RISK FACTORS IN REILIABLE CHILDBEARING AGE WITH ANTI - HBs

ANTIBODY.

Noer Endah Pracoyo1, Raras Anasi 2, Maria Holly Herawati, Kristina 1 Dina Bisara1
1. Research Center for Public Health and Nutrition, National Reseach and Innovation
Agency
2. Health Policy Agency

Corresponding Author (s)

Noer endah Pracoyo
Gedung BJ. Habibi,
Jln Tamrin No 8
Jakarta Indonesia

Noer Endah Pracoyo

pracoyonoerendah@brin.go.id

I allow the journal to publish my email address.

Abstract
Background : Hepatitis B is an infectious disease caused by a virus; if left untreated, it will lead
to cirrhosis. his disease is transmitted horizontally from mother to baby during birth or vertically
through a device. Fertile of Women age are women in the fertile age period to get pregnant.
Anti-Hepatitis B antibody titers indicate that they have ever suffered from hepatitis B or have
been vaccinated against hepatitis B. It is estimated that 240 million people have hepatitis B.
Objectives : This research aimed to assess the relationship between the results of anti-hepatitis B
antibody titers and risk factors in Fertile women of age.
Methods: The sample is in the form of secondary data from the results of anti-hepatitis B
antibody titers from Fertile women aged 15-49 years, which can be linked to their public health
data from Riskesdas 2013. The data were analyzed by cross-sectional and multivariate analysis.
Data analysis using software, namely SPSS 017.

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Results :. In this studyhave relationship that women with a history of pregnancy have a risk of
hepatitis infection by 1,025 compared to women who cannot get pregnant. Meanwhile, women
who have never been pregnant have a risk of hepatitis infection by 1,464 compared to women
who cannot get pregnant.
Conclusions: Suggestions need to check the anti-HBsAg titer to detect the presence of viral
Hepatitis in pregnant women.

Keywords: anti-HBs antibodies, risk factors, women of childbearing age

INTRODUCTION
Hepatitis is an infectious disease that is a public health problem, which affects morbidity,
mortality, public health status, life expectancy, and other socio-economic impacts. (1)
Hepatitis is a public health problem in the world, including in Indonesia. Hepatitis can become
chronic then liver cancer. Hepatitis B virus has infected as many as 2 billion people in the world
and 240 million people suffer from chronic hepatitis and can progress to cancer hepatitis (2)
Indonesia is a high endemic country for hepatitis B, the second largest in the Southeast Asian
region after Myanmar. (3). (4) It is estimated that there are 28 million Indonesians who are
infected with hepatitis B, and 14 million of them have the potential to become chronic and
become liver cancer. These problems will have an impact on public health, productivity, life
expectancy, and other socio-economic impacts (5).
Transmission of hepatitis B can occur vertically and horizontally. Vertically transmitted from
mother to baby at birth and horizontally through body fluids, blood, or equipment contaminated
with hepatitis B virus (6) .
Based on the 2013 Riskesdas, it is known that the prevalence of hepatitis B is 7.1% or an
estimated 18 million Indonesians are infected with hepatitis B. 2%. (7)
Riskesdas 2013 contained data on women of childbearing age and the results of anti-HBsAg
titers and anti-HBs antibody titers with risk factors in the form of questionnaires listed in their
Public Health data, including demographic data consisting of areas of residence, age, education
and occupation, disease history, pregnancy history and dental history. About the respondent's
occupations, they had been diagnosed with Hepatitis and had been pregnant.

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 The HBsAg antibody titer is the titer contained in the body of an individual infected with
hepatitis B. Anti-HBs antibody titer is the antibody titer formed in an individual's body due to
having had hepatitis B or having been vaccinated against hepatitis B. (8)
This article is the result of further analysis of Basic Health Research conducted throughout
Indonesia. The study aimed to obtain an overview of the proportion of hepatitis B sufferers
through anti Hepatitis B ( anti - Hbs) antibody titer data and the two risk factors.
The benefits obtained are input for the program to make a policy in the context of eliminating
hepatitis B in Indonesia.

