|ORIGINAL RESEARCH REPORT
|Year : 2021 | Volume
| Issue : 4 | Page : 191-197
Knowledge, attitude, and risk factors of hepatitis B among waste scavengers in Lagos, Nigeria
Aishat Temitope Oladipo1, Kofoworola Odeyemi2
1 Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine University of Lagos, Lagos, Nigeria
2 Department of Community Health and Primary Care, College of Medicine University of Lagos, Lagos, Nigeria
|Date of Submission||30-Jun-2020|
|Date of Acceptance||25-Dec-2020|
|Date of Web Publication||09-Dec-2021|
Miss. Aishat Temitope Oladipo
Department of Community Health and Primary Care, Faculty of Clinical Sciences, College of Medicine University of Lagos, Lagos
Source of Support: None, Conflict of Interest: None
Background: Hepatitis B is a major global health problem with a higher prevalence among waste workers compared to the general population. Inefficient waste segregation techniques and the unique property of hepatitis B whereby it can survive outside the body for about a week puts waste scavengers at a significant risk of this disease. The study aims to assess the knowledge and attitude toward hepatitis B and identify the risk factors of hepatitis B among waste scavengers in Lagos, Nigeria. Methods: In a descriptive cross-sectional study, information was obtained from waste scavengers using interviewer administered questionnaires. Respondents were selected consecutively. Data were analyzed using Epi Info™ version 184.108.40.206 and MS-Excel. The associations between variables were considered statistically significant if the two-tailed probability is <5%. Results: Out of 417 respondents, 51 (12.0%) were aware of hepatitis B. Among those aware, 95.0% had poor knowledge of hepatitis B. Majority (87.5%) had a negative attitude toward hepatitis B. The prevalence of needle stick injuries and exposure to blood was 46.5% and 25.7%, respectively. There is also a statistically significant association between the age and level of education of respondents and their attitude toward hepatitis B. Conclusions: Overall knowledge and attitude toward hepatitis B among respondents was poor. Exposure of the respondents at work to risk factors of hepatitis B was high as majority reported presence of used syringes and bloody materials in the waste. Health education programs focused on enlightening waste scavengers about hepatitis B should be organized.
Keywords: Attitude, hepatitis B, knowledge, risk-factors, waste scavenger
|How to cite this article:|
Oladipo AT, Odeyemi K. Knowledge, attitude, and risk factors of hepatitis B among waste scavengers in Lagos, Nigeria. J Clin Sci 2021;18:191-7
| Introduction|| |
“Hepatitis B is a global public health threat and the world's most common serious liver infection.” According to the World Health Organization, about 257 million people are living with hepatitis B virus (HBV) infection with Africa accounting for 65% of the infected. In Sub-Saharan Africa, HBV infection is endemic with over 8% of the population being chronic HBV carriers. Nigeria is a country with one of the highest incidence rates of Hepatitis B.
Hepatitis B is an infection of the liver caused by HBV and transmitted when blood and other body fluids of an infected person enters the body of an uninfected person. It is the primary cause of liver cancer which is one of the leading causes of cancer deaths in the world.
Waste scavengers are individuals who pick out recyclables or valuables from mixed waste wherever it may be temporarily accessible or disposed of, for personal gain. Although most of their activities are illegal, in the absence of a formal waste recycling system their informal recycling activities have a major contribution in conservation of the environment.
Pathogenic organisms are abundant in mixed waste, thus waste scavengers are at risk of infection coupled with occupational injuries aiding the entrance of these microorganisms. HBV has the unique ability to survive outside the body for a week. As a consequence, waste scavengers are at a higher risk of being infected when in contact with sharp objects that were disposed of inappropriately. Hepatitis B is an important occupational hazard, it causes chronic infection which puts people at a very high risk of death from liver cirrhosis and cancer. With the high prevalence of HBV infection among waste collectors and scavengers, they could become potential pathways of transmission to the general population.
