95

ORIGINAL ARTICLE

KNOWLEDGE AND AWARENESS OF HEPATITIS BAMONG STUDENTS OF A PUBLIC SECTOR UNIVERSITY

1 2 3 2ASLAM GHOURI , SONIHA ASLAM , YASMEEN IQBAL , AKHTAR ADIL SHAH

1. Assistant Professor of Medicine Liaquat University of Medical and Health Sciences Jamshoro.

2. Assistant Professor of Health and Physical Education3. Professor of Natural Sciences Center for Physical Education, Health and Sports Science, University of Sindh, Jamshoro

Corresponding to:

Aslam Ghouri, FCPSAssistant Professor of MedicineLiaquat University of Medical and Health Sciences Jamshoro.E-mail: aslamghouri2010@hotmail.com

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015

INTRODUCTION

Hepatitis B is the foremost public health problem around the world eating up the major portion of health resources. The increasing prevalence is a constant threat to our community as it is an important cause of liver cirrhosis and hepatocellular

1-3carcinoma resulting in significant morbidity and mortality . Hepatitis B infection is prevalent worldwide, with a probable 2 billion people affected, of whom more than 350 million are chronic carriers. About 700000 die each year from HBV linked

4liver ailment or hepatocellular carcinoma . The prevalence of HBV fluctuates greatly in different areas of world. Approximately three quarters of chronic carriers of hepatitis-B

5live in Asia . The occurrence of HBV infection is 5-10% in Southeast Asia and 1% in North Europe and America. The

6incidence in India is 3-4% . Hepatitis B and C are both endemic in our country and the predictable frequency of hepatitis B antigen among healthy adults in a study done locally was 2.4% (ranging from 1.4-11.0%). The frequency is even greater in high-

1risk groups . Another study recorded an estimate of 405 million 7carriers in Pakistan with a carrier rate of 3-4% for HBV . Likewise

a survey on hepatitis C infections observed that overall prevalence of HCV in Mansehra was 10.3% while among males it

8was 11.8%, whereas, in females it was 9.4% .One more study shows that the prevalence of hepatitis B and C in general population in Khyber Pakhtunkhwa (KPK), Pakistan was 2.28%

9and 3.19 respectively .The key factors responsible for global epidemic of hepatitis B include reuse of syringes, blood transfusion, tattooing, mother to child transmission and unsafe sexual practices. Therapeutic injections are quite common in our community and this pose a

5consistent threat of transmitting such infections .Overuse of injections and unsafe injection practices causes an estimated 8-

1016 million cases of hepatitis B .As management is expensive and lots of the patients cannot afford this expensive treatment, it is essential that everyone, particularly those at risk should be vaccinated against hepatitis B virus and public should be educated regarding its preventive measures. General public particularly the health care personnel should be familiar with epidemiological factors of disease for instance communicability, Sequel, prevention and control. The introduction of training in universal safety measures and countrywide vaccination programs in decreasing the load of disease cannot be overemphasized.Rationale: Hepatitis infection is a main health problem in our state and is responsible for high morbidity and mortality among those infected. Lack of knowledge and awareness about the disease is responsible for this state of affairs. As not many studies are conducted in our country to assess the knowledge of general public concerning Hepatitis B, this study was carried out

ABSTRACT

OBJECTIVE: To determine the level of knowledge and awareness of hepatitis-B infection among students of a public sector university.STUDY DESIGN: A cross-sectional observational study.PLACE AND DURATION: The study was conducted among students of Center for Physical Education Health & Sports Science,

st stUniversity of Sindh, Jamshoro from 1 July to 31 December 2013.METHODOLOGY: Our tool of data collection was a self-administered questionnaire which assessed basic knowledge of hepatitis B, its modes of transmission, prevention, treatment, sequel and practices and attitudes towards patients with HBV infection. The questionnaire was distributed to the students in the class and they were asked to fill it according to their knowledge without guessing. Data gathered was analyzed by SPSS V. 18.RESULTS: A total of 100 students with mean age 21 years (SD ±1.524) took part in this survey. Majority of our students have heard about hepatitis (95%) and a large number of them knew that blood transfusion and re use of syringes (78%) are the main sources of transmission. Interestingly, a reasonable number of students (32%) thought hepatitis B could spread through hug, cough and sneeze of a patient. About half of them were aware that a vaccine is available against HBV. Approximately 70% of the group believed that sterilized syringes and screened blood for HBV should be used to prevent these infections. The mean scores were 66.1%, 42% and 65.4% regarding basic knowledge, transmission and practices about hepatitis, respectively.CONCLUSION: Student's level of knowledge and awareness about hepatitis B was lacking. They had some misconceptions about disease transmission and treatment which has to be addressed. KEY WORDS: Knowledge, Awareness, Students, Hepatitis B, Blood Transfusion.

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015Aslam Ghouri et al.

96

(68% n=68) were recognized by the students to be the methods to protect against these infections. Table - III shows the statements regarding prevention against hepatitis B. Regarding complications of hepatitis B, our respondents were less informed but more than half knew it can cause death. Table - IV shows the statements regarding complications of hepatitis B. our respondents were less informed but more than half knew it can cause death. Table No. IV shows the statements regarding complications of hepatitis B. Majority of the group (68% n=68) believed that screening blood for HBV renders blood safe for transfusion and sterilized syringes should be used (72% n=72). A large number of students (60% n=60) agreed that a person with H/O hepatitis shouldn't donate blood. Table no.V shows the statements regarding attitude and practices against hepatitis B. On an average, 66.1% (n=66) and 33.9% (n=40) had correct and incorrect knowledge about Hepatitis B infection, respectively. A total of 42.7% (n=43) exhibited adequate level of awareness while 57.3% (n=57) exhibited incorrect level of awareness about transmission of Hepatitis B infection. The most popular source of information was television (65% n=65) followed by family and friends (22% n=22) and print media (13% n=13). In our survey we assessed five aspects of hepatitis B like basic knowledge, its modes of transmission, prevention, sequel and attitude and practices. The mean scores of the students were 66.1% (n=66), 42.7% (n=43), 42% (n=42), 40% (n=40) and 65.4% (n=65) respectively. Students had more information about basic knowledge than mode of transmission, treatment and prevention of hepatitis B. Moreover they demonstrated good attitude and practices against hepatitis. A trend was observed in our study with increasing frequency of correct responses associated with increasing educational level.

to determine the level of knowledge and awareness about hepatitis B among the students of a public sector university. This study will identify the gaps in knowledge and misconceptions and help in planning effective health education campaign.

METHODOLOGY

A cross sectional observational study was conducted among the students of Center for Physical Education Health & Sports

st stScience, University of Sindh Jamshoro, from 1 July to 31 December 2013. One hundred students were randomly selected by convenient sampling; the subjects were fully informed about the design and purpose of the study. Out of those selected, 76 (76%) were admitted to bachelor's degree course and 24 (24%) were master's degree students. A written informed consent was obtained from each participant. The participants were given a structured questionnaire. The questionnaire was designed to get information about demographic and it contained five other sections to assess basic knowledge about hepatitis B, its modes of transmission, prevention, sequel and practices and attitudes towards patients with HBV infection. Respondents were asked whether they have ever heard about a disease called hepatitis B. They were further queried about routes of transmission like sexual intercourse, child birth, blood transfusion, sharing toothbrushes and razors and reuse

RESULTS

A total of 100 students participated in the study with mean age of 21 years (±1.524 SD) and age range of 18-35 years. The male to female ratio was 2.5:1 (72 males and 28 females). Graph No.1 shows the sex ratio of the respondents. Majority of the students (95% n=95) had heard about hepatitis but only two-thirds agreed that hepatitis B is a contiguous disease and it affects the liver. A large number of them (74% n=74) were aware that a blood test is the only way to know for sure if you have hepatitis. Table - I shows the statements regarding the basic knowledge about hepatitis B. Regarding mode of transmission, bulk of the respondents (78% n=78) knew that blood transfusion and reuse of syringes were important sources of transmitting these infections. But a large volume (62% n=62) didn't consider sexual contact as a source of transmission. Sharing room with a hepatitis B infected person was acceptable to only (30% n=30) respondents and a reasonable number of students (32% n=32) thought hepatitis B could spread through cough and sneeze of a patient. Visit to a barber (66% n=66) and dental and surgical procedures (48% n=48) were stated to be the major source of infection. Table-II shows the statements regarding transmission of hepatitis B. Half of the students think that HBV infection is a preventable disease and a vaccine is available against it. Wearing gloves (32% n=32) and safe disposal of hospital waste

FIGURE - 1: SEX RATIO OF THE SUBJECTS

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015Aslam Ghouri et al.

97

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015Aslam Ghouri et al.

98

on females attending gynecology clinics, the awareness about routes of transmission was not satisfactory. Less than half thought it can be transmitted by kissing, touching, sharing

5rooms and utensils with hepatitis patient . In a study done at a local university, more than 90 percent of the respondents thought blood and blood products, syringes, razor and sex are

rdthe leading source of infection. More than 2/3 of them knew sharing room and utensils with a patient of hepatitis B don't

10transmit the disease . In a study performed on dental students, majority knew that transmission of HBV results from exposure to contaminated blood (88%), needle stick injury (95%) and unsafe sex (92%) and 95% of them thought it can't be

6transmitted through hand shake . A study conducted in Malaysia also highlights misconception about disease transmission among hepatitis patients. Majority (93.2%) believed that HBV can be communicated by sharing of eating

15 1, 7, 16and drinking utensils . Other studies show similar results .In our study, knowledge about HBV vaccine was not satisfactory. Only half of the respondents knew that a vaccine is available for prevention of HBV but they didn't know about its lifelong protection. Our results are less when compared with other

6, 7, 10studies . This may be because of increasing knowledge and awareness among medical and dental students about the

1,5,14disease. But other studies show similar results .In present study, about half of the responders knew that treatment is available for HBV in the form of injections. Another

7local study reported the same results (50.8%) . A study done on medical students' shows that 85% of them appreciated the

10availability of treatment . A study done in Nawabshah on patients determined a significant lack of knowledge regarding

1treatment of disease . Awareness about complications and consequences of hepatitis

thB was poor in our study population. Only 1/4 of the responders thought it can result in liver cirrhosis and hepatocellular carcinoma but half of them knew it may cause death. In a study done on dental students, 68% students knew hepatitis B can

6result in cirrhosis and carcinoma . In a local study, almost half of 1the students knew about complications .

Regarding practices and attitude towards hepatitis patient, present study reported fair amount of knowledge about good practices and attitude. More than half of our responders knew the role of screening blood for HBV before transfusion in prevention of the disease and majority would prefer using

DISCUSSION

In a study carried out among adults in a periurban community of Karachi, it was found that 81percent of the patients who attended the clinic received injections and in 94 percent of those patients, syringes were reused. More than half were tested for HBV and HCV and it was found that 44 percent of those patients had anti HCV and 19 percent were HBsAg

11positive .Knowledge and awareness about hepatitis B is crucial to reduce the burden of this deadly disease in our community .Safe and clinically indicated injections are needed to prevent these infections in Pakistan. During our survey, we found relatively good fundamental knowledge of hepatitis among the students. Bulk of whom had heard about hepatitis but only half knew that hepatitis B is a

thcontiguous disease and it affects the liver. About 3/4 confessed that a blood test is the only way to know for sure if you have hepatitis. In a local study done on medical students, it was shown that most of the male students (96.8 percent) knew

7about hepatitis B infection . In a study carried out among Asian Canadians, it was establish that 68 percent were aware about HBV but over 60 percent were not aware of that HBV could

12cause HCC or cirrhosis . One more study involving dental students in India, examined that 73 percent students knew that Hepatitis B is an infectious illness caused by HBV and 88 percent of them considered that Hepatitis B surface antigen (HBs Ag) was most commonly used test for the screening of Hepatitis B

6infection . less level A Dutch Turkish community study observed of awareness and knowledge concerning hepatitis B, as the majority of respondents (73percent) never consider about the

13disease . A similar results were reported in otherlmost 1, 2, 3,10,14studies .

Regarding the modes of transmission of hepatitis B, the overall awareness of the students was average. Majority of our respondents knew that transmission of HBV results from exposure to blood and blood products, reuse of syringes and razor of barber. But most of them were less informed about other routes of transmission such as sex, mother to child, tattoo and surgical/dental procedures. In addition, when we inquired about routes of transmission that are not relevant to HBV, a reasonable number of students thought cough, hand shake , sharing of utensils, sharing of room and eating food prepared by an infected person as a source of transmission. In a study done

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015Aslam Ghouri et al.

99

REFERENCES

1. Razi A, Rehman R, Naz S, Ghafoor F, Khan M A. Knowledge attitude and practices of university students regarding hepatitis B and C. ARPN J Agricul and Bio Sci. 2010; 5(4): 38-43.

2. Ghahramani F, Mohammad beigi A, Mohammad salehi N. A Survey of the Students' Knowledge about Hepatitis in Shiraz University of Medical Sciences. Hepatitis monthly. 2006; 6(2): 59-62.

3. Taylor V M, Choe JH, Yasui Y, Li L, Burke N, Jackson JC. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women. J. Commun. Health. 2005; 30(6): 477–490.

4. Bibl F, Alaei M, Negro F. The new EASL guidelines for the management of chronic hepatitis B infection. Swiss Med Wkly 2010; 140(11-12):154-9.

5. Haider G, Haider A. Awareness of women regarding hepatitis B. J. Ayub Med. Coll. Abbottabad 2008; 20(4):141-4.

6. Saini R, Saini S, Sugandha RS. Knowledge and awareness of Hepatitis B infection amongst the students of Rural Dental College, Maharashtra, India. Ann Nigerian Med 2010; 4:18-20.

7. Nisar N, Baloach R, Munir A. A. Does clinical experience affect knowledge regarding Hepatitis-B among male medical students at a private university J Pak Med Assoc. 2009; 59(12): 808-811

8. Jamil M S, Ali H, Shaheen R, Basit A. Prevalence, knowledge and awareness of hepatitis C among residents of three union councils in Mansehra. J. Ayub Med. Coll. Abbottabad 2010;22(3)

9. Farooqi J. I., Farooqi R J, Khan N, Mussarat. Frequency of hepatitis B and C in selected groups of population in NWFP, Pakistan. JPMI 2007; 21(03): 165-8.

10. Anjum Q , Siddiqui H, Ahmed Y, Rizvi SR, Usman Y. Knowledge of Students regarding Hepatitis and HIV/AIDS of a Private Medical University in Karachi. J Pak Med Assoc 2005; 55 (7): 285-8.

11. Khan AJ, Luby SP, Fikree F, Karim A, Obaid S, Dellawala S, Mirza S, Malik T, Fisher-Hoch S, McCormick JB. Unsafe injections and the transmission of hepatitis B and C in a periurban community in Pakistan. Bull World Health Organ.2000; 78(8): 956-63.

12. Cheung J, Lee TK, Teh CZ, Wang CY, Kwan WC, Yoshida EM. Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community Can J Gastroenterol.2005 A; 19(4):245-9.

13. Van der Veen YJ, Voeten HA, deZwart O, Richardus J.H. Awareness, knowledge and self-reported test rates regarding Hepatitis B in Turkish-Dutch: a survey. BMC Public Health 2010, 10:512

14. Al-Jabri AA, Al-Adawi S, Al-Abri J.H., Al-Dhahry SH.

sterilized syringes when required. A reasonable number of students thought patients undergoing surgical or dental procedures should be investigated for HBV and the bulk of the responders would ask barber to use new blades for shaving and hair cut. Reuse of the blades for shaving armpits or beard is quite common especially in the small towns and villages which

1pose a considerable risk for transmitting these infections . Sharing personal things is a known risk factor for hepatitis but a sizeable number of our students were either sharing or not sure about the role of personal belongings in disease transmission. In a local study, majority of the participants had developed good practices of using sterilized syringes (86percent) and screened blood for transfusion (75 percent) but to ask barbers to use new blades for shave was not found as frequent practice (50

1percent) . In a study conducted in India, majority (95%) believed that patients undergoing surgical dental procedures to be

6investigated for HBV . In our study, safe disposal of hospital waste was appreciated as an important method against spread of infection but only one third of responders knew the role of wearing gloves against spread of infection. In a study done in a local university at Karachi, majority of the responders knew the role of wearing gloves (87%) and safe disposal of sharp waste (98%) to protect

10against these infections . Television was the key source of information among our study population followed by internet and family and friends. In a study done on medical students, books (85%), media (85%) and teachers (84%) were mentioned as main source of

10information . In a study done at Isra hospital, teachers, books 7and media were regarded as source of information .

In our study it was found that increasing frequency of correct responses was associated with increasing educational level. In a study conducted by Habra, et al (2005) on medical students of Delhi, senior students had the highest level of information

17compared with other groups . Similar results were reported in a 2 15study done in Iran and Malaysia .

CONCLUSION

The knowledge and awareness about hepatitis B was lacking among university students. They had more knowledge about precautions than transmission and consequences of the disease.

RECOMMENDATIONS

Health education programs were found necessary for all students to improve awareness of these diseases.

Efforts need to be made to ensure greater awareness by arranging public awareness programs and seminars emphasizing on routes of transmission and prevention procedures to avoid the occurrence of these infections. Students are the best targeted group for health education who can educate their family and friends easily.

ISRA MEDICAL JOURNAL | Volume 7 - Issue 2 | Apr - June 2015Aslam Ghouri et al.

100

12(1) 601.16. Khan SJ, Anjum Q, Khan NU, Nabi FG. Awareness about

common diseases in selected female college students of Karachi. J. Pak. Med. Assoc. 2005; 55(5):195-8.

17. Chhabra P, Grover VL, Agrawal KD. Do our medical students have enough knowledge of hepatitis B? A Delhi based study. J. Commun. Dis. 2002; 34(3):221-5.

Awareness of hepatitis B virus among undergraduate medical and non-medical students. Saudi Med J. 2004; 25(4):484-7.

15. Mohamed R, Ng CJ, Tong WT, Abidin SZ, Wong LP, Low WY. Knowledge, attitudes and practices among people with chronic hepatitis B attending a hepatology clinic in Malaysia: A cross sectional study. BMC Public Health 2012;