Burden and Risk Factors of Hepatitis B and C Virus Infections among Hospital and Community Populations in North-Central Nigeria

Burden and Risk Factors of Hepatitis B and C Virus Infections among Hospital and Community Populations in North-Central Nigeria | 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 Burden and Risk Factors of Hepatitis B and C Virus Infections among Hospital and Community Populations in North-Central Nigeria Awayimbo Ruth Jaggu, David Ishaleku, Akolo Yohanna Jaggu, Olubunmi Iyabode Ojji, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8490509/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 4 You are reading this latest preprint version Abstract Chronic viral hepatitis due to hepatitis B virus (HBV) and hepatitis C virus (HCV) remains a significant global public health problem and a major cause of liver-related morbidity and mortality in sub-Saharan Africa. Nigeria bears a substantial share of this burden, particularly in the North-Central region, where endemic transmission persists. However, data describing the prevalence of HBV and HCV infections and their associated risk factors across both community and healthcare settings remain limited. This study assessed the prevalence of HBV and HCV infections and identified associated risk factors among adults in Akwanga, Lafia, and Keffi Local Government Areas of Nasarawa State, Nigeria. Methods : A cross-sectional study involving 852 adults (284 per location) was conducted. Socio-demographic, behavioural, healthcare-related, and household exposure data were collected using structured questionnaires. All participants were screened for HBV and HCV using Rapid Diagnostic Tests (RDT), ELISA and confirmed with PCR. Data were analysed using SPSS v26; descriptive statistics summarized prevalence, and Chi-square, Fisher’s exact tests, and logistic regression identified risk factors (p < 0.05). Results : The overall prevalence of HBV was 13.1% and HCV 7.9%. HBV prevalence was highest in Keffi (15.1%), followed by Akwanga (14.4%) and Lafia (9.9%), while HCV prevalence was highest in Keffi (10.9%), Akwanga (7.7%), and Lafia (4.9%). Significant risk factors for HBV infection included previous surgery or medical procedures involving sharps (OR = 1.27; 95% CI:0.7–2.3), sharing personal items (OR = 1.72; 95% CI:1.1–2.7), and history of sexually transmitted infections (OR = 2.35; 95% CI:1.3–4.2). For HCV, blood transfusion (OR = 2.08; 95% CI:1.0–4.3) and surgery (OR = 1.11; 95% CI:0.5–2.3) were notable risk factors. Knowledge of hepatitis B and C was generally moderate, with gaps in vaccination awareness and preventive behaviours. Conclusion : HBV and HCV infections is highly endemic in Nasarawa State, North Central Nigeria and a significant public health challenge due to its similar route of transmission, with facility and community variations. Targeted interventions focusing on safe medical practices, behavioural education, vaccination promotion, and routine screening are urgently needed to reduce transmission and liver-related morbidity. Hepatitis B Hepatitis C Prevalence Risk Factors Nigeria Nasarawa State Introduction Blood-borne pathogens, Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV), remain significant global public health challenges, contributing substantially to the burden of infectious diseases worldwide. 1 , 2 Globally, over 254 million and 50 million people are estimated to be chronically infected with HBV and HCV, respectively. 3 According to the World Health Organization (WHO) 2024 Global Hepatitis Report, viral hepatitis causes approximately 1.3 million deaths annually, ranking as the second leading infectious cause of death, comparable to tuberculosis. 4 , 5 HBV and HCV are hepatotropic viruses responsible for the majority of viral hepatitis–related morbidity and mortality. Chronic infection can lead to liver cirrhosis, hepatocellular carcinoma (HCC), liver failure, and premature death. 6 , 7 Both viruses share similar transmission routes, including unsafe blood transfusions, reuse of contaminated sharps, sexual contact, household exposures, and unsafe medical practices. 8 , 9 Despite the availability of an effective HBV vaccine, HCV remains non-vaccine-preventable, and a substantial proportion of infected individuals remain undiagnosed and untreated worldwide. 10 , 11 Globally, only 13% of people living with chronic HBV and 36% of those with chronic HCV had been diagnosed by the end of 2022, with treatment coverage remaining low. 12 In Nigeria, HBV and HCV prevalence varies widely across regions and populations, reflecting differences in socio-demographic factors, healthcare access, awareness levels, and health-seeking behaviour. 13 , 14 Screening is often limited to individuals with deranged liver enzymes or symptomatic disease, creating gaps in early detection and management. 15 , 16 Consequently, many cases remain undiagnosed, perpetuating transmission and contributing to the high endemicity observed in various states. 17 , 18 Understanding the distribution, behavioural determinants, and risk factors in specific localities is crucial for effective prevention, targeted interventions, and policy formulation. Previous studies in Nigeria have primarily focused on urban centres or facility-based populations, with limited comprehensive data from both community- and facility-based settings in Nasarawa State, particularly in Lafia, Akwanga, and Keffi. This study aims to provide robust epidemiological data on HBV and HCV prevalence, identify associated risk factors, and inform evidence-based policies, vaccination campaigns, and community interventions tailored to the local context. Methods Study Design and Setting This study employed a cross-sectional analytical design involving both facility-based and community-based populations between June 2025 to December, 2025. The study was conducted in three locations within Nasarawa State 19 , North-Central Nigeria: Akwanga Local Government Area, Lafia Local Government Area, and Keffi Local Government Area. These locations represent a mix of urban and semi-urban settings and were selected to capture variations in hepatitis B virus (HBV) and hepatitis C virus (HCV) burden across community and healthcare environments. The facility-based component was conducted at the Federal Medical Centre, Keffi, a major tertiary referral hospital serving Nasarawa State and neighbouring regions, while the community-based component involved selected households within Akwanga and Lafia LGAs. 2.2 Study Population The study population consisted of adult individuals aged 18 years and above residing in the selected communities (Lafia: Akunza and Shabu, Akwanga: Andaha and Akwanga Central) or attending healthcare services at the Federal Medical Centre, Keffi, during the study period. Participants were recruited irrespective of sex or socioeconomic status. All participants provided informed written consent prior to enrolment. 2.3 Sample Size and Sampling Technique A total of 852 participants were enrolled in the study, with equal representation of 284 from Akwanga, Lafia, and Keffi Local Government Areas respectively. A multistage sampling technique was employed. One tertiary hospital (out of two) and two LGAs were selected using simple random sampling by balloting. Within the selected facility, participants were recruited using systematic random sampling proportional to clinic patient load. In the selected LGAs, wards were randomly chosen, followed by systematic household sampling using a calculated sampling interval. Eligible participants were consecutively enrolled from selected households until the required sample size was achieved. 2.4.1 Inclusion Criteria Individuals aged ≥ 18 years residing in the selected communities or attending the selected health facility during the study period, who provided informed consent, were eligible to participate. 2.4.2 Exclusion Criteria Individuals who were critically ill, mentally incapacitated, non-residents/visitors, or who declined to give informed consent were excluded from the study. 2.5 Data Collection A structured questionnaire captured socio-demographic information. behavioural factors (e.g., sexual practices, alcohol and drug use), healthcare-related exposures (surgery, blood transfusions, vaccination), and household practices (sharing personal items) was administered through face-to-face interviews by trained research assistants, ensuring confidentiality, consistency and completeness. Questionnaires were pretested for clarity, reliability, and validity beforehand. 