EDNA ADAN UNIVERSITY

Transcription

1 EDNA ADAN UNIVERSITY Faculty of clinical nursing Relationship between hepatitis B in pregnancy and blood transfusion at Hargeisa Group Hospital, Hargeisa, Somaliland Hafsa Mohamed Aden Muna Hassan Mohamed Sawsan Abdurrahman Abdilahi zahra Abdi Osman A thesis submitted to the faculty of clinical nursing at Edna Aden University Hargeisa, Somaliland In Partial Fulfillment of the Requirements for Bachelor Degree of clinical Nursing

2 DECLARATION This proposal is our original work and has not been presented for a degree or any other academic award in any university or institution of learning. Hafsa Mohamed Aden Signature. Date Muna Hassan Mohamed Signature Date Sawsan AbdirahmanAbdilahi Signature Date zahra Abdi Osman signature date Name and Signature of Candidate Date: April, June 2017

3 APPROVAL "I confirm that the work reported in this proposal was carried out by the candidate under our supervision". Mr.: Osman M. Osman Name and Signature of Supervisor Date: April, June 2017

4 DEDICATION We dedicate this book to our lovely parent s mothers and fathers to this academic achievement, and all our friends and relatives who have helped us admiringly and cooperatively in our academic struggle.

5 Acknowledgement Praise is due to Allah who enabled us to finish our thesis book by his grace and mercy. Secondly we are grateful to our parents who paid everything possible to make us reach the date of submitting our thesis. Special thanks to Mr. Osman Mohamed Osman, our instructor and research guide, who helped us tremendously throughout this research. Finally we would like to convey our thanking to all managers, staff and other health workers at Hargeisa Group Hospital who helped us to collect the data.

6 Abstract Definition: Hepatitis B is potentially serious form of liver inflammation due to infection by the hepatitis B virus. Blood transfusion: is life saving procedure in which blood cells or products of another person is transferred to the blood stream of another person who lost his blood due to bleeding, depression of the bone marrow or any other cause. Objective: the objective of the study was to assess the relationship between blood transfusion and pregnancy hepatitis B virus. Methodology: the study used predetermined sample size of 52 persons for the staff of Hargeisa group hospital. The collection of data in this study based on collection of Primary data which is data that researchers are collecting information for the specific purposes of their study which involved the use of questionnaires to gather information from the selected respondents. The questionnaire in this research study used close and open end questionnaire by the researcher. The process that was used for analyzing the collected data was SPSS. Result: there was a positive relationship between pregnancy HBV and blood transfusion at Hargeisa Group Hospital. Conclusion: majority of the respondents age was between years of most of them female married nurses of experience of 1-2 years. As the result of the findings, the level of pregnancy HBV is very high and the level of blood transfusion is also high at Hargeisa group hospital.

7 Table of Contents DECLARATION... 2 APPROVAL... 3 DEDICATION... 4 Acknowledgement... 5 Abstract... 9 Chapter one: Introduction 1.1: Background of the study Purpose Objectives of study Research questions Significant of the study Scope Conceptual framework Chapter two: Literature review 2.1 Concepts, Opinions, Ideas from Authors/Experts Anatomy of the liver Physiology of liver Pathophysiology What kind of a virus is hepatitis B? Is hepatitis B contagious Possible methods of transmission: risk of hepatitis B... 18

8 2.9 Signs and symptoms of hepatitis B Diagnose of hepatitis B Hepatitis B surface antigen test Hepatitis B core antigen test Hepatitis B surface antibody test Liver function tests treatments of hepatitis B Treatment options for hepatitis B complications of hepatitis B How can I prevent hepatitis B Blood transfusion Types of Blood Transfusions Who Needs a Blood Transfusion Risks of a Blood Transfusion? Chapter three: Methodology 3.1 Study area STUDY PERIOD RESEARCH DESIGN STUDY POPULATION SAMPLE SIZE AND SAMPLING TECHNIQUE STUDY VARIABLES Operational definition... 32

9 3.8 DATA COLLECTION TECHNIQUE AND TOOLS DATA PROCESSING AND ANALYSIS Pretest INCLUSION CRITERIA EXCLUSION CRITERIA ETHICAL CONSIDERATION DISSEMINATION OF FINDINGS Limitation Chapter four: Data collection and analysis Chapter five: Conclusion, discussion and recommendation 5.1 : Part one : Part two ; Part three ; Part four ; Conclusion : Recommendations Appendix Questionnaire References..59

