KNOWLEDGE OF HEPAPITIS C DISEASE AMONG

PREGNANCY AND NON PREGNANACY WOMEN

ATTENDING PRIMARY HEALTH CARE CENTRE IN
KAGARA, LOCAL GOVERNMENT AREA, NIGER STATE.

May, 2021.

CERTIFICATION

I certify that this research project was carried out by NUHU ANAS DCH/2018/094 in the
department of community health extension workers, Faculty of Medical Sciences Caritas School
of Health Technology, Minna, Niger State. The department recognizes that NUHU ANAS
DCH/2018/094 bears full responsibility for this work.

……………………………. ……………………
Nuhu Anas
Student Date

……………………………… …………………...
MLS. Nnamdi Williams Date
Supervisor
1
…………………… …………………
MLS. Adama Dauda
Date
Head of Department

DEDICATION

Dedicated to almighty Allah for his love and mercy.

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 ACKNOWLEDGEMENT

My appreciation goes to my supervisor MLS. Nnamdi Williams for his painstakingly

supervision, encouragement and his assistance. I wish to thank my HOD Dauda Adama and my

entire lecturers in the SHT Minna, for their inspiration and support. To everyone who contributed

in one way or the other to help me with this work and in partial fulfillment of my course; My

sincere appreciate go to my parents; Late father, Mallam Abubakar Yunusa Bokani, Dr Ahmed

Usman Bokani, Mama, Asha, My lovely mother Mallama Fatima Abubakar, Ya Ba’akatu, Ya

Sani, Ya Baliman, Ya Danladi, Balima, Ya Ibrahim, Ndatsunmadu, Nna lamin, Yunusa 1and 2,

Ballah Lafiyagi, Halidu, Umar Kolo , my siblings, course mates, roommates and most especially

Mustapha Dadda, Yusuf Edokota, Sadiq Agae, Usman Jiya Vunchi, Maryam Yusuf, Maryam

Dalhatu, Hussay, Felix, Rachael Gana, John Clement Barde, Mama Twins.

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 TABLE OF CONTENT

Title page i

Certification ii

Dedication iii

Acknowledgement iv

Table of content v

Abstract vii

1.0 Chapter One

1.1 Introduction 1

1.2 Objectives 4

2.0 Chapter Two

2.1 Mode of transmission and risk factors 5

2.2 Pathogenesis and incubation period 7

2.3 Epidemiology 8

2.4 Signs and symptoms 9

4
2.5 Diagnosis 9

2.6 Prevention and control 11

2.7 Treatment 12

2.8 Hepatitis C virus and pregnancy 12

2.9 Hepatitis C virus and HIV

16

3.0 Chapter Three

3.1 Material 18

3.2 Study population 18

3.3 Sample collection 18

3.4 Method 18

4.0 Chapter Four

4.1 Results 20

5.0 Chapter Five

5.1 Discussion 26

5.2 Conclusion 26

5.3 Recommendation 27

References 28

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 ABSTRACT

The project work was title prevalence of hepatitis C virus among pregnant and non pregnant

women attending Primary Health Care Tunga Minna, Niger State. Hepatitis C virus is the leading

cause of liver transplantation and is a risk factor for liver cancer. Experimental design was

adopted for this research. A simple random technique was used to select hundred (100) pregnant

and non pregnant women for this study. Samples were screened for hepatitis C viral infection

using the rapid one step hepatitis C virus test strip. Thirty five (35) out of 50 pregnant women

were positive, and fifteen (15) were screen negative for Hepatitis C, While thirty six (36) non

pregnant women were screen negative for hepatitis C out of 50 sample, only 14 were screen

positive. The infection was higher in older than younger age. Those aged 36-40 years recorded a

higher prevalence than those in the age group 18-25. This higher prevalence of hepatitis C

suggests that pregnant women may be at risk of hepatitis due to hepatitis C virus. Therefore

routine screening of pregnant women should be instituted for early diagnosis and management of

cases.

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 CHAPTER ONE
1.0 INTRODUCTION

1.1Bacground of the study

Hepatitis C infection is an infection of the liver caused by the hepatitis C virus (HCV). HCV is

one of several viruses that can cause hepatitis. 'Hepatitis' means inflammation of the liver (Ryan

and Ray.,2004).It is unrelated to the other common hepatitis viruses (for example, hepatitis A or

hepatitis B). HCV is a member of the hepacivirus genus in the family Flavi viridae. There are at

least six distinctly different strains of the virus which have different genetic profiles (genotypes).

