research chapter one

                                             

        

 CHAPTER ONE

 INTRODUCTION 

Introduction This chapter explains the background of the study , problem statement ,objective research question, scope of the study , significance of the study an conceptual framework 1.1 Background Hepatitis B virus (HBV) is the causative agent of one of the world‘s major infectious diseases with about 350 million people being chronic carriers of the virus. Hepatitis B infection is the 10th leading cause of death worldwide, as a significant number of the chronic carriers go on to develop liver cirrhosis or hepatocellular carcinoma (HCC) and over 1 million die annually from HBV associated liver disease (r (TL, 2006) . HCC is responsible alone for 320 000 deaths per year ( (Jus00) (D, 2004) However, antiviral drugs are available for HBV infected individuals that may prevent the critical consequences of chronic liver disease, which emphasizes the significance of identifying infected individuals and monitoring the prevalence of the disease. (ate, 2009) Hepatitis B infection, which is caused by Hepatitis B Virus (HBV), is a major public health problem with 2 billion people infected worldwide and more than 400 million chronic carriers worldwide. Globally it causes 1.2 million deaths per year and various complications including chronic hepatitis, cirrhosis and liver cancer [Hou J, Liu Z, Gu F (2005)] (Hou J, 2005) At present, viral hepatitis kills more people than HIV, tuberculosis or malaria with mortality reported to have increased by 63% since 1990 [Stanaway JD, eta (Stanaway JD, 2013)2013]. HBV is a highly infectious virus transmitted mainly via blood, body-fluid contact, and vertical transmission (Lok ASF, 2007))]. The HBsAg in serum is the first serology marker to indicate active HBV infection, either acute or chronic [ (Sood S, 2010) Globally The global prevalence of chronic HBV infection among children under five years declined from 5% in the pre-vaccine era (1980s to early 2000s) to less than 1% in 2019. [World Health Organisation 2021 (Organisation, 2021)]. Vaccination to protect against HBV infection is part of the WHO Extended Programme for Immunisation (EPI) and has been progressively rolled out across Africa since 1995, alongside enhanced interventions for the prevention of mother to child transmission. Despite more than two decades of vaccine introduction which has been critical for reducing infections in  children, the overall population prevalence of HBV infection remains high across many settings in SSA (> 8%) [World Health Organisatio 2021 (Organisation, Hepatitis B key facts, 2021)]. Early epidemiological studies have suggested a high variation in the estimates of HBV prevalence between countries and subgroups of the population in SSA. These variations are often explained by methodological differences [Belo AC 2000]. The prevalence of HBV and its modes of transmission vary geographically, and it can be classified into three endemic patterns [. Knipe DM 2013 (DM, 2013)]. Around 45% of the world‘s population live in regions of high endemic, defined as areas where 8% or more of the population are positive for HBsAg such as Southeast Asia and Sub-Saharan Africa. The moderately endemic areas, such as in Mediterranean countries and Japan, are defined as those areas where 2–7% of the population are HBsAg positive, and around 43% of the world‘s population live in regions of moderate endemic In Western Europe and the United States of America, HBV is usually transmitted horizontally by blood products or mucosal contact. In highly endemic areas like Southeast Asia or Equatorial Africa, the most common mode of transmission is vertical transmission perinatal from an HBV-infected mother to the newborn child [Knipe DM 2013 (DM, Fields virology, 2013)]. Certain types of behaviors increase the risk for contracting HBV such as : use of contaminated needle during acupuncture, intravenous drug abuse, ear piercing and tattooing, sexually active heterosexuals or homosexuals (having more than one sexual partner in the last 6 months), infants/children in highly endemic areas, infants born to infected mothers, health care workers, hemodialysis patients, blood receivers prior to 1975 (blood transfusion), hemophiliacs, prisoners with long term sentences as well as visitors to highly endemic regions [. Nicoletta P, 2002 (Nicoletta P, 2002)].

