KNOWLEDGE, ATTITUDE AND PRACTICE OF HEPATITIS B INFECTION PREVENTION AMONG NURSING STUDENTS OF ABIA STATE UNIVERSITY, UTURU

KNOWLEDGE, ATTITUDE AND PRACTICE OF HEPATITIS B INFECTION PREVENTION AMONG NURSING STUDENTS OF ABIA STATE UNIVERSITY, UTURU BY EZEONYE PRECIOUS CHINELO MATRIC NO: 2018/118263/REGULAR DEPARTMENT OF NURSING SCIENCE FACULTY OF HEALTH SCIENCES ABIA STATE UNIVERSITY, UTURU MAY, 2024 ACKNOWLEDGMENT I wish to first acknowledge God Almighty who in his mercy and grace gave me life, strength and good health to write this project. I give special thanks to my proficient supervisor Mrs. Ogburuafor S.U for her immense supervision, special thanks to my (H.O.D) Dr.Mrs. Emeonye O. P, for her encouragement. I also appreciate all the Lecturers for imparting the knowledge of Nursing to me. I am thankful to my parents Mr. and Mrs. Ezeonye Precious for their encouragement and financial support, my second Dad Mr. Ezeonye Bruno for his advice, prayers and support, to my sisters for their encouragement and to my brothers, for their support and to my friends, Precious, Chisom, Cynthia, Gold, Olivia, Florence and others, you all have been good to me. God bless you all. ABSTRACT Hepatitis B virus is one of the significant global challenges,. Although, the worldwide prevalence of hepatitis B infection has decreased after the introduction of the hepatitis B vaccine and other preventive measures, about 2 billion people are estimated to be infected (Umuhoza, et al, 2021; Hind, et al, 2020).. A quantitative, non-experimental descriptive research design was adopted to explore the Knowledge, Attitude and Practice of Hepatitis B Infection Prevention among Nursing Students in Abia State University, Uturu. Sample size of 240 respondents was gotten using the Taro Yamane formula. The researcher used a self designed questionnaire with close ended questions to collect data that was used for analysis in the study. The data gathered from this study was analyzed using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistical tools like tables and pie charts, etc were also used for the data analysis. The result of this study revealed that all the students had good knowledge of Hepatitis B infection. 230 students (95.8%) answered correctly what HBV stands for. 88% of the respondents have a good attitude towards HBV infection prevention while 12% have poor attitudes towards HBV infection prevention. Only 27% (67) have been screened for Hepatitis B. Out of the sixty seven who have been screened, 75% of respondents have not been vaccinated. A little above half of the population (58.3%) admitted to recapping needles. Almost all (90%) stated that they discard hospital waste appropriately. It was recommended that there should be regular health education program highlighting more on occupational risk of HBV infection, screening, and vaccination. Institutions of learning should screen their students for Hepatitis B as part of the medical screening exercise. Keywords: knowledge, attitude, prevention, hepatitis B virus, infection, nursing students. CHAPTER ONE INTRODUCTION Background of Study Hepatitis B virus is one of the significant global challenges, It is the tenth leading cause of death all over the world and doesn't have any seasonal spreading. The worldwide prevalence of hepatitis B infection has decreased after the introduction of the hepatitis B vaccine and other preventive measures. However, chronic infection remains a challenging global health problem, as about 2 billion people are estimated to be infected, 350 million people suffer from severe Hepatitis B infection and a significant number of 887,000 died in 2015 from its complications (Umuhoza, et al, 2021; Hind, et al, 2020) While being vaccine-preventable, hepatitis B can lead to chronic illness and increase the likelihood of death from cirrhosis and hepatic cancer. Throughout undeveloped and developing countries, contamination of hepatitis B is prevalent. The largest incidence, according to the WHO, is in the West Pacific region and the African region (6.2 percent and 6.1 percent respectively). Whereas America's WHO area is the least contaminated with 0.7 percent incidence (Al Bakri et al, 2021) Hepatitis B virus (HBV) is an enveloped virus of the Hepadnavirus family that infects the liver, causing hepatocellular necrosis and inflammation. HBV, spread by percutaneous or mucosal exposure to infected blood and various body fluids, can cause either an acute or chronic disease. Currently, available treatments fail to eradicate the virus in most of those treated, necessitating potentially lifelong treatment. (Akazong, et al, 2020) Healthcare workers (HCWs), who are frequently in contact with blood and other body fluids in the course of their work, are at a higher risk of exposure to blood borne viral diseases such as HBV, hepatitis C virus and HIV. Since HBV is a blood borne pathogen, healthcare professionals should be immunized. Improving public understanding of the signs, symptoms, and causes of HBV infection is a critical strategy for preventing disease spread. As a result, various studies have been conducted across the world to assess healthcare students’ knowledge, attitudes, and practices (KAP) about HBV and its related variables. Healthcare students in their clinical years should have sufficient awareness of HBV infection, the modes of transmission, the main symptoms, complications, and protective measures, as it would improve their health and direct them to be more sensitive and conscientious toward themselves and their patients. (Alaridah, et al, 2023; Akazong, et al, 2020) Statement of Problem Globally, hepatitis B infection affects about a third of the world’s population and causes 1.34 million mortalities annually. In sub-Saharan Africa, the prevalence of hepatitis B infection is estimated to be 6.1% with an associated 87,890 mortalities annually. Hepatitis B infection has been targeted for elimination by 2030, as provided by Sustainable Development Goal three and the