PREVALENCE AND RISK FACTORS ASSOCIATED WITH

HEPATITIS B AND HEPATITIS C INFECTIONS AMONG

HEMODIALYSIS PATIENTS ATTENDING DARUSALAM HOSPITAL
IN MOGADISHU, SOMALIA

BY

MOHAMED AHMED ALI ID: 130515

RIDWAN MOHAMUD AHMED ID: 130511

JIBRIL MOHAMUD AHMED ID: 130591

KOWTHER ALI ISSE ID: 129895

A PROPOSAL

PRESENTED TO THE FACULTY OF BUSINESS AND ECONOMICS

SOMALI INTERNATIONAL UNIVERSITY,

MOGADISHU –SOMALIA.

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE DEGREE

BACHELOR OF BUSINESS ADMISTRATION

JAN-2024
 DECLARATION A
We dedicate this thesis to our beloved parents our dear mothers and dear fathers also dedicate
to our dear sisters and brothers. Whom impressed this book and interest in constantly reading
all kinds of books to gain knowledge and we also dedicate this book to all our beloved
brothers, sisters, and friends who have been helping our all the time. We would also wish to
express my especial gratitude to our beloved brothers and sisters.

Student’s Name and Signature

MOHAMED AHMED ALI

Signature: ________________________ Date_____/_______/______

RIDWAN MOHAMUD AHMED

Signature: ________________________ Date_____/_______/______

JIBRIL MOHAMUD AHMED

Signature: ________________________ Date_____/_______/______

KOWTHER ALI ISSE

Signature: ________________________ Date_____/_______/______

i
 DECLARATION B
“We confirm that the work reported in this thesis was carried out by the candidate under our
supervision and according to our opinion is enough in term of scope and quality”.

Name of Supervisor:

Dr. Hussein Hassan Mahmoud

Signature:

Date: / /2024

ii
 DEDICATION
Thanks to Allah who made it possible complete this project successfully, we dedicated to our
beloved parents, brothers and sisters, we also thanking to my classmates and individuals who
helped me directly or indirectly and other people that assist our thesis.

iii
 AKNOWLEDGMENT
First and foremost, we start in the name of Allah, the most gracious and most merciful. We
thank the almighty Allah for in springs with strength and energy to achieve this modest study.
We are deeply grateful to all those who have encouraged and helped us, discussed ideas and
insights, which have contributed in various ways to complete our study. We also very grateful
to our parents for their social and sacrifices during our course of study that has made it
possible for us to accomplish this work. the researchers also appreciate for the academic
guidance received from lectures in Somali International University.

We would like also to thank our dear supervisor: Dr. Hussein Hassan Mahmoud

For his motivation and encouragement. We admired the way in which he explained very
difficult concepts in very simple way; he let us through all stages of our research work when
we had no knowledge it at all.

We are also grateful to all people who were helped to us in collecting date, to name all of
them is impossible. May Allah bless you all.

iv
 Table of Contents

DECLARATION A....................................................................................................................i
DECLARATION B...................................................................................................................ii
DEDICATION..........................................................................................................................iii
AKNOWLEDGMENT.............................................................................................................iv
CHAPTER ONE........................................................................................................................1
INRODUCTION........................................................................................................................1
1.0 Introduction..........................................................................................................................1
1.1. Background of the study.....................................................................................................1
1.2. Problem statement...............................................................................................................3
1.3. Objectives............................................................................................................................3
1.3.1. General objective..........................................................................................................3
1.3.2. Specific objectives........................................................................................................3
1.4. Research questions..............................................................................................................3
1.5. Scope of the study...............................................................................................................4
1.5.1. Geographical scope......................................................................................................4
1.5.2. Time Scope...................................................................................................................4
1.5.3. Content.........................................................................................................................4
1.6. Significance of the study.....................................................................................................4
1.7. Operational Definitions of key Terms.................................................................................4
CHAPER TWO..........................................................................................................................6
LITERTURE REVIEW.............................................................................................................6
2.0 REVIEW RELATED LITERTURE....................................................................................6
2.1 Literature of Independent Variable......................................................................................6
2.2 Literature of Dependent Variable.........................................................................................7
2.3 Level of HBV and HCV infections in hemodialysis patients..............................................8
2.5 Conceptual Framework......................................................................................................10
2.6 Related Studies...................................................................................................................11
CHAPTER THREE..................................................................................................................12
RESEARCH METHODOLOGY.............................................................................................12
3.0 Introduction........................................................................................................................12
3.1 Research Design.................................................................................................................12
3.2 Study Area..........................................................................................................................12
3.3. Target Population..............................................................................................................12

