HepatitisBThesis Somaliland Somalia Sanaag

Gollis University
KNOWLEDGE ATTITUDE AND PREVENTION REGARDING HEBATITIS B

AMONG MEDICAL STUDENTS IN ERIGAVO SOMALILAND
__________________________________________
BY:
HASSAN FARAH JAMA
&
IBRAHIM ADAM ALI
_________________________________________
A THESIS SUBMITTED TO THE FACULTY OF HEALTH SCIENCE IN PARTIAL

FULFILMENT OF THE REQUIREMENTS FOR THE AWARD OF BACHELOR’S
DEGREE OF QUALIFIED NURSING AT GOLIS UNIVERSITY IN ERIGAVO,
SOMALILAND
________________________________________
SUPERVISOR BY:
Dr. HAMZE ALI ABDILLAHI
AUGUST 2019
Declaration
We declare that this thesis is our original work and has never been submitted to any institution
for any award what so ever without the writers’ consent or gollis university.
Hassan farah jama Signature………………Date………………………
Ibrahim adam ali Signature…………………Date……………………
i
APPROVAL
This dissertation entitled" the knowledge attitude and prevention regarding hepatitis B among
medical students in Erigavo Somaliland” submitted by Hassan farah jama and Ibrahim adam ali In
partial fulfillment of the requirements for the degree of health science department of clinical
nursing has been examined and approved by the panel with a grade of ________
___________________________________________
Name of Sign. of chairman
____________________________ _____________________________
Name and Sign. of Supervisor Name and Sign. of Department
ii
Dedication
This book is dedicated to our wonderful and respectful parents Sahra Ahmed Ali and Fadumo
Mohamed Omer for their sympathy, guidance and their moral, financial and material support as
well.
iii
Acknowledgement
First, we thank Almighty Allah for giving us the lives and strength to study and allowed to us to
make this research thesis. Secondly, we would like to give countless thanks to our honorable dean
of the faculty of health Dr. Abdullahi abdi dalmar and all our lectures that we can’t list all the
names here, but you are always on our minds.Thirdly, we would also like to express our deepest
gratitude and sincere to our keen supervisor Dr. HAMZE ALI ABDILLAHI Senior medical Lecturer,
Department of health science, who supported us immeasurably throughout this experience and provided
us with the confidence, knowledge, and tools needed to effectively and successfully carry out this task to
the best of our abilities. His excitement and willingness to provide feedback made the completion of this
research paper an enjoyable experience. He should be acknowledged as an outstanding supervisor and we
feel privileged to have collaborated with him. Finally, I wish to thank to our classmates and all staffs
at the Gollis University.
iv
Abstract
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.
Health professionals are among the most vulnerable groups to acquire HBV; with an estimated
risk of four times higher than that of the general population. 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. Vaccination of high-risk groups is a key strategy for
prevention. Despite the safe, effective and highly acceptable HBV vaccine that has been around
since 1982, its use among health care workers in the developing world is low. Immunization among
medical students has two purposes; to protect them from several infectious diseases they may be
exposed to through professional activities and to minimize the odds of infecting the patients they
are taking care of. This was a descriptive cross-sectional study the target population of this study
will be was 390 respondents of medical students in Ergavo city. The sample for this study will
consist of 80 respondents chosen from those medical students. 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%).
Specific knowledge items indicated that majority of the respondents (90%) had heard about
Hepatitis B and (80%) knew that it was mostly transmitted through sexual relationships and
(77.5%) also knew it’s transmitted person to person by sharing toothbrushes with infected person.
Finally, (65%) of the respondents knew if this infection leads to cause liver cancer. 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.
v
ABBREVIATIONS
Anti-HBe Hepatitis B e Antibody
Anti-HBs Hepatitis B Surface Antibody
AVH Acute Viral Hepatitis
FDA Food and Drug Administration
CDC Centre for Disease Control
CLD Chronic Liver Disease
ELISA Enzyme Linked Immuno sorbent Assay
EPI Expanded Programme on Immunisation
HBsAg Hepatitis B Surface Antigen
HBIG Hepatitis B Immunoglobulin
HBV Hepatitis B Virus
MOH Ministry of Education
PHC Primary Health Care
STD Sexually Transmitted Disease
NGO Non- Governmental Organization
SSA Sub-Saharan Africa
WHO World Health Organization
UNFPA United Nations Population Fund
vi
UNICEF United Nations Children’s Fund
List of tables
Table 4.1.1 Gender……………………………………………………………………….24
Table 4.1.2 age of the respondent………………………………………………………..25
Table 4.1.3 marital status…………………………………………………………………25
Table 4.1.4 year of study………………………………………………………………….26
Table 4.1.5 Profession……………………………………………………………………..27
Table 4.1.6 Total monthly income…………………………………………………………27
Table 4.1.7 With whom do you live………………………………………………………..28
Table 4.1.8 Educational level………………………………………………………………29
Table 4.2.1 have you got the hepatitis B vaccination………………………………………29
Table 4.2.2 Do people get HBV from genes (heredity) ……………………………………30.
Table 4.2.3 Do people get HBV through the air…………………………………………….31
Table 4.2.4 Do people get HBV from sexual relationships………………………………….31
Table 4.2.5 Do people get HBV during birth………………………………………………..32
Table 4.2.6 Do people get HBV by sharing spoons or bowls for food………………………33
Table 4.2.7 Do people get HBV by eating food prepared by an infected person……………33
Table 4.2.8 Do people get HBV by sharing a toothbrush with an infected person…………..34
Table 4.2.9 Do people get HBV by holding hands with an infected person…………………35
Table 4.2.10 Does HBV have signs or symptoms……………………………………………35
Table 4.2.11 Does HBV cause liver cancer…………………………………………………..36
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……………………………………………………………37
Table 4.2.13 Have you ever heard/read about HBV………………………………………….37
vii
Table 4.2.14 What is your source of information about HBV………………………….…...38
Table 4.2.15 How many doses of HB vaccine required for complete protection…………....39
Table 4.2.16 Hepatitis B is serious public health problem…………………………………...39
Table 4.2.17 HB vaccine is safe……………………………………………………………...40
Table 4.2.18 Do you know if healthy people need vaccination………………………………41
Table 4.2.19 Do you know if you need a vaccination at your age……………………………41
Table 4.2.20 Do you think you will receive hepatitis B vaccinations………………………...42
viii
Table of contents
Declaration............................................................................................................................................... i
APPROVAL ............................................................................................................................................... ii
Dedication .............................................................................................................................................. iii
Acknowledgement.................................................................................................................................. iv
Abstract .................................................................................................................................................. v
ABBREVIATIONS ..................................................................................................................................... vi
List of tables .......................................................................................................................................... vii
Table of contents.................................................................................................................................... ix
CHAPTER ONE ......................................................................................................................................... 1
1.0 introduction ...................................................................................... Error! Bookmark not defined.
1.1 Background of the study ................................................................................................................ 1
1.2 problem statement ........................................................................................................................ 2
1.3 general objectives .......................................................................................................................... 2
1.4 specific objectives .......................................................................................................................... 3
1.5 research questions ......................................................................................................................... 3
1.6 Significance of the study ................................................................................................................ 3
1.7 Scope of the study ......................................................................................................................... 3
