1.1 BACKGROUND TO THE STUDY
According to the World Health Organization [WHO] (2012), hepatitis B is the world’s most common liver infection, which is caused by a DNA-virus, the hepatitis B virus (HBV). The virus is highly contagious, 50-100 times more infectious than HIV, and is transmitted between people through blood, semen, vaginal fluids and mucous membranes. There are more than 2 billion people World-wide, having evidence of recent or past HBV infection and 350 million are chronic carriers. In south East Asian Region, there are estimated 80 million HBV carriers (about 6% of the total population) (Malik & Lee, 2000). The most common ways of transmission are by unprotected sex, unsafe blood transfusions, and unsafe use of needles, from mother to child at birth, close household contact and between children in early childhood. HBV is unique compared to other sexually transmitted diseases, because it can be prevented with vaccine (WHO, 2012). In 1964 it became possible to identify people with HBV using serological testing, searching for hepatitis B surface antigen (HBsAg) (Weinbaum, Mast & Ward, 2009).
All HBV infections do not give symptoms, meaning that there is a risk that people are contagious without knowing it (Weinbaum et al., 2009; WHO, 2012). However some people may experience acute symptoms like jaundice, fatigue, loss of appetite, nausea and/or abdominal pain. For almost all adults, 90%, the infection heals and they become healthy, but for infants and young children, there is a 90% and 30-50% risk respectively that the infection leads to chronic hepatitis B (WHO, 2012). This provides an increased risk, approximately 25% that they later in life will suffer from liver cirrhosis and/or liver cancer, if the infection is not medically managed (Chao, Chang & So, 2010; WHO, 2012). The patients who are diagnosed with acute hepatitis B will receive symptomatic treatment since there is no cure available. Patients diagnosed with chronic hepatitis B can be treated with interferons, which suppress the HBV and help the immune system to enhance the protection against HBV (WHO, 2012).
Early identification of infected persons with the help of blood tests can break the on-going transmission and lead to necessary treatment with antiviral medication (Nguyen et al., 2010; Weinbaum et al., 2009). It is also important to enable the identification and vaccination of those who share household with the infected person and sexual partners that might have become infected. To avoid transmission there are a few measures that HBV positive individuals can take. For example they should notify sexual partners and the people they share their household with to test themselves for HBV and inform them of the need for vaccination. An HBV-infected person can delay and/or prevent liver disease by limiting their alcohol consumption and by regularly seeking disease monitoring (Weinbaum et al., 2009). Using alcohol in combination with HBV-infection has shown to increase the risk of hepatotoxicity (Tan, Cheah & Teo, 2005).
Hepatitis B virus is efficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids and not by casual contacts. Modes of transmission of Hepatitis B virus (HBV) is the same as the human immunodeficiency virus (HIV), however, HBV is 50 to 100 times more infectious (WHO, 2012). HBV infection has been recognized as an important occupational hazard for health care workers (WHO, 2012 b). Health care workers are at risk of infection through exposure to blood and other body fluids coupled with the high contagiousness of HBV. Fortunately, infective hepatitis B is largely preventable disease by hepatitis B vaccine which is 95% effective in preventing such disease and its chronic consequences (WHO, 2012 c). Transmission of infection is rare among persons who have been immunized and transmission rate may be as high as 30% among those who are not immunized (Centres for Disease Control and Prevention (CDC), 1991).
In health care delivery, HBV transmission possess a major challenge to both patients and health workers especially those who frequently come into contact with blood. These groups of people stand a higher chance of contracting the disease if care is not taken. Apart from health workers, some people in the general public are more prone to contracting hepatitis B than others e.g. drug users or injectors, people who pierce or tattoo their bodies and unprotected sex engaged in by adolescents due to their lack of knowledge about sexual negotiation and safe sex practices. In most countries where HBV prevalence is low, transmission usually occur during adolescence or young adulthood as a result of the unsafe injections and unprotected sexual activities. Research has revealed that, an estimated 21 million new HBV infections occur each year due to unsafe injections in health care settings (Hauri et al, 2003). Hepatitis B is not only a health issue but also an issue of social injustice which rears its ugly head in most endemic countries in the world. Myths and misinformation about modes of HBV transmission have resulted in widespread discrimination against chronically infected persons in some endemic countries, such as China, the country with the world’s largest population of chronically infected people, who are not allowed to work in the food industry, are often forced to go through a routine pre-employment HBV testing, and can be expelled from school or work because of a positive test (CDC, 2006).