v
 3.3.1 Inclusion Criteria.........................................................................................................12
3.3.2 Exclusion Criteria........................................................................................................12
3.4. Sample Size.......................................................................................................................12
3.5. Sampling Procedure..........................................................................................................12
3.6. Data gathering procedure..................................................................................................13
3.6.1 Specimen collection.....................................................................................................13
3.6.2 Materials required........................................................................................................13
3.6.3 Test procedure.............................................................................................................13
3.6.4. Interpretation of results...............................................................................................13
3.7. Research Instrument..........................................................................................................14
3.8. Data analysis.....................................................................................................................14
3.9. Ethical Consideration........................................................................................................14
3.10. Limitation of study..........................................................................................................14
References................................................................................................................................15
APPENDIX I: Study Questionnaire.........................................................................................17
APPENDIX II..........................................................................................................................20
Time Framework......................................................................................................................20
APPENDIX III.........................................................................................................................21
Budget......................................................................................................................................21

vi
 CHAPTER ONE
INRODUCTION

1.0 Introduction

This chapter deal with the background of the study, statement of the problem, objectives of
the study, research question, justification of the study, significance of the study, scope of the
study and limitation of the study.

1.1. Background of the study

Hemodialysis patients are defined as patients who have Serious health risks are linked to
chronic infections with the hepatitis B and hepatitis C viruses, as they can cause hepatic
cirrhosis and hepatocellular carcinoma. Patients on maintenance hemolysis (HD) therapy
have a higher prevalence of HBV and HCV than the general population, and they are more
vulnerable to these infections. Prior to efficient blood donation screening, HCV infection was
linked to blood transfusions required to treat kidney disease-related anemia. However,
patient-to-patient transmission in intensive care units has also been documented. Patient-to-
patient transmission within HD units is typically the cause of HBV infection.(Jeele, Addow et
al. 2021)

Global public health concerns are raised by chronic viral hepatitis, which is mostly brought
on by the hepatitis B and hepatitis C viruses. Three to four million people contract the
hepatitis C virus annually, 240 million people worldwide are thought to have a chronic HBV
infection, and 180 million people have an HBV infection.(Almezgagi, Edrees et al. 2020)

The majority of these combination treatments exhibit good tolerance and a high level of viral
clearance and sustained virological response (SVR >90%). Treating all patients infected with
HCV is also advised by current international guidelines. Although the prognosis of hepatitis
C patients has greatly improved with treatment, preventing the infection from spreading still
has to come first. Determining the risk factors for these patients may be crucial in preventing
the spread of HCV. There isn't much literature from Somalia, despite the fact that this field
has seen a lot of global effort.(Kataruka, Gupta et al. 2020).

1
Patients undergoing dialysis are at risk of contracting blood-borne infections like the hepatitis
B and hepatitis C viruses due to hemodialysis (HD). The primary causes of chronic viral
hepatitis, which can eventually exacerbate liver cirrhosis and hepatocellular carcinoma, are
the hepatitis B and C viruses. Blood transfusions and invasive medical procedures are the
most frequent iatrogenic modes of HCV transmission in sub-Saharan Africa.
Furthermore, it has been shown that patients can contract hepatitis B through nosocomial
cross-contact transmission. Research suggests a strict infection regimen Consequently, the
majority of control measures in hemodialysis units are implemented to restrict the nosocomial
transmission of viral hepatitis. 8 and 9Additional recommendations include immunizing
patients and healthcare personnel against hepatitis B, and treating patients who have either
hepatitis B or C. The number of patients requiring RRT is rising in low- and middle-income
nations like Somalia as a result of the rising prevalence of risk factors for chronic kidney
disease, such as diabetes and hypertension. Due to a lack of appropriate donors and scarce
resources, kidney transplantation is not a common option in Somalia..(Mahupe, Molefe-
Baikai et al. 2021)

Africa is regarded as a high endemicity region and has the second-highest number of chronic
HBV carriers after Asia. Patients receiving maintenance HD are highly likely to have HCV,
which has a negative impact on patient survival. Around the world, the prevalence of HCV
infection varies; it is 0.6% in Canada, 1.5% in Japan, and 6% in Africa. Different nations
have different rates of HBV and HCV during HD. In industrialized nations, stringent
measures to control infection have reduced the rate of transmission. But in developing
nations, the prevalence is still quite high. This may be brought on by a lack of financial
resources, a lack of vaccinations, and a lack of strict adherence to routine HD precautions and
standard precautions. Numerous studies have documented the frequency of HBV and HCV
among HD patients across various African nations. Nonetheless, no research has been done
that displays the combined prevalence and risk factors for HBV and HCV in patients with
HD across the continent. To ascertain the pooled prevalence and associated variables of HBV
and HCV in HD patients in Africa, a systematic review and meta-analysis were conducted.
The study also establishes the combined prevalence of HBV and HCV infections in patients
from the various regions of Africa (Northern, Central, Western, Eastern, and Southern).
(Adane and Getawa 2021).