Global Health Sector Strategy on viral hepatitis 2016–2021. Healthcare workers are known to be four times at risk of hepatitis B infection compared to the general population due to their contact with body fluids. Their trainees including nursing students have been acknowledged to carry a greater risk of infection by HBV, due to inexperience, inadequate training and sheer carelessness. Therefore, this study seeks to assess the Knowledge, Attitude and Practice of Hepatitis B infection prevention among nursing students of Abia State University, Uturu. Objectives of Study The main purpose of this study is to assess the Knowledge, Attitude and Practice of Hepatitis B infection prevention among nursing students of Abia State University, Uturu. The following objectives will guide the study: • To determine the level of knowledge about HBV infection preventive practices among nursing students of Abia State University, Uturu . • To assess the attitude of HBV preventive practices to nursing student of Abia State University Uturu. • To assess the practice of preventive measures of nursing students of Abia State University, Uturu. Research Questions The following research questions were formulated from the research objectives: 1. What is the level of knowledge among nursing students at Abia State University, Uturu regarding the transmission modes and prevention strategies of Hepatitis B infection? 2. What are the attitudes of nursing students at Abia State University Uturu towards Hepatitis B infection prevention measures? 3. Does academic level have a relationship with knowledge of prevention of Hepatitis B infection? 4. How well do nursing students of Abia State University, Uturu practice preventive measures for Hepatitis B infection? Research Hypothesis There is no significant relationship between the knowledge of nursing students of Abia State University, Uturu and their preventive measures towards Hepatitis B infection. Scope of Study With the rising increase in the prevalence of Hepatitis B infection and being aware of the fact that Healthcare personnels especially students are at greater risk, this study is focused on determining the knowledge, attitude and practice of Hepatitis B infection prevention among nursing students of Abia State University, Uturu. Only 240 respondents will be involved in this study which is scheduled to last for a month. Significance of the Study Hepatitis B infection is a global challenge. Its prevalence is on the rise mainly because of ignorance. This study is important for the assessment of the knowledge, attitude and practice of preventive measures for Hepatitis B Virus infection. Information births an increased awareness and ultimately better preventive techniques. Hence, there will be a decrease in infection rate. When this is achieved, the workforce of the country is not threatened and the nation’s economy is boosted. This study is also significant to nursing as the number of patients with this infection reduces. This in turn reduces nurses’ risk of coming down with the disease. Operational Definition of Terms Knowledge: The understanding of Hepatitis B Infection Prevention Among Nursing Students of Abia State University, Uturu. Attitude: Personal view or opinion on Hepatitis B Infection Prevention Among Nursing Students of Abia State University, Uturu. HBV Infection:Hepatitis B infection is a viral infection that affects the liver. Prevention: Action(s) taken to inhibit the development of Hepatitis B Infection Prevention Among Nursing Students of Abia State University, Uturu. CHAPTER TWO LITERATURE REVIEW Brief History It was first detected in the serum of Australian aborigines during the 1960s.The newly discovered antigen at that time initially was named “Australia antigen” and presently called HBV surface antigen (HBsAg), was frequently observed in leukemia patients. It has since become clear that hepatitis B is a wide spread disease, and more than 2 billion people in the world have been exposed to HBV. The World Health Organization (WHO) estimated that 296 million people were chronically infected by HBV in 2019. (Chuang,2022) Virology Hepatitis B virus (HBV) is an enveloped, partially double-stranded DNA virus of the Hepadnaviridae family. The infectious hepatitis B virion, known as the Dane particle, is approximately 42 nm in size and is composed of an outer lipid envelope containing viral glycoproteins as well as an inner nucleocapsid. The viral glycoproteins within the lipid envelope of the virion constitute the hepatitis B surface antigen (HBsAg). The nucleocapsid, composed of hepatitis B core antigen (HBcAg), encloses a copy of double-stranded circular HBV DNA and the HBV DNA polymerase. (Gonzalez, 2019) Transmission Transmission of Hepatitis B is classified into horizontal and vertical transmission. Horizontal transmission is defined as the transmission of the virus in the absence of sexual, perinatal or parenteral modes of spread. Horizontal transmission of hepatitis B virus (HBV) is a significant transmission route in households, among contact sport athletes and institutionalized individuals. Children often are infected by non-sexual close contacts with an increased tendency to become chronic carriers. (Sabeena and Ravinshankar,2022) Vertical transmission of HBV is defined as transmission occurring during pregnancy and in the perinatal period from the HBV-infected mother to the foetus or to the child. Overall, vertical transmission of HBV is a high efficacy phenomenon ranging, in the absence of any preventive interventions. The high success rate of immunoprophylaxis provided to newborns in reducing the incidence of HBV transmission suggests that most vertical transmissions occur at or near the time of birth. (Veronese, at al, 2021) Clinical Manifestation Clinical presentation varies from asymptomatic infection in two-thirds of patients to icteric hepatitis and, rarely, fulminant liver failure. A serum-sickness-like illness, characterized by fever, arthralgias, and