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KNOWLEDGE ATTITUDE AND PREVENTION REGARDING HEBATITIS B
AMONG MEDICAL STUDENTS IN ERIGAVO SOMALILAND

Dr. HAMZE ALI ABDILLAHI

Correspondence to: Dr. HAMZE ALI ABDILLAHI

Tel/00252+634740866

Email/ [email protected]

[email protected]

[email protected]

Article History: 9/3/2019

Abstract
Background:
Hepatitis B Virus (HBV) infection poses a grave public health problem worldwide. Over two
billion people are infected and an estimated 387 million of these suffering from chronic HBV
infection, with a rate of ten million new carriers each year. Another one million die annually.

general objectives: The purpose of this study is to assess the knowledge attitude and prevention
regarding hepatitis B among medical students in Erigavo city Somaliland.

Methods: The study was used a cross-sectional descriptive design. It is used as descriptive non-
experimental research study on the knowledge attitude and prevention regarding hepatitis B among
medical students in Erigavo city Somaliland.
Results: In the case of gender, there were more female (65%) than male (35%). This implies that
the majority of the respondents are female. The age categorization of respondents age present
findings which show that the majority of the respondents were in the age category was 21-25 with
(45%) of the respondents, (25%) were recorded on the age b/w 17-20 years.

Conclusion: The study was set to examine the prevalence the knowledge attitude and prevention
of medical students in Erigavo Somaliland. In conclusion, Knowledge about Hepatitis B infection
on medical students the majority of (90%) were within the good knowledge range while (10%)
showed poor knowledge about hepatitis B, and best way of preventing this infection was getting
HB vaccine but the study was indicated the uptake of vaccine is low in medical students.

Keywords knowledge attitude and prevention regarding hepatitis B.

1
1.1 Introduction
Background of the study
Hepatitis is a general term meaning “inflammation of the liver” and the most common cause is the
infection with 1 of the 5 viruses called Hepatitis A, B, C, D and E virus. Of the 5 viral causes,
hepatitis B infection is the world’s most common liver infection, which is caused by hepatitis B
virus (HBV). HBV is a DNA virus,.It is 42–47 nm in diameter and enters the liver through blood
stream. (WHO 2008)
HBV is highly contagious and is 50–100 times more infectious than HIV. It is transmitted through
blood, semen, vaginal fluid, and mucous membranes. It is transmitted most commonly by
unprotected sexual contact, contaminated blood transfusions, unsafe use of needles, from mother
to child at birth, close household contact, and among children in early childhood. (WHO, Hepatitis
B, 2012)
HBV infection poses a grave public health problem worldwide, with over 2 billion people infected.
An estimated 387 million are suffering from chronic HBV infection, with a rate of around 10
million new carriers each year (Samuel et al., 2009)
About 90% of these cases live in developing countries and 50 million of which are in Africa. It is
the tenth leading cause of death worldwide accounting for an estimated one million deaths per year
worldwide. HBV may be the cause of up to 80% of all cases of hepatocellular carcinoma
worldwide, second only to tobacco among known human carcinogens (Lavanchy, 2004).
HBV infection is a major health concern and is the most common blood-borne viral infection that
places health-care workers, medical and other professionals, at higher occupational risk. In medical
student, the possible forms by which HBV infection can be transmitted are from contact with blood
or saliva of infected patients while drawing blood, giving injections, or suturing, and needle-stick
injuries sustained while performing procedures. In addition to this, medical students who do not
wear gloves while doing procedures are at a higher risk of acquiring HBV infection. (WHO,
hepatitis B infection , 2012).
According to the World Health Organization, vaccination of high-risk groups is a key strategy for
the prevention of both horizontal and vertical transmission of HBV (WHO, 2002). high cost of the
vaccine and a myriad of competing health care needs have so far slowed the uptake of this strategy
countrywide (MOH, 2014)

2
1.2 problem statement
Hepatitis B infection is a highly resilient, blood-borne and sexually transmitted virus, which in
chronically infected individuals can be found in high concentrations in blood, vaginal secretions
and semen. Medical students are constantly exposed to the dangers of acquiring hepatitis B due to
contact with blood and body secretions of patients. The risk of contracting HBV by medical
students is four times greater than that of the general adult population who do not work or practice
in healthcare institutions. It is also a well-established fact that an unvaccinated individual stands
the risk of 6% to 30% to acquire the infection on exposure to HBV contaminated blood or body
fluids.
Hepatitis B may occur with limited or no symptoms, but in advanced stages it often leads to
jaundice, anorexia (poor appetite), and malaise. Persistence of hepatitis for more than six months
is classified as chronic hepatitis. Serologic testing for hepatitis B surface antigen (HBsAg) is the
primary way to identify persons with HBV infection. Testing for HBsAg is recommended for
persons who are the source of blood or body fluid exposures that might warrant post-exposure
prophylaxis.
The incidence of HBV infection can be reduced by giving proper education and awareness
regarding its transmission and vaccination to the medical students and health-care workers, and
also there’s no previous researches have been conducted in Erigavo. Hence, this study was
conducted to assess the knowledge, attitude, and prevention of HBV infection among medical
students in Erigavo city Somaliland.