Aim of the Study the goal of the study is to determine the prevalence and risk factors
associated with HBV and HCV infections among hemodialysis patients in Somalia.

2
1.2. Problem statement
The frequency of HBV and HCV in dialysis units in developing nations is significantly
higher than that of developed nations. One of the world's poorest nations and a developing
nation is Somalia. The health system faces several challenges, including inadequate staffing,
inadequate organizational structure, inadequate healthcare quality, shortages of critical
medications, and unequal distribution of publicly funded facilities and human resources.
Despite advancements in hemodialysis practices, there remains a significant concern
regarding the prevalence of hepatitis B and hepatitis C infections among hemodialysis
patients. This study aims to systematically assess and understand the risk factors contributing
to the persistence of these infections within this vulnerable population, with the ultimate goal
of informing targeted prevention and control strategies.

In Somalia, the prevalence of the hepatitis B virus is rising daily, and the illness is negatively
affecting people of all ages in our society. In the general population, hepatitis B virus
infection is becoming more common and is a serious illness that causes morbidity and death.
A significant number of pregnant women contract the hepatitis B virus, which can then be
passed from mother to child.(Luqmaan, Hassan et al. 2023)

1.3. Objectives
1.3.1. General objective

The overall of objectives of this study is to identify prevalence and risk factors associated
with hepatitis B and hepatitis C infections among hemodialysis patients.

1.3.2. Specific objectives

1. To identify the prevalence and risk factors associated with hepatitis B and hepatitis C
infections among hemodialysis patients.

2. To determine socio-demographic date hepatitis B and HCV of hemodialysis patients.

1.4. Research questions

1. What is the magnitude of the prevalence and risk factors associated with hepatitis B and
hepatitis C infections among hemodialysis patients?

2. How to determine socio-demographic date hepatitis B and HCV of hemodialysis patients?

3
1.5. Scope of the study
1.5.1. Geographical scope
This study will be carried out at Daru-Salam Hospital in Yaqshid District Mogadishu-
Somalia.

1.5.2. Time Scope

This study will be conducted between December 2023 to July 2024.

1.5.3. Content

This study will determine prevalence and risk factors associated with hepatitis B and hepatitis
C infections among hemodialysis patients in Mogadishu-Somalia.

1.6. Significance of the study

This study will be significant to society as the finding of this study will show information
about prevalence and risk factors associated with hepatitis B and hepatitis C infections among
hemodialysis patients. This study's outcome helped raise awareness of hepatitis B and
hepatitis C infections. In order to prevent hepatitis B and hepatitis C at an early stage, this
research will identify the hepatitis B and hepatitis C cases which will help the Doctors the
diagnosis and management of the patients.

Additionally, the research will be used by other researchers who interested this study by
using as a reference especially the fresh students who wants to make father research about
hepatitis B and hepatitis C infections. This research study will benefit the relevant
community, especially hemodialysis patients living in Mogadishu, as well as Somali
researchers, the Ministry of Health affairs, health agencies and health awareness
organizations and anyone interested in learning more about these infections.

1.7. Operational Definitions of key Terms

Prevalence: is the proportion of a population who have a specific characteristic in a given
time period.
Risk factors: something that increases risk or something that makes a person more likely to
get a particular disease or condition.

4
Hepatitis B: is an infectious disease caused by the Hepatitis B virus that affects the liver; it is
a type of viral hepatitis. It can cause both acute and chronic infection. Many people have no
symptoms during an initial infection.
Hepatitis C: is an infectious disease caused by the hepatitis C virus that primarily affects the
liver; it is a type of viral hepatitis. During the initial infection period, people often have mild
or no symptoms. Early symptoms can include fever, dark urine, abdominal pain, and yellow
tinged skin
Hemodialysis: is a procedure to remove waste products and excess fluid from the blood
when the kidneys stop working properly.
Socio-demographic date: refers to the combination of social and demographic factors that
characterize a particular group of people or a population.

5
 CHAPER TWO
LITERTURE REVIEW

2.0 REVIEW RELATED LITERTURE

This chapter consists of Literature of independent variable, literature of dependent variable,
Level of HBV and HVC, Risk factors associated with HBV and HBV, Conceptual
Framework, and Related studies.

