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P,KHIDMAT MAKLUMAT AKADI!MIK
11111 1IIIIiiiilli II II III
1000217954
AWARENESS OF HEPATITIS B INFECTION AMONG YEAR 1 AND YEAR 2 MEDICAL STUDENTS IN FMHS, UNIMAS
John Lee Yen Sing (23680) Irene Wong Tung Yin (23632) Nurhamizah Ismail (24672) Sumayyah Bt Hashim (25182)
Elective 1
(2010/2011)Faculty of Medicine and Health Sciences,
Universiti Malaysia Sarawak
UNIVERSITI MALAYSIA SARAWAK
BORANG PENGESAHAN STATUS TESIS /LAPORAN PROJEK PELAJAR TAHUN AKHIR THESIS AND FINAL YEAR STUDENT PROJECT REPORT STATUS FORM
JUDUL: Awareness of Hepatitis B Infection Among Year 1 and Year 2 Medical Students in FMHS, Unimas
TITLE
SESI PENGAJIAN/ ACADEMIC SESSION: 2010·2011
Saya / I 2009-23680 JOHN LEE YEN SING (group leader)
(HURUF BESAR / CAPITAL LETTERS)
mengaku membenarkan *Tesis I Laporan Projek Pelajar Tahun Akhir ini disimpan di Pusat Khidmat Maklumat Akademik, Universiti Malaysia Sarawak dengan syarat-syarat kegunaan seperti berikut:
Hereby agree that this Thesis I Final Year Student Project Report shall be kept at the Centre for Academic Information Services, Universit Malaysia Sarawak with following terms and conditions
1. Tesis I Laporan Projek Pelajar Tahun Akhir adalah hakmilik Universiti Malaysia Sarawak The Thesis I Final Year Student Project Report is solely own by Universiti Malaysia Sarawak
2. Pusat Khidmat Maklumat Akademik, Univeristi Malaysia Sarawak dibenarkan membuat salinan untuk rujukan pengajian sahaja The Centre for Academic Information Services is given full rights to make copies of for educational purpose only
3. Membuat pendigitan untuk membangunkan Pangkalan Data Kandungan Tempatan
The Centre for Academic Information Services is given full rights to digitize in order to develop local content database 4. Pusat Khidmat Maklumat Akademik, Univeristi Malaysia Sarawak dibenarkan membuat salinan Tesis I Laporan
Projek Pelajar Tahun Akhir ini sebagai bahan pertukaran antara institusi pengajian tinggi
The Centre for Academic Information Services is given full rights to make copies of this Thesis I Final Year Student Project Report as part of its exchange item program between Higher Learning Institutions
~lease tick (V)
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SULIT CONFIDENTIAL (mengandungi maklumat yang berdarjah keselamatan atau kepentingan seperti termaktub diD
dalam AKT A RAHSIA RASMI 1972)
TERHAD (Contains classified information bounded by the OFFICIAL SECRETS ACT 1972) LIMITED
(mengandungi maklumat Terhad yang telah ditentukan oleh organisasi Ibadan di mana penyelidikan dijalankan)
(Contains classified information as dictated by the body or organization the research was TIDAK TERHAD
conducted)
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UNLIMITEDI Validated by
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(T ANDAT ANGAN PENULIS ) (TAN ATANGAN PENYELIA)
(AUTHOR'S SIGNATURE) (SUPERVISOR'S SIGNATURE)
Alamat, Tetap / Permanent Address
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FaCatatan: • Tesis dimaksudkan sebagai tesis ljazah Doktor Falsafah dan Sarjana, manakala Laopran Projek Pelajar Tahun Akhir adalah merujuk kepada Laporan Projek Pelajar Tahun Akhir ljazah Sarjana Muda
Thesis rejer., /0 PhD thesis. Master's DI~'Serralion and Final Year Project /leport r~rer., to Final Year ProJecl Reporr Bachelor Degree .
