|Year : 2021 | Volume
| Issue : 1 | Page : 19-23
Knowledge, attitude and practices for HBV and HCV (Hepatitis B virus and Hepatitis C virus) among the students of a central university in South Delhi (India) and strategies for prevention of disease
Anjum Ara1, Deep Inder2, Pawan Kumar3, Kafil Akhtar4
1 Department of Pathology, FOD, Jamia Millia Islamia, New Delhi, India
2 Department of Pharmacology, FOD, Jamia Millia Islamia, New Delhi, India
3 Directorate General of Health Services, Government of NCT of Delhi, New Delhi, India
4 Department of Pathology, Jawaharlalnehru Medical College, AMU, Aligarh, Uttar Pradesh, India
|Date of Submission||22-Jan-2021|
|Date of Decision||08-May-2021|
|Date of Acceptance||30-Jun-2021|
|Date of Web Publication||17-Aug-2021|
Dr. Deep Inder
Department of Pharmacology, FOD, Jamia Millia Islamia, New Delhi - 110 025
Source of Support: None, Conflict of Interest: None
Hepatitis B and C are one of the major blood-borne viral infections in India and across the globe. There is an urgent need to address this public health problem at the community level. Aims and Objectives: This study aimed to assess knowledge, attitude, and practice (KAP) about hepatitis B virus (HBV) and hepatitis C virus (HCV) among the students of a central university, thus identifying and bridging the gaps in KAP by formulating strategies at the community level. Materials and Methods: A cross-sectional study was done among 127 participants between November 2019 and December 2019. Data for KAP were collected using self-structured questionnaire after obtaining written informed consent. The data included demography, basic knowledge, modes of transmission, attitude, practices, and preventive measures to control HBV and HCV. Descriptive data were analyzed using SPSS-18 software. Results: Overall awareness level was 60% among university students. Knowledge about transmission via blood/blood related products (71%), reuse of needle or syringes (66%), ear/nose piercing/tattooing (33%), prevention through vaccination (76.4%) was found. Overall negative attitude toward the infected patient was 82% and avoidance behavior was 29%. In practice, 55% of participants had completed all doses of vaccination. Eighty-five percent participants agreed to visit a doctor following any symptoms and 70% found proactive in containment and educating the masses. Conclusion: The lacunae in KAP can be bridged by active participation, training, and education of the students of university by focused strategies based on communication and behavior change and positive motivation using public platforms and social media by university authorities from time to time.
Keywords: Attitude, hepatitis, knowledge, practice, prevention
|How to cite this article:|
Ara A, Inder D, Kumar P, Akhtar K. Knowledge, attitude and practices for HBV and HCV (Hepatitis B virus and Hepatitis C virus) among the students of a central university in South Delhi (India) and strategies for prevention of disease. J Integr Health Sci 2021;9:19-23
|How to cite this URL:|
Ara A, Inder D, Kumar P, Akhtar K. Knowledge, attitude and practices for HBV and HCV (Hepatitis B virus and Hepatitis C virus) among the students of a central university in South Delhi (India) and strategies for prevention of disease. J Integr Health Sci [serial online] 2021 [cited 2022 Aug 9];9:19-23. Available from: https://www.jihs.in/text.asp?2021/9/1/19/323951
| Introduction|| |
Viral hepatitis is a significant public health problem globally, particularly in developing countries. Hepatitis is defined as inflammation of the liver which may cause permanent liver injury or death. Among the five major types of viral hepatitis including hepatitis A, B, C, D and E, hepatitis B virus (HBV) and hepatitis C virus (HCV) need special attention as these contribute to significant morbidity and mortality. The World Health Organization has estimated that around two billion people in the world have been infected with HBV; about 350 million people live with chronic HBV infection and about 600,000 people die from HBV or HCV-related liver disease each year., The important factors responsible for the increased prevalence of HBV and HVC in developing countries may be due to reuse of unsterilized syringes, accidental needlestick injury in a hospital setting, intravenous drug addicts, unsafe practices during blood transfusion, vertical transmission to baby, unsafe sexual practices (polygamy), tattooing, etc. In developing countries like India with diverse culture, religion, and belief system, it is important to know the level of awareness among various sections of society regarding HBV and HCV. A better understanding of disease among the public through structured planning and implementation of various health awareness campaigns and policies would strengthen health-care system to control hepatitis.