1.7.1 Geographical scope ................................................................................................................. 3
1.7.2 Content scope ......................................................................................................................... 3
1.7.3 Time scope .............................................................................................................................. 3
1.8 Rationale (Justification).................................................................................................................. 4
1.9 Operational Definitions .................................................................................................................. 4
1.10 Conceptual Framework ................................................................................................................ 4
CHAPTER TWO ........................................................................................................................................ 5
Literature review ..................................................................................................................................... 5
Concepts, opinions and ideas from experts related to the study .............................................................. 5
2.1 Hepatitis B Virus ............................................................................................................................ 5
2.1.1 Epidemiology .......................................................................................................................... 6
ix
2.1.2 Transmission ........................................................................................................................... 8
2.1.3 Sign and Symptoms ................................................................................................................. 9
2.1.4 Disease States ....................................................................................................................... 10
2.1.5 Factors associated with HBV infection ................................................................................... 12
2.1.6 Diagnosis............................................................................................................................... 13
2.1.7 Treatment ............................................................................................................................. 13
2.2 Knowledge and attitude of medical students on hepatitis B risk and hepatitis B vaccination ........ 14
2.2.1 Prevention of hepatitis B ....................................................................................................... 15
2.3 Related study s ............................................................................................................................ 17
CHAPTER THREE .................................................................................................................................... 19
METHODOLOGY ................................................................................................................................ 19
3.0 Introduction ................................................................................................................................. 19
3.1 Research Design........................................................................................................................... 19
3.2 Research population .................................................................................................................... 19
3.3 Sample size .................................................................................................................................. 19
3.4 Sampling Procedure ..................................................................................................................... 20
3.5 Research Instruments .................................................................................................................. 20
3.6 Validity and Reliability.................................................................................................................. 20
3.6.1 Validity.................................................................................................................................. 20
3.6.2 Reliability .............................................................................................................................. 20
3.7 Data gathering procedure ............................................................................................................ 21
3.7.1 before the administration of the questionnaires ................................................................... 21
3.7.2 during the administration of the questionnaires .................................................................... 21
3.7.3 after the administration of the questionnaires ...................................................................... 21
3.8 Data Analysis ............................................................................................................................... 21
3.9 Ethical Considerations .................................................................................................................. 22
3.10 Limitations of the Study ............................................................................................................. 22
CHAPTER FOUR ..................................................................................................................................... 23
DATA PRESENTATION, INTERPRETATION AND ANALYSIS OF FINDINGS.............................. 23
4.1 Demographic features of respondents ......................................................................................... 23
4.2: knowledge and prevention of hepatitis B .................................................................................... 28
CHAPTER FIVE........................................................................................................................................ 42
x
SUMMARY, DISCUSSION OF FINDINGS, CONCLUSIONS AND RECOMMENDATIONS OF THE STUDY ......... 42
5.0 Introduction ................................................................................................................................. 42
5.1. Discussions ................................................................................................................................. 42
5.2 Conclusions.................................................................................................................................. 43
5.3 Recommendation ........................................................................................................................ 44
References ............................................................................................................................................ 45
Appendix II ............................................................................................................................................ 47
Questionnaire ....................................................................................................................................... 47
Appendix III ........................................................................................................................................... 53
Time frame ............................................................................................................................................ 53
Appendix IV ........................................................................................................................................... 54
BUDGET FRAME .................................................................................................................................... 54
xi
CHAPTER ONE
1.1 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, which belongs to hepadnaviridae family. 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 patientswhile 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)
All HBV infections do not have symptoms, which mean that people who are contagious are at a
risk without knowing it. However, many people may experience symptoms such as jaundice,
fatigue, loss of appetite, nausea, and abdominal pain. In nearly all adults, 90% of the infection
heals and they become healthy. But there is a risk of 90% and 30%–50% in infants and young
1
children, respectively, which can lead to chronic infection. This provides an increased risk that
they will suffer from liver cirrhosis or liver cancer in later life, if not medically managed. (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)
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.
1.3 general objectives
The purpose of this study is toassess the knowledge attitude and prevention regarding hepatitis B
among medical students in Erigavo city Somaliland
2
1.4 specific objectives
1 To determine demographic characteristics/ profile of the respondents
2 To assess the attitude of community to get HBV from sexual relationships
3 To assess Hepatitis B is serious public health problem in community
1.5 research questions