In the U. S., genotype 1 is the most common form of HCV. Even within a single genotype there

may be some variations (genotype 1a and 1b, for example). Genotyping is important to guide

treatment because some viral genotype respond better to therapy than others (Wilkins et al.,

2009). According to Hepatitis C NSW (2010), here are some of the things that can happen once

the body contract hepatitis C. The body may deal with hepatitis C of its own accord and you may

7
never get sick. About 25% of all people who contact hepatitis C will clear the infection (although

this happen less commonly in people with HIV). For a range of reasons, hepatitis C infection is

eradicated from the body in these people, usually within 12 months of having been infected. 11

Hepatitis C may remain present in the body. About three quarters of people who contact hepatitis

C will be chronically infected. This means that they have detectable hepatitis C virus (measured

by a PCR test) in their blood for a period of longer than twelve months. People in this group may

be at risk of developing liver problems over time. The genetic diversity of HCV is one reason

that has been difficult to develop an effective vaccine since the vaccine must protect against all

genotypes. It is difficult for the human immune system to eliminate HCV from the body, and

infection with HCV usually becomes chronic. Over decades, chronic infection with HCV

damages the liver and can cause liver failure. Up to 85% of newly-infected people fail to

eliminate the virus and become chronically infected. Infection is most commonly detected

among people who are 40 to 60 years of age, reflecting the high rates of infection in the 1970s

and 1980s. There are 8,000 to 10,000 deaths each year in the U.S. related to HCV infection.

HCV infection is the leading cause of liver transplantation in the U.S and is a risk factor for liver

cancer. Most of the signs and symptoms of HCV infection relate to the liver. Less commonly,

HCV infection causes conditions outside of the liver. Symptoms are generally mild and vague,

including a decreased appetite, fatigue, nausea, fever. Headache, muscle or joint pains, and weir

12 becomes the primary cause of cirrhosis and liver cancer. About 10–30% of people develop

8
cirrhosis over 30 years (Meisel, et al.,1995). HCV infection can cause the body to produce

unusual antibodies called 'cryoglobulins'. These cryoglobulins cause inflammation of the arteries

(vacuities) which may damage the skin, joints, and kidneys. In addition, these patients may

develop Reynaud’s phenomenon in which the fingers and toes turn color (white, then purple,

then red) and become painful at cold temperatures (Iannuzzella, and Vaglio, 2010). Two skin

conditions, lichen planus and porphyria cutaneatarda, have been associated with chronic

infection with HCV. HCV also is associated with B-cell lymphoma, a cancer of the lymph

system. Doctors use various tests to determine if a person has hepatitis C. One type of test

measures antibodies in the blood, indicating that a person been exposed to HCV; the two most

common antibody tests are called ELISA and RIBA. Viral load tests measure how much HCV

genetic material is present in the blood; the two most common viral load tests are called PCR and

DNA.

1.2 STATEMENT OF PROBLEM

Predominantly, viral disease is one of the most infectious and widely spread diseases in many art

of the world, especially in African continent. Nigeria with the outbreak of viral diseases in our

environment, Food, Air, Body fluid contact and water and also with severe adverse effect in both

plants and animals including human beings it is good to practice good and hygiene, safety

precaution and control measures. Hepatitis C virus is one of the deadly infectious and widely

9
spread viral diseases in many part of the world. This disease attacked liver (hepatitis disease)

cause by single strand DNA virus. Proper strategies must be taking to avoid infections and

spread of hepatitis c virus. This can be done by setting up a program to sensitized and enlighten

people more about the danger of HCV, cause, mode of transmission, degree of physiological

damage caused to the liver, prevention and control measure. There is also need to screen people

to detect the infection at the early stage for easy and effective diagnosis.

1.3 AIM OF THE STUDY

 To determine the prevalence of hepatitis C virus in pregnant women attending ante-natal

care in Primary Health Care clinic, kagara LGA, Niger State.

1.4 OBJECTIVE OF THE STUDY

 To determine the age distribution to which the infection occurs most among pregnant

women and non pregnant women and gestation age distribution to which hepatitis C

infection occur most. . .

1.5 SIGNIFICANCE OF THE STUDY

The work provides us with information about hepatitis c virus of the health status of the patient

attending Primary Health Care Centre,Kagara LGA, Rafi Local Government Area of Niger State.

It also provides the government with statistical data analysis of pregnant women with hepatitis C

virus within the local government area of the state.