This study is directed toward waste scavengers as numerous studies have been focused on waste collectors.,, Waste scavengers are integral to the waste management system in Nigeria. With the high prevalence of hepatitis B among them, this study is of utmost importance to provide information which will be useful in planning intervention strategies among this group of people.
| Methods|| |
Lagos State is located at the South-western region of Nigeria. It is the commercial capital of Nigeria with highly diversified economic activities and a large amount of refuse generated. In Lagos state, there are 3 major landfills and 2 satellite sites serving as the legal waste disposal sites. The major landfill sites are Olushosun, Abule-Egba and Soluos sites. The satellite sites are Temu and Ewu-Elepe dumpsites.
A cross-sectional descriptive study using a quantitative data collection tool was used to assess the knowledge, attitude, and risk factors of hepatitis B among waste scavengers in Lagos State, Nigeria.
Waste scavengers in Lagos State, Nigeria.
- Waste scavengers working at the major active landfills in Lagos State.
- Waste scavengers who had not done the job for up to 6 months.
Sample size determination
The minimum sample size suitable for this cross-sectional descriptive study was calculated using the Cochran's formula: n = Z2pq/d2 with a standard normal deviation at 95% confidence interval, prevalence rate of 55.6% from a study on the proportion of waste handlers with knowledge of viral hepatitis. Sample size for this study is 417.
There are three major dumpsites (Olusosun, Soluos II and Soluos III) in Lagos State. All the active major dumpsites (Soluos II and Soluos III) were used in this study. Respondents were selected consecutively at dumpsites till sample size was achieved.
Data were collected using structured, pretested, interviewer-administered questionnaire with closed-ended questions. The questionnaire was adapted from previous research studies.,,, The interviews took place at the dumpsites. The questionnaire elicited information on the respondents' sociodemographic characteristics, knowledge of hepatitis, their attitude toward Hepatitis B and exposure to risk factors of Hepatitis B.
Data were analyzed using Epi Info™ version 220.127.116.11 and MS Excel Microsoft Excel (Microsoft Corporation, Washington, USA). Chi-square was also used to test for associations between categorical and continuous variables respectively. The data analyzed was presented as charts and frequency tables. The association between variables was considered statistically significant if two-tailed probability is <5% (P < 0.05). Knowledge of Hepatitis B was scored as follows: 1 mark for every correct answer and 0 for any incorrect answer making a total of 22 points. The cut off level for the respondent's knowledge was 11 points. Scores <11 were graded as poor knowledge while scores ≥11 were graded as good knowledge. The attitude of the respondents toward Hepatitis B was assessed by giving 1 point to positive attitude and 0 point to negative attitude with a total of 8 points. The scale was used to classify attitude as positive with points >4 and attitude as negative with points ≤4.
Ethical approval was obtained from the Health Research and Ethics Committee (HREC) of the Lagos University Teaching Hospital with assigned number ADM/DCST/HREC/APP/275.
| Results|| |
Majority (37.4%) of the respondents were within the age range of 25–34 years. The mean age was 30.2 ± 10.9 years. A high proportion (85.4%) of the respondents was male. More than half of the respondents (56.6%) were married and less than half (42.5%) of the respondents had attained a secondary level of education while 12.9% of the respondents had a postsecondary education. Among the respondents, 42.5% of them earned a monthly income within the range of 15,000–50,000 naira monthly.
A low proportion (12.2%) of the respondents had heard of hepatitis B. The most common source of information reported was media which was reported by 54.9% of the respondents.
Out of the respondents aware of hepatitis B, over 95.0% of them had a poor knowledge of hepatitis B; the level of knowledge of etiology and symptoms of hepatitis B among the study participants was low. Knowledge of the modes of transmission, treatment, complications and existence of vaccination against hepatitis B was also low; <35.0% of the study participants had knowledge of the common symptoms of hepatitis B and about 52.0% did not know about immunization against hepatitis B [Table 1].
|Table 1: Respondents' knowledge on causes, symptoms, transmission, treatment and prevention of hepatitis B|
Click here to view
Majority (87.5%) of the respondents have a negative attitude toward hepatitis B as 11.3% of respondents worry about HBV infection when they get injured at work and 11.5% of the respondents agreed that their job puts them at risk of hepatitis B. A low proportion (28.5%) of the respondents disagreed that persons with hepatitis B should always be isolated from other people. A very low proportion (4.6%) of the respondents had been screened for hepatitis B [Table 2].
