Abstract

Background:

Hepatitis B represents a major global health concern, affecting up to 58million people per year and 138 million are chronic carriers. This hepatitis B does not only reduce the quality of life and physical functioning of those infected but also have a significant economic impact on communities and the health care system as a whole.

Aim of the study: To investigate student nurses knowledge on the preventive measures of hepatitis B in the Buea municipality

Method: The sampling technique being a cluster random sampling, with a study design of cross-sectional study, have a sample population of student nurses in the Buea municipality, with a sample size of 100 and data was collected using well-structured questionnaires.

Results: With respect to the objectives; To investigate student nurses knowledge on hepatitis B. 62% could identify the definition of hepatitis B. 70%, the cause of hepatitis B 50% identified the signs and symptoms and 15% identified the route of transmission of HBV. With regards to nurses knowledge on the preventive measures on hepatitis B. 43% of respondents knew when the hepatitis B vaccine is given to children in Cameroon and 20% percent knew how to prevent hepatitis B.

Conclusion and recommendations: At the end of this study, it was concluded that the student nurses had adequate knowledge on hepatitis B and very poor knowledge on the preventive measures on hepatitis B. Thus it was recommended that the lecturers of the different institutions should add hepatitis course into their syllables in year one in order to create awareness among this students before they are sent out for clinical.

CHAPTER ONE

INTRODUCTION

1.1 Background

Viral hepatitis b is a major public health problem affecting low and middle income countries in African and Western Pacific regions [Lemoine M. Lacombe K. 2015].. Throughout the world many scientist have wondered where hepatitis b originated from. In 2018, the source was still a debit in the world of science, in 2013 it was thought to have originated from birds, then in 2015 it was thought to have originated from fish.

Throughout all the studies, it is clear that the virus is a prehistoric disease that has existed for at least 82million years ago. Studies have showned that the strands of hepatitis b virus started in North Africa and the Middle East. From there the virus spread to the whole world [Warren W.C. Clayton D.F 2010]. Some forms of viral hepatitis have been affecting humans and harming their livers since 2000BC. Until World War 2, doctors didn’t even know that several types’ hepatitis existed nor did they know how it was transmitted.

A physician, who specialized in liver disorders DR F.O Maccallum, identified the hepatitis b virus when he was researching a yellow fever vaccine during the 1940s. He discovered that many British soldiers who received the yellow fever vaccine developed hepatitis and he named it serum hepatitis. In 1963 Baruch Blumberg discovered this antibody in 2 American hemophilia patients. Dr Blumberg found that the antibody reacted or attacked an antigen from an Australian Aborigine which is identified as hepatitis b surface antigen and was initially called Australian antigen

[Blumberg Bs, Alter HJ, 1965] Dr Blumberg a biochemist and Irving Millman a microbiologist developed a test that identified hepatitis virus in blood samples. In 1971, the test became the first method to screen blood donors for the virus. In 1976 Dr. Blumberg and Millman developed a vaccine against hepatitis b.

The road to HBV VACCINE began in 1963 when the American physician / geneticist Baruch Blumberg discovered HBV in 1965 The American microbiologist / volcanologist Maurice Hilleman at Merck used 3 treatments [pepsin. urea and formaldehyde] of blood scum together with rigorous filtration to yield a product that could be used as a sale vaccine .Hilleman hypothesized that he could make an HBV vaccine by injecting patients with hepatitis b surface protein. In theory this will be very safe as these excess surface proteins lacked infectious viral DNA.

The immune system recognizing the surface proteins as foreign, would manufacture specially shaped antibodies, custom made to bind to, and destroy these proteins. Then, in the future, if the patients were infected with HBV the immune system could promptly deploy protective antibodies, destroying the viruses before they could do any harm [abed world hepatitis day 2012/7/26] . Hilleman collected blood from gay men and intravenous drug users groups known to be at risk of viral hepatitis. This was in the late 1970s when HIV was yet unknown in medicine. In addition to the sought after HB surface proteins, the blood samples likely contained HIV.

Hilleman devised a multistep process to purify this blood so that only the HB surface proteins remained. Every known virus was killed by this process and Hilleman was confident that the vaccine was safe [a b c d world hepatitis day 20 2j. The blood derived HB vaccine was withdrawn from the market in 1986 when Pablo DT Valenzuela, RESEARCH director of chiron corporation, succeeded in making the antigen in yeast and invented the world’s first recombinant vaccine [Fisher LM. 1986].

