PREVALENCE OF HEPATITIS AMONG PREGNANT WOMEN. A CASE STUDY OF CHIROMA WARD IN LAFIA LOCAL GOVERNMENT AREA OF NASARAWA STATE.

PREVALENCE OF HEPATITIS AMONG PREGNANT WOMEN. A CASE STUDY OF CHIROMA WARD IN LAFIA LOCAL GOVERNMENT AREA OF NASARAWA STATE.

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CHAPTER ONE

INTRODUCTION

Background of the Study

A combination of two Greek words “hepatos” (liver) and “itis” (inflammation) gave rise to the current word hepatitis. Hepatitis is usually caused by drugs, toxic agents, or viral infections, but it may also arise as a result of an autoimmune response. The recognition of hepatitis virus (HV) infection as a disease of public health importance came into existence when it appeared as an adverse event associated with a vaccination program. Hepatitis virus infection is a serious disease of humanity and constitutes a global public health problem. Hepatitis virus  can be transmitted by several routes which include vertical transmission, early life horizontal transmission, and adult horizontal transmission (Combs, 2010).

Viral hepatitis is an emerging global health problem. In 2015, an estimated 1.34 million deaths occurred due to viral hepatitis globally. This number is equal to deaths caused by tuberculosis and higher than those deaths caused by human immunodeficiency virus. In the same year, hepatitis B and C viruses (HBV&HCV) alone were responsible for 96% of hepatitis mortality. Untreated hepatitis B and C viral infections can lead to life treating long-term complications such as liver cirrhosis and cancer (UNICEF, 2012).

Women of childbearing age can potentially transmit Hepatitis virus  to their babies. They transmit an infection to newborn usually during birth or soon after birth following close contact. Newborns who exposed to Hepatitis virus  will have almost 85–90% risk of developing chronic liver diseases (WHO, 2013).

In Nigeria, the rate of Hepatitis virus transmission from infected mother to the newborn is not well studied. However, one study revealed that 75% of newborns born from Hepatitis virus infected women were positive with hepatitis B surface antigen (HBsAg) in 2012.

Four hundred million people in the world are living with chronic Hepatitis Virus (HV) infection. The majority of these individuals acquired the infection during the perinatal period and early childhood. The risk of becoming a chronic hepatitis infection carrier is 95% for infections acquired during the perinatal period compared with only 5% for those acquired during adulthood. Up to 50% of Hepatitis virus carriers die of complications including liver cirrhosis and hepatocellular carcinoma (UNICEF, 2014).

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 their newborn infants and about 10–40% risk if they test positive for only HBsAg. Therefore, pregnant women should be routinely screened for HBsAg and hepatitis B vaccine administered at birth to the infants whose mothers test positive (WHO, 2014).

The Nigeria National Expanded Program on Immunizations (NNEPI) scaled-up childhood immunisations in 2005 incorporated the hepatitis 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 Hepatitis virus  through close contacts. The most effective method of preventing Hepatitis virus  infection is through immunisation, which offers over 95% protection against the development of chronic infection. 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 (Philips, 2013).

In Nigeria, the prevalence of Hepatitis virus infection among pregnant women was 11% with an HbeAg positivity of 33%. In northern Nigeria, there is limited knowledge on the prevalence of hepatitis infection among pregnant women. The civil war of 1966 led to the displacement of as many as 4.7 million people from their homes into internally displaced persons camps. These camps were crowded, traditional and social structures were disrupted and sexually transmitted infections (STIs) such as Hepatitis virus seemed to have increased. The Nigeria HIV serobehavioural survey of 2004/2005 estimated the prevalence of hepatitis in northern Nigeria to be between 18.4% and 24.3%, much higher than the national average of 10%.

Seroprevalence studies on Hepatitis virus in Nigeria have shown that the prevalence of the infection in pregnant women ranges from 2% to 15%. In other parts of West African sub region, sero-prevalence of 8%–16.2% has been reported.

In Taiwan, a Hepatitis virus -positive rate of 15.5% was reported. In developed countries such as the United States and Western Europe, less than 2% of the population is chronically infected. A regression analysis in a study done in Birmingham, UK, showed that there was a significant increase in the number of cases of hepatitis B being identified through antenatal screening from 106 cases in 2005 to 161 cases in 2008. This represents a 52% increase in cases in 2008 compared to 2005 with an average increase of 13.7 cases per year. Hepatitis virus  prevalence rate in the general population can be obtained by determining how many women in an antenatal population have the infection (Margret, 2014).

When Hepatitis virus infection occurs in the trimester, about 10% of the neonates are affected by vertical transmission, and when it does occurs in the third trimester, a higher percentage of 60–90% of the children may have the infection by vertical transmission.

Statement of the Problem

Viral hepatitis during pregnancy is associated with high risk of maternal complications and has become a leading cause of foetal death. Hepatitis one of the major and common infectious diseases of the liver world wide is caused by a small enveloped DNA virus, the hepatitis B virus (HBV). Nigeria is classified among the group of countries endemic for HBV infection. Currently about 18 million Nigerians are infected. 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.

