Hepatitis B Virus (Hbv) Infection

¶ … Hepatitis B virus (HBV) Infection Among Makerere University Medical Students written by Pido and Kagimu has no formal literature and provides minimal background information regarding historical literature in the area of scope and scale within the introduction and closing discussions. The introduction provides a very limited literary development while the discussion follows with a greater description, through peer reviewed literature of the importance of the research. The fact that the population of Ugandan medical students is at greater risk for the infection and transmission of HBV as well as the fact that HBV is endemic in the region are supported in these two sections and are supported by the research conducted.

The study design offers the reader a cross-sectional look at pre-clinical and post-clinical medical students attending a single university and sets the stage for further research and understanding regarding the prevalence of HPV among the population and also supports the increased risk of clinical experience among these students, with some evidence that the population rate of 11% HBV positive individuals almost doubled for medical students at about 20%. Increased exposure risk periods were also identified (i.e. year III post clinical students) and recommendations regarding the improvement of pre-clinical vaccination as well as childhood vaccination improvements were also made.

3. Though the scale of the study was limited to an overall size of only 182 students it represents a good cross sectional population of students in the larger group. Conversely there are only three medical schools in Uganda and this study was conducted at one of those three and included the majority of students at all levels of medical school in it. The fact that the study was also inclusive of both post-clinical and pre-clinical students also lends well to the fact that there is a suspicion of heightened risk during the clinical transition for both issues of maturity (i.e. greater sexual exposures) and clinical exposures associated with work.

4. The study has a duel objective one to create a baseline understanding of the number of medical students who have HBV and to determine how, why and when these students are at greater risk for acquiring HBV in either a public manner, via HBV exposure at work, or via private means as a result of exposure in their private lives, through sexual contact or drug use exposure. The study does not exclude any possible mode of infection.

5. The statistical analysis of the findings was limited to reporting the findings on scale, including demographic, prevalence, risk factor reporting at both a baseline level and among the reports of current cohort, one group with active infection and the second with historical infection. The statistical analysis was comprehensive and inclusive of the double objective of the study. The research study is limited to simple means and average reporting and does not offer more in depth statistical analysis though it does compare findings to other populations, including the general population as well as referring to other research that can be assumed to have discovered the larger population risk in and outside the medical profession.

6. The biggest strength of the study is that it represents not only clinical exposure and infection of current acute infection among the population but improves the odds of understanding by including personal risk factors (including behavioral and other medical exposures) and clinical exposure history clearly showing that clinical exposure does play a big part in the problem for this population. The recommendations are also strong as they make clear that eairlier HBV vaccination for children and vaccination compliance among adult students who had not received HBV vaccination as children would largely improve the situation and reduce the number of individuals at risk of infection, exposure or transmission of HBV to patients.

7. The limitations of the study are minimal, including only the fact that the study demonstrates only minimal literature review and would be strengthened by such review, specific to Uganda and not only inclusive of the whole of the region or the whole of Africa. This may be in part due the severely limited set of research information from which to pull from, but if so this is not explained in the work but must then be assumed by the reader.

8. This work is generalizable but it could be challenging to develop the behavior review aspect of the study among different populations due to compliance and privacy issues. Yet, with the assurance of anonymity the study could be repeated and would be helpful elsewhere, where HBV is endemic. The research study might also be better served if it is conducted among other medical and medical support professionals in the nation and in other places where HBV is endemic. In other words there are many individuals in larger groups such as nursing care, technician and other trained medical staff as well as unskilled support staff who may actually receive a greater number of exposures in their work over a longer period of time and though Ugandan student doctors are at risk others people with less knowledge than themselves are probably at higher risk than future doctors.

9. The main findings of the study are significant in that they clearly make the case that medical students are at higher risk for exposure, infection and transmission of HBV and that the population, a crucial aspect of the development of medical care in Uganda should be better protected. Compliance with either proof of childhood immunization for HBV or preclinical HBV vaccination would benefit not only the study population but the whole of the Ugandan population in the face of this highly transmissible and sometimes deadly disease. Adopting universal precautions against blood and body fluids across the medical profession would also greatly improve the rate of transmission and this is made clear in the work.