2.6 Blood Sample Collection and Laboratory Testing Approximately 5ml of venous blood was aseptically collected from each participant by trained phlebotomists into well labelled, sterile, single-use (Plain and K3 BD EDTA) vacutainer. Samples were dispensed into plain tubes and allowed to clot at room temperature before centrifugation. Serum was separated promptly and stored under appropriate cold-chain conditions (2–8°C) prior to laboratory analysis. EDTA tubes were processed to obtain plasma for molecular testing (HBV DNA and HCV RNA) and stored at − 80°C. All samples were transported following standard biosafety and specimen integrity protocols to prevent haemolysis or nucleic acid degradation. 2.7 Laboratory Analysis 2.7.1 Rapid Diagnostic Testing (RDT) Serum samples were screened for HBsAg using the One-Step Cassette Style HBsAg Rapid Test (ACON Laboratories Inc., USA; 100% sensitivity and 100% specificity) and for anti-HCV using the Wondfo One-Step Anti-HCV Rapid Test (Wondfo Biotech Co., Ltd., China; 99% sensitivity and 99.8% specificity), following the manufacturers’ instructions. Participant blood sample was applied to the cassette, buffer added, and results read visually within the recommended time frame. Test validity and reactivity were determined by the presence of both control and test bands. Positive and negative controls provided by the manufacturers were run periodically to ensure quality assurance. The kits are highly reproducible, reliable, and user-friendly. 2.7.2 Enzyme-Linked Immunosorbent Assay (ELISA) All serum samples were further tested using enzyme-linked immunosorbent assay for the detection of HBsAg and anti-HCV antibodies, irrespective of RDT results. ELISA testing was conducted using standardized commercial kits (Abbott Microparticle Enzyme Immunoassay) based on solid-phase immunoassay principles. Serum samples were added to antigen- or antibody-coated microtiter plates and incubated to allow immune complex formation. Following incubation, unbound components were removed by automated washing steps, after which enzyme-labelled conjugates were added. A chromogenic substrate was then introduced, producing a colorimetric reaction proportional to the presence of target analytes. Optical density values were measured using a microplate reader, and results were interpreted according to manufacturer-specified cut-off valuesInternal controls supplied with each kit were included in every assay run to ensure analytical validity, by verifying proper reagent performance, assay integrity, and procedural accuracy, thereby minimizing the risk of false-positive or false-negative results and ensuring the reliability and reproducibility of the laboratory findings. 2.7.3 Polymerase Chain Reaction (PCR) Plasma samples were tested for HBV DNA and HCV RNA using real-time PCR techniques in designated molecular work areas with strict contamination control. HBV DNA was extracted with the QIAamp DNA Mini Kit and amplified using the HBV Real-TM Qual Kit, while HCV RNA was extracted with the QIAamp Viral RNA Mini Kit and detected via one-step RT-qPCR targeting the 5′ UTR region. Positive, negative, and no-template controls, along with internal amplification controls, were included to ensure assay validity. Samples were interpreted based on exponential amplification curves within validated Ct thresholds, with HBV positives confirmed by semi-nested PCR and sequencing and HCV quantification referenced to WHO-traceable standards. All procedures adhered to MIQE and WHO guidelines, ensuring sensitivity, specificity, reproducibility, and biosafety compliance. 2.8 Quality Control and Biosafety All laboratory procedures were conducted in accordance with standard operating procedures and biosafety guidelines. Assays were performed by experienced laboratory personnel, and strict contamination-prevention measures were observed throughout molecular testing. Reagents were stored and used according to manufacturer’s recommendations, and equipment calibration was routinely verified. 2.9 Ethics approval and consent to participate Ethical approval for this study was obtained from the Nasarawa State Health Research Ethics Committee (NHREC), under Protocol Number 18/06/2017. The committee reviewed the study protocol, consent forms, and participant information materials, determining that the research involved no more than minimal risk to participants. Written informed consent was obtained from all study participants prior to data and sample collection, and all procedures adhered to the principles of the Declaration of Helsinki. 20 2.10 Data Analysis Data were entered and analyzed using SPSS version 26. Descriptive statistics (frequencies and percentages) were used to summarize sociodemographic characteristics and estimate the prevalence of HBV and HCV infections in facility-based and community-based populations. Cross-tabulations were performed to assess variations in prevalence across study locations. Associations between infection status and potential risk factors were examined using chi-square tests. Binary logistic regression was applied to identify independent predictors of infection while adjusting for potential confounders. Stratified analyses by study setting (facility versus community) were conducted to explore geographical variation in risk patterns. Odds ratios with 95% confidence intervals were reported, and statistical significance was set at p < 0.05. Results A total of 852 participants were successfully enrolled from both facility-based and community-based settings after obtaining written informed consent. The overall mean age was 37.4 ± 12.9 years. Participants from Lafia, Akwanga, and Keffi had mean ages of 35.6 ± 12.7, 36.3 ± 11.9, and 40.4 ± 13.5 years, respectively. Females constituted a slightly higher proportion of the study population (51.8%). More than half of the respondents were married (54.8%), while 35.6% were single. Most participants (56.3%) had attained tertiary education, and civil servants formed the largest occupational group (26.2%). Monthly income varied across locations, with 28.8% earning below ₦20,000 and 18.3% earning above ₦100,000 as presented in Table 3.1. Statistically significant differences (p < 0.05) were observed in the age distribution and educational status across the three study areas, whereas sex, marital status, occupation, and monthly income did not differ significantly. The prevalence of hepatitis B virus (HBV) infection based on the Rapid Diagnostic Test (RDT) was 9.5% in Lafia, 13.7% in Akwanga, and 14.8% in Keffi, giving an overall prevalence of 12.7% across Nasarawa State. Comparable prevalence estimates were obtained using the ELISA and PCR methods, with rates of 9.9% in Lafia, 14.4% in Akwanga, and 15.1% in Keffi, resulting in an overall state prevalence of 13.1%. For hepatitis C virus (HCV), RDT-based prevalence was 4.6% in Lafia, 7.7% in Akwanga, and 10.9% in Keffi, giving an overall prevalence of 7.7%. These findings were confirmed by ELISA and PCR, which yielded identical site-specific estimates and an overall prevalence of 7.9%, as shown in Table 3.2. Chi-square analysis demonstrated no statistically significant difference in HBV prevalence across the three LGAs (p > 0.05). However, a significant variation was observed for HCV prevalence using both ELISA and PCR (χ² = 7.030; p = 0.030), indicating a higher burden in Keffi compared with Lafia and Akwanga. Associations between behavioural, clinical, and cultural risk factors and HBV and HCV infections are presented in Table 3.3. Illicit drug use was reported among 18.5% of HBV-positive and 24.2% of HCV-positive participants. A history of blood transfusion was observed in 20.4% of HBV-positive and 34.8% of HCV-positive cases. Surgical procedures or exposure to sharp instruments were strongly associated with coinfection (OR = 4.63; 95% CI: 1.1–9.6). Tattoos or body piercings were reported in 16.7–24.2% of infected participants, while sharing personal items such as razors or toothbrushes was associated with increased HBV risk (OR = 1.72). A prior history of sexually transmitted infections significantly increased the likelihood of HBV infection (OR = 2.35; 95% CI: 1.3–4.2). Living with an infected individual was also associated with HBV infection (OR = 1.44). Cultural practices involving scarification demonstrated odds ratios close to unity Discussion Despite global efforts to control viral hepatitis, HBV and HCV continue to contribute substantially to the burden of infectious diseases in Nigeria, often remaining undetected until advanced liver pathology develops. This study provides robust, population-level evidence of a substantial burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Nasarawa State, Nigeria, confirmed by RDT, ELISA and PCR across 852 participants. The overall prevalence of HBV was 13.1% and HCV 7.9%, with the highest burden observed in Keffi, highlighting localized transmission hotspots that warrant targeted public health interventions. The findings align with prior studies in Lafia and Nasarawa State reporting HBsAg prevalence of 15.5–17.0%, 21,22 but contrast with lower prevalence (7.8%) reported in some local communities. 