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Olakunde BO, Itanyi IU, Onyeka TC, Paintsil E, Torpey K, Lasebikan N, Chigbu CO, Ezeanolue EE. Hepatitis B vaccine birth dose coverage among hepatitis B-exposed and hepatitis B-unexposed infants: evidence from the Healthy Beginning Initiative program in Benue State, Nigeria. Pan Afr Med J 2024; 47:67. [PMID: 38681098 PMCID: PMC11055182 DOI: 10.11604/pamj.2024.47.67.40466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 01/16/2024] [Indexed: 05/01/2024] Open
Abstract
Introduction Nigeria offers universal hepatitis B birth-dose vaccine (HepB-BD) for the prevention and control of hepatitis B (HepB). While prior studies suggest low coverage of HepB-BD in Nigeria, there is a paucity of evidence on the association between the uptake of HepB-BD and maternal HepB status. This study aimed to determine HepB-BD coverage and the associated factors among infants of HepB-positive and -negative women in Nigeria. Methods the study was a secondary analysis of data from the Healthy Beginning Initiative program conducted between June 2016 and October 2018 in Benue State, Nigeria. The analysis was restricted to data from a cohort of 6269 mothers who had HepB screening during pregnancy and completed the HepB infant immunization question in the post-delivery survey. The association between the coverage of HepB-BD and maternal HepB status, sociodemographic characteristics, and obstetric factors were determined using crude and adjusted relative risks. Results about 10% of the women tested HepB positive. The coverage of HepB-BD was 64% (63.2% among infants of HepB-positive mothers and 63.8% among HepB-negative mothers). The likelihood of infants of HepB-positive mothers receiving HepB-BD was not significantly different from infants of HepB-negative mothers (aRR=0.97, 95%CI= 0.92-1.04). Among HepB-positive mothers, infants of mothers younger than 20 years (aRR=1.49, 95%CI=1.03-2.16) or those who received antenatal care (aRR=1.41, 95%CI=1.16-1.71) were more likely to receive HepB-BD, while mothers with no previous pregnancies (aRR=0.73, 95%CI=0.59-0.91) were less likely to receive HepB-BD. Among HepB-negative mothers, infants of less-educated mothers were less likely to receive HepB-BD (aRR=0.96, 95%CI=0.92-0.99), whereas infants of mothers who received antenatal care (aRR=1.23, 95%CI=1.16-1.31) or had an institutional delivery were more likely (aRR=1.29, 95%CI=1.23-1.36) to receive HepB-BD. Conclusion: our findings highlight the need to improve HepB-BD uptake, particularly among HepB-exposed infants who are at risk of perinatal transmission of HepB.
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Affiliation(s)
- Babayemi Oluwaseun Olakunde
- Department of Community Prevention and Care Services, National Agency for the Control of AIDS, Abuja, Nigeria
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Ijeoma Uchenna Itanyi
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Community Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Tonia Chinyelu Onyeka
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Anesthesia/Pain and Palliative Care Unit, College of Medicine, University of Nigeria, Nsukka, Nigeria
| | - Elijah Paintsil
- Department of Pediatrics, Yale School of Medicine, New Haven, CT 06510, USA
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT 06510, USA
- Department of Pharmacology, Yale School of Medicine, New Haven, CT, USA
| | - Kwasi Torpey
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Nwamaka Lasebikan
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Radiation Medicine, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Chibuike Ogwuegbu Chigbu
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
| | - Echezona Edozie Ezeanolue
- Center for Translation and Implementation Research, University of Nigeria, Nsukka, Enugu, Nigeria
- Department of Paediatrics, College of Medicine, University of Nigeria, Nsukka, Enugu, Nigeria
- Healthy Sunrise Foundation, Nevada, USA
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Lanyo TN, Adjei CA, Ani-Amponsah M. Informational and Practical Needs of Expectant Mothers with Chronic Hepatitis B in Ghana. SAGE Open Nurs 2024; 10:23779608241255183. [PMID: 38828400 PMCID: PMC11141223 DOI: 10.1177/23779608241255183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 03/24/2024] [Accepted: 04/28/2024] [Indexed: 06/05/2024] Open
Abstract
Hepatitis B virus infection is a global public health problem with disproportionately high endemicity in Africa and Ghana. The current national prevalence of hepatitis B among pregnant women in Ghana stands at 7.44%, highlighting the considerable threat of chronic hepatitis B on pregnant women and their general well-being. The study explored the informational and practical needs of pregnant women with chronic hepatitis B in Ghana. Fourteen pregnant women were selected purposefully using the exploratory descriptive qualitative design. Data were analyzed using thematic analysis. The findings showed that pregnant women with chronic hepatitis B lacked knowledge about the infection and were in great need of hepatitis B-related information. The study also revealed significant financial implications for treating the infection, necessitating policy reforms and stakeholder actions. To achieve effective coping, better health-seeking, and health-promoting behaviors for better health outcomes, it is crucial to provide targeted care that comprehensively covers the specific needs of pregnant women with chronic hepatitis B. It is also essential to consider including hepatitis B management in the National Health Insurance package to improve care quality.
