Community Nursing Profile: Hepatitis B in Inner West, Australia

Introduction

Community nurses play a highly significant role in providing primary health services to people within their local community. They are responsible for educating community members about health problems, detecting health issues through screening, and offering treatment to reduce patient mortality rates. This paper aims to gather information about a selected community in order to propose nursing interventions for health problems identified in the locality. A community profile of Inner West, Australia, is presented using community profile data based on the 2016 census.

Description of Public Health Problem

Hepatitis B is a liver disease caused by the Hepatitis B virus. The aetiology of the disease indicates that it is primarily transmitted through unprotected sex with an infected person, sharing injection needles or related equipment with an infected person, vertical transmission from mother to child during pregnancy, and occupational exposure for healthcare workers who come into contact with infected needles (Mayo Clinic, 2020). The infection is considered chronic when it lasts more than six months, creating a high risk of liver failure, liver cancer, and cirrhosis — a condition in which permanent scarring forms on the liver.

The epidemiology of Hepatitis B shows that it is most common in the Asia-Pacific and sub-Saharan African regions of the world (MacLachlan & Cowie, 2015). In countries where the chronic form is most prevalent, infection is largely acquired at birth or in early childhood, affecting approximately 8% of those populations. The global prevalence rate is estimated at 45%, which is considered high. Vertical transmission is more predominant in Asia than in Africa; in Africa, women of child-bearing age are infected at a higher rate, and HBV genotypes strongly influence the likelihood of transmission to the infant. Regions where Hepatitis B prevalence is considered intermediate — between 2% and 7% — include North Africa, the Middle East, parts of Latin America, Eastern and Southern Europe, and South Asia (MacLachlan & Cowie, 2015). Populations with a relatively low prevalence of less than 2% include Australia, Northern and Western Europe, North America, parts of South America, and Japan (MacLachlan & Cowie, 2015).

Research has suggested that globally, 1.2 million people are infected with Hepatitis B through needle injection, and that the risk of infection in adulthood is elevated through contact with infected persons, among men who have sex with men, through unprotected sex with infected individuals, and among homeless populations (MacLachlan & Cowie, 2015). The migration of people carrying the virus significantly increases the probability of disease spread.

The World Health Organization (2021) reported that 296 million people were living with chronic Hepatitis B in 2019, with approximately 1.5 million new infections occurring each year. Deaths attributable to the disease reached 820,000 in that year, primarily due to cirrhosis and hepatocellular carcinoma (primary liver cancer). Safe and effective vaccines remain the foremost means of prevention.

In Australia, people living with Chronic Hepatitis B (CHB) in 2018 represented 0.90% of the total population, accounting for approximately 226,566 individuals (Hepatitis Australia, 2020). Of those, 68.1% had been screened for the illness, against a national target of 80% by 2022. Only 22.1% of those infected were receiving treatment, compared with a national target of 50% by 2022. Antiviral therapy for CHB was being accessed by just 9.3% of infected individuals — less than half of the 2022 target. The mortality rate stood at 435 deaths in 2018, whereas the national target was fewer than 328 deaths by 2022.

Based on data from ASHM (2014–15a), the prevalence of Hepatitis B in Australia was estimated in 2015 at 1.0% of the total population, representing 239,167 individuals. New cases were occurring at a rate of 26.8 per 100,000 people. Treatment was being provided to 6.1% of all infected individuals — projected as approximately half of total estimated treatment cases nationwide. The number of people receiving treatment in 2015 was slightly higher than in the previous year. ASHM (2018b) further noted that only 63% of Australians with Hepatitis B had been diagnosed. CHB infection was estimated to be present in approximately two-thirds of overseas-born people living in Australia. The majority of cases were identified among men who have sex with men and among migrants — groups whose infection risk cannot be addressed through vaccination alone. One quarter of Hepatitis B-related deaths are due to liver failure, liver cancer, and cirrhosis.