rash, may occur in the prodromal period, followed by constitutional symptoms such as anorexia, nausea, jaundice, and right upper quadrant discomfort. (Burns and Thompson, 2020) Diagnostic Investigations The specimen of choice for the diagnosis of HBV infection is blood. Serological tests for viral antigens and antibodies are typically used for diagnostic screening and can be performed on either serum or plasma. Both HBV antigens and antibody are stable at room temperature for days, at 4°C for months, and frozen at -20°C to -70°C for many years. Treatment Acute hepatitis B infection is self cleared in 95% of healthy adults. Management is supportive in a majority of patients. Patients with severe acute disease and protracted acute severe disease (total bilirubin more than 3 mg/dl or direct bilirubin more than 1.5 mg/dl, INR more than 1.5, hepatic encephalopathy, or ascites) need antiviral treatment. Currently, two types of treatment, interferons (IFNs) and nucleos(t)ide analogues (NAs), have been approved. These treatments are effective in suppressing HBV replication and in decreasing the risk of developing cirrhosis, liver failure, hepatocellular carcinoma (HCC), and death. However, these treatments do not eliminate the virus, and the risk of HCC remains.( Lok, 2019) Knowledge of the Prevention of HBV infection As per the latest World Health Organization (WHO) report in 2018, by the end of 2015, an estimated 257 million people were living with HBV, and approximately 887,000 deaths have occurred, largely because of chronic complications of HBV infection such as hepatic cirrhosis and liver cancer. HBV infection is an occupational hazard and the risk in health-care professionals is 2–10 times higher than the general population. Health-care workers and medical students in clinical years, who come in contact with the patients and their potentially infectious materials such as blood and other body fluids, are at highest risk of acquiring the infection and should be protected. Medical students form the integral part of health-care system and they must have a proper knowledge about hepatitis B infection, modes of transmission, clinical features, complications, and preventive measures. The proper knowledge helps them to take necessary precautions to prevent the disease and also to spread awareness about hepatitis B infection among public, patients, and other health-care professionals.(Mohan, 2019) According to Gebremeskel et al in 2020, medical and health science students, being part of the health-care delivery system, are usually the first level of contact between patients and medical care. They are expected to undertake activities related to patient care at the beginning of their clinical years. Since medical and health science students are at increased risk of acquiring needle stick injury, and exposed to blood and blood products in their professional practice, conducting a study regarding the knowledge and practice level of students is very crucial for intervention to reduce the transmission of the virus The burden of Hepatitis B is on the increase even though effective vaccines to prevent the disease have existed since the 1980s.This continued increase in burden is due to a general lack of awareness with studies showing average to poor knowledge of hepatitis B virus infection and hepatitis vaccine among persons residing in regions of high risk. To curtail this problem, in 2015 the WHO launched an ambitious goal to reduce HBV infections by 90% and increase global vaccine coverage to 90%. Achieving this goal would require proper interventions targeted at behaviour change in regions of high prevalence. (Eni et al, 2019) Attitude towards the Prevention of HBV infection A study was conducted by Kumah et al in 2021 among students. There was a significantly high level of knowledge on Hepatitis B infection. However, the majority of the respondents felt they did not need to be protected from Hep-B infection even though they believed they were at risk of contracting the infection. Surprisingly, most of the students who were not vaccinated against Hepatitis infection were not willing to be vaccinated even if it is offered for free. Practice of Preventive Measures of HBV Infection As stated by Mesfin and Kibret in 2019, prevention against any disease is proportional to knowledge, attitude and practice (KAP) of the population. Health care workers should familiarize themselves with ‘‘universal precautions’’, which is defined by Center for Disease Control, as a set of precautions designed to prevent transmission of Human immunodeficiency virus (HIV), HBV, and other blood-borne pathogens when providing first aid or health care. Under universal precautions, blood and certain body fluids of all patients are considered potentially infectious for HIV, HBV and other blood borne pathogens. A study in Northwest Ethiopia carried out by Tesfa in 2021 indicated up to 4.2% of HBV infection among medicine and health trainees. This study revealed a high prevalence of hepatitis B virus infection among medical students, mainly due to poor knowledge about universal precaution guidelines, needle stick injury, and being unvaccinated. Institutions have to provide training on universal precaution guidelines and safety procedures effectively. In general during training, educational, occupational and personal protection should be provided to health care students. Theoretical Review This research is based on The Health Belief Model The Health Belief Model The Health Belief Model (HBM) was one of the first models of health-promoting behaviours and up till date, it is still remains one of the most generally accepted conceptual frameworks of health behaviours. The Health Belief Model expounds health behaviours from a social psychology perspective and it makes use of theories of value-expectancy and decision making. The Health Belief Model was first established in the 1950s in the United States (US) of America by psychologists Godfrey Hochbaum, Irwin Rosenstock