Perceptions Regarding Hepatitis B and C Diseases, and Their Risk Factors among Ward Boys Working in Tertiary Care Hospitals of Islamabad

Research Article

J Hepat Res. 2020; 5(1): 1038.

Perceptions Regarding Hepatitis B and C Diseases, and Their Risk Factors among Ward Boys Working in Tertiary Care Hospitals of Islamabad

Soomar SM¹* and Abdullah M²

¹Department of Community Health Sciences, Aga Khan University Karachi, Pakistan

²School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan

*Corresponding author: Soomar SM, Department of Community Health Sciences, Aga Khan University Karachi, Pakistan

Received: May 05, 2020; Accepted: May 19, 2020; Published: May 26, 2020


Background: Hepatitis is a serious public health issue in the present era. More than 2 billion population is suffering from Hepatitis infection. Similarly, there are about 36 million healthcare professionals globally, out of which approximately 3 million per year get an injury from some sharps, thus resulting in 2 million subjects being infected with HBV and 1 million with HCV (WHO). A systematic study of 2015 showed HCV sero prevalence in the adult population of Pakistan was 6.8 whereas individuals infected with HCV were 6%.

Methods: A qualitative study, with Phenomenological approach, was conducted among wardboys of Islamabad. Two Tertiary care hospitals of Islamabad, one in the public sector and the other in the private healthcare sector were selected as a study site. In-depth interviews with purposely and conveniently with selected ward-boys working in both the hospitals. A total of 25 in-depth interviews were conducted by the principal researcher from wardboys, 12 and 13 from the public and private sector hospital till the saturation was achieved.

Results: 25 participants were interviewed on the basis of the interview guide and asked in detail about hepatitis B and C disease their risk factors and causes. It was found that wardboys lacked comprehensive knowledge about the disease process. They did not adopt preventive strategies and precautionary measures and they lack refresher training and possess knowledge about the spread of infection which was close to none. Little efforts were made in these hospitals to ensure the safety of this group which would render them at high risk of attaining infection as well as transmitting it. Apart from health care workers, especially the wardboys that are subjects of this study were not compelled and penalize to follow infection control standards which led to the downfall of the system and provided a way for infection to proliferate and prosper.

Conclusion and Recommendations: From this study, it is concluded that ward boys in private and public tertiary care hospitals are at high risk of acquiring Hepatitis B and C infection. They lacked knowledge about the infective disease and its preventions. Certifications should be made mandatory for wardboys to allow for work in this environment. Hospitals do not have an efficient system for infection control measure and lack of infection control training. It is important to make infection control processes strong and conduct regular refresher training for all health care workers.

Keywords: Infectious Disease; Paramedics; Hospitals; Knowledge; Low Middle-Income Country