METHOD
The research design used a cross-sectional, the type of research was retrospective analytic
using secondary data, namely Riskesdas 2013 data. The sample was in the form of women of
childbearing age data contained in their Public Health data which could be linked to biomedical
data at Riskesdas 2013
The population and samples used were anti- hepatitis B antibody titer ( anti- Hbs) data
from the 2013 Riskesdas. The number of biomedical samples/specimens that were checked for
anti-HBs antibody titers was 17069 samples, which could then be linked to the public health data
as many as 10302 samples. Data collection is done by filtering the anti-hepatitis antibody titer
data, which can be linked to the public health data. The data used has gone through data
cleaning and weighting. The inclusion criteria of the sample were data that had gone through
cleaning and data on anti-Hbs antibodies that could be linked to the 2013 Riskesdas public health
data., namely demographic data (age, occupation, education, and rural/urban areas), pregnancy
history, disease history.
The analysis was carried out successively, namely descriptive analysis of the
characteristics of the research subjects, starting with univariate analysis to get an overview of
the frequency distribution of all research variables, the measure used in this analysis was
absolute numbers and percentages presented in tabular form (univariate analysis), then
continued with bivariate analysis. To see the relationship between the dependent variable and the
independent variable, If in the bivariate analysis the results obtained are significant (P = 0.25),
proceed to multivariate analysis to determine the variables that affect the dependent variable.

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Multivariate analysis was performed using logistic regression. Candidates used in multivariate
analysis are bivariate analysis variables with a statistical significance level of p < 0.50. The
modelling used is "Hierarchically Well Formulate" (HWF) with interaction checking and
confounding checking. Significant variables were maintained in the model to determine which
variable had the most effect on anti-Hbs antibody titers. The software used to analyze the
software is SPSS 17.00/state 13.00.
This research obtained permission from the Head of the Health Research and
Development Agency to process data and present it in articles present it in articles.

RESULTS
Distribution of anti-HBs antibody titers in women of childbearing age in several provinces in
Indonesia. (Riskesdas 2013).).

.
Figure 1: Proportion of the spread of anti-HBs antibody titers.
The highest proportion is in the provinces of East Java, West Nusa Tenggara, East Kalimantan,
Southeast Sulawesi, and West Papua.
The characteristic relationship between the independent variable and the anti-HBs antibody titer
can be seen in the table below..

Table 1. Characteristics of Female Respondents of Childbearing Age Based on Anti-HBs

Antibody Titer Examination

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 Caracteritic Anti-body titer results anti-HBs Total (N=10302) P Value
Negative Positive
Region
1.Urban 2130 (28,1 %) 5411 (71,9 %) 7571 (100,0 %) 0,222
2. Rural 2532 (29,0 %) 6199 (71 %) 8731 (100,0 %)
Ages
1. <15 yrs / >35 yrs 6475 (67,2 %) 3154 (32,8 %) 9629 (100,0 %) 0,000
2. 15th - 35th year 5165 (77,4 %) 1508 (22,6 %) 6673 (100,0 %)
Work
1. Work (PNS, TNI, POLRI, 228 (67.1 %) 112 (32.9 %) 340 (100.0 %) 0,000
BUMN)
2. Entrepreneur, Private, Labor, 4121 (69.1 %) 1848 (30.9 %) 5969 (100.0 %)
Fisherman, Farmer, etc
3. Not working, school 7291 (72.9 %) 2702 (27,1 %) 9.993 (100.0 %)

Education
1. Low education 11085 (71.3 %) 4459 (28.69 %) 15544 (100.0 %) 0.257
2. Higher education 555 (73.2 %) 203 (26.78 %) 758 (100.0 %)
Illness History
1. Yes 106 (63.0 %) 62 (36,9 %) 168 (100.0 %) 0,017
2. No 11534 (71,5 %) 4600 (28,5 %) 16134 (100.0 %)
Pregnancy history
1. Yes ever pregnant. 8280 (69,6 %) 3613 (30,4 %) 11893 (100.0 %) 0,000
2. Never been pregnant. 3199 (76,6 %) 977 (23,4 %) 4176 (100.0 %)
3. Can't get pregnant 161 (69.1 %) 72 (30.9 %) 233 (100.0 %)
Dental history
1. Yes 1366 (72,9 %) 509 (27,1 %) 1875 (100.00 %) 0,045
2. No 2618 (70.3 %) 1107 (29.7 %) 3725 (100.00 %)

From the table above, it can be seen that several variables have a P value of less than 0.25 so that
these variables can be candidates for multivariate analysis. From the results of multivariate
analysis with stepwise modeling, it can be seen in the table below.

