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 Table of Contents  
ORIGINAL RESEARCH REPORT
Year : 2021  |  Volume : 18  |  Issue : 1  |  Page : 32-41

Hepatitis B virus infection-related knowledge, attitude, and preventive practices among market traders in Lagos, Nigeria - A cross sectional study


1 Department of Community Health and Primary Care, College of Medicine, University of Lagos; Department of Family Medicine, Lagos University Teaching Hospital, Lagos, Nigeria
2 Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Community Health and Primary Care, Lagos University Teaching Hospital, Lagos, Nigeria

Date of Submission09-May-2020
Date of Acceptance24-Jun-2020
Date of Web Publication2-Feb-2021

Correspondence Address:
Dr. Adebola A Adejimi
Department of Community Health and Primary Care, College of Medicine, University of Lagos, PMB 12003, Surulere, Lagos
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jcls.jcls_38_20

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  Abstract 


Background: Hepatitis B virus (HBV) is highly infectious and a major cause of morbidity and mortality. Prevention of HBV infection can be achieved through safe practices and immunization. The objectives of this study were to assess knowledge, attitude, and preventive practices for HBV infection among market traders in Lagos State, Nigeria. Methods: A descriptive, cross-sectional study involving 417 market traders in Somolu Local Government Area of Lagos State selected by multistage sampling technique was conducted. A pretested interviewer-administered questionnaire was used for data collection. Data analysis was done using Statistical Package for the Social Sciences version 20. Chi-square statistics was used to test the association between variables, and the level of significance was set at 5%. Results: The mean age of the respondents was 39.2 ± 12.5 years. About 64% were female, 69.8% were married, and only 15.6% had tertiary education. Majority (97.6%) were aware of HBV infection. Overall, about 80% of the respondents had good knowledge of HBV infection, while 51.8% had good attitude toward HBV prevention, but only 18.5% of them had good preventive practices toward HBV infection. Only 5% of the respondents had completed the three doses of hepatitis B vaccine. Knowledge and preventive practices of the respondents about HBV infection were significantly associated with the level of education and marital status, while attitude to the preventive practices was associated with gender. Respondents' knowledge and attitude were significantly associated with the preventive practices for HBV infection. Conclusion: There is a need to target the traders in the markets and create appropriate awareness, screening, and vaccination programs for the prevention of HBV infection.

Keywords: Attitude, hepatitis B virus, knowledge, market traders, preventive practices


How to cite this article:
Adejimi AA, Bakare AA, Ogunyemi AO, Adewole AM. Hepatitis B virus infection-related knowledge, attitude, and preventive practices among market traders in Lagos, Nigeria - A cross sectional study. J Clin Sci 2021;18:32-41

How to cite this URL:
Adejimi AA, Bakare AA, Ogunyemi AO, Adewole AM. Hepatitis B virus infection-related knowledge, attitude, and preventive practices among market traders in Lagos, Nigeria - A cross sectional study. J Clin Sci [serial online] 2021 [cited 2021 Feb 27];18:32-41. Available from: https://www.jcsjournal.org/text.asp?2021/18/1/32/308597




  Introduction Top


Hepatitis B virus (HBV) infection is a public health problem globally, especially in developing countries including Nigeria.[1],[2] It is a DNA virus transmitted through exposure to infected blood and body fluids during sexual and nonsexual contacts.[3],[4] There can also be vertical transmission of HBV infection from mother to child during the perinatal period.[5] HBV is a highly infectious virus implicated in about 80% of hepatocellular carcinoma cases, and it is also a major cause of liver cirrhosis.[6] Globally, about two billion people are infected with HBV.[7] About 350 million have chronic infection and 600,000 die of HBV-related liver diseases each year.[8],[9] HBV is the second most carcinogenic agent in Sub-Sahara Africa after tobacco.[10] HBV-associated liver cancer is the most frequent cause of death among young men, and it is also rated as the second most prevalent cancer worldwide.[11] Liver cancer is one of the most common causes of cancer death in Nigeria, and HBV infection is the major cause of liver-related morbidity and mortality globally and in Nigeria.[12]