23 These differences may reflect variations in study populations, sampling methods, and local risk exposures. HCV prevalence in this study was lower than reported in HIV-hepatitis co-infected populations (14.6%), 24 suggesting heterogeneous transmission dynamics. Regional and population-specific factors, including differences in healthcare access, blood transfusion safety, and cultural practices, likely contribute to this variability. The sociodemographic patterns observed in this study are consistent with previous Nigerian research, which reports a predominance of young adults and a slight female majority among at-risk populations. 3 High educational attainment in these populations suggests potential receptivity to health education and preventive messaging, yet persistent infection prevalence indicates gaps between knowledge and practice, aligning with earlier observations, Occupational factors, including employment as civil servants or students, have been shown to influence access to healthcare services and screening uptake, supporting trends reported in prior Nigerian cohorts. 25,26 Behavioural and clinical risk factors identified in this study, including history of blood transfusion, surgical procedures, and sharing of personal items, align with patterns reported in other Nigerian and sub-Saharan African settings. 27,28 Blood transfusion history was reported, reinforcing transfusion as a key risk factor for HCV, particularly in settings with gaps in blood screening. A prior Study observed elevated HCV prevalence among blood recipients in settings with limited blood screening, supporting the role of transfusion as a key route of viral transmission, 29,30,31 which underscore the need to strengthen transfusion safety protocols, including rigorous donor screening and nucleic acid testing, to reduce iatrogenic infection. Surgical and invasive procedures have been identified as key drivers of HBV and HCV transmission in several Nigerian study reported inadequate sterilization and unsafe clinical practices in a secondary healthcare facility contributed to increased hepatitis transmission. 13,32 These findings underscore the importance of strict adherence to infection prevention and control protocols in healthcare settings to minimize the risk of viral hepatitis transmission. Sharing of personal items—such as razors, clippers, and needles—was strongly associated with HBV (50.9%) and moderately with HCV (40.9%). This aligns with horizontal transmission patterns reported in prior Nigerian studies, and mirrors trends observed across sub-Saharan Africa, where community-based sharing practices remain prevalent. Interventions promoting individual ownership of personal hygiene tools and targeted community education have been shown to significantly reduce HBV transmission in similar populations. 9,33 Multiple sexual partnerships and inconsistent use of protective measures have been consistently linked to HBV and HCV transmission. Studies in sub-Saharan and Nigeria settings have reported similar associations, highlighting sexual behaviour as an important pathway for viral spread, indicating persistent gaps in sexual health education and preventive practices, underscoring the need for targeted behavioural interventions to reduce transmission risk . 34,35 The association of prior sexually transmitted infections with HBV and HCV supports previous evidence indicating mucosal injury and sexual transmission as important pathways. 29,36,37 Vaccination coverage among HBV-positive individuals remains suboptimal, a finding that mirrors earlier studies in Nigeria highlighting incomplete immunization or low uptake. 15,38,39 Alcohol consumption was reported in ~28% of infected participants, a factor that exacerbates liver injury. 40 Findings from household exposure was a critical contributor to intra-family transmission, this is consistent with evidence from studies who documented higher seroprevalence among household contacts of infected individuals. Such transmission emphasizes the importance of family-cantered screening, vaccination, and education strategies, particularly in high-prevalence settings, to disrupt intra-household viral spread. 41,42 Cultural practices, including scarification, remain important contributors to the ongoing transmission of HBV and HCV in Nasarawa State, consistent with reports highlighting traditional practices as key drivers of viral spread 43 . The findings from this study suggest that transmission is sustained by a combination of preventable healthcare-related exposures, delayed or absent screening, and persistent high-risk behaviours, highlighting critical gaps in current hepatitis prevention and control strategies. Integrating routine HBV and HCV screening into primary healthcare services, blood transfusion systems, antenatal care, and community outreach—combined with expanded vaccination programs and strengthened infection prevention protocols—could substantially reduce undiagnosed infections and interrupt transmission. Given the high endemicity observed, alongside behavioural, healthcare-related, and cultural factors influencing viral spread, there is an urgent need for targeted, integrated interventions. These include expanded HBV vaccination coverage, reinforced infection prevention in healthcare settings, community education addressing high-risk behaviours, and equitable access to screening and treatment. Public health strategies tailored to the local epidemiological context are essential to mitigate transmission and support progress toward Nigeria’s commitment to achieving the WHO 2030 viral hepatitis elimination targets. Conclusions The study highlights a substantial burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Nasarawa State, with prevalence patterns reflecting localized transmission hotspots. Comparison with previous studies demonstrates both concordance and variability in HBV and HCV prevalence, emphasizing the influence of population-specific, behavioural, and healthcare-related factors on transmission dynamics. Persistent gaps in vaccination coverage, screening, and preventive practices underscore the need for strengthened public health strategies, including routine screening, expanded vaccination, targeted community education, and strict infection prevention measures in healthcare settings. Context-specific, integrated interventions are essential to reduce viral hepatitis transmission and support Nigeria’s progress toward the WHO 2030 viral hepatitis elimination targets. Limitations of the study A possible limitation of this study is that participants may have underreported previous screening or risk behaviours due to recall bias or fear of stigmatization. This was mitigated by anonymous questionnaires, strict confidentiality, and community sensitization to build trust. Another limitation is the cross-sectional design, which limits causal inference; however, this was addressed by combining structured questionnaires with objective laboratory confirmation (RDTs, ELISA, PCR), including both facility- and community-based participants for broader representation, and applying rigorous statistical analyses to identify meaningful associations. Variability in sample collection, transport, and storage could have affected sample integrity, but strict cold-chain procedures and standardized laboratory protocols were followed. Selection bias and the sub-population focus may affect generalizability, yet outreach to diverse participants ensured balanced representation. Despite these limitations, the study’s methodological rigor and integration of survey and laboratory data provide a strong evidence base to guide viral hepatitis prevention, control, and policy in Nigeria. Recommendations From the Study A. Government and Policymakers To curb the rising burden of hepatitis B and C, state and local governments, in collaboration with the Federal Ministry of Health and NCDC, should establish dedicated Hepatitis Control Units to coordinate surveillance, vaccination, and community screening within existing health structures. Universal access to free or subsidized screening and vaccination, especially in rural and underserved areas, should be ensured through mobile clinics, outreach programs, and adult catch-up immunization. Routine healthcare services, including antenatal care, surgeries, and blood donation, should integrate hepatitis testing with confirmatory PCR for accurate diagnosis and linkage to care. Infection prevention and control should be strengthened through staff training and provision of essential