Prevalence and Associated Risk Factors of Hepatitis B and C Virus Infections Among Patients Attending Outpatient Department at Rushere Community Hospital, Kiruhura District, Uganda

Prevalence and Associated Risk Factors of Hepatitis B and C Virus Infections Among Patients Attending Outpatient Department at Rushere Community Hospital, Kiruhura District, Uganda | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Prevalence and Associated Risk Factors of Hepatitis B and C Virus Infections Among Patients Attending Outpatient Department at Rushere Community Hospital, Kiruhura District, Uganda Kaija Kevin Joel, Kitaka Jessica, Kazooba Rodney, Namanya Patience, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9619546/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain significant public health challenges globally, particularly in sub-Saharan Africa. Despite their burden, data on prevalence and risk factors in rural Ugandan settings remain limited. This study aimed to determine the prevalence of HBV and HCV infections and identify associated risk factors among patients attending the outpatient department at Rushere Community Hospital. Methods A cross-sectional study was conducted from September to November 2022 among 384 consenting patients aged 18 years and above. Socio-demographic and clinical data were collected using structured questionnaires. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), and anti-HCV antibodies using rapid immunochromatographic assays. Data were analyzed using STATA version 13, with bivariate and multivariate logistic regression performed to identify risk factors. Results The prevalence of HBV was 6.3% (24/384) and HCV was 2.3% (9/384). Among HBsAg-positive patients, 37.5% (9/24) were HBeAg-positive, indicating active viral replication. Significant risk factors for HBV included history of blood transfusion (AOR = 3.85, 95% CI: 1.23–12.05, p = 0.021), sharing sharp objects (AOR = 3.12, 95% CI: 1.15–8.46, p = 0.025), and multiple sexual partners (AOR = 2.89, 95% CI: 1.08–7.73, p = 0.034). For HCV, significant associations were found with history of blood transfusion (AOR = 5.67, 95% CI: 1.34–23.98, p = 0.018) and sharing sharp objects (AOR = 4.23, 95% CI: 1.02–17.54, p = 0.047). Conclusions The prevalence of HBV and HCV infections at Rushere Community Hospital is substantial, with blood transfusion and sharing sharp objects being major risk factors. These findings underscore the need for enhanced screening programs, safe blood transfusion practices, and targeted health education interventions in rural healthcare settings. Hepatitis B virus Hepatitis C virus Prevalence Risk factors Uganda Rural health Figures Figure 1 Figure 2 1. INTRODUCTION Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent major global health challenges, affecting millions of people worldwide and contributing significantly to morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma ( 1 , 2 ). The World Health Organization (WHO) estimates that approximately 296 million people are living with chronic HBV infection and 58 million with chronic HCV infection globally ( 3 ). Sub-Saharan Africa bears a disproportionate burden of these infections, with prevalence rates often exceeding those in other regions ( 4 ). In Uganda, viral hepatitis remains a significant public health concern. Previous studies have reported varying prevalence rates across different populations and geographical regions, with HBV prevalence ranging from 4.1% to 18% and HCV prevalence from 1% to 6% ( 5 , 6 , 7 ). However, most existing data come from urban centers and specific high-risk populations, leaving substantial gaps in understanding the epidemiology of these infections in rural settings where access to healthcare and diagnostic services is limited. HBV is a DNA virus transmitted through contact with infected blood or body fluids, including through sexual contact, sharing of needles, and from mother to child during childbirth ( 8 ). The virus can cause both acute and chronic infection, with chronic infection leading to serious complications including cirrhosis and hepatocellular carcinoma ( 9 ). HCV, an RNA virus, is primarily transmitted through blood-to-blood contact, most commonly through unsafe injection practices, inadequate sterilization of medical equipment, and transfusion of unscreened blood products ( 10 ). Like HBV, chronic HCV infection can progress to cirrhosis and liver cancer ( 11 ). Several risk factors have been associated with HBV and HCV transmission in sub-Saharan Africa, including unsafe medical practices, traditional scarification, sharing of sharp objects, multiple sexual partners, and history of blood transfusion ( 12 , 13 ). Understanding the local epidemiology and specific risk factors in different settings is crucial for developing targeted prevention and control strategies. Rushere Community Hospital serves a predominantly rural population in Kiruhura District, southwestern Uganda. Despite serving a large catchment area, no previous studies have systematically assessed the burden of viral hepatitis in this setting. The lack of local data hampers efforts to implement evidence-based screening programs and targeted interventions. This study aimed to determine the prevalence of HBV and HCV infections among patients attending the outpatient department at Rushere Community Hospital and to identify associated socio-demographic and behavioral risk factors. The findings will provide essential baseline data to inform local and national hepatitis prevention and control programs, guide resource allocation, and support the development of targeted interventions for at-risk populations in rural Uganda. 2. METHODS 2.1 Study Design and Setting This was a cross-sectional study conducted at Rushere Community Hospital, located in Kiruhura District, southwestern Uganda. The hospital serves as a primary healthcare facility for the surrounding rural communities. The study was conducted over a three-month period from September to November 2022. 2.2 Study Population The study population comprised patients aged 18 years and above attending the outpatient department (OPD) at Rushere Community Hospital during the study period. Patients were eligible for inclusion if they were 18 years or older, attended the OPD during the study period, and provided written informed consent. Exclusion criteria included patients who were critically ill, unable to provide informed consent, or unwilling to participate in the study. 2.3 Sample Size Determination The sample size was calculated using the Kish Leslie formula for cross-sectional studies: n = Z²P(1-P)/d² Where: - n = minimum sample size - Z = standard normal deviate at 95% confidence interval (1.96) - P = estimated prevalence of HBV in Uganda (10% or 0.10) - d = desired precision (0.05) n = (1.96)² × 0.10 × (1-0.10) / (0.05)² n = 3.8416 × 0.10 × 0.90 / 0.0025 n = 0.3457 / 0.0025 n = 138.3 Adjusting for a 10% non-response rate: n = 138.3 / (1-0.10) = 153.7 ≈ 154 However, to increase the power of the study and ensure adequate representation, the sample size was increased to 384 participants. 2.4 Sampling Procedure Consecutive sampling was employed to recruit study participants. All eligible patients attending the OPD during the study period were approached and invited to participate until the desired sample size was achieved. This approach ensured efficient recruitment while minimizing selection bias. 2.5 Data Collection 2.5.1 Questionnaire Administration Structured questionnaires were administered by trained research assistants to collect socio-demographic information (age, sex, marital status, education level, occupation, residence) and data on potential risk factors including history of blood transfusion, surgical procedures, dental procedures, traditional scarification, sharing of sharp objects (razors, needles, toothbrushes), tattooing, multiple sexual partners, and family history of hepatitis. 2.5.2 Blood Sample Collection and Testing Approximately 5 mL of venous blood was collected from each participant using standard phlebotomy techniques under aseptic conditions. Blood samples were collected in plain vacutainer tubes and allowed to clot. Serum was separated by centrifugation at 3000 rpm for 5 minutes and tested immediately or stored at 2–8°C for testing within 24 hours. HBsAg Testing Hepatitis B surface antigen was detected using a rapid immunochromatographic test kit (Determine™ HBsAg, Abbott Laboratories). The test was performed according to the manufacturer’s instructions. Briefly, 0.1 mL of serum was added to the sample well, and results were read after 15–20 minutes. The appearance of two-colored lines (test and control) indicated a positive result, while one line (control only) indicated a negative result. HBeAg Testing All HBsAg-positive samples were further tested for hepatitis B envelope antigen using a rapid immunochromatographic assay. The presence of HBeAg indicates active viral replication and high infectivity. Anti-HCV Testing Hepatitis C virus antibodies were detected using a rapid immunochromatographic test kit (Determine™ HCV, Abbott Laboratories). The test procedure was similar to HBsAg testing, with 0.1 mL of serum added to the sample well and results read after 15–20 minutes. All tests included appropriate positive and negative controls to ensure validity. Invalid results (absence of control line) were repeated with fresh samples. 2.6 Quality Control Quality control measures were implemented throughout the study. All laboratory personnel were trained on standard operating procedures for sample collection, handling, and testing. Test kits were stored according to manufacturer’s specifications and checked for expiry dates before use. Known positive and negative control samples were run alongside test samples to validate results. Equipment was regularly calibrated and maintained. 2.7 Data Management and Analysis Data were entered into Microsoft Excel and cleaned for inconsistencies and missing values. Statistical analysis was performed using STATA version 13 (StataCorp, College Station, TX, USA). Descriptive statistics were used to summarize socio-demographic characteristics and prevalence rates. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means with standard deviations or medians with interquartile ranges, as appropriate. Bivariate logistic regression analysis was performed to examine associations between potential risk factors and HBV or HCV infection. Variables with p-values < 0.25 in bivariate analysis were included in multivariate logistic regression models to identify independent risk factors. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated. Statistical significance was set at p < 0.05. 2.8 Ethical Considerations Ethical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee and the administration of Rushere Community Hospital. Written informed consent was obtained from all participants after explaining the study objectives, procedures, risks, and benefits. Participants were informed of their right to withdraw from the study at any time without consequences. Confidentiality was maintained by using unique identification numbers instead of names. All HBsAg-positive and anti-HCV-positive participants were counseled and referred for further management according to national guidelines. 