THE PREVALENCE OF HEPATITIS B
ABSTRACT
Introduction: Hepatitis B viral infection is a significant global public health problem, highly contagious and a cause of the world’s most common liver infection. In Nigeria, HBV infection is highly endemic with national prevalence of about 10% (WHO, 2010).Vaccines were introduced in Nigeria since 2002 and was expected to give 90- 100% protection against HBV infection (WHO, 2012), yet in 2010,14 people out of 20 cases reported in the district hospital of Uyo died of the HBV infection (Warom, 2013).
Objectives: The study was conducted to determine the individual, socio-economic and health facility factors influencing prevalence of HBV infection among adults aged (18-45 years) in Uyo.
Methods: In this research a cross sectional study design was used where 348 respondents in MTC,
Uyo were involved. Sample size was determined using Cochran’s formula based on an assumption that 50% of the adults aged 18- 45 years in Uyo were knowledgeable about HBV infection, 5% marginal error, and a non-response rate of 10% was used. Multi-stage sampling procedure was used and data collection was done using researcher administered questionnaire and Key Informants Interview guide. The responses were then entered in SPSS 16.0 within which it was statistically analysed using chi- square statistical test values, those considered significant with a (p<0.05) were further analysed at bivariate logistic regression.
Results: According to the study, age groups between 24- 35 had the highest number of respondents infected with HBV 163(42.4%) that accounts for 16 out of the total number 29 of those who were infected. Secondary education was associated with prevalence of HBV infection (uOR= 2.607, 95% CI: 0.998- 6.807, p= 0.050), those who said HBV is not airborne were more likely to get infected of HBV compared to those who said HBV is not airborne(uOR= 8.557, 95% CI: 1.117- 65.532, p= 0.039), respondents who reported that HBV is got through sharing utensils were less like to be infected(uOR= 0.354, 95% CI: 0.129- 0.973, P= 0.044) and those who admitted that condom use prevents them from enjoying sex (uOR= 0.303, 95% CI: 0.094- 0.977, p= 0.046) were more likely to get infected of HBV compared to those who said that condoms were not available(uOR= 0.239.95, 95% CI:0.098- 0.584, p= 0.002).
Conclusion: Level of education was significant in relation to the prevalence of HBV, Knowledge deficiency among respondents and those who said that condoms prevent them from enjoying sex were more likely to get infected of the HBV and were contributory factors to the high prevalence of HBV infection in the district, therefore there is need for community sensitization, screening and vaccination.
Recommendation: There is need for training of all health workers to increase their knowledge on HBV infection, community sensitization on the transmission routes and prevention of HBV, lobbying for funds from government and non- governmental organizations in order to acquire screening test kits and vaccines for HBV for mass screening and vaccination of the community
CHAPTER ONE
INTRODUCTION
1.0 Introduction:
This chapter constitutes; background to the study, statement of the problem, research objectives and questions, significance of the study and conceptual framework.
1.1 Background to the study:
Hepatitis B viral (HBV) infection is a major public health problem worldwide and estimates show that about 30% of the world’s population that is close to 2 billion people are infected with the virus, and about 350 million of them remaining chronically infected and therefore carriers of the virus causing global burden known to be a cause of more than one million deaths (Kane, 1996; WHO, 2007).
Hepatitis B is the world’s most common liver infection caused by highly contagious virus (50- 100
times) more infectious than HIV and the most common ways of transmission are through unprotected sex, unsafe blood transfusion, unsafe use of needles, from mother to child at birth, close household contacts and between children in early in childhood (WHO, 2012).
Vaccines for HBV were introduced in 1982 and was integrated in the EPI, it was expected to give 90- 100% protection against the infection, but there is still a global challenge were more than 350 million are living with chronic Hepatitis B and approximately 600,000 HBV related deaths per year globally Dunford et al (2012); (WHO, 2012) with the most unrelenting health problem found in Africa and developing areas of the globe Seo et al. (2008).
Sub- Saharan Africa is the second endemic area of HBV with about 500million carriers (liver international, 2005), with a prevalence that is 10 times more than the Western world associated with 4% and 5.8% of deaths in south Africa and Nigeria respectively, and the whole region sharing about 25% of the total burden of Hepatitis B and chronic carriers of 65 million (Centre for viral research, Kenya, African Medical and Research Foundation)
North African countries including Egypt, Libya, Tunisia, Algeria, and morocco have an intermediate rate of HBV infection ranging from 2 to 8% according to CDC, whereas the current rate of the infection within the whole Sub- Saharan region ranges between 8 to 20% with the main transmission route being like that of Asia, that is early childhood transmission and contaminated medical equipment.
