|Year : 2022 | Volume
| Issue : 1 | Page : 8-11
Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study
Madhurya H Sachidananda1, TA Dhanalakshmi2, D Venkatesha2
1 Internship, Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India
2 Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India
|Date of Submission||14-Feb-2022|
|Date of Acceptance||12-Mar-2022|
|Date of Web Publication||11-Jul-2022|
Dr. T A Dhanalakshmi
Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Nagamangala Taluk, Mandya - 571 448, Karnataka
Source of Support: None, Conflict of Interest: None
CONTEXT: A critical level of knowledge and awareness about hepatitis B infection and its prevention among the medical students is essential to decrease the burden of occupationally acquired hepatitis B infection.
AIM: To assess the knowledge, attitude and practices (KAPs) among medical students toward HBV infection and its prevention.
SETTING AND STUDY DESIGN: This was a cross-sectional questionnaire-based study done in a rural medical college.
MATERIALS AND METHODS: Written informed consent and Institutional Ethical Committee clearance were taken. Study included 403 randomly selected medical students. Self-administered pre-tested and pre-validated questionnaire containing KAPs items was used as study tool. The responses were recorded in terms of agree, disagree, not sure, yes and no formats.
STATISTICAL ANALYSIS: Data are expressed in frequencies and percentages.
RESULTS: Majority of students were aware of modes of transmission of HBV infection (67%–91%). Only 28.5% of participants agreed that hepatitis B vaccine is used for post-exposure prophylaxis. They had good attitude toward preventive aspects of hepatitis B infection (71%–96.3%). Only 52.9% had taken three doses of hepatitis B vaccination and only 4% of them got tested for antibodies titre post-vaccination.
CONCLUSION: The present study demonstrated gap in the knowledge and practice. This gap should be addressed by implementation of orientation programmes on HBV and mandatory vaccination of medical students at the time of entry to the institution.
Keywords: Hepatitis B, knowledge, attitude and practice, medical students, vaccination
|How to cite this article:|
Sachidananda MH, Dhanalakshmi T A, Venkatesha D. Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study. J Acad Clin Microbiol 2022;24:8-11
|How to cite this URL:|
Sachidananda MH, Dhanalakshmi T A, Venkatesha D. Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study. J Acad Clin Microbiol [serial online] 2022 [cited 2023 Sep 25];24:8-11. Available from: https://www.jacmjournal.org/text.asp?2022/24/1/8/350316
| Introduction|| |
Hepatitis B is a serious infection caused by Hepatitis B virus (HBV) with potential complications of chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma.,,, The prevalence of HBV infection among medical students is 11%. Having enough knowledge and good attitude and practice (KAP) toward the prevention of HBV infection is the cornerstone for preventing the transmission of HBV. Information regarding baseline KAP of the target population will help in devising a suitable educational approach that can be tailored according to their knowledge, beliefs and experience. With this background, the present study was conducted to assess the knowledge, attitude and practices (KAPs) among medical students toward HBV infection and its prevention.
| Materials and Methods|| |
The present cross-sectional, questionnaire-based study was conducted at a rural medical college over a duration of 2 months (May-June 2018). Written informed consent and Institutional Ethical Committee clearance were obtained before study.
A total of 424 medical students (sample size calculated using Epi Info 7 software (Epi Info is statistical software for epidemiology developed by Centers for Disease Control and Prevention in Atlanta, Georgia) based on a simple population formula; considering estimated prevalence rate 50%, margin of error 5% and 95% confidence interval, correction formula as the source population is below 10,000 and including 10% non-response rate), 106 students each from II, IV, VI and VIII term were included in the study and were selected by simple random sampling. Students who were not willing for the study, those who were absent on the day of the survey, those participated in pilot study and incomplete questionnaires were excluded from the study.
Pre-tested, self-administrated questionnaire was distributed to students in the classroom during regular class hours after briefing them about the objectives of the study. Confidentiality of the data and anonymity of the students was maintained throughout the study. The questionnaire included four sections: (A) demographic and academic characteristics, (B) knowledge items, (C) attitude items and (D) practice items. The responses were recorded in terms of agree, disagree, not sure, yes and no formats.
