Prevalence and risk factors of hepatitis B virus infection in Zakho City, Kurdistan Region, Iraq; a population-based study

Abstract

Background and objectives: Hepatitis B virus (HBV) infection remains a significant global health challenge, particularly in developing countries. Despite the availability of an effective vaccine, chronic HBV infection continues to cause substantial morbidity and mortality. This study aimed to determine the prevalence and associated risk factors of HBV infection in Zakho City, Kurdistan Region of Iraq.

Methods: A population-based cross-sectional study was conducted on 26 February 2025 in Zakho City, Kurdistan Region, Iraq, using a multistage random sampling method. Data were collected from 386 participants through structured face-to-face interviews and serological testing for hepatitis B surface antigen (HBsAg) and anti-hepatitis B core immunoglobulin G antibody (HBcAb) using enzyme-linked immunosorbent assay.

Results: The overall HBV positivity rate (HBcAb-positive) was 8%, with 7% indicating past infection (HBcAb-positive, HBsAg-negative) and 1% indicating chronic infection (HBcAb-positive and HBsAg-positive). In the multivariate analysis, HBV positivity was significantly associated with older age (P = 0.001) and male gender (P = 0.026). The highest prevalence (32.1%) was observed among participants aged ≥ 60 years.

Conclusions: The findings demonstrate a moderate prevalence of past HBV infection and a relatively low rate of chronic carriers in Zakho city. Older age and male gender were significant predictors of HBV positivity. These results underscore the importance of continued public health efforts in HBV screening, early detection, and vaccination, particularly targeting older and at-risk populations.

Keywords: Hepatitis B virus (HBV); Kurdistan Region, Iraq; Population-based study; Prevalence; Risk factors; Zakho City.