Literature review

Concepts, opinions and ideas from experts related to the study

2.1 Hepatitis B Virus
Hepatitis B Virus (HBV) is a DNA virus and was first identified in the 1960s. According to the
ICTV classification, this virus belongs to the genus Ortho-hepa-dnavirus of the Hepadnaviridae
family and, along with the Spumaretrovirinae-subfamily of the Retroviridae-family, represents the
only other animal virus with a DNA genome known to replicate by the reverse transcription of a
viral RNA intermediate (Seeger et el, 2007).

3
Hepatitis, inflammation of the liver caused by viruses, bacterial infections, or continuous exposure
to alcohol, drugs, or toxic chemicals, such as those found in aerosol sprays and paint thinners.
Inflammation is the painful, red swellings that result when tissues of the body become injured or
infected, Inflammation can cause organs to not work properly. Hepatitis can also result from an
autoimmune disorder, in which the body mistakenly sends disease-fighting cells to attack its own
healthy tissue (Ganem, D. & Prince, 2004).

The liver is located in the upper right hand side of the abdomen, mostly behind the rib cage. The
liver of an adult normally weighs close to three pounds. No matter what its cause, hepatitis reduces
the liver‘s ability to perform life-preserving functions, including filtering harmful infectious agents
from the blood, storing blood sugar and converting it to usable energy forms, and producing many
proteins necessary for life (Chang, 2007).

Hepatitis B is a potentially life-threatening liver infection caused by the hepatitis B virus (HBV).
It is a major global health problem and the most serious type of viral hepatitis. Originally known
as "serum hepatitis", the disease has caused epidemics in parts of Asia and Africa, and it is endemic
in China, About a third of the world population has been infected at one point in their lives,
including 350 million who are chronic carriers which causes 620,000 deaths worldwide each year
(Edmunds et al, 1993). If your body is able to fight off the hepatitis B infection, any symptoms
that you had should go away over a period of weeks to months, this is termed acute hepatitis B.
some people‘s bodies are not able to completely get rid of the hepatitis B infection. This is called
chronic hepatitis B (Shepard et al, 2006)

2.1.1 Epidemiology
2.1.1.1 Global Situation of HBV Infection
Hepatitis B, an infectious disease of the liver caused by the hepatitis B virus (HBV), is a major
public health problem worldwide. It is a highly resilient, blood-borne and sexually transmitted
virus, which in chronically infected individuals can be found in high concentrations in blood,
vaginal secretions and semen (Baars et al., 2009). It is known to remain viable for seven (7) days
or longer on environmental surfaces at room temperature and acute hepatitis B has a long
incubation period of up to 90 days on average during which the individual is. HBV is the prototype
member of the Hepadnaviridae family, genus Orthohepadnavirus of animal viruses (Carreno and
Hubschen et al., 2009).

4
The infection is highly prevalent in Africa and Asia, and in the different countries, the infection
rate ranges from 5% to 20% (Shin et al., 2006). Global epidemiology of HBV infection is based
on prevalence of HBV surface antigen (HBsAg) in the population. Countries are classified into
three categories of HBV endemicity: low (<2%), intermediate (2- 7%), and high (=8%) prevalence
of HBsAg (Dochez, 2008).
HBV infection is a major global public health problem, warranting a high priority for prevention
and control (Baars et al., 2009). Over 2 billion of the world’s population has been exposed to HBV
and an estimated 387 million of these are now chronically infected with a rate of around 10 million
new carriers each year. Approximately 17% of the carriers will die from the consequences of the
HBV infection with an overall annual mortality rate of about one million. In Sub Saharan Africa
(SSA), HBV infection is endemic. The average carrier rate of the virus in the SSA region is 10%
(Baars et al., 2009).
Despite the fact that since 1982 there is a vaccine against HBV that gives 90-100% protection
against infection, there are in the world today more than 350 million people living with chronic
hepatitis B. The consequence of this is approximately 600 000 HBV related deaths every year
around the world, where the cause is primary liver cirrhosis or liver cancer (WHO, (, 2012)
In the U.S. approximately 1.4 million residents are chronically infected with HBV. According to
the fact that during the years 1974-2008 17.6 million people born in countries of intermediate or
high prevalence of chronic hepatitis B have immigrated to the U.S., there is an increased burden
of chronic hepatitis B in the country (Weinbaum et al, 2010)
2.2 HBV Situation in africa
In Kenya, HBV is highly prevalent and it accounts for about 60% of the cases with liver cirrhosis,
and for 80% of those with HCC. Around 70% of Kenyans have a positive HBV serology by
adulthood. HBsAg carriage ranges between 8-20% depending on the province. Moreover, one in
every three people in every community in the country is HBV positive ( (MoPHS, 2008)
2.3 Transmission
HBV infection can be transmitted at 3 stages in life; around the time of birth, during childhood,
and in adult life. The main modes of transmission are mother-to child (perinatal), child-to-child
(horizontal), sexual and parenteral. The role of each of these modes varies across the globe. In
developed countries (also countries with low endemicity of HBV infection) sexual transmission
and intravenous drug abuse in adolescence and adult life account for the majority of cases of HBV

