|Year : 2015 | Volume
| Issue : 2 | Page : 415-419
Knowledge and attitudes regarding hepatitis viruses among secondary-school students in Menoufia governorate
Mohmoud Abo Salem1, Howaida Al Shazaly1, Aml Salama2, Asherf Abdo Ahmed Elseidy BSc 2
1 Department of Community Medicine, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
2 Department of Family Medicine, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
|Date of Submission||10-May-2014|
|Date of Acceptance||16-Oct-2014|
|Date of Web Publication||31-Aug-2015|
Asherf Abdo Ahmed Elseidy
Desouk, Kafr El-Sheikh
Source of Support: None, Conflict of Interest: None
The main objective of the study is to evaluate the knowledge, attitudes, and practices (KAP) of adolescents regarding viral hepatitis B and C.
Viral hepatitis is a silent epidemic, as it is a leading infectious cause of death, and affects the lives of 12 000-15 000 Americans each year. Adolescents are thought to be at risk because of their high-risk behaviors. They must improve their awareness about these infections to protect themselves.
Participants and methods
This is a cross-sectional study based on the multistage stratified random-sampling technique. Ashmoun district was selected randomly from nine districts of Menoufia governorate; one rural school (Shanshour school) and one urban school (Amin El Kholy school) were selected from Ashmoun district, and 640 students aged between 16 and 18 years were selected randomly from students attending both schools. Students were asked to fill a predesigned questionnaire regarding their KAP towards hepatitis A, B, C, and D infection including their KAP for prevention and control.
The mean age of the participants was 17.25 ± 0.84 years (mean±SD). A total of 180 participants were male (30%) and 420 (70%) were female. The mean of the total score of students' KAP with regard to viral hepatitis were 58.11 ± 9.3, 13.07 ± 2.86, and 7.99 ± 2.84, respectively. Although 78 and 75% of the students had fair knowledge and attitude, respectively regarding viral hepatitis, only 31% had fair practice for self-protection. The sex, the socioeconomic status, and the source of knowledge constituted significant determinants of their knowledge.
There was no relation between students' knowledge and attitude regarding viral hepatitis and their practice for self-protection against it.
Keywords: adolescents, attitude, hepatitis virus knowledge
|How to cite this article:|
Salem MA, Shazaly HA, Salama A, Elseidy AA. Knowledge and attitudes regarding hepatitis viruses among secondary-school students in Menoufia governorate. Menoufia Med J 2015;28:415-9
|How to cite this URL:|
Salem MA, Shazaly HA, Salama A, Elseidy AA. Knowledge and attitudes regarding hepatitis viruses among secondary-school students in Menoufia governorate. Menoufia Med J [serial online] 2015 [cited 2021 Mar 3];28:415-9. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/415/163894
| Introduction|| |
Epidemics of blood-borne pathogens have plagued the entire developing world. Such diseases impose heavy burdens on national economies and individual families due to costs arising from acute and chronic morbidity and mortality. Globally, two billion people are infected with the hepatitis B virus (HBV), of whom more than 350 million have chronic infections  . Important factors contributing to HBV and hepatitis C virus (HCV) spread include unsafe use of therapeutic injections, blood transfusion  , shaving by barbers, tattooing  , mother-to-child transmission  , and unsafe sexual practices  . Razor sharing during shaving by barbers has been identified as a key risk factor for HBV spread in Italy  and for HCV among psychiatric patients in Japan  , Egypt  , and Pakistan  . HBV is present in high concentrations in the blood, the serum, serous exudates, the saliva, the semen, the vaginal fluid, and most body fluids  . Mass media is now frequently used for health education as it is largely influential and accessible, and plays an important role in changing attitudes and behavior of the people. It has been observed that young people perceive commercials and media as the most reliable sources of health information  . Low levels of awareness and knowledge about HCV have been identified as a formidable challenge to prevention and care  . Knowledge about HCV is also limited in the general public. In the 2010 health styles, a consumer marketing survey of 4071 participants, 41% of the respondents disagreed with the statement 'I am knowledgeable about viral hepatitis' and an additional 30% had a neutral opinion  . Many participants assumed that they were tested for hepatitis when blood tests were performed as part of their routine physical examinations. In addition, some focus group participants believed that they would have symptoms if they were infected, and others concluded that the virus could not be detected in their blood if they were asymptomatically infected.
