ABSTRACT
Background: The threat posed by the global hepatitis B virus (HBV) epidemic continues to assume alarming proportions in areas of public health and national development. Globally, two billion people have been infected with HBV at some point in time in their life time and 360 to 400 million people which represents more than 5% of the world’s population are chronic carriers with an estimated 600,000 deaths each year due to consequences of HBV. Objectives: The general objective of the study is to assess the knowledge, attitude and perception (KAP) concerning hepatitis B (HBV) among elderly persons in Hunkuyi in Kudan Local Government Kaduna. Methodology: The study was cross-sectional, carried among young elderly persons in Hunkuyi of Kudan Local Government Kaduna. The tool for the study was structured questionnaire specially designed for this study. A total of 400 young elderly persons (15-40 years) responded to the survey. Data were computerized using Excel and analyzed using SPSS (version 21).
Results: The study showed that, sampled respondent had good knowledge about hepatitis B as majority (67.5%) of the respondent scored between the ranges of 8-12 indicating high knowledge. Additionally, respondents who were employed in the formal sector were one time more likely to show good knowledge on the mode of transmission of the hepatitis B virus infection as compared to those working in the informal sector (OR = 1.23; 95% CI: 1.7– 17.6; p ≤ = 0.001). Regarding the respondent’s attitude and perception towards patients infected with HBV and the infection, the findings showed average attitude and perception as most (49.5%) of the respondents scored an average mark of 3 indicating average attitude and perception. The study also revealed significant association between respondents occupation and willingness to test for the HBV infection (OR=1.23; 95% CI: 1.7-17.6; p ≤ =0.000). It was also observed that, those aged 25 years and above were 4 times more likely to go for the hepatitis B virus screening compared to those aged below 25 years (OR = 4.12; 95% CI: 0.1– 1.6; p = 0.834). Also, females were one time more likely to go for HBV infection screening as compared to the male counterparts (OR =1.36; 95% CI: 0.1– 1.6; p = 0.236). Conclusions: The study revealed relatively high level of knowledge on hepatitis B viral infection among young elderly persons in Hunkuyi, but poor attitude towards the infection. The study therefore recommends amongst others that, more education should be given to public to improve people attitude towards the infection.
CHAPTER ONE
INTRODUCTION
1.1 Background of study
Viral hepatitis is one of the most common diseases worldwide. Hepatitis B, also called inflammation of the liver, which was the first to be discovered, is one of the five types of hepatitis and can cause both acute and chronic diseases. The types include: hepatitis A, B, C, D and E. The global burden of hepatitis B is severe with an estimated 350 million people or more being chronic carriers (WHO, 2012).
The major routes of hepatitis B transmission include blood transfusion, from mother to infant during child birth and sexually. The Hepatitis C virus (HCV) can also cause chronic liver diseases and is transmitted in the same ways as hepatitis B, although mother to infant and sexual transmissions are less common. An estimated 170 million people are said to be chronic carriers of HCV [Center for disease control (CDC), 2006]. Hepatitis D, also called delta hepatitis, is caused by an incomplete virus that requires hepatitis B virus to replicate. Hence, this type of hepatitis is only seen in association with hepatitis B infection. Hepatitis A and E are both transmitted by faecal-oral route, However, signs and symptoms are not seen after being infected with hepatitis A and E and can therefore result in a lifelong development of immunity. Some of the viral hepatitis can be prevented by vaccination, and vaccines for hepatitis A and B have existed for 20 years now. Hepatitis D can be prevented by using hepatitis B vaccines. As at now, the only types of hepatitis that cannot be prevented by the use of vaccine are C and E hepatitis.
According to the World Health Organization (WHO, 2012), hepatitis B is the world’s most common liver infection, which is caused by a DNA-virus, the hepatitis B virus (HBV). The virus is highly contagious, 50-100 times more infectious than human immunodeficiency virus (HIV), and is transmitted between people through blood, semen, vaginal fluids and mucous membranes. There are more than 2 billion people World-wide, having evidence of recent or past HBV infection. In south East Asian Region, there are estimated 80 million HBV carriers representing about 6% of the total population (Malik & Lee, 2000). The most common ways of transmission are by unprotected sex, unsafe blood transfusions, and unsafe use of needles, from mother to child at birth, close household contact and between children in early childhood. HBV is contagious and can also be transmitted from one infected individual to another by blood to blood contact, sharing of eating utensils and other barber shop and beauty salon equipment, (Yayehyirad et al., 2009), skin and mucous membrane infections caused by contaminated blood or body. In addition, tattooing, ear piercing, acupuncture, dialysis, and even using unsterilized syringes can be source of infection. In volunteer blood donors, the prevalence of HBV infection ranges from 5–10%. But the prevalence is higher in lower socio-economic status, older age group and those persons exposed to blood products (Muhammed et al., 2007).