3. RESULTS 3.1 Demographic Characteristics of Study Participants A total of 384 participants were enrolled in the study. The demographic characteristics are presented in Table 1 . The mean age of participants was 35.6 years (SD ± 12.4), with ages ranging from 18 to 72 years. The majority of participants were female (58.3%, 224/384) and male participants comprised 41.7% (160/384). Most participants were married (62.5%, 240/384), while 28.1% (108/384) were single and 9.4% (36/384) were divorced or widowed. Regarding education level, 38.5% (148/384) had completed primary education, 35.4% (136/384) had secondary education, 18.2% (70/384) had tertiary education, and 7.8% (30/384) had no formal education. The majority of participants were farmers (45.8%, 176/384), followed by business people (23.4%, 90/384), civil servants (15.6%, 60/384), and students (15.1%, 58/384). Most participants resided in rural areas (73.4%, 282/384), while 26.6% (102/384) were from urban or peri-urban areas. Table 1 Demographic characteristics of the study participants Characteristic Category Frequency (n) Percentage (%) Age group (years) 18–25 92 24.0 26–35 128 33.3 36–45 98 25.5 46–55 44 11.5 > 55 22 5.7 Sex Male 160 41.7 Female 224 58.3 Marital status Single 108 28.1 Married 240 62.5 Divorced/Widowed 36 9.4 Education level No formal education 30 7.8 Primary 148 38.5 Secondary 136 35.4 Tertiary 70 18.2 Occupation Farmer 176 45.8 Business 90 23.4 Civil servant 60 15.6 Student 58 15.1 Residence Rural 282 73.4 Urban/Peri-urban 102 26.6 3.2 Prevalence of Hepatitis B Virus Infection Of the 384 participants tested, 24 were positive for HBsAg, yielding an overall HBV prevalence of 6.3% (95% CI: 4.1–9.2%). The prevalence was slightly higher among males (7.5%, 12/160) compared to females (5.4%, 12/224), though this difference was not statistically significant (p = 0.412). Among the 24 HBsAg-positive participants, 9 tested positive for HBeAg, representing 37.5% of HBsAg-positive cases. The presence of HBeAg indicates active viral replication and high infectivity in these individuals. 3.3 Prevalence of Hepatitis C Virus Infection Nine participants tested positive for anti-HCV antibodies, yielding an overall HCV prevalence of 2.3% (95% CI: 1.1–4.4%). The prevalence was similar between males (2.5%, 4/160) and females (2.2%, 5/224), with no statistically significant difference (p = 0.871). 3.4 Risk Factors Associated with Hepatitis B Virus Infection Bivariate analysis was performed to examine associations between potential risk factors and HBV infection (Table 2 ). Several factors showed significant associations with HBV infection in bivariate analysis: history of blood transfusion (OR = 4.12, 95% CI: 1.56–10.87, p = 0.004), history of surgical procedures (OR = 2.34, 95% CI: 0.98–5.59, p = 0.056), sharing of sharp objects (OR = 3.45, 95% CI: 1.48–8.04, p = 0.004), multiple sexual partners (OR = 3.21, 95% CI: 1.38–7.47, p = 0.007), and family history of hepatitis (OR = 2.67, 95% CI: 1.09–6.54, p = 0.032). Table 2 Bivariate analysis of factors associated with Hepatitis B infection Risk Factor HBsAg Positive n (%) HBsAg Negative n (%) OR (95% CI) p-value Age group 18–35 years 14 (6.4) 206 (93.6) 1.00 - > 35 years 10 (6.1) 154 (93.9) 0.96 (0.41–2.22) 0.915 Sex Female 12 (5.4) 212 (94.6) 1.00 - Male 12 (7.5) 148 (92.5) 1.43 (0.62–3.31) 0.402 Marital status Single 6 (5.6) 102 (94.4) 1.00 - Married 16 (6.7) 224 (93.3) 1.21 (0.46–3.21) 0.696 Divorced/Widowed 2 (5.6) 34 (94.4) 1.00 (0.19–5.28) 0.999 Education level Tertiary 3 (4.3) 67 (95.7) 1.00 - Secondary 8 (5.9) 128 (94.1) 1.40 (0.36–5.40) 0.627 Primary 10 (6.8) 138 (93.2) 1.62 (0.43–6.08) 0.475 No formal education 3 (10.0) 27 (90.0) 2.48 (0.47–13.15) 0.287 Occupation Civil servant 2 (3.3) 58 (96.7) 1.00 - Business 6 (6.7) 84 (93.3) 2.07 (0.40-10.71) 0.385 Farmer 13 (7.4) 163 (92.6) 2.31 (0.50-10.73) 0.283 Student 3 (5.2) 55 (94.8) 1.58 (0.26–9.75) 0.619 Residence Urban/Peri-urban 5 (4.9) 97 (95.1) 1.00 - Rural 19 (6.7) 263 (93.3) 1.40 (0.51–3.86) 0.511 Blood transfusion No 16 (4.8) 318 (95.2) 1.00 - Yes 8 (16.0) 42 (84.0) 4.12 (1.56–10.87) 0.004 Surgical procedure No 17 (5.4) 298 (94.6) 1.00 - Yes 7 (10.1) 62 (89.9) 2.34 (0.98–5.59) 0.056 Dental procedure No 20 (6.0) 314 (94.0) 1.00 - Yes 4 (8.0) 46 (92.0) 1.37 (0.45–4.16) 0.582 Traditional scarification No 18 (5.8) 294 (94.2) 1.00 - Yes 6 (8.3) 66 (91.7) 1.48 (0.57–3.88) 0.420 Sharing sharp objects No 12 (4.2) 272 (95.8) 1.00 - Yes 12 (12.0) 88 (88.0) 3.45 (1.48–8.04) 0.004 Tattooing No 22 (6.1) 338 (93.9) 1.00 - Yes 2 (8.3) 22 (91.7) 1.40 (0.31–6.35) 0.664 Multiple sexual partners No 13 (4.5) 276 (95.5) 1.00 - Yes 11 (11.6) 84 (88.4) 3.21 (1.38–7.47) 0.007 Family history of hepatitis No 18 (5.3) 322 (94.7) 1.00 - Yes 6 (13.6) 38 (86.4) 2.67 (1.09–6.54) 0.032 In multivariate logistic regression analysis (Table 3 ), after adjusting for potential confounders, three factors remained independently associated with HBV infection: history of blood transfusion (AOR = 3.85, 95% CI: 1.23–12.05, p = 0.021), sharing of sharp objects (AOR = 3.12, 95% CI: 1.15–8.46, p = 0.025), and multiple sexual partners (AOR = 2.89, 95% CI: 1.08–7.73, p = 0.034). Table 3 Multivariate analysis model for factors associated with Hepatitis B infection Risk Factor Adjusted OR (95% CI) p-value Blood transfusion 3.85 (1.23–12.05) 0.021 Surgical procedure 1.67 (0.58–4.82) 0.342 Sharing sharp objects 3.12 (1.15–8.46) 0.025 Multiple sexual partners 2.89 (1.08–7.73) 0.034 Family history of hepatitis 1.98 (0.72–5.44) 0.186 3.5 Risk Factors Associated with Hepatitis C Virus Infection Bivariate analysis of risk factors for HCV infection is presented in Table 4 . Several factors showed significant associations with HCV infection: history of blood transfusion (OR = 6.23, 95% CI: 1.67–23.24, p = 0.007), history of surgical procedures (OR = 3.45, 95% CI: 0.98–12.14, p = 0.054), sharing of sharp objects (OR = 4.67, 95% CI: 1.32–16.51, p = 0.017), and traditional scarification (OR = 3.12, 95% CI: 0.85–11.45, p = 0.086). Table 4 Bivariate analysis of factors associated with Hepatitis C infection Risk Factor Anti-HCV Positive n (%) Anti-HCV Negative n (%) OR (95% CI) p-value Age group 18–35 years 4 (1.8) 216 (98.2) 1.00 - > 35 years 5 (3.0) 159 (97.0) 1.70 (0.45–6.40) 0.432 Sex Female 5 (2.2) 219 (97.8) 1.00 - Male 4 (2.5) 156 (97.5) 1.12 (0.30–4.23) 0.866 Marital status Single 2 (1.9) 106 (98.1) 1.00 - Married 6 (2.5) 234 (97.5) 1.36 (0.27–6.84) 0.710 Divorced/Widowed 1 (2.8) 35 (97.2) 1.51 (0.13–17.43) 0.741 Education level Tertiary 1 (1.4) 69 (98.6) 1.00 - Secondary 3 (2.2) 133 (97.8) 1.56 (0.16–15.21) 0.699 Primary 4 (2.7) 144 (97.3) 1.92 (0.21–17.42) 0.565 No formal education 1 (3.3) 29 (96.7) 2.38 (0.15–38.97) 0.542 Occupation Civil servant 1 (1.7) 59 (98.3) 1.00 - Business 2 (2.2) 88 (97.8) 1.34 (0.12–15.17) 0.816 Farmer 5 (2.8) 171 (97.2) 1.73 (0.20-15.05) 0.621 Student 1 (1.7) 57 (98.3) 1.04 (0.06–17.15) 0.981 Residence Urban/Peri-urban 2 (2.0) 100 (98.0) 1.00 - Rural 7 (2.5) 275 (97.5) 1.27 (0.26–6.21) 0.764 Blood transfusion No 5 (1.5) 329 (98.5) 1.00 - Yes 4 (8.0) 46 (92.0) 6.23 (1.67–23.24) 0.007 Surgical procedure No 5 (1.6) 310 (98.4) 1.00 - Yes 4 (5.8) 65 (94.2) 3.45 (0.98–12.14) 0.054 Dental procedure No 7 (2.1) 327 (97.9) 1.00 - Yes 2 (4.0) 48 (96.0) 1.95 (0.40–9.54) 0.410 Traditional scarification No 6 (1.9) 306 (98.1) 1.00 - Yes 3 (4.2) 69 (95.8) 3.12 (0.85–11.45) 0.086 Sharing sharp objects No 4 (1.4) 280 (98.6) 1.00 - Yes 5 (5.0) 95 (95.0) 4.67 (1.32–16.51) 0.017 Tattooing No 8 (2.2) 352 (97.8) 1.00 - Yes 1 (4.2) 23 (95.8) 1.91 (0.23–16.04) 0.551 Multiple sexual partners No 6 (2.1) 283 (97.9) 1.00 - Yes 3 (3.2) 92 (96.8) 1.54 (0.38–6.20) 0.545 Family history of hepatitis No 7 (2.1) 333 (97.9) 1.00 - Yes 2 (4.5) 42 (95.5) 2.27 (0.46–11.22) 0.313 In multivariate logistic regression analysis (Table 5 ), two factors remained independently associated with HCV infection after adjusting for confounders: history of blood transfusion (AOR = 5.67, 95% CI: 1.34–23.98, p = 0.018) and sharing of sharp objects (AOR = 4.23, 95% CI: 1.02–17.54, p = 0.047). Table 5 Multivariate analysis model for factors associated with Hepatitis C infection Risk Factor Adjusted OR (95% CI) p-value Blood transfusion 5.67 (1.34–23.98) 0.018 Surgical procedure 2.12 (0.48–9.38) 0.321 Traditional scarification 1.89 (0.43–8.32) 0.397 Sharing sharp objects 4.23 (1.02–17.54) 0.047 4. DISCUSSION This study determined the prevalence of HBV and HCV infections and identified associated risk factors among patients attending the outpatient department at Rushere Community Hospital in rural Uganda. The findings reveal a substantial burden of viral hepatitis in this setting, with important implications for public health policy and clinical practice. 4.1 Prevalence of Hepatitis B Virus Infection The overall HBV prevalence of 6.3% observed in this study falls within the intermediate endemicity range (2–7%) as defined by WHO ( 14 ). This finding is consistent with several previous studies conducted in Uganda and other East African countries. A study by Bwogi et al. in Uganda reported an HBV prevalence of 4.1% among blood donors ( 5 ), while Ochola et al. found a prevalence of 10.5% among pregnant women in northern Uganda ( 15 ). The variation in prevalence rates across different studies may be attributed to differences in study populations, geographical locations, and risk factor profiles. Compared to other sub-Saharan African countries, the prevalence observed in this study is moderate. Studies from West Africa have reported higher prevalence rates, with some exceeding 15% ( 16 , 17 ), while studies from Southern Africa have reported lower rates, typically below 5% ( 18 ). These regional variations reflect differences in transmission dynamics, vaccination coverage, and healthcare infrastructure. The finding that 37.5% of HBsAg-positive individuals were also HBeAg-positive is particularly concerning, as HBeAg positivity indicates active viral replication and high infectivity ( 19 ). These individuals are at increased risk of transmitting the virus to others and are more likely to develop chronic liver disease complications ( 20 ). This underscores the need for early identification, monitoring, and treatment of HBV-infected individuals in this setting. 4.2 Prevalence of Hepatitis C Virus Infection The HCV prevalence of 2.3% observed in this study is consistent with estimates for the general population in sub-Saharan Africa, which typically range from 1% to 5% ( 21 ). This finding aligns with previous studies conducted in Uganda. Ochola et al. reported an HCV prevalence of 1.2% among pregnant women in northern Uganda ( 15 ), while Seremba et al. found a prevalence of 3.1% among HIV-infected patients in Kampala ( 22 ). The relatively lower prevalence of HCV compared to HBV in this study is consistent with global patterns, where HBV is generally more prevalent than HCV in most populations ( 23 ). However, the public health significance of HCV should not be underestimated, as chronic HCV infection leads to cirrhosis and hepatocellular carcinoma in a substantial proportion of infected individuals ( 24 ). 