Table of
contents
CHAPTER
ONE
INTRODUCTION
Background
of study
Statement
of the Problem
Purpose of the Study
Research Questions
Research Hypotheses
Significance of the Study
Delimitation of the study
Scope of the Study
Definition
of Terms
CHAPTER TWO
LITERATURE REVIEW
Introduction
Concept
of Hepatitis B Virus
Discovery
of Hepatitis B virus
Transmission
of Hepatitis B Virus
Risk
of Hepatitis B viral infection
The
Prevalence of Hepatitis B Virus Infection among Health Workers
Knowledge
about Hepatitis B Infection among Health Workers
Prevalence
of Hepatitis B Vaccination among Health Care Workers in Nigeria
Barriers
to HBV Vaccination among Health Care Workers in Nigeria
Factors
that Can Enhance Vaccine Completion among Health Care Workers in Nigeria
CHAPTER
THREE
RESEARCH METHODOLOGY
Research
Design
Population
and Sampling Procedures
Research
Instrument
Data
Collection Techniques
Validation
of Instrument
Reliability
of Instrument
Method
of Data Analysis
CHAPTER
FOUR
DATA
ANALYSES AND RESULTS
Introduction
Descriptive
Analysis of Respondents’ Gender and Age Range
Hypotheses
Testing
Summary
of Findings
Discussion
of Findings
CHAPTER
FIVE
DISCUSSION
OF FINDINGS, SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Introduction
Summary
of the Study
Conclusions
Recommendations
Suggestion
for Further Studies
REFERENCES
APPENDIX
CHAPTER ONE
INTRODUCTION
Background
of study
Hepatitis B (HB) is a global public health
problem and is one of the most common infectious diseases in the world. HB
infects nearly 2 billion people around the globe, out of which 350 million
suffer from chronic, lifelong infection. Around 15%–40% of chronic HB patients
are susceptible to develop liver cirrhosis and hepatocellular carcinoma (Lok &
Mcmahon, 2007). In the United States, 804,000-1.4 million persons are estimated
to be infected with the HBV, with majority being unaware of their status.
Hepatitis B virus (HBV) is a major cause
of morbidity and mortality worldwide causing 620,000 deaths per year. It is
responsible for approximately 1.5 million deaths worldwide each year,
two-thirds of which are due to hepatocellular carcinoma. The World Health
Organization estimated the hepatitis B surface antigen (HBsAg) prevalence in
the Eastern Mediterranean region, which includes Middle East to be from 1%–10%,
making it a region of intermediate to high endemicity. Safe and effective
vaccine is available for prevention of HB, the first anticancer vaccine to be
developed. Physicians, dentists, nurses, laboratory staff, and other hospital
staff are at high risk of acquiring infection via the contact with blood and
other body fluids (Centers for Disease Control and Prevention, 2007).
Hepatitis B is a small envelope DNA virus.
It was originally known as ‘serum hepatitis. It is transmitted through contact
with the blood or body fluids (saliva, sweat, semen and vaginal fluid) of an
infected person. Other risk factors for HBV infection include working in a
healthcare setting due to the risk of needle pricks, contact with infected
blood; blood transfusions, dialysis, sexually transmitted, acupuncture, use of
contaminated needles among injecting drug users, sharing of razor blades,
tattoo, flared toothbrushes which can breech the oral mucosa and travel in
countries where it is endemic ( Kew,2010).
HBV infection is highest in sub Africa and
hyper endemic in Nigeria with 14% of the population in Nigeria being exposed
to HBV. 2–5% of the general population in the Middle East and the Indian
subcontinent have been found to be chronically infected. This proportion is
larger compared to less than 1% of the population in Western Europe and North
America that are chronically infected ( WHO, 2015).
The World Health Organization has
classified Ireland as a country of low prevalence for HBV, i.e. prevalence of
HBsAg<2%. In Europe, the total percentage of people infected with HBV varies
between different countries, with higher rates in the southern part of Europe.
The country with the highest prevalence (>4%) is Romania followed by medium
prevalence countries (>1-2%), Spain, (parts of) Italy, and Greece. Belgium,
Finland, Germany, Ireland, Sweden and Slovak have been identified as countries
with a low prevalence of HBV (ECDPC, 2010).
