SUMMARY

Background: Hepatitis is an inflammation of the liver mainly caused by the hepatitis B virus. It contains the Hepatitis B surface antigen (HBsAg) which when found in blood/serum, indicates the presence of hepatitis B virus (HBV) infection. HBV is potentially a life-threatening cause of liver disease in the world.  Health care professionals, especially medical students are at greater risk of contracting HBV infections due to their occupational exposure to percutaneous injuries and other body fluids.

Objective: To determine the seroprevalence and associated factors of hepatitis B virus infection among Medical Laboratory Science students (MLSSs) in the Faculty of Health Sciences, University of Bamenda.

Methods: This study will be a school based cross-sectional study which will be carried out from the 2^nd of January to the 28^th of June 2024. Ethical clearance will be obtained from the ethical review board of the University of Bamenda, administrative authorization will be gotten from the Delegation of Public Health and from the university administration. The study will include all medical laboratory students who accept to freely participate in the study.  Questionnaires will be administered to 152 students to obtain information on socio-demographic characteristics and the associated factors to HBV infection, after which collection of venous blood of the participants will be done and tested for HBV infection using the HBsAg Rapid Diagnostic Test kit. All data will be analysed using the statistical software package for social sciences (SPSS) version 20.0 with 95% confidence interval.

Expected impact: This study will help reveal the seroprevalence of hepatitis B and factors associated among MLSSs as they are among the high risk student populations.

Key words:  Hepatitis B, seroprevalence, associated factors, medical laboratory science students, Bamenda.

CHAPTER ONE: INTRODUCTION

1.1 BACKGROUND

Hepatitis refers to an infection that causes inflammation of the liver that can be self-limiting or may progress to fibrosis(scarring), cirrhosis or liver cancer, impeding the liver’s ability to fight infections, filter blood, and process nutrients [1,2]. Hepatitis is the most common liver disease seen in the world with about 2.3 billion people infected worldwide who are at risk of developing liver cirrhosis and liver cancer [1]. There are 5 main strands of hepatitis virus, namely, hepatitis A, B, C, D and E, with hepatitis B virus (HBV) and hepatitis C virus (HCV) comprising the most common types of viral diseases that cause liver diseases [3].

Hepatitis B virus (HBV) is a double-stranded deoxyribonucleic acid (DNA), enveloped virus of the hepadnaviridae family that infects the liver, causing hepatocellular necrosis and liver inflammation [4]. It is the major cause of acute and chronic hepatitis [1]. Hepatitis B virus can survive outside the body for at least seven days and its incubation period ranges from 30 – 180 days in the cells of the host from the onset of the infection [5]. The complete infectious virion (Dane particle) is a 42nm spherical particle consisting of hepatitis B surface antigen (HBsAg), secreted protein antigen (HBeAg) and carier hepatitis B core antigen (HBcAg) whose presence in blood indicates viral replication of hepatitis B virus [6, 7]. In high endemic areas, Hepatitis B is most commonly spread from mother to child at birth or horizontal transmission (exposure to infected blood) which might happen through blood transfusion, intravenous drug use, surgery, tattooing, sexual intercourse, and contact with infected blood [8]. This Hepatitis B virus is life threatening and results in acute and chronic diseases of the liver [9]. Chronic hepatitis B virus infection is a major global health problem worldwide [9]. According to the WHO, 10% of people infected with chronic HBV are diagnosed, out of whom only 22% receive treatment [9]. Blood contains the highest HBV titters of all body fluids and is the most important vehicle of transmission in the health care setting [10]. Throughout the world, millions of health care professionals work in health institutions and it is estimated that 600,000 to 800,000 cut and puncture injuries occur among them per year, of which 50% are not registered [10]. The risk of contracting HBV by health care workers (HCWs) is four-times greater than that of general adult population with high rate seen among laboratory workers [10]. Medical trainees, especially in developing countries, have a very high risk of getting HBV infection during their training owing to the low HBV vaccine uptake rate and high rate of accidental exposure to body fluids [11].

