Hikma Shikure 34
Hikma Shikure 34
Hikma Shikure 34
BY:
JUNE, 2014
BY:
ADVISOR:
ATO TEFERI FETE (RN, Bsc, Msc)
JUNE 2014
INTERNAL EXAMINER:
I would like to thank my advisor Ato Teferi Fete (RN, Bsc, Msc) for his unreserved comments
My heartfelt gratitude goes to Addis Ababa University, School of Allied Health Science department
of Nursing and Midwifery administrators who provided me all the necessary data for proposal
preparation and data collection of this study which was very important to conduct this study.
My special gratitude and appreciation goes to the students of Addis Ababa University department of
Nursing, Midwifery and Medical Laboratory technology who facilitate their class mate for the
successful data collection, also for the whole study subjects who respond for the study questions.
My beloved family members and friends for their support, in making this research document to end. I
I
Table of content Page
Acknowledgement-----------------------------------------------------------------------------------------------I
Table of content-------------------------------------------------------------------------------------------------II
List of figures---------------------------------------------------------------------------------------------------IV
List of tables-----------------------------------------------------------------------------------------------------V
Abbreviation----------------------------------------------------------------------------------------------------VI
Abstract---------------------------------------------------------------------------------------------------------VII
1. INTRODUCTION ---------------------------------------------------------------------------------------1
1.1 Background ----------------------------------------------------------------------------------------1
1.2 Statement of the problem-------------------------------------------------------------------------3
1.3 Significance of the study-------------------------------------------------------------------------5
2. LITERATURE REVIEW -------------------------------------------------------------------------------6
2.1 Historical Background of HB---------------------------------------------------------------------6
2.2 Epidemiology of HB-------------------------------------------------------------------------------6
2.3 Review of studies on HB KAP-------------------------------------------------------------------11
2.4 Conceptual frame work----------------------------------------------------------------------------17
3. OBJECTIVES---------------------------------------------------------------------------------------------19
3.1 General objective-----------------------------------------------------------------------------------19
3.2 Specific objective-----------------------------------------------------------------------------------19
4. METHOD & MATERIALS-----------------------------------------------------------------------------20
4.1 Study area and period------------------------------------------------------------------------------20
4.2 Study design-----------------------------------------------------------------------------------------21
4.3 Population -------------------------------------------------------------------------------------------21
4.3.1 Source population ------------------------------------------------------------------21
4.3.2 Study population --------------------------------------------------------------------21
4.4 Eligibility criteria-----------------------------------------------------------------------------------21
4.4.1 Inclusion criteria---------------------------------------------------------------------21
4.4.2 Exclusion criteria--------------------------------------------------------------------21
4.5 Sample size Determination ------------------------------------------------------------------------21
4.8 Variables----------------------------------------------------------------------------------------------24
4.8.1 Dependent variable------------------------------------------------------------------24
4.8.2 Independent variables---------------------------------------------------------------24
II
4.9 Operational definitions------------------------------------------------------------------------------24
5. RESULT-----------------------------------------------------------------------------------------------------27
5.1 Socio-demographic characteristics of the study subjects---------------------------------------27
5.2 Primary source of Hepatitis B viral infection information-------------------------------------29
5.3 Hepatitis B Viral infection KAP among Addis Ababa University undergraduate regular
Health Science students
5.3.1 Hepatitis B viral infection Knowledge -------------------------------------------30
5.3.2 Attitude towards hepatitis B viral infection---------------------------------------35
5.3.3 Practice of Hepatitis B viral infection --------------------------------------------36
5.4 Factors associated with knowledge, attitude and practice of hepatitis B viral infection
5.4.1 Factors associated with knowledge about hepatitis B---------------------------39
5.4.2 Factors associated with attitude towards hepatitis B prevention---------------41
5.4.3 Factors associated with practice of hepatitis B prevention---------------------43
6. DISCUSSION-----------------------------------------------------------------------------------------------46
6.1 Hepatitis B information -----------------------------------------------------------------------------46
6.2 Hepatitis knowledge --------------------------------------------------------------------------------46
6.3 Hepatitis B Attitude ---------------------------------------------------------------------------------49
6.4 Hepatitis B Practice----------------------------------------------------------------------------------51
7. STRENGTH AND LIMITATION OF THE STUDY-------------------------------------------------54
7.1 Strength of the study---------------------------------------------------------------------------------54
7.2 Limitations of the Study ----------------------------------------------------------------------------54
8. CONCLUSION AND RECOMMENDATIONS-------------------------------------------------------55
8.1 Conclusion--------------------------------------------------------------------------------------------55
8.2 Recommendations-----------------------------------------------------------------------------------56
9. REFERENCES --------------------------------------------------------------------------------------------58
10. APPENDIX -------------------------------------------------------------------------------------------------62
10.1 Annex I: Information Sheet---------------------------------------------------------------------62
10.2 Annex II- Questionnaire-------------------------------------------------------------------------64
11. DECLARATION-------------------------------------------------------------------------------------------72
III
List of figures
Figure 1: Map of global prevalence of chronic infection with HBV by country, CDC 2005.---------8
Figure 2: Conceptual frame work on assessment of knowledge, attitude and practice towards------18
hepatitis B viral infection among Addis Ababa University, College of Health Science
Figure 4: Primary source of information about Hepatitis B viral infection among Addis Ababa
Figure 5: Graphic representation of overall knowledge category among Addis Ababa University
Figure 6: Graphic representation of overall Attitude category among Addis Ababa University
undergraduate regular Health Science students, towards hepatitis B virus prevention,
June 2014.--------------------------------------------------------------------------------------------36
Figure 7: Distribution of hepatitis B viral test among Addis Ababa University undergraduate regular
Health Science students. Addis Ababa, June 2014.--------------------------------------------37
Figure 8: The overall Practice category among Addis Ababa University, undergraduate regular
Health Science students, towards hepatitis B virus prevention, June 2014------------------38
IV
List of tables
Table 1: Prevalence of HBsAg and HBV markers in the adult population of sub-Saharan Africa
(Adapted from Dr C F Kiire, 1996)------------------------------------------------------------------9
Table 3: knowledge of Hepatitis B viral infection among AAU undergraduate regular Health
science students. Addis Ababa June 2014 --------------------------------------------------------32
Table 4: Overall knowledge of Hepatitis B viral infection in each of the three departments among
AAU undergraduate regular Health science students. Addis Ababa June 2014---------------34
Table 5: Attitude towards hepatitis B among AAU undergraduate regular Health science students.
Addis Ababa June 2014-------------------------------------------------------------------------------35
Table 6: Reasons for not being vaccinated among Addis Ababa University, undergraduate regular
Health Science students, Addis Ababa, June 2014.------------------------------------------------38
Table 7: Cross tabulation between overall knowledge and overall practice of Addis Ababa
University, undergraduate regular Health Science students, Addis Ababa, June 2014.------39
Table 8: Association of knowledge about hepatitis B viral infection with socio demographic
factors among Addis Ababa University, undergraduate regular Health Science Students,
Addis Ababa June 2014.-------------------------------------------------------------------------------40
Table 9: Association of attitude towards hepatitis B prevention with socio demographic and
other factors, among Addis Ababa University, undergraduate regular Health Science
Students, Addis Ababa June 2014.-----------------------------------------------------------------42
Table 10: Association of practice towards hepatitis B prevention with socio demographic and other
factors, among Addis Ababa University, undergraduate regular Health Science Students,
Addis Ababa June 2014.-----------------------------------------------------------------------------44
V
ABBREVIATION/ ACRONYMS
HB: Hepatitis B
VI
ABSTRACT
Background: Hepatitis B is blood born liver infection caused by hepatitis B virus (HBV). It is the
tenth leading cause of death among all diseases worldwide and the fifth leading cause of death from
infectious disease worldwide, surpassed only by lower respiratory tract infections, diarrheal diseases,
HIV/AIDS, and Tuberculosis
Objective: To assess knowledge, Attitude and Practice towards Hepatitis B viral infection among
Addis Ababa University, regular undergraduate students of College of Health Science.
Method: Institution based cross sectional study was conducted among Addis Ababa University
students of college of Health Science, from October 2013 to June 2014. The study population was
selected among students of College of Health Science undergraduate program, with a sample size of
422 students. Data was collected by using self-administered, structured and pre tested questionnaire.
Data was cleaned, coded and entered into computer and analyzed using SPSS version 20. The degree
of association between dependent and independent variables was described using crude odds ratio
(COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI).
Results: A total of 415 students were interviewed with a response rate of 98.3%, among them 91.1%
had good knowledge, 89.9% had positive attitude and 68.92% had good practice towards hepatitis B.
The attitude and practice of the respondents was found to be significantly associated with their
academic year, however, it was not found to have association with the knowledge of the study
participants.
Conclusion: KAP of the study participants in this study was high, though the effect of little lack of
knowledge, positive attitude and good practice can affect the community in which the study
participants work now and then.
