|Year : 2015 | Volume
| Issue : 2 | Page : 163-172
Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis
BM Musa1, S Bussell2, MM Borodo1, AA Samaila1, OL Femi1
1 Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano, Nigeria
2 Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
|Date of Acceptance||03-Oct-2014|
|Date of Web Publication||10-Feb-2015|
Department of Medicine, Bayero University, Aminu Kano Teaching Hospital, Kano
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Vaccination against the hepatitis B virus (HBV) in the West African nation of Nigeria is lower than many Sub-Saharan African countries. In Nigeria, HBV is reported to be the most common cause of liver disease. However, the extent of HBV exposure among Nigerians at average risk is unknown. Our aim, therefore, was to accurately estimate the HBV prevalence for the country and the prevalence for specific subgroups. We used electronic databases to select systematic reviews and meta-analyses from 2000 to 2013. Forty-six studies were included (n = 34,376 persons). We used a random effects meta-analysis of cross-sectional and longitudinal studies to generate our estimates. The pooled prevalence of HBV in Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%). The pooled prevalence (% [95% CI]) among subgroups was: 14.0% (11.7, 16.3) for blood donors; 14.1% (9.6, 18.6) for pregnant women attending antenatal clinics; 11.5% (6.0, 17.0) for children; 14.0% (11.6, 16.5) among adults; and 16.0% (11.1, 20.9) for studies evaluating adults and children. HBV prevalence in Nigeria varied by screening method [% (95% CI)]: 12.3% (10.1, 14.4) by using enzyme-linked immunosorbent assay; 17.5% (12.4, 22.7) by immunochromatography; and 13.6% (11.5, 15.7) by HBV DNA polymerase chain reaction. HBV infection is hyperendemic in Nigeria and may be the highest in Sub-Sahara Africa. Our results suggest that large numbers of pregnant women and children were exposed to HBV from 2000 to 2013. Increased efforts to prevent new HBV infections are urgently needed in Nigeria.
Keywords: Africa, hepatitis B, meta-analysis, Nigeria, prevalence, public health, survey
|How to cite this article:|
Musa B, Bussell S, Borodo M M, Samaila A A, Femi O L. Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis. Niger J Clin Pract 2015;18:163-72
|How to cite this URL:|
Musa B, Bussell S, Borodo M M, Samaila A A, Femi O L. Prevalence of hepatitis B virus infection in Nigeria, 2000-2013: A systematic review and meta-analysis. Niger J Clin Pract [serial online] 2015 [cited 2017 Mar 24];18:163-72. Available from: http://www.njcponline.com/text.asp?2015/18/2/163/151035
| Introduction|| |
Hepatitis B virus (HBV) is a major cause of liver disease morbidity and mortality worldwide, accounting for over 360 million cases of chronic hepatitis and 620,000 deaths per a year.  It is hyperendemic (i.e. >8% of the population infected) in Sub-Sahara Africa (SSA) and a major cause of chronic liver disease. ,, Perz et al. estimated that 44% of cirrhotic liver disease and 47% of heptocellular carcinoma cases in SSA are attributed to HBV.  A highly effective and inexpensive recombinant DNA vaccine for hepatitis B has been available since 1982 and debuted in Nigeria in 1995. Unfortunately, vaccination programs in Nigeria have not received adequate attention or funding by the government. Further, community misconceptions have hindered increasing coverage rates. , The United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) estimated that only 41% of Nigerians were vaccinated against HBV in 2013. 
The risk of contracting HBV in Nigeria is substantial, not only due to low vaccination rates but also given that as many as 75% of the population will be exposed.  Investigators have reported varying national and risk group-specific estimates. Prior reports suggest a prevalence of 10-15% in the average risk Nigerian population.  In Nigeria, investigators have found high HBV prevalence among surgeons (25.7%),  voluntary blood donors (23.4%),  and infants (16.3%).  A 2012 study in Kano Nigeria found that among 440 HIV positive patients, 12.3% were co-positive for HBV.  Although, pregnant women are generally considered low risk for HBV infection, rates as high as 11% have been reported in Nigeria.  Hepatitis B is the commonest cause of chronic liver disease in Nigeria. In southern parts of the country, up to 58.1% of patients with chronic liver disease were found HBsAg positive. 