and Stephen Regels. These individuals worked at the public health service of the United States of America. The model was developed because of the collapse of a free Tuberculosis (TB) health screening programme. The TB screening programme made provisions for a free TB screening X-rays specific centres situated at various neighbourhoods. Few adults utilized the services and this drew the attention of the programme organizers. Hochbaum, however, initiated a study to determine what motivated the few who participated in the programme. He swiftly learned that their perceived risk of disease and perceived benefits of the action played a major role in their motivation. Assumptions of the Health Belief Model The developers of the Health Belief Model specified that the following assumptions are associated to the implementation of health related actions. • The Health Belief Model assumes that an individual will take a health related action if he/she feels that an adverse health condition can be avoided. It is important to help individuals realize that they have the capacity to avoid a condition. It is only when one realizes this, that one would be able to take a preventative action. Thus, the nursing students can take preventive actions towards HBV prevention if they have adequate knowledge of how to do so. • The Health Belief Model also assumes that a person will take preventative action if he/she has an expectation that by taking a recommended action, the adverse health condition will be avoided. The benefits that one will get from practicing the behavior must be seen by the individual if not it would be difficult for one to take the necessary steps, or to maintain it. This means that when the nursing students have an expectation that they would not contract HBV infection when they practice the preventive actions, they would take the necessary actions. • The Health Belief Model also suggests that when an individual feels confident of his/her capacity to take the recommended action, he/she would do so. Therefore, when these students have confidence in their ability to practice preventive actions for HBV infection, they apply these practices. Components of the Health Belief Model The HBM has three major components: • The individual’s perceptions about health. • The modifying factors which include demographic, socio-psychological and structural variables. • The benefits of taking preventive measures Individual Perceptions Individual perceptions are a person’s beliefs about one’s own susceptibility to a disease the degree of the perceived threat of the illness. So, an individual changes perception as a result of acquired knowledge and this brings about a reduction of disease risk. If the nursing students gain more knowledge on HBV prevention, they will begin to see that they are at a great risk of contracting HBV. This will spur them to implement these preventive practices which in turn reduce the risk of contracting the infection. Modifying Factors Modifying factors, like demographic, socio-psychological and structural variables may affect an individual’s perceptions and thus indirectly influence health–related behaviours. Concepts of the Health Belief Model. The Health Belief Model is based on the following concepts: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. Perceived Susceptibility The first concept of the Health Belief Model is perceived susceptibility. This can be defined an individual’s beliefs about the possibilities of contracting a health condition. If an individual believes that a health problem is personally relevant, this will contribute to the application of the required action to prevent the health problem Perceived Severity The second concept of the Health Belief Model is perceived severity. This refers to one’s beliefs of how life threatening a condition is. When one acknowledges one’s susceptibility to a certain problem or condition, such individual is not necessarily motivated to take the necessary preventive actions unless he/she becomes conscious of the physical and social implications. It is when one is aware of the extent of the negative consequences of a condition, that one could take the required actions to avoid these negative consequences. Perceived Benefits Perceived benefits refer to one’s beliefs in the effectiveness of the advised action to reduce the risk or seriousness of impact. The person needs to believe that by taking a certain action, it will help one to avoid or prevent a problem from occurring. It is this belief that gives a person confidence to take the action because of the expected outcomes Perceived Barriers Perceived barriers refer to one’s belief in the substantial and mental costs of the recommended practices for the prevention of a particular disease condition. Perceived barriers to health actions include, physical barriers, psychological barriers, accessibility factors, personal characteristics, Possible hindrances to take in preventive actions for a disease include cost, inconveniences and unpleasantness. When individuals trust in their capacity to overcome these barriers, then they would implement preventive practices for that condition Cues to Action This refers to various factors that stimulate an individual to take action. Some of these factors include: events or experiences, personal (physical symptoms of a health condition), interpersonal or environmental (media publicity), etc.. Cues to action are when an individual is motivated to take the necessary action after believing that he/she has the capacity to do so. The required action will benefit one by knowing how to deal with the expected barriers. Self-Efficacy This is the sixth concept of the Health Belief Model. This is the intensity of an individual’s belief in one’s own ability to respond to new or difficult situations and to deal with any concomitant impediments or hindrances. Self-efficacy is one’s ability to efficaciously take action. Theoretical Framework for The Health Belief Model 2.2.3 Relevance