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Affiliation(s)
- Theresa Norpeli Lanyo
- Department of Women and Children, University of Ghana Medical Centre, Accra, Greater Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana, School of Nursing and Midwifery, Legon, Greater Accra, Ghana
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Sanai F, Alkhatry M, Alzanbagi A, Kumar S. Hepatitis B virus infection in Saudi Arabia and the UAE: Public health challenges and their remedial measures. J Infect Public Health 2023; 16:1410-1417. [PMID: 37482014 DOI: 10.1016/j.jiph.2023.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 06/02/2023] [Accepted: 07/17/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Hepatitis B virus (HBV) infection is a major public health concern globally with higher prevalence in Middle Eastern countries. Both Saudi Arabia and the UAE face critical challenges in HBV treatment and management despite the implementation of a mass vaccination program. This review aimed to understand the gaps and unmet needs related to HBV infection, public health challenges associated with its diagnosis, and treatment barriers in Saudi Arabia and the UAE. Additionally, the review aimed to provide the best practices in the HBV care pathway for effective remedial measures and disease reduction. METHODS The literature search was done from Pubmed. RESULTS The lack of disease awareness and knowledge about disease transmission among patients and their family members and healthcare professionals, lack of proper screening, underdiagnosis, social stigma, lack of established referral system, and treatment cost are the primary barriers to HBV diagnosis and management. CONCLUSION Appropriate healthcare initiatives should be undertaken to lower the disease burden in Saudi Arabia and the UAE.
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Affiliation(s)
- Faisal Sanai
- Liver Disease Research Centre, College of Medicine, King Saud University, P.O. Box 22480, Riyadh 11495, Saudi Arabia; Gastroenterology Unit, Department of Medicine, King Abdulaziz Medical City, P.O. Box 9515, Jeddah 21423, Saudi Arabia.
