During the study period, 480 pregnant women were included with a response rate of 100%. The mean age of our participants was 27.9 ± 4.7 years (range: 18 to 43 years). Most of them were single (60%), had a secondary level of education (57%). Our respondents mostly lived in an urban area (81.5%) and were government employees (43.2%). As illustrated onTable 1.

Table 1. Sociodemographic characteristics of pregnant women screened for viral hepatitis at the Ebolowa Regional Health Center.

When we considered their clinical characteristics, we found that most of our patients were primiparous (45%; 216/480) and were seen in the first trimester of pregnancy (50.2%; 241/480). On average, they had had 4.02 ± 1.70 sexual partners, and their mean age at first intercourse was 17 ± 2.0 years. The majority declared having had just one partner in the last six months (55%; 264/480), with no protection during their last intercourse (80%; 384/480). The use of condoms was rare, with only 28.7% (138/480) of our study population having ever used a condom during sex. Few of our patients had received a blood transfusion (10.6%; 51/480). The majority of respondents had never been scarified or shared sharp objects (73.1%; 351/480) and had never had any unsafe injections (96%; 461/480). Twenty percent (96/480) disclosed having a family history of viral hepatitis. We also found that only 3.5% of our patients had been vaccinated against hepatitis B. AS shown onTable 2.

Table 2. Clinical characteristics of pregnant women screened for viral hepatitis at the Ebolowa Regional Health Center.

Of these, 38 women tested positive for HBsAg, representing a prevalence of 7.9%, while three tested positive for HCV-Ab, representing a prevalence of 0.6%. We found no co-infection of HBV and HCV in our studied population. The highest prevalence of hepatitis B and HCV was found in the 21 - 30 age group (68.3%), in single women (80.5%), and in multiparous women (68.3%). See Tables 3-4.

Table 3.Seroprevalence of hepatitis B and C virus among pregnant women followed at the ERHC.

Table 4.Descriptive analysis and logistic regression of risk factors associated with Hepatitis B infections among pregnant women at the ERHC.

We found that being single (p = 0.0001), aged between 21 - 30 years (p = 0.005), having a family past history of viral hepatitis (p = 0.003), being a multipara (p = 0.01), and having multiple sexual partners(p = 0.04), were found to be significantly associated with viral hepatitis in pregnancy (P < 0.05). A past history of blood transfusion, scarifications and sharing sharp objects or unsafed injections did not significantly increase the risk of viral hepatitis B and C infection in our studied population. SeeTable 4.

In a multivariate analysis, family history of hepatitis B virus (AOR = 6.08; CI [0.22 - 11.67], p = 0.001), single marital status (AOR = 2.00; CI [0.68 - 21.02], p = 0.032) and age (21 - 30 years) (AOR = 4.40; CI [0.86 - 7.21], p = 0.005) were the factors independently associated with viral hepatitis in pregnancy among our studied population.

In our study, the prevalence of HBsAg among pregnant women at the ERHC was 7.9%, reflecting Cameroon’s high endemicity. This prevalence is consistent with the results of various studies conducted in several countries [15][18][20]. However, our results differ from those obtained by Nlinwe et al. in Bamenda, Northwest Region, Cameroon, who found a lower prevalence (4.98%) of hepatitis B virus infection among pregnant women attending Bamenda Regional Hospital [13]. Similarly, Goel et al. found an even lower prevalence of hepatitis B (0.72%) among pregnant women receiving care at a tertiary healthcare facility [17]. Conversely, the prevalence of viral hepatitis B among pregnant women in our study is lower than that reported by Hassan et al. in Somalia (11.24%) [14].

The reasons for the variations in the prevalence of HBV in different studies might be due to sociodemographic differences, differences in behavioural practices and cultural practices towards the risk of HBV and HCV infection. Examining our patients’ clinical profiles, we found that the infrequent use of condoms and early age at first intercourse were common, possibly explaining this high prevalence.

The high prevalence of HBsAg in our study indicates the need to prioritise the southern region of Cameroon in the prevention of viral hepatitis, by raising awareness of the risk factors for hepatitis B and C among the general population. During antenatal visits, talks on these risk factors should be increased, and all pregnant women should be systematically screened for HBsAg and hepatitis C antibodies during their first visit.

The hepatitis B vaccination rate was low among our respondents, in line with several African studies [11]-[15]. Health professionals attending to pregnant women should raise awareness of the hepatitis B vaccine and offer it to those who are not infected. Policymakers could help reduce these problems by ensuring free screening and vaccination against the hepatitis B virus for pregnant women.

