CHAPTER ONE:

GENERAL INTRODUCTION

BACKGROUND

Hepatitis b infection is an ancient disease from the time of bronze age which has been suspected to be an agent of infection in the 50’s which was later reported first as Australian antigen in the 60’s, an subsequently discovered under the electron microscope in the 70’s. Vaccination for hepatitis B was introduced in the 80’s.   

          Hepatitis B virus (HBV) is one of the major public health problems in the world. World health organization (2017) estimated that about one third of the world population is infected with HBV of these, about 360 million people are chronic carriers and are at risk of developing liver diseases such as cirrhosis and hepatocellular carcinoma (HCC) according to the center of a disease control (2017) about 120.000 of Nigeria’s disease population are affected with hepatitis B more than 50.000 suffered lifelong chronic infection, and more than 12.000 individuals die due to HBV induced infections. Therefore, HBV remains the major course of Liver-related morbidity and mortality.

          Hepatitis B virus is associated with the acute viral hepatitis an illness that begins with general ill-health, loss of appetite, nausea vomiting, body aches, mild fever and dark urine and latter on progresses to the development of jaundice. It has been noted that itchiness has been an indication as a possible symptom of all hepatitis virus types. A few people may have severe disease (fulminate hepatic failure) and may die as a result. The infection may be entirely asymptomatic and may go recognized. Chronic infection with hepatitis B virus may either be asymptomatic or associated with chronic of the liver (chronic hepatitis) leading to cirrhosis for several years. This type of infection dramatically increases the incidence of hepotocellular carcinoma (Who 2017).

                   Efforts aimed at increasing community awareness and knowledge of HBV transmission and prevention is important especially among adults. Exposing adults to HB information is important because it is a t this stage that they initiate in sexual relationships and tend to explore and experiment with sex which is a risk factor of contraction and transmission of hepatitis B (Eredoro and Egbochukwu, 2017). It is also this stage that the most detrimental lifelong lifestyle and behaviors are adopted, like substances use, promiscuity which is also predisposing factors for the contraction of HBV infections. Adequate knowledge on the mode of transmission and prevention is the only safe guard against the epidemic of viral hepatitis. Knowing these facts having proper attitudes and behaviors is critical to prevent the speed of the disease. At trough many studies have accessed knowledge of HBV among medical student in the world and their communities and Nigeria. Few have been done among. It is hoped that information from this study will be useful in developing reed-based educational materials on hepatitis B virus. Therefore, the study examined knowledge of the mode transmission in the Batoke community. It also examined significant relationship between gender and knowledge of hepatitis B among people from the Batoke community.

In general, related to knowledge and awareness about officials’ diseases as critical to designing effective prevention programs Caanezaak et al 2016. But more specifically the community awareness to HBV vaccination and testing is a public concern. However, lack of awareness and undiagnosed Hepatitis B is a barrier to prevention sub-Sahara Africa and those to leads to high prevalence of chronic infection Mugisha et al 2017.

Some factors that cause of awareness about mode of transmission in the community are absence of community outreach health programs level of education by members of the community and stigmatization.

Hepatitis B is an infection of the liver caused by the HBV, a double-stranded DNA virus of the hepadnaviridae family. The virus is transmitted via percutaneous or per mucosal exposure to infected blood or body fluids and has an incubation period ranging from 40 to 160 days (average 60—90 days).

Transmission can occur vertically from infected mother to child, horizontally (e.g. child-to-child transmission within a household), sexually or parenterally (e.g. via injecting drug use, sharps injury or contaminated blood products).

The majority of acute HBV infections are asymptomatic. In adults, -30% will present with jaundice and hepatitis and 0.1—0.5% develop fulminant liver failure During acute infection, hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) can be detected in the serum and there are high levels of IgM antibodies to the viral core antigen (IgM anti-HBc) A successful host immune response to the virus leads first to clearance of HBeAg (and appearance of antibody to HBeAg) and subsequent clearance of HBsAg (and appearance of antibody to HBsAg). The appearance of antibodies to HBsAg indicates recovery from acute infection the persistence of HBsAg for > 6 months from its first detection denotes chronic hepatitis B (CHB) infection.

In a recent review conducted by the European Centre for Disease Prevention and Control  population prevalence of CHB was found to vary widely between European countries ranging from 0.1% in Ireland and the Netherlands to >7% in the eastern part of Turkey. The review also found that in all the countries for which data were available, the estimated prevalence of CHB infection was higher among migrant groups than in the general population. Similarly, immigration of individuals with CHB from countries of intermediate and high HBV prevalence has been estimated to account for >95% of the estimated annual incidence of CHB infections in England [9]. HBV virus can be subdivided into different genotypes. To date, eight HBV genotypes (A-H) have been identified and these have distinct geographical distributions. For example, Genotype A is prevalent in northwestern Europe and the USA, Genotypes B and C in Asia and Genotype D in the Mediterranean Basin, Middle East and India. Epidemiological studies suggest that HBV genotype may influence disease progression, with Genotypes A and B associated with more favorable outcomes than Genotypes C and D.

1.2 Research objective

1.2.1 Main objective: 

To assess the level of knowledge of adults (18-45 years) on the mode of hepatitis B virus transmission amongst the Batoke residents.

1.2.2 Specific objectives.

• Knowledge of causes
• Knowledge on transmission
• Knowledge on prevention

1.3 Research questions.

To what extents are members of community knowledgeable about modes of transmission of hepatitis B virus?

Specific research question.

Knowledge of adults (18-45 years) on the mode of transmission of hepatitis B in the Batoke health area, Limbe.

1.4 problem statement  

Hepatitis B is globally one of the most common and severe infectious disease that leads to significant morbidity and mortality (Franco Et Al, 2012). A proximately one –third of the world’s population has been infected with HBV. About 5% of these population are chronic carriers and a quarter of them develop serious liver disease such as chronic hepatitis, cirrhosis and hepatic carcinoma (Shama et al, 2015).

Every year, 780, 000 HBV related deaths are documented around globe. The risk of developing chronic infection and subsequent complications is inversely related to the age of infection. Disease burden of HBV is also high among sub-saharan populations. About 6.1% of African population have HBV infection and about 18 million people have chronic hepatitis B virus infection (WHO, 2015).

Furthermore, studies further reveals that the prevalence of HBV is higher in rural areas compared to urban areas. Statistics holds that nearly one-fifth of the Cameroonian population is affected by hepatitis B and C (Cameroon report, 2018). In Africa, Cameroon is the second most affected by this disease after Egypt. Hepatitis is becoming a public health issue in Cameroon.