Transfusion transmissible infections such as HBV remains a significant threat to safe blood donation, especially in countries where the prevalence of these infections is high. For improved awareness and more efficient strategies to curb HBV infection to be employed, studies on the knowledge, attitude, and prevalence of the disease are necessary. This study evaluated the seropositivity, knowledge and attitude towards HBV infection amongst 250 blood donors at the Bamenda Regional Hospital Blood Service, which serves as a referral hospital for the entire North West Region of Cameroon.
In this study, the overall seropositivity of HBV infection was 6.4%, with first time donors recording a seropositivity of 8.8%. This “high intermediate category” observation on the overall seropositivity is lower than the reports of studies in other African countries including Ghana (7.5% and 13.3%), Equatorial Guinea (10.01%), Cameroon (12.6%),Burkina Faso (14.47%), and Togo (19.08%) [9, 14–18]. Our findings are, nonetheless, higher than the recorded seroprevalence of 4.1% and 3.21 that was reported in respectively, Northwest Ethiopia and Madagascar (19–20). Among first-time donors, our prevalence was higher than the 7.28% observed in Gabon (21) and lower than the 12.14% in Yaoundé-Cameroon (22). Possible explanations for the relatively higher or lower seropositivity in this study include the differences in the epidemiology of HBV between different geographic regions, improvement in diagnostic technologies over the years with greater sensitivity and specificity, the economic status of the country and the increased sensitization about the disease.
Like Tagny et al., (23) and Nwobegahay et al., (24) who recorded 71.7% and 70.4% males respectively for blood donation, our study population also had 70.4% males. This could be explained by the fact that most females are rejected during donor examination because of physiological changes such as menstruation, pregnancy, and breastfeeding. The seropositivity was higher in males (7.95%) than in females (2.70%). The relatively higher seropositivity in males suggest other routes of exposure other than sex. This could be attributed to the use of unsterilized barbing razors to shave hair, outside socialization and multiple sex partners which is more common with males. Again, we observed that males were at a higher risk of being seropositive than females (OR = 3.1). Their behavioral activities could still account for this.
Those that had a history of previous blood donation were protected [ORs:0.4 (95% CI 0.1–1.2)] compared to first time donors. This is contrary to Jagannathan et al. who observed repeat donor status to be associated to HBsAg positivity (25). Our observation in this study could be explained by the fact that those who donate blood repeatedly are counselled on TTIs thus creating awareness on the diseases. Therefore, such donors may tend to adopt a more careful lifestyle compared to first time donors and this corroborates with the WHO recommendation for voluntary, regular, non-remunerated donors (26].
This study also revealed that 46.8% of our study population had adequate knowledge on hepatitis B infection. This result is slightly lower than those obtained by Boutayeb et al. and Bhasker et al. (12–13) who reported that 51.21% and 60% respectively of blood donors had good knowledge on Hepatitis B. Again, it is drastically lower than those seen in Nigeria (27) where 85% of the subjects had good knowledge on HBV. General knowledge on HBV infection in this community is still low. Although efforts on creating awareness about this infection is on the rise, the population is still less informed about it. We observed that participants in the age group 18–25 years were more knowledgeable as well as those who had attended higher education. This age category corresponds mainly to students. It further corroborates our observation on the positive relationship between a higher level of education and knowledge. The higher the student goes into education, the more he/she is exposed to various channels of information on the disease and a high level of understanding as well. Although we did not stratify the various disciplines of education, we realized that this group included students in the medical field. Such participants are expected to be more knowledgeable considering that hepatitis B is part of their teaching curriculum (28). When we considered the categories of donors, paid donors were more knowledgeable than voluntary, and the least was family/replacement donors. This could be explained by the fact that paid and voluntary donors probably donate blood regularly and are counselled on TTIs each time they come for donation. Family/replacement donors are seldom regular donors. Due to an emergency in most cases, such persons are sought to step in to provide blood for a relation. Some might be hearing about the infection for the first-time during a pre-donation counselling session. This scenario might justify the low level of knowledge among this group of participants. As expected, those who had never participated in any health education program related to hepatitis B had a lower mean knowledge score compared to their counterpart that have taken part in one. This underscores the importance of more public education on the disease through various communication media and approaches to increase awareness.
When we evaluated attitude, the overall mean attitude score of 76.3% was obtained. This result was higher compared to that obtained by Bhasker et al (13) where only 47.1% of blood donors had a good attitude towards hepatitis B. Although the level of knowledge on HBV infection is slightly below average, the positive attitude of these participants toward the disease is an indication of their willingness to know and prevent the disease. Though 90.8% of the donors were willing to take the vaccine, only 75.6% were ready to pay for the vaccine at a cost of 9.000FCFA (~$15). Though not examined, we think that financial constraints account for the unwillingness to pay for such a vaccine. As a result, if cost is subsidized, more persons will be willing to take the vaccine for prevention.
Some limitations admitted in this study include the recruitment of participants restricted to the venue of blood donation, which may not be representative of the total blood donors’ proportion of the region. Furthermore, the use of blood donors’ population attending the Bamenda Regional Hospital Blood Bank may overestimate the level of knowledge and attitude towards the disease. That notwithstanding, this is the first study to the best of our knowledge to assess blood donors’ seropositivity, knowledge, and attitude toward Hepatitis B in the North West Region of Cameroon. Since blood donation is a universal exercise that requires community participation; the results of our findings can be extrapolated to the situation in the community since these participants, coming from the community were recruited in an unbiased way.