Hepatitis B is a life-threatening liver infection caused by the hepatitis B virus (HBV). The virus is transmitted through contact with blood or other body fluids of an infected person, sharing sharp objects like needles, razor blade. HBV infection is a major global health problem. It can cause acute and chronic infection and put people at high risk of death from liver cirrhosis and liver cancer (WHO, 2017). An estimated 257 million people are living with hepatitis B virus infection who are defined as hepatitis B surface antigen positive. In 2015, hepatitis B resulted in 887 000 deaths, mostly from complications including cirrhosis and hepatocellular carcinoma and there are over 350 million carriers (Al-Hazmi, 2015; WHO, 2017).
Hepatitis B prevalence is highest in the WHO Western Pacific Region and the WHO African Region, where 6.2% and 6.1% respectively of the adult population is infected. In the WHO Eastern Mediterranean Region, the WHO South-East Asia Region and the WHO European Region, an estimated 3.3%, 2.0% and 1.6%% of the general population is infected, respectively. Also 0.7% of the population of the WHO Region of the Americas is infected (WHO, 2017). The risk of Hepatitis BVirus transmission in health-care workers is highest in a setting of high seroprevalence of the virus within a population, such as sub-Saharan Africa, where the overall prevalence of hepatitis B surface antigen in blood is > 8% (Debes, Kayandabila, & Pogemiller, 2016).
Health care workers are at high risk of HBV infection in the health care settings. The prevalence rate of Hepatitis BVirus in Health Care Workers is about 2–10 times higher than the general populations in the world. In HealthCare Workers, the risk factors for Hepatitis BVirus infection are percutaneous or mucosal exposure to infected blood or body fluids, using inadequately sterilized medical equipment or contact with non-intact skin. The average risk for acquiring Hepatitis BVirus infection for Health Care Workers after percutaneous exposure to infected blood has been estimated to be 6–30 %; whereas it is about 0.3 % for human immunodeficiency virus. This shows that Hepatitis B Virus is easily transmitted from one person to another rather than Human Immunodeficiency Virus. (Abdela, Woldu, Haile, Mathewos, & Deressa, 2016).
Routine screening for Hepatitis BVirus infection is important and would yield benefits for most people, including clinical assessment, appropriate treatment for adult infection, and implementation of measures to reduce vertical and horizontal transmissions. Ongoing evaluation of the risks and benefits of the timing of the first Hepatitis BVirus vaccine dose is required for people at risk such as people who frequently require blood or blood products, dialysis patients, recipients of solid organ transplantations, Children and infants, persons who inject drugs, household and sexual contacts of people with chronic Hepatitis BVirus infection, people with multiple sexual partners, healthcare workers and others who may be exposed to blood and blood products through their work; and travelers who have not completed their hepatitis B vaccination series, who should be offered the vaccine before leaving for endemic areas and others would further reduce trans-mission events of Hepatitis B Virus.(Jooste et al., 2016; WHO, 2017).
Hepatitis B vaccine is the major way of hepatitis B prevention. It is recommended that all infants and people at riskshould receive the hepatitis B vaccine as soon as possible, after birth preferably within 24 hours (WHO, 2017) but in Tanzania, the vaccine is being offered during the 4th, 8th, and 12th weeks after delivery(Kilonzo, Gunda, Mpondo, Bakshi, & Jaka, 2018) and after screening the person with no Hepatitis BVirus infection respectively. The low incidence of chronic Hepatitis BVirus infection in children under 5 years of age at present can be attributed to the widespread use of hepatitis B vaccine. Worldwide, in 2015, the estimated prevalence of Hepatitis BVirus infection in this age group was about 1.3%, compared with about 4.7% in the pre-vaccination era. The complete vaccine series induces protective antibody levels in more than 95% of infants, children and young adults. Protection lasts at least 20 years and is probably lifelong. Thus, it is not recommended to have booster vaccination for persons who have completed the 3 dose vaccination schedule (WHO, 2017).