Aims and objectives
- To assess knowledge, attitude, and practices (KAP) of HBV and HCV among the students of a central university in South Delhi
- To identify lacunae in KAP of HBV and HCV
- To formulate strategies at the community level for the prevention of HBV and HCV.
| Materials and Methods|| |
Design, site, and time period of study
The present study is a descriptive cross-sectional study based on responses of participants in self-structured questionnaire with the objective of exploring the KAP regarding HBV and HCV, among the students of a central university in South Delhi, India. The questionnaire got filled and collected between November 2019 and December 2019. The sample size of our study was 127 participants. The sample size was calculated using level of precision, degree of variation, and level of confidence.
A set of self-structured questionnaire was distributed among the participants pursuing engineering and polytechnic courses in the university. The questionnaire was divided into four sections, with a total of 23 questions. The first section was mainly related to demographic details. The second section incorporated close-ended questions on basic knowledge, mode of transmission, and way of prevention of HBV and HCV. The third section was focused on the attitude of participants toward infection and patients. The fourth section was centered on the practices adopted by participants in view of HBV and HCV.
The observations of the data were depicted in the form of tables, bar diagrams, and pie chart as percentages. The data collected were analyzed using the Statistical Package SSPS-18 (IBM SPSS 18 Version, Delhi, INDIA) software version.
| Observations and Results|| |
Majority of participants (59.8%) were between the age group of 17 and 22 and 69.3% were undergraduates. Out of the total participants, 62.2% of participants were male. Only 29.1% belonged to lower socioeconomic background [Table 1].
Despite having engineering and polytechnic background, on an average, 60% of students had sound knowledge about HBV and HCV. Among the total participants, 64.4% of participants were aware of the mode of transmission of HBV and HCV. Almost 54.4% of participants know the preventive aspect of HBV and HCV.
| Discussion|| |
The present questionnaire study was conducted to assess the KAP among students of the university regarding HBV and HCV. The study was based on a questionnaire filled by study participants (n = 127). Majority of respondents fell between the age group of 17 and 22 years [Table 1].
Route of transmission of HBV and HCV is mainly through blood/blood products and body fluids/secretions (semen, vaginal fluid, saliva, etc.,) of an infected person [Figure 1].
|Figure 1: Awareness level regarding the transmission of hepatitis (B and C)|
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In our study, 71% of participants agreed to mode of spread through blood, whereas 62% of participants also believed the spread through body fluids/secretions [Table 2] in contrast to participants responses as 32.2% and 44.4%, respectively, as reported by Rafiq et al. A previous study by Abbas et al. showed that 83.2% of participants were aware of sexual route of transmission for HBV and HCV with poor insight into transmission via blood/other body fluids.
|Table 2: Self- structured questionnaire used to obtain responses of participants|
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In the present study, 66% of participants identified the reuse of needle/syringes as an important mode of transmission [Table 2]. Previous studies by Rafiq et al. and Razi et al. found awareness level among participants regarding the spread of HBV and HCV through reuse of syringes as 57.2% and 82%, respectively., This is one of the important routes of transmission of HBV and HCV, and therefore, there is a need to spread continuous community awareness about the mode of transmission.
In our study, 33% of participants perceived ear/nose piercing or tattooing skin as one of the routes of transmission of HBV and HCV [Table 2] and [Figure 1]. A review of literature shows very contradictory evidences for the route of transmission of HBV and HCV through piercing and tattooing. Those already having associated risk factors along with body piercing and tattooing are prone to get infected with HBV and HCV.
An overall 61% of the participants in our study were aware of vertical transmission (mother to baby) for HBV and HCV [Figure 1] compared to 17.2% of respondents from a study conducted by Ul Haq et al. There have been 3%–10% of chances of acquiring infection through vertical transmission in early childhood, especially in endemic areas globally. Adequate screening and vaccination during the third trimester of pregnancy can help to curtail the risk of infection through vertical transmission.
