The study investigates Nurses Knowledge and
Preventive Measures of Hepatitis B Virus with focus on LASUTH and Ikeja General Hospital. In this study, some relevant and extensive
literatures were reviewed under relevant sub-headings. The descriptive research
survey was used to assess the respondents’ opinions using the questionnaire and
the sampling technique. In this study, 50 (fifty) respondents were selected and
used as samples to represent the population of the study. Four (4) null
hypotheses were formulated and tested in this study. Also, the statistics of
analysis of variance (ANOVA) was used to test and analyses the null hypotheses
at 0.05 level of significance, at the end of the exercise, the following
results were obtained: Hypothesis one revealed that Knowledge will significantly influence the perception of health workers
on the effect of Hepatitis B virus;
Hypothesis two also indicated that there is a significant difference in the attitude of health workers towards hepatitis B infection; Hypothesis three further indicated that there is a significant difference in the risk perception of hepatitis B virus
infection among health workers and Hypothesis
four finally indicates that there is a significant difference in the prevalence of hepatitis B virus infection among health workers. Based on the findings
from the study the following conclusions were drawn that Hepatitis B virus is an important occupational
hazard for health workers. This study seems to buttress that by the fact that a
majority of the respondents demonstrated a high level of knowledge of hepatitis
B infection, the routes of transmission of the infection, the ways of
preventing the infection and the fact that the infection can be transmitted as
a nosocomial infection. Recommendations were made on the basis of the findings of
this study which include the following: Nationwide
vaccination campaign against hepatitis B in high risk groups especially HCWs.
Nigeria government has greatly improved in vaccination of children against HBV,
the next step could be to consider adults at risk, such as HCWs, hairdressers,
motorist, etc and targeted vaccination should be done for such group; Nigeria
government should further ensure that there should be a written policy on
hepatitis control in all hospitals; hence, they should be encouraged to adopt
standard precautions, to use safety devices and other personal protective equipments
there is need for health workers to take standard precaution against this
deadly virus and Government should ensure that Post-exposure management be put
in place in hospital settings so that it can be centrally initiated, promptly,
as and when required. Similar to HIV prophylaxis there must be a centralized
counselling, testing, vaccination, and treatment facility that is widely
advertised, and the location and contact numbers must be displayed at most
visible sites of the hospital premises and made available round the clock.
Keywords: Nurses, Knowledge, Preventive Measures, Hepatitis
TABLE OF CONTENTS
of Contents vi
CHAPTER ONE: INTRODUCTION
Background of Study 1
Statement of the Problem 4
Purpose of the Study 6
Research Questions 6
Research Hypotheses 6
Significance of the Study 7
Delimitation of the study 7
Scope of the Study 8
Definition of Terms 8
CHAPTER TWO: LITERATURE REVIEW
Concept of Hepatitis B Virus 10
Discovery of Hepatitis B Virus 15
Transmission of Hepatitis B Virus 25
Risk of Hepatitis B viral infection 27
The Prevalence of Hepatitis B Virus
Infection among Health Workers 29
Knowledge about Hepatitis B Infection
among Health Workers 36
Prevalence of Hepatitis B Vaccination
among Health Care Workers in Nigeria 41
Barriers to HBV Vaccination among Health
Care Workers in Nigeria 47
Factors that Can Enhance Vaccine
Completion among Health Care Workers in Nigeria 37
CHAPTER THREE: RESEARCH
Research Design 50
Sampling Procedures 51
Method of Data
CHAPTER FOUR: DATA ANALYSES AND RESULTS
Analysis of Respondents’ Gender and Age Range 54
Hypotheses Testing 60
CHAPTER FIVE: DISCUSSION OF FINDINGS, SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Summary of the
Further Studies 71
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
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,
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,
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
of the Problem
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%.
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.,
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
Purpose of the Study
The purpose of this
research is to investigate nurses knowledge and preventive measures of hepatitis B virus with focus on LASUTH and Ikeja General Hospital .The following
objectives are to achieve the purpose of the study.
To identify the
knowledge of transmission of hepatitis B among health workers.
To determine the attitude of health workers towards hepatitis B
To examine the risk perception of hepatitis B virus infection among
To determine the prevalence of hepatitis B vaccination among health
To identify ways of preventing hepatitis B infection among health
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?
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
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
Delimitation of the study
The study will be delimited to the following
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
5. Self-structured questionnaire as instrument
for data collection.
Scope of the Study
The scope of this
study is to investigate nurses knowledge and preventive measures of hepatitis B virus with focus on LASUTH and
Ikeja General Hospital.
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 is the invasion of bodily tissue by pathogenic microorganisms that
proliferate, resulting in tissue injury that can progress to disease.
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
Workers: Health workers are all
people engaged in actions whose primary intent is to enhance health.
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).
perception is the subjective judgement that people make about the characteristics
and severity of a risk.
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.