Knowledge, attitudes and practices of undergraduate health sciences students on hepatitis B vaccination at a South African university highlight the need for improvement of policies, implementation and co-ordination
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i5.16556Keywords:
Hepatitis B virus, vaccine coverageAbstract
Background. Hepatitis B virus (HBV) infection causes nearly 300 million chronic infections globally. Healthcare workers face up to four times the risk of HBV infection through occupational exposure to contaminated blood and bodily fluids. Health sciences students (HSSs) are regarded as at an even greater risk as they embark on their clinical training journey. While chronic hepatitis B is incurable, it can be prevented by the safe and effective hepatitis B vaccine (HepB). The South African National Department of Health recommends at least three doses of vaccine (HepB3) for HSSs before patient contact. However, data on policy implementation at training institutions, vaccine coverage and HBV immunity in HSSs are lacking or limited.
Objectives. To investigate knowledge, attitudes and practices of HSSs at the University of the Witwatersrand (Wits) in relation to international guidelines and institutional HepB programmes included in the Wits vaccination policy. Sociodemographic factors predicting HepB uptake were also investigated.
Methods. A cross-sectional study was conducted between February and June 2021. An electronic, self-administered survey was emailed to all current HSSs (N=3 785). The survey included questions on sociodemographic characteristics, knowledge of and attitudes towards HepB- related international guidelines and Wits policies, and HepB uptake and vaccine practices at Wits. Descriptive statistical analyses, followed by multivariable regression modelling, were used to identify factors associated with HepB uptake.
Results. A response rate of only 7.1% yielded 269 returned surveys, of which 221 were adequate for analysis. Most respondents were female (69.2%), with a mean (standard deviation) age of 22.5 (3.5) years, and were studying a Bachelor of Medicine and Surgery (MB BCh) degree (76.9%). Only 78% of those students who reported a history of vaccination (89.1% of study sample) reported a completed vaccine series. The only significant predictor, when adjusted for interactions, was being enrolled in MB BCh compared with other courses (odds ratio 4.69; p=0.026). Students displayed higher levels of knowledge around institutional (Wits) vaccine recommendations (94.1%) compared with international recommendations (75.6%). Most students were in favour of mandatory vaccination (91.4%), but not of serological testing following vaccination (42.5%). Half of our students received vaccinations in private facilities, but no follow-up or record was made of this by the designated Wits Campus Health and Wellness Centre.
Conclusion. Institutional HepB policies are suboptimal, with no centralised co-ordination or implementation strategy. Urgent efforts are required to create awareness around policy and management, ensure vaccination coverage in this high-risk group, and foster positive practices with adequate monitoring.
References
World Health Organization. Global hepatitis report, 2017. Geneva: WHO, 2017. https://www.who.int/ publications-detail-redirect/global-hepatitis-report-2017 (accessed 5 November 2021).
World Health Organization. Global progress report on HIV, viral hepatitis and sexually transmitted infections, 2021. Geneva: WHO, 2021. https://www.who.int/publications-detail- redirect/9789240027077 (accessed 23 November 2021).
Alter MJ. Epidemiology of viral hepatitis and HIV co-infection. J Hepatol 2006;44(1 Suppl):S6-S9.
https://doi.org/10.1016/j.jhep.2005.11.004
Centers for Disease Control and Prevention. Hepatitis B FAQs. Atlanta: CDC, 2020. https://www.cdc.
gov/hepatitis/hbv/bfaq.htm (accessed 2 February 2022).
Bond WW, Favero MS, Petersen NJ, Gravelle CR, Ebert JW, Maynard JE. Survival of hepatitis B virus
after drying and storage for one week. Lancet 1981;1(8219):550-551. https://doi.org/10.1016/s0140-
(81)92877-4
Schweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ. Estimations of worldwide prevalence of chronic hepatitis B virus infection: A systematic review of data published between 1965 and 2013. Lancet 2015;386(10003):1546-1555. https://doi.org/10.1016/S0140-6736(15)61412-X
Suk‐Fong Lok A. Hepatitis B treatment: What we know now and what remains to be researched. Hepatol Commun 2018;3(1):8-19. https://doi.org/10.1002/hep4.1281
Expanded programme on immunisation. Global Advisory Group – part I. Weekly Epidemiol Rec 1992;67:11-15. https://apps.who.int/iris/handle/10665/228245 (accessed 25 January 2022).
