predictor of HBV infection. Meta-regressions for the pooled HBV prevalence and sample size, as well as the year of publication, lacked statistical significance (P > 0.05). Omitting the study with the largest sample size slightly increased pooled HBV prevalence to 6.149%, suggesting that the studies are robust. Begg's test showed no evidence of publication bias for overall meta-analysis (p > 0.05).

Conclusion: The burden of HBV is still high, with the male sex, blood transfusion, body scarification, and HIV seropositivity being potential predictors of infection. Thus, it is important to scale up control and prevention measures targeting persons at high risk.

Keywords: East Africa; HBsAg; Hepatitis B; Predictors; Prevalence.

Fig. 1

Flow chart for study eligibility following PRISMA criterion; AJOL: African Journal Online, HBV: Hepatitis B Virus

Fig. 2

Contribution of eligible studies for inclusion in the meta-analysis by country

Fig. 3

Forest plot showing the HBV prevalence by country, publication period, sampling technique and HBsAg detection method; the blue diamond indicates the pooled prevalence of HBV and the horizontal line shows the 95% confidence interval. The longer the lines, the greater is the deviation from the pooled prevalence; ELISA: Enzyme Linked Immunosorbent Assay, RDT: Rapid Diagnostic Test, EIA: Enzyme Immunoassay

Fig. 4

Pooled prevalence estimate of HBV in East-Africa by random effects model

Fig. 5

Begg’s correlation test for publication bias; correlation of log effect size with meta-analysis weight for all the epidemiological studies published between 2005 to 2020 included in the meta-analysis

Fig. 6

Bias assessment plot of studies reporting hepatitis B virus prevalence in East Africa from epidemiological studies published between 2005 to 2020 included in the data synthesis

Fig. 7

Number of studies with disaggregated data on risk factors associated with HBV infection

Fig. 8

History of blood transfusion on the risk of HBV infection when compared between those who have had blood transfusion and those who have never transfused. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 9

History of scarification on the risk of HBV infection when compared between those with the history of scarification and those who have never scarified. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 10

HIV sero-status on the risk of HBV infection when compared between the HIV sero-positive and sero-negative. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 11

Number of sexual partners on the risk of HBV infection when compared those with one sexual partner and those with multiple sexual partners. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 12

Sex on the risk of HBV infection when compared between the male and female. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 13

Marital status on the risk of HBV infection when compared between the married and unmarried. Relative Risk (RR) > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 14

Gravidity on the risk of HBV infection when compared between the primagravida and multigravida. Relative Risk (RR) > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 15

History of surgery on the risk of HBV infection when compared between those previously exposed to surgical operation and those who have never. The RR > 1 indicates increased risk or susceptibility to HBV infection whereas the RR < 1 indicates reduced risk to HBV infection

Fig. 16

Meta-regression analysis for the heterogeneity of HBV prevalence in East Africa 2005 to 2020

Fig. 17

Forest plot for sensitivity analysis with one study with the highest sample size omitted

Fig. 18

Begg’s correlation test for publication bias; correlation of log effect size and meta-analysis weight after exclusion of the study with the largest sample size

Fig. 19

Bias assessment plot for sensitivity analysis of studies reporting hepatitis B virus prevalence in East Africa from 2005 to 2020