A history of injuries from sharp objects at work was seen in 46.5% of the study participants while majority (71.9%) of the study participants reported they find used syringes in the waste; 63.8% of the respondents reported they find bloody materials in the waste but 25.7% of the respondents have had a history of blood contact while working. In contrast to the level of knowledge, a higher percentage of the study participants (67.2%) made use of thick gloves while working although 19.3% of the respondents used torn gloves. More than half (53.0%) of the study participants also used thick soled boots while working. Majority (53.0%) of the respondents made use face mask while working [Table 3].
|Table 3: Risk factors of hepatitis B and use of personal protective equipment among respondents|
Click here to view
The association between the age (P = 0.0216) and level of education (P ≤ 0.0001) of the study participants and their knowledge of hepatitis B was statistically significant [Table 4]. The knowledge of hepatitis B was seen to be better among those who had higher monthly income.
|Table 4: Association between respondents' sociodemographic, socioeconomic characteristics and knowledge level with their attitude towards hepatitis B|
Click here to view
A statistically significant association was seen between the age (P = 0.0142) and level of education (0.0004) of the study participants and their attitude toward hepatitis B [Table 5]. There was a statistically significant association between the study participants' knowledge (P ≤ 0.0001) of hepatitis B and their attitude toward hepatitis B.
|Table 5: Association between respondents' sociodemographic and socioeconomic characteristics with their knowledge of hepatitis B|
Click here to view
| Discussion|| |
In this study, the mean age among the respondents was 30.2 ± 10.9 years and majority (85.4%) of the respondents were male. The predominance of the younger age group and male gender is comparable to findings from a study among garbage scavengers carried out in Karachi.
Among the respondents in this study, 12.2% were aware of hepatitis B less than in another a study carried out among residents of Lagos state where about half (50.9%) of the respondents were aware of hepatitis B. This difference may be attributed to the type of population studied in the latter. The overall knowledge of hepatitis B among the respondents was poor, with only 4.1% of the respondents having good knowledge of hepatitis B. This is similar to a study carried out in Pakistan which reported that 75.4% of the respondents had poor knowledge of hepatitis B. However, another study carried out in Lagos among healthcare workers reported that 56.7% of the respondents demonstrated a good knowledge of hepatitis B. The reason for the higher figure in this study could be attributed to the occupation (doctors and nurses) of the respondents and the presence of frequent educational programs in the hospital environment. The most common modes of transmission mentioned by respondents in this study were sexual contact, cuts from contaminated needles/syringes/razors and blood transfusion. A study carried out in Egypt reported blood transfusion, reusing needles and dental procedures as the most common modes of transmission mentioned by the respondents. Many of the respondents (47.1%) in this study were aware that vaccination is available for hepatitis B which is similar to another study which showed that 42.7% of the respondents were aware of the presence of vaccines for hepatitis B. There were statistically significant associations between the age, level of education, and the estimated monthly income of the respondents and their knowledge of hepatitis B. This implies that knowledge of hepatitis B was better among the younger age group, those with higher level of education and higher monthly income. This finding on higher level of education could be attributed to the exposure of the educated waste scavengers to more sources of information on hepatitis B than the uneducated waste scavengers hereby giving them good knowledge. The finding on the higher monthly income could be attributed to the respondents' quality of life with these respondents having access to good health care services and health facilities and this would serve as their source of information as compared to respondents with low monthly income. Similarly, another study in Kingdom of Saudi Arabia showed that respondents with a college degree, young age and good income had better knowledge of hepatitis B.