The recombinant vaccine was developed by inserting the HBV gene that codes for the surface protein into the yeast Saccharomyces cerevisiae. This allows the yeas’ to produce only non-infectious surface protein, without any danger of introducing actual viral DNA into the final product [abed world hepatitis day 2012/7/26.] This vaccine still in use today. In 2002 Blumberg published a book. HEPATITIS B. the hunt for a killer virus.

Robert Purcell. a virologist has emphasized the importance of the HBV vaccine in figuring out the hepatitis viruses generally [Gerlich Wl l, 2013]. In 2017. a 2 dose HBV vaccine for adults, HEPLISAV-B gained US FDA approval. It uses recombinant HB surface antigen, as previous vaccines but include a novel CpG IK adjuvant a 22-mer phosphorothioate -linked oligodeoxynucleotide. It was non inferior with respect to immunogenicity [Dynavax Technologies Corporation. 2018|. Around the world, hepatitis b virus has a strong hold in ASIA where it is endemic; CFI1NA, South East Asia, TAIWAIN and many Pacific Island have chronic infection rates ranging between 5-20 percent of their population due to infections at birth or during early child hood.

Hepatitis b vaccine was introduced in 1982 in the united states [ Weinbaum et al, 2009], Hepatitis b vaccine was introduced in Cameroon in 20(15 \ WFIO 2005], Dr Blumberg was awarded a noble price in 1965 for the discovery of the virus. After discovery of the virus, Blumberg and millman discover the first anticancer vaccine which was initially a heat treated form of the virus. In 1981.

The FDA approved a more sophisticated plasma derived hepatitis b vaccine for human use. These inactivated type of vaccine involved the collection of blood from hepatitis b virus infected donors. The pooled blood was subjected to multiple steps to inactive the viral particles that included formaldehyde and heat treatment [or pasteurization], Merck pharmaceuticals manufactured this plasma vaccines as heptavax. This was the first commercial hepatitis b virus.

The use of this vaccine was discontinued in 1990 and it is no longer in the United States. In 1986 research resulted in a second generation of genetically engineered or DNA recombinant hepatitis b vaccines, these vaccines are synthetically produced and do not contain blood products, so it is impossible to get hepatitis b from the new recombinant vaccines that are currently approved in the U.S. HBV is one of the most human viral infections in the world.

This virus specifically infects the liver cells of many primates including humans thereby causing severe Unlike symptoms roughly 5 percent remain infected throughout their lives acting as carriers who can infect others whilst also suffering a variety of serious liver diseases including cancer. In fact, HBV is the second only to tobacco amongst known human carcinogens, causing up to 8 percent of all hepatocellular carcinomas worldwide.

HBV infects and replicate in human hepatocytes f Seeger and Mason 2000], the global respond entered a new phase in 2015 when the UN general assembly adopted the 2030 agenda for sustainable development. To move the Held forward, and to expedite the pathway from discovery to regulatory approval, a workshop with key stakeholders was held in September 2016 to develop the census on treatment end points. There are now 179 countries including Australia offering HB vaccine as part of their neonatal immunization [WHO 2011], Throughout the world, more than 350 million individuals are chronically infected with HBV [ Lavanchy 2004],

This is despite the availability of safe and effective vaccines for more than 3 decades, Africa and Asia carry the burden of this infection with up to 58million and 130 million chronic carriers respectively |Custer et al 2004] but the HBV infections varies between 5 and 19 percent in different A It :an countries [Custer et al 2004] and even within African countries |kew 1996 |. S uli Africa introduced HBV vaccine in 1995 to local expanded program and immunization. The vaccine is first administered at the age of 6 weeks although WHO recommends giving the first dose within 24hours after delivery. Estimates from the national Center for disease control and prevention for some regions of Asia indicate that between 1/3 to one half of the entire populations have been infected with HBV [CDC 1990].

Even in European and North American countries with modern health services often the only HBV infections reported to government agencies are new acute cases that have the characteristics of causing symptoms that prompt patients to seek medical care but this is the tip of the Iceberg. In the United States in 2001 there were 7844 acute cases of I IBV infection reported to CDC BUT CDC estimated that there were actually 78000new cases of hepatitis b infections worldwide that year.