5
transmission, In developing countries (countries with intermediate and high endemicity of HBV
infection), mother-to-child and child-to-child transmission during the early years of life are the
major modes of transmission of HBV infection. Placental breakdown and leakage of maternal
blood during delivery, in utero infection, and infection postnatally through breastmilk, babies’
ingestion of blood, and small scratches to the baby during birth are postulated mechanisms of
perinatal transmission (Zuckerman, 2001)
Hepatitis B virus is transmitted between people by direct blood-to-blood contact or semen and
vaginal fluid of an infected person (Hyams, 1995). Modes of transmission are the same as those
for the human immunodeficiency virus (HIV), but the hepatitis B virus is 50 to 100 times more
infectious. Unlike HIV, the hepatitis B virus can survive outside the body for at least seven days.
During this time, the virus can still cause infection if it enters the body of a person who is not
protected by the vaccine (Zuckerman, 2001)

In developing countries, common modes of transmission are:

 perinatal (from mother to baby at birth)

 early childhood infections (in apparent infection through close interpersonal contact with
infected household contacts)
 unsafe injection practices
 unsafe blood transfusions
 Unprotected sexual contact.
 Shared personal items (such as toothbrushes, razors, and nail clippers) with an infected
person. (Zuckerman, 2001).

In many developed countries (e.g. those in Western Europe and North America), patterns of
transmission are different from those in developing countries. The majority of infections in
developed countries are transmitted during young adulthood by sexual activity, tattoo or
acupuncture with unclean needles and instruments, and injecting drug use (Gane, E. 2005).

Hepatitis B is a major infectious occupational hazard of health and medical students (Barker et al.
1996). The hepatitis B virus is not spread by contaminated food or water, and cannot be spread
casually in the workplace (McManhon et al., 1985). The incubation period of the hepatitis B virus

6
is 90 days on average, but can vary from 30 to 180 days (D´ebarre, 2010). The virus may be
detected 30 to 60 days after infection and persists for variable periods of time (Juszczyk, 2000).

The role of parenteral transmission of HBV infection in health institutions should also be currently
limited due to the routine screening of blood and blood products. However, it has been reported
that in some countries of the Africa hospital or health centre waste products are not treated in the
proper manner and that a lot of these waste products lie on streets and are accessible to medical
students and children who poses a serious health risk and hazard (Juszczyk, 2000)

2.4 Sign and Symptoms

Acute infection with hepatitis B virus is associated with acute viral hepatitis; Symptoms may not
appear for up to six months after the time of infection the early symptoms may include:
 Appetite loss
 Fatigue
 Fever, low grade
 Muscles and joint aches
 Nausea and vomiting
 Yellow skin and eyes, and dark urine due to jaundice
 swollen stomach or ankles
 easy bruising
 tiredness
 upset stomach
 diarrhea
 light-colored stools (Diekmann et al., 1990)

The illness lasts for a few weeks and then gradually improves in most affected people. A few
people may have a more severe form of liver disease known as fulminant hepatic failure and may
die as a result. The infection may be entirely asymptomatic and may go unrecognized. (Zuckerman,
2001)

7
Chronic infection with hepatitis B virus either may be asymptomatic or may be associated with a
chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several
years. This type of infection dramatically increases the incidence of hepatocellular carcinoma
(HCC; liver cancer). Across Europe, hepatitis B and C cause approximately 50% of hepatocellular
carcinomas. Chronic carriers are encouraged to avoid consuming alcohol as it increases their risk
for cirrhosis and liver cancer. Hepatitis B virus has been linked to the development of membranous
glomerulonephritis (Wilson et al., 1998).

2.5 Diagnosis
A number of blood tests are available to diagnose and monitor people with hepatitis B. They can
be used to distinguish acute and chronic infections (Xu et al., 1995). Laboratory diagnosis of
hepatitis B infection centers on the detection of the hepatitis B surface antigen HBsAg. A positive
test for the hepatitis B surface antigen (HBsAg) indicates that the person has an active infection
(either acute or chronic) (World Health Assembly, 1992). World Health Organization (WHO)
recommends that all blood donations are tested for this marker to avoid transmission to recipients
(World health Organization, 2004.)

Other commonly used tests include the following: Testing for antibodies to the hepatitis B surface
antigen – a positive test indicates that the person has either recovered from an acute infection and
cleared the virus, or has received a hepatitis B vaccine. The person is immune to future hepatitis
B infection and is no longer contagious. Testing for antibodies to the hepatitis B core antigen – a
positive test indicates that the person has had a recent infection or an infection in the past.
Combined with a positive test for the hepatitis B surface antigen, a positive test usually indicates
a chronic infection. (World Health Organization, 2004; Centre for Disease Control, 2008).