Their overall attitude toward hepatitis B was negative with 87.5% of the respondents having a negative attitude toward hepatitis B and 12.5% of the respondents having a positive attitude toward hepatitis B. This corroborates a study that was carried out in Pakistan which reported that all the respondents had a negative attitude regarding hepatitis B. In contrast, a study done in Saudi Arabia showed that 40% of the respondents had poor attitude toward hepatitis B. This difference could be attributed to the higher level of awareness of hepatitis B among the respondents with 78.1% of the respondents having good knowledge regarding hepatitis B. A low proportion (28.5%) of the respondents in this study disagreed with the statement “Persons with hepatitis B should always be isolated from other people.” In line with a study done in Saudi Arabia which reported that 33.8% of the respondents disagreed with the statement. In contrast is a study done in India where 96.8% of the respondents disagreed with the statement. This difference could be attributed to the very high level of good knowledge regarding the spread of hepatitis B among the respondents. There was a statistically significant association between the age, level of education and the estimated monthly income of the respondents and their attitude toward hepatitis B. The respondents' attitude was seen to be better among the older age group, those with higher level of education and higher monthly income. In addition, there was a statistically significant association between the level of knowledge of the respondents on hepatitis B and their attitude toward hepatitis B. The respondents' attitude was seen to be better among those with good knowledge of hepatitis B. This is similar to another study in Egypt which showed that good knowledge of hepatitis B was proportionately related to the respondents' attitude and practices of hepatitis B.
In this study, 46.5% of the respondents had a history of injury from sharp objects while working, 71.9% of the respondents reported the presence of used syringes in the waste, 63.8% of the respondents also reported the presence of bloody materials in the waste and 25.7% of the respondents have had a history of blood contact while working. These findings are similar to the findings from a study carried out in Pakistan among garbage scavengers which showed that 54% of the respondents have been pricked more than once while working. This is as a result of inappropriate disposal of hospital waste whereby potentially hazardous waste from hospitals are dumped together with domestic waste., These factors (needle stick injuries, bare-handed collection of garbage) are contributory to the high prevalence of hepatitis B among waste scavengers., Majority (67.2%) of the respondents in this study reported use of thick gloves while working although 19.3% of them made use of torn gloves, 53% of the respondents made use of thick soled boots and also 53% of the respondents made use of face mask while working. This is higher than reported in a study carried out in Karachi, Pakistan, which showed that 16% of the respondents wore gloves while working and 30% of the respondents had no footwear. This contrast could be attributed to the difference in sociodemographic characteristics: a very high level (63%) of respondents in the study were illiterates compared to low proportion (25.7%) of the respondents in this study. Out of 417 respondents, only 6 (1.4%) have been vaccinated against HBV. This is similar to a study carried out in Ethiopia which showed that 6.8% of the respondents were immunized against HBV. This could be attributed to the absence of HBV vaccination programs for at risk populations in Nigeria and Ethiopia., In contrast, a study carried out in Ekiti state, Nigeria, among health-care workers showed that a higher percentage (16%) of the respondents had been fully vaccinated against HBV.
| Conclusions|| |
Most of the respondents in this study were not aware of the disease, hepatitis B. Out of those aware, there was an overall poor knowledge and negative attitude toward hepatitis B. The exposure of respondents to risk factors of hepatitis B was high while the use of personal protective equipment was minimal.
Therefore, health education programs focused on enlightening waste scavengers about hepatitis B should be organized. This would help improve the knowledge of hepatitis B among waste scavengers while invariably improving their attitude toward it. Companies managing dumpsites can also organize programs where screening for hepatitis B and vaccines against HBV are administered to the waste scavengers.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Howell J, Ladep NG, Lemoine M, Thursz MR, Taylor-robinson SD. Hepatitis B in Sub-Saharan Africa. South Sudan Med J 2014;7:59-61.
Ndams IS, Joshua IA, Luka SA, Sadiq HO. Epidemiology of Hepatitis B infection among pregnant women in Minna. Sci World J 2008;3.
Nzeadibe TC, Iwuoha HC. Informal waste recycling in Lagos, Nigeria. Commun Waste Resour Manag 2008;9:24-31.
Mol MP, Gonçalves JP, Silva EA, Scarponi CF, Greco DB, Cairncross S, et al
. Seroprevalence of hepatitis B and C among domestic and healthcare waste handlers in Belo Horizonte, Brazil. Waste Manag Res 2016;34:875-83.