4.3 Risk Factors for Hepatitis B Virus Infection This study identified three independent risk factors for HBV infection: history of blood transfusion, sharing of sharp objects, and multiple sexual partners. These findings are consistent with the known modes of HBV transmission and highlight specific areas for targeted interventions. Blood transfusion emerged as the strongest risk factor for HBV infection (AOR = 3.85), which is concerning given that blood transfusion is a potentially preventable route of transmission. This finding suggests possible gaps in blood screening practices or transfusion of blood before the implementation of universal screening policies. Similar associations between blood transfusion and HBV infection have been reported in other African studies ( 25 , 26 ). This underscores the critical importance of maintaining rigorous blood screening protocols and ensuring the safety of the blood supply. Sharing of sharp objects (razors, needles, toothbrushes) was significantly associated with HBV infection (AOR = 3.12). This practice is common in many African communities and represents an important route of HBV transmission ( 27 ). The sharing of razors in barbershops, sharing of needles for traditional medicine or drug use, and sharing of other personal items that may be contaminated with blood facilitates blood-to-blood transmission of the virus. Health education campaigns targeting these behaviors are essential for HBV prevention. Multiple sexual partners was also independently associated with HBV infection (AOR = 2.89), consistent with the sexual transmission route of HBV ( 28 ). This finding highlights the importance of promoting safe sexual practices and integrating HBV prevention messages into existing HIV prevention programs, as both infections share similar transmission routes. Interestingly, while family history of hepatitis showed a significant association in bivariate analysis, it did not remain significant in the multivariate model. This may reflect the complex interplay between genetic susceptibility, shared environmental exposures, and behavioral factors within families. 4.4 Risk Factors for Hepatitis C Virus Infection Two independent risk factors were identified for HCV infection: history of blood transfusion and sharing of sharp objects. These findings are consistent with the predominantly blood-borne transmission of HCV ( 29 ). Blood transfusion was the strongest risk factor for HCV infection (AOR = 5.67), with an even stronger association than observed for HBV. This is consistent with the high efficiency of HCV transmission through blood exposure ( 30 ). Before the implementation of universal blood screening for HCV in the 1990s, blood transfusion was a major route of HCV transmission globally ( 31 ). The continued association between blood transfusion and HCV infection in this study may reflect historical exposures or, more concerning, potential gaps in current screening practices. Sharing of sharp objects was also significantly associated with HCV infection (AOR = 4.23). Given the high concentration of HCV in blood and the efficiency of blood-to-blood transmission, even small amounts of contaminated blood on shared sharp objects can transmit the virus ( 32 ). This finding emphasizes the need for health education about the risks of sharing personal items that may be contaminated with blood. Unlike HBV, sexual transmission did not emerge as a significant risk factor for HCV in this study, which is consistent with the lower efficiency of sexual transmission for HCV compared to HBV ( 33 ). However, sexual transmission of HCV can occur, particularly in the context of HIV co-infection or high-risk sexual behaviors ( 34 ). 4.5 Public Health Implications The findings of this study have several important public health implications. First, the substantial prevalence of both HBV and HCV infections in this rural setting highlights the need for enhanced screening programs, particularly among high-risk populations. Routine screening of patients with risk factors could facilitate early diagnosis and linkage to care, potentially preventing transmission and reducing the burden of chronic liver disease. Second, the strong association between blood transfusion and both HBV and HCV infections underscores the critical importance of maintaining rigorous blood safety measures. All blood donations should be screened for HBV and HCV using sensitive and specific assays, and quality control measures should be regularly monitored and enforced. Third, the association between sharing of sharp objects and viral hepatitis highlights the need for targeted health education interventions. Community-based education programs should emphasize the risks of sharing razors, needles, and other sharp objects, and promote safe practices in barbershops, traditional medicine settings, and households. Fourth, the association between multiple sexual partners and HBV infection suggests that HBV prevention messages should be integrated into existing HIV prevention programs, including promotion of condom use and reduction of sexual partners. The overlap in transmission routes between HBV and HIV provides opportunities for integrated prevention strategies. Fifth, the high proportion of HBeAg-positive individuals among HBsAg-positive patients indicates a substantial pool of highly infectious individuals in the community. This emphasizes the need for early identification, counseling, and treatment of HBV-infected individuals to reduce transmission and prevent disease progression. 4.6 Strengths and Limitations This study has several strengths. The relatively large sample size provides adequate statistical power to detect associations between risk factors and viral hepatitis. The use of standardized questionnaires and validated rapid diagnostic tests ensures data quality and reliability. The consecutive sampling approach minimizes selection bias and enhances the representativeness of the findings. However, several limitations should be acknowledged. First, the cross-sectional design precludes determination of causality and temporal relationships between risk factors and infection. Second, the use of rapid diagnostic tests, while practical and appropriate for this setting, may have lower sensitivity and specificity compared to laboratory-based assays such as ELISA or nucleic acid testing. Third, the study relied on self-reported information for risk factor assessment, which may be subject to recall bias and social desirability bias, particularly for sensitive behaviors such as sexual practices. Fourth, the study was conducted at a single healthcare facility, which may limit the generalizability of findings to other settings. Fifth, the study did not assess some potentially important risk factors such as injection drug use, occupational exposures among healthcare workers, or mother-to-child transmission. Finally, the study did not include confirmatory testing or viral load assessment, which would provide additional information about disease stage and infectivity. 4.7 Recommendations Based on the findings of this study, several recommendations can be made: Screening programs : Implement routine screening for HBV and HCV among high-risk populations, including individuals with history of blood transfusion, those who share sharp objects, and individuals with multiple sexual partners. Blood safety : Strengthen blood screening protocols and quality control measures to ensure the safety of blood transfusions. Regular audits of blood screening practices should be conducted. Health education : Develop and implement targeted health education campaigns focusing on the risks of sharing sharp objects, safe sexual practices, and the importance of HBV vaccination. These campaigns should be culturally appropriate and delivered through multiple channels including community health workers, radio, and social media. Vaccination : Expand HBV vaccination coverage, particularly among high-risk populations and healthcare workers. Catch-up vaccination programs should be considered for adults who were not vaccinated in childhood. Linkage to care : Establish clear referral pathways for HBV and HCV-positive individuals to ensure timely access to specialized care, monitoring, and treatment where indicated. Integration with HIV programs : Integrate viral hepatitis screening and prevention into existing HIV programs, leveraging established infrastructure and taking advantage of overlapping transmission routes. Further research : Conduct longitudinal studies to better understand the natural history of HBV and HCV infections in this setting, assess the impact of interventions, and evaluate the cost-effectiveness of different screening and prevention strategies. 5. CONCLUSIONS This study demonstrates a substantial burden of HBV and HCV infections among patients attending the outpatient department at Rushere Community Hospital in rural Uganda, with prevalence rates of 6.3% and 2.3%, respectively. History of blood transfusion and sharing of sharp objects emerged as major risk factors for both infections, while multiple sexual partners was additionally associated with HBV infection. The high proportion of HBeAg-positive individuals among HBsAg-positive patients indicates significant ongoing viral replication and transmission potential in the community. These findings underscore the urgent need for enhanced screening programs, strengthened blood safety measures, and targeted health education interventions in rural healthcare settings. Integration of viral hepatitis prevention and control activities into existing health programs, particularly HIV programs, could provide cost-effective opportunities for addressing this important public health challenge. Early identification and appropriate management of infected individuals, combined with effective prevention strategies, are essential for reducing the burden of viral hepatitis and its complications in this population. Declarations Conflict of Interest Statement: The authors declare no conflicts of interest. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Ethical Approval: Ethical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee and the administration of Rushere Community Hospital. Data Availability: The data that support the findings of this study are available from the corresponding author upon reasonable request. References World Health Organization (2017) Global hepatitis report 2017. WHO, Geneva Stanaway JD, Flaxman AD, Naghavi M, Fitzmaurice C, Vos T, Abubakar I et al (2016) The global burden of viral hepatitis from 1990 to 2013: findings from the Global Burden of Disease Study 2013. Lancet 388(10049):1081–1088 World Health Organization (2021) Hepatitis B fact sheet. WHO, Geneva Spearman CW, Afihene M, Ally R, Apica B, Awuku Y, Cunha L et al (2017) Hepatitis B in sub-Saharan Africa: strategies to achieve the 2030 elimination targets. Lancet Gastroenterol Hepatol 2(12):900–909 Bwogi J, Braka F, Makumbi I, Mishra V, Bakamutumaho B, Nanyunja M et al (2009) Hepatitis B infection is highly endemic in Uganda: findings from a national serosurvey. Afr Health Sci 9(2):98–108 Ocama P, Opio CK, Lee WM (2005) Hepatitis B virus infection: current status. Am J Med 118(12):1413e15–1413e22 Bayo P, Ochola E, Oleo C, Mwaka AD (2014) High prevalence of hepatitis B virus infection among pregnant women attending antenatal care: a cross-sectional study in two hospitals in northern Uganda. BMJ Open 4(11):e005889 Trépo C, Chan HL, Lok A (2014) Hepatitis B virus infection. Lancet 384(9959):2053–2063 Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ (2015) Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386(10003):1546–1555 Hajarizadeh B, Grebely J, Dore GJ (2013) Epidemiology and natural history of HCV infection. Nat Rev Gastroenterol Hepatol 10(9):553–562 Mohd Hanafiah K, Groeger J, Flaxman AD, Wiersma ST (2013) Global epidemiology of hepatitis C virus infection: new estimates of age-specific antibody to HCV seroprevalence. Hepatology 57(4):1333–1342 Madhava V, Burgess C, Drucker E (2002) Epidemiology of chronic hepatitis C virus infection in sub-Saharan Africa. Lancet Infect Dis 2(5):293–302 Karoney MJ, Siika AM (2013) Hepatitis C virus (HCV) infection in Africa: a review. Pan Afr Med J 14:44 World Health Organization (2015) Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. WHO, Geneva