2.6 Treatment
Acute hepatitis B infection does not usually require treatment and most adults clear the infection
spontaneously. Early antiviral treatment may be required in less than 1% of people, whose
infection takes a very aggressive course (fulminant hepatitis) or who are immunocompromised.
On the other hand, treatment of chronic infection may be necessary to reduce the risk of cirrhosis
and liver cancer. Chronically infected individuals with persistently elevated serum alanine
aminotransferase, a marker of liver damage, and HBV DNA levels are candidates for therapy.
Treatment lasts from six months to a year, depending on medication and genotype. Treatment
duration when medication is taken by mouth, however, is more variable and usually longer than
one year. (CDC, 2014) Although none of the available medications can clear the infection, they
can stop the virus from replicating, thus minimizing liver damage. As of 2018, there are eight

8
medications licensed for the treatment of hepatitis B infection in the United States. These include
antiviral medications lamivudine, adefovir, tenofovirdisoproxil, tenofoviralafenamide,
telbivudine, and entecavir, and the two immune system modulators interferon alpha-2a and
PEGylated interferon alpha-2a. In 2015 the World Health Organization recommended tenofovir or
entecavir as first-line agents. Those with current cirrhosis are in most need of treatment, the use of
interferon, which requires injections daily or thrice weekly, has been supplanted by long-acting
PEGylatedinterferon, which is injected only once weekly. However, some individuals are much
more likely to respond than others, and this might be because of the genotype of the infecting virus
or the person's heredity. The treatment reduces viral replication in the liver, thereby reducing the
viral load (the amount of virus particles as measured in the blood). (CDC 2014)

METHODOLOGY

3.1 Study design

The study was used a cross-sectional descriptive design. It is used as descriptive non-experimental
research study on the knowledge attitude and prevention regarding hepatitis B among medical
students in Erigavo city Somaliland.

3.2 Research population

The target population of this study was 390 medical students at sanaag and gollis universities in
erigavo city Somaliland.

3.4 Sample size

The sample for this study will consist of 80 respondents chosen from the medical students of
Sanaag University and Gollis University in erigavo city. To determine the sample size the
researcher was guided by the Slovene’s sample selection formula, which is:
N
n=
1 + N(e2 )

390
n=
1 + 390(0.102 )

390
n=
1 + 390(0.01)
390
n= = 80
4.9

9
N:Population size
n:Sample size
e:Level of Significance = e=0.10=e2 = (0.10)2= 0.01

3.5 Sampling Procedure

The sapling procedure of this study was purposive sampling and simple random sampling
technique this is probability sample in which the researcher uses (lottery method) the subset of
individual is chosen from larger set, each individual is chosen randomly and entirely by chance.
To select the key respondents

3.6 Research Instruments

The main research instrument that was used in this study is structured questionnaire.

3.7 Data Analysis

Quantitative data entry will be entered in SPSS (IBM v20); data will be cleaned by running
frequencies of all the variables to check for incorrectly coded data. Incorrectly coded data will be
checked again with the raw data in the questionnaire and correct.

Statistical methods were used to analyze the data collected such as Descriptive statistics, for
example numerical summations, graphs and tables. The analysis software was performed using the
data are Statistical Package for Social Sciences (SPSS) and Microsoft Excel (2016) statistical
software packages.

DATA PRESENTATION, INTERPRETATION AND ANALYSIS OF FINDINGS

4.1 Demographic features of respondents

Table 4.1.1 Gender
Frequency Percent Valid Percent Cumulative Percent
Valid male 28 35.0 35.0 35.0
female 52 65.0 65.0 100.0
Total 80 100.0 100.0

10
 Gender

80

60

40
percent
65

20 35

0
male female

Figure 4.1.1 The above figure shows the gender of respondents where 52 out of 80 respondents
which is equivalent 65% of the respondents were female and the remaining 28 out of 80
respondents which is equivalent 35% were male.

Table 4.1.2 age of the respondent

Frequency Percent Valid Percent Cumulative Percent
Valid 17-20 years 20 25.0 25.0 25.0
21-25 years 36 45.0 45.0 70.0
26-30 years 18 22.5 22.5 92.5
above 30 years 6 7.5 7.5 100.0
Total 80 100.0 100.0

11
 Age

50

40

30
45 PERCENT
20
25 22.5
10 7.5
0
17-20 years 21-25 years 26-30 years above 30
years

Figure 4.1.2 As the above graph determine, the age of the respondents, where the age of 17-20 in
the percent of 25%, and the age of 21-25 in the percent of 45%. And the age of 26-30 were the
percent of 22.5% and the remaining 7.5% were the age > 30 years. Therefore, this information
identifies that there were majority of respondents were the age of 21-25.

Table 4.1.3 marital status

Frequency Percent Valid Percent Cumulative Percent
Valid single 52 65.0 65.0 65.0
married 28 35.0 35.0 100.0
Total 80 100.0 100.0

Martial status

single
35%
married
65%

12
Figure 4.1.3 This chart above shows marital status of respondents that the majorities 52 of the
respondents in the percent of 65% were single and the remaining 28 of the respondent which is 35%
were married.

Table 4.1.4 year of study

Frequency Percent Valid Percent Cumulative Percent
Valid first year 18 22.5 22.5 22.5
second year 28 35.0 35.0 57.5
third year 24 30.0 30.0 87.5
fourth year 10 12.5 12.5 100.0
Total 80 100.0 100.0

year of study

fourth year 12.5

third year 30
Percent
second year 35

first year 22.5

0 5 10 15 20 25 30 35

Figure 4.1.4 This figure above shows the year of study period in the university, so that 18 out of
80 respondents which was 22.5% were about first year of the university, 28 out of 80 respondents
which was 35% were second year of the university, 24 out of 80 respondents which was 30% were
third year of the university and 10 out of 80 respondents which was 12.5% were fourth year of the
university

Table 4.1.5 Profession

Frequency Percent Valid Percent Cumulative Percent
Valid health officer 24 30.0 30.0 30.0
nurse and midwife 56 70.0 70.0 100.0
Total 80 100.0 100.0

13
 Profession

30

70 health officer
nurse and midwife

Figure 4.1.5: The above chart shows the profession of research respondents, so that the majority
70% of the respondents was nursing and midwives, while the remaining 30% was heath officers.