Hepatitis BVirus infection is believed to be common in Tanzania where its appropriate diagnosis and conventional management are uncertain. Many review summarizedthe recent information in epidemiology of the disease and the pertaining challenges in its treatment and prevention in the country(Kilonzo et al., 2018).The global health sector strategy on viral hepatitis prevention involves: prevention of mother to child transmission in which provide Hepatitis BVirus infection screening with subsequent treatment of pregnant women diagnosed to have Hepatitis BVirus infection, safe delivery practice, screening of blood donor before donating blood. It is emphasized that health care workers should follow guidelines on Infection Prevention and Control(IPC) in which extensive instructions on proper hand washing, surgical hand preparations, use of gloves, injection safety, safe cleaning of equipment, and sharps disposal have been provided(Kilonzo et al., 2018).
It is reported that many health care workers including medical, nursing and paramedical students in Tanzania have little knowledge and they are unaware of the Hepatitis BVirus vaccine also most of preventive measure of Hepatitis BVirus infection a not in place in the country (Kilonzo et al., 2018), this highlight a gap of knowledge on Hepatitis BVirus infection and prevention for students who in one way contribute the health care team with no priority of giving them a chance to be vaccinated against Hepatitis BVirus infection. Therefore, this study will assess the knowledge on Hepatitis BVirus infection and prevention among undergraduate students, as the future of health care workers.
1.1. Problem statement.
Globally, an estimated 257 million people are living with hepatitis B virus infection being defined as hepatitis B surface antigen positive. In 2015, hepatitis B resulted in 887 000 deaths of people, mostly from complications including cirrhosis and hepatocellular carcinoma and there are over 350 million carriers of hepatitis B virus (Al-Hazmi, 2015; WHO, 2017). Mortality and morbidity is closely linked with the nature of the disease, lack of early screening, prevention measures and lack of information about the disease. These are among the factors that contribute to increase in morbidity and mortality of people.
Hepatitis B Virus infection is common among Tanzania Health Care Workers. The prevalence of Hepatitis BVirus infection in Health Care Workers will be at least as high as in the general population, about 30%of Health Care Workers remain susceptible to Hepatitis BVirus infection. Non-immune Health Care workers have a risk of contracting an infection at the time of work. Therefore, there must be national recommendation or vaccination program against Hepatitis BVirus infection for Health Care Workers and other people with reduced cost or no cost at all.So they would benefit from effective prevention and from vaccination against Hepatitis BVirus infection(Mueller et al., 2015).
The prevalence of acute and chronic Hepatitis BVirus infection among blood donor or adult keep increasing with an estimation of 8.8% and 6% respectively. This highlight the need of every blood donor undergoing screening before donating blood to the recipient. Furthermore, for adult increasing in prevalence indicate a need of conducting community education basing on early screening and how to prevent them from getting the infection. This education on prevention still a bit challenge at community level as well as at national level.(Mueller et al., 2015).Tanzania is regarded to be a higher-endemic country. A sero-prevalence of HBV infection in the country was reported to be 6% in the general population of Dar es Salaam (Kilonzo et al., 2018). This rate has increased from older studies that reportedtheprevalence of 4.4% inthesame population.
Hepatitis BVirus infection prevention,control and elimination is a challenge process due to the nature of the infection, mode of transmission, difficult in diagnosing its symptoms, treatment and prevention of the infection for both Health Care Workers and the community members. Also the vaccine is expensive, people have low knowledge regarding the disease and its prevention measures. Furthermore, Poverty of the country and their people also increase the challenge of combating the infection(Debes et al., 2016). The government should try to arrange a budget for the programmes of fighting against Hepatitis B Virus infection.
Students in medical, nursing and other courses in health universities are the future Health Care Workers. They do routine health services in different Hospital at their respectively area as a part of their clinical practice. There is a need of these students to get education about Hepatitis BVirus infection, be vaccinated and get elaboration on other prevention measures(Al-Hazmi, 2015). In Tanzania there is little research to assess students’ knowledge on HBV infection and prevention which has been done, hence many students in Tanzania remain unknowledgeable on Hepatitis B infection. Also there is no research on prevalence of student’s vaccination status which has been done in Tanzania.