In our study, 76.4% of participants had knowledge regarding the prevention of HBV and HCV through vaccination and 26.8% had a concept of a particular schedule of vaccination. Interestingly, 71.7% of participants had an idea about the earnest need of vaccination in high-risk groups and special conditions (pregnancy, children, and elderly). Approximately 50% of the participants were aware of the lifelong (more than 20 years) protection/immunity through vaccination. Overall response remained good as far as knowledge of hepatitis vaccine was concerned [Table 2]. Our study is comparable with a study carried out by Sultan et al. where a one-fourth of participants were aware of availability of vaccine and almost a quarter of participants never had knowledge regarding the extent of successful treatment of hepatitis. Many systematic studies including meta-analysis have emphasized the importance of public awareness regarding all aspects of hepatitis., Level of knowledge and awareness about hepatitis has been more among young educated individuals compared to the general public due to more exposure to information. Therefore, young educated population can be targeted to sensitize masses about hepatitis.
On an average, 82% of participants in our study showed a negative attitude toward HBV and HCV patients compared to 47.5% in the study conducted by Nazri et al. In our study, only 18.4% of participants had no issues working with infected fellow students as well as in taking care of the infected family member. Seventy-one percent of participants had fear of acquiring disease and spreading it to family members if they come in contact with an infected person compared to 70% of participants, as shown by Ahmad et al.
About 29% of the participants in our study exhibited avoidance behavior like not sharing personal belongings or room with a diagnosed infected person [Table 2]. There is a wide variation in the trend of sharing personal things as reviewed in literature. Increased trend of sharing common use personal things with friends leads to increased prevalence of HBV and HCV.,
We found 22% of participants perceiving HBV and HCV as stigma leading to negative attitude toward the infected person [Table 2]. Participants carried a thought of ruined future with no worth or life. There is a need to curtail stigma among masses and to emphasize the role of public awareness as well as psychological counseling to sensitize people to have a positive attitude toward the infected person.
More than 50% of participants believed that proper infection control methods such as complete prophylactic vaccination and screening procedures can prevent the spread of this disease even in close contact [Table 2]. Previous studies have claimed that with judicious screening and awareness campaigns including safe sex practices, a significant reduction in the risk of acquiring hepatitis can be achieved., Perhaps, such positive attitudes could be because of easy access to information through Internet, public awareness campaigns, announcements, advertisements, lectures, panel discussions, and Continuing Medical Education (CMEs) conducted by states using public media and social platforms.
Regarding the practices adopted in view of HBV and HCV, fairly good response was attained. Fifty-five percent of our participants had already completed the three doses of vaccination through various health initiatives taken up by university authorities in collaboration with government-run health schemes [Table 2]. They also mentioned that university health centers initiated various health camps in which free hepatitis vaccination was provided to the university students. These results are consistent with a study performed by Almualm et al. In their study, they showed that vaccination got by 48.5% of participants. Out of them, only 34.5% of participants completed all three doses of their vaccination schedule. There is an increasing need of sensitizing the public to complete the vaccination schedule at the very first visit and follow-up of patients should be done for subsequent visits to complete the vaccination schedule.
Strength and limitations of the study
The strength of the present study is highlighting the awareness levels regarding hepatitis among university students, having no medical background. Being a cross-sectional study and small sample size, the results cannot be generalized. There may have a subjective bias in assessing reported risk factors.
| Conclusion|| |
Based on our study findings, we found a lack of many important lacunae as far as KAPs are concerned, regarding HBV and HCV. There is an urgent need to bridge the gaps in KAP among students with no medical background. These educated young minds can play an important role in sensitizing the various strata of our Indian society. These students should get an opportunity to get updated about hepatitis through various community health programs organized in the form of lectures, symposia, conferences, radio programs, and health talks using all kinds of public platforms and social media, through university authorities from time to time. Students voluntarily spreading awareness programs on behalf of health system should be provided recognition in the form of awards and appreciation to motivate them. Such public awareness efforts are essential to reduce the burden of hepatitis at the community level.
Identifying the associated risks factors related to hepatitis, it is advisable to frame and implement various health policies to prevent and curb the spread of hepatitis at the community level. Students of university should be recognized as major stakeholders in implementation of these policies, to educate masses (peer groups and families) after formal training at state and national levels.
The authors are thankful to the participants for their co-operation and contribution to this research work.