Table 4.1.6 Total monthly income

Frequency Percent Valid Percent Cumulative Percent
Valid <100%$ 46 57.5 57.5 57.5
100-300$ 32 40.0 40.0 97.5
300-600$ 2 2.5 2.5 100.0
Total 80 100.0 100.0

Total monthly income

60
50
40 57.5
30 40 Percent
20
10
2.5
0
<100%$ 100-300$ 300-600$

Figure 4.1.6 This above graph shows the total monthly income of the respondents, so that most of
the respondents 57.5% have a monthly income less than <100$, the next 40% have a income
between 100-300$, and the remaining 2.5% respondents have a income between 300-600$
.

14
Table 4.1.7 With whom do you live
Frequency Percent Valid Percent Cumulative Percent
Valid Parents 38 47.5 47.5 47.5
Family 28 35.0 35.0 82.5
Friends 8 10.0 10.0 92.5
by my self 6 7.5 7.5 100.0
Total 80 100.0 100.0

With whom do you live

by my self 7.5

Friends 10
Percent
Family 35

Parents 47.5

0 10 20 30 40 50

Figure 4.1.7 The above graph shows the of research respondents with whom they live, so that
47.5% of the respondents said live with their parents, 35% of the respondents said live their family,
10% of the respondents said live with their friends, and the remaining 7.5% said live with alone
by itself. Therefore, this information identifies that majority of respondents were live with their
parents and family.

Table 4.1.8 Educational level

Frequency Percent Valid Percent Cumulative Percent
Valid diploma 18 22.5 22.5 22.5
Degree 62 77.5 77.5 100.0
Total 80 100.0 100.0

15
 Educational level

80

60
Percent
40 77.5
20 22.5
0
diploma Degree

Figure 4.1.8 As the above figure shows the level of education of research respondents where the
majority 62 out of 80 respondents which were 77.5% are degree, while the remaining 18 out of 80
respondents which were 22.5% are diploma. Therefore, this information identifies that there were
majority of respondents are university degree level.
4.2: knowledge and prevention of hepatitis B
Table 4.2.1 have you got the hepatitis B vaccination
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 22 27.5 27.5 27.5
No 58 72.5 72.5 100.0
Total 80 100.0 100.0

have you got the hepatitis B vaccination

No 72.5

Percent

Yes 27.5

0 20 40 60 80

Figure 4.2.1: The above graph identifies the research respondents whether have got hepatitis B
vaccination or not, so that majority of the respondents 72.5% said no while the remaining 27.5%

16
said yes. Therefore, this information identifies that the majority of respondents don’t get hepatitis
B vaccination.

Table 4.2.2 Do people get HBV from genes (heredity)

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 32 40.0 40.0 40.0
No 38 47.5 47.5 87.5
I don’t know 10 12.5 12.5 100.0
Total 80 100.0 100.0

Do people get HBV from genes (heredity)

50

40

30
47.5 Percent
40
20

10 12.5
0
Yes No I don’t know

Figure 4.2.2: The above graph identifies whether people get hepatitis B from hereditary traits or
not, therefore; the majority of respondents 47.5% answered no while 40% of the respondents
answered yes.

Table 4.2.3 Do people get HBV through the air

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 14 17.5 17.5 17.5
No 56 70.0 70.0 87.5
I don’t know 10 12.5 12.5 100.0
Total 80 100.0 100.0

17
 Do people get HBV through the air

12.5% 17.5% Yes

No

70% idont know

Figure 4.2.3: The above chart identifies whether people get HBV through the air or not, so that
the majority of respondents 70% said no which means that people don’t get HBV through the air,
while 17.5% of the respondents said yes which means that people get HBV through the air.
Therefore the information identifies that the people don’t get HBV through the air.

Table 4.2.4 Do people get HBV from sexual relationships

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 64 80.0 80.0 80.0
No 12 15.0 15.0 95.0
I don’t know 4 5.0 5.0 100.0
Total 80 100.0 100.0

Do people get HBV from sexual relationships

5%

15%
Yes
No
I don’t know
80%

18
Figure 4.2.4: The above chart identifies whether people get HBV from sexual intercourses, so that
the majority of respondents 80% said yes which means that the people get HBV from sexual
intercourse, while 15% of the respondents said no which means that people don’t get HBV from
sexual intercourse. Therefore the information identifies that the people get HBV through sexual
relationships.

Table 4.2.5 Do people get HBV during birth

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 48 60.0 60.0 60.0
No 20 25.0 25.0 85.0
I don’t know 12 15.0 15.0 100.0
Total 80 100.0 100.0

Do people get HBV during birth

60
50 60
40
30 Percent
25
20
15
10
0
Yes No I don’t know

Figure 4.2.5: according the research respondents the above graph shows whether people get HBV
during birth or not, so that the majority of respondents 60% said yes which means that people get
HBV during birth, while 25% of the respondents said no which means that people don’t get HBV
during birth. Therefore the information identifies that the people get HBV during birth from
infected mother to child.

