Source: iStock
In 2023, the CDC reported that two-thirds of all chronic hepatitis B cases worldwide are acquired in childhood, mostly through mother-to-child transmission (MTCT). This invisible epidemic threatens generations, with hepatitis B alone affecting more than 60 million people in Africa.
Mother-to-child transmission doesn’t just threaten the baby’s health but it sets the stage for chronic infection, liver cancer, and premature death later in life. Preventing these infections at birth is one of the most effective public-health investments any country, or global community, can make.
Epidemiology of Hepatitis B and C in Sub‑Saharan Africa
Prevalence Rates Among Women of Childbearing Age
- In recent studies, the prevalence of hepatitis B among pregnant women in sub-Saharan Africa ranges from 7% to 12%. For instance, a 2024 study from Somalia found an 11.2% infection rate among pregnant women, far above the global average and well above the WHO’s threshold for high endemicity.
- By contrast, in the U.S., hepatitis B infection among pregnant women is below 1%.
- Hepatitis C prevalence among pregnant women in the region is lower, with pooled estimates around 2.5%; but rates are higher in certain West and Central African countries.
Comparison to Global Averages
- Globally, the average prevalence of hepatitis B among pregnant women is less than 2%. In sub-Saharan Africa, the rate is four to six times higher, making it a hotspot for both new and chronic cases.
Source: Hepatitis is a silent killer’ | UCT News
How Mother‑to‑Child Transmission Occurs
Biological Mechanisms
- Hepatitis B virus (HBV) is often transmitted during delivery, when the baby is exposed to blood and body fluids from the mother.
- Hepatitis C virus (HCV) has a lower risk of transmission, but the virus can cross the placenta or infect the baby during birth.
- Breastfeeding is safe for infants of mothers with hepatitis B, provided the baby receives timely vaccination.
Relative Risks:
For hepatitis B, the risk of a mother transmitting the virus to her baby without medical intervention is as high as 90% if the mother has high levels of the virus and is also positive for a marker called HBeAg. For hepatitis C however, the risk of transmission from an infected mother to her baby is around 5%–10%, but can be higher if the mother has HIV or high viral loads.
Source: Flickr
Prevention Strategies:
Birth‑Dose Vaccination
- The World Health Organization recommends that every infant receive a hepatitis B vaccine within 24 hours of birth, the so-called “birth dose”, followed by two or three additional doses.
- In Africa, birth dose coverage is just 18% (compared to 80% in other global regions), primarily due to challenges in infrastructure, supply chain, and awareness.
- A recent trial in the Democratic Republic of Congo found that more than 85% of infants who received the birth dose developed protective immunity, showing real-world impact even in resource-limited settings.
Source: Getty Images
Antiviral Therapy in Pregnancy
For pregnant women with very high levels of hepatitis B virus, taking antiviral medications (like tenofovir) in the third trimester significantly lowers the risk of passing the virus to the baby. These medicines are considered safe in pregnancy, with no increase in birth defects or complications based on studies tracking thousands of mother-baby pairs. However, access and adherence can be difficult: in a recent study from Kinshasa, women cited trust in providers, family support, and education as keys to staying on treatment.
Safe Delivery Practices & Breastfeeding Guidelines
- Babies should receive the first vaccine dose within 24 hours of birth, and if possible, a dose of hepatitis B immune globulin (a type of antibody shot) if the mother is known to be infected.
- Breastfeeding is encouraged as long as vaccination occurs, the virus does not transmit through breast milk if babies are immunized.
- WHO guidelines do not recommend caesarean section solely for hepatitis B prevention. Standard safe-delivery practices are sufficient; special measures are mainly needed for HIV-positive mothers or if the mother’s viral load is extremely high.
Gaps in Prenatal Screening and Care
Infrastructure and Resource Challenges
Many clinics in sub-Saharan Africa face shortages of test kits, lack of vaccines, and a deficit of trained staff. In Nigeria, only 26% of pregnant women were tested for hepatitis B, mainly because the screening wasn’t free, and test kits were often unavailable. Some clinics have to choose which infections to test for, prioritizing HIV over hepatitis because international funding streams focus on HIV.
Cultural, Economic, and Policy Barriers
- Social stigma keeps some mothers and even health workers from talking about hepatitis. Many women aren’t told their hepatitis status, and some deny it due to fear or shame.
- Policy gaps are common: only a few African countries mandate hepatitis B birth-dose vaccination as part of their routine immunization schedule.
- Lack of public awareness means missed opportunities for prevention and treatment.
Recent Surveys and Reports
A multi-country study in 2023 found significant barriers at every level, from patient awareness and acceptance to systemic issues like stockouts and affordability. Health workers recommended making both screening and vaccines free at the point of care and increasing community education efforts.
Source: Hepatitis B Virus | Transmission electron micrograph of hepa… | Flickr
The Role of African‑Diaspora Support Networks
African-American communities and diaspora organizations in the U.S. have a unique opportunity and some crucial advantages, to help change the story for mothers and children facing hepatitis in Africa.
How Diaspora Groups Can Help
- Fundraising: Church groups, cultural associations, and professional organizations can pool resources to supply test kits, vaccines, and medications. Even small amounts, when targeted, can make a real difference.
- Advocacy & Awareness: Diaspora voices carry weight in both the U.S. and Africa. Lobbying for U.S. foreign aid to support hepatitis elimination and for African governments to include birth-dose vaccination, can shift national priorities.
- Partnership & Mentorship: U.S.-based physicians, nurses, and public-health experts can offer mentorship, training, and telehealth support to African colleagues. Volunteer missions and exchange programs have helped train hundreds of midwives and laboratory techs.
Successful Campaign Examples:
- The African Communities Public Health Coalition (ACPHC) in the U.S. partnered with local clinics in Ghana to train staff and support “screen and treat” efforts, reaching thousands of mothers in 2024.
- Diaspora-run telehealth programs connect U.S.-based hepatitis specialists with African providers, sharing expertise via video calls for complex cases.
Opportunities for Broader Engagement
- Telemedicine: Providing remote consultations for difficult pregnancies, helping local clinics interpret test results, or offering emotional and practical support.
- Volunteer Missions: Short-term volunteer trips for direct clinical care, health education, or logistics support.
- Remittances: Direct support to family or communities to cover medical costs or strengthen local facilities.
Bridging Continents, Saving Lives
Here’s how you can help:
- Donate: Support proven hepatitis prevention programs in Africa. Look for organizations with clear impact, like the WHO Hepatitis Programme, CDC Global Health, or diaspora-led NGOs such as African Hepatitis B Foundation.
- Volunteer: If you are a healthcare professional, explore virtual mentorships or short-term service in African countries through groups like Seed Global Health.
- Lobby Policymakers: Advocate for increased U.S. funding for global hepatitis control and recognition of hepatitis as a priority in U.S. international health efforts.
- Spread Awareness: Share reliable information in churches, professional networks, and on social media, especially the importance of screening, vaccination, and community support.
- Partner: Organize fundraising drives, partner with African clinics on supplies, or start a skills exchange.
A Shared Responsibility
The fight against mother-to-child transmission of hepatitis in sub-Saharan Africa is a test of our collective will and compassion. Behind every statistic is a child, a mother, a family hoping for a better future.
Anand Subramanian is a freelance photographer and content writer based out of Tamil Nadu, India. Having a background in Engineering always made him curious about life on the other side of the spectrum. He leapt forward towards the Photography life and never looked back. Specializing in Documentary and Portrait photography gave him an up-close and personal view into the complexities of human beings and those experiences helped him branch out from visual to words. Today he is mentoring passionate photographers and writing about the different dimensions of the art world.