World Health Organization. Hepatitis B Fact Sheet. Geneva: WHO, 2021. https://www.who.int/news- room/fact-sheets/detail/hepatitis-b (accessed 5 November 2021).
De Villiers MJ, Nayagam S, Hallett TB. The impact of the timely birth dose vaccine on the global elimination of hepatitis B. Nat Commun 2021;12(1):6223. https://doi.org/10.1038/s41467-021-26475-6
Edmunds J, Jones E, Apolloni A, et al. Estimating the impact of HBV vaccination policies, 2016. https:// www.who.int/immunization/sage/meetings/2016/october/Session9-Estimating-the-impact-of-HBV- vaccination-policies.pdf (accessed 2 November 2021).
West DJ. The risk of hepatitis B infection among health professionals in the United States: A review. Am J Med Sci 1984;287(2):26-33. https://doi.org/10.1097/00000441-198403000-00006
Prüss-Ustün A, Rapiti E, Hutin Y. Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. Am J Ind Med 2005;48(6):482-490. https:// doi.org/10.1002/ajim.20230
Byrne EB. Viral hepatitis: An occupational hazard of medical personnel: experience of the Yale-New Haven Hospital, 1952 to 1965. JAMA 1966;195(5):362-364. https://doi.org/10.1001/ jama.1966.03100050070021
Shepard CW, Simard EP, Finelli L, Fiore AE, Bell BP. Hepatitis B virus infection: Epidemiology and vaccination. Epidemiol Rev 2006;28(1):112-125. https://doi.org/10.1093/epirev/mxj009
Schmid K, Schwager C, Drexler H. Needlestick injuries and other occupational exposures to body fluids among employees and medical students of a German university: Incidence and follow-up. J Hosp Infect 2007;65(2):124-130. https://doi.org/10.1016/j.jhin.2006.10.002
Musekene E, Modjadji P, Madiba S. The occurrence and contributing factors of needle stick and sharp injuries among dental students in a South African university. Open Public Health J 2020;13(1). https:// doi.org/10.2174/1874944502013010126
Sharma GK, Gilson MM, Nathan H, Makary MA. Needlestick injuries among medical students: Incidence and implications. Acad Med 2009;84(12):1815-1821. https://doi.org/10.1097/ ACM.0b013e3181bf9e5f
Yang Y-H, Wu M-T, Ho C-K, et al. Needlestick/sharps injuries among vocational school nursing students in southern Taiwan. Am J Infect Control 2004;32(8):431435. https://doi.org/10.1016/j. ajic.2004.02.007
World Health Organization. Hepatitis B vaccines: WHO position paper, July 2017 – recommendations. Vaccine 2019;37(2):223-225. https://doi.org/10.1016/j.vaccine.2017.07.046
Fernandes L, Burnett RJ, François G, Mphahlele MJ, Van Sprundel M, De Schryver A. Need for a comprehensive, consistently applied national hepatitis B vaccination policy for healthcare workers in higher educational institutions: A case study from South Africa. J Hosp Infect 2013;83(3):226-231. https://doi.org/10.1016/j.jhin.2012.11.026
Aspinall S, Kocks DJ. Immunogenicity of a low-cost hepatitis B vaccine in the South African Expanded Programme on Immunisation. S Afr Med J 1998;88(1):36-39.
World Health Organization. WHO-UNICEF coverage estimates HepB3: Immunisation, Vaccines and Biologicals. Vaccine-preventable diseases: monitoring system 2020 global summary. Geneva: WHO, 2020. https://apps.who.int/immunization_monitoring/globalsummary/timeseries/ tswucoveragehepb3.html (accessed 17 February 2022).
National Department of Health, South Africa. National guidelines for the management of viral hepatitis. Pretoria: NdoH, 2020. https://sahivsoc.org/Files/SA%20NDOH_Viral%20Hepatitis%20 guideilnes%20final_.pdf (accessed 5 November 2021).
