Abstract
Hepatitis B virus (HBV) infection is a major public health concern, particularly in sub-Saharan Africa, including Ethiopia. It is vertically transmitted, highly infectious, and an occupational hazard for healthcare providers, causing acute and chronic liver disease. Despite suboptimal intrapartum HBV infection prevention in many developing settings, evidence on obstetric healthcare providers’ knowledge and practices in Central Ethiopia remains limited. This study aimed to assess obstetric healthcare providers’ knowledge and practices regarding intrapartum HBV infection prevention and their associated factors in public hospitals in the Kembata Zone of Central Ethiopia. A multicenter facility-based cross-sectional study was conducted among 309 obstetric healthcare providers in public hospitals of the Kembata Zone, Central Ethiopia, from April 3 to June 4, 2025. All eligible providers were included through a census, and data were collected using pretested, structured, self-administered questionnaires. Bivariable and multivariable logistic regression analyses were performed to identify factors associated with knowledge and practices of intrapartum HBV infection prevention. Variables with p < 0.05 in the multivariable analysis were considered statistically significant. The overall level of knowledge regarding intrapartum HBV infection prevention among obstetric healthcare providers was 72.9% (95% CI: 69.2–75.3), while 53.8% (95% CI: 50.3–56.3) had good practice regarding intrapartum HBV infection prevention. Years of work experience (AOR = 4.29; 95% CI: 2.52–9.36), availability of infection prevention guidelines (AOR = 2.45; 95% CI: 1.49–5.62), and training (AOR = 3.41; 95% CI: 1.97–6.47) were significantly associated with good knowledge of HBV infection prevention. Furthermore, work experience (AOR = 2.24; 95% CI: 1.57–6.71), training (AOR = 3.02; 95% CI: 1.37–5.80), and good knowledge (AOR = 4.31; 95% CI: 1.99–8.67) were significantly associated with good practice of intrapartum HBV infection prevention. The study showed that most participants had good knowledge, whereas nearly half had good practice of intrapartum HBV infection prevention. Strengthening training and access to guidelines could be considered to support better prevention practices.
Keywords: Knowledge, Practice, Intrapartum HBV prevention, Central Ethiopia
Subject terms: Diseases, Gastroenterology, Health care, Medical research, Risk factors
Introduction
Hepatitis B is a viral infection that attacks the liver and can lead to both acute and chronic disease1,2. Globally, 254 million people were living with hepatitis B infection, with 1.2 million new infections each year and around 1.1 million deaths, due to complications related to cirrhosis and hepatocellular carcinoma1,3. The Hepatitis B virus (HBV) is transmitted when blood, semen, or other body fluids from an infected person enter the body of an uninfected person. The most common means of transmission include sexual contact, sharing of sharp items, poor infection control, and particularly during labor and delivery from mother to baby at birth3. The study revealed that in the United States, up to 2.4 million people are estimated to have hepatitis B, and about 50% of those with hepatitis B are unaware of their infection3.
Mother-to-child transmission (MTCT) of HBV contributes to an estimated 21% of global deaths, with regional rates ranging from 13% in the Eastern Mediterranean to 26% in the Western Pacific4. The study reported that up to 70–90% of infants acquire infection from HBsAg/HBeAg-positive mothers without prophylaxis during the intrapartum period5. The likelihood of developing chronic hepatitis B depends on age at infection: Up to 90% of infants infected with the Hepatitis B virus will develop a chronic infection, as compared to about 5% of adults who will develop chronic Hepatitis B infections. If not controlled early, chronic Hepatitis B can cause serious health problems, including liver damage, cirrhosis, liver cancer, and even death6. Perinatal HBV transmission accounts for most global infections and severe outcomes7. Without intervention, up to 85% of infants born to HBV-infected mothers become infected; 90% develop chronic hepatitis B, and 25% die prematurely from cirrhosis or liver cancer6,7.
In Ethiopia, the mother-to-child transmission rate of HBV infection from infected mothers was 30.9%8. Evidence shows that intrapartum HBV prevention practices among obstetric care providers play a critical role in interrupting vertical transmission through appropriate screening, infection prevention measures, safe delivery practices, and timely neonatal prophylaxis9. However, some providers demonstrate inconsistent implementation of infection prevention and intrapartum risk-reduction practices during labor and delivery, which leads to intrapartum transmission of hepatitis B infection9,10.
Across African countries, areas of HBV endemicity make intrapartum prevention of mother-to-child transmission particularly important. A study conducted in Ghana among health care providers reported suboptimal preventive practices toward HBV vertical transmission. Even though many providers were aware of HBV transmission routes, fewer consistently practiced standard infection prevention measures during intrapartum care11. Similarly, a study from Cameroon examining HBV knowledge and practices among healthcare workers found significant gaps in infection prevention behaviors, including inconsistent glove use, inadequate handling of blood and body fluids, and limited counseling of pregnant women regarding HBV transmission, which directly affect intrapartum care quality and increase the risk of HBV transmission to newborns12. Furthermore, evidence from Uganda also highlights systemic barriers, including weak integration of HBV services into maternal and newborn care, limited screening coverage, and inadequate provider preparedness to implement intrapartum HBV prevention interventions13. The factors that affect intrapartum HBV infections include lack of training, absence of institutional protocols, and limited access to supplies, which are associated with poor preventive practices11,12.
The study conducted in Addis Ababa reported low awareness and inadequate preventive practices related to HBV exposure in clinical settings14. Furthermore, research on evidence-based intrapartum care practices in Ethiopia indicates that many obstetric care providers do not consistently apply recommended practices during labor and delivery15–17. This suggests potential gaps in the implementation of intrapartum HBV prevention measures, including proper use of personal protective equipment, safe handling of sharp items, and adherence to infection prevention protocols for HBV-positive mothers17,18.
Therefore, the absence of studies specifically addressing intrapartum HBV prevention practices among obstetric care providers in Ethiopia represents a critical knowledge gap. Although intrapartum HBV prevention practices remain suboptimal in many developing settings, Knowledge and practices in Central Ethiopia remain underexplored, with limited evidence on their influence on maternal health outcomes. This study aimed to assess knowledge, practices, and factors associated with intrapartum HBV prevention among obstetric healthcare providers in public hospitals of Central Ethiopia.
Methods and materials
Study setting, design, and period
A multicenter facility-based cross-sectional study was conducted from April 3 to June 4, 2025, in public hospitals of Kembata Zone, Central Ethiopia. The Zone is located 340 km southwest of Addis Ababa, Ethiopia. According to the 2016 Central Statistical Agency census, the zone has a total population of 1,080,837, comprising 536,676 males and 544,161 females19. Based on the Zonal health department report, there were 430 health facilities, including five public hospitals, 68 health centers, and 352 health posts. In the Zone, there were 6537 healthcare workers. Of these, 309 are obstetrics care providers working in hospitals in the Kembata Zone19. The study included all obstetric care providers from the five public hospitals: Dr. Bogalech Gebre Memorial General Hospital, Doyogana Primary Hospital, Shinshicho Primary Hospital, Angecha Primary Hospital, and Mudula Primary Hospital.
Study population
The study population consisted of all obstetric healthcare providers working in labor and delivery units of public hospitals in the Kembata Zone, Central Ethiopia. A census approach was employed; therefore, all 309 eligible obstetric healthcare providers involved in intrapartum care were included. Providers with less than six months of work experience and those on annual leave, maternity leave, or sick leave during the study period were excluded. Since all eligible obstetric healthcare providers were included, sample size determination was not applicable.
Study variable
The dependent variables were knowledge and practices of intrapartum HBV infection prevention. The independent variables included sociodemographic characteristics (sex, age, marital status, profession, qualification, and years of work experience); organizational and individual factors (duration of work in intrapartum care, access to updated intrapartum infection prevention guidelines, access to health information, training on infection prevention, workload, professional development in the last six months, and number of obstetric care providers on duty per shift); and knowledge of intrapartum HBV prevention.
Operational definition
Intrapartum care is the care provided to women and their babies during labour and childbirth, ensuring high-quality, evidence-based clinical and supportive care throughout the process20.
Intrapartum HBV infection prevention practice
The measures taken during labour and childbirth to prevent transmission of hepatitis B virus (HBV) from mother to newborn1,2,6,20. The practice of intrapartum HBV prevention was assessed using 10 standardized practice-related questions. Obstetric healthcare providers who scored at or above the mean value were considered to have good practice, whereas those who scored below the mean were considered to have poor practice9,21. Since there is no standardized or validated cutoff point for classifying practice level in this context, the mean score was used as a relative measure of central tendency, consistent with previous similar studies.
Knowledge of intrapartum HBV infection prevention
Knowledge of intrapartum HBV prevention was assessed using 12 standardized knowledge questions. Obstetric healthcare providers who scored at or above the mean were considered to have good knowledge, whereas those who scored below the mean were considered to have poor knowledge9,21. Since there is no established validated cutoff for categorizing knowledge level using this specific tool, the mean score was used as a relative cutoff, consistent with previous studies.
Obstetric healthcare providers are professionals, including midwives, integrated emergency surgical officers (IESOs), health officers, and medical doctors, who work in labor and delivery wards to provide care and treatment to women before, during, and after childbirth15,18.
Professional development activities refer to participation in at least one formal or informal learning activity, such as in-service training, continuing professional development (CPD), workshops, seminars, mentorship, or clinical supervision, during the previous six months to enhance professional competence22,23. Participants who answered “yes” were considered to have participated in professional development activities, while those who answered “no” were considered not to have participated.
Data collection tool and procedures
Data were collected using a pre-tested, self-administered structured questionnaire adapted from previously published studies on hepatitis B prevention knowledge and preventive practices1,2,6,9,15,18,20,21. The questionnaire included sociodemographic characteristics of obstetric healthcare providers; Organizational and individual-related factors of obstetric healthcare providers; knowledge of intrapartum HBV prevention; and intrapartum HBV prevention practices. Questionnaires were first prepared in English and translated into the local language, and then back to English by language experts to ensure their consistency. Most knowledge and practice items were retained from the original instruments and were contextually modified based on expert recommendations. Content validity was assessed through expert review by a panel of seven professionals, including two obstetricians and gynecologists, one epidemiologist, one infectious disease specialist, and three maternal and reproductive health nursing experts. The experts evaluated the instrument for relevance, clarity, and comprehensiveness. Based on their feedback, minor modifications were made, including rephrasing unclear items and removing redundant questions. The Content Validity Index (CVI) and Content Validity Ratio (CVR) were conducted to ensure the relevance and essentiality of the questionnaire contents. Following expert review, a pretest was conducted on 5% of the sample size, and necessary adjustments were made before the final data collection. Internal consistency reliability was assessed using Cronbach’s alpha. The knowledge section demonstrated a Cronbach’s α value of 0.893, while the practice section demonstrated a Cronbach’s α value of 0.95, indicating acceptable reliability. Data collectors were five Bachelor of Science-qualified midwives, and supervisors were five Master of Science-qualified midwives. The completeness of the questionnaires was regularly checked, and the reviewed questionnaires were returned to the principal investigator.
The obstetric healthcare providers’ knowledge of intrapartum HBV prevention was assessed using 12 standardized knowledge-specific questions. Each correct response was scored one point, whereas an incorrect response scored 0. Obstetric healthcare providers who scored at or above the mean on the knowledge questions were considered to have good knowledge of intrapartum HBV prevention, whereas those who scored below the mean were considered to have poor knowledge.
Intrapartum prevention of Hepatitis B Virus practices was assessed using 10 standardized practice-related questions. Each correct response was scored 1, whereas an incorrect response was scored 0. Obstetric healthcare providers who scored at or above the mean value were considered to have good practice, whereas those who scored below the mean value were considered to have poor practice.
Data quality management
A pretest was conducted on 5% of the sample at Halaba Kulito General Hospital, which was not included in the actual data collection, two weeks before the actual data collection period, to assess the clarity, sequence, consistency, understandability, and time taken to complete the questionnaire. Later on, any ambiguity, complex words, and differences in understanding were revised based on pretest experience. The data collectors and supervisors were trained for two days on the objective of the study and how to collect the data by the investigator. Daily on-site supervision was given to facilitate and solve any mistakes during the data collection process by the principal investigator. The completeness and consistency of the collected data were cross-checked and compiled by supervisors and principal investigators daily.
Statistical analysis
Data were coded and entered into EpiData version 4.6.0.2 and exported into SPSS version 26 for further analysis. Incomplete and partially completed questionnaires were excluded from the final analysis, and only fully completed responses were included in the analysis (complete-case analysis). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to describe the study population with respect to relevant variables. Bivariate and multivariable logistic regression analyses were employed to identify the association between dependent and independent variables. Variables having a P-value < 0.25 in the bivariate analysis were fitted into the multivariable logistic regression model. Odds ratios (ORs), 95% confidence intervals (CIs), and P-values were computed. Variables having a P-value < 0.05 in the multivariable logistic regression analysis were considered statistically significant factors associated with the outcome variables.
The logistic regression model fitness was checked using the Hosmer and Lemeshow goodness-of-fit test and was well fitted at p-values of 0.439 and 0.623 for knowledge and intrapartum HBV prevention practices, respectively. Multicollinearity among independent variables was assessed using both the variance inflation factor (VIF) and tolerance statistics before fitting the multivariable models. All VIF values were below the commonly accepted threshold of 10, and tolerance values were greater than 0.1, indicating no evidence of multicollinearity among the independent variables. Knowledge and practice were measured using separate sets of questionnaire items, scored independently, and analyzed as distinct outcome variables to minimize measurement overlap. Finally, tables, graphs, and narration were used to present the data.
Ethical clearance and consent to participate
Ethical clearance was obtained from the Institutional Health Research Ethics Review Board of Wolkite University, reference number IRB/291/2025. The study was conducted in accordance with the ethical standards of the Declaration of Helsinki. The ethical letter was provided to Kembata Zone public hospitals to initiate the permission process for data collection. The purpose of the study, participants’ right to refuse, confidentiality, and voluntary participation were explained in detail to the study participants, and informed written consent was obtained. All participants were aged 18 years or older. Coding was implemented to remove respondents’ names and other personal identifiers throughout the study to ensure participant confidentiality. To minimize social desirability bias, the questionnaire was self-administered and completed anonymously. Participants were assured that their responses would be kept confidential, used solely for research purposes, and would not affect their employment status or professional evaluation.
Results
Sociodemographic characteristics of study participants
Of the 309 obstetric healthcare providers initially enrolled, 303 completed the questionnaire and were included in the final analysis, yielding a 98% response rate. Two participants refused to participate, and four questionnaires were incomplete; therefore, they were excluded from the final analysis and considered non-respondents. The mean age of the participants was 36 years (SD ± 1.6). The majority of participants were aged ≥ 35 years (43.6%), and 68% were married. A total of 264 (87.2%) were midwifery professionals, and 69.3% had a Bachelor of Science (BSc) qualification. Regarding work experience, 195 (64.4%) reported five or more years of experience (Table 1).
Table 1.
Sociodemographic characteristics of obstetric healthcare providers in public hospitals in the Kembata Zone, Central Ethiopia, 2025 (n = 303).
| Study Variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Age | 18–24 | 98 | 32.3 |
| 25–34 | 73 | 24.1 | |
| ≥ 35 | 132 | 43.6 | |
| Sex | Female | 152 | 50.2 |
| Male | 151 | 49.8 | |
| Marital status | Married | 206 | 68.0 |
| Single | 97 | 32.0 | |
| Profession | Midwife | 264 | 87.2 |
| Medical doctor | 21 | 6.9 | |
| IESO | 11 | 3.6 | |
| OB/GYN specialist | 7 | 2.3 | |
| Educational qualification | OB/GYN specialist | 7 | 2.3 |
| Medical doctor | 21 | 6.9 | |
| Master of Science (MSc) | 35 | 11.6 | |
| Bachelor of Science (BSc) | 210 | 69.3 | |
| Diploma | 30 | 9.9 | |
| Total professional work experience | < 5 years | 108 | 35.6 |
| ≥ 5 years | 195 | 64.4 |
IESO: Integrated Emergency Surgical Officer, OB/GYN: Obstetrics and Gynecology.
