Open access peer-reviewed chapter
Demographic profile of study participants.
Abstract
To evaluate the knowledge, attitude, and practice of participating entities toward hepatitis B and C to know about prevalence, literacy rate, and socioeconomic status of community people. A baseline survey was conducted to study the awareness, knowledge, and screening in a randomly selected population in different communities. Among common people of age above 16 years, a survey was conducted by filling out data collection forms for 560 individuals according to the plan of work designed. From the data collected, results were keenly analyzed, organized, and arranged in the form of tables for the comparison between the observed awareness about the disease and its screening. The prevalence of hepatitis B was found to be 18 (3.2%), hepatitis C 104 (18.6%), and both positive 17 (3%). It showed the high prevalence of hepatitis C. Out of 560 participants, 275 people (49.1%) knew the term hepatitis. Two hundred twenty-two (39.6%) participants did not know about the signs and symptoms of hepatitis. The descriptive statistics showed that 451 (80.5%) did not know the availability of vaccination against hepatitis B. Three hundred and thirty-six (60%) respondents strongly agreed that hepatitis can cause death. Out of 560 participants, 322 people (57.5%) strongly agreed that blood transfusion from hepatitis patients is the cause of hepatitis. Three hundred and seventy-three (66.6%) participants said that they use filtered plant water. In addition, 480 participants (85.7%) never vaccinated themselves. Chi-square test result (p = 0.004) showed a significant relation in the practice of male and female participants of study. A significant value of chi-square in practice domain of KAP was seen in educational qualification (p = 0.021) with undergraduates having better practice among all other levels of qualification. Current study concluded that people are unaware of the causes, prevention, and treatment of hepatitis B and C. People who are with positive signs and symptoms of hepatitis are reluctant to its long-term treatment. Government must arrange awareness campaigns and screening camps in communities to educate people about the importance of prevention and treatment of the disease.
Keywords
- prevalence
- hepatitis B and C
- rural areas
- awareness
- KAP (knowledge
- attitude
- and practice)
1. Introduction
Hepatitis is a word combined of two words, “hepatic” meaning liver, and “titis” meaning inflammation. Hepatitis refers to an inflammation of the liver. It is a viral infection that affects the normal functioning of liver. Hepatitis can be caused by secondary agents like drugs, toxins, medications, and alcohol. In our body, liver performs different functions, such as bile production, filtering of toxins, metabolism of drugs, storage of glycogen, breakdown of carbohydrates, fats and proteins, activation of enzymes, and excretion of bilirubin [1]. Globally, about 1 billion people are infected by hepatitis B and among them, 400 million people are suffering from chronic HBV infection [2]. Every year, in Pakistan, 2.4% of people are affected by hepatitis B. This viral infection causes cirrhosis and hepatocellular carcinoma. Mostly pregnant women are at high risk of getting this infection confirmed by one research work done at district Bannu and 60% of babies got infection from their mothers [3]. In Europe, more than 10 million Europeans suffer from chronic viral hepatitis. The prevalence of HBV is estimated to be around 0.9% and of HCV about 1.1% [4]. In Asia, the Southeast Asia Region of WHO has an estimated 39 million people living with chronic hepatitis B and 10 million people living with chronic hepatitis C [5]. In Pakistan, hepatitis B antigen, hepatitis C infection, and antibodies weighted average were found different in both nonblood giver and blood donors [6]. In Pakistan, from epidemiological data, it was estimated that the spread of HCV will increase about 3.9% to 5.1% from 2016–30 [7]. So far, four (A, B, C, and D) out of eight reported genotypes were identified. Genotypes A, B, and C were predominant. HBV genotype C was the most predominant in this collection [8].
Why current study is a need: As Pakistan is the second largest country in the world after China, that is, with high prevalence of hepatitis B and C. People of Pakistan have a lack of knowledge and awareness regarding hepatitis. The current study is needed to evaluate the knowledge, transmission mode, vaccination available, and treatment availability of hepatitis B and C [9].
Aims and objectives: The aim of this study is to
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2. Literature review
A cross-sectional study was conducted in Karachi, Pakistan, to assess the knowledge and awareness of HBV infection, its prevalence, transmission, and perception of HBV vaccine and vaccination status among young females. Descriptive statistics were used and out of 550 survey questionnaires, only 434 were returned. Response rate was 78.9%. More than 90% had knowledge of HBV infection. Only 17% had received HBV vaccination during childhood. Only 24% had been tested for HBV in adulthood. Majority of respondents had some awareness of HBV and related consequences [11].
