Assessment of HBsAg, Prevalence, Knowledge of Risk Factors and Prevention of Hepatitis B Infection among Patients Attending the Limbe Health district

Assessment of HBsAg, Prevalence, Knowledge of Risk Factors and Prevention of Hepatitis B Infection among Patients Attending the Limbe Health district | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Study protocol Assessment of HBsAg, Prevalence, Knowledge of Risk Factors and Prevention of Hepatitis B Infection among Patients Attending the Limbe Health district ATEM BESONG ENOWOROCK This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8419750/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Hepatitis B is a virus that attacks the liver and can cause both acute and chronic disease. The virus is most commonly transmitted from mother to child during birth, as well as through contact with infected human blood, being pricked with a contaminated needle, intimate contact with an infected person, oral, vaginal and anal sex and using a razor or any other personal item with remnants of infected fluid. Many people still leave with ignorance about this viral infection which leads to many deaths. This is therefore a major public health problem. This cross-sectional hospital-based study was carried out from April to June 2020 and participants were administered an open-ended questionnaire asking what they know about the risk factors and how they can prevent this viral infection. We collected blood samples from each participant and these samples were screened for the presence of HBsAg using a one-step commercial test strip. The questions answered by participants were graded using 1 as good knowledge 0.5 as intermediate knowledge and 0 as poor knowledge. Children age 0-14 years were considered as not knowledgeable. We observed that participants were affected with this virus despite having good, intermediate or poor knowledge and children age 0 to 14 who were considered not knowledgeable were still affected suggesting mother to child transmission. A greater Proportion of people where between 18-40 years (204 I.e. 68%) and the most affected aged group with 74 cases (36.27%). the most affected area was Mile 1, with 31(37.80%) cases from 82 participants and Bota with 25 (27.77%) cases from 90 respectively. Among the 300 participants 199 participants were negative for HBsAg and 101 participants were positive for HBsAg given a prevalence of 36.66%. Hepatitis B Limbe health district Bota Mile 1 Hepatitis B surface antigen Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Figure 11 1.0. Introduction Hepatitis B is a virus that attacks the liver and can cause both acute and chronic disease. The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids. WHO estimates that in 2015, 257 million people were living with chronic hepatitis B infection (defined as hepatitis B surface antigen positive).In 2015, hepatitis B resulted in an estimated 887 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (i.e. primary liver cancer).As of 2016, 27 million people (10.5% of all people estimated to be living with hepatitis B were aware of their infection, while 4.5 million (16.7%) of the people diagnosed were on treatment. Hepatitis B can be prevented by vaccines that are safe, available and effective [ 1 ]. HBV can cause acute and chronic liver disease. The clinical presentation ranges from sub-clinical hepatitis to symptomatic hepatitis and, in rare instances, fulminant hepatitis. Long-term complications of hepatitis B include cirrhosis and hepatocellular carcinoma [ 2 ]. Childhood infection is associated with few or no symptoms but has a high risk of becoming chronic. A limited number of medications can be used to effectively treat chronic hepatitis B; a safe and effective vaccine is available to prevent hepatitis B infection caused by HBV [ 3 ]. The public health burden of HBV infection is almost entirely due to its long-term effects on liver function. Chronic HBV infection is a major cause of cirrhosis and hepatocellular carcinoma. In addition to the human suffering that these diseases cause; the social and economic costs are large. More than $ 1 billion is spent each year for hepatitis B–related hospitalizations. The indirect costs of chronic HBV infection are harder to measure but include reduced physical and emotional quality of life, reduced economic productivity, long-term disability, and premature deaths [ 4 ]. 2.0. Methodology 2.1. Study design The study design used was a cross-sectional hospital-based study 2.2. Study area Limbe (known as Victoria from 1858 to 1982) is a seaside city in the South-West Region of Cameroon. Limbe was founded in 1858 on the southern slopes of Mount Cameroon by the British missionary Alfred Saker. At the 2005 Census, the population was 84,223. Figure one below represents the Limbe Health District. 2.3. Study population The study population consists of patients attending hospitals in the Limbe health district (Limbe Regional hospital, Bota district hospital, Batoke integrated health center and mile 4 health center) 2.4. Inclusion and exclusion criteria 2.4.1. Inclusion criteria The inclusion criteria for this study considered 1. Patients who attend the above-mentioned hospitals 2. Those who are coming to the laboratory for a lab test and willing to take part in the study. 3. Patients who don’t know their positive status 2.4.2. Exclusion criteria 1. Patients who have received the vaccine against the HBV 2. Patients who would refuse to participate in the study. 3. Mentally disabled people 2.5. Sample seize determination The sample size used was that of a similar study carried on pregnant women in the Limbe and Muyuka health districts which was 135 participants, by Eyong et al [5]. Sample size Lorenz formula N= 135 the sample size was increased to 300 participants by adding 165 participants to the 135 gotten from above. 2.6. Selection of hospitals in the Limbe Health District The Limbe health district is divided into Health areas. Some health facilities where randomly chosen from these Health Areas using a non-probability random sampling method. From each health facility, participants were randomly recruited based on their eligibility to the study (participant level) (table 1). Table 1 health structures involved in the study and areas the covered Batoke integrated health center Batoke Mile four health center Mile four Limbe Regional hospital Mile one Bota district hospital Bota 2.7. Study procedure A consent form was given to participants to read and sign and well-structured questionnaire was used for data collection like patient sociodemographic data (age, sex, occupation, address) and also their knowledge on hepatitis B and the associated risk factors. A rapid diagnostic test strip “one step rapid test” with LOT HBSG1151911B EXP: 2021-11 was used to screen for the presence of hepatitis B surface antigen from patient serum and results were recorded and negative (one red line) and positive (two red lines). 