UMYU Scientifica

A periodical of the Faculty of Natural and Applied Sciences, UMYU, Katsina

ISSN: 2955 – 1145 (print); 2955 – 1153 (online)

ORIGINAL RESEARCH ARTICLE

Prevalence and Risk Factors of Hepatitis B Infections among Students in Tertiary Institutions in Kano State, Nigeria

Faiza Aliyu Ismail¹, Abdullahi Muhammad Umar¹, Nasir Sirajo Sadi², Amina Shehu³, Abdullahi Nasir Salmanu⁴ and Abdullahi Musa Hassan²

¹Department of Integrated Science, Faculty of Sciences Education, Yusuf Maitama Sule Federal University of Education, Kano, Nigeria

²Department of Biochemistry, Faculty of Basic Medical Sciences, Bayero University, Kano, Nigeria

³Department of Biochemistry and Molecular Biology, Faculty of Life Sciences, Federal University Dutsin-Ma, Katsina, Nigeria

⁴School of General Studies, Federal University of Transportation, Daura, Katsina, Nigeria

*Corresponding Author: Faiza Aliyu Ismail. Email: faizaismailaliyu@gmail.com

Abstract

Infection with the hepatitis B virus (HBV) remains a significant global public health concern, particularly in sub-Saharan Africa, where its prevalence is disproportionately high. This study investigates the frequency of hepatitis B infections and the associated risk factors among students attending postsecondary institutions in Kano State, Nigeria. Five academic institutions in Kano State participated in this descriptive cross-sectional study, which included all eligible individuals. Serological tests (HBsAg screening) and 1,200 structured, interviewer-administered questions were utilized. The Statistical Package for the Social Sciences (SPSS) version 24 was used to analyze the data electronically. Among the study population, 492 (41.0%) were men and 708 (59.0%) were women. The majority of participants (79.3%) were between the ages of 18 and 29. The prevalence of the hepatitis B virus in the study population was 14.1%, with 14.1% of participants testing positive and the remaining individuals testing negative. One possible explanation for this discrepancy is the young age of the research population. The knowledge evaluation indicated that participants demonstrated a strong understanding of hepatitis B virus infection. Major risk factors identified included tattoos or body piercings, sharing needles, razors, clippers, toothbrushes, and injections, as well as contact with an infected person's fluids, having unprotected intercourse, and a lack of awareness regarding HBV transmission methods. The high prevalence of HBV revealed in this study underscores the critical need for HBV education and vaccination. It also provides essential information about the epidemiological trends of hepatitis B in a significant demographic group in Kano State. This research calls for multi-sectoral cooperation among legislators, healthcare professionals, and educational authorities to implement effective measures to reduce the spread of HBV, increase vaccination rates, and promote a healthier learning environment.

KEYWORDS: Hepatitis, hepatitis B (HBV), Viruses, Vaccination

INTRODUCTION

According to the International Sustainable Development Goals, aimed at eradicating HBV infection by 2030, there are an estimated 290 million cases worldwide (Mohammed et al., 2022). The majority of these cases go undiagnosed and untreated (O'Hara et al., 2017). Hepatitis B is a serious liver infection primarily spread through direct contact with infected blood or bodily fluids (Rajamoorthy et al., 2019; Suan et al., 2019). The hepatitis B virus (HBV) replicates in liver cells (hepatocytes), causing damage and potentially leading to death (Adeyemi et al., 2013; Ullah et al., 2022).

Based on the most recent estimates from the WHO and the Global Burden of Disease research, viral hepatitis causes approximately 1.34 million fatalities annually, which is comparable to the annual number of deaths from TB (1.3 million), HIV/AIDS (1.3 million), and malaria (0.9 million). Viral hepatitis is currently the seventh leading cause of death worldwide, with a 63% rise in mortality since 1990. Despite this, there is still a lack of global recognition of the problem's seriousness and a commitment to battle the disease (WHO 2017).

