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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