1. What is the profile of the respondents?
2. Do people get HBV from sexual relationships
3. Do think Hepatitis B is serious public health problem in community
1.6 Significance of the study

This research is significant to the following stakeholders the government and hospitals This study
was aimed at generating data from medical students in Erigavo context which can help health
policy makers and development planners to design and develop appropriate strategies and
programs that can reduce hepatitis B infection and enhance hepatitis B vaccine by medical students
and health care workers.
This study is also useful to academia, especially researcher who may be interested in carrying out
empirical studies.
1.7 Scope of the study
1.7.1 Geographical scope

The study was carried out in a Erigavo which is capital city of the largest region in Somaliland.
1.7.2 Content scope

This study was contained finding out the knowledge attitude and prevention regarding hepatitis B
among medical student in Erigavo city Somaliland.
1.7.3 Time scope

The period of this study was covered from April 2019 to July 2019 and will focus the relevant data
of the knowledge attitude and prevention regarding hepatitis B among medical student in Erigavo
city Somaliland.
3
1.8 Rationale (Justification)
The rationale behind this study about to determine the Knowledge attitude and prevention
regarding hepatitis B among medical student is important because of hepatitis B virus (HBV)
infection is a major global public health problem which can lead to life-threatening conditions like
liver cirrhosis and hepatocellular carcinoma (meads, 2011)
Medical students are key in prevention of Hepatitis B but can also be a major source of infection.
Despite the availability of the vaccine, adherence to recommendations has not been as great as
initially expected.
There have been few researches examining the Knowledge attitude and prevention regarding
hepatitis B among medical student in Somaliland, while there is no previous researches carried on
this variable in Erigavo so that this study will be valuable study that help to know more about more
about hepatitis B virus infection. (meads, 2011)
1.9 Operational Definitions
Hepatitis B is a contagious liver disease that ranges in severity from a mild illness lasting a few
weeks to a serious, life long illness. (Pooverawan, 1993, 1990)
Vaccination is the process of artificially administering into human body to get immunity for the
protection of diseases. This may be done either by stimulating the body’s immune system with
the vaccine or toxin to produce antibodies which prevent disease. A vaccine is a suspension of
live or killed organism (i.e., viruses) or parts of organism. ((CDC), 1996).
1.10 Conceptual Framework

Dependent variable Independent variable
 Unsafe injections when giving medications
Hepatitis B virus infection
 Unsafe blood transfusions
 Suturing, and needle-stick injuries
 Unprotected sexual contact.
 Shared personal items (such as
toothbrushes, razors, and nail clippers) with
Hepatitis B Prevention Methods an infected person.
 Unvaccinated medical students
 immunization with hepatitis B vaccine (childhood
and at-risk populations).
 routine screening of blood donors for HBsAg,
universal precautions when handling human blood
and body fluids (use of gloves, protective garments
and masks, when handling potentially infectious or
contaminated materials).
 good personal hygiene, strict surveillance, and 4
appropriate environmental control measures.
CHAPTER TWO
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).
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)
5
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).
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)
6
More than half of the estimated chronic hepatitis B cases were from the Western Pacific region,
from countries such as the Philippines, China and Vietnam. These were the main countries of birth
for imported cases of chronic hepatitis B. Africa was the second largest region for imported cases
of chronic hepatitis B. (Mitchell, 2011)
According to systematic review (Rossi, 2012) migrants from East Asia, the Pacific and Sub-
Saharan Africa represented a high seroprevalence of chronic hepatitis B, 10.3-11.3%, and migrants
from Eastern Europe, Central Africa and South Asia were an intermediate seroprevalence. The
seroprevalence of chronic hepatitis B was low among migrants from the Caribbean, Latin America,
the Middle East and North Africa. Refugees and asylum seekers had higher seroprevalence of
chronic hepatitis B compared to migrants.
2.1.1.2 Hepatitis B - situation in Asia

Even though all humans can be infected with HBV, Asians have the highest proportion (two thirds)
of HBV-infected persons (The hepatitis B foundation, 2013). HBV is endemic in Vietnam as in
many other countries in Southeast Asia and it is the leading cause of chronic liver disease (Nguyen
et al., 2008). Approximately 90% of the infants, who are infected during their first year, develop
chronic liver infections later in life. About 25% of the adults who developed these infections die
from infection related conditions, such as liver cirrhosis or liver cancer (Nguyen, 2008).
According to Bui (2002), in the article by Nguyen, McLaws and Dore (2007), 8-25% of the
Vietnamese population are carriers of chronic hepatitis B. That is approximately 8.4 million
Vietnamese individuals. It was estimated in the year of 2005 that this resulted in 23 300 HBV-
related mortalities per year in Vietnam.
Hipgrave and co-workers (2003) investigated the prevalence of HBV infection among 1579
individuals (infants, children, teenagers and adults from 9 months to 40 years old) in rural Vietnam.
They found that the prevalence of current HBV infection was highest among teenagers (20.5%),
followed by adults (18.8%), children (18.4%) and infants (12.5%) and the current or previous
infection increased with age. There was also a slightly higher risk for men to have a current or
previous HBV infection. None of the participants reported that they had received vaccine against
HBV.
In a study to foresee the prevalence of HBV and liver disease in Vietnam by 2025, it was calculated
that the prevalence of chronic HBV would increase until the year 2013 when it would peak at 8.6
7
million cases. It would then decrease to approximately 8 million cases in the year of 2025. The
decreasing would be due to the implementation of universal infant HBV vaccinations in 2003.
Despite the increasing amount of infants vaccinated, the projected prevalence of HBV-related liver
diseases will continue to increase during the following two decades due to the long latency period
of the disease’s development. This will result in 40 000 HBV-related deaths in Vietnam in the year
of 2025 (Nguyen, 2008).
2.1.1.3 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)
2.1.2 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
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:
8
 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
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)
2.1.3 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
9
 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)
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).
2.1.4 Disease States
2.1.4.1 Acute Viral Hepatitis B