10 Chapter one: Introduction This study was examine the relationship between pregnancy HBV and blood transfusion. this chapter will cover the following sections such us background of the study, statement of the problem, purpose of the study, research objectives, research questions, research hypotheses, scope, significant of the study and conceptual framework. 1.1 Background of the study Hepatitis B is a potentially serious form of liver inflammation due to infection by the hepatitis B virus. Blood transfusion is life saving procedure in which blood cells or products of another person is transferred to the blood stream of another person who lost his blood due to bleeding, depression of the bone marrow or any other cause. 9 Globally two billion people are infected with HBV and they are at high risk of death from its complications like Liver cancer which kill more than one million people globally each year. Approximately 400 million people are chronically infected with HBV worldwide and almost half of them have acquired their infection through mother transmission. Its prevalence difference worldwide, the high prevalence countries include Asia, parts of Middle East, and sub Saharan Africa. 4 In India the HBV positivity differs in the different regions of the country, but more recent studies have reported HBsAg positivity among pregnant women ranging from 0.8 to 1.1 %. 4 There is paucity of information on the prevalence of HBV infections among general population in Sudan, and previously the studies were conducted in selected group of people with high risk factors such as blood donors, drug addicts, commercial sex workers or hospitalized patients. The previous and new studies showed that hepatitis B is increasing according to percentage weather a high risk group or not. Research carried out on 728 pregnant woman showed that 28.1% of them had a history of blood transfusion and jaundice and HBsAg was detected in 41 (5.6%) out of 728 women. 5 10

11 A nationwide sero epidemiological study of hepatitis B prevalence was conducted in Ethiopia on69 women attending the ANC clinic showed that the overall sero prevalence of HBsAg was 7.8%. Although it reflected a remarkable geographical and ethnic variability in terms of sociocultural, environment and activities. 6 Hepatitis B spread is a major problem. It exists everywhere but its more in some places like where people live in overcrowded and in un educated people also in place where there are a people who lack any health education or experience and in un hygienic place. This problem exists and also increasing uncontrollably because we can see how the infected hepatitis B patients are increasing in the hospitals whether they are children or adults. In Bangladesh, total collection is about 4, 00,000 per year. Out of which, 60% donation comes from family relative donors, 31% comes from voluntary donors and 9% donation from paid donors. 7 Nearly 30,000 bags of blood are collected per year in Ethiopia for a population of 56 million people. Eighty percent of this volume is obtained from family donors at the ten blood banks run by the National Transfusion Blood Service (NTBS) under the auspices of the International Red Cross. The remaining 20% are collected in hospital laboratories not affiliated with the NTBS but where blood bank procedures are used including the ability to screen for HIV contamination. Transfusion is thus a safe procedure in the major towns of Ethiopia. Screening for hepatitis B is performed only on blood to be administered to children and foreigners. 8 Blood transfusion in Djibouti is organized with reference to relevant French regulation and the recommendations of the World Health Organization. The system is basically family donor system operating on the principle of one tested unit of blood for every two untested units donated. Spontaneous donations mainly from the police and army personnel account for only 20% of the 2500 units collected each year

12 1.2 Statement of the problem Hepatitis B is a viral infection that causes liver inflammation and damage (Signs and symptoms include fatigue, dark urine, Joint and muscle pain, loss of appetite, fever, abdominal discomfort, Weakness jaundice) Blood transfusion refers to the administration of donated blood products such as red blood cells, platelets or plasma. In Somaliland over all hepatitis B virus is increasing day after day there is high incidence of hepatitis B virus recently the disease has negative impact on different age groups of our society there is trending numbers of hepatitis B virus cases, the disease is severe causing morbidity and greater mortality overall population, there is also high pregnancy hepatitis B virus and mother to child transmission. Therefore, that s why we are going to conduct a research to assess if blood transfusion causes the high level of hepatitis B in pregnant women. 1.3 Purpose The purpose of this study is to seek significant relationship between pregnancy HBV and blood transfusion. 1.4 Objectives of study General objective: to assess the relationship between blood transfusion and pregnancy hepatitis B virus. Specific objectives 1) To determine the demographic characteristics of respondents. 2) To find out the level of pregnancy hepatitis B virus at Hargeisa Somaliland. 3) To identify the level of blood transfusion at Hargeisa Somaliland. 12

13 4) To establish if there is significant relationship between blood transfusion and hepatitis B virus at Hargeisa group hospital(hgh). 1.5 Research questions 1. What were the demographic characteristics of the respondents in terms of? A) Age? B) Gender? C) Marital status? D) Educational back ground? E) Qualification under health experience? 2) What is the level of pregnancy HBV at Hargeisa Somaliland? 3) What is level of blood transfusion at Hargeisa Somaliland? Is there a signifance relationship between blood transfussion and pregnant hepatitis B virus? 1.6 Significant of the study The findings of the study was use full for any health association and organizations that contribute the eradication of hepatitis B spread. The future researchers will utilize the findings of this study as a base line data to their study. The ministry of health can use the finding to encourage the health workers to do heath education, awareness and prevention. 1.7 Scope Knowledge scope:this study will be about to know the level of hepatitis b in pregnancy and to also know the level of blood transfusion. Hepatitisb is not only caused by blood transfusion, other things can cause such us lack of awareness, low socio economic status, poor hygiene. Geographical scope: the study was conduct from Hargeisa Group Hospital in Hargeisa Somaliland.. Hargeisa is the capital of Somaliland with the total population of 3.5 million Hargeisa is located in east Barbara region, west gabiley region, South hawd region and north Djibouti. HGH 13

14 is located in Hargeisa in the center of the city. It gives multiple services like dental, medical, surgical, ophthalmology, psychiatry and obstetrics This area have chosen because it is were almost sick patients come for treatment. Time scope: the duration of the study was three months from April to June Conceptual framework Blood transfusion pregnancy HBV Lack of awareness Lack of enough health centers Lack of health workers Poor hygiene Lack of education Transmission to child Decreasing health status Nutritional deficiencies Social withdrawal Extraneous variables Low socio economic status Policy Culture Environment 14

