1. Background

Inflammation of the liver is generally referred to as hepatitis. It happens as a result of infection with pathogens, primarily the five types of the hepatitis virus (A–E), as well as exposure to drugs, alcohol, toxins, and autoimmune disorders [1]. Regarding viral hepatitis, the Hepatitis B virus (HBV) and Hepatitis C virus (HCV) both have major consequences for public health. For example, HBV and HCV, respectively, caused 296 and 58 million cases of chronic hepatitis infections in 2019. In addition, 1.11 million deaths globally are attributed to HBV and HCV, with HBV accounting for 73.9% (820,000) of these deaths. The primary causes of these deaths are liver cancer and chronic liver disease [2, 3]. As with viral hepatitis, human immunodeficiency virus (HIV) is a serious public health problem globally. For instance, an estimated 37.7 million individuals worldwide were positive for HIV in 2020, including 1.5 million new infections [4].

HIV and hepatitis have been linked to several adverse outcomes during pregnancy, such as intrauterine growth restriction, low birth weight, congenital defects, an increase in perinatal mortality, stillbirths, and spontaneous miscarriages [5–8]. There is a higher risk of morbidity, death, and vertical transmission of HBV, HCV, and HIV from mother to child during pregnancy because these viruses are coendemic, share the same transmission pathway, and coinfect during pregnancy [2–4].

HBV is transmitted horizontally through contact with blood and blood products and vertically from infected mother to child [2]. HCV shares most of the transmission with HBV, but transmission via sexual practices is less common [9]. Studies showed that a history of abortion [10], a history of surgical procedure [11, 12], multiple sexual partners [11, 13], tattooing [14, 15], and blood transfusion [12, 16] were some of the risk factors associated with increased risk of HBV and HCV infection in pregnant women. Regarding HIV infections, multiple sexual partners [17, 18], history of abortion [10, 19], and history of blood transfusion [20] were associated with an increased risk of HIV infection in pregnant women.

Several studies conducted in Ethiopia have shown variations in the prevalence of HIV, HBV, and HCV among pregnant women. For instance, one study at the Attat Hospital in Central Ethiopia found a 4.5% prevalence of HBV and a 1.8% prevalence of HCV [21]. However, another study at the same hospital reported a higher prevalence of HBV at 10.9% [22]. In northeastern Ethiopia, a study at the Borumeda General Hospital found an 8.1% prevalence of HBV and a 3.2% prevalence of HCV [23]. A separate study in the Amhara Region found an overall prevalence of 4.6% for Hepatitis B surface antigen (HBsAg) and 1.6% for anti-HCV antibodies [24]. According to a meta-analysis in Ethiopia, the pooled prevalence of HBV in pregnant women was 4.7% [25].

In studies conducted in Addis Ababa, the Amhara Region, and South–Central Ethiopia, the prevalence of coinfections with HBV and HCV was found to be 1.1%, 1.4%, and 1.8%, respectively [17, 21, 24]. Additionally, the prevalence of coinfection between HCV and HIV was 1.1% in Addis Ababa [17] and 1.8% in South–Central Ethiopia [21].

In the 2014 national antenatal care (ANC) survey, it was found that the prevalence of HIV among pregnant women in Ethiopia was 2.2%. There were regional variations with the highest rates reported in Gambela (7.5%), Harari (6.6%), and Amhara (6.1%) [26]. Studies conducted in rural hospitals in the western and southern parts of Ethiopia reported lower prevalence rates of 1% and 0.2%, respectively, compared to the national average. However, higher rates were found in referral hospitals in the Amhara Regional State (8.68%) [27] and the University of Gondar Referral Hospital (10.33%) [28].

Despite the significant impact on the health of pregnant women and their infants, viral hepatitis, HIV/AIDS, and their coinfections are often overlooked in Ethiopia. There is a lack of routine antenatal screening and intervention strategies for hepatitis, leading to the transmission of the virus from mother to child. Additionally, there is a need for reliable national and subnational epidemiological data on HBV, HCV, HIV, and their coinfections among pregnant women. Therefore, this study is aimed at determining the prevalence of HBV, HCV, and HIV infections and their co-occurrence among pregnant women at Simada Hospital’s ANC. The findings will help identify associated risk factors and serve as a basis for developing local and regional control measures.

