Abstract

Hepatitis B virus (HBV) infection has been a silent problem in society with a lot of ignorance about it being the order of the day. Majority of the population do not know how to protect themselves against this infection which is 100 times more infectious than HIV. Transmission of this infection is through blood and body fluids. Since men and women alike always need the services of a barber more often than not, this serves as a means of exposure to this virus.

It was on this premise that thus study was conceived, to assess the seroprevalence of hepatitis B and the Knowledge, Attitude and Practice of Hepatitis B prevention among barbers in Buea municipality. This was a random cross-sectional and laboratory-based study among barbers in Buea municipality. A questionnaire was adopted from a previous study and modified to suit this particular study.

The questionnaire was divided into sociodemographic information, knowledge, attitude towards prevention and shaving practices of barbers and a space for results of the laboratory test. One hundred and fifteen barbers in the study area were interviewed and 48 consented to be tested for hepatitis B. Then a scale was used to determine the knowledge, attitude and practice scores of the barbers.

Majority of the barbers (40.9%) were between 26 and 33years with a mean age of 29.6 (SD:7.4). Males dominated the study with 99.1%. The prevalence of hepatitis B virus among the participants who consented to be tested (48) was 2.1%.

Barbers in this study demonstrated poor knowledge (37.4%) or no knowledge (44.3%) regarding the mode of transmission of HBV. Finally, the participants demonstrated good knowledge on the importance of disinfection but the effectiveness of the process was found to be poor.

CHAPTER ONE

INTRODUCTION

1.1 Background to the study

Hepatitis refers to an inflammatory condition of the liver. This disease may be caused by infectious viruses or noninfectious agents, leading to serious health problems. The latter may occur because of excessive alcohol consumption and certain toxins, including misuse of medications. This may also occur due to an autoimmune system response, where an individual’s immune system sees their liver as foreign and attacks it.

Though these other causes cannot be ignored, hepatitis is most commonly caused by one of the following five viral agents; hepatitis A, B, C, D and E viruses (Appendix 1). This research focuses on hepatitis B because it is more common, causing more liver-related cancer and deaths worldwide (Hepatitis B Foundation, 2019).

Hepatitis B virus is one of the smallest DNA viruses and the prototype member of the family of hepadnaviridae (Rajoriya et al., 2017). It causes both acute and chronic hepatitis in mammals (including humans) and birds. This disease is a major health problem worldwide and is one of the main causes of hepatic decompensation, cirrhosis, and hepatocellular carcinoma (HCC) (Golsaz et al., 2014).

The damage to the liver reduces its ability to function and makes it harder for your body to filter out toxins. This is further enhanced by the fact that a significant proportion of those exposed to HBV become chronically infected and may not be aware of their status nor get ill, and therefore constitute a source of infection to others (Kumatsu et al., 2015).

The World Health Organization (WHO) estimated that about 296 million people were living with hepatitis B infection in 2019, and about 1.5 million new cases are reported each year (WHO, 2022). Also, deaths from cirrhosis and HCC caused by HBV infection was estimated at about 820,000 in 2019. Hepatitis B virus infection can be prevented by a safe an effective vaccine, which offers 98% to 100% protection against hepatitis B (Middleman et al., 2014). The last two decades has seen a tremendous global efforts to achieve high hepatitis B vaccination coverage (Flores et al., 2022), to decrease the mortality and morbidity from the disease.

Persons working in particular occupations are considered as high-risk groups for HBV infection. For example, health care personnel are expected to immediately report any blood or bodily fluid exposures to their occupational health offices, according to the Centre for Disease Control and Prevention (CDC). By virtue of their trade, barbers are also a high-risk group for hepatitis B infection, as they handle sharp objects and may be accidentally exposed to the blood and bodily fluids of their customers. Apart from sharp equipment, instruments like combs and brushes can get exposed to blood from micro-abrasions while brushing in contact with the scalp, the risk increasing if conditions like psoriasis and dermatitis are present.

Several studies have reported varying levels of hepatitis B infection among barbers in different settings. Shalaby et al. found a 4.1 % HBV prevalence rate among barbers in Gharbia governorate in Egypt. Also, a cross-sectional survey conducted in the district of Sukkur of the Sindh Province in Pakistan by Abbasi et al. (2014), reported a 2.1% prevalence of HBV among barbers. In addition, several studies have reported low level of knowledge on HBV among barbers in developing countries, despite the high occupational hazard posed to them (Mutocheluh et al., 2015).

This might be a reason for the continuous spread through this sector. One of the sustainable development agenda (SDG) for 2030 is the elimination of viral hepatitis (defined as a 90% reduction in new chronic infections and a 65% reduction in mortality, compared to the 2015 baseline) and implementation of key prevention, diagnosis, treatment and community intervention (like creating awareness) strategies were adopted by WHO, in order to achieve this goal.

Hence, this study aims to assess the knowledge, attitude and preventive practice against hepatitis B, and by extension, determine its prevalence among barbers in the Buea municipality. Such that recommendations can be made which will improve the awareness in the sector and encourage the achievement of the 2030 SDG of eliminating viral hepatitis.

1.2 Statement of the problem

Hepatitis B is a potentially life-threatening liver infection and a major global health issue, that puts people at risk of death from cirrhosis or liver cancer. Hepatitis B virus is transmitted through exposure to the blood and body fluids of infected persons. Since the barbing profession in most developing countries such as Cameroon operate under little or no regulations, there is some “laisser-faire”, and proper sanitation is usually not met during the shaving process.

Therefore, improper disinfection of the shaving instruments may lead to transmission of the HBV between barbers and their customers (Sood et al., 2021). This laxity is the reason why the shaving trade has been identified as a key risk factor for the spread of HBV. Therefore, this poor knowledge, coupled with the poor practices by barbers would only lead to continuous spread of the HBV through this sector, increasing the burden of the disease.

1.3 Research Questions

1. What is the prevalence of HBV among barbers in Buea municipality?
2. How much do barbers in the Buea municipality know about HBV and its transmission?
3. What is the attitude of barbers in the Buea municipality towards HBV infection prevention?
4. What are the HBV infection prevention practices adopted by barbers in the Buea municipality during the shaving process?

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