Full Project – Assessment of knowledge attitude and practices among health care workers towards hepatitis B infection in General Hospital

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          CHAPTER ONE

                                                   1.0 INTRODUCTION

• Background of the study

Hepatitis B (HB) infection is one of the most common viruses in the modern world and ranked by the WHO as one of the top ten killers (Samir and Nazar, 2013). It is highest in the developing world particularly Asia and sub Saharan Africa (Ndoka et al., 2014). Health care workers are at extra risk of acquiring blood borne viral infections particularly hepatitis B infection (Ndoka et al., 2014) It is a major public health problem globally, and tenth leading cause of mortality worldwide, and one of the most important infectious diseases especially in developing countries, similar to HIV (human immune deficiency virus) (Baig et al., 2015).

The infection is about 50-100 times more infectious than HIV. HB is the most common cause of chronic liver disease globally accounting for 80% of all liver cancer mortality worldwide (Fufore et al., 2016). It is also the second the second most significant human carcinogen after tobacco. The hepatitis B virus (HBV) is estimated to have infected more than two billion people worldwide, and about 360-400 million people are chronically infected (Fufore et al.,2016).It is also estimated that 400 million individual are carriers of the hepatitis B virus and more than a million people die annually from HBV related causes (Samuel et al., 2009).

The annual mortality due to HB infection estimated that between 0.61 million and one million every year, 4.5 million new cases are recorded worldwide. Seventy five to ninety five percent of cases of chronic HB carriers are from Africa and Asians origins. The prevalence of HBV varies across the globe particularly in developing countries; it ranges between2.1% and 7.1% in Ethiopia, 5%–30% in Kenya, 6%–30% in Bangladesh and 10% -40% in Nigeria (Fufore et al., 2016).

The disease was originally known as the “serum hepatitis” it has caused epidemic in part of Asia and Africa. Hepatitis B is endemic in china and in various part of Asia. The proportion of the world population infected with the virus is estimated as 3-6% but up to a third has been exposed (Baig et al., 2015). The high prevalence rate with it sequel such as cirrhosis of the liver and hepatocellular carcinoma make HBV infection a disease of major public health importance worldwide. More than three quarters of HBV infection occur in Asia, the Middle East and Africa. Although the prevalence of the HBV carriers varies between countries in the same continent, it can be broadly classified in to region of high endemicity of Hepatitis B serum Antigen (HBsAg prevalence 8%), intermediate (HBsAg prevalence 2-7%) and low (HBsAg 2%). HBV occurs frequently and is highly endemic in Nigeria (Samuel et al., 2009).HBV is transmitted through blood and blood products, body fluids, sharps, sexual intercourse and through vertical transmission. Health care workers (HCWs) are at higher risk of contracting the virus because of their exposure to sharp, blood and other body fluids (Fufore et al., 2016).

The prevalence of hepatitis B is increasing in the developing countries including Nigeria, while HB preventive measures are not practiced by many HCWs. There were studies that have been carried out mostly have focused on medical student and dentists on HBV, most of the studies were from the southern part of the country, only few of the studies conducted on general health care workers. Therefore, I intended to assess the knowledge, attitude and practices among health care workers toward hepatitis B infection at general hospital Gwarzo, Gwarzo local government, Kano state, Nigeria.

• Statement of the problem

Hepatitis B virus infection is an important occupational risk for health care workers; they are known to be at higher risk of the infection following needle stick injuries and accidental exposure to infected blood and other body fluids. Health care workers in Nigeria are particularly at increased risk of contracting HBV infection at their work place, because the country is holoendemic for the disease. HBV is by far the most dreaded and more infectious than the other blood borne pathogens. Estimate of the risk of a single needle stick injury indicated 30% risk of hepatitis B infection, 3% of hepatitis c infection, 0.3% risk of HIV infection. The risk of transmission of HBV from patients to HCWs is higher than the risk of transmission from HCWs to patients (Hassan et al., 2016).

The practice of modern medicine has adequately contributed to increasing the cases and spreading the disease in the society. It is common due to lapse in the sterilization technique of instruments or due to the improper hospital waste management as 10 -20% of health care waste is regarded hazardous and it may create variety of health risk. Among health care personnel, HBV is transmitted by skin prick with infected contaminated needles and syringes or through accidental inoculation of minute quantities of blood during surgical and dental procedures. Knowledge regarding HBV and safety precautions is needed to minimize the health care settings acquired infections among health personnel. Health care personnel should have complete knowledge of hepatitis B infection, importance of vaccination and practice of simple hygienic measures apart from that of specific preventive measures (Samir and Nazar, 2013).

