Prevalence of Hepatitis C Virus Among Voluntary Blood Donors in Central Hospital Auchi

Prevalence of Hepatitis C Virus Among Voluntary Blood Donors in Central Hospital Auchi

CHAPTER ONE

Objectives of the study

Objectives of the study

General Objective

To determine the prevalence of hepatitis c virus among voluntary blood donors in Central Hospital Auchi.

Specific Objectives

1. To determine the prevalence of HCV among voluntary blood donors at Central Hospital Auchi – Nigeria.
2. To determine the risk factors associated with HCV infection among voluntary blood donors at Central Hospital Auchi-Nigeria.
3. To establish the existing knowledge on HCV infection among voluntary blood donors at Central Hospital Auchi- Nigeria.

CHAPTER TWO

LITERATURE REVIEW

Overview of Hepatitis C infection  

The virus is a small (55-65nm in size), enveloped, positive sense, single stranded RNA virus of approximately 9.6kb (Ji-Hoon et al., 2013) from the family Flaviviridae, genus Hepacivirus, and Hepatitis C virus type species (Simmonds et al., 2005; Eze et al., 2010). Its complete genome organization resembles that of the Pestiviruses and Flaviviruses and encodes untranslated conserved regions (5′UTR and 3′UTR) (Suwanna et al., 2010). The viral proteins are translated as a polyprotein of about 3010 amino acids that is processed co-and post-translationally by cellular and viral proteases into structural and non structural proteins (Ji-Hoon et al., 2013).

The open reading frame of the virus encodes the structural proteins, core (C), envelope (E1, E2), and the nonstructural proteins (p7, NS2, NS3, NS4a, NS4b, NS5a and NS5b) (Rogo et al., 2010; Hoshida et al., 2014). The viral genome is extremely heterogeneous (Casanova et al., 2014) and is enclosed in a protein coat which is wrapped in a lipid envelope derived from the host cell (Ejiofor et al., 2010). Based on genetic differences between HCV isolates, the genotype has been recently updated to seven main genotypes that differ by more than 30% in their nucleotide sequence (Casanova et al., 2014). The subtypes are further broken down into quasispecies based on their genetic diversity (Kato, 2000; Rogo, 2010) and high error rate on the part of the virus RNA dependent RNA polymerase.

Hepatitis C virus genotyping is an important tool for the diagnosis and follow-up of infected patients (Campiotto et al., 2005). The structure and replication of HCV are incompletely understood due to low viral titers found in sera and livers of individuals infected and lack of an efficient cell culture system or small animal model permission for HCV infection (Kawo et al., 2012). The virus principally replicates in the hepatocytes even though other sites (haematopoietic cells such as B lymphocytes and stem cells) of replication have been reported (Greenwood et al., 2012) Hepatitis C infection is a contagious liver disease that results from infection with the hepatitis C virus.

Hepatitis C is a contagious disease of the liver characterized by mild illness lasting afew weeks to a lifelong illness. It is caused by hepatitis C virus identified in 1989 (Ryan et al., 2004). It is either acute or chronic disease spread by contact with infected blood or other infectious body fluid (WHO, 2018). Hepatitis C virus is a flavivirus, has an RNA genome and is spread by the same routes as HBV. It causes chronic disease and can increase risk for primary hepatocellular carcinoma (PHC). It has a positive sense RNA single stranded enveloped genome. It has a diameter of 30 to 60 nm (Murray et al., 2013). The genome has single open reading frame that is 9600 nucleotide bases long. Viral RNA dependent polymerase is prone to errors as there is no proof reading and generates mutations in the glycoprotein and other genes. This generates antigenic variability that makes vaccine development difficult (Murray et al., 2013).

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CHAPTER THREE

MATERIALS AND METHODS

Study Area

The study was carried out at Central Hospital Auchi because of its cosmopolitan population, diverse culture and level education is good among residents. This center collects an estimated 1800 units of blood each month which translated to 5400 units during the three months’ study period. The Centre serves transfusing facilities within Auchi LGA by providing quality screened blood.

