Prevalence and risk factors for hepatitis B virus infection among expectant mothers in Jirapa Municipality, Upper West Region, Ghana: a facility-based cross-sectional study

BACKGROUND: Chronic HBV infection remains a global health priority, contributing to over 800,000 annual deaths. In sub-Saharan Africa, high endemicity persists despite the availability of preventive vaccines. This study assessed the HBsAg seroprevalence and identified independent socio-demographic and clinical correlates among pregnant women in the Jirapa Municipality, providing the evidence base required for targeted maternal-child health interventions in the UWR of Ghana. METHODS: A facility-based cross-sectional study was conducted among 235 pregnant women in the Jirapa Municipality using a mixed purposive-consecutive sampling approach. HBV infection status was determined via prospective data abstraction of laboratory-confirmed HBsAg rapid diagnostic test results. Firth's penalized logistic regression was employed to minimize small-sample bias and ensure parameter stability. Model performance was validated through sensitivity analyses comparing penalized likelihood with complementary log-log regression. Final model selection was guided by Akaike (AIC) and Bayesian (BIC) Information Criteria, with specification verified via the link test. All analyses were performed in Stata 16.0, with significance set at p < 0.05. RESULTS: The clinical prevalence of HBsAg seropositivity among the sampled population was 10.6% (95% CI: 7.0-15.3%), categorizing the Jirapa Municipality as a region of high HBV endemicity per WHO criteria. Bivariate analysis identified maternal age, marital status, number of co-wives, parity, religion, prior blood transfusion, hospital admission, gestational age, and ANC visit frequency as significant correlates (p < 0.05). However, in model 2, only the number of co-wives remained a persistent independent correlate. Specifically, having exactly one co-wife was associated with significantly lower odds of HBV infection compared to other marital structures (AOR = 0.05; 95% CI: 0.00-0.72; p = 0.027). Other socio-demographic and clinical factors did not retain statistical significance after adjustment for confounding variables. CONCLUSION: The 10.6% HBsAg prevalence documented in the study classifies Jirapa Municipality as a high-endemicity cluster. The independent association between HBV infection and spousal marital structure suggests antenatal care should serve as a gateway for family-centered interventions. The study recommends adopting a "Triple-Linkage" model integrating universal screening, reflex HBeAg risk stratification, and partner-inclusive counseling. Transitioning to this proactive care continuum is essential to strengthen the clinical infrastructure required to mitigate the regional burden of chronic hepatitis B.