| | - Maryam Alkhatry
- Department of GI Endoscopy, Ibrahim Bin Hamad Obaidullah Hospital, Ras Al Khaimah, United Arab Emirates
| | - Adnan Alzanbagi
- Department of Gastroenterology and Hepatology, King Abdullah Medical City, Makkah, Saudi Arabia
| | - Shiva Kumar
- Department of Gastroenterology and Hepatology, Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates
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YENDEWA GA, SELLU EJ, KPAKA RA, JAMES PB, YENDEWA SA, CUMMINGS PE, BABAWO LM, MASSAQUOI SP, GHAZAWI M, OCAMA P, LAKOH S, BABAWO LS, SALATA RA. Measuring stigma associated with hepatitis B virus infection in Sierra Leone: Validation of an abridged Berger HIV stigma scale. J Viral Hepat 2023; 30:621-629. [PMID: 37084170 PMCID: PMC10330123 DOI: 10.1111/jvh.13838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 04/08/2023] [Indexed: 04/22/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included four additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant, and construct validity. Exploratory factor analysis produced a three-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (six items), negative self-image (two items), and disclosure concerns (two items). Overall, 72.8% of respondents reported perceived HBV-related stigma (mean score 29.11 ± 4.14) and a similar proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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Affiliation(s)
- George A. YENDEWA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Edmond J. SELLU
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
| | - Rashid A. KPAKA
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Peter B. JAMES
- Faculty of Health, Southern Cross University, Lismore, Australia
| | | | | | - Lawrence M. BABAWO
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | | | | | - Ponsiano OCAMA
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Sulaiman LAKOH
- Ministry of Health and Sanitation, Freetown, Sierra Leone
- Department of Medicine, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
- Connaught Hospital, University of Sierra Leone Teaching Hospitals Complex, Freetown, Sierra Leone
| | - Lawrence S. BABAWO
- Department of Nursing, School of Community Health Sciences, Njala University, Bo Campus, Sierra Leone
- Department of Public Health, Faculty of Health Sciences and Disaster Management, Eastern Technical University, Kenema, Sierra Leone
| | - Robert A. SALATA
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Drysdale K, Persson A, Smith AKJ, Wallace J, Valentine K, Gray RM, Bryant J, Hamilton M, Newman CE. Professional perspectives on serodiscordant family service provision in the context of blood-borne viruses. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2023; 32:145-160. [PMID: 35980804 DOI: 10.1080/14461242.2022.2110922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 08/03/2022] [Indexed: 05/18/2023]
Abstract
In recognition of the broader relational aspects of viral infections, family support is considered important when someone is diagnosed with a blood-borne virus (BBV), such as HIV, hepatitis C (HCV) and hepatitis B (HBV). However, families' own support needs are often not a priority in service provision within the BBV sector. In this article, we draw on qualitative interviews with 20 key informants working in various professional capacities in health, social policy, care and advocacy sectors in Australia, and explore their experiences and perspectives on family inclusivity in their services. Overall, key informants acknowledged the diversity of what constitutes family, and consistently viewed family engagement as beneficial to both diagnosed individuals and the wider familial networks affected by a diagnosis. However, prioritising individual care in support services presented barriers to engaging families, which are further complicated by the role of stigma in shaping the social realities of living with a BBV. Increasing understanding in service provision settings that serodiscordance can be a family experience has the potential to widen this analytic lens to consider the support needs of families in their own right.
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Affiliation(s)
- Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | | | - Kylie Valentine
- Social Policy Research Centre, UNSW Sydney, Sydney, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
| | - Myra Hamilton
- Centre of Excellence in Population Ageing Research, Work and Organisational Studies, University of Sydney, Sydney, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, Australia
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6
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Yendewa GA, Sellu EJ, Kpaka RA, James PB, Yendewa SA, Cummings PE, Babawo LM, Massaquoi SP, Ghazawi M, Ocama P, Lakoh S, Babawo LS, Salata RA. Measuring Stigma Associated with Hepatitis B Virus Infection in Sierra Leone: Validation of an Abridged Berger HIV Stigma Scale. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.02.17.23286086. [PMID: 36824916 PMCID: PMC9949200 DOI: 10.1101/2023.02.17.23286086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Stigma associated with hepatitis B virus (HBV) is common in endemic countries; however; instruments are lacking to accurately measure HBV-related stigma. We therefore aimed to develop and validate a concise instrument for measuring perceived HBV-related stigma in Sierra Leone. We enrolled 220 people living with HBV (PWHB) aged ≥ 18 years from August to November 2022. The initial Likert-scale instrument entailed 12 items adapted from Berger's HIV Stigma Scale. We included 4 additional items adapted from the USAID indicators for enacted stigma. The proposed scale's psychometric properties were assessed. After item reduction, the final HBV Stigma Scale consisted of 10 items and had good internal consistency (overall Cronbach's α = 0.74), discriminant and construct validity. Exploratory factor analysis produced a 3-dimensional structure accounting for 59.3% of variance: personalized stigma driven by public attitudes (6 items), negative self-image (2 items), and disclosure concerns (2 items). Overall, 72.8% of respondents reported perceived HBV stigma (mean score 29.11 ± 4.14) and a similar a proportion (73.6%) reported at least one instance of enacted stigma. In assessing criterion-related validity, perceived HBV-related stigma correlated strongly with enacted stigma (r = 0.556) and inversely with having family/friends with HBV (r = -0.059). The 10-item HBV Stigma Scale demonstrated good internal consistency and validity and is suitable for screening for HBV-related stigma in Sierra Leone. The psychometric properties of the scale can be optimized with item additions/modifications and confirmatory factor analysis. The scale may help in combating stigma as a barrier to achieving HBV global elimination goals.