2.1 Literature of Independent Variable

Hepatitis B and C infections among hemodialysis patients are often associated with factors
such as inadequate infection control practices, reuse of contaminated equipment, and the
presence of infected individuals in dialysis units. Additionally, shared medication vials, poor
sterilization techniques, and the length of time on hemodialysis contribute to the risk. Strict
adherence to infection control protocols and regular screening are crucial in preventing and
managing these infections in this vulnerable population, in dialysis patients, intravenous drug
use, total dialysis time, blood transfusions, and a history of kidney transplantation are risk
factors for HBV and HCV. Depending on the country, the risk associated with dialysis is
approximately 2%. Control measures designed to prevent the spread of blood-borne
pathogens can eliminate the spread of HCV in healthcare settings.(Ali, Hussain et al. 2019)

Worldwide, HBV and HCV infections are problems for public health. A plan has been
established by the World Health Organization to eradicate the infection by 2030. Eliminating
infections in patients who are at high risk, such as those receiving hemodialysis, is crucial in
order to achieve this goal (10). According to recent studies, the prevalence of HCV positivity
in patients receiving regular hemodialysis falls between 1.4% and 28.3% in developed
countries and 4.7% and 41.9% in developing countries. The prevalence of HBV in patients
receiving ESKD hemodialysis was found to be 4.6% and 5.9%, respectively, in two projects
carried out in Saudi Arabia and Jordan. Patients with ESKD receiving regular hemodialysis in
the USA had an HCV prevalence that varied from 5% to 10% (Saleem, Naqid et al. 2020).

Compared to developed countries, the frequency rates of HBV and HCV in dialysis units in
developing countries are significantly higher. As one of the world's poorest nations, Somalia
is classified as a developing nation. The health system faces challenges related to poor
management and organization, low staffing levels, inadequate healthcare quality, shortages of
necessary medications, and unequal distribution of publicly funded facilities and human

6
resources (WHO, 2010). Several epidemiological studies on viral hepatitis were carried out
among HD patients in various Mogadishu cities (Almezgagi, Edrees et al. 2020).

2.2 Literature of Dependent Variable

The effect focused on hemodialysis patients and hepatitis B and hepatitis C infections would
typically be the presence or absence of these infections among the hemodialysis patients. It is
a binary outcome, where patients are categorized as either having the infection (positive) or
not having the infection (negative). And also may use diagnostic tests, medical records, or
other reliable methods to determine the status of hepatitis B and C infections in the
hemodialysis patient population, Hemodialysis (HD) patients who have viral hepatitis have
higher mortality and morbidity rates because of cellular immunodeficiency brought on by
uremia, frequent blood transfusions, and prolonged exposure to infectious agents through the
extracorporeal circulation (3, 4). Since hepatitis B vaccinations were developed in the 1980s
and healthcare providers began to use special hemodialysis equipment for patients with
hepatitis B, the incidence of HBV infection among patients receiving HD has gradually
decreased (5-8). In contrast, because an HCV vaccine has not yet been created, a notable
decrease in the incidence of HCV infections has not been accomplished. 4% to 60% of
patients worldwide and less than 5% in high-income nations have HCV among them while
undergoing HD (Asgin and Satilmis 2019).

According to studies, over 240 million people carry the HBV virus chronically, and over
780000 people die from the virus each year. Different geographical areas have reported
varying rates of HBV seroprevalence; in HD patients, the rate is estimated to be between 0.8
and 17.0%. 3.7 percent of people in South-East Iran , 3.88% in Turkey , 6.2% in Cameroon ,
and 4.5% in Sudan tested positive for HBV. Based on the classifications of the World Health
Organization (WHO) and the Iranian Blood Transfusion Organization, Iran is categorized as
having an intermediate level of HBV infection, with a prevalence rate of roughly 3.0%
HBsAg seropositivity. According to available data, the overall prevalence of HBV infection
in Cyprus ranges from 0.6% (9) to 1.2% .(Güvenir, Guler et al. 2019)

Hemodialysis patients are at risk of contracting HCV from blood transfusions, contaminated
dialysis systems, dirty and unclean environmental surfaces, erroneous contact between
medical staff and patients, and improper handling of parenteral medications. The main
strategy for limiting HCV transmission in dialysis facilities is infection control. In an effort to
reduce the transmission of HCV infections among chronic hemodialysis patients, the Centers
for Disease Control and Prevention (CDC) has released recommendations since 2001. Every
time there is a new case of HCV infection, the KDIGO 2018 guidelines for preventing HCV

7
transmission in hemodialysis units advise taking strong measures to improve hygiene in these
settings. These actions include injection safety and environment cleaning. It is acceptable to
reuse the dialyzers of HCV-positive patients as long as standard infection control procedures
are observed Currently, the global prevalence of HCV infection in hemodialysis patients
worldwide and to show geographical differences based on areas and their economic systems.
Evaluations were conducted on clinical outcomes, such as hospitalization and mortality, as
well as risk factors for HCV transmission.(Greeviroj, Lertussavavivat et al. 2022)