15 Chapter two: Literature review 2.1 Concepts, Opinions, Ideas from Authors/Experts This chapter was include all related concepts, idea and theoretical perspectives which are corporate testable reviews that is summery of all documents conceding about the effectiveness of anemia and pregnancy women. Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus. 2.2 Anatomy of the liver The liver is located in the upper right-hand portion of the abdominal cavity, beneath the diaphragm and on top of the stomach, right kidney, and intestines 11. The liver, a dark reddish-brown organ, has multiple functions. There are two distinct sources that supply blood to the liver: Oxygenated blood flows in from the hepatic artery. Nutrient-rich blood flows in from the hepatic portal vein. The liver consists of two main lobes, both of which are made up of 8 segments. The segments are made up of a thousand lobules. The lobules are connected to small ducts that connect with larger ducts to ultimately form the common hepatic duct 11. The common hepatic duct transports bile produced by the liver cells to the gallbladder and duodenum (the first part of the small intestine). 2.3 Physiology of liver The liver regulates most chemical levels in the blood and excretes a product called bile. Bile helps to break down fats, preparing them for further digestion and absorption 11. All of the blood leaving the stomach and intestines passes through the liver 12. The liver processes this blood and breaks down, balances, and creates nutrients for the body to use 12. It also metabolized drugs in the blood 15

16 into forms that are easier for the body to use 13. Many vital functions have been identified with the liver 11. Some of the more well-known functions include the following: Production of bile, which helps carry away waste and break down fats in the small intestine during digestion Production of certain proteins for blood plasma Production of cholesterol and special proteins to help carry fats through the body Store and release glucose as needed Processing of hemoglobin for use of its iron content (the liver stores iron) Conversion of harmful ammonia to urea (urea is one of the end products of protein metabolism that is excreted in the urine) Clearing the blood of drugs and other harmful substances Regulating blood clotting Resisting infections by producing immune factors and removing bacteria from the bloodstream Clearance of bilirubin (if there is a buildup of bilirubin, the skin and eyes turn yellow) When the liver has broken down harmful substances, they are excreted into the bile or blood 13. Bile by-products enter the intestine and ultimately leave the body in the feces. Blood by-products are filtered out by the kidneys and leave the body in the form of urine Pathophysiology The virus does not directly kill hepatocytes. 12 The host's immune response to viral antigens is thought to be the cause of the liver injury in HBV infection 13.The cellular immune response, rather than the humoral immune response, seems to be primarily involved in disease pathogenesis. Induction of antigen-specific T-lymphocyte response is thought to occur when host T lymphocytes are presented with viral epitopes by antigen-presenting cells in lymphoid organs. These antigenspecific T cells mature and expand and then migrate to the liver. In acute HBV infection, most HBV DNA is cleared from hepatocytes through non-cytocidal effects of inflammatory byproducts of CD8+ T lymphocytes, stimulated by CD4+ T lymphocytes, notably interferon-gamma and tumour necrosis factor-alfa. These cause down-regulation of viral replication, and trigger direct 16

17 lysis of infected hepatocytes by HBV-specific CD8+ cytotoxic T cells. [14] In contrast, people with chronic HBV infection display weak, infrequent, and narrowly focused HBV-specific T-cell responses, and the majority of mononuclear cells in livers of chronic HBV-infected people are non-antigen-specific What kind of a virus is hepatitis B? The hepatitis B virus is a DNA virus, meaning that its genetic material is made up of deoxyribonucleic acids. It belongs to a family of viruses known as Hepadnaviridae. The virus is primarily found in the liver but is also present in the blood and certain body fluids. Hepatitis B virus consists of a core particle (central portion) and a surrounding envelope (outer coat). The core is made up of DNA and the core antigen (HBcAg). The envelope contains the surface antigen (HBsAg). These antigens are present in the blood and are markers that are used in the diagnosis and evaluation of patients with suspected viral hepatitis.(mary D. Nettle man, MD, MS, MACP,2016) Is hepatitis B contagious Hepatitis B is highly contagious. It spreads through contact with infected blood and certain other bodily fluids. Although the virus can be found in saliva, it s not spread through sharing utensils or kissing. It also doesn t spread through sneezing, coughing, or breastfeeding. Symptoms of hepatitis B may not appear for 3 months after exposure and can last for 2 12 weeks. However, you are still contagious, even without symptoms. The virus can live outside the body for up to seven days Possible methods of transmission: 1. direct contact with infected blood 2. transfer from mother to baby during birth 3. being pricked with a contaminated needle 4. intimate contact with a person with HBV 5. oral, vaginal, and anal sex 6. using a razor or any other personal item with remnants of infected fluid 17

18 2.8 risk of hepatitis B Certain groups are at particularly high risk of HBV infection. These include: Healthcare workers Men who have sex with other men People who use IV drugs People with multiple sex partners People with chronic liver disease People with kidney disease People over the age of 60 with diabetes Those traveling to countries with a high incidence of HBV infection 2.9 Sings and symptoms of hepatitis B Symptoms of acute hepatitis B may not be apparent for months. However, common symptoms include: Fatigue Dark urine Joint and muscle pain Loss of appetite Fever Abdominal discomfort 18