Acute Hepatitis infections have a 1 month (4-6 weeks) to as long as 6 months incubation period
after transmission as the virus spreads within the liver. In approximately 65% of acute infections
the infection and resolution is clinically silent. Symptoms that are clinically recognized in the
remaining cases include decreased appetite, nausea and vomiting, fatigue and abdominal pain as
10
well as jaundice in the more severe cases. These symptoms most often result from increased
production of pro-inflammatory cytokines such as INF or TNF (Seeger, 2007)
The first serological marker to become detectable during infection is the HBsAg, which usually
becomes detectable at 8-12 weeks post-infection, assuming 1 month incubation. This marker
typically precedes an elevation of serum ALT levels and symptoms of hepatitis by 2 to 6 weeks
and remains detectable throughout the symptomatic phase. After the onset of jaundice,
HBsAgtitres gradually decrease and usually and become undetectable after 2 to 6 months. Shortly
thereafter antibodies against S-antigen (Anti-HBs) become detectable in the serum and may remain
detectable indefinitely (Dienstag 2010).
A third serological marker, HBeAg, is readily detectable either concurrently or shortly after the S-
antigen. This marker is associated with a period of high levels of virus replication, more circulating
intact virions and detectable levels of HBV DNA in plasma samples. In self-limited cases, HBeAg
levels decrease and become undetectable shortly after the characteristic peak in serum ALT
activity.
This coincides with the appearance of Anti-HBe and a period of lower infectivity with little to
undetectable HBV DNA levels, the most severe cases of acute infection (0.1-1%) lead to complete
liver failure and are termed fulminant hepatitis.
2.1.4.2 Chronic Viral Hepatitis B

Chronic Hepatitis B, or the persistence of HBsAg and HBV disease for more than
6 months, is host and virus dependant and presents in several distinct phases based on differing
levels of viral replication and intensity of the immune response.
Carriers experience an initial immune tolerant phase characterized by near normal levels of ALT,
high levels of HBV DNA and both HBsAg and HBeAg positivity (Dienstag 2010; Seeger et al.
2007).
This phase ends when the immune system matures (in younger carriers) or recovers and begins to
control and clear the virus. The end of the immune clearance (or immune active) phase is often
marked by HBeAg seroconversion when HBeAg levels become undetectable and Anti-HBe
antibodies appear. This is considered a good clinical sign and marks the beginning of an inactive
carrier state because high HBeAg levels are indicative of high viral replication and infectivity,
whereas high Anti-HBe levels indicate a low level of viral replication with low to moderate
infectivity (Seeger et al. 2007)
11
During this phase the virus causes more severe liver damage while the host immune system is
unable to control the infection, this eventually contributes to liver cirrhosis and hepatocellular
carcinoma (Seeger et al. 2007; Kramvis 2008).
2.1.5 Factors associated with HBV infection

The most common factors found to be associated with HBV infection and carrier status in the East
Africa are family size, socioeconomic status, age, educational status and a history of previous
blood transfusion, surgery or contact with a jaundiced person. (Gilbert, 1981)
The association of a history of jaundice, previous blood transfusions, and surgery with HBV
infection and carrier status has been reported in Jordan, Egypt, Libya and Yemen. In Yemen, a
multi variable analysis found age, a history of jaundice, and a combined history of blood
transfusion and surgery, to be associated with HBV infection (Scott et al., 1990).
It would be useful to know the nature of these injections and by whom they were administered.
Involvement of non-health personnel may be an important explanatory factor for infections
resulting from these injections. In Egypt, for example, involvement of non-health personnel and
medical students during practice in parenteral and surgical procedures was found to be associated
with a higher risk of HBV infection (Scott et al., 1990).
A large number of surgical procedures such as tattooing and circumcision are also carried out by
unqualified individuals in Egypt, which is the case in many other Middle Eastern countries and it
is important to investigate the role ear piercing and circumcision may have in the transmission of
HBV infection in these countries (Scott et al., 1990).
In Egypt, Ghaffar et al examined risk factors for perinatal transmission. Apart from the proven
importance of HBeAg/ anti HBe status in perinatal transmission, they found that maternal history
of schistosomal infection was significantly associated with perinatal transmission (Ghaffar et al.,
1989). A possible explanation for this association was that schistosomal infection resulted in
impaired cell-mediated immunity, which might contribute to the presence of a higher titre of
HBsAg, and hence increased viraemia and infectivity (Scott et al., 1990).
12
2.1.6 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)
2.1.7 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 medications licensed for the
13
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)
2.2 Knowledge and attitude of medical students on hepatitis B risk and hepatitis B
vaccination
Generally, it is easy to assume that health care workers and medical students should have adequate
knowledge about diseases and other health conditions, by virtue of their training and proximity to
health facilities. Assessing people’s knowledge is a useful step to assess the extent to which an
individual or community is in a position to adopt a disease-free behavior for this disease.
Knowledge regarding HBV and safety precautions is needed to minimize the health care settings
acquired infections among health personnel. Health care personnel should have complete
knowledge of HBV infections, importance of vaccinations are practice of simple hygienic
measures apart from that of specific protective measures (Othman et al., 2013)
Knowledge of the clinician plays a key role in prevention of spread of infection; people particularly
health care workers who lack adequate knowledge about HBV might ignore the importance of
vaccination (Othman et al., 2013).
Unfortunately, researchers have also not shown enough interest in evaluating the knowledge of
medical students on hepatitis B virus infection or the vaccine. Most previous studies in medical
students in developing countries have revealed inadequate knowledge of hepatitis B virus infection
and inadequate practice of preventive measures against the disease (Kesieme et al., 2011)
14
2.2.1 Prevention of hepatitis B
2.2.1.1 Hepatitis B vaccine