A comparative cross-sectional facility-based survey between HCV-positive and negative respondents at Taluka Hospital (OPD) Rural district of Sindh was conducted to assess the knowledge regarding risk factors of HCV transmission and options to prevent the risk factors associated with HCV transmission. Out of 520 respondents, only 66% having HCV infection were interviewed. Highest infection was present among 21
A cross-sectional study was done in Nigeria, antenatal clinics in six different geopolitical zones recruited 159 pregnant women who agreed to undergo antihepatitis C virus testing, which was then validated using the polymerase chain reaction method. Out of 159, 99 pregnant women in Nigeria are not well informed about hepatitis C virus infection, and those 77, who are informed, are more likely to be young and highly educated. High hepatitis C virus infection rates serve as early support for the need for routine prenatal screening [13].
Eliminating the hepatitis C virus (HCV) requires an understanding of its obstacles and overcoming them. The current study set out to look into the prevalence of HCV disease awareness, linkage to care, and treatment uptake in a Taiwanese hyperendemic area. Residents in Tzukuan, between the years 2000 and 2018, were invited to take part in the questionnaire-based HCV interviews. Anti-HCV-seropositive participants’ rates of disease knowledge, accessibility, and anti-HCV therapy were assessed. Even in the early days of direct-acting antiviral agents, found out significant gaps in disease awareness, link-to-care, and treatment uptake in the HCV care cascade in an HCV-hyperendemic area. It is critical to overcome these obstacles to achieve HCV eradication [14].
By using survey results, hepatitis B free campaign was conducted to eliminate HBV in San Francisco by increasing awareness, testing, and vaccination. The campaign conducted 306 street intercepts and telephone interviews of San Francisco patients for assessment. One-third of respondents ranked HBV as a key health issue in Asian community, second to diabetes. General HBV awareness is high. The campaign used survey results to focus efforts on more intensive provide outreach and to create messages for public media campaign [15].
A general population-based study was carried out in Nawabshah Sindh, Pakistan, to evaluate the epidemiological rate and risk factors of hepatitis B and hepatitis C. In count, 523 people were tested for hepatitis B and C, with 232 being female and 291 being male. Hepatitis C and B were found in 14.3% and 6.7% of the population, including both. Public health issues are being raised by the higher numbers of hepatitis B surface antigens and hepatitis C virus in Nawabshah. Precautionary action must be taken immediately [16].
This study aims to examine cost-effectiveness of community-born screening and early treatment with antiviral therapy for HBV in The Gambia. In Gambia, the prevalence of HBsAg is 8.8% in people older than 30 years. Adult community-born screening and treatment for HBV in The Gambia is likely to be a cost-effective intervention [17].
In the United States, a community-born study was conducted to assess attitudes about HCV screening and knowledge about HCV disease at several sites that serve high-risk populations. 140 participants were surveyed. Baseline hepatitis C knowledge was poor. However, brief educational intervention improved knowledge and raised acceptability of testing [18].
The study regarding HIV and hepatitis C viral screening practices in a geographic disease sample of American community Health Centers. It involves the complete survey of their attitudes and beliefs about HIV and HCV testing. Statistics were generated to describe the prevalence of HIV and HCV and associated demographics by CHCs. HCV prevalence ranged from 0.1–3.7%. Additional education and counseling may facilitate increased screening rates [19].
A prospective community-wide screening was conducted to assess rates of chronic HBV and HCV infections among Somali, Liberian, and Kenyan immigrants in Minnesota. Out of 853 participants, 13.5% had chronic HBV infection while 7% of them had HCV infection. Chronic HBV and HCV are major health problems among African immigrants. Community-based screening is effective to identify and provide health education for those who are at risk of viral hepatitis [20].
A street outreach study was conducted to assess the prevalence of HCV infection among many homeless PWUDs in Tel Aviv, detect risk factors for HCV infection, evaluate knowledge of the disease status, and measure the probability of connection to care. Data showed that HCV infection is very common in PWUDs who are homeless. Importantly, it was discovered there was startlingly limited access to care in this cohort despite relatively high awareness of HCV status. To stop the spread of HCV, these findings inspire new therapeutic strategies aimed at enhancing accessibility and conformity among homeless PWUDs [21].
