THE STUDY OF THE IMPORTANCE OF HEPATITIS B

SCREENING AMONG BLOOD DONORS IN ARAFAT

HOSPITAL, MOGADISHU-SOMALIA

BY:

Mohamed Abdirahim Omar

ID:

00511

A thesis submitted in partial fulfillment of the re requirement

for the degree bachelor of Laboratory & pharmacy presented

to the faculty of health science of Salaam university

Mogadishu - Somalia.

July 2016
 DECLARATION

This thesis is my original work and to the best of my knowledge has not been presented

for a degree in any other university.

Signature ……………………………… Date…………………………….

Mohamed Abdirahim Omar

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 APPROVAL

I confirm that the work reported in this dissertation was carried out by the
candidate/student under my Supervision.

Supervisor: Abdisamad Hashi Nor

Signature: …………………………

Date: ………………………………

Dean faculty: Dr. Hassan Ali Mohamed (Anaboro)

Signature: …………………………

Date: ………………………………

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 ACKNOWLEDGEMENT

All thanks to Allah, who created my made Muslims and enabled this thesis to be
completed successfully.

Thanks to my supervisor ABDISAMAD HASHI NOR his valuable suggestions support and
guidance in successful completion of this thesis.

I would like to express my deepest gratitude to my beloved my dear Mother Amina

Ahmed Sheikh Da’ud, my dear Father Abdirahim Omar Ali, my dear uncle Abdikarim
Mohiyadin Sacid and my dear anti Hidayo Abdalla Sheikh Da’ud for their remarkable
suggestions and an unforgettable helping in all my lives.

I would like to acknowledge Salaam University especially Faculty of Health Sciences

department of medical laboratory and pharmacy in provision of education to Somali
community and also thank to some of our lecturers in the University who also encouraged
learning.

Although it's not possible to name every individual we greatly extend my appreciation to
various persons who directly or indirectly helped this research.

For all time, guidance and excellent supervision that more than words can describe.
Without his precious guidance, help, we couldn’t be able to accomplish this thesis.

Special thanks to the dean of the faculty, all our golden teachers for their valuable
teaching, guidance, training, helping and supporting to get the right way

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 ABSTRACT

Background of the study: Hepatitis B is a virus that causes inflammation of the liver.

According to the most recent World Health Organization estimate, two billion people

worldwide have serologic evidence of past or present HBV infection, and 360 million are

chronically infected and at risk for HBV-related liver disease

Main Objectives: The main objective of this research it is to assess the importance of

hepatitis B screening among blood donors in Arafat hospital Mogadishu-Somalia.

Research methods: The sample size was 81 respondents selected conveniently from

study population. Data analysis was done by using EXCEL before transferring to

Microsoft ward. The method of HBs Ag is one step rapid Test by with Serum. It’s only

method that used in the research.

Results: The majority of the sample respondents 32 (40%) were aged between 29-38

years and followed by 28 (34%) aged between18-28 years while 13 (16%), 8(10%) were

aged between 39-48 years and >48 years respectively. The majority of the sample

respondents of the blood group 48 (59%) were O+ while 24 (30%), 9 (11%) were A+ and

B+ respectively. The majority of the sample respondents (91%) were negative while

(9%) were positive.

Conclusions: This study has provided information on the prevalence of HBV infection

among blood donors at Arafat hospital which was 9% and the disease is still major health

problem in male gender and age group 29-38 years.

Recommendations: The researcher recommends that the rapid test of hepatitis b virus

have errors so it will be detected by Eliza machine.

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 ABBREVIATIONS AND ACRONYMS

CI Confidence Interval

ELISA Enzyme Linked Immuno Sorbant Assay

HBsAb Antibodies to Hepatitis B surface antigen

HBsAg Hepatitis B Surface Antigen

HbcAg Hepatitis B Core Antigen
HbeAg Hepatitis B e Antigen
HBIG Hepatitis B Immunoglobulin
HBV Hepatitis B virus

HCV Hepatitis C Virus

HCC Hepatocellular Carcinoma

HIV Human Immunodeficiency Virus

ssDNA single stranded Deoxyribonucleic acid

STDs Sexually Transmitted Diseases

TTI Transfusion Transmitted Infections

CDC Center of Disease Control

DNA Deoxyribonucleic acid

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TABLE OF CONTENTS

DECLARATION.............................................................................................................. I

APPROVAL ..................................................................................................................... I

ACKNOWLEDGEMENTS ........................................................................................... II

ABSTRACT ................................................................................................................... IV

ABBREVIATIONS ......................................................................................................... V

TABLE OF CONTENTS ............................................................................................. VI

LIST OF TABLES ....................................................................................................... VII

LIST OF FIGURES ...................................................................................................... XI

LIST OF APPENDICES ............................................................................................. XII

CHAPTER 1: INTRODUCTION ................................................................................... 1

1.0: introduction…………………………………………………………………………..1

1.1 Background…………………………………….………………………………...1

1.2 Statement of the problem ..................................................................................... 3

1.3 Parpose of the study .............................................................................................. 4

1.4 Research Objectives .............................................................................................. 4

1.4.1 General objective .........................................................................………...…. 4

1.4.2 Specific objectives ................................................................................................4

1.5 research questions ................................................................................................. 5

1.6 significance of the study......................................................................................... 5

1.7 scope of the study ………………………………………………………………….5

1.8 Conceptual framework………………………………………………………………...6

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CHAPTER 2: LITERATURE REVIEW ...................................................................... 7

2.0: INTRODUCTION .................................................................................................... 7

2.1 Breaf overview ofHepatitis B viral infection ..................................................... 7

2.2 Effect of hepatitis B in the liver ........................................................................ 13

2.2.1 sympotoms of hepatitis B.................................................................................... 15

2.2.2 spread of hepatitis B ........................................................................................... 16

2.2.3 medical advice of hepatitis B ..........................................................................17

2.2.4 Diagnosis of hepatitis B infection………………………………………….…..18

2.2.5 Treatment of hepatitis B infection………………………………………………..18

2.2.6 preventation of hepatitis B infection ................................................................. 21

2.2.7 Outlook of hepatitis B infection ......................................................................... 22

2.3. methods and acurance of HBV serological test during the screening of HBV
.......................................................................................................................................... 23

2.3.1 Accuracy ………………………………...………………………………………23

2.3.1 Methods …………………………………………………………………………23

2.3.3 Interpretation of HB serological test results ……………………………………24

2.4 Laboratory procedure manual for HBs Ag, HBs Ab, HBc Ab………………… 25

2.4.1 Intended use……………………………………………………………………...25

2.4.2 Principle of the assay…………………………………………………………….25

2.4.3 Storage conditions………………………………………………………………..26

2.4.4 Precaution …………………………………………………………………….....26

2.4.5 Specimen collection……………………………………...………………………27

2.4.6 Materials provided………………………………………………………………27

2.4.7 Materials required but not provided…………………………………………….27

2.4.8 Assay procedure…………………………………………………………………28

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2.4.9 Interpretation of results…………………………………………………………..29

CHAPTER 3: METHODOLOGY ............................................................................ 30

3.0:INTRODUCTION ................................................................................................... 30

3.1 Research dising ................................................................................................... 30

3.2 Research Area ..................................................................................................... 30

3.3 Research papulation and sampling ................................................................... 31

3.3.1 target papulation ................................................................................................ 31

3.3.2 sample size .......................................................................................................... 31

3.3.3 sampling teqnique ............................................................................................. 31

3.4 data collection .................................................................................................... 32

3.4.1 instrument .......................................................................................................... 32

3.4.2 research procedure ........................................................................................... 32