National strategies for the prevention, treatment, and control of viral hepatitis are in place in an additional half of the Americas (57%). According to WHO (2017), just 54% of nations have set targets to eradicate hepatitis B. According to Debsikréo et al. (2024), 6.1% of adults in Africa are expected to be infected, making it the continent with the second-highest number of people with chronic HBV infection. More than 60 million people in Sub-Saharan Africa have HBV, making it one of the regions with the greatest disease burdens. According to WHO (2017), the regional prevalence of HBV infection is approximately 6.1%, meaning that 1 in 15 individuals is affected. Numerous community-based investigations conducted in Ethiopia indicate that the prevalence of HBsAg ranges from 5.4% to 12.7% (PAHO, 2019). Clinical care, therapy, and interventions aimed at reducing onward transmission are ineffective for around 95% of people with chronic HBV infection because they are unaware of their illness (Spearman et al., 2017).

According to data by Khazaei et al. (2018), the prevalence of HBV infection is 6.2% in the Western Pacific Region and 6.1% in Africa. Prevalence rates in Nigeria range from 12.2% to 14% in various sub-regions (Olayinka et al., 2016; Oti et al., 2021); in Nasarawa State, rates of 7.1% and 13.3% have been reported. Morbidity and mortality are often higher in areas with high endemicity (Dwiartama et al., 2022; Ndubuisi et al., 2022). The impacts of infections on young people are multifaceted. The majority of infections occur during adolescence and adulthood (Ashaka et al., 2025). The problem of HBV infections used to progress silently, which results in delayed diagnosis and treatment starting. Because infected individuals may unknowingly transmit the disease to others, and tertiary institutions are environments where most students are adults and use public toilets and other shared spaces. There’s still a lot we don’t know about the extent of Hepatitis B among students in tertiary institutions in Kano State, Nigeria. Most research so far has focused on the general population or groups such as healthcare workers, overlooking students, even though they may engage in behaviors that increase their risk of infection. There's also limited data specific to this region, and not much is known about how aware students are of the disease, whether they’re getting vaccinated, or how their schools are helping to prevent its spread. On top of that, many studies don’t account for age or gender differences, and some still use outdated testing methods. This leaves a big gap that needs to be filled. Therefore, this research aims to determine the prevalence and risk factors of hepatitis B infections among students in tertiary institutions in Kano State

MATERIALS AND METHODS

Study Area

Kano State is located in the northwestern part of Nigeria. To the north and west of Kano State lies Katsina State; to the south, Jigawa State; and to the east, Bauchi State. The coordinates of Kano State on the world map are 11° 51' 60'' North and 8° 31' 60'' East. One of the state's central geographical features is the Kano (Dala) Hill, an inselberg in the middle of the city of Kano. Geographically, Kano State lies between latitudes 11° 31' North and 12 ° 0' North, and longitudes 8 ° 18 'East and 9 ° 0' East. The state occupies a total surface area of about 20,131 km² and is situated in the Sudan Savannah vegetation zone. The terrain is mostly sandy in the north, gradually changing to clay and black cotton soils in the central part of the state. The southern part of Kano State is largely fertile, with extensive areas suitable for farming. Kano State lies on the edge of the dry Sahel Savannah. Accordingly, it has one of the highest temperatures in the country, with a mean daily maximum temperature of 35°C. Nevertheless, Kano State has a dual rainfall pattern.

Study design

A descriptive cross-sectional study design was used for this study.

Study population

The study population will include students in tertiary institutions in Kano State.

Sampling Techniques

Multi-stage sampling was used.

Stage 1: Selection of institutions: Out of twenty-three (23) tertiary institutions in Kano State, five (5) were selected using simple random sampling by balloting.

Stage 2: Selection of faculty: Three faculty members from each selected institution were selected using simple random sampling via ballot.

Stage 3: Selection of departments: Departmental facilities (i.e., lecture halls, theaters, and restrooms) in each selected faculty were numbered to obtain a sampling frame; thereafter, the sampling fraction and interval were also calculated. The sampling interval was determined by dividing the total number of lecture halls, theaters, and restrooms in the selected faculty by the calculated sample size.

