Current Status of Mother-to-Child HBV Transmission in Pregnant Women with Chronic HBV Visiting and Managing Pregnancy at Hai Phong Obstetrics and Gynecology Hospital in 2017-

not only to manage pregnant women but also to help health workers control risks

infection when performing procedures on patients.

Perinatal transmission is the main cause of chronic HBV infection in Vietnam, so newborn HBV vaccination plays an important role in preventing new chronic HBV infection. Hospital health workers are the most trusted consultants influencing the newborn HBV dose for children. In our study, after the intervention, 91.6% of health workers believed that the newborn HBV vaccine was safe (Table 3.37). This is very significant in improving the rate of newborn HBV vaccination in newborns - one of the effective measures to eliminate mother-to-child transmission. This influence was also demonstrated through the vaccination rate in children born to HBsAg-carrying mothers in our previous longitudinal study of 98.7% (2 children were not vaccinated due to jaundice and congenital heart disease).

Practice change intervention results:

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The practice rate of health workers on mother-to-child transmission of HBV improved insignificantly (Effectiveness index from 12.1 to 14.2%) (Table 3.38).

After the intervention, the achievement rate in knowledge, attitude and practice all increased.

increased significantly (p < 0.05), the efficiency index reached from 12.1 to 33.7% (Table 3.39).

This shows that there is a need for a more concerted effort to improve the practice of health workers on mother-to-child transmission of HBV. Each health worker needs to identify himself as an important link in the strategy to prevent mother-to-child transmission of HBV, not just the doctor who discusses with pregnant women about their condition as well as the measures to be taken to prevent mother-to-child transmission in mothers with HBsAg, and the discussion can even take place at any time, not necessarily in clinics, counseling or treatment rooms. This is truly a major challenge in reducing mother-to-child transmission to eliminate hepatitis.

4.3. Novelties and limitations of the study

The new points of our study are: (1) Contributing to the national data system on the status of mother-to-child transmission of hepatitis B virus in pregnant women with chronic HBsAg in Hai Phong. The implementation of the study helps provide a scientific and practical basis for Hai Phong Obstetrics and Gynecology Hospital in general and Hai Phong city in particular to research and develop screening and preventive treatment procedures to minimize the possibility of mother-to-child transmission of hepatitis B virus. (2) The study also showed that the health education communication intervention model for pregnant women and obstetric medical staff is feasible and meaningful for implementing measures to prevent HBV transmission. This shows the effectiveness of simple health education communication measures, suitable for current prevention conditions, helping localities improve their knowledge and practice of preventing mother-to-child transmission of HBV.

In addition, our study also has some limitations: First, our study is a longitudinal study from the first month of pregnancy to 12 months postpartum - one of the major difficulties in tracking the study participants. Second, the study lacks a control group for comparison after the intervention, which may limit some of the study results, but due to research ethics, we did not design a control group. Third, due to limited resources, we have not been able to evaluate the anti-HBs antibody concentration of children at 12 months of age to further confirm the effectiveness of measures to prevent HBV transmission from mother to child.

CONCLUDE

4.1. Current status of HBV transmission from mother to child in pregnant women with chronic HBV who came for examination and pregnancy management at Hai Phong Obstetrics and Gynecology Hospital in 2017-2020

- The rate of pregnant women with chronic HBV infection is 10.6%.

- The rate of HBV transmission from mother to child in mothers with chronic HBV is 8.0%

- In the multivariate regression model, maternal HBeAg status was associated with

to HBsAg-positive status in 12-month-old children

4.2. Results of health education communication interventions for mothers and health workers

4.2.1. Intervention on mothers

- After the intervention, mothers' knowledge and attitudes about mother-to-child transmission of HBV increased significantly, with an effectiveness index ranging from 25.5 to 40.7%.

- High rate of mothers with good practice: 100% of mothers tested for HBV during pregnancy; 98.0% of mothers complied with treatment instructions; 98.7% of mothers vaccinated their children with HBV within 24 hours after birth; 82.0% of mothers vaccinated their children with HBIG within 12 hours after birth.

4.2.2. Intervention on medical staff

- After intervention, knowledge, attitude, and practice on HBV transmission from mother to child all increased significantly with p<0.05. The effectiveness index increased from 12.1 to 33.7%.

PROPOSAL

1. Hepatitis B screening for pregnant women from the first prenatal visit to have a plan for management and treatment to prevent mother-to-child transmission of HBV in pregnant women who are HBsAg positive.

2. Communication counseling for pregnant women should especially emphasize the importance of treatment for pregnant women who are indicated for antiviral therapy and are HBeAg positive.

3. Training obstetricians at all levels on the process of managing and caring for pregnant women with chronic HBsAg to effectively control the transmission of HBV from mother to child.

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