Financial support and sponsorship
The present research work is a self-funded work.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yu S, Yu C, Li J, Liu S, Wang H, Deng M. Hepatitis B and hepatitis C prevalence among people living with HIV/AIDS in China: A systematic review and Meta-analysis. Virol J 2020;17:127.
World Health Assembly. Draft Global Health Sector Strategies. Geneva: World Health Organization; 2016.
Alter MJ. Epidemiology of hepatitis C virus infection. World J Gastroenterol 2007;13:2436-41.
Rehan HS, Manak S, Yadav M, Deepinder, Chopra D, Wardhan N. Diversity of genotype and mode of spread of hepatitis C virus in Northern India. Saudi J Gastroenterol 2011;17:241-4.
] [Full text]
Inder D, Rehan HS, Yadav M, Manak S, Kumar P. IFN-α-2a (Interferon) and ribavirin induced suicidal attempt in a patient of chronic HCV: A rare case report. Indian J Pharmacol 2011;43:210-1.
] [Full text]
Rafiq A, Fatima S, Masood B, Khan RA, Khan FA, Liaquat A, et al.
Awareness of hepatitis B and C among students of nonmedical universities in Karachi. Asian Biomedicine 2015;9:155-9.
Abbas M, Hussain MF, Raza S, Shazi L. Frequency and awareness of hepatitis B and C in visitors of hepatitis awareness mela. J Pak Med Assoc 2010;60:1069-71.
Razi A, Rehman RU, Naz S, Ghafoor F, Khan AU. Knowledge attitude and practices of university students regarding hepatitis B and C. ARPN J Agric Biol Sci 2010;5:38-43.
Messahel A, Musgrove B. Infective complications of tattooing and skin piercing. J Infect Public Health 2009;2:7-13.
Ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Aljadhey H. A cross sectional assessment of knowledge, attitude and practice towards hepatitis B among healthy population of Quetta, Pakistan. BMC Public Health 2012;12:692.
Gentile I, Zappulo E, Buonomo AR, Borgia G. Prevention of mother-to-child transmission of hepatitis B virus and hepatitis C virus. Expert Rev Anti Infect Ther 2014;12:775-82.
Sultan NY, YacoobMayet A, Alaqeel SA, Al-Omar HA. Assessing the level of knowledge and available sources of information about hepatitis C infection among HCV-infected Egyptians. BMC Public Health 2018;18:747.
Martin NK, Vickerman P, Dore GJ, Hickman M. The hepatitis C virus epidemics in key populations (including people who inject drugs, prisoners and MSM): The use of direct-acting antivirals as treatment for prevention. Curr Opin HIV AIDS 2015;10:374-80.
Pawłowska M, Sobolewska-Pilarczyk M. Recommendations for the management of prevention of vertical HBV and HCV infection. Przegl Epidemiol 2016;70:33-4, 119-20.
Nazri NN, Rahman NA, Shafri MA, Rahman NI, Haque M. Knowledge, attitude and practice of Malaysian public university students on viral hepatitis. Adv Hum Biol 2019;9:46-53.
Ahmad F, Hamzah NA, Mustaffa N, Gan SH. Anti-hepatitis A seroprevalence among chronic viral hepatitis patients in Kelantan, Malaysia. World J Gastroenterol 2011;17:4130-4.
Aslam M, Aslam J. Seroprevalence of the antibody to hepatitis C in select groups in the Punjab region of Pakistan. J Clin Gastroenterol 2001;33:407-11.
Grebely J, Robaeys G, Bruggmann P, Aghemo A, Backmund M, Bruneau J, et al
. Recommendations for the management of hepatitis C virus infection among people who inject drugs. Int J Drug Policy 2015;26:1028-38.
Socías ME, Shannon K, Montaner JS, Guillemi S, Dobrer S, Nguyen P, et al.
Gaps in the hepatitis C continuum of care among sex workers in vancouver, British Columbia: Implications for voluntary hepatitis C virus testing, treatment and care. Can J Gastroenterol Hepatol 2015;29:411-6.
Almualm YK, Banafa NS, Hanshi ASA. Knowledge, attitude and practice (KAP) about hepatitis B and C among students of Hadhramout University, Al Mukalla City, Yemen. Acta Sci Med Sci 2018; 2 :87 95.
[Table 1], [Table 2]