In Nigeria,HBV infection is highly endemic, with national prevalence of about 10%(3.3million) according to WHO 2010, although the distribution of the virus varies from region to region with the northern Nigeria having the highest prevalence, 21% in the North Western part of Nigeria (MoH, 2012) and 25%in the North, 4% registered in South Western Nigeria, Kampala rate varies between 6% to 7%, Kasese at 10%, although it is not yet clear why this variation occurs (Ocama, 2013).
HBV vaccine was introduced in Nigeria in 2002 in accordance with WHO recommended strategy and was included as part of EPI, which involved the introduction of HBV sero-survey to be conducted among adults aged 15- 59 years and children under five years of age (WHO, 2002)
1.2 Statement of the Problem
The Annual Health Sector Performance Report 2011/2012 indicated that 235 cases of HBV where detected in the districts of Arua, Kitigum and Lira, with a regional prevalence of 21% (MoH, 2012). The Prevalence of HBV infection in the general population in Nigeria is about 10% (WHO,
2012). Adjumani Hospital reported 90 cases of HBV in the last three years with eight deaths (Benon, 2014).
Uyo reported 16 deaths since July 2012 to 2013(Warom, 2013) and Out of the 193 people screened in 2013 in one of the private health facilities, 23 were found positive with the virus. In 2010, 14 people out of 20 cases reported in Uyo hospital died of the HBV infections (Warom, 2013).
Ideally, all adults at risk of acquiring the virus are supposed to be screened and vaccinated against HBV as it is about 95% effective due to the development of hard immunity, hence preventing the infection and its chronic consequences from occurring. (CDC. 2010; NICE, 2012; WHO, 2013).
Despite the introduction of Vaccines against HBV in Nigeria in the year 2002 which was expected to give 90- 100% protection against the infection (WHO, 2012), injection safety measures put in place by the government and availability of screening programs in some private health facilities, the prevalence of the HBV infection continues to increase and if no action is taken, it may result to increased morbidity and mortality caused by liver cirrhosis or liver cancer Dun ford et al( 2012); (WHO, 2012).
Therefore, this study seeks to determine factors influencing prevalence of Hepatitis B viral infection among adults aged (18 -45 years) in Uyo.
1.3 Research Objectives
1.3.1 General Objective
To determine factors influencing prevalence of Hepatitis B viral infection among adults aged (18 45 years) in Uyo.
1.3.2 Specific objectives
- To determine individual factors influencing prevalence of Hepatitis B viral infection among adults aged (18- 45 years) in Uyo.
- To assess socio economic factors influencing prevalence of Hepatitis B viral infection among adults aged (18- 45 years) in Uyo.
- To assess health facility factors influencing prevalence of Hepatitis B viral infection among adults aged (18- 45 years) in Uyo.
1.4 Research Questions
- What are the individual factors influencing prevalence of Hepatitis B viral infection among adults aged (18 -45 years) in Uyo?
- What are the socio economic factors influencing prevalence of Hepatitis B viral infection among adults aged (18- 45 years) in Uyo? iii. What are the health facility factors influencing prevalence of Hepatitis B viral infection among adults aged (18- 45 years) in Uyo?
1.5 Significance of the study
The study seeks to determine factors responsible for high prevalence of Hepatitis B viral infection in Uyo.
The study may also contribute to the provision of specific action plans to local government and the MoH to address the current problem of HBV infection in the West Nile region and Nigeria at
large.
The findings from this study may be used to inform policy formulation, health care workers and the general public on preventing Hepatitis B virus infection in Uyo and the whole country.
This study may also serve as a basis for carrying out further research in areas where Hepatitis B viral infection prevalence is high, especially like that of the West Nile region.
1.6 CONCEPTUAL FRAMEWORK
Independent Variables
Individual Factors:
- Knowledge about Hepatitis B
- Age
- Sex
- Occupation
- Co-infection
Dependent Variable
Socio-economic Factors:
- Income level Prevalence of Hepatitis B
- Education level virus infection
- Belief
Health Facility Factors:
- Availability of vaccines and Study Outcome
screening test kits High Prevalence
- Accessibility of health facilities
- Quality of record keeping
- Increased Morbidity
- Skills and knowledge of the health workers Increased Mortality
- Aseptic techniques used
Prevalence of Hepatitis B virus infection is the dependent variable and factors influencing the prevalence of Hepatitis B virus infection, like individual factors, socio economic factors and health facility factors are the independent variables.