CHAPTER ONE
INTRODUCTION
Background to the study
Viral hepatitis is a term commonly used for several clinically similar yet etiologically and epidemiologically distinct diseases. Hepatitis A (formerly called infectious hepatitis) and hepatitis B (formerly called serum hepatitis) have been recognized as separate entities since the early 1940s and can be diagnosed with specific serologic tests. Delta hepatitis is an infection dependent on the hepatitis B virus (HBV). It may occur as a co-infection with acute HBV infection or as super infection of an HBV carrier (Ascherio, 2001). Hepatitis B virus (HBV) infection is an important health problem in developing countries, including Nigeria. According to World Health Report 2000, it is estimated that HBV infection accounts for about 600 000 disability adjusted life years (DALY) and about 31 000 deaths annually in South Nigeria. About 4% of the population are estimated to be carriers of HBV, giving a total pool of approximately 36 million carriers in Nigeria. HBV is reported to be responsible for 70% of cases of chronic hepatitis and 80% of cases of cirrhosis of the liver. About 80% of Nigerian patients with hepatocellular carcinoma have hepatitis virus associated liver disease (Dhir, 1997). HBV infection is predominantly acquired at an early age in developing countries, which includes vertical transmission from mother to child, perinatal transmission, and horizontal transmission from child to child. However, HBV can also be transmitted sexually and sexual transmission, both heterosexual and homosexual, accounts for a majority of the transmission occurring in adult life.
Numerous studies have reported high prevalence of HBV markers in subjects practising risky sexual behaviour, like STD patients and commercial sex workers. A high prevalence of HBV infection has also been reported among individuals practising risky behaviours and HIV infected individuals in Nigeria. However, a majority of such reports were based on the presence of HBV surface antigen only. Though spouses of HBV carriers were shown to have higher risk of HBV acquisition, limited data are available with regard to the extent of sexual transmission of HBV. Data on incidence of HBV infection in STD patients and other population are not available from Nigeria (Tandon, 1996).
Mast and Ward (2008), states that HBV as well as HIV can be transmitted sexually. Dual infection of HIV and HBV can lead to reactivation of HBV infection and also increase in replication of HIV. Currently, STD control programmes in Nigeria do not generally include administration of hepatitis B vaccine to STD patients. Therefore, this study was undertaken to assess the prevalence and incidence of hepatitis B infection, as well as the HBV risk determinants among patients attending three urban STD clinics in Pune.
Epidemic jaundice was described by Hippocrates in the 5th century BCE. The first recorded cases of serum hepatitis, or hepatitis B, are thought to be those that followed the administration of smallpox vaccine containing human lymph to shipyard workers in Germany in l883. In the early and middle parts of the 20th century, serum hepatitis was repeatedly observed following the use of contaminated needles and syringes. The role of blood as a vehicle for virus transmission was further emphasized in 1943, when Beeson described jaundice that had occurred in seven recipients of blood transfusions. Australia antigen, later called hepatitis B surface antigen (HBsAg), was first described in 1965, and the Dane particle (complete hepatitis B virion) was identified in 1970. Identification of serologic markers for HBV infection followed, which helped clarify the natural history of the disease. Ultimately, HBsAg was prepared in quantity and now comprises the immunogen in highly effective vaccines for prevention of HBV infection (Kane, 1993).
HBV is a small, double-shelled virus in the family Hepadnaviridae. Other Hepadnaviridae include duck hepatitis virus, ground squirrel hepatitis virus, and woodchuck hepatitis virus. The virus has a small circular DNA genome that is partially double-stranded. HBV contains numerous antigenic components, including antigen of the hepatitis B virus (HBsAg), hepatitis B core antigen (HBcAg), and hepatitis B e antigen (HBeAg). Humans are the only known host for HBV, although some nonhuman primates have been infected in laboratory conditions. HBV is relatively resilient and, in some instances, has been shown to remain infectious on environmental surfaces for more than 7 days at room temperature.
An estimated 2 billion persons worldwide have been infected with HBV, and more than 350 million persons have chronic, lifelong infections.
. It is the cause of up to 80% of hepatocellular carcinomas. The World Health Organization estimated that more than 600,000 persons died worldwide in 2002 of hepatitis B-associated acute and chronic liver disease (Lewis, Shinefield, and Woodruff, 2001).