19 Weakness Yellowing of the whites of the eyes (sclera) and skin (jaundice) Any symptoms of hepatitis B need urgent evaluation. Symptoms of acute hepatitis B are worse in people over the age of 60. Let your doctor know immediately if you have been exposed to hepatitis B. You may be able to prevent infection Diagnose of hepatitis B Doctors can usually diagnose hepatitis B with blood tests. Screening for hepatitis B may be recommended for individuals who: Have come in contact with someone with hepatitis B Have traveled to a country where hepatitis B is common Have been in jail Use IV drugs Receive kidney dialysis Are pregnant Are men who have sex with men Have HIV Ultrasound Liver function test Billirun Physical examination and history 19

20 2.11 Hepatitis B surface antigen test A hepatitis B surface antigen test shows if you re contagious. A positive result means you have hepatitis B and can spread the virus. A negative result means you don t currently have hepatitis B. This test doesn t distinguish between chronic and acute infection. This test is used together with other hepatitis B tests to determine the state of a hepatitis B infection Hepatitis B core antigen test The hepatitis B core antigen test shows whether you re currently infected with HBV. Positive results usually mean you have acute or chronic hepatitis B. It may also mean you re recovering from acute hepatitis B Hepatitis B surface antibody test A hepatitis B surface antibody test is used to check for immunity to HBV. A positive test means you are immune to hepatitis B. There are two possible reasons for a positive test. You may have been vaccinated, or you may have recovered from an acute HBV infection and are no longer contagious Liver function tests Liver function tests are important in individuals with hepatitis B or any liver disease. Liver function tests check your blood for the amount of enzymes made by your liver. High levels of liver enzymes indicate a damaged or inflamed liver. These results can also help determine which part of your liver may be functioning abnormally. If these tests are positive, you might require testing for hepatitis B, C, or other liver infections. Hepatitis B and C viruses are a major cause of liver damage throughout the world. You will likely also require an ultrasound of the liver or other imaging tests(2). 20

21 2.15 treatments of hepatitis B Hepatitis B vaccination and immune globulin Talk to your doctor immediately if you think you have been exposed to hepatitis B within the last 24 hours. If you have not been vaccinated, it may be possible to prevent infection by receiving the hepatitis B vaccine and an injection of HBV immune globulin. This is a solution of antibodies that work against HBV Treatment options for hepatitis B Acute hepatitis B usually doesn t require treatment. Most people will overcome an acute infection on their own. However, rest and hydration will help you recover. Antiviral medications are used to treat chronic hepatitis B. These help you fight the virus. They may also reduce the risk of future liver complications. You may need a liver transplant if hepatitis B has severely damaged your liver. A liver transplant means a surgeon will remove your liver and replace it with a donor liver. Most donor livers come from deceased donors complications of hepatitis B Complications of having chronic hepatitis B include: Hepatitis D infection Liver scarring (cirrhosis) Liver failure Liver cancer 21

22 Death Hepatitis D infection can only occur in people with hepatitis B. Hepatitis D is uncommon in the United States but can also lead to chronic liver disease How can I prevent hepatitis B The hepatitis B vaccine is the best way to prevent infection. Vaccination is highly recommended. It takes three vaccines to complete the series. The following groups should receive the hepatitis B vaccine: All infants, at the time of birth. Any children and adolescents who weren t vaccinated at birth. Adults being treated for a sexually transmitted infection. People living in institutional settings. People whose work brings them into contact with blood. HIV-positive individuals. Men who have sex with men. People with multiple sexual partners. Injection drug users. Family members of those with hepatitis B. Individuals with chronic diseases. People traveling to areas with high rates of hepatitis B 22

23 In other words, just about everyone should receive the hepatitis B vaccine. It s a relatively inexpensive and very safe vaccine. There are also other ways to reduce your risk of HBV infection. You should always ask sexual partners to get tested for hepatitis B. Use a condom or dental dam when having anal, vaginal, or oral sex. Avoid drug use. If you re traveling internationally, check to see if your destination has a high incidence of hepatitis B and make sure you are fully vaccinated prior to travel Blood transfusion A blood transfusion is the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient). This is usually done as a lifesaving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when blood loss occurs or to increase the blood count in an anemic patient. The following material is provided to all patients and/or their family members regarding blood transfusions and the use of blood products. Although in most situations the likelihood of a blood transfusion associated with surgery is uncommon, at times patients may require blood products. You are encouraged to discuss your particular need for transfusion as well as the risks of transfusion with your doctor 1 Your options may be limited by time and health factors, so it is important to begin carrying out your decision as soon as possible. For example, if friends or family members are donating blood for a patient (directed donors), their blood should be drawn several days prior to the anticipated need to allow adequate time for testing and labeling. The exact protocols are hospital and donor site specific 1 The safest blood product is your own, so if a transfusion is likely, this is your lowest risk choice. Unfortunately this option is usually only practical when preparing for elective surgery. In most other instances the patient cannot donate their own blood due to the acute nature of the need for blood. Although you have the right to refuse a blood transfusion, this decision may have lifethreatening consequences. If you are a parent deciding for your child, you as the parent or guardian must understand that in a life-threatening situation your doctors will act in your child's best interest to insure your child's health and wellbeing in accordance with standards of medical care regardless of religious beliefs. Please carefully review this material and decide with your doctor which 23