Several authors report on the prevalence of HBV among sub-populations in Nigeria with estimates varying depending on population studied and methods used. However, there is no reliable national survey of HBV exposure in the average risk population and in subgroups most likely to benefit from early detection, surveillance, and treatment. Given this gap in our understanding of HBV in Nigeria, we performed a systematic review and meta-analysis to provide an accurate estimate. We hope that the information presented here will draw attention to HBV as an important cause of morbidity and mortality in Nigeria and will inform those interested in developing policies and programs for its control.
| Materials and Methods|| |
PubMed, EMBASE, Institute of Science Information, Google Scholar, Scopus, and African Journal Online were searched from 2000 to 2013. The last search was performed on February 31 2014. The keywords Hepatitis B, Hepatitis B surface antigen, prevalence, Nigeria, and similar terms such as HBV, HBsAg, were crossed. References were reviewed to extend the search, and Nigerian content experts were consulted for additional materials.
English language prospective cohort studies and surveys published from 2000 to 2013 were included. Articles that assessed the prevalence of HBV in voluntary blood donors, pregnant women attending antenatal clinics, and in the general population were used. No age restriction was imposed. Children were defined as those of 12 years and below, adolescent as those aged 13-17 years while adults were defined as those of age 18 years and above.
Data extraction and quality assessment
Three investigators independently applied inclusion criteria, selected studies, and extracted data. Consensus adjudication was used to resolve disagreements. Reviewers abstracted data on study year, population characteristics, sample size, prevalence, age, and HBV screening technique [Table 1]. Study quality was assessed using a 12-point scoring system based on the Downs and Black checklist. These are: (objective of the study clearly described, study design clearly stated, participants representative of the population from which they were recruited, participants accrued during the same time period, modest sample size, management of missing data, age, gender and other characteristics explored/reported, e.g. were confounders reported, was detection method of HBV reported, were potential biases reported, was outcome clearly described?), the assessment also included other items known to be associated with study quality.  The studies were classified into three levels that represented their quality. The total score was 12 with a higher score indicating better quality. 
|Table 1: Summary of studies on prevalence of hepatitis B viral infection in Nigeria, 2000-2013 |
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Studies were pooled using the DerSimonian-Laird method of random effects meta-analysis to estimate overall and sub-group specific prevalence. ,, Heterogeneity of results was determined by inspecting graphical presentations and calculating Cochran's Q test. The low, medium and high heterogeneity was predefined as a Cochrane Q of 25%, 50%, and 75%, respectively. , Meta-regression was used to determine potential confounders. The model included study level characteristics such as year of study, region, population, age, and method of HBV screening. Results were expressed as percentages with 95% CIs.
Publication bias was appraised with Egger's and Begg's adjusted rank correlation test and graphically depicted by a funnel plot. Publication bias was dealt with using the Trim and fill method; which is, a rank-based data augmentation technique. It ratifies the use of funnel plots, estimating the number and outcomes of missing studies and adjusting the meta-analysis to incorporate the theoretical missing studies. The level of significance was set at P < 0.05.
| Results|| |
Our search yielded 249 citations. Forty-six articles were included after applying exclusion criteria, including 31 cross-sectional studies and 15 longitudinal studies [Figure 1]. ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
|Figure 1 : Flow diagram of the studies reviewed for inclusion into meta-analysis|
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All included studies were pooled for meta-analysis. The prevalence of HBV infection ranged from 0.5% to 46.8% among analyzed studies. The pooled prevalence estimate for Nigeria was 13.6% (95% confidence interval [CI]: 11.5, 15.7%) [Figure 2]. Assuming Nigeria has an estimated population of 160 million people, the overall HBV burden based on our estimates would be 21,760 million sero-positive persons (95% CI 18,400 000, 25,120 000).
|Figure 2 : Forest plot of studies included in meta-analysis with pooled HBV prevalence|
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Stratified analysis showed a wide variation in the prevalence of HBV exposure based on study population, year of study, region, and age category [Table 2]. HBV prevalence was greatest among pregnant women attending antenatal clinics 14.1% (95% CI, 9.6, 18.6%) followed closely by voluntary blood donors 14.0% (95% CI, 11.7, 16.3%). The highest prevalence occurred in 2003 at 53.9% (95% CI, 10.3, 118%) and the lowest in 2011 at 7.0% (95% CI, 6.3, 11.6%). HBV prevalence was estimated to be 14.0% (95% CI, 11.6, 16.5%) among adults and 11.5% (95% CI, 6.0, 17.9%) among children. Prevalence was slightly greater for Northern Nigeria at 14.7% (95% CI, 11.4, 17.0%) compared with 13.6% (95% CI 11.5, 15.7%) for Southern Nigeria.
|Table 2: Estimated hepatitis B prevalence by study design, year, age, population, and region, Nigeria, 2000-2013 |
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HBV prevalence also varied by screening method, [Table 3]. Among all populations, the HBV prevalence was estimated as 12.3% (95% CI, 10.1, 14.4%), 17.5% (95% CI, 12.4, 22.7), and 13.6% (CI, 11.5, 15.7) by using enzyme link immunosorbent assay (ELISA), immunochromatography (ICT), and HBV DNA polymerase chain reaction, respectively.
|Table 3: Estimated prevalence of HBV among average risk populations by screening method, Nigeria, 2000-2013 |
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Only one study additionally reported on HBeAg, with 4(2.3%) reported for both HBsAg and HBeAg positive; while none of the studies commented on HBV phase activity.