2.3 Level of HBV and HCV infections in hemodialysis patients

HBV/HCV co-infection is not uncommon in highly endemic areas; subjects who are at high
risk of parenteral transmission may also have this dual infection because these two
hepatotropic viruses share the same modes of transmission. In these patients with dual
HBV/HCV infections, the additional risk of hepatocellular carcinoma (HCC) accentuates the
risk of progression to cirrhosis and decompensated liver disease. According to reports, the
prevalence of HBV and HCV in Indian dialysis patients ranges from 3.4 to 43% and 20% to
80%, respectively. Prolonged HBV and HCV infections may pose health risks because they
can lead to hepatic cirrhosis and hepatocellular carcinoma Due to regular screening,
immunization campaigns, HBV infection control strategies, and greater rates of viral
clearance, HBV infection is less common in HD units than HCV infection. (Actually, the
separation of patients who test positive for HBV, the use of specialized dialysis equipment,
and routine surveillance for HBV infection have significantly slowed the rise in HBV.
Essential infection control procedures and routine HCV screening of HD patients serve as the
cornerstones for preventing HCV infection in HD settings. Unless there are documented local
outbreaks, it is not recommended to isolate HCV-positive patients or to use special machines
for them. Strict adherence to universal precautions and the segregation of dialysis patients
infected with HBV and HCV may help prevent the spread of illness in HD units (Raina,
Rawat et al. 2022)

Geographic distribution affects the prevalence of HCV and HBV. The prevalence of HBV
and HCV confection varies from 0.2% to 16% in India. The prevalence rate of HCV varies
from 2.8% to 14.7% in Cambodia. The frequency of HBV varies between 4.9% and 8.7% in
Bangladesh. The range of HCV prevalence rates in Pakistan is 1.2% to 15.9%. Numerous
studies carried out in high-risk groups have reported on the factors linked to the spread of
HBV and HCV in Pakistani settings. The relationship between age and the spread of hepatitis
reveals that HCV and HBV infections tend to rise with age, with the age group over 30
having the highest prevalence. Additionally, studies have linked gender to HBV and HCV

8
infections. rising across the nation. This could be due to the large number of people infected
with HBV and HCV, who are spreading their infections throughout the general population.
One possible explanation for this could be a lack of knowledge regarding prevention
strategies and routes of transmission. Finding out the national, provincial, and local
circumstances surrounding the dynamics of HCV and HBV infection is imperative for public
health. Monitoring the various regional risk factors that contribute to the rising incidence of
viral hepatitis, including HBV and HCV, as well as studying the evolving clinical, social, and
epidemiological features of these infections would benefit from such reporting.(Samo,
Laghari et al. 2021)

2.4 Risk factors associated with HBV and HCV in hemodialysis patients

Hepatitis B and C transmission in hemodialysis patients can be associated with factors like
inadequate infection control practices, reuse of contaminated equipment, and exposure to
infected blood. Strict adherence to sterilization protocols, single-use equipment, and regular
screening can help mitigate these risks. Consultation with healthcare professionals for
personalized advice is crucial in managing these conditions in hemodialysis settings Patients
on hemodialysis are especially vulnerable to contracting HCV infection due to IV drug abuse,
recurrent blood transfusions, contaminated dialysis equipment, and numerous other
unidentified factors. Six Less than 5% of people with CKD-ESRD (chronic kidney disease-
end stage of renal disease) live in developed countries, while up to 60% of people live in
developing nations due to the global prevalence of HCV in this population. 7 In 2002, a
national surveillance study comprising 263,820 patients from 4035 dialysis centers in the
United States found that 0.12% of dialysis patients had an annual incidence of HBV infection
and that 1% of dialysis patients were seropositive for hepatitis B surface antigen (HBsAg).8
With a seroconversion rate of 0.9%, the prevalence of HBV infection among dialysis patients
in India ranges from 5 to 13%. (Kataruka, Gupta et al. 2020)

The virus spreads when a healthy person comes into contact with an infected person's blood
or bodily fluids. This can result in cancer and cirrhosis. Hazards associated with HBV and
HCV include unintentional contact with contaminated blood, sexual contact, haircutting and
shaving in public areas, hospitalization, risky surgery, tooth extraction, circumcision, and
hemodialysis. Numerous studies indicate that people who received blood transfusions and
worked in hospitals and 8–106 had a higher prevalence of HBV infection. Risk factors
include contaminated barber razors, contaminated surgical instruments, and dental
extractions. Every region of the nation is seeing an increase in HCV, furthermore Hepatitis-
related deaths now outnumber deaths from tuberculosis, malaria, and acquired