2.8. Data management and analysis Data was entered into a logbook, then it was transferred into an excel spreadsheet which was then analyzed using R version 3.6.1. 2.9. Ethical considerations Ethics approval was obtained from the Regional Ethics Committee for Human Health Research in the South-west Region (CRERSH-SW), the Institutional Review board of the Faculty of Health Sciences, University of Buea. Administrative clearance was obtained from the regional delegation of Public Health for South West Region Cameroon and approval letters from the head of each health facility included in this study. 2.10. Consent to participants The study was conducted in accordance with the declaration of Helsinki, approved by the Cameroon National Ethics Committee (CNERSH). All participants provided written informed consent before enrolment in to this study in which their rights, safety and dignity was considered 3.0. Results 3.1. Socio-demographic data As summarized on table 2, a total of 300 participants were enrolled in this study from April to June from four hospitals in the Limbe health district, with more females (63%) as compared to males 7%) Table 2 General characteristics of study population Modalities Variables Number Percentage SEX Male 111 37% Female 189 63% AGE 18-40 204 68% >40 52 17.33% LOCATION Batoke 50 17% Bota 90 30% Mile 4 45 15% Mile 1 82 27% Others 33 11% 3.2. Clinical data 3.2.1. Prevalence of HBsAg in the Limbe Health District In this cross-sectional hospital-based study, 199 (66.3%) participants were negative while 101 (33.7%) were diagnose positive for HBsAg giving a prevalence of 33.66%. this was also seen to be high in Mokolo [6] and in LHD and MHD [7] (Figure 2). Distribution of participants based on sex and prevalence of HBsAg based on sex Out of 300 participants 189 (63%) were females and 111 (37%) were males indicating more females took part in the study than males as compared to 68.15% males and 31.85% females observed by [9] (Figure 3). HBsAg status based on gender Among 189 females in the study population 121(64.0%) were diagnose negative for HBsAg and 68 (36.0%) were diagnose positive for HBsAg while among the 111 males enrolled in the study population 78 (70.3%) where negative while 33 (29.7%) were positive for HBsAg. (p=0.3118131 that is p>0.05); Gender has no influence on the results of both sexes. More males were found to be infected by this virus than women in Pakistani [8] (figure 4) Distribution of participants based on location As summarized in Figure 5, the locations of participants were also taken into consideration to identify the most affected areas. And majority of participants came from bota (30%), mile 1(27%), batoke (17%), alpha club (15%) and the other locations (11%). Case distribution based on location The results showed that, mile 1 with 31 cases (10.33%) is the most affected area followed by Bota with 25 cases (8.33%), with mile 4 having 17 cases (5.66%) and Batoke having 13 cases (4.33%) with other locations having few cases (Figure 6) 3.2.2. Distribution based on knowledge of risk factors Participants were graded based on their knowledge on risk factors that predisposes them to the HBV infection and it was seen that 220 participants(73%) had poor knowledge on the risk factors, 32 participants(11%) had intermediate knowledge, 34 participants (11%) had no knowledge ( considering their age 0-14) , and 32 participants (11% )had intermediate knowledge while only 14(5%) had good knowledge on the risk factors this was graded using 1 (good knowledge), 0.5 (intermediate), 0 (poor) and not knowledgeable (Figure 7). Results based on knowledge of risk factors It is seen from the results that irrespective of the knowledge of participants on the risks factors from good to poor, every group had a considerate number of cases. Poor knowledge had 220 participants (73.33%), 138 negatives for HBsAg (62.72%) and 77 (35%) positive cases for HBsAg. Participants with no knowledge had a total of 34 (11.33%), 24 (70.58%) negative cases and 9 (26.47%) where positive for HBsAg, while those with intermediate knowledge had 32 (10.66) participants 23 (71.87%) where negative and 9 (28%) where positive for HBsAg, and a total of 14 participants (4.66%) had good knowledge with 9 (64.28%) negative and 5 (35.71%) were positive. Patient’s knowledge had no influence on the number of cases (p= 1 0.8584312, that is p>0.05); this means that participants knowledge on the risk factors of HB infection had no influence on their results (Figure 8). 3.2.2. Distribution based on knowledge of prevention Participants were assessed on their knowledge on prevention of hepatitis B infection to see if they have basic knowledge on how they can prevent this infection this result was obtained as seen below. 1 was graded as good, 0.5 as intermediate and 0 as poor and children 0 to 14 as not knowledgeable (Figure 9). Distribution of participants on different knowledge of prevention and the prevalence of HBsAg Knowledge of prevention of hepatitis B infection among participants was compared to their results. Those with poor knowledge had a total of 214 participants (71.33%) with 138(64%) negative and 76 positives (35.51%), those with no knowledge had a total of 35(11.66%), 26 negative (74.28%) and 9 positive (25.71%) and a total of 14 (4.66%) participants with good knowledge, 9 (64%) where negative and 5 (35.71%) where positive for hepatitis B p= 0.8191931. that is p >0.05 this means their knowledge has no influence on the participants results. (Figure 10). HBV results based on age group Figure 11 summarized results of different age groups which were separated into three major groups. Age 40 had 52 (17.33%) participants. This age group is classified to see the one most affected by this virus. Among the three major age groups, the highest number of cases are seen in the age group 18-40 with 74 cases from (36.27%) followed by age group >40 with 15 cases (28.84%) and age group 0.05 that means their age had no influence on their results. 