According to the WHO, approximately 257 million people are living with chronic HBV infection which resulted in 877,000 deaths in 2015, most from adverse effects such as liver cancer and cirrhosis of the liver [12]. However, the WHO estimates sub-Saharan Africa and East Asia as the areas of high endemicity, with a prevalence above 8%, of the adult population chronically infected [13]. Thus the prevalence of hepatitis B is high in Africa and accounts for 87890 deaths annually in Sub Saharan Africa [1]. In Cameroon, hepatitis B virus causes public health problems with high prevalence seen among health care workers. In the Mvog-Ada Health Area of the Djoungolo Health District Yaounde, the prevalence of hepatitis B infection among health care workers was 11% [14]. In a similar research conducted among HCWs in the Bamenda Health District of the North West Region, the seroprevalence was 10.6% [4]. Although the major public global health sector strategy on viral hepatitis 2016 – 2021 has as target to eliminate viral hepatitis as a public health threat by 2030, there is rather an increase in the number of deaths caused by hepatitis B [15]. Currently, about 2 million HCW are exposed and about 70 000 are infected with HBV annually [4].

Prevention of HBV infection among HCWs through vaccination of hepatitis B vaccine is crucial to prevent chronic infection and subsequent complications of chronic liver cases as recommended by the Centre of Disease Control Advisory Committee on Immunization Practices for HCWs [16]. Therefore, this study will help determine the Seroprevalence of Hepatitis B and associated factors among MLSSs.

1.2 PROBLEM STATEMENT

Hepatitis B remains a major health problem. However, despite all the knowledge about the infection, there is limited information on the magnitude of HBsAg among health professional students who are also considered as high risk group for HBV infection. The seroprevalence and associated factors of HBV infection amongst health professional students who are frequently in contact with blood and other body fluids continue to be a burden. In Cameroon, while several studies have investigated the seroprevalence of Hepatitis B among different populations, including healthcare professionals, little attention has been paid to Medical Laboratory Science students (MLSSs).

1.3 RATIONALE

Hepatitis B is a global public health problem, with 66% of all the world population living in areas where there are high levels of infection. It is responsible for an estimated 1.4 million deaths per year from acute infection and hepatitis-related liver cancer and cirrhosis [2]. HBV infection is a serious job-related risk for HCWs especially students pursuing health-care related programs due to their inexperience in the field of work at the various health facilities [17]. MLSSs are at high risk to getting HBV infection because of their direct contact with patients’ blood and other body fluids during their professional training, and lack of experience and professional skills which makes them potentially vulnerable to acquiring Hepatitis B during medical procedures [13].

However, a literature search reveals a significant gap in knowledge regarding the seroprevalence of hepatitis B and its associated factors among MLSSs. Hence, conducting a study in this area is necessary to bridge this knowledge gap and address the specific concerns of this particular population.

By examining the seroprevalence of hepatitis B and associated factors among MLSSs, this study will contribute to the existing body of knowledge, provide useful evidence to guide preventive strategies and highlight the effectiveness of infection control practices. The findings will also provide an inside for raising awareness, thereby promoting the health and safety of this study population.

1.4 RESEARCH QUESTIONS

• What is the seroprevalence of Hepatitis B virus infection among Medical Laboratory Science students of the University of Bamenda?
• What are the factors associated with Hepatitis B virus infection among Medical Laboratory Science students of the University of Bamenda?
• What are the sociodemographic characteristics of the Medical Laboratory Science students of the University of Bamenda who will test positive for Hepatitis B?

1.5 RESEARCH HYPOTHESIS

Hepatitis B virus is common among medical laboratory science students of the University of Bamenda.

1.6 RESEARCH OBJECTIVES

1.6.1 Main Objective

• To determine the seroprevalence and associated factors of Hepatitis B infection among Medical Laboratory Science students of the Faculty of Health Science University of Bamenda.

1.6.2 Specific Objectives

1. To determine the seroprevalence of Hepatitis B infection among Medical Laboratory Science students of the University of Bamenda.
2. To identify the factors associated with Hepatitis B infection among Medical Laboratory Science students of the University of Bamenda.
3. To describe the sociodemographic characteristics of the students who will test positive for Hepatitis B.