2. Materials and Methods

3. Results

4. Discussion

In the present study, the overall prevalence of HBsAg in pregnant women was 4%. The prevalence of HBsAg among pregnant women in this study can be categorized as intermediate (2%–8%) based on World Health Organization (WHO) criteria [2]. The prevalence is also comparable to studies conducted in Bahir Dar City, Northwest Ethiopia (3.8%) [19]; Attat Hospital, South–Central Ethiopia (4.5%) [21]; Dawuro Zone, Southern Ethiopia (3.7%) [32]; and the Democratic Republic of the Congo (3.9%) [33]. However, it is much lower compared to studies conducted in Attat Hospital, South–Central Ethiopia (10.9%) [22]; Borumeda General Hospital, Northeast Ethiopia (8.1%) [23]; Gambella Hospital, Southwest Ethiopia (7.8%) [34]; Yirgalem Hospital, Sidama Region (7.2%) [35]; Yemen (10.8%) [36]; Nigeria (6.78%) [37]; and Cameroon (10.2%) [38]. The observed variations in HBsAg prevalence might result from sample size, location, diagnostic methods, immunization status, cultural practices, and pregnant women’s socioeconomic characteristics.

According to this study, 2% of the pregnant women tested positive for HCV, within the 1.5%–3.5% WHO intermediate prevalence category [3]. The prevalence is also comparable with the findings of studies conducted in different parts of the country, such as at Attat Hospital in Southern Ethiopia (1.8%) [21], in hospitals in the Amhara Region (1.6%) [24], and in a meta-analysis study in Ethiopia (1.83%) [39]. This proportion was lower than the HCV prevalence among pregnant women conducted in Western Ethiopia (8.1%) [20], Borumeda General Hospital, Northeast Ethiopia (3.2%) [23], and the Democratic Republic of the Congo (4.1%) [40]. However, it was higher than other studies conducted in Bahir Dar, Northwest Ethiopia (0.6%) [19]; Nigeria (0.8% and 0.5%) [41, 42]; and Southwest China (0.19%) [43]. The study population’s diverse socioeconomic background and cultural practices may account for the observed variation in the prevalence of HCV. Furthermore, regional variations in potential risk factors for viral hepatitis, differences in study design, and variations in diagnostic procedures used might have an impact on the previously indicated disparity.

In this study, 2% of the pregnant women were found positive for HIV, which is comparable with the findings of earlier studies conducted in south Ethiopia (2.3% and 1.8%) [44, 45] and the nationwide HIV study in ANC clinics in Ethiopia (2.2%) [26]. However, the present finding was lower than the previous report from Addis Ababa, Ethiopia (4.2%) [14]; Bahir Dar, Northwest Ethiopia (6.6%) [19]; Amhara Regional State (8.68%) [27]; Cameroon (13.1%) [18]; Nigeria (7.3% and 8.5%) [41, 42]; and Tanzania (5.6%) [46]. To the contrary, the HIV prevalence was higher in the present study compared to studies conducted in rural hospitals in Western Ethiopia (1.0%) [20], Southern Ethiopia (0.2%) [44], Southwest China (0.24%) [43], and Iran (0.09%) [47]. The observed difference in HIV prevalence might be attributed to variations in the study populations, variations in the regional and worldwide distribution of HIV, and variations in the diagnostic method.

The prevalence of HBV and HCV coinfection was 1.2% in this study, which is comparable to a study conducted in Addis Ababa, Ethiopia (1.1%) [17]; Attat Hospital, South–Central Ethiopia (1.8%) [21]; and Amhara Region (1.4%) [24]. However, it is higher than studies conducted in Nigeria (0.15%) [37] and the Democratic Republic of the Congo (0.66%) [40]. The observed differences in the frequency of HBV/HCV coinfection could be explained by a variety of factors, including different geographic regions, sample sizes, behavioral and socioeconomic factors, host genetic variations, and diagnostic approaches.

