Study Variables and Risk Factors for Hepatitis B Among Blood Donors in Hossana, Ethiopia

Study Variables

Dependent Variable

The study focused on determining the Hepatitis B infection status among participants.

Independent Variables

Socio-Demographic Factors

The socio-demographic variables included sex, age, income, marital status, place of residence, ethnicity, religion, and educational level.

Clinical Factors

Clinical factors evaluated were illicit drug use, frequency of blood donation, history of blood donation, contact with jaundiced patients, tooth extraction, blood transfusion history, hospitalization, HBV vaccination status, sexually transmitted infection history, and post-donation counseling.

Behavioral Factors

Behavioral variables assessed included the number of sexual partners, history of sharp material exchange, smoking history, alcohol consumption, and tattooing.

Operational Definitions

Hepatitis B Surface Antigen (HBsAg)

HBsAg, an antigen found on the surface of the Hepatitis B virus, indicates HBV infection.

Hepatitis B surface antigen seropositivity is defined as the presence of HBsAg in serum or plasma detected by a diagnostic kit.

Alcohol Consumption

Alcohol consumption involves drinking beverages with ethyl alcohol. According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), heavy drinking is defined as more than four drinks on any one day or more than 14 drinks per week for men, and more than three drinks on any one day or more than seven drinks per week for women.

Smoking

Smoking entails inhaling and exhaling plant material vapors. While various substances can be smoked, tobacco is the most common, typically consumed through cigarettes, cigars, or pipes.

Post-Donation Counseling

Post-donation counseling is a private discussion between a blood donor and a qualified counselor. It includes explaining test results, confirming findings, discussing health impacts on the donor and the provided blood, and evaluating the donor’s suitability for future donations.

Multiple Sexual Partners

Multiple sexual partners refers to engaging in sexual activities with two or more individuals over a specific period. These activities can occur simultaneously or sequentially and encompass relationships between different genders as well as same-sex partners.

Data Collection Procedures and Measurement

Data was collected using a standardized questionnaire based on previous studies. Initially written in English, the questionnaire underwent translation to local languages and back to English to ensure accuracy. Consent was obtained from participants, after which a five-milliliter blood sample was taken from each donor using sterilized test tubes. Serum was separated from the cells via centrifugation at 3500 RPM for five minutes and stored in sterile plastic vials.

The collected serum was sent to the Hawassa Blood Bank laboratory in a refrigerated cold chain device. If analysis could not be completed within eight hours, samples were briefly warmed to room temperature and stored at a controlled temperature of + 2°C to + 8°C for up to seven days. Activities were performed by a senior lab technician using an automated alinity device capable of testing approximately 150 samples at once. Three trained nurses were responsible for collecting data.

Data Quality Management

The questionnaire was initially drafted in English, translated into Amharic, and further back-translated to English to verify consistency. Before actual data collection, data collectors underwent a week-long training program focusing on questionnaire administration, sample handling, and pre-testing methodologies. Additionally, daily spot checks were conducted to ensure the accuracy and completion of questionnaires.

Data privacy was prioritized throughout the data collection process.

Data Processing and Analysis

Data from the questionnaires was collected using an Open Data Kit (ODK), cleaned, and analyzed using STATA version 14. Descriptive statistics such as frequency, percentage, and mean were used to summarize the data, which was then presented in tables and figures.

Bivariate and multivariable logistic regression analyses were performed to identify potential influencing factors on the dependent variable.

Results

Socio-Demographic Characteristics

Data from 546 blood donors from the Hossana Blood Bank catchment area were analyzed. The majority of donors were female (426, or 78.02%), with around 256 (46.89%) falling within the age range of 25 to 34 years. Most participants (426, or 94.51%) lived in urban areas, and approximately 344 (63%) had completed college or higher education, with a smaller percentage having attended secondary school (182, or 33.33%).

Clinical Factors

Among the respondents, 442 (80.95%) had a history of prior blood donation. Over 98% (538, or 98.53%) did not interact with jaundiced patients, and virtually all (92.65%) had no history of blood transfusion.

Behavioral Factors

The majority of the study participants (438, or 80.51%) had only one sexual partner. None of the participants practiced tattooing. About 70% reported never drinking alcoholic beverages, and 92.65% had never smoked tobacco products.

Prevalence of HBV

Of the 546 screened participants, 43 tested positive for HBV, indicating a prevalence rate of 7.88% with a 95% confidence interval ranging from 5.76% to 10.46%.

Interestingly, the study found that 55% of smokers and 34% of individuals with more than one sexual partner tested positive for HBV.

Risk Factors Associated with HBV

The preliminary analysis considered variables with a p-value indicating potential significance in the final model. Six variables emerged as candidates: sharing of sharp materials, alcohol consumption, smoking, having multiple sexual partners, contact with jaundiced patients, and tooth extraction.

The multivariable analysis pinpointed multiple sexual partners, sharing of sharp materials, and tooth extraction as independent risk factors for HBV among blood donors in the Hossana Blood Bank catchment area. Individuals who had undergone tooth extraction were found to be five times more likely to test positive for HBV, compared to those who had not, when controlling for other variables.

The findings underscore the importance of understanding and mitigating these risk factors to safeguard the health of future blood donors and recipients.

By identifying such independent risk factors, health professionals can develop targeted prevention strategies, including education and early intervention programs.

Continued research and monitoring efforts are essential to track the prevalence and distribution of Hepatitis B among blood donors and adapt public health measures accordingly.

The study also highlights the significance of maintaining robust data collection methodologies and ensuring data quality to derive accurate and actionable insights.

Comprehensive and accurate information is vital for crafting policies and interventions that effectively reduce the risk of HBV transmission.