Meta-regression analysis did not show that study year, region, population, age, or method of screening confounded prevalence estimates. However, this analysis suggested that HBV prevalence decreased by 0.8% annually [Figure 3].
|Figure 3 : (a) Regression plot depicting correlation of HBV prevalence with year of study. (b) Meta-regression plot showing the trend in HBV prevalence with year of study|
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There was evidence of publication bias with Egger's test having a P = 0.007, whereas Begg's test had a P = 0.0001. This was depicted graphically by a funnel plot which incorporated the Trim and filled method. It showed asymmetry of prevalence reported by various studies. Prevalence reported in reviewed studies were represented by diamond points, whereas augmented data point derived based on the trim and fill method are indicated by the addition of a square placed around the data symbol [Figure 4].
|Figure 4 : Graphic representation of Publication bias with Funnel plot of included studies and representation of missing studies using Trim and Fill method|
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| Discussion|| |
In 2010, the World Health Assembly adopted resolution 63.18 to recognize viral hepatitis as a global health problem.  In response, the WHO developed a four-prong strategy aimed at raising awareness/mobilizing resources, policy, preventing transmission and screening and treatment.  While 180 countries included Hepatitis B vaccination as part of their routine vaccination schedule and the worldwide coverage approached 80% in 2011, disparities remain between developed and developing countries. 
Nigeria has made notable gains along the four-prong strategy, for example, by registering hepatitis-related cancer cases, creating national guidelines for prevention of infection in health care workers, adopting universal vaccination, and screening all donated blood.  However, national policies aimed at prevention of mother to child infections and elimination of HBV are lacking; this is perhaps reflected in our finding that approximately 14% of Nigerians were exposed to HBV from 2000 to 2013. This estimate would place Nigeria as one most affected countries in Africa and indeed the world.  The prevalence peaked at 53.9% in 2003, although this estimate was weighted by only two studies.
Our finding of a skewed funnel plot, suggests publication bias that may be due to wide variability in the reported prevalence, and gaps for unreported prevalence in other sub-populations. This have been accounted for by the "filled" data points derived from the trim and fill method. However, the finding may also be due to other reasons, such as variation in the sensitivity of HBV screening kits and methodological quality of the studies and indeed, in study sample sizes. Furthermore, it may be due to variation in the temporal prevailing risk for HBV among the populations of primary studies and chance occurrence. However, we are of the opinion that the difference in the prevailing risk among the studied populations likely accounts for the skewing of the funnel plot. 
Whereas, routine detection of HBV infection has been based on the detection of HBsAg, occasionally this could be undetected creating occult HBV infection. In a study of HBV occult infection among HIV positive patients, Opaleye, et al.,  found HBV DNA in 21/188 (11.2%) of patients without detectable HBsAg. A similar study in South-Eastern Nigeria found 8.0% with HBV DNA among HBsAg negative blood donors. 
Nigeria has multiple challenges of terrain and treasury, making an accurate evaluation of HBV carrier rates extremely difficult. The country is vast and diverse; with its semi-arid plains and plateau in the north, the highland and coastal plains in the south; the dispersion of much of its population among rural areas, and the perennial challenge of resources. Thus, the findings of our study are important for policy formulation pending the conduct of a national sero-prevalence survey.
The variation noted between sub-populations may have resulted from differences in the risks of acquisition of HBV infection and unmeasured socioeconomic and environmental factors across Nigeria. In the past, there were practices that increased the risk of HBV infection such as mass childhood circumcision in the north; even though, it's still been practiced in some rural areas. Similarly, there is usage of local unsterilized blades for commercial barbing services and use of unsterilized tools for facial marks and tattoos.