3.5 validity...............................................................................................................32

3.6 reliability ..........................................................................................................33

3.7 Analysis of data .................................................................................................33

3.8 limitation of the study………………………………………………………......33

3.9 ethical concentration ……………………………………………………………33

CHAPTER 4: DATA PRESENTATION AND ANALYSIS……………..................34

4.0 INTRODUCTION.................................................................................................... 34

4.1 Distribution of HB according to respondents by sex ..................................... 34

4.2 Distribution of HB according to respondents by age group ........................ 35

4.3 Distribution of HB according to respondents by occupation ........................ 36

4.4 Distribution of HB according to respondents by residence …………………….37

4.5 Distribution of HB according to respondents by donation type ………...………38

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4.6 Distribution of HB according to respondents by blood group ……………..……39

4.7 Distribution of HB according to respondents by results…………………………40

4.8 prevalence of HB among females………………………………..………………41

3.9 prevalence of HB among males………………………………….………………42

CHAPTER 5: FINDINGS, CONCLUSIONS & RECOMMENDATIONS ............. 43

5.1 findings ................................................................................................................ 43

5.2 Conclusions……………………………………………………………………...43

6.2 Recommendations ..............................................................................................44

REFERENCES ............................................................................................................... 45

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 LIST OF TABLES

Table 2.1 Interpretation of hepatitis B infection test result……………………......…..24

Table 4.1 Sample of distribution according to the respondents by Sex…….…..………34

Table 4.2 Sample of distribution according to the respondents by Age group ................ 35

Table 4.3 Sample of distribution according to the respondents by Occupation………. . 36

Table 4.4 Sample of distribution according to the respondents by Residence ................ 37

Table 4.5 Sample of distribution according to the respondents by Donation type .......... 38

Table 4.6 Sample of distribution according to the respondents by Blood group ............ 39

Table 4.7 Distribution of hepatitis B according to the respondents' result……………..40

Table 4.8 Prevalence of hepatitis B infection among female……………………………41

Table 4.9 Prevalence of hepatitis B infection among male…………………………….42

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 LIST OF FIGURES

Figure 1.1 Conceptual framework……………………………………………………..6

Figure 2.1 Test card of HBs Ag………………………….……………………........…..28

Figure 2.2 Test strip of HBs Ag …………………………………………………………28

Figure 4.1 Sample of distribution according to the respondents by Sex………..………34

Figure 4.2 Sample of distribution according to the respondents by Age group ............. 35

Figure 4.3 Sample of distribution according to the respondents by Occupation……….36

Figure 4.4 Sample of distribution according to the respondents by Residence .............. 37

Figure 4.5 Sample of distribution according to the respondents by Donation type ........ 38

Figure 4.6 Sample of distribution according to the respondents by Blood group .......... 39

Figure 4.7 Distribution of hepatitis B according to the respondents' result………….....40

Figure 4.8 Prevalence of hepatitis B infection among female…...………………………41

Figure 4.9 Prevalence of hepatitis B infection among male…………………………….42

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 LIST OF APPENDICES

Appendix A Data collection tool .................................................................................. 48

Appendix B Dummy Table ........................................................................................... 50

Appendix C Consent Form ........................................................................................... 51

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 CHAPTER ONE: INTRODUCTION

1.0: INTRODUCTION

This chapter covers the background, problem statement, general objective, specific

objective, research questions, scope, significance and conceptual framework of the study.

The study related to the importance of Hepatitis B virus screening among blood donors in

Arafat hospital Mogadishu – Somalia.

1.1: Background

Hepatitis B is an infectious disease caused by the hepatitis B virus (HBV) which affects

the liver. It can cause both acute and chronic infections. Many people have no symptoms

during the initial infection. Some develop a rapid onset of sickness with vomiting,

yellowish skin, tiredness, dark urine and abdominal pain (WHO July 2014) .Often these

symptoms last a few weeks and rarely does the initial infection result in death (Raphael

Rubin; David S. Strayer 2008).

It may take 30 to 180 days for symptoms to begin (WHO July 2014). In those who get

infected around the time of birth 90% develop chronic hepatitis B while less than 10% of

those infected after the age of five do (U.S. centers for disease control and prevention

(CDC). Retrieved 29-11-2011.)

Most of those with chronic disease have no symptoms; however, cirrhosis and liver

cancer may eventually develop (Chang MH June 2007). These complications result in

the death of 15 to 25% of those with chronic disease (WHO July 2014).The virus is

transmitted by exposure to infectious blood or body fluids. The hepatitis B viruses cannot

be spread by holding hands, sharing eating, utensils, kissing, hugging, coughing,

sneezing, or breastfeeding. (CDC. Retrieved 29-11-2011).The infection can be diagnosed

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30 to 60 days after exposure. Diagnosis is typically by testing the blood for parts of the

virus and for antibodies against the virus It is one of five known hepatitis viruses: A, B,

C, D, and E. (WHO July 2014).

The infection has been preventable by vaccination since 1982.(Pungpapong S, Kim WR,

Poterucha JJ 2007).Vaccination is recommended by the World Health Organization in the

first day of life if possible. Two or three more doses are required at a later time for full

effect. This vaccine works about 95% of the time (WHO July 2014) About 180 countries

gave the vaccine as part of national programs as of 2006 (Williams R 2006)

It is also recommended that all blood be tested for hepatitis B before transfusion to

prevent infection..(WHO. July 2014)

About a third of the world population has been infected at one point in their lives,

including 240 million to 350 million who have chronic infections.(Schilsky ML 2013)

Another 129 million new infections occurred in 2013 (Global Burden of disease study 22

august 2013). Over 750,000 people die of hepatitis B each year (WHO. July 2014). About

300,000 of these are due to liver cancer (GBD 2013 Mortality and causes of death,

collaborators (17 December 2014)).

The disease is now only common in East Asia and sub-Saharan Africa where between 5

and 10% of adults have chronic disease. Rates in Europe and North America are less than

1%.(WHO.int. July 2014) It was originally known as serum hepatitis.[barker LF, Shulm

an NR, marry R, Hirschman RJ, Ranter F, Diefenbach WC, Geller HM (2006) Research

is looking to create foods that contain HBV vaccine.(Thomas Bruce (2002). The disease

may affect other great apes as well.(Plotkin, Stanley A.; Orenstein,, Walter A.; Offit, paul

A. 2013)

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1.2: Statement of the problem

Blood is a scarce, but lifesaving resource; however, blood transfusion can be a source of

life threatening infections, if screening is not carried out properly (Dodd RY.2003).

Unscreened donated blood, unsafe therapeutic practices, including the use of

inadequately sterilized needles and medical instruments, are the major routes of HBV

transmission apart from sexual exposure in sub-Saharan Africa. (Burnett R. et al., 2005)

With an estimated global incidence of one million cases and 1500,000 deaths annually,

hepatitis causes HBV remains a public health problem in many tropical and sub- tropical

countries.

After destruction of the central government in Somali country all public services

including health services such as hospitals and health centers and community faced many

problems such as death rate, mortality rate and morbidity rate increased at that time

because lack of complete medical lab techniques and lack of available vaccine

preparations also there is lot of error for investigation due to lack of qualified lab After

recognizing above mentioned problems, the researcher decided to make this research in

order to get detailed about how to investigate hepatitis B virus.

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1.3: Purpose of the study

The study of the importance of Hepatitis B virus screening among blood donors, most

developed countries saw declining rates of Hepatitis virus throughout the first half of the

20th century due to vaccinations and advances in public sanitation and hygiene.

