INTRODUCTION
Hepatitis
B virus (HBV) infection presents a significant worldwide threat and poses
considerable public health concern, impacting approximately 10% of the global
population. It is vaccine preventable and around 400 million individuals
worldwide are chronic carriers, leading to over a million deaths each year due
to associated complications.[1]
HBV belongs to the Hepadnaviridae family and
is characterized by its double-stranded DNA structure. Humans serve as the only
primary host, with the virus present in the bloodstream at concentrations
reaching up to 108 virions per ml. Its spread is through percutaneous or
mucosal contact with infected bodily fluids, including sexual intercourse and
intravenous drug use. Additionally, nosocomial transmission of HBV has been
observed [2].
HBV is said to be the most infectious
occupational hazard seen among healthcare workers (HCWs) [3]. Contact with
bodily fluids like blood, urine, semen/vaginal fluids, and cerebrospinal fluids
poses a substantial risk of contamination, particularly for viral diseases [4].
Many HCWs encounter the risk of Hepatitis B and C infections as they perform
their duties, often through percutaneous transmission resulting from
needlestick injuries or cuts from contaminated sharp objects.
HBV infection is particularly widespread in
certain regions, notably in developing countries where it is endemic. In
Africa, an estimated 60 million individuals are affected by Hepatitis B virus
[5]. In Nigeria, its prevalence ranges from 11% to 13.7% and it is estimated
that approximately 20 million Nigerians are living with chronic HBV infection
[6]. The worldwide spread of viral hepatitis surpasses that of HIV by a factor
of 10, making chronic viral hepatitis the second most lethal infectious disease
after tuberculosis [7,8]. Various prevalence rates are documented across
different demographics [9,10,11]. Among healthcare workers, prevalence rates
range from 9.6% to as high as 24.4% among those who have not been vaccinated
[12,13,14]. Despite these statistics, characteristics that are likely to
contribute to transmission of HBV infection is rife in Nigeria. These factors
include insufficient understanding of hepatitis B virus infection, lack of
effective safety protocols to prevent its transmission, [15] and low
participation in vaccination programs [16,17].
Knowledge is usually the first step towards
modification of behaviour conducive to health. Regarding Hepatitis B virus
infection, the awareness of its risk and the implementation of safe practices
among healthcare workers play a vital role in reducing the prevalence and
transmission of the infection. Vaccination is an effective preventive measure
against hepatitis B virus infection. In Nigeria, HB vaccination was first
introduced in 1995 but became integrated into the National Programme of
Immunization (NPI) in 2004.[18,19] Although children are protected from HBV
infection by HBV immunization under the NPI schedule, unvaccinated adults
remain unprotected and at risk of infection as there are no public funded
programmes targeting HBV infection for adults.[20] The participation of
healthcare workers in vaccination programs has been notably inadequate [21,22].
Past research on hepatitis B virus infection
worldwide has primarily concentrated on its prevalence among medical doctors,
students, nurses, laboratory personnel, and other healthcare workers in
healthcare settings [23,24]. Studies focusing on the awareness of hepatitis B
vaccination and its uptake among adults in South-South Nigeria is limited,
despite their vulnerability to the infection [17]. Therefore, this pilot study
is aimed at assessing the awareness of hepatitis B vaccination and its uptake among
adult in a tertiary health facility in South-South Nigeria.
METHODOLOGY
Study Area
The
study was carried out at Rivers State University Teaching Hospital (RSUTH) Port
Harcourt, South-South Nigeria. Historically RSUTH began in 1925 as Braithwaite
Memorial Hospital (BMH) which was established by the Colonial Administrators to
provide healthcare services to the colonial masters and senior civil servants.
It is a government-owned tertiary healthcare facility located in Port Harcourt,
Rivers State, Nigeria. Currently, it is a 571-bed specialist hospital that
provides healthcare services in Rivers State. It receives referrals for medical
services from other healthcare facilities within and without the State in
addition to providing extensive medical training and education in the
South-South Nigeria. The facility as a centre for training of health manpower,
carries out health sensitization programs on International Days. The
predominant language spoken in the State is English, pidgin English, Ikwerre,
along with other local dialects.
Study Design
A
descriptive cross-sectional study design was employed for this study.
Study
population
A
purposive sample of 260 consenting hospital personnel, adult patients and
caregivers who attended the 2023 World Hepatitis Day celebration in RSUTH.