Whereas most SSA countries are classified as hyperendemic for HBV, prevalence do vary among countries. Although Nigeria share similarity with South Africa in the burden of HIV, the Nigerian estimate is higher than that of South Africa, with a prevalence of 10%. , Nigeria has prevalence similar to neighboring countries such as Ghana 5-10%, Cameroon 8-20% Benin 12% and Chad 12%. ,,
Furthermore, finding of high HBV seroprevalence in SSA countries like Nigeria is echoed in a meta-analysis by Rossi et al., were high prevalence of HBV were found among migrants to developed countries from high HBV burden regions including SSA. 
Encouragingly, our meta-analysis suggests that there is a sustained decline in the prevalence of HBV infection over the last 13 years. A similar pattern has been observed in other African countries like Gambia and Senegal where the HBV prevalence rates have declined progressively from 10-0.6% to 18.7-2.2%, respectively.  The observed decline in HBV prevalence in Nigeria may be related to a gradual increase in HBV vacation among children. In 2000-2005, HBV vaccination coverage was reported as zero by UNICEF, 18% in 2006, and peaked at 41% in 2013.  While most recently reported coverage level is low by the worldwide average, the impact can be magnified with a rapid reduction in HBV prevalence. This type of response was demonstrated in the Gambia.  Therefore, incremental efforts and even small scale efforts aimed at HBV prevention and control are likely to have great benefit.
Nigeria is one of the countries with the highest population in the world; with children and young adults constituting the bulk of these numbers. It is also a low-middle income nation, with gross national income per capita purchasing power parity (PPP) of $2290.  Moreover, it has relatively low life expectancy at birth of 54 years.  It is also the country with the third highest burden of HIV in the world.  While HIV has decimating effect on the socioeconomic fabric of the country; HBV could lead to chronic liver disease and cancer of the liver and ultimately early death marked by loss of able-bodied young adults. Both diseases are share common means of transmission. There have been positive results following various interventions aimed at curbing the burden of HIV in Nigeria as evident by a sustained decline in HIV prevalence. Thus, it should be envisaged that proper implementation of interventions such as early immunization and screening of high risk groups could further reduce HBV burden as well as improve Nigeria's socioeconomic indices.
The accuracy of detection for active HBV infection depends on the screening method. Additional markers such as HBV Igm and HBV core antigen must be used to distinguish past infection from active infection. DNA testing, conversely, detects the presence of hepatitis even before the appearance of antibodies.  Most included studies used ELISA for HBV screening. ICT is less sensitive than ELISA and thus yield false positives. This could explain the discrepancy in HBV prevalence between ICT compared to other methods in our analysis.  Further, reporting over a 13-year period, we may have included studies using different generations of screening kits and thus their sensitivity and specificity may have varied.
In Nigeria, blood donations are routinely screened for HBV. Consequently, they are a convenient sample and comprised the bulk of our analysis. This population may have had a difference risk profile than other groups. Using voluntary blood donors largely excluded women and children who infrequently donate blood in Nigeria. Thus, the HBV prevalence in voluntary blood donors could be considered as a surrogate representation of young and middle-aged men exclusively. Nevertheless, we believe the estimated HBV prevalence for this population is robust as it is similar to other studies from SSA countries. ,,
Our analysis showed that HBV prevalence was hyperendemic among women. Data in this population were limited as HBV estimates were sourced from hospital-based antenatal care that represents only a fraction of all antenatal care received by women. Further, our analysis included more studies reporting on HBV prevalence in males than women. Therefore, it is possible we underestimated the true prevalence in this population.
| Conclusion|| |
Our study suggests that the HBV is hyperendemic in Nigeria. It underscores the need for universal vaccination of all children and the development of policies to prevent mother to child transmission. Our work is useful for planning interim national control strategies to combat hepatitis B infection as well as providing a robust basis for ultimately organizing hepatitis B national prevalence surveys and control measures.
| References|| |
World Health Organization. Hepatitis B and C, Immunization, Vaccines and Biologicals. 2013. Available from: http://www.who.int/immunization/topics/hepatitis/en/. [Last accessed on 2013 Nov 18].
Ola SO, Odaibo GN. Alfa-feto protein, HCV and HBV infections in Nigerian patients with primary hepatocellular carcinoma. Niger Med Pract 2007;51:33-5.
Lesi OA, Kehinde MO, Omilabu SA. Prevalence of the HBeAg in Nigerian patients with chronic liver disease Nig Q Hosp Med 2004;14:1-4.
Ndububa DA, Ojo OS, Adetiloye VA, Durosinmi MA, Olasode BJ, Famurewa OC, et al.
Chronic hepatitis in Nigerian patients: A study of 70 biopsy-proven cases. West Afr J Med 2005;24:107-11.
