ADDIS ABABA UNIVERSITY

COLLEGE OF HEALTH SCIENCES

SCHOOL OF ALLIED HEALTH SCIENCE

DEPARTMENT OF MEDICAL LABORATORY SCIENCES

The prevalence, knowledge, attitude and practice of Federal police crime prevention staffs
towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis Ababa, Ethiopia.

By: Tekilu Israel (BSc)

Advisors: Kassu Desta (Associate professor, PhD candidate)

Wondatir Negatu (PhD)

A Thesis Paper Submitted To the Department Of Medical Laboratory Sciences, School of Allied
Health Science, College Of Health Science, Addis Ababa University, In Partial Fulfillment of
Master of Science Degree in Clinical Laboratory Sciences (Diagnostic and Public Health
Microbiology)

June, 2019

Addis Ababa, Ethiopia

Acknowledgment
My gratitude goes to God Almighty, the essence of my existence, all I have ever been and will
ever be in my life, I owe it all to you.
I would like to acknowledge my advisors Mr Kassu Desta and Dr Wondatir Negatu for their
inspiring guidance and valuable comments from the point of topic selection to thus far and who
made me stable and energize by giving first positive response to writing the proposal and thesis.
I would also thank Addis Ababa University, College of Health Science, School of Allied Health
Science, department of Medical Laboratory Science instructors for their great support by giving
proposal and thesis preparation guidance.
My best regards extends to federal police crime prevention health center for financial support. I
would also thank head officers and all staffs for their cooperation to accomplish this thesis
during data collection.
My deep gratitude also goes to all the study participants for their cooperation during sample
collection. Without their willingness, realization of this thesis would have been hardly realized.

Finally, my special thanks go to my family and all my friends who have partly made their
contribution in the development of the proposal and thesis.

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Table of contents

Contents
Acknowledgment ........................................................................................................................................... i
Table of contents ........................................................................................................................................... ii
List of table .................................................................................................................................................. iv
List of figures ................................................................................................................................................ v
Abbreviations ............................................................................................................................................... vi
Abstract ....................................................................................................................................................... vii
1. Introduction:.............................................................................................................................................. 1
1.1 Background: ........................................................................................................................................ 1
1.2 Statement of the problem .................................................................................................................... 6
1.3 Significance of the study ............................................................................................................... 7
2. Literature Review: .................................................................................................................................... 8
3. Objectives ............................................................................................................................................... 14
3.1 General objective .............................................................................................................................. 14
4. Hypothesis............................................................................................................................................... 15
5. Materials and methods ............................................................................................................................ 16
5.1. Study area......................................................................................................................................... 16
5.2. Study design and period ................................................................................................................... 16
5.3. Population ........................................................................................................................................ 16
5.3.1. Source population ..................................................................................................................... 16
5.3.2. Study Population ....................................................................................................................... 16
5.4. Inclusion and exclusion criteria ....................................................................................................... 16
5.4.1. Inclusion criteria ....................................................................................................................... 16
5.4.2. Exclusion criteria ...................................................................................................................... 16
5.5. Study variables ................................................................................................................................. 17
5.5.1. Dependent variables .................................................................................................................. 17
5.5.2. Independent variables ............................................................................................................... 17
5.6. Sample size calculation and Sampling method ................................................................................ 17
5.6.1. Sample size calculation ............................................................................................................. 17
5.6.2. Sampling Method ...................................................................................................................... 18

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 5.7. Measurement and Data collection .................................................................................................... 19
5.7.1. Data collection procedure ......................................................................................................... 19
5.7.2. Laboratory analysis ................................................................................................................... 19
5.8. Data Quality Assurance ................................................................................................................... 22
5.9. Data analysis and interpretation ....................................................................................................... 22
5.10. Operational definitions................................................................................................................... 22
5.11. Ethical considerations .................................................................................................................... 22
5.12. Dissemination of the result ............................................................................................................ 23
6. Work flow ............................................................................................................................................... 24
7. Results ..................................................................................................................................................... 25
7.1. Socio-Demographic Characteristics................................................................................................. 25
7.2. Prevalence of HBV and HCV .......................................................................................................... 27
7.3. Adjusted Odds Ratio, Crude Odds ratio and p- value of HBsAg ..................................................... 29
7.4. Knowledge, Attitude and Practices (KAP) assessment on HBV and HCV ..................................... 31
7.4.1. Knowledge of participant .......................................................................................................... 31
7.4.2. Attitude of participants.............................................................................................................. 31
7.4.3. Practice of participants .............................................................................................................. 31
8. Discussions ............................................................................................................................................ 33
9. Strength and Limitation of the study ....................................................................................................... 36
10. Conclusion and Recommendation ......................................................................................................... 37
10.1. Conclusion ..................................................................................................................................... 37
10.2. Recommendations .......................................................................................................................... 37
11. References ............................................................................................................................................. 38
12. Annex .................................................................................................................................................... 43
12.1 Annexes of Information letter to participants of the study.............................................................. 43
12.2 Annexes of Consent Form .............................................................................................................. 46
12.3 Annexes of questionnaire ................................................................................................................ 47
12. 4 Annexes of principle and procedure of tests .................................................................................. 52
12.5 Annex of thesis declaration ............................................................................................................. 56

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List of table
Table 1: Socio-Demographic Characteristics among federal police crime prevention staffs in
Addis Ababa, Ethiopia, June 2019……………………………………………………………...24

Table2: Prevalence of HBV and HCV among federal police crime prevention staffs in Addis

Ababa, Ethiopia, June 2019 ……………………………………………………..……………26

Table3: Adjusted Odds Ratio, Crude Odds ratio and p- value of HBsAg among federal police
crime prevention staffs in Addis Ababa, Ethiopia, June 2019.……………………..…………29

Table 4: Knowledge, Attitude and Practice assessment among federal Police crime prevention
staff towards HBV and HCV in Addis Ababa , Ethiopia, June 2019 …………………………...30

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List of figures
Figure 1: Geographic distribution of hepatitis B virus infection………………………………2

Figure 2: Geographic distribution of hepatitis C virus ……………………………………….4

Figure 3: Sampling method…………………………………………………………………..16

Figure 4: Workflow ……………………………………………………………………….…22

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Abbreviations
Anti-HBc- Anti-Hepatitis B Core Antigen
Anti- HBe- Anti-Hepatitis B envelope Antigen
Anti-HBs- Anti-Hepatitis B Surface Antigen
Anti-HCV- Anti-Hepatitis C Virus
AOR- Adjusted Odds Ratio
CDC- Center for Disease Control and Prevention
CHB- Chronic Hepatitis B virus
CIs - Confidence Intervals
CS - Cross Sectional Study Design
DAAs- Direct Acting Antiviral Drugs
DNA - Deoxy Ribonucleic Acid HAV-Hepatitis A Virus
ELISA Enzyme Linked Immunosorbent Assay
HBeAg- Hepatitis envelope Antigen
HBsAg- Hepatitis B surface Antigen
HBV- Hepatitis B Virus
HCC- Hepatocellular Carcinoma
HCV- Hepatitis C Virus
HRP- Horse radish peroxidase
INF- Interferon
IRB- Institutional Review Board
IU- International Unit
KAP- knowledge, attitude and practice
Kb- Kilo Base
Ml- Milliliter
Nm- nanometer
OR- Odds Ratio
RNA- Ribonucleic Acid
Ss- Single stranded
TMB- tetra-methyl Benzedrine
WHO- World Health Organization

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Abstract
Background: Viral hepatitis could be an international public health problem affecting many
individuals each year, causing disability and death. Hepatitis B and Hepatitis C viruses are
common causes of hepatitis. Federal police crime prevention staffs are high-risk people for
parenteral and sexually transmitted diseases such as hepatitis B virus (HBV) and hepatitis C
virus (HCV). Data regarding prevalence, knowledge, attitude and practice of Federal police
crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Ethiopia
is limited.
Objective: Determining the prevalence, knowledge, attitude and practice of Federal police
crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis
Ababa, Ethiopia.

Methods: Institutional based cross sectional study was conducted among 500 federal police
crime prevention staffs, in Addis Ababa, Ethiopia from December 2018 to June 2019. A
systematic probability sampling method was employed. A structured questionnaire was used to
collect data on socio-demographic characteristics, knowledge, attitude and practice. All samples
were tested, using a wondfo one step test strip for HBsAg and Ecotest test strip for HCV. Positive
samples were retested by using Murex HBsAg version 3 UK ELISA kits. Data entry and analysis was
done using SPSS version 20 computer software.

Results: The overall prevalence of HBV among Federal police crime prevention staffs in Addis Ababa,
Ethiopia was 4.6% (n=23/500). Of those 4.9% (n=20/407) males and 3.2% (n=3/93) of females were
positive for HBV. The overall prevalence of HCV was 0(0%). From the total participants, 51%
(n=255/500) did not heard about hepatitis, 61.4% (n=332/500) and 61% (n=305/500) incorrectly
identified that HBV and HCV can be transmitted by feco-oral and contaminated water, 97%
(n=485/500) were not screened and 99.6% (n=498/500) were not vaccinated. The majority of the study
participants 349(69.8%) believe that their job puts them at high risk of acquiring of HBV and HCV, 84.6%
(n=423/5) agreed that taking of HBV vaccine is safe.

Conclusion and recommendation: The prevalence of hepatitis B viruses among federal police crime
prevention staffs in Addis Ababa was intermediate and very low hepatitis C. Majority of the participants
had limited knowledge about the transmission and protection of HBV and HCV infection. Large scale
study is important to make generalization and conducting regular health education is essential.

Key words: Hepatitis B and C virus, prevalence, federal police crime prevention, KAP

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1. Introduction:
1.1 Background: Viral hepatitis could be an international public health problem affecting many
individuals each year, causing disability and death. Hepatitis B and hepatitis C viruses are common
causes of hepatitis. Universally, hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are
major causes of acute and chronic liver disease (e.g. cirrhosis and hepatocellular carcinoma
(HCC)), resulting in an evaluated 1.4 million deaths every year[1]. It is evaluated that 2 billion
individuals are living with HBV and from them 248 million are chronic HBV infection (CHB) [2],
and that 110 million persons are HCV-antibody positive and 80 million have chronic viraemic
HCV disease [3]. Around the world, it is estimated that a similar proportion of the whole liver
cancer mortality can be credited to HCV (34,500) and HBV (30,000), with a smaller fraction due to
alcohol [1]. The burden of HBV and HCV remains excessively high in low and middle-income
countries. Around 60% of the world’s population lives in regions where HBV infection is highly
endemic, especially Asia and Africa. Additionally, even in low-prevalence zones, certain sub
populations have high levels of HCV and HBV disease, such as men who have sex with men,
people who inject drugs, people with HIV, as well as indigenous communities and transients. The
World Health Organization classifies countries according to the hepatitis B surface antigen
(HBsAg) into low (<2%), intermediate (2–8%), and high (>8%) prevalence and (HCV) into very
low (<0.1%), low (0.2-1%), intermediate (1.1–5%), and high (>5%) prevalence. [4, 5, 6, 7].
In most cases, federal police live in police camps which may contribute to predispose them to HBV
and HCV transmission through some common routes. The risk of sharing utensils such as hair-
brushes, combs, razors and tooth brushes is common among people living in groups that can
facilitate transmission of the viruses [8, 9]. Additionally, usually federal police travel from place to
place for different professional reasons and stay longer apart from their family. This may force
them to have multiple sex partners that can expose them for different sexually transmitted
infections including HBV and HCV.
1.1.1 Hepatitis B infection
Natural history of HBV infection
Hepatitis B virus is an enveloped DNA virus, measuring 42–47 nm in diameter and a member of
the family Hepadnaviridae hepatotropic DNA viruses. Hepatitis B viral hepatitis virus causes both
acute and chronic infection that may range from symptomless infection or mild illness to severe or
sudden hepatitis. Acute hepatitis B is typically a self-limiting illness marked by acute inflammation