A study conducted an evidence review to determine the burden of hepatitis C information in the immigrant population and to assess effectiveness of screening and treatment programs for chronic hepatitis C infection in Canada for the Canadian collaboration for immigrant and refugee’s health. Immigrants had a high prevalence of chronic hepatitis C infection as compared to the Canadian-born population. They are also at increased risk of mortality from complications of Cirrhosis and hepatocellular carcinoma. Treatment of chronic HCV in those with Cirrhosis eliminated the risk of liver failure [22].
A cross-sectional survey-based study was conducted among healthcare workers of the Federal Medical Center Bida, Nigeria to assess knowledge, awareness, and prevalence of viral hepatitis. About 248 individuals participated in this study. Overall awareness of the various types of hepatitis was 70.6% with a marked trend over educational level. There is a need to provide education to raise awareness and knowledge among this group [23].
A cross sectional study was conducted to assess awareness and knowledge of hepatitis B infection in selected areas of Puchong, Malaysia. Out of 400 subjects, 48.5% were not aware, and 66.5% had never taken vaccine for hepatitis B. Overall, the level of awareness and knowledge was low. This low level should be improved through health education and frequent vaccination program for hepatitis B among public, especially in Puchong, Malaysia [24].
A cross-sectional study was done in Nigeria, antenatal clinics in six different geopolitical zones recruited 159 pregnant women who agreed to undergo antihepatitis C virus testing, which was then validated using the polymerase chain reaction method. Out of 159, 99 pregnant women in Nigeria are not well informed about hepatitis C virus infection, and those 77, who are informed, are more likely to be young and highly educated. High hepatitis C virus infection rates serve as early support for the need for routine prenatal screening.
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3. Materials and methods
A cross sectional study was conducted including 560 people from rural areas. A nonprobability technique of sampling was used (using convenient sampling). The duration of study was from May 2018 to September 2018.
Inclusion criteria: Male and female having an age above 16 years. Who attends hepatitis screening and awareness camps?
Exclusion criteria: people below 16 years of age.
Methodology: First of all, we engaged different doctors who were gastroenterologist in their profession. They facilitated our project. Then, with the assistance of Hilton Pharmaceuticals, we arranged hepatitis screening and awareness camps in different communities of rural areas of Lahore like Taj bhag, Nawab pura, Hameed Pura, SA Rehman darogah wala, and Sadar (Naseer Hospital). In these camps, we screened approximately 600 people from which 560 people respond to our questionnaire. In every camp, we arranged three counters, at first counter, screening of hepatitis B and C was done, at second counter, questionnaire evaluating disease and knowledge was filled and at the third counter results of Screening were intimated to community population. After that, people with negative screening results were referred to our group members for awareness regarding prevention of hepatitis, and people with positive screening results were referred to doctor Jameel who is the owner of Al Maki Al Madni Trust. In this Trust, they were provided with hepatitis treatment at discount or free of charge to the needy patients.
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4. Results
A total of 600 questionnaires were distributed and 560 were returned, giving a response rate of 93.3%. The very high response rate might be due to face-to-face interaction with the study participants. Non-respondents were not followed up. The demographic profile of study participants, including frequencies of gender, marital status, screening results, etc. are shown in following Table 1.
| Variables | N (%) |
|---|---|
| 1. Gender | |
| Male | 165 (29.5%) |
| Female | 395 (70.5%) |
| 2. Marital status | |
| Single | 62 (11.1%) |
| Married | 498 (88.9%) |
| 3. Occupation | |
| Unemployed | 73 (13%) |
| Government employee | 24 (4.3%) |
| Private job | 149 (26.6%) |
| House wife | 314 (56.1%) |
| 4. Education qualification | |
| Primary (upto 12 years) | 379 (67.7%) |
| Secondary (upto 17 years) | 63 (11.3%) |
| Undergraduate | 17 (3%) |
| Post graduate | 16 (2.9%) |
| Illiterate | 85 (15.2%) |
| 5. Socioeconomic status | |
| No income | 111 (19.8%) |
| <5000 | 33 (5.9%) |
| 5000–10,000 | 113 (23.8%) |
| 10,000–20,000 | 189 (33.8%) |
| >20,000 | 94 (16.8%) |
| 6. Screening Test Result | |
| B +ve | 18 (3.2%) |
| C +ve | 104 (18.6%) |
| Both –ve | 421 (75.2%) |
| Both +ve | 17 (3%) |
Table 1.
