Abstract
Introduction
: Hepatitis is an infection of liver tissue that results in extensive liver scarring, liver failure, liver cancer, and death. An individual’s knowledge, attitudes, and prevention practices toward hepatitis B (HBV) and C (HCV) infection are vital for controlling their adverse health impacts. Our study aimed to examine the knowledge, attitudes, and prevention practices (KAPs) and associated factors among patients in the North Gondar Zone toward hepatitis B and C virus infection.
Method
A facility-based cross-sectional study was conducted from November to December 2023 among 383 randomly selected patients visiting Debark and Janamora Hospitals in the North Gondar Zone. Data on KAP related to hepatitis B and C viruses among patients were collected by interviewing participants via pretested and well-structured questionnaires. Bivariate (P value less than 0.25) and multivariate (P- value less than 0.05) logistic regression were performed to identify factors associated with KAP levels among patients attending Debark and Janamora hospitals.
Results
In this study, 208 (54.3%) of participants had good knowledge, 203 (53%) had poor attitudes, and 210 (54.8%) had poor prevention practices. Educational level and hospital admission history were significantly associated with knowledge; residence and educational level were significantly associated with attitudes; and only study participants’ attitudes were significantly associated with prevention practices.
Conclusion
A large number of patients included in our study had poor attitudes and prevention practices toward the hepatitis B and C viruses. Therefore, intervention strategies such as community-based education on attitude improvement and prevention practices should be planned and implemented by the local health bureau to overcome morbidity and mortality due to HBV and HCV.
Keywords: Attitude, HBV, HCV, Knowledge, Practice
Introduction
Viral hepatitis is one of the main causes of chronic liver disease and liver failure worldwide. A considerable proportion of liver problems are due to hepatitis B virus (HBV) and hepatitis C virus (HCV) infections [1]. HBV and HCV infections are common causes of chronic hepatitis, which can lead to liver cirrhosis, liver failure, liver cancer, and even death [2]. Viral hepatitis is the tenth leading cause of death worldwide and the main cause of liver cancer [3]. Globally, an estimated 2 billion people have viral hepatitis [3]. It is also a serious public health issue, particularly in areas with limited resources. 350 million chronic HBV infections and 170 million chronic HCV infections, respectively, are estimated by the WHO to exist worldwide. HBV is thought to cause 563,000 fatalities annually, whereas HCV is thought to cause 366,000 deaths. The majority of people with HBV and HCV infections live in low-income countries in sub-Saharan Africa [4].
In Ethiopia, 31% of deaths and 12% of hospital admissions are related to viral hepatitis [5]. In no intact skin, highly contagious HBV and HCV can infect mucosal membranes, blood, and other body fluids. The primary mode of transmission for the hepatitis virus involves direct contact with blood or body fluids [6]. Hepatitis B and C are common among many communities that have little knowledge, a negative attitude, and poor preventive practices [7].
To prevent infection spread and morbidity or death due to the hepatitis B and C viruses, it is crucial to study knowledge, attitudes, and preventive practices (KAPs) related to what is understood, believed, and understood about HBV and HCV infection [8]. The interplay among knowledge, attitudes, and practices (KAPs) significantly influences health outcomes, particularly in reducing morbidity and mortality rates. Enhancing knowledge, fostering positive attitudes, and encouraging effective health practices are essential strategies for decreasing morbidity and mortality due to hepatitis viruses. By focusing on these areas, public health initiatives can significantly improve health outcomes across various populations [9]. Thus, the goal of this research was to evaluate patient knowledge, attitudes, preventive practices, and associated factors regarding HB and HC virus infection among patients in the North Gondar Zone, Ethiopia.
The objectives of the study were as follows
To determine the level of knowledge, attitudes, and preventive practices of hepatitis B and C virus infection among patients attending Debark and Janamora Hospitals.
To identify factors associated with knowledge, attitudes, and preventive practices related to hepatitis B and C virus infection among patients attending Debark and Janamora Hospitals.
Methodology
Study period, area, and design
A facility-based cross-sectional study was conducted from November 1 to December 30, 2023, at Janamora Primary Hospital and Debark General Hospital to assess the knowledge, attitudes, and prevention practices of patients toward HB and HC virus infection in the North Gondar Zone, Ethiopia.
Population
Source population
All the adults lived in the northern Gondar zone during the study period. According to data from the Central Statistical Agency of Ethiopia 2007 census, the total population of the North Gondar Zone is 905,680, of which 479,834 are females and 425,846 are males [10].