Data Collection: An interviewer
administered structured questionnaire, validated by the researcher and a
statistician was used to collect information from hospital personnel, adult
patients and care givers who attended 2023 world hepatitis day program at
RSUTH. The information obtained from participants who gave consent for the
survey were on their socio-demography, history of
previous vaccination against HB virus, awareness of HB vaccination, outcome of
the HB screening exercise at the world hepatitis Day program and uptake of HB
vaccine by participants who tested negative on the HB screening test.
Screening for HBV was done using HBsAg Rapid Test stripes (LabACON model)
donated by Emzor Pharmaceutical Industries Ltd.
Data Analysis: The data collected
was collated and entered into IBM Statistical Package for Social Sciences
(SPSS) Version 23.0 used for analysis. Categorical variables were presented as
percentages and continuous variables as mean and standard deviation. The primary outcome variables were awareness
of HB vaccination determined as proportion of participants who have heard of HB
vaccination, and uptake of HB vaccination determined as proportion of
seronegative participants who received HB vaccination following the screening
test. Chi-square test and logistic regression analysis was done to determine
factors associated with these outcome variables. The level of statistical
significance was set at p < 0.05.
Ethical
Consideration
Ethical
approval for this study was obtained from the Ethics and Review Committee of the Rivers State University Teaching
Hospital Port Harcourt, Nigeria. Participants were assured of their safety and
confidentiality of their information and subsequently obtained their written
informed consent.
RESULT
Majority
(n = 78, 30.0%) of the participants were adults aged 60 years and above, mean
age (SD) was 41.2 ±13.9 years, 175 (67.3%) were females and 69 (26.5%) were
public servants (Table 1).
Approximately
three-quarter (n = 192, 74%) of the participants have the awareness of HB
vaccination (Fig. 1).
Almost all (n = 256, 98%) the participants
were seronegative with only 4 (2%) testing positive (Fig
2)
Among the participants who were HB
seronegative, only 20 (8%) had a history of
previous HB immunization (Fig 3)
Among the
participants who were seronegative for HBV, only 12 (5%) accepted HB
vaccination. (Fig 4)
Table 2 shows that there is a statistically significant association between awareness of HB
vaccination and age (p < 0.000), occupation (p < 0.000), outcome of
screening (p = 0.025) and whether the participant has been previously immunized
(p = 0.025).
Table 3 shows that participants below 20 years were approximately 16
times more likely to have the awareness of HB vaccination compared to those who
are 60 years and above (OR = 14.54; 95% CI 2.760 - 76.629), those who were
seropositive were 13 times more likely to be aware of HB vaccination compared
to those seronegative (OR = 13.063; 95% CI 1.232 138.541), Public servants
were about 19 times more likely to have heard of HB vaccination compared to
others (OR = 19.427; 95% CI 2.386 158.196) and participants who were not previously
immunized are about 11 times less likely
to have the awareness of HB vaccination compared to those who have been
previously immunized (OR = 0.088; 95% CI 0.011 0.735).
Table 1:
Sociodemographic characteristics of attendees of 2023 World Hepatitis Day
programme in RSUTH Port Harcourt
|
Variables
|
Frequency
(n = 260)
|
Percentage
|
|
Age
|
|
<20
|
10
|
3.8
|
|
20
-29
|
38
|
14.6
|
|
30
39
|
44
|
16.9
|
|
40
49
|
58
|
22.3
|
|
50
59
|
32
|
12.3
|
|
60
and above
|
78
|
30.0
|
|
Mean
(SD) in years
|
41.2
(13.9)
|
|
Sex
|
|
Male
|
85
|
32.7
|
|
Female
|
175
|
67.3
|
|
Occupation
|
|
Doctor
|
39
|
15.0
|
|
Healthcare
worker
|
37
|
14.2
|
|
Self
employed
|
59
|
22.7
|
|
Students
|
34
|
13.1
|
|
Public
servants
|
69
|
26.5
|
|
Others
(Retirees, Clergy, Farmer, Lawyer, applicant, driver)
|
22
|
8.5
|
DISCUSSION
This pilot survey conducted among 260 participants
of the 2023 World Hepatitis Day program at RSUTH Port Harcourt sought to assess
the awareness and uptake of hepatitis B vaccination in Rivers State Nigeria.
