Nigerian Journal of Paediatrics

3Risk factors for hepatitis B surface antigenaemia among secondary school students in Abakaliki South Eastern Nigeria

Niger J Paediatr 2017; 44 (1): 14 – 21

ORIGINAL

Omeje KN

Risk factors for hepatitis B surface

Ibekwe RC

Ojukwu JO

antigenaemia among secondary

Una AF

school students in Abakaliki,

Ibe BC

South Eastern Nigeria

DOI:http://dx.doi.org/10.4314/njp.v44i1.3

Accepted: 8th November 2016

Abstract : Background: Majority

Results: Nine students out of 266

of secondary school students are

tested positive giving a prevalence

Omeje KN (

)

adolescents; an age group with a

value of 3.38%.

Ojukwu JO

tendency to engage in health-

There was no significant associa-

Department of Paediatrics,

Federal Teaching Hospital Abakaliki,

compromising risky behaviours in

tion between gender (p = 0.31) or

Ebonyi State Nigeria.

order to deal with anxiety and

socioeconomic status (p = 0.81)

Email: ksnomeje@gmail.com

gain admission to peer groups.

and the seroprevalence of HBsAg

This exposes them to risk of

among the subjects. Similarly,

Ibekwe RC, Ibe BC

Hepatitis B virus infection which

none of the risk factors studied,

Department of Paediatrics,

is a major public health concern

including previous history of jaun-

University of Nigeria Teaching

globally and in Nigeria.

dice (p = 0.26), blood transfusion

Hospital Ituku-Ozalla,

Objectives: This study focuses on

(p = 0.24), past history of surgery

Enugu Nigeria.

some common risky behavioural

(p = 0.47), scarification marks (p =

practices that characterize the

0.17), sharing of sharp objects (p =

Una AF

lifestyle of contemporary adoles-

0.74), drug injections (p = 0.32),

Department of Community Medicine,

cent subculture; with a view to

unprotected sex (p = 0.64) and

Federal Teaching Hospital,

Abakaliki Nigeria

determining

their

effect

family history of hepatitis (p =

HBsAg seroprevalence.

0.79), was significantly associated

Method: Using multi-stage sam-

with HBV infection.

pling method, 266 students were

Conclusion: None of the risk fac-

selected from 5 secondary schools

tors assessed played significant

in Abakaliki. Each subject first

role in the transmission of HBV

filled a questionnaire regarding

among secondary school students

biodata and history of exposure to

in Abakaliki.

risk factors. Subsequently, they

were screened for HBsAg using

Key words: Hepatitis B surface

enzyme immunoassay-based chro-

antigen, Risk factors, Adolescents.

matographic test kit.

Introduction

tance to pay special attention to the health needs of this

population.

Earlier studies

8-17

Over the years there have been massive media and pub-

on the prevalence of HBsAg anti-

lic awareness campaigns on HIV/AIDS in Nigeria.

genaemia in different populations in Nigeria have shown

These efforts have resulted in an increased knowledge

varying prevalence rates. However, there is a dearth of

about HIV, positive behavioral change, and a gradual

studies on the prevalence of HBV infection among ap-

decline of the national prevalence of HIV/AIDS from

parently healthy adolescents. These adolescents are at

2,3

5.8% in 2001 to 4.1% in 2010.

The routes of trans-

high risk of contracting HBV infection because of their

mission are similar for both human immunodeficiency

tendency for risky lifestyles.

18-20

Moreover, majority in

virus (HIV) and HBV.

4,5

However in comparison to

this population were delivered before the protective HB

HIV, little attention is being paid to HBV infection by

vaccine became available in Nigeria in 2004.

As the

government and non-governmental agencies in Nigeria.

complications of HBV carriage often manifest decades

Unlike HIV infection, the trend in the prevalence of

after exposure,

4,22

the need for periodic monitoring of

HBV infection in the general population in Nigeria is

the trend of infection in the general population

not known.

