Factors associated with differential community prevalence of hepatitis e in, Kitgum district, northern Uganda.

Abstract

Background: In Uganda, Hepatitis E caused morbidity and mortality in more than 10,437 persons and 167 deaths Case Fatality Rate (CFR) of 1.6%, northern Uganda 2009. The risk factors for the transmission were clearly known, however there was still a knowledge gap in the factors associated with differential community prevalence of Hepatitis E in sub counties of Mucwini and Kitgum Matidi as reflected in Kitgum District Health Management Information System (HMIS) 2011.

Objective: The objective of this study was to investigate factors associated with differential community prevalence of Hepatitis E in sub counties of Mucwini and Kitgum Matidi, Kitgum district.

Methods: We conducted a survey of 474 heads of households’ aged 18-84 years, and key informant interviews with Local Council(LC) III chairpersons, Health Centre(HC) III In-charges of Mucwini and Kitgum Matidi sub counties and the District Health officer. Four Focus Group Discussions (FGDs) with LC I chairpersons and Village Health Team (VHT) were conducted in the two sub counties. Completed questionnaires were checked for completeness, coded and entered into the computer using Epi-Info version 3.5.1. Data was cleaned and stored for analysis. Qualitative data from the tape recorder during the discussions and interviews was transcribed and kept for analysis. Qualitative data that was entered and stored in Epi-Info version 3.5.1 was transferred to STATA version 10 for analysis. The responses from the key informant interviews and FGDs were summarized and analysed manually

Results: A total of 97 (41.99%) of respondents in Mucwini sub county, compared to 63 (26.47%) in Kitgum Matidi sub county reported to have had a family member that suffered from hepatitis E The risk of suffering from Hepatitis E was 1.61 times higher in Mucwini sub county than Kitgum Matidi sub county(p=≤ 0.001). Hand washing after latrine use (p=0.003), frequency of communal hand washing (p=0.01), reception by health workers (p=<0.001), frequency of village health meetings held on Hepatitis E (p=0.001) and knowledge on causative organism of Hepatitis E (p=0.015) were factors associated with differential community prevalence of Hepatitis E in the sub counties of Kitgum District. Hepatitis E prevention practices; correct latrine use, drinking clean/safe water and washing hands after latrine also differed significantly (p=<0.001), in the two sub counties of Mucwini and Kitgum Matidi.

Conclusions and Recommendations: Mucwini Sub County had a higher prevalence of Hepatitis E as compared to Kitgum Matidi. The Factors responsible for the difference included poor practice washing hands after use of latrine, increased frequency of communal hand washing, and incorrect household practice of Hepatitis E preventive measures in Mucwini Sub County as compared to Kitgum Matidi Sub County. More meetings were held in Kitgum Matidi than in Mucwini Sub County. The district health team should ensure that Hepatitis E prevention and control interventions in Mucwini sub county encompasses measures to improve personal hygiene especially hand washing after using the latrine and increased frequency of village health meetings to educate the community about the dangers of communal hand washing. The DHT should also place more effort to increase uptake of Hepatitis E prevention practices like correct latrine use and drinking clean/safe water form protected water sources in Mucwini sub county.