24 option(s) you prefer, understanding that your doctor will always act in the best interest of his or her patient 1 To assure a safe transfusion make sure your healthcare provider who starts the transfusion verifies your name and matches it to the blood that is going to be transfused. Besides your name, a second personal identifier usually used is your birthday. This assures the blood is given to the correct patient.if during the transfusion you have symptoms of shortness of breath, itching, fever or chills or just not feeling well, alert the person transfusing the blood immediately 1 Blood can be provided from two sources: autologous blood (using your own blood) or donor blood (using someone else's blood). Autologous blood (using your own blood) Pre-operative donation: donating your own blood before surgery. The blood bank draws your blood and stores it until you need it during or after surgery. This option is only for non-emergency (elective) surgery. It has the advantage of eliminating or minimizing the need for someone else's blood during and after surgery. The disadvantage is that it requires advanced planning which may delay surgery. Some medical conditions may prevent the pre-operative donation of blood products 1 Intra-operative autologous transfusion: recycling your blood during surgery. Blood lost during surgery is filtered, and put back into your body during surgery. This can be done in emergency and elective surgeries. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. Large amounts of blood can be recycled. This process cannot be used if cancer or infection is present 1 Post-operative autologous transfusion: recycling your blood after surgery. Blood lost after surgery is collected, filtered and returned to your body. This can be done in emergency and elective surgeries. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. This process can't be used in patients where cancer or infection is present1 Hem dilution: donating your own blood during surgery. Immediately before surgery, some of your blood is taken and replaced with IV fluids. After surgery, your blood is filtered and returned 24

25 to you. This is done only for elective surgeries. This process dilutes your own blood so you lose less concentrated blood during surgery. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. The disadvantage of this process is that only a limited amount of blood can be removed, and certain medical conditions may prevent the use of this technique 1. Apheresis: donating your own platelets and plasma. Before surgery, your platelets and plasma, which help stop bleeding, are withdrawn, filtered and returned to you when you need it later. This can be done only for elective surgeries. This process may eliminate the need for donor platelets and plasma, especially in high blood-loss procedures. The disadvantage of this process is that some medical conditions may prevent apheresis, and in actual practice it has limited applications Types of Blood Transfusions Blood is transfused either as whole blood (with all its parts) or, more often, as individual parts. The type of blood transfusion you need depends on your situation. For example, if you have an illness that stops your body from properly making a part of your blood, you may need only that part to treat the illness 1. Red Blood Cell Transfusions Red blood cells are the most commonly transfused part of the blood. These cells carry oxygen from the lungs to your body's organs and tissues. They also help your body get rid of carbon dioxide and other waste products. You may need a transfusion of red blood cells if you've lost blood due to an injury or surgery. You also may need this type of transfusion if you have severe anemia (uh-nee-me-uh) due to disease or blood loss. Anemia is a condition in which your blood has a lower than normal number of red blood cells. Anemia also can occur if your red blood cells don't have enough hemoglobin (HEE-muh-glow-bin).Hemoglobin is an iron-rich protein that gives blood its red color. This protein carries oxygen from the lungs to the rest of the body 1 25

26 Platelets and Clotting Factor Transfusions Platelets and clotting factors help stop bleeding, including internal bleeding that you can't see. Some illnesses may cause your body to not make enough platelets or clotting factors. You may need regular transfusions of these parts of your blood to stay healthy. For example, if you have hemophilia (hem-o-fill-ee-ah), you may need a special clotting factor to replace the clotting factor you're lacking. Hemophilia is a rare, inherited bleeding disorder in which your blood doesn't clot normally. If you have hemophilia, you may bleed for a longer time than others after an injury or accident. You also may bleed internally, especially in the joints (knees, ankles, and elbows) 1 Plasma Transfusions Plasma is the liquid part of your blood. It's mainly water, but also contains proteins, clotting factors, hormones, vitamins, cholesterol, sugar, sodium, potassium, calcium, and more. If you have been badly burned or have liver failure or a severe infection, you may need a plasma transfusion (6) Who Needs a Blood Transfusion Blood transfusions are very common. Each year, almost 5 million Americans need blood transfusions. This procedure is used for people of all ages. Many people who have surgery need blood transfusions because they lose blood during their operations. For example, about one-third of all heart surgery patients have a transfusion. Some people who have serious injuries such as from car crashes, war, or natural disasters need blood transfusions to replace blood lost during the injury. Some people need blood or parts of blood because of illnesses. You may need a blood transfusion if you have: A severe infection or liver disease that stops your body from properly making blood or some parts of blood. An illness that causes anemia, such as kidney disease or cancer. Medicines or radiation used to treat a medical condition also can cause anemia. There are many types of anemia, including aplastic, Fanconi, hemolytic, iron-deficiency, and cell anemia and thalassemia (thal-ah-se-me-ah).a bleeding disorder, such as hemophilia or thrombocytopenia (THROM-bo-si-to-PE-ne-ah). 1 26