Statement of the problem
Hepatitis B virus (HBV) infection is a major public health problem and one of the most common infectious diseases in African. The prevalence of chronic HBV infection varies widely in different parts of the world. Nigeria is one of the countries with intermediate endemicity in the African region of the World Health Organization. Hepatitis B seropositivity varies between 2% and 7% in the regions with intermediate endemicity. Many people, especially expectants mother are infected with hepatitis B Virus as a result of their unguided sexuality and lack of proper education, awareness program and information about hepatitis B virus. The HB virus is pre-dominant among pregnant women, who serve as primary carrier of the virus to their unborn babies and health worker that are exposed at the time of delivery. This research work is to examine sexual activity and level of education as a determinant of high incidence of hepatitis B virus among pregnant women with a specific interest on its effects, causes, symptoms, preventive measures and treatment.
Research Questions
The following research questions were raised for this study
1, Will sexual activity and level of education be a determinant factors for increase HBV among pregnant women in Lagos metropolis?
- Do HBV have any significant health effect on the unborn baby?
- What are the implications of unguided sexual activity on women in Lagos metropolis?
- How can the pregnant women in the metropolis increase their knowledge about sexual activity and HBV?
- How can HBV be prevented during sexual activity among women in Lagos metropolis?
HYPOTHESES
1 Sexual activity and level of education are not the determinant factors for increase HBV among pregnant women in Lagos metropolis.
2 High incidence of Hepatitis B virus has no relationship between pregnant women level of education and their sexual activity.
3 Hepatitis B virus does not have any significant health effect on the unborn baby.
4 Unguided sexual activity does not have any implication on women in Lagos metropolis.
5 There is no significant relationship between adequate knowledge about sexual activity and Hepatitis B virus.
6 Hepatitis B virus can not be prevented during sexual activity among pregnant women in Lagos metropolis.
7 Proper management and preventive will not drastically reduce the high incidence of Hepatitis B virus among expectant mothers.
8 There is no significant relationship between ignorance and high incidence of Hepatitis B virus among pregnant women.
SCOPE OF STUDY
The study examines Sexual activity and level of education as determinants of high increase of HBV among pregnant women in Lagos Metropolitan City.
DELIMITATION OF THE STUDY
This study was delimited to the following:
- some selected pregnant women in the Lagos metropolis, Lagos, as target population of study.
- Cross-sectional describe survey research design.
- Systematic stratified sampling technique.
- A self develop and well structured questionnaire as research tool.
- Descriptive statistics of simple percentage and inferential statistics of Chi-Square were used to test the hypotheses formulated at 0.05 level of significance.
- Two trained research assistants.
SIGNIFICANCE OF THE STUDY
This research work rest on government, health sector and the general public, most especially the expectant mothers. The outcome of which is to provide database for intervention and bail out strategy to reduce HBV infections and promote healthy living among pregnant women in particular and the public in general.
The work will also inform the expectant mothers on the danger of contacting hepatitis B virus to them and their unborn baby.
This work will also be of great usefulness to both government and non-governmental organization and all health related sectors in the provision of adequate information about the incidence of the virus most especially among pregnant women, using Lagos metropolis as the research area.
It will also provide explicit information on the cause, symptoms, preventive measures and possible treatment of the diseases.
Finally, the research work aim at proposing how this diseases can be reduce among expectant mothers in Lagos metropolis and around the world.
OPERATIONAL DEFINITION OF TERMS
These following concepts which are frequently used in this study were given operational definitions. This is to avoid is interpretation of concept:
HEPATITIS B: Is a liver disease.
INFLAMMATION: Is the painfully, red swelling that results when tissues of the body become injured or infected.
LIVER: Is an organ of the body that does many things.
VIRUS: Is any of various types of germs that are smaller than known bacterial, can grow on body cells and are a cause of disease.
H.B: Hepatitis B
H.B.V: Hepatitis B Virus.
PREGNANT WOMEN: Is a female being (human) who carry unborn young in the womb.
EXPECTANT MOTHER: Is also a female being (human) who carrying unborn young in the womb.
SYMPTOM: It is something that is a sign of a particular disease.
INFECTION: Is the process of infecting or state of being infected
VIRAL: Is a disease caused by Virus?
INCIDENCE: It means the frequency and extent of an occurrence.
HIGH: Means great which is associated with very much of something.
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