Knowledge, attitude, and practice (KAP) surveys are representative of a specific population to collect information on what is known, believed and done in relation to a particular topic, and are the most frequently used study tool in health-seeking behaviour research (WHO, 2008). Knowledge is usually assessed in order to see how far community knowledge corresponds to biomedical concepts (Good, 1994). Typical questions include knowledge about causes and symptoms of the illness under investigation. People reported knowledge which deviates from biomedical concepts is usually termed as ‘beliefs’ (Tannahill, 2008). Attitude has been defined as “a learned predisposition to think, feel and act in a particular way towards a given object or class of objects”. As such, attitude is a product of a complex interaction of beliefs, feelings, and values. Practices in KAP surveys usually enquire about the use of preventive measures or different health care options (Yoder, 1997).
1.2 PROBLEM STATEMENT
Hepatitis B (HB) is a serious and common infectious disease of the liver. The World Health Organization (WHO) in 2009 reported HB to infect nearly 2 billion people around the globe. Furthermore, out of those 2 billion, 350 million suffered from chronic, lifelong infection. Moreover, an estimated 15–40% of chronic HB carriers were susceptible to develop liver cirrhosis and hepatocellular carcinoma (Lok & McMahon, 2007). HB is a confronting ailment and results in 0.6 million deaths annually. Although HB is classified as ‘disease of priority,’ there is an incessant increase in detection of new cases worldwide. Furthermore, HB is widespread in the Asia Pacific region and 10 to 15 million of the population suffer from this disease (Keeffe et al., 2008; Lok & McMahon, 2009; Lesmana et al., 2006). The prevalence of HBV chronic infection is particularly high in sub-Saharan Africa, ranging from 7 to 26% (Andre, 2000).
The secret killer hepatitis B, though a major threat to health globally, is yet to catch the attention of health institutions, policy makers, the general public and decision makers in Ghana. The disease has a long history in the country immediately after the Second World War. A study by Morrow et al, (1971) revealed that hepatitis has being on the increase in Accra which led to the development of shanty towns with poor sanitation. Despite the long history of the disease in Ghana, there have not been any bold and pragmatic measures put in place to curb it except the formation of the Ghana Hepatitis B Foundation (GHBF) which started its operation just in September, 2007. In the light of the lukewarm attitude shown towards the disease and due to acts of selective prevention of infectious diseases by health professionals including HBV, the disease is said to be fast spreading with an estimated number of four million people as carriers. The 2009 Ghana Health Service report released a scary figures suggesting an increase in the prevalence ratio from 8:1 in 2005 to 6:1 in 2009 (GHS, 2009). This means one out of every sixth person is infected with the disease. There has also been an increase in the number of deaths associated with the disease in the country. In a 13-year hospital based study conducted in a rural district of Berekum in the Brong and Ahafo region of Ghana to assess the role of indirect causes of maternal mortality among the 229 maternal deaths recorded during the period of review, 15 out of 229 deaths were due to HBV (Diederike et al, 2003).
Also, unlike HIV/AIDS, tuberculosis and malaria that have attracted the attention of both government and foreign donors leading to the inflows of monies in developing countries including those of President Bush’s 15-billion initiatives and the Global Fund for Malaria, Tuberculosis and HIV/AIDS which Ghana is part of, health education on HBV activities are extremely limited. This is evident by the fact that schools are not covered and a budgetary allocation in the Ministry of Health is yet to be given to hepatitis B activities since it is not in their topmost health priorities. Hepatitis B education is demoted to the background such that even adults do not have any place to obtain information about this deadly disease.
As discussed earlier, the frequency of HB is increasing progressively worldwide, prevention is considered as one best way to safeguard populations’ health. Prevention against any disease is proportional to Knowledge, attitude, and practice (KAP) of the population and is reflective of the importance that is paid to health related issues by the society. Therefore, KAP studies play an important role in determining the ambiguities of a society and are widely used in population reported assessment research worldwide. To the contrary, there is insufficient of data from Ghana and knowledge and perception on HBV among SHS students is never explored. In spite of the efforts made by authorities to raise knowledge and awareness about HBV, no progress is reported. However, the current study aimed to assess knowledge and perception of HBV among SHS students in Dunkwa-on-Offin.
1.3 PURPOSE OF THE STUDY
HBV is a major problem in Ghana and people suffer and die from complications of the disease daily. To decrease the transmission of HBV in Ghana, it is important to increase the populations’ knowledge about the disease, the vaccine and the benefits that comes with it. Review of other studies has shown that the knowledge about HBV only is average and there are few Ghanaian studies concerning young adults’ and SHS students’ knowledge and perception of HBV. Therefore, it is very interesting to carry out this study to investigate the knowledge and perception of hepatitis B among SHS students in Dunkwa-on-Offin.