Data is expressed in frequencies and percentages.
| Results|| |
Twenty-one students were absent on the day of questionnaire distribution, and for final data analysis, 403 questionnaires were considered (II term – 100 students, IV term – 106 students, VI term – 99 students and VIII term – 98 students). The response rate was 100%. [Table 1] shows the knowledge of the participants toward modes of transmission of Hepatitis B infection. Majority of respondents were aware of transmission modes of HBV. Only 28.5% of participants agreed that hepatitis B vaccine is used for post-exposure prophylaxis (PEP). Thirty-seven percent of students agreed that medical students should be vaccinated with hepatitis B vaccine at the time of admission to MBBS course. [Table 2] shows the attitude of participants toward the prevention of hepatitis B infection. The participants had relatively good attitude (71%-96.3%) toward preventive aspects of hepatitis B infection. [Table 3] shows the participant's self-reported practice regarding hepatitis B vaccination. Only 52.9% of participants had completed hepatitis B vaccination at the time of study and only 4% of those who had completed vaccination tested for antibodies titre. Lack of information (46.3%) was the main reason stated by the participants for not taking vaccination. Few (24.4%) were of the opinion that there is no need for vaccination. Few students (12.2%) had not taken vaccine because of fear of injection.
|Table 1: Medical student's term wise correct response for knowledge items|
Click here to view
|Table 2: Medical student's attitudes toward prevention of hepatitis B infection|
Click here to view
|Table 3: Practice regarding hepatitis B vaccination among medical students|
Click here to view
| Discussion|| |
Hepatitis B infection is a potentially life-threatening occupational hazard for health-care workers, especially medical students. Assessment of student's KAP is an important step to assess to what extent the student is in a position to adopt a disease risk-free behaviour for this deadly disease.
In the present study, students had good knowledge toward the transmission of HBV [Table 1]. These findings are in line with studies by Alhowaish et al., Abdela et al. and Singh et al. However, Paul et al. found poor knowledge about transmission in their study. Surprisingly, in the present study, 44.7% of students were of the opinion that HBV can be transmitted by ingestion of contaminated food and water. This may be due to the confusion between Hepatitis A virus which is more prevalent. In the present study, only 28.5% agreed that vaccine is used for PEP. Similar results were noted in the study by Al-Hazmi et al. Conversely, Ray et al. had reported higher knowledge toward PEP (94.6%) in their study. There is a gap in knowledge about PEP noted in the present study. This issue needs to be clarified to students otherwise may affect their decision regarding PEP following accidental needle stick injury during their professional training.
Thirty-seven percent of participants stated that medical students should be vaccinated at the time of admission to MBBS course. By the time, they are posted to clinical postings in phase II, majority would have completed vaccination and will have protection. Poor correct response rate was observed among participants belong to II term and IV term [Table 1] and [Table 2]. This may be due to the fact that, medical curriculum did not include chapters on communicable diseases in the 1st year and virology portions are dealt in fifth term. This problem can be solved to some extent with the new competency-based medical education which includes foundation course and early clinical exposure in the 1st year of the course. Overall favourable attitude toward preventive aspects of HBV infection was noted in the present study [Table 2]. Variations noted in other studies may be due to differences in study population.,,,,
Hepatitis B vaccination for health-care workers is a key component of the World Health Organization-Hepatitis B Elimination strategy 2016-2021. In the present study, 52.9% had received three doses of vaccine. Majority of the students were not tested for antibody titres to HBV surface antigen post-vaccination [Table 3]. Higher vaccination rate and antibody titre estimation were observed in the study by Ghomraoui et al. Lower rates were observed in other study. [Table 4] shows the vaccination details of the participants in various studies. The variations observed in the vaccination rates in different studies may be due to the differences in the Institutional policies toward vaccination of medical students. It is imperative for each and every medical student to receive complete vaccination as well as to check for antibody titres because of possibility of non-response to the first series of vaccination. Majority of students stated lack of information as the main reason for not taking vaccination (46.3%) similar to other studies., Other reasons given by students in various studies were non-accessibility in the region and lack of motivation.,,,
Recall bias is the limitation in the present study as the data were obtained by questionnaire and health records of the students regarding vaccination status were not available.
| Conclusion|| |
A gap noted in knowledge and practice of students in the present study can be addressed by imparting orientation about HBV infection and its prevention in the 1st year of admission so that they can, not only protect themselves but also play a vital role in creating awareness among other health-care workers. Mandatory HBV vaccination should be implemented to vaccinate all medical students upon entry into medical colleges. Vaccinated students should be checked for seroconversion. Non-responders if any should be dealt according to the guidelines.
