Ssendegeya Asuman

 THE AWARENESS AND VACCINATION STASUS OF HEPATISIS B AMONG PRIMARY SCHOOL TEACHERS IN KAMPALA DISTRICT. BY MPENDO COSMAS 14/U/9300/PS NAKIMBUGWE HARRIET 14/U/11411/PS SSENDENGEYA ASUMAN 14/U/1169 EJANU ANTHONY 14/U/243 RESEARCH PROPORSAL SUBMITTED TO THE DEPARTMENT OF SCIENCE TECHNICAL AND VOCATIONAL EDUCATION AT THE COLLEGE OF EDUCATION AND EXTERNAL STUDIES IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE A WARD OF A DEGREEE OF BACHELOR OF SCIENCE WITH EDUCTION OF MAKERERE UNIVERSITY. CHAPTER ONE INTROTRODUCTION 1.0 Overview This chapter presents the following; background of the study, statement of the problem, purpose of the study, objectives of the study, research questions, scope of the study, ethical considerations while in the study and significance of the study. 1.1 Back ground of the study Awareness is the ability to directly know and perceive, to be conscious of the event, objects thoughts, emotions or sensory patterns. However, awareness is closely related to the knowledge but knowledge differs from awareness in that; Knowledge is the information, understanding and skills that an individual gains through education or experience. Awareness highlights the current trends of disease, policies on disease and gives direction to the future. This can lead to behavior modification in the community and more funding from the government and National Government Organization (NGOs) towards the prevention of the disease. There is need to create awareness about a disease in order to formulate effective guidelines and policies to easily prevent the spread of diseases. On part of the government, awareness about the prevalence of disease in a country to develop vaccination programs of the disease among the population who are at high risk of infection. Vaccination is the only single most important disease control measure (Johns Hopkins Bloomberg School of Republic Health, 2006) The virus interferes with the function of the liver and causes pathological damage. Hepatitis B (HBV) is spread by contact with blood/body fluid of an infected person. HBV is 50-100 times more infectious than HIV. A number of factors influence awareness which may include; the level of education of an individual which increases with increase in awareness, development of media also increases awareness, awareness is promoted by higher level literacy. The world health organization (2016) defines Hepatitis B as a viral infection that attacks the liver and cause both acute and chronic diseases Hepatitis Virus (HBV) infection is a global public health problem. It is estimated that approximately 2 billion people worldwide have evidence of past or present infections of hepatitis B and 245 million individuals are chronic carriers. The overall prevalence of HBV is reported to be 3.6% however it varies depending upon the geographical area. There are approximately 50 million chronic carriers of hepatitis B Virus in Africa with 25% mortality risks (WHO, 2016) Worldwide 2 billion people are exposed to hepatitis B infection, 350 million people have chronic infection, and 65 million in the sub-Saharan Africa .Uganda is highly endemic with 10% national prevalence of hepatitis B infection, rates varying across the country from 4% in the south west and 25% in the north east. Uganda I one of the countries with the highest prevalence in the world. HBV is estimated to be 10 times more deadly than HIV/AIDS. The highest rates of infection are in Karamoja region (23.9%), Northern Uganda (20%), West Nile (18.5%) and Western region (10%). In 2002, the Uganda National Expanded Program of Immunization (UNEPI) was introduced with the strategy of hepatitis B Vaccination as one of the world health organization strategies in response to control of hepatitis B Prevalence among sub Saharan countries. (Ochola etal. 2013). 1.2 Statement of the study According to the world health organization (2015), Uganda is one of the countries in sub-Saharan Africa endemic for hepatitis B with a 10% national prevalence. Hepatitis B is life threatening and according to a survey carried out in Mulago hospital, the virus is responsible for 80% of the liver cancer infections. Majority of the people in Uganda have little awareness and knowledge about the virus. The high prevalence of hepatitis B can largely be attributed to low levels of vaccination in the country. 1.3 Objectives of the study To establish the level of awareness and vaccination status among primary school teachers in Kampala district. To establish the level of awareness of hepatitis B among primary school teachers in Kampala district. To establish the level of vaccination status of hepatitis B among primary school teachers in kampala district. 1.4 Research questions The study is meant to answer the following questions; i) To what extent are primary school teachers aware of hepatitis B virus. ii) To what extent are primary school teachers vaccinated. 