of the theories to the study The Health Belief Model is based on the following concepts: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action and self-efficacy. • Perceived Susceptibility: When the nursing students believe that a health problem is personally relevant, this will contribute to the application of the required action to prevent them from contracting HBV infection. • Perceived Severity: These students will not take any preventive action unless they become aware of the negative consequences of not practicing them. • Perceived Benefits: These students need to believe that by taking a certain action for preventing HBV infection, it will help them to avoid or prevent the problem from occurring. • Perceived Barriers: When individuals trust in their capacity to overcome the barriers of implementing preventive practices for HBV infection, then they would do so. • Cues to Action: Some factors stimulate an individual to take action. Some of these factors include: events or experiences, personal (physical symptoms of a health condition), interpersonal or environmental (media publicity), etc. • Self-Efficacy: Self-efficacy is one’s ability to efficaciously take actions towards preventing HBV infection. Empirical Review Taranga et al conducted a research in 2020 on a study of knowledge and practice regarding Hepatitis B among nursing students attending tertiary care hospitals in Agartala city. A total of 300 selected nursing students were selected to participate in the research. 73.3% were females and majority of them were within the age group 19-22 years (50.2%) with a mean age of 21.07 years. Majority (99.7%) of participants knew Hepatitis B is a virus. Majority (92.7%) knew that Hepatitis B is transmissible and 63.1% of them were aware that Hepatitis B transmission was possible through unsafe sex, infected blood/body fluid contaminated syringe, needle & scalpel. An institution-based cross-sectional study was conducted by Aynalem at al in 2021 to assess the practice towards hepatitis B virus infection prevention and its associated factors among undergraduate students at Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia. 370 (93.4%) knew that people infected with hepatitis B virus are at risk of infecting others and 366 (92.4%) knew that hepatitis B virus can be transmitted by unsterilized syringes, needles, and surgical instruments. Their attitude towards Hepatitis B Virus Infection Prevention was also evaluated and out of 396 study participants, 222 (56.1%) had a favorable attitude while 174 (43.9%) of the respondents had an unfavorable attitude towards hepatitis B virus infection prevention. A descriptive survey was carried out using self-administered questionnaire among undergraduate medical and nursing students of a medical college in India. Statistical Package for Social Sciences (SPSS Ver 22.0) was used for analysis. It was discovered that more than three-fourths of medical and nursing students identified Hepatitis B as a public health problem. It can be further inferred from around 80% of medical (83.3%) and nursing students (79.8%) reported wearing gloves before handling patients. Around one-third of subjects accepted that they have come in direct contact with blood/body fluids. Among them exposed to blood/body fluids (N = 114), more than 85% of MBBS (86.8%) and nursing subjects (100.0%) performed post-exposure handwashing with soap and water. Visibly, a majority of medical and nursing candidates reported that they followed universal precautions, biomedical waste management rules while handling and disposing needles, respectively(Chhabra at al, 2019) Nduka conducted a research on a study of Hepatitis B Knowledge And Preventive Practices Amongst Medical Students In A Tertiary Institution In Abia State, South-East Nigeria. A total of 395 students participated in the study. Generally, most of the students had adequate knowledge of Hepatitis B infection. Students in year 5 [136 (87.2%) had the highest knowledge score followed by students in year 4 [122 (70.5%)]. There was a statistical significant association between knowledge score of HBV and year of study. An institutional-based cross-sectional study design was employed in Woldia University from January 30 to May 30, 2019. Out of the 200 participants, 96 (48%) have poor knowledge whereas 104 (52%) showed good knowledge about HBV. Thirty-two percent of 65 (32.5%) of the study participants did not know about hepatitis B postexposure prophylaxis. 79 (39.5%) of students have good practice, whereas 121 (59.5%) had poor practice towards HBV infection prevention. 149 (74.5%) of the respondents were never screened for HBV, and 16 (8%) of the students were vaccinated against HBV. (Gebremeskel et al, 2020) CHAPTER THREE METHODOLOGY Design of Study A quantitative, non-experimental descriptive research design was adopted to explore the Knowledge, Attitude and Practice of Hepatitis B Infection Prevention Among Nursing Students in Abia State University, Uturu. Setting of Study The research was carried out in the Nursing Department of Abia State University, Uturu. Abia State University is located in Uturu, Abia state at longitude 42°N and latitude 48°E. It has three campuses (Uturu, Umuahia and Aba) of which the main campus is located in Uturu. The Nursing Department which is a branch of the Faculty of Health Sciences is located in the main campus. Target Population The target population for this study was Nursing Students of Abia State University, Uturu. The respondents consists of selected amount of students across all academic levels Sample (Size and Formula) The sample size of this study was obtained using Taro Yamane formula. It is used for calculating the sample size of a finite population so that the findings and conclusion reached after analysis can be generated to the entire population from which the sample was derived. The Taro Yamane statistical formula is stated below: n=N/1+N(e)2 Where n=sample size sought N=population size e=level of