Perz JF, Armstrong GL, Farrington LA, Hutin YJ, Bell BP. The contributions of hepatitis B virus and hepatitis C virus infections to cirrhosis and primary liver cancer worldwide. J Hepatol 2006;45:529-38.
Cutts FT, Izurieta HS, Rhoda DA. Measuring coverage in MNCH: Design, implementation, and interpretation challenges associated with tracking vaccination coverage using household surveys. PLoS Med 2013;10:e1001404.
Rainey JJ, Watkins M, Ryman TK, Sandhu P, Bo A, Banerjee K. Reasons related to non-vaccination and under-vaccination of children in low and middle income countries: Findings from a systematic review of the published literature, 1999-2009. Vaccine 2011;29:8215-21.
GAVI Alliance. Country Tailored Approach for Nigeria 2014-2018; 2014. Available from: http://www.apps.who.int/immunization_monitoring/globalsummary/estimates?c=NGA. [Last accessed on 2014 May 27].
Ola SO, Otegbayo JA, Odaibo GN, Olaleye OD, Olubuyide OL. Serum hepatitis C virus and hepatitis B surface antigenaemia in Nigerian patients with acute icteric hepatitis. West Afr J Med 2002;21:215-7.
Emechebe GO, Emodi IJ, Ikefuna AN, Ilechukwu GC, Igwe WC, Ejiofor OS, et al
. Hepatitis B virus infection in Nigeria - A review. Niger Med J 2009;50:18-22. [Last accessed on 2014 Oct 14].
Belo AC. Prevalence of hepatitis B virus markers in surgeons in Lagos, Nigeria. East Afr Med J 2000;77:283-5.
Bada AS, Olatunji PO, Adewuyi JO, Iseniyi JO, Onile BA. Hepatitis B surface antigenaemia in Ilorin, Kwara State, Nigeria. Cent Afr J Med 1996;42:139-41.
Sadoh AE, Sadoh WE. Serological markers of hepatitis B infection in infants presenting for their first immunization. Niger J Paeadiatr 2013;40:248-53.
Hamza M, Samaila AA, Yakasai AM, Musa B, Musa MB, Abdulrazaq GH. Prevalence of Hetatitis B and C virus infections among HIV-infections in a tertiary hospital in North-Western Nigeria. Niger J Basic Clin Sci 2013;10:76-81.
Mbaawuaga EM, Enenebeaku MN, Okopi JA, Damen JG. Hepatitis B Virus (HBV) Infection among. Pregnant Women in Makurdi, Nigeria. Afr J Biomed Res 2008;11:155-9.
Lesi OA, Kehinde MO, Omilabu SA. Prevalence of the HBeAg in Nigerian patients with chronic liver disease. Niger Q Hosp Med 2004;14:1-4.
Habib AG, Yakasai AM, Owolabi LF, Ibrahim A, Habib ZG, Gudaji M, et al.
Neurocognitive impairment in HIV-1-infected adults in Sub-Saharan Africa: A systematic review and meta-analysis. Int J Infect Dis 2013;17:e820-31.
Barth RE, Huijgen Q, Taljaard J, Hoepelman AI. Hepatitis B/C and HIV in sub-Saharan Africa: An association between highly prevalent infectious diseases. A systematic review and meta-analysis. Int J Infect Dis 2010;14:e1024-31.
Cohn LD, Becker BJ. How meta-analysis increases statistical power. Psychol Methods 2003;8:243-53.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D, et al.
Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis of observational studies in epidemiology (MOOSE) group. JAMA 2000;283:2008-12.
Haghdoost AA, Sadeghirad B, Hajarizadeh B, Mirzazadeh A. The application of systematic review and meta-analysis concepts in summarizing the findings of observational studies. Iran J Psychiatry 2007;2:132-6.
Ado A, Alhassan S, Chonoko UG, Samaila AU. Sero-prevalence of hepatitis B surface antigen (HBsag) among blood donors attending Ahmadu Bello university teaching hospital (ABUTH), Zaria, Nigeria.
Okonko I, Okerentugba P, Innocient AH. Detection Of Hepatitis B Surface Antigen (HBsAg) Among Children In Ibadan, Southwestern Nigeria.
Int J Infect Dis 2012;10. Available from: http://www.ispub.com/IJID/10/1/14183. [Last accessed on 2014 Oct 14].
Oje OJ, Sule WF, Famurewa D. Dual positivity of hepatitis B surface antigen and anti-hepatitis C virus antibody and associated factors among apparently healthy patients of Ekiti State, Nigeria. Viral Immunol 2012;25:448-55.