consumables, while public awareness campaigns via local media, schools, faith-based organizations, and community leaders can reduce stigma and promote healthy behaviours. Finally, state-level surveillance systems and investment in research and capacity building are essential to monitor outcomes, support evidence-based interventions, and sustain hepatitis control efforts B. Health Institutions Healthcare facilities should implement regular training for staff on hepatitis management, infection prevention, and patient counselling. Ensuring continuous availability of diagnostic test kits and functional cold-chain systems is essential for reliable screening. Confidentiality protocols and structured counselling will build patient trust, while linkage-to-care systems must be strengthened to guarantee follow-up and treatment adherence for seropositive individuals. C. Communities and Civil Society Community engagement is critical for promoting safe practices and awareness. Religious and traditional leaders should be involved to normalize hepatitis discussions, while peer education programs can discourage risky behaviours such as sharing personal items or unsafe sexual practices. Encouraging household screening and vaccination, coupled with collaboration with NGOs, will help interrupt intra-family transmission and sustain long-term community-level prevention efforts. Abbreviations HBV Hepatitis B virus HCV Hepatitis C Virus LGA Local Government Council PPE Personal Protective Equipment FMC Federal Medical Centre SPSS Statistical Package for the Social Sciences NHREC – National Health Research Ethics Committee WHO – World Health Organization HIV – Human Immunodeficiency Virus NCDC – Nigeria Centre for Disease Control IPC – Infection Prevention and Control NHIS – National Health Insurance Scheme CI – Confidence Interval OR – Odds Ratio HCC - Hepatocellular Carcinoma EDTA- Ethylenediaminetetraacetic acid. PCR – Polymerase Chain Reaction ELISA -Enzyme-linked Immunosorbent Assay Declarations Acknowledgements The authors express their profound gratitude to all individuals and organizations that contributed to this study. Special thanks go to the study participants for their willingness to engage, the community leaders for facilitating access, the healthcare facility staff for their cooperation, and the dedicated field and research team members whose efforts ensured the smooth and successful execution of this research. Their invaluable support and commitment were essential to the completion of this work. Author contributions Awayimbo R. J. and Akolo Y. J. conceived and designed the study. Akyala I. A., Awayimbo R. J., and Akolo Y. J. performed data curation and statistical analysis. Grace A. M. contributed to data management and manuscript review. Akyala I. A. and David I. supervised the study. David I., Olubunmi I. O., Yakubu Y. A., and Olanrewaju O. critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript Funding No funding was obtained for this study Data availability The datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request, in accordance with ethical approvals and data protection guidelines. Ethics approval and consent to participate Ethical approval for this study was obtained from the Nasarawa State Health Research Ethics Committee (NHREC) under Protocol Number 18/06/2017. Written informed consent was obtained from all participants prior to data and sample collection. All study procedures were conducted in accordance with the principles of the Declaration of Helsinki. Consent for publication Not applicable. Competing interests The authors declare that they have no competing interests. Clinical trial number Not applicable. References Makuza JD, Jeong D, Wong S, Binka M, Adu PA, Velásquez García HA, et al. 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Behavioural Risk for HIV, Hepatitis B, and Hepatitis C Infections among a Population of Drug Users and Injectors across Four Regions in Ghana. Interdiscip Perspect Infect Dis. 2022;2022. Onubi J, Eseigbe P, Agyema JPA, Chima AAG. Seroprevalence of Hepatitis B and C Virus Infections among Healthcare Seekers at a Tertiary Health Facility in North-Central Nigeria: A Retrospective Study. West Afr J Med. 2023;40(12):1355–61. Alassad A, Al Rahwanji MJ, Yousfan A, Al Moualem S, Farhat A, Youssef LA. Seroprevalence and trends of hepatitis B virus, hepatitis C virus and human immunodeficiency virus in Syrian blood donors at Damascus University Blood Center between 2004 and 2021. Front Public Health. 2023;11. Mangala C, Maulot-Bangola D, Moutsinga A, Okolongo-Mayani SC, Matsomo-Kombet GE, Moundanga M et al. Prevalence and factors associated with transfusion-transmissible infections (HIV, HBV, HCV and Syphilis) among blood donors in Gabon: Systematic review and meta-analysis. PLoS One [Internet]. 2024;19(8):1–17. Available from: http://dx.doi.org/10.1371/journal.pone.0307101 Caminada S, Mele A, Ferrigno L, Alfonsi V, Crateri S, Iantosca G, et al. Risk of parenterally transmitted hepatitis following exposure to invasive procedures in Italy: SEIEVA surveillance 2000–2021. J Hepatol. 2023;79(1):61–8. Amlak BT, Lake Mengistie B, Teshale SA. Prevention practices of hepatitis B virus and its associated factors among barbers in East Gojjam Zone, Northwest Ethiopia. Front Public Health. 2025;13(April):1–11. Mustapha GU, Ibrahim A, Balogun MS, Umeokonkwo CD, Mamman AI. Seroprevalence of hepatitis B virus among antenatal clinic attendees in Gamawa Local Government Area, Bauchi State, Nigeria. BMC Infect Dis. 2020;20(1):4–9. Zang Y, Xu W, Qiu Y, Jiang X, Fan Y. Presence of diabetes further heightens hepatocellular carcinoma risk in patients with hepatitis B or hepatitis C virus-related cirrhosis: A meta-analysis. Heliyon [Internet]. 2023;9(8):e18425. Available from: https://doi.org/10.1016/j.heliyon.2023.e18425 Anejo-Okopi J, Okeke E, Davwar PM, Onwuamah C, Onywera H, Omaiye P, et al. Molecular detection of hepatitis B virus genotype E with immune escape mutations in chronic hepatitis B patients on long-term antiviral therapy in Jos, Nigeria. Afr J Lab Med. 2022;11(1):1–7. Mohamud AK, Inchon P, Suwannaporn S, Prasert K, Dirie NI. Assessment of prevalence and risk factors associated with Hepatitis B virus infection among blood donors in Mogadishu Somalia. BMC Public Health. 2024;24(1):1–9. Haber P, Schillie S. Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. Cap. 10 Hepatitis B. Centers for Disease Control and Prevention Epidemiology and Prevention of Vaccine-Preventable Diseases [Internet]. 2021; Available from: https://www.scopus.com/inward/record.uri?eid=2-s2.0-33751566358%7B%7B%7D%7B& ;%7D%7B%7D%7DpartnerID=40%7 B%7B%7D %7B&%7D%7B%7D%7Dmd5=1ff 058a1b01b32cff95d6392104ffac0 Al-Busafi SA, Alwassief A. Global Perspectives on the Hepatitis B Vaccination: Challenges, Achievements, and the Road to Elimination by 2030. Vaccines (Basel). 2024;12(3). Morojele NK, Shenoi SV, Shuper PA, Braithwaite RS, Rehm J. Alcohol use and the risk of communicable diseases. Nutrients. 2021;13(10). Zivarifar H, Rahimzadeh A, Ahrari F, Ali-Hassanzadeh M. Intra-familial Transmission of Hepatitis B and C Infections: A Systematic Review and Meta-Analysis. Middle East J Rehabilitation Health Stud. 2026;13(1):1–10. Larebo YM, Anshebo AA, Behera SK, Gopalan N. Prevalence of hepatitis B virus infection and associated factors among adults intrafamilial household contacts attending antenatal care clinics in the Central Ethiopian region: from pregnant women index cases. Virol J. 2025;22(1). Egbe KA, Ike A, Egbe F. Knowledge and burden of hepatitis B virus in Nasarawa State, Nigeria. Sci Afr [Internet]. 2023;22(October):e01938. Available from: https://doi.org/10.1016/j.sciaf.2023.e01938 Tables Tables are available in the Supplementary Files section. Additional Declarations No competing interests reported. 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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-8490509","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":569661252,"identity":"33d51c68-7a4c-409e-b4b9-e273d67d059d","order_by":0,"name":"Awayimbo Ruth 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50\u0026nbsp;million people are estimated to be chronically infected with HBV and HCV, respectively.\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e According to the World Health Organization (WHO) 2024 Global Hepatitis Report, viral hepatitis causes approximately 1.3\u0026nbsp;million deaths annually, ranking as the second leading infectious cause of death, comparable to tuberculosis.\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e,\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eHBV and HCV are hepatotropic viruses responsible for the majority of viral hepatitis\u0026ndash;related morbidity and mortality. Chronic infection can lead to liver cirrhosis, hepatocellular carcinoma (HCC), liver failure, and premature death.