1.6 SCOPE OF THE STUDY

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Due to the limited resources and time, the study was concentrated only on hepatitis C virus

screening for the pregnant and non pregnant women attending Primary Health Care Centre

Kagara, Local Government Area of Niger State.

CHAPTER TWO

2.0 LITERATURE REVIEW

Hepatitis C virus is a small (55-65 nm in size)envelope single stranded positive sense RNA virus

The hepatitis C virus particle consists of a core of genetic material (RNA), surrounded by an

icosahedral protective shell of protein, and further encased in a lipid (fatty) envelope of cellular

origin. Two viral envelope glycoproteins, E1 and E2, are embedded in the lipid envelope. It is a

member of the hepacivirusgenus in the family flaviviridae (Rosen., 2011).

2.1 Mode of transmission and risk factors

According to Maheswari, and Thuluvath (2010) the primary method of transmission in the

developed world is intravenous drug use (IDU), while in the developing world the main methods

are blood transfusions and unsafe medical procedures. Hepatitis C virus is spread parentally,

sexually (Bryan Ogeneh, 2004). IDU is a major risk factor for hepatitis C in many parts of the

11
world. Of 77 countries reviewed 25 including the United States were found to have prevalence of

hepatitis C in the intravenous drug user population of between 60% and 80% (Xia, et al., 2008).

Transfusion of blood products or organ transplantation without HCV screening may carry

significant risks of infection. The United States instituted universal screening in 1992 and the

risk subsequently has decreased from one in 10,000 to 10,000,000 per unit of blood down from a

risk of one in 200 units of blood (Day., 2009) . Those who have experienced a needle stick injury

from someone who was HCV positive have about a 1.8% chance of subsequently contracting the

disease themselves, the risk is greater if the needle in question is hollow and the puncture wound

is hollow. Sexual practices that involve higher levels of trauma to the a genital mucosa, such as

anal penetrative sex, or that occur when there is a concurrent sexually transmitted infection,

including HIV or genital ulceration, do present a risk (Tohme,2010). The United States

government only recommends condom use to prevent hepatitis C transmission in those with

multiple partners. Tattooing is associated with two to three fold increased risk of hepatitis C.

This can be due to either improperly sterilized equipment or contamination of the dyes being

used. Tattoos or piercings performed either before the mid-1980s, "underground," or

nonprofessionally are of particular concern, since sterile techniques in such settings may be

lacking (Jafari, 2010). According to (Lock, 2006), Personal-care items such as razors,

toothbrushes, and manicuring or pedicuring equipment can be contaminated with blood. Sharing

such items can potentially lead to exposure to HCV. Vertical transmission of hepatitis C from an

12
infected mother to her child occurs in less than 10% of pregnancies. It is not clear when during

pregnancy transmission occurs, but it may occur both during gestation and at delivery (Lam.,

2010). A long labour is associated with a greater risk of transmission. There is no evidence that

breast-feeding spreads HCV; however, to be cautious, an infected mother is advised to avoid

breastfeeding if her nipples are cracked and bleeding, or her viral loads are high (Alter., 2006).

2.2 pathogenesis of hepatitis C virus

Hepatitis C virus enters a susceptible host either directly through needle inoculation or

transfusion of contaminated blood or inadvertently through breakage of a percutaneous barrier

(as exemplified by sexual or prenatal transfusion) (Alter., 1997). The virus then enters

hepatocytes or other susceptible cells probably through a unique surface molecule as the viral

receptor (Pileriet al., 1998) 17 After uptake, the virus uncoats and releases the genome to begin

replication. The viral genome first serves as a template for the translation of polyprotein. The

processed non-structural protein then form a complex with the genome and initiate synthesis of

the negative strand which in turn function as the template for positive strand synthesis. The

replication complex probably resides in a membranous compartment in the cytoplasm. The RNA

replicative intermediate matures and interact with the core and envelope proteins to assemble

into a virion.

2.3 EPIDEMIOLOGY OF HCV PREVALENCE IN AFRICA

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Who to test for hepatitis c virus

According to MMWR (1998) Persons who ever injected illegal drugs, Persons who were ever on chronic

(long-term) hemodialysis; gloss. Hepatitis C after many years13 Persons with persistently abnormal

alanine aminotransferase level Persons who were notified that they received blood from a donor who later

tested positive for HCV infection; Persons who received a transfusion of blood or blood components and

organ transplant before July 1992; and Healthcare, emergency medical and public safety workers after

needle sticks, or mucosal exposures to HCV-positive blood Children born to HCV-positive women.

