CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Health is considered the most paramount to individuals, societies and groups. This particular

reason is why experts and professional have been sampling the sickness and illness that are

considered prevalence among groups, societies, states and countries.

Hepatitis B virus (HBV), a DNA virus of the family Hepadnaviridae is the causative agent of

hepatitis B infection (Yakasai, 2010). Hepatitis B is one of the most common infectious diseases

in the world and a major health problem. According to the most recent World Health

Organization estimate, 2 billion people worldwide have serologic evidence of past or present

HBV infection, and 350 million are chronically infected and at risk for HBV-related liver

disease(Yakasai, 2010). It is 50 to 100 times more infectious than HIV and 10 times more

infectious than hepatitis C virus (HCV) with many carriers not realizing they are infected with

the virus. It is an important cause of liver diseases such that chronic infection with HBV is a

common cause of death associated with liver failure, cirrhosis and liver cancer (Yakasai, 2010)

Hepatitis B Virus (HBV) is a ubiquitous partially double stranded DNA virus with areas of

highest prevalence being the sub-Saharan Africa, South-East Asia, the Amazon basin, Alaska,

Northern Canada, Eastern Europe, Greenland, parts of the Middle East, China, and parts of

Pacific Islands (Taura and Hafsat, 2008). The infectious virus consists of an outer envelope

(HBsAg), the first seromarker and one of the most useful markers of active or chronic hepatitis B

infection, and an inner core made up of Hepatitis B core Antigen (HBcAg), found in acute or

chronic infections and the e-antigen (HBeAg), which serves as a marker of active viral

replication (Taura and Hafsat, 2008). An estimated 2 billion people have been infected with
 HBV, with 350-400 million of them remaining chronic carriers worldwide (Iloh, 2013). It has

also been estimated that 25 - 30% of the chronic carriers will die of the sequelae (Iloh, 2013). In

Africa, the number of HBV carriers is estimated to be about 50 million representing about 10-

20% of the general population and as many as 12.5 million will eventually die due to

complications from hepatitis B – chronic hepatitis, cirrhosis and hepatocellular carcinoma

(HCC) (Ibrahim, 2014). Annual mortality directly related to hepatitis B liver disease and cancer

worldwide has been between 600,000 -1 million (Ibrahim, 2014).

The virus has caused severe endemic in parts of Africa and Asia. The prevalence of HBV varies

between 2% in developed countries where the prevalence is low to about 8% in developing

countries where infection is endemic with sex, age and socio-economic status as important risk

factors for infection (Ibrahim, 2014). The degree of HBV endemicity often correlates with

predominant mode of transmission. The disease has an enormous impact on health and national

economy of many countries and the severity of the disease is highly variable and often

unpredictable. The minimum infectious dose is so low that such practices like sharing of tooth

brush or a razor blade can transmit infection (Bello, 2005).

Hepatitis B virus is a blood borne and sexually transmitted pathogen that is spread through

contaminated blood or other body fluids (saliva, sweat, semen, vaginal secretions, breast milk,

urine, and feaces). Transmission can occur when using the same syringe as an infected person,

from blood transfusions prior to 1975 (now screened in most countries), having tattoos or body

piercing, from mother to child during childbirth, during medical procedures, occupational

exposure, during sexual intercourse. Thus, Hepatitis B virus shares similar routes of transmission

with HIV. Currently, there are four recognized modes of transmission (Viral Hepatitis Prevention

Board, 1996) which are; from mother to child at birth (prenatal), by contact with infected person
(horizontal), by sexual contact and by exposure to blood or other infected fluids. Because HBV

can remain stable and infectious on environmental surfaces for at least 7 days, transmission may

occur indirectly via contaminated surfaces and other objects such as tooth brush, baby bottles,

razors, eating utensil, hospitals equipments, by contact with mucous membranes or open skin

breaks (Adoga, 2010).

Hepatitis affects people of all age groups, but in most studies conducted recently, HBV infection is

predominant in young adults and are acquired through sexual intercourse or by abusing drugs

through injection. However, younger age (babies) acquisition of HBV continues to be the most

important predictor of chronic carriage and those who develop chronic hepatitis B have a 15 - 40

% risk of developing complications due to their immature immune system (Eze, 2007).

The eradication of HBV is one of the most important but difficult tasks facing public health in

Nigeria. This may be due to ignorance about the infectivity (including mechanisms of

transmission) and the dire consequences of HBV infection. This most probably, being because the

infections are asymptomatic and the sequalae are long. It may also be from the poor immunization

coverage in Nigeria. As at 2010, the national immunization coverage was 69% using DPT3

coverage (Eze, 2007). There are three major methods of controlling HBV infection. The first is

immunization, which is the single most important factor in hepatitis B control (Adekunle, 2010).

