ABSTRACT
Background: Chronic hepatitis B virus (HBV) seroprevalence varies globally but is positively correlated with the prevalence of HIV since both have the same route of transmission-contact with infected body fluids. Sierra Leone has a nascent hepatitis B epidemic and there is a paucity of research data and public health awareness about the infection. Bo where this research is done is the second largest city of Sierra Leone and is the regional headquarters of southern Sierra Leone. Aim: To determine the seroprevalence of hepatitis B surface antigen (HBsAg) among female healthcare seekers who used the main government referral hospital in Bo, southern Sierra Leone. Methodology: We retrospectively analysed the serological diagnostic results of HBsAg for female healthcare seekers at the Bo Government Hospital. We later determined the HBsAg seroprevalence for various categories of the study subjects; pregnant women, lactating mothers, girls 5-18years and adults >18years for the period under review. Place and Duration of Study: This study is a multicenter investigation conducted at the Bo Government Hospital laboratory, the Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University in Bo southern Sierra Leone. All laboratory diagnostic tests for HBsAg diagnosis were conducted at the Bo Government Hospital laboratories from May 2012 to June 2013. Literature review and data analysis were done at Departments of Community Health and Clinical Sciences and Environmental Health Sciences at Njala University Study Subjects: A total of 2,218 female subjects took part in this investigation; girls 5-18yrs (15.2%), adults females >18yrs (48.9%), pregnant women (17.4%), and lactating women (18.3%). Study subjects were between 5-45yrs; mean age 26yrs; HBsAg+ mean age was 24yrs; HBsAg- mean age was 29yrs. Results: One thousand and fifty four (47.5%) of all females who sought healthcare service at the Bo Government Hospital laboratory during the period under review were tested positive for HBsAg; 159(7.1%) pregnant women, 168 (7.5%) lactating mothers, 154 (6.9%) were girls 5-18yrs and 573 (25.8%) were >18yrs. Forty-five percent (154/339) of all girls between 5-18years who took part in this study were HBV seropositive. Discussions: Few independent investigations in Sierra Leone have estimated the national HBsAg seroprevalence at 2.6%-5.1%. One import of this study is the high 154/2218(6.9%) HBsAg seroprevalence rate among girls 5-18 years which can be attributed to multiple sex partners, unsafe sex practice and other socioeconomic and behavioral factors that might have been prevailing during the period under review. The generally high HBsAg seroprevalence rate in our study can also be as a result of our large cohort size and the low sensitivity and specificity of the Rapid Determine diagnostic test kits used in our study compared to previous similar studies conducted in Sierra Leone. Conclusions: The high seroprevalence rate of HBsAg among girl between 5-18years in this study emphasizes the need for a robust public health preventive and control measures for HBsAg including HBsAg vaccination, routine blood screening, and safe sex practice as a means of reducing the spread and prevalence of HBV infection in Bo.
ABSTRACT
Background: Sierra Leone started the Direct Observation Treatment Strategy (DOTS) for the treatment of pulmonary tuberculosis in 1992. The country’s pulmonary tuberculosis (PTB) treatment program is now standardized according to international scale. Under the national standardized PTB treatment system, the regimen for new PTB patients consists of a 2-month intensive treatment phase with isoniazid, rifampicin, pyrazinamide and ethambutol, followed by a 4-month continuation phase with rifampicin and isoniazid. Aims: To determine and analyse the annual PTB treatment success and incidence rates, treatment defaulters’ rate, and pulmonary tuberculosis mortality from 1992 to 2002 under the DOTS program at the Germany Leprosy Relief Association’s (GLRA) 13 regional diagnostic centers and chest clinics in Sierra Leone and to compare this data with the annual national tuberculosis data stored in WHO tuberculosis database covering the period 1992-2010. Study Design: The study retrospectively analysed pulmonary tuberculosis annual incidence rates for study subjects who registered for diagnosis and later for treatment at the GLRA 13 regional diagnostic centers and chest clinics from 1992 to 2002. From these data we were able to determine the treatment success and defaulters’ rates, and PTB mortality for these subjects. We also analysed data of the annual national tuberculosis incidence and success rates, and mortality rates retrieved from World Health Organisation (WHO) TB data for Sierra Leone for the period 1992-2010. Twenty six (26) healthcare service providers were also interviewed for additional information about the main cause of mortality and reasons for treatment defaults among pulmonary tuberculosis patients during the period under investigation. Study Subjects: A total of 2,958 (1,881 men and 1,077 females) mostly adults of age range 15-65 years were diagnosed and later treated for pulmonary tuberculosis from 1992 to 2002 at the various GLRA diagnostic and treatment centers in the country. Setting: The study was a multicenter study conducted at the Germany Leprosy Relief Association’s (GLRA) main referral diagnostic center and chest clinic at Lakka in Freetown and the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone. Pulmonary tuberculosis treatment outcomes data used in this study were obtained from TB patients who were admitted at various GLRA chest clinics in Sierra Leone from 1991-2002. Data analysis and literature reviews were done at the Department of Environmental Health Sciences, Njala University in Bo, Sierra Leone from 2011 to 2012. Results: The most important finding of this investigation was that the annual pulmonary tuberculosis incidence and treatment success rates (% cured rate and % completed treatment rate) rose significantly during the period under review for both the GLRA’s study subjects and the cases stored in the WHO tuberculosis database. Conclusion: The significantly high and growing number of annual PTB incidence rates during this HIV/AIDS epidemic reinforces the need for routine PTB treatment monitoring and supervision as well as compulsory HIV testing for tuberculosis patients seeking treatment.