Table 2. Results of multivariate analysis

Variabel B S.E. Wald Df Sig. Exp(B) 95% CI

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Age(1) -0.573 0.064 80.950 1 0.000 0.564
0.498 - 0.639
Work 1.752 2 0.416
Work(1) -0.243 0.206 1.397 1 0.237 0.784 0.524 – 1.174
Work(2) -0.048 0.064 0.560 1 0.454 0.954 0.842 – 1.080
In the past 12 months
have had fever,
weakness, yellow
eyes (yes) -0.508 0.219 5.377 1 0.020 0.602 0.392 – 0.924
Pregnancy history 18.624 2 0.000

Pregnancy history
(yes) 0.341 0.244 1.959 1 0.162 1.406 0.872 - 2.267
Pregnancy history
(never) 0.648 0.251 6.654 1 0.010 1.911 1.168 - 3.127
Dental history(yes) 0.176 0.064 7.561 1 0.006 1.193 1.052 - 1.353
Constant 0.835 0.249 11.281 1 0.001 2.305 0.498 - 0.639

From the results of the multivariate analysis above, there are several variables that have a P value
of 0.05 so that further analysis is carried out, the results obtained are shown in table 3 below.

Table 3. Multivariate analysis results of pregnancy history

Variabel B S.E. Wald Df Sig. Exp(B) 95% CI
Pregnancy history 73.986 2 0.000
Pregnancy history
(yes) 0.025 0.143 0.029 1 0.864 1.025 0.774 -1.357
Pregnancy history
never) 0.381 0.146 6.785 1 0.009 1.464 1.099 - 1.951
Constant 0.805 0.142 32.219 1 0.000 2.236

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The results of multivariate analysis are that women with a history of pregnancy have a risk of
hepatitis infection by 1,025 compared to women who cannot get pregnant. Meanwhile, women
who have never been pregnant have a risk of hepatitis infection by 1,464 compared to women
who cannot get pregnant..

DISCUSSION
The prevalence of Hepatitis in Indonesia in 2013 was 1.2%, an increase of two times
compared to the previous year. Reset kesehatan dasar ( Basic Research Of Health) in 2007,
which amounted to 0.6%. East Nusa Tenggara was the province with the highest hepatitis
prevalence in 2013 which was 4.3%. (7) (6) Based on the results of the anti-hepatitis B ( anti-
Hbs) antibody titer examination, it can be seen that the highest percentage is in the provinces of
East Kalimantan, Southeast Sulawesi, and West Papua, East Java, NTB and NTT. The presence
of anti-hepatitis B antibody titers indicates that the individual has had Hepatitis or has received a
hepatitis B vaccine. The results of this study are that women with a history of pregnancy have a
risk of hepatitis infection by 1,025 compared to women who cannot get pregnant. Meanwhile,
the result of the study of viral Hepatitis in women of childbearing age in a rural area in China
was Fertile Age Women alamundiiare women in a state of reproductive organs functioning
correctly between the ages of 20-45 years. The fertile peak in women is in the age range of 20-29
years. At this age, women have a 95% chance of getting pregnant, at the age 30-39 years the
percentage decreases to 90 % and after entering the age 40 years the chance of pregnancy
becaome 40%, then it will decreases to 10 % if women are over 40 years old (2,3,9) very
important because they will soon be married and have children. The purpose of this study was to
determine Hepatitis based on HBsAg. (10) The research of screening in two Community Health
Centers in Malang City has been conducted in Malang to determine the prevalence of pregnant
women with hepatitis B in Malang. Pregnant women infected with hepatitis B can transmit the
virus to their baby during pregnancy or delivery, so screening is necessary to determine the
prevalence of pregnant women with hepatitis B in Malang. The screening was carried out in the
two Community Health Centers of Malang City, Dinoyo and Kedungkandang, two Community
Health Centers, i.e.Malang Regency, Sumberpucung and Gondanglegi, and Hermina Hospital.
Participants were given counselling, i.e. anamnesis, vital signs checks, and blood sample
collection. The serum of participants was tested for HBsAg and Anti-HBS; the method used was