27 2.22 Risks of a Blood Transfusion? Most blood transfusions go very smoothly. However, mild problems and, very rarely, serious problems can occur 1. Allergic Reactions Some people have allergic reactions to the blood given during transfusions. This can happen even when the blood given is the right blood type. Allergic reactions can be mild or severe. Symptoms can include: Anxiety Chest and/or back pain Trouble breathing Fever, chills, flushing, and clammy skin A quick pulse or low blood pressure Nausea (feeling sick to the stomach) A nurse or doctor will stop the transfusion at the first signs of an allergic reaction. The health care team determines how mild or severe the reaction is, what treatments are needed, and whether the transfusion can safely be restarted 1 Viruses and Infectious Diseases Some infectious agents, such as HIV, can survive in blood and infect the person receiving the blood transfusion. To keep blood safe, blood banks carefully screen donated blood. The risk of catching a virus from a blood transfusion is very low. HIV. Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning. Only about 1 in 2 million donations might carry HIV and transmit HIV if given to a patient. 27

28 Hepatitis B and C. The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million. If you receive blood during a transfusion that contains hepatitis, you'll likely develop the virus. Variant Creutzfeldt-Jakob disease (vcjd). This disease is the human version of Mad Cow Disease. It's a very rare, yet fatal brain disorder. There is a possible risk of getting vcjd from a blood transfusion, although the risk is very low. Because of this, people who may have been exposed to vcjd aren't eligible blood donors 1 Fever You may get a sudden fever during or within a day of your blood transfusion. This is usually your body's normal response to white blood cells in the donated blood. Over-the-counter fever medicine usually will treat the fever. Some blood banks remove white blood cells from whole blood or different parts of the blood. This makes it less likely that you will have a reaction after the transfusion 1. Iron Overload Getting many blood transfusions can cause too much iron to build up in your blood (iron overload). People who have a blood disorder like thalassemia, which requires multiple transfusions, are at risk for iron overload. Iron overload can damage your liver, heart, and other parts of your body. If you have iron overload, you may need iron chelation (ke-lay-shun) therapy. For this therapy, medicine is given through an injection or as a pill to remove the extra iron from your body 1 Lung Injury Although it's unlikely, blood transfusions can damage your lungs, making it hard to breathe. This usually occurs within about 6 hours of the procedure. Most patients recover. However, 5 to 25 percent of patients who develop lung injuries die from the injuries. These people usually were very ill before the transfusion. Doctors aren't completely sure why blood transfusions damage the lungs. Antibodies (proteins) that are more likely to be found in the plasma of women who have been 28

29 pregnant may disrupt the normal way that lung cells work. Because of this risk, hospitals are starting to use men's and women's plasma differently 1 Acute Immune Hemolytic Reaction Acute immune hemolytic reaction is very serious, but also very rare. It occurs if the blood type you get during a transfusion doesn't match or work with your blood type. Your body attacks the new red blood cells, which then produce substances that harm your kidneys. The symptoms include chills, fever, and nausea, pain in the chest or back, and dark urine. The doctor will stop the transfusion at the first sign of this reaction 1 Delayed Hemolytic Reaction This is a much slower version of acute immune hemolytic reaction. Your body destroys red blood cells so slowly that the problem can go unnoticed until your red blood cell level is very low. Both acute and delayed hemolytic reactions are most common in patients who have had a previous transfusion 1 Graft-Versus-Host Disease Graft-versus-host disease (GVHD) is a condition in which white blood cells in the new blood attack your tissues. GVHD usually is fatal. People who have weakened immune systems are the most likely to get GVHD. Symptoms start within a month of the blood transfusion. They include fever, rash, and diarrhea. To protect against GVHD, people who have weakened immune systems should receive blood that has been treated so the white blood cells can't cause GVHD 1 29

30 3.0:Chapter three: Methodology 3.1 Study area Hargeisa is the first largest city in Somaliland after, situated in the woqooyi galbeed region in northwestern Somalia, it is the capital of the republic of Somaliland,, located in the marodijeh region. Hargeisa is the capital of Somaliland with the total population of 3.5 million Hargeisa is located in east Barbara region, west gabiley region, South hawd region and north Djibouti, in Hargeisa number of education positions in their level of education such as universities include biggest one University of Hargeisa,Edna Adan university gollis university,adis- Ababa university, There are also several state-run and privately owned secondary and high schools like hamdan secondary school, Noradin secondary school,bahrian, and other governmental others like Mahmud ahmed ali, dayib guray and 26 June. This study area will be carried out of Hargeisa group hospital. Hargeisa group hospital is the largest hospital in Somaliland. The hospital was established in 1953 to serve a population of 30,000. It offers primary and specialty care and has several psychiatric wards. The psychiatric wards house approximately 200 patients and are managed by nurses STUDY PERIOD Study of relationship between hepatitis b in pregnancy and blood transfusion causes and risk factors was conducted from April up to June 2017 in Hargeisa group hospital. 3.3 RESEARCH DESIGN In this study the type of the study design we used was cross sectional study to the relationship between hepatitis b in pregnancy and blood transfusion in Hargeisa group hospital who were attending Hargeisa group hospital at Hargeisa health centers. The study was conducted the period between April up to June Inclusion criteria was all pregnancy woman attending at Hargeisa group hospital during data collection period and can give consent and health care providers working at that unit of the selected health centers. The exclusion criteria was non-pregnancy woman who were not attending in Hargeisa group hospital and those who are seriously sick and unable to respond to the questions, pregnancy woman who could not give consent, and quantitative and qualitative techniques were used to conduct the study. 30

