Research Proposal

Topic: Hepatitis C
Research Proposal
Submitted By:
Group#5
Submitted to

Miss Razia Parveen

Subject: Nursing Research

LAHORE SCHOOL OF Nursing

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CHAPTER ONE

Introduction

Many people infected with hepatitis c virus (HCV), but they can’t visit to any hospital or health

care centers because the virus may be asymptomatic for years or the peoples have lack of

knowledge, People are unaware about hazards of hepatitis C.

Hepatitis C was discovered by a scientist at a California biotechnology company called Chiron

who were collaborating with investigators at the Centers for Disease Control and Prevention

(CDC) in 1989. Pakistan has the second highest number of hepatitis C virus (HCV) infection in

the world after Egypt. Hepatitis day organized on 28 July in Pakistan while in United States 19

May is the hepatitis testing day. Hepatitis C is still a neglected disease in many countries.

Hepatitis C virus (HCV) linked with liver or the main effect of hepatitis C on liver in other words

hepatitis C damage liver. The work of liver is to Bile production and excretion, Enzyme

activation, Storage of glycogen, vitamins, and minerals.

The hepatitis C virus is an RNA virus that belong to family flaviviridae, hepatitis C is a silent

infection or a silent killer. Hepatitis C effect peoples in different ways, there are two stages of

hepatitis C the one is acute hepatitis C on the other hand chronic hepatitis C. Acute hepatitis C

called short term illness that least for the first 6 month after the virus enter your body while

chronic hepatitis C occur if your body doesn’t clear the virus on its own after 6 months it

becomes long term. Many people with hepatitis C have no symptoms. But between 2 weeks and

6 months after the virus enters your bloodstream, you could notice some symptoms. Dark urine,

fatigue, Jaundice (a condition that causes yellow eyes and skin, as well as dark urine) Joint pain

and Stomach pain.

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A person can get hepatitis C with different ways when blood contaminated with hepatitis C virus

gets into your blood stream through contact with the blood. Person can get hepatitis C by having

sex with someone who has hepatitis C. The risk for transmission with vaginal intercourse is

about 1 in 190,000, according to research published in the March 2013 issue of the

journal Hepatology. HCV transmission is most commonly associated with direct percutaneous

exposure to blood, via blood transfusions, health-care-related injections, and injecting drug use.

Key high-risk populations include people who inject drugs, men who have sex with men, and

prisoners. Approximately 10–20% of individuals who are chronically infected with HCV

develop complications, such as cirrhosis, liver failure, and hepatocellular carcinoma over a

period of 20–30 years.While on the other hand according to WHO hepatitis C cannot be spread

by food water, breast milk, hugging or sharing food and drinks with an infected person.

The peoples who infected with hepatitis C can be used preventions to get rid of hepatitis C by

using different ways. Don’t share personal items, don’t share needles and syringes, be careful if

you get a tattoo, and don’t engage in unprotected sex with multiple partners or with any partner

whose health status is uncertain. Sexual transmission between monogamous couples may occur,

but the risk is low. In some cases patients of hepatitis C can’t require treatment because in

some patients immune system fight against infection or clear the infection. The treatment is

necessary when hepatitis C become chronic while on the other hand no any special diet

recommended for hepatitis C patients but exercise is important for hepatitis C patient it not only

reduce weight but also relieve some of the side effects of hepatitis C medication if patient taking

them.

WHO estimates that approximately 71 million people worldwide have chronic hepatitis C

infection and around 400 000 people die every year from it, mostly from cirrhosis or liver cancer.

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While there is no vaccine against hepatitis C, antiviral medicines can cure more than 95% of

people with the disease. Approximately 399 000 people died from hepatitis C, mostly from

cirrhosis and hepatocellular carcinoma (WHO,2016)

According to the Centers for Disease Control and Prevention, 21% of all acute viral hepatitis in

the United States may be attributed to hepatitis C viral infection. Infection with hepatitis C

almost always results in chronic infection. Sixty-seven percent of all cases develop chronic liver

disease with accompanying elevation of liver enzymes.