Approximately one health care worker dies
each day from hepatitis B. Hence, HBV accounts for a major occupational hazard
for health care workers due to their regular exposure to blood, blood products
and body fluids, although, the concentration of hepatitis B virus in different
body fluids varies. It is high in blood, serum, wound exudates; moderate in
semen, vaginal fluid, saliva, and low/not detectable in urine, faeces, sweat,
breast milk, tears which are all the working medium of health care workers especially
doctors, nurses, medical laboratory scientists ( OSHA,2011).
More so, the risk of HBV infection in an
unvaccinated person from a single HBV-infected needle stick injury ranges from
6-30%. According to Rampal, Zakaria, Sook and Zain (2010), the risk exposure
varies among the HCWs but exposure rate is higher among the nurses due to a
number of activities they are involved in more than others. This is also in
line with Ndakoda (2014), who reveals that the prevalence of HBV tends to be
high among personnel with high proximity to blood and body fluids. Elmulkasfi
(2012), has also established the fact that there is association between
occupation and type of department and the rate of getting HBV. In the
industrialised world, occupational surveillance assess and monitor the health
hazards related to blood borne pathogens and preventive measures to reduce the
risk of transmission but this is in contrast to what we have in the developing
countries where exposure and health impacts are rarely monitored and much remains
to be done to protect health workers from such risk that causes infection
(Ndako, 2014).
According to Okwara (2012), there’s is
poor adherence to safety practices among health care personnel in Nigeria which
contribute to the risk of Needle Prick Injuries and majority of health care
workers who have had needle prick injuries never take post exposure prophylaxis
(PEP) despite the fact that they are aware of this PEP. Hepatitis B is
preventable with the currently available safe and effective vaccine, usually a
recombinant type. The vaccine has been available since 1982 and it’s effective
in preventing infection and its chronic denouement. It was the first vaccine
against a major human cancer. World Health Organization recommends that all
infants receive the hepatitis B vaccine as soon as possible after birth,
preferably within 24hours. If missed, the child can take it 6weeks after, as
part of pentavalent regime. For adults, the recommended outright vaccination
still remains a three-dose regimen, with the second and third doses at 1and 6
months after the first dose. A post vaccination test is required to verify the effectiveness
and a booster dose is needed after 5years (Poland and Jacobson, 2004).
Those to be vaccinated include: Everyone
but especially health-care workers, people who frequently require blood or
blood products, dialysis patients, recipients of solid organ transplantations,
people interned in prisons and internally displaced persons in camps, injecting
drug users; people with multiple sexual partners and travellers. Travellers who
have not completed their hepatitis B vaccination series should be offered the
vaccine before leaving for endemic areas (Odusanya and Meurice, 2007). It is on
this note that the study examines a perception of health workers on hepatitis B
virus.
Statement
of the Problem
Hepatitis
B is the most important infectious occupational disease that health workers are
exposed to (Samuel, Aderibigbe, Salami, &Babatunde, 2009). The risk of
being infected is dependent on the prevalence of the virus carriers in the
environment, the frequency of exposure of the health worker to blood and body fluid
and the infectivity of the hepatitis B virus. Health workers, in Nigeria are
particularly at increased risk because Nigeria is a holoendemic area, with a
hepatitis B virus carrier rate of 15.37%.
Hepatitis
B virus (HBV) infection threatens the health of populations across the globe.
An estimated 240 million people are chronically infected and more than 780,000
people die every year due to complications of hepatitis B including cirrhosis
and liver cancer (WHO, 2015).Approximately one third of all cases of cirrhosis
and half of all cases of hepatocellular carcinoma can be attributed to chronic
HBV infection, and the disease is estimated to be responsible for
50,000-700,000 deaths each year (Shepard et al., 2006; WHO, 2004). The risks
and preventive measures against occupational exposure of HCWs to blood borne
pathogens are well documented. Although, universal precautions were established
many years ago to address this problem, their application is difficult in
developing countries, owing to organizational problems and lack of necessary
materials such as gloves and proper needle disposal facilities (Le Pont et al.,
2003).