\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e,\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e Both viruses share similar transmission routes, including unsafe blood transfusions, reuse of contaminated sharps, sexual contact, household exposures, and unsafe medical practices.\u003csup\u003e\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e,\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e Despite the availability of an effective HBV vaccine, HCV remains non-vaccine-preventable, and a substantial proportion of infected individuals remain undiagnosed and untreated worldwide.\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e Globally, only 13% of people living with chronic HBV and 36% of those with chronic HCV had been diagnosed by the end of 2022, with treatment coverage remaining low.\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn Nigeria, HBV and HCV prevalence varies widely across regions and populations, reflecting differences in socio-demographic factors, healthcare access, awareness levels, and health-seeking behaviour.\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e Screening is often limited to individuals with deranged liver enzymes or symptomatic disease, creating gaps in early detection and management.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e Consequently, many cases remain undiagnosed, perpetuating transmission and contributing to the high endemicity observed in various states.\u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e Understanding the distribution, behavioural determinants, and risk factors in specific localities is crucial for effective prevention, targeted interventions, and policy formulation. Previous studies in Nigeria have primarily focused on urban centres or facility-based populations, with limited comprehensive data from both community- and facility-based settings in Nasarawa State, particularly in Lafia, Akwanga, and Keffi. This study aims to provide robust epidemiological data on HBV and HCV prevalence, identify associated risk factors, and inform evidence-based policies, vaccination campaigns, and community interventions tailored to the local context.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e \u003cb\u003eStudy Design and Setting\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThis study employed a cross-sectional analytical design involving both facility-based and community-based populations between June 2025 to December, 2025. The study was conducted in three locations within Nasarawa State\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e, North-Central Nigeria: Akwanga Local Government Area, Lafia Local Government Area, and Keffi Local Government Area. These locations represent a mix of urban and semi-urban settings and were selected to capture variations in hepatitis B virus (HBV) and hepatitis C virus (HCV) burden across community and healthcare environments. The facility-based component was conducted at the Federal Medical Centre, Keffi, a major tertiary referral hospital serving Nasarawa State and neighbouring regions, while the community-based component involved selected households within Akwanga and Lafia LGAs.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.2 Study Population\u003c/h2\u003e \u003cp\u003eThe study population consisted of adult individuals aged 18 years and above residing in the selected communities (Lafia: Akunza and Shabu, Akwanga: Andaha and Akwanga Central) or attending healthcare services at the Federal Medical Centre, Keffi, during the study period. Participants were recruited irrespective of sex or socioeconomic status. All participants provided informed written consent prior to enrolment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.3 Sample Size and Sampling Technique\u003c/h2\u003e \u003cp\u003eA total of 852 participants were enrolled in the study, with equal representation of 284 from Akwanga, Lafia, and Keffi Local Government Areas respectively. A multistage sampling technique was employed. One tertiary hospital (out of two) and two LGAs were selected using simple random sampling by balloting. Within the selected facility, participants were recruited using systematic random sampling proportional to clinic patient load. In the selected LGAs, wards were randomly chosen, followed by systematic household sampling using a calculated sampling interval. Eligible participants were consecutively enrolled from selected households until the required sample size was achieved.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section3\"\u003e \u003ch2\u003e2.4.1 Inclusion Criteria\u003c/h2\u003e \u003cp\u003e Individuals aged\u0026thinsp;\u0026ge;\u0026thinsp;18 years residing in the selected communities or attending the selected health facility during the study period, who provided informed consent, were eligible to participate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003e2.4.2 Exclusion Criteria\u003c/h2\u003e \u003cp\u003eIndividuals who were critically ill, mentally incapacitated, non-residents/visitors, or who declined to give informed consent were excluded from the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5 Data Collection\u003c/h2\u003e \u003cp\u003eA structured questionnaire captured socio-demographic information. behavioural factors (e.g., sexual practices, alcohol and drug use), healthcare-related exposures (surgery, blood transfusions, vaccination), and household practices (sharing personal items) was administered through face-to-face interviews by trained research assistants, ensuring confidentiality, consistency and completeness. Questionnaires were pretested for clarity, reliability, and validity beforehand.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6 Blood Sample Collection and Laboratory Testing\u003c/h2\u003e \u003cp\u003eApproximately 5ml of venous blood was aseptically collected from each participant by trained phlebotomists into well labelled, sterile, single-use (Plain and K3 BD EDTA) vacutainer. Samples were dispensed into plain tubes and allowed to clot at room temperature before centrifugation. Serum was separated promptly and stored under appropriate cold-chain conditions (2\u0026ndash;8\u0026deg;C) prior to laboratory analysis. EDTA tubes were processed to obtain plasma for molecular testing (HBV DNA and HCV RNA) and stored at \u0026minus;\u0026thinsp;80\u0026deg;C. All samples were transported following standard biosafety and specimen integrity protocols to prevent haemolysis or nucleic acid degradation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7 Laboratory Analysis\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003e2.7.1 Rapid Diagnostic Testing (RDT)\u003c/h2\u003e \u003cp\u003eSerum samples were screened for HBsAg using the One-Step Cassette Style HBsAg Rapid Test (ACON Laboratories Inc., USA; 100% sensitivity and 100% specificity) and for anti-HCV using the Wondfo One-Step Anti-HCV Rapid Test (Wondfo Biotech Co., Ltd., China; 99% sensitivity and 99.8% specificity), following the manufacturers\u0026rsquo; instructions. Participant blood sample was applied to the cassette, buffer added, and results read visually within the recommended time frame. Test validity and reactivity were determined by the presence of both control and test bands. Positive and negative controls provided by the manufacturers were run periodically to ensure quality assurance. The kits are highly reproducible, reliable, and user-friendly.