Knowledge of Hepatitis-B Management and its Prevention among the Senior Staff Nurses Working at Bangabandhu Sheikh Mujib Medical University (BSMMU)

Abbreviations

HBV: Hepatitis B Virus; BSMMU: Bangabandhu Sheikh Mujib Medical University; IRB: Institutional Review Board; PPE: Personal Protective Equipment; HSE: Health Service Executive.

Introduction

Hepatitis B, caused by the Hepatitis B virus (HBV), stands as a formidable global public health challenge, particularly in regions like Bangladesh where its prevalence falls in the intermediate range. The transmission of this virus primarily occurs through percutaneous or mucosal exposure to infectious blood or bodily fluids [1], posing a substantial risk not only to the general populace but also to healthcare workers [2] who are consistently in contact with infected individuals. Hepatitis B manifests as acute illness, exhibiting symptoms ranging from mild discomfort to severe liver failure [3], and if left untreated, it can progress to chronic infection, potentially leading to debilitating conditions such as cirrhosis and liver cancer [4, 5].

In Bangladesh, the burden of Hepatitis B looms large, affecting millions across the nation. Alarmingly, studies conducted in hospitals in Dhaka, the capital city, have reported a high prevalence of acute HBV cases [3, 4, 5, 6, 7], underlining the pressing need for urgent intervention. Among the healthcare professionals grappling with this challenge, senior staff nurses emerge as frontline warriors, playing a pivotal role in the management and prevention of Hepatitis B due to their close and continuous interaction with infected patients [8]. It is imperative to comprehend their knowledge levels and the factors influencing their practices to develop targeted interventions aimed at combatting the disease effectively.

Understanding the knowledge gaps and barriers faced by senior staff nurses is paramount to designing effective strategies to combat Hepatitis B effectively. By shedding light on these issues, this study endeavours to assess the knowledge levels of senior staff nurses at Bangabandhu Sheikh Mujib Medical University (BSMMU) concerning Hepatitis B management and prevention. By discerning the influencing factors and determinants of knowledge acquisition and vaccination practices among this demographic, the research aimed to lay the groundwork for the development of context- specific policies and interventions tailored to the unique challenges faced by Bangladesh in combatting Hepatitis. Ultimately, the goal is to contribute to the eradication of Hepatitis B and alleviate the burden of liver diseases in the country, ensuring a healthier and more prosperous future for all Bangladeshis.

Methods

This study adopted a quantitative approach, employing a cross-sectional study design to investigate selected variables among the target population. This research was carried out at Bangabandhu Sheikh Mujib Medical University (BSMMU), focusing on its Medical, Surgical, Gynecology, and Orthopedic departments, with registered senior staff nurses comprising the study population. The sample size of 210 registered nurses from BSMMU was determined by using a standard formula, ensuring a representative sample for robust analysis. Convenience sampling was employed for data collection due to practical considerations and accessibility. Data was gathered through structured interviews using a questionnaire, ensuring strict confidentiality and anonymity. Ethical clearance was obtained from the Institutional Review Board (IRB) of BSMMU before initiating the study to ensure adherence to ethical standards. Data analysis involved the meticulous checking, coding, and utilization of the SPSS software package (Version 24.0), with descriptive statistics facilitating comprehensive data interpretation. The study was lasted for one year. Collaboration with the Ministry of Health and Family Welfare and the University Grant Commission was sought to ensure support and coordination throughout the research process. In addition to this, both written and verbal consent was sought from the respondents prior to data collection. In order to avoid error in data collection and the miscommunication, questionnaire and consent form was translated into Bengali for the better understanding of participants.

Results

In this chapter, the findings based on the study subjects’ respond can be noticed systematically. This includes in the order of the socio-demographic characteristics of the participants, occupational exposure history of the respondents, knowledge of the participants about Hepatitis B virus infection and prevention, and the relationship between the socio-demographic characteristics and nurses’ knowledge about Hepatitis B virus infection and prevention.

The distribution of socio-demographic characteristics among the nurses surveyed (N = 210) reveals several notable trends in Table 1. A significant portion of the respondents were younger, with 59.5% aged below 30 years, while 33.8% fall within the 31-40 age range, and only 6.7% are over 40 years old. Additionally, the majority of the nurses were female (70%) and adhered to the Islamic faith (70%). Regarding marital status, significant proportions were married (69%), and the majority had basic education in nursing (89.5%) as opposed to higher education (10.5%). In terms of work experience, most nurses had between 1 to 10 years of experience (89%), with fewer having 11 to 20 years (7.6%) or 21 to 30 years (3.3%) of experience. Moreover, a majority of respondents earned a monthly income of less than 35,000 BDT (78.1%). Regarding vaccination status, a substantial proportion of nurses completed their vaccination (64.3%), while 26.7% had partially completed it, and 9% did not take the vaccine.

Table 2 illustrates a substantial majority of respondents (73.3%) reported experiencing exposure to blood or body fluids on intact skin. Additionally, a notable proportion of respondents’ reported incidents of splashes of blood or body fluids in their eyes or mouth (20%). Furthermore, a considerable portion of respondents encountered splashes of blood on cuts or unprotected skin (37.1%).