| Participants and methods|| |
This is a cross-sectional study. Ashmoun district was selected randomly from nine districts of Menoufia governorate; one rural school (Shanshour school) and one urban school (Amin El Kholy school) were selected, and 640 students aged between 16 and 18 years were selected randomly from students attending both schools. The study was conducted during the period from the beginning of December 2012 to the end of June 2013. Informed consent was signed by all participants after simple and clear explanation of the research objectives and procedures. Students were asked to fill a predesigned questionnaire regarding their knowledge, attitudes, and practices (KAP) towards hepatitis A, B, C, and D infection and their self-protection and immunizations. Only 600 completed questionnaires were returned (response rate = 93%) as some students refused to participate as they were not interested. The questionnaires were administered to all students in the selected classes of the school, with items being read out verbally to students by the researcher. Questions were explained in an easy language to be understood by the students, and the researcher was sure that they understood each of the questions.
Data collected from students included the following: age, sex, residence, the level of education of the father and the mother, income, job of the father and the mother, the average monthly household income, and the number of individuals per room. The socioeconomic status and the source of their knowledge were also assessed. The socioeconomic standard was assessed through the father's education, occupation, income, and the number of individuals per room. According to Ibrahim and Abdel-Ghaffar  , the total score of their KAP about viral hepatitis A, B, and C transmission and immunization against them was calculated by the summation of the scores of KAP questions. Questions that assessed the knowledge (34 questions) included whether hepatitis B is an infectious disease, and whether HBV is transmitted through blood transfusion, using an unsterilized syringe for injection, using blades of barbers, sharing of tooth brush, tattooing, ear or nose piercing, or through polluted water or food. Each question was answered by Yes, No, or I don't know. The right answers were given a score of 2, wrong answers were given a score of 0, and I don't know responses were given a score of 1; summation of scores was performed to assess the knowledge and the practice with regard to viral hepatitis (a total score of 68): score greater than 75% was considered as a good score, score 50-75 fair, and score less than 50% a poor score.
Scores for their attitude (in case of self-infection with viral hepatitis, self-protection, and immunization against infection) was calculated by the summation of scores of the following questions on attitude (21 questions): If you are found positive for hepatitis B or C, would you like to have further treatment or tell your dentist when you visit him/her? Have you ever thought of going in for hepatitis B screening? If you are asked to be investigated for hepatitis B, would you agree. The attitude, in case of contact infection, was assessed through the following questions: If your friend is infected with viral hepatitis, would you eat with him or her, shake hands with him or her, kiss him or her, stop visiting him/her, avoid sitting near him/her. The attitude score was identified as follows: score greater than 75%, a positive attitude; score less than 50%, a negative attitude. Data were analyzed by the statistical package of social science program, version 20 using a personal computer.
| Results|| |
Regarding the demographic characteristics of the studied group, the present study showed that of the total of 600 respondents, 284 (47.3) were from rural areas and 316 (52.7%) were from urban areas. Regarding the sex of the students, 180 (30%) were male and 420 (70%) were female [Table 1]. The mean age of the participants was 17.25 ± 0.84 years (mean ± SD) [Table 1]. The mean of the total score of students' KAP with regard to viral hepatitis were 58.11 ± 9.3, 13.07 ± 2.86, and 7.99 ± 2.84, respectively [Table 2]. Although 78 and 75% of the students had fair knowledge and attitude, respectively, regarding viral hepatitis, only 31% had fair practices for self-protection and vaccination [Table 2]. Age, sex, the socioeconomic status, and the source of knowledge constituted significant determinants of students' knowledge. The residence (urban or rural) and the presence of a relative with viral hepatitis constituted nonsignificant determinants of students' knowledge [Table 3], [Table 4], [Table 5].