The nature version is known as Dane particles and is 42nm in diameter [Dane et al 1970]. In 1992 WHO passed a resolution recommending global vaccination against HB. Africa as a whole is considered to have greater than 8 percent of hepatitis b surface antigen chronic carriers on their general population. In the Sub-Saharan countries such as Nigeria, Namibia. Gabon, Cameroon, Burkina Faso, OTHER like Kenya, Zambia, Ivory coast. Liberia, Sierra Leone and Senegal are countries in Africa with chronic hepatitis b carriers [Kramvis A 2007] .

The expanded program on immunization started in some African countries in 1995 and it is administered at 6lh. 10th. and I41’1 of age and it has proven to decrease the prevalence of hepatitis B over the past years [ Burnet R.I 2012], A study in 1983 by PROZESKY et al showed that the prevalence of HBsAg was I percent in 103 vaccinated infant’s age less than 6. However, this study was carried out when HIV endemic was not yet carried out in AFRICA. In 2015, WHO established that 3.5 percent of the world’s populations [257million people] were living with |-‘BV infections resulting in 887000deaths each year mostly from complications like: cirrhosis, hepatocellular carcinoma [WHO 2017). United Nations sustainable development goals set out the challenge of elimination of viral hepatitis as a public- health threat by 2035 [WHO 20I6 |.

ONE of the existing strategies in the elimination tool box is used of antiviral drugs in the form of nucleoside analogue [NAS] Africa is the continent with the second largest number of individuals with chronic HBV INFECTION HAVING 6.1 percent of adult population infected [WHO 2017], However, there is very little commitment and resources invested into the burden of this disease and many barriers are contributing to the epidemic [LEMOINE M. MAPONG T et al 2017]. Globally, less than 10 percent of the populations with chronic I1IW infection are diagnosed with an even smaller proportion on treatment [WHO 2017]. This proportion is likely to be even lower in Africa.

High coinfections rates worsens the prognosis in dually infected individuals [Occumap et al 2015]. There is also lack of epidemiological data on HBV from Africa [Lemoine, Mapong T et al 2017], WHO estimate that the prevalence of HBV in Cameroon is 8-20 percent in young people under the age of 30 years. In immune-compromised individuals, viral replication is poorly controlled by host immune system resulting in high viral load [COLIN et al 1999] and lower rates of HBsAg clearance [Thio 2009J which increases the risk of mother to child transmission.

Recent searches have showed a varying prevalence of HBsAg from 0.4-23 percent [BARTH et al 2010], It has been established that chronic HBV affects approximately 300million individuals or 5 percent of the total population. This is of particular concern in the ASIAN. Pacific regions where chronic HBV infection is most prevalent. HBV infection in Cameroon is I 1.9 percent [WHO 2006], Internationally, chronic HBV is the single most important risk factor of developing liver cancer with 60.80 percent of the world’s cases of primary liver cancer attributed to chronic HBV [WHO 2013] Australian Institute of health and welfare.

HBsAg prevalence in the population of blood donors in Cameroon is estimated to be 6-16 percent [Koanga Mogtomo et al 2009], In Cameroon with a population 22.25million inhabitants, 2250000 inhabitants are infected. [Cameroon national institute of statistics 2016], HBV universal program was introduced in Cameroon in 2005. The circulation of Three HBV genotypes A, E and D was reported in patients in Cameroon, however genotype A and E are predominantly found [Ducancelle Aet al 2013. Kramvis Act al 2017], In Canada the incidence of HBV is 2.3/100000 resulting in about 700 reported cases [CDC 2001] Asia is the Country with the highest prevalence of HBV worldwide j CDC 2001J . In Europe Scandinavia and France has the lowest prevalent rate 0.1 and 0.4 percent respectively [CDC 2001].

In Cameroon I 1.9 percent of the total population is infected with 2million Cameroonians exposed to the disease [Brenda Y Nchewi iv Ngassa 2016]. The prevalence of hepatitis b virus varies in different region, of Cameroon. In areas where hepatitis b prevalence is high, it is mostly transmitted through horizontal routes which is transmission from an infected child to an uninfected child within the first 5 years of life and also from mother to child which is the vertical transmission [ WHO 2017] . Worldwide hepatocellular carcinoma is the most common cause of death from cancer and was estimated to be responsible for about 750000de deaths in 2012 [J ARC 2016], According to estimates of global burden of disease study.