•• Jika Tesis f Laporan Projek Pelajar Tahun Akhir ini SULlT atau TERHAO, sila lampirkan surat daripada pihak berkuasa forganisasi berkenaan dengan menyatakan sekali sebab dan tempoh Tesis f Laporan Projek Pelajar Tahun Akhir perlu dikelaskan sebagoi SULlT atau TERHAD f For Confulenlial or Limiled work, please allach relevant documenr frolll Ihe relevant aUlhorilY
ACKNOWLEDGEMENT
We are heartily thankful to our supervisor, Dr. Aye Aye Aung for her guidance, inspiration and unending feedback throughout the completion of the research. We would also like to thank our co-supervisor, Dr. Md Mizanur Rahman for his dedication in guiding us especially in data analysis, statistic analysis and report writing process.
Furthermore, we would like to express our appreciation to Dr. Zunika Amit, the Elective I coordinator for giving us the opportunity and guidance to conduct this research. In addition, we would also like to extend our greatest gratitude to our previous Elective I Coordinator, Prof. Dr. Mohd Syafiq Abdullah for his guidance in this research. Our sincere appreciation also directed to Mr. Paul Cliff Simon Divis for his beneficial lectures on research report writing and poster presentation which have greatly assisted us in carrying out this research study.
We would like to thank Tan Sri Prof. Dr. Mohd Taha Arif, the Dean of Faculty of Medicine and Health Sciences. Moreover, we would like to thank the librarians for their guidance especially in searching references through books, online database and e-joumals.
We also appreciated the support from our seniors (Year 4 and Year 5 medical students) for their cooperation and advice in our pilot study. We are very much thankful for the support from our respondents (Year 1 and Year 2 medical students) for their cooperation in completing the questionnaires. Last but not least, we offered our regard and blessing to all those who supported us in any aspect during the completion of this research project. Thank you.
ABSTRACT
Introduction: A cross-sectional study was conducted among Year 1 and Year 2 medical students of FMHS, UNIMAS to assess level of knowledge, attitude and practice (KAP) on Hepatitis B infection.
Method: Non-probability sampling method was used. A pre-tested self-administered questionnaire was used to collect the relevant information from pre-clinical students.
Results: The overall level of knowledge (mean score
=
0.55), attitude (mean score=
1.61), and preventive practice (mean score = 1.82) were found to be good. Analysis revealed that age, year of study and previous education had significance influence on level of knowledge (p<0.05). In terms of attitude and practice, significant difference had shown between age and year of study (p<0.05). Two-thirds of the students had received vaccination against Hepatitis B. Another two-thirds of the students had done their blood screening with one-fourth of them was reactive to Hepatitis B surface antibody. Only 2.3% of these students screened was found to be reactive to Hepatitis B surface antigen.Conclusion: Though the students had good knowledge towards Hepatitis B, but a large segment of the students was found to be at risk of getting the infection. An intervention program had been warranted to prevent Hepatitis B infection among medical students.
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ABSTRAK
Pendahuluan: Satu kajian keratan rentas te1ah dija1ankan da1am ka1angan mahasiswa perubatan Tahun 1 dan Tahun 2 di FPSK, UNIMAS bagi meni1ai tahap pengetahuan, sikap dan praktis terhadap Hepatitis B.
Kaedah: Kaedah sampe1 bukan probabi1iti te1ah digunakan. Satu pra-kaji borang soa1 se1idik te1ah diedarkan kepada pe1ajar pra-klinika1 untuk mengumpu1 data-data yang re1evan.
Keputusan: Secara keseluruhan, tahap pengetahuan (skor mean = 0.55), tahap sikap (skor mean
=
1.61), dan tahap praktis (skor mean=
1.82) terhadap jangkitan Hepatitis B ada1ah baik.Ana1isis menunjukkan bahawa umur, tahun pengajian, dan pendidikan du1u mempunyai hubungkait yangje1as dari segi tahap pengetahuan (p<0.05). Dari segi tahap sikap dan praktis, hubungkait yang je1as dapat di1ihat antara umur dan tahun pengajian (p<0.05). Dua pertiga daripada kese1uruhan jum1ah pe1ajar te1ah menerima vaksin Hepatitis B dan meja1ani ujian penyaringan darah, dengan satu perempat daripada mereka mempunyai antibodi permukaan Hepatitis B yang reaktif manakala 2.3% daripada mereka mempunyai antigen permukaan Hepatitis B yang reaktif.
Konklusi: Secara kese1uruhannya, responden mempunyai tahap kesedaran yang baik terhadap Hepatitis B tetapi sebahagian besar mahasiswa didapati memi1iki risiko untuk mendapat jangkitan Hepatitis B. Program intervensi per1u disarankan untuk menghindari jangkitan Haptitis B da1am ka1angan pe1ajar perubatan.
