DETECTION OF HEPATITIS B VIRUS FROM INMATES IN SELECTED CORRECTIONAL FACILITIES IN NIGER STATE

ABSTRACT

Research has shown high transmission of hepatitis B virus (HBV) among inmates in correctional facilities in the developed world, but the data base for the developing countries is still lacking information on same. The aim of this study was to determine the prevalence of Hepatitis B virus infection  in  inmates  of  selected  correctional  facilities  in  Niger  state.  Blood  samples  were collected from inmates in three correctional facilities namely Bida, Kontagora and Minna. A total of 344 inmates consented to giving their blood samples for the test. Questionnaires were administered to get their Bio-data and 5ml of blood sample was collected from each person. The plasma was separated and tested for hepatitis B surface antigen (HBsAg) using rapid chromatographic immunoassay test (ICT). The negative samples were further screened using enzyme linked immunosorbent assay (ELISA). All the HBsAg positive samples either by ICT or ELISA were subjected to further test using 5-panel (HBsAg, HBsAb, HBeAg, HBeAb and HBcAb) HBV test card. Out of the 344 samples collected, 75 (22%) were positive by ICT for HBsAg. ELISA gave an overall prevalence rate of 25% (87/344) as additional 12 samples were positive. TThe result of the 5-panel showed that HBsAg, HBsAb, HBeAg, HBeAb and HBcAb were present in 87, 19, 20, 47 and 68 plasma respectively. This implies that 87 persons were infected, 19 had immunity against the virus, 20 had active viral replication, 47 with no viral replication and 68 with onset of acute infection. The HBV infection was highest in the age bracket 21-30 years (29.7%) and lowest in 61-70% (0%). There was no statistically significant difference between the viral infection and locations. However, out of the associated risk factors, sharing of objects showed statistically significant association with the high prevalence of the HBV. This study showed the prevalence of HBV among inmates. As such, there is need for constant screening of the inmates for effective prevention measure and proper clinical management strategy.

CHAPTER ONE

1.0        INTRODUCTION

1.1       Background to the Study

Hepatitis B is a blood borne virus (BBV) which spreads through body fluids, mainly the blood (Liang, 2010). Early symptoms of the infection may include loss of appetite, vomiting, loss of weight,  tiredness,  dark  urine, right  upper abdominal  pain  and  yellowing of skin  (jaundice) (Connor et al.,2006). If the virus is not combated at the early stage, the system of the host may be further deteriorated showing some symptoms such as fluid retention, bruising and prolonged bleeding   (Ayiku,   2015).   This   infection   could   later   result   into   acute   and   chronic necroinflammatory liver diseases (Liang, 2010).

Till recent time, Hepatitis B virus is a major public health concern worldwide, due to its high chronicity  rate  in  liver  disease  morbidity and  mortality  in  spite  of  the  accessibility of  the populace to the effective vaccination (Almasio et al., 2011). On the global scene, the virus accounts for over 360 million cases of chronic hepatitis and claim the lives of about 620,000 persons per year (WHO, 2013). More than 8% of the populations in the Sub-Sahara Africa are infected with the virus with about 44% of cirrhotic liver disease and 47% of hepatocellular carcinoma cases are linked to it (Musa et al., 2015). The virus is contracted through a number of means which include; body fluids (saliva and blood), HBV contaminated equipment, venereal transmission, mother to child transmission, and intravenous drug use (Dana et al., 2013).

Research has shown that Intravenous Drug Users (IDUs) are at high risk for HBV infection as with other blood-borne pathogens (such as hepatitis C and human immunodeficiency virus) (Dana et al., 2013). It is a common knowledge that correctional facilities often comprise of inmate who are IDUs and those who are not but relate freely with them.  Hence, transmission of blood-borne diseases among inmates are higher than the general population due to high presence of  IDUs  with  high-risk  addiction-related  behaviors,  having  past  history  of  multiple  sexual partners and homosexuality, life style of the inmates and limited educational opportunities (Dana et al., 2013; Tavakkoli et al., 2008). The health implication of this on the larger society is highly detrimental  as  they  become  potential  reservoirs  of  infection  to  the  non-incarcerated  and uninfected individuals upon regaining their freedom (Adoga et al., 2009).

It is worth mentioning that in the developed worlds, which have citizens with high level of literacy and Governments which provide highly effective recombinant vaccine for the viruses, HBV is still a source of threat to them, talk more of the developing nation (such as Nigeria) where majority of the populace are having misconceptions or bias mind towards the vaccine and where vaccination programs receive less attention from government (Cutt et al., 2013; Rainey et al., 2011). This account for the reason why the risk of contracting the virus  in Nigeria is significantly high as it creates room for exposure of about 75% of the population to the virus (Musa et al., 2015).

HBV is not like AIDS at its early stage as its infection can be prevented through vaccination and 95% of adults newly infected with the virus get cleared of the virus naturally and become immune for life (Ishikawa, 2012). However, once it gets chronic, it becomes incurable; treatment will only be aimed at suppressing HBV replication and retard the progression of liver disease before the development of cirrhosis and hepatocellular carcinoma (D‟Souza and Foster, 2004).

1.2       Statement of the Research Problem

Though, a number of studies have been conducted on hepatitis B virus in some parts of developing nations, including Nigeria (Moses et al., 2009; Musa et al., 2015; Alkali et al.,2017), no work seems to have been documented on transmission of HBV within correctional facilities particularly in Niger state. Evidences has shown high transmission of HBV among inmates in the correctional facilities (Haber et al., 1999; Taylor et al., 2002; Adjei et al., 2006; Ayiku, 2015, Alkali et al., 2017), however, no periodic national survey on the virus is conducted. The inmates are at high risk of contracting HBV due to over congestion, high risk behavior, correctional facility life style and limited education and awareness of the inmate and probable intra- correctional facility spread (Adjei et al., 2006; Kassaian et al., 2012).

1.3       Justification for the Study

The risk of free intermingling, unprotected sex and injecting drug use, commonly known with inmates do not stop at correctional facilities as that is continued after the release of inmate from the facilities. These make inmates who have become reservoir for virus (such as hepatitis B virus) to be sources of threat not only to their families but also to the society at large (Jack, 2011).  Hence,  understanding  the  prevalence  rate  of  hepatitis  B  virus  in  such  correctional facilities will aid in recommending appropriate method to prevent its further transmission among the inmate, the staff of the facility and to the outer world.

1.4       Aim and objectives of the Study

This study aimed at the detection of Hepatitis B Virus from inmates in three selected correctional facilities in Niger State.

The objectives of the study were to:

i.         determine hepatitis B surface antigen among inmates;

ii.        determine the level of significance between the rapid chromatographic test (ICT) and the ELISA;

iii.        determine HBV infection serological markers; surface antigen (HBsAg), surface antibody (HBsAb,), envelope antigen (HBeAg), envelope antibody, (HBeAb) and core antibody (HBcAb);

iv.       determine risk factors that are of high significance.

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