A community-based cross-sectional survey conducted among 195 adult residents in the Tolon district of Northern Ghana identified an overall Hepatitis B surface antigen seroprevalence of 7.2 percent, reflecting moderate endemicity in the rural locality. Published in Discover Viruses by researchers Abdul-Manaf Mutaru, Ahmed Tijani Bawah, and Martin Nyaaba Adokiya, the investigation sought to establish geography-specific prevalence and determine the socio-demographic factors associated with viral infection among adults aged 18 to 49 years. The detected serological rate, comprising fourteen positive individuals out of the total sampled cohort, aligns with international epidemiological thresholds that classify a Hepatitis B surface antigen prevalence between 2 percent and 7 percent as moderate endemicity, contrasting with high-endemicity zones exceeding 8 percent. Furthermore, the empirical findings documented a distinct variation between demographic strata, revealing an 8.6 percent seropositivity among male respondents compared to 5.9 percent among females. As viral hepatitis persists as an abnormal physiological state marked by liver cell inflammation and progressive fibrosis, establishing localized community baseline data represents a vital operational prerequisite for informing targeted public health strategies and tracking progress toward Sustainable Development Goal target 3.3.

Viral hepatitis remains a global public health concern affecting diverse populations across all racial groups, with global hepatitis B virus prevalence estimated at approximately 3.9 percent. Within this worldwide epidemiological burden, an estimated two billion individuals have experienced exposure, and approximately 350 million endure chronic infections, positioning the virus as an urgent priority within the United Nations Sustainable Development Goal framework aimed at curbing new infections by 2030. To address transmission trajectories, the World Health Organization instituted hepatitis B immunization into standardized pediatric schedules, which has documented substantial reductions in seroprevalence among cohorts younger than 15 years, particularly within China. Conversely, the pathogen exhibits pronounced endemicity across Sub-Saharan Africa, where overall Hepatitis B surface antigen seroprevalence persists at 6.1 percent despite the implementation of universal vaccination and accessible antiviral therapeutics. While early neonatal immunization serves as an indispensable instrument for viral elimination alongside available Hepatitis B Virus Immunoglobulin to mitigate perinatal transmission among infants born to seropositive mothers, substantial regional vulnerabilities remain across the African continent.

In Ghana, the Expanded Program on Immunization was formally inaugurated in 2002, yet national hepatitis B prevalence continues to be classified as high. Epidemiological estimates indicate that national seroprevalence climbed from 10.0 percent in 2012 to 12.3 percent in 2016, with rural populations enduring the heaviest burden at a specific rate of 13.3 percent, while the northern territorial sector demonstrates a regional estimate of 10.8 percent. Notwithstanding these elevated burdens, empirical investigations specifically examining adult cohorts within rural Ghanaian communities remain scarce, creating substantial epidemiological data gaps given the critical role adult demographics occupy in vertical transmission dynamics. Tolon district encompasses an estimated land area of 1353.66 square kilometers with a human population of 118,101 growing at an annual rate of 2.9 percent. Supported by seventeen local healthcare facilities, consisting of two hospitals, three health centres, one clinic, and eleven Community-based Health Planning and Services compounds, the district represented an ideal setting to implement this novel community-based investigation into adult seroprevalence and socio-demographic determinants.

To generate robust quantitative findings, the investigators deployed a community-based cross-sectional design restricting participant eligibility to indigenous adult residents aged 18 to 49 years who had not received prior vaccination against hepatitis B. Prospective subjects who reported previous screening coupled with complete vaccination, or individuals with confirmed active infections undergoing medical therapy, were systematically excluded from participation alongside those withholding informed consent. The operational sample size was computed using Cochran’s formula based on a 95 percent confidence level, an anticipated 10.8 percent Hepatitis B surface antigen prevalence in Northern Ghana, and a 5 percent margin of error, which initially established a baseline requirement of 150 participants. Anticipating potential subject hesitancy linked to the concurrent coronavirus disease pandemic, the investigative team adjusted for an estimated 70 percent response rate by integrating an intentional 30 percent volumetric expansion, ultimately yielding a finalized target cohort of 195 consenting individuals.

Subject recruitment followed a rigorous multistage stratified sampling procedure synchronized with the traditional administrative zoning demarcated by the Tolon district assembly. The geographical territory was initially divided into three primary administrative sub-districts or strata: Tolon in the central sector, Nyankpala in the northwest, and Waantugu situated to the west. Within the second operational tier of the sampling hierarchy, comprehensive sampling frames were compiled for the settlements comprising each sub-district, from which five distinct communities per stratum were selected at random through formal balloting procedures, totaling fifteen discrete rural localities. In the third stage, investigators conducted household-level random selection within each designated community to enroll individual participants. Ethical clearance for the research protocol was officially granted by the Navrongo Health Research Centre Institutional Review Board under protocol identifier NHRCIRB443, complemented by direct administrative permission from the Tolon District Director of Health Services prior to field data collection.