The HBV vaccine was introduced 1982 in the U.S. and in 1997 infant HBV vaccination was
introduced in Vietnam. It was part of a trial and was implemented in two cities; Hanoi and Ho Chi
Minh City (PATH, 2012)
In 2003 a universal infant vaccination programme was implemented in the whole country, but in
2006 still only 64% of the new-borns got the birth-dose vaccine within 24 hours. If the birth-dose
of hepatitis B vaccine is given within the first 24-hours of birth, it prevents 80-90% of the virus
transmission between mother and child (PATH, 2012)
Hepatitis B vaccine is a vaccine that prevents hepatitis B. The first dose is recommended within
24 hours of birth with either two or three more doses given after that. This includes those with
poor immune function such as from HIV/AIDS and those born premature. It is also recommended
for health-care workers to be vaccinated.In healthy people routine immunization results in more
than 95% of people being protected. (Socialstyrelsen, 2008)
The hepatitis B vaccine contains a protein (antigen) that stimulates the body to make protective
antibodies. Examples of hepatitis B vaccines available include hepatitis B vaccine-injection
(Engerix-B, Recombivax-HB). Three doses (given at 0, 1, and 6 months of age) are necessary to
assure protection (Edmunds et al, 1993)
The HBV vaccine gives healthy infants, children and adults a protective concentration of anti-HBs
in 90-100% of the cases if following the vaccination schedule properly. The vaccine is typically
given in a three-dose series. Persons who are immune-suppressed or over 40 years old are less
likely to develop protective concentrations (Shepard et al, 2006). It is not known if the HBV
vaccine gives lifelong protection against HBV and if boosters are necessary. However, it is known
that the protection is long lasting, at least 10-15 years, if the vaccination schedule is followed
correctly. Fever and pain at the injection site are the most common side effects of the HBV vaccine.
Allergic reactions have been reported but are not common (Shepard et al, 2006).
Hepatitis B vaccines are effective and safe. Up to 95% of vaccinated individuals form effective
antibodies when they get the vaccine and are protected from hepatitis B (Edmunds et al, 1993). In
15
healthcare workers, medical students, high-risk public safety workers, dialysis patients, and sexual
partners of infected persons, a blood test for antibodies is recommended after vaccination to ensure
that the person produced antibodies. For the few who do not form antibodies, revaccination may
improve response, especially in infants. However, a small proportion of individuals will never
respond to hepatitis B vaccination (Liu et al., 2002).
2.2.1.2 Policies on HBV Vaccination