Ochola E, Ocama P, Orach CG, Nankinga ZK, Kalyango JN, McFarland W et al (2013) High burden of hepatitis B infection in Northern Uganda: results of a population-based survey. BMC Public Health 13:727 Kramvis A, Kew MC (2007) Epidemiology of hepatitis B virus in Africa, its genotypes and clinical associations of genotypes. Hepatol Res 37(s1):S9–S19 Lemoine M, Eholié S, Lacombe K (2015) Reducing the neglected burden of viral hepatitis in Africa: strategies for a global approach. J Hepatol 62(2):469–476 Andersson MI, Rajbhandari R, Kew MC, Vento S, Preiser W, Hoepelman AI et al (2015) Mother-to-child transmission of hepatitis B virus in sub-Saharan Africa: time to act. Lancet Glob Health 3(7):e358–e359 Liaw YF, Chu CM (2009) Hepatitis B virus infection. Lancet 373(9663):582–592 Chen CJ, Yang HI, Su J, Jen CL, You SL, Lu SN et al (2006) Risk of hepatocellular carcinoma across a biological gradient of serum hepatitis B virus DNA level. JAMA 295(1):65–73 Gower E, Estes C, Blach S, Razavi-Shearer K, Razavi H (2014) Global epidemiology and genotype distribution of the hepatitis C virus infection. J Hepatol 61(1 Suppl):S45–57 Seremba E, Ocama P, Opio CK, Kagimu M, Yuan HJ, Attar N et al (2010) Validity of the rapid strip assay test for detecting HCV antibodies in HIV-positive patients in Uganda. J Viral Hepat 17(2):102–106 Lavanchy D (2011) Evolving epidemiology of hepatitis C virus. Clin Microbiol Infect 17(2):107–115 Westbrook RH, Dusheiko G (2014) Natural history of hepatitis C. J Hepatol 61(1 Suppl):S58–68 Matee MI, Magesa PM, Lyamuya EF (2006) Seroprevalence of human immunodeficiency virus, hepatitis B and C viruses and syphilis infections among blood donors at the Muhimbili National Hospital in Dar es Salaam, Tanzania. BMC Public Health 6:21 Buseri FI, Muhibi MA, Jeremiah ZA (2009) Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus 7(4):293–299 Mutagoma M, Balisanga H, Malamba SS, Sebuhoro D, Remera E, Riedel DJ et al (2017) Hepatitis B virus and HIV co-infection among pregnant women in Rwanda. BMC Infect Dis 17(1):618 Alter MJ (2006) Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 44(1 Suppl):S6–9 Shepard CW, Finelli L, Alter MJ (2005) Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 5(9):558–567 Terrault NA, Dodge JL, Murphy EL, Tavis JE, Kiss A, Levin TR et al (2013) Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study. Hepatology 57(3):881–889 Alter MJ (2007) Epidemiology of hepatitis C virus infection. World J Gastroenterol 13(17):2436–2441 Paintsil E, He H, Peters C, Lindenbach BD, Heimer R (2010) Survival of hepatitis C virus in syringes: implication for transmission among injection drug users. J Infect Dis 202(7):984–990 Tohme RA, Holmberg SD (2012) Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis 54(8):1167–1178 Yaphe S, Bozinoff N, Kyle R, Shivkumar S, Pai NP, Klein M (2012) Incidence of hepatitis C virus infection among HIV-positive men who have sex with men. Syst Rev Meta-anal 16(12):1569–1578 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9619546","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":634868957,"identity":"7adb456b-ca5c-4156-af17-e67df6b5fa27","order_by":0,"name":"Kaija Kevin Joel","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIie3OMQuCQBTA8SfCTVeuJ4Z+hRPHvowSdItBU1PDTbU4h+DQV7BvYBw4ia2CDbY0NTg2FHTVnrYF3R8O7sH7wQNQqX4wAhqnkCH7PaIviPcNeZZBwHsTcy34/FoM2XZTUGgXAoyEfyYWDrgbVWiW1iHV4lIAOWafiS1PoriVxAqpPlgJoMTvIMaJu7cWMSeR5N6HWCTgHq6QD/IwXetDzPjEvVGB3LSezvdRyTCpOgg5sLN7yXPHSSa75roY20bcQWSIAuSvXyYf7tyX6Q3Ass+iSqVS/WsPEDBEBM5QCiwAAAAASUVORK5CYII=","orcid":"","institution":"Southern Medical University","correspondingAuthor":true,"prefix":"","firstName":"Kaija","middleName":"Kevin","lastName":"Joel","suffix":""},{"id":634877556,"identity":"8875c1df-f5d3-4d05-88a6-9adcc8157c40","order_by":1,"name":"Kitaka Jessica","email":"","orcid":"","institution":"Mbarara University Of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Kitaka","middleName":"","lastName":"Jessica","suffix":""},{"id":634877557,"identity":"bb3c0094-1681-4aae-915a-63cb7d16e71c","order_by":2,"name":"Kazooba Rodney","email":"","orcid":"","institution":"Mbarara University Of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Kazooba","middleName":"","lastName":"Rodney","suffix":""},{"id":634877558,"identity":"d9517ce3-fdbe-4cec-a257-6c3931fe2b1c","order_by":3,"name":"Namanya Patience","email":"","orcid":"","institution":"Mbarara University Of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Namanya","middleName":"","lastName":"Patience","suffix":""},{"id":634877559,"identity":"5bc052ca-88e5-4303-a573-620778047a70","order_by":4,"name":"Anguzu Micheal","email":"","orcid":"","institution":"Mbarara University Of Science and Technology","correspondingAuthor":false,"prefix":"","firstName":"Anguzu","middleName":"","lastName":"Micheal","suffix":""}],"badges":[],"createdAt":"2026-05-05 13:57:49","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-9619546/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9619546/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108633853,"identity":"ce67ee17-6464-43bb-87c9-f213ca94d720","added_by":"auto","created_at":"2026-05-06 17:15:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":41136,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HBV among study participants attending OPD at Rushere Community Hospital\u003c/p\u003e","description":"","filename":"drawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9619546/v1/0ccb0b74fa7aaa1ef2b49c6f.png"},{"id":108633854,"identity":"bbf66969-eca5-4670-b771-ededfed7f550","added_by":"auto","created_at":"2026-05-06 17:15:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":41599,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of HCV among study participants attending OPD at Rushere Community Hospital\u003c/p\u003e","description":"","filename":"drawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9619546/v1/54512cbe4da1c4ece69ce465.png"},{"id":108805821,"identity":"1d28b096-24b7-4ca8-a9ea-4dc2cabd3fb6","added_by":"auto","created_at":"2026-05-08 15:26:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":790721,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9619546/v1/54714836-68a1-4b79-b482-18d736cf0954.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003ePrevalence and Associated Risk Factors of Hepatitis B and C Virus Infections Among Patients Attending Outpatient Department at Rushere Community Hospital, Kiruhura District, Uganda\u003c/p\u003e","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eHepatitis B virus (HBV) and hepatitis C virus (HCV) infections represent major global health challenges, affecting millions of people worldwide and contributing significantly to morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). The World Health Organization (WHO) estimates that approximately 296\u0026nbsp;million people are living with chronic HBV infection and 58\u0026nbsp;million with chronic HCV infection globally (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Sub-Saharan Africa bears a disproportionate burden of these infections, with prevalence rates often exceeding those in other regions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn Uganda, viral hepatitis remains a significant public health concern. Previous studies have reported varying prevalence rates across different populations and geographical regions, with HBV prevalence ranging from 4.1% to 18% and HCV prevalence from 1% to 6% (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). However, most existing data come from urban centers and specific high-risk populations, leaving substantial gaps in understanding the epidemiology of these infections in rural settings where access to healthcare and diagnostic services is limited.\u003c/p\u003e \u003cp\u003eHBV is a DNA virus transmitted through contact with infected blood or body fluids, including through sexual contact, sharing of needles, and from mother to child during childbirth (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The virus can cause both acute and chronic infection, with chronic infection leading to serious complications including cirrhosis and hepatocellular carcinoma (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). HCV, an RNA virus, is primarily transmitted through blood-to-blood contact, most commonly through unsafe injection practices, inadequate sterilization of medical equipment, and transfusion of unscreened blood products (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Like HBV, chronic HCV infection can progress to cirrhosis and liver cancer (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSeveral risk factors have been associated with HBV and HCV transmission in sub-Saharan Africa, including unsafe medical practices, traditional scarification, sharing of sharp objects, multiple sexual partners, and history of blood transfusion (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Understanding the local epidemiology and specific risk factors in different settings is crucial for developing targeted prevention and control strategies.\u003c/p\u003e \u003cp\u003eRushere Community Hospital serves a predominantly rural population in Kiruhura District, southwestern Uganda. Despite serving a large catchment area, no previous studies have systematically assessed the burden of viral hepatitis in this setting. The lack of local data hampers efforts to implement evidence-based screening programs and targeted interventions.\u003c/p\u003e \u003cp\u003eThis study aimed to determine the prevalence of HBV and HCV infections among patients attending the outpatient department at Rushere Community Hospital and to identify associated socio-demographic and behavioral risk factors. The findings will provide essential baseline data to inform local and national hepatitis prevention and control programs, guide resource allocation, and support the development of targeted interventions for at-risk populations in rural Uganda.\u003c/p\u003e"},{"header":"2. METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Design and Setting\u003c/h2\u003e \u003cp\u003eThis was a cross-sectional study conducted at Rushere Community Hospital, located in Kiruhura District, southwestern Uganda. The hospital serves as a primary healthcare facility for the surrounding rural communities. The study was conducted over a three-month period from September to November 2022.