Hepatitis B Virus Infection among Students in Iganga High School Iganga District -Eastern Uganda
Faculty of Medicine and Surgery Kampala International University, Western Campus, Uganda.
The World Health Organization (WHO) estimates that up to two billion people in the world have been infected with Hepatitis B Virus (HBV); about 350 million people live with chronic HBV infection, and about 600,000 people die from HBV- related liver disease or HCV each year. The Infection is highly endemic in Uganda with a national prevalence estimate of 10%. To the best of my knowledge, there is no data regarding the knowledge, attitude, and influence of socio-economic status on hepatitis B infection in secondary school settings in Uganda. This study aimed at assessing HBV infection knowledge, HBV vaccination attitude, and the influence of socioeconomic status on HBV vaccination among students of Iganga high school Iganga District Eastern Uganda. This study used a cross-sectional design that recruited a total of 247 secondary school students from Iganga High School randomly. The main method that was employed in selecting a sample from the population was a simple random sampling technique. Questionnaires were the main tools used for data collection and collected data was analyzed using STATA software version 14.0. Logistic regression analysis was carried out to determine the socioeconomic factors influencing the immunization status of Iganga High school students. The mean age of the study participants was 15.9 years with a standard deviation of 2.3 years from the mean. The minimum age was 12 years whereas the maximum age was 25 years. The mean knowledge score was 5.2 with a standard deviation of 2.4 from the mean, the majority of the study participants 70.04% (173/247) had a low level of knowledge on HBV infection and 29.96% (74/247) had a high level of knowledge. The majority of the study participants 68.98% (169/245) had an unfavorable attitude towards HBV vaccination meanwhile 31.02% (76/245) had a favorable attitude. The age group of 12–14 years versus the age group of 15–17 years (cOR3.07, 95%CI 1.67 – 5.62, P<0.001). Having an extra job (cOR2.81, 95%CI 1.06 – 7.45, P=0.037) and having heard about HBV (cOR2.04, 95%CI 1.07 – 3.90, P=0.029) were the socio-economic factors influencing the hepatitis B vaccination status of study participants. There was a low level of knowledge of Hepatitis B infection and an unfavorable attitude towards Hepatitis B vaccination among students of Iganga High School. The study indicates that the age of the students; having an extra job and hearing about HBV were the socio-economic factors influencing HBV vaccination among students in Iganga high school.
Keywords: HBV infection, Liver disease, HBV vaccination, Students, Immunization status.
Hepatitis B is a liver infection caused by the hepatitis B virus (HBV) that can lead to both acute and chronic liver disease. In most cases, an acute HBV infection may have nonspecific symptoms; less frequent, as in the case of fulminant hepatitis, the infection can have fatal consequences unless liver transplantation is carried out urgently. Early identification of infected persons with the help of blood tests can break the ongoing transmission and lead to necessary treatment with antiviral medication -. It is also important to enable the identification and vaccination of those who share a household with the infected person and sexual partners that might have become infected. To avoid transmission there are a few measures that HBV-positive individuals can take. For example, they should notify sexual partners and the people they share their household with to test themselves for HBV and inform them of the need for vaccination. An HBV-infected person can delay and/or prevent liver disease by limiting their alcohol consumption and by regularly seeking disease monitoring. Using alcohol in combination with HBV infection has been shown to increase the risk of hepatotoxicity -. The HBV vaccine was introduced in 1982 in the U.S. . In 2002 infant HBV vaccination was introduced in Uganda . In 2015 a universal vaccination program was introduced in the whole country, to prevent mother-to-child transmission of HBV. The birth dose is given and when the birth-dose of hepatitis B vaccine is given within the first 24 hours of birth, it prevents 80-90% of the virus transmission between mother and child . The HBV vaccine gives healthy infants, children, and adults a protective concentration of anti-HBs in 90-100% of the cases if following the vaccination schedule properly. The vaccine is typically given in a three-dose series. It is known that the protection is long-lasting, at least 10-15 years if the vaccination schedule is followed correctly , . Despite the fact that since 1982 there is a vaccine against HBV that gives 90-100% protection against infection, more than 2 billion people worldwide are estimated to have had hepatitis B virus and there are in the world today more than 350 million people living with chronic hepatitis B. The consequence of this is an estimated 500,000- 700 000 HBV-related deaths every year around the world, where the cause is primary liver cirrhosis or liver cancer . The high rate of liver-related diseases and death has increased dependence on herbal medications, especially among residents of rural communities in the management of liver