Prevalence of infection, modes of transmission and human behavior occur in geographically different epidemiologic patterns of HBV infection. The practice of modern medicine have contributed a lot in the increase of the case and spreading of blood borne diseases like Human immune deficiency virus and HBV due to lapse in the sterilization technique of instruments and improper hospital waste management as 10 to 20% health care waste is regarded hazardous (Taneja & Biswal, 2009). In health care delivery, HBV transmission poses a major challenge to both patients and health workers especially those who frequently come into contact with blood. These groups of people stand a higher chance of contracting the disease if care is not taken. Apart from health workers, some people in the general public are more prone to contracting hepatitis B than others e.g. drug users or injectors, people who pierce or tattoo their bodies and unprotected sex engaged in by adolescents due to their lack of knowledge about sexual negotiation and safe sex practices.
In most countries where HBV prevalence is low, transmission usually occur during adolescence or elderly personhood as a result of the unsafe injections and unprotected sexual activities. Research has revealed that, an estimated 21 million new HBV infections occur each year due to unsafe injections in health care settings (Hauri et al., 2003).
Prevention against any disease is proportional to knowledge, attitude and practice (KAP) of the population and reflection of the importance that is paid to health related issue by the society. Health care workers should familiarize themselves with “universal precautions”, which is defined by Center for Disease Control (CDC) as a set of precautions designed to prevent transmission of Human immunodeficiency virus (HIV), HBV, and other blood-borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other blood borne pathogens. In 1964, it became possible to identify people with HBV using serological testing by searching for hepatitis B surface antigen (HBsAg) (Weinbaum, Mast & Ward, 2009).
HBV is unique compared to other sexually transmitted diseases, because it can be prevented with a vaccine (WHO, 2012). Vaccination gives long term protection from HBV infection, possibly life-long.
All HBV infections do not give symptoms, meaning that there is a risk that people are contagious without knowing it (Weinbaum et al., 2009; WHO, 2012). However, some people may experience acute symptoms like jaundice, fatigue, loss of appetite, nausea and/or abdominal pain. For almost all elderly persons (90%), the infection heals and they become healthy, but for infants and young children, there is a 90% and 30-50% risk respectively that the infection leads to chronic hepatitis B (WHO, 2012). This provides an increased risk, approximately 25%, that they later in life will suffer from liver cirrhosis and/or liver cancer, if the infection is not medically managed (Chao et al., 2010; WHO, 2012).
Early identification of infected persons with the help of blood tests can break the on-going transmission and lead to necessary treatment with antiviral medication (Nguyen et al., 2010; Weinbaum et al., 2009). It is also important to enable the identification and vaccination of those who share household with the infected person and sexual partners that might have become infected. To avoid transmission there are a few measures that HBV positive individuals can take. For example, they should notify sexual partners and the people they share their household with to get tested for HBV and inform them of the need for vaccination. An individual infected with the HBV can delay and/or prevent liver disease by limiting their alcohol consumption and by regularly seeking disease monitoring (Weinbaum et al., 2009). Using alcohol in combination with HBV- infection has shown to increase the risk of hepatotoxicity (Tan, Cheah & Teo, 2005).
Hepatitis B virus is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids and not by casual contacts. Modes of transmission of Hepatitis B virus (HBV) is similar to human immunodeficiency virus (HIV), however, HBV is 50 to 100 times more infectious (WHO, 2012). HBV infection has been recognized as an important occupational hazard for health care workers (WHO, 2008). Health care workers are at risk of infection through exposure to blood and other body fluids coupled with the high contagiousness of HBV. Fortunately, infective hepatitis B virus is largely preventable by hepatitis B vaccine which is 95% effective in preventing such disease and its chronic consequences (WHO, 2012). Knowledge, attitude, and practice (KAP) surveys are representative of a specific population to collect information on what is known, believed and done in relation to a particular topic, and are the most frequently used study tool in health-seeking behaviour research (WHO, 2008). Knowledge is usually assessed to see how far community knowledge corresponds to biomedical concepts (Good, 1994). Practices in KAP surveys usually inquire about preventive measures or different health care options. Normally, hypothetical questions are asked, so it permits statements about actual practices and therefore, yields information on people’s behaviors or on what they know should be done. This study is to assess the knowledge, attitude and perception of people towards HBV infection in Hunkuyi in Kaduna state
• Problem statement
Hepatitis B virus (HBV) infection is a serious and common infectious disease of the liver. It is a confronting ailment and results in 0.6 million deaths annually (WHO,2009).Although HBV infection is classified as ‘disease of priority,’ there is an incessant increase in detection of new cases worldwide. Furthermore, HBV is widespread in the Asia Pacific region and 10 to 15 million of the population suffer from this disease (Keeffe et al., 2008; Lok & McMahon, 2009; Lesmana et al., 2006). The prevalence of HBV chronic infection is particularly high in sub-Saharan Africa, ranging from 7 to 26% (Andre, 2000).
The secret killer hepatitis B virus, though a major threat to health globally, is yet to catch the attention of health institutions, policy makers, the general public and decision makers in Nigeria. The disease has a long history in the country immediately after the Second World War. A study by Morrow et al., (1971) revealed that hepatitis has been on the increase in Accra arising from the development of shanty towns with poor sanitation. Despite the long history of the disease in Nigeria, there have not been any bold and pragmatic measures put in place to curb it except the formation of the Nigeria Hepatitis B Foundation (GHBF) which started its operation just in September, 2007.
