CHAPTER ONE
INTRODUCTION
Background to the Study
Hepatitis B infection is a viral infection which is caused by the hepatitis B virus (HBV) that attacks the liver and can cause both acute and chronic disease. It is a one of the main global health problems which can cause chronic infection and leaves people at high risk of death from cirrhosis and liver cancer (1). HBV is the number one worldwide cause of chronic hepatitis, cirrhosis and hepatocellular cancer (2). The hepatitis B virus can live outside the body for at least 7 days. During this time, the virus can still cause infection if it gets in to the body of a person who is not vaccinated (1). Genotypes of HBV (A–H) have been identified with different geographic distributions (3). It is most usually spread from mother to child at birth, percutaneous or mucosal exposure to infected blood and various body fluids, such as saliva, menstrual, vaginal, and seminal fluids (4) and by reuse of needles and syringes either in health care institution or through tattooing. It’s also transmitted sexually in unvaccinated homosexual and persons with multiple sex partners. Infection in adulthood leads to chronic hepatitis in less than 5% of cases (1, 5). Primary testing should include serologic testing for surface antigen (HBsAg), hepatitis B core antibody (anti-HBc total), and hepatitis B surface antibody (anti-HBs) (3). Acute hepatitis B has symptoms like fever, fatigue, loss of appetite, nausea and/or vomiting, jaundice, pain in muscles, joints, and stomach. Chronic hepatitis B virus infection is a long-term illness that most people do not have symptoms, but it is still very severe and can lead to liver damage (cirrhosis), liver cancer and even death (5). People can protect themselves from hepatitis B by being vaccinated However, for those already infected treatment is the only choice for survival. Antiviral agents active against HBV are available and shown to suppress HBV replication, prevent progression to cirrhosis, and reduce the risk of HCC and liver-related deaths. Currently available treatments fail to eradicate the virus. In addition, these drugs are not widely available to be used in low and middle income countries, (6). Knowledge, attitude, and practice (KAP) surveys are representative of a detailed population to collect information on what is known, believed and done in relation to a particular topic and are the most recurrently used study tool in health seeking behavior researches. This studies are the reflection of the important health related issues by the society and help to design prevention strategies (7).