disorders. Traditional medicine is an old global practice that aids the maintenance of health if adequately utilized . Consequently, there have been numerous reports of herbs with liver-protective and liver disease-preventive potentials. Some of these herbs are Pterocarpus santalinoides , Moringa oleifera , Datura stramonium , and Chromolaena odorata . The chemical components in these herbs are responsible for their various pharmacological effects , . Hepatitis B virus is transmitted differently between geographic regions and countries depending on how endemic the HBV is there. In regions where the endemicity is low, it is more common that the virus is transmitted through horizontal routes such as injecting drug use, high-risk sexual behavior, and receiving blood products. When in regions with high endemicity, for example in Uganda, HBV is primarily spread by vertical transmission early in childhood or perinatally, from mother to child at birth . The World Health Organization (WHO) estimates that up to 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- related liver disease or HCV each year . The disease has a long history in Uganda especially Northern Uganda with the highest percentage of HBV infection. In spite of the efforts made by authorities to raise knowledge about HBV and attitude towards HB vaccination, little progress is reported. There is insufficient of data from Uganda on knowledge about HBV infection, attitudes towards HBV vaccination and the influence of socio-economic status on hepatitis B virus vaccination among secondary school students. To that end, the current study sought to assess the knowledge about HBV infection; attitude towards HBV vaccination and the influence of socio-economic status on hepatitis B virus vaccination among Iganga High School Students in Iganga District Eastern Uganda.
The Knowledge Level of Students of Iganga High School about HBV Infection
The study revealed that the mean score was 5.2 with a standard deviation of 2.4 from the mean. The majority of the study participants 70.04% (173/247) had a low level of knowledge on HBV infection; meanwhile, 29.96% (74/247) had a good level of knowledge. The result of the present study is in line with the findings of a study by Vu et al.  in Australia which revealed a low level of knowledge among the study participants. Similarly, the result of the present study is in line with the result of a study done in Senegal which revealed that of the 284 students, 27% had a good level of knowledge . The result of the study is in agreement with the findings from a study done in Malaysia which showed a low level of knowledge among the study participants much as the previous study was done within the community . Conversely, the results of the present study are lower than the results of a cross-sectional study conducted in Kuwait which revealed that knowledge about the hepatitis B virus, vaccine and routes of transmission of HBV was relatively high . The difference in the study findings could have risen due to the variation in the set of questions used to assess knowledge. The findings of the present study were low compared to what was found in a study done among health science students in North Eastern Ethiopia which showed that 81.1% of the study participants had adequate knowledge of hepatitis B infection with the mean knowledge score of the study participants being 13.4(SD+1.6) . The discrepancy in the study findings could have been raised due to the fact that the study participants in the present study were secondary school students meanwhile the study participants in the previous study were health science students. The results of the current study were in disagreement with the results of a study done in Ethiopia which showed that approximately three-fourths (73.1%) of the participants had good knowledge of HBV . The reason for the disagreement in the study findings is that the above study was done among healthcare workers meanwhile the present study was done among secondary school students. There is a discrepancy between the findings of the present study when compared with the results of a study done by Abeje and Azage , which revealed that the mean knowledge score of the respondents about hepatitis B infection was 7.6 with a standard deviation of 1.27. Similarly, Almualm et al. - found that more than half (66.5%) had good knowledge about the modes of transmission of HBV infection; this is in disagreement with the finding of the present study. The reason for disagreement in the study findings could be because of the difference in the study settings.
The study by Taylor et al.  showed that 81% of the 715 participants had heard of hepatitis B and the knowledge of the infection was generally good, with about three-quarters knowing the different ways of transmission. This result is in disagreement with the findings of the present study perhaps because the previous study was done among adults in the general population whereas the present study was done among students in a secondary school. Lee et al.  carried out a study in the U.S. among Vietnamese Americans and found high levels of knowledge about HBV infection. The results of the above study were not in line with the findings of the present study, this could be because of the variation in the cut points used to demarcate between a high level of knowledge and a low level of knowledge.