In the light of the lukewarm attitude shown towards the disease and due to acts of selective prevention of infectious diseases by health professionals including HBV, the disease is said to be fast spreading with an estimated number of four million people as carriers (NHS, 2009). The 2009 Nigeria Health Service report released scary figures suggesting an increase in the prevalence ratio from 8:1 in 2005 to 6:1 in 2009 (NHS, 2009). This means one out of every sixth person is infected with the disease.
It is also important to state that Nigeria forms part of the 134 developing countries and economies in transition that have successfully introduced hepatitis B vaccine into their National Immunization Schedules by 2003. However, there is no program for mass screening and vaccination of children born before the vaccine introduction. Also, there is no screening for mothers, adolescents and the general public. It is an undeniable fact that although hepatitis B screening and vaccination is carried out in some few health facilities in Nigeria, it is not a national policy and is not incorporated into national health policies like the free counseling and testing for HIV or the mass immunization of children against measles. This brings to the fore problems of accessibility and affordability which the general public has to battle with. Apart from being expensive and preserve of the rich, the few people who are willing to access it find it difficult to access these screening facilities because of the inadequate and ill-equipped screening centers to cater for their needs. Media publicity on the disease is not substantial as compared to other infectious diseases.
The above mentioned factors and their threat to the health of the future leaders of the country (elderly persons) have necessitated this study.
In the light of these, the current study is aimed at assessing the knowledge attitude and perception of HBV infection among people of Hunkuyi. There have been some reported increasing cases of hepatitis B virus infection in the annual reports of the Hunkuyi health directorate (Hospital data, Annual report, 2015). Figures for 2012, 2013 and 2014 were 49, 62 and 75 respectively. It is not clear if this increment is due to poor KAP of HBV infection, which this study seeks to address.
• General objective.
The general objective of the study is to assess the knowledge, attitude and perception on hepatitis B virus infection among elderly persons in Hunkuyi of Kaduna state.
• Specific objectives.
In order to achieve this goal (general objective), the study addresses the following specific objectives;
• To determine the knowledge level of Hepatitis B virus infection among elderly persons in Hunkuyi in Kaduna state.
• To explore the attitude and practices of elderly persons in Hunkuyi in the Kaduna state towards Hepatitis B virus infection.
• To examine the perception about Hepatitis B virus infection among elderly persons in Hunkuyi in Kaduna state of Nigeria.
• To determine the association between participants’ demographic characteristics and their knowledge and attitude towards the condition.
• Research questions
The study sought to answer the following questions to achieve the aim and objectives of the research;
• What is the knowledge level about Hepatitis B virus infection among elderly persons in Hunkuyi in Kaduna state?
• What is the attitude and practices of elderly persons in Hunkuyi in Kaduna state towards Hepatitis B virus infection?
• What is the perception on Hepatitis B virus infection among elderly persons in Hunkuyi in Kaduna state?
• Hypothesis
The study objectives are guided by the following hypothesis.
• H0: There is low level of knowledge on hepatitis B viral infection among the people of Hunkuyi.
H1: There is relatively high level of knowledge on hepatitis B viral infection among the people of Hunkuyi.
• H0: Attitude of people towards hepatitis B viral infection is not encouraging.
H1: Attitude of people towards hepatitis B viral infection is good.
• H0: Perception of people towards hepatitis B viral infection is positive.
H1: Perception of people towards hepatitis B viral infection is negative.
• Significance of the study
Findings from this study would be very useful in diverse ways: Continual transmission of this disease could be attributed to a number of reasons including: missing of opportunities for prevention, lack of awareness about the prevalence and prevention (vaccination), misdiagnosis, absence of medical care and poor health outcomes in infected people. The result from this study will increase the understanding and knowledge of elderly persons in Hunkuyi and will also be used to plan an intervention programme for primary prevention of this disease.
Secondly, this research will be used as a mouthpiece to lobby for HBV immunization and treatment to be included under the current list of diseases being taken care of by the National Health Insurance Scheme (NHIS) or incorporate HBV screening and vaccination into the voluntary counseling and testing of HIV to be done concurrently.
1.8 Organisation of the study
The study is organized into six chapters. Chapter one contains the background of the study, the problem statement, the purpose of the study, the objectives, significance of the study, hypothesis, conceptual frame work and organization of the study.
Chapter two contains related literature review of hepatitis B from other studies, textbooks, manuals, internet and publications on annual reports.
Chapter three consists of research methods; including research design, population under study setting, sample size, sampling technique, instrumentation, validity and reliability, delimitation, analytical procedure, ethical consideration, and pretesting/pilot study.
Chapter four contains the collected data which was analyzed and presented in raw tabular form and narrative summaries.
Chapter five also entails the discussion of findings of the study with literature review, whiles the last chapter (six) talks about summary, recommendations and conclusion.
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