4.0. Discussion A total of 300 participants were enrolled in this study (Gotten from Limbe regional hospital, Bota district hospital, Mile 4 health center and the Batoke integrated health center). Questionnaires (open-ended) where administered to participants to assess their knowledge on the risk factors of hepatitis B infection and prevention of HB infection, and their locations, age and sex were also considered. Blood samples were collected, processed and screened for HBsAg using a commercial one step test strip. In this study we found the prevalence of HBsAg to be 33.66% which is very high with the level of vaccine availability a\and accessibility. A cross-sectional analytical study was conducted during a screening campaign for viral hepatitis organized at the Mokolo District Hospital, Cameroon, from January 19, 2017 to February 27, 2017.Of the 364participants enrolled, 28.6% tested positive for HBsAg [ 6 ] and the prevalence of HBV in LHD and MHD where 5.7% and 7.5% respectively [ 7 ]. This also supports out research findings on the prevalence of HBsAg. This is also similar to a study conducted by [ 8 ] which showed that the prevalence of HBsAg positivity was high (42, 10.6%) given that there is an efficient and available vaccine. In this study which included all age groups, they were more females 189 (63%) than males 111 (37%), with more females being infected by the HBV [ 9 ]. It was also seen that people between the age group of 18 to 40years where more affected having 74 cases positive with HBsAg. At this age people are more sexually active and also have jobs that expose them to risk factors that can cause them to come into contact with this viral infection. This is also seen in a study conducted by [ 10 ], which showed that the infection rate rises over the span of three years. The age group of 21–30 had the highest infection rate at 34.93%, while the 31–40 age group followed with 23.83%. Only (13.39%) were part of the age group 11–20 years. The infection rate decreases with age, evidenced by age brackets 41–50 (16.13%) and 51–60 (7.09%). Children aged 0–10 and seniors over 60 were infected at very low rates of 1.49% and 1.65%, respectively. Based on the knowledge on hepatitis B infection and methods on prevention we found out that the participants of this study had poor knowledge (73%) on the risk factors of hepatitis B and 71% of the participants had poor knowledge on the methods of preventing hepatitis B infection at the Limbe Health District. This is supported by a key study in Cameroon focused on hepatitis awareness among the general public in Cameroon and their findings showed that the average awareness level of the survey respondents was 5.38. Although the results indicated that the survey participants had some knowledge about hepatitis, it was observed that there was lack of awareness in some key areas of the disease such as modes of transmission and vaccination. There is a need for initiatives at a population level to increase the awareness about viral hepatitis, modes of transmission, treatment and prevention in Cameroon [ 11 ]. 5.0. Conclusion This study shows the high percentage of hepatitis B and the poor knowledge about the infection risk factor and prevention in the Limbbe Health District, indicating the need for more educational and sensitization programs about the disease. Declarations Ethical consideration Ethical clearance was obtained from the Institutional Review board of the Faculty of Health Sciences, University of Buea. Administrative clearance was obtained from the Regional delegation of Public Health for South West Region Cameroon and approval letters from the head of each health facility included in this study. The study protocol was carefully explained to each participant and participation in the study was voluntary. Written informed consent was gotten from all participants before enrolment in the study. Data confidentiality of study participants was maintained by limiting access of the information and basic data obtained to the principal investigator. Acknowledgement We appreciate everyone who participated in this study and willingly offered their time, including the staff of the selected health facilities in the Limbe Health District. Data Availability Data is available from the corresponding authors Funding This study was self-funded, no external funding was available for this study Authors’ contributions A.M, E.K, B.G initiated the project, wrote and corrected the manuscript, late T.B, N.T, supervised the study and conducted statistical analysis. All the authors read and approved the final manuscript. Conflict of interest The authors declare no conflicts of interest regarding the publication of this paper Acknowledgement We appreciate everyone who participated in this study and willingly offered their time, including the staff of the selected health facilities in the Limbe Health District. Data Availability Data is available from the corresponding authors Funding This study was self-funded, no external funding was available for this study Authors’ contributions A.M, E.K, B.G initiated the project, wrote and corrected the manuscript, late T.B, N.T, supervised the study and conducted statistical analysis. All the authors read and approved the final manuscript. Conflict of interest The authors declare no conflicts of interest regarding the publication of this paper References World health organization. Hepatitis B key facts [internet] July 18 2019 [17 may2020]; available from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b Izzo F, Cremona F, Ruffolo F, et al. Outcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis. Ann Surg . 1998 Apr. 227(4):513-8. Bhimma R, Coovadia HM, Adhikari M, Connolly CA.The impact of the hepatitis B virus vaccine on the incidence of hepatitis B virus-associated membranous nephropathy. Arch Pediatr Adolesc Med .2003;157(10):1025-30. Sorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, Kern ER, McHugh JA, Petersen GM, Rein MF, Strader DB. National Institutes of Health consensus development conference statement: management of hepatitis B. Annals of internal medicine. 2009 Jan 20;150(2):104-10. Eyong EM, Yankam BM, Seraphine E, Ngwa CH, Nkfusai NC, Anye CS, Nfor GK, Cumber SN. The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka Health Districts of the South West region of Cameroon: a three-year retrospective study. Pan African Medical Journal. 