Organizational and Individual-Related Factors of Study Participants
In the present study, 62.7% of respondents had worked in the labor and delivery unit for ten or more years. Among the study participants, 237 (78.2%) had updated infection prevention guideline. Additionally, 65.0% of respondents had received training on infection prevention and control. A total of 257 (84.8%) respondents reported participating in at least one professional development activity during the previous six months (Table 2).
Table 2.
Organizational and Individual-Related Factors of Obstetric Healthcare Providers in public hospitals in the Kembata Zone, Central Ethiopia, 2025 (n = 303).
| Study variable | Category | Frequency | Percentage (%) |
|---|---|---|---|
| Duration of work in the labor and delivery unit | < 10 years | 113 | 37.3 |
| ≥ 10 years | 190 | 62.7 | |
| Availability of updated infection prevention guideline | No | 66 | 21.8 |
| Yes | 237 | 78.2 | |
| Access to sources of health information | No | 33 | 10.9 |
| Yes | 270 | 89.1 | |
| Trained on infection prevention and control | No | 106 | 35.0 |
| Yes | 197 | 65.0 | |
| Number of deliveries per day | < 10 | 139 | 45.9 |
| ≥ 10 | 164 | 54.1 | |
| Participation in at least one professional development activity in the last six months | Yes | 257 | 84.8 |
| No | 46 | 15.2 | |
| Number of obstetric care providers on duty per shift | < 5 | 193 | 63.7 |
| ≥ 5 | 110 | 36.3 |
Level of knowledge and practices regarding intrapartum HBV infection prevention
The overall level of knowledge regarding intrapartum HBV infection prevention among obstetric healthcare providers was 72.9% (95% CI: 69.2, 75.3), while 53.8% (95% CI: 50.3, 56.3) had good practice of intrapartum HBV infection prevention (Fig. 1).
Fig. 1.
Level of knowledge and practices regarding intrapartum HBV infection prevention among Obstetric Healthcare Providers in Public Hospitals of Kembata Zone, Central Ethiopia, 2025 (n = 303).
Factors associated with knowledge of intrapartum HBV infection prevention
Bivariable logistic regression analysis was conducted to identify candidate variables. Variables with a p-value < 0.25 in the bivariable analysis (age, sex, work experience, availability of IP guideline, access to health information, and training) were entered into the multivariable logistic regression model. In the multivariable logistic regression analysis, work experience, availability of IP guideline, and training were found to be significantly associated with knowledge of intrapartum HBV infection prevention at a p-value < 0.05.
Accordingly, obstetric healthcare providers with five years or more of work experience were 4.29 times more likely to have good knowledge of intrapartum HBV infection prevention than those with less than five years of experience (AOR = 4.29, 95% CI: 2.52–9.36; P < 0.001). The odds of having good knowledge of intrapartum HBV infection prevention were 2.45 times higher among obstetric healthcare providers working in facilities where an infection prevention (IP) guideline was available compared with those working in facilities where an IP guideline was not available (AOR = 2.45, 95% CI: 1.49–5.62; P = 0.020). Obstetric healthcare providers who had received training on infection prevention and control were 3.41 times more likely to have good knowledge of intrapartum HBV infection prevention compared with their counterparts (AOR = 3.41, 95% CI: 1.97–6.47; P = 0.010) (Table 3).
Table 3.
Factors associated with knowledge of intrapartum HBV infection prevention among obstetric healthcare providers in public hospitals in the Kembata Zone, Central Ethiopia, 2025 (n = 303).
| Knowledge of intrapartum HBV infection prevention (n = 303) | |||||
|---|---|---|---|---|---|
| Study Variables | Good | Poor | COR [ 95% CI ] | AOR [ 95% CI ] | P-value |
| Age | |||||
| 18–24 | 58 | 40 | 1 | 1 | |
| 25–34 | 60 | 13 | 3.20 [1.47–6.45] | 2.42 [0.83–4.42] | 0.130 |
| ≥ 35 | 103 | 29 | 2.45 [1.35–4.43] | 2.12 [0.83–3.42] | 0.090 |
| Sex | |||||
| Female | 110 | 42 | 1 | 1 | |
| Male | 111 | 40 | 1.06 [0.67–1.73] | 0.97 [0.54–1.83] | 0.320 |
| Work experience | |||||
| < 5 years | 50 | 58 | 1 | 1 | |
| ≥ 5 years | 171 | 24 | 8.37 [2.91–14.13] | 4.29 [2.52–9.36] | < 0.001 |
| IP guideline | |||||
| No | 30 | 36 | 1 | 1 | |
| Yes | 191 | 46 | 4.98 [1.73–9.02] | 2.45 [1.49–5.62] | 0.020 |
| Access to health information | |||||
| No | 11 | 12 | 1 | 1 | |
| Yes | 210 | 70 | 3.27 [1.23–6.31] | 1.53 [0.97–2.69] | 0.230 |
| Training | |||||
| No | 49 | 57 | 1 | 1 | |
| Yes | 172 | 25 | 8.00 [2.77–15.21] | 3.41 [1.97–6.47] | 0.010 |
AOR: Adjusted Odds Ratio, IP: infection prevention, COR: Crude Odds Ratio, CI: Confidence Interval, 1: Reference category.
Factors associated with intrapartum HBV infection prevention practices
Bivariable logistic regression analysis was first performed to identify candidate variables. Variables with a p-value < 0.25 in the bivariable logistic regression analysis were entered into the multivariable logistic regression model. These variables included age, work experience, availability of an infection prevention (IP) guideline, and participation in professional development (PD) during the previous 6 months, training, and knowledge of intrapartum HBV infection prevention. In the multivariable logistic regression analysis, work experience, training, and knowledge of intrapartum HBV infection prevention were found to be significantly associated with intrapartum HBV infection prevention practices at a p-value < 0.05.
Accordingly, obstetric healthcare providers with five years or more of work experience were 2.24 times more likely to have good practice of intrapartum HBV infection prevention than those with less than five years of experience (AOR = 2.24, 95% CI: 1.57–6.71; P = 0.030). Obstetric healthcare providers who had received training on infection prevention and control were three times more likely to have good practice of intrapartum HBV infection prevention compared with those who were not trained (AOR = 3.02, 95% CI: 1.37–5.80; P = 0.010). Participants with good knowledge of intrapartum HBV infection prevention were 4.31 times more likely to have good practice of intrapartum HBV infection prevention compared with their counterparts (AOR = 4.31, 95% CI: 1.99–8.67; P < 0.001) (Table 4).
Table 4.
Factors associated with intrapartum HBV infection prevention practices among obstetric healthcare providers in public hospitals in the Kembata Zone, Central Ethiopia, 2025 (n = 303).
| Intrapartum HBV infection prevention practices (n = 303) | |||||
|---|---|---|---|---|---|
| Study variables | Good | Poor | COR [ 95% CI ] | AOR [ 95% CI ] | P-value |
| Age | |||||
| 18–24 | 39 | 59 | 1 | 1 | |
| 25–34 | 30 | 43 | 1.06 [0.49–2.15] | 0.68 [0.43–1.73] | 0.330 |
| ≥ 35 | 94 | 38 | 3.74 [1.53–6.33] | 2.32 [0.87–3.93] | 0.082 |
| Work Experience | |||||
| < 5 years | 37 | 71 | 1 | 1 | |
| ≥ 5 years | 126 | 69 | 3.50 [1.91–7.23] | 2.24 [1.57–6.71] | 0.030 |
| IP guideline | |||||
| No | 23 | 43 | 1 | 1 | |
| Yes | 140 | 97 | 2.69 [1.53–4.04] | 1.48 [0.47–2.62] | 0.421 |
| Participated in PD in the last 6 months | |||||
| No | 19 | 27 | 1 | 1 | |
| Yes | 144 | 113 | 1.81 [1.03–2.39] | 1.30 [0.59–1.99] | 0.362 |
| Training | |||||
| No | 38 | 68 | 1 | 1 | |
| Yes | 125 | 72 | 3.12 [1.81–6.88] | 3.02 [1.37–5.80] | 0.010 |
| Knowledge of intrapartum HBV prevention | |||||
| Poor | 21 | 61 | 1 | 1 | |
| Good | 142 | 79 | 5.22 [2.23–11.44] | 4.31 [1.99–8.67] | < 0.001 |
AOR: Adjusted Odds Ratio, IP: infection prevention, PD: Professional development, COR: Crude Odds Ratio, CI: Confidence Interval, 1: Reference category.
Discussion
Hepatitis B infection is a serious infectious disease in developing countries. This is the first study to examine the knowledge and practices of intrapartum HBV infection prevention among obstetric healthcare providers in public hospitals in the Kembata Zone of Central Ethiopia. The study revealed that good knowledge of intrapartum HBV infection prevention was 72.9% (95% CI: 69.2, 75.3). The finding of this study was lower than those reported in studies conducted in Cameroon (86.31%)24, Egypt (86.5%)9, and Nigeria (99%)25, in which the study participants had good knowledge of HBV infection prevention. The variations may be a difference in study populations, professional composition, healthcare settings, and definitions of good knowledge. For instance, studies conducted in Egypt primarily included obstetricians and gynecologists, who are more specialized and may have greater access to updated clinical guidelines and infection prevention training compared with the broader group of obstetric healthcare providers included in the present study. In addition, differences in institutional context may also contribute to the observed variation. Moreover, settings with stronger infection prevention and control systems, better availability of guidelines, continuous professional development opportunities, and adequate protective resources are associated with higher levels of knowledge. On the other hand, limited access to training, workload constraints, and resource shortages in low-resource settings such as the present study area may influence their knowledge levels. Furthermore, differences in study settings, sample size, professional categories, and qualification status may also be associated with the observed variations.
However, the present finding was higher than those reported in studies conducted at Suez Canal University, Egypt, where only 55.5% of participants had good knowledge of HBV infection prevention21, and a study carried out at the University of Douala, Cameroon, where 68.04% of participants were found to have good knowledge of HBV infection prevention26. This variation may be related to differences in the study population, where those studies included general healthcare providers rather than obstetric healthcare providers. Since obstetric healthcare providers are directly involved in intrapartum care, they may have more frequent exposure to maternal infection prevention practices, which may be linked with higher levels of knowledge.
In this study, work experience, availability of IP guidelines, and having training were factors associated with good knowledge of intrapartum HBV infection prevention. Obstetric healthcare providers who had five or more years of work experience were 4.29 times more likely to have good knowledge of intrapartum HBV infection prevention. This association may reflect that healthcare providers with longer work experience have higher knowledge of infection prevention. Increased years of service is associated with greater exposure to clinical practice, in-service training, and updated guidelines, which may be associated with higher knowledge levels. The evidence indicates that working experience is associated with knowledge of evidence-based intrapartum care18.
Obstetric healthcare providers who have access to infection prevention guidelines were 2.45 times more likely to have good knowledge of intrapartum HBV infection prevention. This may be explained by the fact that access to infection prevention guidelines provides healthcare providers with up-to-date, standardized information, which is associated with better understanding and knowledge of intrapartum HBV infection prevention. Furthermore, it may reflect better access to infection prevention resources and may also serve as an indicator of better-resourced healthcare facilities. The observed association may reflect the role of updated intrapartum care guidelines in supporting evidence-based practice, as healthcare providers may use these guidelines to update their knowledge and apply current evidence in clinical care15,18.
Obstetric healthcare providers who had training on intrapartum infection prevention and control were 3.41 times more likely to have good knowledge of intrapartum HBV infection prevention compared to their counterparts. This association may reflect that training on intrapartum infection prevention may enhance healthcare providers’ knowledge and provide updated, evidence-based information and practical guidance, which may be associated with better prevention of Hepatitis B transmission during childbirth. The evidence indicates that up-to-date in-service training not only fills gaps in professional knowledge but may also be associated with greater adherence of healthcare providers to evidence-based care18.
The present finding revealed that the intrapartum HBV infection prevention practice was 53.8% (95% CI: 50.3, 56.3). This finding was aligned with a study conducted in Cameroon (55.83%)24. However, it is lower than studies conducted in Nigeria (60.9%)25 and the University of Douala, Cameroon (87.62%)26, which reported higher levels of HBV prevention practices. The differences may be associated with variations in the healthcare professionals included, healthcare settings, and the operational definitions used to assess HBV prevention practices across studies. The observed variation may also be related to differences in institutional factors, such as the availability of infection prevention guidelines, access to personal protective equipment, opportunities for in-service training, and the overall implementation of infection prevention programs. In addition, differences in the sociodemographic and professional characteristics of participants, including educational level, professional qualification, and work experience, may have contributed to the variation in reported practice levels across studies.
In the present study, work experience, training, and knowledge of intrapartum HBV prevention were found to be significantly associated with good practices of intrapartum HBV infection prevention. Obstetric healthcare providers who had five or more years of work experience were 2.24 times more likely to have good practice of intrapartum HBV infection prevention. This association may reflect that increased years of service are associated with greater exposure to clinical practice and updated guidelines, which may be associated with intrapartum HBV infection prevention practices. This is consistent with previous studies, which indicate that as experience increases, evidence-based intrapartum care practices may also increase15,18.
Obstetric healthcare providers who had received training were three times more likely to have good practice of intrapartum HBV infection prevention. This may reflect that training is associated with improved practical competence, which is associated with better intrapartum infection prevention practices. The evidence indicated that in-service training not only fills gaps in professional knowledge but may also be associated with greater adherence of healthcare providers to evidence-based intrapartum care practices15.
Obstetric healthcare providers with good knowledge of intrapartum HBV infection prevention were 4.31 times more likely to have good practice of intrapartum HBV infection prevention. This association may indicate that healthcare providers with higher levels of knowledge about HBV infection prevention are more likely to be associated with appropriate preventive practices. Several previous studies have shown that higher knowledge levels are also associated with good practices of intrapartum HBV infection prevention15,18,24,25. Furthermore, a study conducted in Egypt supports this finding, showing that increased knowledge is associated with improved preventive practices9.
Strengths and limitations of the study
The study employed a multicenter, facility-based design with an adequate sample size, enhancing the reliability and representativeness of the findings. Potential biases were reduced through clear objectives, a pretested questionnaire, training of data collectors and supervisors, inclusion of all eligible participants, and statistical adjustment for confounding variables. Ethical guidelines were followed to ensure voluntary and unbiased participation.
However, several limitations should be acknowledged. The study may be subject to self-reporting bias, which could lead to over or under reporting of responses. Furthermore, in a workplace survey, social desirability bias may have influenced participants to report more favorable knowledge and practices. However, this was minimized by using a self-administered anonymous questionnaire and assuring confidentiality and that responses would not affect employment or professional evaluation. In addition, as a cross-sectional study, it cannot establish causal relationships.
Conclusion
The present findings indicate that most respondents had good knowledge of intrapartum HBV infection prevention, whereas nearly half had good practice. Work experience, availability of infection prevention guidelines, and training were associated with good knowledge. In addition, work experience, training, and good knowledge of intrapartum HBV infection prevention were associated with good practice of intrapartum HBV infection prevention. Therefore, these modifiable factors were associated with better knowledge and better practices in this study. Strengthening training and access to infection prevention guidelines may be associated with better infection prevention practices among obstetric healthcare providers.
Acknowledgements
We would like to thank Wolkite University for granting ethical approval. We extend our gratitude to the study participants, data collectors, the supervisor, and all hospital staff.
Author contributions
MA, MDS, AB, and ABD participated in conception and design, acquisition of data, analysis and interpretation of data, and took part in drafting the article. MA, ABD, KNM, MGS, and MDS participated in the sequence alignment and design of the study and performed the statistical analysis. AB and MGS conceived the study and participated in its design and coordination, and helped with editing the English language. MA, ABD, AB, and MDS critically reviewed and revised the manuscript for important intellectual content and participated in the revision. All authors made substantial contributions to the work, critically reviewed the manuscript, approved the final version for publication, and agree to be accountable for all aspects of the work.
Data availability
Data that support the findings are available from the corresponding author upon a reasonable request.
Declarations
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Data that support the findings are available from the corresponding author upon a reasonable request.