Hepatitis is the inflammation of the liver and vital organ in the human body. Its main function is a purification of blood and protects from multiple infectious diseases. If any defect occurs in the liver it alters all its functions and causes liver disease, which includes Hepatitis B and C. Hepatitis is a serious public health issue nowadays [1]. According to WHO, the Hepatitis C virus is responsible for Hepatitis C infectious disease of the liver. Two types of Hepatitis acute and chronic occurred through this virus. It affects mild to severe illness. The hepatitis C viral infection spreads through a small quantity of blood via intravenous drugs, needle sticks injury and donation and receives of blood and blood products [2]. After the arrival of Hep B vaccination in the year 1980, a reduction was observed in the prevalence of Hep B. It was also observed that prenatal screening of long term infected mothers can prevent transmission of disease to their new born. Health care workers all around the world are at risk of attaining infectious diseases like hepatitis B and C in comparison to other occupational groups because of the working environment [3]. Pakistan has a significantly high prevalence in urban areas as compared to rural areas and it is increasing day by day. In term of health care, a study in which samples of health care workers were analysed. Samples showed a prevalence of Hep B and C to be 5.8 and 3.25 respectively. This can reduce health workforce productivity, put patients at risk and affect the health systems performance. Hepatitis B is a serious issue in public health that can easily be prevented through knowledge [4]. Hepatitis B virus infection transmission occurs from blood and body fluids needle stick injuries or re-use of needles razor blades, unprotected sex and vertical transmission from mother to child [5]. Without intervention, Hep B positive mother faces a 20% risk of infecting her baby at the time of birth. It can also be transmitted from household items through non-intact skin or through the mucous membrane. However, at least 30% of reported hepatitis among adults cannot be associated with an identifiable risk factor [6]. Pakistan is a developing country, therefore, it showed focus on devising ways to promote and maintain preventive strategies to maintain and eliminate the burden of this disease. The risk factors associated with Hep C transmission in Pakistan were injection use, Unsafe medical and medical practices, Blood Transfusion and perinatal transmission are common [7]. Several studies showed that factors associated with these unsafe practices are poor knowledge, lack of skills, awareness, sterile. Barbers also play a pivotal role in the spread of infectious diseases including hepatitis B and C via unsterile razor. Another study shows that most of these barbers are unaware of the phenomenon about the spread of blood-borne infections [8]. The main reasons for the rapid spread of this disease are lack of knowledge and poor medical facilities especially in the least developed countries like Pakistan. In 2015 about 1.34 million deaths were caused by this disease [2]. Effective preventive measures are needed to be practised along with vigilant primary care services to put a hold on this threat that has engulfed Pakistan for many years and has affected its health as well as the quality of life of its residents due to non-compliance. Although primary health care strategies have reduced the HIV incidence, they have been less efficient in reducing HCV incidence. The worldwide prevalence of HCV remains on the higher side among injecting drug users. This will require some new interventions to be designed to create a better response at this global health problem. Even though its prevalence is high many interventions in progress seem to be applicable and cost-effective due to their impact on the prevalence of HIV, therefore, this threat can be reduced. Even though Hep B and C is becoming a huge threat to public health yet there is little information till date on its incidence and prevalence about Hepatitis in Pakistan as compared to the developed countries like America and UK where there is a significant amount of information. However, several attempts have been made to measure the sero prevalence of HCV in Pakistan. In four provinces of Pakistan prevalence turns out to be Punjab 6.7%, Sindh 5%, Baluchistan 1.5% Khyber Pakhtunkhwa 1.1% respectively. A total of about 10 million people suffer from HCV in Pakistan and the majority of them develop a chronic liver disease that is why it is a disease of epic proportions and needs to be dealt with [9]. Public health programs need to make way for the public to fight this problem and thus make progress in the following 4 fields. Prevention of new Infections, awareness about the spread of infection, Increasing testing and diagnosis, getting diagnosed individuals into treatment and care. Apart from vaccination and screening, another important component is educating the population so that they are aware of the threat that this disease poses. In this regard, the Centre for Disease Control and Prevention has highlighted the need to work with stakeholders of a community. This will increase awareness about the disease among them. However globally, 71 million people suffer from chronic Hep C infection. A substantial number of these people will develop cirrhosis or liver cancer. 0.39 Million people are dying each year from Hep C, most of them die from cirrhosis and cancer of hepatocellular. HCV infection is hard to diagnosis and its management is not too good [10]. Currently, immunization for HCV is not available. But there are many types of research related to it are in progress. It is estimated that 2,000.000.000 peoples are infected with the Hepatitis virus globally, and 350000000 people are carriers for life and most of these are in the INDO-PAK region. Its transmission occurs from blood and body fluids needle stick injuries or re-use of needles razor blades, unprotected sex and spread of infection to child by mother. The areas where the prevalence rate is so high are Pakistan India and China, where transmission through contaminated syringes, apparatus use and blood product was utmost relevant. Hep B Virus and Hep C Virus are responsible for the two most extensively spread liver diseases globally [11]. Healthcare Professionals have the risk of getting Hepatitis B&C viral infection through skin eye, syringes and blades. 25% of the total occupational exposure is through the oral route and 75% exposure is through the skin. According to the World Health Organization (WHO) statistics, there are about 36 million healthcare professionals globally, out of which approximately 3 million per year get an injury from some sharps, thus resulting in 2000000 subjects being infected with HBV and 1000000 with HCV [12]. Other studies have predicted that frequency of injury to healthcare professionals caused by sharps ranges from 1.4 to 9.5 per 100 healthcare professionals per year those results in 0.42 Hep B Virus infections per 100 sharps injuries annually. This research shall contribute to assessing the perceptions of wardboys working in a tertiary level hospital concerning hepatitis B & C infection and its risk factors in a developing country.