VII
1. INTRODUCTION
1.1. BACKGROUND
Hepatitis B infection is a potentially life-threatening blood born liver infection caused by hepatitis
B virus (HBV). It can cause chronic liver disease and chronic infection and puts people at high risk
of death from cirrhosis of the liver and liver cancer (World health organization (1). It is the tenth
leading cause of death among all diseases worldwide (2) and the fifth leading cause of death from
infectious disease worldwide, surpassed only by lower respiratory tract infections, diarrheal
diseases, Human Immunodeficiency Virus Acquired Immuno-Deficiency Syndrome (HIV/AIDS),
and Tuberculosis (3).
HBV is concentrated most highly in blood with low concentration in certain body fluids, such as
semen, vaginal secretions, and saliva, of persons infected with HBV (4). Person-to-person spread
of HBV can occur among those living with someone chronically infected with hepatitis B. it is
mainly spread by sexual contact with an infected person, sharing needles during injection drug use;
occupational needle sticks or sharps exposure, or transmission from an infected mother to her baby
during birth (5).
People at high risk include health care workers (HCWs) in contact with blood and human
secretions, haemodialysis staff, oncology and chemotherapy nurses, all personnel at risk of needle
stick/sharps injuries, which includes those working in operating rooms and clinical laboratories,
respiratory therapists, surgeons, doctors, dentists, as well as medical, dental and nursing students
(6).
An exposure that might place health care professional at risk for HBV is defined as a percutaneous
injury, (a needle stick or cut with a sharp object) or contact of mucous membrane or non-intact
skin with blood, tissue, or other body fluids that are potentially infectious: cerebro spinal fluid
(CSF), synovial fluid, pleural fluid, peritoneal fluid, pericardial fluid and amniotic fluid are also
considered potentially infectious (7).
1
It is not possible, on clinical grounds, to differentiate hepatitis B from hepatitis caused by other
viral agents and, hence, laboratory confirmation of the diagnosis is essential (1). In clinical practice
diagnosis of HBV infection is established by the serological detection of HBV protein products
antigens as well as host-produced antibodies. Serological markers are key elements in diagnosing
acute HBV infection and determining its possible evolution towards chronicity (8).
HBV is unique compared to other sexually transmitted diseases, because it can be prevented with
vaccine which is highly efficacious that protects against HBV infection 90-100% (1). Primary
vaccination consists of greater or equal to three doses of hepatitis B vaccine administered
intramuscularly with the interval of one month between the first and the second dose and six
months between the second and the third dose produces a protective antibody response in
approximately 30%–55% of healthy adults aged <40 years after the first dose, 75% after the
second dose, and >90% after the third dose (9).
There is no specific treatment for acute hepatitis B. Care is aimed at maintaining comfort and
adequate nutritional balance, including replacement of fluids that are lost from vomiting and
diarrhea (1). The aims of treatment of chronic HBV infection are to achieve sustained suppression
of HBV replication and to induce remission of liver disease before cirrhosis and hepatocellular
carcinoma (HCC) develop. Several antiviral agents that were developed for the treatment of HIV
infection proved to be effective in inhibiting HBV replication. It is well accepted that antiviral
therapy for chronic hepatitis is effective to improve prognosis of patients with HBV by preventing
development of hepatitis state and HCC (7).
2
1.2 STATEMENT OF THE PROBLEM
Hospital acquired infections are a problem in both developed and developing countries and are
important causes of death (11). HCWs are potentially exposed to blood and body fluids containing
transmissible diseases and are at increased risk to acquire these pathogens (12, 13). Hepatitis B is
blood borne pathogens, which might be acquired occupationally. Occupational exposure to blood
and body fluids occur frequently among health professionals (14, 13).
The most serious occupational health hazard faced by HCWs worldwide is exposure to blood-
borne pathogens; these blood-borne pathogens are mainly Hepatitis B, C, and HIV infections (2).
Hepatitis B is by far the most dreaded and more infectious than the other blood-borne pathogens, it
is one hundred times more contagious than HIV/AIDS, the estimated risk of a single needle stick
injury indicate a risk of 300 hepatitis B virus infection (30% risk), 30 hepatitis C virus infection
(3% risk) and 3 HIV infection (0.3% risk), per 1,000 respective exposures (15).
A serologic study conducted in the United States found that, HCWs had a prevalence of HBV
infection approximately 10 times higher than the general population (12). WHO Report estimates
that 40% of HBV infection is a result of occupational exposure, it has been estimated that 14.4% of
hospital workers are infected with HBV. Nurses were most commonly exposed to infection (41%)
than other HCWs (16). Although nurses are clearly a high-risk sub group for such events, nursing
students may be at a similar or even at a greater risk due to their limited clinical experience (17).
3
Because students who consist future health staff face the threat of percutaneous injuries with the
consequent risk of contracting hepatitis B, their general knowledge, attitude and practice towards
hepatitis B infection can stop the spread of this disease in hospitals and society (18). Therefore this
study was tried to identify the level of knowledge, Attitude and Practice towards Hepatitis B viral
infection among regular undergraduate students of College of Health Science, Addis Ababa
University.
4
1.3. SIGNIFICANCE OF THE STUDY
Prevention is the only safe strategy against high prevalence of HBV, having enough knowledge
and proper Attitude towards this infection are the corner-stones of preventing the spread of the
virus.
The significance of this study is to describe the knowledge, Attitude and Practice towards Hepatitis
B viral infection among Addis Ababa University, regular undergraduate students of College of
Health Science, which enable to identify the gap of KAP in the study population in order to reduce
all the effects of HBV on these students and their patients, if this category of HCWs is not taken
The result of this study will assist the college managers, the clinical facilities managers
aware of the extent of vaccination uptake, and develop strategies for promoting awareness creation
and improving HBV immunization uptake amongst students, also end results of this study can also
5
2. LITERATURE REVIEW
Hepatitis B surface antigen which was originally called the Australia antigen because it was
found in serum from an Australian patient. Dr Baruch Samuel Blumberg was awarded the 1976
Noble Prize in Physiology or Medicine for this discovery (19). A few years later, Dane (1970)
visualized the HBV. Since then, considerable progress has been made regarding the
epidemiology, virology, natural history, and treatment of this hepato-tropic virus (20).
Merck created the first hepatitis B vaccine in 1982, this was plasma derived, but these have
largely been replaced by recombinant derived ones, which were introduced in 1986. In 1991, the
WHO recommended that HB vaccine should be introduced into the Expanded Programme of
2.2 Epidemiology of HB
Despite the fact that since 1982 there is a vaccine against HBV that gives 90-100% protection
against the infection, it is continuing to be the major diseases of mankind and serious global
The Hepatitis B Foundation (HBF) estimates that there are more than 2 billion peoples infected
with HBV, of whom about 400 million people are chronically infected and approximately 10-30
million people become infected and 1 million people die from HBV induced liver disease
(chronic hepatitis, cirrhosis, and hepatocellular carcinoma) per year, which equates to about 2
6
HBV infection prevalence varies markedly in different geographical areas of the world, as well
as in different population subgroups. It ranges over 10% in some Asian and Western Pacific
countries to under 0.5% in the United States and northern European countries (23).
The WHO has therefore demarcated the world according to chronic hepatitis B prevalence into
three major blocks which include high, intermediate and low prevalence. High prevalence areas
have a prevalence of chronic hepatitis B infection that is equal to or greater than eight percent
(>8%) made up of countries with large population from North America, South America, Sub-
Saharan Africa and most Asian countries where at least 8% of the population are HBV chronic
carrier and 70–95% of the population shows past or present serological evidence of HBV
infection. Intermediate prevalence areas have a prevalence rate which ranges between 2% and
7% and include countries from South America, North Africa, Western Europe, Eastern Europe
and the Indian subcontinent, between 10-60% of the population have evidence of infection, and
2-7% is chronic carriers. Low prevalence areas are estimated to have a prevalence of chronic
infection less than (2%) which includes most of the North American countries, Australia and
most of Western Europe including the United Kingdom (UK). Overall, approximately 45% of
the global populations live in areas of high chronic HBV prevalence. (2, 23).
Hepatitis B transmission route varies according to the prevalence rate of the virus. Countries
with very high prevalence rate usually have vertical transmission as the main route of
transmission which is mostly found during childhood. Countries with intermediate prevalence
rates normally have horizontal transmission as its major route where the disease is transmitted
through sexual contact or through injecting of drugs. In countries with low prevalence rates such
7
as the United Kingdom, the epidemic is mostly acquired during adulthood through sexual
In regions of the world where hepatitis B is highly endemic, HBV accounts for around 3% of the
total mortality, ranking with other vaccine preventable childhood diseases such as measles,
Figure 1: Map of global prevalence of chronic infection with HBV by country, CDC 2005.