• Research Question And Research Hypothesis

Research question 1

Is there any in equalities of knowledge, Attitude and Practices on Hepatitis B infection among Health care workers in relation to educational qualification?

Research hypothesis I

There is no any in equalities on knowledge, Attitude and Practices on Hepatitis B infection among Healthcare workers in relation to educational qualification.

Research question II

Is there any significance in relation to professional differences and of upper and lower cadre among Health care workers on Knowledge, Attitude and Practices towards Hepatitis B infection?

Research hypothesis II

There is no significance in relation to professional differences and of upper and lower cadre among Health care workers on Knowledge, Attitude and Practices towards Hepatitis B infection.

•  Research Objectives

The aim of the study is to assess the knowledge, attitude and practices among health care workers toward hepatitis B infection at General hospital Gwarzo, Kano state, Nigeria. Other objectives include:

1. To determine the level of knowledge, among health care workers at general hospital Gwarzo regarding HB infection, its transmission and preventive measures.
2. To determine the level of attitude of healthcare workers towards hepatitis B infection at general hospital Gwarzo.

• To assess the level of practices of health care workers towards hepatitis B infection at general hospital Gwarzo.

1.5 Significance of the study

The study will be more beneficial to health care workers and students there by motivating level of their knowledge, attitude and practices of hepatitis B infection. It will also improve the level of public awareness towards hepatitis B infection. The study would be of importance to the governments, institutions of higher learning, national and international organizations as well as other research institutions that may conduct a study on hepatitis B.

1.6 Scope of the Study

The aim of the study is to assess the knowledge, attitude and practices among health care workers toward hepatitis B infection at General hospital Gwarzo, Kano state, Nigeria. Other objectives include:

1.7 Limitation of the study

The study is limited to health care workers working at General hospital Gwarzo, especially those groups who are more exposed to patients bloods and blood products as well as other biological waste, this include: Medical doctors, nurses, community health practitioners, medical laboratory, environmental health professionals and health attendants.

1.8 Definition of key terms

Antibodies: Also known as immunoglobulin (Ig) is protein in nature produced by the body that is used by immune system to neutralized pathogens.

Antigen: A toxin or other foreign substance which induces an immune response in the body especially the production of antibodies.

Anorexia: In adequate food intake that lead to weight loss.

Attitude: Settled way of thinking or feeling about something.

Carrier: A person that harbors the infection without symptoms capable of transmitting the infection to another.

Community Health: Is a major field of study within the medical and clinical sciences which focuses on the maintenance, protection and involvement of health status of a population, group and communities as oppose to the individual patient, it is a distinct field of study that may be thought within a separate school of public health or environmental health.

Chronic Cancer: Cancers that spread or have come back in other part of the body.

Extrahepatic: Situated or originated outside the liver.

Fulminant: Severe and sudden unset of the disease symptoms.

Hepatitis B: Is a viral infection that attacks the liver and can cause both acute and chronic infection and put people at high risk from cirrhosis and liver cancer.

HBcAg: Hepatitis B core antigen.

HBeAg: (Hepatitis B sero positive antigen) an indicator of high level of viruses multiplication.

HBsAg: (Hepatitis B surface antigen) refers a positive or reactive HBsAg test result means that the person is infected with hepatitis B virus (called surface antigen) in the blood.

HCWs: Health care workers are professional staff working at General Hospital Gwarzo,Kano state.

Hepatocellular Carcinoma: (HCC) Also called malignant hematoma is the most common type of liver cancer.

Immunoglobulin (Ig): Are protein present in the serum and cells of the immune system which function as antibodies.

Knowledge: Facts information and skills acquired through experience or education.

Liver Cirrhosis: Is the severe scarring of the liver and poor liver function seen at the terminal end stage of chronic liver disease which is caused by long term exposure to toxins such as alcohol and viral infection.

Practice: Carryout or perform a particular activity, method or custom, habitually or regularly.

Sub-Clinical Manifestation: Have no recognizable findings, ie sign and symptoms.

Vertical Transmission: Infection transmission from mother—child during pregnancy or child birth.

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Full Project – Assessment of knowledge attitude and practices among health care workers towards hepatitis B infection in General Hospital