Descriptive statistics for each item in the questionnaire are given in Tables 1–6. Table 1 is related to the demographic profile of the study participants. In our study, females participated more as compared to the males, such as 395 (70.5%) participated and from which 498 (88.9%) were married and 314 (56.1%) were housewives. Socioeconomic status of 189 (33.8%) was from 10,000 to 20,000. The prevalence of hepatitis B was found to be 18(3.2%), hepatitis C 104 (18.6%), and both positive 17 (3%). It showed the high prevalence of hepatitis C.
| Domain | Ques no. | Yes | No | Don’t know |
|---|---|---|---|---|
| Knowledge | 1 | 275 (49.1%) | 148 (26.4%) | 137 (24.5%) |
| 2a | 66 (11.8%) | 140 (25%) | 354 (63.2%) | |
| 2b | 82 (14.6%) | 118 (21.1%) | 360 (64.3%) | |
| 2c | 6 (1.1%) | 174 (31.1%) | 380 (67.9%) | |
| 3a | 98 (17.5%) | 106 (18.9%) | 356 (63.6%) | |
| 3b | 155 (27.7%) | 74 (13.2%) | 331 (59.1%) | |
| 3c | 149 (26.6%) | 76 (13.6%) | 335 (59.8%) | |
| 4 | 65 (11.6%) | 107 (19.1%) | 388 (69.3%) | |
| 5 | 139 (24.8%) | 199 (35.5%) | 222 (39.6%) | |
| 6a | 96 (17.1%) | 47 (8.4%) | 417 (74.5%) | |
| 6b | 69 (12.3%) | 52 (9.3%) | 439 (78.4%) | |
| 6c | 49 (8.8%) | 58 (10.4%) | 453 (80.9%) | |
| 6d | 107 (19.1%) | 45 (8%) | 408 (72.9%) | |
| 6e | 64 (11.4%) | 55 (9.8%) | 441 (78.8%) | |
| 6f | 44 (7.9%) | 56 (10%) | 460 (82.1%) | |
| 7 | 249 (44.5%) | 82 (14.6%) | 229 (40.9%) | |
| 8 | 39 (7%) | 238 (42.5%) | 483 (50.5%) | |
| 9a | 11 (2%) | 74 (13.2%) | 475 (84.8%) | |
| 9b | 81 (10.9%) | 48 (8.6%) | 451 (80.5%) | |
| 9c | 9 (1.6%) | 71 (12.7%) | 480 (85.7%) | |
| 10a | 4 (0.7%) | 62 (11.1%) | 494 (88.2%) | |
| 10b | 48 (8.6%) | 46 (8.2%) | 466 (83.2%) | |
| 10c | 18 (3.2%) | 60 (10.7%) | 482 (86.1%) | |
| Do you think you can get hepatitis? | 193 (34.5%) | 367 (65.5%) | 0 (0%) |
Table 2.
Responses to hepatitis knowledge items.
| Domain | Ques No. | Definitely agree | Moderately agree | Neutral | Moderately disagree | Definitely disagree |
|---|---|---|---|---|---|---|
| Attitude | 1 | 247 (44.1%) | 12 (2.1%) | 247 (44.1%) | 12 (2.1%) | 42 (7.5%) |
| 2 | 90 (16.1%) | 9 (1.6%) | 307 (54.8%) | 26 (4.6%) | 128 (22.9%) | |
| 3 | 336 (60%) | 8 (1.4%) | 190 (33.9%) | 6 (1.1%) | 20 (3.6%) | |
| 4 | 316 (56.4%) | 15 (2.7%) | 203 (36.3%) | 6 (1.1%) | 20 (3.6%) | |
| 5 | 322 (57.5%) | 10 (1.8%) | 201 (35.9%) | 4 (0.7%) | 23 (4.1%) | |
| 6 | 79 (14.1%) | 9 (1.6%) | 313 (55.9%) | 22 (3.9%) | 137 (24.5%) | |
| 7 | 171 (30.5%) | 10 (1.8%) | 308 (55%) | 15 (2.7%) | 56 (10%) | |
| 8 | 245 (43.8%) | 21 (3.8%) | 255 (45.5%) | 8 (1.4%) | 31 (5.5%) | |
| 9 | 277 (49.5%) | 14 (2.5%) | 218 (38.9%) | 15 (2.7%) | 36 (6.4%) | |
| 10 | 341 (60.9%) | 12 (2.1%) | 185 (33%) | 2 (0.4%) | 20 (3.6%) |
Table 3.