Disease burden and distribution

The estimated prevalence of HCV in Africa is 5.3% (Pybus OG et al.,2003). Egypt has the

highest worldwide prevalence (17.5%). Egypt’s unusually high prevalence is attributable to the

history of unsterile injection equipment use for mass treatment of the general population with

parenteral antischistosomal therapy (PAT) from the 1920s to the 1980s (Frank C, 2000). The

prevalence of HCV increases with age, with the highest rate being reported in the age group

older than 40 years. No data were available on HCV morbidity and mortality in Africa. However,

based on the general trends for most other diseases, it is possible that these indicators may be

worse than the WHO reports of 75% of HCV-infected individuals developing chronic liver

disease. Of those HCV-infected patients who develop chronic liver disease 1.6% progress to

14
Hepatocellular carcinoma (HCC), a condition with a mortality rate >80% (Masheshwari A.,

2010).

Transmission

The routes of transmission of HCV described in literature are: blood, blood products, tissue and

organs; unsafe medical procedure; healthcare exposure e.g. needle stick injury (Xia et al., 2008);

intravenous drug use (Tohme RA et al.,2010); sexual transmission (Jafari S et al.,2010); body

piercings (Lam NC et al., 2010) and vertical transmission (Owusu-ofri S et al.,2005). In Africa,

only 19% of blood is screened for HCV (anti HCV antibodies). The main reason for this low

screen rate is the prohibitive cost of the laboratory tests (Jeannel D et al., 2007). Also,

inconsistent screening procedures for blood donors make blood transfusion a major means of

acquisition of HCV infection. This is evidenced by a high HCV prevalence in sickle cell patients

(17%) who have received multiple blood transfusions (Touzet.S.,2000). While reported

prevalence of HCV in intravenous drug users in the developed world is as high as 80%, little is

known about the prevalence of similar risk groups in Africa 9 (Simonsen L et al.,1999).

However, Madhava et al found drug use to be an uncommon means of HCV transmission in

Africa (WHO, 2012). While there is significant variation between countries, WHO estimates that

in sub Saharan Africa, approximately 18% of injections are given with reused syringes or

unsterilized needles thus increasing risk of transmission through unsafe injection practices (Gibb

15
DM et al., 2000). Vertical transmission is low but significant in the setting of co-infection with

HIV, a condition that is of pandemic proportions in Africa (Alter MJ, 2007).

Prevalence

The prevalence of HCV in the general population in Africa ranges between 0.1% and 17.5%,

depending on the country. The countries with the highest prevalence include Egypt (17.5%),

Cameroon (13.8%) and Burundi (11.3%). The countries with the lowest prevalence include

Zambia, Kenya, Malawi and South Africa (all with a prevalence <1%). Table 2 gives details of

the prevalence (and confidence intervals) of HCV in select African countries.

Risk groups

High risk populations include: Intravenous drug users; HIV-infected; patients on hemodialysis;

patients with history of blood transfusions or organ transplantation; health care workers after

needle stick injuries; children born to HCV infected mothers. Also, sexually active adults with

multiple partners have higher prevalence rates. Available data on HCV reveal high prevalence in

patients with hepatocellular carcinoma or chronic liver disease: (Burundi; 55%, Rwanda; 45.7%)

and sexually transmitted diseases (Ethiopia; 38.2%). Countries with low HCV prevalence in

high-risk groups include Zimbabwe (1.3%) and Kenya (1.7%).

Genotypes

There are 11 HCV genotypes: 1-11, with many subtypes: a, b, c, and about 100 different strains:

1,2,3 based on the sequence of the HCV genome. Genotypes 1-3 are widely distributed globally,

16
with genotypes 1a and 1 b accounting for 60% of infections worldwide. Genotype 4 is

characteristic for the Middle East, Egypt and Central Africa. Genotype 5 is almost exclusively

found in South Africa (RPC,1998). More information on genotype distribution is available.

