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THE PREVALENCE AND AWARENESS OF HEPATITIS B VIRUS IN PREGNANT WOMEN ATTENDING ANTENATAL CARE IN GOVT. HOSPITALS

A pregnant woman with Hepatitis B can pass the virus to her baby at birth. Fortunately, there is a vaccine to prevent this if they are aware

Photo of Terhemba Ahom
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INTRODUCTION

Hepatitis  B,  one  of  the  major  and  common infectious   diseases   of   the   liver   world   wide it  is caused   by   a   small   enveloped   DNA   virus,   the hepatitis   B   virus   (HBV).   The   virus   was   first discovered  as  “Australia  antigen”,  later  named hepatitis  B  surface  antigen  (HBsAg),  in  patient blood.   Hepatitis   B   e   antigen   (HBeAg)   was identified   several   years   later   as   a   marker   for patients at high risk for transmission of the disease (Tonget al,2005). It  is  estimated  that  more  than  two  billion people  have  been  infected  by  HBV  world  wide and  350  million  people  have  chronic  infection (Unekeet  al,2005).  When  a  pregnant  woman  is infected  with  HBV,  there  is  a  chance  she  may infect her foetus. It has been reported that 10 -20%of  women  seropositive  for  HBsAg  transmit  the virus  to  their  neonates,  but  in  women  who  are seropositive for both HBsAg and HBeAg, vertical transmission is approximately 90% (Vranckxet al,1999).  Chronic  HBV  infection  have  been  defined as carriage of HBsAg for at least 6 months and the highest  risk  (80  –  90%)  of  chronic  infection  have been   found   among   infected   neonates   born   to HBeAg  positive  carrier  mothers  followed  (30%) by children infected before 6 years of age (Hyams,1995). Nigeria   is   classified   among   the   group   ofcountries  endemic  for  HBV  infection.  Currentlyabout  18  million  Nigerians  are  infected  (Sirisenaet  al,2002,  Jomboet  al,2005). Many  of  these people  may  not  be  aware  of  the  infection  and hence  fail  to  seek  appropriate  medical  attention therefore   progressing   to   chronic   liver   disease, cirrhosis  and  hepatocellular  carcinoma. Similarly when pregnant women are involved they constitute a serious health risk not only to their unborn child but also the society at large.

Although,  studies  have  been  carried  out  on HBV  in  other  parts  of  the  country,  information  is very  scarce  on  the  prevalence  of  HBV  among pregnant   women attending antenatal care   in Federal Medical Centre Makurdi Benue State in comparison to General Hospital Nyanya, Abuja, FCT.   As   a   result guidelines  and  other  adequate  information  on  the prevention  and  control  strategies  are  lacking.  The objectives  of  this  study  therefore  are  to  determine the  prevalence  of  hepatitis  B  virus  carrier  and infectivity  status  of  carrier  pregnant  women  in Makurdi/Nyanya  and   to   provide   information   on   its prevention and control strategies.

MATERIALS AND METHODS

Study Area :The    study    will be conducted    in    Makurdi/Nyanya metropolis  which  is  located  in  an  area  covering about   16   square   kilometer,   in   North-Central Nigeria. Its average annual rainfall is 1200mm and the   average   annual   maximum   temperature   is 33.4oC.  Makurdi  is endowed  with  agricultural  viability  which  attract people  from  many  other  parts  of  the  country. Consequently,  the  area  is  reported  to  have  the highest prevalence of sexually transmitted diseases(Federal Ministry of Health, 2003). 

Nyanya is a sprawling cobweb of rusty and decrepit low-cost quarters, nestled on the foot of the rolling green peaks in the central area of Abuja, the Federal Capital Territory.

It is a stone throw from the highbrow Asokoro and Mogadishu Cantonment. It is located along a major route that serves as an artery linking the FCT and central part of the country. 

It is a community populated by middle and low class public workers and others in the same category, who cannot afford the high cost of accommodation inside Abuja.

But unfortunately as is the nature of cleverly conceived schemes in this clime, a declining standard of living has set in the area arising from neglect and infrastructural decay, such that to residents and visitors, Nyanya is no more than a slum and an eyesore.

