| Abstract|| |
Background: Hepatitis B is a major health problem in India. To prevent transmission and progression of the disease in the community, proper community awareness about the disease, including prevention, is necessary. Our objective was to study the awareness amongst the general population about hepatitis B virus, including knowledge regarding vaccine.
Materials and Methods: The study was conducted in Department of Gastroenterology of SCB Medical College. The patients attending the OPD and their attendants were subjected to a questionnaire about different aspects of hepatitis B. Binary logistic regression analysis (SPSS 16) was employed to assess the statistical importance of the observations.
Results: In all, 682 individuals (65% patients, 35% non-patients) were studied; 78% were males while 22% were females. Majority were in the age group of 31-40 years. 65% hailed from rural area; 65% were poor. About half of the subjects attended state run medical centers for medical attention; only 17% preferred medical colleges. Awareness about the disease and the vaccine among the subjects was 38% and 32%, respectively. 50% of those who were aware had no knowledge about route of transmission, infectivity, or importance of vaccination. Educated individuals were more aware about hepatitis B vaccine (P < 0.05). Those who read newspaper and listened to radio were more aware about hepatitis B (P < 0.05), and its vaccine (P < 0.05). The percentage of vaccination was 20% among study subjects, but in 30%, their children were vaccinated. The common reason for non-vaccination was lack of awareness (50%); of them, 60% blamed government/doctors/media for their ignorance. Majority (56%) received the vaccine from government hospitals or health centers. Only (10%) obtained vaccination from private centers. Reasons cited for non-vaccination included ignorance (50%), carelessness (12%), high cost (10%), and nonavailability (6%). Source of information regarding hepatitis B included television (75%), newspapers (55%), and radio (26%).
Conclusions: Only about one-third of the population in coastal Eastern India are aware about hepatitis B and its vaccine. Less than a third of the population are vaccinated for hepatitis B. The educated, especially those who read newspapers and listened to radio, were more aware about the disease/vaccine. The government health agencies and physicians should work together to educate the masses about hepatitis B and its vaccine.
Keywords: Awareness, education, hepatitis B, hepatitis B virus, hepatitis B vaccine, knowledge, mass media
|How to cite this article:|
Misra B, Panda C, Das HS, Nayak KC, Singh SP. Study on awareness about Hepatitis B viral infection in coastal Eastern India. Hep B Annual 2009;6:19-28
| Introduction|| |
Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide.  Its prevalence in India and many other parts of the Asia pacific region is quite high. More than 1,000,000 Indian children run a lifetime risk of becoming chronic carriers and about 100,000 Indians die from HBV complications annually.  During the course of hepatitis B virus (HBV) infection, an estimated 15-40% of CHB patients would develop complications such as acute exacerbation, liver cirrhosis and hepatocellular carcinoma (HCC). ,, The HBV is present in high concentration in blood, serum, serous exudates, saliva, semen, vaginal fluid and most body fluids.  However, perinatal transmission is believed to be the most important mode in regions with intermediate and high HBV prevalence rates; in contrast, sexual transmission is the predominant route among adolescents in low prevalence and developed countries.  Moreover, most of the babies born to mothers who are carriers of HBV also become carriers. About 25% of the babies who are infected with HBV subsequently develop severe chronic liver disease or even liver cancer.  India has a population of approximately 1000 million of which about 30 million people are carriers of HBV infection. HBV is responsible for about 68% of cirrhosis and 80% of HCC in India. A decision-analytical model estimates that in India, vaccination would save 25 lives per 100,000 population per year.  The awareness of HBV infection and its vaccine in our country is believed to be very poor; however, there are no published study/data on the community awareness about HBV infection and its vaccine from India. In the present study, we have made an attempt to know about the awareness of HBV infection and its vaccine amongst the general population and the relation of the socioeconomic and educational status with awareness about HBV infection and its vaccine.
| Materials and Methods|| |
The present study was conducted in the Department of Gastroenterology, SCB Medical College and Hospital at Cuttack in coastal eastern India. Patients and their attendants attending the OPD of the gastroenterology department for various diseases were taken into study. A questionnaire was developed to assess the knowledge of general population regarding HBV infection and its vaccine. The questionnaire was designed to assess the demographic status of the study subjects, including the educational status, socioeconomic status, knowledge about HBV infection and the HBV vaccine, source of the awareness, vaccination status of the study group, their children, and family members, and reasons for non-vaccination, and the perceived culpability for lack of awareness (government/media/doctors/personal) about existence/necessity of vaccine. The questionnaire was explained to them in detail and their opinions were recorded by a health worker. After compilation, the data were analyzed using software SPSS 16 and application of binary logistic regression analysis.
| Results|| |
The present study population included 682 individuals (65% patients; 35% non-patients accompanying the patients). Of these, 78% were males and 22% were females. 48% were in the age group of 31-40 years. Two-thirds of the study population (65%) were from rural regions. Besides, two-thirds (65%) were poor, belonging to the "below poverty limit" (BPL) category [Figure 1]. It was also observed that about half of the study subjects attended state run primary health centers (PHCs) only for seeking medical attention, while only 17% visited medical colleges for treatment of diseases. Awareness about the disease and the vaccine among the subjects was only 38% and 32%, respectively. Further, only about 40% of the "aware" population had proper knowledge about the disease; but unfortunately, over 50% of those who were "aware" did not have adequate knowledge about route of transmission, infectivity, or importance of vaccination [Table 1].