(especially in the younger population) as a necessary

public health strategy for effective intervention cannot

Thirty two percent of Nigeria’s population is made up of

be overemphasized.

adolescents and young adults between 10-24 years. This

Ugwuja and Ugwu

implies that the country has a predominantly younger

in Abakaliki over 7 years ago

population. Therefore, it is logical and of great impor-

found that the prevalence of HBsAg antigenaemia

among adolescents was 4.1%. The risk factors for HBV

While every apparently healthy student in the selected

infection identified in that study were blood transfusion,

schools was qualified to participate in the study, stu-

history of jaundice and injection by a medical quack.

dents who refused assent and those whose parents re-

This present study in addition to the above also focused

fused consent to participate were excluded from the

on some common risky behavioural practices that char-

study.

acterize the lifestyle of contemporary adolescent subcul-

ture; with a view to determining their effect on HBsAg

Social class determination was done using the social

classification method described by Olusanya et al.

seroprevalence. These practices include tattooing, body

piercing, intravenous drug use, engaging in unprotected

Questionnaires were first administered to 30 students in

sex, and communal use of sharp objects like razor

a secondary school that was not selected for the study.

blades, nail cutters and hair clippers.

The interview guide covered the name, age, father’s

Therefore, this study was carried out to determine the

occupation, mother’s level of education and risk factors

current seroprevalence, the socio-demographic variables

for HBV infection like blood transfusion, family history

and the associated risk factors of hepatitis B surface

of hepatitis, injections, scarification marks and tattoos,

antigen (HBsAg) among secondary school students in

and sexual activity.

Abakaliki urban, South Eastern Nigeria.

The result of the pretest showed that some questions

were not easily understood by the subjects. They were

eventually rephrased in the final questionnaire that was

Methods

used. Questionnaire administration was done by the PI

(KNO) with the assistance of junior doctors in the De-

This study was cross-sectional and was carried out in

partment of Paediatrics of Federal Teaching Hospital

Abakaliki, the capital city of Ebonyi state in the south-

Abakaliki.

eastern region of Nigeria. It is an agricultural trade cen-

tre for rice, yam and cassava and has a population of

Data collection was done over a period of six weeks.

151,723 . Abakaliki has 12 officially registered secon-

Each of the five selected schools took four days-Monday

dary schools: seven public schools and five private

to Thursday. The first two days were for making ac-

schools; the students enrollment for 2010/2011 aca-

quaintance with the school staff mandated to assist the

demic year was 12, 634.

author and his team, selecting of subjects and giving the

selected subjects parental consent forms to be delivered

The minimum sample size was determined at 230 using

to their parents or guardians. The remaining two days

the formula for determining sample size in an infinite

were for questionnaire administration, pre-test counsel-

population with a prevalence of HBsAg of 18.4%

ing, testing and result-notification to those students

among secondary school students in a previous study in

whose parents gave their consent and who also agreed to

North central Nigeria.

Making allowance for an ex-

participate. Test results were individually handed di-

pected attrition rate of 15%, the desired sample of 270

rectly to all the participating students in the form of

was derived. However, 300 students were recruited.

sealed letters.

Multi-stage random sampling was used to select the sub-

jects for the study. There are 12 secondary schools in the

Two hundred and eighty two (94%) returned with paren-

city : seven public schools and five private schools. The

tal consent given. Each of these students were given a

schools were stratified into private co-educational, pub-

pretested questionnaire to answer on their own, after

lic co-educational, public male, public female schools.

explaining what it was all about. Information on the age,

Using a simple random sampling method of the lottery

sex, mother’s educational level and father’s occupation,

variety; 2 private co-educational schools, and 1 public

history of jaundice, blood transfusion, scarification, tat-

co-educational, 1 public male and 1 public female

toos, additional ear piercing, sharing of sharps (like nee-

school were selected. The 5 schools thus selected have a

dles, razor blade or hair-clippers), and sexual activity

combined population of 9,063.

were obtained. Sharing of ideas while filling the ques-

tionnaires was discouraged and research assistants were

Each of the five selected schools was stratified into 6

available to assist any respondent who sought clarifica-

classes, Junior Secondary (JS) 1 to Senior Secondary

tion(s) on any question. After filling the questionnaire,

(SS) 3. From each of these classes, one arm was ran-

HBsAg screening tests were carried out.

domly selected by balloting; that is one arm each from

JS1 to SS3, making it a total of 6 arms from each school.