1
and hepatocellular necrosis, with a case death rate of 0.5–1%. Chronic hepatitis B (CHB)
encompasses a spectrum of illness, and is defined as persistent HBV infection (the presence of
detectable HBsAg within the blood or serum for extended than six months), with or without
associated active viral replication and evidence of hepatocellular injury and inflammation [10, 11,
12].
Epidemiology of hepatitis B infection
It is estimated that worldwide, 2 billion individuals have evidence of past or present infection with
HBV, and 248 million are chronic carriers of HBV surface antigen (HBsAg). Age-specific HBsAg
seroprevalence varies markedly by geographical region, with the highest prevalence in sub-
Saharan Africa, East Asia, some parts of the Balkan region, the Pacific Islands and Amazon Basin
of South America. Prevalence below two is seen in regions such as Central America, North
America and Western Europe [2]. In Asia and most different regions, the incidence of HCC and
cirrhosis is low before the age of 35–40 years on the other hand rises exponentially [1]. However,
in some parts of Africa, Alaska and also the Amazon, the incidence of HCC is additionally high in
infected children and young adult men [13, 14].

Figure 1: Geographic distribution of hepatitis B virus infection (Hollinger and Lau, 2006)
Transmission of hepatitis B infection
HBV is spread predominantly by percutaneous or mucosal exposure to infected blood and varied
body fluids, including saliva and discharge, vaginal and seminal fluids. Prenatal transmission is
that the major route of HBV transmission in several parts of the globe, and a very important factor
in maintaining the reservoir of the infection in some regions, significantly in China and South-East

2
Asia. Horizontal transmission, including family, interfamilial and particularly child to child, is
additionally important [15, 16].
Preventing hepatitis B infection through vaccination
Vaccination of infants and, specifically, delivery of hepatitis B vaccine within 24 hours of birth is
90–95% effective in preventing infection with HBV as well as in decreasing HBV transmission if
followed by a minimum of two other doses. WHO recommends universal hepatitis B vaccination
for all infants, and giving the first dose as soon as possible when birth [17].
Treatment of hepatitis B infection
WHO recommends antiviral agents (tenofovir and entecavir) that are active against HBV infection
and are shown to effectively suppress HBV replication, prevent progression to cirrhosis, and reduce
the risk of HCC and liver-related deaths [18, 19]. However, within the majority of patients,
treatment with these medication doesn't give cure (i.e. the person continues to have replicating
virus), necessitating probably lifelong treatment.
1.1.2 Hepatitis C infection
Natural history of hepatitis C infection
HCV may be a little (50nm in size); positive-stranded RNA-enveloped virus with multiple
genotypes and sub genotypes, and their distribution varies considerably in several parts of the
planet. Hepatitis C virus causes both acute and chronic infection. Acute HCV infection is outlined
because the presence of certain markers of HCV infection within six months of exposure to and
infection with HCV, and is characterized by the appearance of HCV RNA, HCV core antigen (p22
Ag), and after HCV antibodies, which may or may not be related to viral clearance [1]. Left
untreated, chronic HCV infection can cause liver cirrhosis, liver failure and HCC. Of these with
chronic HCV infection, the risk of cirrhosis of the liver is 15–30% within 20 years [20, 21]. The
risk of HCC in persons with cirrhosis is close to 2–4% each year [22].
Epidemiology of hepatitis C infection
A recent systematic review estimated that 110 million persons have a history of HCV infection (i.e.
are HCV-antibody positive) and 80 million have chronic viraemic infection [3]. Regions estimated
to have a high prevalence within the general population 3.5% are Central and East Asia, and North
Africa/Middle East; those with a moderate prevalence (1.5–3.5%) include South and South-East
Asia, Sub-Saharan Africa, Latin America, the Caribbean, Oceania, Australasia, and central, eastern
and western Europe. whereas low-prevalence 1.5% regions include Asia–Pacific, Latin America,
3
and North America [3].Updated estimates in Africa show a HCV prevalence of 2.98%, with a
higher prevalence determined in West Africa and lower in south-east Africa [23].
According to estimates from the worldwide Burden of disease study, the number of deaths because
of hepatitis C exaggerated from 333 000 in 1990 to 499 000 in 2010 and 704 000 in 2013[24, 1, 2].

Figure 2 Geographic distribution of hepatitis C virus (Norderstedt et al., 2010)

Transmission of hepatitis C infection
There are four main routes of transmission: healthcare- associated transmission, injecting drug use,
mother-to-child transmission and sexual transmission. In low and middle income Countries,
infection with HCV is most commonly related to unsafe injection practices, and invasive
procedures in health-care facilities with inadequate infection management practices, like renal
dialysis and unscreened (or inadequately screened) blood transfusions [25, 26, 27]. Other routes of
blood borne transmission include acquisition by health-care workers, cosmetic procedures (such as
tattooing and body piercing), scarification, circumcision and intranasal drug use [28, 29, 30].
Prevention of hepatitis C infection
In the absence of a vaccine for hepatitis C, prevention of HCV infection depends up on reducing
the risk of exposure to the virus. This can be difficult due to the varied routes of transmission and
also the different populations that are affected. Globally, most HCV infections occur in health-care
settings as results of inadequate infection control procedures. WHO has published guidelines with
recommendations for preventing health-care-associated HCV infection, and for screening of blood
product [31, 32].

4
Treatment of hepatitis C infection
A new category of medicines, referred to as direct-acting antiviral (DAAs), have transformed the
treatment of HCV, with regimens that may be administered for a short period (as short as eight
weeks), leading to cure rates more than 90th, however are related to fewer serious adverse events
than the previous interferon containing regimens. WHO updated its hepatitis C treatment guidelines
in 2016 to provide recommendations for the use of recent DAAs [33].

5
1.2 Statement of the problem
Viral hepatitis is a world public health problem affecting millions of individuals every year,
causing disability and death around 500 million individuals chronically infected with hepatitis B
virus (HBV) or hepatitis C virus (HCV) within the world. Approximately 1.4 million individuals
die each year (~2.7% of all deaths) from causes associated with viral hepatitis, most commonly
liver disease, including liver cancer [34].
Estimated 57% of cases of liver cirrhosis and 78% of cases of primary liver cancer result from
HBV or HCV infection [35]. Viral hepatitis places a heavy burden on the health care system due to
the costs of treatment of liver failure and chronic liver disease. In many countries, viral hepatitis is
the leading cause of liver transplants. Such end-stage treatments are expensive, simply reaching up
to many thousands of dollars per person [33]. Chronic viral hepatitis also leads to loss of
productivity [36]. The early information on viral hepatitis indicates that from 1990 to 2005 the
prevalence of HBV infection was reduced on the average below 2% in Central and Tropical Latin
American regions, where as it remained between 2% and 4% within the Caribbean, Indian and
Southern Latin American regions [37].
All countries within the African Region consider viral hepatitis an urgent public health issue. The
burden of viral hepatitis, although not accurately known, is believed to be one of the highest within
the world. Hepatitis A, B, C and E are the types mostly found within the Region. The prevalence of
HBV is estimated at 8% in West Africa and 5-7% in Central, eastern and Southern Africa. The
prevalence of HCV is even higher in some areas, reaching levels of up to 10% the worries [38].
Studies from the Horn of Africa, particularly Ethiopia, report HBsAg carriage rate between 5.4%
and 15% and anti-hepatitis C virus positivity between 0.8 and 5.1% in the different groups
Considered [39].
Several researchers have investigated prevalence rates of HBV and HCV infections in various
groups (patients with chronic liver infection, health science students, blood donors, medical waste
handlers and others) [8, 51, 52, and 53]. As to my best knowledge there is no study done on the
prevalence, knowledge, attitude and practice of Federal police crime prevention staffs towards
hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis Ababa, Ethiopia. Therefore, this
study was designed to determine the prevalence, knowledge, attitude and practice of Federal police
crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis
Ababa, Ethiopia and fill the existing information gap among federal Police staffs.

6
1.3 Significance of the study
In view of the fact that viral hepatitis is key public health problems that pose an enormous risk
for disease transmission in the general population, especially people who lives in crowded area
like in military camp. Therefore, Prevention is the only safe strategy against high prevalence of
HBV and H C V . H aving enough knowledge, proper attitude and practice towards this infection
are the corner-stones of preventing the spread of the virus. The investigation of this study helps
the target groups to know the disease status and to take prevention for themselves and their
family. It also helps for already exposed individuals to take treatments. It is also used to generate
current and relevant information on the prevalence, knowledge, attitude and practice of Federal
police crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in
Addis Ababa, Ethiopia. Moreover, the finding of the study uses to formulate preventive
mechanisms to halt the spread of the disease in Federal police as well as in the general
population. Finally, the information obtained from knowledge; attitude and practice of
participants (population under investigation) about the disease can give clue to the responsible
bodies for planning health education program based on the level of understanding of targeted
group.