Reports
from studies conducted in health facilities across Nigeria show high prevalence
of injury from sharps and accidental exposure to potentially infected blood and
body fluids, while use of personal protective equipment was found to be low due
to unavailability, inadequate or irregular supply of materials and equipment
needed for protective and hygienic practices in most of the health facilities
(Adesunkanmi et al., 2003; Ansa et al., 2002). Therefore, the researcher tends
to investigate the perception of health workers on the effect of Hepatitis B
virus
Purpose of the Study
The purpose of this research is to investigate perception of health workers on hepatitis B
virus with focus on LASUTH and Ikeja
General Hospital .The following objectives are to achieve the purpose of the study.
1.
To identify the
knowledge of transmission of hepatitis B among health workers.
2.
To determine the attitude of health workers towards hepatitis B
infection.
3.
To examine the risk perception of hepatitis B virus infection among
health workers.
4.
To determine the prevalence of hepatitis B vaccination among health
workers.
5.
To identify ways of preventing hepatitis B infection among health
workers.
Research Questions
The study will raise
the following question in the course of the study:
1. What are the knowledge of transmission of hepatitis B
among health workers?
2. What is the attitude of health workers towards
hepatitis B infection?
3. What is the risk perception of hepatitis B virus
infection among health workers?
4. What is the prevalence of hepatitis B vaccination
among health workers?
Research Hypotheses
H01: Knowledge will not significantly influence
the perception of health workers on the effect of Hepatitis B virus
H02: There is no significant difference in the attitude of health workers towards hepatitis
B infection
H03: There is no significant difference in the risk perception of hepatitis B virus
infection among health workers.
H04: There is no significant difference in the prevalence of hepatitis B virus
infection among health workers
Significance of the Study
This study might be
useful to health managers and planners to develop appropriate preventive
services, allocate resources, decide on priorities and target certain
populations as regard hepatitis B virus.
The study may provide
information on the routes of transmission of hepatitis B among health workers, attitude of health workers towards hepatitis
B infection, the risk perception of
hepatitis B virus infection among health workers,the prevalence of hepatitis B vaccination among health workers and the ways of preventing hepatitis B infection
among health workers.
Finally, the research
will also be of practical relevance to the government, non-governmental
organizations and social researchers who may be interested in this field of
study.
Delimitation of the study
The study will be delimited to the following
study
1. Descriptive research method
2. All health care workers in Lagos state
3. 150 respondents will be selected from LASUTH
through purposive sampling technique.
4. Descriptive statistic of frequency count and
percentage and inferential statistic of chi-square to test the stated
hypotheses
5. Self-structured questionnaire as instrument
for data collection.
Scope of the Study
The scope of this
study is to investigate
perception of health workers on hepatitis B virus with focus on LASUTH and
Ikeja General Hospital.
Definition
of Terms
Hepatitis
B Virus: Hepatitis B is a viral
infection that attacks the liver and can cause both acute and chronic disease.
The virus is transmitted through contact with the blood or other body fluids of
an infected person.
Infection:
An
infection is the invasion of bodily tissue by pathogenic microorganisms that
proliferate, resulting in tissue injury that can progress to disease.
Transmission:
Transmission is the passing of a pathogen
causing communicable disease from an infected host individual or group to a
particular individual or group, regardless of whether the other individual was
previously infected.
Health
Workers: Health workers are all
people engaged in actions whose primary intent is to enhance health.
Attitude:
Attitude is a predisposition or a tendency to
respond positively or negatively towards a certain idea, object, person, or
situation. Attitude influences an individual's choice of action, and responses
to challenges, incentives, and rewards (together called stimuli).
Risk
Perception: Risk
perception is the subjective judgement that people make about the
characteristics and severity of a risk.
Knowledge:
Knowledge is a familiarity, awareness or
understanding of someone or something, such as facts, information,
descriptions, or skills, which is acquired through experience or education by
perceiving, discovering, or learning.
Vaccination: Vaccination is the administration of antigenic
material (a vaccine) to stimulate an individual's immune system to develop
adaptive immunity to a pathogen. Vaccines can prevent or ameliorate morbidity
from infection. When a sufficiently large percentage of a population has been
vaccinated, this results in herd immunity.
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