Attitude toward hepatitis.
| Domain | Ques no. | Always | Frequently | Sometimes | Rarely | Never |
|---|---|---|---|---|---|---|
| Practice | 1 | 108 (19.3%) | 24 (4.3%) | 73 (13%) | 28 (5%) | 327 (58.4%) |
| 2 | 160 (28.6%) | 4 (0.7%) | 28 (5%) | 12 (2.1%) | 356 (63.6%) | |
| 3 | 77 (13.8%) | 17 (3%) | 39 (7%) | 7 (1.3%) | 420 (75%) | |
| 4 | 486 (86.8%) | 11 (2%) | 22 (3.9%) | 4 (0.7%) | 37 (6.6%) | |
| 5 | 119 (21.3%) | 18 (3.2%) | 46 (8.2%) | 11 (2%) | 366 (65.4%) | |
| 6 | 107 (19.1%) | 10 (1.8%) | 35 (6.3%) | 12 (2.1%) | 396 (70.7%) | |
| 7 | 373 (66.6%) | 7 (1.3%) | 40 (7.1%) | 8 (1.4%) | 132 (23.6%) | |
| 8 | 279 (49.8%) | 11 (2%) | 30 (5.4%) | 8 (1.4%) | 232 (41.4%) | |
| 9 | 55 (9.8%) | 7 (1.3%) | 15 (2.7%) | 3 (0.5%) | 480 (85.7%) | |
| 10 | 40 (7.1%) | 16 (2.9%) | 26 (4.6%) | 12 (2.1%) | 466 (83.2%) |
Table 4.
Practice related to hepatitis.
| Q No. | TV | Internet | Magazine | HCP | Relative | Friend | Poster | Brochure | No where |
|---|---|---|---|---|---|---|---|---|---|
| 1 | 128 (22.9%) | 8 (1.4%) | 6 (1.1%) | 146 (26.1%) | 135 (24.1%) | 18 (3.2%) | 13 (2.3%) | 2 (0.4%) | 104 (18.6%) |
Table 5.
Information obtained regarding hepatitis.
| Ques No | Excellent | Good | Satisfactory | Unsatisfactory |
|---|---|---|---|---|
| 1 | 104 (18.6%) | 108 (19.3%) | 206 (36.8%) | 142 (25.4%) |
Table 6.
Role of government in prevention and treatment of hepatitis.
The responses of the participants toward the hepatitis knowledge were assessed by the questions focusing on the types of hepatitis, sign and symptoms, vaccination available, and oral treatment of hepatitis, Table 2. Out of 560 participants, 275 people (49.1%) knew the term of hepatitis. Two hundred twenty-two (39.6%) participants did not know about the sign and symptoms of hepatitis. The descriptive statistics showed that 451 (80.5%) did not know the availability of vaccination for hepatitis B. Attitude toward hepatitis was assessed by asking ten questions as shown in Table 3. Three hundred and thirty-six (60%) respondents strongly agreed that hepatitis can cause death. Out of 560 participants, 322 people (57.5%) strongly agreed that blood transfusion from hepatitis patients is the cause of hepatitis. In addition, 313 (55.9%) remained neutral on asking question no 6 that is; vaccination of hepatitis is only for children.
The practice toward hepatitis was assessed and described in Table 4. Descriptive statistics showed that 327 (58.4%) participants respond never to question to exercise. On asking if they avoid meeting hepatitis patients 420 (75%) respond on never. Three hundred and seventy-three (66.6%) participants said that they use filter plant water. In addition, 480 participants (85.7%) never vaccinated themselves.
