CHAPTER ONE

INTRODUCTION

1.1 BACKGROUND

There are so many different types of infections and they often pose danger to our state of
wellbeing. Out of the world’s population, millions of people are at risk of getting infection
from viruses and bacteria, and millions more already suffer from viral and bacterial
infections. Some of these diseases tend to lose potency in a matter of days or weeks while
others may just remain dormant inside our bodies.
One such disease is Hepatitis, which is a disease that affects the liver. According to Lemoine
2015, viral hepatitis has recently gained global notice as a public health issue that needs to be
handled very fast, especially in West Africa. It is said to be responsible for millions of death
around the world annually (Stanaway et al, 2013).
West Africa is found to be among the world’s largest affected regions by Hepatitis B virus as
supported by (Stanaway, 2013, Lemoine, 2013 & Schweitzer 2015). The World Health
Organisation (WHO) has released several action plans to help fight the viral hepatitis (WHO,
2012), also an updated health sector strategy was released in 2016 by WHO against viral
hepatitis (WHO, 2016), and WHO’s Sustainable Development Goals for 2016-2030, has a
provision for combatting the viral hepatitis (UN, 2016).
It is characterized by inflammatory condition of the liver which in turn leads to liver failure
or conditions known as jaundice, anorexia (poor appetite) and malaise (Beckingham et al.,
2001). Although this infection may seem to cause mild disease and is mostly asymptomatic it
can lead to chronic diseases that will remain undetected. Signs and symptoms include
Fatigue, flu-like symptoms, dark urine, pale stool, abdominal pain, and loss of appetite,
unexplained weight loss, yellow skin and eyes. Viral hepatitis can be caused by infection with
any of at least five distinct viruses: hepatitis A virus (HAV), hepatitis B virus (HBV),
hepatitis C virus (HCV), hepatitis D virus (HDV), and hepatitis E virus (HEV). The World
Health Organization (WHO) estimates that in 2015: 257 million people in the world had
hepatitis B, 71 million people in the world had hepatitis C. Both hepatitis B and C can lead to
a lifelong infection. WHO estimated that during the same year, 1.34 million people died from
liver cancer, cirrhosis, and other conditions caused by chronic viral hepatitis. (WHO, 2017)
Hepatitis A and hepatitis E infections do not result in chronic infection but can be severe and
cause liver damage and death. Outbreaks of these infections occur worldwide, particularly in
parts of the world with poor sanitation.
Normally, most people, including health care Workers (HCWs) are unaware of their HBV
serological statues, that is, they are infected by HBV but unknown to them (Shao et al, 2018).
They have clinically silent infections for a very long period of time (about 10 years) before
developing cirrhosis, end-stage liver disease, or hepatocellular carcinoma (HCC).
Hepatocellular carcinoma causes 1 million deaths each year. It has been regarded as the 6th
and most prevalent cancer worldwide Infection and the 3rd cause of cancer death in the
world. This virus causes about 57% of global cirrhosis and 78% of the world’s cases of
hepatocellular carcinoma (HCC).
Hepatitis can be found in the blood and other fluids of the body as such, it can transmit from
person to person. Common way of getting infected is through blood transfusions where no
screening is done to see whether the donor blood is safe for transfusion, using of unsterilized
equipment in clinics and hospitals during childbirth. It is also a sexually transmitted disease
(STD), the exchange of unsterile piercing and cutting equipment with infected people in
general, increases the rate of transmission (Taylor et al., 2004). HBV can also be transmitted
by percutaneous or mucosal exposure to blood or body fluids of an infected person. Adults
with diabetes mellitus are at an increased risk for acquiring HBV infection if they share
diabetes- care equipment such as blood glucose meters, finger stick devices, syringes and/or
insulin pens. Antiretroviral drugs like Entecavir and tenofovir reduces aggressiveness of the
disease and reduces mortality. (Ashraf, 2010, Ko, 2017).
Hepatitis B vaccine is available for use in most countries but not everywhere and most adults
worldwide were born before hepatitis B vaccination was part of their childhood vaccine
schedules. (Ansumana et al, 2013). From 2010 to 2012 World health organisation and World
Health assembly planned out strategies to help prevent and control chronic viral Hepatitis
infections in countries that are highly affected by the disease.
In 2005, a study done in Sierra Leone supported the evidence of 6.2% seroprevalence of
hepatitis B among pregnant women that were middle classed and high socio-economic class
(Wurie, 2005). Another study from a single hospital in Tonkolili Province, Sierra Leone show
a screening blood donor candidates for blood-borne pathogens found HBsAg prevalence of
15% in men and 13% in women (Garcia-Tardon, 2017). These results throw light on the
severity level that hepatitis B has grown to in Sierra Leone.