7
2. Literature Review:
Globally hepatitis B virus (HBV) and hepatitis C virus (HCV) infection are major causes of acute
and chronic liver disease (e.g. cirrhosis and hepatocellular carcinoma), and cause an estimated 1.4
million deaths annually. It is estimated that, at present, 248 million people are living with chronic
HBV infection, and that 110 million persons are HCV-antibody positive, of which 80 million have
active viraemic infection [1].
A cross-sectional Study was conducted by Livia M. et al in Brazil to evaluate a prevalence of
HBV and HCV among military personnel working in Rio de Janeiro south east Brazil. The
investigators selected 433 military male personnel in the age range of 18–25 years old were
screened for prevalence of HBV and HCV. All individuals tested negative for HBsAg or anti-HBc
IgM markers;18 (4.1%) were anti-HBc/anti-HBs reactive, indicating previous HBV infection, and
247 (57.0%) individuals presented isolated positivity for anti-HBs, showing HBV immunity
secondary to vaccination. Anti-HCV was detected in three individuals, resulting in an overall
prevalence of 0.7% and at univariate analysis; age-group was associated to anti-HBc and anti-HBs
positivity. They concluded that this study shows a low prevalence of HBV and HCV infection
among Brazilian military personnel, reflecting the success of universal immunization toward the
eradication of HBV transmission [40].
Another study conducted by Pankaji Puri B. et al 2016 in India to determine viral hepatitis:
Armed forces perspective. They selected more than 22,000 recruits from 25 training centers and
from them a total of 0.93% was seropositive for HBsAg and 0.44% for HCV. The investigators
concluded that parenterally transmitted hepatotropic viruses have a lower reported prevalence in
Armed Forces personnel compared to national data; this still constitutes a large burden of disease in
the Armed Forces. They consider instituting a screening programme at the entry level for recruits
from areas of high prevalence of HBV and HCV [41].
A cross-sectional study conducted by Yuan-Yuan L. et al in China to determine knowledge about
hepatitis B among new military recruits in China. They conducted a prospective cross-sectional
survey using a newly developed questionnaire among 800 new military recruits. Out of a total of
800 questionnaires sent out, 792 questionnaires were returned completed. Of the 727 respondents,
665 were male (91.5%) and 62were female (8.5%), with a mean age of 18.9 ± 1.7 years. Their
investigation showed that a total of 608 respondents (83.6%) demonstrated poor knowledge and
119(16.4%) adequate knowledge about HBV. Older age, female and higher education level were
8
statistically associated with higher total knowledge scores. They concluded that against of
backdrop of high HBV prevalence in china, new recruits had poor knowledge of HBV and new
recruits need better education about HBV to assist in reduction and prevention HBV infection [42].
Reyes P. et al, conducted a cross-sectional study in Philippines 2016 to determine the level of
assessment on knowledge, attitude and practice (KAP) on Hepatitis B and C, prevalence, and risk
factors among high-risk individuals. Of the 450 respondents, 32 (7.1%) were infected with HBV
and 19 (4.2%) were infected with HCV. only 5 (1.1%) were infected with both HBV and HCV.
Majority of the respondents answered that they had knowledge on a disease termed hepatitis (85%),
a disease termed as hepatitis B or C (78%), however, majority of them replied that they do not have
knowledge in terms of: hepatitis B and C are viral diseases (84%), that the diseases could cause
liver cancer (77%), that the diseases could be transmitted by using blades of the barber or ear and
nose piercing (57%), that the diseases could be transmitted by unsafe sex (78%).The investigators
concluded that there is a lack of understanding of the basics of infection control and the prevention
of transmission of Hepatitis B and C. Health education campaign should be provided [43].

The systematic review by Pimpin L .et al, 2018 in Europe, titled by Burden of liver disease in
Europe: Epidemiology and analysis of risk factors to identify prevention policies. They extracted
information on historical and current prevalence and mortality from national and international
literature and databases on liver disease in 35 countries in the World Health Organization European
region, as well as historical and recent prevalence data on their main determinants; alcohol
consumption, obesity and hepatitis B and C virus infections. They extracted information from peer
reviewed and grey literature to identify public health interventions targeting these risk factors.
Their data was supplemented with data from WHO European Health for all databases for broader
categories of liver disease (1970 to 2015). The result indicates that the prevalence of HBV range
from 1% to 8% and HCV 0.1% to 5.9%. The study groups suggest that the Liver disease in Europe
is a serious issue, with increasing cirrhosis and liver cancer [44].

A study conducted by Kupcinskas, L et al in Lithuania to determine prevalence of hepatitis B

serological markers (hepatitis B virus (HBV) superficial antigen (HBsAg)) and risk factors for
HBV infection among Lithuanian Army soldiers. They selected 1,830 army soldiers average age
21.6 and from them a total of 1.97% was seropositive for HBsAg. Their investigation showed that
there is association among soldiers who were a lower education level and soldiers offered to drug

9
use. The investigators concluded that HBV infection distribution among Lithuania Army soldiers is
equal to the Lithuanian population and the results from this study support the need for examination
of all conscripts to detect HBsAg, vaccination against HBV infection, and health education
programs in the Lithuanian Army [45].
German V.et al conducted a cross-sectional study in Greece to investigate serologic indices of
hepatitis B virus infection in military recruits in Greece (2004–2005). The investigators selected
1,840 army recruits and from them only 6 (0.32%) were positive to HBsAg. Their analysis showed
that younger age and advanced education level were independently associated with serologic
evidence suggestive of previous HBV vaccination. Overall, 1,144 recruits (62.17%) had antibodies
against HBsAg [HBsAg (-)/anti-HBsAg (+)/anti-HBcAg (-)]; 665 recruits (36.14%) had
undetectable anti-HBsAg levels. They generalized a further decline of prevalence of chronic HBV
infection among Greece military recruits; a fact that may support the effectiveness of the ongoing
immunization programs [46].
A cross-sectional study conducted by Souly K.et al in Rabat capital city of Morocco to determine
sero-prevalence of viral hepatitis B (HBV) and C (HCV), frequency occurrence of blood exposure
accidents (BEA) and identifies key risk factors for infection among health care personnel of Ibn
Sina Hospital in Rabat. From 601 participants 242 (40.26%) men and 359 (59.74%) women; the
mean age was 42.30 years (range 22 to 59). The study result shows HBsAg was positive in 19
cases (3.16%) and HCV-Ab was positive in 15 cases (2.50%). No HBV and HCV co infection was
detected. They concluded that the prevalence of serological markers of viral hepatitis B and C in
their hospital personnel exceeds that of general population so the establishing of a correct
vaccination scheme against viral hepatitis B are urgently required to decrease the risk of infection
with hepatitis B and C viruses and protect the medical staff in Morocco[47].
Shalaby S. et al conducted a cross-sectional study in Egypt 2010 to determine Hepatitis B and C
viral infection: prevalence, knowledge, attitude and practice among barbers and clients in Gharbia
governorate, Egypt. They selected 616 subjects (308 pairs of barbers and clients) were
included: 322 from urban areas (161 pairs) and 294 from rural settings (147 pairs). HBsAg
was detected in 25 individuals (13 barbers and 12 clients), an overall prevalence of 4.1%
and Anti-HCV antibodies were detected in 77 individuals with an overall prevalence of
12.5%. Knowledge was high among the majority of participants and good practice during shaving
and hair cutting were observe for the majority of barbers. They concluded that a very similar
10
infection rate of HBV and HCV among barbers and their clients to that reported nationally.
Barbers appeared to have no job-related risk of acquiring viral hepatitis [48].
Another cross-sectional Study was conducted by Umumararungu E. et al in Rwanda to evaluate a
Prevalence of Hepatitis C Virus Infection and Its Risk Factors among Patients Attending Rwanda
Military Hospital, Rwanda. They selected randomly 324 patients attending Rwanda Military
Hospital. Their study shows 16.0%of Anti-HCV antibody and 9.6% of active HCV infection were
found in total participants. The HCV infection was significantly higher in the older age population
(>55 years) and exposure to injection from traditional practitioners was identified as a significant
risk factor of infection. They generalize further studies to determine the factors causing the high
prevalence of HCV in Rwanda are recommended [49].
The systematic review and meta-analysis by Belyhun Y.et al, 2016 in Ethiopia, The research
focused on all published studies with epidemiological and/or clinical data on the seroprevalence of
hepatitis viruses (HAV, HBV, HCV, HDV, and HEV) in Ethiopia from the first scientific
description (1968) to 2015. The total study population size screened for hepatitis viruses and
involved in this systematic review and meta-analysis was 79,931. Among these, 62,955 were
screened for hepatitis viruses from the general population. The study result indicates that the
overall pooled prevalence of hepatitis B virus (HBV) was 7.4% (95%CI: 6.5–8.4) and anti-hepatitis
C virus antibody (anti-HCV) was 3.1% (95%CI: 2.2–4.4). The investigators concluded that all
types of viral hepatitis origins are endemic in Ethiopia. Adapting a recommended diagnostic and
treatment algorithm of viral hepatitis in the routine healthcare systems and implementing
prevention and control policies in the general population needs an urgent attention [50].
Birku T. et al conducted a cross-sectional study in Bahirdar town, Ethiopia, to determine
Prevalence of hepatitis B and C viruses’ infection among military personnel at Bahirdar Armed
Forces General Hospital from the 1st of February to the 30th of May 2015. They selected 403
military personnel and the majority of the study subjects 362 (89.8 %) were male and the mean age
of the study participants was32.6 ± 7 SD years. The study indicated that overall prevalence 17 (4.2
%) was positive for HBV and only one individual was positive for HCV. However, none of the
soldiers were co-infected by HBV and HCV. They concluded that intermediate prevalence of HBV
and low prevalence of HCV were observed among military personal and strengthening HBV
screening among military personal may further reduce these viral disease [8].

11
 A cross-sectional study conducted by Demises W.et al in Northeast Wollo, Ethiopia, to determine
Hepatitis B and C Sero-prevalence, knowledge, practice and associated factors among medicine
and health science students. The investigators selected a total of 408 medicine and health science
students from March to September 2017. Their investigation showed that sero-prevalence of HBV
infection was 4.2% and 0.7% for HCV, 331 (81.1%) of the study participants had adequate
knowledge on hepatitis B & C infection, its mode of transmission and preventive measures. The
investigators concluded that a high sero-prevalence but poor practice of hepatitis B and C virus
infection was found in the study area despite their good knowledge towards occupational risk of
viral hepatitis infection [51].
Another cross-sectional study conducted by Mesfin YM. et al 2013 in Haramaya, Ethiopia to
determine Knowledge and Practice towards Hepatitis B among Medical and Health Science
Students in Haramaya University, Ethiopia. They selected 322 health science and medical students
who are starting clinical attachment (year II, III, IV, V and IV). Majority of the students (91%)
were in the age group 20–24 and 232 (72%) of the respondents were male. Majorities (95.3%) of
students were not fully vaccinated against Hepatitis B and 48.4% of the students were not aware
about the availability of post exposure prophylaxis for HB. They concluded that lack of awareness
about Hepatitis B, its route of transmission and modes of prevention among the medical students
entering into the profession. Similarly, 95.3% the students were not fully vaccinated against
Hepatitis B, which makes them vulnerable to the disease [52].
A cross-sectional Study conducted by Mekonnen A.et al in Addis Ababa to determine the
Prevalence of HBV, HCV and Associated Risk Factors Among Cleaners at Selected Public Health
Centers in Addis Ababa, Ethiopia. The investigators selected a total of 252 public health center
cleaners from May to September 2014. Their finding showed that HBV were detected in 9 (3.57%)
and HCV in 4 (1.59%). Of the 9 HBV positive subjects 1(11.1%) was male and 8(3.3%) were
females. However, all of the HCV positive study participants were females. Their investigation
showed that none of the observed risk factors of HBV and HCV were significantly associated with
the occurrence of hepatitis infection. They concluded that prevalence of HBV and HCV is higher in
the study setting as it also revealed by other researches in our country. Therefore, it is important to
implement a screening program for these diseases at large [53].
Girma A.et al conducted a cross-sectional study in 2012 Addis Ababa, Ethiopia to evaluate
Prevalence and Risk Factors of Hepatitis B and Hepatitis C Virus Infections among Patients with
12
Chronic Liver Diseases in Public Hospitals in Addis Ababa, Ethiopia. They conducted on 120
clinically diagnosed chronic liver disease patients and from them Hepatitis B surface antigen was
detected in 43 (35.8%) and anti-HCV antibody 27(22.5%) patients clinically diagnosed to have
chronic liver diseases. Hepatitis B virus infection was higher in males 29/76 (38.2%) compared to
14/44 (31.8%) females, while hepatitis C virus antibody was higher in females 13/44 (29.5%)
compared to 14/76(18.4%) males. Of the study participants, 3 (2.5%) had dual hepatitis B and C
virus co infection. The investigators generalized that prevalence of hepatitis B surface antigen and
anti-HCV antibody was high in patients below 50 years of age and Dental extraction procedure at
health facility was associated with hepatitis C virus [54].