Despite the World Health Organization preventive barriers guideline recommendations against Hepatitis B Virus infection to be in place(WHO, 2017) but in Tanzania these preventive measures and recommendations are not in standard operation protocol in different hospitals,so this put in danger on contracting the infection most of health care workers and students who go for clinical practice(Debes et al., 2016). Health care workers fatigue and been overloaded by patients also keep them in high risk of unawareness of those preventive measure standard, hence they are susceptible to infection.
1.2.1. Broad objectives.
To assess knowledge on hepatitis B infection and prevention among undergraduate students at MUHAS from November 2018 to March 2019.
1. To assess knowledge on hepatitis B infection among undergraduate students at MUHAS from November 2018 to March 2019.
2. To assess Knowledge on prevention of Hepatitis B infection among undergraduate students at MUHAS from November 2018 to March 2019.
1.3. Research questions.
1. What is the level of knowledgeon Hepatitis B infection among undergraduate students at MUHAS?
2. What is the level of knowledge on prevention of Hepatitis B infection among undergraduate students at MUHAS?
1.4. Research Variables.
Independent variable; knowledge on prevention.
Dependent variables; Hepatitis B infection.
1.5. Research Hypothesis.
Undergraduate students who have knowledge on hepatitis B infection are more likely to have high knowledge on prevention of hepatitis B infection than those who have no knowledge.
1.6. Conceptual framework.
A set of concepts with propositions that describe them and express their relationships. The conceptual framework of this study will describe knowledge on Hepatitis B infection and prevention of Hepatitis B infection concepts. This conceptual framework has been constructed with reference to different literature explaining the relationship of HBV infection with its preventive measures, so that people are safe from the Hepatitis B infection in the provision of health care services and community activities.(Abdela et al., 2016).
Figure 1: Showing the relationship between knowledge on Hepatitis B infection and the preventive measure toward the safety of the population against HBV infection.
2.O. Literature review.
Infection with the hepatitis B virus (HBV) represents a major cause of morbidity and mortality worldwide, with an estimated 350 million people infected, of which the great majority reside in Asia and sub-Saharan Africa(Debes et al., 2016). The high number of people who are infected with Hepatitis B infection reflect that many people lack knowledge on Hepatitis B infection and prevention. The factors that lead people toget infection includes negligence on the use of protective gear example condom, glove and lack of knowledge on avoiding sharing sharp instruments. This section will involve review of different studies which have been conducted on knowledge on Hepatitis B infection and preventive measure against Hepatitis B infection.
2.1. Knowledge on Hepatitis B infection.
A study done in Tanzania by Debes, Kayandabila, & Pogemiller in 2016 shows that most people are unaware of their Hepatitis BV status and also highlight that people lack knowledge on vaccine as a preventive measure against the disease. The study also shows that about 60% of people know the transmission route like blood, intercourse or mother to child transmission as the only routes of transmission. The study shows that Hepatitis BVirus infection is vaccine preventable and more effort should be devoted to improve awareness of Hepatitis BVirus infection complications and the availability of vaccine.
Most study show that there are many risk factors of Hepatitis BVirus infection. In study done in Ethiopia on show that, the higher risk of Hepatitis BVirus infection among Health Care Workers in developing countries could be attributed to the prevailing careless handling of contaminated objects, reuses of inadequately sterilized medical equipment, and an improper waste disposal system(Abdela et al., 2016). Also the study highlight that the risk for accidental exposure among the Health Care Workers could be higher due to their lack of experience, insufficient training, duty overload, and fatigue.
In 2015 a study done in India by Paul and Arumugam show that 52.4% of students had not heard of the other types of hepatitis and 66% did not know the hepatitis infection. Also the study revealed that student had more knowledge on prevention than other aspect of hepatitis such as mode of transmission, symptoms and complication. The study also revealed that the level of knowledge is very basic in the study of student population and therefore, it should be a first priority to create more knowledge on various aspect of Hepatitis BVirusinfection, prevention, and its outcome among medical and paramedical students who are going to be the future workers in health care services delivery.
