The risk of mother-to-child transmission of hepatitis B virus infection in Ethiopia: A systematic review and meta-analysis.

INTRODUCTION: Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a predominant route of infection for children in Ethiopia. No study has so far reported a nationwide estimate of the risk of MTCT of HBV. We conducted a meta-analysis of surveys and estimated the pooled risk of MTCT of HBV in the context of human immunodeficiency virus (HIV) infection. METHODOLOGY: We searched PubMed, EMBASE, Web of Science, Africa Index Medicus, and Google Scholar databases for peer-reviewed articles. The pooled risk of MTCT of HBV was estimated using the DerSimonian-Laird technique with logit transformed proportions and statistical heterogeneity was estimated using I2 statistic, which was explored by subgroup and meta-regression analyses. RESULTS: The overall pooled risk of MTCT of HBV in Ethiopia was 25.5% (95% CI, 13.4%-42.9%). In women without HIV infection, the risk of MTCT of HBV was 20.7% (95% CI 2.8%-70.4%), and 32.2% (95% CI 28.1%-36.7%) in women with HIV infection. After excluding the outlier study, the risk of MTCT of HBV in studies that included only HIV negative women was 9.4% (95% CI, 5.1%-16.6%). CONCLUSIONS: The risk of MTCT of HBV in Ethiopia widely varied by HBV/HIV coinfection. A sustainable control and elimination of HBV in Ethiopia requires improved access to birth-dose HBV vaccine and implement immunoglobulin prophylaxis for exposed infants. Given the limited health resources in Ethiopia, prenatal antiviral prophylaxis integrated with antenatal care may be a cost-effective approach to significantly reduce the risk of MTCT of HBV.

Targeted antiviral treatment of hepatitis B virus in culturally and linguistically diverse populations to achieve elimination targets in Australia.

The majority of Australia's hepatitis B virus (HBV) burden is borne by culturally and linguistically diverse (CALD) populations, and antiviral treatment is the mainstay of intervention. Using modelling, we estimated the impact of targeted antiviral treatment scale-up and changes in migration on HBV-related mortality and HBV elimination in CALD populations in Australia. We fitted a deterministic mathematical model based on the natural history of HBV and the Australian migration effect in four CALD population groups according to country of birth. We used three antiviral treatment scale-up scenarios: baseline (9.3% coverage); intermediate (coverage of 80% of patients eligible for antiviral therapy by 2030); and optimistic (coverage of 20% of all patients living with HBV by 2022). Our model predicted that if the baseline treatment is followed between 2015 and 2030, the number of chronic HBV cases and HBV-related mortality will increase. Following the optimistic scale-up, the number of new HBV cases could be reduced by 78%, 73%, 74% and 83% in people born in Asia-Pacific, Europe, Africa and the Middle East, and Americas, respectively, between 2015 and 2030. An optimistic treatment scale-up could result in a 19.2%-24.5% reduction in HBV-related mortality and a 15%-25% reduction in HCC-related mortality in CALD populations between 2015 and 2030. In conclusion, our findings highlight that targeted antiviral treatment for CALD populations provides significant health system benefits by reducing HBV-related complications from cirrhosis and HCC. Expanded antiviral treatment programmes focusing on high-prevalence CALD populations may be an effective strategy to reduce HBV-related morbidity and mortality.

Fitting Health Care to People: Understanding and Adapting to the Epidemiology and Health Literacy of People Affected by Viral Hepatitis from Culturally and Linguistically Diverse Migrant Backgrounds.