13
3. Objectives

3.1 General objective

Determining the prevalence, knowledge, attitude and practice of Federal police crime prevention
staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis Ababa, Ethiopia.

3.2 Specific objectives

 To determine the prevalence of HBV among Federal police crime prevention staffs in Addis
Ababa, Ethiopia.
 To determine the prevalence of HCV among Federal police crime prevention staffs in Addis
Ababa, Ethiopia.
 To assess the knowledge, attitude and practice among Federal police crime prevention staffs
towards HBV and HCV in Addis Ababa, Ethiopia.

14
4. Hypothesis
Null hypothesis (HO)
There is no difference in the Prevalence, knowledge, attitude and practice of federal police crime
prevention staffs towards HBV and HCV with the other study conducted in Ethiopia.

15
5. Materials and methods

5.1. Study area

The study was conducted in Addis Ababa City Administration which is the capital city of the
Ethiopia. A population of 3,384,569 according to the 2007 population census with annual growth
rate of 3.8%. This capital city holds 527 square kilometers of area in Ethiopia and the population
density was 5,165.1/km2); all of the population is urban inhabitants. All Ethiopian ethnic groups
are represented in the city. Around 30,000 federal police staffs found in Ethiopia and from them
approximately 13,500 are in Addis Ababa. The investigation focused on the federal police staffs
selected from four sub-cities (Lideta, Bole, Arada, and Kolfe) out of ten sub-cities of Addis Ababa.

5.2. Study design and period

Institutional based cross-sectional study was conducted to determine the prevalence of HBV and
HCV by taking blood samples and screened sera with rapid test. Positive tests were further tested
with ELISA, and KAP was assessed using a semi-structured questionnaire. The study was
conducted from December 2018 to June 2019 at Addis Ababa, Ethiopia.

5.3. Population

5.3.1. Source population

The source population was all federal police staffs in Addis Ababa, Ethiopia.

5.3.2. Study Population

The study population was all federal police crime prevention staffs around study area who meet the
inclusion criteria and selected for the study.

5.4. Inclusion and exclusion criteria

5.4.1. Inclusion criteria

All federal police crime prevention staffs those present in the work area during data collection day.

5.4.2. Exclusion criteria

 Those who are unable to communicate for different reasons
 Those who knew their status of HBV and HCV
 Those who have critical health problems

16
5.5. Study variables

5.5.1. Dependent variables

 Prevalence of HBV and HCV among federal police crime prevention staffs in Addis Ababa,
Ethiopia.
 Knowledge, attitude and practice of federal police crime prevention staffs towards HBV
and HCV in Addis Ababa, Ethiopia.

5.5.2. Independent variables

 Socio demographic (Age, sex, marital status, position, educational status, background
residence (rural and urban).

5.6. Sample size calculation and Sampling method

5.6.1. Sample size calculation
The sample size is calculated using a formula for single population proportion considering the
following assumptions
Assumptions: With the assumptions of Confidence interval = 95%, Critical value
Zα/2 = 1.96, Degree of precision d = 0.05. The proportion (p) = 50% since there was no research
done in the same setting as this study concerning prevalence of HVB, HCV and knowledge,
attitude and practice of federal police crime prevention staffs. Non-response rate 10%.
Using n= Z α/2) 2 p (1-p)
d2
Where, n= the required sample size
Z α/2= the standardized normal distribution curve value for the 95% confidence interval (1.96)
P= the level of KAP of federal police crime prevention staffs were unknown so we take as 50%
d= degree of precision (the margin of error between the sample and population, 5%) = 0.05
n = (1.96)2(0.5(1 − 0.5))
(0.05)2
n= 384
By taking additional 10% contingency for non-response rate, the sample size was = 422.
However, we have collected 500 samples.

17
5.6.2. Sampling Method
Among the seven directorates in federal police crime prevention, five directorates are not included
under this study, because rapid police directorate is out of Addis Ababa (study area) and the other
four are not participate in crime prevention work. The two directorates’ selected for this study each
have four divisions giving a total of eight divisions. From them, four divisions were selected
randomly from the two directorates. The study participants were selected from each divisions by
proportion to population size based on the total number of police in each division. Systematic
random sampling method was used to select specific police from the selected divisions by using
their list in the role sheet.
Federal police crime prevention

 Anti-terrors and collective crime control

directorate
 Riot control directorate

 Anti-terrors and collective

Riot control directorate
crime control directorate

Anti-terrors Division Division

Bole division
division=1550 4=1850 3=2000
=1628

Proportion to population size

Bole division Division

Anti-terrors Division
=116 3=142
division =110 4=132
100

Figure 3 Sampling method

500

18
5.7. Measurement and Data collection

5.7.1. Data collection procedure

5.7.1.1. Demographic data collection

Written consent was obtained from study groups and then questionnaire was used to collect
information about knowledge, attitude and practice of the disease and to assess the socio
demographic characteristics of the study participants.
The questionnaire was prepared by principal investigator in simple understandable language,
Amharic and English. The pre-designed questionnaire was pre-tested on 5% of federal police in the
camp other than the study participants in order to check the applicability and then necessary
modifications were made accordingly. Information was given to the study participants about; the
benefit of the study, individual’s right, informed consent before the data collection started.

5.7.1.2. Specimen collection and processing

After obtaining the participant written consent, five milliliter of venous blood was collected from
each participant using gel and clot activator tubes. The tubes were labeled, processed at the time of
collection and transported to the laboratory. The blood was allowed to clotting and serum was
separated by centrifugation at room temperature at 10,000 rpm for ten minutes. After separation, all
serum samples were tested for HBsAg and HCV with rapid screening method according to the
manufacturer’s instruction of the selected test kit and leftover sera were stored in the freezer at -20
o
C. All rapid positive tests were confirmed using ELISA at national blood bank.

5.7.2. Laboratory analysis

5.7.2.1 HCV rapid test principle

Ecotest (Hangzhou Co., Ltd. China) HCV Test strip (serum/plasma) detects antibodies to HCV
through visual interpretation of color development in the internal strip. Recombination of HCV
antigen is immobilized on the test region of the membrane. During testing the specimen reacts with
recombinant HCV antigen conjugate to colored particles and precoated onto the sample pad of the
test. The mixture then migrates through the membrane by capillary action and interacts with
reagents on the membrane. If there are sufficient HCV antibodies in the specimen, a colored band
will form at test region of membrane. The presence of a colored band indicates a positive result,
while the appearance of colored band at control region serve as a procedural control, indicating that
the proper volume of specimens has been added and membrane wicking has occurred.
19
Interpretation of results

Positive (+): Two colored bands appear on the membrane. One band appears in control region
(C) another band appears in the test region (T).

Negative (-): Only one colored band appears, in control region (C). No apparent colored band
appears in the test region (T).

Invalid: No visible band at all, there is a visible band only in the test region but not in control
region. Report with a new test kit. If test still fails, please contact the distributer or the store, where
you bought the product with the lot number.

5.7.2.2 HBsAg rapid test principle

Wondfo (Guangzhou wondfo biotech co., Ltd, china) one step HBsAg serum/plasma Test
cassette is a rapid immunochromatographic test for the visual detection of hepatitis B surface
antigen (HBsAg) in serum/plasma samples. When the specimen is added in to the test device, the
specimen is absorbed in to the device by capillary action, mixes with the antibody conjugate and
flows across the pre-coated membrane. When the antigen levels are at or above the detection limit
of the test, HBsAg in the sample combines to the antibody conjugated in the pad then are captured
by the anti-body immobilized in the Test Region (T) of the device. This produces a visible colored
band in the Test Region (T), which indicates a positive result. When the antigen level is zero or
below the detection limit of the test, there will be no colored band in the Test Region (T), which
indicates a negative result. To serve as a procedure control, a colored line will appear at the control
Region(C).

Interpretation of results

Positive (+): Rose –pink bands are visible both in the control region and the test region. This
positive result indicates the concentration of HBsAg is equal to or higher than the detection limit of
the test.

Negative (-): A rose-pink band is visible in the control region. No color band appears in the test
region. A negative result indicates that HBsAg is zero or below the detection of the test.

20
Invalid: No visible band at all, there is a visible band only in the test region but not in control
region. Report with a new test kit. If test still fails, please contact the distributer or the store, where
you bought the product with the lot number.

5.7.2.3 HBsAg ELISA test principle

Murex HBsAg version 3 UK this is a Sandwich Enzyme linked Immune-sorbent assay method in
which polystyrene micro well strips are pre-coated with monoclonal antibodies specific to HBsAg.
Participant’s serum or plasma sample is added to the micro-wells together with a secondary
antibody conjugated with horseradish peroxidase (HRP) and directed against a different epitope of
HBsAg. During incubation, the specific immune-complex formed in the case of presence of
HBsAg in the sample, is captured on the solid phase. After washing to remove sample serum
protein and unbound HRP conjugate, chromogen solution containing Tetra-methyl Benzedrine
(TMB) and urea peroxidase are added to the walls. In the presence of the antibody-antigen-
antibody (HRP) sandwich immunecomplex, the colorless chromogens are hydrolyzed by the bound
HPR conjugate a blue colored product. The blue color turns to yellow after stopping the reaction
with sulfuric acid. The amount of color can be measured and is proportional to the amount of
antigen in the sample (Test kit insert sheet).
Interpretation of Results
Non-Reactive Results: Samples giving an absorbance less than the Cut-off Value are considered
non-reactive in Murex HBsAg Version 3.
Reactive Result: Samples giving an absorbance equal to or greater than the Cut-off Value are
considered initially reactive in the assay

5.7.2.4 Anti-HCV ELISA test principle

Woodland Hills, California, 91367, USA. This is Polystyrene micro-well stripes are pre-coated
with recombinant, highly immune-reactive antigens corresponding to the core and non-structural
regions of HCV. During the first incubation step, anti- HCV specific antibodies, if present, will be
bound to the phase pre-coated HCV antigens. The wells are washed to remove unbound serum
proteins, and rabbit antihuman IgG antibodies (anti- IgG) conjugated to HRP is added. During the
second incubation step, these HRP conjugated antibodies will be bound to any antigen- antibodies
complexes previously formed and the unbound HRP-conjugate is then removed by washing.
Chromogen solutions containing Tetra-methyl Benzedrine (TMB) and urea peroxidase are added to
21
the wells and in presence of the antigen antibody- anti-IgG (HRP) immune-complex; the colorless
chromogens are hydrolyzed by the bound HRP-conjugated to a blue colored product. The blue
color turns to yellow after stopping the reaction with sulfuric acid. The amount of color can be
measured and is proportional to the amount of antibody in the sample.