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section3\"\u003e \u003ch2\u003e2.7.2 Enzyme-Linked Immunosorbent Assay (ELISA)\u003c/h2\u003e \u003cp\u003eAll serum samples were further tested using enzyme-linked immunosorbent assay for the detection of HBsAg and anti-HCV antibodies, irrespective of RDT results. ELISA testing was conducted using standardized commercial kits (Abbott Microparticle Enzyme Immunoassay) based on solid-phase immunoassay principles. Serum samples were added to antigen- or antibody-coated microtiter plates and incubated to allow immune complex formation. Following incubation, unbound components were removed by automated washing steps, after which enzyme-labelled conjugates were added. A chromogenic substrate was then introduced, producing a colorimetric reaction proportional to the presence of target analytes. Optical density values were measured using a microplate reader, and results were interpreted according to manufacturer-specified cut-off valuesInternal controls supplied with each kit were included in every assay run to ensure analytical validity, by verifying proper reagent performance, assay integrity, and procedural accuracy, thereby minimizing the risk of false-positive or false-negative results and ensuring the reliability and reproducibility of the laboratory findings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section3\"\u003e \u003ch2\u003e2.7.3 Polymerase Chain Reaction (PCR)\u003c/h2\u003e \u003cp\u003ePlasma samples were tested for HBV DNA and HCV RNA using real-time PCR techniques in designated molecular work areas with strict contamination control. HBV DNA was extracted with the QIAamp DNA Mini Kit and amplified using the HBV Real-TM Qual Kit, while HCV RNA was extracted with the QIAamp Viral RNA Mini Kit and detected via one-step RT-qPCR targeting the 5\u0026prime; UTR region. Positive, negative, and no-template controls, along with internal amplification controls, were included to ensure assay validity. Samples were interpreted based on exponential amplification curves within validated Ct thresholds, with HBV positives confirmed by semi-nested PCR and sequencing and HCV quantification referenced to WHO-traceable standards. All procedures adhered to MIQE and WHO guidelines, ensuring sensitivity, specificity, reproducibility, and biosafety compliance.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e2.8 Quality Control and Biosafety\u003c/h2\u003e \u003cp\u003e All laboratory procedures were conducted in accordance with standard operating procedures and biosafety guidelines. Assays were performed by experienced laboratory personnel, and strict contamination-prevention measures were observed throughout molecular testing. Reagents were stored and used according to manufacturer\u0026rsquo;s recommendations, and equipment calibration was routinely verified.\u003c/p\u003e \u003c/div\u003e\u003cp\u003e\u003cstrong\u003e2.9 Ethics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Nasarawa State Health Research Ethics Committee (NHREC), under Protocol Number 18/06/2017. The committee reviewed the study protocol, consent forms, and participant information materials, determining that the research involved no more than minimal risk to participants. Written informed consent was obtained from all study participants prior to data and sample collection, and all procedures adhered to the principles of the Declaration of Helsinki.\u003csup\u003e20\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.10 Data Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData were entered and analyzed using SPSS version 26. Descriptive statistics (frequencies and percentages) were used to summarize sociodemographic characteristics and estimate the prevalence of HBV and HCV infections in facility-based and community-based populations. Cross-tabulations were performed to assess variations in prevalence across study locations. Associations between infection status and potential risk factors were examined using chi-square tests. Binary logistic regression was applied to identify independent predictors of infection while adjusting for potential confounders. Stratified analyses by study setting (facility versus community) were conducted to explore geographical variation in risk patterns. Odds ratios with 95% confidence intervals were reported, and statistical significance was set at p \u0026lt; 0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 852 participants were successfully enrolled from both facility-based and community-based settings after obtaining written informed consent. The overall mean age was 37.4 \u0026plusmn; 12.9 years. Participants from Lafia, Akwanga, and Keffi had mean ages of 35.6 \u0026plusmn; 12.7, 36.3 \u0026plusmn; 11.9, and 40.4 \u0026plusmn; 13.5 years, respectively. Females constituted a slightly higher proportion of the study population (51.8%). More than half of the respondents were married (54.8%), while 35.6% were single. Most participants (56.3%) had attained tertiary education, and civil servants formed the largest occupational group (26.2%). Monthly income varied across locations, with 28.8% earning below ₦20,000 and 18.3% earning above ₦100,000 as presented in Table 3.1. Statistically significant differences (p \u0026lt; 0.05) were observed in the age distribution and educational status across the three study areas, whereas sex, marital status, occupation, and monthly income did not differ significantly.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe prevalence of hepatitis B virus (HBV) infection based on the Rapid Diagnostic Test (RDT) was 9.5% in Lafia, 13.7% in Akwanga, and 14.8% in Keffi, giving an overall prevalence of 12.7% across Nasarawa State. Comparable prevalence estimates were obtained using the ELISA and PCR methods, with rates of 9.9% in Lafia, 14.4% in Akwanga, and 15.1% in Keffi, resulting in an overall state prevalence of 13.1%. For hepatitis C virus (HCV), RDT-based prevalence was 4.6% in Lafia, 7.7% in Akwanga, and 10.9% in Keffi, giving an overall prevalence of 7.7%. These findings were confirmed by ELISA and PCR, which yielded identical site-specific estimates and an overall prevalence of 7.9%, as shown in Table 3.2. \u0026nbsp;Chi-square analysis demonstrated no statistically significant difference in HBV prevalence across the three LGAs (p \u0026gt; 0.05). However, a significant variation was observed for HCV prevalence using both ELISA and PCR (\u0026chi;\u0026sup2; = 7.030; p = 0.030), indicating a higher burden in Keffi compared with Lafia and Akwanga.\u003c/p\u003e\n\u003cp\u003eAssociations between behavioural, clinical, and cultural risk factors and HBV and HCV infections are presented in Table 3.3. Illicit drug use was reported among 18.5% of HBV-positive and 24.2% of HCV-positive participants. A history of blood transfusion was observed in 20.4% of HBV-positive and 34.8% of HCV-positive cases. Surgical procedures or exposure to sharp instruments were strongly associated with coinfection (OR = 4.63; 95% CI: 1.1\u0026ndash;9.6). Tattoos or body piercings were reported in 16.7\u0026ndash;24.2% of infected participants, while sharing personal items such as razors or toothbrushes was associated with increased HBV risk (OR = 1.72). A prior history of sexually transmitted infections significantly increased the likelihood of HBV infection (OR = 2.35; 95% CI: 1.3\u0026ndash;4.2). Living with an infected individual was also associated with HBV infection (OR = 1.44). Cultural practices involving scarification demonstrated odds ratios close to unity\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite global efforts to control viral hepatitis, HBV and HCV continue to contribute substantially to the burden of infectious diseases in Nigeria, often remaining undetected until advanced liver pathology develops. This study provides robust, population-level evidence of a substantial burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) in Nasarawa State, Nigeria, confirmed by RDT, ELISA and PCR across 852 participants. The overall prevalence of HBV was 13.1% and HCV 7.9%, with the highest burden observed in Keffi, highlighting localized transmission hotspots that warrant targeted public health interventions. The findings align with prior studies in Lafia and Nasarawa State reporting HBsAg prevalence of 15.5\u0026ndash;17.0%,\u003csup\u003e21,22\u003c/sup\u003e but contrast with lower prevalence (7.8%) reported in some local communities.\u003csup\u003e23\u003c/sup\u003e These differences may reflect variations in study populations, sampling methods, and local risk exposures. HCV prevalence in this study was lower than reported in HIV-hepatitis co-infected populations (14.6%),\u003csup\u003e24\u003c/sup\u003e suggesting heterogeneous transmission dynamics. Regional and population-specific factors, including differences in healthcare access, blood transfusion safety, and cultural practices, likely contribute to this variability.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The sociodemographic patterns observed in this study are consistent with previous Nigerian research, which reports a predominance of young adults and a slight female majority among at-risk populations.\u003csup\u003e3\u003c/sup\u003e High educational attainment in these populations suggests potential receptivity to health education and preventive messaging, yet persistent infection prevalence indicates gaps between knowledge and practice, aligning with earlier observations, Occupational factors, including employment as civil servants or students, have been shown to influence access to healthcare services and screening uptake, supporting trends reported in prior Nigerian cohorts.\u003csup\u003e\u0026nbsp;25,26\u003c/sup\u003e Behavioural and clinical risk factors identified in this study, including history of blood transfusion, surgical procedures, and sharing of personal items, align with patterns reported in other Nigerian and sub-Saharan African settings.