Out of 560 participants, majority of the people (146) obtained information regarding hepatitis from the Health Care Professionals (HCP). In addition, 206 (36.8%) found the role of government satisfactory (Tables 7–9).
| Variable (N = 560) | Poor | Moderate | Good | #p-value |
|---|---|---|---|---|
| Gender | ||||
| Male | 153 (27.3%) | 12 (2.1%) | 0 | 0.416 |
| Female | 375(67%) | 19 (3.4%) | 1 (0.2%) | |
| Marital status | ||||
| Single | 57 (10.2%) | 4 (0.7%) | 1 (0.2%) | 0.017 |
| Married | 471 (84.1%) | 27 (4.8%) | 0 | |
| Occupation | ||||
| Unemployed | 67 (12%) | 6 (1.1%) | 0 | 0.223 |
| Govt. servant | 24 (4.3%) | 0 | 0 | |
| Private job | 136 (24.3%) | 12 (2.1%) | 1 (0.2%) | |
| Housewife | 301 (53.8%) | 13 (2.3%) | 0 | |
| Educational qualification | ||||
| Primary | 364 (65%) | 15 (2.7%) | 0 | 0.014 |
| Secondary | 53 (9.5%) | 9 (1.6%) | 1 (0.2%) | |
| Undergraduate | 16 (2.9%) | 1 (0.2%) | 0 | |
| Postgraduate | 15 (2.7%) | 1 (0.2%) | 0 | |
| Illiterate | 80 (14.3%) | 5 (0.9%) | 0 | |
| Socioecnomic status | ||||
| No income | 107 (19.1%) | 4 (0.7%) | 0 | 0.465 |
| <5000 | 33 (5.9%) | 0 | 0 | |
| 5000–10,000 | 126 (22.5%) | 7 (1.3%) | 0 | |
| 10,000–20,000 | 177 (31.6%) | 11 (2%) | 1 (0.2%) | |
| >20,000 | 85 (15.2%) | 9 (1.6%) | 0 | |
| Screening test result | ||||
| B+ve | 18 (3.2%) | 0 | 0 | 0.521 |
| C+ve | 94 (16.8%) | 10 (1.8%) | 0 | |
| Both –ve | 400 (71.4%) | 20 (3.6%) | 1 (0.2%) | |
| Both +ve | 16 (2.9%) | 1 (0.2%) | 0 | |
Table 7.
Categorization of study population in different knowledge ranks by using chi-square test.
| Variable (N = 560) | Poor | Moderate | Good | #p-value |
|---|---|---|---|---|
| Gender | ||||
| Male | 102 (18.2%) | 46 (8.2%) | 17 (3%) | 0.558 |
| Female | 228 (40.7%) | 115 (20.5%) | 52 (9.3%) | |
| Marital status | ||||
| Single | 39 (7%) | 14 (2.5%) | 9 (1.6%) | 0.501 |
| Married | 291 (52%) | 147 (26.3%) | 60 (10.7%) | |
| Occupation | ||||
| Unemployed | 49 (8.8%) | 16 (2.9%) | 8 (1.4%) | 0.281 |
| Govt. servant | 10 (1.8%) | 8 (1.4%) | 6 (1.1%) | |
| Private job | 91 (16.3%) | 41 (7.3%) | 17 (3%) | |
| House wife | 180 (32.1%) | 96 (17.1%) | 38 (6.8%) | |
| Educational qualification | ||||
| Primary | 215 (38.4%) | 116 (20.7%) | 48 (8.6%) | 0.00 |
| Secondary | 30 (5.4%) | 17 (3%) | 16 (2.9%) | |
| Undergraduate | 12 (2.1%) | 4 (0.7%) | 1 (0.2%) | |
| Post graduate | 7 (1.3%) | 8 (1.4%) | 1 (0.2%) | |
| Illiterate | 66 (11.8%) | 16 (2.9%) | 3 (0.5%) | |
| Socioecnomic status | ||||
| No income | 58 (10.4%) | 38 (6.8%) | 15 (2.7%) | 0.377 |
| <5000 | 19 (3.4%) | 11 (2%) | 3 (0.5%) | |
| 5000–10,000 | 87 (15.5%) | 33 (5.9%) | 13 (2.3%) | |
| 10,000–20,000 | 116 (20.7%) | 52 (9.3%) | 21 (3.8%) | |
| >20,000 | 50 (8.9%) | 27 (4.8%) | 17 (3%) | |
| Screening test result | ||||
| B+ve | 10 (1.8%) | 5 (0.9%) | 3 (0.5%) | 0.004 |
| C+ve | 75 (13.4%) | 20 (3.5%) | 9 (1.6%) | |
| Both –ve | 240 (42.9%) | 125 (22.3%) | 56 (10%) | |
| Both +ve | 5 (0.9%) | 11 (2%) | 1 (0.2%) | |
Table 8.