Study design

A cross-sectional study design was adopted to determine the prevalence of HBV and HC infections among voluntary blood donors.

CHAPTER FOUR

RESULTS

Demographic characteristic of voluntary blood donors

A total of 384 voluntary blood donors (VBD) participated in this study with a response rate of 100%. The age of participants ranged from 18 to 53 years categorized into 4 groups; 1825, 26-35, 36-45 and 46-56 years.  The mean age was 25.12 years with a SD of 6.963 and a variance of 48.480. Minimum age recorded was 18 years and maximum recorded age was 53 years with a range of 35 years. Two hundred and fifty (65.1%) males 134 (34.9%) female voluntary blood donors (VBD) were enrolled into this study. More than half 262

CHAPTER FIVE

DISCUSSION

Conclusion

Demographic of study population  

Nigeria National Blood transfusion service (NNBTS) depends on voluntary blood donors for supply of blood. In this study high numbers of voluntary blood donors were below 35 years; however, majority were aged 18-25 years at 68.2%. The results compare well with (Eric et al., 2017), in Ghana where 50.2 % voluntary blood donors were below 35 years,

64.4% were 19 to 35 years (Ciamala et al., 2017) and below 35 years in Gabon (Eko et al., 2018). Motivating factor for donating blood were, peer pressure, saving lives, self-esteem and expressing gratitude to the society. It is also a life experience; one would want to know how it feels to be a blood donor. Others gave blood because a friend or a relative required to be transfused with blood. Moreover, some donated blood to bank in case they might need it in future.

The number of donors aged above 36 years was only 9.6%.  The results compare well to that of Bartonjo et al., (2013), where less than 10% voluntary blood donors were >40 years of age this contrast with over 40- 45% voluntary blood donors aged above 40 to 50 years in the USA (Mwambungu et al., 2015). Low turn up was attributed to beliefs and myths like older people are weak and vulnerable to infection. In this study males formed majority (64.8%) of the voluntary blood donors compared to female (25.2%) voluntary blood donors. Most females were deferred due to low hemoglobin, body physiological changes and pregnancy (Okoroiwu et al., 2019). They are prone to vasovagal reactions which affects their experience as blood donors. Deferral to donate diminishes likelihood of donor return, especially for first-time blood donors or longer period allowed before next donation. Women have difficulties when blood is withdrawn and fear adverse and vasovagal reaction during or after donation than men. Materials used in blood donation such as needles, sight of blood and the feeling of discomfort make women defer themselves from blood donation.

Fewer women give blood because it is not their relative who needs blood (Okoroiwu et al., 2019).

Fewer men were deferred because their hemoglobin was okay and willingness to donate. In Ghana (Dongdem et al., 2012) reported 2.05% female and 97.95% male donors. The difference in respondents was attributed to difference in design of study, participant’s number and entry criteria used. Geographical location may also have affected the outcome also due to different believes and myth about blood. The selection criteria used and type of population approached impact on respondents. Some religion and myth about blood affect number of voluntary blood donor turnout.

Most voluntary blood donors had tertiary education and formed bulk of donors for this cohort. Low level of HCV could be attributed to most voluntary blood donors having tertiary education. However, this contradicts the finding of this study where the general knowledge among respondents about HCV 37%. This indicates an existing gap which needs to be filled by educating the public on HCV.

Prevalence of hepatitis C virus among voluntary blood donors at Central Hospital Auchi  

This study recorded 1.3% prevalence of hepatitis B and hepatitis C among voluntary blood donors, 1.0 % and 0.3% respectively for hepatitis B and hepatitis C. Prevalence of 1.5% HBV was recorded among voluntary blood donors aged 18-25 years. Prevalence of hepatitis B in this age group was higher than overall prevalence of HBV. The results indicated that HBsAg carriage is higher among young people. Early infection may complicate in both HBV and HCV leading to liver cancer and liver cirrhosis. Prevalence of HBV and HCV was not significant (χ2=1.882, df=3, P=0.597). Low prevalence of both HCV and HBV at Central Hospital Auchi was probably attributed to strict selection and health talk segment given to potential VBDs before blood donation. In addition, low risk groups which include faith-based organization, institution, schools colleges and disciplined forces are used. Low prevalence can also be attributed to self-exclusion as a result of pre-donation counseling and 100 % voluntary blood donation. More so, Nigeria is classified by WHO as low prevalence country.