2019 Mar 15;32(1). Abdoul Rahamane Njigou et al. Seroprevalence of Hepatitis B and C Infections in Mokolo District Hospital, Northern Cameroon: The Value of a Screening Campaign. Volume 3, issue 3, 2018;7984 Esum Mathias Eyong et al. The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka health districts.2019;32:122. [doi: 10.11604/pa, j.2019.32.122.16055] Akazong E, Tume C, Njouom R, Ayong L, Fondoh V, Kuiate JR. Knowledge, attitude and prevalence of hepatitis B virus among healthcare workers: a cross-sectional, hospital-based study in Bamenda Health District, NWR, Cameroon. BMJ open. 2020 Mar 1;10(3):e031075. Fawad k, sulaiman s et al.hepatitis b virus infection among different sex and age groups in Pakistani Punjab.2011; 8: 225.doi: 10.1186/1743-422X-8-225 Khan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, Ilyas M. Hepatitis B virus infection among different sex and age groups in Pakistani Punjab. Virology journal. 2011 May 13;8(1):225. Patil A, Foguito F, Balasubramanian G, Flore N, Patrick EP, Gowda A. Hepatitis awareness among the general public in Cameroon: A survey study. International Journal of Innovation and Applied Studies. 2014 Sep 1;8(3):1370. Additional Declarations No competing interests reported. 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1","display":"","copyAsset":false,"role":"figure","size":707963,"visible":true,"origin":"","legend":"\u003cp\u003eLimbe health district map\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/1c3ced75058577cef3ba9e73.png"},{"id":99316048,"identity":"4a84ab18-3fa8-40cb-850b-a05d2a9f4ede","added_by":"auto","created_at":"2025-12-31 16:27:39","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":20671,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHBsAg Test Results\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/704e6dfb3cd923606e030906.png"},{"id":99316758,"identity":"2c472321-423b-4b52-bb04-d367954cfa6c","added_by":"auto","created_at":"2025-12-31 16:29:08","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":13230,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003edistribution of HBsAg based on sex\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/54736dd9fbb384ed0bbbb266.png"},{"id":99191840,"identity":"bdccbe53-162c-42ef-ae41-c509a1b0290c","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":15087,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHBV status based on gender\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/79f9602299a9e2211a7f2c2c.png"},{"id":99316448,"identity":"51773723-fd39-47ff-af0e-0a6ca781cf5e","added_by":"auto","created_at":"2025-12-31 16:28:28","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":50174,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003edistribution of participants based on location\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/5120d713cb2f20c31ee1cdca.png"},{"id":99191850,"identity":"a4f550f7-4b92-4292-86b0-024c7c3f0913","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":39007,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCase distribution based on location\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/99296dd429e9291da3a5af41.png"},{"id":99191851,"identity":"04a6ba5c-0ba1-4287-b607-d8241684fbd0","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":23897,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eparticipant’s knowledge on HBV risk factors\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/f844e760569586b9af7fbc03.png"},{"id":99191844,"identity":"966be8f8-55bd-405a-95f4-978f0f34a334","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":18031,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eResults based on knowledge of risk factors\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/27393803aa902c824232d8c9.png"},{"id":99191846,"identity":"66894d18-87c8-4f8c-8492-c007c8be2e9b","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":27571,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003edistribution based on knowledge of HBV prevention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/ffbb520b0aac8937dd1206c8.png"},{"id":99316720,"identity":"3559303d-da3d-4365-bfe9-ffe4f44af3e9","added_by":"auto","created_at":"2025-12-31 16:29:04","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":25725,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eKnowledge of HBV prevention\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/59435032ef4f2619c738ad1b.png"},{"id":99191857,"identity":"c237f81f-bc66-4a04-b0e5-f50c08adb41d","added_by":"auto","created_at":"2025-12-30 00:59:39","extension":"png","order_by":11,"title":"Figure 11","display":"","copyAsset":false,"role":"figure","size":17624,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHBV results based on age group\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"11.png","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/bcc831461646ff66a4ded096.png"},{"id":99325845,"identity":"bc02c782-b8c0-494a-bf0b-84e62b376ee0","added_by":"auto","created_at":"2025-12-31 16:50:19","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1708071,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8419750/v1/4ecab103-0b80-4212-83fc-d20392e3f930.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of HBsAg, Prevalence, Knowledge of Risk Factors and Prevention of Hepatitis B Infection among Patients Attending the Limbe Health district","fulltext":[{"header":"1.0. Introduction","content":"\u003cp\u003eHepatitis B is a virus that attacks the liver and can cause both acute and chronic disease. The virus is most commonly transmitted from mother to child during birth and delivery, as well as through contact with blood or other body fluids. WHO estimates that in 2015, 257\u0026nbsp;million people were living with chronic hepatitis B infection (defined as hepatitis B surface antigen positive).In 2015, hepatitis B resulted in an estimated 887 000 deaths, mostly from cirrhosis and hepatocellular carcinoma (i.e. primary liver cancer).As of 2016, 27\u0026nbsp;million people (10.5% of all people estimated to be living with hepatitis B were aware of their infection, while 4.5\u0026nbsp;million (16.7%) of the people diagnosed were on treatment. Hepatitis B can be prevented by vaccines that are safe, available and effective [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. HBV can cause acute and chronic liver disease. The clinical presentation ranges from sub-clinical hepatitis to symptomatic hepatitis and, in rare instances, fulminant hepatitis. Long-term complications of hepatitis B include cirrhosis and hepatocellular carcinoma [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Childhood infection