Prevalence and Burden of Chronic Hepatitis B Virus Infection in Sierra Leone, 1997-2022: Evidence from a 25-Year Systematic Review and Meta-Analysis

ABSTRACT Objective To estimate the prevalence and burden of chronic HBV in Sierra Leone. Methods We used electronic databases PubMed/MEDLINE, Embase, Scopus, ScienceDirect, Web of Science, Google Scholar and African Journals Online to systematically review articles reporting hepatitis B surface antigen (HBsAg) seroprevalence estimates in Serra Leone during 1997-2022. We estimated pooled HBV seroprevalence rates and assessed sources of heterogeneity Results Of 406 publications screened, 22 studies of total sample size 107,186 were included in the meta-analysis. The crude pooled HBV seroprevalence was 13.0% (95% CI 10.0-16.0) (I2=99%, p-heterogeneity<0.01), translating into 1.06 million people (95% uncertainty interval 0.81-1.30) or 1 in 8 Sierra Leoneans living with chronic HBV in 2021. Sensitivity analysis yielded a pooled HBV seroprevalence of 12.0% (95% CI 10.0-14.0) (sample size 104,968) (I2=98%, p-heterogeneity<0.001). The highest HBV seroprevalence estimates were among adolescents aged 10-17 years (17.0%, 95% CI 8.8-30.5), Ebola survivors (36.8%, 95% CI 26.2-48.8), people living with HIV (15.9%, 95% CI 10.6-23.0) and in the Northern (19.0%, 95% CI 6.4-44.7) and Southern (19.7%, 95% CI 10.9-32.8) regions. HBV seroprevalence progressively declined from 17.9% during 1997-2014 to 10.7% during 2020-2022. Conclusions These findings necessitate the urgent implementation of national HBV prevention and control programs in Sierra Leone.