5.8. Data Quality Assurance

Prior to the beginning of any data collection, all data collectors were trained by the principal
investigator on an overview of the assessment and its objectives. During the entry of data it was
cross checked to assure the right data was entered correctly. All specimens were collected
according to the standard operating procedure of specimen collection. The quality of test results
was maintained by using the internal quality control of the test kits and by using a known negative
and positive sample an external quality control.
5.9. Data analysis and interpretation
Data entry and analysis was done by using SPSS version 20.0 computer software. Data was
summarized and presented in descriptive measures such as a table and percentage. To determine
the correlation between the data obtained from the questionnaire and the laboratory results, odds
ratios (ORs) and their corresponding 95% confidence intervals (CIs) was calculated using logistic
regression analysis. Whether a variable was significantly associated with HBV and or HCV
infections if the p-value < 0.05.
5.10. Operational definitions
positive: In addition to a pink colored control (C) band, a distinct pink colored band will also
appear in the test (T) region, that indicate the presence of HBsAg in the serum.
Negative: only one colored band appears on the control (C) region. No apparent band on the test
(T) region that indicates the absence of HBsAg in the serum.
Invalid:-No visible band at all or there is a visible band only in the test region but not in the control
region

5.11. Ethical considerations

The study was carried out after it was approved by Addis Ababa University, College of Health
Sciences, Department of medical laboratory Ethical Review Committee and Institutional Review
Board (IRB).It was also be approved by federal police crime prevention health center Ethical
Review Committee then a support letter was obtained from Addis Ababa Health Bureau. The

22
purpose of the study was explained to each participant and sample was obtained only after each
participant gives his/ her written consent. All information obtained held securely and stored on
paper and computer files with a unique identification number. No one except the interviewers knew
the participant took part in the study and the answers were given by the participant marked with an
especial study number only, and not the name.

5.12. Dissemination of the result

This study on completion could serve as a reference material to researchers, experts or policy
makers for intervention. To reach these bodies the finalized paper was submitted to College of
Health Sciences, Department of medical laboratory Addis Ababa University. So it can serve as a
reference in the library. In addition, a copy of this material was given to federal police crime
prevention health center and police hospital. The result was also being disseminated through
publication in peer reviewed local and international journals and through presenting it in relevant
workshops and seminars.

23
6. Work flow
Site assessment and selection

Ethical review letter from FPCP Ethical Review Committee and

support letter from Addis Ababa Health Bureau.

Training of clinical nurses and other participants

Consent was obtained from study participants. Socio-demographic and KAPs

related data was gathered by trained nurses &HO

Venous Blood was draw from participant and serum was separated

HBsAg and HCV Rapid test was ELISA test was done for confirmatory
performed test for HBsAg.

Figure 4: Workflow

24
7. Results

7.1. Socio-Demographic Characteristics

From the total federal police crime prevention staffs, 500 participants were selected for current
study. During the study, for those selected volunteer participants have given their consent to be
participating in the study and then the questionnaire was given to be filled. From total 500
participants, 81.4 % (n=407/500) were males and the remaining 18.6 % (n=93/500) were females.
Large number of the study participant’s, 64% (n=320/500) were belong to the age group of 18 to
25 years old with a minimum and maximum age of 18 and 52 respectively. Related to marital
status, majority of the study participants were single, 59.4 % (n=297/500) and regarding to
educational status, 42.6 % (n=213/500) participants were college and above while only 1.6%
(n=8/500) had elementary school education. Out of the respondents 54.8% (n=274/500) were
constable followed by sergeant 33.6% (n=168/500). Majority of the participants under this study,
24.8% (n=124/500) were from Amhara ethnic group followed by, 21.2% (106/500) are Oromo
ethnic group. From the total participants under this study, 59.6% (n=298/500) were followers of
Orthodox Christianity followed by, 28.6% (n=143/500) are protestant Christianity. The most of
federal police crime prevention staffs 75% (n=375/500) were rural residence background (Table
7.1).

25
Table 7.1: Socio-Demographic Characteristics among federal police crime prevention staffs in Addis
Ababa Ethiopia, January 2018 to June 2019 (n=500), 2019.
Variables Frequency(n=500) Percentage (%)
Sex Male 407 81.4
Female 93 18.6
Age category 18-25 320 64
26-35 137 27.4
>36 43 8.6
Educational background 1-8 8 1.6
9-12 279 55.8

Collage and above 213 42.6

Marital status Married 196 39.2
Single 297 59.4
Divorced 7 1.4
Widowed 0 0
Position Constable 274 54.8
Sergeant 168 33.6
Inspector 49 9.8
Commander 9 1.8
Ethnicity Oromo 106 21.2

Amhara 124 24.8

Tigray 60 12
Woliyta 40 8

Others 170 34
Religion Orthodox 298 59.6
Muslim 51 10.2

Protestant 143 28.6

Catholic 7 1.4
Others 1 0.2
Residence background Rural 375 75
Urban 125 25
N=total sample size
26
7.2. Prevalence of HBV and HCV
From total of 500 study participants included, 4.6 % (n=23/500) were positive for HBsAg and all
participants were negative for HCV. From total of 407 males, 4.9% (n=20/407) and from total of
93 females 3.2% (n=3/93) were positive for HBsAg. Regarding to age category, higher prevalence
of HBsAg infection 5.6 % (n=18/320) were found in age 18-25 years old. Participants who are
positive for HBsAg 4.7 % (n=14/297) are single and 4.6% (n=9/196) are married. Regarding to
educational background, 5.2% (n=11/213) for HBV positive federal police crime prevention staffs
were educated at college and above (Table 7.2).

27
Table 7.2: Prevalence of HBV and HCV among federal police crime prevention staffs Addis
Ababa, Ethiopia January 2018 to June 2019 (n=500), 2019.
Variables HBsAg ELISA Anti-HCVELISA Total
Pos (%) Neg (%) Pos Neg (%)
(%)
Sex Male 20(4.9) 387(95.1) 0(0) 407(100) 407
Female 3(3.2) 90(96.8) 0(0) 93(100) 93

Age category 18-25 18(5.6) 302(94.4) 0(0) 320(100) 320

26-35 4(3) 133(97) 0(0) 137(100) 137
>36 1(2.3) 42(97.7) 0(0) 43(100) 43
Educational 1-8 0(0) 8(100) 0(0) 8(100) 8
background 9-12 12(4) 267(96) 0(0) 279(100) 279
Collage & above 11(5.2) 202(94.8) 0(0) 213(100) 213
Marital status Married 9(4.6) 187(95.4) 0(0) 196(100) 196
Single 14(4.7) 283(95.3) 0(0) 297(100) 297
Divorced 0(0) 7(100) 0(0) 7(100) 7
Widowed 0(0) 0(0) 0(0) 0(0) 0
Position Constable 14(5.1) 260(94.9) 0(0) 274(100) 274
Sergeant 7(4.2) 161(95.8) 0(0) 168(100) 168
Inspector 2(4.1) 47(95.9) 0(0) 49(100) 49
Commander 0(0) 9(100) 0(0) 9(100) 9
Residence Rural 13(3.5) 362(96.6) 0(0) 375(100) 375
background Urban 10(8) 115(92) 0(0) 125(100) 125
Total 23(4.6) 473(65.4) 0(0) 500(100) 500

HBsAg-hepatitis B surface antigen, ELISA-Enzyme Linked Immunoassay, HCV-

Hepatitis C virus

28
7.3. Adjusted Odds Ratio, Crude Odds ratio and p- value of HBsAg
As shown in table 7.3 below, after controlling for possible confounding variables, crude odds
ratio of sex (COR=1.6, CI=0.45-5.33, P=0.486) and age category of 18-25 years (COR=0.399,
CI=0.52-3.070, P=0.378) and 26-35years (COR=0.836, CI=0.86-7.279, P=0.836) are not
significantly associated for HBsAg. However, residence background of the respondents was
found to be significantly associated for HBsAg with (AOR =0.41:95% CI, 0.174-0.98, p- value
=0.042).

29
Table7.3. Adjusted Odds Ratio, Crude Odds ratio and p- value of HBsAg among federal
police crime prevention staff in Addis Ababa , Ethiopia, January2018 to June 2019 (n=500).
Variables HBsAg HBsAg COR CI (95%) AOR CI (95%) P-Value
Positive Negative
Sex Male 20(4.9) 387(95.1) 1.6 0.45-5.33 1.8 0.51-6.3 0.486
Female 3(3.2) 90(96.8) 1
Age 18-25 18(5.6) 302(94.4) 0.399 0.52-3..070 0.378
Category
26-35 4(3) 133(97) 0.836 0.86-7.28 0.836
>36 1(2.3) 42(97.7) 1
Education 1-8 0(0) 8(100)
9-12 12(4) 267(96)
Collage and 11(5.2) 202(94.8)
above
Marital Married 9(4.6) 187(95.4)

Single 14(4.7) 283(95.3)

Divorced 0(0) 7(100)

Position Constable 14(5.1) 260(94.9)

Sergeant 7(4.2) 161(95.8)

Inspector 2(4.1) 47(95.9)

Commander 0(0) 9(100)

Residence Rural 13(3.5) 362(96.6) 1

background
Urban 10(8) 115(92) 0.41 0.176-0.97 0.41 0.174-0.98 0.042

AOR=adjusted odds ratio

COR=crude odds ratio CI=confidence interval

30
7.4. Knowledge, Attitude and Practices (KAP) assessment on HBV and HCV

7.4.1. Knowledge of participant

As can be observed in table 7.4, out of 500 participant’s 51% (n=255/500) were never heard
about HBV and HCV. Majority of the study participants are correctly identified the basic
transmission roots. From this, 91% (n=455/500) responded as the transmission takes place
through blood and blood products, 90% (n=450/500), responded as it takes place through
injury with contaminated needle and sharp material, and also 92.6% (n=463/500)
participants responded sexual intercourse as rout of transmission. However, most
participants 66.4% (n=332/500) and 61% (n=305/500) incorrectly identified that HBV and
HCV can be transmitted by feco-oral and contaminated water. In case of vaccine 84.2%
(n=421/500) have information about availability of HBV vaccine and 65% (n=325/500) know
that there is effective treatment for HBV and HCV (Table 7.4).

7.4.2. Attitude of participants

The majority of the study participants 69.8% (n=349/500) believe that their job puts them at high
risk of acquiring of HBV and HCV. In this study 84.6% (n=423/500) federal police crime
prevention staffs agreed that taking of HBV vaccine is safe. About 86.4% (n=432/500)
participants were considering that HBV and HCV are serious public health problems and 74.8%
(n=374/500) participants were believed that vaccine of HBV is costs too much (Table 7.4).

7.4.3. Practice of participants

All of 100% (n=500/500) the study participants were not having history of HBV and HCV. The
majority of the study participants 58.8% (n=294/500) were sharing sharp materials with others.
Most participants, 99.6% (n=498/500) were not vaccinated to HBV. (Table 7.4).