HBV screening was performed using the rapid chroma-

Since the 5 schools are large and without much differ-

tographic immunoassay test strips for the qualitative

ence in the student populations, and in order to get a fair

detection of HBsAg (ACON Laboratories, Incorporated

representation of all the strata in the selected schools,

San Diego, California, USA), in accordance with the

the sample size of 300 was shared equally among the 5

manufacturer’s instructions.

schools. Therefore 60 students were recruited from each

school wherein 10 students were recruited from each of

The HBsAg test strip is a rapid chromatographic immu-

the 6 selected arms in each school using systematic ran-

noassay for the qualitative detection of Hepatitis B sur-

dom sampling method.

face antigen in serum or plasma, with a relative sensitiv-

ity, greater than 99.8% and specificity of 99.7%.

Those subjects with positive test to HBsAg were confi-

while 3 (2.10%) female students tested positive. Fisher’s

dentially counselled by the researcher on the nature of

exact test = 1.56, df = 1, p = 0.31 (Table 1).

HBV infection and the need for follow up in the Gastro-

enterology clinic at the Federal Teaching Hospital,

Table 1: Gender distribution of respondents and HBSAG test

Abakaliki.

results

The subjects with negative results were also counselled

Sex

Neg. (%)

Pos. (%)

Total (%)

on healthy lifestyles to avoid contracting the infection;

and the need to go for vaccination for those that had not

Male

117 (95.12)

6 (4.88)

123

been vaccinated against Hepatitis B virus.

Female

140 (97.90)

3 (2.10)

143

Ethical clearance for this study was approved by the

Total

257 (96.62)

9 (3.38)

266

Research and Ethics Committee of Federal Teaching

Hospital, Abakaliki. Approval was also obtained from

Fisher’s exact test = 1.56, df = 1, p = 0.31

Ebonyi State Ministry of Education while written con-

sent was obtained from the schools’ principals and par-

Age: The age group of 12-14 yr has the lowest preva-

ents or guardians of the subjects.

lence (1.27%), followed by 15-17 yr (4.03%) and 18-20

Statistical analysis of results was with the aid of Statisti-

yr (5.37%), in an increasing order. However, the differ-

cal Package for Social Science (SPSS) version 17.0.

ence is not statistically significant (Fisher’s exact test =

Results were presented in tables. Differences in propor-

3.36, df = 4, p = 0.53; Table 2).

tions were compared using the chi square statistic.

Where figures in the cells were less than five, Fisher’s

Table 2: Age distribution of respondents and HBSAG test

results

exact test was used instead of chi square test. p-values of

<0.05 were considered statistically significant.

Age (yr)

Negative (%)

Positive (%)

Total

9-11

5 (100.00)

0 (0.00)

12-14

78 (98.73)

1 (1.27)

15-17

119 (95.97)

5 (4.03)

124

Results

18-20

53 (94.64)

3 (5.36)

21-23

2 (100.00)

0 (0.00)

In this study, out of 300 students selected and given con-

Total

257 (96.62)

9 (3.38)

266

sent forms for their parents or guardians, 282 (94%)

Fischer’s exact test =3.36, df = 4, p = 0.53

returned the consent forms. Thirteen of these opted out

of the study for fear of finger-prick and consequently

Socioeconomic status : 6 (3.87%) subjects whose par-

were excluded from the study. Another 3 students were

ents are of upper socio-economic status tested positive

excluded because the information provided in the ques-

to HBsAg compared to 2 (3.64%) from middle socio-

tionnaire was considered too scanty for analysis. The

economic background and 1(1.79%) from lower socio-

remaining 266 students were used as the subjects for the

economic background. The difference is not statistically

study.

significant (Fisher’s exact test =0.48, df = 2, p=0.81;

Nine out of 266 respondents were seropositive for

Table 3).