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ELISA. One hundred fifty-six pregnant women participated in this screening. The mean age of
participants was 28 5±5 eight years old, and the mean age at marriage was 22; 53; 8 years
was much as% and 8% positive anti-HBs was found in patients with negative HBsAg. This data
is expected to be the basis of policies for the prevention of hepatitis B, such as promoting
hepatitis B vaccination and education about hepatitis B to a broader population (11).
The study of examined the duration and uniformity of protection conferred by infant
hepatitis B vaccination within a setting where HBV is highly endemic. Children born to HBsAg
positive mothers were less protected from HBV infection in adulthood by a three-dose
recombinant HBsAg vaccine administered in infancy compared to children born to HBsAg
negative mothers. These children will likely benefit from a fourth HBV vaccine dose in early
adolescence, before the age of sexual debut. (12) Screening that has been carried out on
pregnant women in Cameroon, pregnant women are rarely screened routinely in most health
facilities in Cameroon. The study was to determine the prevalence, knowledge and risk factors of
hepatitis B among pregnant women in Loom Health District. This study was a cross sectional
hospital and community-based carried out among pregnant women in the Loom Health District.
All five health areas and 24 health facilities were included. Data on the socio-demography and
knowledge on hepatitis B infection were collected using a structure. Pregnant women were
screened for hepatitis B surface antigens (HBsAg) using the DiaSpot One Step Hepatitis B. test.
Data were analyzed using SPSS version 26. The Chi-square test was used to compare
proportions and logistic regression. The model was fitted to find out factors independently
associated with knowledge, prevalence and attitude of the 200 pregnant. Of women screened, 18
(9%) were positive for hepatitis B. Higher prevalence was observed for the age group 16-25
(10.8%). Furthermore, the primary level of education is 7 (13.5%). The results showed that
pregnant women had inadequate knowledge of HBV infection. History of multiple sex partners
(AOR=5.58, P=0.001), history of surgery (AOR=3.04, P=0.026) and history of tattooing.
(AOR=2.36, P=0.041) were all significantly associated with hepatitis B zero-positivity. The
prevalence of HBsAg was 9%. Only one-third of participants had adequate knowledge of
Hepatitis B. Although hepatitis B is recognized as one of the significant health problems,
pregnant women in the Loum health district were less aware of its mode of transmission,
consequences and prevention. History of surgery, tattooing and multiple sexual partners
increased hepatitis transmission (13). (14).