The prevalence of HCV in pregnancy was 0.6%, which is lower than the results obtained by Foelifack et al in Yaounde in 2018 [24] which was 1.7%. This difference could be due to the fact that our population seemed younger than theirs and it is well known that the baseline risk may be lower in a population like ours, because age is strongly associated with cumulative exposure over time. When considering our studied population clinical characteristics we noticed a low blood transfusions rate, low practice of common risk behaviours (scarification, sharing razors, unsafe dental work, tattooing/piercing, etc.) Hence the opportunities for HCV to spread are fewer. Nevertheless, the available data point toward a low-to-moderate HCV seroprevalence among pregnant women in Cameroon—likely in the range of ~1–2% in some urban antenatal settings, though meta-analysis suggests that in broader or mixed settings it could be around 3%

In a bivariate analysis, the following factors were significantly associated with viral hepatitis B and C infection: age group (21 - 30 years), marital status (single), family history of hepatitis B virus, multiparity, and multiple sexual partners. This is in line with the findings of several authors (6, 7, 15, 18).

On the contrary, risk factors identified by several other authors (15 - 20), such as dental extraction, blood transfusions, and scarifications, were not significantly associated with viral hepatitis B and C infection in our study.

The age group most affected by infection during pregnancy was 21 - 30 years. This age group is characterised by high promiscuity, which exposes them to various genital infections. However, Nlinwe et al. found a fairly high prevalence of HBV infection in the 27 - 38 age group among pregnant women in Bamenda [13]. Counselling on safe sexual behaviour in colleges and universities, where women of this age group can be found, seems necessary. This seems all the more important considering that the majority of our study population were women of this age group, most of whom declared infrequent condom use and no hepatitis B vaccination.

In our study, single women were found to be at a higher risk of developing HBV and HCV infections. This finding is supported by a study conducted by Mve et al. [7], who also noted that unmarried individuals engage in riskier sexual behaviour, making them more prone to STIs such as HBV [16].

Among the pregnant women in our study, those with a history of household contact with an HBV- or HCV-positive family member were significantly more likely to have these infections. These findings corroborate those of several other authors worldwide [7][15][18]. However, our results differ from those of Hassan et al. and Goel et al., who found no statistical significance between household contact and HBV infection [14][17]. These differences may be due to variations in hygiene practices, vaccination rates, and the availability of HBV and HCV screening methods. In our African setting, closer interpersonal interactions and the sharing of cutlery and sharp objects are commonplace, thereby increasing the transmission of HBV. Health personnel should educate HBV-infected pregnant women about the importance of encouraging their family members to undergo routine screening and vaccination against HBV, as this could reduce the transmission of HBV within the household.

Having multiple sexual partners was significantly associated with HBV infection, in line with the findings of Robel et al. [18]. It is evident that unsafe sexual practices contribute to the spread of HBV. This could be explained by the fact that HBV can be present in blood, semen, and other bodily fluids exchanged during sexual contact. Differences in HBV and HCV prevalence in different studies may be due to variations in sexual health education, the availability of protective measures and access to STI management services. Our findings highlight the need to prevent the transmission of HBV infection, primarily by encouraging behavioural changes to promote safer sexual practices. Having multiple sexual partners is a factor frequently cited in the transmission of hepatitis B [22][23], and a cumulative number of sexual partners greater than two was the critical threshold associated with hepatitis B in pregnancy [23]. However, other studies found no association [15][16][20].

In line with the results obtained by Goel et al., our study found that multiparous pregnant women were at a higher risk of screening positive for HBV and HCV infections, which could be explained by them undergoing more medical interventions, such as caesarean sections, blood transfusions, and other invasive procedures, which could increase the risk of HBV and HCV infections. Also, due to several deliveries, multiparous women may have been exposed to unsafe procedures during delivery.

In a multivariate analysis after adjusting for other confounding factors, multiparity and having multiple sexual partners were no longer significantly associated to viral hepatitis B and C infection in pregnancy, while being a single pregnant woman, aged 21 - 30 and having a family past history of hepatitis B remained statistically significant.

Strengths of the study: We used ELISA diagnostic method which has high sensitivity and specificity to confirm HBV and HCV infections. The study also used a standardized questionnaire to collect information from the study participants.

Limitations of the study: The study was conducted at a point in time hence rendering causal association impossible. The study was a hospital based study which may not be generalizable to the entire population.