Injection safety and appropriate use of injections has been considered as a priority issue in the
control of HBV. The estimated risk of infection following a needle prick from an infected source
is 30% compared to only 3% for HCV and 0.3% for HIV. To prevent the adverse effects of unsafe
injection practices the United Nations, NGOs, governments, donors and universities joined their
forces in Safe Injection Global Network (SIGN) which is to enable identification of strategies for
development of large scale initiative to ensure safe injection as a priority. The Kenya National
Vaccination (Draft) Policy has also recommended Monovalent Hepatitis B vaccine for prevention
of hepatitis B infection in health workers and other special risk groups (MoPHS, 2008)
2.2.1.3 Warnings/Precautions
Concerns related to adverse effects:
• Anaphylaxis/hypersensitivity reactions: Hypersensitivity and anaphylactic reactions can occur;
immediate treatment (including epinephrine 1 mg/ml) should be available. Use with caution in
patients with isolated immunoglobulin A deficiency or a history of systemic hypersensitivity to
human immunoglobulin’s.
• Infusion reactions: When administered IV, do not exceed recommended infusion rates; may
increase risk of adverse events. Patients should be monitored for adverse events during and after
the infusion.
• Thrombotic events: Thrombotic events have been reported with administration of intravenous
immune globulin; use with caution in patients of advanced age, with a history of atherosclerosis
or cardiovascular and/or thrombotic risk factors, patients with impaired cardiac output, coagulation
disorders, prolonged immobilization, or patients with known/suspected hyperviscosity. Consider
a baseline assessment of blood viscosity in patients at risk for hyper viscosity (CDC, 2014)
16
2.3 Related study s
The study by (Taylor and co-workers , 2005) investigated knowledge and awareness of hepatitis
B among randomly selected Vietnamese adults living in the United States. 81% of the 715 adults
that participated in the study had heard of hepatitis B and 67% had been tested for HBV. The
knowledge of the infection was generally good, with about three-quarters knowing the different
ways of transmission but only 69% knew about infection through unprotected sex.
The (Ma and co-workers , 2007) Examined the knowledge of HBV and liver cancer among 256
Vietnamese Americans with low socioeconomic status. The results showed that the participants
had general knowledge of HBV, but only 22% knew that HBV can spread through unprotected
sex. Many did not know that liver cancer is preventable or that it is curable. Only a third of the
participants knew about the vaccine that protects against HBV.
HBV infection and its effects, another study conducted among first-year dental students among
three dental colleges in Haryana showed that 84.9% of the students were aware regarding the
spread of HBV infection and only 23.7% of the students had complete vaccination against hepatitis
B. A study done in Taiwan reported that 75.0% of the dental students had knowledge of hepatitis
B infection, but had little knowledge about vaccine dosage, transmission, prevention, and
precautions of HBV infection. Another study done on dental students in Maharashtra indicated
that they had good knowledge about HBV infection. A study done among Iranian dental students
showed that they had a relatively good level of knowledge about HBV infection and its control
practices. A study done in Pondicherry reported that 92.7% of the dental interns were aware of
HBV immunization. Another study done at the University of Dundee on medical and dental
students showed that 99.2% of students were aware of HBV immunization. (Zhao et al., 2000)
A study was carried out in China to investigate the knowledge about HBV among 250 health
professionals by handing out a questionnaire at the “China national conference on the prevention
and control of viral hepatitis”. The results showed that even among highly educated health
professionals the knowledge and education was deficient. One-third of the respondents did not
know that it is common for chronic HBV infection to be asymptomatic or that it can lead to liver
cancer, liver cirrhosis and premature death. The authors believe that this increases the risk of health
professionals overlooking the significance of screening even those who are asymptomatic, and
vaccinating those who need it. (Chao et al., 2010) Mohamed and co-workers (2012)
17
In (Slonim and co-workers, 2005) study carried out in the U.S., 96 adolescents were individually
interviewed and 17 063 adolescents and young adults filled in a questionnaire. The participants
were European-Americans, African-Americans, multiracial, Native Americans, Asian and Pacific
Islanders, and other races. The study showed that the most common barrier to hepatitis B vaccine
acceptance was that the adolescents did not like getting shots (94%) and time-related barriers
(50%), as they had to come back two more times to the clinic to get the remaining doses of vaccine.
Almost two-thirds of the adolescents that were interviewed could not provide any correct
information before their clinic visit about hepatitis B.
18
CHAPTER THREE
METHODOLOGY
3.0 Introduction
This chapter presents the methodologies of this study includes the place where the study to be
conducted, the design being used in constructing the research, sampling design was used in getting
the population size, the subjects, the tools and treatments was utilized in analyzing and interpreting
the data was taken and the instrument to be used in data gathering, ethical consideration and finally
limitation of the study.
3.1 Research 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.
3.3 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
19
N:Population size
n:Sample size
e:Level of Significance = e=0.10=e2 = (0.10)2= 0.01
3.4 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
3.5 Research Instruments
The main research instrument that was used in this study is structured questionnaire.
3.6 Validity and Reliability
3.6.1 Validity
Validity is arguably the most important criteria for the quality of a test. The term validity refers
to whether or not the test measures what it claims to measure. On a test with high validity the
items will be closely linked to the test's intended focus
V= RQ/ TQ
V= validity
RQ= relevant questions
TQ= total questions
3.6.2 Reliability
Test-retest reliability is a measure of reliability obtained by administering the same test twice
over a period of time to a group of individuals.
𝑅= 𝑇𝐷/𝑇𝑄
TD= total difference
TQ=total questionnaire
R= reliability
20
3.7 Data gathering procedure
3.7.1 before the administration of the questionnaires

The approval latter should be obtained from the supervisor of this study for the researcher
to conduct the study.
After the approval the researcher will check the list of respondents from the sample.
The respondents will explained about the study and request to sign the Informed Consent
Form.
3.7.2 during the administration of the questionnaires

The respondents were requested to answer completely and not to leave any part of the
questionnaires unanswered.
The researchers and assistants were emphasizing retrieval of the questionnaires within
seven days from the date of distribution.
On retrieval, all returned questionnaires were checked if all are answered.
3.7.3 after the administration of the questionnaires

The data gathered was collated, encoded into the computer and statistically treated using
the Statistical Package for Social Sciences (SPSS).
3.8 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
21
3.9 Ethical Considerations
To ensure confidentiality of the information provided by the respondents and to ascertain the
practice of ethics in this study, the author’s knowledge is quoted in this study and the author of the
standardized instrument through citations and referencing. Present the findings in a generalized
manner.
3.10 Limitations of the Study
The limitations may have different dimensions during this study and will be vary from one and
another
 Limitation for the time:-is one of the major challenge that was faced the researchers
because of its difficulties to get much time as well as research is enough as needed to
finalize this dissertation and also short time in analysis data collection
 Limitation for the resources: - is one of the challenges, which do not know where the
beginning of our research, every things needs effort and more preparations. And also
there’s no previous researches done at this area of study.
 Difficulties to usingStatistical Package for Social Sciences (SPSS) during the data
analyze and also poor understanding of the respondents to the study
 Limitation may be budget attend to the study
22
CHAPTER FOUR
DATA PRESENTATION, INTERPRETATION AND ANALYSIS OF FINDINGS