Today, the incidence of hepatitis virus in developed countries is around 15 cases per

10,000,000 people per year. "The number of cases is two or even three times what was

there last year so Hepatitis B an epidemic, so this is the main problem that compelled the

researcher to make research about Hepatitis B to educate the people and enhance

awareness of its complication among the community living in Yaqshid district

Mogadishu – Somalia, especially patients which admitted in Arafat hospital, as well as

this topic will be very important in our population who has no complete health system,

health education, good screening and good remedy about Hepatitis B.

1.4: Research objectives

1.4.1: General objectives

The study of the importance of Hepatitis B virus screening among blood donors in Arafat

Hospital.

1.4.2: Specific objectives

The specific objectives of this study are:-

1. To identify the effect of hepatitis B virus in the liver.

2. To observe whether the age and sex of the patient influences the clinical

expressions of HBV.

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 3. To determine the methods and accuracy the serological tests during screening of

HBV infection.

4. To enhance the knowledge of lab technician in screening of hepatitis b virus .

1.5: Research questions

1. How to identify the effect of hepatitis B virus in the liver?

2. How to observe whether the age and sex of the patient influences the clinical

expressions of HBV?

3. How to determine the methods and accuracy of serological tests during screening

of HBV infection?

4. How to enhance the knowledge of lab technician in screening of HBV?

1.6: Significance of the study

The research hopes that this study will be bring updated knowledge about the

hepatitis B and that it will useful for enhancing community awareness about

Hepatitis B. The findings and the recommendations of this study will be enables

the readers to generate ideas for better understanding in the effective management

of Hepatitis B and will benefit from this study Health works, government, and NGOs

society and the potential students.

1.7: Scope of the study

1. Content scope: this research is concerned with the study of the importance of

HBV screening among blood donors.

2. Geographical scope: this study is conducted in Arafat Hospital Mogadishu –

Somalia.

3. Time scope: this study was conducted between April to July 2016

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 1.8: Conceptual framework of HBV infection

Socio-demographic
* Sex
Donation type
* Age
* Residence
* Occupation

HBV infection

Immune-
Cirrhosis
active phase

Clearance Inactive
Hepatocellular
of HBsAg carrier phase
carcinoma

HBV screening

Figure1. Conceptual framework shows importance related with HBV infection

screening.

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 Chapter Two

Literature review

2.0: Introduction

This chapter of the study brought to the fore what was known about the research subject

from what was unknown Numerous studies and ideas written down by other researchers

on the exact variables of interest to this researcher among other related ones were

critiqued as gaps that need to be filled and were identified.

2.1: Brief overview

Hepatitis is an inflammation of the liver. The condition can be self-limiting or can

progress to fibrosis (scarring), cirrhosis or liver cancer. Hepatitis viruses are the most

common cause of hepatitis in the world but other infections, toxic substances (e.g.

alcohol, certain drugs), and autoimmune diseases can also cause hepatitis. (WHO July

2015)

There are 5 main hepatitis viruses, referred to as types A, B, C, D and E. These 5 types

are of greatest concern because of the burden of illness and death they cause and the

potential for outbreaks and epidemic spread. In particular, types B and C lead to

chronic disease in hundreds of millions of people and, together, are the most common

cause of liver cirrhosis and cancer. ( WHO retrieved 4 November 2014)

Hepatitis A and E are typically caused by ingestion of contaminated food or water.

Hepatitis B, C and D usually occur as a result of parenteral contact with infected body

fluids. Common modes of transmission for these viruses include receipt of

contaminated blood or blood products, invasive medical procedures using

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contaminated equipment and for hepatitis B transmission from mother to baby at birth,

from family member to child, and also by sexual contact. (WHO July 2015)

Acute infection may occur with limited or no symptoms, or may include symptoms

such as jaundice (yellowing of the skin and eyes), dark urine, extreme fatigue, nausea,

vomiting and abdominal pain.

Scientists have identified 5 unique hepatitis viruses, identified by the letters A, B, C,

D, and E. While all cause liver disease, they vary in important ways. (WHO July 2015)

 Hepatitis A virus (HAV)

Hepatitis A virus (HAV) is present in the faeces of infected persons and is most often

transmitted through consumption of contaminated water or food. Certain sex practices

can also spread HAV. Infections are in many cases mild, with most people making a

full recovery and remaining immune from further HAV infections. However, HAV

infections can also be severe and life threatening. Most people in areas of the world

with poor sanitation have been infected with this virus. Safe and effective vaccines are

available to prevent HAV. (WHO July 2015)

 Hepatitis C virus (HCV)

Hepatitis C virus (HCV) is mostly transmitted through exposure to infective blood.

This may happen through transfusions of HCV-contaminated blood and blood

products, contaminated injections during medical procedures, and through injection

drug use. Sexual transmission is also possible, but is much less common. There is no

vaccine for HCV. (WHO July 2015)

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  Hepatitis D virus (HDV)

Hepatitis D virus (HDV) infections occur only in those who are infected with HBV.

The dual infection of HDV and HBV can result in a more serious disease and worse

outcome. Hepatitis B vaccines provide protection from HDV infection. (WHO July

2015)

 Hepatitis E virus (HEV)

Hepatitis E virus (HEV) is mostly transmitted through consumption of contaminated

water or food. HEV is a common cause of hepatitis outbreaks in developing parts of

the world and is increasingly recognized as an important cause of disease in developed

countries. Safe and effective vaccines to prevent HEV infection have been developed

but are not widely available. (WHO July 2015)

 Hepatitis B Virus.

Hepatitis B virus is a partially double-stranded circular DNA virus and is a member of

the Hepadnaviridae family.( Mason, WS.; et al 2009) The virus consists of a core capsid

which contains viral DNA and this is surrounded by an envelope containing surface

antigen (HBsAg). Both whole, intact virions and incomplete virus particles, consisting

entirely of HBsAg, are produced during replication of HBV. The HBsAg particles vary

greatly in morphology and are found in high concentrations in early acute infection and

continue to be produced in chronic disease. (World J Gastroenterol. 2007 Jan 7)

HBV infection in industrialized countries occurs predominantly in adults where the

clinical course most frequently seen is of acute infection, comprising an incubation

period (generally 4 - 12 weeks), followed by an acute illness (2 weeks – 3 months) and

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recovery with no further sequelae, although up to 30% may show no or very mild

symptoms in the acute phase.

In resource-poor settings, however, chronic infections frequently occur leading to a high

prevalence of hepatitis B infection in such areas. High numbers of infants and young

children are infected of whom approximately 90% of infants infected at birth and 30% of

children aged under 5 do not clear the virus completely and continue to be chronically

infected for the remainder of their lives. (CDC Retrieved 29-11-2011)

Chronic infections may take one of two courses. The infected individual may remain

HBeAg positive, a marker of viral replication which correlates with evidence of HBV

DNA, for the remainder of the individuals’ lives, see Figure C. Alternatively, after a

number of years, chronically infected individuals may become HBeAg negative

concomitant with the production of antibody to HBe. However, individuals

in whom HBsAg is present in their blood for more than six months are considered to be

chronically infected with HBV and are at a greater risk of development of cirrhosis and

hepatocellular carcinoma.

HBsAg is the most commonly used marker of infection for diagnostic and blood

screening.

An individual positive for HBsAg is considered to be infected with HBV, and is therefore

potentially infectious. Confirmation of a reactive HBsAg ELISA screening test is usually

done by performing a neutralization test using a specific anti-HBs antiserum in the same

screening ELISA. Where a simple/rapid HBsAg test is used and no neutralization

reagents are available, confirmation of an acute or chronic infection for diagnostic

purposes may be concluded based upon symptoms and appropriate monitoring tests.