The second objective of the present study was to determine the attitude of the study participants toward Hepatitis B vaccination. Results of data analysis revealed that the mean score was 5.2 with a standard deviation of 2.1 from the mean. The majority of the study participants 68.98% (169/245) had an unfavorable attitude towards HBV infection meanwhile 31.02% (76/245) had a favorable attitude. The finding of the present study is in agreement with the result of a study done in Senegal which revealed that the majority of the participants had a negative attitude toward HBV vaccination . The agreement in study findings could be because both studies were conducted in African countries. The result of the current study is low compared to the results from an Indian base study which showed that 86.5% had a positive attitude that HBV vaccination is safe and effective . Based on premises that the previous study was conducted from Asia and the present study was conducted in Africa that can explain the disagreement in the study findings. The finding from the present study is low compared to the findings from a study conducted by Mariam and Al-Mousa  which revealed that most of the respondents had a positive attitude towards HBV vaccination with around 14% having a negative attitude toward HBV vaccination because they are worried of its adverse effects . The discrepancy in the study findings could be because the above study was conducted among dentists whereas the present study was conducted among secondary school students. The results of an Ethiopian-based study revealed that the majority (94%) of HCPs believe that it is necessary for them to receive a hepatitis B vaccine. This finding is higher than the result of the present study . The difference in the study findings could have come about because the previous study was conducted among health care professionals whereas the present study was done among secondary school students. The result of the present study is lower than what was found in a study done in Kaduna state, Nigeria which revealed that 72.4% (246/340) had some level of risk perception while 27.6% (94/340) had no risk perception for HBV . The difference in the study findings could have risen due to the variation in the nature of study participants and the study settings.
The present study showed that age of the students, having an extra job and hearing about HBV had statistical influence on HBV vaccination. Age: Students who were in the age group of 12 – 14 years were 3.07 times more likely to be vaccinated compared to students who were in the age group of 15 – 17 years (cOR3.07, 95%CI 1.67 – 5.62, P<0.001). This finding is in line with the result of a study among health science students in Ethiopia , . Younger students may easily accept being vaccinated because they still don’t hold a lot of myths and false beliefs as compared to older students. Furthermore, the younger students are not so occupied with academic roles therefore they have plenty of time to go and get vaccinations meanwhile the older students are in the candidate classes and perhaps Advances level of education, as such they give priority to academics making them to have little time to go for vaccination. Having an extra job: Study participants who had an extra job were 2.81 times more likely to be vaccinated against HBV than their counterparts who had no extra job (cOR2.81, 95%CI 1.06 – 7.45, P=0.037). This finding is in agreement with what was found in a study conducted by Ayalew et al.  much as the study was done among health professionals whereas the present study was done among students. The results of the present study is also in line with the findings of a study done in Accra which showed that the odds of having worked for 16 years or more among those who had been vaccinated against hepatitis B was 3.8 times higher compared to those who had not vaccinated . Students who have extra jobs have perhaps interacted with people who have higher level of education than their or people who are more than them. Therefore, they got motivated to go for vaccinations. Hearing about Hepatitis B: Study participants who had ever heard about HBV were 2.04 times more likely to be vaccinated against HBV than those who had never heard about HBV (cOR2.04, 95%CI 1.07 – 3.90, P=0.029). The result of the present study is in agreement with the result of a study done in Bangladesh , -. Hearing about the virus is the first step in knowing about its existence and hence the need to get vaccinated against it. That explains the reason why in the present study those who had heard about the hepatitis B virus were vaccinated more than those who had not heard about it.
Findings from the study suggest that there was a low level of knowledge of Hepatitis B infection and an unfavorable attitude towards Hepatitis B vaccination among students of Iganga High School. The study indicates that age of the students; having an extra job and hearing about HBV were the socio-economic factors influencing HBV vaccination among students in Iganga high school. Therefore, is recommended that the government of Uganda through the Ministry of Health should intensively sensitize the students about the Hepatitis B virus and the need to get vaccinated as well as the dangers of failing to get vaccinated.
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CITE AS:Kasango Joet (2023). Hepatitis B Virus Infection among Students in Iganga High School Iganga District -Eastern Uganda. IDOSR JOURNAL OF SCIENTIFIC RESEARCH 8(3) 26-43. https://doi.org/10.59298/IDOSR JSR /2023/00.3.6000