1.2 PROBLEM STATEMENT

The cases of Hepatitis Type B are said to be very high in Sierra Leone, with a speculated 8%
of the country’s population is said to be infected with the disease. The disease is often
transmitted through childhood and up to 6 – 11 percent of mothers transmit the disease to
their children during childbirth (Hwang, 2019).
The disease can be transmitted from person to person (horizontal transmission and vertically),
through sex, child birth, and through the use of unsterilized clinical equipment. According to
WHO 2015, Hepatitis is an understudied topic in Sierra Leone. Little has been put in place to
prevent and control hepatitis B in Sierra Leone despite the suspected rate at which the disease
is growing. The hepatitis B vaccine was introduced for 6 to 14 week-old children, however
there are currently no active programs administering the vaccine at birth other than the
resolution passed by The African Regional Committee of the World Health Organisation.
No coordinated HBV vaccination program has been put in place to prevent infection among
the adult population. Qin et al 2018.
Hepatitis is highly prevalent in many part of the country and three recent papers now support
this (2005 paper showed middle and upper class women in Freetown were positive with a
percentage of 6.2, 2017 Masanga, Tonkolili District, with 15% of 214 males and 13% of 112
females turning up positive after a blood donor test was done on them and in Bo Urban area
21.4% of 308 asymptomatic Patients at the Government Hospital Bo were also tested positive
with no sex differentiation) (Higbie and Moigula, 2018).
Hence, my study will add to the body of Knowledge that is already existing on the research
matter.

1.3 AIM AND OBJECTIVES OF THE STUDY

1.3.1 Aim of the Study

The aim of the study is to ascertain the sero-prevalence of hepatitis B infection among
patients tested at The Mercy Hospital in Bo District, Sierra Leone.
1.3.2 Objectives of the study

1. To describe demographic characteristics of study participants

2. To determine the percent prevalence of hepatitis B among patients in Bo
3. To determine prevalence of hepatitis B among patients with respect to sex
4. To determine prevalence of hepatitis B among patients with respect to age

1.5 HYPOTHESIS

The study is guided by the following hypothesis:

 Prevalence of Hepatitis B infection among patients at the Mercy Hospital Bo is higher

than the WHO threshold (>8%)
 Males are more affected by Hepatitis B than females
 Adults of working age are more affected than the young or very old

1.6. SIGNIFICANCE OF STUDY

 Result from the study will benefit the community and general public by creating an
awareness of how severe the disease is
 This study will determine whether the disease is decreasing or increasing by
referencing previous studies
 Finally, this research would act as a template for more elaborate research in the future
from which other researchers and scientists would benefit.

1.7. LIMITATIONS OF STUDY

The study will be limited to only data from one hospital, that is, The Mercy Hospital, Bo
district Sierra Leone and may not therefore be reflective of the general population in the
country.
No statistical method was used to estimate sample size. It will be difficult to draw an
inference from study result that will relate to the nation at large.
This study is based on pre-existing electronic data. Errors due to typos cannot be ruled out’
and questionnaires are not going to be used due to patient confidentiality, therefore drawing
substantial conclusion regarding the prevalence of this disease across the country will not be
possible.