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Other HBV markers which can be used diagnostically to monitor an HBV infection

include HBeAg, IgM anti- HBc, total anti-HBc, anti-HBe, anti-HBs and HBV DNA. The

presence of HBeAg indicates an individual is of higher infectivity, and seroconversion to

anti-HBe correlates with reduced infectivity. In an acute infection this suggests that the

infected person is progressing towards resolving their infection. Individuals who have

seroconverted from HBsAg to anti-HBs have resolved their infection and are immune to

further HBV infection.

The most widely used HBsAg screening tests worldwide are ELISAs as they are the most

appropriate for screening large numbers of specimens on a daily basis, as is the case in

blood transfusion services in industrialized countries. However, many blood transfusion

services in resource limited countries only process limited numbers of specimens. Hence,

individual tests would be more appropriate. Several simple, instrument and electricity-

free screening tests have been developed including agglutination, immunofiltration (flow

through) and immunochromatographic (lateral flow) membrane tests. In general, these

simple/rapid (S/R) tests are most suitable for use in laboratories that have limited

facilities and/or process low numbers of specimens daily. Care should be taken however

to ensure that the test meets any regulatory specifications, eg in some countries the use of

tests with a minimum detection level of 0.5ng/ml HBsAg for testing of donated blood is

mandatory.( WHO 2004)

Hepatitis B virus (HBV) is the prototype member of a steadily growing family of

viruses called hepadnaviruses. Hepadnaviruses can be found in both mammals

(orthohepadnaviruses) and birds (avihepadnaviruses). HBV, the hepadnavirus infecting

humans, is classified into eight genotypes today. Since the first definition of the

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genotypes A, B, C and D, genotypes E, F, G and H have been detected. Due to the

genetic diversity of HBV, numerous subgenotypes of HBV have been described HBV

subgenotypes.

HBV genotypes and most subgenotypes show a distinct geographic distribution. In Asia,

where there is a high prevalence of HBV carriers, strong evidence suggests that HBV

genotypes influence the course of disease. Several recent reviews have summarised

knowledge on different aspects of HBV genotypes and on hepadnaviruses that infect

species other than homo sapiens. This review will update recent developments in

understanding HBV genotypes and taxonomy.( World J Gastroenterol. 2007 Jan 7)

Hepatitis B virus belongs to the Hepadnaviridae family of the viruses. (Hunt, Richart

2001-11-11) The entire virus is spherical particle with a diameter of 42nm, consists of an

outer protein envelope and an inner 28 nm icosahedral core known as nucleocapsid. The

outer envelope is composed of several proteins known as hepatitis B surface protein

(HBs) which encase the nucleocapsid. The inner protein shell contains hepatitis B core

protein. (Howard CR 1986)

Hepatitis B virus was originally recognized as the agent responsible for “serum

hepatitis”, the most common form of parenterally transmitted viral hepatitis, and an

important cause of acute and chronic infection of the liver. The incubation period of

hepatitis B is variable with a range of 1 to 6 months. The clinical features of acute

infection resemble those of the other viral hepatitides. Acute hepatitis B is frequently

anicteric and asymptomatic, although a severe illness with jaundice can occur and

occasionally acute liver failure may develop. (Arie J. Zuckerman. 2007)

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Hepatitis B is a liver infection caused by the Hepatitis B virus (HBV). Hepatitis B is

transmitted when blood, semen, or another body fluid from a person infected with the

Hepatitis B virus enters the body of someone who is not infected. Risk for chronic

infection is related to age at infection: approximately 90% of infected infants become

chronically infected, compared with 2%–6% of adults. hepatitis B surface antigen

(HBsAg) in the serum for more than six months, have been estimated to affect about 350

million people worldwide. Chronic Hepatitis B can lead to serious health issues, like

cirrhosis or liver cancer. The best way to prevent Hepatitis B is by getting vaccinate

(CDC May 31, 2015)

During the period of replication, the viral genome may integrate into the chromosomal

DNA of some hepatocytes and these cells may persist and expand clonally. Rarely does

seroconversion to anti-HBs follow clearance of virus replication but, more frequently,

HBsAg persists during a second phase of chronicity as a result of the expression of

integrated viral DNA. (Arie J. Zuckerman. 2007)

2.2: Effect of hepatitis B virus in the liver

Hepatitis B is an infection of the liver caused by a virus that's spread through blood and

body fluids. It often doesn't cause any obvious symptoms in adults and typically passes in

a few months without treatment, but in children it often persists for years and may

eventually cause serious liver damage. (WHO July 2015)

Hepatitis B is less common in the UK than other parts of the world, but certain groups are

at an increased risk. This includes people originally from high-risk countries, people who

inject drugs, and people who have unprotected sex with multiple sexual partners.

A hepatitis B vaccine is available for people at high risk of the condition. People with

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hepatitis B can sometimes develop serious liver problems. These mostly affect people

with an untreated long-term (chronic) infection. ( NHS 23 March 2016)

 Cirrhosis

Scarring of the liver (cirrhosis) affects around one in five people with chronic hepatitis B,

often many years after they first got the infection.

Cirrhosis doesn't usually cause any noticeable symptoms until extensive damage to the

liver has occurred, when it can cause:

 tiredness and weakness

 loss of appetite

 weight loss

 feeling sick

 very itchy skin

 tenderness, pain, or swelling in the tummy

 swelling of the ankles

There's currently no cure for cirrhosis, although it's possible to manage the symptoms and

slow its progression. If the liver becomes severely damaged, a liver transplant may be

needed.

 Liver cancer

People with cirrhosis caused by hepatitis B have around a 1 in 20 chance of

developing liver cancer every year.

Symptoms of liver cancer include:

 unexplained weight loss

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  loss of appetite

 feeling very full after eating, even if the meal was small

 feeling and being sick

 yellow skin and eyes (jaundice)

Treatment for liver cancer may involve surgery to remove the affected section of liver, a

procedure to destroy the cancerous cells, or a liver transplant.

 Fulminant hepatitis B

In less than 1 in 100 cases, short-term (acute) hepatitis B can lead to a serious problem

called fulminant hepatitis B.

This is where the immune system attacks the liver and causes extensive damage to it.

It can lead to symptoms such as:

 confusion

 collapsing

 swelling of the tummy caused by a build-up of fluid

 severe jaundice

Fulminant hepatitis B can cause the liver to stop working properly and is often fatal if not

treated quickly.

2.2.1: Symptoms of hepatitis B

Many people with hepatitis B won't experience any symptoms and may fight off the virus

without realising they had it. If symptoms do develop, they tend to occur two or three

months after exposure to the hepatitis B virus. (NHS 23 march 2016)

Symptoms of hepatitis B include:

~ 15 ~
  flu-like symptoms, including tiredness, a fever, and general aches and pains

 loss of appetite

 feeling and being sick

 diarrhoea

 tummy (abdominal) pain

 yellowing of the skin and eyes (jaundice)

These symptoms will usually pass within one to three months (acute hepatitis B),

although occasionally the infection can last for six months or more (chronic hepatitis B).

(NHS 23 march 2016)

2.2.2: Spread of hepatitis B

The hepatitis B virus is found in the blood and bodily fluids, such as semen and vaginal

fluids, of an infected person.

