Cango Lyec (Healing the Elephant): Chronic Hepatitis B Virus among post-conflict affected populations living in mid-Northern Uganda
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Date
2021
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
The legacy of war in Northern Uganda continues to impact people’s health and wellbeing in
the Acholi region. Despite increasing attention to Hepatitis B Virus (HBV) in Uganda and
globally, concerns remain that unique drivers of infection, and barriers to screening, and
treatment, persist among those affected by conflict.
Methods
Cango Lyec (Healing the Elephant) cohort survey involved conflict-affected adults aged 13–
49 in three mid-Northern Uganda districts (Gulu, Amuru and Nwoya). Baseline (2011–2012)
samples were tested for HBV surface antigen (HBsAg), HBV e-antigen (HBeAg), antibodies
to HBV surface antigen (HBsAb), antibodies to HBV e-antigen (HBeAb), and antibodies to
HBV core antigen (HBcAb). All HBsAg positive samples were tested for IgM antibodies to
HBV B core antigen (HBc-IgM) and where available, >6-month follow-up samples were
tested for HBeAg and HBV DNA. Data were analyzed using STATA 15 software. Logistic
regression accounted for variance due to complex two-stage sampling that included stratification,
unequal selection probabilities and community clustering. Odds ratios measured
effect potential risk factors associated with chronic HBV infection.
Results
Among 2,421 participants, 45.7% were still susceptible to HBV infection. HBsAg seropositivity
was 11.9% (10.9–13.0), chronic HBV was 11.6% (10.4–12.8), acquired immunity resulting
from vaccination was 10.9%, and prior natural infection was 31.5%. Older age
(OR:0.570; 95%CI:0.368–0.883) and higher education (OR:0.598; 95%CI:0.412–0.868)
were associated with reduced odds of chronic HBV infection. Being male (OR:1.639; 95%
CI:1.007–2.669) and having been abducted (OR:1.461; 95%CI:1.055–2.023) were associated with increased odds of infection. Among women, having 1 or 2 pregnancies
(compared to none or >2) was associated with increased odds of infection (OR:1.764; 95%
CI:1.009–3.084).
Conclusion
Chronic HBV is endemic in Gulu, Amuru and Nwoya districts. Recommended strategies to
reduce post-conflict prevalence include establishment of Northern Uganda Liver Wellness
Centres, integration of screening and treatment into antenatal care, and roll out of birth-dose
vaccination.
Description
Keywords
Cango Lyec (Healing the Elephant), Chronic Hepatitis B Virus, populations
Citation
Malamba SS, Muyinda H, Ogwang DM, Katamba A, Zamar DS, Jongbloed K, et al. (2021) Cango Lyec (Healing the Elephant): Chronic Hepatitis B Virus among post-conflict affected populations living in mid-Northern Uganda. PLoS ONE 16(5): e0251573. https://doi.org/10.1371/ journal.pone.0251573