1.5 Scope of the study The study is meant to target only primary school teachers (about hundred) in Kampala whether they are aware of hepatitis B and their immunization status. Teachers from which to get information are to be selected randomly from the school population. The number will be able to provide unbiased information and minimize errors that can arise from small population. 1.6 Significance of the study The findings from this study will be relevant and will benefit the following categories of people: Teachers Through the conclusions that will be drawn, the teachers will be made aware of the effects of hepatitis B virus and therefore the importance of vaccination against hepatitis B virus. The research will help teachers to screen and pass over the preventive measures to children at high risk of hepatitis B Community This includes parents, guardians and the general public. Since the school is a public (for the general community) institution, the public can get information from teachers and therefore this research will enable them to seek for vaccination against hepatitis B. They will get to know how they can get access to vaccination against hepatitis B virus. Researchers Researchers will use this information gathered in this study to boost their own findings. 1.7 Review This chapter has been describing the general topic and the main ideas about the awareness and vaccination of hepatitis B. Since its wide spread in Uganda, the hepatitis B vaccine has become an essential part of the immunization program and is a key component of global hepatitis B control program for the World Health Organization(WHO). CHAPTER TWO LITERATURE REVIEW 2.0 Over view. This chapter presents relevant literature on the awareness and vaccination status of HBV. It discusses the hepatitis B vaccine and importance of vaccination. It discusses the awareness and vaccination status of HBV worldwide, Africa and Uganda. 2.1 Hepatitis B vaccine and importance of vaccination. Despite the vast population of infected people. Effort to prevent and control Hepatitis B virus has met with increased level of success and hold promise for large reduction in disease burden in the future. Hepatitis B virus vaccine is now one of the most widely used vaccine in the world .Where the vaccine has been used effectively, signs that hepatitis B related sequelea will be significantly reduced as vaccinated population age. (Hoplans, J., 2006). According to Adam S. and Janice H. (2014), safe and effective Hepatitis B vaccine has been available since 1982 and the implementation of mass immunization programme has been recommended by the world health organization (WHO) since 1991 prevention is focused on vaccination of groups at risk and including at this risked are people working in public and community centers like schools and hospitals. According to the national serosurvey, 2009, HBV vaccine was introduced in Uganda in 2002 as part of the expanded programme on immunization (EPI) and given at 6, 10, and 14 weeks of age. 2.2 Hepatitis B awareness and vaccination status World wide Prevention is the only safe strategy against high prevalence of viral hepatitis B and hence having enough knowledge, awareness and mode of infection as well as adequate vaccinating of hepatitis B may reduce the rate of infection and also prevent the rate of hepatitis B transmission. (Olusegun et. al 2015). Approximately 60% of the world’s population lives in areas where HBV infection is highly endemic, including China (total population, 1.3 billion), Indonesia (222 Million), Nigeria (132 million), and much of the rest of Asia and Africa (57) A number of studies have assessed awareness and knowledge about HBV among American people of immigrants (API) population including Vietnamese Cambodian, Korean and Chinese Americans who are known to have a high prevalence of chronic Hepatitis B population than the general United states (US ) population ( Hwang et al. 2008). Among the Vietnamese America about 64% had never heard about hepatitis B vaccine (Ma et al. 2007) and most were un informed about the route of Hepatitis B transmission ( Taylor et al. 2002). In communities of low social economic status, less than 10% had been vaccinated for Hepatitis B and 25% knew that chronic infection is life long and incurable (Taylor et al. 2002). Among Chinese America, less than half have been vaccinated (Thompson et al. 2002), up to 53% believed that Hepatitis B can transmitted through contaminated food (Wu et al. 2007), up to 61% were unaware that chronic Hepatitis B is typically a symptomatic and 46% believed that there is a curative for chronic hepatitis B (Wu et al. 2007), about 65% of those who were chronically infected were un aware of their infection status (Lin et al. 2007). 