Tsovili E, Rachiotis G, Symvoulakis EK, Thanasias E, Giannisopoulou O, Papagiannis D, et al
. Municipal waste collectors and hepatitis B and C virus infection: A cross-sectional study. Infez Med 2014;22:271-6.
Sawyerr HO, Yusuf RO, Adeolu AT. Risk factors and rates of hepatitis B virus infection among municipal waste management workers and scavengers in Ilorin, Kwara State, Nigeria. J Health Pollut 2016;6:1-6.
Rachiotis G, Papagiannis D, Markas D, Thanasias E, Dounias G, Hadjichristodoulou C. Hepatitis B virus infection and waste collection: Prevalence, risk factors, and infection pathway. Am J Ind Med 2012;55:650-5.
Ansari-Moghaddam A, Ansari H, Khosravi S, Sanei-Moghaddam E, Mohammadi M, Alavian SM, et al
. The prevalence of hepatitis B virus among municipal solid waste workers: Necessity for immunization of at-risk groups. Hepat Mon 2016;16:e30887.
Shiferaw Y, Abebe T, Mihret A. Hepatitis B virus infection among medical waste handlers in Addis Ababa, Ethiopia. BMC Res Notes 2011;4:479.
ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Aljadhey H. A cross sectional assessment of knowledge, attitude and practice towards Hepatitis B among healthy population of Quetta, Pakistan. BMC Public Health 2012;12:692.
Okonkwo UC, Ngim OE, Osim H, Inyama MA, Esu MK, Ndoma-Egba R, et al
. Knowledge of hepatitis B virus infection among traders. Niger J Clin Pract 2017;20:415-20.
] [Full text]
The Association of Public Health Physicians of Nigeria (APHPN) Lagos Chapter. Hepatitis B & C Sero-prevalence Survey among Residents of Lagos State; 2014. [Last accessed 2018 May 20].
Rauf MU, Saleem MD, Anwer MO, Ahmed G, Aziz S, Memon MA. HIV, hepatitis B and hepatitis C in garbage scavengers of Karachi. J Pak Med Assoc 2013;63:798-802.
Abiola AH, Agunbiade AB, Badmos KB, Lesi AO, Lawal AO, Alli QO. Prevalence of HBsAg, knowledge, and vaccination practice against viral hepatitis B infection among doctors and nurses in a secondary health care facility in Lagos state, South-western Nigeria. Pan Afr Med J 2016;23:160.
Shalaby S, Kabbash IA, El Saleet G, Mansour N, Omar A, El Nawawy A. Hepatitis B and C viral infection: Prevalence, knowledge, attitude and practice among barbers and clients in Gharbia governorate, Egypt. East Mediterr Health J 2010;16:10-7.
Wedhaya MA, Abyadh DA, Alhabi HA, Alrehaily SS, Kurban MA, Alzahrani GS, et al
. Assessment of hnowledge, attitude and practice towards hepatitis B among healthy population in Saudi Arabia. Egypt J Hosp Med 2017;69:1973-7.
Hussain SF, Ahmad SR, Muslehuddin OM, Muslehuddin HM. Knowledge, attitude and practice regarding hepatitis B among medical students. Int J Community Med Public Heal 2016;3:2977-81.
Corrao CR, Del Cimmuto A, Marzuillo C, Paparo E, La Torre G. Association between waste management and HBV among solid municipal waste workers: A systematic review and meta-analysis of observational studies. Sci World J 2013;2013.
Mekonnen A, Desta K, Damtew E. Prevalence of HBV, HCV and associated risk factors among cleaners at selected public health centers in Addis Ababa, Ethiopia. Int J Basic Appl Virol 2015;4:35-40.
Biset Ayalew M, Adugna Horsa B. Hepatitis B vaccination status among health care workers in a Tertiary Hospital in Ethiopia. Hepat Res Treat 2017;2017.
Alese OO, Alese MO, Ohunakin A, Oluyide PO. Seroprevalence of Hepatitis B surface antigen and occupational risk factors among health care workers in Ekiti State, Nigeria. J Clin Diagn Res 2016;10:LC16-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]