The burden of chronic carriage falls predominantly in Asia where 75% of chronic HBV carriers
live. Africa has the second largest number of chronic carriers. Of approximately 470 million
people living in Africa, about 50 million are lifetime (chronic) carriers of the virus and as many
as 12.5 million will eventually die due to hepatitis B induced liver disease. This represents a
8
In Africa, infections with HBV play a major role in the etiology of most liver diseases. The
WHO African region includes all of Sub-Saharan Africa estimated hepatitis B surface antigen
(HBsAg) seroprevalence ranges between 5% and 19.It is quite clear that the whole of sub-
Saharan Africa falls into the high endemicity category (HBsAg carrier rates 9-20%). Between
56% and 98% of the adult population shows evidence of past exposure to and infection with
HBV (26).
Table 1; Prevalence of HBsAg and HBV markers in the adult population of sub-Saharan Africa
9
In Ethiopia as in other Sub-Saharan Africa, the prevalence of liver disease is high. They account
for 12% of the hospital admissions and 31% of the mortality in medical wards of Ethiopian
conducted in Ethiopia on 5,270 young males from all regions of the country, the overall
prevalence rates were 10.8% for HBsAg and 73.3% for "at least one marker positive";a
remarkable geographical and ethnic variability of marker prevalence was observed, reflecting the
wide differences existing in Ethiopia in socio-cultural environment and activities such as tribal
practices and traditional surgery. Sexual practices and medical exposure also play some role as
In Ethiopia, the prevalence of HBV markers has also been studied among blood donors, the
HBsAg carrier rate was found to be 11% with a total HBV infection rate of 79% (including
antibodies). Once more, the predominant form of HBV transmission in Ethiopia was found to be
horizontal interfamilial spread, with factors such as tattooing, tonsillectomy, circumcision, and
A community based seroprevalence study in the capital city of Ethiopia; Addis Ababa has shown
a 7% seroprevalence of HBsAg, higher in males than females. The age at which 50% had
evidence of infection was around 20 years (30). Screening sera of all male donors appearing at
the blood bank of a regional hospital in Northwest Ethiopia (Gondar) in 1994 and 1995, for
HBsAg was carried out on 549 consecutive sera. The crude seroprevalence of HBsAg was 14.4%
(31). One or more hepatitis B virus markers were found in 86% of chronic hepatitis, 88%
cirrhosis and 78% hepatocellular carcinoma patients studied in Addis Ababa (32).
10
A cross sectional study conducted on 267 HCWs of Tikur Anbesa University Hospital and Ras
Desta Damtew Memorial Hospital the overall prevalence of HBV infection was found to be
51.3%, by taking HBsAg and Anti HBc as the only marker of infection (7).
2.3 Review of different studies on HBV infection Knowledge, Attitude and Practice
of higher educational institution students.
Public University mentioned that almost all (98.9%) of the respondents have heard or know
about hepatitis B. Ninety seven point two percent (97.2%) of the respondents know that there is a
vaccine against the disease, 1.1 % and 1.7% of the students say no about the availability of
vaccine and don’t know about the availability respectively. Among those respondents who
knows the availability of HBV vaccine most of them (87.4%) says there is three dose of
complete HBV vaccine. Seventy nine point nine percent (79.9%) of dentistry students were
received hepatitis B vaccine, among them 62.2% were fully vaccinated, those who didn’t take
and have no idea whether they take or not were 9.5% and 10.6% respectively. Forgetfulness were
the most frequently answered reason for not receiving HBV vaccine (50%) and the least
Amongst Health‑care Workers of a Tertiary Hospital in India, revealed that all respondents were
aware of the hepatitis B infection. The awareness regarding modes of transmission of hepatitis B
suggested that all nursing interns knew about blood and blood products, as a mode of
transmission, but awareness in relation to other modes of transmission is slightly low that only
11
58.3% of them know HBV is a nosocomial infection, 61.8% of the respondents answer HBV can
be transmitted through sexual intercourse and 43.6% of them answer incorrectly HBV can also
be transmitted through feco-oral and contaminated water. Sixty three point six percent (63.6%)
of nursing interns believed that HCWs are at a risk of developing hepatitis B infection owing to
their profession due to constant contact with their patients, which pre‑disposes them to acquire
and transmit infection, These results revealed that not all interns believe that the HCWs can
acquire hepatitis B infection owing to their professional contact with their patients. Some interns
felt that they were safe from any transmission of infection via patients, which showed a lack of
awareness among these interns. Regarding the vaccine against HBV 87.3% of nursing interns
were aware of the presence of vaccine against HBV and 78.2% of them were vaccinated against
the disease, 72% had received a complete dose and 14% of the nursing students had received
A research done on 753 Residents in Kuala Lumpur and Selangor, Malaysia regarding
knowledge on hepatitis compared to the public from town areas (63.6%) and rural areas (52.7%).
Most of the public knew about the diseases through the mass media; undergraduates, however,
acquired knowledge of the diseases through formal education. All the undergraduates and almost
all the HCWs knew that hepatitis would affect the liver compared to only 69.4% and 50.3% of
the public from town areas and from rural areas, respectively (35).
12
In a study conducted to assess Knowledge and attitude of medical science students in Guilan
University, Iran toward hepatitis B and C infections less than half percent of males (33.3) and
females (34.8%) answer correctly for the question, always after the entrance of HBV to the body
symptoms appear. Fifty one point seven percent (51.7%) of the respondent agree that health
professionals who are HBV positive should not give health care services to patients, 29% of the
respondent doesn’t know about it and the remaining are disagree for the question. Sixty five
point eight (65.8%) of the students agree for they are delivering the same standard of care to
patients with HBV as they do for other patients, 18.4% and 15.8% of them don’t have any idea
about the question and disagree by the idea to give the same standard of care to HBV patients as
other patients respectively. In relation to this 27.1% of the students don’t want to treat patients
with HBV and 38% of them disagree with this idea. Sixty five point six percent (65.6%) of the
respondents often use additional infection control precautions when treating patients with HBV.
Slightly higher than half percentile of the students (56.8%) feel that they do not have the skills
needed to effectively and safely treat patients with HBV, and relatively less number of the
respondents (11.8%) disagree with this idea and believe that they do have a skill to handle HBV
patients effectively and safely. Majority of the respondents (74.5%) agree that following
infection control guidelines will protect them from being infected with HBV at work 5.2% didn’t
agree for this question and the remaining don’t have any idea about it. Slightly greater than half
of the respondents (54.5%) answer correctly that there is no specific pharmaceutical treatment
A study conducted to assess the knowledge of Iranian dental students about hepatitis B Virus
Infection and Its Control Practices indicated that 95.8% of the respondents know that there is a
high risk of HBV than HIV transmission through needle stick injury. Ninety six point five
13
percent (96.5%) of the respondents answer yes for the question Dentists are at higher risk of
HBV infection than the general population. Regarding treatment of HBV-infected patients 60%
of sixth year dental students reported having treated at least one HBV-infected patient. When the
students were asked about their willingness to treat HBV-infected patients, 20% of them
answered they would not treat such patients. The remaining students mostly preferred to
postpone the treatment of HBV-infected patients. In three independent questions, students were
asked: if infection control methods are not followed in the dental setting would patient-to-patient,
patient-to-dentist, and dentist-to-patient transmission risk increase? For the three questions,
81.0%, 83.1%, and 55.6% of the total students answered yes respectively (37).
Avoid needle/sharps injury were the most frequently answered (92.1%) prevention method of
HBV followed by Proper disposal of sharps, needles and blood (90.8%) and Avoid casual sex
or/and multiple sexual partners (74.2%), in the study to assess Knowledge, Attitudes and Self-
Reported Behavior of Primary Health Care Workers for Hepatitis B and C Virus and other
Health Care Associated Infection in two randomly selected heath regions of Kuwait, incorrect
answers like Avoid drinking contaminated water and avoid foods which are not well cooked are
also answered as a prevention method of HBV by 30% and 25.7% of the respondents
respectively. Regarding HBV vaccination 65.9% of the respondents knows Doses of Hepatitis B
Vaccine required for complete protection is three and 44.4% answers correctly the Expected
Interval between last dose and dose preceding it. Majority of the study groups are agree for
questions concerning their risk for HBV and importance of vaccination against it, 80.5% of the
primary HCWs agree that their job put them at risk of getting HBV, 87.1% were accept the need
of protection against HBV and 86.3% of them were Considered it necessary to receive vaccine
(38).