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Adjei CA, Suglo D, Ahenkorah AY, MacDonald SE, Richter S. Barriers to Timely Administration of Hepatitis B Birth Dose Vaccine to Neonates of Mothers With Hepatitis B in Ghana: Midwives' Perspectives. SAGE Open Nurs 2023; 9:23779608231177547. [PMID: 37261100 PMCID: PMC10227873 DOI: 10.1177/23779608231177547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 04/22/2023] [Accepted: 05/06/2023] [Indexed: 06/02/2023] Open
Abstract
Background The global health sector strategy on viral hepatitis aims to reduce new hepatitis B infections by 90% by 2030. Yet, hepatitis B birth dose (HepB-BD) vaccination, which is effective in preventing mother-to-child transmission of hepatitis B, remains low in sub-Saharan Africa. Given the essential role that midwives play in infants' birth dose immunisation, we explore their perspectives on the reasons for delays and non-administration of HepB-BD to eligible neonates in Ghana. Methods We conducted interviews with 18 midwives, stratified by region (Greater Accra and Northern regions). Participants were selected purposively. The data were transcribed, coded, and analysed following the Braun and Clarke data analysis procedure. Results The participants conveyed a broad range of barriers to HepB-BD vaccination in Ghana. These include the mother's denial of hepatitis B seropositivity; the mother's ignorance of the impact of hepatitis B on their newborn; partners' non-involvement in post-test counselling; and the high cost of hepatitis B immunoglobulin and hepatitis B monovalent vaccine. Other reasons included vaccine unavailability and midwives' oversight and documentation lapses. Conclusion We recommend educating expectant mothers on the importance and effectiveness of HepB-BD vaccination during antenatal care (ANC) visits, as well as educating midwives on HepB-BD vaccination procedures. In addition, ensuring sufficient supplies and administering hepatitis B vaccines in the delivery ward should be done to guarantee that babies receive the vaccines on time. Importantly, Ghana needs policies that require HepB-BD vaccination as part of the Expanded Programme on Immunisation (EPI) to ensure the investments and funding it needs.
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Affiliation(s)
| | | | | | | | - Solina Richter
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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8
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Mitchell T, Nayagam JS, Dusheiko G, Agarwal K. Health inequalities in the management of chronic hepatitis B virus infection in patients from sub-Saharan Africa in high-income countries. JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 5:100623. [PMID: 36636709 PMCID: PMC9829705 DOI: 10.1016/j.jhepr.2022.100623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
Chronic hepatitis B virus disproportionately affects migrant communities in high-income countries, reflecting increased migration from sub-Saharan Africa. Chronic hepatitis B virus is endemic in sub-Saharan Africa, yet the natural history of chronic infection experienced by patients remains incompletely understood, with evidence of variability across genotypes and regions within sub-Saharan Africa. Clinical guidelines recommending treatment thresholds are not specific to sub-Saharan African patients and are based on natural history studies from Western Pacific Asian countries. Access to standard of care treatment is available for sub-Saharan African people with chronic hepatitis B virus infection in high-income countries; however, the evidence base for these treatments was not established in this cohort and areas of uncertainty remain, particularly regarding HCC surveillance and treatment discontinuation. Participation in phase III clinical trials for chronic hepatitis B therapies is almost non-existent amongst sub-Saharan African patients, even when residing in high-income countries that participate in multicentre trials. Engagement with sub-Saharan African patients with chronic hepatitis B in high-income countries is challenging because of the stigma associated with the diagnosis, absence of routine screening systems and the complexities involved in navigating the healthcare system. Nonetheless, improved engagement is critical if we are to achieve global hepatitis B virus elimination.