This study explored the epidemiology and health literacy of people affected by viral hepatitis (VH) from migrant culturally and linguistically diverse (CALD) backgrounds attending a community-based general practitioner and specialty hepatology shared-care (HEPREACH) clinic in Brisbane, Australia. Patient-reported data on health literacy and clinical information from adult patients (n = 66) of CALD background recruited from the liver clinic were analyzed. Health literacy was assessed using a 5-question, 12-point scale. Variance weighted multiple linear regression was used to identify factors associated with knowledge about VH. About three-quarters of patients (74.2%) were diagnosed with hepatitis B. The median knowledge score was 7.8 (interquartile range [IQR] 6‒9). One in five patients did not understand the infective nature of VH, 30.3% did not understand mother-to-child transmission risk, and 30-40% of patients thought activities such as kissing, sharing food or mosquito bites could spread VH. Only 6% of patients understood the risk of liver cancer and the need for regular screening. Higher educational level (secondary, ß = 4.8, p < 0.0001 or tertiary, ß = 8.1, p < 0.0001 vs. primary) was associated with better knowledge, and transition through a refugee camp (vs. not, ß = - 1.2, p = 0.028) and country of diagnosis (overseas vs. Australia, ß = - 1.9, p = 0.016) were associated with poorer knowledge. Country of origin, refugee status and opportunities for tertiary education impact patients' understanding of VH. Ensuring delivery of culturally appropriate care and education is critical to improve knowledge, reduce misconceptions to improve care and outcomes for VH in CALD migrant communities.

Remoteness of residence predicts tumor stage, receipt of treatment, and mortality in patients with hepatocellular carcinoma.

BACKGROUND AND AIM: Surveillance and early detection and curative treatment of hepatocellular carcinoma (HCC) are the mainstay of improving survival for patients, but there are several barriers to achieving this goal. We reported the impact of remoteness of residence on receipt of treatment, tumor stage, and survival in patients with HCC in Queensland. METHODS: We conducted a retrospective cohort study of 1651 HCC patients (147 migrants) from 1 January 2007 to 31 December 2016. We used Wilcoxon rank-sum test to compare the median age at the time of diagnosis and Bayesian Weibull accelerated failure time regression to identify independent predictors of time to death. RESULTS: The median survival time after HCC diagnosis was 9.0 months (interquartile range 2.0-24.0). Metropolitan residence (P = 0.02), non-English language (P < 0.001), foreign country of origin (P < 0.001), and HBV etiology (P < 0.001) were significantly associated with receiving surgical resection for HCC treatment. The strongest predictors of time to death were undifferentiated tumor at presentation (time ratio [TR] = 0.30, 95% credible interval (CrI) 0.23-0.39), age ≥70 years (TR = 0.42, 95% CrI 0.34-0.53), living in remote areas (TR = 0.67, 95% CrI 0.55-0.80), and presence of ≥1 comorbidity (TR = 0.69 95% CrI 0.54-0.90). All the other covariates adjusted, including country of birth (TR = 0.76, 95% CrI 0.49-1.06), did not predict survival time. CONCLUSIONS: Patients living in rural and remote areas had late stage clinical presentation and poor survival. Remoteness of residence may limit access to HCC surveillance in at-risk patients such as those with cirrhosis, and timely curative treatment to improve survival in these patients.

Predictors of dental caries among children 7-14 years old in Northwest Ethiopia: a community based cross-sectional study.

BACKGROUND: Dental caries in children remains a significant public health problem. It is a disease with multifactorial causes. The aim of the study was to assess the prevalence and associated factors of dental caries among children between 7 to 14 years old. METHODS: A community based cross-sectional study was conducted in Gondar town from June 2011 to September 2011. A total of 842 children were involved in the study. Multi-stage sampling technique was used to select the children. Pretested and structured questionnaires were used to collect data from mothers. Clinical examination of children was done using dental caries criteria set by world health organization. Data were entered, cleaned and edited using EPI Info version 3.5.1 and exported to SPSS version 16.0 for analysis. Binary multiple logistic regression analyses was applied to test the association. RESULTS: Four hundred sixty three (55%) children were females. The prevalence of dental caries was 306(36.3%).The educational status of children's father (AOR=0.3, 95%CI, 0.17, 0.80), monthly household income (AOR=0.59, 95%CI, 0.01, 0.45), regular teeth brushing (AOR=0.08, 95% CI, 0.03, 0.20) and using mouth rinsing (AOR=0.40, 95% CI, 0.2, 0.80) were found statistically significantly associated with dental caries. CONCLUSIONS: Dental caries were high among children in Gondar town. Low socioeconomic status and poor oral hygiene practices were the influencing factors for dental caries. Oral hygiene, dietary habits and access to dental care services are supreme important for the prevention of the problem.