precision(5%or0.05) Given that N=600,e=0.05 n=600/1+600(0.05)2 n=600/1+600×0.0025 n=600/1+1.5 n=600/2.5 n=240 Therefore, the sample size for this study was 240 students. Sampling Technique A non-probability purposive sampling method was utilized. A purposive sampling is a technique that relies on the researchers judbement when identifying and selecting the individuals, cases or events that can provide the best information to achieve a study's objectives. The inclusion criteria were that the respondents must be nursing students of Abia State University and they must be willing to participate in the study voluntarily. Instrument for Data Collection The instrument for data collection was a self-structured questionnaire comprises of close-ended question. The questions were grouped into the following sections: Section A: Socio Demographic Data Section B: Knowledge of HBV Infection Prevention Among Nursing Students Section C: Attitude towards HBV Infection Prevention Among Nursing Students Section D: Practice of HBV Infection Prevention Techniques Among Nursing Students Validity of Instrument The questionnaire was validated using a face and content validity by the supervisor of the study who read the questionnaire and ensured that they were relevant to the study, meet the research objectives and answer the research questions. Reliability of Instrument The reliability of the instrument was measured using the test-retest technique to assess the stability of the instrument. 20 copies of the questionnaire were shared to students who were not part of the sample size. After two weeks, the same instrument was administered to the same set of women and the different scores of both tests were compared. Furthermore, the two different scores from the pilot test were calculated and the reliability coefficient was obtained using the Spearman Rank Correlation. Method of Data Collection A self-administered questionnaire was used. It contained closed ended questions on the Knowledge, Attitude and Practice of Hepatitis B Infection Prevention Among Nursing Students. A letter of introduction was submitted to the department to obtain permission to collect data. A total of 240 questionnaires were used. All the questionnaires were administered and collected within three days with a 100% return rate. Method of Data Analysis The data gathered from this study was analyzed using the Statistical Package for Social Sciences (SPSS) software. Descriptive statistical tools which include measures of central tendencies, percentages, tables and bar charts, etc were also used for the data analysis. Hypothesis generated were tested using chi-square test to determine whether to reject or accept the null hypothesis. Ethical Consideration The following ethical issues were performed and considered in the course of this study:. • Informing the respondents about the research study, its purpose and significance. • Obtaining informed consent from the respondents. • Assuring and respecting respondents’ confidentiality. • Maintaining effective personal and interpersonal relationship • Maintaining effective communication • Ensuring anonymity of the respondents by reason of their names not required on the questionnaire. • Respondents were told that they are free to pull out at any point of the study and that pulling out will not have any consequences. CHAPTER FOUR Data Presentation and Analysis A sample of 240 respondents was selected comprising of Nursing students of Abia State University, Uturu. The study recorded a 100% response rate as a total of 240 out of 240 questionnaires administered were correctly filled, returned and used for data analysis. SOCIO-DEMOGRAPHIC DATA OF RESPONDENTS Table 1: SOCIO-DEMOGRAPHIC CHARACTERISTICS OF RESPONDENTS Variable Options Frequency. Percentage (%) Age. 18-20 72 30 21-23 100 41.67 24-26 30. 12.25 27-29. 23. 9.58 Above 29. 15. 6.25 Sex. Male 60 25 Female 180 75 Academic Level. 100 level. 15. 6.25 200 level 30. 12.25 300 level 45. 18.75 400 level 90. 37.5 500 level. 60. 25 Religion. Christianity. 240. 0 Islam. 0. 0 Others. 0. 0 Table 1 indicates that most (41.67%) of the students are within the age bracket of 21-23 years, 30% are within 18-20 years, 12.5% within 24-26 years and the least population(6.25%) are above 29years. Females were more in population with a percentage of 75%. Majority of the respondents were in 400 level. All respondents were Christians. KNOWLEDGE OF HBV INFECTION PREVENTION Table 2a: KNOWLEDGE OF HBV INFECTION PREVENTION Variable Frequency. Percentage (%) What does HBV stand for?. Human Benign Virus 0 0 Harmful Immunodeficiency Virus 0 0 Hepatitis B Virus 230 95.8 Herpes B Virus 10 4.2 Total 240 100 Where did you get to know about HBV? Health personnel 13 5.4 School 220 91.7 Media 5 2.1 Family 2 0.8 Total 240 100 Which of the following is true of HBV infection? It can lead to liver cancer 220 91.7 It can be genetically acquired 10 4.1 It is a progressive version of Hepatitis A 5 2.1 It has no treatment 5 2.1 Total 240 100 Which of the following is not true of HBV infection? Dark coloured urine 6 2.5 Buffalo hump sign 229 95.4 Fatty stools 5 2.1 Jaundice 0 0 Total 240 100 From Table 2a, it can be noted that 230 students (95.8%) answered correctly what HBV stands for. Majority of the students got to know about HBV from school (91.7), followed next by a smaller percentage who got their knowledge from a health personnel (5.4%). 91.7% of respondents were aware of the fact that HBV infection could ultimately lead to liver cancer if not managed properly. 4.1% of respondents thought HBV could be genetically acquired. 