Categorization of study population in different attitude ranks by using chi-square test.
| Variable (N = 560) | Poor | Moderate | Good | #p-value |
|---|---|---|---|---|
| Gender | ||||
| Male | 131 (23.4%) | 28 (5%) | 6 (1.1%) | 0.004 |
| Female | 354 (63.2%) | 36 (11.4%) | 5 (0.9%) | |
| Marital status | ||||
| Single | 53 (9.5%) | 9 (1.6) | 0 | 0.375 |
| Married | 432 (77.1%) | 55 (9.8%) | 11 (2%) | |
| Occupation | ||||
| Unemployed | 64 (11.4%) | 8 (1.4%) | 1 (0.2%) | 0.001 |
| Govt. servant | 20 (3.6%) | 4 (0.7%) | 0 | |
| Private job | 114 (20.4%) | 28 (5%) | 7 (1.3%) | |
| House wife | 287 (51.3%) | 24 (4.3%) | 3 (0.5%) | |
| Educational qualification | ||||
| Primary | 331 (59.1%) | 43 (7.7%) | 5 (0.9%) | 0.021 |
| Secondary | 53 (9.5%) | 8 (1.4%) | 2 (0.4%) | |
| Undergraduate | 10 (1.8%) | 5 (0.9%) | 2 (0.4%) | |
| Post graduate | 14 (2.5%) | 2 (0.4%) | 0 | |
| Illiterate | 77 (13.8%) | 6 (1.1%) | 2 (0.4%) | |
| Socioecnomic status | ||||
| No income | 89 (15.9%) | 18 (3.2%) | 4 (0.7%) | 0.096 |
| <5000 | 31 (5.5%) | 2 (0.4%) | 0 | |
| 5000–10,000 | 121 (21.6%) | 11 (2%) | 1 (0.2%) | |
| 10,000–20,000 | 169 (30.2%) | 17 (3%) | 3 (0.5%) | |
| >20,000 | 75 (13.4%) | 16 (2.9%) | 3 (0.4%) | |
| Screening test result | ||||
| B+ve | 17 (3%) | 0 | 1 (0.2%) | 0.126 |
| C+ve | 85 (15.2%) | 15 (2.7%) | 4 (0.7%) | |
| Both –ve | 370 (66.1%) | 45 (8%) | 6 (1.1%) | |
| Both +ve | 13 (2.3%) | 4 (0.7%) | 0 | |
Table 9.
Categorization of study population in different practice ranks by using chi-square test.
0 (0%)–12 (52%) Poor
13 (56%)–18 (78%) Moderate
19 (82%)–23 (100%) Good
The results of chi-square test showed a significant difference between the knowledge of single and married participants of the study (p = 0.017). According to marital status mean score, the single people had more knowledge than the married participants of the study. Another significant finding of the study was that although there was no significant difference between KAP of undergraduates and postgraduates; however, there was a statistically significant difference between knowledge of participants (p = 0.014) belonging to different educational categories (primary, secondary, and illiterate) as compared to undergraduates. Test result shows that participants belonging to undergraduate level showed high mean score on knowledge section than participants belonging to postgraduate level. Chi-square test results revealed that there is no significant difference in knowledge of male and female (p = 0.416) but the mean score value of male participants was greater than compared to females. The other demographic factors of knowledge section, such as occupation, socioeconomic status, and screening test results also showed nonsignificant p-values of 0.223, 0465, and 0.521, respectively.
# p-value calculated by using chi-square test.
0 (0%)
6 (60%)–7 (70%) Moderate
8 (80%)–10 (100%) Good
In the attitude section of current KAP study, two demographic factors, educational qualification, and screening test results have significant p-values. Chi-square test result of educational qualification (p-value = 0.00) showed that there was almost no significant difference between KAP of undergraduates and postgraduates; however, there was statistically significant difference between attitudes of participants belonging to different educational categories (primary, secondary, and illiterate) as compared to undergraduates and postgraduates. Chi-square results of screening test results indicate a significant difference (p = 0.004) in the attitude of people having B+, C+, and both +ve -ve. The most positive attitude was seen among the participants having positive hepatitis B and hepatitis C. The poorest attitude was seen among the participants having both hepatitis B and C negative. And the other demographic factors of attitude section, such as gender, marital status, occupation, and socioeconomic status, showed non-significant chi-square test results with p-value of 0.558, 0.501, 0.281, and 0.377, respectively.