14
A school based study on prevention of HBV among final year nursing students in Gauteng
province South Africa revealed that majority (89.1%) of the students mentioned a vaccine
against HBV can protect the infection effectively, 2.9% of the respondent answer no for the
question can HBV vaccine prevents HBV infection effectively? And 5.8% of the respondents
didn’t know about it. 69% of the respondents didn’t agree for the question that mentions they are
not at risk of acquiring HBV 3.6% and 27.4% of the respondent agree and don’t have idea about
this question respectively. Regarding the coast of HBV vaccine majority of the respondents are
not sure about HBV vaccine cost, 24.7% and 15.3% were agree and disagree that the coast of
A research conducted in south Nigeria to assess Health workers’ knowledge, attitude and
behavior towards hepatitis B infection, wearing of gloves were the most frequently answered
(92.6%) measures taken to protect against hepatitis infection followed by adequate disposal of
sharps and avoid patients diagnosed with hepatitis B with a respective percentile of 88.9% and
29.6%, a significant number of respondents (61.1%) answer use antibiotics after contact as
measures taken to protect against hepatitis infection. Seventy point two percent (70.2%) of the
respondents had already receive vaccine and the remaining did not, among those who did not
receive HBV vaccine majority (44.4 %) of them have no reason and 22.2% them mention they
15
A cross sectional study was conducted at the University of Kassala, Sudan to assess the non
medical profession student’s knowledge and awareness about Hepatitis B and HIV. regarding
HBV, poor knowledge was found among the students. The causes of HBV, and its vaccination
were known to 110 (27.8%) and 39 (09.9%) of the students respectively. Only 49 (12.4%) of the
students were aware of the symptoms of the disease and 15 (3.8%) had good knowledge of the
transmission route, while the prevention methods were known only by 12.7% of the students
(41).
16
2.4 Conceptual Framework
The Conceptual framework was adopted from Health Belief Model, the primary concept of the
Health Belief Model is used to predict why people decide, or do not decide, to control, prevent or
screen for different illness conditions. The primary concepts are perceived susceptibility,
The conceptual framework showed the boundary that the study was covered and the relationship
which has been proven after going through all research steps. The relationship was proposed
between categories of independent variables and dependent variable; KAP on hepatitis B among
study participants. It was prepared by principal investigator after reviewing for different
literatures.
17
MODIFYING FACTORS LIKELIHOOD OF ACTION
INDIVIDUAL PERCEPTION
Likelihood of
behavioral changes
Perceived Knowledge, Attitude and
susceptibility and Practicing
Practice towards HBV
seriousness of HBV standard working
infection
infection precautions
Testing for HBV
Taking HBV
vaccine
Perceived threat of
HBV infection
Figure 2. Conceptual frame work on assessment of knowledge, attitude and practice towards
hepatitis B viral infection among Addis Ababa University, College of Health Science
18
3. Objectives
To assess knowledge, Attitude and Practice towards Hepatitis B viral infection among
1. To assess the level of knowledge about Hepatitis B viral infection among regular
19
4 METHODS AND MATERIALS
Allied Health Science (SAHS). AAU was established in 1950. The university is the oldest and
largest higher education institution in Ethiopia which made a remarkable contribution to the
country through provision of trained manpower, research and community services. The service it
has rendered in the training of high level skilled manpower and professionals in various key
areas of development is unprecedented, and yet shines everyday as it stood the only University
for decades. It currently runs 65 undergraduate and 220 graduate programs (of which 69 are
PhD) in 14 campuses.
The College of Health Sciences (CHS), AAU is a professional health sciences college,
one umbrella. The CHS is comprised of four schools and one teaching hospital. The four schools
are the School of Medicine, the School of Pharmacy, the School of Public Health and SAHS.
The SAHS offers professional trainings in nursing, midwifery and medical laboratory
technology. The Tikur Anbessa Specialized Hospital (TASH) is the teaching hospital of the
College, which is the largest specialized hospital in Ethiopia, with over 700 beds, and serves as
the training center for undergraduate and postgraduate students, who shoulder the health
problems of the community and the country at large. This study was conducted from October
20
4.2 Study design
A quantitative Institution based cross-sectional study design was used to assess knowledge,
Attitude and Practice towards Hepatitis B viral infection among Addis Ababa University, regular
4.3 Population
21
Using n= Z α/2) 2 p (1-p)
d2
Where, n= the required sample size
Z α/2= the standardized normal distribution curve value for the 95% confidence interval (1.96)
P= the level of KAP of students learning in AAU were unknown so we take as 50%
d= degree of precision (the margin of error between the sample and population, 5%) = 0.05
(1.96)2(0.5(1 − 0.5))
=
(0.05)
= 384
By taking additional 10% contingency for non-response rate, the sample size were = 422
Among the four schools of College of Health Science school of Public Health is not included
under this study since it has no undergraduate program under it. Among the three schools,
School of Allied Health Science is selected by using lottery method. There are three departments
under the school of Allied Health science which are Nursing, Midwifery and Medical Laboratory
Technology, the study participants were selected from each department as well as from each year
by proportion to population size based on the total number of students in each department and
systematic random sampling method was used to select specific student from the class room by
using their list in the role sheet the first student was selected by lottery method and the next
respondent were selected in the interval of three according to their order in the list. In case of
absent students the next student was taken as a respondent and the interval continue as in the
previous.
22
College of Health Science
School of Medicine
School of Pharmacy
School of Allied Health Science
Lottery Method
Midwifery M.
Nursing
Laboratory
207 Technology
249
N= 422
23
4.7 Method and tools of data collection
The data was collected from study subjects by self-administered questionnaire using pre-tested
structured questionnaire adopted from previous researches on the same topic with proper author
permission asked by their email address. The questionnaire consisted thirty five questions
divided into four sections that cover questions to assess socio demographic characteristics,
4.8 Variables
Poor knowledge: Refers for those study participants who answer half and less than half of
knowledge questions correctly.
Good Attitude: Refers to those study participants who scored point greater than the mean of
attitude questions
24
Poor Attitude: Refers to those study participants who scored point equal to and less than the
mean of attitude questions
Good Practice: Refers to those study participants who correctly respond to practice questions
and score above the median value
Poor Practice: Refers to those study participants who correctly respond to practice questions
and score median value and below median value.
ten assigned supervisors divided in to second, third and fourth year students who were working
in the institutions and can speak Amharic and English language, so that the students can’t consult
each other, go on to the internet, or visit the library to find the answer of knowledge questions.
on another private health science college in Addis Ababa one week before the actual data
collection period. In addition, the supervisors were adequately trained for two days on the rules
and regulations during data collection and closer supervision was undertaken during data
The collected data was cleaned, coded and entered to Epi Info version 3.5.4 imported and
analyzed into the statistical Package for Social Sciences (SPSS) version 20. To identify the
determinants of KAP of the students, binary and multiple logistic regression models with KAP of
the students towards hepatitis B viral infection as a dependent variable was constructed. The
degree of association between dependent and independent variables was described using crude
25
odds ratio (COR) and adjusted odds ratio (AOR) with 95% confidence interval (CI). Analysis of
data was done using stepwise logistic regressions in order to evaluate the effects of independent
variables on the dependent. The results of the study were presented in the form of texts, tables
and charts.
The proposal was approved by Institutional Review Board (IRB) and Ethical clearance was
obtained from the Ethical Committee of Department of Nursing and Midwifery School of Allied
Health Science, College of Health Science, Addis Ababa University before conducting the study.
Autonomy was insured by explaining the aims and objectives of the study to the students
beforehand, and informing them that if they do not want to take part in the study they do not
have to, and that this non-participation had no bearing on their grades. Confidentiality was
ensured since the participants were anonymous. A statement was included at the top of the
questionnaire, requesting students not to include identification, and that by completing the
questionnaire and handing it in, they are consenting to take part in the study.
The study result was presented to Addis Ababa University, College of Health Science Allied
School of Health Sciences, department of Nursing & Midwifery. The finding of the study was
disseminated to all responsible bodies in the study area. Further efforts will be made to published
26
5. RESULT
A total of 415 Addis Ababa University Health Science students were enrolled in the study giving a
respondent rate of 98.3%. The study participants from nursing department constituted 44.8% while
38.6% and 16.6% of students were from Midwifery and Medical Laboratory technology departments
respectively. More than half 285 (68.7%) of the study subjects were males and the remaining 130
(31.3%) were females, large number of the study participants 357 (86%) were belongs to the age
group 20 to 24 years old with a minimum and maximum age of 16 and 30 respectively. Most 162
(39.0%) of the study subjects were from fourth academic year while the least 124 (29.9%) were from
third academic year. Majority of the study subjects 158 (38.1%) were from Amhara ethnic group
followed by Oromo ethnic group 91 (21.9%) and 280 (67.5%) of the total study subjects were
27
Table 2: Socio-Demographic Characteristics of Addis Ababa University, undergraduate regular
Health Science Students. Addis Ababa June 2014.
28
5.2 Primary source of Hepatitis B viral infection information
About 254 (61.2%) of the study participants had got information about Hepatitis B from Lectures
and seminars followed by books and journals, media and family and friends with a respective
frequency of 105 (25.3%), 25 (6.0%) and 16 (3.9%). Special workshops on Hepatitis B virus takes
the least 7 (1.7%) place as a source of information for the study subjects. (Table-)
Figure 4: Primary source of information about Hepatitis B viral infection among Addis Ababa
29
5.3 Hepatitis B Viral infection Knowledge, Attitude and Practice among Addis Ababa
University undergraduate regular Health Science students
Almost all of the study subjects know or hear of hepatitis B. Regarding the Knowledge of the
respondents about the organs affected by Hepatitis B majority 385 (92.8%) of the respondents
correctly answered to it by choosing Liver, while a least number of study participants choose
incorrect answer Kidney and Brain with a respective frequency of 1 (0.2%) and 2 (0.5%) the
remaining 27 (6.5%) of the study subjects were not sure about which organ does hepatitis B affects.