The prevalence of HBV infection varies in different regions of the world and in different countries as a result of disparities in the social and cultural factors, relating to different modes of transmission of this virus.[13] It ranges between 2% and 7% in developed countries of America and Europe and between 5% and 20% in Asia, Africa, and the Middle East.[8],[13] Studies from Nigeria on the prevalence of hepatitis B among subgroups showed the prevalence of 12.2% among the general population, 16% among adults, 14% among blood donors, 14.1% among pregnant women attending antenatal clinic, 13.7% among traders, 13% among healthcare workers, and 11.5% among children.[14],[15],[16],[17],[18] About 12% of the Nigeria population are HBV chronic carriers.[15],[16]

While safe practices are important, the prevention of HBV infection is effective through immunization.[19] Immunization against HBV infection was introduced about two decades ago in Nigeria, and it was included in the routine immunization schedule for children.[20] However, a study done in the southwestern part of Nigeria among doctors showed that vaccination practice was poor; only about 45% of these doctors received three doses of HBV vaccine.[21] Thus, the low immunization rate among the general population and workers who are at risk of this infection is one of the risk factors, contributing to the high prevalence of this infection in Nigeria.[22] Other risk factors include low level of awareness about this infection and the preventive practices, unsafe sexual practices (including heterosexual and homosexual), unsafe blood transfusion, sharing of sharp instruments, intravenous drug use, poor sterilization of surgical instruments, vertical transmission from mother to child, some traditional practices such as tattoo, occupational exposures, and clustering of carriers in families and institution.[2],[21],[23],[24]

Studies have shown a positive linear correlation between knowledge of a particular illness and health-seeking behavior.[25],[26] A previous study in Cross Rivers State, Nigeria, showed a low level of awareness of HBV infection in the general population.[27] It is important to assess the knowledge of HBV infection and its preventive practices among the community members in Nigeria to implement the effective preventive measures against the infection. Many previous studies on the knowledge of HBV infection were conducted among healthcare workers such as doctors, nurses, and medical students.[21],[28],[29],[30],[31] A study conducted among traders in Calabar, Nigeria, indicated their poor knowledge of HBV infection.[32]

The World Health Organization global health sector strategy on viral hepatitis, created in May 2016, aims to achieve a 90% reduction in new cases of chronic hepatitis B and C and 60% reduction in mortality due to hepatitis B and C by 2030.[33] For Nigeria to meet up with the global target of elimination of viral hepatitis by 2030, there is a need for effective and targeted interventional programs. Market traders represent a subset of the general population in Lagos which is the economic hub of Nigeria. This study assessed the level of knowledge, attitude, and preventive practices of HBV infection among market traders in Somolu Local Government Area (LGA) of Lagos State, Nigeria. The findings will be useful for the development of interventions and policy formulation.


  Materials and Methods Top


Study area

Lagos State, located in the southwestern part of Nigeria, is the most populous city in Nigeria and the second fastest growing city in Africa. It is one of the 36 states and one of the most economically important states in Nigeria. It has a projected population of about 20 million people. There are 20 LGAs in Lagos State, and each is further divided into political wards. This study was conducted in Somolu LGA in Lagos State which is a densely populated urban area. Somolu LGA has both commercial and residential areas with people from different tribes but predominantly from Yoruba tribe. There are six wards and six major markets in Somolu LGA.

The six markets in Somolu LGA are Olaleye, Ajeigbe, Abraham Adesanya, Alade, Alarape, and Oyediran markets. On an average, there are about 420 registered traders with lockup shops in each market. There are blocks of shops with about 30 shops per block in each market. The markets are known for different goods at both wholesale and retail levels. The major goods and items sold in these markets are foodstuffs and household commodities, fabrics, clothes, shoes, home appliances, and cosmetics. Factors that can promote HBV transmission in these markets include poor awareness about the infection and the modes of transmission as well as poor preventive practices including lack of vaccination and missing of opportunity for early diagnosis and medical care. There are primary healthcare centers and other health facilities located close to these markets. However, awareness and enlightenment programs on HBV have not been recently carried out in these markets.