is associated with few or no symptoms but has a high risk of becoming chronic. A limited number of medications can be used to effectively treat chronic hepatitis B; a safe and effective vaccine is available to prevent hepatitis B infection caused by HBV [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. The public health burden of HBV infection is almost entirely due to its long-term effects on liver function. Chronic HBV infection is a major cause of cirrhosis and hepatocellular carcinoma. In addition to the human suffering that these diseases cause; the social and economic costs are large. More than \u003cspan\u003e$\u003c/span\u003e1\u0026nbsp;billion is spent each year for hepatitis B\u0026ndash;related hospitalizations. The indirect costs of chronic HBV infection are harder to measure but include reduced physical and emotional quality of life, reduced economic productivity, long-term disability, and premature deaths [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e"},{"header":"2.0. Methodology","content":"\u003cp\u003e2.1.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Study design\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study design used was a cross-sectional hospital-based study\u003c/p\u003e\n\u003cp\u003e2.2.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Study area\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimbe (known as Victoria from 1858 to 1982) is a seaside city in the South-West Region of Cameroon. Limbe was founded in 1858 on the southern slopes of Mount Cameroon by the British missionary Alfred Saker. At the 2005 Census, the population was 84,223. Figure one below represents the Limbe Health District.\u003c/p\u003e\n\u003cp\u003e2.3.\u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;Study population\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe study population consists of patients attending hospitals in the Limbe health district (Limbe Regional hospital, Bota district hospital, Batoke integrated health center and mile 4 health center)\u003c/p\u003e\n\u003cp\u003e2.4. Inclusion and exclusion criteria\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.4.1. Inclusion criteria\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe inclusion criteria for this study considered\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1. Patients who attend the above-mentioned hospitals\u003c/p\u003e\n\u003cp\u003e2. Those who are coming to the laboratory for a lab test and willing to take part in the study.\u003c/p\u003e\n\u003cp\u003e3. Patients who don\u0026rsquo;t know their positive status\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.4.2. Exclusion criteria\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp; \u0026nbsp;Patients who have received the vaccine against the HBV\u003c/p\u003e\n\u003cp\u003e2.\u0026nbsp; \u0026nbsp;Patients who would refuse to participate in the study.\u003c/p\u003e\n\u003cp\u003e3.\u0026nbsp; \u0026nbsp;Mentally disabled people\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.5. Sample seize determination\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe sample size used was that of a similar study carried on pregnant women in the Limbe and Muyuka health districts which was 135 participants, by Eyong \u003cem\u003eet al\u0026nbsp;\u003c/em\u003e[5].\u003cem\u003e\u0026nbsp;\u003c/em\u003eSample size Lorenz formula\u003c/p\u003e\n\u003cp\u003e\u003cimg 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\"\u003e\u003c/p\u003e\n\u003cp\u003eN= 135 the sample size was increased to 300 participants by adding 165 participants to the 135 gotten from above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.6. Selection of hospitals in the Limbe Health District\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Limbe health district is divided into Health areas. Some health facilities where randomly chosen from these Health Areas using a non-probability random sampling method. From each health facility, participants were randomly recruited based on their eligibility to the study (participant level) (table 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;health structures involved in the study and areas the covered\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBatoke integrated health center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBatoke\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eMile four health center\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eMile four\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eLimbe Regional hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eMile one\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBota district hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 282px;\"\u003e\n \u003cp\u003eBota\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e2.7. Study procedure\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA consent form was given to participants to read and sign and well-structured questionnaire was used for data collection like patient sociodemographic data (age, sex, occupation, address) and also their knowledge on hepatitis B and the associated risk factors. A rapid diagnostic test strip \u0026ldquo;one step rapid test\u0026rdquo; with\u0026nbsp;LOT HBSG1151911B EXP: 2021-11 was used to screen for the presence of hepatitis B surface antigen from patient serum and results were recorded and negative (one red line) and positive (two red lines).\u003c/p\u003e\n\u003cp\u003e2.8. Data management and analysis\u003c/p\u003e\n\u003cp\u003eData was entered into a logbook, then it was transferred into an excel spreadsheet which was then analyzed using R version 3.6.1.\u003c/p\u003e\n\u003cp\u003e2.9. Ethical considerations\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained from the Regional Ethics Committee for Human Health Research in the South-west Region (CRERSH-SW), the Institutional Review board of the Faculty of Health Sciences, University of Buea. Administrative clearance was obtained from the regional delegation of Public Health for South West Region Cameroon and approval letters from the head of each health facility included in this study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.10. Consent to participants\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was conducted in accordance with the declaration of Helsinki, approved by the Cameroon National Ethics Committee (CNERSH). All participants provided written informed consent before enrolment in to this study in which their rights, safety and dignity was considered\u0026nbsp;\u003c/p\u003e"},{"header":"3.0. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1. Socio-demographic data\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAs summarized on table 2, a total of 300 participants were enrolled in this study from April to June from four hospitals in the Limbe health district, with more females (63%) as compared to males 7%)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;General characteristics of study population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eModalities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNumber\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSEX\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e37%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e63%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eAGE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026lt;18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e14.66%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026gt;18-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e204\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e68%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026gt;40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e17.33%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eLOCATION\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eBatoke\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e17%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eBota\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e30%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMile 4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e15%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eMile 1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eOthers\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e11%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. \u0026nbsp; \u0026nbsp; \u0026nbsp;Clinical data\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e3.2.1. \u0026nbsp; Prevalence of HBsAg in the Limbe Health District\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn this cross-sectional hospital-based study, 199 (66.3%) participants were negative while 101 (33.7%) were diagnose positive for HBsAg giving a prevalence of 33.66%. this was also seen to be high in Mokolo [6] and in LHD and MHD [7] (Figure 2).\u003c/p\u003e\n\u003cp\u003eDistribution of participants based on sex and prevalence of HBsAg based on sex\u003c/p\u003e\n\u003cp\u003eOut of 300 participants 189 (63%) were females and 111 (37%) were males indicating \u0026nbsp;more females took part in the study than males as compared to 68.15% males and 31.85% females observed by [9] (Figure 3).\u003c/p\u003e\n\u003cp\u003eHBsAg status based on gender\u003c/p\u003e\n\u003cp\u003eAmong 189 females in the study population 121(64.0%) were diagnose negative for HBsAg and 68 (36.0%) were diagnose positive for HBsAg while among the 111 males enrolled in the study population 78 (70.3%) where negative while 33 (29.7%) were positive for HBsAg. (p=0.3118131 that is p\u0026gt;0.05); Gender has no influence on the results of both sexes. More males were found to be infected by this virus than women in Pakistani [8] (figure 4)\u003c/p\u003e\n\u003cp\u003eDistribution of participants based on location\u003c/p\u003e\n\u003cp\u003eAs summarized in Figure 5, the locations of participants were also taken into consideration to identify the most affected areas. And majority of participants came from bota (30%), mile 1(27%), batoke (17%), alpha club (15%) and the other locations (11%).\u003c/p\u003e\n\u003cp\u003eCase distribution based on location\u003c/p\u003e\n\u003cp\u003eThe results showed that, mile 1 with 31 cases (10.33%) is the most affected area followed by Bota with 25 cases (8.33%), with mile 4 having 17 cases (5.66%) and Batoke having 13 cases (4.33%) with other locations having few cases (Figure 6)\u003c/p\u003e\n\u003cp\u003e3.2.2. Distribution based on knowledge of risk factors\u003c/p\u003e\n\u003cp\u003eParticipants were graded based on their knowledge on risk factors that predisposes them to the HBV infection and it was seen that 220 participants(73%) had poor knowledge on the risk factors, 32 participants(11%) had intermediate knowledge, 34 participants (11%) had no knowledge ( considering their age 0-14) , and 32 participants (11% )had intermediate knowledge while only 14(5%) had good knowledge on the risk factors this was graded using 1 (good knowledge), 0.5 (intermediate), 0 (poor) and not knowledgeable (Figure 7).\u003c/p\u003e\n\u003cp\u003eResults based on knowledge of risk factors\u003c/p\u003e\n\u003cp\u003eIt is seen from the results that irrespective of the knowledge of participants on the risks factors from good to poor, every group had a considerate number of cases. Poor knowledge had 220 participants (73.33%), 138 negatives for HBsAg (62.72%) and 77 (35%) positive cases for HBsAg. Participants with no knowledge had a total of 34 (11.33%), 24 (70.58%) negative cases and 9 (26.47%) where positive for HBsAg, while those with intermediate knowledge had 32 (10.66) participants 23 (71.87%) where negative and 9 (28%) where positive for HBsAg, and a total of 14 participants (4.66%) had good knowledge with 9 (64.28%) negative and 5 (35.71%) were positive. Patient\u0026rsquo;s knowledge had no influence on the number of cases (p=\u003cem\u003e1 0.8584312, that is p\u0026gt;0.05);\u0026nbsp;\u003c/em\u003ethis means that participants knowledge on the risk factors of HB infection had no influence on their results (Figure 8).\u003c/p\u003e\n\u003cp\u003e3.2.2. \u0026nbsp; Distribution based on knowledge of prevention\u003c/p\u003e\n\u003cp\u003eParticipants were assessed on their knowledge on prevention of hepatitis B infection to see if they have basic knowledge on how they can prevent this infection this result was obtained as seen below. 1 was graded as good, 0.5 as intermediate and 0 as poor and children 0 to 14 as not knowledgeable (Figure 9).\u003c/p\u003e\n\u003cp\u003eDistribution of participants on different knowledge of prevention and the prevalence of HBsAg\u003c/p\u003e\n\u003cp\u003eKnowledge of prevention of hepatitis B infection among participants was compared to their results. Those with poor knowledge had a total of 214 participants (71.33%) with 138(64%) negative and 76 positives (35.51%), those with no knowledge had a total of 35(11.66%), 26 negative (74.28%) and 9 positive (25.71%) and a total of 14 (4.66%) participants with good knowledge, 9 (64%) where negative and 5 (35.71%) where positive for hepatitis B p= \u003cem\u003e0.8191931. that is p \u0026gt;0.05 this means their knowledge has no influence on the participants results.