HBsAg in this study. Thus the seroprevalence of hepati-

tis B surface antigen among secondary school students

Table 3: Effect of socioeconomic status (SES) on HBSAG

in this study is 3.38%.

seroprevalence

SES

Neg. (%)

Pos. (%)

Total

Demographic characteristics of the subjects

Upper

149 (96.13)

6 (3.87)

155

The ages of the students ranged from 9 to 23 years, with

Middle

53 (96.36)

2 (3.64)

a mean age of 15.56 ± 2.25 years (95% C.I:15.28-

Lower

55 (98.21)

1 (1.79)

15.84). One hundred and twenty three respondents

Total

257(96.62)

9 (3.38)

266

(46.24%) were males while 143 (53.76%) were females.

Male: female ratio was 1:1.2.

Fisher’s exact test =0.48, df = 2, p=0.81

Of the 266 students in this study, 155(58.27%) belong to

the upper socioeconomic class; 55 (20.68%) belong to

Association between HBsAg and risk factors

the middle socioeconomic class; and 56 (21.05%) were

from lower socioeconomic background.

The association between the various risk factors based

on clinical history and lifestyle of the subjects and hepa-

The prevalence of HBsAg among respondents

titis B surface antigen status were assessed.

Past history of jaundice: Forty three out of 266

Nine out of 266 students tested positive for HBsAg,

(16.17%) respondents had a previous history of jaun-

giving a prevalence of 3.38%.

dice. One hundred and seventy five (65.79%) had no

history of jaundice, while the remaining 48 (18.05%)

Association between HbsAg and sociodemographic vari-

respondents were uncertain. Two (4.65%) of the subjects

ables

with past history of jaundice tested positive to HBsAg.

Among those with no past history of jaundice, 3 (1.71%)

Gender: Six (4.88%) male students tested positive

subjects tested positive for HBsAg. Forty eight

(18.05%) did not know whether they had jaundice in the

Table 4(A): Association between risk factors and the sero-

past; four (8.33%) of them were seropositive for

prevalence of HBsAg

HBsAg. There is no statistically significant difference in

Risk Factors Neg (%)

Pos (%) Total Fishers test p-value

HBsAg seropositivity between students with past history

History of Jaundice

of jaundice and those without. Fisher’s exact test = 1.33,

Yes

41(95.35)

2(4.65)

1.33

0.26

df = 1, p = 0.26 {Table 4 (A)}.

172(98.29)

3(1.71)

175

Don’t know 44(91.66)

4(8.33)

Family history of hepatitis : There was a positive fam-

Family history of hepatitis

ily history of hepatitis among 11 (4.14%) of the respon-

dents, none of them (0.00%) tested positive to HBsAg.

Yes

11(100)

0(0.00)

0.24

0.79

Of the 180 (67.67%) subjects with no history of a family

180(97.82)

4(2.18)

184

member who had been diagnosed of hepatitis, four

Don’t know 66(92.96)

5(7.04)

(2.22%) tested positive for HBsAg. The remaining 71

Blood transfusion

(26.69%) subjects were uncertain of this and five

Yes

19(100)

0(0.00)

2.69

0.24

(7.04%) tested positive for HBsAg. The difference is not

204(97.14)

6(2.86)

210

significant {Fisher’s exact test = 0.24, df = 1, p = 0.79;

Don’t know 34(91.89)

3(8.11)

Table 4 (A)}.

Injection by a quack

Yes

83(97.65)

2 (2.35)

2.89

0.20

History of blood transfusion: Nineteen subjects (7.1%)

141(97.24)

4 (2.76)

145

had been transfused in the past and none (0.0%) of them

Don’t know 33(91.67) 3 (8.33)

tested positive for HBsAg. Of the 210 respondents who

Self injection

had never received blood transfusion, six (2.9%) tested

positive for HBsAg. The remaining 37 (13.9%) respon-

Yes

32(94.12)

2 (5.88)

0.75

0.32

dents did not know if they had been transfused in the

225(96.98)

7 (3.02)

232

past and 3 (8.1%) of them tested positive for HBsAg.