It can be spread by:

 a mother to her newborn baby, particularly in countries where the infection is

common – read more about hepatitis B in pregnancy

 within families (child to child) in countries where the infection is common

 injecting drugs and sharing needles and other drug equipment, such as spoons and

filters

 having sex with an infected person without using a condom

 having a tattoo, body piercing, or medical or dental treatment in an unhygienic

environment with unsterilised equipment

 sharing toothbrushes or razors contaminated with infected blood

~ 16 ~
Hepatitis B isn't spread by kissing, holding hands, hugging, coughing, sneezing, or

sharing crockery and utensils. (NHS 23 march 2016)

2.2.3: medical advice of hepatitis B

Hepatitis B can be serious, so you should get medical advice if:

 you think you may have been exposed to the hepatitis B virus – emergency

treatment can help prevent infection if given within a few days of exposure

 you have symptoms associated with hepatitis B

 you're at a high risk of hepatitis B – high-risk groups include people born in a

country where the infection is common, babies born to mothers infected with

hepatitis B, and people who have ever injected drugs

You can go to your local GP surgery, drug service, genitourinary medicine (GUM)

clinic or sexual health clinic for help and advice.

A blood test can be carried out to check if you have hepatitis B or have had it in the

past. The hepatitis B vaccine may also be recommended to reduce your risk of infection.

If you have hepatitis, you should:

 avoid having unprotected sex – including anal and oral sex, unless you're sure

your partner has been vaccinated against hepatitis B

 avoid sharing needles used to inject drugs with other people

 take precautions to avoid the spread of infection – such as not sharing

toothbrushes or razors with other people; close contacts such as family members

may need to be vaccinated

 eat a generally healthy, balanced diet – there's no special diet for people with

hepatitis B

~ 17 ~
  avoid drinking alcohol – this can increase your risk of developing serious liver

problems

2.2.4: Diagnosis of hepatitis B

Diagnosis of hepatitis B is based on a physical exam and blood tests. The person will ask

about his/her medical history (including possible risks for the virus, such as your job and

sexual activity).

 Blood tests to diagnose hepatitis B

Blood tests are done to help diagnose hepatitis B. They include:

Hepatitis B antigens and antibodies. These help tell if you are or were infected with the

virus. They also can show if you have been immunized and if you have long-term

(chronic) infection. You also may get tested for the virus's genetic material (HBV DNA).

 Blood tests to check for liver damage

Blood tests may be done to help find out if your liver has been damaged. They include:

Bilirubin, albumin, and prothrombin time. These help show how well your liver is

working. Cholesterol testing also may be done.

Alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline

phosphatase, and lactic dehydrogenase (LDH). These show whether your liver is

damaged or inflamed

2.2.5: Treatments for hepatitis B

Treatment for hepatitis B depends on how long you've been infected for:

 short-term (acute) hepatitis B doesn't usually need specific treatment, but may

require treatment to relieve the symptoms

~ 18 ~
  long-term (chronic) hepatitis B is often treated with medication to keep the virus

under control

 Emergency treatment can also be given soon after possible exposure to the

hepatitis B virus to stop an infection developing.

 Emergency hepatitis B treatment

See your GP as soon as possible if you think you may have been exposed to the hepatitis

B virus.

To help stop you becoming infected, they can give you:

 a dose of the hepatitis B vaccine – you'll also need two further doses over the next

few months to give you long-term protection

 hepatitis B immunoglobulin – a preparation of antibodies that work against the

hepatitis B virus and can offer immediate but short-term protection until the

vaccine starts to take effect

These are most effective if given within 48 hours after possible exposure to hepatitis

B, but you can still have them up to a week after exposure. (NHS 23 march 2016)

 Treatment for acute hepatitis B

If you're diagnosed with hepatitis B, your GP will usually refer you to a specialist, such

as a hepatologist (liver specialist).

Many people don't have any troublesome symptoms, but if you do feel unwell, it can help

to:

 get plenty of rest

 take over-the-counter painkillers, such as paracetamol or ibuprofen, for tummy

(abdominal) pain

~ 19 ~
  maintain a cool, well-ventilated environment, wear loose clothing, and avoid hot

baths or showers if itching is a problem

 take medication such as metoclopramide to stop you feeling sick and

chlorphenamine to reduce itching – your doctor can give you a prescription for

these if necessary

Most people recover completely in a couple of months, but you'll be advised to have

regular blood tests to check that you're free of the virus and haven't developed chronic

HBV. (Hepatitis b foundation march 2014)

 Treatment for chronic hepatitis B

If blood tests show that you still have hepatitis B after six months, your doctor may

recommend medication to reduce the risk of complications of hepatitis B and regular tests

to assess the health of your liver.

Treatment is usually offered if:

 your immune system is unable to control the hepatitis B by itself

 there's evidence of ongoing liver damage

Hepatitis B medications can help keep the virus under control and stop it damaging your

liver, although they won't necessarily cure the infection and some people need lifelong

treatment. (Hepatitis b foundation march 2014)

The main medicines for chronic hepatitis B are outlined below.

 Peginterferon alfa-2a

If your liver is working fairly well, the first treatment offered is usually a medicine

called peginterferon alfa 2-a.

~ 20 ~
This stimulates the immune system to attack the hepatitis B virus and regain control over

it. It's usually given by injection once a week for 48 weeks.

Common side effects include flu-like symptoms, such as a fever and muscle and joint

pain, after you start to take the medicine, although these should improve with time.

Tests will be carried out during treatment to see how well it's working. Alternative

medicines may be recommended if it's not helping. ( Lok SFL, McMahon BJ 2009)

 Antiviral medicines

If your liver isn't working well, or peginterferon alpha-2a is not suitable or not working

for you, your doctor may recommend trying antiviral medication instead.

This will usually be either tenofovir or entecavir, both of which are taken as tablets.

Common side effects of these medicines include feeling sick, vomiting and dizziness. .

(NHS 23 march 2016)

 Liver transplant. If your liver has been severely damaged, a liver transplant may be

an option. During a liver transplant, the surgeon removes your damaged liver and

replaces it with a healthy liver. Most transplanted livers come from deceased donors,

though a small number come from living donors who donate a portion of their livers.

(mayo clinic Aug.29.2014)

2.2.6: Preventing of hepatitis B

A vaccine that offers protection against hepatitis B is available for people at high risk of

the infection.

This includes:

 babies born to infected mothers

~ 21 ~
  close family and sexual partners of someone with hepatitis B

 people travelling to or from a part of the world where hepatitis B is widespread,

such as sub-Saharan Africa, east and southeast Asia, and the Pacific Islands

 people who inject drugs or have a sexual partner who injects drugs

 people who change their sexual partner frequently

 men who have sex with men

The hepatitis B vaccine isn't given as part of the routine vaccination schedule and

sometimes you may have to pay for it. (NHS 23 march 2016)

2.2.7: Outlook for hepatitis B

The vast majority of people infected with hepatitis B in adulthood are able to fight off the

virus and fully recover within one to three months. Most will then be immune to the

infection for life.

Babies and children with hepatitis B are more likely to develop a chronic infection.

Chronic hepatitis B affects around:

 90% of babies with hepatitis B

 20% of older children with hepatitis B

 5% of adults with hepatitis B

Although treatment can help, there's a risk that people with chronic hepatitis B could

eventually develop life-threatening problems such as scarring of the

liver (cirrhosis) or liver cancer. (NHS 23 march 2016)

~ 22 ~
2.3: the methods and accuracy of HBV serological tests during
screening of HBV infection.
Hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) were

conventionally determined by enzyme immunoassays. We aimed to apply a rapid, simple,

and

To determine the methods and accuracy the serological tests during screening of HBV

infection.

2.3.1: Accuracy

All laboratories carrying out HBsAg tests should have a well-functioning quality

assurance programme. It is most important that quality assurance procedures are

stringently complied with so as to maximize the accuracy of the laboratory results.