Primary Healthcare (PHC) Standard Treatment Guidelines and Essential Medicines List for South Africa, 2020. https://www.knowledgehub.org.za/elibrary/primary-healthcare-phc-standard- treatment-guidelines-and-essential-medicines-list-south (accessed 5 November 2021).
Roux CL, Dramowski A. South African undergraduate health science students’ knowledge, attitudes, practices and preferences regarding vaccination. Wits J Clin Med 2019;1(2):81-88.
Madiba T, Nkambule N, Kungoane T, Bhayat A. Knowledge and practices related to hepatitis b infection among dental and oral hygiene students at a university in Pretoria. J Int Soc Prev Community Dent 2018;8:200. https://doi.org/10.4103/jispcd.JISPCD_31_18
Ebert JF, Huibers L, Christensen B, Christensen MB. Paper- or web-based questionnaire invitations as a method for data collection: Cross-sectional comparative study of differences in response rate, completeness of data, and financial cost. J Med Internet Res 2018;20(1):e24. https://doi.org/10.2196/ jmir.8353
Greenlaw C, Brown-Welty S. A comparison of web-based and paper-based survey methods: Testing assumptions of survey mode and response cost. Eval Rev 2009;33(5):464-480. https://doi. org/10.1177/0193841X09340214
McCabe SE. Comparison of web and mail surveys in collecting illicit drug use data: A randomised experiment. J Drug Educ 2004;34(1):61-72. https://doi.org/10.2190/4HEY-VWXL-DVR3-HAKV
Galea S, Tracy M. Participation rates in epidemiologic studies. Ann Epidemiol 2007;17(9):643-653.
https://doi.org/10.1016/j.annepidem.2007.03.013
Haile K, Timerga A, Mose A, Mekonnen Z. Hepatitis B vaccination status and associated factors among students of medicine and health sciences in Wolkite University, Southwest Ethiopia: A cross-sectional study. PLOS One 2021;16(9):e0257621. https://doi.org/10.1371/journal.pone.0257621
Launay O, Le Strat Y, Tosini W, et al. Impact of free on-site vaccine and/or healthcare workers training on hepatitis B vaccination acceptability in high-risk subjects: A pre-post cluster randomised study. Clin Microbiol Infect 2014;20(10):1033-1039. https://doi.org/10.1111/1469-0691.12689
Vo TQ, Nguyen LHT, Pham MN. Exploring knowledge and attitudes toward the hepatitis B virus: An internet-based study among Vietnamese healthcare students. J Pharm Pharmacogn Res 2018;6(6):458- 470. https://jppres.com/jppres/knowledge-attitudes-of-healthcare-students-toward-hbv/ (accessed 9 January 2022).
Machmud PB, Glasauer S, Gottschick C, Mikolajczyk R. Knowledge, vaccination status, and reasons for avoiding vaccinations against hepatitis b in developing countries: A systematic review. Vaccines 2021;9(6):625. https://doi.org/10.3390/vaccines9060625
Pathoumthong K, Khampanisong P, Quet F, Latthaphasavang V, Souvong V, Buisson Y. Vaccination status, knowledge and awareness towards hepatitis B among students of health professions in Vientiane, Lao PDR. Vaccine 2014;32(39):4993-4999. https://doi.org/10.1016/j.vaccine.2014.07.022
Ochu CL, Beynon CM. Hepatitis B vaccination coverage, knowledge and sociodemographic determinants of uptake in high risk public safety workers in Kaduna State, Nigeria: A cross sectional survey. BMJ Open 2017;7(5):e015845. https://doi.org/10.1136/bmjopen-2017-015845
Diekema DJ, Ferguson KJ, Doebbeling BN. Motivation for hepatitis B vaccine acceptance among medical and physician assistant students. J Gen Intern Med 1995;10(1):1-6. https://doi.org/10.1007/ BF02599567
Adjei Gyimah A, Peprah P, Agyemang-Duah W, Frimpong E, Kwegyir Tsiboe A, Aboagye Darkwa M. Hepatitis B vaccination status and associated factors among university students in Ghana: A cross- sectional survey. Cogent Med 2021;8(1):2005226. https://doi.org/10.1080/2331205X.2021.2005226
Downloads
Published
Issue
Section
License
Copyright (c) 2023 N Makan
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