31
Table7.4. Knowledge, Attitude and Practice of federal police crime prevention staff towards
HBV and HCV in Addis Ababa , Ethiopia, January 2018 to June 2019 (n=500), 2019
Knowledge assessment questions (n=500) (n=500)
Yes (%) No (%)
Do you know or have you heard of Hepatitis B&C? 245(49) 255(51)
Is Hepatitis transmitted through blood and blood products? 455(91) 45(9)
Is Hepatitis transmitted through needle and sharp material injury? 450(90) 50(10)
Is Hepatitis transmitted through sexual intercourse? 463(92.6) 37(7.4)
Is Hepatitis transmitted through feco-oral? 332(66.4) 168(33.6)
Is Hepatitis transmitted through contaminated water? 305(61) 195(39)
Does HBV have vaccine? 421(84.2) 79(15.8)
Is there effective treatment for HBV and HCV? 325(65) 175(35)
Attitude assessment questions
Do you think your job puts you at a high risk of acquiring 349(69.8) 151(30.2)
Hepatitis B and C virus?
Do you think hepatitis B vaccine costs too much? 374(74.8) 126(25.2)
Do you think taking HBV vaccine is safe? 421(84.2) 79(15.8)
Do you believe hepatitis infection is serious public health problem? 432(86.4) 68(13.6)
Practice assessment questions
Do you have history of Jaundice or Diagnosed for liver disease? 0(0) 500(100)
Have you ever taken care of hepatitis patient? 30(6) 470(94)
History of operation/ surgery for yourself? 58(11.6) 442(88.4)
Do you have history of multi sexual partner in life? 148(29.6) 352(70.4)
Do you have sharing of sharp materials with others? 294(58.8) 206(41.2)
Do you have history of tattooing? 94(18.8) 406(81.2)
Do you have history of tooth extraction? 91(18.2) 409(81.8)
Do you have History of ear piercing? 142(28.4) 358(71.6)
Have you received HBV vaccination? 2(0.4) 498(99.6)
Do you have history of blood transfusion? 5(1) 495(99)
Have you screened for HBV and HVC? 15(3) 485(97)
HBV-Hepatitis B Virus, HCV-Hepatitis C virus.

32
8. Discussions
HBV and HC V infections are significant health problems around the globe. Both infections are
associated with a broad range of clinical presentations ranging from acute hepatitis to chronic
infection that may be clinically asymptomatic or may progress to chronic hepatitis and liver
cirrhosis [1].The current study was conducted to determine the prevalence, knowledge, attitude
and practice of Federal police crime prevention staffs towards hepatitis B virus (HBV) and
hepatitis C virus (HCV) in Addis Ababa, Ethiopia.
The prevalence of HBsAg among federal police crime prevention staffs in the current study was
23(4.6 %). This finding is in agreement with previous studies conducted in different population
groups in different part of Ethiopia, systematic review of Ethiopia 7.1% [50], in Bahirdar military
personnel 4.2% [8], in Northeast Wollo medicine and health science students 4.2% [51] and
among cleaners at selected public health centers in Addis Ababa 3.57% [53]. Similar findings
were observed in other countries among different population groups. For instance, a prevalence in
morocco among health care personnel 3.16% [47], in Egypt among barbers and clients 4.1% [48]
and in Philippines among high risk individuals 7.1% [43]. However, this finding was higher than
the finding done in different parts of the world among military groups, such as in Brazil 0% [40],
in India 0.93% [41], in Lithuania 1.7% [45] and in Greece 0.32% [46]. Variation in prevalence of
HBsAg across study could be multifactorial in which difference in geographical distribution as
well as population differences in terms of life style, awareness, socio-cultural environment,
traditional practices, and sexual practices, medical exposure, the difference in hepatitis
epidemiology, study subjects and sample size might also be the cause of such differences.
On the other hand, the prevalence of HBsAg in the current study was lower than other studies in
Addis Ababa among patients with chronic liver diseases 35.8% [54]. This might be because our
study populations are all volunteer federal police crime prevention staffs and most of them could
be confident of their sero-status and study subjects, sample size, might also be the cause of such
differences.
The highest prevalence 18(5.6%) of HBsAg was detected among federal police crime prevention
staffs who were age group 18-25 followed by 26-35 4(3%), but the difference was not statistically
significant 18-25 (COR=0.399, CI=0.52-3.070, P=0.378) and 26-35 (COR=0.836, CI=0.86-7.279,
P=0.836). This finding was in good agreement with the study conducted in Greece military recruits
all positives (0.32%) are found in the age group 19-22 [46]. The observed high prevalence of

33
HBsAg positivity among younger age group could be defined with the high probability of exposure
for high risk health behavior.
In term of gender, 20(4.9%) male staffs were positive for HBsAg and 3(3.2%) were females,
however, the difference was not statistically significant (COR=1.6, CI 95%=0.245-5.37, P=0.486).
This finding is more or less similar with Bahirdar military personnel study were 14(4.2%)
males and 2(4.9%) female were positive [8]. However, higher prevalence is incomparable
with the study conducted in Addis Ababa among cleaners at selected public health centers male
1(11.1%) and females 8(3.3%) [53]. This difference may be due to differences in the sample
size and study population of participants.
In relation to marital status, prevalence of HBsAg was higher among single participants, which
was 14(4.7%) this finding was incomparable with a study conducted in Bahirdar military
personnel which showed the prevalence of HBsAg among married 12(5.6%) and single
5(2.8%) [8].
As can be observed from the table 7.2, which describes the education level of the study groups,
federal police crime prevention staffs who were in college level education and above had higher
11(5.2%) prevalence of HBsAg. This finding was incontrary to a study conducted in Bahirdar
military personnel which shows, high school 11(6%) and college level and above 6(3.1%) [8].
Likewise, in Lithuania army groups, personnel in primary level and college level education
had a prevalence of 41.7% and 25% respectively [45].
In relation to residence background, prevalence of HBsAg was higher among urban residence
background participants 10(8%) than rural residence background 13(3.5%), residence background
(AOR =0.41:95% CI, 0.174-0.98, p- value =0.042) significantly associated with HBsAg
prevalence. This finding was incomparable with to a study conducted in Bahirdar military
personnel urban 12(3.8%) and rural 5(6%) and Greece military recruits rural 5 out of 6(0.32)
positives [46].
In the current study, all study participants were negative for HCV (0.0%). This result is in contrast
with different studies conducted: in Bahirdar military personnel 0.2% [8], in Northeast Wollo
medicine and health science students 0.7% [51], in Addis Ababa among cleaners at selected public
health centers 1.59% [53], in Addis Ababa among patients with chronic liver diseases 22.5% [54],
In Brazil military 0.7% [40), in Morocco among health care personnel 2.5% [47], in Egypt among
barbers and clients 12.5% [48] and in Rwanda among patients attending military hospital 28.4%
34
[49]. This difference might be due to difference in study participants and sample size.
In this study it was assessed that the knowledge, attitudes and practices of participants towards to
HBV and HCV infection are vital areas of investigation. Apart from significant number of federal
police staffs 51% were responded that they have never heard about HBV and HCV infection, in
other ways, they have poor knowledge about HBV and HCV infection, which is in line with studies
conducted in china among new military recruits that showed 83.6% poor knowledge [42], in
Philippines among high risk individuals 78% have poor knowledge and 97.6% never heard about
HBV [43]. In addition, in Haramaya among medical and health science students, 76.1% never
heard about HBV [52]. This is further reflected with their response for mode of transmission of
HVB and HCV, where 332(66.4%) and 305(61%) believed that HBV and HCV can transmitted by
feco-oral and consumption of contaminated water respectively.
With regard to participants attitude, the majority of the study participants, 349(69.8%) believe that
their job puts them at high risk acquiring of HBV and HCV. In this study 423(84.6%) federal police
crime prevention staffs agreed that taking of HBV vaccine is safe. Similar finding were
observed in Haramaya among medical and health science students 93.2% [52].
In relation to participants practice, screening and vaccination of HBV and HCV was assessed by
using questionnaire prepared. Among the total study population 485(97%) responded not screened
and 498(99.6%) were not vaccinated respectively which is in line with study conducted in
Philippines among high risk individuals 94% and 72% respectively [43]. The results of previous
and current investigation are also in good agreement with the study carried in Haramaya among
medical and health science students 85.7% and 95.3% respectively [52].

35
9. Strength and Limitation of the study

9.1. Strength of the study

 The research was conducted for the first time among police staffs.
 It was critically arranged that HBsAg positive participants to get further diagnosis and
treatment.

9.2 Limitation of the Study

 High shortage of domestic and international (abroad) literatures done in related study
area.
 Other federal police directorates were not included because of different resource
constrains.
 The ELISA test was only performed for those sera which were positive by rapid tests.

36
10. Conclusion and Recommendation

10.1. Conclusion
The present study showed an intermediate prevalence of HBV and very low HCV infection among
apparently federal police crime prevention staffs in Addis Ababa according to World Health
Organization’s classification.
A 4.6% and 0% overall prevalence of HBV and HCV infection respectively in our study setting
among federal police crime prevention staffs in Addis Ababa that need for timely intervention
strategies to alleviate the burden of HBV infection in the federal police staffs and community. This
prevalence rate also calls for additional efforts regarding active screening and vaccination for all
federal police staffs and public health education campaigns in the media to promote better
awareness of risk factors.
In this study, age groups 18-25 had prevalence of 5.6% which was the highest prevalence. It may
be at high risk and serves as a reservoir which requires routine screening and vaccine schedules
(for HBV) may be important for those high risk groups. Majority of the participants had limited
knowledge about the transmission and protection of HBV and HCV infection.

10.2. Recommendations
Based on the current investigation, the following recommendation forwarded

 National surveillance screening for Hepatitis B and C among Ethiopia federal police
crime prevention staffs is required.
 Conducting regular health education for federal police crime prevention staffs, their
family and community to prevent the transmission of hepatitis.
 Large scale study is important to make generalization among federal police staffs in
Ethiopia.

37
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12. Annex
12.1 Annexes of Information letter to participants of the study
1. Information Sheet
Hello, how are you? My name is _______________. This is an interview to be done with you for a
study that is being conducted at Addis Ababa University, college of health Science, School of
allied health science, department of medical laboratory sciences.

Title of the study

The title of the study is the determine the prevalence, knowledge, attitude and practice of Federal
police crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in
Addis Ababa, Ethiopia.
Propose of the study
The purpose of the study is to determine the prevalence, knowledge, attitude and practice of
Federal police crime prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus
(HCV) in Addis Ababa, Ethiopia.
What it will mean if you decide to take part in the study?
If you agree to participate in this study, you will participate in this interview in a private place. The
interview will last for about10-20 minutes and will be facilitated by me and my colleague. During
the interview, you will be asked to respond questions related to hepatitis infections and knowledge,
attitude and practice. During the interview, my colleague will write down what you say. The
recorded data will not contain your names or other identifying information. They will just be
labeled with a study number.
The results will assist policy makers, planners and health service providers for making
considerations regarding the prevalence, knowledge, attitude and practice of Federal police crime
prevention staffs towards hepatitis B virus (HBV) and hepatitis C virus (HCV) in Addis Ababa,
Ethiopia. It will also help to contribute in the subsequent efforts to improve prevention, diagnosis,
treatment and support of viral hepatitis in relation to their family, at large in the community.
Risks and discomforts
There is no possible risk associated with participating in this study. But there is a little pain during
drawing venous blood which will be collected by professional phlebotomists. You are free to
decline answering any question that you do not wish to answer and you may leave our interview at
any time you want to.