Procedures for detecting both (technical) laboratory and clerical errors must be included

in all protocols. For example, procedures that guarantee the correct identification of

initially reactive units of donated blood, which must be discarded, are essential to the

maintenance of a safe blood supply. It is recommended that laboratories submit to an

external quality assessment at least once a year.

2.3.2: Methods

There is three methods make up the "hepatitis B blood panel, the hepatitis B blood panel

requires only one blood sample but includes three tests:

HBsAg (hepatitis B surface antigen)

HBsAb or Anti-HBs (hepatitis B surface antibody)

HBcAb or anti-HBc (hepatitis B core antibody) (hepatitis b foundation March 2014)

~ 23 ~
2.3.3: Interpretation of Hepatitis B Serologic Test Results

Hepatitis B serologic testing involves measurement of several hepatitis B virus (HBV)-

specific antigens and antibodies. Different serologic “markers” or combinations of

markers are used to identify different phases of HBV infection and to determine whether

a patient has acute or chronic HBV infection, is immune to HBV as a result of prior

infection or vaccination, or is susceptible to infection.

Tests Results Interpretation

HBsAg Negative Susceptible
anti-HBc negative
anti-HBs negative
HBsAg Negative Immune due to natural infection
anti-HBc positive
anti-HBs positive
HBsAg Negative Immune due to hepatitis B vaccination
anti-HBc negative
anti-HBs positive
HBsAg Positive Acutely infected
anti-HBc positive
IgM anti-HBc positive
anti-HBs negative
HBsAg Positive Chronically infected
anti-HBc positive
IgM anti-HBc negative
anti-HBs negative
HBsAg Negative Interpretation unclear; four possibilities:
anti-HBc positive 1. Resolved infection (most common)
anti-HBs negative 2. False-positive anti-HBc, thus susceptible
3. “Low level” chronic infection
4. Resolving acute infection
Table: 2.1: Interpretation of Hepatitis B Serological Test Results

 Hepatitis B surface antigen (HBsAg): A protein on the surface of hepatitis B

virus; it can be detected in high levels in serum during acute or chronic hepatitis B

virus infection. The presence of HBsAg indicates that the person is infectious.

The body normally produces antibodies to HBsAg as part of the normal immune

response to infection. HBsAg is the antigen used to make hepatitis B vaccine.

~ 24 ~
  Hepatitis B surface antibody (anti-HBs): The presence of anti-HBs is generally

interpreted as indicating recovery and immunity from hepatitis B virus infection.

Anti-HBs also develops in a person who has been successfully vaccinated against

hepatitis B.

 Total hepatitis B core antibody (anti-HBc): Appears at the onset of symptoms

in acute hepatitis B and persists for life. The presence of anti-HBc indicates

previous or ongoing infection with hepatitis B virus in an undefi ned time frame.

 IgM antibody to hepatitis B core antigen (IgM anti-HBc): Positivity indicates

recent infection with hepatitis B virus (<6 mos). Its presence indicates acute

infection. (CDC February-14-2012)

2.4: Laboratory Procedure Manual for HBsAg, HBsAb and HBcAb.

2.4.1: INTENDED USE

the advanced quality one step hbsag HBsAb and HBcAb tests is a rapid, one step,

immunochromatographic assay for the detection of hepatitis b surface antigen, hepatitis

b surface antibody, & hepatitis b core antibody, (hbsag, hbsab & hbcab) in human

serum or plasma. the presence of 5ng/ml hbsag can be detected within 5 minutes and

0.5ng/ml hbsag in 15 minutes. the test provides a visual, qualitative result, and is

intended for professional use. (Wands JR, Zurawski VR 1981)

2.4.2: PRINCIPLE OF THE ASSAY

The Advanced Quality One Step HBsAg, HBsAb and HBcAb Tests is a colloidal gold

enhanced immunoassay that detects Hepatitis B surface antigen Hepatitis B surface

antibody, & Hepatitis B core antibody in human serum or plasma. The sample initially

reacts with the monoclonal antibody-colloidal gold conjugate on the sample pad. This

~ 25 ~
 mixture migrates across the membrane by capillary action and reacts with the anti-

HBsAg, hbsab & hbcab in the tests region. If the sample contains HBsAg, hbsab &

hbcab a line will form on the membrane at this point. If the antigen is not present in the

sample no line is formed, indicating a negative result. The mixture continues to flow

to the control area of the membrane, where it forms a line indicating the test result is

valid. (Wolters G, Kuipers L, Kacaki J, and Schuurs A. 1979)

2.4.3: STORAGE CONDITIONS

The test kits must be stored at 2-30℃in the sealed pouch and under dry conditions.

2.4.4: PRECAUTIONS

It is recommended that all specimens be handled in accordance with Biosafety Level

practices as described in the CDC NIH Publication, Biosafety in Microbiological

and Biomedical Laboratories (HHS Publication(NIH) 88-8395 2006) or other

equivalent guidelines.( NCCLS Document M29-T. Villanova, PA.: NCCLS,

2001) ( WHO, 2010)

1. Wear gloves to perform this procedure and treat all specimens and used devices as

potentially infectious.

2. clean and disinfect all spills of specimens and using a suitable disinfectant, sucg as

1% sodium

3. Hypochlorite Sterilize all devices used in ( MMWR 36, Supplement No. 2S,

2010)

4. Do not use test beyond the expiration date.

~ 26 ~
 2.4.5: SPECIMEN COLLECTION

1. Serum or plasma may be used in this test. Anticoagulants typically used for

blood collection do not interfere with this test.

2. Remove the serum or plasma from the clot or red cells as soon as possible to

avoid hemolysis.

3. Hemolyzed, extremely thickened or fatty specimens are NOT suitable for this

assay. Specimens containing particulate matter may give inconsistent results

and should be clarified prior to testing.

4. Serum or plasma specimens should be refrigerated at 2-8℃ up to 3 days and

frozen at -20℃ for longer periods.

5. Shipped specimens should be packed in compliance with federal and

international regulations covering the transportation of etiologic agents.

6. Avoid frequent (more than 3 times) thaw-and-freeze of specimens.

7. 0.1% sodium azide can be added to the specimen as a preservative

without affecting the results of the assay.

2.4.6: MATERIALS PROVIDED

• Test cards/test strips individually foil pouched with a desiccant

• Instruction for use

• Sample dispensing plastic dropper with each test pouch.(for card only)

2.4.7: Materials Required but not provided:

1. Pipettes to deliver 100µl of sample

2. Positive and negative controls

~ 27 ~
2.4.8: ASSAY PROCEDURE

Do not open pouch until you are ready to test the sample.

For test cards:

1. Bring all reagents and specimens to room temperature.

2. Remove the test card from the foil pouch and place on a clean dry surface.

3. Identify the test card for each specimen or control.

4. Dispense 100µl (3 drops) of the specimen or control into the sample well on

the card.

5. Interpret test results at 15 minutes.

Positive Negative Invalid

Finger 2.1: test cars of HBS Ag

For test strips:

1. Bring all reagents and specimens to room temperature.

2. Remove the test strip from the foil pouch and place on a clean dry surface.

3. Identify the test strip for each specimen or control.

4. Apply at least 80µl of specimen to the sample pad behind the ( ↓↓↓ ) mark at the

bottom of test strip.

5. Interpret test results at 15 minutes

Positive Negative Invalid

Finger 2.2: test strips of HBS Ag.

~ 28 ~
Caution: Use a clean pipette or tip for every sample to avoid cross-contamination.

NOTE: A positive result may be interpreted early, however read any negative at 15

minutes to ensure sample is negative and not a low concentration of the

HBsAg,HBsAb,& HBcAb requiring more time to develop. Do not interpret the result

after 15 minutes.