In this study 90.6% voluntary blood donors had tertiary education, however, this did not reflect on how much information was known to them about HBV and HCV infection, transmission and risks. Educated people are believed to make informed decisions, understand the risks and control measures of infection, engage in positive health behaviors that protect their lives. In a study done at Mbagathi hospital (Asundula et al., 2016) reported that education plays a major role in control of infection.

In Eritrea (Siraj et al., 2018) reported a 2.0%, 0.7% HBV and HCV respectively. The results do not compare to those of (Asundula et al., 2016) who reported HBV prevalence of 3.8% among pregnant women at Mbagathi hospital in Nigeria. The prevalence of HBV reported in the study are lower compared to those of (Jean et al., 2019) which reported HBV prevalence of 3.9% among general population in Rwanda. In DRC prevalence of HBV was reported to be 2.2% by (Ciamala et al., 2017).

Results variation were attributed to differences in collection sites in Auchi and different type of groups involved in blood donations. It could also vary depending on prevalence of hepatitis in the general population or participants. The differences were also attributed to study design and study population. The criteria used for inclusion or exclusion of participants contributed to the variation in results of this study. The low prevalence could also be attributed to use of voluntary and regular blood donors. Regular and voluntary blood donors are believed to be low risk individuals (WHO, 2010). Globally there is variation in sero-prevalence of HCV, with (0.1%) prevalence as the lowest recorded in United States and in Egypt as the highest- 24.8%. In morocco (Baha et al., 2013) reported 0.62% HCV and 0.96% HBV prevalence (Fethi et al., 2011) in Jordan.

Prevalence of hepatitis C disease in voluntary blood donors at Central Hospital Auchi –Auchi

Prevalence of hepatitis C in Nigeria varies from 0.2% to about 0.9 % in the general population. Females were most affected with HCV which was attributed to unawareness of infection and luck of information. The prevalence of HCV in females was lower compared to that of females in Ghana. The study done by (Dongdem et al., 2012) reported a prevalence of 8.33% and 10.84% in females and males respectively. In Zambia, (Mwambungu et al., 2015) reported 6.74% and 6.53% HBV seroprevalence in male and female blood donors. However, they were consistence with those reported by (Suresh et al., 2015) in India; prevalence of 0.27% in females. Lower results were reported in Pakistan (Arshad et al., 2016) and Ethiopia (Meseret et al., 2013), Nigeria (Okwesili et al., 2014). The prevalence of HCV infection among blood donor population varies considerably probably due differences in lifestyles habits, risk behaviors and low prevalence of HBV in the general population. There was no proper explanation as to why more females had HCV infection.

Risk factors associated with HCV infection among voluntary blood donors.

Among the risks that were identified and associated with hepatitis C were; use of illicit drugs like marijuana and cocaine. At least (30, 7.8%) voluntary blood donors had used these drugs. However, this was insignificant (P=0.92) in terms of prevalence or infection by hepatitis C among voluntary blood donors. Promiscuity, 3.9%, 3.1% sexual activity with people of unknown hepatitis background, 1.8 % sharing of contaminated needles and syringes. Contact with people having signs of infection by hepatitis 1.3%, 1% giving or receiving money to get sexual favors. Most risks were associated with peer pressure, social environment, belief that marijuana has medicinal value, curiosity and low perception of harm. The participant who had used non medicinal drugs had first used them while in school or college. This pattern suggested peer pressure influence to start doing drugs. Frequency in type of risks differs depending on the geographical location and also target population.  The most significant risks in this study were engaging in unprotected sex, sex with multiple partners (P= 0.04, p= 0.05) respectively.