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Population\u003c/h2\u003e \u003cp\u003eThe study population comprised patients aged 18 years and above attending the outpatient department (OPD) at Rushere Community Hospital during the study period. Patients were eligible for inclusion if they were 18 years or older, attended the OPD during the study period, and provided written informed consent. Exclusion criteria included patients who were critically ill, unable to provide informed consent, or unwilling to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sample Size Determination\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using the Kish Leslie formula for cross-sectional studies:\u003c/p\u003e \u003cp\u003en\u0026thinsp;=\u0026thinsp;Z\u0026sup2;P(1-P)/d\u0026sup2;\u003c/p\u003e \u003cp\u003eWhere: - n\u0026thinsp;=\u0026thinsp;minimum sample size - Z\u0026thinsp;=\u0026thinsp;standard normal deviate at 95% confidence interval (1.96) - P\u0026thinsp;=\u0026thinsp;estimated prevalence of HBV in Uganda (10% or 0.10) - d\u0026thinsp;=\u0026thinsp;desired precision (0.05)\u003c/p\u003e \u003cp\u003en = (1.96)\u0026sup2; \u0026times; 0.10 \u0026times; (1-0.10) / (0.05)\u0026sup2; n\u0026thinsp;=\u0026thinsp;3.8416 \u0026times; 0.10 \u0026times; 0.90 / 0.0025 n\u0026thinsp;=\u0026thinsp;0.3457 / 0.0025 n\u0026thinsp;=\u0026thinsp;138.3\u003c/p\u003e \u003cp\u003eAdjusting for a 10% non-response rate: n\u0026thinsp;=\u0026thinsp;138.3 / (1-0.10)\u0026thinsp;=\u0026thinsp;153.7\u0026thinsp;\u0026asymp;\u0026thinsp;154\u003c/p\u003e \u003cp\u003eHowever, to increase the power of the study and ensure adequate representation, the sample size was increased to 384 participants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4 Sampling Procedure\u003c/h2\u003e \u003cp\u003eConsecutive sampling was employed to recruit study participants. All eligible patients attending the OPD during the study period were approached and invited to participate until the desired sample size was achieved. This approach ensured efficient recruitment while minimizing selection bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Collection\u003c/h2\u003e \u003cdiv id=\"Sec8\" class=\"Section3\"\u003e \u003ch2\u003e2.5.1 Questionnaire Administration\u003c/h2\u003e \u003cp\u003eStructured questionnaires were administered by trained research assistants to collect socio-demographic information (age, sex, marital status, education level, occupation, residence) and data on potential risk factors including history of blood transfusion, surgical procedures, dental procedures, traditional scarification, sharing of sharp objects (razors, needles, toothbrushes), tattooing, multiple sexual partners, and family history of hepatitis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003e2.5.2 Blood Sample Collection and Testing\u003c/h2\u003e \u003cp\u003eApproximately 5 mL of venous blood was collected from each participant using standard phlebotomy techniques under aseptic conditions. Blood samples were collected in plain vacutainer tubes and allowed to clot. Serum was separated by centrifugation at 3000 rpm for 5 minutes and tested immediately or stored at 2\u0026ndash;8\u0026deg;C for testing within 24 hours.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHBsAg Testing\u003c/strong\u003e \u003cp\u003eHepatitis B surface antigen was detected using a rapid immunochromatographic test kit (Determine\u0026trade; HBsAg, Abbott Laboratories). The test was performed according to the manufacturer\u0026rsquo;s instructions. Briefly, 0.1 mL of serum was added to the sample well, and results were read after 15\u0026ndash;20 minutes. The appearance of two-colored lines (test and control) indicated a positive result, while one line (control only) indicated a negative result.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eHBeAg Testing\u003c/strong\u003e \u003cp\u003eAll HBsAg-positive samples were further tested for hepatitis B envelope antigen using a rapid immunochromatographic assay. The presence of HBeAg indicates active viral replication and high infectivity.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eAnti-HCV Testing\u003c/strong\u003e \u003cp\u003eHepatitis C virus antibodies were detected using a rapid immunochromatographic test kit (Determine\u0026trade; HCV, Abbott Laboratories). The test procedure was similar to HBsAg testing, with 0.1 mL of serum added to the sample well and results read after 15\u0026ndash;20 minutes.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eAll tests included appropriate positive and negative controls to ensure validity. Invalid results (absence of control line) were repeated with fresh samples.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Quality Control\u003c/h2\u003e \u003cp\u003eQuality control measures were implemented throughout the study. All laboratory personnel were trained on standard operating procedures for sample collection, handling, and testing. Test kits were stored according to manufacturer\u0026rsquo;s specifications and checked for expiry dates before use. Known positive and negative control samples were run alongside test samples to validate results. Equipment was regularly calibrated and maintained.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Data Management and Analysis\u003c/h2\u003e \u003cp\u003eData were entered into Microsoft Excel and cleaned for inconsistencies and missing values. Statistical analysis was performed using STATA version 13 (StataCorp, College Station, TX, USA). Descriptive statistics were used to summarize socio-demographic characteristics and prevalence rates. Categorical variables were presented as frequencies and percentages, while continuous variables were presented as means with standard deviations or medians with interquartile ranges, as appropriate.\u003c/p\u003e \u003cp\u003eBivariate logistic regression analysis was performed to examine associations between potential risk factors and HBV or HCV infection. Variables with p-values\u0026thinsp;\u0026lt;\u0026thinsp;0.25 in bivariate analysis were included in multivariate logistic regression models to identify independent risk factors. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) were calculated. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Ethical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Mbarara University of Science and Technology Research Ethics Committee and the administration of Rushere Community Hospital. Written informed consent was obtained from all participants after explaining the study objectives, procedures, risks, and benefits. Participants were informed of their right to withdraw from the study at any time without consequences. Confidentiality was maintained by using unique identification numbers instead of names. All HBsAg-positive and anti-HCV-positive participants were counseled and referred for further management according to national guidelines.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"3. RESULTS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.1 Demographic Characteristics of Study Participants\u003c/h2\u003e \u003cp\u003eA total of 384 participants were enrolled in the study. The demographic characteristics are presented in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The mean age of participants was 35.6 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;12.4), with ages ranging from 18 to 72 years. The majority of participants were female (58.3%, 224/384) and male participants comprised 41.7% (160/384). Most participants were married (62.5%, 240/384), while 28.1% (108/384) were single and 9.4% (36/384) were divorced or widowed.\u003c/p\u003e \u003cp\u003eRegarding education level, 38.5% (148/384) had completed primary education, 35.4% (136/384) had secondary education, 18.2% (70/384) had tertiary education, and 7.8% (30/384) had no formal education. The majority of participants were farmers (45.8%, 176/384), followed by business people (23.4%, 90/384), civil servants (15.6%, 60/384), and students (15.1%, 58/384). Most participants resided in rural areas (73.4%, 282/384), while 26.6% (102/384) were from urban or peri-urban areas.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics of the study participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency (n)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercentage (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u0026ndash;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e160\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e41.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e224\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e58.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e62.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e176\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e45.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e282\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e73.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban/Peri-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Prevalence of Hepatitis B Virus Infection\u003c/h2\u003e \u003cp\u003eOf the 384 participants tested, 24 were positive for HBsAg, yielding an overall HBV prevalence of 6.3% (95% CI: 4.1\u0026ndash;9.2%). The prevalence was slightly higher among males (7.5%, 12/160) compared to females (5.4%, 12/224), though this difference was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.412).\u003c/p\u003e \u003cp\u003eAmong the 24 HBsAg-positive participants, 9 tested positive for HBeAg, representing 37.5% of HBsAg-positive cases. The presence of HBeAg indicates active viral replication and high infectivity in these individuals.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Prevalence of Hepatitis C Virus Infection\u003c/h2\u003e \u003cp\u003eNine participants tested positive for anti-HCV antibodies, yielding an overall HCV prevalence of 2.3% (95% CI: 1.1\u0026ndash;4.4%). The prevalence was similar between males (2.5%, 4/160) and females (2.2%, 5/224), with no statistically significant difference (p\u0026thinsp;=\u0026thinsp;0.871).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Risk Factors Associated with Hepatitis B Virus Infection\u003c/h2\u003e \u003cp\u003eBivariate analysis was performed to examine associations between potential risk factors and HBV infection (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Several factors showed significant associations with HBV infection in bivariate analysis: history of blood transfusion (OR\u0026thinsp;=\u0026thinsp;4.12, 95% CI: 1.56\u0026ndash;10.87, p\u0026thinsp;=\u0026thinsp;0.004), history of surgical procedures (OR\u0026thinsp;=\u0026thinsp;2.34, 95% CI: 0.98\u0026ndash;5.59, p\u0026thinsp;=\u0026thinsp;0.056), sharing of sharp objects (OR\u0026thinsp;=\u0026thinsp;3.45, 95% CI: 1.48\u0026ndash;8.04, p\u0026thinsp;=\u0026thinsp;0.004), multiple sexual partners (OR\u0026thinsp;=\u0026thinsp;3.21, 95% CI: 1.38\u0026ndash;7.47, p\u0026thinsp;=\u0026thinsp;0.007), and family history of hepatitis (OR\u0026thinsp;=\u0026thinsp;2.67, 95% CI: 1.09\u0026ndash;6.54, p\u0026thinsp;=\u0026thinsp;0.032).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors associated with Hepatitis B infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHBsAg Positive n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHBsAg Negative n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (6.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e206 (93.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e154 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.96 (0.41\u0026ndash;2.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e212 (94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (7.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148 (92.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.43 (0.62\u0026ndash;3.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.402\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e102 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e224 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.21 (0.46\u0026ndash;3.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (5.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34 (94.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00 (0.19\u0026ndash;5.28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.999\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (4.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67 (95.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (5.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e128 (94.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.40 (0.36\u0026ndash;5.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.627\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10 (6.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e138 (93.