Determinants of Hepatitis B Infection and Mitigation Strategies Utilized to Prevent and Control Infection in Population Health of Nyabiheke Refugee Camp in Rwanda

Abstract

A review of the determinants of viral hepatitis infections shows a serious impact on population health, with over 325 million people infected annually. Hepatitis infection is primarily attributed to HBV and HCV, which are leading causes of hepatitis-related comorbidities and high mortality rates. In the study area, a refugee camp, a high number of cases and contributing factors related to hepatitis infection remain undocumented. Despite various government efforts to initiate measures for preventing and controlling the spread of infection over the last decade, millions continue to suffer from HBV without comprehensive data on the underlying factors. This gap in documentation led to the study on determinants of hepatitis infections and mitigation strategies employed in Nyabiheke Refugee Camp to prevent and control Hepatitis B infection in the camp's population. Specifically, the study aimed to determine the prevalence of hepatitis B infections among the camp’s population, evaluate the socio-cultural and environmental risk factors affecting hepatitis spread, and assess the influence of knowledge, attitudes, and practices (KAP) on the effectiveness of the Ministry of Health's prevention and control strategies within the camp. The study employed a mixed-methods approach, combining descriptive, cross-sectional, and cohort study designs, with purposive sampling conducted retrospectively over the last five years and prospectively for three months of data collection. Data collection tools included semi-structured questionnaires for surveys, in-depth interviews, and focus group discussion guides. Data was managed using SPSS version 25.0. Results from the first objective indicated that among the 7,100 refugees screened, 3.4% were diagnosed as Hepatitis B positive. Findings for the second objective identified key transmission sources, including overcrowding (87.9%), unsafe injections (44.5%), and vertical transmission (20.4%), with a p-value below 0.05 indicating insignificant relationships with infection rates in the camp. The availability of sanitation facilities was significant, with a p-value of 0.53 and an odds ratio (OR) of 0.64, signifying a protective role in the camp’s health environment. The third objective found that 38% of participants pointed to the influence of taboos, while 45% agreed with cultural norms as factors affecting healthcare-seeking behavior. Objective four confirmed that the influence of KAP on the spread of Hepatitis B in the camp remains limited, underscoring the need for health education to promote effective prevention and control of Hepatitis B infection. In conclusion, the prevalence of Hepatitis B among refugees in Nyabiheke Refugee Camp is lower than the national prevalence. The study recommends that the Ministry of Health increase HBV vaccination coverage, while health implementation partners in the camp should educate refugees on HBV transmission and prevention. There is a need for ongoing follow-up campaigns and universal access to affordable, high-quality diagnostic tests and vaccines for unscreened individuals. Further studies should investigate vertical transmission levels in Nyabiheke and other refugee camps in Rwanda.

Keywords: Hepatitis Infections, Mitigation Strategies, Utilized, Nyabiheke Refugee Camp, control of the Infection, Rwanda