Study design and population

This was a descriptive cross-sectional study conducted among male and female market traders in Somolu LGA of Lagos State. Traders who had shops in the selected markets for at least 1 year were invited to participate in the study. Traders who were sick or absent at the time of the study were excluded.

Sample size determination

The minimum sample size (n) of 417 was calculated using the Cochran's formula for descriptive studies (n = Z2pq/d2), based on the standard normal deviate (Z) at 95% confidence interval (1.96), the prevalence rate (p) of 44.2% (0.442), which was the proportion of market traders who had good knowledge of HBV virus infection in Calabar, Nigeria,[32] the proportion of failure (q) (q = [1p)] which was 55.8% (0.558), the level of precision or margin of error 5%, and the nonresponse rate of 10%.

Sampling technique

A multistage sampling technique was used to select the respondents. In stage one, three markets were selected out of the six markets in Somolu LGA using simple random sampling technique (ballot method). These were Olaleye, Alarape, and Alade. There were 1300 registered traders with shops in Alarape, Alade, and Olaleye markets with a population of 500, 420, and 380 traders, respectively. Considering the minimum sample size, 160, 135, and 122 respondents were proportionally allocated to Alarape, Alade, and Olaleye markets, respectively. However, there were 20, 15, and 10 blocks of shops, respectively, and 30 shops per block in the selected markets. In stage two, a simple random sampling technique by balloting was used to select 12 out of 20 blocks of shops in Alarape market, 10 out of 15 blocks of shops in Alade market, and 8 out of 10 blocks of shops in Olaleye market. In stage three, 15 shops were selected from each block in the selected markets by systematic sampling technique using the calculated sampling interval (K) of 2 (K = 30/15); simple random sampling method (by balloting) was used to select the starting point between the first and second shop on each block, and then, the alternate shop was selected until the desired sample size in each market was met. The owner of the selected shop was then interviewed.

Data collection

Three trained research assistants were involved in the data collection using a pretested, semistructured, intervieweradministered questionnaire adapted from the literature.[21],[25],[26],[32] The questionnaire was pretested among 42 traders (about 10% of the minimum sample size) in Ojuwoye market in Mushin LGA. The questionnaire collected quantitative data on the respondent's sociodemographic characteristics (such as age, sex, level of education, tribe, and religion), knowledge of HBV (such as knowledge of signs and symptoms, route of transmission, treatment, and complications of HBV), attitude toward HBV (such as attitude toward HBV positive patients, screening for HBV, as well as vaccine safety and effectiveness), and preventive practices of HBV infection (such as practices concerning screening for HBV, vaccination against HBV, sexual practices, use of sharp instruments, and safe blood transfusion). The responses were spontaneous. The interviews which lasted for about 15 min per respondents were conducted between 12 noon and 2 pm daily; this time was considered as the break time by the traders' association.

Data analysis

Data analysis was done using IBM Statistical Package Social Sciences (SPSS) for Windows, version 20.0 of IBM Corp. in Armonk, NY. The data were presented as frequencies, proportions, and mean ± standard deviation (SD). Knowledge, attitude, and preventive practices of hepatitis B infection were summarized as categorical variables. Knowledge of hepatitis B infection was assessed using 19 questions. A correct response was awarded a score of 1 while a wrong or unknown response attracted a score of 0. With the maximum obtainable score of 19, scores from 1 to 9 were categorized as poor knowledge while scores from 10 to 19 were categorized as good knowledge. Attitude to hepatitis B infection was assessed using 13 statements on 3-point Likert scale. Respondents could agree, disagree, or be indifferent to the statements. A score of 3 was awarded to agree, 2 to indifferent, and 1 to disagree. With the maximum obtainable score of 39 and minimum score of 13, the midpoint of the two scores was used as the cut off point. Therefore, scores <26 were categorized as poor attitude while scores ≥26 were categorized as good attitude. Preventive practices for hepatitis B infection were assessed with seven questions. A correct response in this segment was awarded a score of 1, while a wrong or unknown response attracted a score of 0. With a maximum obtainable score of 7, scores from 1 to 4 were categorized as poor preventive practices and scores from 5 to 7 were categorized as good preventive practices. The scoring method was categorized using the modified Bloom's cutoff point.[34] Chi-square statistics was used to test the associations between the categorical variables, and the level of significance was set at 5% (P ≤ 0.05).