III
TABLE OF CONTENT
ACKNOWLEDGEMENT ABSTRACT
ABSTRAK
TABLE OF CONTENTS LIST OF TABLES LIST OF FIGURES LIST OF APPENDICES
CHAPTER 1: INTRODUCTION 1.1 Background
1.2 Rationale
1.3 Statement of problem 1.4 Objective
1.5 Scope and assumption
CHAPTER 2: LITERATURE REVIEW 2.1 Epidemiology
2.2 Overview of Hepatitis B virus
2.2.1 Clinical manifestations of HBV infection 2.3 Knowledge on Hepatitis B
2.3.1 Source of information 2.3.2 General level of knowledge 2.3.3 Mode of transmission
IV
PAGE
11
111
IV
vii
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V111
2 3 3 4
5 6 6
8 8 9
2.3.4 Complications 10
2.3.5 Medical treatment 11
2.3.6 Risk groups 11
2.3.7 Preventive measures of HBV infection 12
CHAPTER 3: METHODOLOGY
3.1 Research design 13
3.2 Population 13
3.3 Sampling 13
3.4 Instrument 14
3.5 Data collection 15
3.6 Data analysis 15
3.7 Ethical issue 16
3.8 Operational definition 16
3.9 Reseaech methodology and flow chart 17
CHAPTER 4: RESULT
4.1 Introduction 18
4.2 Socio-demographic characteristics 18
4.3 Level of knowledge on Hepatitis B 21
4.4 Level of attitude towards Hepatitis B 28
4.5 Status of preventive practice against Hepatitis B 31 4.6 Relationship between knowledge, attitude and practice 35
and socio-demographic characteristic
v
4.6.1 Knowledge score and socio-demographic background 4.6.2 Attitude score and socio-demographic background 4.6.3 Practice score and socio-demographic background
CHAPTER 5: DISCUSSION 5.1 Introduction
5.2 Socio-demographic characteristics of the respondents 5.3 Sources of Hepatitis B information
5.4 Level of knowledge on Hepatitis B 5.5 Level of attitude towards Hepatitis B
5.6 Level of preventive practice against Hepatitis B
CHAPTER 6: CONCLUSION 6.1 Conclusion
6.2 Recommendation 6.3 Limitation
REFERENCES
APPENDICES
35 37 39
41 41 42 42
47
48
50 51 51
52
56
VI
LIST OF TABLES
PAGE 4.1 Distribution of students by socio-demographic characteristics 20 4.2 Distribution of the students by source of infonnation on Hepatitis B
25
4.3 Distribution of students by level of knowledge on Hepatitis B
25
4.4 Distribution of students by preventive attitudes
29
4.5 Distribution students by status of HBV vaccination 32 4.6 Distribution of students by status of blood screening 33 4.7 Relationship between socio-demographic characteristics and level of 36
knowledge
4.8 Relationship between socio-demographic characteristics and level of 38 attitudes
4.9 Relationship between socio-demographic characteristics and level of 40 practice
LIST OF FIGURES
PAGE
4.1 Distribution of students by level of knowledge
27
4.2 Distribution of students by level of attitudes 30
4.3 Distribution of students by level of practice 34
Vll
LIST OF APPENDICES
PAGE
Appendix A Infonned Consent Fonn 56
Appendix B Questionnaire 59
.~
Vlll
CHAPTER 1: INTRODUCTION 1.1 Background
Hepatitis B is a substantially life-threatening liver infection caused by the Hepatitis B Virus (HBV). The HBV, which was discovered in 1966, has become a global public health challenge. World Health Organization (WHO) (2008) has shown an astounding data on this major disease of mankind where an estimate of approximately two billion people worldwide have been infected with HBV.
In year 2008, the incidence rate of Hepatitis B in Malaysia is about 3.2 per 100,000 populations with mortality rate of 0.05 per 100,000 populations (MOHM, 2009). It marks the highest incidence rate among the vaccine preventable communicable diseases.