Next is the use of antiviral drugs such as lamivudine, tenofovir, ribavirin etc. Then the

immunostimulatory therapy with α-interferon and pegylated α-interferon. Other adjuncts include

continued screening of pregnant mothers for HBsAg to prevent vertical transmission, post

exposure prophylaxis using hyperimmune globin within 24 hours or at most 7 days following

exposure, and massive and sustained public health education on the various avoidable modes of

transmission of HBV and available preventive measures (Adekule, 2010).

Most people who become infected with HBV are able to clear the virus from their blood stream

within 6 months of post infection and develop immunity. Those who have not cleared the virus

after 6 months are considered to have chronic hepatitis B carriers. The risk of death from HBV

related liver cancer or cirrhosis is approximately 25% for persons who acquire chronic infection at

childhood. Moreover, 8% to 10% of people in the general population in developing countries

become chronically infected and most acquire infection with HBV at childhood. (Aba, 2012).

The universal HB immunization was commenced in Nigeria in 2004 as other major modalities are

almost nonexistent. Hence mass vaccination in a large scale ought to become imperative as this

will decrease the reservoir of chronic carriers. HB immunization coverage in Nigeria in 2010 was

66% (Aba, 2012). Nigeria is classified among the group of countries highly endemic for HBV

infection. About 75% of the Nigerian population is reportedly likely to have been exposed to HBV

at one time or the other in their life. Although hepatitis B vaccination is highly effective in

preventing infection with HBV and consequent acute and chronic liver disease, the disease still

remains a major problem to Nigeria health workers (Aba, 2012). Some previous studies between

1983-2005 have reported prevalence rate in Wamba and the environs when HB immunization was

nonexistent (Forbi, 2008). This study is therefore undertaken to determine the prevalence of HBV

among persons within the age bracket of 18 to 49, with a limited scope of the case history in

Model Primary Health Care, Wamba, Local of Nasarawa State.

1.2 Statement of the Problem

Contacts among human is inevitable. Every blessed day, human beings are prone to interaction

and social mingling. It may be for business purposes, sports activities, marital and premarital

contacts ect. When fear is taking away these freedom enjoy by man, there is a problem already.
The spread of Hepatitis B Virus among persons has lead to the termination of lives and creation of

obstacle to human interaction. The frivolity of the means of infection, which as discussed, is

almost similar to that of HIV, has made HBV a common phenomenon among Nigerians and

amidst Wamba people. In addition, failure to take preventive measures through vaccination is

among the worrisome factors that is prompting this investigation. We have also come to realize

that most people, particularly within Wamba, are victims of personal assumption and self

medication on the issue of Hepatitis B. Thus, they mostly come to realize that HBV is the cause of

their illness only when it has got to chronic stage, thereby leading to their deaths. These problems

deserve investigation and the postulation of proper solution on how to address the prevalence of

HBV in Wamba Local Government.

1.3 Aim and Objectives

The aim of this exercise is to evaluate the prevalence of Hepatitis B Virus in people that fall

within the age bracket of 18 to 49 in Model Primary Health Care Centre, Wamba. In doing that,

the following specific objectives will be considered:

i.To ascertain the likely causes of Hepatitis B Virus among the patients that visited MPHC,

Wamba.

ii. To find out the level at which the patients have been cured or the level at which the virus

had led to the death of the patients.

iii. To find out the degree at which vaccination of HBV has been carried out in contrast to the

percentage of cases on record.

iv. To identify the means through which the virus is mostly spread.

v. To come up with practical solutions and advise on prevention and treatment of HBV.
1.4 Significance of the Study

This work is of significance to the prevention and treatment of HBV. It will also be of great

importance to the community and the facility under review by providing them with adequate

information needed for reducing the rate of death cases that come as a result of misconceiving

HBV for other forms of diseases. Additionally, this work will be of significant importance to

students who intend to carry out further researches on Hepatitis B Virus.

1.5 Research Question

This work intends to answer the following questions:

1. What are the causes of HBV and it possible neans of transmission?

2. What is the percentage of the patients that that were cured when compared to that of those that

lost their lives as a result of HBV infection?

3. What is the attitude of Wamba people on towards Hepatitis B Vaccination?

4. Can we suggest a more practical ways of ensuring prevention and spread of the virus?

1.6 Scope of the Study

This work is to limit itself on the prevalence of Hepatitis B Virus among persons that fall within

the age bracket of 18 to 49,in Model Primary Health Care, Wamba. It is not a laboratory work on

the virus, but a review on the causes and the reason behind its spread in some of the communities

within Wamba that visited MPHC, Wamba for treatment.

1.7 Operational Definition of Terms Used

HBV= Hepatitis B Virus. This is a liver disease that can easily be contracted through contact of

boy fluid with an already infected person, maybe through sex, blood transfusion, or exchange of

saliva.

Hepatocellular carcinoma (HCC)= this is one of the deadliest cancer that is caused by liver

cirrhoses resulting from HB Virus infection.

HBsAg= This is the Hepatitis B Surface Antigen that occurs during the acute and chronic phase of

HBV infection.

Lamivudine, tenofovir, ribavirin= Names of anti-viral drugs for the treatment of Hepatitis B

Virus.