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Affiliation(s)
- Tim Mitchell
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Gastroenterology and Hepatology Department, Royal Perth Hospital, Perth, Australia,Corresponding author. Address: Gastroenterology and Hepatology Department, Level 8 A Block, Royal Perth Hospital, 197 Wellington Street, Perth, Western Australia 6000, Australia; Tel.: +61 8 9224 2179.
| | - Jeremy S. Nayagam
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,Department of Inflammation Biology, King’s College London, London, UK
| | - Geoffrey Dusheiko
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom,University College London Medical School, London, UK
| | - Kosh Agarwal
- Institute of Liver Studies, King’s College Hospital, London, United Kingdom
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9
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Individuals' Perceptions of Liver Cirrhosis. Gastroenterol Nurs 2022; 45:410-418. [DOI: 10.1097/sga.0000000000000683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
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Jin D, Brener L, Treloar C. Hepatitis B-related stigma among Chinese immigrants living with hepatitis B virus in Australia: A qualitative study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e5602-e5611. [PMID: 36068665 PMCID: PMC10086810 DOI: 10.1111/hsc.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 07/05/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Chinese immigrants in Australia are overrepresented among people with chronic hepatitis B virus (PWCHB) but experience poor access to healthcare. Given the historical discriminatory policies against PWCHB in mainland China, this study aimed to explore the lived experiences of stigma and discrimination surrounding hepatitis B virus (HBV) among Chinese immigrants originally from mainland China. Semi-structured in-depth interviews were conducted by a researcher with a Chinese background in 2019-2020. Sixteen Chinese immigrants living with HBV were recruited across Sydney and Melbourne through advocacy and support groups. This study is positioned in social constructionism. Data analysis was informed by the Health Stigma and Discrimination Framework that highlights the interaction between layered stigmas. This study revealed the historical, social and cultural construction of HBV-related stigma among PWCHB and demonstrated how this stigma was manifested across socioecological levels in China and Australia. Findings show that HBV-related stigma has mostly been driven by knowledge deficits about HBV and fear of HBV infection. HBV-related stigma was mostly demonstrated around social isolation including isolation imposed by family and the community and employment restrictions in the Chinese workplace. In the Australian context, HBV-related stigma was related to the ethnic and cultural background of PWCHB, and primarily occurred as anticipated stigma in the community and in employment. The findings provide significant insights for crosscutting research and policy endeavours to develop and test cross-disciplinary initiatives that more broadly address the complex lived realities of Chinese immigrants living with hepatitis B virus.
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Affiliation(s)
- Defeng Jin
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Loren Brener
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
| | - Carla Treloar
- Centre for Social Research in Health, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
- Social Policy Research Centre, Faculty of Arts, Design and ArchitectureUniversity of New South WalesSydneyNew South WalesAustralia
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Lanyo TN, Ani-Amponsah M, Adjei CA. Challenges and ways of coping of parturient women with chronic hepatitis B in Ghana during COVID-19 pandemic: a qualitative inquiry. BMJ Open 2022; 12:e062557. [PMID: 36283752 PMCID: PMC9606735 DOI: 10.1136/bmjopen-2022-062557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To explore the psychosocial concerns and ways of coping of pregnant women with chronic hepatitis B infection in Ghana. SETTING Participants were selected from public health facilities in the Tema Metropolis. DESIGN Exploratory descriptive qualitative design was employed. PARTICIPANTS Fourteen pregnant women were purposively selected to participate in face-to-face interviews. The data were analysed using the content analysis procedure. RESULTS The participants' psychosocial concerns and coping strategies were diverse. A significant number of the participants were concerned about the impact their hepatitis B seropositivity would have on their relationships, finances, and general well-being. Specifically, they feared that their social network, especially their spouses, would perceive them as having led a promiscuous lifestyle in the past to acquire hepatitis B infection. Also, fear of transmitting the infection to their infants and the effects of the infection on their infants later in life were identified as major concerns by nearly all participants. The participants further reported feelings of distress and diminished self-esteem. These psychosocial afflictions reported were attributed to lack of pre-test counselling during the antenatal care period. However, the participants coped using different strategies, including avoidance/denial, spirituality, and alternative treatment use. CONCLUSION To achieve optimal psychological and social well-being of pregnant women with chronic hepatitis B, it is important that their unique challenges are considered in their care and treatment cascade. Explicitly, protocols for supportive care addressing the specific needs of pregnant women with chronic hepatitis B should be implemented in the study setting.