|Table 3 Knowledge, attitudes, and practices regarding viral hepatitis among secondary-school students|
Click here to view
|Table 4 Determinants of students' knowledge about viral hepatitis in the studied group|
Click here to view
|Table 5 Determinants of students' attitude about viral hepatitis in the studied group|
Click here to view
| Discussion|| |
This cross-sectional study represents data on the KAP regarding hepatitis viruses among secondary-school students. Of the total of 600 respondents, 284 (47.3) were from rural areas and 316 (52.7%) were from urban areas. Regarding the sex of the students, there were 180 (30%) male and 420 (70%) female participants. In a study conducted by Batholomew  to assess KAP concerning hepatitis B among adolescents in the upper west region of Ghana, the rural-urban gradient, the overall response rate was 408 (100%): 204 (50%) were from rural areas and 204 (50%) were from urban areas, and there were 214 (52%) male and 194 (48%) female participants. Although 78 and 75% of the students had fair knowledge and attitude, respectively, regarding viral hepatitis, only 31% had fair practices for self-protection and vaccination. The low score for students' knowledge about HBV transmission modes (32%) indicated poor knowledge: 42% of them knew about the availability of the vaccine, the same percent of students knew that HBV may cause liver cancer. The lack of knowledge about viral hepatitis may be due to deficient covering of this important topic in schools, either informally in different school activities, such as health clubs or regular health news, besides health education programs, or formally in the form of the school curriculum  . The fair knowledge was slightly higher when compared with the study conducted by Badr et al.  : in their study of 643 secondary-school students in Alexandria, the study revealed that 55.2% of the study sample had a fair level of knowledge about hepatitis B. The lack of knowledge of hepatitis B in this study is consistent with similar studies conducted on Asian populations in North America, including Vietnamese, Cambodian, Korean, and Chinese communities ,,,,,,,,, . The present study showed that 252 (42%) students knew that a vaccine for HBV is available . In a study conducted by Batholomew  about KAP concerning hepatitis B among adolescents in the upper west region of Ghana, 242 (59%) participants knew about the availability of the vaccine for HBV. This percentage of true knowledge about the availability of the vaccine (42%) was high compared with another study conducted by Lohouès-Kouacou et al.  in Côte-d'Ivoire, who show that only 35.7% of the students knew that an effective vaccine was available. Similarly, in Côte-d'Ivoire, Lohouès-Kouacou et al.  reported that mass media (62%) was the main source of information, followed by knowledge from school (12%). The present study showed that 234 (39%) of the students knew that hepatitis B was transmitted by tattooing and ear and nose piercing. This finding is in agreement with Lohouèès-Kouacou et al.  in Côôte-d'Ivoire, who showed that 29, 40, and 41% of the students, respectively, were aware that acupuncture, body piercing, and tattooing are high-risk practices, and it is also in agreement with Batholomew  in the upper west region of Ghana, who showed that 220 (53.9) of the adolescents in their study knew that hepatitis B was transmitted by tattooing and ear and nose piercing. The current study showed that nearly half of the students (300, 50%) knew that hepatitis B is caused by a virus, whereas 253 (62%) of the adolescents were aware of HBV being a viral disease in the study by Batholomew  in the upper west region of Ghana. It was encouraging to find that 82% of the adolescent participants in the study by Sotiroski  were aware that hepatitis C is transmissible through injecting drug use, whereas 51% were not aware or were not sure that receiving a tattoo poses a hepatitis C transmission risk; 40% identified hepatitis C as a sexually transmitted disease rather than a blood-borne virus. The present study showed that students were more knowledgeable about reused blades of barbers and HBV transmission 330 (55%) compared with adolescents in the study by Batholomew  in the upper west region of Ghana (206, 50%); similarly, 30% of the Chinese healthcare workers did not have knowledge that vaccination and avoiding needle reuse are two potent means for the prevention of HBV in the study by Chao et al.  .
| Conclusion|| |
The level of awareness among secondary-school students about hepatitis and the risks of transmission is low. Messages about hepatitis need to be incorporated in media campaigns, in addition to regulation of practices. Knowledge and awareness regarding the causative agent, the mode of transmission, and the consequences of hepatitis B and C are poor in rural communities.
| Acknowledgements|| |
Conflicts of interest
There are no conflicts of interest.
| References|| |
Taylor VM, Yasui Y, Burke N, Nguyen T, Chen A, Acorda E, et al.
Hepatitis B testing among Vietnamese American men. Cancer Detect Prev 2004; 28
Francisci D, Antonelli S, Preziosi R, Mecozzi F, Stagni G, Pauluzzi S. Risk factors for acute parenterally transmitted viral hepatitis: a 20-year study. Eur J Epidemiol 1993; 9
Haley RW, Fischer RP. Commercial tattooing as a potentially important source of hepatitis C infection. Clinical epidemiology of 626 consecutive patients unaware of their hepatitis C serologic status. Medicine (Baltimore) 2001; 80
Gibb DM, Goodall RL, Dunn DT, Healy M, Neave P, Cafferkey M, Butler K. Mother-to-child transmission of hepatitis C virus: evidence for preventable peripartum transmission. Lancet 2000; 356
Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med 2001; 345
Mele A, Corona R, Tosti ME, Palumbo F, Moiraghi A, Novaco F, et al.