Table 4.2.6 Do people get HBV by sharing spoons or bowls for food
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 30 37.5 37.5 37.5
No 21 26.25 26.25 63.75
I don’t know 29 36.25 36.25 100.0
Total 80 100.0 100.0

19
 Do people get HBV by sharing spoons or bowls for food

I don’t know 36.25

No 26.25 Percent

Yes
37.5

0 5 10 15 20 25 30 35 40

Figure 4.2.6: The above graph identifies whether people get HBV by sharing spoons for food or
not, so that 37.5% said yes which means that people get HBV by sharing spoons for food, likewise
36.5% said don’t know, while 26.5% of the respondents said no which means that people don’t
get HBV by sharing spoons for food.

Table 4.2.7 Do people get HBV by eating food prepared by an infected person
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 50 62.5 62.5 62.5
No 22 27.5 27.5 90.0
I don’t know 8 10.0 10.0 100.0
Total 80 100.0 100.0

Do people get HBV by eating food prepared by an infected

person

10
27.5 Yes
62.5
No
I don’t know

Figure 4.2.7: according the research respondents the above chart identifies whether people get
HBV by eating food prepared by an infected person or not, so that the majority of respondents

20
62.5% said yes which means that people get HBV by eating food prepared by an infected person,
while 27.5% of the respondents said no which means that people don’t get HBV by eating food
prepared by an infected person through the air. Therefore the information identifies that the people
get HBV by eating food prepared by an infected person.

Table 4.2.8 Do people get HBV by sharing a toothbrush with an infected person
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 62 77.5 77.5 77.5
No 6 7.5 7.5 85.0
I don’t know 12 15.0 15.0 100.0
Total 80 100.0 100.0

Do people get HBV by sharing a toothbrush with an infected

person

80

60

40
77.5 Percent

20
7.5 15
0
Yes No I don’t know
Figure 4.2.8: The above graph identifies whether people get HBV by sharing toothbrush with an
infected person or not, so that the majority of respondents 77.5% said yes which means that people
get HBV by sharing toothbrush, while 7.5% of the respondents said no and 15% of the respondents
said don’t know. Therefore the information identifies that the people get HBV by sharing
toothbrush with an infected person.

Table 4.2.9 Do people get HBV by holding hands with an infected person
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 46 57.5 57.5 57.5
No 10 12.5 12.5 70.0
I don’t know 24 30.0 30.0 100.0
Total 80 100.0 100.0

21
 Do people get HBV by holding hands with an infected person

60
50
40
30
57.5 Percent

20 30
10 12.5
0
Yes No I don’t know

Figure 4.2.9: The above graph identifies whether people get HBV by holding hands with an
infected person or not, so that the majority of respondents 57.5% said yes which means that people
get HBV by holding hands with an infected person, while 12.5% of the respondents said no and
30% of the respondents said don’t know. Therefore the information identifies that the people get
HBV by holding hands with an infected person.

Table 4.2.10 Does HBV have signs or symptom

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 32 40.0 40.0 40.0
No 36 45.0 45.0 85.0
I don’t know 12 15.0 15.0 100.0
Total 80 100.0 100.0

Does HBV have signs or symptoms

15
Yes
40
No
I don’t know
45

Figure 4.2.10: The above chart show does HBV have a sing and symptoms, so that 45% said no
which means HBV don’t have a sign and symptoms, while 40% of the respondents said yes which
22
means HBV have a sign and symptoms, and the remaining 15% of the respondents said don’t
know.

Table 4.2.11 Does HBV cause liver cancer

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 52 65.0 65.0 65.0
No 14 17.5 17.5 82.5
I dont know 14 17.5 17.5 100.0
Total 80 100.0 100.0

Does HBV cause liver cancer?

I don’t know 17.5

No 17.5
Percent

Yes 65

0 10 20 30 40 50 60 70
Figure 4.2.11: The above graph and table shows whether HBV leads liver cancer or not, so that
the majority of respondents 65% said yes, and same as 17.5% of the respondents said no and don’t
know. Therefore according the research respondents this Information identifies that the HBV cause
liver cancer if not protecting and treating.

Table 4.2.12 If someone is infected with hepatitis B but they look and feel
healthy, do you think that person can spread hepatitis B
Frequency Percent Valid Percent Cumulative Percent
Valid Yes 58 72.5 72.5 72.5
No 8 10.0 10.0 82.5
I dont know 14 17.5 17.5 100.0
Total 80 100.0 100.0

23
 If someone is infected with hepatitis B but they look and feel healthy,
do you think that person can spread hepatitis B

17.5%
yes
10%
no
72.5% I don’t know

Figure 4.2.12: The above chart and table shows if someone is infected with hepatitis B but they
look and feel healthy, whether that person can spread hepatitis B virus or not, so that the majority
of respondents 72.5% said yes, 17.5% of the respondents said don’t know and least respondents
10% said no. Therefore according the research respondents this Information identifies that if
someone is infected with hepatitis B but they look and feel healthy, can spread hepatitis B virus.