Hepatitis B is a viral disease transmitted mainly parenterally by intimate personal contact or from infected mother to neonate (Dorland's Dictionary, 2009). HBV is found in the highest concentration in blood and in lower amount in other body fluids such as semen, vaginal secretions, and wound exudates (CDC, 2010). Thus, HBV is sufficiently transmitted by percutaneous or mucous membrane exposure to infectious blood or body fluids. Modes of transmission of HBV are the same with the Human Immunodeficiency Virus (HIV).
However, HBV is about 50 to 100 times more infectious than HIV (WHO, 2008). Moreover, unlike HIV, HBV can survive outside the body for at least one week. During that time, the virus can still cause infection if it enters the body of an uninfected people.
The common modes of transmission of HBV are unprotected sex with an infected partner, perinatal (from infected mother to baby at birth), early childhood infections (unapparent infection via close interpersonal contact with infected household contacts), unsafe injections practices, and contaminated blood transfusions. HBV cannot be transmitted by contaminated food, water, or through casually in the workplace (WHO, 2008).
HBV is a vital occupational hazard for healthcare workers as well as medical students (WHO, 2008). The magnitude of the problem can be gauged from the fact that about 2 million out of 35 million healthcare workers worldwide have received percutaneous exposures to HBV annually. WHO also stated that about 40% of HBV infections among health care workers are attributable to occupational sharp exposures (WHO, 2002). Despite of this high risk of infection, the awareness among the medical students and healthcare workers on knowledge, attitude and preventive practice are still limited. The risk of Hepatitis B infection can be prevented by vaccination. However, according to Ho and Rashwan (2003), it was found out that not all the healthcare workers in nephrology unit and blood bank of Hospital Kuala Lumpur were vaccinated against Hepatitis B. Majority who had received the hepatitis B vaccine did not follow up on their immunisation status. It was also noted that the extent of knowledge is an important factor in vaccination as well as in determining the vaccination status of people from high risk groups.
1.2 Rationale
This study aims to assess the level of awareness of hepatitis B among Year I and Year 2 medical students in FMHS, UNIMAS. This study will provide information on the level of awareness among pre-clinical year medical students in FMHS, UNIMAS on the knowledge about Hepatitis B, the attitude towards Hepatitis B, and the preventive practice against Hepatitis B. This group of students will further approach, educate and spread the information on Hepatitis B to their family as well as the public, in which the public can gain better knowledge and raise their awareness on Hepatitis B infection. It may also be helpful to the faculty for the improvement of the awareness of preclinical students on Hepatitis B infection.
2
1.3 Statement of problem
Hepatitis B is one of the alerted communicable diseases that constitute a major public health challenge particularly in developing countries. The personnel healthcare workers such as doctors, nurses, dentist and medical students are among the most potential groups to be infected by this disease. The knowledge on Hepatitis B is very crucial in preventing the spread of this infection. However, Daud et al. (2007) reported that there was lack of awareness about the hazards of Hepatitis B among the first year MBBS students in Lahore and all the students were not vaccinated against Hepatitis B which made them at high risk of getting the disease.
There are limited studies done on the awareness (KAP) of medical students in Malaysia especially in Sarawak. Hence, this study is carried out in order to measure the level of awareness among the Year I and Year 2 medical students in FMHS, UNIMAS. This study expects to raise the awareness of this group of people who are in high risk to be infected by this disease and also to spread this disease to the patients.
1.4 Objective
To assess the level of knowledge of Hepatitis B infection among the Year I and Year 2 medical students in FMHS, UNIMAS which includes the knowledge of the disease, their sources of information, modes of transmission, risk groups, complications, preventive measures, the attitude and practice towards Hepatitis B vaccination.
Specific Objectives:
(a) To determine the socio-demographic characteristics of respondents.
(b) To assess the level of knowledge towards Hepatitis B infection.
3
(c) To assess the level of attitude towards Hepatitis B infection.
(d) To assess the level of preventive practice against Hepatitis B vaccination.
(e) To detennine the relationships between knowledge, attitude and practice with socio
demographic characteristics.
1.5 Scope and Assumption
This study is limited to pre-clinical medical students in Faculty of Medicine and Health Sciences (FMHS), UNIMAS. It is assumed that all the participants involved in the questionnaires understand English.
.....