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.62 (0.43\u0026ndash;6.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.475\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (10.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (90.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.48 (0.47\u0026ndash;13.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58 (96.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.07 (0.40-10.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (7.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163 (92.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.31 (0.50-10.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.283\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (5.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (94.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.58 (0.26\u0026ndash;9.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban/Peri-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (4.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97 (95.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e19 (6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e263 (93.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.40 (0.51\u0026ndash;3.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood transfusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e16 (4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e318 (95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (84.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.12 (1.56\u0026ndash;10.87)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e17 (5.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e298 (94.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (10.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62 (89.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.34 (0.98\u0026ndash;5.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (6.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e314 (94.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.37 (0.45\u0026ndash;4.16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraditional scarification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e294 (94.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e66 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.48 (0.57\u0026ndash;3.88)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.420\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSharing sharp objects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e272 (95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12 (12.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (88.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.45 (1.48\u0026ndash;8.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.004\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTattooing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22 (6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e338 (93.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e22 (91.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.40 (0.31\u0026ndash;6.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.664\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMultiple sexual partners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e276 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11 (11.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e84 (88.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.21 (1.38\u0026ndash;7.47)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of hepatitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18 (5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e322 (94.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (13.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e38 (86.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.67 (1.09\u0026ndash;6.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn multivariate logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e), after adjusting for potential confounders, three factors remained independently associated with HBV infection: history of blood transfusion (AOR\u0026thinsp;=\u0026thinsp;3.85, 95% CI: 1.23\u0026ndash;12.05, p\u0026thinsp;=\u0026thinsp;0.021), sharing of sharp objects (AOR\u0026thinsp;=\u0026thinsp;3.12, 95% CI: 1.15\u0026ndash;8.46, p\u0026thinsp;=\u0026thinsp;0.025), and multiple sexual partners (AOR\u0026thinsp;=\u0026thinsp;2.89, 95% CI: 1.08\u0026ndash;7.73, p\u0026thinsp;=\u0026thinsp;0.034).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis model for factors associated with Hepatitis B infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.85 (1.23\u0026ndash;12.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.67 (0.58\u0026ndash;4.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.342\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharing sharp objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.12 (1.15\u0026ndash;8.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultiple sexual partners\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.89 (1.08\u0026ndash;7.73)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.034\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily history of hepatitis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.98 (0.72\u0026ndash;5.44)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Risk Factors Associated with Hepatitis C Virus Infection\u003c/h2\u003e \u003cp\u003eBivariate analysis of risk factors for HCV infection is presented in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e. Several factors showed significant associations with HCV infection: history of blood transfusion (OR\u0026thinsp;=\u0026thinsp;6.23, 95% CI: 1.67\u0026ndash;23.24, p\u0026thinsp;=\u0026thinsp;0.007), history of surgical procedures (OR\u0026thinsp;=\u0026thinsp;3.45, 95% CI: 0.98\u0026ndash;12.14, p\u0026thinsp;=\u0026thinsp;0.054), sharing of sharp objects (OR\u0026thinsp;=\u0026thinsp;4.67, 95% CI: 1.32\u0026ndash;16.51, p\u0026thinsp;=\u0026thinsp;0.017), and traditional scarification (OR\u0026thinsp;=\u0026thinsp;3.12, 95% CI: 0.85\u0026ndash;11.45, p\u0026thinsp;=\u0026thinsp;0.086).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate analysis of factors associated with Hepatitis C infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAnti-HCV Positive n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnti-HCV Negative n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e216 (98.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;35 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (3.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e159 (97.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.70 (0.45\u0026ndash;6.40)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.432\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e219 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e156 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.12 (0.30\u0026ndash;4.23)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.866\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e106 (98.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e234 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.36 (0.27\u0026ndash;6.84)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.710\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35 (97.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.51 (0.13\u0026ndash;17.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.741\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e133 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.56 (0.16\u0026ndash;15.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.699\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e144 (97.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.92 (0.21\u0026ndash;17.42)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.565\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (3.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29 (96.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.38 (0.15\u0026ndash;38.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.542\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBusiness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.34 (0.12\u0026ndash;15.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.816\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFarmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (2.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171 (97.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.73 (0.20-15.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (1.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57 (98.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.04 (0.06\u0026ndash;17.15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.981\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban/Peri-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (2.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100 (98.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275 (97.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.27 (0.26\u0026ndash;6.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.764\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBlood transfusion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e329 (98.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (8.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46 (92.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e6.23 (1.67\u0026ndash;23.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSurgical procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (1.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e310 (98.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (5.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65 (94.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.45 (0.98\u0026ndash;12.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDental procedure\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e327 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e48 (96.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.95 (0.40\u0026ndash;9.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.410\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTraditional scarification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e306 (98.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e69 (95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.12 (0.85\u0026ndash;11.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.086\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSharing sharp objects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4 (1.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e280 (98.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5 (5.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95 (95.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.67 (1.32\u0026ndash;16.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTattooing\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8 (2.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e352 (97.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (4.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e23 (95.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.91 (0.23\u0026ndash;16.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMultiple sexual partners\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e283 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (3.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92 (96.