Study population
All adult patients visited Debark and Janamora hospitals during the data collection period.
Inclusion and exclusion criteria
Study participants whose ages were above 18 years and who visited Debark General and Janamora primary hospitals during the study period and were willing to participate were included in our study, whereas patients who had a serious illness and refused to participate were excluded.
Sample size determination and sampling technique
The sample size of our study was calculated via a single population proportion formula with the assumptions of confidence level = 95%, critical value Zα/2 = 1.96, degree of precision d = 0.05, and proportion (p) = 50% [11] because no studies have been conducted in Ethiopia concerning knowledge, attitudes, and prevention practices toward HBV and HCV infection among patients and to collect an adequate sample that can be a true representative of the population.
 |
A total of 383 samples were included from Janamora Primary Hospital and Debark General Hospital.
Study variables
Dependent variables
Knowledge, attitudes, and prevention practices.
Independent variables
Socio-demographic variables and each dependent variable were analyzed as independent variables for the other two variables.
Operational definitions
Good knowledge
Participants score points greater than or equal to the mean of knowledge-related questions and poor when the score is below the mean. There were 11 knowledge questions, and the responses were coded as 1 for correct responses and 0 for incorrect responses. The total sum score ranged from 0 to 11. The mean value was subsequently calculated [12].
Good attitude
The study participants score points greater than or equal to the mean for the attitude questions and poor when the score is below the mean. The attitude questions comprised 8 items, and responses were coded as 1 for correct responses and 0 for incorrect responses. The total sum score ranged from 0 to 8. The mean value was subsequently calculated [12].
Good practice
The study participants score points greater than or equal to the mean for the practice questions and poor when the score is below the mean. Practice-related questions comprise 5 items, and the response was coded as 1 for correct and 0 for incorrect practice. The total sum score ranged from 0 to 5. The mean value was subsequently calculated [12].
Data collection tool and procedure
The data collection tool was adopted from different studies [13–16] and validated by senior researchers and experts. Those tools included data on sociod-emographic characteristics, knowledge, attitudes, and prevention practices toward HBV and HCV infection. Among the four hospitals in the North Gondar Zone, Janamora Primary Hospital and Debark General Hospital were selected by the researcher, and then the sample sizes were allocated proportionally to each hospital on the basis of their quarterly patient follow-up data. Finally, data were collected from 383 patients who were selected via simple random sampling through a lottery method. Each patient’s ID was written on a slip of paper, which was then mixed together. Data collectors from different wards simultaneously drew the required number of slips until the desired sample proportion was reached.
Quality assurance mechanism
A pretest was performed on 5% of the study participants from the study area to check the clarity and consistency of the questionnaire. The data collection process was checked on a daily basis by the investigators and supervisors. The consistency and completeness of the collected data were checked every day by supervisors and investigators.
Data analysis
After collection, the data were coded and entered into Epi Data version 4.6.0 and then exported to SPSS version 25 for further analyses. The results are reported via descriptive statistics, frequencies, and percentages. Bivariate and multivariate logistic regression analyses were also used to distinguish factors related to the knowledge, attitudes, and practices of patients toward HBV and HCV infections. Bivariate logistic regression was performed to select variables with P values less than 0.25 [17]. Then, the variables with P values less than 0.25 in the bivariate regression analysis were processed in the multivariate analysis to identify factors related to the knowledge, attitudes, and prevention practices of patients toward HBV and HCV infections among patients. Variables with a P value of 0.05 at the 95% confidence level were considered significantly associated with the dependent variable.
Results
Socio-demographic characteristics of the patients
Three hundred eighty-three participants were included in the study, for a response rate of 99.7%. Fifty-eight (15.1%) were male, and the remaining 84.9% were female. The participants’ ages ranged from 18 to 70 years, with a mean of 26.1 ± 5.5 years. More than one-third of the patients were urban residents (n = 58%), 143 (37.3%) were 18–26 years old, 286 (74.7%) were married, and 189 (49.3%) of the respondents had received secondary education and had a monthly income of less than 1000 birr 209 (54.6%) (Table 1).
Table 1.