Disease progression

Few data are available on natural history and progression of HCV infection in Africa. However

studies done on African Americans show higher rates of chronic HCV infection compared to

whites (Lauer GM et al.,200). Acute infections and less advanced stages of chronic disease are

clinically silent (Fried MW et al.,2002) and only about half of the viremic patients exhibit

elevated Alanine Aminotransferase (ALT) activity. HCV is often first diagnosed in late stage

when the therapeutic options are already limited. Due to slow and silent onset, many patients are

unaware of their infection and at least 40% cases remain undetected (Te HS, 2010). Chronic

hepatitis C is difficult to assess, because it is frequently subclinical. Patients with chronic

hepatitis C are at risk of cirrhosis and hepatocellular carcinoma and their contacts at risk of

acquiring the infection through exposure to the virus (Hu KQ et al., 2000). The risk of

developing cirrhosis ranges from 5% to 25% over periods of 25 to 30 years (Seeff LB, 2002).

2.4 Laboratory Diagnosis HCV

HCV testing is recommended among persons with high risk of getting infected and patients with

unexplained high ALT levels [1]. Highly sensitive and specific rapid tests for diagnosis of HCV

are available. HCV RNA can be detected in the blood using amplification techniques such as

17
polymerase chain reaction (PCR) or transcription-mediated amplification (TMA) (McHutchison

JG et al, 2007). Quantitative HCV RNA should be determined before initiating treatment.

Follow-up HCV RNA is useful in monitoring success of HCV

Incubation period

A viraemia can be detected within 1 to3 weeks of transfusion of HCV contaminated blood. The viraemia

lasts for 4 to 6 months in people with acute infection and longer than 10 years in persistent infection. The

average time to sero-conversion after exposure to HCV is 8 to 9 weeks (Bryan Ogeneh., 2004).

Biopsy

Liver biopsies are used to determine the degree of liver damage present; however, there are risks

from the procedure. The typical changes seen are lymphocytes within the parenchyma, lymphoid

follicles in portal triad, and changes to the bile ducts. There are a number of blood tests available

that try to determine the degree of hepatic fibrosis and alleviate the need for biopsy. (Rosen.

2011)

Screening

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 It is believed only 5–50% of those infected in the United States and Canada become

aware of their status. Testing is recommended in those at high risk,(Alter MJ.,2007)

which includes those with tattoos. Screening is also r19 immunoblot assay is used to

verify the immunoassay and the viral load is determined by a HCV RNA polymerase

chain reaction. If there is no RNA and the immunoblot is positive it means that the person

had a previous infection but cleared it either with treatment or spontaneously; if the

immunoblot is negative, it means that the immunoassay was wrong. It takes about 6–8

weeks following infection before the immunoassay will test positive. Liver enzymes are

variable during the initial part of the infection and on average begin to rise at seven

weeks after infection. Liver enzymes are poorly related with disease severity.

2.5 Treatment indications

All patients with chronic hepatitis C infection should be considered potential candidates for drug

therapy 9 (Kim AL et al., 2005). Treatment is recommended for patients who are at risk of

developing cirrhosis, generally defined by a measurable hepatitis C RNA level and liver biopsy

showing portal or ridging fibrosis along with moderate inflammation and necrosis (Ghany MG et

al.,2009). Treatment is also recommended for patients with elevated serum ALT levels who meet

the following criteria (Sandeep M et al., 2012):

 Age >18 years

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  Positive HCV antibody and serum HCV RNA test results

 Compensated liver disease (e.g., no hepatic encephalopathy or ascites)

 Acceptable hematologic and biochemical indices (hemoglobin at least 13 g/dL for men

and 12 g/dL for women; neutrophil count >1500/mm3, serum creatinine < 1.5 mg/dL)

 Willingness to be treated and to adhere to treatment requirements

 No contraindications for treatment

 A pre-treatment liver biopsy is not mandatory but may be helpful in patients with normal

transaminase levels, particularly those with a history of alcohol dependence, in whom

little correlation may exist between liver enzyme levels and histological findings

(Sandeep M et al., 2012).

2.6 Recommended treatment regimens

Spontaneous resolution of hepatitis C virus is common and waiting 2-4 months before initiation

of therapy is recommended. The objective of therapy is to eradicate the virus and prevent

potential complications from chronic HCV infection. If detected early, progression of chronic

hepatitis to severe liver disease can be prevented in 54-63% of patients through antiviral

treatment [25-28]. Efficacy of treatment is assessed by measuring Hepatitis C RNA viral load.

The goal is to achieve a Sustained Virological Rate (SVR), defined by the continued absence of

hepatitis C RNA 6 months after the completion of treatment (Ghany MG et al., 2012). Treatment

20
for chronic HCV infection has evolved from interferon monotherapy, which results in an SVR of

10 to 20% [38] to combination therapy with interferon plus ribavirin, which is associated with a

higher SVR rate of nearly 40%.