31 3.4 STUDY POPULATION Study population included children less than five years of age resident at Hargeisa group hospital In Hargeisa Somaliland is too large. Since the children were too young at this age to be interviewed, recruited pregnancy woman instead were interviewed to identify relationship between hepatitis b in pregnancy and blood transfusion at Hargeisa group hospital We will take some of that population considering that small sample was representative all characteristics of the Population The target population of the research study was composed 52 The researcher was collected research pregnancy woman in order to find full information about this research for causes and risk factors of hepatitis b in pregnancy 3.5. SAMPLE SIZE AND SAMPLING TECHNIQUE The sample size was 52 respondents drawn from the categories of respondents in the study area and population. The sample size was calculated by using Slovenes formula n = N =60 =52 1+N*(e) (0.0025) Where n = number of sample N = total population E = Level of significance (0.05) 3.6 STUDY VARIABLES The dependent variable for the study is: 31

32 The dependent variable for this study is relationship between hepatitis b in pregnancy and blood transfusion in which The independent variables were: Direct contact with infected blood Transfer from mother to baby during birth Being pricked with a contaminated needle Intimate contact with a person with HBV Oral, vaginal, and anal sex Using a razor or any other personal item with remnants of infected fluid 3.7 Operational definition Pregnancy Pregnancy, also known as gravidity or gestation, is the time during which one or more offspring develops inside a woman [1]. A multiple pregnancy involves more than one offspring, such as with twins [1]. Pregnancy can occur by sexual intercourse or assisted reproductive technology. It usually lasts around 40 weeks from the last menstrual period (LMP) and ends in childbirth [1]. This is just over nine lunar months, where each month is about 29½ days [1]. When measured from conception it is about 38 weeks. An embryo is the developing offspring during the first eight weeks following conception, after which, the term fetus is used until birth [1]. Hepatitis B Hepatitis B is a liver infection caused by the hepatitis B virus (HBV). HBV is one of five types of viral hepatitis. The others are hepatitis A, C, D, and E. Each is a different type of virus, and types B and C are most likely to become chronic. The Centers for Disease Control and Prevention (CDC) 32

33 state that around 3,000 people in the United States die each year from complications caused by hepatitis B. It s suspected that 1.4 million people in America have chronic hepatitis B. HBV infection can be acute or chronic. Acute hepatitis B causes symptoms Blood transfusion A blood transfusion is the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient). This is usually done as a lifesaving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when blood loss occurs or to increase the blood count in an anemic patient. 3.8 DATA COLLECTION TECHNIQUE AND TOOLS The collection of data in this study was based on two forms, namely the collection of primary data and the collection of data in secondary form Primary data is data that researchers are collecting information for the specific purposes of their study which involved the use of questionnaires to gather information from the selected respondents. The collection of secondary data involved review of official documents such as Patient files, Patient examination papers, patient diagnostic paper and others previous data collecting. The researcher will be used instrument questionnaires. The questionnaire in this research study used close and open end questionnaire by the researcher. 3.9 DATA PROCESSING AND ANALYSIS Data processing and analyzing we used for both words and SPSS package. After that analyzing result we presented by using tables and charts. 3.9 Pretest Pretest technique used to determine the reliability of questionnaire we was give out 15 questions in the different parts of the questionnaire to some respondents. After two days later, the same 15 questions was been given again to the same some respondents to ensure if the results are reliability and basically the same in both times and also there were questionnaire translation to the 33

34 respondents and pre-test were done Such as health staffs,mothers they have above five children ages and other mothers in reproductive age INCLUSION CRITERIA In addition of all hepatitis in pregnancy women attending Hargeisa group maternity hospital during data collection period and can give permission was included the study and also undying tenant of the study area were include in the study EXCLUSION CRITERIA Those who are seriously sick and unable to respond to the questions, hepatic women who could not give permission and all Women, who could not talk or listen, who have psychological problem were expelled from the Stud ETHICAL CONSIDERATION To make sure maximum privacy for the respondents and the data provided by them to reflect ethics that would be practiced in this study, the following measures was done: 1. The entire questionnaire was coded to present secrecy of the respondents. 2. The respondents was requested to sign the informed consent 3. Authors quoted in this study are recognized through citations and referencing 4. The researcher was request for permission through a written request to the concerned those agriculture groups /experts included in the study. 5. And finally, the researcher was get approval from the ethical body/ethics group 3.13 DISSEMINATION OF FINDINGS When finished data the researcher will publish or disseminate the results that getting when the research is finished, that result we can able to change that bad situation when we finish our research or we do not have any ability to cover that problem. 34