 In Africa, Nigeria is ranked as one of the countries that is hyper-endemic for HBV infection (> 8%) [Kramvis A, Kew MC 2007 (Kramvis A, 2007)]. Approximately nine in ten Nigerians who live with chronic HBV are unaware of their infection status, and are missing from the global public health statistics due to a lack of resources, awareness, and political will for addressing Nigeria‘s HBV plight [The Journey to hepatitis elimination in Nigeria. 2020]. Consequently, Nigeria has one of the highest rates of HBV-attributable cancer in West Africa, with an age-standardised incidence estimate o 2.6 to < 5.1 cases per 100,000 personyears [de Martel C 2020 (de Martel C, 2020) ]. HCC is a highly aggressive cancer with limited treatment options, often lacking in resource-constrained settings [Howell J, Lemoyne M, 2014 (Howell J, 2014)]. Roughly a quarter of the world‘s population, or 2 billion people, has serological evidence of past or present hepatitis B virus (HBV) infection. A total of 250 million people are estimated to have chronic hepatitis B (CHB) infection. It is further estimated that almost 700,000 die of HBV per year, with 300,000 because of the development of HBV-inducedhepatocellular carcinoma, the second most common cause of death from cancer. (Nelson NP, Easterbrook PJ, McMahon BJ, 2016) (Nelson NP, 2016)This is true despite the presence of a safe and effective vaccine and the availability of efficient therapy. In industrialized Western countries, including theUnited States, immigrants from hepatitis B– endemic areas represent an important source of new HBV infections.3 Thisgroup represents a much greater risk than, for example, the intravenous drug user population, which is estimatedto account worldwide for slightly more than a million CHBinfections, whereas the immigrant HBV population in the United States alone is estimated at 1.6 million. Rossi C, Shrier I, Marshall L, et al.2012 (Rossi C, 2012) Middle Eastern countries are considered developing countries that possess a suboptimal health care infrastructure. Reliable data on epidemiology may be difficult to obtain. In such areas, assessing HBV prevalence in blood donors appears attractive because they are based on a large number of individuals. Data obtained from blood donor studies can be considered acceptable indicators of the HBV burden in developing countries provided it is understood that these prevalence data underestimate the real problem because high-risk groups for HBVare rejected from blood donation without pretransfusion blood screening for hepatitis B surface antigen (HBsAg).( Bananejad M, Izadi N, Najafi F, et al.2016) (Bananejad M, 2016) In Somalia, viral hepatitis, especially HBV, is of significant public health importance. Somalia is an area of the world with a high prevalence HBV infection of > 8. There are several studies of the prevalence of HAV, HBV, HCV, HDV, and HEV in Somalia; however, to the best of our knowledge, there is no meta-analysis to provide an overall estimation of the prevalence of all viral hepatitis infections in this country. A recent report explored the reasons for such a dearth of data[Hassan-Kadle MA 2017 (MA, 2017)]. 

In Somalia, largely due to the unsettling decades-long civil war, medical staffs are underqualified and undertrained, and limited access to modern laboratory facilities poses substantial diagnostic challengesSo[Hassan-Kadle MA 2017 (MA, The Diagnostic Challenges, Possible Etiologies and Lack of Researches of Hepatocellular Carcinoma in Somalia, 2017)]. epidemiology was carried out among 383 adults fromdifferent areas of Somalia and in 135 pregnant women and 428 children from Mogadishu. The study showed a high incidence of HBsAg among nomadic males 20/85; (23%) and a lower incidence among males from agricultural and coastal areas, i.e., 16/93 (17%) and 14/98 (14%), respectively. Meanwhile, the lowest frequency of HBsAg was observed among women from coastal areas (6/72; 8%) and among pregnant women (14/135; 10.4%), none of whom had HBeAg. However,a low number of children were HBsAg-positive, both under 4 years old (3/94; 3%) and 4-13 years of age (5/128; 4%). In the 15-19 age group, 50% of subjects showed seroconversion from HBeAg to anti-HBe. A total of 7 out of 41 HBsAg carriers aged over 20 had HBeAg, while the overall prevalence of 8.2% (78/946) was HBsAg-positive( Bile KM, eta 1987) (Bile KM, 1987)