It is recommended to run a known positive control and negative control in

each performance to ensure the assay procedure.

2.5.9: INTERPRETATION OF RESULTS

1. Negative: Only one purplish red test band appears in the control region.

2. Positive: In addition to the control purplish red test band, a distinct purplish red test

band also appears in the test region.

3. Invalid: Neither test band nor control band appears. The specimen should be tested

again using a new test card.

~ 29 ~
 CHEPTER THREE

METHODOLOGY

3.0 INTRODUCTION

Chapter three illustrated the details of the methodology that were used during the process

of research and research report making. The chapter gave details of the research area,

Research design, population and sampling, data collect, validity, reliability, data analysis,

assumption and limitation, ethical concentrations

3.1: Research design

This study was descriptive cross-sectional study designed to assess the importance of

HBV-screening among blood donors aimed collecting information of the Arafat hospital.

3.2: research area: ARAFAT HOSPITAL

Arafat hospital was established in 2001 as part of ZAMZAM foundation development

projects to Somali people which included other infrastructures as well. The hospital is

situated in the southeastern of the Somali capital, Mogadishu.

After the collapse of the former military government, ZAMZAM foundation and

professional doctors was established the Arafat hospital to save people’s life.

The hospital comprises three main departments:

 The medical and surgical activities are also delivered routinely or as emergency

forms

 The maternity which offers treatment services to medical to medical and surgical

conditions of pregnant and non- pregnant women similarly.

 The pediatric department deals with medical and surgical conditions for all ages

of children.

~ 30 ~
3.3: Research population and sampling

3.3.1: target population

The study population is the people whom donate the blood into the ARAFAT hospital in

May and June 2016.

3.3.2: sample size

Respondents will be selected randomly the populations was the sample (102) out of them

are selected to have document analysis of the study of the importance of HBV-screening

among blood donors in Arafat hospital.

N
n = 1+ (N*e2)

Slovenes’ Formal:

Target population = 102

N = Target population

E2 = 0.05

E = 0.0025

N = 102
1+ (102*0.0025)

= 81 respondents

3.3.3: sampling technique

Simple random sampling technique was used to select study units.

~ 31 ~
3.4: data collection

3.4.1: Instrumentation

The research conducting academic research and also we request to allow data collected

from the importance of HBV-screening among blood donors for data collected. The study

was gather data by document analysis.

3.4.2: Research procedure

The sample procures which were used for the research probability sampling was selected

to collect data especially Purposive sampling is a Method of sampling where the study

intentionally chooses who will include in the study Based on their ability to provide

necessary data because they will able to judge and choose population members who are

good prospects for accurate information and it also will save time and cost.

3.5: validity

Validity determines the strength of the conclusion or whether the research truly measures

what it was intended to measure. All the questionnaires prior to use were piloted to

ensure the questions provide the required information, consistency and easily

understandable. Changes were made to the questionnaires before they were used. The

findings of this study reflect the availability and the quality of blood transfusion service

in these regions. All transfusing facilities in these regions were covered. Again,

standardized questionnaires and document analysis were administered by trained

interviewers.

Questions on blood transfusion knowledge were based on day to day practices. Therefore

there are no concerns of recall or selection bias in this study.

~ 32 ~
3.6: reliability

Reliability is the degree of the consistency of an instrument in providing the same results

when used the same conditions and similar subjects. Reliability in this study was

achieved by piloting the questionnaires and document analysis, using the same

interviewers for the interviews.

3.7: data analysis

All completed data collection forms were examined for completeness, consistency and

clarity during data management, storage, and analysis. The data was coded, entered, and

cleaned before analysis. All analyses were done using EXELL.

3.8: limitation of the study

In this study, the researcher faced a lot of problems, including:-

 Lack of security and stability.

 There is no public library to access books for references.

 The research was very costly and time consuming.

 Language barrier.

3.9: ethical concentrations

To preserve confidentiality, extraction of data from records was carried out by data

collectors working in the hospital. There was no any personal identifier included in the

data collection form. The data obtained had not been accessed by a third person, except

the principal investigator. After fulfilling the above requirements and obtaining the

permission, the data collection was proceeded.

~ 33 ~
 CHAPTER FOUR:

DATA PRESENTATION AND ANALYSIS

4.0 INTRODUCTION
To test hepatitis B, a total 81 participants were included in this study throughout the
period from May up to July- 2016 in Arafat hospital, Mogadishu – Somalia.

4.1 DISTRIBUTION ACCORDING TO RESPONDENTS BY SEX

The majority of the sample respondents 80 (99%) were males while 1 (1%) were females.
Table 4.1: Sample of distribution according to the respondents by Sex

SEX FREQUENCY PERCENTAGE %

Male 80 99%

Female 1 1%

Total 81 100%

Figure 4.1: Sample of distribution according to the respondents by Sex

1%

99%

Male Female

~ 34 ~
4.2DISTRIBUTION ACCORDING TO RESPONDENTS BY AGE GROUP
The majority of the sample respondents 32 (40%) were aged between 29-38 years, 28
(34%) aged between18-28 years and followed by 13 (16%) aged between 39-48 years
while 8 (10%) were aged >49 years.

Table 4.2: Sample of distribution according to the respondents by Age group.

AGE GROUP FREQUENCY PERCENTAGE %

18-28 years 28 34%

29-38 years 32 40%

39-48 years 13 16%

> 40 years 8 10

Total 81 100%

Figure 4.2: Sample of distribution according to the respondents by Age group.

45%
40%
40%
34%
35%

30%

25%

20% 16%

15% 10%
10%

5%

0%
18-28 years 29-38 years 39-48 years > 48 years

~ 35 ~
4.3 DISTRIBUTION ACCORDING TO RESPONDENTS BY OCCUPATION.
The majority of the sample respondents of the Occupation 25 (31%) were professional,
24 (30%) were Business, 18 (22%) were Unemployed, 10 (12%) were Student and 4
(5%) were others.

Table 4.3: Sample of distribution according to the respondents by Occupation.

OCCUPATION FREQUENCY PERCENTAGE %

Professional 25 31%

Business 24 30%

Unemployed 18 22%

Student 10 12%

Others 4 5%

Total 81 100%

Figure 4.3: Sample of distribution according to the respondents by Occupation

35%
31% 30%
30%

25% 22%

20%

15% 12%

10%
5%
5%

0%
professional Business Unemployed Student others

~ 36 ~
4.4 DISTRIBUTION OF HEPATITIS B ACCORDING TO RESPONDENTS BY
RESIDENCE.
The majority of the sample respondents residence 76 (94%) are city while 5(6%) are
region.

Table 4.4: Sample of distribution according to the respondents by Residence.

RESIDENCE FREQUENCY PERCENTAGE %

CITY 5 6%

REGION 76 94%

Total 81 100%

Figure 4.4: Sample of distribution according to the respondents by Residence.

6%

Negative
Positive

94%

~ 37 ~
4.5 DISTRIBUTION OF HEPATITIS B ACCORDING TO RESPONDENTS BY
DONATION TYPE.
The majority of the sample respondents in the donation type 27 (33%) are volunteer
while 54 (67%) are region.

Table 4.5: Sample of distribution according to the respondents by donation type.

RESIDENCE FREQUENCY PERCENTAGE %

Volunteer 27 33%

Family 54 67%

Total 81 100%

Figure 4.5: Sample of distribution according to the respondents by donation type.

33%

volunteer
family

67%

~ 38 ~
4.6: DISTRIBUTION ACCORDING TO RESPONDENTS BY BLOOD GROUP
The majority of the sample respondents of the blood group 48 (59%) were O+ while 24
(30%), 9 (11%) were A+ and B+ respectively.