David OM, Oluduro AO, Ariyo AB, Ayeni D, Famurewa O. Sero-epidemiological survey of hepatitis B surface antigenaemia in children and adolescents in Ekiti State. Niger J Public Health Epidemiol 2013;5:11-4.
Aminu M, Okachi EE, Abubakar SM, Yahaya A. Prevalence of hepatitis B virus surface antigen among healthy asymptomatic students in a Nigerian University. Ann Afr Med 2013;12:55-6.
Ndako JA, Echeonwu GO, Nwankiti OO, Onovoh EM, Ujah A, Ikani PA, paul GA. Hepatitis B Virus Sero-Prevalence among pregnant females in Northern Nigeria. Res J Med Sci 2012;6:129-33.
Adeleke S, Adebimpe MA, Sam-Wobo WO, Wahab SO, Akinyosoye AA, Adelowo TO. Sero-prevalence of malaria, hepatitis b and syphilis among pregnant women in Osogbo, Southwestern Nigeria. J Infect Dis Immun 2013;5:13-7.
Kemebradikumo P, Isa I. The Sero-prevalence of Hepatitis B surface antigen and anti-hepatitis C antibody among women attending antenatal clinic at a tertiary health facility in the Niger Delta of Nigeria. Glob Adv Res J Med Med Sci 2013;2:006-12.
Alao O, Okwori E, Egwu C, Audu F. Seroprevalence of hepatitis B surface antigen among prospective blood donors in an Urban Area of Benue State. Internet J Hem 2008:5. Available from: http://www.ispub.com/IJHE/5/2/3040. [Last accessed on 2014 Oct 14].
Ibrahim AY, Rabi'u A, Idris SA, Saidu AI. Sero-prevalence of hepatitis B virus infection and its risk factors among pregnant women attending antenatal clinic at Aminu Kano Teaching Hospital, Kano. Niger J Basic Clin Reprod Sci 2012;1:49-55.
Ndams IS, Joshua IA, Luka SA, Sadiq HO. Epidemiology of hepatitis B infection among pregnant women in Minna, Nigeria. Sci World J 2008;3:5-8.
Chukwuka JO, Ezechukwu CC, Egbouonu I, Okoli CC. Prevalence Of hepatitis B surface antigen in primary school children In Nnewi, Nigeria. Niger J Clin Pract 2004;7:8-10.
Olokoba AB, Salawu FK, Danburam A, Olokoba LB, Midala JK, Badung LH, et al.
Hepatitis B virus infection amongst pregnant women in North-eastern Nigeria - A call for action. Niger J Clin Pract 2011;14:10-3.
Adoga MP, Gyar SD, Pechulano S, Bashayi OD, Emiasegen SE, Zungwe T, et al.
Hepatitis B virus infections in apparently healthy urban Nigerians: Data from pre-vaccination tests. J Infect Dev Ctries 2010;4:397-400.
Okocha EC, Oguejiofor OC, Odenigbo CU, Okonkwo UC, Asomugha L. Prevalence of hepatitis B surface antigen seropositivity among HIV-infected and non-infected individuals in Nnewi, Nigeria. Niger Med J 2012;53:249-53.
Alikor EA, Erhabor ON. Seroprevalence of hepatitis B surface antigenaemia in children in a tertiary health institution in the Niger Delta of Nigeria. Niger J Med 2007;16:326-9.
Christy NE, Denis EA, Gilbert ON, Chidi UI, Matthias IA, Herbert OO, et al.
: The Seroprevalence of Hepatitis B surface antigen and human immunodeficiency virus among pregnant women in Anambra state, Nigeria. Shiraz E Med J 2004; 5. http://semj.sums.ac.ir/vol5/apr2004/HIV_HBV.htm. [Last accessed on 2014 Oct 14].
Uneke CJ, Ogbu O, Inyama PU, Anyanwu GI, Njoku MO, Idoko JH. Prevalence of hepatitis-B surface antigen among blood donors and human immunodeficiency virus-infected patients in Jos, Nigeria. Mem Inst Oswaldo Cruz 2005;100:13-6.
Sirisena ND, Njoku MO, Idoko JA, Isamade E, Barau C, Jelpe D, et al.
Carriage rate of hepatitis-B surface antigen (HBsAg) in an urban community in Jos, Plateau State, Nigeria. Niger Postgrad Med J 2002;9:7-10.
Adekeye AM, Chukwuedo AA, Zhakom PM, Yakubu RS. Prevalence of hepatitis b and c among blood donors in jos South LGA, Plateau State. Asian J Med Sci 2013;5:101-4.