2.3 Hepatitis B awareness and vaccination status in Africa By 2005, 28(61%) countries of the world Health Organization African regions reported using the Hepatitis B vaccination (http://www. Who , int/ bulletin) The percentage of vaccination ranged from 8% in Nigeria to 100% in sao Tome. However, most countries that introduced the vaccine had achieved coverage of 60% or higher. A study was carried out in Makurdi communities Benue states in Nigeria to assess the level of awareness showed that 81% of the population heard about Hepatitis B and only 18.9% have never heard about Hepatitis B. And across the sexes 78.9% of female and 82% of the male had information about Hepatitis B with only 34.9% aware that Hepatitis B can be transmitted during breast feeding and 43.8% of the population were informed that the Hepatitis B is transmitted through sexual contact (Odimayo et al. 2015). Studies carried out among health care workers in Sudan and morocco reviewed that most of them had a good knowledge of blood as a medium of infection but lacked adequate vaccine coverage. (Djerir et al. 2008). Studies carried out in among health care workers Nigeria show a high level of HBV awareness and low vaccination coverage. In north and central Nigeria, 48% completed their HBV vaccination with an awareness level of 92%. The reason between the level of awareness and vaccination in the study was due to lack of opportunity and forgetting to be vaccinated (Okeke et al. 2008). In south geopolitical zone of Nigeria, Keiseme et al. 2011 reported an 87% awareness level but only 27% vaccination coverage. 2.4 Hepatitis B awareness and vaccination status in Uganda A national task force for Hepatitis B has not been established, yet this is very important in steering awareness campaign at the national, regional, and district level, the people who commonly serve as resources for raising awareness about issues in communities, health workers, politicians cultural and religious leaders themselves have little factual information on viral hepatitis B. National Booklets developed for health education have not been translated into local languages for information dissemination. Hepatitis B activities at various levels is still poor in regard to resource mobilization and awareness raising. There is a need for collaboration at the international level and for engaging government to continue to provide leadership to address this problem. (Action for rural transformation (ART) 2013). Edit, CHAPTER THREE METHODOLOGY 3.0 Introduction/over view This chapter presents the procedures which were used in conducting the study. The chapter is organized in the following sub-headings: research design, location of the study, target population, sample, sampling techniques, research instruction, data collection procedures, data analysis techniques and review. 3.1 Research design This study will be employ descriptive survey design to establish the level of awareness and vaccination status of primary school teachers. Mugenda and Mugenda (1999) observed that survey design is the best method available to social scientists who are interested in collecting original data for the purpose of describing a population which is too large to observe directly. 3.2 Location of the study. This study will be carried out in Kampala District, Uganda. The District is mainly urban. The choice of the District will be determined by accessibility and familiarity of the locality to the researchers which will make it easy to develop immediate rapport with the respondents hence making data collection easy. The researchers also found the location quite accessible. Best (1993) argues that since research requires careful thoughts, a number of practical factors including accessibility and cost factors become legitimate considerations. 3.3 Target population Orodho, (2005) considers a target population to be a set of elements that the researchers focusses upon and which the results obtained by testing the sample should be generalized. From these premises the target population for this study will be ten (10) public primary schools in Kampala District. Respondents will both be male and female in all visited schools. 3.4 Sample From the ten (10) sampled schools a sample of hundred (100) teachers will be randomly selected. Gay (2003) suggests that 10% of the accessible population is adequate to serve as a study sample. 3.5 Sampling techniques The study will proportionately sample hundred (100) respondents from ten (10) selected primary schools. Ten (10) teachers will be selected from each school. The teachers will also include student teachers, if any. 3.6 Research instruments The study will use questionnaires and interviews. 