About the appearance of hepatitis B viral infection symptoms; 112 (27.0%) of the study
participants respond correctly that the symptoms doesn’t appear within few days always after the
entry of hepatitis B virus to the body, while 209 (50.4%) and 94 (22.6%) answer incorrectly and
To the study which queried about route of transmission of hepatitis B viral infection 409 (98.6%),
398 (95.9%), 352 (84.8%) and 283 (68.2%) of the respondents answer correctly that blood and
blood products, needle and sharp injury, sexual intercourse and vertically mother to child can be a
Three hundred and fourteen (75.7%) of the respondents noticed that there is a high risk of hepatitis
B transmission through needle stick injury than HIV while 56 (13.5%) and 45 (10.8%) of the
respondents answer there is no high risk of hepatitis B virus transmission than HIV through needle
stick injury and they don’t know about the risk respectively.
Regarding prevention of hepatitis B viral infection 391 (94.2%), 372 (89.6%), 384 (92.5%), 349
(84.1%) of the respondents answer correctly that vaccination, standard working precaution,
avoiding needle and sharp injury and avoiding unsafe sex will prevent hepatitis B viral infection.
30
Among those who answers vaccine as a means of hepatitis B virus prevention 321 (77.3%) of them
answers that the vaccine can prevent the disease effectively. Regarding the dose of the vaccine only
162 (39.0%) of the respondents answer the correct dose of hepatitis B virus vaccine which in three
dose. The expected interval between the last dose and the dose preceding it were answer correctly
Slightly less than half 202 (48.7%) of the respondents were answer hepatitis B doesn’t have specific
pharmaceutical treatment which cures the disease, which was the correct answer.
31
Table 3: knowledge of Hepatitis B viral infection among AAU undergraduate regular Health
science students. Addis Ababa June 2014
32
Table 3: knowledge of Hepatitis B viral infection among AAU undergraduate regular Health
science students. Addis Ababa June 2014…………. Continued
33
Out of the total mark (19) the overall knowledge category of the study participants shows that
majority 378 (91.1%) of the respondents had good knowledge and the remaining 37 (8.9%) had
poor knowledge with a maximum and minimum value of 7 and 3 points respectively.
Figure 5: Graphic representation of overall knowledge category among Addis Ababa University
undergraduate regular Health Science students, June 2014.
Table 4: Overall knowledge of Hepatitis B viral infection in each of the three departments among
AAU undergraduate regular Health science students. Addis Ababa June 2014
Knowledge
Variables
Poor Knowledge N (%) Good knowledge N (%)
Department
Nursing 18 (9.7) 168 (90.3)
Midwifery 14 (8.8) 146 (91.3)
Laboratory technology 5 (7.2) 64 (92.8)
34
5.3.2. Attitude towards hepatitis B viral infection
Most of the study participants 373 (89.9%) were agreed that their job puts them at a high risk of
acquiring Hepatitis B virus and 386 (93%) of the study participants agreed that they are in need of
protection against HBV.
Three hundred and ninety seven (95.7%) of the respondents consider that it is necessary to receive
vaccine even though 288 (69.4%) of the respondents think hepatitis B vaccine costs too much.
One hundred fifty six (37.6%) of the study subjects feel that they do not have skill needed to
effectively and safely care patients with hepatitis B and 109 (26.3%) of them says they do not want
to serve (care) people with hepatitis B in their clinical practice.
Table 5: Attitude towards hepatitis B among AAU undergraduate regular Health science students
Addis Ababa June 2014
Likert Scale
Agree Not sure Disagree
Indicators of attitude
N (%) N (%) N (%)
35
Out of the total (9) make the overall attitude category of study participants towards hepatitis B virus
prevention shows that majority 373 (89.9%) of the respondents had positive attitude and the
remaining 42 (10.1%) had negative attitude towards the prevention of hepatitis B viral infection,
with a maximum and minimum value of 8 and 1 respectively.
Figure 6: Graphic representation of overall Attitude category among Addis Ababa University
undergraduate regular Health Science students, towards hepatitis B virus prevention, June 2014.
Among the study subjects 235(56.6%) of them responded that they deliver the same standard of
care to patients with hepatitis B as they do for other patients but the remaining 177(42.7%) do not.
Two hundred and ninety three (70.6%) of the study subjects often use additional infection control
precaution when they are caring for patients with Hepatitis B. Among the measures the respondents
use to protect themselves against Hepatitis B Glove, Google, Accurate sharp disposal of sharp
36
respectively. while 88 (21.2%), 178 (42.9%) and 191(46.0%) of them use incorrect measures
against hepatitis B as avoiding patients diagnosed with Hepatitis B, multivitamins and Antibiotic
respectively.
Regarding Hepatitis B virus test only 92(22.17%) of the total respondents were tested for Hepatitis
B virus and 24 (5.8%) of them were received Hepatitis vaccine. among those who received the
Figure 7: Distribution of hepatitis B viral test among Addis Ababa University undergraduate regular
Health Science students. Addis Ababa, June 2014.
All of the study subjects who didn’t take even one dose of hepatitis B virus vaccine had their own
reason shown in the table below
37
Table 6: Reasons for not being vaccinated among Addis Ababa University, undergraduate regular
Health Science students, Addis Ababa, June 2014.
Out of the total (12) marks the overall practice category of study participants towards hepatitis B
virus prevention were 286 (68.92%) for good practice and 129 (31.08%) for poor practice towards
hepatitis B virus prevention, with a maximum and minimum value of 9 and 1 respectively.
Figure 8: The overall Practice category among Addis Ababa University, undergraduate regular
Health Science students, towards hepatitis B virus prevention, June 2014
38
Among the total respondents who had good knowledge 68.5% of them have good practice too the
remaining 31.5 % had poor practice.
Table 7: Cross tabulation between overall knowledge and overall practice of Addis Ababa
University, undergraduate regular Health Science students, Addis Ababa, June 2014.
Overall Practice
Total
Overall Knowledge Poor practice Good Practice
N (%)
N (%) N (%)
Poor Knowledge 10 (27) 27 (73.0) 37 (100)
Good Knowledge 119 (31.5) 259 (68.5) 378 (100)
Total 129 (31.1) 286 (68.9) 415 (100)
After controlling for possible confounding variables, sex of the respondents was found to be
significantly associated with their knowledge towards hepatitis B, female students were found to
have 2.522 times more good knowledge than male students [ AOR= 2.522,95% CI (1.025, 6.205)].
The bivariate analyses were confirmed that there was no significant association between the
respondents knowledge about hepatitis B and socio demographic factors other than sex.
39
Table 8: Association of knowledge about hepatitis B viral infection with socio demographic factors
among Addis Ababa University, undergraduate regular Health Science Students, Addis Ababa June
2014.
Knowledge of hepatitis B Odds Ratio (95% CI)
Variables Poor Knowledge Good knowledge
N (%) N (%) Crude Adjusted
Age
15-19 1 (7.7) 12 (92.3) 1
20-24 32 (9.0) 325 (91.0) 0.841 (0.107, 6.721)
25-34 4 (9.8) 41 (90.2) 0.791 (0.77, 8.107)
Sex
Male 31 (10.9) 254 (89.1) 1 1
Female 6 (4.6) 124 (95.4) 2.522 (1.025, 6.205)⃰ 2.522 (1.025, 6.205)⃰
Ethnicity
Amhara 19 (12.0) 139 (88.0) 1
Oromo 5 (5.5) 86 (94.5) 2.351 (0.847, 6.528)
Tigre 7 (10.5) 63 (90.0) 1.230 (0.492, 3.076)
Gurage 1 (3.8) 25 (96.2) 3.415 (0.438, 26.690)
Others ⃰ ⃰ 4 (7) 53 (93) 1.230 (0.394, 3.842)
No respond 1 (7.7) 12 (92.3) 1.640 (0.202,13.336)
Department
Nursing 18 (9.7) 168 (90.3) 1
Midwifery 14 (8.8) 146 (91.3) 1.117 (0.537, 2.325)
Laboratory 5 (7.2) 64 (92.8) 1.371 (0.489, 3.848)
Academic Year
Two years 11 (8.5) 118 (91.5) 1
Three years 11 (8.9) 113 (91.1) 1.095 (0.485, 2.473)
Four years 15 (9.3) 147 (90.7) 1.048 (0.464, 2.370)
40
5.4.2 Factors associated with attitude towards hepatitis B prevention
Before and after adjusting for confounding variables a significant association was found between
sex of the study participants and the participants attitude towards hepatitis B; female respondents
had 0.433 times less likely to have positive attitude towards hepatitis B prevention than males.
