Hepatitis C virus screening attendance and its relation to age, education, geographic region and perinatal mortality - Georgian Birth Registry 2017/2018

Abstract

Introduction: Hepatitis C virus (HCV) causes a liver disease hepatitis C, which can manifest in acute and chronic form, with potentially life-threatening complications. Globally, in 2017, there were approximately 115 million HCV infected people. Currently, screening for HCV during pregnancy is offered to all pregnant women in a very few countries in the world. Importance of screening every pregnant woman is based on the fact that many HCV infected pregnant women are undetected when screening is risk based. It was estimated that the risk of vertical transmission of HCV (from mother to child) is 5.8%. Infants born to HCV infected mothers have poor birth outcomes such as low birth weight (LBW) and intrauterine foetal growth restriction (IUGR), which are main causes of overall perinatal mortality (PM). In Georgia, country located at the border between Europe and Asia, hepatitis C is burning public health problem, with prevalence of 7.7% in 2015. Screening for HCV is from 2015, offered to all pregnant women through the Maternal and Child Care program. In 2017/18, Georgia had PM of 12.9 per 1000 births. Purpose: The purpose of this thesis was to compare HCV screening attendance of pregnant women in Georgia, according to age, education, region of antenatal care (ANC) clinic at the firs ANC visit, and PM. Material and methods: Data were extracted from the Georgian Birth Registry (GBR). All women who gave birth in 2017/18 were included in the study and categorized into screened and non-screened groups, while non-screened group was further divided into two groups, with and without ANC visits. After exclusions, the study sample included 103 079 women. The descriptive statistics were presented by using percentages, means and standard deviations and the differences were tested by Chi-square test and one-way ANOVA. Binary logistic regression analysis was used to estimate multivariable adjusted odds ratios (OR) with 95% confidence intervals (CI), for being screened according to age, education, and region of ANC clinic, as well as to estimate the association between PM and HCV screening attendance adjusted for age, birthweight of a new born, and complications at delivery. Results: The odds of being screened was 9% lower for women older than 34 compared to the women in the age-group 25-34 (95% CI 0.85-0.97). Women with only primary education had 49% lower odds of being screened compared to women with secondary education (95% CI 0.47-0.55). Women from other regions in which a woman had ANC visit had significantly lower odds of being screened compared to Guria region, the region with lowest proportion of non-screened women. Noticeable differences in screening attendance were also observed between ANC clinics in Tbilisi. There was no association between HCV screening attendance overall and PM in the multivariable binary regression analysis (OR=0.98, 95% CI 0.79-1.22). Conclusion: Differences in age and education were observed between screened and non-screened pregnant women. There were considerably differences in screening attendance rates between regions in Georgia, as well as between ANC clinics in Tbilisi. There was no association between HCV screening attendance and PM.