Inclusion Criteria

Adults, both male and female, aged 15 to 49 who are willing to participate, will satisfy the inclusion criteria. 

Exclusion Criteria

The exclusion criteria will be adults with complications or concomitant diseases that require specific medical treatment.

Sample Size Determination

Fisher’s formula (1998) was used to determine the sample size:

 n = z²p (1-p)/d²

Where: n = the desired sample size, z = 95% confidence interval (or 1.96), d = degree of precision usually set at 0.05, and p = 0.5%. The prevalence of 29.91% was used (Isah et al., 2020). The minimum sample size was 322; adding 5% makes it 338. Therefore, we recruited 1200 participants to ensure broader coverage among tertiary institutions in Kano State and to account for possible dropouts.

Study Instrument

A multi-stage sampling technique was used to obtain representation from each tertiary institution in Kano State.

Instrument for data collection

An interviewer-administered, restructured questionnaire was used to collect data from the respondents (Shuaibu et al., 2022).

The questionnaire has 3 sections.

Section A: Socio-demographic characteristics

Section B: Knowledge of Hepatitis B infection

Section C: Risk factors of Hepatitis B infection

Specimen Collection

Venous blood (1 ml) was collected aseptically from participants using a syringe or pricker after the site was sterilized with methylated spirit. Screening for Hepatitis B surface antigen (HBsAg) was performed using rapid immunochromatographic test kits. A small drop of blood was collected from each participant using a sterile lancet and applied to the test cassette, followed by a few drops of buffer solution. The test results were read after 15 to 20 minutes. A positive result showed two visible lines (one for the test and one for the control), while a negative result showed only the control line. Any test without a control line was considered invalid and repeated. All tests were done using clean procedures and proper safety measures to protect both participants and researchers.

Ethical Approval

The Kano State Ministry of Health granted ethical approval (SHREC/2024/5790, NHREC/17/03/2018). After being fully informed about the study, participants provided their informed consent.

Data Analysis

Data collected were imported from Microsoft Excel into the Statistical Package for the Social Sciences (SPSS) software version 24.0 and checked for completeness, coded, entered, and analyzed.

RESULTS

Table 1 presents the socio-demographic information of the study population. Among the participants, 708 (59.0%) were female, of whom 74 had HBV, while 492 (41.0%) were male, with 95 of them having HBV infection. This study indicates that males have a higher prevalence of HBV than females. The majority of the study population was aged 18-29 years, comprising 952 (79.3%) individuals, suggesting they are adults. Most participants reported being financially stable, totaling 683 (57.1%). Furthermore, a significant portion of the study population reported never consuming tobacco, alcohol, or drugs, with figures of 1118 (93.1%), 1162 (96.8%), and 1017 (84.6%), respectively. Overall, there is a statistical difference at P < 0.05 between non-HBV and HBV individuals in terms of age, gender, marital status, financial status, and substance use. Those at the highest risk for HBV are individuals aged 18-29, single, and self-employed, who engage in tobacco, alcohol, or drug use.

Table 1: Socio-Demographic Characteristics

Figure 1 illustrates the prevalence of Hepatitis B infections among students attending higher institutions in Kano State. The findings it reveal that 85.9% are non-hepatitis, and only 14.1% of the total population have hepatitis.

Fig 1. Prevalence of Hepatitis B Infection

Table 2 shows the knowledge of Hepatitis B. The results reveal that 76.9% of respondents had heard of Hepatitis B, but those with the disease were less likely to report knowing about it than those without. Knowledge of Hepatitis B causes (65.3%) and its adverse effects (58.3%) was generally low, with no significant differences between groups. This indicates a broad lack of detailed understanding, even among those living with the virus. Only 60.7% were aware of preventive measures. Alarmingly, infected individuals were less likely to know how to prevent the disease, raising concerns about missed opportunities for health education and early intervention. Infected individuals were more likely to know someone with hepatitis (58.6%), suggesting that transmission may be clustered in social or risk-based networks. A high proportion (49.1%) believed hepatitis could be spread through physical contact—a significant misconception, especially prevalent among those infected (62.7%). This highlights the urgent need to correct myths to reduce stigma and misinformation. A significant difference at P<0.05 was observed between the infected and uninfected groups regarding knowledge of the disease, knowledge of patients, awareness of preventive measures, and misconceptions about whether it can be transmitted through physical contact.