2.1% each, where of the opinion that Hepatitis B virus infection is a progressive version of Hepatitis A and that it had no treatment. Table 2b: KNOWLEDGE OF MEANS OF TRANSMISSION OF HBV INFECTION (N=240) Means of transmission Yes. No Unprotected sex. 240 0 Contact with infected body fluids and secretions 234 6 Mother to child 239 1 Use of infected and unsterilized medical instruments 240 0 Total 240 100 From table 2b, almost all the respondents believe that unprotected sex, contact with infected body fluids and secretions, mother to child and use of infected and unsterilized medical instruments are means of HBV transmission. Table 2c: RELATIONSHIP BETWEEN ACADEMIC LEVEL AND KNOWLEDGE OF HBV INFECTION AND TRANSMISSION Academic level Good knowledge(%) Poor knowledge(%) 100 level 60 40 200 level 80 20 300 level 90 10 400 level 95 5 500 level. 97 3 From table 2c, it can be seen that the level of knowledge increases with increase in academic level FIG 1: RELATIONSHIP BETWEEN ACADEMIC LEVEL AND LEVEL OF KNOWLEDGE ON HBV INFECTION From FIG 1, it can be seen that the level of knowledge increases with increase in academic level. The 500 level students demonstrated a high level of knowledge (97%) while the 100 level student demonstrated the least knowledge (60%) ATTITUDE TOWARDS HBV INFECTION PREVENTION Table 3a: ATTITUDE TOWARDS HBV INFECTION PREVENTION Strongly agree Agree Undecided Disagree Strongly disagree HBV infection is a public health issue of concern 200 39 1 0 0 I am aware of the fact that being a nursing student puts me at a great risk of having HBV infection 180 60 0 0 0 It is necessary to practice preventive measures for HBV infection 194 38 1 5 2 All patients should be tested for HBV before they receive health care 189 45 4 2 0 HBV-infected patients should be allowed to work routinely 205 30 0 3 2 I do not feel comfortable taking care of people with HBV 219 15 0 0 6 HBV vaccines are safe and effective 150 80 8 1 1 Instrument sterilization is important to prevent hepatitis B transmission 160 75 5 0 0 From table 3a, 200(83.3%) strongly agree that Hepatitis B is a public health concern. All respondents agreed that their profession puts them at risk for contracting HBV infection. Most (96.6%) of the respondents accepted that it was necessary to practice preventive measures for HBV infection, and 189 (78.7%) agree strongly that patients should be screened before hospitalization. Majority (97.5%) admitted that they were not comfortable taking care of patients with Hepatitis B virus infection. One hundred and sixty (66.6%) of the respondents strongly agree that instrument sterilization is important to prevent HBV transmission and 75 (31.25%) also agrees to this. Table 3b: OVERALL ATTITUDE TOWARDS HBV INFECTION PREVENTION Vsriable Frequency . Percentage Good attitude212 88 Poor attitude 28 12 Total 240 100 From table 3b, 88% of the respondents have a good attitude towards HB infection prevention while 12% have poor attitudes towards HBV infection prevention. FIG 2: A PIE CHART SHOWING THE OVERALL ATTITUDE OF RESPONDENTS FIG 2 indicates that 88% of the respondents have a good attitude towards HBV infection prevention while 12% have poor attitudes towards HBV infection prevention. PRACTICE OF HBV INFECTION PREVENTION Table 4a: PRACTICE OF HBV INFECTION PREVENTION YES NO TOTAL Have you ever been screened for Hepatitis B? 67 173 240 Have you received Hepatitis B vaccine? 60 180 240 I wash my hands before and after coming in contact with a patient and his/her surrounding. 200 40 240 Do you make use of personal protective equipment as indicated for procedures? 163 77 240 Do you recap needles? 140 100 240 I discard waste materials in hospitals into their appropriate container 230 10 240 From table 4a, only sixty-seven (27%) have been screened for Hepatitis B virus while 173 (73%) respondents have not gone for screening. Out of the sixty seven who have been screened, seven did not go for the vaccine. This ultimately means that 75% of respondents have not been vaccinated. Majority (83.3%) practice good hand hygiene. 163 respondents make use of personal protective equipments while 77 do not. A little above half of the population (58.3%) admitted to recapping needles. Almost all (90%) stated that they discard hospital waste appropriately. Table 4b: OVERALL PRACTICE OF PREVENTIVE MEASURES FOR HBV INFECTION Vsriable Frequency . Percentage Good Practices156 65 Poor Practices 28 12 Total 240 100 From table 4b, 65% of the respondents practice good preventive measures while 35% practice poor preventive measures of HBV infection. FIGURE 3: A PIE CHART INDICATING OVERALL PRACTICE OF PREVENTIVE MEASURES FOR HBV INFECTION From FIG 3, a little above half (65%) of the respondents practice good preventive measures while 35% practice poor preventive measures of HBV infection. ANSWERING RESEARCH QUESTIONS Question 1: What is the level of knowledge of Nursing students on preventive practices for Hepatitis B infection prevention? From Table 2a, 230 students (95.8%) answered correctly what HBV stands for with 91.7% who stated their source of knowledge was from school. 91.7% of respondents were aware of the fact that HBV infection could ultimately lead to liver cancer if not managed properly. 4.1% of respondents thought Hepatitis B could be genetically acquired. 2.1% each, where of the opinion that Hepatitis B virus infection is a progressive version of Hepatitis A and that it had no treatment. From table 2b, almost all the respondents believe that unprotected sex, contact with infected body fluids and secretions, mother to child and use of infected and unsterilized medical instruments are means of Hepatitis B transmission.. Question 2: What is the attitude of Nursing students towards HBV infection? From table 3b, 88% of the respondents have a good attitude towards HBV infection prevention while 12% have poor attitudes towards HBV infection prevention. Question 3: Does Academic level have a relationship with knowledge of and prevention of HBV infection? From table 2c, it can be seen that the level of knowledge increases with increase in academic level. This is more likely because of the higher the academic level, the higher the clinical exposure and the more exposed they are. Question 4: How well do nursing students of Abia State University, Uturu practise preventive measures for Hepatitis B infection? From figure 3, it is seen that about 