9
immunodeficiencies in humans. Deaths attributable to the efficiency virus. Different body
fluids have significantly different concentrations of HBV and HCV. HBV and HCV are
found in higher concentrations in human body fluids such as blood, serum, and wound
extracts. Semen, vaginal fluid, and saliva are found to contain HBV and HCV to a lesser
extent.(Arain, Laghari et al. 2020)

The following risk factors are aligned with nearly all of the available data on the subject:
Study results in hemodialysis centers in Tripoli, 2002, and Dhaka, Bangladesh, 2006, show
that blood transfusion history, diabetes mellitus, and hypertension increase the morbidity and
mortality of hemodialysis patients, making them more variable in disease and risk of HBC
and HCV infection. The period spent receiving hemodialysis, Intervention with surgery
Performed surgery of any type may increase the risk of HCV seroconversion, according to
findings from a study conducted in Tabriz, Iran, history of organ transplantation, age, and
Gender According to a 2010 study conducted in thirty-nine hemodialysis centers in Libya,
having a history of prior renal transplants increases the risk of developing HBC and HCV
infections.(Abdulwahab, Al-Juboori et al. 2021)

2.5 Conceptual Framework

This conceptual framework is based on the concepts that are the main variables in this study,
as well as a variety of factors such as socioeconomic, biological demographic, and chronic
risk factors that contribute to hemodialysis patients.

RISK FACTORS ASSOCIATED WITH

HEMODIALSIS PATIENTS

CHRONICAL
RISK FACTORS
BIO- SOCIO-
DEMOGRAPHIC ECONOMIC
Blood transfusion

Family History Diabetic

Drug use behavior
Age organ
Awareness about
transplantation
Gender elimination program
Hypertension

HEMODIALYSIS

10
2.6 Related Studies
In this study conducted in Botswana-2021 out of 168 participants, were HBsAg seropositive
at the initiation of hemodialysis, the prevalence of HBsAg was 5 (2.98%) of the hemodialysis
patients (Mahupe, Molefe-Baikai et al. 2021).

In this study conducted in Yamen-2020 out of 100 serum specimens were screened with HBV
and HCV serology test (Rapid test strip) at the initiation of hemodialysis, the prevalence of
hepatitis C and hepatitis B was 3%, 21%, and respectively, recorded in this study. The age
group of 31-45 years, males, unmarried patients had the highest rate of HBV infection while
HCV infection was highly recorded among age group >45 years, female, and married in
hemodialysis patients (Almezgagi, Edrees et al. 2020).

in this study conducted in India-2019 out of 196 patients were examined with for HCV and
HBV serology test ( Rapid test strip) at the initiation of hemodialysis, the prevalence
seroconverted to HCV RNA positive and 0.7% patient became hepatitis B surface antigen
positive, 16.3% in hemodialysis patients (Kataruka, Gupta et al. 2020).

in this study conducted in Iraq-2020 out of 143 patients were screened positive for HBV and
positive for HCV serology test at the initiation of hemodialysis, the prevalence of HBV was
(5/143) (3.49%) and the prevalence of HCV was 3/143 (2.1%) in hemodialysis patients
(Saleem, Naqid et al. 2020).

in this study conducted in Pakistan-2021 out of 523 participants were screened for hepatitis B
and hepatitis C serology test, among whom 232 were females and 291 were males at the
initiation of hemodialysis, the prevalence of hepatitis C and hepatitis B was 14.3% and 6.7%,
in hemodialysis patients (Samo, Laghari et al. 2021).

11
 CHAPTER THREE
RESEARCH METHODOLOGY

3.0 Introduction
This chapter will be discussing the research methodology that research design followed by
target population, research area, research population, sample procedure sample size, research
instruments, ethical considerations, and limitation of the study.

3.1 Research Design

The study design that will be used descriptive cross-sectional s tudy design.

3.2 Study Area

The study will be held at Darus-Salam Hospital in Yaqshid District, Mogadishu-Somalia. The
hospital is private hospital and has different departments: department of medical lab,
department of emergency, department of obstetrics and gynecology, department of general
surgery, department of kidney dialysis and other departments.

3.3 Target Population

All hemodialysis patients attending to Darus-Salam Hospital during study will be the study
population. Approximately, 120 hemodialysis patients attend to Darus-Salam Hospital.

3.3.1 Inclusion Criteria

Hemodialysis patients are confirmed to have a diagnosis of ESRD and currently receiving
hemodialysis treatment.