The prevalence of HBV and HIV coinfection was 0.4% in this study, which is comparable to a study conducted in Southwest China (0.24%) [43]; however, this proportion is lower than a study conducted in Addis Ababa, Ethiopia (3.4%) [17]; Bahir Dar City, Northwest Ethiopia (1.3%) [19]; Attat Hospital, South–Central Ethiopia (1.8%) [21]; and Rwanda (4.3%) [48]. In the present study, the prevalence of HCV/HIV coinfection was also 0.4%, which is comparable with a study conducted in Nigeria (0.5%) [42]. However, this proportion is lower than a study conducted in Attat Hospital, South–Central Ethiopia (1.8%) [21], and Addis Ababa, Central Ethiopia (1.1%) [17]. These differences may be explained by the types of research participants employed, their socioeconomic background, cultural norms that encourage the coexistence of the two viral infections, and their degree of knowledge about how diseases spread and how to prevent them.

In the current study, it was found that pregnant women with a history of abortion were almost 11 times more likely to have HBV infection (AOR = 11.028; 95%CI = 1.671, 72.776; p = 0.013) compared to women without a history of abortion. This finding is consistent with previous studies conducted in different parts of Ethiopia [14, 19, 21]. Unsafe abortions done outside of healthcare facilities often do not follow proper infection prevention and control measures. This increases the risk of HBV infection among pregnant women who have had abortions. Additionally, unsafe and unwanted sexual practices may lead to abortions, which in turn increase the risk of HBV infections.

The current study also revealed that a history of blood transfusions was a significant independent risk factor for HBV infection. This is consistent with research conducted in Ethiopia and Cameroon [21, 24, 38]. Nonetheless, the results of this investigation contradict those of other research conducted in Ethiopia [14, 15, 17, 23] and outside of Ethiopia [36, 41]. This suggests that HBV can spread through blood transfusions if proper screening is not done. Although blood and blood products have been subjected to HIV, HBV, and HCV testing in Ethiopia [24], molecular techniques are necessary for accurate virus identification to prevent the transmission of HBV during blood transfusion, as ELISA-based HBV screening from blood and blood products may miss the virus during the window period and occult hepatitis.

The study found that having multiple sexual partners was the main risk factor for acquiring HCV infection. This is consistent with a study from Nigeria [13], which also linked having multiple sexual partners with a higher prevalence of HCV. However, in Ethiopia, having multiple sexual partners was not identified as an independent risk factor for HCV transmission [20, 23, 24]. The increased risk of HCV associated with multiple sexual partners in our study might be due to engaging in unprotected sexual activity with different partners, which increases the likelihood of HCV transmission through sexual intercourse.

Similarly, the study found that a history of abortion was the only independent risk factor for HIV infection. This is consistent with findings in pregnant women in Ethiopia [19] and Nigeria [42], where a history of abortion increases the risk of HIV infection. This association may be due to a higher risk of contracting HIV from unsafe abortions, which could result from unprotected sexual activity or unintended pregnancies due to rape.

The current study has some limitations. One of the limitations is that it did not include pregnant women who were unable to access ANC services or those who had follow-ups at the health centers. This could have affected the reported results, leading to a potential underestimation or overestimation of the prevalence of HBV, HCV, and HIV among pregnant women. Additionally, the study’s findings were influenced by not using ELISA or molecular approaches for diagnosis, which may have underestimated the prevalence of the three studied viruses.

5. Conclusions

The study found that the prevalence of HBV and HCV among pregnant women was moderate. The prevalence of HIV in this study was similar to the 2014 national ANC sentinel surveillance study in Ethiopia. The multivariate logistic regression analysis revealed that having multiple sexual partners and a history of abortions were independent risk factors for HCV and HIV infections, respectively. Meanwhile, having a history of blood transfusions and previous abortions were the main predictors of HBV infections. It is recommended that all pregnant women undergo screening for the hepatitis virus, receive treatment if necessary to reduce their viral levels, and be administered the single-dose Hepatitis B vaccine to prevent transmission to their child.

Conflicts of Interest

The authors declare no conflicts of interest.

Author Contributions

S.T. identified the research problem, collected and analyzed the data, and participated in the draft and final write-up of the manuscript. T.A. identified the research problem, collected and analyzed the data, and participated in the draft and final write-up of the manuscript. E.B. collected and analyzed the data and participated in the draft and final write-up of the manuscript. D.M. analyzed the data and participated in the draft and final write-up of the manuscript. A.A. participated in the writing up of the manuscript and reviewed and edited the final version of the manuscript.

Funding

No funding was obtained for this study.