The crude analysis revealed as the religion of the respondents was significantly associated with
their attitude towards hepatitis B; Catholic respondents had 0.068 times less likely to have positive
attitude towards hepatitis B than Orthodox respondents. [COR= 0.068, 95% CI (0.007, 0.616)]. But
According to the result of multivariate analysis, academic year of the respondents was significantly
associated with their attitude towards hepatitis B prevention; those respondents who were in third
academic year was found to had 2.237 times more positive attitude than second academic year
students. [AOR= 2.237, 95% CI (1.046, 4.787)]. Alike with third academic year student’s
respondents from fourth academic year was found to have 5.537 times more positive attitude
The bivariate analyses were confirmed that there was no significant association between the
respondents attitude towards hepatitis B prevention and there hepatitis B knowledge and practice .
41
Table 9: Association of attitude towards hepatitis B prevention with socio demographic and other
factors, among Addis Ababa University, undergraduate regular Health Science Students, Addis
Ababa June 2014.
Attitude of hepatitis B Odds Ratio (95% CI)
Variables Negative Positive Attitude
Attitude N (%) N (%) Crude Adjusted
Age
15-19 2 (15.4) 11 (84.6) 1
20-34 40 (10) 362(90) 1.645 (0.352, 7.688)
Sex
Male 21 (7.4) 264 (92.6) 1 1
Female 21 (16.2) 109 (83.8) 0.413 (0.217, 0.787)⃰ 0.433 (0.221, 0.848)⃰
Ethnicity
Amhara 14 (8.9) 144 (91.1) 1
Oromo 10 (11.0) 81 (89.0) 0.788 (0.335, 1.853)
Tigre 9 (12.9) 61 (87.1) 0.659 (0.271, 1.604)
Gurage 4 (15.4) 22 (84.6) 0.535 (0.161,1.772)
Others⃰ ⃰ 3 (5.3) 54 (94.7) 3.792 (0.484, 29.731)
No respond 2 (15.4) 11 (84.6) 0.729 (0.151, 3.519)
Department
Nursing 19 (10.2) 167 (89.8) 1
Midwifery 18 (11.3) 142 (88.8) 0.898 (0.454, 1.776)
Laboratory 5 (7.2) 64 (92.8) 1.456 (0.522, 4.065)
Academic Year
Two years 24 (18.6) 105 (81.4) 1 1
Three years 12 (9.7) 112 (90.3) 2.133 (1.015, 4.482)⃰ 2.237 (1.046, 4.787)⃰
Four years 6 (3.7) 156 (96.3) 5.943 (2.349, 15.035)⃰ 5.537 (2.160, 14.194)⃰
Knowledge
Poor knowledge 1 (2.7) 36 (97.3) 1
Good knowledge 41(10.8) 337 (89.2) 0.228 (0.030, 1.710)
42
Table 9: Association of attitude towards hepatitis B prevention with socio demographic and other
factors, among Addis Ababa University, undergraduate regular Health Science Students, Addis Ababa
June 2014, ……… Continued
Practice
Poor Practice 16 (12.5) 112 (87.5) 1
In multivariate analysis, age of the respondents was found to be associated with the practice of
hepatitis B prevention; those respondents who were in the age group of 20 to 24 years old was
found to have 3.553 times more good practice towards hepatitis B prevention than respondents from
the age 15-19 years old. [AOR= 3.553, 95% CI (1.124, 11.234)]. Those respondents who were in
the age group of 25 to 34 years old was found to have 5.622 times more good practice towards
hepatitis B prevention than respondents from the age 15-19 years old.[AOR= 5.622, 95% CI (1.460,
21.657)].
After controlling for possible confounding variables, the department of the respondents was found
to be significantly associated with their practice towards hepatitis B prevention; respondents from
Midwifery department were found to have 1.796 times more good practice towards hepatitis B
prevention than respondents from Nursing department. [AOR= 1.796, 95% CI (0.809, 2.993)].
According to the result of multivariate analysis, academic year was significantly associated with
practice towards hepatitis B prevention; respondents from fourth academic year had 4.069 times
good practice towards hepatitis B prevention than those respondents from second academic year.
43
Both multivariate and bivariate analyses were confirmed that there was no significant association
between the respondents’ hepatitis B prevention practice and their hepatitis B knowledge and
attitude.
Table 10: Association of practice towards hepatitis B prevention with socio demographic and other
factors, among Addis Ababa University, undergraduate regular Health Science Students, Addis
Ababa June 2014.
Department
Nursing 69(37.3) 116(62.7) 1 1
Midwifery 40(25.0) 120(75.0) 1.784 (1.120, 2.843)⃰ 1.796 (1.102, 2.930)⃰
Laboratory 19(27.5) 50(72.5) 1.565 (0.854, 2.871) 1.557 (0.808, 2.993)
44
Table 10: Association of practice towards hepatitis B prevention with socio demographic and other
factors, among Addis Ababa University, undergraduate regular Health Science Students, Addis
Ababa June 2014……………. Continued
Academic Year
Two years 59(45.7) 70(54.3) 1 1
Three years 43(34.7) 81(65.3) 1.588 (0.957, 2.635) 1.345 (0.790, 2.291)
Four years 26(16.1) 135(83.9) 4.376 (2.540, 7.542)⃰ 4.069 (2.261, 7.322)⃰
Knowledge
Poor knowledge 10 (27) 27 (73) 1
Good knowledge 118 (31.3) 259 (68.7) 0.813 (0381, 1.734)
Attitude
Negative attitude 16 (38.1) 26 (61.9) 1
Positive attitude 112 (30.1) 260 (69.9) 1.429 (0.738, 2.767)
45
6. DISCUSSION
According to the result of this study all of the study participants know or heard of hepatitis B
similar to study investigating attitude and awareness regarding hepatitis B and C among health care
As it was found from this study most 254 (61.2%) of the study participant had got their primary
information about Hepatitis B from lectures and seminars congruent with a study done in Kuala
Lupmur and Selangor, Malaysia most (88.1%) of health care workers had got their information
from education, but in reverse and with less value than the health care workers, the rural area
community of Kuala Lumpur and Selangor had got only 20% of the information from education
(35).
In this study 382 (92.8%) of study participants knows that the organ which can be affected by
hepatitis B virus is liver , in contrary with the study done in Kuala Lupmur rural area community
in which only 50.3% of them had know that hepatitis B would affect the liver (35). This can be due
to the difference in level of education and the extent of exposure to health information.
According to a study done in university of Kassal, Sudan among non-medical students, only 21%,
12.9%, 8.9% and 9.1% of the study participants know that contaminated blood, contaminated sharp
instrument, sexual intercourse and vertical from mother to child transmission can be route of
Hepatitis B virus transmission respectively. In the same study this students know route of
transmission of HIV better than Hepatitis B transmission contaminated blood, contaminated sharp
46
instrument, sexual intercourse and vertical from mother to child transmission of HIV was known by
71.9%, 73.7%, 88.4and 64.1%of the study participant respectively .This results are lower than the
result of knowledge of Hepatitis B transmission in this study (4). Those discrepancies could be due
to difference in field of study that health science students may get more information than the non-
medical students and these findings may be attributable to the efforts of HIV /AIDS control
program through mass media, lectures, and seminars in Sudan as it was also mentioned by the
researcher.
As it was found from these study 75.7 % of respondents know that there is a high risk of hepatitis B
virus than HIV transmission through needle stick injury which is less than the study done in Iran
(95.8%) among Iranian dental medical students (37). This discrepancy may be due to less
information coverage that the stake holders give to hepatitis B prevention and control as compare to
HIV/AIDS.
This research has showed that the study respondents know ways of preventing hepatitis B virus like
avoid Sharpe needle injury, and avoiding unsafe sex with a respective percentile of 92.1% and
74.2%. This figure is similar to the study done in Kuwait among primary health care workers. Also
incorrect answers like avoiding drinking contaminated waters and food which are not well cooked
Regarding the availability of hepatitis B vaccine studies which are conducted in India (87.3%) and
Brazil (97.2%) had know that there is vaccine for Hepatitis B viral infection (34,33), this figure are
approximately in line to this study finding (94.3%) and it may be due to study subjects access of
47
A study done in South Africa revealed that majority (89.1%) of the respondents mentioned that a
vaccine against hepatitis B virus can protect the disease effectively (39). This finding is congruent
with the result of this study in which 81.9% of the respondents among those who respond the
availability of vaccine was mention the vaccine is effective to protect the disease.
A study done in Teresina, Brazil decline that 87.4% of the respondent know that there is three dose
of Hepatitis B virus vaccine (33).another study conducted in Kuwait reported that 65.9 % of the
respondent know dose of Hepatitis B vaccine required for complete protection is three and 44.4% of
them answers correctly the expected interval between last dose and dose preceding it is grater or
equal to six months (38). On the other hand the result of this study was only 20% of the study
participants know the correct full dose of Hepatitis B vaccine and only 22.7% of them knows the
correct interval between the last dose and dose preceding it. This difference may rises from lake of
Regarding the overall knowledge of the study participants, the vast majority (91.1%) of the study
participants had good knowledge and 8.9 % of them had poor knowledge. similarly a study
conducted in Gauteng province; South Africa revealed that 87% of the study participants had
indicated good knowledge and the remaining 13% had poor knowledge regarding hepatitis B viral
infection (39).