3.3.2 Exclusion Criteria

Individuals with contraindications to hemodialysis, Cognitive impairment affecting the ability

to provide informed consent and unstable medical conditions.

3.4. Sample Size

Since the target population which is a hemodialysis patient attending to Darus-Salam Hospital.
Every month is about 120.

3.5. Sampling Procedure

Consecutive sampling will be use to conduct this study.

12
3.6. Data gathering procedure
3.6.1 Specimen collection
Serum or plasma may be used in this test Anticoagulants typically used for blood collection
do not interfere with this test. Remove the serum or plasma from the clot or red cells as soon
as possible to avoid hemolysis. Hemolyzed, extremely thickened or fatty specimens are NOT
suitable for this assay. Specimens containing particulate matter may give inconsistent results
and should be clarified prior to testing. Seum or plasma specimens should be refrigerated at
2-8 ° C up to 3 days and frozen at -20° C for longer periods. Shipped specimens should be
packed in compliance with federal and international regulation covering the transportation of
etiologic agents. Avoid frequent (more than 3 times) thaw ad freeze of specimen. 0.1%
sodium aside can be added to the specimen as preservative without affecting the result of the
assay.

3.6.2 Materials required

 Timer or stopwatch
 Blood collection tools (syringe with needle, blood tubes, tourniquet, cotton and
antiseptic)
 Biohazard disposal container
 Disposable gloves
 Pipettes to deliver suitable sample (e.g. 80ul or 100ul of sample)
 Sample dispensing plastic dropper with each test pouch (for card only)

3.6.3 Test procedure

1. Apply 100μL of specimen to the sample pad behind the mark at the bottom of test
strip.
2. Interpret the test results at 15 minutes.
3. Do not interpret the results after 20 minutes.

3.6.4. Interpretation of results

The presence or absence of syphilis antibody provides useful information on the status of
individuals with infection of syphilis.

Positive: Both purplish red test band and purplish red control band appear on the membrane.

Negative: Only the purplish red control band appears on the membrane The absence of a test
band indicates a negative result.

13
Invalid: There should always be a purplish red control band in the control region regardless
of test result. If control band is not seen, the test is considered invalid. Repeat the test using a
new test device.

3.7. Research Instrument

Data will be collected by the using questionnaire that had been specifically tailored with
questions on socio-demographic data of the hemodialysis patients. Additional data was
obtained from the HBV and HCV serology test results.

3.8. Data analysis

Data was exported to SPSS version 20. Using double entry, the data was cross-checked for
consistency and accuracy. Responses and observations were given points and tallied then
recorded to obtain means then presented in graphs, charts and tables.

3.9. Ethical Consideration

Ethical approval will be obtained from faculty of health science, department medical
laboratory science, Somali international university. An official permission will be obtained
from Daru-Salam hospital where the actual data will be collected.

For all study participants the objective of the study was explained and written informed
consent was obtained.

3.10. Limitation of study

 Low speed of the internet
 Limitation of source
 In adequacy of times

14
References
Abdulwahab, H. A., et al. (2021). "Seroprevalence of Hepatitis B & C Virus and Associated
Risk Factors in Hemodialysis Units in Al-Anbar Province." J. Global. Sci. Res. 6(1): 1051-
1068.

Adane, T. and S. Getawa (2021). "The prevalence and associated factors of hepatitis B and C
virus in hemodialysis patients in Africa: A systematic review and meta-analysis." PloS one
16(6): e0251570.

Ali, N., et al. (2019). "Prevalence and risk factors of hepatitis B and C viruses among
haemodialysis patients: a multicentric study." European journal of gastroenterology &
hepatology 31(1): 29-33.

Almezgagi, M. M., et al. (2020). "Prevalence of hepatitis B virus and hepatitis C virus and
associated risk factors among hemodialysis patients in Ibb city-Yemen." PSM Microbiology
5(2): 32-40.

Arain, M. A., et al. (2020). "Prevalence and risk factors associated with Hepatitis B and
Hepatitis C infection in Mirpurkhas, Sindh, Pakistan." Rawal Medical Journal 45(4): 750-
750.

Asgin, N. and S. Satilmis (2019). "Evaluation of hepatitis B virus and Hepatitis C virus
frequency in hemodialysis patients."

Greeviroj, P., et al. (2022). "The world prevalence, associated risk factors and mortality of
hepatitis C virus infection in hemodialysis patients: a meta-analysis." Journal of Nephrology
35(9): 2269-2282.

Güvenir, M., et al. (2019). "Evaluating the prevalence of HBV, HCV, and HIV in
hemodialysis patients in North Cyprus." Hepatitis Monthly 19(1).