3.6.1 Questionnaires These will be developed for both student teachers and experienced teachers picked at random from the school teacher population which will be visited to obtain quantitative and qualitative data. They will comprise different sets of both closed-ended and open-ended questions. This will be preferred because it will enable a large amount of information to be collected within a short time. Bailey (1987) asserts that open ended questions give freedom of expression to the respondents and will encourage validity of responses. 3.6.2 Interviews Interviews will also be used by the researchers, the information that will be obtained from the interviews will help the researchers discover the awareness of teachers on HBV. 3.7 Data collection procedure The researchers will obtain an introductory letter from the Head of Department Science, Technical and Vocational Education. The permission to carry out the study in schools will be obtained from the authorities (school administration). The researchers will self- administer the questioners to each of the respondents and will then be given ample time of 10 minutes to respond to the questions. This will ensure achievement of a good return ratio and help respondents get a chance to seek clarification on the items which prove difficult. The respondents will be assured of confidentiality and then the records of the study will be kept for references during analyses, the names of schools sampled will not be presented for confidentiality purposes. 3.8 Data analysis technique The data will be processed using Microsoft excel. Graphs, pie charts and percentages will be used to present data. They will be then presented in statistical data. Qualitative data concerning the views of teachers will be recorded and expressed in a frequency tables to show their trends. CHAPTER FOUR PRESENTATION, ANALYSIS AND INTERPRETATION OF RESEARCH FINDINGS. 4.0 Introduction The purpose of this study was to establish the awareness, of, and vaccination status against hepatitis B of primary school teachers in Kampala district, Uganda. The findings of the study were as presented in the following sections in which data analysis, presentations and discussions were based on the objectives of the study. 4.1 Characteristic Category Frequency Percentage (%) Sex Female Male- Marital status Single Married - Age group- and above- Teaching experience Less than 5 years 5-10 years 11-20 years Above 20 years- 4.2 Objective one Statement Yes No F % F % Heard of hepatitis B - Is hepatitis B preventable?- Is hepatitis B curable?- Should hepatitis B patients be allowed to work?- Statement Item F % Source of information Radio Television News paper Hospital Others - Ideal age for vaccination Infancy Youth Adulthood No ideal age- Mode of spread Blood transfusion Sexual intercourse Mother to baby Food Physical contact with infected person- Risk factors Smoking Alcohol Piercing and tattoos Blood transfusion Eating contaminated food Drinking contaminated drinks Dental visits. -l 4.3 Objective two Statement yes No F % F % Tested for hepatitis B- Diagnosed with any liver disease- Vaccinated against hepatitis B- Statement item F % Source of vaccination Public hospital Private hospital Clinic others- number of doses vaccinated one two three- When did you get the last dose 3 months back 6 months back 9 months back More than a year back- AWARENESS OF HEPATITS B For questions 1 to 5 tick in the box 1.) What is your gender? Male female 2.) Which of the following age groups do fall in? A 20-30 B 31-40 C 41-50 D 50 and above 3.) For how long have you been teaching primary school? A less than five years B between 5-10 years C between 11 – 20 years D above 20 years 4.) What is your marital status? A) married B) single 5.) Have you ever heard of hepatitis B? A) Yes B) No 6.) If yes, where did you get the information? A) Radio B) Television C) News papers D) Hospital E) Others …………………………………….. 7.) Is hepatitis B preventable or not? YES NO 8.) Does hepatitis B Vaccination protect against HBV infection? YES NO 10.) Is hepatitis B curable or not? YES NO 11.) What is the ideal age for vaccination? i) Infancy ii) Youth iii) Adult hood 12.) Should Hepatitis B patients allowed to work? YES NO 13.) What is the mode of spread of Hepatitis B? A) Transfusion of blood B) Sexual intercourse C) Mother to her baby D) Food E) Physical contact with the person with Hepatitis B F) Saliva 14.) What are the risk factors that may be the cause of Hepatitis B? A.) Smoking B.) Alcohol C.) Piercing and tattoos D.) Blood transfusion E.) Dental visits F.) Eating from contaminated food G.) Drinking from contaminated drinks 15.) Have you ever been tested for hepatitis B? YES NO NO 18.) Have you ever been diagnosed with any liver disease before? Yes NO 16.) Have you ever been vaccinated against Hepatitis B? YES NO 17) If yes, from where? A Hospital I) public hospital (ii) private hospital B Clinic C Others …………………………………………………………. 19) How many doses have been vaccinated? A One B Two C Three 20 When did you get your last dose? Month ……………………………………… Year……………………………………………………….