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 When HBV is acquired during pregnancy, prenatal transmission can occur to the fetus.
Therefore, this study aims to estimate seroprevalence and associated factors of HBV infection
among pregnant women attending the Antenatal Clinic (ANC) of Arba Minch Hospital, Southern
Ethiopia. A facility-based cross-sectional study was conducted on 232 pregnant women visiting
ANC from February to April 2015. Data regarding sociodemographic and associated factors
were gathered using a questionnaire. An Enzyme-Linked immunosorbent assay tested serum
samples for hepatitis B surface antigen (HBsAg). Data were analyzed using SPSS version 20.
The overall seroprevalence of HBV infection was 4.3% (95% CI: 2.2–6.9%). Multivariate
analysis showed that history of abortion (AOR = 7.775; 95% CI: 1.538–39.301) and having
multiple sexual partners (AOR = 7.189; 95% CI: 1.039–49.755) were independent predictors of
HBsAg seropositivity. In conclusion, the prevalence of HBV infection is intermediate.
Therefore, screening for HBV infection should be a routine part of ANC; health information on
having a single sexual partner for women of childbearing age and following aseptic techniques
during an abortion should be provided to health facilities working on abortion (15).
The study of the prevalence of HBV infection, therefore, screening for HBV infection
should be a routine part of ANC, health information on having a single sexual partner for
women of childbearing age and following aseptic techniques during an abortion should be
provided to health facilities working on abortion. (16)
The study of Impac of pentavalent hepatitis B vaccination has the chronic hepatitis B
virus infection (CHBI) is effectively prevented by vaccination starting at birth. In 2002, Uganda
adopted a policy of providing the pentavalent hepatitis B vaccine starting at six weeks. However,
there is concern that this delay may leave the infant vulnerable to infection during the first six
weeks of life. They assessed whether vaccination at six weeks was an effective strategy by HBV
serologic study. Of 656 persons tested for HBV, 9.4% were chronically infected; among
children aged 5–9 years, the prevalence was 7.6%. Of all tested, 73 were born (i.e., aged ≤4
years) after the introduction of the pentavalent vaccine; none were infected with HBV (p =
0.003) (17).
The results of the research of The Prevalence of hepatitis B among pregnant women
assisted at the public maternity hospitals of São Luís, Maranhão Brazil. This study was to assess
the prevalence of HBV markers in pregnant women receiving prenatal care at the public
maternity hospitals of São Luís. The samples are 541 pregnant women samples were collected,

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and the anti-HBc test was performed first. If positive, the sample was subsequently tested for
HBsAg and anti-HBs. All HBsAg and/or anti-HBc positive samples were additionally tested for
HBV-DNA. The results is 40 (7.4%) pregnant women turned out positive for anti-HBc. Of
those, five (0.9%) were HBsAg positive, four (0.7%) were anti-HBc positive with negative
HBsAg and anti-HBs, and 31 (5.7%) were positive for anti-HBc and anti-HBs. Anti-HBc
positivity was associated with family history of hepatitis and education level below 11 years of
schooling. HBV-DNA was positive in only one HBsAg-positive sample. There was no HBV-
DNA positivity among HBsAg negative samples. Conclusions: The prevalence of HBsAg in
pregnant women in this study confirmed that São Luís is a low endemicity area. Occult hepatitis
B was not detected in these samples..(18)
The study of Pentavalent hepatitis B vaccine starting at 6 weeks of age. However, there is
concern that this delay may leave the infant vulnerable to infection during the first 6 weeks of
life. There assessed whether vaccination at 6 weeks was an effective strategy by HBV serologic.
Study. Of 656 persons tested for HBV, 9.4% were chronically infected; among children aged 5-9
years the prevalence was 7.6%. Of all tested, 73 were born (i.e., aged ≤4 years) after the
introduction of the pentavalent vaccine; none were infected with HBV (p=. 0.003). In this study,
vaccination with the pentavalent vaccine at 6 weeks did not result in CHBI, but rather provides
an opportunity to prevent mother-to-infant transmission of HBV infection where there is no
access to birth-dose vaccine .(19)

CONCLUSIONS
In this study, we conclude that women with a history of pregnancy have a risk of hepatitis
infection by 1,025 compared to women who cannot get pregnant. Meanwhile, women who have
never been pregnant have a risk of hepatitis infection by 1,464 compared to women who cannot
get pregnant.. Advice for women of childbearing age to check Hbs Ag titer before marriage and
get Hepatitis B vaccination

ACKNOWLEDGMENTS

We take this opportunity to thank the Head of the Health Policy Agency for giving permission to
analyze the 2013 Riskesdaas data as material for writing this paper.

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COMPETING INTERESTS

The authors declare that there are no financial competing interests.

AUTHORS’ CONTRIBUTIONS

Noer Endah Pracoyo participated in data collection, analysis, and interpretation and participated
in the drafting of the manuscript, Raras Anasi participated in analysis, and interpretation, Maria
Holly Herawati participated to correct and participated to complete the bibliography, Kristin
participated to complete the bibliography. All authors read and approved the final manuscript.

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