43
Confidentiality
All information obtained will be held securely and stored on paper, and computer files. No one
except the interviewers will know that you took part in the study the answers that you give will be
marked with a special study number only, and not your name. The data will protect information
about you in this research to be the best of our ability.
Voluntary participation
Your participation is voluntary. You may withdraw from the interview at any time without giving a
reason and without any penalty. If you have questions regarding this study or would like to be
informed of the results after its completion, please do not hesitate to contact:
Investigator: Tekilu Israel, Cell phone: +251913317958
Email: teklu59@gmail.com
Advisors: Kassu Desta (Associate professor, PhD fellow), +251911107099

Wondatir Negatu (PhD), +251910851900

For additional information, please contact Addis Ababa University, College of Health Sciences,
Department of Medical Laboratory Sciences at: Telephone +251112755170

44
ቅጽ II: ስለ ጥናቱ ማስተዋወቂያና በጥናቱ ለመሳተፍ ፈቃደኝነት መጠየቂያ የአማርኛ ቅጽ

በፌደራል ፖሊስ ወንጀል መከላከል ላይ የጉበት በሽታን የሚያመጡ ረቂቅ ተህዋሥያን ስርጭት
(መጠን) ፣ግንዛቤና አጋላጭ ምክንያቶች ላይ የሚደረግ ጥናት

ስለ ጥናቱ ማስተዋወቂያ ቅፅ

ጥናቱ የሚሰራው በፌደራል ፖሊስ ወንጀል መከላከል ላይ የጉበትን በሽታን የሚያመጡ ረቂቅ
ተህዋሥያን ስርጭት ፣መጠን፣ ግንዛቤና አጋላጭ ምክንያቶች የሚል ነው፤

የጥናቱ አላማ በረቂቅ ተህዋስያን የሚመጣ የጉበትን በሽታን መጠን፤ ስርጭት፣ ግንዛቤና አጋላጭ
ምክንያቶችን ማጥናት ነው፡፡ ጥናቱ የሚካሄደው በአዲስ አበባ ከተማ ይሆናል፡፡ እርሰዎንም
በፌደራል ፖሊስ ወንጀል መከላከል ላይ የጉበትን በሽታን የሚያመጡ ረቂቅ ተህዋሥያን ስርጭት
(መጠን), ግንዛቤና አጋላጭ ምክንያቶች ተያያዥነት ያላቸውን ጥያቂዎች እንጠይቀዎታለን፡፡

ጥናቱ ለእርሰዎ ቀጥተኛ የሆነ ጥቅም ባይኖረውም ለፖሊሲ አውጭዎችና አስፈጻሚዎች እንዲሁም
ለማህበረሰቡ ስለ አጋላጭ ሁኔታዎችና ስለመከላከያ መንገዶች ለማወቅ ይረዳል፡፡ በሌላ በኩልም
ስለበሽታው ግንዛቤና ጥንቃቂ ለማገኘት ይረዳል፡፡ የደምዎ ናሙና በላብራቶሪ ሲመረመር ምንም
አይነት ችግር ካሳየ ባለሙያ ምክር ይሰጥዎታል፡፡

እርሰዎንም በዚህ ጥናት እንዲሳተፉ በትህትና እንጠይቀዎታለን፡፡ በዚህ ጥናት በመሳተፈዎ

የምናገኘው መረጃ ለጥናታችን ውጤታማነት እነዲሁም በጥናቱ ውጤት ላይ ከፍተኛ አስተዋፅዎ
ይኖረዋል፡፡ ስለዚህም በዚህ ቃለ-መጠይቅ በመሳተፈዎ ምስጋናዬ የላቀ ነው፡፡ በጥናቱ በመሳተፈዎ
ምክንያት የሚመጣበዎት ምንም አይነት ችግር አይኖርም፡፡ ነገር ግን 5 ሚሊ ሊትር የደም ናሙና
ለመዉሰድ መርፌ ሲገባ ከሚፈጥረዉ የቅጽበት የህመም ስሜት በስተቀር የጎላ ችግር አያመጣም፤
ምቾት ካልተሰማዎት ባለሙያ እንዲያይዎት ይደረጋል፡፡ በጥናቱ ውስጥ ስምዎ በማንኛውም ሁኔታ
አይገለጽም፤ ስለሆነም የሚሠጡት መረጃ ሙሉበሙሉ ሚስጢራዊነቱ የተጠበቀ ነው፡፡ ስለዚህ በጥናቱ
ለመሳተፍ የእርሠዎ ሙሉ ፈቃድ አስፈላጊ ነው፡፡ በተጨማሪም ለመመለስ የማይፈልጉዋቸው
ጥያቂዎች ካሉ ጥያቂዎችን ለመመለስ አይገደዱም፡፡ አንዲሁም በጥናቱ ላለመሳተፍ ከፈለጉ
የሚያመጠው ምንም አይነት ጉዳት የለውም፡፡

ቃለ መጠየቁን በተመለከተ ወይንም አጠቃላይ ስለጥናቱ ማንኛውንም አይነት ጥያቄና አስተያየተ

ቢኖረዎት በሚከተሉት አድራሻዎች መጠቀም ይችላሉ፡፡

ተክሉ እስራኤል፡ ስልክ፡ሞባይል፡ 0913-31 79 58 ኢ-ሜይል፡ teklu59@gmail.com

ለተጨማሪ መረጃ፡ አዲስ አበባ ዩኒቨርሲቲ፤ የሕክምና ላብራቶሪ ሳይንስት ክፍል ይጠይቁ፡፡

ስልክ +251 112 75 51 70

45
12.2 Annexes of Consent Form
I have read the information sheet concerning this study (or have understood the verbal explanation)
and I understand what will be required of me and what will happen to me if I take part in it. I also
understand that any time I may withdraw from this study without giving a reason and without me
or my families’ are being affected for my refusal.
May I continue the interview?
1. Yes ____________Continue the interview
2. No ______________Stop the interview and thank the respondent
Witness's signature certifying that the informed consent has been given
Witness's signature ______________ Date ______________
Introduction to the interview
Thank you for deciding to participate in the interview and for coming to this session, previously
(on the statement of consent form), we have discussed briefly on the purpose of the research, how
you were identified, and your part in the research study. Now I am going to have discussion with
you on the relevant topic items. Before going to the discussion, would you tell me important
backgrounds such as age, educational background etc.? There is no right or wrong answers. All
answers /responses/ ideas you provide are equally important and you are requested to respond
honestly from your experiences and beliefs. I may interrupt and probe your ideas. Once again I
would like to tell you that what we are going to discuss is very confidential and it will be used only
for the research.
III. ስምምነት ማረጋገጫ ቅፅ
ከላይ በመግቢያው ላይ የተጠቀሰውን መረጃ አንብቢያለሁ ወይም በቃ ልየተሰጠኝን ማብራሪያ
ተረድቻለሁ፡፡ በዚህ መሰረት ከእኔ የሚጠበቅብኝን ድርሻ በሚገባ አውቄያለሁ እናም በዚህ ጥናት
ላይ በመሳተፌ ሊከሰቱ የሚችሉትን ሁኔታዎች ተገንዝቢያለሁ፡፡ ከዚህ ጥናት በማንኛውም ሠዓት
ያለምንም ቅድመ ሁኔታና ምክንያት እራሴን ከተሳታፊነት የማግለል ሙሉ መብት እንዳለኝ
ተረድቻለሁ፡፡ ይህን ውሳኔዬን ተከትሎ በእኔም ሆነ በቤተሰቦቼ ላይ በምንፈልገው የጤና
አገልግሎት ላይ ምንም አይነት አሉታዊ ተጽዕኖ እንደማይደርስብኝ ተረድቻለሁ፡፡ በመሆኑም
ስለጥናቱ ማብራሪያ የተሰጠ መሆኑን በተለመደው ፊርማዬ አረጋግጣለሁ፡፡
የተሳታፊው ስም--------------------------------ፊርማ ---------------ቀን-----------------------

46
12.3 Annexes of questionnaire
Addis Ababa University
College of health sciences
Department of Medical laboratory Sciences
For data collectors: For each question please encircle the answer.
If you make a mistake; simply cross out the mistake and encircle the correct choice. Identification
number: ------------------------- Date of data collection------------------------

1. Socio-demographic information

S.NO Questions Answer Remark

1 Sex 1. Male 2. Female

2 Age ………….years
3 Educational status 1. No formal education 2. 1-8 3. 9-124.
College and above
4 Marital status 1. Married 2. Single
3. Divorced 4. Widowed
5 Your position 1. Constable 2. Sergeant
3. Inspector 4. >Commander
6 Religion 1. Muslim 2. Orthodox 3. Protestant
4.Catholic 5. Other, specify __________
7 Residence (your background 1. Rural 2. Urban
residence)
8 Ethnicity 1. Oromo 3. Tigray 4. Gurage
2. Amhara 5. Wolayta
6. Others specify ………………...

47
 2. Knowledge about Hepatitis B & C infection questions
1 Do you know or have you 1. Yes 2. No
heard of Hepatitis B&C?
2 If you hear, from where did 1. Books and journal articles 2. Lectures and
seminars 3. Media 4. Family and friends 5.
you hear?
Special workshops 6. Other specify……
3 Which part of our organ does 1. Liver 2. Heart3. Kidneys
Hepatitis B &C affects?
4. Brain 5. Not sure
4 Route of transmission of 1. Blood and blood products A. yes B. No
2. Needles and sharps injury A. yes B. No
Hepatitis B &C infection
3. Sexual intercourse A. yes B. No
(answer each of the following 4. Vertically from mother to child. A. yes B.
No
choices)
5. Feco-oral A. yes B. No
6. Contaminated water A. yes B. No
5 Does HBV have vaccine? 1. Yes 2. No
6 Is there effective treatment for 1. Yes 2. No
HBV and HCV?
3. Attitude Regarding Hepatitis Band C viral infection
1 Do you think your job puts you 1. Yes 2. No 3. I don’t have idea
at a high risk of acquiring
Hepatitis B and C virus?
2 Do you think hepatitis B 1. Yes 2. No
vaccine costs too much?
3 Do you think taking HBV 1. Yes 2. No
vaccine is safe?
4 Do you believe hepatitis 1. Yes 2. No
infection is serious public
health problem?
4. Participants practice towards HBV and HCV infection
1 Do you have history of 1. Yes 2. No
Jaundice or Diagnosed for
liver disease?
2 Have you ever taken care of 1. Yes 2. No
hepatitis patient?
3 History of operation/ surgery 1. Yes 2. No
for yourself?
4 Do you have history of multi 1. Yes 2. No
sexual partner in life?
5 Do you have sharing of sharp 1. Yes 2. No
materials with others?
6 Do you have history of 1. Yes 2. No
tattooing?
7 Do you have history of tooth 1. Yes 2. No
48
 extraction?
8 Do you have History of ear 1. Yes 2. No
piercing?
9 Have you received HBV 1. Yes 2. No
vaccination?
10 Do you have history of blood 1. Yes 2. No
transfusion
11 Have you screened for HBV and 1. Yes 2. No
HVC?