4
CHAPTER 2: LITERATURE REVIEW 2.1 Epidemiology
The Hepatitis B virus (HBY), discovered in 1966, has become a major public health challenge globally. World Health Organization (2008) has shown an astounding data on this major disease of mankind. An estimate of approximately one third of the world population (two billion people) has been infected with HBY and more than 350 million people are chronically infected. Out of these, about seventy-five percent of all chronic carriers live in Asia and the Western Pacific rim. In Malaysia, about l.3 thousand Malaysians are carriers of HBY (Utusan Online, 2008). Most of them are not awared that they are infected carriers and capable of spreading the disease to others (WHO, 2005). Moreover, Hepatitis B carriers are 200 times more likely to develop liver cancer as complication than non-carrier (Richard et al., 2008). World Health Organization (WHO) also indicates that at least 600, 000 people die yearly due to the complications of HBY infection (WHO, 2008). Hepatocellular carcinoma resulted from HBY infection is one of the tenth most common cancers worldwide (Richard et al., 2008).
According to the Health Facts 2009 from Ministry of Health Malaysia (MOHM) (2010), the incidence rate of Hepatitis B in Malaysia in 2009 was about 2.13 per 100,000 populations with the mortality rate of 0.02 per 100,000 populations. The incidence rate shown was decreasing as compared to 2008 in which about 3.2 per 100,000 populations were infected with Hepatitis B with the mortality rate of 0.05 per 100,000 populations (MOHM, 2009). However, it still marked the highest incidence rate among the vaccine preventable communicable diseases in Malaysia. A survey on over 3000 chronic Hepatitis B patients from 11 public hospitals in Malaysia stated that the HBY patients came from all ethnic groups in which most of them were in productive-age group (New Straits Times, 2009).
5
In Malaysia, the Expanded Program of Immunization (EPI) involving Hepatitis B vaccination for newborns had been implemented since 1989 (MOHM, n.d.). The introduction of the national EPI has successfully prevented perinatal HBV transmission among the newborns in Malaysia. Three doses of Hepatitis B immunisation are given to newborns at birth, followed by first and fifth month. After the national EPI is implemented, the HBsAg carrier rate has been reduced from 2.7% to 0.4% among school children (Ng et al., 2004).
2.2 Overview of Hepatitis B virus (HBV)
Hepatitis B is caused by Hepatitis B virus (HBV). Hepatitis B virus is classified under Hepadnavinls family. It has partially double-stranded DNA (dsDNA) as its genome (Kumar et aI., 2005). The only known natural host of HBV is human (Colin et al., 2006). HBV spreads through bloodstream and replicates only in liver tissue.
2.2.1 Clinical manifestations ofHBV infection
The clinical manifestations of HBV infection include subclinical or asymptomatic phase, acute self-limiting phase, or fulminant phase that required liver transplant. Patients infected with HBV may also progress to chronic HBV infection, which will eventually result in liver cirrhosis or hepatocellular carcinoma (liver cancer). The chronic HBV infection may develop by the newly infected individuals depend on their age at time of infection. According to Collin et al. (2006), infected infants (>90%), infected children aged between I to 5 years (25-50%), and acutely infected older children and adults (6-10%) are more likely to develop chronic infection. Those who have higher risk of developing chronic infection include immunosuppressed patients, i.e. patients on haemodialysis and HIV-infected patients.
6
[I
II
r
Due to strong association between age and risk of getting chronic infection, infected children have accounted for a higher morbidity and mortality rate attributable to HBY. About 25% HBY-infected infants and older children eventually progress to liver cancer or cirrhosis (Colin et aI., 2006). Adults who are chronically infected since childhood eventually develop primary liver cancer at a rate of 5% per decade, which is 100-300 times the rate among uninfected individuals (WHO, 2004).
Generally, HBY has a prolonged incubation period, which is approximately 4 to 26 weeks. HBY can remain in the blood during active episodes of acute and chronic hepatitis.
According to Kumar et at. (2005), up to 70% of acutely infected patients show mi~d or no symptoms and do not develop jaundice. The rest of 30% patients develop non-specific symptoms: fever, anorexia, jaundice, and upper right quadrant pain. Most patients develop infection that is self-limited and resolves without treatment. Adults in non-endemic areas rarely develop chronic disease. Fulminant hepatitis also rarely occurs as in only 0.1-0.5%
cases.
For acute Hepatitis B infection, the average incubation period (from the time of exposure to onset of jaundice) is 90 days (range: 60-150 days) in newly infected individuals.