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Affiliation(s)
| | - Mary Ani-Amponsah
- Department of Maternal and Child Health, University of Ghana School of Nursing, Accra, Ghana
| | - Charles Ampong Adjei
- Department of Public Health Nursing, University of Ghana School of Nursing, Accra, Ghana
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12
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Hou L, Zhang Y, Tang S, Tang X. The loss and return of self: An interpretative phenomenological analysis of coping and recovery from chronic hepatitis B in China. Nurs Health Sci 2022; 24:625-633. [PMID: 35670524 DOI: 10.1111/nhs.12963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 05/13/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022]
Abstract
Chronic hepatitis B (CHB) is a prevalent disease with various negative consequences. The lived experience of coping and recovery of a patient with Chronic hepatitis B was explored in this study. A semistructured interview was conducted with one participant who had been recovered from Chronic hepatitis B for 10 years. Data were analyzed using interpretative phenomenological analysis. Five superordinate themes emerged, including lingering in the shadow of death anxiety, diminished functioning of the self, adopting a highly disciplined lifestyle, receiving social support, and the return of the self with scars. The findings revealed that the disease is deeply associated with moral standing, which means the diagnosis of Chronic hepatitis B might imply a loss of moral face for Chinese people living with the condition. Our findings point to the need for increasing knowledge about chronic hepatitis B, decoupling the disease from a moral standpoint, and providing a supportive environment.
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Affiliation(s)
- Liqi Hou
- Department of Sociology, Peking University, Beijing, China
| | - Yansong Zhang
- School of Journalism, Fudan University, Shanghai, China.,Department of Media and Communication, City University of Hong Kong, Hong Kong SAR, China
| | - Suqin Tang
- School of Psychology, Shenzhen University, Shenzhen, China
| | - Xinfeng Tang
- Department of Psychology, Renmin University of China, Beijing, China
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13
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Kolbila L, Adjei CA, Kyei JM, Agyemang-Prempeh C, Fosu PK. Perceived Supportive Care Needs of Adolescents With Chronic Hepatitis B in a Resource-limited Setting. J Patient Exp 2022; 9:23743735221106596. [PMID: 35694016 PMCID: PMC9185008 DOI: 10.1177/23743735221106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In Ghana, adolescents are disproportionately affected by hepatitis B. However, studies
into adolescents’ supportive care needs are lacking. The purpose of this exploratory
qualitative study was to explore the supportive care needs of 18 adolescents with chronic
hepatitis B who were receiving care at a tertiary hospital in Ghana. The data were
processed using QSR Nvivo version 11.0 and analyzed using the Braun and Clarke procedure
for thematic data analysis. According to the findings, adolescents with chronic hepatitis
B have unmet supportive care needs ranging from information to financial need,
psychological support, and social support. Explicitly, participants reportedly had a
dilemma as to whether to keep or terminate their pregnancy to prevent transmission of the
virus to their newborns. Physicians and nurses were perceived to be preoccupied with
medication prescription and laboratory request writing rather than giving pretest and
posttest counseling following diagnosis. This study highlights the need to have a
tailor-made liver care for adolescents. Pretest and posttest counseling for adolescents
with hepatitis B are also required.