Hepatitis is becoming an emerging public health concern in Nigeria. Recent systematic review of all types of viral hepatitis in Nigeria concluded that the prevalence of Hepatitis virus among the population is 7.4%. Hepatitis virus infection in Nigeria is still a public health issue. It remains a major cause of mortality, especially in underdeveloped countries. In this low-resource setting, vertical transmission of Hepatitis virus infection is thought to be a major route of transmission. Despite the above, routine antenatal screening for Hepatitis virus infection is not practiced in many Nigerian hospitals. Hepatitis virus infection is still a serious global health issue. In the continents of Africa and Asia, it remains a major cause of morbidity and mortality (Philips, 2012).

Every year, as much as 1 million of the infected population dies from the sequelae of the infection such as liver cirrhosis and hepatocellular carcinoma. Although, there is a safe and effective vaccine for Hepatitis virus infection, Nigeria is yet to move away from being counted among the hyperendemic area for Hepatitis virus  infection. An estimated 12% of the populations are documented to be chronic carriers of this virus. New cases of Hepatitis virus are still being reported annually. Coverage for hepatitis immunization is still not adequate in Nigeria; this is despite its availability. Currently, hepatitis vaccine coverage in Nigeria is about 41%. As a result of the poor screening and low vaccination rate, the vertical transmission of Hepatitis virus has become a major route of transmission of the virus in Nigeria. This leaves the children born at risk of developing chronic liver disease later in life (UNICEF, 2014).

The consequences of an acute hepatitis in pregnancy may include premature labour with the resultant sequelae of prematurity. An increase in the incidence of prematurity over that seen in the general population has being demonstrated in some studies. Other sequelae of Hepatitis virus infection may include a higher risk of intraventricular hemorrhage and low Apgar scores. When coagulation failure occurs due to lack of production of Vitamin K-dependent clothing factors, it could lead to intra- and post-partum hemorrhage. This happens more so if the prothrombin time is prolonged, as it may happen in fulminant hepatic failure. The above are possible sequelae that may arise when there is chronic Hepatitis virus infection.

Purpose of the Study

The purpose of this study is to examine the Prevalence of Hepatitis among pregnant women. A case study of Chiroma Ward in Lafia Local Government Area of Nasarawa State. Specifically, it seeks to:

The following are the purposes of this study:

1.     Examine the prevalence of hepatitis virus infection among pregnant women in Chiroma Ward in Lafia Local Government Area of Nasarawa State.

2.     Identify the factors associated with transmission of Hepatitis Virus among pregnant women.

3.     Ascertain the strategies meant to curb the factors associated with transmission of Hepatitis Virus among pregnant women.

Significance of the Study

The following are the significance of this study:

The results from this study will educate the general public especially the pregnant women on the prevalence and prognosis of hepatitis virus infection of pregnant women.

This research will be a contribution to the body of literature in the area of the effect of personality trait on student’s academic performance, thereby constituting the empirical literature for future research in the subject area.

The findings of this study will enable the researcher understand the causes of hepatitis virus infection among pregnant women, ascertain the effects of hepatitis virus infection among pregnant women and know mothers perception about hepatitis virus.

The findings of this study may be useful to health educators, medical and paramedical officers, public health officers, counselors, media educators, researchers, curriculum planners, government and adults in many ways.

The study may help to develop a positive regard towards hepatitis. The Ministry of Health may benefit from the study by discovering a gap in knowledge of the population, and emphasize strategies to teach the pregnant women on how to prevent the risk factors.

It may also be useful to other researchers to carry out this study in areas where disease prevention measures and health promotion are needed with regards to hepatitis.

The anticipated findings from the study of the prevalence of hepatitis among pregnant women will generate new knowledge relating to the effectiveness of health education and intervention programmes to improve the knowledge of signs and symptoms associated with hepatitis for pregnant women. It may likely be useful to health educators on the need to create awareness on the signs and symptoms of hepatitis.

The results generated from the study on prevalence of hepatitis among pregnant women revealed those risk factors that have been in existence over the years, which have been predisposing people to hepatitis. The results may be useful to health educators, media educators and medical officers in sensitizing community members through awareness campaigns in the form of seminar to alert people on the risk factors of hepatitis.

The results generated from the study on the prevalence of hepatitis among pregnant women revealed the preventive measures that may promote health and well-being. The results may be useful to health educators, medical and paramedical officers and Centre for Disease Control Agencies in organizing orientation endeavours to raise level of awareness on measures of preventing hepatitis

The study will also help mothers realize the consequences of hepatitis virus, the knowledge of the prevalence of hepatitis virus among pregnant women will enable Chiroma Ward in Lafia Local Government Area of Nasarawa State to educate mothers more on the prevention of hepatitis virus.

Research Questions

1.     What is the prevalence of hepatitis virus infection among pregnant women?

2.     What are the factors associated with transmission of Hepatitis Virus among pregnant women?

3.     What strategies can be adopted to curb the factors associated with transmission of Hepatitis Virus on pregnant women?

Scope of the Study

This study will cover the prevalence of hepatitis virus infection among pregnant women in Chiroma Ward in Lafia Local Government Area of Nasarawa State. It will focus on the factors responsible for the hepatitis virus, consequences and strategies that could be adopted to curb the menace of hepatitis virus among pregnant women in the study area.




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