\u003csup\u003e27,28\u003c/sup\u003e Blood transfusion history was reported, reinforcing transfusion as a key risk factor for HCV, particularly in settings with gaps in blood screening. A prior Study observed elevated HCV prevalence among blood recipients in settings with limited blood screening, supporting the role of transfusion as a key route of viral transmission, \u003csup\u003e29,30,31\u003c/sup\u003e which underscore the need to strengthen transfusion safety protocols, including rigorous donor screening and nucleic acid testing, to reduce iatrogenic infection.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e Surgical and invasive procedures have been identified as key drivers of HBV and HCV transmission in several Nigerian study reported inadequate sterilization and unsafe clinical practices in a secondary healthcare facility contributed to increased hepatitis transmission.\u003csup\u003e13,32\u003c/sup\u003e These findings underscore the importance of strict adherence to infection prevention and control protocols in healthcare settings to minimize the risk of viral hepatitis transmission.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSharing of personal items\u0026mdash;such as razors, clippers, and needles\u0026mdash;was strongly associated with HBV (50.9%) and moderately with HCV (40.9%). This aligns with horizontal transmission patterns reported in prior Nigerian studies, and mirrors trends observed across sub-Saharan Africa, where community-based sharing practices remain prevalent. Interventions promoting individual ownership of personal hygiene tools and targeted community education have been shown to significantly reduce HBV transmission in similar populations.\u003csup\u003e9,33\u003c/sup\u003e Multiple sexual partnerships and inconsistent use of protective measures have been consistently linked to HBV and HCV transmission. Studies in sub-Saharan and Nigeria settings have reported similar associations, highlighting sexual behaviour as an important pathway for viral spread, indicating persistent gaps in sexual health education and preventive practices, underscoring the need for targeted behavioural interventions to reduce transmission risk\u003cstrong\u003e.\u003csup\u003e\u0026nbsp;34,35\u003c/sup\u003e\u003c/strong\u003e The association of prior sexually transmitted infections with HBV and HCV supports previous evidence indicating mucosal injury and sexual transmission as important pathways.\u003csup\u003e29,36,37\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eVaccination coverage among HBV-positive individuals remains suboptimal, a finding that mirrors earlier studies in Nigeria highlighting incomplete immunization or low uptake.\u003csup\u003e15,38,39\u003c/sup\u003e Alcohol consumption was reported in ~28% of infected participants, a factor that exacerbates liver injury.\u003csup\u003e40\u003c/sup\u003e\u0026nbsp; Findings from household exposure was a critical contributor to intra-family transmission, this is consistent with evidence from studies who documented higher seroprevalence among household contacts of infected individuals. Such transmission emphasizes the importance of family-cantered screening, vaccination, and education strategies, particularly in high-prevalence settings, to disrupt intra-household viral spread.\u003csup\u003e41,42\u003c/sup\u003e Cultural practices, including scarification, remain important contributors to the ongoing transmission of HBV and HCV in Nasarawa State, consistent with reports highlighting traditional practices as key drivers of viral spread\u003csup\u003e43\u003c/sup\u003e. The findings from this study suggest that transmission is sustained by a combination of preventable healthcare-related exposures, delayed or absent screening, and persistent high-risk behaviours, highlighting critical gaps in current hepatitis prevention and control strategies. Integrating routine HBV and HCV screening into primary healthcare services, blood transfusion systems, antenatal care, and community outreach\u0026mdash;combined with expanded vaccination programs and strengthened infection prevention protocols\u0026mdash;could substantially reduce undiagnosed infections and interrupt transmission. Given the high endemicity observed, alongside behavioural, healthcare-related, and cultural factors influencing viral spread, there is an urgent need for targeted, integrated interventions. These include expanded HBV vaccination coverage, reinforced infection prevention in healthcare settings, community education addressing high-risk behaviours, and equitable access to screening and treatment. Public health strategies tailored to the local epidemiological context are essential to mitigate transmission and support progress toward Nigeria\u0026rsquo;s commitment to achieving the WHO 2030 viral hepatitis elimination targets.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe study highlights a substantial burden of hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in Nasarawa State, with prevalence patterns reflecting localized transmission hotspots. Comparison with previous studies demonstrates both concordance and variability in HBV and HCV prevalence, emphasizing the influence of population-specific, behavioural, and healthcare-related factors on transmission dynamics. Persistent gaps in vaccination coverage, screening, and preventive practices underscore the need for strengthened public health strategies, including routine screening, expanded vaccination, targeted community education, and strict infection prevention measures in healthcare settings. Context-specific, integrated interventions are essential to reduce viral hepatitis transmission and support Nigeria\u0026rsquo;s progress toward the WHO 2030 viral hepatitis elimination targets.\u003c/p\u003e\n"},{"header":"Limitations of the study","content":"\n\u003cp\u003eA possible limitation of this study is that participants may have underreported previous screening or risk behaviours due to recall bias or fear of stigmatization. This was mitigated by anonymous questionnaires, strict confidentiality, and community sensitization to build trust. Another limitation is the cross-sectional design, which limits causal inference; however, this was addressed by combining structured questionnaires with objective laboratory confirmation (RDTs, ELISA, PCR), including both facility- and community-based participants for broader representation, and applying rigorous statistical analyses to identify meaningful associations. Variability in sample collection, transport, and storage could have affected sample integrity, but strict cold-chain procedures and standardized laboratory protocols were followed. Selection bias and the sub-population focus may affect generalizability, yet outreach to diverse participants ensured balanced representation.\u003c/p\u003e\n\u003cp\u003eDespite these limitations, the study\u0026rsquo;s methodological rigor and integration of survey and laboratory data provide a strong evidence base to guide viral hepatitis prevention, control, and policy in Nigeria.\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRecommendations From the Study\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA. Government and Policymakers\u003c/strong\u003e\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003eTo curb the rising burden of hepatitis B and C, state and local governments, in collaboration with the Federal Ministry of Health and NCDC, should establish dedicated Hepatitis Control Units to coordinate surveillance, vaccination, and community screening within existing health structures. Universal access to free or subsidized screening and vaccination, especially in rural and underserved areas, should be ensured through mobile clinics, outreach programs, and adult catch-up immunization. Routine healthcare services, including antenatal care, surgeries, and blood donation, should integrate hepatitis testing with confirmatory PCR for accurate diagnosis and linkage to care. Infection prevention and control should be strengthened through staff training and provision of essential consumables, while public awareness campaigns via local media, schools, faith-based organizations, and community leaders can reduce stigma and promote healthy behaviours. Finally, state-level surveillance systems and investment in research and capacity building are essential to monitor outcomes, support evidence-based interventions, and sustain hepatitis control efforts\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB. Health Institutions\u003c/strong\u003e\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003eHealthcare facilities should implement regular training for staff on hepatitis management, infection prevention, and patient counselling. Ensuring continuous availability of diagnostic test kits and functional cold-chain systems is essential for reliable screening. Confidentiality protocols and structured counselling will build patient trust, while linkage-to-care systems must be strengthened to guarantee follow-up and treatment adherence for seropositive individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC. Communities and Civil Society\u003c/strong\u003e\u003cbr\u003e \u003c/p\u003e\n\u003cp\u003eCommunity engagement is critical for promoting safe practices and awareness. Religious and traditional leaders should be involved to normalize hepatitis discussions, while peer education programs can discourage risky behaviours such as sharing personal items or unsafe sexual practices. Encouraging household screening and vaccination, coupled with collaboration with NGOs, will help interrupt intra-family transmission and sustain long-term community-level prevention efforts.