This chapter focused on the analysis and interpretation of data. The study based on primary data.
Primary data have been collected by conducting a questionnaire among 80 medical students in
the universities of erigavo district. The collected data were organized and presented in form of
table, graph, and charts. Various statistical techniques like, descriptive frequency and percentage
were adopted for the analysis. The purpose of analyzing data is to obtain usable and useful
information
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
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.
23
Table 4.1.2 age of the respondent
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
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

Valid single 52 65.0 65.0 65.0
married 28 35.0 35.0 100.0
Total 80 100.0 100.0
24
Martial status
single
35%
married
65%
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

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
25
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

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
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

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
26
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$
.
Table 4.1.7 With whom do you live
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
27
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

Valid diploma 18 22.5 22.5 22.5
Degree 62 77.5 77.5 100.0
Total 80 100.0 100.0
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

Valid Yes 22 27.5 27.5 27.5
No 58 72.5 72.5 100.0
Total 80 100.0 100.0
28
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%
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)

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
29
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

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
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

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
30
Do people get HBV from sexual relationships
5%
15%
Yes
No
I don’t know
80%
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

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
31
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
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
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
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
32
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
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
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
33
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
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
Do people get HBV by holding hands with an infected person
60
50
40
30
57.5 Percent
20 30
10 12.5
0
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

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
34
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
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

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
35
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
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
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

Valid Yes 72 90.0 90.0 90.0
No 8 10.0 10.0 100.0
Total 80 100.0 100.0
36
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.
Table 4.2.14 What is your source of information about HBV

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
37
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
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
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

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
38
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

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
39
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

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

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
40
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

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.
41
CHAPTER FIVE
SUMMARY, DISCUSSION OF FINDINGS, CONCLUSIONS AND

RECOMMENDATIONS OF THE STUDY
5.0 Introduction
This chapter presents the summary, discussion of findings conclusions and recommendations
arising from the findings of the study along the study objectives.
5.1. Discussions
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.
42
Generally, it is easy to assume that medical students should have adequate knowledge about
diseases and other health conditions, by virtue of their educating and training to health facilities.
The study findings found out that a fairly high number of medical students (90%) were within the
good knowledge range while (10%) showed poor knowledge about hepatitis B.
Specific knowledge items indicated that majority of the respondents (90%) had heard about
Hepatitis B and (80%) knew that it was mostly transmitted through sexual relationships and
(77.5%) also knew it’s transmitted person to person by sharing toothbrushes with infected person.
Finally (65%) of the respondents knew if this infection leads to cause liver cancer. This was much
higher than in a study among Southern Nigeria where (85%) had heard of hepatitis B, the
knowledge on transmission was also higher than (60%) (Schenkel,2008).
Prevention then seems to be the best mode of halting spread of hepatitis B infection, so that
vaccination is an important measure in preventing HBV infection. This study reveals that the
majority (92%) of the respondents knew that vaccination is a safe for protection and mostly (55%)
of the respondents knew the complete 3 doses of vaccination and its duration. However this study
indicated that uptake of hepatitis B vaccination by the medical students was low (22.5%). There
was no statistically significant association between knowledge the uptake of hepatitis B
vaccination.
5.2 Conclusions
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. Hepatitis is an inflammation
of the liver that may occurs following infection by HBV or other causes. Viral hepatitis is a leading cause
of virus associated morbidity and mortality, affecting millions of individuals worldwide. Hepatitis B leads
to chronic liver disease and put people at high risk of death from cirrhosis of the liver and liver cancer.
According to World Health Organization (WHO) estimation, there are over 2 billion HBV infected people
and there are about 620,000 HBV related deaths each year. In addition, approximately 4.5 million new HBV
infections occur worldwide each year, of which a quarter progresses to liver disease.
43
5.3 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.
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.
44
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.
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 ).
45
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).
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.
46
Appendix II
Questionnaire
Gollis University
Erigavo Campus
Faculty of nursing
Dear of respondent
We are the students from Gollis University doing Bachelor degree in nursing, we are conducting
a study whose objective is to generate, Information of the knowledge attitude and prevention
regarding hepatitis B among medical students in erigavo district. We kindly requested you to fill
in this questionnaire with a lot of sincerely and to the best of your knowledge, The data you provide
will be only used for academic purpose and the information you offer will be treated with most
confidently, your contribution of answering these questions will be highly appreciated.
Thanks a lot.
47
Part one: Profile of the Respondents
1. Gender
Male
Female
2. Age
17-20 years 26-30 years
21-25 years above 30 years
3. Marital status
1. Single
2. Married
3. divorced
4. Year of study
First year Third year
Second year Fourth year
5. Profession
Medical doctor health officer
Nurse and midwife pharmacist
Laboratory technologist other
6. Total monthly income

A) Less than $100
B) $100 – $300
C) $300 – $600
D) $600 – $900
E) more than $1000
7. With whom do you live?
1. Parents
2. family
3. Friends
48
4. By myself
5. Other/others (please specify) ……………………
8. Your educational level

1. Certificate
2. Diploma
3. First Degree
4. Master’s Degree
5. Specialist/specify the field______
Part two: knowledge and prevention of hepatitis B

1. Have you heard about hepatitis B virus (HBV) infection?
1. Yes
2. No
2. Have you got the hepatitis B vaccinations?

1. Yes
2. No
3. Do people get HBV from genes (heredity)?
1. Yes
2. No
3. I Do not know
4.Do people get HBV through the air (coughing or staying in the same room)?
1. Yes
2. No
3. I Do not know
5.Do people get HBV from sexual relationships?
1. Yes
49
2. No
3. Don’t know
6.Do people get HBV during birth?
1. Yes
2. No
3. Don’t know
7.Do people get HBV by sharing spoons or bowls for food?
1. Yes
2. No
3. Don’t know
8.Do people get HBV by eating food prepared by an infected person?
1. Yes
2. No
3. Do not know
9. Do people get HBV by sharing a toothbrush with an infected person?
1. Yes
2. No
3. Don’t know
10.Do people get HBV by holding hands with an infected person?
1. Yes
2. No
3. Don’t know
11. Does HBV have signs or symptom?