Sharing of sharps

{Fisher’s exact test = 2. 694, df = 2, p = 0.235; Table 4

Yes

140(97.20)

4(2.78)

144

0.35

0.74

(A)}.

117(95.90)

5(4.10)

122

Scarification/tribal marks

Injection from medical quacks: Eighty five (32.95%)

Yes

41(93.18)

3(6.82)

1.90

0.17

of the respondents reported that they had received injec-

216(97.30)

6(2.70)

222

tions from quacks, while 145 (54.51%) reported that

they had not. The remaining 36 (13.53%) did not know

Body Tattooing: Ten (3.76%) respondents had body

if they had been injected by a medical quack in the past.

tattoos; none of them (0.00%) tested positive to HBsAg.

Two (2.35%) of those with a history of being injected by

Out of the remaining 256 respondents who had no body

quacks tested positive for HBsAg. Among those that

tattoos, nine (3.52%) were seropositive for HBsAg. The

reported that they had not

been injected by a quack,

difference is not significant. Fisher’s exact test= 0.36, df

four (2.8%) tested positive while 3 (8.3%) of those who

= 1, p = 0.70; {Table 4 (B)}.

were not sure if they had been injected by a quack tested

positive for HBsAg. {Fisher’s exact test = 2.89, df = 2, p

Body piercing : Twenty one (7.89%) of the respondents

= 0.20; Table 4 (A)}.

had their bodies pierced for ornaments. Ten (47.62%) of

these were males while 11 (52.68%) were females. None

Self-injection: Thirty four (12.78%) respondents re-

(0.00%) of those with body piercing was seropositive

ported that they had indulged in self-injection; among

for HBsAg; and nine (3.67%) of the remaining 245 re-

them, two (5.9%) tested positive for HBsAg, compared

spondents without body piercing tested positive for

to 7 (3.0%) of the remaining 232 who had never per-

HBsAg. The difference is not significant: p > 0.05.

formed self- injection. Fisher’s exact test = 0.75, p =

{Table 4 (B)}.

0.32; {Table 4 (A)}.

History of surgery: twenty one (7.89%) students had

Sharing of sharp objects: One hundred and forty four

undergone surgical operations in the past. None (0.00%)

(54.14%) of the respondents share sharp objects (like

of them was seroopositive for HBsAg. Of the remaining

hair clippers, nail cutters, razor blades, etc.) with others.

245 subjects without a surgical history, nine (3.67%)

Four of them (2.78%) tested positive for HBsAg. Of the

were seropositive for HBsAg. This is shown in Table 4

122 respondents who did not share sharp objects, five

(B).

(4.1%) tested positive for HBsAg. {Fisher’s exact test=

0.35, df = 1, p = 0.74; Table 4 (A)}.

History of dental procedure: thirty five (13.16%) of

the respondents had undergone dental procedures in the

Scarification/ tribal marks: Forty four students

past. None (0.00%) tested positive for HBsAg. Two

(16.54%) have scarification/ tribal marks. Amongst

hundred and thirty one (86.84%) had never undergone

them, three (6.82%) tested positive for HBsAg while 6

any dental procedure and 9 (3.90%) were seropositive

(2.70%) of the remaining 222 students who had no scari-

for HBsAg. {Table 4 (B)}.

fication marks/ tribal marks tested positive.{Fisher’s

exact test = 1.90, df = 1, p = 0.17; Table 4 (A)}.

Sexual activity: Thirty eight (14.28%) respondents re-

ported that they were sexually active. Of these, 2

(5.26%) tested positive for HBsAg; while 7 (3.1%) of

years old compared to 3% of the subjects in this study

the remaining 228 tested positive for HBsAg. Fisher’s

that were above 20 years old. Therefore the higher

prevalence reported by Ndako et al is not surprising as

exact test = 0.479, df = 1, p = 0.621. Table 4 (B).

Of the 38 sexually active respondents, 23 (60.53%) had

the older subjects used in that study could have been

had unprotected sex; one (4.35%) was seropositive for

more exposed to risk factors for HBV transmission such

HBsAg. Fifteen (39.47%) respondents used some form

as injections from medical quacks and unprotected sex.

of protection; one (6.67%) tested positive to HBsAg.