Eight point nine percent (8.9%) poor knowledge when comparing to the total study subject it may
not be significantly large number but when we analyze the number of population who will be
served by this poor knowledgeable study participants it will be a great number of population that
need knowledge regarding different health concerning issues including hepatitis B viral infection.
48
According to the Federal Democratic Republic of Ethiopia Ministry of health, Health Sector
Development Programme report of 2010 one nurse is for 3,870 populations, one midwife is for
13,204 populations, one laboratory technician is for 25,961 populations (42), and when we calculate
how much population does a respondent of this study with poor knowledge will serve it becomes
69,660 population will be served by the nurses,184,856 population will be served by midwifes and
129,805 population will be served by medical laboratory technicians. Totally 329, 270 populations
will be served by health care professionals who have poor knowledge about hepatitis B infection.
Comparing the knowledge that the student had regarding Hepatitis B viral infection which was
nearly hundred percent (91.1%) with their practice towards hepatitis B prevention 68.5% of them
had good practice, it confirms all the notion that states knowledge does not always translate in to
practice.
About 90% of the respondents in this study were agreed that their job puts them at a higher risk of
acquiring Hepatitis B viral infection nearly the same as in the study conducted in Iran and Kuwait
were 96.5% and 80.5%, of the study subject agreed with this idea (37,38). With some result
discrepancy in the studies conducted in India and South Africa were 63.6% and 69% of the
respondent were agreed that their job puts them at the higher risk of acquiring hepatitis B infection
respectively (34,39). This may be due to the respondent’s good knowledge towards hepatitis B viral
In a study conducted in Kuwait majority 87.1% and 86.3% of respondents agreed that they are in
need of protection against hepatitis B and also they consider it necessary to receive vaccine against
the virus respectively (38). In congruent with the finding of this study were 93.0% of the
49
respondents were agreed that they are in need of protection against hepatitis B and 95.7% of the
study subjects were consider it is necessary to receive vaccine against the virus. This may be due to
the study participant’s positive attitude towards the risk of hepatitis B virus.
Twenty six point three percent (26.3%) of this study participants were do not want to serve or give
care for people with Hepatitis B virus . this may be due to a feeling that they do not have the skill
needed to effectively and safely care for peoples with Hepatitis B virus with a figure of 23.6% of
this study participants. A slightly higher percentile (56.8%) and (38%) of study participants were
also feel that they do not have the skill to effectively and safely care for people with hepatitis B
virus and do not went to serve people with Hepatitis B virus , as it is reported from a study
Majority (83.6%) of the study participant of this study agreed that following infection control
guidelines will protect hepatitis B infection, 89% and 7% of the study participants disagree and not
sure about this topic. similar to a study done in Iran that greatest than half (74.5%) of the
respondent agreed that infection control guidelines will protect hepatitis B infection (36). This
contingency may be due to study participant’s good knowledge concerning hepatitis B virus
According to multivariate analysis, academic year of the respondents was significantly associated
with their attitude towards hepatitis B prevention; as the academic year of the students increase
positive attitudes of the student towards hepatitis B prevention is also increase, this association is
may be due to increasing of courses related to the disease like communicable disease control in
their third academic year curriculum and get more clinical experience from their practical
attachment.
50
The overall attitude of the study participants of this study was 89.9% with positive attitude and
10.1% with negative attitude. According to the health sector development programme ratio of
health care professional with population they serve (42), respondents of this study with poor
attitude towards hepatitis B prevention will serve a total of 441,007 populations. Since the main
purpose of teaching these study participants is to prepare them to give good health care to the
community even small number of respondents with poor attitude towards hepatitis B prevention can
Even though 70.6 % of respondents of this study and 65.6% of respondents of a study conducted in
Guilan University Iran reported that they were using additional infection control precautions while
caring for hepatitis B patient (36), 42.7% of the study participants of this study didn’t practice the
same standard of care for peoples living with hepatitis B as they do for other patients, also 21.2% of
the study participants practice avoiding of patients with hepatitis B as a measure to prevent hepatitis
B. In contrast a study conducted in Guilan University Iran among medical science students only
15.8% of the participants were respond that they were not giving same standard of care for hepatitis B
patients (36). This figure is may be due to the difference in characteristics of the study subjects.
The fact that 46.0% of Addis Ababa University Health Science students in this study answered wrong
that using antibiotics after contact also found in a study conducted in south Nigeria that 61.0% of the
prevention (40). This indicates that they do not understand the correct measure to be taken against
hepatitis B.
51
Majority of the study participants of this study didn’t get hepatitis B vaccine, while only 5.8% of the
total study subject were vaccinated, among these only 2 (8.3%) of them had complete the full dose of
the vaccine. This figure is highly contradicted with several studies conducted in different countries. A
study conducted in Brazil shows 79.9% and 62.2% of the study participants had receive vaccine and
completed the full dose respectively (33). Also in a study conducted in India 78.2% 72.0% of the
study subjects had received the vaccine and complete the dose respectively (34). Here in our
continent south Nigeria a study revealed that 70.2% of the study participants received hepatitis B
vaccine (40). This difference may be due to un-affordability of the vaccine for the students and lack
Among the reason for not being vaccinated which is answered by the majority of the study subjects
who didn’t take the vaccine, unavailability of the vaccine through government channels is chosen by
most (40.4%) of the study participants of this study than other reasons, this can be an indicator that
low vaccination status can be due to lack of access. Contrary to this figure forgetfulness (50%) and
having no reason are the most frequently answered choices as a reason for not being vaccinated in a
As the multivariate analysis shows age of the respondents had significant association with their
practice towards hepatitis B prevention; as the age of the respondents increase good practice towards
hepatitis B also increase, this association is may be due to experience that they learn through life is
increased when they become older and mature enough to care and value their life.
52
According to multivariate analysis, academic year of the respondents was significantly associated
with their practice towards hepatitis B prevention; fourth academic year students had good practice
towards hepatitis B prevention than second academic year students, this association is may be due to
more clinical experience they get from their practical attachment in hospitals and health centers.
The overall practice of this study participants were 68.92% and 31.08% with good and poor practice
towards hepatitis B prevention respectively, using the health sector development programme ratio of
health care professional with population they serve (42), a total of 238 respondents with poor practice
towards hepatitis B prevention will serve 1,288,449 populations all over the country.
53
7. STRENGTH AND LIMITATION OF THE STUDY
Adequate sample size representing all the departments Nursing, Midwifery and Medical
The utilization of appropriate statistical methods to minimize biases was made and the data
Other health science students were not included because of different resource constraint
54
8. CONCLUSION AND RECOMMENDATIONS
8.1 Conclusion
In this study much more than half of the respondents had good knowledge, positive attitude and good
practice towards hepatitis B, while minority of the study subjects had poor knowledge, negative
attitude and poor practice towards hepatitis B, which generally have a great impact on the population
The attitude and practice of the respondents was found to be significantly associated with their
academic year, however, it was not found to have association with the knowledge of the study
participants.
Lastly it is of great important that the students who in the near future will be a part of the Ethiopia
health care system have sufficient knowledge, positive attitude and good practice towards hepatitis B,
not only for themselves but also for the purpose of the large community in which this students will
influence the knowledge, attitude, practice and the decision making towards several health related
55
8.2 Recommendations
Based on the finding from this study, the following recommendations are made.
Hepatitis B prevention and control implementation guideline and hepatitis B data has to be
derived, and from this guideline each concerned bodies including Health Science College of
Hepatitis B training package should also be prepared to mainstream hepatitis B related issues
to health care professionals including students, instructors, college administrators and other
concerning stakeholders.
The college management should work to build the capacity of the school teachers and
concerned bodies.
Give sufficient coverage about hepatitis B prevention and control issues through different
Fix a free telephone line in which people can get information about hepatitis B 24 hours
without payment.
56
For Researchers
A study which assesses KAP of the large community towards hepatitis B and their
Further study is needed to investigate the factors affecting hepatitis B knowledge, Attitude
57
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11 Sridhar MR, Boopathi S, Lodha R, Kabra SK. 2004. Standard precautions and postexposure
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16 Tetali S, Choudhury PL. 2006. Occupational exposure to sharps and splash risk among health
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17 Smith DR, Leggat PA. 2005.Needlestick and sharps injuries among nursing students. J Adv
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18 Ghahramani F, Mohammadbeigi A and Mohammadsalehi N. 2006. A survey of the students’
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20 Glanz, K., Rimer, B.K. & Lewis, F.M. 2002. Health behavior and health education theory,
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24 Margolis HS, Alter MJ, Hadler SC. 1991. Hepatitis B: evolving epidemiology and implications
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Conti S, Bassani F. 1988. Ethiopian national hepatitis B study. J Med Virol vol 24: pp 75-84.