Death due to viral hepatitis increased by 63 percent from 0.89million to l.45million between 19990 and 2013 and Africa is one of the regions with the highest mortality rate [Stanaway JD, Flaxman ADet al 2013]. An estimated 50-80 percent of cases of primary liver cancer results from infections with HBV | Perz JF. Armstrong GL et al 2006J.

There is a high risk of contracting hepatitis b in Nigeria because about 75 percent of Nigerians populations exposed to the disease [Ola so et al 2002]. FIBV vaccine was introduced in Nigeria, in 2004. In the US, Approximately 1.4 million residents’ are chronically infected with HBV [Weinbaum et al 2009, Nguyen el al 2010J. According to the fact that during the years 1974 -2008. 17.6 million People born in countries of intermediate or high prevalence of chronic hepatitis B have migrated to the US. There is an increase burden of chronic hepatitis b in this country [Mitchell, Armstrong III.

Wasley painter 2011], More than half of the estimated chronic HBV cases were from the Western Pacific regions from countries such as the Philipines. China and Vieti m. these were the main countries of birth for imported cases of chronic HBV. Africa was the second largest region for imported cases of HBV. According to a systematic review [ Rossi el al 2012] migrants from East Asia, the Pacific and sub Saharan represented a high seroprevalence rate of chronic HBV 10.3- 11.3PERCENT AND MIGRANTS FROM Eastern Europe Central Africa and South Asia were an intermediate seroprevalence.

This seroprevalence was of chronic HBV was low in migrants horn Caribean, La thin America the Midie East and noith Africa. In a study made in Taiwain [ Su et al 2012] the authors analyzed data from an acute hepatitis b surveillance during S years , they found that the execution of immunization program effectively had reduced the prevalence of acute HBV among young adults and adolescent .

Although many infants are vaccinated, there is still a high incidence of acute HBV among infants due to mother to child transmission at birth. The combination of HB vaccines and immunoglobulin within the first 24 hours were given to new bonis whose mothers were tested positive for HBsAg and I IBeAg, HBeAg that gave 85-95percent

These studies entitle investigating student nurses knowledge on the preventive measures of hepatitis b in the Buea municipality is carried out from November 2018 -January 2019. Buea is found in the south west region of Cameroon with the highest population made up of youths. Owing to the fact that hepatitis b vaccine was introduce- in Cameroon in 2005, most youths in BUEA are not immunized against hepatitis B.

Following that youths are also very sexually active, these two main aspects expose.- the population of Buea at very high risks of contracting the hepatitis B virus there by exposing student nurses at risk of contracting this virus when they are being rushed to the hospital and since student nurses are not having enough skills they can easily contract this disease when they come in contact with infected body fluid so decided to  investigate student nurses knowledge on how to prevent this silent killer disease since the prevalence rates keeps increasing in Cameroon.

1.2 Statement Problem

Despite the availability of safe and effective vaccines, the prevalence of hepatitis b in Cameroon is a call for concern with a prevalence rate of 11.9 percent and about 2million people exposed to this disease [Brenda Y, Nchewnong NGASSA . 2016].

Also following the fact that transmission of this disease through body fluids is very common, the researcher felt worried about student nurses since health care workers are at higher risks of contracting this disease and student nurses which are less skillful when handling body fluid in the hospital, and during my second year internship at the district hospital Deido, the researcher came in contact with a hepatitis B positive nurse who was advising the researcher  to be careful the way she handle sharp objects indicating that she got it  out of carelessness during her internship period. So this motivated the researcher to carry out the research titled investigate student nurses knowledge on the preventive measures of hepatitis B in the Buea municipality.

1.3 Objectives

1.3.1 General Objective

To investigate student nurses knowledge on the preventive measures of hepatitis b in the Buea municipality.

1.3.2 Specific Objectives

1. To investigate student nurses’ knowledge of hepatitis B in the Buea municipality
2. To investigate student nurses’ knowledge of the preventive measures for hepatitis B in the Buea municipality.

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