49
IV. መጠይቅ
አዲስ አበባ ዩኒቨርስቲ
የህክምና ፋኩልቲ
የላቦራቶትሪ ትምህርት ክፍል
ለመረጃ ሰብሳቢዎች፤ጥያቄዉን ከጠየቃችሁ በኋላ መልሱን ከተሰጡት አማራጮች ያክብቡ፡፡
1. መለያ ቁጥር________መረጃው የተሰበሰበበት ቀን____________________________
1. የማህበራዊና ስነ-ህዝብ ሁኔታ የሚዳስሱ ጥያቄዎቸ
ተ.ቁ ጥያቄ መልስ ምርመራ
1 ጾታ 1. ወንድ 2. ሴት
2 እድሜ ---------------------------ዓመት
3 የትምህርት ሁኔታ 1. 1-8 2. 9-12
3. ኮሌጅና ከዛ በላይ
4 የጋብቻ ሁኔታ 1. ያገባ /ች 3. የፈታ/ች
2. ያላገባ/ች
4 የሞተበት/ባት
5 የሃላፊነት ደረጃ 1.አባል 2. ሳጅን
3.ኢንስፈክተር 4. >ኮማንደር
6 ኃይማኖት 1.ሙሲሊም 2.ኦርቶዶክስ
3.ፐሮተስታንት 4.ካቶልክ
5. ለላ--------------
7 የትውልድ አከባቢ 1. ገጠር 2 .ከተማ
8 ብሔርዎ ምንድ ነው? 1. ኦሮሞ 4. ጉራጌ
2. አማራ 5.ወላይታ
3. ትግሬ 6. ሌላ (ይገለጽ) ---------
2.የግንዛቤ መጠን መለኪያ ጥያቄ
1 የጉበት በሽታ ተህዋስያን ቢናሲን 1. አወ2. አላውቀውም
ሰምተውት ያዉቃሉ?
2 ሰምተውት ከሆነ ከየትነው 1. ከመፃሀፍና ከጋዜጦች
የሰሙት 2. ከአስተማሪዎች እና ከተለያዩ
ስብስባዎች 3. ከሚዲያ
4.ከቤተሰብና ከጓደኞች 5.ከተለያዩ
ቦታዎች
3 የጉበት በሽታ አምጭ ተህዋስያን 1. ጉበት2. ልብ 3. ኩላሊት
ቢናሲ የትኛውን የሰውነት ክፍል 4.ጭንቅላት 5.አላውቀውም
ያጠቃሉ
4 የጉበት በሽታ ተህዋስያን ቢናሲ 1. ደምና የደም ውጤቶች
መተላለፊያ መንገድ ሀ. አወ ለ.የለም
2. መርፌና ስለታማ ነገሮች
ሀ. አዎ ለ.የለም
3. በግብረ ስጋ ግንኙነት

50
 ሀ. አወ ለ.የለም
4. ቀጥታ ከእናት ወደ ልጅ
ሀ. አወ ለ. የለም
5. ከተበከለ እጅ ወደ አፍ
ሀ. አወ ለ.የለም
6. ከተበከለ ውሀ ሀ. አወለ.የለም
5 ለጉበት በሽታ ተህዋስያን ቢ ሀ. አወ ለ.የለም
ክትባት አለ ብለው ያስባሉ
6 ለጉበት በሽታ ተህዋስያን ቢናሲ ሀ. አወ ለ.የለም
የሚዋጡ መድሀኒቶች አለ ብለው
ያስባሉ
3. የአኩዋሓን (Attitude) መጠን መለኪያ ጥያቄ

1 የስራ ሁኔታ የጉበት በሽታ ተህዋስያን ቢናሲ ያጋሊጣል ብለው ሀ.አወ ለ.የለም
ያስባሉ
2 የጉበት በሽታ ተህዋስያን ቢ. ክትባቱ ውድ ብለው ያስባሉ ሀ. አወ ለ.የለም

3 የጉበት በሽታ ተህዋስያን ቢ. ክትባቱ መዉሰድ በሽታን ይከላከላል ሀ. አወ ለ.የለም

ብለው ያስባሉ

4 ጉበት በሽታ ለሕብረተሰቡ ፈተና ነው ብለው ያስባሉ ሀ. አወ ለ.የለም

4.የጉበት በሽታ ቢና ሲ ልምምድ (practice) ሁኔታ መለክያ ጥያቅዎች

1 በጉበት በሽታ ተይዘው ያውቃሉ? ሀ. አወ ለ.የለም

2 ከቤተሰበዎ በጉበት በሽታ ተይዞ እሚያውቅ አለ? ሀ. አወ ለ.የለም

3 ሆስፒታል ውስጥ ታመዉ ተኝተዎ ያቃሉ? ሀ. አወ ለ.የለም

4 ከአንድ ሰው በላይ የጾታ ግንኙነት አድርገው ያውቃሉ? ሀ. አወ ለ.የለም

5 ስለታማ ነገር ቆርጦዎት ያውቃል? ሀ. አወ ለ.የለም

6 ሰውነተዎ ላይ ንቅሳት አለ? ሀ. አወ ለ.የለም

7 ጥርሰዎን ኣስነቅሎ ያውቃሉ? ሀ. አወ ለ.የለም

8 ጀሮዎን ተበስተው ያውቃሉ? ሀ. አወ ለ.የለም

9 የጉበት በሽታ ክትባት ተከትበው ያውቃሉ? ሀ. አወ ለ.የለም

10 ከሌላ ሰው ደም ተቀብለዎ ያውቃሉ? ሀ. አወ ለ.የለም

11 የጉበት በሽታ ምርመራ አድርገው ያውቃሉ? ሀ. አወ ለ.የለም

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12. 4 Annexes of principle and procedure of tests

A. HCV test principle

Principle
Ecotest (Hangzhou Co., Ltd. China) HCV Test strip (serum/plasma) detects antibodies to HCV
through visual interpretation of color development in the internal strip. Recombination of HCV
antigen is immobilized on the test region of the membrane. During testing the specimen reacts with
recombinant HCV antigen conjugate to colored particles and precoated onto the sample pad of the
test. The mixture then migrates through the membrane by capillary action and interacts with
reagents on the membrane. If there are sufficient HCV antibodies in the specimen, a colored band
will form at test region of membrane. The presence of a colored band indicates a positive result,
while the appearance of colored band at control region serve as a procedural control, indicating that
the proper volume of specimens has been added and membrane wicking has occurred.

Test procedure

Allow the device and specimen to equilibrium to room temperature (15 -30 oC) before testing.

1. Remove a testing device from the foil pouch by tearing at the notch and place it on a level
surface.

2. Holding a sample dropper vertically, add two drops (approximately 50 ul) of specimen to the
sample well then add 1 drop of buffer and start timer.

3. Wait for 10 minute and read results .Do not read results after 20 Minuit

Interpretation of results

Positive (+): Two colored bands appear on the membrane. One band appears in control region
(C) another band appears in the test region (T).

Negative (-): Only one colored band appears, in control region (C). No apparent colored band
appears in the test region (T).

Invalid: No visible band at all, there is a visible band only in the test region but not in control
region. Report with a new test kit. If test still fails, please contact the distributer or the store, where
you bought the product with the lot number

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Note: The intensity of the red color in the test line region (T) will vary depending on the
concentration of anti-HCV antibodies present in the specimen. However, neither the quantitative
value nor the rate of increase in anti-HCV antibodies can be determined by this qualitative test.

B. Hepatitis B surface antigen test principle and procedure

Principle

Wondfo (Guangzhou wondfo biotech co., Ltd, china) one step HBsAg serum/plasma Test cassette
is a rapid immunochromatographic test for the visual detection of hepatitis B surface antigen
(HBsAg) in serum/plasma samples. When the specimen is added in to the test device, the specimen
is absorbed in to the device by capillary action, mixes with the antibody conjugate and flows across
the pre-coated membrane. When the antigen levels are at or above the detection limit of the test,
HBsAg in the sample combines to the antibody conjugated in the pad then are captured by the anti-
body immobilized in the Test Region (T) of the device. This produces a visible colored band in the
Test Region (T), which indicates a positive result. When the antigen level is zero or below the
detection limit of the test, there will be no colored band in the Test Region (T), which indicates a
negative result. To serve as a procedure control, a colored line will appear at the control Region(C).

Test procedure

Allow the device and specimen to equilibrium to room temperature (10 -30 oC) prior to testing.

1. Remove a testing device from the foil pouch by tearing at the notch and place it on a level
surface.

2. Holding a sample dropper vertically, add four drops (80ul-100ul) of specimen to the sample
well.

3. Wait for 15 minute and read results .Do not read results after 30 Minuit.

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Interpretation of results

Positive (+): Rose –pink bands are visible both in the control region and the test region. This
positive result indicates the concentration of HBsAg is equal to or higher than the detection limit of
the test.

Negative (-): A rose-pink band is visible in the control region. No color band appears in the test
region. A negative result indicates that HBsAg is zero or below the detection of the test.

Invalid: No visible band at all, there is a visible band only in the test region but not in control
region. Report with a new test kit. If test still fails, please contact the distributer or the store, where
you bought the product with the lot number.

C. HBsAg ELISA test principle

Murex HBsAg version 3 UK this is a Sandwich Enzyme linked Immune-sorbent assay method in
which polystyrene micro well strips are pre-coated with monoclonal antibodies specific to HBsAg.
Participant’s serum or plasma sample is added to the micro-wells together with a secondary
antibody conjugated with horseradish peroxidase (HRP) and directed against a different epitope of
HBsAg. During incubation, the specific immune-complex formed in the case of presence of
HBsAg in the sample, is captured on the solid phase. After washing to remove sample serum
protein and unbound HRP conjugate, chromogen solution containing Tetra-methyl Benzedrine
(TMB) and urea peroxidase are added to the walls. In the presence of the antibody-antigen-
antibody (HRP) sandwich immunecomplex, the colorless chromogens are hydrolyzed by the bound
HPR conjugate a blue colored product. The blue color turns to yellow after stopping the reaction
with sulfuric acid. The amount of color can be measured and is proportional to the amount of
antigen in the sample (Test kit insert sheet).

D. Anti-HCV ELISA test principle

Woodland Hills, California, 91367, USA. This is Polystyrene micro-well stripes are pre-coated
with recombinant, highly immune-reactive antigens corresponding to the core and non-structural
regions of HCV. During the first incubation step, anti- HCV specific antibodies, if present, will be
bound to the phase pre-coated HCV antigens. The wells are washed to remove unbound serum
proteins, and rabbit antihuman IgG antibodies (anti- IgG) conjugated to HRP is added. During the
second incubation step, these HRP conjugated antibodies will be bound to any antigen- antibodies
complexes previously formed and the unbound HRP-conjugate is then removed by washing.
Chromogen solutions containing Tetra-methyl Benzedrine (TMB) and urea peroxidase are added to
54
the wells and in presence of the antigen antibody- anti-IgG (HRP) immune-complex; the colorless
chromogens are hydrolyzed by the bound HRP-conjugated to a blue colored product. The blue
color turns to yellow after stopping the reaction with sulfuric acid. The amount of color can be
measured and is proportional to the amount of antibody in the sample.
F) Test Procedures for ELISA

1. A micro titration well plate is coated with known antigen.

2. Add patent’s serum. If the serum contains antibody it combine with antigen.

3. Wash carefully by using automatic washer more than 5 times.

4. Add enzyme labeled antihuman globulin, which attaches to the antibody.

5. Wash carefully.

6. Add the substrate, which is hydrolyzed (broken down) by the enzyme to give a color change.
7. Read the result.

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12.5 Annex of thesis declaration
I, the undersigned, declare that this Master science degree thesis is my original work, has not been
presented for a degree in this or any other University and that all sources of materials used for the
thesis have been duly acknowledged.
Principal investigator: Tekilu Israel (BSc, MSc candidate)
Signature: ___________________
Date of submission: _____________________

Name of Advisors:
1. Mr- Kassu Desta (Bsc, Msc, PhD fellow, Associate professor)
Signature Date
2. Dr Wondatir Negatu (PhD)
Signature Date

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