Date of Award


Document Type

Open Access Dissertation


Epidemiology and Biostatistics



First Advisor

Wilfried Karmaus


HIV, hepatitis B and C virus (HBV, HCV) are three of the most common blood-borne infections and they continue to be a major public health problem in the United States (US) and globally. It is not well understood if maternal infection with either HBV or HCV has an adverse impact on pregnancy outcomes as findings from previous studies have provided some mixed results. The overall goal of this study was to assess the risk of preterm birth, low birth weight (LBW), small for gestational age (SGA) and admission into neonatal intensive care unit (NICU) for babies born to HBV- and HCV-infected women. To this end, our objectives were to 1) describe the epidemiology of HBV and HCV and their co-infection with HIV in South Carolina (SC), 2) assess the spatial distribution of HCV infection in SC, and 3) estimate the risk of preterm birth, LBW, SGA, NICU admission in babies born to hepatitis-infected mothers. Linked data from multiple sources for years 2004 to 2011 was utilized and descriptive statistics, Bayesian spatial and logistic regression analyses were conducted to evaluate the objectives of the study. Results revealed substantial variation in the epidemiology of these infections among females in SC to include an emerging epidemic of HCV infections among young white females. The spatial analysis identified Charleston, Darlington, Florence, Georgetown, Greenville, Horry, Oconee, McCormick and Richland counties as high-risk counties for HCV infection. Lastly, results from the logistic regression analysis supported the fact that low birth weight is independently associated with HCV infection during pregnancy, specifically, newly diagnosed mothers. Our findings are useful for providers to advise infected expectant mothers on the potential risk to their baby. Local and state public health officials can also use these data for taking further public health action and make informed decisions on how to allocate limited resources to help prevent and reduce the spread on HCV and HBV infections within the state.


© 2014, Afiba Manza-Azele Agovi

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