We thank the participants and teaching faculty of the institution for their co-operation during data collection and our sincere thanks to Dr. Raghavendra S K, Assistant professor of Community medicine for the statistical help.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Mesfin YM, Kibret KT. Assessment of knowledge and practice towards hepatitis B among medical and health science students in Haramaya University, Ethiopia. PLoS One 2013;8:e79642.
Paundel DP, Prajapati SK, Paneru DP. Hepatitis B related knowledge and perception of nursing students: An institutional based study in Kathmandu, Nepal. Int J Health Sci Res 2012;2:57-66.
Ghomraoui FA, Alfaqeeh FA, Algadheeb AS, Al-Alsheikh AS, Al-Hamoudi WK, Alswat KA. Medical students' awareness of and compliance with the hepatitis B vaccine in a tertiary care academic hospital: An epidemiological study. J Infect Public Health 2016;9:60-5.
Cruz HM, de Paula VS, Villar LM. A cross-sectional study of viral hepatitis perception among residents from Southeast and North regions of Brazil. Int J Environ Res Public Health 2018;15:189.
Pilot B, Kaginu M. Prevalence of hepatitis B virus (HBV) infection among Makerere University medical students. Afr Health Sci 2005;5:93-8.
Ibrahim N, Idris A. Hepatitis B awareness among medical students and their vaccination status at Syrian private university. Hepat Res Treat 2014;2014:131920.
Abeje G, Azage M. Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar city administration, Northwest Ethiopia: A cross sectional study. BMC Infect Dis 2015;15:30.
Othman SM, Saleh AM, Shabila NP. Knowledge about hepatitis B infection among medical students in Erbil city, Iraq. Eur Sci J 2013;3:299-305.
Alhowaish MA, Alhowaish JA, Alanazi YH, Alshammari MM, Alshammari MS, Alshamari NG, et al.
Knowledge, attitudes and practices toward prevention of hepatitis B virus infection among medical students at Northern Border university, Arar, Kingdom of Saudi Arabia. Electron Physician 2017;9:5388-94.
Abdela A, Woldu B, Haile K, Mathewos B, Deressa T. Assessment of knowledge, attitudes and practices toward prevention of hepatitis B virus infection among students of medicine and health sciences in Northwest Ethiopia. BMC Res Notes 2016;9:410.
Singh A, Jain S. Prevention of Hepatitis B. knowledge and practices among Medical students. Health line 2011;2:8-11.
Paul P, Arumugam B. Knowledge and awareness regarding hepatitis B infection among medical and dental students: A comparative cross sectional study. Int J Res Med Sci 2015;3:2352-6.
Al-Hazmi AH. Knowledge, attitudes, and practice of medical students regarding occupational risks of hepatitis B virus in college of medicine, Aljouf university. Ann Med Health Sci Res 2015;5:13-9.
] [Full text]
Ray SS. Study of awareness about hepatitis B among medical students, a vulnerable group of healthcare workers. J Evid Based Med Healthc 2017;4:3880-3.
Demsiss W, Seid A, Fiseha T. Hepatitis B and C: Seroprevalence, knowledge, practice and associated factors among medicine and health science students in Northeast Ethiopia. PLoS One 2018;13:e0196539.
Sharma S, Dixit M, Mittal H, Jain J, Jain D, Khandelwal A. Assessment of knowledge, attitude and practices towards prevention of hepatitis B virus infection among medical students in Geetanjali Medical College, Udaipur. Int J Community Med Public Health 2018;5:1509-13.
Yasobant S, Saxena D, Puwar T, Trivedi P, Patel S, Fancy MJ, et al.
Knowledge of hepatitis B among doctors working in public health system of Gujarat India: An interventional study. J Family Med Community Health 2017;4:1136.
Aaron D, Nagu TJ, Rwegasha J, Komba E. Hepatitis B vaccination coverage among healthcare workers at national hospital in Tanzania: How much, who and why? BMC Infect Dis 2017;17:786.
Noubiap JJ, Nansseu JR, Kengne KK, Ndoula ST, Agyingi. Occupational exposure to blood, hepatitis B vaccine knowledge and uptake among medical students in Cameroon. BMC Med Educ 2013;13:148.
Shah DK, Jha RK, Ansari S, Sah P, Dhungana GP, Basnet S. Knowledge and awareness regarding hepatitis B among preclinical medical and dental students of Chitwan Medical College Nepal: A questionnaire based study. Int J Med Sci Public Health 2016;5:1-6.
[Table 1], [Table 2], [Table 3], [Table 4]