Literature Review

Global perspective

Hepatitis viral infection is a challenge that occurs globally. As per the World Health Organization, more than 2 billion populations are suffering from Hepatitis virus infection. Chronically carriers around the world are 378 million people. About 257 million people have HBV infection (those who have surface positive antigen of Hepatitis B. There are approximately 620000 deaths relate to Hep B Virus annually. Moreover, the incidence of Hep B Virus is 4.5 million globally per year, out of which ¼ leads to liver ailments. The prevalence of Hepatitis C virus is at 2.5%. 177 million of HCV infected adults globally. An estimated 71 million people suffer from chronic Hep C infection. A noteworthy number of those who are chronically infected will cultivate cirrhosis or cancer of the liver. Hep C in low endemic regions, like the U.S, North Europe, parts of South America and Australia, have less than 2% occurrence of HBs Ag. Carrier rate between 2% and 8% includes the Middle East, Eastern European countries and the Mediterranean basin are considered areas of moderate endemicity whereas In high endemic areas, like central Asian republics, Southeast Asia, Sub-Saharan Africa and the Amazon basin, the HBV carrier rate is over 8% [13]. According to a 2014 report on Hepatitis C in the UK One of the most important risk factors is injectable drug use as evidenced by a study in the UK in 2013. Data from the same study suggested that infection injectable drug users was on higher side 50% in England 32% In North Ireland and 47% in Wales 57% of Scottish injectable drug users tested positive for Hep C. A sub survey in England and Wales that people who inject image and performance enhancing drugs 3.6% had Hep C antibodies positive [14]. Most recent estimates suggest that around 160,000 people in England are living with chronic HCV infection and modeling work is ongoing to update this estimate The practice of injecting drugs is deemed one of the most important risk factor for HCV infection being as much as 90% of all the reports among risk factors In year 2015 as much as 54% of the population, who had injected themselves with psychoactive drugs participating in the UAM survey of people who inject drugs, survey showed that they were tested positive for antibodies of HCV and this proportion has thus been constant over the past 10 years or so. There is some evidence of an increase since 2011. The study also recognizes factors in generating useful “Global” and even “Regional” estimates for hepatitis C. Due to markedly different epidemiology in each country as seen in anti-HCV prevalence between Egypt and the rest of North Africa/Middle East [15]. In Europe Hepatitis C is a major public health concern because of the high burden of infection and high levels of associated morbidity rate and mortality rate. The global strategy aimed at the elimination of hepatitis virus and provides a much-welcomed chance to improve struggles meant to control this burden. It is essential that countries have access to health information to achieve the goal of elimination, through control programming and operative prevention. In 2013 according to WHO Prevalence of chronic Hep B virus in Thailand prevalence was 6.4% for Thailand 4300000 individuals, Cambodia 4.1%, 3.4% for Myanmar, In Laos 8.7%, and in Vietnam, it was 10.8%. In Rwanda, tertiary care hospital workers are at increased risk of exposure and low rate of HBV being vaccinated, among the high-risk group for Hepatitis B Virus/Hepatitis C Virus spread. Advancement of infection control practices is immediately suggested to deliver shield to this possibly high-risk cluster [16]. In the National hospital of Tanzania Hepatitis B vaccine coverage is presently low, although adequate knowledge of and optimistic approaches to the immunization. This is a challenge and severe public health situation for a country with an elevated prevalence of Hep B infection. The prevalence of current Hep B virus infection and lifetime exposure among health care workers was significantly high in Uganda. Body fluid exposure infection was high as well and only a small amount of HCW was immunized for Hep B infection. Furthermore, infection control practices, knowledge, attitudes and other approaches for control of infection need to be strengthened [17]. In Egypt, the Alexandria University Hospitals exposure of Hepatitis-C Virus through contact with Body Fluid and Blood in Nurses care professionals and Paramedical Employees the prevalence of anti-HCV positivity was 8.6% and HCV infection was 4.4% [18]. In Palestine study was conducted about the risk factor of hepatitis B according to study Many behavioural and health care related risk factors like blood transfusion, hospitalization, Intravenous drugs usage, shaving equipment’s sharing were identified to be more prevalent among the Hep B cases. Specifically, raising public awareness about the determinants of HBV and its mode of transmission are necessary actions to prevent and control the disease [18].

