Associated factors of hepatitis B virus infection among pregnant women in Africa: an extension of a previous systematic review and meta-analysis on prevalence

Hepatitis B virus (HBV) infection is a significant public health concern among pregnant women in Africa. While previous reviews have focused on the prevalence of HBV, comprehensive evidence regarding the associated factors of HBV infection is limited. Therefore, this systematic review and meta-analysis aimed to identify the associated factors of HBV infection in pregnant women in Africa. We systematically searched PubMed/MEDLINE, Scopus, Advanced Google Scholar, the Cochrane Library, and African Journal Online for observational studies published between July 18, 2013, and July 18, 2023. Studies reporting adjusted effect estimates for factors associated with HBV infection among pregnant women were included. We assessed methodological quality using the Newcastle-Ottawa Scale (NOS). We conducted separate random-effects meta-analyses using the DerSimonian–Laird method for each associated factor reported by at least two studies to estimate pooled adjusted odds ratios (AORs) with 95% confidence intervals (CIs). Associated factors examined across multiple studies that differed substantially in exposure categories or reference groups were synthesized narratively. Statistical heterogeneity was assessed using the I² statistic. Of the 19 included studies, 20 associated factors were eligible for the quantitative synthesis. Significant associations with HBV infection among pregnant women were a history of abortion (AOR = 3.08, 95% CI: 1.58–4.58), multiple sexual partners (AOR = 5.33, 95% CI: 2.50–8.17), blood transfusion (AOR = 2.64, 95% CI: 1.38–3.90), hospital admission (AOR = 3.28, 95% CI: 2.02–4.53), surgery (AOR = 2.48, 95% CI: 1.04–3.92), HIV infection (AOR = 9.22, 95% CI: 2.39–16.05), tattooing (AOR = 2.53, 95% CI: 1.26–3.80), female genital mutilation (AOR = 2.48, 95% CI: 2.02–2.94), dental procedures (AOR = 2.30, 95% CI: 1.16–3,44), family history of HBV infection (AOR = 3.37, 95% CI: 1.94–4.80), contact with jaundiced patients (AOR = 4.18, 95% CI: 2.09–6.27), tonsillectomy (AOR = 4.87, 95% CI: 3.36–6.37), and sharing sharp materials (AOR = 2.87, 95% CI: 2.47–3.27). This meta-analysis identified multiple behavioral, medical, and household-related associated factors of HBV infection. Strengthening routine antenatal HBV screening, targeted risk assessment, vaccination strategies, and linkage-to-care interventions may help improve early detection and reduce mother-to-child transmission of HBV. PROSPERO 2025 CRD420251240694.