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.54 (0.38\u0026ndash;6.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily history of hepatitis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e7 (2.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e333 (97.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.00\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (4.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42 (95.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.27 (0.46\u0026ndash;11.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn multivariate logistic regression analysis (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e), two factors remained independently associated with HCV infection after adjusting for confounders: history of blood transfusion (AOR\u0026thinsp;=\u0026thinsp;5.67, 95% CI: 1.34\u0026ndash;23.98, p\u0026thinsp;=\u0026thinsp;0.018) and sharing of sharp objects (AOR\u0026thinsp;=\u0026thinsp;4.23, 95% CI: 1.02\u0026ndash;17.54, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMultivariate analysis model for factors associated with Hepatitis C infection\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRisk Factor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAdjusted OR (95% CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBlood transfusion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e5.67 (1.34\u0026ndash;23.98)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2.12 (0.48\u0026ndash;9.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.321\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional scarification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1.89 (0.43\u0026ndash;8.32)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSharing sharp objects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e4.23 (1.02\u0026ndash;17.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eThis study determined the prevalence of HBV and HCV infections and identified associated risk factors among patients attending the outpatient department at Rushere Community Hospital in rural Uganda. The findings reveal a substantial burden of viral hepatitis in this setting, with important implications for public health policy and clinical practice.\u003c/p\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Prevalence of Hepatitis B Virus Infection\u003c/h2\u003e \u003cp\u003eThe overall HBV prevalence of 6.3% observed in this study falls within the intermediate endemicity range (2\u0026ndash;7%) as defined by WHO (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). This finding is consistent with several previous studies conducted in Uganda and other East African countries. A study by Bwogi et al. in Uganda reported an HBV prevalence of 4.1% among blood donors (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e), while Ochola et al. found a prevalence of 10.5% among pregnant women in northern Uganda (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). The variation in prevalence rates across different studies may be attributed to differences in study populations, geographical locations, and risk factor profiles.\u003c/p\u003e \u003cp\u003eCompared to other sub-Saharan African countries, the prevalence observed in this study is moderate. Studies from West Africa have reported higher prevalence rates, with some exceeding 15% (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), while studies from Southern Africa have reported lower rates, typically below 5% (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These regional variations reflect differences in transmission dynamics, vaccination coverage, and healthcare infrastructure.\u003c/p\u003e \u003cp\u003eThe finding that 37.5% of HBsAg-positive individuals were also HBeAg-positive is particularly concerning, as HBeAg positivity indicates active viral replication and high infectivity (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). These individuals are at increased risk of transmitting the virus to others and are more likely to develop chronic liver disease complications (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). This underscores the need for early identification, monitoring, and treatment of HBV-infected individuals in this setting.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e4.2 Prevalence of Hepatitis C Virus Infection\u003c/h2\u003e \u003cp\u003eThe HCV prevalence of 2.3% observed in this study is consistent with estimates for the general population in sub-Saharan Africa, which typically range from 1% to 5% (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This finding aligns with previous studies conducted in Uganda. Ochola et al. reported an HCV prevalence of 1.2% among pregnant women in northern Uganda (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e), while Seremba et al. found a prevalence of 3.1% among HIV-infected patients in Kampala (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe relatively lower prevalence of HCV compared to HBV in this study is consistent with global patterns, where HBV is generally more prevalent than HCV in most populations (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). However, the public health significance of HCV should not be underestimated, as chronic HCV infection leads to cirrhosis and hepatocellular carcinoma in a substantial proportion of infected individuals (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e4.3 Risk Factors for Hepatitis B Virus Infection\u003c/h2\u003e \u003cp\u003eThis study identified three independent risk factors for HBV infection: history of blood transfusion, sharing of sharp objects, and multiple sexual partners. These findings are consistent with the known modes of HBV transmission and highlight specific areas for targeted interventions.\u003c/p\u003e \u003cp\u003e \u003cb\u003eBlood transfusion\u003c/b\u003e emerged as the strongest risk factor for HBV infection (AOR\u0026thinsp;=\u0026thinsp;3.85), which is concerning given that blood transfusion is a potentially preventable route of transmission. This finding suggests possible gaps in blood screening practices or transfusion of blood before the implementation of universal screening policies. Similar associations between blood transfusion and HBV infection have been reported in other African studies (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This underscores the critical importance of maintaining rigorous blood screening protocols and ensuring the safety of the blood supply.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSharing of sharp objects\u003c/b\u003e (razors, needles, toothbrushes) was significantly associated with HBV infection (AOR\u0026thinsp;=\u0026thinsp;3.12). This practice is common in many African communities and represents an important route of HBV transmission (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). The sharing of razors in barbershops, sharing of needles for traditional medicine or drug use, and sharing of other personal items that may be contaminated with blood facilitates blood-to-blood transmission of the virus. Health education campaigns targeting these behaviors are essential for HBV prevention.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMultiple sexual partners\u003c/b\u003e was also independently associated with HBV infection (AOR\u0026thinsp;=\u0026thinsp;2.89), consistent with the sexual transmission route of HBV (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). This finding highlights the importance of promoting safe sexual practices and integrating HBV prevention messages into existing HIV prevention programs, as both infections share similar transmission routes.\u003c/p\u003e \u003cp\u003eInterestingly, while family history of hepatitis showed a significant association in bivariate analysis, it did not remain significant in the multivariate model. This may reflect the complex interplay between genetic susceptibility, shared environmental exposures, and behavioral factors within families.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003e4.4 Risk Factors for Hepatitis C Virus Infection\u003c/h2\u003e \u003cp\u003eTwo independent risk factors were identified for HCV infection: history of blood transfusion and sharing of sharp objects. These findings are consistent with the predominantly blood-borne transmission of HCV (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eBlood transfusion\u003c/b\u003e was the strongest risk factor for HCV infection (AOR\u0026thinsp;=\u0026thinsp;5.67), with an even stronger association than observed for HBV. This is consistent with the high efficiency of HCV transmission through blood exposure (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). Before the implementation of universal blood screening for HCV in the 1990s, blood transfusion was a major route of HCV transmission globally (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The continued association between blood transfusion and HCV infection in this study may reflect historical exposures or, more concerning, potential gaps in current screening practices.\u003c/p\u003e \u003cp\u003e \u003cb\u003eSharing of sharp objects\u003c/b\u003e was also significantly associated with HCV infection (AOR\u0026thinsp;=\u0026thinsp;4.23). Given the high concentration of HCV in blood and the efficiency of blood-to-blood transmission, even small amounts of contaminated blood on shared sharp objects can transmit the virus (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e). This finding emphasizes the need for health education about the risks of sharing personal items that may be contaminated with blood.\u003c/p\u003e \u003cp\u003eUnlike HBV, sexual transmission did not emerge as a significant risk factor for HCV in this study, which is consistent with the lower efficiency of sexual transmission for HCV compared to HBV (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). However, sexual transmission of HCV can occur, particularly in the context of HIV co-infection or high-risk sexual behaviors (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e4.5 Public Health Implications\u003c/h2\u003e \u003cp\u003eThe findings of this study have several important public health implications. First, the substantial prevalence of both HBV and HCV infections in this rural setting highlights the need for enhanced screening programs, particularly among high-risk populations. Routine screening of patients with risk factors could facilitate early diagnosis and linkage to care, potentially preventing transmission and reducing the burden of chronic liver disease.\u003c/p\u003e \u003cp\u003eSecond, the strong association between blood transfusion and both HBV and HCV infections underscores the critical importance of maintaining rigorous blood safety measures. All blood donations should be screened for HBV and HCV using sensitive and specific assays, and quality control measures should be regularly monitored and enforced.\u003c/p\u003e \u003cp\u003eThird, the association between sharing of sharp objects and viral hepatitis highlights the need for targeted health education interventions. Community-based education programs should emphasize the risks of sharing razors, needles, and other sharp objects, and promote safe practices in barbershops, traditional medicine settings, and households.\u003c/p\u003e \u003cp\u003eFourth, the association between multiple sexual partners and HBV infection suggests that HBV prevention messages should be integrated into existing HIV prevention programs, including promotion of condom use and reduction of sexual partners. The overlap in transmission routes between HBV and HIV provides opportunities for integrated prevention strategies.