National perspective

In developing countries, most people are still having hepatitis viral infection. Hospital workers have different risk awareness and Hep B infection knowledge. Health care professionals like nurses have different knowledge and cleaners have different knowledge because of the differences in education status, training programs, and professed significance within the hospital. The overall risk perception is poor [11]. Another article highlighted that nurses and housekeepers have frequent Needle Stick Injuries and Blood Body Fluids exposures. It has been noted that hospital workers have a low risk of Hep B infection and low immunization rate although having adequate knowledge of the Hep B vaccine. Pakistan is in the high prevalence areas for Hepatitis B and hepatitis C. 4.5 million people are carriers of Hepatitis B Virus with a rate of 3-4% for, about 12.8 million patients with Hep B virus have 6-8% sero prevalence. 10% develop chronic hepatitis and 15% - 25% about 50% of these individuals develop hepatic decomposition or hepatocellular carcinoma develops cirrhosis after having Hep B viral infection. Chronic liver illness progresses due to prolonged Infection of Hepatitis C in which KAP, Hepato -cellular carcinoma is 50%. In 2015 about 1.34 million deaths were caused by this disease. Knowledge Attitude and Practices; of health care professionals, physicians and groups of the healthy community towards the patients of Hepatitis-B and C were studied by different scholars at international. Awareness about biomedical concepts of diseases like cause, symptoms, precaution and prevention shapes up the attitude of people towards patients of those diseases. Practices of health care professionals and non-health care employees working in health care setup also vary due to their knowledge about the disease. Studying knowledge, of a disease helps to understand the general perception of people. This information may help to change peoples’ perceptions towards the disease and creating a positive environment for controlling infectious diseases like Hepatitis argued that better knowledge is essential for control of Hep B&C disease in emerging countries [17]. Hepatitis B and C virus contribute to the global threat of general population specifically in developing countries because research shows that that lack preventive measures as well as appropriate knowledge to avoid these infections [19]. According to a study, Hep B was named disease of the poor as the disease was found to have a higher association with people of lower socioeconomic status [19]. Estimates showed that 3-4% of people suffer from Hep B virus and 5-6% of people in Pakistan suffer from Hep C infection. Since 1994 WHO worked with Pakistan Ministry of Health to add Hep B vaccine in its Expanded Programs on Immunization so that burden of disease could be reduced. Multiple studies have shown that about 80% of HCV related infections proliferated into Chronic Liver Disease. Considering this threat in 2004 first project was morphed by the Ministry of Health namely Hepatitis Control Programme through the funding of the World Health Organization. The focus of this program shall be on vaccination, safe use of injections, safe blood and blood product transfusion, Behavior Change Communication of the population as well as the health care workers, hospital waste management and hospital waste surveillance [20]. In Pakistan approximately 10 million people suffer from Hep Pakistan has one of the biggest burdens of Hep C infection in the world. National hepatitis survey shows about 8 million people living with Hep C in Pakistan [5]. Majority of these individuals are not even aware of their disease due to which their diagnosis is delayed and so does their treatment, therefore, treatment is [6]. A review highlighted lack of communitybased work in Pakistan on Hep B and C as a number of subjects studied were majority high-risk groups, patients that suffer from Hep B or C and donors of blood. The mean prevalence of Hep B and C in data collected from children was 2.3% and 2.5%, in pregnant women it came out to be 2.5% and 5.2%, in general, population prevalence was 2.6% and 5.3% in army recruits prevalence of Hep B and C was 3.5% and 3.1%. Among Blood donors 2.4% and 3.6%. In health Care workers 6.0% and 5.4 %, in high-risk groups 13.0% and 10.3%. Patients with provisional diagnoses of hepatitis had a percentage of 12.3% and 12.0% where patients with chronic liver disease showed a prevalence of Hep B and C to be 25.7% and 54% respectively.