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHBV \u0026nbsp; \u0026nbsp; \u0026nbsp;Hepatitis B virus\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHCV \u0026nbsp; \u0026nbsp; \u0026nbsp;Hepatitis C Virus\u003c/p\u003e\n\u003cp\u003eLGA \u0026nbsp; \u0026nbsp; \u0026nbsp;Local Government Council\u003c/p\u003e\n\u003cp\u003ePPE \u0026nbsp; \u0026nbsp; \u0026nbsp; Personal Protective Equipment\u003c/p\u003e\n\u003cp\u003eFMC \u0026nbsp; \u0026nbsp; Federal Medical Centre\u003c/p\u003e\n\u003cp\u003eSPSS \u0026nbsp; \u0026nbsp;Statistical Package for the Social Sciences\u003c/p\u003e\n\u003cp\u003eNHREC \u0026ndash; National Health Research Ethics Committee\u003c/p\u003e\n\u003cp\u003eWHO \u0026ndash; World Health Organization\u003c/p\u003e\n\u003cp\u003eHIV \u0026ndash; Human Immunodeficiency Virus\u003c/p\u003e\n\u003cp\u003eNCDC \u0026ndash; Nigeria Centre for Disease Control\u003c/p\u003e\n\u003cp\u003eIPC \u0026ndash; Infection Prevention and Control\u003c/p\u003e\n\u003cp\u003eNHIS \u0026ndash; National Health Insurance Scheme\u003c/p\u003e\n\u003cp\u003eCI \u0026ndash; Confidence Interval\u003c/p\u003e\n\u003cp\u003eOR \u0026ndash; Odds Ratio\u003c/p\u003e\n\u003cp\u003eHCC - Hepatocellular Carcinoma\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEDTA- Ethylenediaminetetraacetic acid.\u003c/p\u003e\n\u003cp\u003ePCR \u0026ndash; Polymerase Chain Reaction\u003c/p\u003e\n\u003cp\u003eELISA -Enzyme-linked Immunosorbent Assay\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors express their profound gratitude to all individuals and organizations that contributed to this study. Special thanks go to the study participants for their willingness to engage, the community leaders for facilitating access, the healthcare facility staff for their cooperation, and the dedicated field and research team members whose efforts ensured the smooth and successful execution of this research. Their invaluable support and commitment were essential to the completion of this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAwayimbo R. J. and Akolo Y. J. conceived and designed the study. Akyala I. A., Awayimbo R. J., and Akolo Y. J. performed data curation and statistical analysis. Grace A. M. contributed to data management and manuscript review. Akyala I. A. and David I. supervised the study. David I., Olubunmi I. O., Yakubu Y. A., and Olanrewaju O. critically revised the manuscript for important intellectual content. All authors read and approved the final manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was obtained for this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are available from the corresponding author on reasonable request, in accordance with ethical approvals and data protection guidelines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Nasarawa State Health Research Ethics Committee (NHREC) under Protocol Number 18/06/2017. Written informed consent was obtained from all participants prior to data and sample collection. All study procedures were conducted in accordance with the principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Not applicable.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMakuza JD, Jeong D, Wong S, Binka M, Adu PA, Vel\u0026aacute;squez Garc\u0026iacute;a HA, et al. Association of hepatitis B virus treatment with all-cause and liver-related mortality among individuals with HBV and cirrhosis: a population-based cohort study. 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Knowledge and burden of hepatitis B virus in Nasarawa State, Nigeria. Sci Afr [Internet]. 2023;22(October):e01938. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.sciaf.2023.e01938\u003c/span\u003e\u003cspan address=\"10.1016/j.sciaf.2023.e01938\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis B, Hepatitis C, Prevalence, Risk Factors, Nigeria, Nasarawa State","lastPublishedDoi":"10.21203/rs.3.rs-8490509/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8490509/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eChronic viral hepatitis due to hepatitis B virus (HBV) and hepatitis C virus (HCV) remains a significant global public health problem and a major cause of liver-related morbidity and mortality in sub-Saharan Africa. Nigeria bears a substantial share of this burden, particularly in the North-Central region, where endemic transmission persists. However, data describing the prevalence of HBV and HCV infections and their associated risk factors across both community and healthcare settings remain limited. This study assessed the prevalence of HBV and HCV infections and identified associated risk factors among adults in Akwanga, Lafia, and Keffi Local Government Areas of Nasarawa State, Nigeria.\u003c/p\u003e \u003cp\u003e \u003cb\u003eMethods\u003c/b\u003e: A cross-sectional study involving 852 adults (284 per location) was conducted. Socio-demographic, behavioural, healthcare-related, and household exposure data were collected using structured questionnaires. All participants were screened for HBV and HCV using Rapid Diagnostic Tests (RDT), ELISA and confirmed with PCR. Data were analysed using SPSS v26; descriptive statistics summarized prevalence, and Chi-square, Fisher\u0026rsquo;s exact tests, and logistic regression identified risk factors (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e \u003cp\u003e \u003cb\u003eResults\u003c/b\u003e: The overall prevalence of HBV was 13.1% and HCV 7.9%. HBV prevalence was highest in Keffi (15.1%), followed by Akwanga (14.4%) and Lafia (9.9%), while HCV prevalence was highest in Keffi (10.9%), Akwanga (7.7%), and Lafia (4.9%). Significant risk factors for HBV infection included previous surgery or medical procedures involving sharps (OR\u0026thinsp;=\u0026thinsp;1.27; 95% CI:0.7\u0026ndash;2.3), sharing personal items (OR\u0026thinsp;=\u0026thinsp;1.72; 95% CI:1.1\u0026ndash;2.7), and history of sexually transmitted infections (OR\u0026thinsp;=\u0026thinsp;2.35; 95% CI:1.3\u0026ndash;4.2). For HCV, blood transfusion (OR\u0026thinsp;=\u0026thinsp;2.08; 95% CI:1.0\u0026ndash;4.3) and surgery (OR\u0026thinsp;=\u0026thinsp;1.11; 95% CI:0.5\u0026ndash;2.3) were notable risk factors. Knowledge of hepatitis B and C was generally moderate, with gaps in vaccination awareness and preventive behaviours.\u003c/p\u003e \u003cp\u003e \u003cb\u003eConclusion\u003c/b\u003e: HBV and HCV infections is highly endemic in Nasarawa State, North Central Nigeria and a significant public health challenge due to its similar route of transmission, with facility and community variations. Targeted interventions focusing on safe medical practices, behavioural education, vaccination promotion, and routine screening are urgently needed to reduce transmission and liver-related morbidity.\u003c/p\u003e","manuscriptTitle":"Burden and Risk Factors of Hepatitis B and C Virus Infections among Hospital and Community Populations in North-Central Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-06 09:31:01","doi":"10.21203/rs.3.rs-8490509/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-07T06:31:50+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-06T11:59:57+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-06T11:58:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-12-31T14:34:50+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"39b2f606-e83b-44fb-9892-ca8b5e6a6868","owner":[],"postedDate":"January 6th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-18T12:09:32+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-06 09:31:01","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8490509","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8490509","identity":"rs-8490509","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}