Ethical considerations

The study proposal was approved by the Health Research Ethics Committee of Lagos University Teaching Hospital. Through the assistance of the Medical Officer of Health and the designated Community Health Extension Worker in Somolu LGA of Lagos State Nigeria, the research team was granted audience by the leaders of the Market Traders Association (MTA). The purpose of the research was explained, and permission was obtained from the MTA to carry out this study in the market. Written informed consent was obtained from all participants before the interview. Participation was voluntary, and confidentiality was maintained. After the interview, participants were referred to the nearest primary healthcare centers for further assistance and vaccination.


  Results Top


The mean (SD) age of the respondents was 39.2 ± 12.5 years. Majority were female (64.3%), married (69.8%), Christians (64%), and Yoruba (76%). About half of the respondents completed secondary school education (48.2%) [Table 1].
Table 1: Sociodemographic characteristics of the respondents

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Knowledge of hepatitis B virus infection

Most (97.6%) of the respondents were aware of HBV infection. Majority (82.7%) knew that HBV is a viral infection and highly contagious (61.4%) and that all age groups can be infected (62.1%). About 21% of the respondents did not know about the symptoms of HBV infection, and 68.6% did not know that the disease could be asymptomatic. While majority (81.52%) of the respondents knew that it can be transmitted by the use of infected or unsterilized instruments, only about 10% knew that it can be transmitted through sexual intercourse. Majority (78.0%) knew that it could affect liver function, 66.4% knew that it can cause liver cancer, while 66.8% knew that it could be managed. More than half of the respondents (62.4%) knew that HBV infection is preventable through immunization [Table 2].
Table 2: Knowledge of hepatitis B virus infection (n=417)

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The major source of information about HBV infection was through the healthcare workers (34.3%). Others were through friends/family (29.0%) and mass media (25.7%) [Table 3].
Table 3: Major source of information about hepatitis B virus infection (n=417)

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Attitude to hepatitis B virus infection

More than half of the respondents (63.8%) agreed that HBV infection is a major health issue, but about half (55.4%) were not concerned about this infection. Majority (79.4%) agreed that HBV vaccine is safe and effective for the prevention of this infection. While about 44% felt that chronic HBV infection is shameful, about 43% did not feel comfortable to take care of people infected with the virus, and 46.8% agreed that infected patients should be isolated. About two-third (67.6%) felt that early screening may reduce incidence [Table 4].
Table 4: Attitude toward hepatitis B virus infection (n=417)

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Preventive practices for hepatitis B virus infection

About 40% of the respondents have been screened for HBV infection, while only 5% were immunized against the infection by receiving the complete doses of appropriate vaccine. More than half (65.7%) would request for new needles and 66.6% would request for safe equipment when needed. About 75% of the respondents reported having multiple sexual partners [Table 5].
Table 5: Preventive practices of hepatitis B virus infection (n=417)

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Overall knowledge, attitude, and preventive practices of hepatitis B virus infection

Overall, majority (79.9%) of the respondents had good knowledge of HBV virus infection, about half (51.8%) of the respondents had good attitude toward the infection, but only 18.5% of the respondent had good preventive practices of HBV infection [Figure 1].
Figure 1: Overall knowledge, attitude, and preventive practices of hepatitis B virus infection

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Sociodemographic factors affecting knowledge, attitude, and preventive practices for hepatitis B virus infection