Patients may show signs and symptoms such as jaundice, fever, nausea, abdominal pain, dark urine, change in stool colour, and hepatomegaly (Colin et
at.,
2006).In patients with acute HBY infection, the first detectable serologic markers are HBsAg
and antibodies against HBcAg. The presence of anti-HBs in blood shows immunity towards HBV infection. Most individuals who recover from natural infection have both anti-HBs and anti-HBc antibody in their bloodstream, but over time anti-HBs antibody may become undetectable in some individuals (Colin et
at.,
2006).7
,
On the other hand, chronic or lifelong HBV infection occurs in 80-90% of infected infants, 30% of infected children, and less than 5% in infected adults. Among these, their lifetime risk of advanced liver disease is approximately 20-30% (Dore et al., n.d.). Chronic HBV significantly leads to poor quality of life as well as death.
2.3 Knowledge on Hepatitis B 2.3.1 Source ofinformation
Sources of information can be from family members, friends, formal education, electronic media, and healthcare workers. According to Anjum et at. (2005), information regarding hepatitis obtained by the students from Medical University in Karachi was from books (85%), media or internet (85%), teachers (84%), friends and relatives (70%). Study by Razi et al. (20 I 0) showed that television was the major source of information, followed by internet.
2.3.2 General Level ofKnowledge
Knowledge on Hepatitis B is important for healthcare professionals due to the increase prevalence of this infection. Occupational risk of HBV infection is well known in medical, nursing and dental workers especially during their professional training periods because they are more susceptible to be in contact with infected fluids and blood. This accounts for one of the main reason to educate and deliver the knowledge on the modes of transmission, complications, high risk groups, preventive measures and universal precautions of Hepatitis B.
van der Veen et at. (2010) claimed that overall level of knowledge was higher in people who had been tested. Study also showed that only 33.6% of medical and dental interns in India had good knowledge on Hepatitis B (Tirounilacandin et aI., 2009). According to
8
Saini et al. (20lO), 59.23% of the students had good knowledge on Hepatitis B. However, Daud et al. (2007) reported that there is lack of awareness among medical students in Lahore about hazards of Hepatitis B and its mode of transmission and mode of prevention.
According to Razi et al. (20 I 0), majority of university students knew that Hepatitis B is communicable. Study by Saini et al. (20 lO) found that majority (73%) of students knew that Hepatitis B is an infectious disease caused by HBV.
2.3.3 Mode oftransmission
HBV is spread among people through contact with infected blood as well as other infected body fluids such as semen and vaginal fluid. The modes of transmission are similar as compared to human immunodeficiency virus (HIV), however, HBV is 50 to 100 times more infectious than HIV (WHO, 2008). HBV has the ability to survive for at least 7 days when outside the body, unlike HIV. During that time, the virus is still infectious and can cause infection if entering others body.
The common modes of spread include unsafe injection practices, blood transfusions, sexual contact, perinatal (from mother to baby at birth), early childhood infections through close contact with infected household contacts. This was stated in the study done by Anjum et al. , 2005) where blood transfusion, syringes and needles are among the important source of transmission of HBV. In addition, according to Razi et al. (2010), majority of university students knew that Hepatitis B could be transmitted by unsafe syringes, needles, contaminated blood and shared blades. This was in contrast with the study done by Daud et al. (2007) in which only 28% medical students knew that blood transfusion, and only 21 % students regarded the use of injection are among the mode of transmission of Hepatitis B.
9
I :
However, only a few university students knew that tattooing, and ear and nose piercing were also among the methods of transmission (Razi et al., 20 I 0). In fact, HBV cannot be transmitted through contaminated water or food, as well as contact casually in the workplace.
Thus, good knowledge of the modes of transmission helps to reduce the risk or chance for getting infected with HBV. About 64.6% of medical and dental interns in India had good knowledge on mode of transmission of HBV (Tirounilacandin et al., 2009). Study by Saini et al. (2010) showed that majority (81.55%) of students of Rural Dental College had good knowledge on mode of transmission of Hepatitis B.