Rational of the study

Reason for conducting this study is to identify the perception about disease and risk factors in wardboys working in tertiary care hospitals Islamabad. This is leading disease in Pakistan its prevalence is high in general population and health care workers. This will provide a lead to know regarding perceptions of disease and its risk factors in the marginalized group.

Research question

What is the perception about hepatitis B and C in wardboys working in tertiary care hospital?

What is the perception about risk factors of hepatitis B and C in wardboys working in tertiary care hospital?

Aims and objectives

Aim: To control the spread of Hep B and C diseases in wardboys working in hospitals.

Research 0bjective: To assess perception about risk factors of Hepatitis B and C among wardboys working in tertiary care hospitals Islamabad.


A qualitative study, with Phenomenological approach, was conducted in tertiary care hospitals among wardboys of Islamabad. Two Tertiary care hospitals of Islamabad, one in the public sector and the other in the private healthcare sector were selected as a study site. The study was conducted in 3 months. In-depth interviews with purposely and conveniently with selected ward-boys working in both the hospitals. Lists of the target population from both the hospitals were obtained. From the list, the study participant depending upon their availability and consent to participate were approached. According to the interview, guide participants were interviewed through random sampling until saturation achieved. In-depth Interviews were conducted on a prepared in-depth interview guide following the Phenomenological design. In which the participant described their live phenomenal experience. Data collection was done through interview guide by trained staff. The time limit was 20-25 mints. Inclusion Criteria was all ward boys are working in these hospitals that consent to participate and Exclusion Criteria was ward boys being either a case or carrier of Hepatitis B or C, and being treated for the disease. All consenting wardboys were included in the study. A total of 25 in-depth interviews were conducted by the principal researcher with wardboys who were working in tertiary care hospitals of Islamabad, 12 from public sector hospital and 13 from the private sector hospital till the saturation was achieved. All interviews were conducted in a hospital setting. By using interview guide questions were asked in Urdu and response were in Urdu and Punjabi then response interpreted in English. Only three interviews were conducted in the Punjabi language on the request of participants. Only 02 participants refused to participate in this study. The average length of the interviews was 13 minutes. Participants were fully authorized to discontinue at any point. Consent was clear and well described.


Demographic data

All participant were Male of different age range 23 years – 27 years were 6 participants, 28 years – 32 years were 7 participants and 33 years and above were 12 participants. Mean qualification was matric and 4 out of 25 participants were intermediate. Job experience range 1-3 years were 04 participants, 4 years-7 years were 10 participants, 8 years-11 years were 06, 12 years and above were 05 years. Out of 25 participants, 12 interviews were taken from the public sector and 13 interviews were taken from participants who belonged to the private sector (Table 1).

Citation: Soomar SM and Abdullah M. Perceptions Regarding Hepatitis B and C Diseases, and Their Risk Factors among Ward Boys Working in Tertiary Care Hospitals of Islamabad. J Hepat Res. 2020; 5(1): 1038.