65% of the students practice good preventive measures for HBV Infection and 35% practice bad preventive measures for HBV Infection. CHAPTER FIVE DISCUSSION OF FINDINGS SOCIO DEMOGRAPHICAL DATA From the analysis of the study, most (41.67%) of the students are within the age bracket of 21-23 years, 30% are within 18-20 years, 12.5% within 24-26 years and the least population(6.25%) are above 29years. Females were more in population with a percentage of 75%. These findings agreed with that of Taranga et al in 2020 on a study of knowledge and practice regarding Hepatitis B among nursing students attending tertiary care hospitals in Agartala city where 73.3% were females and majority of them were within the age group 19-22 years (50.2%). Majority of the respondents were in 400 level KNOWLEDGE OF THE STUDENTS ON HBV INFECTION PREVENTION The result of this study revealed that all the students had good knowledge of HBV infection. 230 students (95.8%) answered correctly what HBV stands for. Majority of the students got to know about HBV from school (91.7), followed next by a smaller percentage who got their knowledge from a health personnel (5.4%). 91.7% of respondents were aware of the fact that HBV infection could ultimately lead to liver cancer if not managed properly. 4.1% of respondents thought HBV could be genetically acquired. 2.1% each, where of the opinion that Hepatitis B virus infection is a progressive version of Hepatitis A and that it had no treatment. Almost all the respondents believe that unprotected sex, contact with infected body fluids and secretions, mother to child and use of infected and unsterilized medical instruments are means of HBV transmission which corresponds to a research carried out by Taranga et al, in 2020 where majority (92.7%) knew that Hepatitis B is transmissible. ATTITUDE TOWARDS HBV INFECTION PREVENTION 88% of the respondents have a good attitude towards HBV infection prevention while 12% have poor attitudes towards HBV infection prevention. This is the opposite in an institution-based cross- sectional study was conducted by Aynalem at al in 2021 where it was observed that nearly half of the respondents. (43.9) exhibited poor attitudes towards Hepatitis B infection Prevention. PRACTICE OF PREVENTIVE MEASURES FOR HBV INFECTION Findings from this study shows that only 27% (67) have been screened for Hepatitis B. Out of the sixty seven who have been screened, seven did not go for the vaccine. This ultimately means that 75% of respondents have not been vaccinated. This is in synchrony with a research undertaken by Gebremeskel in 2020 where 4.5% of the respondents were never screened for HBV, and just 8% of the students were vaccinated against HBV. A little above half of the population (58.3%) admitted to recapping needles. Almost all (90%) stated that they discard hospital waste appropriately. This tallies with the data gotten from a descriptive survey was carried out using self-administered questionnaire among undergraduate medical and nursing students of a medical college in India. Implications to Nursing From this study, it is revealed that although the students had good knowledge of HBV infection, but their attitude towards the disease prevention and their practice of these measures were still lacking to a level.. Therefore: • Nurses should be involved in organizing training sessions on HBV infection • Nurses should create more awareness programs on HBV infection in their localities • Nurses should collaborate with the ministry of education in reforming the curriculum Limitations of the Study • Time constraint • Transportation issues • Financial challenges Summary This study was designed to assess the Knowledge, Attitude and Practice of Hepatitis B Infection Prevention Among Nursing Students in Abia State University, Uturu. Literatures from previous studies related to this study were reviewed to form a basis for comparison and evaluation of the results that were obtained. A total of 240 questionnaires were distributed and all of them were returned. The questionnaire comprised 26 questions divided into 4 sections. Data collected were analyzed using the Statistical Package for Social Sciences (SPSS v.22). Descriptive statistics like tables, bar charts, pie charts and percentages were utilized. The findings revealed that sverall level of knowledge increases with increase in academic level. 88% of the respondents have a good attitude towards HBV infection prevention while 12% have poor attitudes towards HBV infection prevention. 65% of the respondents practice good preventive measures while 35% practice poor preventive measures of HBV infection. Conclusion Nigeria is highly endemic for HBV infection which is cause for alarm. Such a high prevalence questions the effectiveness of the Nigerian HBV vaccination programme. From the findings of this research, most of the respondents had good knowledge of Hepatitis B virus infection prevention but it's saddening to see that many have not received the vaccine. Therefore, there is a need for health promotion awareness campaign to educate the general public on the danger, mode of transmission and the risk factors associated with HBV infection especially among youth population; and most importantly a Widespread Hepatitis B vaccination scheme. Recommendations The following recommendations were made from the findings of this research: • There should be regular health education program highlighting more on occupational risk of HBV infection, screening, and vaccination. • Institutions of learning should screen their students for Hepatitis B as part of the medical screening exercise • The Ministry of Health should ensure disbursement of hepatitis B vaccines to the public at large. Suggestions for Further Studies Based on the findings of this study, further qualitative studies should be carried out to determine the reasons for nursing students not being vaccinated against Hepatitis B infection. 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