Table 4.2.13 Have you ever heard/read about HBV

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 72 90.0 90.0 90.0
No 8 10.0 10.0 100.0
Total 80 100.0 100.0

Have you ever heard/read about HBV

10%

yes
no
90 %

Figure 4.2.13: The above chart and table shows respondents knowledge about HBV, so that the
majority of respondents 90% said yes which means they heard or read more about hepatitis B virus,
and remaining 10% of the respondents said no which means don’t know any about HBV.

24
Table 4.2.14 What is your source of information about HBV
Frequency Percent Valid Percent Cumulative Percent
Valid training 18 22.5 25.0 25.0
mass media 18 22.5 25.0 50.0
schools 8 10.0 11.1 61.1
friends 2 2.5 2.8 63.9
internet 18 22.5 25.0 88.9
journals 8 10.0 11.1 100.0
Total 72 90.0 100.0
Missing System 8 10.0
Total 80 100.0

What is your source of information about HBV

25
22.5 22.5 22.5
20
15
10 10 10 Percent
5 2.5
0
training mass schools friends internet journals
media

Figure 4.2.14: The above graph determines the respondents’ source of getting information about
HBV, so that the most of respondents 22.5% said same as training, mass media, and internet,
likewise 10% of the respondents said same as schools and journals, finally 2.5% of the respondents
said friends

Table 4.2.15 How many doses of HB vaccine required for complete protection
Frequency Percent Valid Percent Cumulative Percent
Valid 1 months 16 20.0 20.0 20.0
3 months 44 55.0 55.0 75.0
Don’t know 20 25.0 25.0 100.0
Total 80 100.0 100.0

25
 How many doses of HB vaccine required for complete protection

I dont know 25

3 months 55 Percent

1 months 20

0 10 20 30 40 50 60
Figure 4.2.15: The above graph and table shows exact period to complete doses of hepatitis B
vaccine for protection, so that majority of the respondents said 3 months for complete doses of
vaccine, 25% of the respondents said don’t know, while 20% of the respondents said 1 months.

Table 4.2.16 Hepatitis B is serious public health problem

Frequency Percent Valid Percent Cumulative Percent
Valid agree 42 52.5 52.5 52.5
strongly agree 22 27.5 27.5 80.0
disagree 8 10.0 10.0 90.0
strongly disagree 8 10.0 10.0 100.0
Total 80 100.0 100.0

26
 Hepatitis B is serious public health problem

60
50
40
30 52.5 Percent
20
27.5
10 10 10
0
agree strongly disagree strongly
agree disagree

Figure 4.2.16: The above graph determines that hepatitis B is a serious public health problem,
therefore majority of the respondents 52.5% said agree and also 27.5% said strongly agree, while
10% of the respondents answered same as strongly disagree and disagree.

Table 4.2.17 HB vaccine is safe

Frequency Percent Valid Percent Cumulative Percent
Valid agree 34 42.5 42.5 42.5
strongly agree 40 50.0 50.0 92.5
disagree 4 5.0 5.0 97.5
strongly disagree 2 2.5 2.5 100.0
Total 80 100.0 100.0

HB vaccine is safe

5
2.5
42.5 agree
50 strongly agree
disagree
strongly disagree

27
Figure 4.2.17: The above chart determines that hepatitis B vaccine is safe, because of half of the
respondents 50% of respondents said strongly agree and also 42.5% said agree while 5% and 2.5%
of the respondents answered strongly disagree and disagree respectively.

Table 4.2.18 Do you know if healthy people need vaccination

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 48 60.0 60.0 60.0
No 16 20.0 20.0 80.0
I dont know 16 20.0 20.0 100.0
Total 80 100.0 100.0

Do you know if healthy people need vaccination?

60
50
40
30 Percent
60
20
20 20
10
0
yes no I don’t know

Figure 4.2.18: The above graph and table determines if health people need vaccination, so that the
majority of respondents 60% said yes, 20% of the respondents said same as no and don’t know.
Therefore according the research respondents this Information identifies that even health people
need vaccination for protection.

Table 4.2.19 Do you know if you need a vaccination at your age

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 50 62.5 62.5 62.5
No 12 15.0 15.0 77.5
I dont know 18 22.5 22.5 100.0
Total 80 100.0 100.0

28
 Do you know if you need a vaccination at your age

I dont know 22.5

No 15 Percent

Yes 62.5

0 20 40 60 80
Figure 4.2.19: The above graph and table determines if your peer group need vaccination, so that
the majority of respondents 62.5% said yes, 22.5% of the respondents said don’t know, and 15%
of the respondents said no. Therefore according the research respondents this Information
identifies that even your age or peer group need vaccination for protection.

Table 4.2.20 Do you think you will receive hepatitis B vaccinations

Frequency Percent Valid Percent Cumulative Percent
Valid Yes 52 65.0 65.0 65.0
No 24 30.0 30.0 95.0
I dont know 4 5.0 5.0 100.0
Total 80 100.0 100.0

Figure 4.2.20: This above graph and table determines whether research respondent’s will think
receiving of vaccination or not, so that the majority of respondents 65% said yes which means they
think will receive vaccination, while 30% said no which means they don’t think will receive
hepatitis B vaccination.