1. Yes
2. No
3. Don’t know
50
12 .Does HBV cause liver cancer?
1. Yes
2. No
3. Don’t know
13. If someone is infected with hepatitis B but they look and feel healthy, do you think that
person can spread hepatitis B?
1. yes
2. No
3. Don’t know
15.Have you ever heard/read about HBV?
1. Yes
2. No
16.What is your source of information about HBV?
1. Training
2. Mass media
3. Formal education/school
4. Friends
5. Internet
6. Journals
7. Other/specify………
17.How many doses of HB vaccine required for complete protection?
1. 1 months
2. 3 months
3. Don’t know
18.Hepatitis B is serious public health problem?
1. Agree
2. Strongly agree
3. Disagree
4. Strongly disagree
51
19.HB vaccine is safe?
1. Agree
2. Strongly agree
3. Disagree
4. Strongly disagree
20.Do you know if healthy people need vaccination?
1. yes
2. No
3. Don’t know
21.Do you know if you need a vaccination at your age?
1. yes
2. No
3. Don’t know
22.Do you think you will receive hepatitis B vaccinations?
1. yes
2. No
3. Don’t know
Thanks for your participation
52
Appendix III
Time frame
No Duration Activity
1 25 April 2019 Title approval

2 4 May 2019 Chapter one
3 23 May 2019 Chapter two
4 1 June 2019 Questionnaire
5 22 June 2019 Chapter three
6 24 July 2019 Chapter four
7 25 July 2019 Chapter five
8 25 July 2019 Primarily pages
9 26 July 2019 Copy and printing
53
Appendix IV
BUDGET FRAME
NO Description Amount
1 Transportation cost $ 14
2 Internet excess $ 36
3 Printing and copy cost $ 15
5 Total $ 65
54
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Gollis University

KNOWLEDGE ATTITUDE AND PREVENTION REGARDING HEBATITIS B

HASSAN FARAH JAMA

IBRAHIM ADAM ALI

A THESIS SUBMITTED TO THE FACULTY OF HEALTH SCIENCE IN PARTIAL

Dr. HAMZE ALI ABDILLAHI

Hassan farah jama Signature………………Date………………………

Ibrahim adam ali Signature…………………Date……………………

Name of Sign. of chairman

Name and Sign. of Supervisor Name and Sign. of Department

Anti-HBe Hepatitis B e Antibody

Anti-HBs Hepatitis B Surface Antibody

AVH Acute Viral Hepatitis

FDA Food and Drug Administration

CDC Centre for Disease Control

CLD Chronic Liver Disease

ELISA Enzyme Linked Immuno sorbent Assay

EPI Expanded Programme on Immunisation

HBsAg Hepatitis B Surface Antigen

HBIG Hepatitis B Immunoglobulin

HBV Hepatitis B Virus

MOH Ministry of Education

PHC Primary Health Care

STD Sexually Transmitted Disease

NGO Non- Governmental Organization

SSA Sub-Saharan Africa

WHO World Health Organization

UNFPA United Nations Population Fund

Table 4.1.2 age of the respondent………………………………………………………..25

Table 4.1.3 marital status…………………………………………………………………25

Table 4.1.4 year of study………………………………………………………………….26

Table 4.1.5 Profession……………………………………………………………………..27

Table 4.1.6 Total monthly income…………………………………………………………27

Table 4.1.7 With whom do you live………………………………………………………..28

Table 4.1.8 Educational level………………………………………………………………29

Table 4.2.1 have you got the hepatitis B vaccination………………………………………29

Table 4.2.2 Do people get HBV from genes (heredity) ……………………………………30.

Table 4.2.3 Do people get HBV through the air…………………………………………….31

Table 4.2.4 Do people get HBV from sexual relationships………………………………….31

Table 4.2.5 Do people get HBV during birth………………………………………………..32

Table 4.2.10 Does HBV have signs or symptoms……………………………………………35

Table 4.2.11 Does HBV cause liver cancer…………………………………………………..36

Table 4.2.13 Have you ever heard/read about HBV………………………………………….37

Table 4.2.16 Hepatitis B is serious public health problem…………………………………...39

Table 4.2.17 HB vaccine is safe……………………………………………………………...40

Table 4.2.18 Do you know if healthy people need vaccination………………………………41

Table 4.2.19 Do you know if you need a vaccination at your age……………………………41

Table 4.2.20 Do you think you will receive hepatitis B vaccinations………………………...42

1.2 problem statement

1.5 research questions

1.6 Significance of the study

1.7.1 Geographical scope

1.7.2 Content scope

1.7.3 Time scope

1.10 Conceptual Framework

Concepts, opinions and ideas from experts related to the study

2.1.1.1 Global Situation of HBV Infection

2.1.1.2 Hepatitis B - situation in Asia

2.1.1.3 HBV Situation in africa

In developing countries, common modes of transmission are: