Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study

Madhurya H Sachidananda; TA Dhanalakshmi; D Venkatesha

doi:10.4103/jacm.jacm_2_22

ORIGINAL ARTICLE

Year : 2022 | Volume : 24 | Issue : 1 | Page : 8-11

Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study

Madhurya H Sachidananda¹, TA Dhanalakshmi², D Venkatesha²
¹ Internship, Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India
² Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, Mandya, Karnataka, India

Date of Submission	14-Feb-2022
Date of Acceptance	12-Mar-2022
Date of Web Publication	11-Jul-2022

Correspondence Address:
Dr. T A Dhanalakshmi
Department of Microbiology, Adichunchanagiri Institute of Medical Sciences, B.G. Nagara, Nagamangala Taluk, Mandya - 571 448, Karnataka
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/jacm.jacm_2_22

Abstract

CONTEXT: A critical level of knowledge and awareness about hepatitis B infection and its prevention among the medical students is essential to decrease the burden of occupationally acquired hepatitis B infection.
AIM: To assess the knowledge, attitude and practices (KAPs) among medical students toward HBV infection and its prevention.
SETTING AND STUDY DESIGN: This was a cross-sectional questionnaire-based study done in a rural medical college.
MATERIALS AND METHODS: Written informed consent and Institutional Ethical Committee clearance were taken. Study included 403 randomly selected medical students. Self-administered pre-tested and pre-validated questionnaire containing KAPs items was used as study tool. The responses were recorded in terms of agree, disagree, not sure, yes and no formats.
STATISTICAL ANALYSIS: Data are expressed in frequencies and percentages.
RESULTS: Majority of students were aware of modes of transmission of HBV infection (67%–91%). Only 28.5% of participants agreed that hepatitis B vaccine is used for post-exposure prophylaxis. They had good attitude toward preventive aspects of hepatitis B infection (71%–96.3%). Only 52.9% had taken three doses of hepatitis B vaccination and only 4% of them got tested for antibodies titre post-vaccination.
CONCLUSION: The present study demonstrated gap in the knowledge and practice. This gap should be addressed by implementation of orientation programmes on HBV and mandatory vaccination of medical students at the time of entry to the institution.

Keywords: Hepatitis B, knowledge, attitude and practice, medical students, vaccination

How to cite this article:
Sachidananda MH, Dhanalakshmi T A, Venkatesha D. Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study. J Acad Clin Microbiol 2022;24:8-11

How to cite this URL:
Sachidananda MH, Dhanalakshmi T A, Venkatesha D. Knowledge, attitude and practices toward prevention of Hepatitis B Virus infection among medical students: A cross-sectional study. J Acad Clin Microbiol [serial online] 2022 [cited 2023 Sep 30];24:8-11. Available from: https://www.jacmjournal.org/text.asp?2022/24/1/8/350316

Introduction

Hepatitis B is a serious infection caused by Hepatitis B virus (HBV) with potential complications of chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma.^{[1],[2],[3],[4]} The prevalence of HBV infection among medical students is 11%.^[5] Having enough knowledge and good attitude and practice (KAP) toward the prevention of HBV infection is the cornerstone for preventing the transmission of HBV.^[6] Information regarding baseline KAP of the target population will help in devising a suitable educational approach that can be tailored according to their knowledge, beliefs and experience. With this background, the present study was conducted to assess the knowledge, attitude and practices (KAPs) among medical students toward HBV infection and its prevention.

Materials and Methods

The present cross-sectional, questionnaire-based study was conducted at a rural medical college over a duration of 2 months (May-June 2018). Written informed consent and Institutional Ethical Committee clearance were obtained before study.

A total of 424 medical students (sample size calculated using Epi Info 7 software (Epi Info is statistical software for epidemiology developed by Centers for Disease Control and Prevention in Atlanta, Georgia) based on a simple population formula; considering estimated prevalence rate 50%, margin of error 5% and 95% confidence interval, correction formula as the source population is below 10,000 and including 10% non-response rate),^[7] 106 students each from II, IV, VI and VIII term were included in the study and were selected by simple random sampling. Students who were not willing for the study, those who were absent on the day of the survey, those participated in pilot study and incomplete questionnaires were excluded from the study.

Pre-tested, self-administrated questionnaire was distributed to students in the classroom during regular class hours after briefing them about the objectives of the study. Confidentiality of the data and anonymity of the students was maintained throughout the study. The questionnaire included four sections: (A) demographic and academic characteristics, (B) knowledge items, (C) attitude items and (D) practice items. The responses were recorded in terms of agree, disagree, not sure, yes and no formats.

Statistical analysis

Data is expressed in frequencies and percentages.

Results

Twenty-one students were absent on the day of questionnaire distribution, and for final data analysis, 403 questionnaires were considered (II term – 100 students, IV term – 106 students, VI term – 99 students and VIII term – 98 students). The response rate was 100%. [Table 1] shows the knowledge of the participants toward modes of transmission of Hepatitis B infection. Majority of respondents were aware of transmission modes of HBV. Only 28.5% of participants agreed that hepatitis B vaccine is used for post-exposure prophylaxis (PEP). Thirty-seven percent of students agreed that medical students should be vaccinated with hepatitis B vaccine at the time of admission to MBBS course. [Table 2] shows the attitude of participants toward the prevention of hepatitis B infection. The participants had relatively good attitude (71%-96.3%) toward preventive aspects of hepatitis B infection. [Table 3] shows the participant's self-reported practice regarding hepatitis B vaccination. Only 52.9% of participants had completed hepatitis B vaccination at the time of study and only 4% of those who had completed vaccination tested for antibodies titre. Lack of information (46.3%) was the main reason stated by the participants for not taking vaccination. Few (24.4%) were of the opinion that there is no need for vaccination. Few students (12.2%) had not taken vaccine because of fear of injection.

Table 1: Medical student's term wise correct response for knowledge items

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Table 2: Medical student's attitudes toward prevention of hepatitis B infection

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Table 3: Practice regarding hepatitis B vaccination among medical students

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Discussion

Hepatitis B infection is a potentially life-threatening occupational hazard for health-care workers, especially medical students.^[6] Assessment of student's KAP is an important step to assess to what extent the student is in a position to adopt a disease risk-free behaviour for this deadly disease.^[8]

In the present study, students had good knowledge toward the transmission of HBV [Table 1]. These findings are in line with studies by Alhowaish et al.,^[9] Abdela et al.^[10] and Singh et al.^[11] However, Paul et al.^[12] found poor knowledge about transmission in their study. Surprisingly, in the present study, 44.7% of students were of the opinion that HBV can be transmitted by ingestion of contaminated food and water. This may be due to the confusion between Hepatitis A virus which is more prevalent. In the present study, only 28.5% agreed that vaccine is used for PEP. Similar results were noted in the study by Al-Hazmi et al.^[13] Conversely, Ray et al. had reported higher knowledge toward PEP (94.6%) in their study.^[14] There is a gap in knowledge about PEP noted in the present study. This issue needs to be clarified to students otherwise may affect their decision regarding PEP following accidental needle stick injury during their professional training.

Thirty-seven percent of participants stated that medical students should be vaccinated at the time of admission to MBBS course. By the time, they are posted to clinical postings in phase II, majority would have completed vaccination and will have protection. Poor correct response rate was observed among participants belong to II term and IV term [Table 1] and [Table 2]. This may be due to the fact that, medical curriculum did not include chapters on communicable diseases in the 1^st year and virology portions are dealt in fifth term. This problem can be solved to some extent with the new competency-based medical education which includes foundation course and early clinical exposure in the 1^st year of the course. Overall favourable attitude toward preventive aspects of HBV infection was noted in the present study [Table 2]. Variations noted in other studies may be due to differences in study population.^{[8],[10],[15],[16],[17]}

Hepatitis B vaccination for health-care workers is a key component of the World Health Organization-Hepatitis B Elimination strategy 2016-2021.^[18] In the present study, 52.9% had received three doses of vaccine. Majority of the students were not tested for antibody titres to HBV surface antigen post-vaccination [Table 3]. Higher vaccination rate and antibody titre estimation were observed in the study by Ghomraoui et al.^[3] Lower rates were observed in other study.^[19] [Table 4] shows the vaccination details of the participants in various studies. The variations observed in the vaccination rates in different studies may be due to the differences in the Institutional policies toward vaccination of medical students. It is imperative for each and every medical student to receive complete vaccination as well as to check for antibody titres because of possibility of non-response to the first series of vaccination.^[12] Majority of students stated lack of information as the main reason for not taking vaccination (46.3%) similar to other studies.^[1],[12] Other reasons given by students in various studies were non-accessibility in the region and lack of motivation.^{[1],[9],[4],[20]}

Table 4: Vaccination rates and compliance observed in various studies

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Limitation

Recall bias is the limitation in the present study as the data were obtained by questionnaire and health records of the students regarding vaccination status were not available.

Conclusion

A gap noted in knowledge and practice of students in the present study can be addressed by imparting orientation about HBV infection and its prevention in the 1^st year of admission so that they can, not only protect themselves but also play a vital role in creating awareness among other health-care workers. Mandatory HBV vaccination should be implemented to vaccinate all medical students upon entry into medical colleges. Vaccinated students should be checked for seroconversion. Non-responders if any should be dealt according to the guidelines.

Acknowledgement

We thank the participants and teaching faculty of the institution for their co-operation during data collection and our sincere thanks to Dr. Raghavendra S K, Assistant professor of Community medicine for the statistical help.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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