29
 CONCLUSIONS AND RECOMMENDATIONS OF THE STUDY
This study was set out to establish the knowledge attitude and prevention of medical students in
Erigavo Somaliland. This chapter is focused on the discussion of the results of the study. Moreover,
the conclusions and recommendations are drawn and given respectively; the study was specifically
showed data on profile of the respondents, level of knowledge and prevention of hepatitis B
infection.

In the case of gender, there were more female (65%) than male (35%). This implies that the
majority of the respondents are female. The age categorization of respondents age present findings
which show that the majority of the respondents were in the age category was 21-25 with (45%)
of the respondents, (25%) were recorded on the age b/w 17-20 years, followed by the age bracket
of 26-30 with (22.5%) and finally 30 above with (9.8%). On the marital status of the respondents,
the findings were that majority of the respondents were single with 65% of the respondents, those
who were married was (35%). On the education characteristics of respondents were educated
because of they are university students, the majority of the respondents (70%) were nursing and
midwifery degree while (30%) of the respondents were health officers, the findings on this imply
that majority of the respondents were educated, it is of no doubt that researcher attained data from
the educated people.

Finally the research findings on the total monthly income of the respondents the presents findings
show that majority of the respondents were 57.5% have income less than 100$ and 40% of the
respondents have a income between 100-300$. On the respondents whom they live so that majority
of the respondents (47.5%) and (35%) live with parents and family respectively, this findings
implies that majority of the respondents were not responsible.

Recommendation
1. Ministry of Health should come up with measures to increase the knowledge of hepatitis B
2. We would recommend conducting further research.
3. Universities and medical students should enhance awareness about the benefits and
protection safety of HB-vaccination.
4. The person who gets HB vaccine must receive all three doses of hepatitis B vaccine. Children
and adults receiving only one dose of hepatitis B vaccine are a missed opportunity of
becoming completely vaccinated.

30
 5. The government and the health institutions should make hepatitis B vaccine available for free
or at a cost that most medical students and staffs can afford.
6. It would be much helpful if awareness creation activities like disseminating important
information on HBV infection and its vaccination are done.
7. Further study should be conducted in other level of health care settings and other part of
the country so as to have broader understanding of KAP of HBV.
8. Governmental and non-governmental organizations need to consider expanding the
currently available prevention facilities and put in place sustainable infection control and
prevention strategies.
9. Co-ordination between ministry of health and ministry of education to discuss the findings of this
study.
10. Incidence of HBV should be reported very early and patients should comply with treatment
as required by the medical assistants.
11. The district administration should engage local leaders in their attempt to operationalize
the district health plan. Local community involvement is critical to any HBV prevention
plans whether national or local in scope.

References
CDC, c. o. (2014). Treatment of hepatitis B infection.

Chang. (2007, June ).

Chao et al. (2010). knowlege of HBV. China.

Dochez, M. a. ( 2008). Global situation of HBV infection.

Edmunds et al. (1993). knowledge and prevention of HBV.

Ganem, D. & Prince. (2004).

Juszczyk. ( 2000). medical student hazard on HBV.

Kesieme et al. (2011). adequate knowledge of HBV.

Liu et al. (2002).

Ma and co-workers . (2007). knowlege of HBV and livercancer . US.

Mitchell, A. H. (2011).

MoPHS. (2008). national vaccination draft. nairobi.

31
Nguyen. (2008). global situation in asia. vietnam.

Othman et al. (2013).

PATH, P. f. (2012).

Rossi. (2012). systemic review of migrants from asia.

Seeger. (2007).

Seeger et el. (2007).

Shepard et al. (2006). global review problems of HBV.

Slonim and co-workers. (2005). US.

Socialstyrelsen. (2008).

Taylor and co-workers . (2005). knowledge and awareness of hepatitis b . viatnam.

WHO. ( 2012). (. epidemiology of heaptitis b.

World health Organization, (. (2004.). diagnosis and tests of HBV. geneva.

Zhao et al. (2000). hebatitis B and its effects in dental students.

Zuckerman. (2001). features of hepatitis B.

CDC, c. o. (2014). Treatment of hepatitis B infection.

Chang. (2007, June ).

Chao et al. (2010). knowlege of HBV. China.

Dochez, M. a. ( 2008). Global situation of HBV infection.

Edmunds et al. (1993). knowledge and prevention of HBV.

Ganem, D. & Prince. (2004).

Juszczyk. ( 2000). medical student hazard on HBV.

Kesieme et al. (2011). adequate knowledge of HBV.

Liu et al. (2002).

Ma and co-workers . (2007). knowlege of HBV and livercancer . US.

Mitchell, A. H. (2011).

MoPHS. (2008). national vaccination draft. nairobi.

Nguyen. (2008). global situation in asia. vietnam.

Othman et al. (2013).

PATH, P. f. (2012).

32
 Rossi. (2012). systemic review of migrants from asia.

Seeger. (2007).

Seeger et el. (2007).

Shepard et al. (2006). global review problems of HBV.

Slonim and co-workers. (2005). US.

Socialstyrelsen. (2008).

Taylor and co-workers . (2005). knowledge and awareness of hepatitis b . viatnam.

WHO. ( 2012). (. epidemiology of heaptitis b.

World health Organization, (. (2004.). diagnosis and tests of HBV. geneva.

Zhao et al. (2000). hebatitis B and its effects in dental students.

Zuckerman. (2001). features of hepatitis B.

33

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