Hepatitis B Virus (HBV)
Hepatitis B is a serious liver disease caused by the hepatitis B virus (HBV), which is transmitted through human body fluids, including blood and serum This global public health issue is spread via perinatal transmission, sexual contact, and unsafe injection practices Over two billion people have been infected with HBV at some point in their lives, with approximately 350 million becoming chronic carriers Among these carriers, 25-30% may ultimately die from complications such as liver cirrhosis or primary liver cancer, highlighting the severe risks associated with this infection Additionally, these carriers serve as a reservoir for the virus, perpetuating its transmission across generations.
Approximately 70% of healthy adults with acute HBV infections are asymptomatic, while the rest exhibit liver disease symptoms like abdominal pain and jaundice Fatalities from acute HBV infections are rare, occurring in less than 1.5% of cases The likelihood of progressing to chronic HBV infection, defined as lasting beyond six months, significantly depends on the age at initial infection Infants under one year old have an 80-90% chance of developing chronic infections, while 25-30% of those infected before age six and less than 1-12% of older children and adults progress to chronicity Most individuals resolve their HBV infection and gain immunity However, chronic HBV can lead to severe long-term health issues, including chronic hepatitis, cirrhosis, and hepatocellular carcinoma, affecting nearly 25% of those chronically infected in childhood and 15% of others.
HUPH those infected in adulthood will die prematurely from cirrhosis or liver cancer (Thomas et al 2011; Agbim et al 2017)
Hepatitis B is a DNA virus belonging to the Hepadnaviridae family, primarily replicating in infected liver cells known as hepatocytes The virus is characterized by its structure, which includes an inner core and an outer surface coat, commonly referred to as the Dane Particle.
The hepatitis B virus is found in the blood and various body fluids, including semen, vaginal secretions, menstrual blood, and, to a lesser extent, perspiration, breast milk, tears, and urine of infected individuals This resilient virus is easily transmitted through contact with infected body fluids, primarily through blood.
1) Perinatal (mother to child) transmission:
Perinatal transmission is a significant and prevalent mode of hepatitis B virus (HBV) transmission, primarily occurring from mothers who test positive for hepatitis B surface antigens (HBsAg) Over 90% of these mothers are chronic HBV carriers, and even those with acute infections can transmit the virus during pregnancy While infected newborns seldom develop acute hepatitis, there have been instances of fatal fulminant hepatitis This group of carriers contributes to the spread of the virus within the community and poses a risk to future generations.
2) Transmission through an unsafe injection, needle-prick or reuse of unsterile needles and use of contaminated needles and other medical and dental equipment:
Surveys conducted in developed countries have revealed that approximately 30% of injections used for immunization are not sterilized (Eric et al,
The reuse of disposable syringes and improper sterilization of reusable syringes significantly increases the risk of transmitting blood-borne pathogens, including hepatitis B Implementing auto-destructive syringes and single-use pre-filled devices can help mitigate this risk by preventing inappropriate usage In certain Western countries, needle-sharing among drug users also contributes to the spread of HBV Additionally, the use of non-sterile needles during body piercing, tattooing, drug injection, and acupuncture can further facilitate the transmission of hepatitis B.
Lastly, hepatitis B virus transmission is carried out during sexual intercourse through contact with blood or other body fluids
1.1.3 Diagnosis of HB Viral Infection
A straightforward blood test can effectively diagnose hepatitis B by detecting specific antigens and antibodies It typically takes 4 to 6 weeks after infection for the virus to be identifiable in the bloodstream This blood test reveals crucial information about the patient's hepatitis B status.
- Has an acute hepatitis B infection presently
- Has recovered from a past infection and is now immune
- Has a chronic hepatitis B infection and the virus is present in the blood
- Is immune to hepatitis due to vaccination (Alavian et al, 2013)
Hepatitis B serologic testing, as noted by Eric E Mast (2005), involves the measurement of various hepatitis B virus (HBV)-specific antigens and antibodies These serologic markers or their combinations are essential for identifying different phases of HBV infection and determining whether a patient has an acute or chronic infection, or if they are immune to HBV.
HUPH of prior infection or vaccination or is susceptible to infection (Black et al,
Vaccination is the most effective method for preventing HBV infection Hepatitis vaccines consist of highly purified preparations of the hepatitis B surface antigen (HBsAg), which is the glycoprotein that makes up the outer coat of the hepatitis B virus (Sarah et al, 2017).
Definitions of knowledge of and attitudes towards HBV prevention
Knowledge encompasses the acquisition, retention, and application of information and skills (Badran, 1995) It is a cognitive process that involves understanding, distinct from mere emotional experience Knowledge is gained through both education and personal experience For instance, individuals with diabetes possess knowledge about their condition, including its progression and the self-care practices essential for effective management (Fazal et al., 2016).
