Tattooing and vaccination uptake are key predictors of hepatitis B virus infection among sellers and workers in a market in Ghana

Hepatitis B virus (HBV) infection remains a major public health challenge
in sub-Saharan Africa, including Ghana, despite the introduction of infant
vaccination programs. Limited data exist on HBV prevalence and risk
factors in informal sector populations such as market workers, who may
face unique occupational and behavioural exposures. This study assessed
the prevalence and determinants of HBV infection among sellers and workers
at a market in Ghana. A cross-sectional study was conducted among 489
adult market workers. Participants were selected through stratified random
sampling across occupational groups. Data on sociodemographic,
occupational, and behavioral factors were collected using structured
questionnaires. On-site testing for hepatitis B surface antigen (HBsAg)
was performed using the Hightop One Step Rapid Test kit. Bivariate and
multivariate logistic regression analyses were used to identify
independent predictors of HBV infection. The overall prevalence of HBV
infection was 7.36% (36/489), consistent with intermediate-to-high
endemicity. Multivariate analysis identified three independent predictors
of HBV infection: male gender (aOR = 0.455, 95% CI: 0.221–0.937; p =
0.033), presence of tattoos (aOR = 0.283, 95% CI: 0.110–0.730; p = 0.009),
and vaccination status (unvaccinated individuals had 3.37-fold increased
odds of infection; 95% CI: 1.395–8.142; p = 0.007). HBV prevalence
declined progressively with increasing vaccine doses, from 9.2% in
unvaccinated individuals to 2.3% among those who had completed three or
more doses. HBV infection is common among the market workers, with
prevalence exceeding both continental and global estimates. Male gender,
tattooing, and poor vaccination uptake were significant predictors of
infection. Strengthening adult vaccination programs, promoting safe
tattooing practices, and implementing male-focused screening and
prevention interventions are critical to reducing HBV burden and achieving
Ghana’s contribution to the WHO goal of eliminating HBV by 2030.