The awareness of HB vaccination was found to be high with 74% of the
participants reporting having heard of HB vaccination. This finding may reflect
the health awareness creation and sensitization efforts of the government and
non-governmental agencies in Nigeria like the annual World Hepatitis Day program
supported by mass media.[25] This high level of awareness has been reported in
other studies. For instance, the level of awareness of HB vaccination among
medical students was found to be 88% in University of Jos, 97.3% in Cameroun,
100% in University of Port Harcourt Teaching Hospital Port Harcourt. The high
awareness of HBV vaccination in these populations may be due to their
occupational vulnerability to the infection, the demand for pre-employment HBV
vaccination by their institutions and also as a content of their curriculum for
training as medical students. The awareness of HB vaccination was reportedly
low in another study in Nigeria where Eni et al (2019) found that only
32% of the adult population had the awareness of HB vaccination. [26] The
finding of a low level of awareness of HBV vaccination in this study may be
because the study was carried out among the general population whose exposure
to HBV infection and perception its risk is low.
This study showed
that there is a statistically significant association between awareness of HBV
vaccine by participants and their occupation, age, outcome of HBV screening and
history of previous vaccination. Participants below 20 years were approximately
15 times more likely to have the awareness of HB vaccination compared to those
who are 60 years and above (OR = 14.54; 95% CI 2.760 - 76.629), those who were
seropositive on HBV screening test were
13 times more likely to be aware of HB vaccination compared to those who were
seronegative (OR = 13.063; 95% CI 1.232 138.541), Public servants were about
19 times more likely to have heard of HB vaccination compared to others (OR =
19.427; 95% CI 2.386 158.196). However, participants who were not previously
immunized are about 11 times less likely to have the awareness of HB
vaccination compared to those who have been previously immunized (OR = 0.088;
95% CI 0.011 0.735).
The prevalence of
HBV in this study was found to be 4%. This finding is consistent with the
prevalence of 4.5% reported by Simidele et al (2018) among staff of a tertiary
health facility in Ado Ekiti Nigeria.[21] However, it is lower than the
prevalence of more than 8% reported in countries of Africa and higher than the
2.4% reported among HCW in Enugu and less than 2% found in developed
countries.[25,27]
There was low
uptake of HB vaccination in this study despite the high level of awareness. It
has been reported that vaccine refusal rate was highest among high-risk
individuals.[25] Only 5% of the seronegative participants in this study
received HB vaccination following the outcome of the screening test. Fatusi et
al (2000) similarly reported low vaccination rate among clinical staff of a
tertiary health facility in Nigeria despite their high level of awareness of
HBV vaccine.[17] The Uptake of HB vaccination was 14.2% among HCW in
Enugu[27]This finding is better compared to our result and may be largely due
to differences in population studied. Furthermore, the low uptake of HB
vaccination may be due to vaccine apathy which may reflect the poor HBV risk
perception of participants. Chingle et al (2017) found that in
University of Jos, the risk perception of HB vaccine among Public
Administration students, with low level of awareness of HB, was poorer compared
to medical students and so was the uptake of HB vaccination. Public Administration students were four
times less likely to receive HB vaccination than medical students with better
risk perception and knowledge of HB infection. [20]
Other reasons for poor vaccination have been
reported as fear of side effect, fear of needles, negative test result being
interpreted as not warranting vaccination, procrastination, long immunization
schedule, not knowing where to access vaccine, high cost of vaccine, lack of
time, stigmatization of HB infection, cultural biases and misconceptions on
vaccines and no reason in some cases.[25,20, 27,26,28,29,]
CONCLUSION
This pilot study showed that there was high level of
awareness of and poor uptake of HB vaccination among participants of 2023 World
Hepatitis Day program at Rivers State University Teaching Hospital, Rivers
State. This finding may reflect on the
status of HB vaccination in the general population. Concerted efforts to change
the behaviour of adults who are occupationally at risk of HB infection should
be made by the government.
Declarations
Conflict
of interest: There was no conflict of interest among the authors.
Authors
Contribution:
BOO: Conceptualization, design of the study, data
analysis, final draft
AIB: Data collection, interpretation of data,
initial draft, review of final draft
UAO: Literature search, Data collection, review of
initial and final draft,
IY: Literature search, Data collection, review of
final draft
Acknowledgment:
The authors acknowledge staff of Community Medicine
Rivers State University Teaching Hospital Port Harcourt for their cooperation
during the 2023 World Hepatitis Day celebration.
Funding:
The authors solely funded this research.
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