Another possible explanation for the difference is that

Fisher’s exact test = 0.10, df = 1, p = 0.64{Table 4 (B)}.

while this study was carried out among subjects living in

Twenty (52.63%) of the sexually active students had one

an urban area, Ndako’s study was among subjects in a

sexual partner, of these, 2 (10.00%) tested positive for

rural area. Several studies in Nigeria and other African

HBsAg. Ten (26.32%) had two sexual partners while

countries have reported higher HBsAg seroprevalence in

rural areas compared to urban areas.

31-34

eight (21.05%) students had three or more sexual part-

This is because

ners. None of these students with more than one sexual

rural dwellers are more likely to patronize quacks and

partner tested positive to HbsAg. The difference is not

patent medicine vendors who may not observe safe in-

significant: p = 0.72 {Table 4 (B)}.

jection practices. Moreover, skin incisions for various

purposes including herbal treatment and tribal marks are

Table 4(b): Association between risk factors and the sero-

more likely to occur in rural than in urban settings.

prevalence of HBsAg

This study did not find a significant association between

Risk Factor

Neg (%) Pos (%) Total Fishers test p-value

age and HBV transmission; however, it was observed

that the prevalence of HBsAg increased with age. Other

Body tattooing

researchers

4,30

in Nigeria have found similar pattern.

Yes

10(100.00)

0(0.00)

0.36

0.70

This trend of increasing prevalence with age suggests

247(96.48)

9(3.52)

256

that the predominant mode of transmission may be hori-

Body piercing

zontal. In this study, the increasing HBsAg prevalence

with age may also be as a result of increased sexual ac-

Yes

21(100)

0 (0.00)

0.80

0.47

tivity in this age group; thus supporting the observation

236(96.33)

9 (3.67)

245

that sexual activity may be an important risk factor for

Surgery

the acquisition of HBV infection.

30, 36, 37

Yes

21 (100.00)

0 (0.00)

0.80

0.47

This study revealed a non-significant association be-

236 (96.33)

9 (3.67)

245

tween the gender of the students and HBV transmission.

Dental procedure

This contrasts with earlier studies that reported gender

Yes

35 (100.00)

0 (0.00)

1.41

0.38

difference. The non-significant association between gen-

222 (96.1)

9 (3.90)

231

der and HBV transmission in this study suggests that

Sexual activity

both sexes were equally exposed to the same environ-

Yes

36 (94.7)

2 (5.26)

0.48

0.62

mental risk factors HBV infection. However, this study

221 (96.93)

7 (3.07)

228

corroborates with studies that found non-significant gen-

Unprotected sex

der association.

8, 15,38

Yes

22 (95.7)

1 (4.35)

0.01

0.64

14 (93.3)

1(6.67)

In this study, parental socioeconomic status is not sig-

Sexual partners

nificantly associated with HBs antigenaemia. This is in

1.20

0.72

agreement with earlier studies.

One

18 (90.00)

2 (10.00)

However, this finding

Two

10 (100.00)

0 (0.00)

is in contrast with other studies which reported a signifi-

Three or more

8 (100.00)

0 (0.00)

cant association between lower socioeconomic status

and HBV transmission.

The lack of association be-

tween socioeconomic status and HBsAg seropositivity

in this study is not very clear. The higher HBsAg sero-

Discussion

prevalence found among the respondents of upper socio-

economic background, though not statistically signifi-

In this study, 3.38% of secondary school students in

cant, could be a reflection of the fact that the adoles-

Abakaliki tested positive to HBsAg. This value falls

cents’ behaviour is more influenced by peer pressure

than societal norms and parental influence.

39,40

within the HBsAg prevalence range of 2-7% which is

the definition of intermediate endemicity for HBV infec-

Past history of jaundice was not found to be a significant

tion by the Centre for Disease Control and Prevention

risk factor in this study. This finding was corroborated

by Agbede et al . However, this finding contrasts with

(CDC).

