Factors associated with hepatitis B and C in over one million adults in sub-Saharan Africa: a systematic review and meta-analysis

Background Viral hepatitis is a major cause of disability and premature death worldwide, with Sub-Saharan Africa (SSA) accounting for approximately 25% of this burden. Studies on risk factors for hepatitis B (HBV) and hepatitis C (HCV) in SSA have shown inconsistent results, mainly because of small sample sizes. This systematic review and meta-analysis investigated the factors associated with HBV and HCV among adults in SSA. Methods We searched MEDLINE, Embase, and other databases from database inception to identify observational studies reporting factors associated with HBV and HCV among adults in SSA. Study screening, data extraction, and risk of bias assessment were performed by pairs of reviewers. We used random-effects meta-analysis to pool study estimates, with meta-regression to examine heterogeneity. Findings Approximately 1.6 million and 1.3 million participants were included across 126 and 69 studies on HBV and HCV, respectively. Factors significantly associated with HBV included male gender (p < 0.0001); unemployment (p < 0.0001); tattoos (p < 0.0001); sharing razors/sharps (p = 0.0001); household HBV contact (p < 0.0001); living with HIV (p = 0.0002); multiple sexual partners (p < 0.0001); and histories of scarification (p < 0.0001), STI (p < 0.0001), abortion (p = 0.0016), blood transfusion (p < 0.0001), surgery (p < 0.0001), and dental procedures (p = 0.0281). Factors associated with HCV included urban residence (p = 0.0307), sharing razors/sharps (p = 0006); living with HIV (p = 0.0034); and histories of STI (p = 0.0307), blood transfusion (p = 0.0049), surgery (p = 0.0235), and dental procedures (p < 0.0001). Interpretation Demographic, sociocultural, household, sexual, and healthcare-related factors are associated with HBV and HCV in SSA. This underscores the need for targeted prevention strategies in both healthcare and community settings. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.