Table 3 Association between participants’ laboratory test results and HBsAg positivity On multivariable analysis, women 20 years of age or younger were

2.5-fold more likely to test positive than those aged above 20 years; aOR 2.54, CI (1.31 to mostly 4.90); p value 0.006 (table 2 footnote). Discussion This study highlights the high prevalence of HBV infection (11.8%) among pregnant women attending ANC in two hospitals in postconflict northern Uganda. Although the prevalence of HBV and HIV infections in this region exceeds those in most other regions of Uganda that have not experienced prolonged civil conflict and internment in camps, no causal relationship between HBV infection and civil conflict can be inferred from these findings from a cross-sectional study. We also found that about 15% of the HBsAg positive mothers were also

HBeAg positive. The prevalence of HBV infection was higher among women aged 20 years or younger (20%) compared with the older women (8.7%). HIV infection among the study population was also high (9.3%). However, there was no significant association between HIV infection and HBV infection among the pregnant women included in this study. The prevalence of HBV infection among pregnant women in this study is consistent with findings from a study in Nigeria of a prevalence of 11%. The prevalence of HBeAg (33%) was, however, higher in the Nigerian study.12 The majority of people who get HBV infection after the neonatal period tend to clear the virus over time. The natural history of hepatitis B infection follows three phases: immune tolerant, immune active and immune inactive phases. During the immune active phase when the virus is actively replicating and HBV DNA is high, HBeAg becomes positive and the individual is at a higher risk of transmitting the virus. In the immune inactive phase, the individual has cleared the virus and HBsAg from the blood and becomes less or not infectious to others unless they revert to the immune active phase. The liver enzymes, particularly ALT, are normal during the immune tolerant and immune inactive phases. In our study, the liver enzymes were

largely within normal ranges and did not vary significantly between HBsAg-positive and HBsAg-negative pregnant mothers. This may mean that most of our mothers were in the immune intolerant or immune inactive phases of their infections. In the Nigerian study where prevalence Cilengitide of HBeAg was up to 33%, it is probable that the mothers were in the immune active phases and could have had recent infections or were reverting from immune inactive to active phases.19 The finding in this study that 3 in 20 pregnant women with positive HBsAg are also HBeAg positive means that many unborn babies in northern Uganda are at an even higher risk of infection with HBV. The infants of all these HBsAg positive mothers will need immediate vaccination with HBV vaccine on delivery.