There were 1.75 million new HCV infections in the world 23.7 new HCV infections per 100 000

people (WHO,2015)The percentage prevalence of HCV found for all of the provinces

was Punjab: 5.46%, Sindh: 2.55%, Khyber Pakhtoonkhaw: 6.07%, Balochistan: 25.77%, and

federally administrated tribal areas: 3.37%. In sub-Saharan Africa, the number of estimated

deaths due to cirrhosis almost doubled from 53 000 in 1980, to 103 000 in 2010.

The EU/EEA rate increased steadily between 2010 and 2014, and the highest observed rate was

9.0 cases per 100 000 population. In 2015 and 2016, the EU/EEA rates were 8.0 cases and 7.4

cases per 100 000 population, respectively.

Problem Statement :After visiting the community, the researcher found that community have the

lack of knowledge towards hepatitis C, There are many reasons behind hepatitis C as we knew

that hepatitis C transmitted to the body by various ways but the common one is that hepatitis C

is spread by the skin the use of infected needles is a common malpractice in Pakistan on the other

hand the women’s who go parlors on daily basis are at high risk due to sharing facial tools and

the men’s who visit barber shop and used shaving tools.

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Purpose of Study:The purpose of the study is to Asses knowledge, and preventions regarding

hepatitis C among community people in Jhang.

Research Questions

Knowledge of the community effect on the hepatitis C?

Prevention of the community effect s on the hepatitis C?

Conceptual Definitions

Knowledge: Knowledge is awareness or understanding someone, such as fact, information and

skill it is also related to the capacity of the acknowledge of the humanity.

Prevention: Some steps community people can take to help prevent becoming infected with

hepatitis C, never share needles, avoid direct exposure to blood, don’t share personal care items.

(Jennifer Robinson, MD, 2011)

Hepatitis C: Hepatitis C is asymptomatic and was isolated in 1988. Hepatitis C was spread by

infected blood, infection may case mild or swear illness that lasts several weeks or a lifetime; in

the early 21st century an estimated 71 million people worldwide had chronic HCV infection. (

Kara Rogers)

Operational Defination

Knowledge: Knowledge is to give awareness to people, what is hepatitis C and what are the

sources of hepatitis C.

Hepatitis C: Hepatitis C is asymptomatic. It effects liver. It is formally called non-A and non-B

hepatitis and it is transmitted in effected blood.

Significant of Study

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Personal benefit

For participants: After research study the participant got a whole view in his/her mind about

hepatitis C and participant should be able to understand the knowledge and preventions

regarding hepatitis C in community.

For institute: The whole research results will be discuss to community authoritative persons of

corresponding institution this thing will help them to improve their health and they will be able

that to get rid of hepatitis C disease.

For researcher: By study this the researcher got new ideas, also able to understand more

knowledge and researcher can improve his own performance.

CHAPTER 2

LITRATURE REVIEW

Mercy Jelagat Karoney and Abraham Mogisi Siika published an article after 1995 only. The

data was summarized and presented. Africa has the highest WHO estimated regional HCV

prevalence (5.3%). Egypt has the highest prevalence (17.5%) of HCV in the world. Genotypes

commonly found in Africa are 1, 4 and 5. Genotype 3 is found in Egypt and parts of Central

Africa. Blood transfusion is a major means of acquisition of HCV infection. While treatment

with peginterferon and ribavirin is recommended for patients with chronic HCV, no data were

found on their use in Africa. Neither were there any data on definitive management (liver

transplantation) for those with end stage disease. Data on HCV infection in Africa are scarce.

This suggests that hepatitis C is still a neglected disease in many countries.

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In 2016  the Global Health Sector Strategy on Viral Hepatitis (GHSS) WHO passed calling for

its elimination by 2030.

Ministry of health data showed that HCV prevalence was 9 to 11 percent among transplant

recipients between 2011 and 2015 no data are available on the number infected with HCV

among their populationAccording to WHO approximately 399 000 people died from hepatitis C

in 2016 and on the other hand in 2015 according to WHO in 2015 there were 1.75 million new

HCV infections in world. Castillo et al describe in January 2014 the role of occult hepatitis C

virus (HCV) infection in chronic liver disease of unknown. In Karachi a 24 blood bank selected

randomly Very high prevalence rates of HBV and HCV in multi-transfused populations are due

to blood transfusions, but limited data are available about the practice of blood banks in Pakistan.

(Luby et al,1995). In Canada Chronic hepatitis C virus (HCV) is a highly burdensome public

health problem causing more years of life lost than any other infectious disease in the country.

(Schanzer DL et al,2013)Hepatitis C is non symptomatic not symptoms found in hepatitis C and

Hepatitis C virus infection can present as acute or chronic hepatitis and hepatitis C virus effect

liver. (Hoofnagl, 2002)

Hepatitis C virus is a main contributor to chronic liver disease worldwide, it was first

recognized in 1975 they found that most cause transfusion-associated hepatitis were not

associated with hepatitis A virus or hepatitis B virus infection. ( Feinstone et al,1975)

According to the “Burden of Disease Study The 5th commonest cause of premature mortality in

Pakistan are chronic liver between 75 to 85 % infections move on to chronic hepatitis C, most

people have no symptoms and unaware their treatment also may also unknowingly spread the

virus to others, people have lack of knowledge about hepatitis c on the other hand no vaccine to

prevent HCV virus. Effective but costly treatment is available. ( Hyder and Morrow,2001)

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For World Hepatitis Day 2019, WHO is focusing on the theme “Invest in eliminating hepatitis”

to highlight the need for increased domestic and international funding to scale up hepatitis

prevention, testing and treatment services, in order to achieve the 2030 elimination targets.

There is no effective vaccine against hepatitis C, therefore prevention of HCV infection depends

upon reducing the risk of exposure to the virus in health-care settings and in higher risk

populations, for example, people who inject drugs and men who have sex with men, particularly

those infected with HIV or those who are taking pre-exposure prophylaxis against HIV.

A survey was done by a College of Obstetricians and Gynecologists (ACOG) in America of 593

fellows who considered themselves a primary health care team member, assessed screening and

counseling practices for HCV infection. According to their survey (49%) reported that they

tested for HCV infection in all obstetric and gynecologic patients who self-reported ever having

injected illicit drugs while the 35% tested all patients who reported having received blood

transfusions before 1992.  (Boaz et al., 2003).Only 64% recommended that patients who had

HCV infection avoid alcohol, which has been found to increase the risk of disease progression

(Ascione et al., 2009)

CHAPTER THREE

RESEARCH METHADOLOGY

Research Design: The cross sectional descriptive study design will be used in the research.

Data Analysis: Arithmetical study will be done through consuming the driver statistical package

for social sciences (SPSS) for window version 21.

Target population : Target population will be the rural community of the Jhang.

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Inclusion Criteria:The inclusion criteria will be the people aged 20 to 60 years, who will

resident of rural community of the Jhang community people expressed the willingness of

participation for this study will included after taking the consent.

Exclusion Criteria

 The exclusion criteria will be include children of less 17 years old and male and females

above 70 years.

 Those who refuse to take part in study.

Sample Size

Sample size was the 76

Data collection techniques: Asses various families of the community for the purpose of

identifying problems. Assessment including questionnaires, observation, focus groups,

interviews.

Ethical Considerations :The research was done with permission from the Department. All

information of the participants were been protected by confidentiality, Permission was taken

from the community and consent form was signed before data collecting the data from the

participant.

Sr# Questionnaire Yes No Do not know

1 Do you know about hepatitis C?
2 Do you know hepatitis C is a common

disease?
3 You can get hepatitis C by getting Blood

transfusion from an infected donor?

