PREVELANCE OF SERUM HEPATITIS B VIRUS (HBsAg) IN NIGERIA - AFRICA | Ph.D THESIS DISCUSSION



Our study showed a total prevalence rate of 8.3% of HBsAg in the study population in Ebonyi State, Nigeria. According to WHO (2009) classification for hepatitis B virus endemicity, areas with 8.0% prevalence are endemic for hepatitis B virus infection. Hence, Ezzangbo is an endemic area for hepatitis B virus infection. This result agrees with previous studies at Ahmadu Bello University Teaching Hospital, Zaria, by Luka et al. (2008)    and in Nnewi, by Eke et al. (2011) both in Nigeria with prevalence rate of 8.3% each.
It is also similar to the works done by Chukwuka et al. (2004) in Nnewi, Nigeria, Ni et al. (2001) in Taiwan, Ezegbudo et al. (2004) in Awka  and Al-Faleh et al. (1992) in Saudi Arabia with prevalence of 7.6%, 7.0%, 9.3% and 6.7% respectively.
            However, it is higher than the prevalence of 3.9% reported among adolescents in Abakaliki, Southeastern Nigiera by Ugwuja (2010). Nevertheless, the prevalence of 8.3% is lower than the 12.4% reported by Alikor and Erhabor (2007) among children attending tertiary health institution in Niger Delta of Nigeria, 15.5% reported by Komas et al. (2010) in a cohort of students in Bangai, 13.4% reported prevalence in Abakaliki by Idioha et al. (2010), 15.8% occurrence of HBV infection reported by Baba et al. (1999), at the University of Maiduguri Teaching Hospital, Maiduguri, Bono State.
            Our finding revealed that the age group 21-30 years was more infected than other age groups. This is in agreement with recent sero-prevalence studies conducted in Nnewi,Nigeria by Eke et al. (2011) in Nigeria, Vazquez-Martinez, (2003) in Mexico and Sarwar, et al. (2010) in Kashmir. This might be the fact that the group 21-30 years is most sexually active than other age groups and especially with sexual intercourse as a predisposing factor to high prevalence of HBV infection.
Furthermore,  our study revealed that females were more infected than males as corroborated by previous studies by Alam et al. (2007), Agbede et al. (2007), Al-Faleh et al. (1992)   and Ugwuja and Ugwu (2009) in Parkistan, Ilorin, Nigeria, Saudi Arabia, and Abakaliki, Nigeria respectively. This may be due to the active involvement of females in activities like tattooing, surgery, health care services, multipartner sex practice and rape as adduced in those studies. However, in the studies of Sarwar et al. (2010), Zhang et al. (2011) and Bunyamin et al. (2009), males were infected more than females. This may be as a result of restriction of women to their houses which reduced the chances of being involved in activities that predispose to infection like tattooing, multipartner sex practice, health care services.
            Occupationally, higher prevalence of HBV infection was found among motorists and traders with the farmers having the least prevalence. This may be due to the high exposure rate of motorists and traders to multi-sex partners. This is in agreement with the findings of Zhang et al., (2011), and Bunyamin et al. (2009).
Our findings also revealed that transfusion of blood or blood products was the most common risk factor for HBV transmission. This is in agreement with the findings of Sarwar et al. (2010). According to a study by Ali et al. (2006), 50% blood banks utilized the services of paid blood donors and only 25% had made an arrangement to actively recruit voluntary blood donors. Majority of these donors are paid, many of them are addicted to intra-venous drug administration (IVDA) and their chances of being infected are quite high leading to transmission of HBV infection to recipients. Also, there was a higher prevalence of HBV in paid blood donors compared to voluntary blood donors. Also, used blood bags and needles, instead of being destroyed properly, may be reused illegally which can pose a serious threat for spread of infection. Other risk factors include dental procedures and surgery, needle stick injuries/unsafe injection and scarification and this emphasizes the need to take proper precautions and impart health education to all. In very high percentage of study participants, (9.0%), no risk factor could be identified. This is worrisome and needs to be investigated thoroughly. A very important risk factor in this respect may be improper disposal of hospital waste like sharp objects, swabs, gloves and materials soiled with human secretions.
            Our findings also revealed that people from lower socioeconomic class were more infected than those in the higher classes. This is in agreement with the findings of Ugwuja and Ugwu (2009), and Toukan et al. (1990) but contrarily to the work of Al-Faleh et al. (1992), where socio-economic factors and family size did not significantly influence HBV prevalence. This may be as a result of the lower socioeconomic class patronizing and receiving medical treatment (including injection) from unqualified medical personnel.
            Moreover, our study revealed that married participants were infected more than singles though they are equally exposed to HBV. This may be as a result of some singles abstaining from those acts that promotes HBV transmission such as sexual intercourse, tattooing, receiving unscreened blood or blood products and other intimate behaviours that bring about contacts with body fluids. But married patients have higher chances of the infection due to their involvement in unprotected sexual intercourse among other factors.
Our findings revealed that patients who attained only primary education were more infected and this is in agreement with the study in low resource settings in Nigeria, by Eke et al. (2011), and in Mexico by Vazquez-Martinz, (2003). It appeared that the education of the patients improved their willingness to accept testing, re-testing and seeking medical attention, while those without formal education or those that attended only primary education only, felt reluctant to go for testing and treatment.
Conclusion 
            Hepatitis B virus infections remain serious health hazard in the history of man and have been recorded in all countries and continents of the world (Ogbu 2006). The detection of HBV DNA in the saliva, tears and urine of chronic carriers is a serious health challenge to mankind. The fact that HBV infection can lead to hepatocellular carcinoma (HCC), liver cirrhosis and chronic hepatitis which are deadly diseases should be of public health concern to all nations of the world. This survey, the first of its kind in Ebonyi State indicates a high prevalence of HBV infection in asymptomatic patients. Strong association between HBV infection and socio-demographic parameters such as age, occupation, sex, risk factors, educational level, socioeconomic class etc. were observed.
 Recommendations
            Based on the result of this study, we therefore recommend as follows:
1.         Government should be encouraged to include HBV vaccination in their immunization             programme to save the poor and ignorant masses from the menace of this disease.            The             subjects for the programme should include; non immunized children, mothers       especially pregnant mothers, and other risk groups who have not been immunized       with HBV Vaccination.
2.         Government should design a HBV awareness programme to help educate the poor            masses.
3.         Government should introduce free HBV screening particularly for the less privileged     to known their HBV status.
4.         Government should fund HBV research so that HBV prevalence of different         locations should be known and treatment given to such populace immediately.
5.         Health workers should inform HBV positive individuals the risks     of the infection if     not treated.
6.         All blood and blood products must be screened with sensitive techniques like ELISA      based techniques before transfusion.
7.         Individuals should know their HBV status. If positive but asymptomatic should     seek medical attention from time to time.
8.         Individuals should avoid; casual sexual intercourse, unsafe injection,         scarification (tribal marks/circumcision), and indiscriminate use of sharp objects etc.

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