2.2. Knowledge on prevention of HBV infection.
Most studies have indicated that there is a clear gap of knowledge among trainees of health profession towards the risks of occupational exposure to Hepatitis BVirus infection. A study done in Ethiopia (Abdela et al., 2016) shows that Hepatitis B virus infection can be prevented by adhering to universal precautions including the use of protective barriers like gloves, proper sterilization of medical equipment, proper hospital wastes management system and vaccination. Moreover, post-exposure prophylaxis can be used as a means of Hepatitis BVirus prevention after accidental exposure to contaminated blood or body fluids.
A study done in Saudi Arabia show that 90% of students believed that through following infection, prevention, andcontrol guidelines such as wearing protective barriers like gloves, use of condom during sexual intercourse, avoid contact with contaminated blood and body fluids, avoid sharing sharp instruments like needles, razor blade and vaccination: would protect them and other health care workers from being infected by Hepatitis BVirus infection at work (Alshammari, Alshamari, Alshammari, & Kareem, 2017).
In 2018 a study done in Tanzania by Kilonzo, Gunda, Mpondo, Bakshi, & Jaka in 2018 show that the government of Tanzania had made an effort to prevent and control Hepatitis B infection by taking appropriate measures to address the problem. The government has already been announced that Hepatitis BVirus vaccine will be freely offered to high risk group including health care worker from 2018 (Kilonzo et al., 2018), but others people will be getting the vaccination service for affordable cost.
The government also use the WHO recommendation toward eliminating Hepatitis by 2030. The high level national committee for hepatitis elimination program has already been formed in the country and currently the government is setting up the national elimination targets and the strategic plans.The subsequent step will be the dedication of funds for the universal access for treatment. In recognition of these efforts, the country has been recently attributed by WHO to be among the countries that are significantly advancing in the efforts to eliminate viral hepatitis(Kilonzo et al., 2018).
Abdela, A., Woldu, B., Haile, K., Mathewos, B., & Deressa, T. (2016). Assessment of knowledge, attitudes and practices toward prevention of hepatitis B virus infection among students of medicine and health sciences in Northwest Ethiopia. BMC research notes, 9(1), 410.
Al-Hazmi, A. H. (2015). Knowledge, attitudes, and practice of medical students regarding occupational risks of hepatitis B virus in college of medicine, Aljouf University. Annals of medical and health sciences research, 5(1), 13-19.
Alshammari, M. S., Alshamari, N. G., Alshammari, A. S., & Kareem, M. (2017). Knowledge, attitudes and practices toward prevention of hepatitis B virus infection among medical students at Northern Border University, Arar, Kingdom of Saudi Arabia. Electronic Physician, (September), 5388–5394.
Debes, J. D., Kayandabila, J., & Pogemiller, H. (2016). Knowledge of Hepatitis B Transmission Risks among Health Workers in Tanzania. The American Society of Tropical Medicine and Hygiene, 94(5), 1100–1102.
Jooste, P., van Zyl, A., Adland, E., Daniels, S., Hattingh, L., Brits, A., … Matthews, P. C. (2016). Screening, characterisation and prevention of Hepatitis B virus (HBV) co-infection in HIV-positive children in South Africa. Journal of Clinical Virology, 85, 71–74.
Kilonzo, S. B., Gunda, D. W., Mpondo, B. C. T., Bakshi, F. A., & Jaka, H. (2018). Hepatitis B Virus Infection in Tanzania?: Current Status and Challenges. Journal of Tropical Medicine, 2018.
Mueller, A., Stoetter, L., Kalluvya, S., Stich, A., Majinge, C., Weissbrich, B., & Kasang, C. (2015). Prevalence of hepatitis B virus infection among health care workers in a tertiary hospital in Tanzania. BMC Infectious Diseases, 1–9.
Paul, P., & Arumugam, B. (2015). Knowledge and awareness regarding hepatitis B infection among medical and dental students?: a comparative cross sectional study. International Journal of Research in Medical Sciences, 3(9), 2352–2356.
World Health Organization. (2017). Global hepatitis report 2017. World Health Organization.