# p-value calculated by using chi-square test.
0 (0%)–5 (50%) Poor
6 (60%)–7 (70%) Moderate
8 (80%)–10 (100%) Good
The practice section also revealed significant values of three demographic factors. According to the gender section chi-square test result (p = 0.004), there was a significant relation in the practice of male and female participants of the study. Mean score of male shows better practice of male participants toward hepatitis B and C. Another significant value was seen among the participants associated with different levels of occupation. A significant difference (p = 0.001) was observed in the practice of these groups (unemployed, government servants, private jobs, and housewives). And the third significant value in practice domain of KAP was seen in educational qualification (p = 0.021) with undergraduates having better practice among all other levels of qualification. Other demographic factors of practice domain, such as marital status, socioeconomic status, and screening test results, showed non-significant chi-square test results with p-values 0.375, 0.096, and 0.126, respectively.
# p-value calculated by using chi-square test.
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5. Discussion
This study was done to evaluate the KAP toward hepatitis B and C among different community populations. Firstly, in this study, there is no age grouping for study participants, only people with age less than 16 years are not included in this study. Above 16 year of age participants are included in current study. Second prospect of this study was to evaluate knowledge, different attitudes, and practices of literate and illiterate community toward hepatitis B and C. In this study, we also look for the socioeconomic status of study participants. To evaluate how much of the community was non-affording. A scoring system was developed and scores of participants for each domain were analyzed and co-related with various demographic factors, also for each domain participants have been categorized according to their scores. Results of this study revealed that demographic factor gender showed no significant difference in knowledge and attitude of male and female candidates, but the practice of these two categories showed significant value of chi-square (p = 0.004). According to marital status, the single people had more knowledge than the married participants in this study. The results of chi-square test showed a significant difference between the knowledge of these two groups (p = 0.017), but there was no significant difference between the attitude and practice of the married and single participants in this study. Another significant finding of the study was that although there was no significant difference between KAP of undergraduates and postgraduates, there was statistically significant difference between knowledge of participants belonging to different educational categories (primary, secondary, and illiterate), as compared to undergraduates. Current study shows that participants belonging to undergraduate level showed high mean score on knowledge and practices section than participants belonging to postgraduate level. The study has attempted to shed light on KAP by engaging study participants from different levels of education (primary, secondary, undergraduates, postgraduates, and illiterate). As the p values of knowledge, attitude, and practice were 0.014, 0.00, and 0.021, respectively. These results clearly showed a significant difference between the knowledge, attitude, and practice of the participants belonging to different levels of education. One of the important findings of study was the evaluation of knowledge attitude and practice among the participants according to screening test results. Chi-square results indicate significant difference (p = 0.004) in the attitude of people having B+, C+, and both +ve and -ve. The most positive attitude was seen among the participants having positive hepatitis B and C. But there was no significant difference between knowledge and practice among these groups. The poorest knowledge, attitude, and practice were seen among the participants having both hepatitis B and C negative. Another significant value was seen among the participants associated with different levels of occupation. A significant difference was observed in the practice (p = 0.021) of these groups (unemployed, government servants, private jobs, and housewives). There was no significant difference in knowledge and attitude; however, the mean score value showed that government servants had better knowledge and attitude; whereas, according to the mean scores, the knowledge, attitude, and practice of housewives were poorest among all. According to health belief model, the perception of disease and probability of adoption of positive practices and attitude of an individual depends on four important variables, that is, perceived seriousness of a disease, susceptibility of a disease, perceived benefits of positive attitude and practice, and lastly, perceived barriers that might restrain an individual to make positive changes [25]. A common negative attitude that was observed among study participants was low perceived seriousness of hepatitis B and C, financial barriers, and lack of time and knowledge about disease treatment and vaccination. Due to these barriers and somehow due to superstitious thoughts of people about hepatitis, people did not agree to get treatment. According to a previous study of WHO in 2015, only 3–5% of infected individual receive treatment annually, worldwide. About 75% of infected individuals are not aware of their HCV positive status and remain undiagnosed. This cause a huge economic impact cost for government, society, and also for patient. As with the progression of ailment, cost also increases [26].
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6. Conclusion
Current study concluded that people are unaware about the causes, prevention, and treatment of hepatitis B and C. People who are with positive signs and symptoms of hepatitis are reluctant to its long-term treatment. Government must arrange awareness campaigns and screening camps in communities to educate people about the importance of prevention and treatment of the disease.
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