1,2 Statement Problem Four hundred million people in the world are living with chronic hepatitis B virus (HBV) infection.( (L, 2008) Ching-Lung L 2008) The majority of these individuals acquired the infection during the perinatal period and early childhood.( Ott JJ 2012 (JJ, 2012)) The risk of becoming a chronic hepatitis B infection carrier is 95% for infections acquired during the perinatal period(Stevens CE 1985 (Stevens CE, 1985)) compared with only 5% for those acquired during adulthood.( Tassopoulos NC 1987 (eta T. N., 1987)) Up to 50% of HBV carriers die of complications including liver cirrhosis and hepatocellular carcinoma.5 Pregnant mothers who test positive for both hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) have 70– 90% risk of transmitting infection to theirnewborn infants and about 10–40% risk if they test positive for only HBsAg.( . Alter MJ. 2003 (MJ., 2003)) Therefore, pregnant women should be routinely screened for HBsAg and hepatitis B vaccine administered at birth to the infants whose mothers test positive.( US Preventive Services Task Force. 2014 (Force., 2014)) However, this is not the practice in Uganda. The Uganda National Expanded Program on Immunizations (UNEPI) scaled-up childhood immunisations in 2002 (Ministry of Health Republic of Uganda 2008 (Uganda, 2008)) incorprated the hepatitis B vaccine into a combination vaccine whose first dose is administered at 6 weeks of age. The 6 weeks window both limits the efficacy of the vaccine in the prevention of vertical transmission and also allows for the potential transmission of HBV through close contacts. (WHO. 2001 (WHO., 2001))The most effective method of preventing HBV infection is through immunisation, which offers over 95% protection against the development of chronic infection. ( Lavanchy D. 2004 (D., 2004) )Such immunisation should be done at birth for exposed infants. There is no evidence of protection against perinatal transmission if the first dose of vaccine is given more than 7 days after birth. (1. Andre FE, 1994 (1. Andre FE, 1994)) In Nigeria, the prevalence of HBV infection among pregnant women was 11% with an HbeAg positivity of 33%.(. Mbaawuaga EM, 2008 (.Mbaawuaga EM, 2008)) In northern Uganda, there is limited knowledge on the prevalence of hepatitis B infection among pregnant women. The civil war in this region between the government of Uganda and the Lord‘s resistance army from the late 1980s up to 2006 led to the displacement of as many as 1.7 million people from their homes into internally displaced persons camps.( Rujumba J 2010 (eta R. J., 2010)) These camps were crowded, traditional and social structures were disrupted and sexually transmitted infections (STIs) such as HBV seemed to have increased. The Uganda HIV serobehavioural survey of 2004/2005 estimated the prevalence of hepatitis B in northern Uganda to be between 18.4% and 24.3%, much higher than the national average of 10%,14(Ministry of Health Uganda 2005)(Uganda M. o., 2005)  

1.3.0 Objectives

1.3.1 General Objective

These study aimed to assess prevalence and risk factor associate with hebatitis B varuse among patients in dufle hospital hodan distrct mogadisho somalia

1.3.2 Specific Objective

1 To identify prevalence of hepatatis B Among patients in dufle hospital hodan district in Mogadisho somalia

 2 To describe transfusion factors associated with hepatitis B virus among patient in Duffle hospital

 3 To Identify sexually factors associated with hepatitis B virus among patient in adufle hospital

1.4 Research question

 1-How is the prevalence of hepatitis B Virus Among patients in dufle hospital hodan district in Mogadisho somalia ?

 2-What are the transfusion factors associated with hepatitis B virus Among patients in dufle hospital Hodan district in Mogadishu ? 

3-How is the sexually factors associated with hepatitis B virus among patients in dufla hospital? 

1.5 Scope of the study

 1.5.1 Contact OF The scope 

 This study was contained Prevalence and risk factors associated with hepatitis B virus among patients at some selected Hospitals at dufle hospital hodan district

 1.5.2 geographical of the scope

 This study was conducted in dufle hospital hodan district Mogadishu somalia 

1.5.3 Time of scope

 the study will focus on the period between march 2022 and august 2022

 1.6 Significance of the study

 The findings of the study will serve as guidance for the local authorities ‗civil society NGO and the international community operating in somalia

The findings of the study will provide research based and up to date information to future researchers and factors influencing of the prevalence and risk factor associate with hepatitis B Virus among patient dufle hospital hodan distrct mogadisho somalia The study is helpful to the ministry of health and other health institutions both public and briefed because it makes then full aware of the subsequent is studies related to same problem