HEPATITIS B VIRUS LABORATORY DIAGNOSIS MATERIALS AND METHODS: COLLECTION OF CLINICAL SPECIMEN (SERUM)



The research work was carried out at General Hospital Ezzamgbo in Ohaukwu L.G.A, Ebonyi State, Nigeria. The subjects included 448 patients who visited the hospital with various cases and were recommended for laboratory test. A total of 448 serum samples were screened for the presence of hepatitis B surface antigen (HBsAg). The age of the patients studied varied from 1 to 71 years and above of both male and female. Their occupations were civil servants, traders, motorists, students, and farmers.

About 5 mls of venous blood samples were aseptically collected using disposable sterile syringes with needle through venipuncture from the patients enlisted for the study, put into ethyl diaminetetracetic acids (EDTA) bottles, allowed to stand for one hour (1hr) to clot at room temperature and then centrifuged using a centrifuge.
            The patients were interviewed to obtain information on their socio-demographic data such as age, sex, occupation, history of blood/blood product transfusion, scarification, marital status, educational qualification, patients living accommodation, previous history of surgery, injection by unqualified medical personnel etc.
            The study employed parallel testing method. The method involved the use of two rapid Enzyme Linked Immuno-Sorbent Assay (ELISA) test kits simultaneously. The two rapid testing kits used in this study were the Hepatitis B surface antigen ELISA kits produced by Acon Biotech Diagnostic Systems, USA (Acon Hepatitis B ultra fast diagnostic kits) and Antek Diagnostic Incorporated, United Kingdom. The entire test was performed according to the manufacturer’s instruction to determine seropositivity.
            The results were read thus: if distinct red lines appeared in the control region (C) and test region (T) of the test kits after 15 minutes, the samples was positive. Conversely, if only one red line appeared in the control region (C), the sample was negative.
The results were interpreted as positive if both test kits were positive and negative if both test kits were negative. Thus:  
Positive on both kits ……………positive result
Negative on both kits…………….negative result
If one of the test kits was positive or negative, a third test kit (tie breaker) was used to determine if the result was positive or negative. The third kit used as tie breaker was HBsAg fast diagnostic kit produced by Welcome Laboratory, UK.
            The results were analyzed using Chi-square and ANOVA tests to explore proportional relationship at 95% Confidence interval.

3. RESULTS
 The age-related distribution of Hepatitis B surface antigen showed the highest prevalence in the age groups 21-30 (12.2%) and 11-20 (11.3%) and the least prevalence in the age group ≥ 71 (3.2%) (Fig 1). The relative prevalences in respect of other age categories are 31-40 (9.5%), 41-50 (7.1%), 51-60 (6.3%) and 61-70 (5.7%), (P<0.05). The sex-related distribution showed higher prevalence in females (10.0%) than in males (7.4%) (Fig 2). Fig 3 shows the distribution of HBsAg by occupation. Motorists (11.1%), Traders (9.0%), and Students (8.5%) had higher prevalences than Civil servants (6.2%) and Farmers (5.3%). The distribution of HBsAg according to reported risk factors showed the highest prevalence in patients with previous transfusion with blood/blood products (18.2%) and the least in persons with tribal marks/circumcision (4.4%) (Fig 4). Persons with the lower socio-economic class had higher distribution of HBsAg (11.9%) than those in upper socio-economic class (3.1%) and middle socio-economic class (3.7%) (Fig 5), (P<0.05). The distribution of HBsAg according to marital status showed the highest prevalence in married patients (9.0%) than in singles (6.4%), (Fig 6). Fig 7 shows the distribution of HBsAg by level of education. Patients with primary education (12.1%) and patients with secondary education (9.3%) had higher prevalences than those with tertiary (4.4%) and no educational qualification (5.9%), (P<0.05).
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