2.3.4 Complications
People with chronic Hepatitis B infection are at high risk of death from liver cirrhosis and liver carcinoma (WHO, 2008). The Minister of Health Malaysia, Dato's Sri Liow Tiong Lai (2009) announced that the 8th most common cancer among men in Malaysia is liver cancer as referring to the National Cancer Registry Report of 2003-2005. The most common cause of chronic liver disease is chronic Hepatitis B, which leads to majority of liver cancer in Malaysia.
According to Ho and Rashwan (2003), many undergraduates knew that liver damage (93.5%), liver cancer (61.4%) and death (52.2%) are the consequences of HBV. However, the study by Razi et at. (2010) showed that the level of awareness on the complications among the university students was found to be relativeily low.
10
,
2.3.5 Medical Treatment
Treatment is not specific in patients with acute Hepatitis B as about 95 % infected adults recovered by themselves without any medical treatment (Doyle & Urban, 2005).
Although drugs such as interferon and anti-viral agents can be used as the treatment for chronic Hepatitis B, it is not widely used due to its high cost and is not available to most patients in developing countries (WHO, 2008). The main target of treatment is to suppress the viral replication so as to reduce the complications. In more severe case such as liver cirrhosis, liver transplants with varying outcomes can be done. Medical treatment is not recommended for all patients especially with chronic hepatitis B (Doyle & Urban, 2005). Hence, vaccination is the most effective method to prevent this disease. However, study showed that only 11.5%
of medical and dental interns in India had good know ledge on the HBV treatment options (Tirounilacandin et aI., 2009).
2.3.6 Risk groups
HBV is one of the main infectious occupational hazards of healthcare workers (WHO, 2008). Medical students are included in the risk groups to be infected with Hepatitis B during their practice or training sessions (Ahmad et af., 2010). According to Anjum et al. (2005), many medical students agreed that doctors, dentists, surgeons, nurses, lab technicians (60%
each), and barbers (88%) were among the sources of transmission of Hepatitis B. Moreover, Daud et af. (2007) stated that 32% medical students responded that surgeon was susceptible, followed by barbers (12%), intravenous drug users (8%), and recipient of blood transfusion (6%). However, only 2% students mentioned that sex workers were susceptible to HBV infection.
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2.3.7 Preventive measures ofHB V infection
Liver cancer is preventable by the Hepatitis B vaccine which has been introduced since 1982. Vaccination can induce a protective anti-Hepatitis B antibody as response in about 95% of infants, children, and adolescents (Kumar et al., 2005). Three injections of vaccine over 6 month period give good protection in over 90% of healthy adults. The price of the hepatitis B vaccine is cheaper and more affordable with the use of new technology for manufacturing vaccine and it is only a matter of raising the public awareness on the importance of getting vaccinated (MOHM, 2009). HBV screening should be conducted and followed by subsequent vaccination for effective prevention.
In Malaysia, the newly born babies are given Hepatitis B vaccination under the Expanded Programme on Immunization (EPI). Hepatitis B vaccination has been started since 1989. The government also promotes the Teenagers Programs which provide vaccination to people who were born before 1989. Those who had undergone hepatitis B vaccination under EPI program should follow up their immunization status by doing antigen and antibody screening. Necessary booster dose or revaccination should be done. This is necessary especially among the high risk groups so that they can be prevented from being infected.
Medical universities should take necessary action to inform, educate and vaccinate the medical students and health professionals who are at risk in order to improve their knowledge of Hepatitis B. The Ministry of Health should make HBV vaccination mandatory for all health professionals.
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CHAPTER 3: METHODOLOGY
3.1 Research Design
This was a cross sectional study which was carried out among the Year 1 and Year 2 medical students from FacuIty of Medicine and Health Sciences (FMHS), UNIMAS. The total duration of this study was about 10 months starting from June 2010 until April 2011.
3.2 Population
Year 1 and Year 2 medical students of FMHS, UNIMAS were the study population.
This research was done to assess their level of awareness on hepatitis B infection before they enter the clinical phase.
3.3
SamplingA non-probability sampling method was chosen to select Year 1 and Year 2 medical students ofFMHS, UNIMAS. There are 98 Year 1 and 112 Year 2 medical students. Among them, 193 students participated in this study with the response rate of 91.9%.
These students were selected based on the following inclusion and exclusion criteria:
1. Inclusion criteria
a. Year 1 and Year 2 medical students b. Understand English
2. Exclusion criteria
a. Students who are not willing to participate in the questionnaire
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