Ugwuja E, Ugwu N. Seroprevalence of hepatitis B surface antigen and liver function tests among adolescents in Abakaliki, South East Nigeria. Internet J Trop Med 2008:6. Available from: http://www.ispub.com/IJTM/6/2/8952. [Last accessed on 2014 Oct 14].
Kolawole OM, Wahab AA, Adekanle DA, Sibanda T, Okoh AI. Seroprevalence of hepatitis B surface antigenemia and its effects on hematological parameters in pregnant women in Osogbo, Nigeria. Virol J 2012;9:317.
Olajide OA, Juliet OI, Mathew OK, Ajuawo A. Risk factors and prevalence of hepatitis B surface antiginaemia in mothers and their preschool age children in Illorin, Nigeria. Therapy 2007;4:67-72.
Gambo IM, Rabiu, AM, Muhammad MB, Shugaba I. Seroprevalence of HBsAg among Fulani nomads in Toro, North-Eastern Nigeria. Glob Adv Res J Med Med Sci 2012;1:214-7.
Oladeinde BH, Omoregie R, Oladeinde OB. Prevalence of HIV, HBV, and HCV infections among pregnant women receiving antenatal care in a traditional birth home in Benin City, Nigeria. Saudi J Health Sci 2013;2:113-7.
Bukbuk DN, Bassi AP, Mangoro ZM. Sero-prevalence of hepatitis B surface antigen among primary school pupils in rural Hawal valley, Borno State, Nigeria. J Community Med Prim Health Care 2005;17:20-3.
Otegbayo JA, Fasola FA, Abja A. Prevalence of hepatitis B surface and e antigens, risk factors for viral acquisition and serum transaminase among blood donors in Ibadan, Nigeria. Trop Gastroenterol 2003;24:196-7.
Opaleye OO, Tijani BA, Zakariyahu TO, Taiwo SS. Prevalence of HBsAg and HIV among blood donors in Osogbo, Osun State, Nigeria. Int Res J Med Med Sci 2013;1:68-71.
Egah DZ, Banwat EB, Audu ES, Iya D, Mandong BM, Anele AA, et al.
Hepatitis B surface antigen, hepatitis C and HIV antibodies in a low-risk blood donor group, Nigeria. East Mediterr Health J 2007;13:961-6.
Udeze AO, Aliyu AS, Kolawole M, Okonko O, Sule WF, Akanbi K. Hepatitis B surface antigenaemia and risk factors O transmission among apparently healthy students of universit of Ilorin, Ilorin-Nigeria. Sci Afr 2012;11:1-8.
Eke AC, Eke UA, Okafor CI, Ezebialu IU, Ogbuagu C. Prevalence, correlates and pattern of hepatitis B surface antigen in a low resource setting. Virol J 2011;8:12.
Adekanle O, Ndububa DA, Ayodeji OO, Paul-Odo B, Folorunso TA. Sexual transmission of the hepatitis B virus among blood donors in a tertiary hospital in Nigeria. Singapore Med J 2010;51:944-7.
Dirisu JO, Alli TO, Adegoke AO, Osazuwa F. A Survey of prevalence of serum antibodies to human immunodeficiency deficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV) among blood donors. N Am J Med Sci 2011;3:35-8.
Buseri F, Seiyaboh E, Jeremiah Z. Surveying infections among pregnant women in the Niger Delta, Nigeria. J Glob Infect Dis 2010;2:203-11.
Forbi JC, Vaughan G, Purdy MA, Campo DS, Xia GL, Ganova-Raeva LM, et al.
Epidemic history and evolutionary dynamics of hepatitis B virus infection in two remote communities in rural Nigeria. PLoS One 2010;5:e11615.
Opaleye OO, Zakariyahu TO, Tijani BA, Bakarey AS. HBV, HCV co-infection among blood donors in Nigeria. Indian J Pathol Microbiol 2010;53:182-3.
Buseri FI, Muhibi MA, Jeremiah ZA. Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus 2009;7:293-9.
Akani CI, Ojule AC, Opurum HC, Ejilemele AA. Sero-prevalence of hepatitis B surface antigen (HBsAg) in pregnant women in Port Harcourt, Nigeria. Niger Postgrad Med J 2005;12:266-70.
Jombo GT, Egah DZ, Banwat EB. Hepatitis B virus infection in a rural settlement of northern Nigeria. Niger J Med 2005;14:425-8.