Existing general knowledge about hepatitis C infection among voluntary blood donors at Central Hospital Auchi- Auchi.

Knowledge is described as facts, skills, awareness or information acquired through experience or education. In this study knowledge was described based on what the respondents knew about HCV transmission, risk factors, symptoms and general knowledge. Knowledge was assessed based on what the respondents knew about HCV classification, duration of infection and or if there is a cure.

The respondent who scored of 70% or more had sufficient or satisfactory knowledge about HCV. Scores of 49% and below, respondents were considered to have inadequate knowledge or information about HCV. According to this study, few respondents had satisfactory knowledge on how HCV was transmitted.  This meant that infection was happening as majority will continued to share contaminated needles and syringes, engage in unprotected sex or get into contact with body fluids because of poor knowledge. More than half 67.8% of the participants disagreed that HCV was transmitted by engaging in unprotected sex. Most commonly known disease that can be transmitted through sex is human immune virus (HIV). Generally, the participants agreed on these modes of HCV transmission, mother to child, transfusion with contaminated blood and contaminated needled and syringe. They may have heard this information while seeking treatment from a health facility. Despite lack of knowledge Hepatitis C virus remains low among voluntary blood donors.

In Nigeria a study in Medical students by (Aroke et al., 2018) reported that 10% of students thought that HCV was not transmitted via needle stick injury. In Egypt (Sultan et al., 2018) reported that only (19.5%) of HCV infected patients knew that HCV was transmitted via unprotected sex. The study also reported that only 31.3% of the patients knew that HCV infection can be transmitted vertically from mother to child at birth. In Ethiopia (Abeje et al., 2015) reported that 21% medical students knew that HCV was transmitted via fecaloral route. In a systematic review (Maxine et al., 2012) reported that 90.8% among individuals who tested positive for HCV knew transmission occurred via contact with blood and body fluids whereas 1.2 % were not aware. Prevalence of HCV and HBV among voluntary blood donors remained low, this was attributed to strict donor selection, discriminative selection of donor groups and engagement of repeat donors. The poor knowledge regarding HCV transmission modes, HCV infection could be attributed to lack of accessible informational facts, a poor reading culture and poor policies.

Conclusions  

Prevalence for HCV markers as observed was low among voluntary blood donors suggesting low residual risk for transmission. However, there is an overall 0.3% expression for HCV. This conforms to existing prevalence rates among blood donors in Auchi.

1. Major risks of exposure to HCV was unsafe injections, unprotected sex and intravenous drug use.
2. Lack of Knowledge about HCV transmission, risks, infection awareness and calls for broader community education that include use of print and electronic media.
3. There were only 34% respondents with sufficient knowledge about HCV modes of transmission.

Recommendations  

1. Establish biobanks for specimens and data bank for all seronegative blood donors and recipients of blood for references in case of post transfusion infection. Nigeria blood transfusion to encourage repeat voluntary blood donors.
2. Interventions should be focused on reducing risk factors associated with hepatitis B and hepatitis C viral infection among blood donors and the general population.
3. The world has become a global village likewise diseases, due to movement of people who also are blood donors. Due to globalization of diseases there is need to incorporate into screening for other infection like Zika virus, West Nile virus for all blood donors travelling from outside Nigeria or depending on the country of origin. Malaria, herpes simplex, Human T-Lymphotropic Virus Types I and II (HTLV) and Bacterial contamination for very platelet donation should be considered.
4. Set up mechanism for data collection and information management and encourage repeat donations.
5. Promote public education and awareness on transmission, risks and disease progression to improve on knowledge.

Suggestions for further studies  

1. Post transfusion infection among patients who were transfused with blood and blood products in the last 12 months.
2. Country wide study on prevalence, knowledge and risk factors of hepatitis B and hepatitis C viruses in the general population and among voluntary blood donors.
3. Carry out HCV and HBV genotyping among voluntary donors in Auchi region to determine variants.

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