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ORIGINAL ARTICLE
Year : 2015  |  Volume : 28  |  Issue : 2  |  Page : 415-419

Knowledge and attitudes regarding hepatitis viruses among secondary-school students in Menoufia governorate


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 Submission10-May-2014
Date of Acceptance16-Oct-2014
Date of Web Publication31-Aug-2015

Correspondence Address:
Asherf Abdo Ahmed Elseidy
Desouk, Kafr El-Sheikh
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.163894

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  Abstract 

Objective
The main objective of the study is to evaluate the knowledge, attitudes, and practices (KAP) of adolescents regarding viral hepatitis B and C.
Background
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.
Results
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.
Conclusion
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 2020 Apr 6];28:415-9. Available from: http://www.mmj.eg.net/text.asp?2015/28/2/415/163894


  Introduction Top


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 [1] . Important factors contributing to HBV and hepatitis C virus (HCV) spread include unsafe use of therapeutic injections, blood transfusion [2] , shaving by barbers, tattooing [3] , mother-to-child transmission [4] , and unsafe sexual practices [5] . Razor sharing during shaving by barbers has been identified as a key risk factor for HBV spread in Italy [6] and for HCV among psychiatric patients in Japan [7] , Egypt [8] , and Pakistan [9] . HBV is present in high concentrations in the blood, the serum, serous exudates, the saliva, the semen, the vaginal fluid, and most body fluids [10] . 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 [10] . Low levels of awareness and knowledge about HCV have been identified as a formidable challenge to prevention and care [11] . 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 [12] . 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 Top


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 [13] , 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 Top


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 1 Demographic data of the studied group

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Table 2 Knowledge of the students regarding viral hepatitis

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Table 3 Knowledge, attitudes, and practices regarding viral hepatitis among secondary-school students

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Table 4 Determinants of students' knowledge about viral hepatitis in the studied group

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Table 5 Determinants of students' attitude about viral hepatitis in the studied group

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  Discussion Top


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 [14] 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 [15] . The fair knowledge was slightly higher when compared with the study conducted by Badr et al. [16] : 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 [17],[18],[19],[20],[21],[22],[23],[24],[25],[26] . The present study showed that 252 (42%) students knew that a vaccine for HBV is available . In a study conducted by Batholomew [14] 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. [27] 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. [27] 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. [27] 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 [14] 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 [14] in the upper west region of Ghana. It was encouraging to find that 82% of the adolescent participants in the study by Sotiroski [28] 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 [14] 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. [29] .


  Conclusion Top


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 Top


Conflicts of interest

There are no conflicts of interest.



 
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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