\u0026nbsp;\u003c/em\u003e(Figure 10).\u003c/p\u003e\n\u003cp\u003eHBV results based on age group\u003c/p\u003e\n\u003cp\u003eFigure 11 summarized results of different age groups which were separated into three major groups. Age \u0026lt;18 had 44 (14.66%) participants, age 18-40 had 204 (68%) participants and age group \u0026gt;40 had 52 (17.33%) participants. This age group is classified to see the one most affected by this virus. Among the three major age groups, the highest number of cases are seen in the age group 18-40 with 74 cases from (36.27%) followed by age group \u0026gt;40 with 15 cases (28.84%) and age group \u0026lt;18 with 12 cases (27.27%). p=0.28 that is p\u0026gt;0.05 that means their age had no influence on their results.\u003c/p\u003e"},{"header":"4.0. Discussion","content":"\u003cp\u003e A total of 300 participants were enrolled in this study (Gotten from Limbe regional hospital, Bota district hospital, Mile 4 health center and the Batoke integrated health center). Questionnaires (open-ended) where administered to participants to assess their knowledge on the risk factors of hepatitis B infection and prevention of HB infection, and their locations, age and sex were also considered. Blood samples were collected, processed and screened for HBsAg using a commercial one step test strip. In this study we found the prevalence of HBsAg to be 33.66% which is very high with the level of vaccine availability a\\and accessibility. A cross-sectional analytical study was conducted during a screening campaign for viral hepatitis organized at the Mokolo District Hospital, Cameroon, from January 19, 2017 to February 27, 2017.Of the 364participants enrolled, 28.6% tested positive for HBsAg [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] and the prevalence of HBV in LHD and MHD where 5.7% and 7.5% respectively [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. This also supports out research findings on the prevalence of HBsAg. This is also similar to a study conducted by [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] which showed that the prevalence of HBsAg positivity was high (42, 10.6%) given that there is an efficient and available vaccine. In this study which included all age groups, they were more females 189 (63%) than males 111 (37%), with more females being infected by the HBV [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It was also seen that people between the age group of 18 to 40years where more affected having 74 cases positive with HBsAg. At this age people are more sexually active and also have jobs that expose them to risk factors that can cause them to come into contact with this viral infection. This is also seen in a study conducted by [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which showed that the infection rate rises over the span of three years. The age group of 21\u0026ndash;30 had the highest infection rate at 34.93%, while the 31\u0026ndash;40 age group followed with 23.83%. Only (13.39%) were part of the age group 11\u0026ndash;20 years. The infection rate decreases with age, evidenced by age brackets 41\u0026ndash;50 (16.13%) and 51\u0026ndash;60 (7.09%). Children aged 0\u0026ndash;10 and seniors over 60 were infected at very low rates of 1.49% and 1.65%, respectively.\u003c/p\u003e \u003cp\u003eBased on the knowledge on hepatitis B infection and methods on prevention we found out that the participants of this study had poor knowledge (73%) on the risk factors of hepatitis B and 71% of the participants had poor knowledge on the methods of preventing hepatitis B infection at the Limbe Health District. This is supported by a key study in Cameroon focused on hepatitis awareness among the general public in Cameroon and their findings showed that the average awareness level of the survey respondents was 5.38. Although the results indicated that the survey participants had some knowledge about hepatitis, it was observed that there was lack of awareness in some key areas of the disease such as modes of transmission and vaccination. There is a need for initiatives at a population level to increase the awareness about viral hepatitis, modes of transmission, treatment and prevention in Cameroon [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e"},{"header":"5.0. Conclusion","content":"\u003cp\u003eThis study shows the high percentage of hepatitis B and the poor knowledge about the infection risk factor and prevention in the Limbbe Health District, indicating the need for more educational and sensitization programs about the disease.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical consideration Ethical clearance was obtained from the Institutional Review board of the Faculty of Health Sciences, University of Buea. Administrative clearance was obtained from the Regional delegation of Public Health for South West Region Cameroon and approval letters from the head of each health facility included in this study. The study protocol was carefully explained to each participant and participation in the study was voluntary. Written informed consent was gotten from all participants before enrolment in the study. Data confidentiality of study participants was maintained by limiting access of the information and basic data obtained to the principal investigator.\u003c/p\u003e\n\u003cp\u003eAcknowledgement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe appreciate everyone who participated in this study and willingly offered their time, including the staff of the selected health facilities in the Limbe Health District.\u003c/p\u003e\n\u003cp\u003eData Availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData is available from the corresponding authors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was self-funded, no external funding was available for this study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.M, E.K, B.G initiated the project, wrote and corrected the manuscript, late T.B, N.T, supervised the study and conducted statistical analysis. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest regarding the publication of this paper\u003c/p\u003e\n\u003cp\u003eAcknowledgement\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWe appreciate everyone who participated in this study and willingly offered their time, including the staff of the selected health facilities in the Limbe Health District.