2.7 Prevention of Hepatitis C

As of 2011, no vaccine protects against contracting hepatitis C. However, a number are under

development and some have shown encouraging results (Halliday, 2011). A combination of harm

reduction strategies, such as the provision of new needles and syringes and treatment of substance use,

decrease the risk of hepatitis C in intravenous drug users by about 75%. The screening of blood donors is

important at a national level, as is adhering to universal precautions within healthcare facilities. Not

sharing personal care items that may contain blood, such as razors and toothbrushes and always using

latex condoms during sexual intercourse, particularly if you or your partner has Hepatitis C not donating

blood, organs or tissues if you are HCV positive. In countries where there is an insufficient supply of

sterile syringes, medications should be given orally rather than via injec21

2.8 Hepatitis C virus and pregnancy

Women with HCV are concerned about the risk of transmitting the virus to their babies during

pregnancy or birth. Studies consistently show that the rate of . 22 perinatal or vertical

transmissions is low, about 5% or 1 in 20. Vertical transmission is most likely to happen when

the mother has a high HCV viral load; several studies have shown that no transmission occurred

when women had undetectable viral loads. Studies also show that women who are co-infected

with both HCV and HIV have a higher risk (15-35%) of transmitting HCV to their infants. One

21
British study has suggested that the risk of vertical HCV transmission may be reduced through

Cesarean delivery; however, according to the Society of Obstetricians and Gynecologists of

Canada, “routine Cesarean section is not recommended as a specific measure to reduce the risk

of vertical transmission of HCV” (Alter, 1999). According to (Tajiriet al. 2001), Although HCV

has been detected in breast milk in some studies, there is no indication that breastfeeding

transmits the virus. Most experts do not discourage HCV-positive women from breastfeeding.

But women may wish to exercise caution if their nipples are cracked or bleeding. HCV is not

transmitted from mothers to children through normal household contact. According to Terrault,

who treats many women with HCV, being pregnant does not adversely affect the progression of

hepatitis C. Likewise, women with HCV do not have a higher rate of pregnancy or birth

complications compared to uninfected women. However, women with severe, advanced liver

disease may experience difficulties during pregnancy. 23 Universal prenatal screening of women

for HCV is not currently recommended. Babies of HCV-positive women should be tested for

HCV after 12-18 months. According to the Centers for Disease Control and Prevention, most

infants infected with HCV at birth have no symptoms and do well during childhood. Studies

suggest that infants are more likely than adults to completely clear the virus from their bodies.

HCV treatment has not been well studied in infants and children. Ribavirin is known to cause

miscarriages and birth defects, so pregnant women should not take this drug. Most doctors also

recommend that interferon should not be taken during pregnancy, because its effect on the

22
human fetus is not well known. Mothers taking Rebetron (interferon and Ribavirin therapy)

should not breast feed because of the potential for an adverse reaction from the drug in their

infant. Pregnant patients with hepatitis C should be advised to; Obtain vaccination against

hepatitis viruses A and B as indicated. Abstain from alcohol use. Avoid hepatotoxic drugs such

as acetaminophen (Tylenol) that may worsen liver damage. Inform the infant’s pediatrician of

the mother’s hepatitis C status. Not donate blood, body organs, or tissue not share any personal

items that may have blood on them (e.g., toothbrushes and razors). Discuss the low but present

risk for transmission with their partner and discuss the need for counseling and testing. However,

HCV-positive persons with one long-term, steady sex partner do not need to change their sexual

practices (CDC 1998). (Davies et al. 2003) “Amniocentesis in women infected with hepatitis C

does not appear to significantly increase the risk of vertical transmission, but women should be

counseled that very few studies have properly addressed this possibility. Risk of vertical

transmission of HCV appears to be related to the level of viraemia in the pregnant mother and

not to the route of delivery. The virus does not appear to be transmitted when a woman's titer is <

10^6/mL or is negative. Although (Tejari et al and Conte et al, 2000) did not find cesarean

section to be protective against transmission of HCV to the neonate(Gibb et al 2000) have found

the HCV maternal to child (MTC) transmission rate to be reduced in patient delivered by elective

cesarean. The latter study has yet to be confirmed. Most women become pregnant during the

years between 20 and 40, which is also the age group in which the incidence of hepatitis C

23
infection is rising most quickly. Any woman with risk factors for hepatitis C (such as exposure to

transfusions, contaminated needles, or injected drug use) should be screened for hepatitis C

before and during pregnancy (Hunt and Christine, 1999).