Table 2: Knowledge of Hepatitis B Infection

Table 3 shows the risk factors for hepatitis B infection. The results indicate that risky behaviors are common across both groups, but some are significantly more prevalent among hepatitis-positive individuals, suggesting a strong link between these actions and infection. Sharing personal items such as razors and toothbrushes was reported by 20.3% of respondents, with no significant difference between groups, suggesting that this risky behavior is widespread regardless of infection status. Condom use during intercourse was low overall (36.5%), with no significant differences between groups. This highlights a gap in sexual health practices, despite the role of unprotected sex in transmitting hepatitis B. Tattooing and body piercing demonstrated a significant association with hepatitis: 23.1% of infected individuals had body art, compared to just 7.6% of the non-infected. This suggests a possible connection to non-sterile practices. Sixteen percent of infected people reported sharing needles, compared to 6.3% of non-infected individuals. This statistically significant difference supports needle sharing as a primary mode of transmission. Hepatitis-positive individuals were more likely to avoid contact with infectious body fluids (60.4%), presumably as a result of greater awareness following diagnosis, but over 40% continued to engage in dangerous contact.

Table 3: Risk Factors of Hepatitis B Infection

Table 4 indicates the related risk factors of Hepatitis B infection with knowledge in which there is significant difference at P<0.05 with knowledge of Hepatitis B, Knowledge of hepatitis patients, awareness of hepatitis B preventative methods and the myths of contacting it through physical contact.

Table 4: Factors Associated with Knowledge of Hepatitis B Infection

Values are expressed as Crude Odd Ratio (Lower limit, Upper limit) at 95% Confidence Interval; * signifies values with p-value <0.250 and included in multivariate analysis.

Values are expressed as Adjusted Odd Ratio (Lower limit, Upper limit) at 95% Confidence Interval; * signifies correlation at p-value <0.05; ** signifies strong correlation at p-value <0.01; NE signifies not entered in multivariate analysis as p-value >0.250 in bivariate analysis.

DISCUSSION

In Kano State, Nigeria, this study evaluated the risk factors and prevalence of HBV infections among students enrolled in tertiary institutions. There were 1,200 participants in the research, with 708 (59.0%) of the study population being female, 74 of whom had HBV. The majority of these individuals were between 18 and 29, which corresponds to the reproductive-age segment of the population. Younger people may be more likely to engage in risky activities, including tattooing, unprotected sex, and limited access to healthcare. There were also clear gender inequalities, with men carrying a significantly higher risk of Hepatitis B. This supports research from around the world that indicates a greater frequency among men, possibly due to riskier sexual behavior and less frequent use of preventative healthcare. Similarly, educational level did not significantly correlate with infection status since most participants had a tertiary education, which may have reduced the variability needed to detect differences. However, marital status was significantly associated with infection status, with a higher prevalence among single individuals, potentially indicating increased exposure through multiple sexual partners or limited awareness of protective practices. The results of this study indicate that 14.1% of participants (169/1,200) had an HBV infection. One possible explanation for this high frequency is the low knowledge of HBV infections within the study communities.