35 3.14 Limitation Language barrier was main limitation now, I'm not sure what I would get the people we need Research questioner may have little issue like time in sufficiency and cost serious illness and critical situation of child cause less chance to the respondents 35

36 Chapter four: Data analysis Part one question related to the profile of the respondent what is your age Valid Frequen cy Percent Valid Percent Cumulative Percent and above Total According to the above table shows that 34(65.4% )of the respondents are of years, and 9(17.3.4%) of them are years, while 6(11.5% )of the participants answered for 36 years and above, the rest 3(5.8%) answered that they are between years, so we concluded that the majority of the age group are20-25 years which means most of them are middle age. what is your gender Valid Frequency Percent Valid Percent Cumulative Percent male female Total According to the above table shows that 45(86.5%) of staff are female while 7(13.5%) are males, so we concluded that the majority of these respondents were female. 36

37 what is your marital status Valid Frequency Percent Valid Percent Cumulative Percent single married divorced Total The above table shows 30(57.7%) are married also 36.5% are single while remaining is 3(5.8% )are divorced revealing that majority of respondents were married. what is your level education Valid Frequency Percent Valid Percent Cumulative Percent primary secondary university Total According the above table shows 21(40.4%) of the respondents which are the majority are secondary, 19(36.5%) are university, also 12(23.1%) finished primary school 37

38 what is your occupation Frequency Percent Valid Percent Cumulative Percent nursing Valid midwife lab Total According to the above table it shows 19(38.5%) of respondents are nurse, also 19(38.5%) of respondents are midwife while 14(23.1%) are lab, so the majority of respondents were nurse what is your level of experience Vali d Frequency Percent Valid Percent Cumulative Percent less than one year year years years Total According above table shows 19(36.5%) have experience of 1-2 year, and 17(32.7%) have 2-3years, 12(28%) have 3-4year while the rest 1(1.9%) have less than one year so the majority of respondents have experience of 1-2year 38

39 Section two=question related pregnancy hepatitis b virus According above this figure shows 100% of respondents answered yes According above this figure 19(36.5%) heard hepatitis B from health professions, 15(28.8%) heard it from media, while 12(23.1%) heard it from the family and the rest 6(11.5%) heard it from others sources. The majority of the people heard it from the health professions. 39

40 According above this figure shows 100% of respondents answered the symptom of HBV is jaundice. According this figure show 24(46.15%) of respondents answered that the complication of hepatitis B is cirrhosis, 12(23.08%) of respondents answered liver failure, while 9(17.31%) of respondents answered death, and 5(9.62%) of respondents answered hepatic cancer, and the rest 2(3.85%) of respondents answered others. The majority of respondents answered liver cirrhosis 40

41 According this figure shows that (38.08%) of the respondents answered that hepatitis B is very high in HGH, and 32.69% of respondents answered high, while 23.08% of respondents answered low, and the rest 1.92% of respondents answered others. The majority of respondents answered very high. According this figure show 21(40%) of respondents answered hepatitis B is transmitted through blood transfusion, 18(34.62%) of respondents answered sex, while 7(13.46%) of respondents answered Mather to child, and the rest 6(11.54%) of respondent answered needle injury. The majority of respondents answered blood transfusion. 41

42 According above this figure shows 100% of respondents answered the diagnose of hepatitis is blood test. According to the above figure it shows 26(50%) of respondents answered agree that hepatitis B is increasing, while 20(37.50%) answered strong agree, and the rest 6(12.50%) respondents answered disagree, so most of respondents answered agree. Part three: questions related blood transfussion According this figure shows 50(96.15%) answered yes that they heard blood transfusion can cause hepatitis B, while 2(3.85%) answered no. so majority respondents answered yes. 42

43 According above this figure shows 24(46.15%) answered they heard blood transfusion in hospitals,11(21.15%) answered from family,10(19.23%) answered from media, and 6(11.54% )answered from health professions, while the rest 1(1.92%) are missing question because they never heard it. So the majority of respondents answered in hospitals According figure shows 32(61.54%) of respondents answered that the blood transfusion is high in HGH, and 18(36.62%) answered low while 1(1.92%) answered medium and the missing questions are 1(1.92%.)so majority of respondents answered high 43

44 According this figure show 22(42.31%) of respondents answered 6-10 women have a blood transfusion in the hospital per month, while 19(36.54%) of respondents answered 1-5 women, and the rest 11(21.15) of respondents answered 10 above of women, the majority of respondents answered 6-10 women. According above this figure shows 39(75%) of respondents answered that anemia is the cause of blood transfusion, and 13(25%) of the respondents answered sever blood loss from injury, so most of respondents answered anemia. 44

45 According above this figure below shows all of respondents answered the complication of blood transfusion is allergic reaction. Part four: Questions related to relationship between pregnancy HBV and blood transfusion According to the above figure it shows that 32(37.50%) of respondents answered yes that there is relationship between pregnancy HBV and blood transfusion, while the rest 20(62.50%) respondents answered no. so most of respondents answered yes 45

46 According to the above figure it shows that 13(25%) of respondents answered very strong to the level of relationship between HBV and blood transfusion, while 7(12.50%)answered strong agree and the rest 33(62.50%) were missed. 46