2.9 Hepatitis C virus and HIV

There is still some debate about whether hepatitis can affects HIV. Some studies have suggested

that hepatitis C infection can lead to more rapid progression of HIV but others have not.

Hepatitis C is a more serious illness in people with HIV disease as it progresses more rapidly in

these patients. The reasons for this are not known completely but probably relate to the

possibility that your body’s ability to control hepatitis C may be reduced if you have HIV

infection. HIV can still be treated even if you also have hepatitis C. In fact, it’s really important

to be aware of your HIV viral load and your CD4 count, and to treat HIV to keep it under

control. Hepatitis C can affect HIV treatment choices, because of the potentially toxic effects

some HIV drugs have on the liver. There’s no accepted list of “best HIV treatments” for people

with both HIV and hepatitis C virus. Ritonavir (in full doses) and nevirapine are two HIV drugs

which are more likely to affect the liver. Your doctor is likely to regularly check up on how your

liver is coping, to make sure the HIV drugs aren’t causing any problems.

Taking care of the liver with infection

According to Hepatitis C NSW (2010), one of the really important things is to have the liver

function carefully and regularly tested, in addition, avoiding other risky things which can

24
damage or stress your liver; This can include: Being drinking or heavy drinking; Use of some

prescription and other drugs: as your doctor for more information about drugs which can affect

your liver. Many people with hepatitis C use non prescribed alternative treatments like herbs.

One herb which should not be used if you have hepatitis C related liver problems is kava.

Maintaining a healthy, balanced diet is a good idea, although there is no evidence that a special

diet is needed for people with hepatitis C. Vaccination against hepatitis A and B is essential for

people with both hepatitis C and HIV. These preventable forms of hepatitis can cause serious

complications for people who already have chronic hepatitis C.

CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 STUDY AREA

This study was carried out at the Primary Health Care Centre Kagara, Niger State. Niger State is

situated in the middle bed North-central part of Nigeria and lies in latitude 10N and 13E. The

state was formed in 1976 from the split of North-Eastern State. The Niger State is a west-central

Nigeria, bounded to the south by the Niger River. It also bounded by the states of Kebbi and

Zamfara to the north, Kaduna to the north and northeast, Kogi to the southeast, and Kwara to the

south. Niger State also share international border with the Bennin Republic. Most important to

the country is the state strategic location as a gateway to East and central Africa. Internally the

state also share a borders with the neighboring States Kwara, Kogi, Abuja, Kaduna, Kebbi, and

25
Sokoto, The Niger State is regarded as a largest state with high land mass. It has a area of

76,363m2

3.2 Research method

The research was a cross-sectional, knowledge of hepatitis C virus among pregnant and non

pregnant women attending Primary Health Care Centre in kagara, Niger State. A total of about

100 pregnant women and non pregnant women were screen for hepatitis C virus.

3.3 Study population

This study involves pregnant and non pregnant women attending primary health care clinic in

kagara LGA, Niger State.

3.4 Sampling techniques and sample size

A simple random sampling techniques was used to select fifty (50) pregnant women and fifty

(50) non pregnant women for this study, making a total sample size of one hundred (100).

3.5 Experimental method

3.51 Serology

Anti-HCV and antibodies were determined in plasma using HCV strip.

3.52 Sample collection

26
Venous blood (3 mls) was obtained from the participants and tested for antibody to HCV (anti-

HCV) using hepatitis C virus one step rapid diagnostic test using the serum or plasma. The

serum or plasma was separated from blood as soon as possible to avoid haemolysis.

3.53 Materials

HCV test strip, Centrifuge, Timer, Tourniquet, Rack, Syringe, Cotton wool, Test tubes EDTA

bottle, Glove.

3.54 Procedure

Anti-HCV antibodies were determined in plasma using HCV TEST STRIP. This is one step

immunochromatographic Rapid Screening Test. Two purified recombinant antigens of HCV are

use in test band as band as capture materials and gold conjugates. If antibody of Anti-HCV is

present in the sample concentrated above the labeled regions, complex was formed. This

complex was capture by antigen immobilized in the Test Zone of the membrane, producing a

visible pink-rose color band on the membrane. The color intensity depend on the concentration

of the anti-HCV present in the sample.

3.6 Interpretation of result;

Positive: two distinct red lines appear. One should be in the control region and the other line

should be in the test region.

