Key words

HIV, HBV, syphilis, pregnant women,

Introduction

In developing countries, pregnant women encounter difficulties in view of STIs. Very often, such infections are transmitted to them by their unfaithful husband through extra-marital affairs. Either HIV infection, or those from the Hepatitis B virus and syphilis constitute a main public health issue around the World. These infections are transmitted primarily by sex, parenterally, or to the fœtus from pregnancy, suggesting the risk of coinfection on the same patient. The rate of infection keeps rising, despite of measures taken in each country to fight it. Each year, the World Health Organisation estimates at more than 340 millions of new cases of sexually transmitted infections [1]. The objectives of this study were to understand the sociodemographic behaviours of pregnant women, to identify the level of infection with Hepatitis B virus and eventually that of HIV, and to determine the prevalence rate of syphilis

Material And Methods

The study was conducted a descriptive study on women, at the integrated Health Centre of Mahajanga in Madagascar in collaboration with the laboratory of the University Hospital Centre of Zafisaona Gabriel (UHC ZAGA) from February to April 2016. Blood samples were taken during prenatal consultation (PNC) of pregnant women. It includes also subjects who accepted to undergo PNC every monday all along the study. A rapid assay of immunochromatography was used to detect both HIV and syphilis infection « OnSite HIV/Syphilis Ab Combo Rapid tests » (Batch: F0115M11C01, Expiry Date 14/07/2017) and for the Hepatitis B, Kit «OnSite Hbs Combo Rapid Tests» (Batch : F0115M11C01, Expiry date 14/07/2017).

Results and Discussion

Table I : Sociodemographic characteristics.

Effective Variables (n = 95) Percentage (%)
Age
Less than 18 years old 07 7.36%
[18 – 28 ] 62 65.26%
[28 – 38 ] 23 24.21%
≥ 38 years old 03 3.58%
Profession
Housewife 48 50.50%
Merchant 44 46.30%
Teacher 1 1.10%
Student 2 2.10%
Level of study
Illiterate 11 11.51%
Primary 46 48.42%
Secondary 34 35.78%
Academic 04 4.21%
Age of pregnancy
10-25 SA 53 55.78%
≥ 26 SA 42 44.21%
Number of pregnancy
1 36 37.89%
2 30 31.57%
≥ 3 29 30.52%
Parity
0 40 42.10%
1 27 28.42%
2 13 13.68%
≥ 3 15 15.78%
Abortion
0 80 84.21%
1 12 12.63%
≥ 2 03 3.15%
Sexual partner
1 27 28%
≥ 2 68 72%

Table II : Biological characteristics.

Sérologie Number Percentage (%)
Hépatite B 05 5.3%
Syphilis 05 7.4%
VIH 00 0%
Coïnfection 00 0%

Infections on pregnancy

None of the 95 pregnant women screened for HIV, were tested positive (TableII). Some authors reported a HIV infection rate of 0,8% among pregnant women [2]. The time monitoring of HIV prevalence on pregnant women is certainly an interesting way to follow up the spread of virus among population, particularly when the rates of heterosexual contamination seem recently to rise with newly detected seropositive cases [2].

The prevalence rate of Hepatitis B was of 5,3% (TableII). This figure is higher than that found in Antananarivo by Randriamahazo and al. in 2012 [3]. In Cameroun, Hepatitis B which attains many pregnant women has a prevalence rate of 10,2% [4].

In Madagascar, systematic screening of Hepatitis B on pregnant women is not mandatory during the prenatal consultation and tests are not available at the Basic Health Centre. Conversely, in developed countries, such screening is recommended from the six months of pregnancy. It enables to determine the serological status of women and to allow a better handling at the occurence of the infection.

No significant relationship was found between age and Hepatitis B infection. Andréas and al. as well did not relate the age factor to the main risk of contracting Hepatitis B during pregnancy [5]. In opposite, Entisar and al. in Cameroun realized in 2011 that age was mainly linked to Hepatitis B occurence among pregnant women [6].

As for the syphilis infection, the seroprevalence was of 7,4%. This figure is close to that reported by Newman and al. in 2012 in Ouganda, they found 6,49% on pregnant women [7]. However, it is by far superior to that of Ormaeche in Perou in 2008 (1,6%) [8]. Other study led by Katenga in 2012 in Congo on the same population showed a higher result with 10,9% [9]. Syphilis is one of the least known pathologies among the population of Madagascar, despite of its screening on pregnancy.

Coinfection

In this study, no HIV-Hepatitis B coinfection was found on tested subjects. Conversely, in South Africa, Anderson and al. reported in 2012, 3,4% cases of HIV and Hepatitis B coinfection on pregnant women [10]. Similarly, Noubiap and al. investigated that 1,5% of women were infected with both HIV and Hepatitis B [4]. Such outcomes imply that coinfection is confirmed among pregnant women but at a low level of prevalence.

Conclusion

This work enabled to estimate the level of HIV, Hepatitis B virus and the syphilis infections on pregnant women. None of the subjects under study were tested positive with HIV. In opposite, hepatitis B and syphilis occurence were confirmed. Coinfection was not evidenced. The antenatal screening helps to lower and to prevent the vertical or horizontal spread of HIV, and syphilis. These assays are available and free at the the Basic Health Centre. Which is not the case of the Hepatitis B test. Immunization is recommended and this despite of low prevalence rate of the Hepatitis B infection, systematic screening is of such importance.