Chronic Hepatitis B Prevalence among Children and Mothers: Results from a Nationwide, Population-Based Survey in Lao People's Democratic Republic

BACKGROUND: Hepatitis B is regarded as a serious public health issue in Lao People's Democratic Republic (Lao PDR), a Southeast Asian country. However, disease epidemiology among the general population is not well known, and thus a nationwide cross-sectional survey for hepatitis B surface antigen (HBsAg) prevalence in children and their mothers was conducted. METHODS AND FINDINGS: We applied three-stage cluster sampling using probability proportionate to size. After randomly selecting child (5 to 9 years old) and mother (15 to 45 years old) pairs from the selected villages, questionnaires and HBsAg rapid tests were conducted. Data from 965 child and mother pairs were analyzed. Multivariate logistic regression analyses were used to investigate the independent association of individual background characteristics for the odds of being HBsAg positive. In total, 17 children and 27 mothers were HBsAg positive. HBsAg prevalence was estimated to be 1.7% (95% confidence interval: 0.8%-2.6%) in children, and 2.9% (95% confidence interval: 1.7%-4.2%) in their mothers after taking sampling design and weight of each sample into account. Mother's infection status was positively associated with HBsAg positivity in children (p<0.001), whereas other potential risk factors, such as ethnicity, proximity to health centers, and history of surgery, were not. There were no significant associations between mother's HBsAg status and history of surgery, and other sociodemographic factors. CONCLUSIONS: Despite the slow implementation of the hepatitis B vaccination program, HBsAg prevalence among children and their mothers was not high in Lao PDR compared to reports from neighboring countries. The reasons for the differences in prevalence among these countries are unclear. We recommend that prevalence surveys be conducted in populations born before and after the implementation of a hepatitis B vaccination program to better understand the epidemiology of hepatitis B.