4 You can get hepatitis C by shaking Hands

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with someone who has hepatitis C?

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You can get hepatitis C if you hug such Kind

of patient?
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You can get hepatitis C by having sex with

someone who has hepatitis C?

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You can get hepatitis C by working with

someone who has hepatitis C?

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8 Is hepatitis C transfer or occur in a form of

any kind of virus?

9 Is hepatitis C is a curable disease?
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10 Hepatitis C transmit by infected person

shared tooth bursh?

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Do you know hepatitis C effect your liver?
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People with hepatitis C should be restricted

from working in the food industry?

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Is there any prescribed diet for hepatitis C

patient?
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14 It is transmit by barber used infected

blades?
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Is first major symptom of hepatitis C is fever?
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16 Is any vaccine is need to cure against

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hepatitis C
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17 You can get hepatitis C by

Being born to a woman who

Had hepatitis C when she give Birth?

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19 It is likely to get hepatitis C from tattoos or

piercings?
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By taking precautions you can get rid of

hepatitis C?
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You can get hepatitis C by Drinking

uncontaminated Water?

CHAPTER FOUR

RECOMMENDATIONS

This survey base report was on the knowledge and preventions regarding hepatitis C of people of

community of the Jhang. Many people in the community are unaware about hepatitis C but they

show appropriate response. This survey base report give them knowledge and prevention

regarding hepatitis C, it also include definitions, types, causes, sing and symptoms,

complications. The overall assessment that community of Jhang have lack of knowledge

regarding hepatitis C. Pakistani health care providers needs to launch an activity regarding

hepatitis C so with the help of those activities people should aware about hepatitis C.

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References

1. European Centre for Disease Prevention and Control. Introduction to the Annual

epidemiological report for 2016. In: ECDC. Annual epidemiological report for 2016.

Stockholm: ECDC; 2017. Available from: https://ecdc.europa.eu/en/annual-

epidemiological-reports-2016/methods. 2. European Centre for Disease Prevention and

Control. Surveillance systems overview [internet]. Stockholm: ECDC; 2017. Available

from: https://ecdc.europa.eu/en/publications-data/surveillance-systems-overview-2016

3. 2.

2. World Health Organization. Hepatitis C Fact Sheet. 2011. Available at: http://

www.who.int.mediacentre/factsheets/ fs164/en. Accessed January 6, 2012.

3. Alter MJ, Kruszon-Moran D, Nainan OV, McQuillan GM, Gao F, Moyer LA, et al. The

prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med

1999;341:556-562

4.Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis

C virus infection in the United States, 1999 through 2002. Ann Intern Med 2006;144:705-714.

5.Bell BP, Manos MM, Zaman A, Terrault N, Thomas A, Navarro VJ, et al. The epidemiology of

newly diagnosed chronic liver disease in gastroenterology practices in the United States: results

from populationbased surveillance. Am J Gastroenterology 2008;103:2727-2736; quiz, 2737

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Everhart JE, Ruhl CE. Burden of digestive diseases in the United States. Part III: liver,

biliary tract, and pancreas. Gastroenterology 2009;136: 1134-1144.

6.Cheung R, Mannalithara A, Singh G. Utilization and antiviral therapy in patients with

chronic hepatitis C: analysis of ambulatory care visits in the US. Dig Dis Sci

2010;55:1744-1751.

7. Centers for Disease Control and Prevention. Recommendations for prevention and

control of hepatitis C virus (HCV) infection and HCVrelated chronic disease. MMWR

Recomm Rep 1998;47:1-39.

8. Volk ML, Tocco R, Saini S, Lok AS. Public health impact of antiviral therapy for

hepatitis C in the United States. HEPATOLOGY 2009;50: 1750-1755.

9. Centers for Disease Control and Prevention. About the National Health and Nutrition

Examination Survey (NHANES) Available at: www.cdc.gov/

nchs/about/major/nhanes/intro_mec.htm 2009. Accessed on March 8, 2011.

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