Data acquisition was executed in two sequential phases, pairing face-to-face structured questionnaire administration with point-of-care serological screening for Hepatitis B surface antigen. Laboratory screening was carried out by qualified biomedical laboratory scientists affiliated with the University for Development Studies using the commercial Onsite Hepatitis B Surface Antigen Rapid Test-Cassette manufactured by CTK Biotech Incorporated, conforming to technical recommendations outlined by the World Health Organization and the Declaration of Helsinki. The diagnostic cassette utilizes lateral flow chromatographic immunoassay technology capable of detecting Hepatitis B surface antigen in human serum at concentrations as low as one nanogram per milliliter. Each diagnostic cassette, preserved at controlled temperatures between 15 and 30 degrees Celsius, was validated with confirmed positive and negative reference samples alongside a thirty-person district pretest. Venous blood draws yielded three milliliters of whole blood collected into serum separator tubes, maintained on ice packs, and centrifuged within twenty-five minutes; subsequently, two drops measuring 60 to 90 microliters of separated serum were applied alongside one drop of diluent, with definitive visual interpretations recorded at fifteen minutes via internal control and test line indicators.

Descriptive statistical analysis of the 195 participants revealed that females constituted 52.3 percent of the analyzed cohort (102 individuals), while males comprised 47.7 percent (93 individuals). The age profile skewed noticeably younger, with 51.3 percent of subjects falling between 18 and 23 years of age and the collective sample presenting an overall mean age of 24.4 years with a standard deviation of 4.8 years. Regarding formal schooling, 56.4 percent of all respondents had received no formal education, representing 55.9 percent of female participants and 57.0 percent of male participants. Occupational profiling documented that artisan activities accounted for the single largest employment category, encompassing 46.2 percent of the surveyed population. In terms of domestic arrangements, 67.6 percent of female participants were married compared to 49.5 percent of their male counterparts, while religious affiliation showed that 84.1 percent of the total sample identified as adherents of Islam.

Primary analytical procedures involved coding participant data into SPSS version 26.0 to execute bivariate chi-square tests and multivariate logistic regression models assessing independent predictors of Hepatitis B surface antigen seropositivity. At the bivariate level, statistically significant associations emerged for chronological age, which yielded a chi-square value of 9.97 and a p-value of 0.002, and occupational classification, demonstrating a chi-square value of 8.75 with a p-value of 0.003, whereas educational attainment met the relaxed inclusion threshold of p less than 0.20 with a chi-square of 3.01 and a p-value of 0.083. Upon adjusting for confounding variables within the multivariate regression equation, participants aged 30 years and older exhibited an adjusted odds ratio of 4.3, demonstrating 4.3 times higher odds of testing positive for Hepatitis B surface antigen compared to adults aged 18 to 29 years, supported by a 95 percent confidence interval spanning 1.24 to 14.38 and an associated p-value of 0.018. Simultaneously, participation in non-formal employment sectors conferred a statistically significant reduction in infection likelihood compared to formal employment, registering an adjusted odds ratio of 0.25 with a 95 percent confidence interval from 0.07 to 0.84 and a p-value of 0.024.

The observed heightened vulnerability among older adults diverged from initial research hypotheses anticipating increased transmission among younger cohorts via horizontal routes, prompting the authors to discuss potential historical exposures and waning preventive practices. Advancing age may capture early vertical or horizontal exposures sustained prior to modern pediatric vaccination rollouts, particularly in settings where family infection histories remain unmonitored and older cohorts exhibit less satisfactory attitudes toward infection prevention. Concurrently, the unexpected finding linking formal employment to elevated seropositivity was interpreted through occupational exposure dynamics, heightened social interactions, and inadequate workplace infection controls, noting that higher formal education does not uniformly produce consistent preventive behaviors. Gender patterns showing higher absolute seropositivity in males, while not achieving statistical significance in multivariate modeling, echoed national trends where Ghanaian females demonstrate superior completion rates for full-dose hepatitis B vaccination, highlighting behavioral complacency among men.

While providing pioneering baseline evidence from community-based screening in Northern Ghana, the authors highlighted critical methodological limitations that restrict causal inferences. Primary omissions included the absence of data regarding familial infection history, which prevented the differentiation of vertical transmission from horizontal exposure, alongside unmeasured cultural practices such as scarification marks and tribal scarring that entail potential blood contact. Furthermore, funding constraints capped the sample size at 195 subjects, limiting statistical power for subgroup analyses and underscoring the necessity of larger, multi-setting investigations. To address the identified moderate endemicity, the study team advocated for intensified community health education, expanded rural screening initiatives, and targeted workplace awareness campaigns. Finally, the researchers recommended integrating hepatitis B screening and vaccination services directly into the Ghana National Health Insurance Scheme to reduce financial barriers and protect vulnerable adult populations, particularly aging individuals and underserved rural residents.

Subject of Research: Socio-demographic determinants of hepatitis B virus seroprevalence among adults in Tolon, Ghana

Article Title: Socio-demographic determinants of hepatitis B virus seropositivity among adults in Tolon, Ghana: a community-based survey

Article References: Mutaru, A.-M., Bawah, A. T., & Adokiya, M. N. (2025). Socio-demographic determinants of hepatitis B virus seropositivity among adults in Tolon, Ghana: a community-based survey. Discover Viruses, 2(1), Article 7. https://doi.org/10.1007/s44370-025-00016-x

Image Credits: AI Generated

DOI: 10.1007/s44370-025-00016-x

Keywords: Hepatitis B Virus, HBsAg Seroprevalence, Tolon District, Ghana Public Health, Viral Hepatitis, Epidemiology, Socio-Demographic Factors, Adult Health Screening, Socio-demographic, determinants, hepatitis, virus