Though it is a satellite town divided into five areas for proper enumeration and served by a General Hospital plus a Squadron 21 Mobile Police Unit and the Nigeria Police Divisional Police Headquarters, its roads are deplorable and without a bus terminal, public park, market and adequate public schools.

Most Nyanya residents can’t access potable water while the sanitary condition in many houses is alarming because they are not linked to the central sewage plant.

Selection of Subjects.

All    pregnant    women    attending    antenatal care in the aforementioned hospitals in Makurdi/Nyanya metropolis will be   eligible   for   the   study.   Participation will be voluntary  and  each  subject  involved  in  the  study will give  a  written  consent.  The  recruitment  will be  by  a simple  random  sampling  method to cover five months period. The ethical approval will be obtained from the ethical committee of  Benue  State  Ministry  of  Health  and  Human  Board of Services, Makurdi and FCTA Health Board. 

Variables

The   following   information will be requested from  the  subjects  in  a  structured  questionnaire; age, occupation,marital status,previous  use  of  contraceptive devices, smoking and  alcoholic  consumption, knowledge of HBV, any implications during any birth etc.Subjects  will be  asked whether  they  have  suffer  from jaundice  or  not  and their  blood  group.

Collection of sample/Analysis 

Five milliliter (5ml) of blood will be obtained by venopuncture.  One  milliliter  (1ml)  of  the  freshly collected  blood  will be  introduced  into  an  EDTA  bottle  for  ABO  blood  grouping.  The  remaining  (4ml)  will be  introduced  into  a  clean  test  tube,  allowed  to  clot  naturally  and  separated  by  centrifugation   at   1,500   revolutions   per   minute   (rpm).  Part  of  the  sera  collected  will be  tested  for  hepatitis  B  surface  antigen  (HBsAg)  using  latex  rapid  agglutination  slide  test  kits  (Cal  –  Tech  Diagnostic,  Inc.  USA.)  in  the  laboratories  of  the  hospitals   where   the   samples   will be collected.   Reactive   samples will be stored   at  –20oC  and further  confirmed  for  HBsAg  using  commercially  available  enzyme  linked  immunosorbent  assay  kit  (ELISA)   (Bio   Rad,   France)   in   immunology   laboratory. HBsAg   positive   samples   will also be  tested   for HBeAg using ELISA kit (ORGENICS, Israel). Statistical Analysis Results will be obtained and subjected to statistical analysis using statistical package for social sciences (SPSS) version 11.Comparison of result from the two hospitals will be done using chi-square test while P values less than 0.05 will be considered significant. 

What is a provocation or insight that might inspire others during this challenge?

When babies become infected with Hepatitis B, they have a 90% chance of developing a lifelong, chronic infection. As many as 1 in 4 people with chronic Hepatitis B develop serious health problems. Hepatitis B can cause liver damage, liver disease, and liver cancer.HBIG is a medicine that gives a baby’s body a “boost” to fight the virus as soon as he or she is born. So the HBV status must be known.

How does this research relate to our use cases and personas?

The Mother suffering from chronic disease: Nigeria is classified among the group of countries endemic for HBV infection.Currently about 18 million Nigerians are infected (Sirisena et al, 2002, Jombo et al, 2005).Many pregnant women may not be aware of the infection and hence fail to seek appropriate medical attention therefore progressing to chronic liver disease,cirrhosis, hepatocellular carcinoma and transmission of the virus to their neonates and the society at large.

Tell us about yourself:

I am a public servant with a microbiology background.

Are you currently an employee of Sutter Health or UCB Pharmaceuticals?

  • No

3 comments

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Spam
Photo of Lauren Ito

Hello Terhemba Ahom thank you for joining this challenge and sharing your story! Are there any organizations in your community in Nigeria or in the greater region that focus on chronic disease for pregnant women? Would love to hear your feedback and orgs you recommend in the space, especially with the unique lens you bring to this challenge.

Please provide those suggestions in the comments section or by emailing newlife@ideo.com.

Excited to learn more!

Spam
Photo of Terhemba Ahom

Hello Lauren thank you for your comments. Well, am sure some organizations here are focused on chronic disease so i will take time to find out which ones and feed you back. Thanks once again.

Spam
Photo of Terhemba Ahom

Hi Lauren, there are many NGOs focused on this and they include Malaria Consortium, Society for Family Health, etc