Hepatitis B Virus in West African Children: Systematic Review and Meta-Analysis of HIV and Other Factors Associated with Hepatitis B Infection

Abstract

While Hepatitis B virus (HBV) and the human immunodeficiency virus (HIV) are endemic in West Africa, the prevalence of HBV/HIV coinfection and their associated risk factors in children remains unclear. In this review, we sought to assess HBsAg seroprevalence among 0- to 16-year-olds with and without HIV in West African countries and the risk factors associated with HBV infection in this population. Research articles between 2000 and 2021 that reported the prevalence of HBV and associated risk factors in children in West Africa were retrieved from the literature using the Africa Journals Online (AJOL), PubMed, Google Scholar, and Web of Science databases as search tools. StatsDirect, a statistical software, was used to perform a meta-analysis of the retained studies. HBV prevalence and heterogeneity were then assessed with a 95% confidence interval (CI). Publication bias was evaluated using funnel plot asymmetry and Egger's test. Twenty-seven articles conducted across seven West African countries were included in this review. HBV prevalence among persons aged 0 to 16 years was 5%, based on the random analysis, given the great heterogeneity of the studies. By country, the highest prevalence was observed in Benin (10%), followed by Nigeria (7%), and Ivory Coast (5%), with Togo (1%) having the lowest. HBV prevalence in an HIV-infected population of children was (9%). Vaccinated children had lower HBV prevalence (2%) than unvaccinated children (6%). HBV prevalence with a defined risk factor such as HIV co-infection, maternal HBsAg positivity, undergoing surgery, scarification, or being unvaccinated ranged from 3-9%. The study highlights the need to reinforce vaccination of newborns, screening for HBV, and HBV prophylaxis among pregnant women in Africa, particularly in West Africa, to achieve the WHO goal of HBV elimination, particularly in children.

Keywords: HIV; West Africa; children; hepatitis B virus; prevalence; risk factors.

Figure 1

Study Eligibility Flow Diagram.

Figure 2

Overall HBV Prevalence in Children, 0–16 Years Old, in West Africa, Pooled by Country. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence.

Figure 3

Forest Plot of Pooled HBV Prevalence by Year of Study Interval. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence.

Figure 4

(A) Forest Plot of Global HBV Prevalence in Children in West Africa, 2000 and 2021. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence in each study in the meta-analysis [24,25,26,27,28,29,30,31,32,33,34,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50]. (B) Bias Assessment Plot.

Figure 5

Forest Plots of HBV Prevalence in Children 0–16 Years Old in West Africa, (A) Without Risk Factors and (B) With Risk Factors [24,25,26,27,28,29,30,31,32,33,34,36,37,38,39,40,41,43,44,45,47,48,49,50]. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence in each study in the meta-analysis.

Figure 6

Pooled HBV Infection Prevalence by Risk Factor A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence.

Figure 7

(A) Forest Plots of HBV Prevalence in Children, 0–16 Years Old, in West Africa, Conducted in Community Settings, (B) Heterogeneity in Community Setting Studies, (C) Forest Plots of HBV Prevalence in Hospital Settings, and (D) Heterogeneity in Hospital Setting Studies [24,25,26,28,29,30,31,32,33,34,36,37,38,39,40,41,43,44,45,46,47,48]. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence in each study in the meta-analysis.

Figure 8

(A) Forest Plots of HBV/HIV Co-Infected Children, (B) Bias Assessment of Co-Infected Children, (C) Forest Plots of HBV Mono-Infected Children, (D) Bias Assessment of HBV Mono-Infected Children [24,25,26,27,28,29,30,31,32,33,34,36,37,38,39,40,42,43,44,45,47,48,49,50]. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence in each study in the meta-analysis.

Figure 9

(A) HBV Prevalence Among Unvaccinated and (B) Vaccinated Children [24,25,26,27,28,29,30,31,32,33,34,36,37,38,39,40,41,43,45,46,47,49]. A black square represents the HBV prevalence in the forest plot. The square position represents the prevalence in each study in the meta-analysis.