HBsAg prevalence of 3.38% found in this study is also

that of Ashraf et al

who found a significant associa-

considerably lower than the 18.4% reported by Ndako et

tion of past history of jaundice and HBsAg seropreva-

al among secondary school students in a rural commu-

lence. The precise cause of jaundice was not determined

nity in Kaduna State. The higher value reported by

in this study and could have been from aetiologies other

Ndako et al

may be attributable to the difference in

than viral hepatitis. This may explain the finding of his-

sample populations. The subjects used in that study were

tory of jaundice as a non-significant risk factor for

relatively much older than the subjects in this study as

HBsAg seroprevalence in this study

over 51% of the subjects in that study were above 20

This study did not find any significant association be-

tween family history of hepatitis or liver disease and

tice of giving skin incisions for some ailments and for

HbsAg seropositivity. This is similar to the findings of

tribal marks.

Chang et al. However, this finding contrasts with that

of Zhang et al

who reported a significant association

This study also shows that the HBsAg test result is nega-

between family history of HBV and HBsAg seropositiv-

tive among the respondents who had had body tattoo,

ity in an adult population in Northeast China. This find-

body piercing, surgery or dental procedure. The reason

ing could be attributed to poor history recall by the re-

for this finding may be because of the small percentage

spondents and their ignorance about the clinical mani-

of respondents who have been exposed to those risk

festations of hepatitis and liver disease.

factors: 3.4%, 7.9%, 8.3%, and 12.5% respectively. In

this part of the country, it is not culturally and socially

History of blood transfusion did not contribute signifi-

acceptable for people to wear body tattoos or have their

cantly to HBV transmission in this study. This finding is

bodies pierced for ornaments. Therefore it is not surpris-

similar to what was documented in previous studies

ing that these practices are not common among the sub-

across Nigeria;

44,45

but contrasts with some other studi-

jects in this study.

8, 23

, which demonstrated

higher prevalence among

In this study, there is higher prevalence of HBsAg

subjects with previous history of blood transfusion. This

among sexually active students (5.0%) than among those

was attributed to exposure to unscreened blood or blood

not sexually active (3.1%), though this difference is not

products. The increased awareness of the risk of transfu-

statistically significant. This trend has been previously

reported. This underscores the important role of unpro-

sion transmitted infections with consequent routine

screening of blood prior to transfusion may also have

tected sexual intercourse as a mode of transmission of

accounted for the zero prevalence of HBsAg among the

HBV.

subjects with history of blood transfusion in this study.

Among the sexually active students, unprotected sexual

Self-injection and injection from medical quacks were

practice and multiple sexual partners did not appear to

not significantly associated with HBV transmission in

increase the risk of Hepatitis B infection. The reason for

this study. This study was conducted in a naïve commu-

this finding is not clear as it has been severally reported

nity not exposed to intravenous drug abuse. A higher

that condom use protects against sexually transmitted

diseases including HBV.

47,48

percentage of the respondents in this study were from

However the respondents’

upper socioeconomic background not visiting quacks for

knowledge of proper condom use was not sought for in

injections.

this study.

In this study, sharing of sharp objects such as hair clip-

pers, razor blades and nail cutters were not found to be

associated with HBV infection. But it was observed that

Conclusion

53% of the respondents agreed to have shared such

sharp objects with family members or friends. This ob-

In conclusion, the prevalence of HBsAg carriage among

servation is important considering the role of contami-

secondary school students in Abakaliki is relatively low

nated sharp objects in the transmission of HBV as ear-

at 3.38%. Risk factors like socio-economic status, past

lier reported.

Traditional scarification/tribal marks

history of jaundice, blood transfusion, tattoos, past his-

have been previously implicated in the transmission of

tory of surgery or dental procedure and sexual activity

HBV.

10,45

The lack of strong association between tradi-

played insignificant roles in the transmission of HBV

tional scarification/tribal marks and HBsAg seropreva-

among secondary school students in Abakaliki.

lence in this study in corroboration with earlier stud-

ies,

4,23

is possibly due to high proportion of the respon-

dents who belong to upper socioeconomic background;

Conflict of Interest: None

with fewer tendencies to subscribe to the cultural prac-

Funding: None

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