According to the most recent data from the NSW Government, the number of Hepatitis B tests conducted in 2019 declined by 1.7% compared with 2018 (NSW Government, 2019). The number of patients discharged from treatment centres increased by 2% in the same year, suggesting that the NSW Government is making meaningful progress in reducing Hepatitis B infection and improving health outcomes. The percentage of infants vaccinated against the disease increased in 2019 relative to 2018, and the proportion of pregnant women screened for signs of Hepatitis B at the time of delivery increased by 0.4%. The five districts recording the highest Hepatitis B notifications from January 2017 to December 2019 were Western Sydney, Northern Sydney, South Eastern Sydney, South Western Sydney, and Sydney (NSW Government, 2019). The principal prevention and control strategies in Australia are infant vaccination, vaccination for pregnant women, and vaccination of high-risk groups within the population.

Characteristics of the Inner West Local Government Area

The impact of Hepatitis B in the Inner West Local Government Area (LGA) can be assessed in light of the epidemiology outlined above. As noted, vertical transmission of Hepatitis B from mother to child is common, and early vaccination of newborns is a central element of Australia's Hepatitis B prevention strategy for 2014–2020. According to the most recent data from the Australian Bureau of Statistics (2016), the 0–4 age group in Inner West comprised 5,419 males and 4,326 females. This population segment should be prioritised for vaccination given their elevated risk of infection.

As established in the preceding section, migrants arriving in Australia may carry the Hepatitis B virus. Data from the Inner West community profile indicate that 92% of the population are non-indigenous, reflecting a high level of cultural diversity and, correspondingly, a heightened risk of Hepatitis B prevalence in the area.

Factors not included as relevant indicators for Hepatitis B prevalence in Inner West are language, religion, household type, marital status, relationship within the household, unpaid assistance to disabled persons, landlord type, and tenure. Although sexual orientation would have been a relevant variable — given the elevated infection risk among men who have sex with men — the community profile does not provide this information.

Socio-economic indicators such as education, household income, unemployment, and poverty rate are key determinants of population health (Darin-Mattsson, Fors & Kareholt, 2017). Research consistently demonstrates that people of lower socio-economic status lack access to the basic necessities of a healthy life, including healthcare services, and experience higher mortality rates. Health inequalities arising from socio-economic disparities affect different segments of the same community differently, which is why these indicators are important when studying health outcomes and disease prevalence in a community like Inner West.

The Socio-Economic Indexes for Areas (SEIFA) score for Inner West is 1053. A higher SEIFA score indicates lower socio-economic disadvantage and therefore a reduced risk of Hepatitis B infection associated with poor living conditions (Australian Bureau of Statistics, 2008; Australian Bureau of Statistics, 2018).

Conclusion

A major barrier in providing adequate Hepatitis B care to pregnant women is the lack of appropriate patient education, combined with culturally influenced beliefs and attitudes, as well as gaps in nurses' own awareness of available interventions (Chao et al., 2019). Effective counselling of pregnant women depends on nurses being equipped with culturally appropriate communication strategies. This is equally true for migrant populations in Australia, where deeply held cultural beliefs — such as the perception that illness is a divine punishment, or that a diagnosis carries social stigma — can impede uptake of therapeutic interventions. Research on Middle Eastern migrants in Sydney underscores how community awareness and cultural beliefs shape engagement with Hepatitis B prevention services (Robotin et al., 2021). Nurses must therefore approach these populations with sensitivity and cultural competence.

Limited understanding of culturally diverse populations contributes significantly to the risk of Hepatitis B becoming widespread and chronic in those communities. Australia's ethnic diversity and its substantial migrant population place the Inner West community at elevated risk of Hepatitis B infection. Although the community profile of this LGA reflects generally strong health indicators, specific risk factors remain — notably the high proportion of migrants and the population of newborn babies who require targeted nursing care. Many migrants, particularly those who are pregnant, may be unaware of available vaccine and treatment options. Community health nurses in Inner West should therefore direct focused attention to these segments of the population, implementing nursing interventions that encompass health literacy around nutrition, hygiene, and healthy lifestyle practices, as well as education and training designed to reduce fear and stigma associated with Hepatitis B diagnosis and treatment.