Aboagye Evelyn

8/4/2019 Aboagye Evelyn

http://slidepdf.com/reader/full/aboagye-evelyn 1/14

MPH Capstone Project

Evelyn Aboagye

May 10th , 2010



PROBLEM DEFINITION

Hepatitis B (Hep B) viral infection is a vaccinepreventable illness that still affects 2 billionpeople worldwide

Viral transmission occurs through exposure toblood/blood products and other body fluids

Vertical (mother to child) or horizontal (childto child) transmission



PROBLEM DEFINTION

The hepatitis B virus (HBV) affects the liver resulting inacute disease that most people can recover from.

However, infection can also lead to chronic liver disease

including cirrhosis and liver cancer.

Chronic Hep B infection is an identified risk factor for thedevelopment of liver cirrhosis and liver cancer.

An estimated 350 million people have chronic infection

25% of adults deaths are related to chronic infection.



PROBLEM DEFNITION

In highly endemic Hep B areas, acquisition of infection is usually in infancy and childhood.

Childhood acquisition impacts development of chronic infection and its sequelae

90% of babies infected perinatally will developchronic infection

30 to 50% of children under 5 years who acquirethe infection will develop chronic infection



MAGNITUDE OF THE PROBLEM

40% of Ghana’s population is below 15 years of age.

Overall prevalence of Hep B in Ghanaian children is 21%(10- 37%)

Doubles from < 5 years to > 12 years

1 in 3 children between 5 and 15 years already haveserological evidence of infection

6%-16% seroprevalence with pregnant women

8.3% Maternofetal transmission



MAGNITUDE OF THE PROBLEM

HBV is the primary viral cause of morbidityand mortality associated with liver diseasein Ghana

70% of diagnosed cases are between 20 to49 years

40% were HBsAg positive.



KEY DETERMINANTS

Lack of awareness of Hep B infection and itssequelae

- Lack of data on knowledge and attitudes

- Recent media talk

Sociocultural norms

- Sharing of personal items- Cultural practices such as tribal marks



KEY DETERMINANTS

Geographical location- Rural vs urban

Lack of comprehensive national policy- EPI program allows immunization of babies at 6, 10 and14 weeks of age using pentavalent vaccine

- No program for children born before vaccine introductionand babies

- No maternal screening

Vaccine costs- Pentavalent + monovalent vaccines brings additional costs



PREVENTION/INTERVENTION STRATEGIES

Universal Infant immunization

- Recommended by WHO for countries with Hep Bprevalence > 8% including newborns

- Ghana introduced hep B immunization in 2002 in theExpanded Program of Immunization (EPI)

- Pentavalent vaccine (Diptheria, pertussis, tetanus, H.fluand Hep B)

- Given at 6, 10 and 14 weeks

- No provisions were made for newborns and children bornbefore vaccine introduction



PREVENTION/INTERVENTION STRATEGIES

Maternal testing and immunization of at riskbabies with Hep B vaccine and HBIGadministration- Not part of current maternal health services

- Some developed countries

- Hep B vaccine and HBIG unavailable and not coveredunder National Health Insurance Scheme

Public information and Education- Some discussion in civil society and media but limited

- Does not guarantee behavior and cultural change



RECOMMENDATION

Comprehensive immunization policy includingprovision of monovalent hep B vaccines in EPI

Newborn, childhood and adolescent immunizationusing existing cold chain services

Retraining health personnel in timely vaccineadministration

Hep B immunization should be covered as part of preventive services in NHIS



RECOMMENDATION

Key stake holders support – parents, healthcare workers, schools, government of Ghanaand its immunization partners

Child welfare clinics, home visits, primary andhigh school entry points to identify those in

need of immunization



CONCLUSION

To reduce the current prevalence of Hep B among

Ghanaian children and interrupt viral transmission

in the long term, there is the need for provision of monovalent Hep B vaccines to all newborns and

unimmunized children with key stakeholdersupport.



Thank You

Aboagye Evelyn

Documents

Transcript of Aboagye Evelyn