American Journal of Epidemiology Vol. 147, No. 5: 478-487
Copyright © 1998 by The Johns Hopkins University School of Hygiene and Public Health
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Risk Factors for Horizontal Transmission of Hepatitis B Virus in a Rural District in Ghana
1Department of Epidemiology, School of Public Health, The University of North Carolina at Chapel Hill Chapel Hill, NC
2Department of Medicine, School of Medicine, The University of North Carolina at Chapel Hill Chapel Hill, NC
3Ministry of Health, National Headquarters Accra, Ghana, West Africa
4Department of Biostatistics, School of Public Health, The University of North Carolina at Chapel Hill Chapel Hill, NC
Reprint requests to Dr. Francis E. A. Martinson, Department of Epidemiology, School of Public Health, University of North Carolina at Chapel Hill, CB#7400, McGavran-Greenberg Building, Chapel Hill, NC 27599–7400.
5Current address: Department of Microbiology and Immunology, The University of Texas Medical Branch at Galveston, Galveston, TX.
Most hepatitis B virus (HBV) infections in sub-Saharan African infants and children are acquired through horizontal transmission, but the exact mechanisms of spread have not been documented. The authors conducted a study in rural Ghana which determined seroprevalence in a probability sample of 1.385 individuals of all ages, and evaluated risk factors for horizontal transmission of HBV in a subsample of 547 children aged 1–16 years who were not hepatitis B surface antigen (HBsAg) carriers. Most residents in this district live in compounds which typically contain 2–4 households each. Overall prevalence of HBV seropositives (any HBV marker) was 74.7% (95% confidence interval (CI) 72.5%-76.9%). Prevalence of HBsAg was 20.9% (95% CI 18.8%-23.1%). The data suggest a continous nonuniform acquisition of HBV infection with advancing age predominantly through horizontal transmission in childhood, with the household, rather that the domestic compound, being the primary place for transmission. The behaviours most strongly associated with prevalence of HBV were sharing of bath towels (OR = 3.1, 95% CI 2.10-4.5), sharing of chewing gum of partially eaten candies (OR = 3.4, 95% CI 2.3-5.0), sharing of dental cleaning materials (OR = 2.5, 95% CI 1.3-4.6), and biting of fingemails in conjuction with scratching the backs of carriers (OR = 2.5, 95% CI 1.6-4.3) Am J Epidemiol 1998; 147:478–87.
Africa; disease transmission; disease transmission, horizontal; hepatitis B surface antigen; hepatitis B virus; risk factors
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