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Affiliation(s)
| | | | - Josephine M Kyei
- School of Nursing and Midwifery, University of Ghana, Accra, Ghana
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14
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Coste M, Badji MA, Diallo A, Mora M, Boyer S, Prah JJ. Applying the health capability profile to empirically study chronic hepatitis B in rural Senegal: a social justice mixed-methods study protocol. BMJ Open 2022; 12:e055957. [PMID: 35410929 PMCID: PMC9003616 DOI: 10.1136/bmjopen-2021-055957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Despite the early implementation of hepatitis B vaccination and the ongoing decentralisation of chronic hepatitis B (CHB) care, over 10% of the Senegalese adult population lives with CHB and liver cancer remains a main cause of death. Investigating factors associated with CHB infection, prevention of CHB-related morbidity, and prevention and treatment of mortality secondary to CHB calls for a holistic and multidimensional approach. This paper presents the adaptation of the health capability profile (HCP) to a specific epidemiological issue and empirical setting: it seeks to identify and analyse inter-related abilities and conditions (health capabilities) in relation to the CHB epidemic in the rural area of Niakhar, Senegal. METHODS AND ANALYSIS This ongoing study relies on a sequential social justice mixed-methods design. The HCP is comprehensively adapted to CHB in rural Senegal and guides the design and conduct of the study. Objective and subjective data are collected at the individual level following a mixed-methods explanatory core design. The quantitative module, embedded in the ANRS12356 AmBASS cross-sectional survey (exhaustive sampling), is used to select a purposeful sampling of participants invited for one-on-one qualitative interviews. Additional data are collected at the institutional and community level through health facility surveys and an ethnography (in-depth interviews) of local and national CHB stakeholders. Data analysis adopts a synergistic approach to produce a multilayered analysis of individual HCPs and crosscutting analysis of the 15 health capabilities. The data integration strategy relies on a mixed-methods convergent core design, and will use 0-100 health capability scores as well as flow diagrams to measure and characterise levels of development and interactions among health capabilities, respectively. ETHICS AND DISSEMINATION This study was approved by Senegalese and French authorities. Results dissemination through local workshops and scientific publications aim at fuelling effective policy change towards CHB-related health capability.
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Affiliation(s)
- Marion Coste
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
- Aix-Marseille University, CNRS, AMSE, Marseille, France
| | | | - Aldiouma Diallo
- Campus International IRD-UCAD de l'IRD, UMR VITROME, IRD-Université Aix Marseille, AP-HM, SSA, IHU-Méditerranée Infection, Dakar, Senegal
| | - Marion Mora
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Sylvie Boyer
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, ISSPAM, Marseille, France
| | - Jennifer J Prah
- School of Social Policy and Practice & Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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15
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Freeland C, Racho R, Kamischke M, Moraras K, Wang E, Cohen C, Kendrick S. Health-related quality of life for adults living with hepatitis B in the United States: a qualitative assessment. J Patient Rep Outcomes 2021; 5:121. [PMID: 34757456 PMCID: PMC8581088 DOI: 10.1186/s41687-021-00398-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 11/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In 2019, an estimated 296 million people were living with chronic hepatitis B virus (HBV) globally with approximately 2.4 million living within the United States. Those living with HBV require years if not decades of regular monitoring to prevent liver complications from occurring. The aim of this study was to explore the working conceptual framework of health related quality of life (HRQL) for those living with chronic HBV through qualitative analysis. METHODS Data were collected by in-depth telephone interviews conducted in 2019 using purposeful sampling as part of a disease understanding assessment on the HBV patient experience within the United States. A directed content analysis approach was utilized by creation of a codebook to guide the organization of data, codes were developed by review of the literature (a priori) and through line-by-line reading of a subsample of queries. All transcripts were analyzed by at least two members of the study team and intercoder reliability was assessed using Dedoose software. FINDINGS A sample of 19 individuals living with chronic HBV were included within this study. Themes identified from transcripts noted the significant overlap between the reported experience of HBV and constructs within the HRQL model. The psychological impact of chronic HBV on study participants' HRQL overall was considerable and contributed to depression, anxiety, homelessness, drug use, and incarceration. CONCLUSION Our analysis supports the hypothesis that HBV impacts HRQL and often negatively affects emotional health. Our findings suggest that it would be beneficial to include HRQL assessment in the medical management of HBV, so that interventions can focus on reducing the burden of disease and improving quality of life for those living with HBV.