\u003c/p\u003e\n\u003cp\u003eData Availability\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eData is available from the corresponding authors\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunding\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study was self-funded, no external funding was available for this study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eA.M, E.K, B.G initiated the project, wrote and corrected the manuscript, late T.B, N.T, supervised the study and conducted statistical analysis. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eConflict of interest\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflicts of interest regarding the publication of this paper\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld health organization. Hepatitis B key facts [internet] July 18 2019 [17 may2020]; available from https://www.who.int/news-room/fact-sheets/detail/hepatitis-b\u003c/li\u003e\n\u003cli\u003eIzzo F, Cremona F, Ruffolo F,\u003cem\u003e et al. \u003c/em\u003eOutcome of 67 patients with hepatocellular cancer detected during screening of 1125 patients with chronic hepatitis. \u003cem\u003eAnn Surg\u003c/em\u003e. 1998 Apr. 227(4):513-8. \u003c/li\u003e\n\u003cli\u003eBhimma R, Coovadia HM, Adhikari M, Connolly CA.The impact of the hepatitis B virus vaccine on the incidence of hepatitis B virus-associated membranous nephropathy. \u003cem\u003eArch Pediatr Adolesc Med\u003c/em\u003e.2003;157(10):1025-30.\u003c/li\u003e\n\u003cli\u003eSorrell MF, Belongia EA, Costa J, Gareen IF, Grem JL, Inadomi JM, Kern ER, McHugh JA, Petersen GM, Rein MF, Strader DB. National Institutes of Health consensus development conference statement: management of hepatitis B. Annals of internal medicine. 2009 Jan 20;150(2):104-10.\u003c/li\u003e\n\u003cli\u003eEyong EM, Yankam BM, Seraphine E, Ngwa CH, Nkfusai NC, Anye CS, Nfor GK, Cumber SN. The prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka Health Districts of the South West region of Cameroon: a three-year retrospective study. Pan African Medical Journal. 2019 Mar 15;32(1).\u003c/li\u003e\n\u003cli\u003eAbdoul Rahamane Njigou\u003cem\u003eet al.\u003c/em\u003eSeroprevalence of Hepatitis B and C Infections in Mokolo District Hospital, Northern Cameroon: The Value of a Screening Campaign. Volume 3, issue 3, 2018;7984\u003c/li\u003e\n\u003cli\u003eEsum Mathias Eyong \u003cem\u003eet al. \u003c/em\u003eThe prevalence of HBsAg, knowledge and practice of hepatitis B prevention among pregnant women in the Limbe and Muyuka health districts.2019;32:122. [doi: 10.11604/pa, j.2019.32.122.16055] \u003c/li\u003e\n\u003cli\u003eAkazong E, Tume C, Njouom R, Ayong L, Fondoh V, Kuiate JR. Knowledge, attitude and prevalence of hepatitis B virus among healthcare workers: a cross-sectional, hospital-based study in Bamenda Health District, NWR, Cameroon. BMJ open. 2020 Mar 1;10(3):e031075.\u003c/li\u003e\n\u003cli\u003eFawad k, sulaiman s et al.hepatitis b virus infection among different sex and age groups in Pakistani Punjab.2011; 8: 225.doi: 10.1186/1743-422X-8-225\u003c/li\u003e\n\u003cli\u003eKhan F, Shams S, Qureshi ID, Israr M, Khan H, Sarwar MT, Ilyas M. Hepatitis B virus infection among different sex and age groups in Pakistani Punjab. Virology journal. 2011 May 13;8(1):225.\u003c/li\u003e\n\u003cli\u003ePatil A, Foguito F, Balasubramanian G, Flore N, Patrick EP, Gowda A. Hepatitis awareness among the general public in Cameroon: A survey study. International Journal of Innovation and Applied Studies. 2014 Sep 1;8(3):1370.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Hepatitis B, Limbe health district, Bota, Mile 1, Hepatitis B surface antigen","lastPublishedDoi":"10.21203/rs.3.rs-8419750/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8419750/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground\u003c/p\u003e\n\u003cp\u003eHepatitis B is a virus that attacks the liver and can cause both acute and chronic disease. The virus is most commonly transmitted from mother to child during birth, as well as through contact with infected human blood, being pricked with a contaminated needle, intimate contact with an infected person, oral, vaginal and anal sex and using a razor or any other personal item with remnants of infected fluid. Many people still leave with ignorance about this viral infection which leads to many deaths. This is therefore a major public health problem. This cross-sectional hospital-based study was carried out from April to June 2020 and participants were administered an open-ended questionnaire asking what they know about the risk factors and how they can prevent this viral infection. We collected blood samples from each participant and these samples were screened for the presence of HBsAg using a one-step commercial test strip. The questions answered by participants were graded using 1 as good knowledge 0.5 as intermediate knowledge and 0 as poor knowledge. Children age 0-14 years were considered as not knowledgeable. We observed that participants were affected with this virus despite having good, intermediate or poor knowledge and children age 0 to 14 who were considered not knowledgeable were still affected suggesting mother to child transmission. A greater Proportion of people where between 18-40 years (204 I.e. 68%) and the most affected aged group with 74 cases (36.27%). the most affected area was Mile 1, with 31(37.80%) cases from 82 participants and Bota with 25 (27.77%) cases from 90 respectively. Among the 300 participants 199 participants were negative for HBsAg and 101 participants were positive for HBsAg given a prevalence of 36.66%.\u003c/p\u003e","manuscriptTitle":"Assessment of HBsAg, Prevalence, Knowledge of Risk Factors and Prevention of Hepatitis B Infection among Patients Attending the Limbe Health district","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-30 00:59:34","doi":"10.21203/rs.3.rs-8419750/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"60069e5d-7845-4310-bb7e-f64be46f791c","owner":[],"postedDate":"December 30th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-12-31T16:30:03+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-30 00:59:34","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8419750","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8419750","identity":"rs-8419750","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}