CHAPTER ONE INTRODUCTION
Background of the study
This study was designed to examine the knowledge, attitudes and practices of nursing mothers in relation to Hepatitis B prevention in and immunisation of children. The World Health Organisation (WHO, 1948) defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. In order to ensure that this definition of health is realised in an individual’s life, accurate information about health-related issues is necessary. This information provides the individual with knowledge of the causes, modes of transmission, prevention and treatment of the disease.
Hepatitis B is an acute infection which attacks the liver and is caused by the Hepatitis B Virus (HBV). It is a major health problem globally and is ranked as the tenth leading cause of death in the world (Lavanchy, 2004). According to the World Health Organisation (2015), an estimated 240 million people are chronically infected with Hepatitis B. Within this broad statistic, an estimated 780 000 people die every year from complications of Hepatitis B (WHO, 2015). However, Hepatitis B is most prevalent in Sub-Saharan Africa and Asia (Raza et al, 2007). In highly endemic areas like Africa, Hepatitis B is more commonly spread from mother to child at birth (Lavanchy, 2004 & WHO, 2015). Most people with chronic Hepatitis B in Ghana were infected at birth or in their childhood (Theobald Hepatitis B Foundation, 2014). Moreover, a notable danger associated with Hepatitis B is that most infected people are unaware of their infection because the Hepatitis B Virus can persist for decades without observable symptoms.
Hepatitis B can cause chronic liver disease and infection and put people at high risk of death from cirrhosis (scarring) of the liver and liver cancer (Theobald Hepatitis B Foundation, 2014; Sharma, Sharma & Khajuria, 2004; Siakwa et al, 2014; Othman, Saleh & Shabila, 2014; WHO, 2002).
According to WHO (2015), it is essential to vaccinate a child against Hepatitis B within the first 24 hours after birth. The first day and week are most critical for the survival of new- borns. In 2013, almost one million new-borns (36%) died on the day they were born, another one million (37%) died within the next six days of birth and some 0.8 million neonatal deaths (27%) occurred between day 7 and day 27 of life. WHO (2015) also stated that most neonatal deaths are preventable. Children who die in the first 28 days of life suffer from diseases and conditions that are often associated with quality of care around the time of childbirth and are readily preventable or treatable.
Three facts may be distilled from these statistics: the prevalence of Hepatitis B, the severity of the disease and the susceptibility of people to its infection.
Incidence of Hepatitis B and Role of Vaccination in Ghana
Chronic infection occurs in 80% to 90% of infants infected during the first year of life and in 30% to 50% of children infected before the age of six years. However, less than 5% of healthy persons who get infected as adults develop chronic infections (WHO, 2015).
Majority of the world’s chronic Hepatitis B infection carriers, especially children, acquire this infection via the perinatal route (Jonas, 2009 and Lavanchy, 2004). According to a report by Theobald Hepatitis B Foundation (2014), the prevalence rate of Hepatitis B is 15.6% in
children. The prevalence rate increased from 6.4% in 1994 to 10.5% in 2005 in pregnant women.
Ghana is one of the areas with a high prevalence (more than 8%) of Hepatitis B. This is in line with the definition of endemic areas by WHO (2015). The organisation describes a country or an area as highly endemic if it has more than 8% carrier rate of the disease.
According to the Hepatitis B Foundation of Ghana, there has been an increase in the number of deaths associated with the disease in the country. Although national data on specific types of viral hepatitis in Ghana is scanty, surveillance data on clinical viral hepatitis from the Disease Surveillance Department shows an increasing annual trend of reported viral hepatitis cases from all the ten regions of Ghana. At the end of 2012, 52 deaths were recorded out of a total of 26,470 Hepatitis B cases. This represented a 30% increase in Hepatitis B cases from the year 2011 where 21,522 cases were recorded. However, 86 deaths related to Hepatitis B infection were reported in 2011. Also in 2012, out of 842 blood specimen investigated at the National Public Health Reference Laboratory, 175 cases (20%) were confirmed Hepatitis B positive (Hepatitis B Foundation of Ghana, 2014).
As of 2008, 177 countries including Ghana, had incorporated Hepatitis B vaccine as an integral part of their national infant immunisation programmes, and an estimated 69% of the 2008 birth cohort received three doses of Hepatitis B vaccine (WHO, 2013). By the end of 2014, WHO revealed that 184 countries had introduced the Hepatitis B vaccine nationwide.
In line with this knowledge, some institutions and non-governmental bodies in Ghana have tried in diverse ways to educate the general public on the disease and also organised screening exercises for them. Some of these are Hepatitis B campaigns and screening exercises organised by the Okyeame Kwame Foundation, schools and churches over the years.
Mode of Transmission
According to WHO (2013), the Hepatitis B virus can survive outside the body for at least seven days, during which time the virus can still cause infection if it enters the body of a person who has not been vaccinated. According to Grob (1995) and Esteban (1995), the Hepatitis B virus can be transmitted either horizontally or vertically.