Beauty treatments and risk of parenterally transmitted hepatitis: results from the hepatitis surveillance system in Italy. Scand J Infect Dis 1995; 27
Sawayama Y, Hayashi J, Kakuda K, Furusyo N, Ariyama I, Kawakami Y, et al.
. Hepatitis C virus infection in institutionalized psychiatric patients: possible role of transmission by razor sharing. Dig Dis Sci 2000; 45
Habib M, Mohamed MK, Abdel-Aziz F, Magder LS, Abdel-Hamid M, Gamil F, et al.
. Hepatitis C virus infection in a community in the Nile Delta: risk factors for seropositivity. Hepatology 2001; 33
Bari A, Akhtar S, Rahbar MH, Luby SP. Risk factors for hepatitis C virus infection in male adults in Rawalpindi-Islamabad, Pakistan. Trop Med Int Health 2001; 6
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
Colvin HM. Hepatitis and liver cancer: a national strategy for prevention and control of hepatitis B and C. Washington, DC: Committee on the Prevention and Control of Viral Hepatitis Infections; 2010. 21
DHHS. Combating the silent epidemic of viral hepatitis: action plan for the prevention, care and treatment of viral hepatitis. Washington, DC: DHHS, 2011.
Ibrahim M, Abdel-Ghafar A. Sackellares JC, Berent S, eds. Estimation of the social and economic state of the family. Psychological disturbance in epilepsy. Boston: Butterworth-Heinemann 2008; 125
Batholomew C. KAP concerning hepatitis B among adolescents in the upper west region of Ghana [dissertation]; Umeå University, Sweden; 2011.
Mkandawire P1, Richmond C, Dixon J, Luginaah IN, Tobias J. Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention. Health Place 2013; 23
Badr HH, Mounir GM, Mahdy NH. Measurement of KAP concerning hepatitis B among secondary school students in Alexandria. J Egypt Public Health Assoc 1999; 74
Taylor VM, Jackson JC, Pineda M, Pham P, Fischer M, Yasui Y. Hepatitis B knowledge among Vietnamese immigrants: implications for prevention of hepatocellular carcinoma. J Cancer Educ 2000; 15
Taylor VM, Jackson JC, Chan N, Kuniyuki A, Yasui Y. Hepatitis B knowledge and practices among Cambodian American women in Seattle, Washington. J Community Health 2002; 27
Taylor VM, Choe JH, Yasui Y, Li L, Burke N, Jackson JC. Hepatitis B awareness, testing, and knowledge among Vietnamese American men and women. J Community Health 2005; 30
Taylor VM, Yasui Y, Burke N, Nguyen T, Chen A, Acorda E, et al.
. Hepatitis B testing among Vietnamese American men. Cancer Detect Prev 2004; 28
Taylor VM, Yasui Y, Burke N, Choe JH, Acorda E, Jackson JC. Hepatitis B knowledge and testing among Vietnamese-American women. Ethn Dis 2005; 15
Taylor VM, Tu SP, Woodall E, Acorda E, Chen H, Choe J, et al.
Hepatitis B knowledge and practices among Chinese immigrants to the United States. Asian Pac J Cancer Prev 2006; 7
Choe JH, Taylor VM, Yasui Y, Burke N, Nguyen T, Acorda E, Jackson JC. Health care access and sociodemographic factors associated with hepatitis B testing in Vietnamese American men. J Immigr Minor Health 2006; 8
Thompson MJ, Taylor VM, Jackson JC, Yasui Y, Kuniyuki A, Tu SP, Hislop TG. Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington. J Cancer Educ 2002; 17
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; 19
Chen H, Tu SP, Teh CZ, Yip MP, Choe JH, Hislop TG, et al.
. Lay beliefs about hepatitis among North American Chinese: implications for hepatitis prevention. J Community Health 2006; 31
Lohouès-Kouacou MJ, Assi C, Ouattara A, Bonao SG, Kone S, Soro D, et al.
Hepatitis B knowledge among secondary school students in Côte-d'Ivoire. Sante Publique 2013; 21
Sotiroski M. Predictors of adolescents attitudes towards hepatitis C [internet]
. National Academy Press; 2012. 2. Available at: http://ro.ecu.edu.au/spsyc
[Last accessed on 2014 Jun 1].
Chao J, Chang ET, So SK. Hepatitis B and liver cancer knowledge and practices among healthcare and public health professionals in China: a cross-sectional study. BMC Public Health 2010; 1:98.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]