29 Tsega E, Mengesha B, Nordenfelt E, Hansson B, Lindberg J. 1987. Prevalence of hepatitis B
virus markers among Ethiopian blood donors: Is HBsAg necessary? Trop Geogr Med vol 39: pp
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30 Abebe A, Nokes DJ, Dejene A, Enquselassie F, Messele T, Cut FT. (2003). Sero-epidemiology
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31 Rahlenbeck SI, Yohannes G, Molla K, Reifen R, Assefa A. (1997). Infection with HIV,syphilis
and hepatitis B in Ethiopia: a survey in blood donors. Int J STD AIDS vol 8: pp 261-264.
32 Tsega E, Nordenfelt E, Hansson BG, Mengesha B, Lindberg J. 1992. Chronic liver disease in
Ethiopia: a clinical study with emphasis on identifying common causes. Ethiop Med J vol 30:
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33 Marina Sena Lopes da Silva Sacchetto, Simone Souza Lobão Veras Barros, Thaís de Alencar
Araripe, Aryvelto Miranda Silva, Symonara Karina Medeiros Faustino, José Mário Nunes da
Silva. 2013 October. Hepatitis B: Knowledge, Vaccine Situation and Seroconversion of
Dentistry Students of a Public University. Hepatitis Monthly doi:10.5812/hepatmon.13670.
34 Setia S, Gambhir RS, Kapoor V, Jindal G, Garg S, Setia S.2013. Attitudes and Awareness
Regarding Hepatitis B and Hepatitis C Amongst Health‑care Workers of a Tertiary Hospital in
India. Annals of Medical and Health Sciences Research Vol 3 Issue 4: pp 551-558.
35 Ho Chiew Lim, Hesham Rashwan. 2003. Awareness of Hepatitis A and Hepatitis B among
Residents in Kuala Lumpur and Selangor. Malaysian Journal of Pharmacy 1(3): pp 76-85.
36 Roya Mansour-Ghanaei, Farahnaz Joukar, Fatemeh Souti, Zahra Atrkar-Roushan. March 31,
2013. Knowledge and attitude of medical science students toward hepatitis B and C infections.
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37 Seyed Moayed Alavian, Nima Mahboobi, Nastaran Mahboobi, Maryam Mohammadi,
Savadrudbari; Pardis Soleimanzade Azar; Sedigheh Daneshvar. 2011. Iranian Dental Students’
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38 Areej Alkandari, Shaikha Aljodar, Hanouf Adnan Albahhouh, Gamal Makboul, Medhat El-
Shazly. January 2013. Knowledge, Attitudes and Self-Reported Behavior of Primary Health
Care Workers for Hepatitis B and C Virus and other Health Care Associated Infection. Greener
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39 Mpho Margaret Satekge. 2010. Knowledge, Attitudes and practices regarding the prevention of
Hepatitis B virus infection, in final year College Student Nurses in Gauteng Province.
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workers’ knowledge, attitude and behavior towards hepatitis B infection in Southern Nigeria.
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10. APPENDIX
10.1 Annex I: Information Sheet
Here, I the undersigned, at Addis Ababa University College of Health Science, School of Allied
Health Sciences Department of Nursing and Midwifery Graduate studies Program, currently I will
be undertaking research entitled assessment of knowledge, Attitude, Practice and factors associated
with it towards Hepatitis B viral infection among Addis Ababa University, regular undergraduate
students of College of Health Science, For this study you are selected as a participant and before
getting your consent or permission of your participation you need to know all necessary information
Objective: To assess knowledge, Attitude, Practice and factors associated with it towards Hepatitis
B viral infection among Addis Ababa University, regular undergraduate students of College of
Health Science.
Significance of the study: This study is important in providing ways to prevent Hepatitis B viral
Participants: Selected students of Addis Ababa University, School of Allied Health Science.
Confidentiality: All information you give will be kept confidential and won't be accessible to any
third party. You are not asked to write your name on the questionnaire sheet so that you will not be
identified.
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Risks: The procedure doesn’t bear any physical or psychological trauma on you. You will not be
Benefits: For your participation in the study no payment will be granted. But, participating in the
study and giving your information to questions asked will have great input in efforts to describe the
knowledge, Attitude and practice of the study population towards hepatitis B viral infection.
Consent: Your participation in the study will be totally based on your willingness. You have the
right not to participate from the beginning, or stop any time after starting participation. You will
Date: ________________________
Signature_____________________
Email: hikmashikure@gmail.com
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10.2 Annex II- Questionnaire
Consent form
Dear Respondent; my name is Hikma Shikure. Currently I am a graduate student at Addis Ababa
University, college of Health Sciences, School of Allied Health Science Department of Nursing and
associated with it towards Hepatitis B viral infection among Addis Ababa University, regular
undergraduate students of College of Health Science. The main purpose of the study is to collect
information necessary to describe the level of knowledge, Attitude and practice of the students
towards HBV infection and in order to identify the gap to recommend possible solutions. To attain
this purpose your honest and genuine participation is very important and highly appreciable. I,
therefore, kindly request you to fill this questionnaire as accurately and carefully as possible.
Please be assured that all the information gathered will be kept strictly confidential and your name
does not need to written in any page of the questionnaire. Only the researcher has the access of the
information and used it for the study purpose only. You have a full right not to participate in this
study.
Thank you
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Section A: Socio-demographic characteristics of the respondent
1. What is your age? ____________
2. Sex 1. Male 2. Female
3. Religion
1. Muslim
2. Orthodox
3. Protestant
4. Catholic
5. Other, specify ____________
4. From which part of Ethiopia do you came from?
1. Central Ethiopia
2. North Ethiopia
3. South Ethiopia
4. East Ethiopia
5. West Ethiopia
6. From abroad, specify _____________
7. Ethnicity _______________________
5. Which program are you studying?
1. Nursing
2. Midwifery
3. Medical Laboratory technology
6. How long have you stayed in Addis Ababa University school of Allied Health science?
1. Two years
2. Three years
3. Four years
4. More than four year specify the year___________
7. How much is your last cumulative GPA specify ______________
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Section B: Respondents Knowledge about Hepatitis B infection
1. Yes
2. No
1. Yes
2. No
3. I don’t know
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12. Route of transmission of Hepatitis B infection (answer each of the following choices)
13. There is a higher risk of Hepatitis B than HIV transmission through needle stick injury.
1. Yes
2. No
3. I don’t know
14. Ways of preventing Hepatitis B infection can be through (answer each of the following choices)
1. Vaccination yes □ No □
2. Practicing standard working precaution yes □ No □
3. Avoid needle/sharp injury yes □ No □
4. Avoid unsafe sex yes □ No □
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5. Avoid drinking contaminated water yes □ No □
6. Avoid foods not well cooked yes □ No □
7. Other specify _____________________________________
15. If your answer is yes for Q.No 14 choice 1, Can Hepatitis B vaccine prevents the disease
effectively?
1. Yes
2. No
16. How many doses of hepatitis vaccine are there?
1. One dose
2. Two doses
3. Three doses
4. Four doses
17. What is the Expected Interval between last dose and dose preceding it?
1. < 6 months
2. ≥ 6 months
3. I don’t know
18. There is specific pharmaceutical treatment available to cure hepatitis B
1. Yes
2. No
3. I don’t know
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Section C: Respondents Attitude Regarding Hepatitis B viral infection
19. Do you think your job puts you at a high risk of acquiring Hepatitis B virus?
1. Yes
2. No
3. I don’t have idea
20. Do you think hepatitis B vaccine costs too much?
1. Yes
2. No
23. Do you think that health professionals who are Hepatitis B virus positive should not give health
care services to patients?
1. Yes
2. No
24. Do you feel that you do not have the skills needed to effectively and safely care patients with
Hepatitis B?
1. Yes 2. No
[
25. Do you want not serve people with Hepatitis B in your clinical attachment?
1. Yes
2. No
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27. Following infection control guidelines will protect you from being infected with Hepatitis B
1. Agree
2. Disagree
3. Don’t have idea
28. Do you often use additional infection control precautions when you caring for patients with
Hepatitis B
1. Yes
2. No
29. Do you deliver the same standard of care to patients with Hepatitis B as you do for other
patients?
1. Yes
2. No
30. Measures taken to protect against hepatitis B infection (answer each of the following choices)
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31. Have you ever tested for hepatitis B virus?
1. Yes
2. No
32. Have you ever received hepatitis B Vaccine? (if yes answer question No 33 & 34)
1. Yes
2. No
33. If “yes” for question number 32, Number of doses of vaccine you received
1. 1 dose
2. 2 dose
3. ≥ 3 dose
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11. DECLARATION
I, the undersigned, declare that this thesis is my original work, has not been presented for a
degree in this or another university and that all sources of materials used for this thesis have
Signature: _______________________________.
This thesis work has been submitted for examination with my approval university advisor.
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