27
Negative: one red line appears in the control region. No apparent or red line appears in the test

region. Invalid: the control line fails to appear. This is due to insufficient specimen volume or

incorrect procedural technique. Review the procedure and repeat the test with a new test strip.

3.7 Method of Data analysis

The data was subjected to statistical analysis (the x2-test, with the level of significance set at

p<0.005) using statistical package (R version 2.13.1) to determined any significant relationship

between age and prevalence of HCV.

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 CHAPTER FOUR

RESULT

It was observed that 35 pregnant women out of total number that were screen for hepatitis C

were positive, which is shown in the table below, and 15 pregnant women out of the total

number were screen negative for hepatitis C. While 36 non pregnant were screen for hepatitis C,

and 14 non pregnant women out of the total number were screen negative for hepatitis C. It was

also observed that the age range

(18-25) 9 of the pregnant women that was tested were all negative. The age range between (26-

30) 11 pregnant women that was tested, (8) among were positive, while only (3) pregnant

women were tested negative. The age range between (31-35) 14 pregnant women were tested, 13

among were positive while only 1 tested negative. The last age range were between (36-40), 16

pregnant women were tested, 14 among the pregnant women tested positive, while 2 among were

tested negative. As above mention age group of (18-25) samples examine for hepatitis C and non

tested positive. According to the result of the table bellow, hepatitis C seems to affect the older

age range than the younger age range. The older the age the higher the risk.

Table 4.1 show age distribution of hepatitis C in pregnant women attending Primary Health

Care, Tunga, Minna.

29
 Age Group Number Examined Number Infected

18 – 25 9 0

26 – 30 11 8

31 – 35 14 13

36 – 40 16 14

Total 50 35

Table 4.3 show age distribution of hepatitis C in non pregnant women attending primary health

care clinic, Tunga Minna.

Age group Number examine Number infected

18-25 6 3

26-30 10 5

31-35 16 15

36-40 18 13

Total 50 36

30
From the above results obtained, it indicates high prevalence of hepatitis C virus is higher among

the older age distribution than the younger age distribution. This due to low immune response to

the exposure of the infection. It is as more prevalence in immune compromised individual;

HIV/AIDS patients.

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 CHAPTER FIVE

DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 DISCUSSION

The result showed that a total of 100 samples were collected; of which 35 were tested positive

and 15 were tested negative out of total number of 50 samples of pregnant women screened. And

14 were tested positive while 36 were test negative for hepatitis C in non pregnant women

attending the primary health care clinic Tunga Minna. It was observed that the prevalence of

hepatitis C virus was higher in those within the age range of 36-40 than in those within the age

range of 18-25 26-30and 31-35 due to exposure to exposure to the risk factor of hepatitis C virus

(Alter 1990). The prevalence of HCV is higher in older age pregnant women than in younger age

of both pregnant women and non pregnant, this can be due to reduced immunity and routes of

transmission of HCV. HCV is one of world most prevalence diseases that affect many people in

different part of the world. It causes a major burden among people especially those with weak

immune system. HCV,is one of the major causes of liver transplantation and cancer cases in

many part of the world due to their mode and route of transmission in human.

5.2 CONCLUSION

Given the poor prognosis and paucity of effective treatment for HCV, it appears important to

examine complementary medicine treatment possibilities. Most of the treatment described here

32
have the dual advantages of being inexpensive and having a favorable therapeutic index. The

standard of care for chronic HCV infection is interferon and Ribavirin therapy in those who do

not achieve sustained responses to the interferon therapy (Fried MW, 2002). The therapy should

be employed to reduce or control this infection. Though the prevalence of hepatitis C virus is

high from this work, the infection has an adverse effect in all susceptible individual; men,

women and children. Though there is no vaccination against this virus, medical management and

ant-viral.

5.3 RECOMMENDATION

 Since the prevalence of hepatitis C virus is high, it is recommended that Primary

prevention activities such as screening and testing of blood, organ, tissue and semen

donors can reduce the potential risk of HCV transmission from blood or blood

component, intravenous drug use, multiple sex partners, tattooing.

 Secondary prevention activities such as identifying HCV infected persons through

diagnostic test, medical management and anti-viral therapy and providing appropriate

medical follow-up and promoting healthy life styles and behavior can reduce risk for

chronic infection.

 Professional and public education; Health care emergency medical and public safety

workers should be educated regarding the risk for contacting HCV.

33
 Immunization against HCV is not available; therefore identifying persons at risk but not

infected with HCV provides opportunity for counseling on how to reduce the risk of

becoming infected.

34
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