Similar findings were noted in another study conducted in N'Djamena (14.9%) (Debsikre’o et al., 2024). This percentage places the study population in the high-prevalence category, meaning it exceeds the 8% cutoff set by the World Health Organization (Guidelines for Prevention, 2024). Another reason for the high incidence could be that the majority of the students were young (18–29 years old). The HBV prevalence in our research population is also higher than that reported in studies of students from Cameroon (5.6%) (Servaisalbert, 2014), Togo (4.6%) (Ecovevi et al., 2015), and Ethiopia (91.5%) (Tesfu et al., 2021). Surprisingly, this finding is comparable to another study published in the Central African Republic (15.5%) (Komas et al., 2010) and lower than that conducted in Nigeria (31.5%) as reported by Tula and Iyola (2015). Although Nigerian students are currently provided with preventive information (such as on sexuality, sexually transmitted diseases, risk factors, and preventive measures), many are reluctant to attend these lectures because sex education remains a taboo topic, particularly in northern Nigeria, such as Kano, where the study was conducted. This contributes to the high incidence. The presence of drugs, alcohol, sex, and other risk factors may also affect the students' living environment (Bamikole et al., 2025). Additionally, compared to other age groups, students are in a stage of life where risk-taking may be more common.

The knowledge evaluation revealed that the participants in this study had extensive knowledge about hepatitis B virus infection. As in earlier studies, which found that over 70% of respondents demonstrated outstanding knowledge, fewer participants in this study did so (Hassan et al., 2016). This information imbalance may suggest that the scientific community recognizes the threat posed by HBV. The average level of knowledge indicates that most individuals have a higher level of education. Nonetheless, the study found that members of the general population were more likely to have received informal education about HBV and to have been tested or vaccinated against it. The information gathered also points to another cause. Prior research has demonstrated a correlation between vaccination rates and educational achievement (Kakshour et al., 2014; Awoleye & Thorn, 2015). The results of the current study, which clearly demonstrate a relationship between age and HBV knowledge, align with prior research that has identified age as a predictor of HBV knowledge (Adekanle et al., 2015; Hajarizadeh et al., 2015). Nonetheless, the study again found that members of the general population were more likely to have received informal education about HBV infection and to have been tested or vaccinated against the virus. The information gathered also points to another cause. Prior research has demonstrated a correlation between vaccination rates and educational achievement (Kakshour et al., 2014; Awoleye & Thorn, 2015). The results of the current study, which clearly demonstrate a relationship between age and HBV knowledge, align with prior research that has identified age as a predictor of HBV knowledge (Adekanle et al., 2015; Hajarizadeh et al., 2015).

People who tested positive for hepatitis were more likely to avoid contact with infectious body fluids (60.4%), presumably due to increased awareness after diagnosis. However, over 40% still engaged in risky behaviors. According to Debsikre´o et al. (2024), some respondents may have taken part in dangerous practices that exposed them to bloodborne infections. To reduce the likelihood of transmission in these high-risk settings, preventive measures are necessary. A significant difference (P<0.05) exists between the following risk factors for Hepatitis B infection and knowledge: knowledge about Hepatitis B, awareness of Hepatitis patients, understanding of Hepatitis B prevention strategies, and misconceptions regarding physical contact. This suggests that the link between being aware of one's HBV status and infection might stem from the fact that those informed of their status are more likely to get tested, as they often have risk factors or symptoms that increase the chance of infection. Some respondents may be unaware of their status for various reasons, including cultural influences, ignorance, lack of information, privacy concerns, personal choice, and fear of stigma and prejudice (Subic and Zoulim, 2018; Martyn et al., 2023). It is essential to enhance screening and awareness, especially among high-risk populations.

CONCLUSION

The high HBV prevalence reported in the most recent study underscores the critical need for HBV education and vaccination. Significant risks for HBV exposure were linked to drug use, alcohol consumption, nicotine use, and unprotected sexual contact. It is essential to remember that the general population is divided into several subgroups, each with unique needs. Therefore, it makes sense to tailor interventions, particularly community-based risk factor education, to each subgroup.

FUNDING

Tertiary Education Trust Fund (TETFUND) provided funding for this study, through the Institutional-Based Research (IBR) grant of Federal University of Education, Kano, under the grant number (FCEK/GEN.311/Vol. VII).

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