Practice of gynecologists
Only 55% (n=55) of participants reported screening pregnant females on HBV during their current daily practice. A significant difference was found between the screening rates of HBV and both; level of specialty and experience of the practitioners respectively (p=0.002, p= 0.044; Fig. 2), as longer years of experience associated with more screening conducted.
Binary logistic regression modeling (Nagelkerke R Square= 0.145, p=0.318) showed no significant association between screening rates of Hepatitis B (dependent variable) and the independent variables: years since graduation and level of specialty (Table 2).
As for the practice settings, there was a significant difference between the level of specialty and the type of health facility where the doctors practiced (p=0.007; Fig. 3). Most of the surveyed specialists practiced in private hospitals (n=12), while most of the residents practiced in public educational hospitals (n=56). Moreover, it was found that screening rates of pregnant females on HBV were higher in private hospitals than public hospitals but were not statistically significant (p=0.136; Fig. 3).
Most of the practitioners (n=61, 59.2%) relied on HBsAg level as the first marker for infection followed by HBeAg levels (n=8, 7.8%). Few participants (n=20, 19.6%) always referred HBsAg positive pregnant females regardless of HBV DNA viral load, while 39.2% (n=40) were uncertain; they would sometimes refer them. Almost half of the surveyed practitioners (n=42, 42.4%) never prescribe antiviral therapy for pregnant females in the third trimester, only 12.1% (n=12) answered always/very often they would when needed. Cesarean section recommendation as a mode of delivery in HBV pregnant females was not common between the practitioners, as 44.4% (n=44) would never recommend it, 18.2% (n=18) stated that they would rarely recommend it and 23.2% (n=23) would sometimes. More than half of practitioners (n=61, 61%) would always recommend Hepatitis B immunoglobulin (HBIG) injection at birth for newborns of HBsAg carrier mothers as well as 51% (n=49) would always request HBIG administration to newborns in their practicing hospital. Part of the practitioners (n=54, 54.6%) reported always/very often following up with infants born to HBsAg carrier mothers. When the practitioners were asked about the greatest barriers against HBV screening in early pregnancy, 64.5% of them (n=69) referred that the lack of patient’s education, followed by the high cost of the test (n=55, 51.4%), as the greatest barriers (Fig. 4).