Prevalence and Predictors of Hepatitis B Virus among Healthcare Workers in Sub-Saharan Africa: Systematic Review with Meta-Analysis

Abstract

Background: About three million healthcare workers face occupational exposure to blood borne viruses each year; of which 2 million are exposed to Hepatitis B viral infections and have 10 times higher risk of contracting the disease due to occupational exposure. Though, the pooled data of this review will help for decision-makers and program planners of health to design/redesign strategies and guidelines that are related to HBV prevention and control in sub-Saharan Africa. Objective: To review and analysis of published manuscripts on prevalence and predictors of Hepatitis B Virus among Healthcare workers in sub-Saharan Africa, from 2010 to 2022. Methods: Studies reporting the prevalence and predictors of HBV was identified from major databases and hand search literature. PubMed, POPLINE, African Index Medicus, WHO Afro Library, and Google Scholar were systematically searched to identify relevant studies. A random-effect model was used to estimate the pooled prevalence of hepatitis B among health care workers in sub-Saharan Africa. The heterogeneity of the studies was assessed using 𝐼2 tests statistics and Publication bias was assessed using funnel plots and egger’s tests. The possible sources of heterogeneity were analyzed through subgroup analysis, sensitivity analysis, and meta-regression. Result: In total, 7470 articles were retrieved. Of these, 32 studies met the inclusion criteria and included in the final analysis. A total of 7282 healthcare workers were included. Overall, the pooled prevalence of hepatitis B among HCWs in sub-Saharan Africa using the random-effect model was estimated to be 5.53 (95% CI=4.47 to 6.60) with a significant level of heterogeneity (𝐼2= 88.7%; p < 0.05). Mucocutaneous exposure to blood and body fluid and unvaccinated HCWs were significantly associated with HBV infection, OR of 3.58 (95% CI 1.87-6.88, p<0.05) and OR of 4.24 (95% CI 2.55 – 7.04, p<0.05) respectively. Omitting the studies with the largest sample size slightly increased pooled HBV prevalence to 5.64%, suggesting that the studies are robust. Egger’s test showed the evidence of publication bias for overall meta-analysis (p < 0.05). Conclusion: Overall, one in Eighteen healthcare workers were infected by HBV. Relatively the high burden of HBV infections remains a significant problem among healthcare workers in Sub-Saharan Africa. Thus, blood and body fluids exposure, and unvaccinated for HBV were independent factors significantly associated with the risk of acquiring HBV infection.