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Affiliation(s)
- Catherine Freeland
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA.
| | - Rhea Racho
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Maureen Kamischke
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Kate Moraras
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Evangeline Wang
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
| | - Chari Cohen
- Hepatitis B Foundation, 3805 Old Easton Rd., Doylestown, PA, 18902, USA
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16
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Smith AKJ, Persson A, Drysdale K, Bryant J, Valentine K, Wallace J, Hamilton M, Gray RM, Newman CE. Family imaginaries in the disclosure of a blood-borne virus. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:1422-1436. [PMID: 34160829 DOI: 10.1111/1467-9566.13316] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/23/2021] [Accepted: 05/14/2021] [Indexed: 06/13/2023]
Abstract
Contemporary sociological work has emphasised that family is not static, but actively shaped by ideas of who and what makes family. Disclosure of an illness, including diagnosis of stigmatised infections such as HIV, hepatitis B virus and hepatitis C virus, can change the dynamics of family relationships. This paper draws on 61 qualitative semi-structured interviews conducted between 2017 and 2019 with people in Australia with one or more of these blood-borne viruses (BBVs) and their family members, to understand the experiences of serodiscordant (mixed viral status) families. Through a thematic analysis, we explore the family imaginaries that participants evoked when describing their disclosure practices in relation to (self-defined) family members, revealing how some participants disclosed in ways that enabled them to shape their family, to maintain boundaries between self and family or to protect family from distress. Participants' accounts of disclosure to family revealed imaginaries of family as a precious web of connections to be nurtured or protected, but also as sites of ambivalent belonging and complex history. We conclude that BBV disclosure practices within families reveal important ideas about families that are imagined in response to the threat of loss, change and stigma.
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Affiliation(s)
- Anthony K J Smith
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Asha Persson
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kerryn Drysdale
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
- Health Equity Research and Development Unit, UNSW Sydney, Sydney, New South Wales, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Kylie Valentine
- Social Policy Research Centre, UNSW Sydney, Sydney, New South Wales, Australia
| | - Jack Wallace
- Burnet Institute, Melbourne, Victoria, Australia
| | - Myra Hamilton
- Centre of Excellence in Population Ageing Research, University of Sydney, Sydney, New South Wales, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Christy E Newman
- Centre for Social Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
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17
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Exploring the social stressors and resources of husbands of women diagnosed with advanced breast cancer in their role as primary caregivers in Kumasi, Ghana. Support Care Cancer 2020; 29:2335-2345. [PMID: 32915296 DOI: 10.1007/s00520-020-05716-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE We aimed to explore the experiences of husbands of women diagnosed with advanced breast cancer, highlighting their stressors and the resources they rely on to cope, in Kumasi, Ghana. METHOD An exploratory descriptive qualitative research design was adopted. Fifteen in-depth interviews with participants were conducted. After a participant's written consent, we audio-recorded the interview sessions and transcribed them verbatim. We managed and analysed the data manually. RESULT The experiences of husbands as primary caregivers of their wives diagnosed with advanced breast cancer have been broadly categorized under two main themes: stressors and resources. The analyses revealed that the burdens associated with the husband's primary caregiving roles threatened the marriage, their relationships with others, work, and finances. Regardless of the stressors, participants drew on a range of resources such as acceptance, marital obligation and commitment to marital vows, social support, and spirituality to cope. CONCLUSION The study is the first of our knowledge to explore the experiences of husbands acting as primary caregivers of their wives who are diagnosed with advanced breast cancer in Ghana. It revealed that they rely on specific resources to cope with the burdens associated with their role. Policies and programs aiming at assisting women diagnosed with advanced breast cancer to manage and cope with the disease should include the partners of the married ones by designing programs that help the husbands to understand the situation and adequately provide the care that promotes the quality of life of the husband, wife, and the family.
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