Jeele, M. O. O., et al. (2021). "Research Article Prevalence and Risk Factors Associated with
Hepatitis B and Hepatitis C Infections among Patients Undergoing Hemodialysis: A Single-
Centre Study in Somalia."

Kataruka, M., et al. (2020). "Incidence and risk factors for hepatitis C virus and hepatitis B
virus seroconversion in end-stage renal failure patients on maintenance hemodialysis."
Journal of clinical and experimental hepatology 10(4): 316-321.

15
Luqmaan, F. M., et al. (2023). "Seroprevalence of Hepatitis B Virus Infection and Associated
Factors Among Antenatal Clinic Attendees at SOS Hospital, Mogadishu, Somalia." African
Journal of Health and Medical Sciences (AFJHMS) 8: 14-25.

Mahupe, P., et al. (2021). "Prevalence and risk factors for hepatitis b and c among end-stage
renal disease patients on hemodialysis in Gaborone, Botswana." Nigerian Journal of Clinical
Practice 24(1): 81-88.

Raina, D., et al. (2022). "Prevalence of Hepatitis B and Hepatitis C in Patients undergoing
hemodialysis at a teaching hospital in Uttarakhand." Journal of family medicine and primary
care 11(4): 1348.

Saleem, Z. S. M., et al. (2020). "The prevalence of hepatitis B and C virus in patients with
end-stage kidney disease on regular hemodialysis in Duhok, Iraq: A brief report." Avicenna
Journal of Clinical Microbiology and Infection 7(1): 31-33.

Samo, A. A., et al. (2021). "Prevalence and risk factors associated with hepatitis B and C in
Nawabshah, Sindh, Pakistan." The American journal of tropical medicine and hygiene
104(3): 1101.

16
 APPENDIX I: STUDY QUESTIONNAIRE

SECTION A: DEMOGRAPHIC AND SOCIO-ECONOMIC INFORMATION

1. Residential Information:
a) Urban ( )
b) Suburban ( )
c) Rural ( )

2. Demographic Information:

A. Age:

a) 20 to 25 yrs ( )
b) 25 to 30 yrs ( )
c) 30 to 35 yrs ( )
d) above 35 yrs ( )
B. Gender:

Male ( )

Female ( )

C. Marital Status
a) married ( )
b) widowed ( )
c) Divorced ( )
D. Education level
a) None ( )
b) Primary ( )
c) Secondary ( )
d) Diploma ( )
E. Occupation:
a) Jobless
b) Business ( )
c) Employee ( )
F. Duration of undergoing hemodialysis:

a) 2 times a week ( )

17
 b) 3 times a week ( )
c) 4 times a week ( )
d) Weekly ( )

SECTION B: Information of Prevalence And Knowledge Of Hbv And Hcv Among

Hemodialysis.

1. Medical History:

A) Do you have a history of hepatitis B infection?

Yes ( )
No ( )
B) Do you have a history of hepatitis C infection?

Yes ( )
No ( )
C) Have you received the hepatitis B before or after hemodialysis?
A) Before ( )
B) After ( )
10) Have you received the hepatitis C before or after hemodialysis?
A) Before ( )
B) After ( )
11) Have you received the hepatitis B vaccine?
Yes ( )
No ( )
12) Have you received the hepatitis C treatment?

Yes ( )
No ( )
Hemodialysis Facility Details:

13) How often do you undergo hemodialysis?

Yes ( )
No ( )
14) How long have you been receiving hemodialysis?

18
Yes ( )
No ( )
15) Have you received hemodialysis at multiple facilities?
Yes ( )
No ( )

SECTION- C
RISK FACTORS AND PREVENION MEASURES OF HBV AND HCV INFECTIONS.

16) Have you received education on preventing hepatitis transmission?

Yes ( )
No ( )

17) Are there regular screenings for hepatitis among hemodialysis patients?

Yes ( )
No ( )
18) Are you aware of the risks associated with hepatitis transmission during hemodialysis?

Yes ( )
No ( )

19
 APPENDIX II
Time Framework

Activity November December January

Topic selection 15

Chapter one 1

Chapter two 16

Chapter three 15

Proposal Submission 25

Proposal defense THE END OF JAN

20
 APPENDIX III
Budget
No Task Cost

1. HBV CARS TESTS 50$

2. EDETA TUBE 10$

3. HCV CARD TETS 60$

4. GLOVES 10$

5. TRANSPORTATION 30$

6. LUNCH 50$

7. BOOK PRINT 30$

8. DATA INTERNET 30$

9. 5 ML SYRINGE 25$

10. 3 ML SYRINGE 20$

11. TOTAL 315$

21