Breaking the Cycle: Preventing Mother-to-Child Transmission of Hepatitis B in Peri-Urban Yangon

Pregnant and reproductive-age women gather at a Hepatitis B health education session in South Dagon. Photo: Community Partners International

​On February 15, 2019, around 50 pregnant and reproductive-age women in the Yangon suburb of South Dagon, Myanmar, gathered to learn about the hepatitis B virus (HBV), including the nature of HBV, transmission pathways, treatment options and prevention. This health education session was part of a pilot study, led by Community Partners International (CPI) in collaboration with the Myanmar Liver Foundation (MLF) and the B. K. Kee Foundation, to develop a workable and effective community-based model to prevent mother-to-child transmission of HBV in low-income peri-urban communities in Myanmar.

An estimated 3.5 million people are living with HBV in Myanmar. The virus is sometimes referred to as the 'silent killer' as many people are unaware that they are infected. Those who remain untested and untreated face a significantly higher risk of contracting liver disease, including cirrhosis and liver cancer.

In Myanmar (as in the rest of Southeast Asia), HBV is most commonly transmitted from mothers to children during childbirth. In up to 95% of cases, mother-to-child transmission can be prevented by testing mothers during pregnancy, treating those who test positive for HBV with antiretroviral medication, and ensuring that newborns receive the birth dose HBV vaccine within 24 hours of birth. However, for women in low-income communities in Myanmar such as South Dagon, the lack of access to health education, testing and treatment for HBV means that mother-to-child transmission remains a significant problem.
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Through this pilot study, CPI is researching the most effective ways to reach and educate pregnant and reproductive-age women in this context about HBV and prevention. The study will enroll 110 HBV positive pregnant women onto a successful antiretroviral treatment program, and ensure that at least 90% of newborns born to this HBV positive group receive the HBV vaccine within 24 hours after birth. The research team will also be able to identify barriers and facilitators to reaching the project’s goals to help inform future initiatives.

In carrying out the study, CPI is working closely with community-based volunteers from the Myanmar Maternal and Child Welfare Association (MMWCA) to reach pregnant and reproductive-age women in South Dagon and Dagon Seikkan townships. These volunteers already provide primary care services to these communities, including immunization and tuberculosis surveillance. With CPI’s training and support they are now integrating pregnancy surveillance and HBV education into their activities.

In their new roles as advocates for the prevention of mother-to-child transmission of HBV, the volunteers also led the Health Education session held on February 15th for pregnant and reproductive-age women. This was the first in a series of 24 sessions that they will conduct across 6 wards of South Dagon and Dagon Seikkan townships during the course of 2019.

During the health education session, the MMCWA volunteers stressed the need for women to seek pre-natal care as soon as they know they are pregnant. One of the key challenges identified in these communities is that pregnant women tend to present very late for pre-natal care, usually around the fifth or sixth month. This means that those who test positive for HBV will receive a shorter course of antiretroviral treatment before giving birth, meaning an increased risk of transmission. The session participants were provided with information on where they could access free pre-natal care and HBV screening, including at the B. K. Kee Foundation’s clinic situated in South Dagon.

Using the preliminary evidence generated through this pilot study, CPI plans to develop workable and effective model for the prevention of mother-to-child transmission of HBV that can be expanded and applied to similar peri-urban contexts in Myanmar. ​Such an initiative could help prevent many thousands of new HBV infections.