\u003c/p\u003e \u003cp\u003eFifth, the high proportion of HBeAg-positive individuals among HBsAg-positive patients indicates a substantial pool of highly infectious individuals in the community. This emphasizes the need for early identification, counseling, and treatment of HBV-infected individuals to reduce transmission and prevent disease progression.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e4.6 Strengths and Limitations\u003c/h2\u003e \u003cp\u003eThis study has several strengths. The relatively large sample size provides adequate statistical power to detect associations between risk factors and viral hepatitis. The use of standardized questionnaires and validated rapid diagnostic tests ensures data quality and reliability. The consecutive sampling approach minimizes selection bias and enhances the representativeness of the findings.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be acknowledged. First, the cross-sectional design precludes determination of causality and temporal relationships between risk factors and infection. Second, the use of rapid diagnostic tests, while practical and appropriate for this setting, may have lower sensitivity and specificity compared to laboratory-based assays such as ELISA or nucleic acid testing. Third, the study relied on self-reported information for risk factor assessment, which may be subject to recall bias and social desirability bias, particularly for sensitive behaviors such as sexual practices. Fourth, the study was conducted at a single healthcare facility, which may limit the generalizability of findings to other settings. Fifth, the study did not assess some potentially important risk factors such as injection drug use, occupational exposures among healthcare workers, or mother-to-child transmission. Finally, the study did not include confirmatory testing or viral load assessment, which would provide additional information about disease stage and infectivity.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e4.7 Recommendations\u003c/h2\u003e \u003cp\u003eBased on the findings of this study, several recommendations can be made:\u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eScreening programs\u003c/b\u003e: Implement routine screening for HBV and HCV among high-risk populations, including individuals with history of blood transfusion, those who share sharp objects, and individuals with multiple sexual partners.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eBlood safety\u003c/b\u003e: Strengthen blood screening protocols and quality control measures to ensure the safety of blood transfusions. Regular audits of blood screening practices should be conducted.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eHealth education\u003c/b\u003e: Develop and implement targeted health education campaigns focusing on the risks of sharing sharp objects, safe sexual practices, and the importance of HBV vaccination. These campaigns should be culturally appropriate and delivered through multiple channels including community health workers, radio, and social media.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eVaccination\u003c/b\u003e: Expand HBV vaccination coverage, particularly among high-risk populations and healthcare workers. Catch-up vaccination programs should be considered for adults who were not vaccinated in childhood.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eLinkage to care\u003c/b\u003e: Establish clear referral pathways for HBV and HCV-positive individuals to ensure timely access to specialized care, monitoring, and treatment where indicated.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eIntegration with HIV programs\u003c/b\u003e: Integrate viral hepatitis screening and prevention into existing HIV programs, leveraging established infrastructure and taking advantage of overlapping transmission routes.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eFurther research\u003c/b\u003e: Conduct longitudinal studies to better understand the natural history of HBV and HCV infections in this setting, assess the impact of interventions, and evaluate the cost-effectiveness of different screening and prevention strategies.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"5. CONCLUSIONS","content":"\u003cp\u003eThis study demonstrates a substantial burden of HBV and HCV infections among patients attending the outpatient department at Rushere Community Hospital in rural Uganda, with prevalence rates of 6.3% and 2.3%, respectively. History of blood transfusion and sharing of sharp objects emerged as major risk factors for both infections, while multiple sexual partners was additionally associated with HBV infection. The high proportion of HBeAg-positive individuals among HBsAg-positive patients indicates significant ongoing viral replication and transmission potential in the community.\u003c/p\u003e \u003cp\u003eThese findings underscore the urgent need for enhanced screening programs, strengthened blood safety measures, and targeted health education interventions in rural healthcare settings. Integration of viral hepatitis prevention and control activities into existing health programs, particularly HIV programs, could provide cost-effective opportunities for addressing this important public health challenge. Early identification and appropriate management of infected individuals, combined with effective prevention strategies, are essential for reducing the burden of viral hepatitis and its complications in this population.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement:\u003c/strong\u003e The authors declare no conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval:\u003c/strong\u003e Ethical approval was obtained from the Mbarara University of Science and Technology Research Ethics Committee and the administration of Rushere Community Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability:\u003c/strong\u003e The data that support the findings of this study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization (2017) Global hepatitis report 2017. 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BMC Public Health 6:21\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBuseri FI, Muhibi MA, Jeremiah ZA (2009) Sero-epidemiology of transfusion-transmissible infectious diseases among blood donors in Osogbo, south-west Nigeria. Blood Transfus 7(4):293\u0026ndash;299\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMutagoma M, Balisanga H, Malamba SS, Sebuhoro D, Remera E, Riedel DJ et al (2017) Hepatitis B virus and HIV co-infection among pregnant women in Rwanda. BMC Infect Dis 17(1):618\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlter MJ (2006) Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 44(1 Suppl):S6\u0026ndash;9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShepard CW, Finelli L, Alter MJ (2005) Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 5(9):558\u0026ndash;567\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTerrault NA, Dodge JL, Murphy EL, Tavis JE, Kiss A, Levin TR et al (2013) Sexual transmission of hepatitis C virus among monogamous heterosexual couples: the HCV partners study. Hepatology 57(3):881\u0026ndash;889\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlter MJ (2007) Epidemiology of hepatitis C virus infection. World J Gastroenterol 13(17):2436\u0026ndash;2441\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePaintsil E, He H, Peters C, Lindenbach BD, Heimer R (2010) Survival of hepatitis C virus in syringes: implication for transmission among injection drug users. J Infect Dis 202(7):984\u0026ndash;990\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTohme RA, Holmberg SD (2012) Transmission of hepatitis C virus infection through tattooing and piercing: a critical review. Clin Infect Dis 54(8):1167\u0026ndash;1178\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYaphe S, Bozinoff N, Kyle R, Shivkumar S, Pai NP, Klein M (2012) Incidence of hepatitis C virus infection among HIV-positive men who have sex with men. Syst Rev Meta-anal 16(12):1569\u0026ndash;1578\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Mbarara University of Science and Technology","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis B virus, Hepatitis C virus, Prevalence, Risk factors, Uganda, Rural health","lastPublishedDoi":"10.21203/rs.3.rs-9619546/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9619546/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHepatitis B virus (HBV) and hepatitis C virus (HCV) infections remain significant public health challenges globally, particularly in sub-Saharan Africa. Despite their burden, data on prevalence and risk factors in rural Ugandan settings remain limited. This study aimed to determine the prevalence of HBV and HCV infections and identify associated risk factors among patients attending the outpatient department at Rushere Community Hospital.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted from September to November 2022 among 384 consenting patients aged 18 years and above. Socio-demographic and clinical data were collected using structured questionnaires. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B envelope antigen (HBeAg), and anti-HCV antibodies using rapid immunochromatographic assays. Data were analyzed using STATA version 13, with bivariate and multivariate logistic regression performed to identify risk factors.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe prevalence of HBV was 6.3% (24/384) and HCV was 2.3% (9/384). Among HBsAg-positive patients, 37.5% (9/24) were HBeAg-positive, indicating active viral replication. Significant risk factors for HBV included history of blood transfusion (AOR\u0026thinsp;=\u0026thinsp;3.85, 95% CI: 1.23\u0026ndash;12.05, p\u0026thinsp;=\u0026thinsp;0.021), sharing sharp objects (AOR\u0026thinsp;=\u0026thinsp;3.12, 95% CI: 1.15\u0026ndash;8.46, p\u0026thinsp;=\u0026thinsp;0.025), and multiple sexual partners (AOR\u0026thinsp;=\u0026thinsp;2.89, 95% CI: 1.08\u0026ndash;7.73, p\u0026thinsp;=\u0026thinsp;0.034). For HCV, significant associations were found with history of blood transfusion (AOR\u0026thinsp;=\u0026thinsp;5.67, 95% CI: 1.34\u0026ndash;23.98, p\u0026thinsp;=\u0026thinsp;0.018) and sharing sharp objects (AOR\u0026thinsp;=\u0026thinsp;4.23, 95% CI: 1.02\u0026ndash;17.54, p\u0026thinsp;=\u0026thinsp;0.047).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eThe prevalence of HBV and HCV infections at Rushere Community Hospital is substantial, with blood transfusion and sharing sharp objects being major risk factors. These findings underscore the need for enhanced screening programs, safe blood transfusion practices, and targeted health education interventions in rural healthcare settings.\u003c/p\u003e","manuscriptTitle":"Prevalence and Associated Risk Factors of Hepatitis B and C Virus Infections Among Patients Attending Outpatient Department at Rushere Community Hospital, Kiruhura District, Uganda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 17:15:30","doi":"10.21203/rs.3.rs-9619546/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d1aaf647-893d-4f7c-a193-c06c04417d3d","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T17:15:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 17:15:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9619546","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9619546","identity":"rs-9619546","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}