Socio-demographic characteristics of participants in North Gondar zone, ethiopia, 2023 (n = 383)
| Variables | Category | Frequency (n) | Percentage (%) |
|---|---|---|---|
| Age | 18–25 year | 143 | 37.3 |
| 26–30 year | 121 | 31.6 | |
| > 30 year | 119 | 31.1 | |
| Sex | Female | 325 | 84.9 |
| Male | 58 | 15.1 | |
| Residence | Urban | 222 | 58 |
| Rural | 161 | 42 | |
| Marital status | Single | 74 | 19.3 |
| Married | 286 | 74.7 | |
| Divorced | 22 | 5.7 | |
| Widowed | 1 | 0.3 | |
| Level of education | Illiterate | 100 | 26.1 |
| Elementary | 83 | 21.7 | |
| High school | 189 | 49.3 | |
| College and above | 11 | 2.9 | |
| Monthly income | Below 1000 birr | 209 | 54.6 |
| 1000–5000 birr | 115 | 30.0 | |
| Above 5000 birr | 59 | 15.4 | |
| Occupation | Private Employee | 177 | 46.2 |
| Gov. Employee | 99 | 25.8 | |
| Self- Employee | 107 | 27.9 |
Knowledge of the prevention of HBV and HCV infection in participants’ HBV and HCV infections
In this study, 208 (54.3%), 95% CI: 49.1–59, had good knowledge about HB and HC virus infection, and the remaining 175 (45.7%), 95% CI: 41.0–50.9, had poor knowledge about HB and HC virus infection.
One hundred thirty-three patients, or 34.7%, were unaware of hepatitis B and C virus infections. Similarly, 192 patients, or 50.1%, and 124 patients, or 32.4%, were unaware that contaminated body fluids and blood can spread HBV and HCV, respectively. Thirty-six people, approximately 30.3%, were unaware of the connection between HB and HC viruses and liver cancer. With respect to vaccination, 88 (23%) patients did not have information on the availability of a vaccine against the HB virus, and 67 (17.5%) and 87 (22.7%) patients did not know about hepatitis B and C virus laboratory tests and treatment, respectively (Table 2).
Table 2.
Knowledge of HBV and HCV infection among patients in North Gondar zone ethiopia, 2023 (n = 383)
| Variable | Category | ||
|---|---|---|---|
| Yes (%) | No (%) | Not sure (%) | |
| Prior information about HBV and HCV infection. | 217(56.7) | 133(34.7) | 33(8.6) |
| Hepatitis transmitted through sex. | 80(20.9) | 192(50.1) | 111(29) |
| Hepatitis B and C viruses cause liver cancer. | 122(31.9) | 116(30.3) | 145(37.9) |
| Can Hepatitis B and C viruses’ carrier transmit the infection? | 100(26.1) | 125(32.6) | 158(41.3) |
| Hepatitis B and C viruses can transmit by spread by blood and body fluids. | 86(22.5) | 124(32.4) | 173(45.2) |
| Hepatitis B and C viruses can transmit by unsafe sex. | 83(21.7) | 149(38.9) | 151(39.4) |
| Hepatitis B and C viruses are more infectious than HIV. | 76(19.8) | 196(51.2) | 111(29.0) |
| Vaccine can prevent Hepatitis B virus infection. | 100(26.1) | 88(23.0) | 195(50.9) |
| Hepatitis B and C viruses have laboratory tests. | 194(50.7) | 67(17.5) | 122(31.9) |
| Hepatitis B and C viruses have post exposure prophylaxis. | 50(13.1) | 99(25.8) | 234(61.1) |
| Hepatitis B and C viruses Can treat. | 141(36.8) | 87(22.7) | 155(40.5) |
Attitudes toward HBV- and HCV-infected participants’ prevention practices
Among the study participants, 203 (53%), 95% CI: 48–58.2, had poor attitudes, and the remaining 180 (47%), 95% CI: 41.8–52, had good attitudes toward the HBVs and HCVs.
Two hundred twenty-three (58.2%) study participants believed that there was no need to be concerned about contracting hepatitis B or C viruses, whereas 67 (17.5%) disagreed that hepatitis B virus vaccination is safe and effective. Approximately 50 (13.1%), 95 (24.8%), 144 (33.6%), 196 (51.2%), and 78 (20.4%) of the study participants disagreed that patients should be tested for hepatitis B and C viruses before receiving other health services; adhering to infection control guidelines will prevent them from contracting the viruses at home; occasionally coming into contact with blood will not necessarily increase their risk of contracting the viruses; HBV and HCV infections are not potentially serious because those who acquire them lead normal lives; and post exposure prophylactics can prevent HBV and HCV infections, respectively (Table 3).
Table 3.
Attitudes toward hepatitis B and C virus infection among participants in the North Gondar zone, ethiopia, 2023 (N = 383)
| Variable | Category | ||
|---|---|---|---|
| Agree (%) | Disagree (%) | Not sure (%) | |
| No concern of being infected with hepatitis B and C viruses. | 103(26.9) | 223(58.2) | 57(14.9) |
| Hepatitis B virus vaccine is effective and safe. | 174(45.4) | 67(17.5) | 142(37.1) |
| All patients should be tested for hepatitis B and C viruses before receive other health service. | 203(53) | 50(13.1) | 130(33.9) |
| You are at risk of getting hepatitis B and C virus’s infection. | 117(30.5) | 137(35.8) | 129(33.7) |
| Following infection control guidelines will protect from being infected with hepatitis B and C viruses at home | 104(27.2) | 95(24.8) | 184(48.0) |
| Occasional contact with blood will not necessarily increase my risk of getting hepatitis B and C viruses’ infection. | 71(18.5) | 144(37.6) | 168(43.9) |
| Hepatitis B and C viruses’ infection is not potentially serious because people who acquire it live normal lives. | 48(12.5) | 196(51.2) | 139(36.3) |
| Post exposure prophylactic can prevent from hepatitis B and C viruses infection. | 82(21.4) | 78(20.4) | 223(58.2) |
Hepatitis B and C virus infection prevention practices
According to this study, 173 (45.2%), 95% CI: 40–50.4) of the patients had good HB and HC virus prevention practices. The other 210 (54.8), 95% CI: 49.6–60), had poor hepatitis B and C virus prevention practices. Two hundred twenty-three (58.2%) did not screen for HBV/HCV (Table 4).
Table 4.
Practice of prevention of HBV and HCV infection among participants in North Gondar zone, ethiopia, 2023 (N = 383)
| Variable | Category | ||
|---|---|---|---|
| Yes (%) | No (%) | ||
| Have you ever screened from hepatitis B/C viruses | 160(41.8) | 223(58.2) | |
| Have you ever had a sharp stick injury | 110(28.7) | 273(71.3) | |
| do you report for sharp stick injury | 100(26.2) | 283(73.8) | |
| Are you practicing a safe sex | 313(81.7) | 70(18.3) | |
| Do you discard waste material their appropriate container | 144(37.6) | 239(62.4) | |
Factors associated with knowledge, attitudes, and prevention practices for HBV and HCV infection
Factors associated with knowledge of HBV and HCV infections
Bivariate logistic regression revealed strong relationships between knowledge of HB and HC virus infection and age, residence, educational level, monthly income (in the ETB), and hospital admission history. Among them, a history of hospital admission and education level were significantly associated with knowledge levels of hepatitis B virus (HB) and hepatitis C virus (HC) infection according to multivariable analyses. This study revealed that among those who had a history of hospital admission, the odds ratio of having good knowledge was 1.85 [AOR = 1.85, 95% CI: (1.13–3.12)] greater than that among participants who did not. Individuals whose level of education was high school (AOR = 5.24, 95% CI: 2.83–9.74] and whose level of education was college and above (AOR = 5.25, 95% CI: 1.29–12.30) had 5.24 and 5.25 times more knowledge about HBV/HCV, respectively, than illiterate individuals did (Table 5).
Table 5.
Multivariate logistic analyses of factors associated with knowledge, attitudes, and prevention practices toward HB and HC virus infection (N = 383)
| Variable | Knowledge Category | COR(95%CI) | P value | AOR(95%CI) | P value | |
| Good | Poor | |||||
| Age in year | ||||||
| 18–25 | 79 | 64 | 1.43(0.87–2.36) | .158 | .89(.48-1.67) | .720 |
| 26–30 | 53 | 68 | 2.27(1.35–3.81) | .002 | 1.20(.63-2.260) | .583 |
| Above 30 | 76 | 43 | 1.00 | 1.00 | 1.00 | 1`.00 |
| Residency | ||||||
| Urban | 106 | 116 | 1.89(1.249–2.86) | .003 | 1.28(.79-2.05) | .309 |
| Rural | 102 | 59 | 1.00 | 1.00 | 1.00 | 1.00 |
| Education level of respondents | ||||||
| Illiterate | 78 | 22 | 1.00 | 1.00 | 1.00 | 1.00 |
| Elementary | 53 | 30 | 2(1.05–3.85) | .036 | 1.599(.781 − 3.24) | .201 |
| High school | 73 | 116 | 5.63(3.23–9.83) | .000 | 5.24(2.83–9.74) | .000* |
| College and above | 4 | 7 | 6.2(1.66–23.14) | .007 | 5.25(1.29–12.30) | .020* |
| Monthly Income | ||||||
| Below 1000 birr | 127 | 82 | 1.00 | 1.00 | 1.00 | 1.00 |
| 1000–5000 birr | 60 | 55 | 1.42(.897 − 2.25) | .135 | .63(.32-1.25) | .186 |
| Above 5000 birr | 21 | 38 | 2.8(1.54–5.11) | .001 | .56(.28-1.12) | .099 |
| History of admission | ||||||
| Yes | 61 | 73 | 1.73(1.13–2.63) | .012 | 1.85(1.13–3.02) | .014* |
| No | 147 | 102 | 1.00 | 1.00 | 1.00 | 1.00 |
| Variable | Attitude Category | COR(95%CI) | P value | AOR(95%CI) | P value | |
| Good | Poor | |||||
| Age in year | ||||||
| 18–25 | 60 | 83 | 1.02(.63-1.68) | .917 | 1.23(.68-2.21) | .490 |
| 26–30 | 50 | 71 | .506(.31-.83) | .007 | 1.19(.64-2.18) | .586 |
| Above 30 | 70 | 49 | 1.00 | 1.00 | 1.00 | 1.00 |
| Residency | ||||||
| Urban | 80 | 142 | 2.91(1.91–4.43) | .000 | 2.27(1.42–3.62) | .001* |
| Rural | 100 | 61 | 1.00 | 1.00 | 1.00 | 1.00 |
| Education level of respondents | ||||||
| Illiterate | 66 | 34 | 1.00 | 1.00 | 1.00 | 1.00 |
| Elementary | 44 | 39 | 1.72(.93-(3.13) | .075 | 1.09(.56-2.12) | .801 |
| High school | 65 | 124 | 3.70(2.22–6.17) | .000 | 2.22(1.20–4.08) | .011* |
| College and above | 5 | 6 | 2.33(.66-8.18) | .187 | .951(.23 − 3.80) | .944 |
| Monthly Income | ||||||
| Below 1000 birr | 111 | 98C | 1.00 | 1.00 | 1.00 | 1.00 |
| 1000–5000 birr | 52 | 63 | 1.37(.87-2.17) | .175 | .58(.29-1.15) | .119 |
| Above 5000 birr | 17 | 42 | 2.80(1.50–5.23) | .001 | .55(.27-1.11) | .096 |
| Variable | Practice Category | COR(95%CI) | P value | AOR(95%CI) | P value | |
| Good | Poor | |||||
| Attitude | ||||||
| Good | 89 | 91 | 1.79(1.19–2.69) | .005 | 1.79(1.19–2.69) | .005* |
| Poor | 84 | 119 | 1.00 | 1.00 | 1.00 | 1.00 |
(*) Statistically significant at p value < 0.05
AOR = adjusted odds ratio, CI = confidence interval, COR = crude odds ratio,
Factors associated with attitudes toward HBV and HCV infections
Age, place of residence, monthly income (in the ETB), and level of education were shown to be substantially correlated with attitudes toward HB and HC virus infection in bivariate analyses. Residence and educational level were shown to be statistically associated with a good attitude toward HB and HC infection in multivariable analyses. The results of the factor analyses revealed that people who lived in urban areas were 2.27 times (AOR = 2.27, 95% CI: (1.42–3.62)) more likely to have a good attitude toward hepatitis B and C virus infection than people who lived in rural areas were. Compared with those who were illiterate, those with college degrees and above had 2.22 times [AOR = 2.22, 95% CI: (1.20–4.08)] greater chances of having a good attitude (Table 5).
Factors associated with prevention of hepatitis B virus (HB) and hepatitis C virus (HC) infection
The study revealed that participant attitudes toward HB and HC infection were the only variable associated with HB and HC virus preventive practices. When participants with a good attitude toward HB and HC virus infection were compared to those with a poor attitude, their odds of having excellent preventative practices were 1.79 times [AOR = 1.79, 95% CI: (1.19–2.69)] greater (Table 5).
Discussion
Knowledge, attitudes, and practices play crucial roles in the prevention of hepatitis B and C viruses. Understanding the impact of KAP can help in designing effective public health interventions aimed at reducing the transmission of these viruses [18]. In the present study, 58 participants (15.1%) were male, whereas the majority (84.9%) was female. The ages of the participants ranged from 18 to 70 years, with an average age of 26.1 years (± 5.5). The predominance of female participants can largely be attributed to the inclusion of wards related to labor and delivery, immunization, and antenatal care, in which only female participants are visited. This demographic distribution also reflects a tendency toward younger individuals, particularly those in their 20s, as reproductive age typically begins at approximately 15 years.
When we compared our findings on knowledge with those from other studies, we found similarities with a study conducted in Saudi Arabia, which reported that 50.5% of participants had good knowledge [19]. However, our results indicate a greater level of knowledge than similar studies in Cameroon, where only 22.1% demonstrated good knowledge; among sub-Saharan immigrants, 15%; in Ethiopia, 25%; in Pakistan, 23.6%; and in Malaysia, 38.8% exhibited good knowledge [13, 16, 20–22]. The observed differences in knowledge levels can indeed be attributed to variations in educational attainment among participants. In our study, the illiteracy rate was 26%, which is significantly lower than the rates reported in Cameroon (48.4%) and among sub-Saharan African immigrants (75.4%) [16, 21]. This disparity suggests that higher educational levels may contribute to better health knowledge [16, 21]. Furthermore, our analysis identified participants’ educational level and history of hospital admission as statistically significant factors associated with knowledge. This aligns with findings from studies conducted in Cameroon, Pakistan, and sub-Saharan Africa [13, 16, 21], which also indicate that education plays a crucial role in enhancing health knowledge [23]. A history of hospital admissions can enhance knowledge about hepatitis B and C through increased exposure to healthcare education, personal experiences, and ongoing medical care. Research also indicates that individuals with higher educational attainment tend to have a better understanding of the hepatitis B and C viruses [24].
The attitudes of the participants indicated that fewer than half, specifically 180 (47%), with a 95% confidence interval of 41.8–52, had a positive attitude toward the hepatitis B and C viruses. This percentage is lower than the findings reported in Cameron (54.6%) and Gambia (70%). However, our results demonstrate a more favorable attitude than those of other studies conducted in Ghana, where only 33% of the respondents reported good attitudes, and in Pakistan, where 21.8% of the respondents reported good attitudes. This discrepancy can be attributed to the larger number of participants; 56.4% of the participants in Ghana [25] were illiterate, but in our study, 26% were illiterate. In this study, both participants’ level of education and residency were statistically associated with their attitudes. This finding aligns with other research conducted among sub-Saharan immigrants, as well as in Jordan and Ghana, where education has been shown to be statistically linked to attitudes [21, 25, 26]. In contrast, studies in Ethiopia, Pakistan, and Cameroon demonstrated that participants’ residency was a statistically significant factor associated with their attitudes [13, 16, 22]. The residency of individuals can shape their attitudes toward hepatitis B and C through factors such as access to healthcare, cultural influences, educational initiatives, and personal experiences. These elements collectively contribute to how communities perceive and respond to the challenges posed by these viral infections [16].
In our study, the levels of prevention practices for HBV and HCV were categorized as follows: 173 participants (45.2%) demonstrated good practices, with a 95% confidence interval of 40–50.4, whereas 210 participants (54.8%) exhibited poor practices, with a 95% confidence interval of 49.6–60. Notably, these results indicate that the prevention practice levels among our participants were higher than those reported in similar studies, such as in Cameroon (24.3%), sub-Saharan immigrants (33.4%), Pakistan (33.1%), and Ethiopia, where 37.6% of participants had good prevention practices [13, 16, 21, 22]. This discrepancy may be attributed to differences in the educational levels of the participants. In our study, 26% of the participants were illiterate, whereas in Cameroon, 48.4% [16] of the participants had no education, and this figure rose to 75.4% among sub-Saharan immigrants [21]. Furthermore, in our research, the only variable that showed a statistically significant association with hepatitis B and C virus prevention practices was the participants’ attitudes toward these infections. This finding aligns with other studies conducted in Cameroon and among sub-Saharan immigrants, where participants’ attitudes were also statistically linked to their prevention practices [16, 21]. The attitudes of study participants toward hepatitis B and C viruses significantly affect their prevention practices, as supported by research conducted in Ethiopia and Pakistan [13, 22]. Positive attitudes can foster greater involvement in preventive measures, whereas negative perceptions may hinder effective prevention efforts [27].
Conclusion
This study highlights gaps in knowledge of hepatitis B and C infection and the adoption of prevention practices, which require a comprehensive approach that combines targeted educational interventions, including community workshops, multimedia campaigns, and training, with supportive measures such as public awareness initiatives, primary care integration, harm reduction strategies, and affordable treatment to improve public health outcomes related to these infections.
Limitations
We use the same assessment tool for both HBV and HCV. Therefore, we recommend that other researchers use different assessment tools for each type of hepatitis. The study was conducted among all patients who had visited hospitals for all health services, including antenatal care, delivery, vaccination, etc., which increased the female-to-male ratio. Therefore, we also recommend that future researchers conduct such research at the community level.
Acknowledgements
We thank Debark University for supporting this study and Debark University for providing ethical clearance for this study. We are also grateful to the staff members of Debark General Hospital and Janamora Primary Hospital for their support and permission to conduct this study at these hospitals. We also express our gratitude to the patients for their willingness to complete the questionnaire.
Abbreviations
- HBV
Hepatitis B virus
- HCV
Hepatitis C virus
- WHO
World Health Organization
- KAP
Knowledge, Attitude and Practice
Author contributions
GA, YA, and JC were involved in title selection, quality assessment, and data collection methods and designed the study, interpreted results, and drafted the manuscript. SG was involved in extracting and analyzing the data.
Funding
There is no funding for publication or other costs, but Debark University covers data collection costs.
Data availability
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Ethics approval and consent to participate
Ethical approval was obtained from the ethical clearance committee of Debark University with Ref No, DKU/RCS/09/23, and permission was obtained from Janamora Primary and Debark General hospitals. Written consent was also obtained from the patients. The data obtained during the study were kept confidential. Paper data were kept in a locked cabinet, and computer-based data were secured with passwords. Except for the research team members, no one was accessing patient data.
Consent for publication
The authors and participants of this manuscript declare the following: This manuscript represents original research work and has not been previously published, nor is it currently under consideration for publication elsewhere. All the authors have made substantial contributions to the conception, design, execution, analysis, and interpretation of the data. All the authors have read and approved the final version of the manuscript and agree to its submission for publication. The research was conducted ethically and in accordance with relevant guidelines and regulations, including obtaining informed consent from all participants. There are no conflicts of interest to declare.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
References
- 1.Bauer-Staeb C, Jörgensen L, Lewis G, Dalman C, Osborn DP, Hayes JF. Prevalence and risk factors for HIV, hepatitis B, and hepatitis C in people with severe mental illness: a total population study of Sweden. Lancet Psychiatry. 2017;4(9):685–93. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Tang LS, Covert E, Wilson E, Kottilil S. Chronic hepatitis B infection: a review. JAMA. 2018;319(17):1802–13. [DOI] [PubMed] [Google Scholar]
- 3.Asrani SK, Devarbhavi H, Eaton J, Kamath PS. Burden of liver diseases in the world. J Hepatol. 2019;70(1):151–71. [DOI] [PubMed] [Google Scholar]
- 4.Amponsah-Dacosta E. Hepatitis B virus infection and hepatocellular carcinoma in sub-Saharan africa: implications for elimination of viral hepatitis by 2030? World J Gastroenterol. 2021;27(36):6025. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Shiferaw F, Letebo M, Bane A. Chronic viral hepatitis: policy, regulation, and strategies for its control and elimination in Ethiopia. BMC Public Health. 2016;16:1–13. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Ifeanyi OE, Leticia OI, Nwosu D, Chinedum OK. A review on blood borne viral infections: universal precautions. Int J Adv Res Biol Sci. 2018;5(6):60–6. [Google Scholar]
- 7.Hang Pham TT, Le TX, Nguyen DT, Luu CM, Truong BD, Tran PD, et al. Knowledge, attitudes and medical practice regarding hepatitis B prevention and management among healthcare workers in Northern Vietnam. PLoS ONE. 2019;14(10):e0223733. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Roien R, Mousavi SH, Ozaki A, Baqeri SA, Hosseini SMR, Ahmad S, et al. Assessment of knowledge, attitude, and practice of health-care workers toward hepatitis B virus prevention in kabul, Afghanistan. J Multidisciplinary Healthc. 2021:3(1):77–86. 10.2147/jmdh.s334438 [DOI] [PMC free article] [PubMed]
- 9.Woods JA, Hutchinson NT, Powers SK, Roberts WO, Gomez-Cabrera MC, Radak Z, et al. The COVID-19 pandemic and physical activity. Sports Med Health Sci. 2020;2(2):55–64. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Adugna A, Kloos H, Degefa T. Evaluation of the 2007 Ethiopian census data with an emphasis on coverage in Amhara region. Ethiop J Dev Res. 2014;36(1):1–33. [Google Scholar]
- 11.Cornelius P. Properties of components of covariance of inbred relatives and their estimates in a maize population. Theor Appl Genet. 1988;75:701–11. [Google Scholar]
- 12.Belay MZ, Wondyifraw EB, Yirdaw LT, Tefera BD. Knowledge, attitude, practice and their associated determinants, in relation to updated coronavirus illness 19 prevention and control among Dessie town residents in the South Wollo zone of Northeast ethiopia: community-based cross-sectional study cross-sectional study. Annals Med Surg. 2023;85(6):2480–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 13.ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Haseeb A, et al. A cross-sectional assessment of knowledge, attitude and practice among Hepatitis-B patients in quetta, Pakistan. BMC Public Health. 2013;13:1–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 14.Mohamed R, Ng CJ, Tong WT, Abidin SZ, Wong LP, Low WY. Knowledge, attitudes and practices among people with chronic hepatitis B attending a hepatology clinic in malaysia: a cross sectional study. BMC Public Health. 2012;12:1–14. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 15.Mukherjee PS, Dutta E, Das DK, Ghosh S, Neogi S, Sarkar A. Knowledge about hepatitis B and hepatitis C virus infection and consequences: a cross-sectional assessment of baseline knowledge among infected patients in West bengal, India. Hepatol Med Policy. 2017;2:1–9. [Google Scholar]
- 16.Abongwa LE, Sunjo NS, Afah NG, Abongwa L, Sunjo N, Afah N. Assessment of knowledge, attitude, and practice toward Hepatitis B among two rural communities of the Anglophone regions in Cameroon. IRA-International Journal of Applied Sciences, 4 (3). Sciences. 2016;4(03):2016.
- 17.Hosmer DW. Applied logistic regression, 2. 2000.
- 18.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(1):19–23. [Google Scholar]
- 19.SalemBSc SS, Almubark N, Alharbi W, Alhusaynan M. Knowledge and practice of adult population regarding hepatitis B virus (HBV) in Riyadh, Saudi arabia. 2018.
- 20.Rajamoorthy Y, Taib NM, Munusamy S, Anwar S, Wagner AL, Mudatsir M, et al. Knowledge and awareness of hepatitis B among households in malaysia: a community-based cross-sectional survey. BMC Public Health. 2019;19:1–11. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Saaed FM, Ongerth JE, Ali MH, Knowledge. Attitude and practice (KAP) survey about hepatitis B (HBV) and C (HCV) among migrant populations from Sub-Saharan Africa. MedRxiv. 2022:2022.11. 29.22282852. 10.1101/2022.11.29.22282852
- 22.Larebo YM, Anshebo AA, Behera SK, Gopalan N. Knowledge, attitudes, and practices toward preventing and controlling hepatitis B virus infection among pregnant women attending antenatal care at a university hospital in central ethiopia: a cross-sectional study. Therapeutic Adv Infect Disease. 2024;11:20499361241285342. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 23.Jarju L, Bittaye SO, Keita A, Tamba S, Njie R. Knowledge and attitude of hepatitis B infection among patients with the infection in the main liver clinic in the Gambia. Pan Afr Med J. 2022;42(1):252. 10.11604/pamj.2022.42.252.34577 [DOI] [PMC free article] [PubMed]
- 24.Zhou Y, Su Y, Yan R, Tang X, Deng X, Zhu Y, et al. Knowledge and awareness of viral hepatitis and influencing factors among the general population aged 15–69 years in Zhejiang province, China. Hum Vaccines Immunotherapeutics. 2023;19(2):2252241. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Mutaru A-M, Nanyim JK, Adokiya MN. Knowledge and predictors of attitudes of hepatitis B virus infection prevention among adults in tolon, Northern Ghana. J Infect Developing Ctries. 2023;17(08):1152–9. [DOI] [PubMed] [Google Scholar]
- 26.Alaridah N, Jereisat RA, Abu-Mutaw S, Abuhani HO, Jarrar RF, Joudeh RM, et al. Knowledge, attitude, and practices toward hepatitis B infection among Hemodialysis patients: A nationwide study in Jordan. PLoS ONE. 2024;19(10):e0312226. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Dwiartama A, Nirbayati WF, Giri-Rachman EA, Niloperbowo W, Tan MI, Anin A. Knowledge, attitude, and practice toward hepatitis B infection prevention and screening among Indonesians. Int J Environ Res Public Health. 2022;19(8):4644. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.