The statistics from Table 3, which illustrate the knowledge about Hepatitis B virus infection among the respondents (N = 210). A significant majority (87.6%) did understand that Hepatitis B can be asymptomatic for a long time, and 88.1% recognized it as a highly infectious disease. Nearly all respondents (99%) were aware that Hepatitis B can be diagnosed through a blood test. Moreover, 84.3% of respondents correctly identified that the virus can be found in semen or vaginal fluid. However, knowledge about the presence of the virus in oral mucosa was less widespread, with only 36.2% acknowledging this fact. Additionally, a smaller proportion (31.1%) believed that only a small proportion of people are infected with Hepatitis B. Most respondents (87.1%) knew that Hepatitis B primarily affects the liver, and a substantial majority (93.8%) recognized it as a significant public health problem in Bangladesh. Lastly, an overwhelming majority (96.7%) recommended vaccination for everyone, including healthcare workers.

The data from Table 4, which presents the knowledge about Hepatitis B virus transmission among the respondents (N = 210). A significant majority (93.3%) correctly identified that Hepatitis B can be transmitted through sharp instruments, and an even higher percentage (98.1%) were aware that blood donation can be a transmission route. Additionally, 94.3% recognized that sexual intercourse is a mode of transmission. Furthermore, a substantial majority (86.7%) understood that mother-to-child transmission is possible. A noteworthy finding is that only 26.7% of respondents mistakenly believed that Hepatitis B can be transmitted through contaminated water, indicating that a majority (73.3%) correctly understood that this is not a transmission route for Hepatitis B. Additionally, 88.1% of the respondents knew that using a contaminated blade or razor can transmit the virus.

The statistics from Table 5, which outline the knowledge about Hepatitis B virus prevention among the respondents (N = 210). An overwhelming majority (95.2%) understood that Hepatitis B can be prevented through vaccination, and 96.7% recognized the importance of proper disposal of sharp instruments in preventing transmission. Similarly, 96.7% were aware that avoiding multiple sexual partners is a preventive measure. The use of gloves as a preventive measure was acknowledged by 94.3% of respondents and

94.8% understood the necessity of proper sterilization to prevent the spread of Hepatitis B. However, there were notable misconceptions regarding other preventive measures. Over half of the respondents (54.8%) incorrectly believed that avoiding contaminated drinking water is a method to prevent Hepatitis B, and 27.1% mistakenly thought that avoiding uncooked food can prevent the virus.

Table 6 presents the relationship between socio- demographic characteristics and nurses’ knowledge about Hepatitis B virus infection, transmission and prevention. An independent t-test was employed to assess the relationship between age, sex, marital status, professional education, and monthly income with nurses’ knowledge. Additionally, Analysis of Variance (ANOVA) was conducted to explore the relationship between religion, working experience, and vaccination status with nurses’ knowledge. Among these characteristics, marital status (p = 0.02) and vaccination status (p = 0.000) are found to be statistically significant in relation to nurses’ knowledge about Hepatitis B. Specifically, the findings reveal that marital status is significantly associated with nurses’ knowledge (t = -2.29, p < 0.05), indicating that married nurses possess higher knowledge about Hepatitis B compared to single nurses. Moreover, vaccination status showed a significant difference in knowledge levels (F = 8.86, p < 0.001).

Conclusion

This study reveals significant insights into the knowledge levels of senior staff nurses at Bangabandhu Sheikh Mujib

Medical University (BSMMU) concerning Hepatitis B virus (HBV) infection, transmission, and prevention. The findings indicate that nurses possess a good understanding of HBV, particularly regarding its diagnosis, transmission routes, and prevention methods. However, misconceptions persist, particularly about HBV’s transmission through contaminated water and uncooked food. The study underscores the importance of marital and vaccination status in influencing nurses’ knowledge levels, with married and fully vaccinated nurses demonstrating higher awareness. This highlights the critical role of life experience and professional practices in enhancing healthcare workers’ knowledge and readiness to combat HBV.

Recommendations

Based on the study findings, several recommendations are proposed to improve the understanding and management of Hepatitis B Virus (HBV) among healthcare workers. Firstly, comprehensive training programs should be developed to address specific knowledge gaps and misconceptions about HBV, particularly its transmission and prevention. Secondly, robust vaccination campaigns must be implemented, targeting healthcare workers to ensure complete vaccination coverage, as this is significantly associated with higher knowledge levels. Additionally, educational interventions should consider the unique needs and responsibilities of married nurses, leveraging their experience to enhance overall knowledge and practice. Continuous education initiatives are also essential, keeping healthcare workers updated on the latest HBV management and prevention strategies to ensure sustained knowledge enhancement. Finally, collaboration with health authorities is crucial to develop policies that mandate regular training and vaccination for healthcare workers, thereby standardizing preventive practices across medical institutions.

Limitations

This study has several limitations that should be acknowledged. The use of convenience sampling might limit the generalizability of the findings to all senior staff nurses in Bangladesh, as it may not fully represent the entire population. Reliance on self-reported data for assessing knowledge and practices might introduce response bias, as participants may overestimate their knowledge or adherence to preventive measures. Additionally, the cross-sectional nature of the study provides only a snapshot of knowledge and practices at a single point in time, limiting the ability to assess changes or trends over time. The study’s focus on a single medical university may also limit the applicability of the findings to other healthcare settings with different demographics or resource availability. Furthermore, the influence of cultural factors on knowledge and practices was not extensively explored, which could provide deeper insights into the socio-demographic determinants of HBV- related knowledge.

Acknowledgment

The researchers extend their heartfelt gratitude to all the participants as well as officials and the authorities of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital for their invaluable support in facilitating this study despite their busy schedules.