The educational status of the study population was classified into six categories, and the educational break-up of the study population was as follows: illiterate (4%), middle school (5%), matriculate (19%), graduate (26%), postgraduates (34%), and professionals (12%). Those who were better educated had greater awareness about HBV infection (P < 0.05) and its vaccine (P < 0.05) as depicted in [Table 2]. The role of mass media in awareness of HBV infection and its vaccination was also studied [Table 3]. Majority (75%) of the study population watched television. In the study, the proportion of subjects who read newspapers, listened to radio, and read English magazines was 55%, 52%, and 26%, respectively. Besides, it was observed that those who read newspapers and listened to radio had greater awareness about hepatitis B (P < 0.05) and its vaccine (P < 0.05).
|Table 2: Effect of educational status on awareness of hepatitis B and its vaccine|
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Analysis of the vaccination rate showed that only 20% of the study subjects were vaccinated; however, children of 30% of the study population were vaccinated. The reasons cited by the study subjects for non-vaccination were also analyzed. The reasons cited for non-vaccination included ignorance (50%), fear of side effects (14%), carelessness (12%), high cost (10%), lack of awareness about the need and benefit of vaccination (8%) and nonavailability (6%), as shown in [Table 4]. Of the persons who were not aware about the existence or necessity of vaccine, 60% blamed the government/doctors/media for their ignorance, while 26% accepted personal liability for their ignorance. Majority (56%) received the vaccine from government associated hospitals or health centers, while only 10% received the vaccine from private institutions.
| Discussion|| |
HBV is probably the most important chronic viral infection affecting Indians. However, despite the development of an effective vaccine against HBV, this infection remains a serious threat to public health in India. The vast majority of our study population belonged to rural regions, hailed from very low socioeconomic status and depended on the state run PHC to get health service and for disease awareness. Awareness about the disease and the vaccine among the subjects was 38% and 32%, respectively, which is quite low and at par with other studies conducted in different parts of the world. ,,,,,,, There is only a solitary study reported from India on this subject. A study was conducted to know the knowledge, attitude and practices of married women in the reproductive age group in Jammu regarding HBV infection. Only 20% of the women were found aware of the mode of transmission of HBV. However, 50% of the women were having the misconceptions regarding mode of transmission of HBV. 4% of women, 30% of children up to 5 years and 15% of children above 5 years were fully immunized with hepatitis B vaccine. 80% of children up to 5 years and 75% of children above 5 years were fully immunized. This study had clearly demonstrated the level of ignorance and the low immunization rate with vaccine against HBV than that under universal immunization programme and emphasized the need for incorporation of the HBV immunization in the universal immunization programme at the earliest. 
Those who read newspapers and listened to radio were significantly more aware about the disease and vaccine. It is apparent that that media could play a vital role in promoting awareness and educating the community regarding the prevention of transmission of HBV, as reported earlier. ,,,,, The study clearly showed that those who were more educated were significantly more aware about HBV infection and its vaccine. Similar to earlier studies with HBV carriers, including the community-based study in Canadian subjects with tertiary (college) education, there was significant association of higher educational status with better knowledge/awareness about the disease. , This finding is not surprising as subjects with better education are more likely to have read or heard about HBV infection in schools or through the mass media. Besides, the subjects with better education were more likely to seek professional advice and understand the complexity of various aspects of HBV infection. The present study strengthens the belief that interventions to create awareness and public education measures to augment community awareness regarding HBV infection and its vaccine should especially target those with less or no education, and limited access to mass media. ,,, The success which can be achieved by media-based, community outreach campaign when combined with a physician office intervention was clearly shown by the intervention program targeting the Vietnamese community in northern California. Following a 1-year intervention, the percentage of adults who had heard of hepatitis B increased from 52 to 85% (P < 0.001) and the percentage who had received serologic testing increased from 24 to 48% (P < 0.001). Further, the childhood hepatitis B immunization rates too increased from 41 to 61% (P < 0.05) as a result of the intervention. 
| Conclusions|| |
Only about one-third of the population in coastal Eastern India are aware about hepatitis B and its vaccine. Less than a third of the population are vaccinated for hepatitis B. The educated, especially those who read newspapers and listened to radio, were more aware about the disease/vaccine. The government health agencies and physicians should work together to educate the masses about hepatitis B and its vaccine. The community should be informed that HBV infection can affect any age and can persist for one's whole life despite the best of available therapies and that the infected person may remain asymptomatic and undiagnosed for long periods, and the diseased person may develop chronic complications like liver failure and liver cancer. Emphasis should especially be laid on awareness campaigns to educate the public that hepatitis B is vaccine preventable disease and that it could be easily prevented by three simple, easily available, inexpensive shots of hepatitis B vaccine. The mass media should act more conscientiously and come forward to educate the community about this easily preventable infection.
| Acknowledgment|| |
Funding for this study was provided by the Kalinga Gastroenterology Foundation, Cuttack, India.
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Shivaram Prasad Singh
Department of Gastroenterology, Sriram Chandra Bhanja Medical College, Cuttack - 753007
[Table 1], [Table 2], [Table 3], [Table 4]