Statistically significant association was found between educational status, marital status, religion, and knowledge of HBV infection. Respondents with tertiary education had better knowledge than those who were less educated (P = 0.040), while those who were single (P = 0.003) and those who practice Christianity (P = 0.010) were also found to have better knowledge of the infection. A statistically significant higher proportions of male respondents (63.1%) had good attitude to the infection compared to female (P = 0.001). Level of education, marital status, and ethnicity were significantly associated with the preventive practices for the infection. Respondents with tertiary education (P < 0.0001), those who were divorced (P < 0.0001), and those who were Yoruba (P = 0.010) had good preventive practice for the infection [Table 6].
Table 6: Association between sociodemographic characteristics and knowledge, attitude, and preventive practices for hepatitis B virus infection

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Association between knowledge, attitude, and preventive practices for hepatitis B virus

Statistically significant associations were found between knowledge, attitude, and practice of prevention of HBV infection. A higher proportion of those who had good knowledge of HBV had good preventive practices compared with those who had poor knowledge of HBV. About 91% of those who had poor knowledge of HBV had poor preventive practices (P = 0.020). Similarly, attitude to and practice of prevention were significantly associated as more of those with good attitude had good practice of prevention and 90% of those with poor attitude had poor practice of prevention (P < 0.0001). The association between knowledge of and attitude to the infection is also statistically significant. A higher proportion of those who had good knowledge of HBV had good attitude compared to those who had poor knowledge of HBV (P < 0.0001) [Table 7].
Table 7: Association between knowledge, attitude, and preventive practices for hepatitis B virus infection

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  Discussion Top


In this descriptive cross-sectional study among market traders in Lagos State, Nigeria, we found that despite their high level of knowledge of HBV infection, about half of them had good attitude toward HBV infection and only a few (18.5%) had good preventive practices for HBV infection. While about three quarters had multiple sexual partners, only 10.6% knew that HBV can be transmitted by sexual intercourse. However, only 5% of them were fully immunized against HBV infection. Knowledge, attitude, and preventive practices for HBV were significantly associated. Knowledge and preventive practices of the respondents about HBV infection were significantly associated with the level of education and marital status, while attitude to the preventive practices was associated with gender.

The sociodemographic characteristics of these market traders in Lagos are comparable to the findings of the study among traders in Calabar, Nigeria.[32] This may be due to the similarities of these markets which are urban markets in Lagos and Calabar, Nigeria. On the contrary, majority of the respondents in this study were married. The level of awareness about HBV was high among the respondents in this study, and this is similar to the findings of the study among internet users where 80.4% of them admitted that they had already heard of HBV infection.[35] The market traders are also part of the general population; hence, the findings from this group may also be similar to those from the general population.

The respondents' overall knowledge of HBV infection, its mode of transmission, as well as knowledge of symptoms, treatment, complications, and prevention was high (79.9%). This can be attributed to the various educational programs on HBV infection among the general population in a city such as Lagos, Nigeria. However, only 20.5% of the internet users in Taif in Saudi Arabia had satisfactory knowledge of HBV infection.[35] Most of the respondents in this study knew that HBV infection is a viral infection causing liver disease and that HBV is contagious. On the other hand, only 45% of the general population in Calabar knew that HBV infection causes hepatitis,[27] and some respondents in that study did not know that liver disease is a chronic complication of HBV infection.[21] Most of the respondents in this study knew that HBV can be transmitted through the use of unsterilized instrument and unprotected sexual intercourse. Sexual activity with multiple partners and use of contaminated sharp objects were known risk factors for the transmission of HBV infection.[17],[36],[37]

The level of awareness of HBV infection among the respondents in this study is lower than the findings of a study conducted among healthcare workers in Nigeria;[21] the high level of awareness among healthcare workers can be attributed to increased exposure to health information in the course of their training and practice. Yet, the level of awareness of HBV infection among the respondents in this study is consistent with the findings of previous study conducted among the medical students in Cameroon.[38] However, the level of knowledge of the HBV infection among these market traders in Lagos was higher than the findings among the market traders in Calabar who have similar educational status[32] and among pregnant women in Ibadan, Nigeria, where about a third of them were traders.[39] This can be attributed to the different levels of exposure of the general population to health information in these cities of Nigeria.