Table 4.6: Sample of distribution according to the respondents by blood group.

BLOOD GROUP FREQUENCY PERCENTAGE %

O+ 48 59%

A+ 24 30%

B+ 9 11%

Total 81 100%

Figure 4.6: Sample of distribution according to the respondents by blood group.

60%

50%

40%
59%
30%

20% 30%

10% 11%

0%
O+ A+ B+
O+ A+ B+

~ 39 ~
4.7: DISTRIBUTION OF HEBATITIS B ACCORDING TO RESPONDENTS BY
RESULT
The majority of the sample respondents result 13(22%) are positive while 47(78%) are
negative.

Table 4.7: Distribution of hepatitis B according to the respondents’ result

RESULTS FREQUENCY PERCENTAGE %

Positive 7 9%

Negative 74 91%

Total 81 100%

Figure 4.7: Distribution of hepatitis B according to the respondents’ result

9%

Negative
Positive

91%

~ 40 ~
4.8 PREVALENCE OF HEBATITIS B AMONG FEMALES
The majority of the sample female respondents 1(1%) were negative while 0(0%) were
positive.

Table 5: Prevalence of hepatitis B among female respondents

RESULT FREQUENCY PERCENTAGE %

Positive 0 0%

Negative 1 100%

Total 1 100%

Figure 5: Prevalence of hepatitis B among female respondents

Negative Positive

0%

100%

~ 41 ~
4.9 PREVALENCE OF HEBATITIS B AMONG MALES
The majority of the sample male respondents 73 (91%) were negative while 7(9%) were
positive.

Table 4.9: Prevalence of hepatitis B among Males respondents

RESULT FREQUENCY PERCENTAGE %

Positive 7 91%

Negative 73 9%

Total 80 100%

Figure 4.9: Prevalence of hepatitis B among Males respondents

Negative Positive

9%

91%

~ 42 ~
 CHAPTER FIVE
FINDINGS, CONCLUSIONS & RECOMMENDATIONS

5.1: FINDINGS

Findings in this study will serve as baseline information for the laboratory of Arafat

hospital and other researchers to conduct community based study which comprises a

more representative participant to monitor the disease incidence, investigates all possible

associated risk factors and determines the sources of infection and modes of transmission

which are crucial to prevent HBV infection.

The majority of the sample respondents 32 (40%) were aged between 29-38 years and

followed by 28 (34%) aged between18-28 years while 13 (16%), 8(10%) were aged

between 39-48 years and >48 years respectively. The majority of the sample respondents

of the blood group 48 (59%) were O+ while 24 (30%), 9 (11%) were A+ and B+

respectively. The majority of the sample respondents (91%) were negative while (9%)

were positive.

5.2: Conclusion
Hepatitis B represents one of the world’s most common and serious infectious diseases.
World-wide, over 350 million people are currently estimated to be persistent carriers of
the hepatitis B virus (HBV) and each year approximately 1 million persons die from the
chronic sequel of HBV infection, i.e. liver cirrhosis and Hepatocarcinoma.

In conclusion, This study has provided information on the prevalence of HBV infection
among blood donors at Arafat hospital which was 9% and the disease is still major health
problem in male gender and age group 29-38 years.

It is recommended that further larger studies be performed to support the findings, since
the calculated sample size was based on a higher prevalence figure than the level found in
the Study. This will allow for ultimately coming up with a policy of routine screening for
HBV is introduced to all blood donors during the blood transfusion.

~ 43 ~
All blood donors must be treated that found to be HBs Ag positive to reduce and prevent
the spread of infection.

5.3: Recommendation
 The study recommends that the rapid test of hepatitis b virus have same errors so
the Eliza machine is well by detect of hepatitis b virus.
 The research recommends training the community members and community
leaders to understand importance of knowing the disease.
 The research recommends giving proper management to patients suffered from
hepatitis b virus when donates the blood to prevent further complication.
 The research recommends health facility staff should try to pass their knowledge
to people concerning of hepatitis b virus.
 The research recommends health facility staff should provide Public health
education campaigns encouraging people to wash their open wounds to contact
infected patient and do not donate the blood without checking or screening
infection disease.
 The research recommends the hepatitis b virus are transmitted for sexual contact
so must be avoid for more patterns or checking before marriage.
 The study recommends increasing the knowledge of lab technician in screening of
hepatitis b virus.

~ 44 ~
 References

1. Barker LF, Shulman NR, Murray R, Hirschman RJ, Ratner F, Diefenbach WC, Geller

HM (2002). "Transmission of serum hepatitis. 1970". Journal of the American Medical

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8. Hepatitis B Fact sheet N°204". who.int. July 2014. Retrieved4 November 2014.

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9. Hepatitis B FAQs for the Public — Transmission". U.S. Centers for Disease Control and

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Infection: an Update for Clinicians". Mayo Clinic Proceedings 82 (8): 967–

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19. Schilsky ML (2013). "Hepatitis B "360"".Transplantation Proceedings 45 (3): 982–

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~ 47 ~
APPENDIX I: Data collection tool

Date of review [___/___/_____]

Name of the reviewer ______________________________ Signature ____________

Time (Started/ Ended) [________/__________]

Supervisor Name _______________________________

Signature _______________ Date [___/____/_______]

Total number of records reviewed ________

Reviewed Donor card No. from ______________to_________________

Available Data: I. Complete______ II. Incomplete______ III. Excluded________

Action taken for the incomplete data:

________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________

(Please use additional blank paper if the space is not enough)

~ 48 ~
SECTION I: Laboratory test result
Donor code ______________________

VARIABLE CODING CATEGORIES REMARK

HBs Ag 1. Negative
2. Positive
Blood Group 1. O +
2. A+
3. B+

SECTION II: Socio-demographic characteristics

VARIABLES CODING CATEGORIES REMARK
Sex 1. Male
2. Female
Age 1.18-28
2. 29-38
3. 39-48
4. >48
Residence 1 Region
2 City
Occupation 1.professional
2. Business
3. unemployed
4. student
5. Other
Donation Type 1. Volunteer
2. family

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 APPENDIX II: Dummy table

Part I: Laboratory Test Result

Characteristics Category Number Percent

HBs Ag Negative 74 91%

Positive 7 9%

Blood group O+ 48 59%

A+ 24 30%
B+ 9 11%

Part II: Socio Demographic characteristics

Characteristics Category Number Percent
Male 80 99%
Sex
Female 1 1%
1.18-28 28 34%
2. 29-38 32 40%
3. 39-48 13 16%
Age group 4. >48 8 10%
Residence City 76 94%
Region 5 6%
1.professional 25 31%
2. business 24 30%
3. unemployed
Occupation 18 22%
4. student 10 12%
5. Other 4 5%
Donation Type Volunteer 27 33%
Replacement 54 67%

~ 50 ~
 APPENDIX III: Transmittal letter

MOHAMED ABDIRAHIM OMAR

Email: Alraxiim22@gmail.com

Tell: 00252615797985

SALAAM UNIVERSITY

TO: The ethical committee (Arafat hospital)

Dear sir/madam

Re-application to be allowed to undertake research in Arafat hospital

I am student in Salaam University undertaking Bachelor degree in laboratory and

pharmacy science.

I kindly ask for permission to conduct research in Yaqshid distract specially in Arafat

hospital Mogadishu –Somalia.

Title: the study of the importance of hepatitis B screening among blood

donors in Arafat hospital.

I have ensured that all ethical regulation have put in place.

I am looking forward to positive response.

Ethical yours faithfully

______________ _______________

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