Umolu PI, Okoror LE, Orhue P. Human immunodeficiency virus (HIV) seropositivity and hepatitis B surface antigenemia (HBSAG) among blood donors in Benin city, Edo state, Nigeria. Afr Health Sci 2005;5:55-8.
Oronsaye FE, Oronsaye JI. Prevalence of HIV-positives and hepatitis B surface antigen-positives among donors in the University of Benin Teaching Hospital, Nigeria. Trop Doct 2004;34:159-60.
Odusanya OO, Alufohai FE, Meurice FP, Wellens R, Weil J, Ahonkhai VI. Prevalence of hepatitis B surface antigen in vaccinated children and controls in rural Nigeria. Int J Infect Dis 2005;9:139-43.
Baba MM, Onwuka IS, Baba SS. Hepatitis B and C virus infections among pregnant women in Maiduguri, Nigeria. Cent Eur J Public Health 1999;7:60-2.
Mbamara SU, Obiechina NJ. Seroprevalence of hepatitis B surface antigen among antenatal clinic attendees in a private specialist hospital in Onitsha Southeast Nigeria. Niger Med J 2010;51:152-4.
World Health Organization. Recommendations on Viral hepatitis 2010. Available from: http://www.apps.who.int/gb/ebwha/pdf _files/EB126/B126_R16-en.pdf. [Last accessed on 2014 May 31].
World Health Organization. Global policy report on the prevention and control of viral hepatitis. Available from: http://www.apps. who.int/iris/bitstream/10665/85397/1/9789241564632_eng.pdf. [Last accessed on 2014 May 31].
Ott JJ, Stevens GA, Groeger J, Wiersma ST. Global epidemiology of hepatitis B virus infection: New estimates of age-specific HBsAg seroprevalence and endemicity. Vaccine 2012;30:2212-9.
Sutton AJ, Abrams KR, Jones DR, Sheldon TA, Song F. Methods for meta analysis in medical sciences. England: John Wiley and Sons Ltd.; 2000.
Opaleye OO, Oluremi AS, Atiba AB, Adewumi MO, Mabayoje OV, Donbraye E, et al.
Occult Hepatitis B Virus Infection among HIV Positive Patients in Nigeria. J Trop Med 2014;2014:796121.
Nna E, Mbamalu C, Ekejindu I. Occult hepatitis B viral infection among blood donors in South-Eastern Nigeria. Pathog Glob Health 2014;108:223-8.
Firnhaber C, Reyneke A, Schulze D, Malope B, Maskew M, MacPhail P, et al.
The prevalence of hepatitis B co-infection in a South African urban government HIV clinic. S Afr Med J 2008;98:541-4.
Dongdem JT, Kampo S, Soyiri IN, Asebga PN, Ziem JB, Sagoe K. Prevalence of hepatitis B virus infection among blood donors at the Tamale Teaching Hospital, Ghana (2009). BMC Res Notes 2012;5:115.
Fomulu NJ, Morfaw FL, Torimiro JN, Nana P, Koh MV, William T. Prevalence, correlates and pattern of Hepatitis B among antenatal clinic attenders in Yaounde-Cameroon: Is perinatal transmission of HBV neglected in Cameroon? BMC Pregnancy Childbirth 2013;13:158.
World Health Organization. Hepatitis B Global Infection rate. 2006. Available from: http://www.pkids.org/files/pdf/phr/02-09 globalhbv.pdf. [Last accessed on 2013 Dec 22].
Rossi C, Shrier I, Marshall L, Cnossen S, Schwartzman K, Klein MB, et al.
Seroprevalence of chronic hepatitis B virus infection and prior immunity in immigrants and refugees: A systematic review and meta-analysis. PLoS One 2012;7:e44611.
Custer B, Sullivan SD, Hazlet TK, Iloeje U, Veenstra DL, Kowdley KV. Global epidemiology of hepatitis B virus. J Clin Gastroenterol 2004;38:S158-68.
UNAIDS. HIV burden in Nigeria; 2008. Available from: http://www.unaids.org/en/KnowledgeCentre/HIVData/GlobalReport/2008. [Last accessed on 2014 May 31].
Kuhns MC, Busch MP. New strategies for blood donor screening for hepatitis B virus: Nucleic acid testing versus immunoassay methods. Mol Diagn Ther 2006;10:77-91.
Weber B, Bayer A, Kirch P, Schlüter V, Schlieper D, Melchior W. Improved detection of hepatitis B virus surface antigen by a new rapid automated assay. J Clin Microbiol 1999;37:2639-47.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1], [Table 2], [Table 3]
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