Nevertheless, this study found that about a third of the respondents believed that HBV infection can be treated (66.8%) and about 62% knew that vaccine for the prevention of HBV is available. This is consistent with the study conducted among market traders in Calabar where 66% of the respondents believed that HBV infection is treatable, and a greater majority (72.6%) responded that it can be prevented by immunization.[32] As one of the major preventive measures is the administration of HBV vaccine, only 33.6% of the respondents in this study knew that three doses of HBV vaccine will ensure immunization which is lower that the proportion of healthcare workers in Lagos, Nigeria (74.6%), who knew that effective protection against HBV can only be achieved after three doses of HBV vaccine.[28]

The level of education, marital status, and religion of the respondents were significantly associated with the knowledge of HBV infection where higher proportions of the respondents with tertiary education, those who were single, and those who were Christians had good knowledge of HBV infection compared to others in these sociodemographic groups. This shows the positive influence of the level of education on knowledge of health-related issues.[25],[26] This is also similar to the findings among internet users in Taif in Saudi Arabia where university education is associated with satisfactory knowledge.[35] Health education can also be provided at religious gathering as different religious groups could have been exposed to information about HBV infection in different ways. Respondents who were single in this study had significant better knowledge of HBV infection; this association was not significant in other studies from Nigeria and Ethiopia.[39],[40],[41]

With regard to the sources of information on HBV, this study showed that many market traders relied on the healthcare workers (34.3%). Others were through friends/family (29.0%) and mass media (25.7%). This shows that many people rely on the information from healthcare workers and mass media in our environment. This findings is similar to the sources of information about HBV infection among market traders in Calabar[32] but differs from the report of studies conducted among secondary school teachers in Kwara State, Nigeria, and barbers in Egypt where the major sources of information about HBV infection were through family and friends.[26],[42] Health education using peer education may also be an additional means of getting health information across to individuals in our communities.

In this study, about half of the respondents had a positive attitude toward HBV infection. A large proportion agreed that HBV vaccine is safe and effective and that early screening may reduce the incidence of HBV infection, which is comparable with similar report from Pakistan where 81.7% of them agreed that HBV vaccine is safe and effective.[43] While only 40.3% were concerned of being infected with HBV in this study, 77% of the health practitioners in Pakistan were concerned about the risk of contracting HBV.[43] The difference is understandable because health professionals are at a higher risk of been infected with HBV as result of their occupation and can be more concerned about this infection than the market traders. This result is also in line with the study done in Saudi Arabia among internet users.[35] However, some market traders in this study had negative attitudes toward HBV infection: 66.2% agreed that HBV infection can affect the ability to travel, 54.4% agreed that they will not accept HBV-infected person in the market, and 46.8% agreed that HBV patients should be isolated from others. This might be due to the knowledge gap in the transmission of this infection. This is also similar to the poor attitude of the general population in Calabar to HBV infection.[27] A higher proportion of male respondents in this study had positive attitude to HBV infection compared to the female respondents; this association is statistically significant (P = 0.001). This finding is different from the report among market traders in Calabar which showed no gender variation in the knowledge, attitude, and practice of HBV infection among the respondents.[32] Yet, studies among asymptomatic population have shown that HBV infection rate is significantly higher among male compared to female.[44],[45]

The practice of prevention for HBV infection among the respondents was poor, despite their level of knowledge of the infection and their attitude toward the infection. This is similar to the findings of the study conducted among market traders in Calabar.[32] The majority had poor preventive practice for HBV, only a few have been screened for HBV and vaccinated against HBV, and only 5% of the respondents had completed the three doses of HBV vaccine, despite their knowledge about the availability of HBV vaccine. Similar results were also shown from the studies conducted among market traders in Calabar, Nigeria; healthcare workers in Ile-Ife, Nigeria; medical students in Ethiopia; and among healthy population in India.[21],[32],[46],[47] This immunization coverage is lower than the proportion of those who have been vaccinated among healthcare workers in Lagos, Nigeria, and internet users in Saudi Arabia.[28],[35] Although not assessed in this study, other studies showed that the cost of vaccine and government policy for HBV vaccination were some of the factors that were associated with vaccine coverage.[21],[48] As found among market traders in Calabar,[32] majority (75.1%) of the respondents in this study also had multiple sexual partners. Having multiple sexual partners is a risky behavior that can predispose an individual to HBV infection.[16],[21],[49]

