Awareness of Hepatitis B Infection among First Year College Students of Dammam University

Objectives: To determine the awareness of hepatitis B infection among first year college students of medical, nursing and community service of Dammam University and, to compare the knowledge level between them. Methods: A descriptive cross-sectional study was conducted on 485 first year medical nursing, and community service students of Dammam University (Eastern Province of Kingdom of Saudi Arabia). A self-administered questionnaire was distributed to all the students and their awareness on the definition, modes of transmission, diagnosis, complications, treatment availability and prevention of hepatitis B was obtained. [The data was entered and analyzed using SPSS 16 for Windows. Descriptive statistics with cross-tabulation were performed. The Chi square test, and t-test was used.] Results: Overall, 420 (86.6%) students correctly defined hepatitis B and 76.9% knew about the types of hepatitis. The majority of the students believed that hepatitis B was blood-borne but there was poor awareness about other modes of transmission. Less than one-fourth of the students knew about needle-stick injury from an infected patient, drug abuse, careless dental procedures and mother-to-child transmission of the disease. Prevention of the disease by vaccination was known to only 54.4 % of the students. Conclusion: The present study concludes that the majority of the students lacked knowledge regarding important modes of transmission. They also had poor knowledge about the complications and prevention of hepatitis B. Health education needs to be given to all students regarding this subject.


INTRODUCTION
Hepatitis B virus (HBV) is an important agent of hepatitis, cirrhosis and hepatocellular carcinoma.It accounts for one million deaths annually.It is estimated currently that more than two billion of the global population have HBV infection; of whom 350 million are chronically infected (1) .
The disease has a high endemicity in the Middle East and Saudi Arabia. (2)Many studies have shown that the patterns of hepatitis B in Saudi Arabia has changed.
The disease was highly endemic prior to1990 when the national strategy to eliminate hepatitis B infection through vaccination of all infants was introduced in Bull High Inst Public Health Vol.42 No. 1 [2012]   the Kingdom.This lead to a gradual decline in the incidence of hepatitis B mainly in children. (3)Prevalence of hepatitis B surface antigen (HBs AG) among children before this strategy was reported to be 6.7% and after implementation of the vaccination, the prevalence has dropped to 0.05%.however, the incidence among adults rose slightly perhaps, due to population growth. (3)Selected risk groups like blood donors in some studies have shown a high prevalence of hepatitis B among adult male Saudi blood donors in the north west (Tabuk) of Saudi Arabia (3%) and South-Western region (5.4%). (3,4)A report from Aramco hospital in the Eastern Province estimated the annual incidence of hepatitis "B" as 46 per 100.000population served by them. (6)in 2010, Memish et al, in his study, reported that HBV was the most frequent cause of viral hepatitis sero-positivity. (7)patitis B remains a major public health problem in Saudi Arabia and there is a need to strengthen the effective preventive  groups of students on this question was statistically significant (p 0.029) (table1)

Methods
Table 1 shows that the question on types of Hepatitis was answered correctly by 76.5% of the students.Most of them were medical students (89.6%), the difference between the three groups was found to be statistically significant (p 0.003).Also, the cause of hepatitis was answered correctly by 64.6% of medical students compared on lie 58.4% of the community service students, the difference was found to be statistically significant, (p=0.037).Table 4 shows that overall, more than half of the students (53.4%) believed that there was treatment for hepatitis B but recurrence was prevalent.There was no significant difference in the responses of the three groups of students (p=0.947).Knowledge of vaccine for prevention of hepatitis was also known to half of the students (54.4%) with more nursing students aware of it than their counterparts ().

DISCUSSION AND CONCLUSION:
The majority of the students defined hepatitis B correctly.Medical students knew more about the types and the causative agent of hepatitis than nonmedical students.Similar findings were reported by Al Jabrietal (8) and Duad et al (9) .(Sultanate of Oman) in which it was found that medical students were more knowledgeable than the non-medical students. (8)Also, Anjum et al reported that 95% of students responded that blood transfusion is an important mode of transmission. (10)erhaps, a better background of science at high school level  (11) Another study in India also reported that second year medical students had poor knowledge about transmission of hepatitis. (12)Knowledge of transmission of hepatitis B by needle stick accident is essential specially for medical and nursing students because they have an increased risk of this accident in their future careers and hence they need to be educated to exercise caution in handling needles.Lack of Knowledge of transmission of hepatitis from the mother to the child is similar to a study done among first year nursing and medical students in a university of North India. (13)significantly larger proportion of medical and nursing students had knowledge about the diagnosis of hepatitis compared to community service students and this finding is similar to that of a study done among university students in India, where it was found that biological science university students had better knowledge than non-biological sciences students regarding health topics (14) .

Regarding
It was encouraging to note that a majority of students knew that there was treatment available for Hepatitis B but disappointing to learn that about half of students were not aware that the disease could be prevented by vaccination.This is an unexpected finding considering it is well known that hepatitis B vaccination was introduced as a mandatory procedure to all infants in the kingdom in 1990. (3)Also our findings is lower than a study by Khan et al who reported 75% of first year medical students were aware of hepatitis B vaccine (15) .
The present study concludes that in general, the awareness for hepatitis B among the first year medical students is better than that for nursing or community measures.However, prior to any successful preventive program it is important to know the level of awareness of the population regarding the disease.This will help in planning needbased health education activities for the people among other preventive measures.Since it is expected that high school graduates have some basic knowledge about important prevalent diseases in the community.The objective of the current study was to determine the level of awareness of hepatitis B infection among first year female college students of medical, nursing and community service studying at Dammam University and to compare the knowledge level between students of the three different colleges.Any deficiencies in knowledge identified would be addressed by special health education sessions for this target group.
transmission of the infection, more medical students correctly regarded blood borne transmission, sexual relation, dentistry operation, sharing razors, tattooing as important modes of transmission of infection compared to the community service students.These findings were similar to a study in Muscat among medical students compared to nonmedical candidates explains this finding.Surprisingly the majority of the students had poor knowledge regarding transmission of the infection among drug abusers, mother to child transmission and accidental needle stick injury from infected patients.Only one-third of the medical students knew about these modes of transmission.A study performed in Pakistan reported insufficient knowledge about the transmission of hepatitis among pre-clinical years.
transmission of the disease.Overall, a majority of the students lacked knowledge regarding transmission of hepatitis B by accidental needle-stick injury, drug abuse, careless dental procedures and mother-to-child transmission.Moreover, many students had poor knowledge about the complications of hepatitis especially liver cancer and chronic hepatitis.Moreover, around half of the medical and nursing students were not aware of vaccination.Bull High Inst Public Health Vol.42 No.1 [2012] Students are one of the best groups to focus for health education.In Saudi Arabia, the curriculum of the high school students should include education on hepatitis B, modes of transmission and its prevention.Also; universities should conduct welldesigned awareness programs and workshops on hepatitis B. Health education at PHC centers should focus more on risk factors of transmission and prevention of spread of hepatitis B. Health education campaigns in schools and at Malls is also recommended for wider publicity.These efforts are likely to lower the prevalence of the disease in the community.

Demographic characteristics of the study population:
The mean age of the students was 18.1±0.60yearswithnostatistically significant difference between the mean ages of the students from the three colleges (p= 0.69).Most of the students were not married 99.4% with no statistically significant difference between students in the medical college (91.7%), community college (91.1%) and nursing college (88.1%) (p= 0.361).Regarding definition of Hepatitis' 420 (86.6%) students correctly defined it as an inflammation of the liver.Medical students were the most knowledgeable and the difference in the responses of the three Bull High Inst Public Health Vol.42 No.1 [2012]