Higher prevalence of HBV infection was found among individuals with previous history of blood transfusion and those who share sharp objects.[37] In this study, more than half of the respondents would ask for safe equipment such as needles and blade when needed, accept blood transfusion from accredited sources, and go for treatment if found positive for HBV infection. These practices can be attributed to the educational status as well as the level of knowledge of HBV infection and exposure to health information among the market traders in Lagos. The level of education was significantly associated with the practice of prevention of HBV infection in this study. A statistically significant higher proportion of respondents with tertiary education had good practice of prevention of HBV infection compared to those respondents with lower levels of education, P < 0.0001.

Studies have shown positive associations between knowledge, attitude, and preventive practices of HBV infection among barbers and their clients in Egypt[26] and the healthy population in Pakistan;[25] similar significant results were found in this study. In this study, singles had significant better knowledge, males had better attitude, and divorcees had significant better practices of HBV infection. However, about three quarters of the respondents in this study were female and married. Studies have shown that sexual activity is an important risk factor for the acquisition of HBV infection.[17],[50] Only a few (10.6%) of the respondents in this study knew that HBV can be transmitted by sexual intercourse, and about three quarters of the respondents in this study had multiple sexual partners. Multiple sexual partner is a known risk factor for the transmission of HBV infection.[21],[49] Studies have shown that the carriage rate of HBV infection is high among traders and females.[17],[44] In addition, majority of the female respondents in this study were in the reproductive age group with the possibility of getting pregnant; pregnant women infected with HBV constitute a serious risk to the unborn child and the society. A significant association exists between the level of education and better knowledge and preventive practices for HBV infection in this study; however, only 15% of the respondents in this study had tertiary level of education. This may be one of the reasons why only 5% of the respondents in this study were fully immunized against HBV infection as studies have shown a positive association exist between the knowledge of HBV and HBV vaccine uptake.[21]


  Conclusion Top


The findings of this study highlight high levels of awareness and good knowledge of HBV infection among market traders in Somolu LGA of Lagos, Nigeria. About half of the respondents showed good attitude toward HBV infection. However, the respondents showed poor preventive practices for HBV infection. Majority of the participants were not immunized against HBV infection through vaccination, and they practice unhealthy behaviors that put them at risk of this infection. Poor preventive practices are the barriers to effective control and eradication of HBV. Level of education was significantly associated with knowledge and preventive practices of HBV infection, which highlights the importance of formal and mass health education of the public.

Recommendations

Public health advocacy and education on HBV infection should be intensified in public places such as the market so that the traders as well as their clients can be well educated about the preventive practices against this infection. This can be done through health outreaches and campaigns by the healthcare workers and volunteers, religious groups, peer educators, and mass media. There is a need to formally educate the community members including market traders through universal basic education and mass education up to tertiary education; emphasis should be laid on female education up to tertiary level of education. More emphasis should also be laid on preventive practices and more especially on immunization against HBV with complete doses after appropriate screening and safe sexual practices, such as avoidance of multiple sexual partners. The role of vaccination in the prevention and control of HBV infection in the general population cannot be overemphasized. There is a need for government at all levels in Nigeria to ensure that immunization against HBV through National Immunization Program should include adult population including market traders for effective prevention and control of HBV infection in Nigeria.

Acknowledgments

The authors would like to thank the Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria, for sponsoring the presentation of this research findings at the 14th Annual Research Conference and Fair: An International Conference of the Humanities and Science of the University of Lagos, Nigeria, held in Lagos, Nigeria, from August 21–23, 2019. The authors would also like to thank the respondents for their voluntary participation in this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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