Eagly and Chaiken (1993) define attitude as a psychological tendency that involves evaluating an entity with varying degrees of favor or disfavor Attitudes consist of three components: cognition, affect, and behavior, as noted by Katz & Stotland (1959), Krech & Crutchfield (1948), and Rosenberg & Hovland (1960) Cognition includes beliefs about the attitude object, which can be influenced by health education, indicating a potential overlap between knowledge and attitude For instance, hepatitis B patients may develop negative beliefs about their health prospects due to familial experiences with severe complications, such as heart attacks or strokes.
Patients with hepatitis B often exhibit a range of emotions and attitudes towards their self-care management While some may enjoy exercising for its positive effects, they might dislike self-monitoring their blood sugar due to the discomfort of pricking their skin This variability in attitudes influences their behavior; some patients diligently follow their physician's recommendations, while others may not Overall, attitudes towards hepatitis B encompass preconceived notions about the condition, emotional responses to its management, and the likelihood of engaging in specific health-related behaviors.
1.3 Overview and empirical studies on the knowledge of and attitudes towards prevention of hepatitis B virus
In 1967, Krugman identified two types of hepatitis, labeled MS-1 and MS-2, with MS-1 being transmitted orally after a short incubation period and MS-2 transmitted parentally with a longer incubation period These were later classified as hepatitis A and B, respectively Research involving chimpanzees and humans established that the Australia antigen was responsible for hepatitis B, leading to its renaming as HBV In 1970, Dane and colleagues utilized electron microscopy to visualize various subviral particles, including hepatitis B surface antigen in circular and filamentous forms, as well as complete enveloped virions known as Dane particles.
A study conducted from February to May 2015 at Bahir Dar Armed Forces General Hospital in Ethiopia examined the prevalence of hepatitis B and C virus infections among 403 military personnel.
A sectional study conducted by HUPH revealed a sero-prevalence of HBV and HCV infections at 4.2% and 0.2%, respectively, with no co-infections observed The study identified a higher prevalence of HBV (11.3%) in individuals aged 40 and above Significant associations were found between HBV infection and factors such as being 40 years or older (COR 7.6; 95% CI 2.0-29.0, p=0.003), a history of nose piercing (COR 5.9; 95% CI 1.2–29.9, p=0.033), and previous sexually transmitted infections (COR 4.3; 95% CI 1.1–16.4, p=0.03) Among military personnel, intermediate HBV prevalence and low HCV prevalence were noted, suggesting that enhancing HBV screening strategies could further mitigate these viral infections (Tigist et al, 2015).
A survey conducted among new military recruits in China revealed that most participants had limited knowledge about Hepatitis B virus (HBV), with only 16.4% (119 individuals) demonstrating adequate understanding of the disease (Li et al., 2017).
In Saudi Arabia, military personnel face a higher risk of HBV infection compared to the general population, yet there is a notable lack of research on their awareness of the virus A study focusing on the knowledge, attitude, and practice (KAP) regarding HBV among Saudi National Guard personnel revealed a significant overall improvement of 204% in KAP scores following an educational intervention This enhancement was observed across all components: disease nature (272%), transmission methods (206%), prevention and control (109%), attitudes (155%), and practices (192%) The improvements were consistent regardless of socio-demographic factors and prior HBV vaccination history Additionally, higher KAP scores were linked to greater educational attainment, increased monthly income, administrative roles, and higher job ranks (Majid et al., 2012).
A study conducted at Nawabshan Medical College Hospital involving 500 admitted patients revealed that individuals with education beyond the primary level demonstrated a greater understanding of Hepatitis B and C compared to those who were illiterate.
Many individuals, particularly those who are illiterate, lack knowledge about hepatitis B virus (HBV) conditions, including its causes, affected organs, societal prevalence, symptoms, and vaccination options Additionally, even educated individuals often exhibit a lack of responsibility and poor attitudes towards the treatment of these diseases Both literate and illiterate people tend to adhere to community customs, frequently opting for homeopathic or herbal remedies instead of seeking conventional medical treatment (Altaf et al., 2007).
A study conducted at Irrua Specialist Teaching Hospital in Edo State, Nigeria, assessed health workers' knowledge, attitudes, and behaviors regarding hepatitis B infection among 200 respondents The findings revealed that 81% of participants had heard of hepatitis B, with 92% recognizing blood and blood products as transmission routes, while only 37% identified sexual intercourse as a means of transmission Misconceptions included face-oral transmission (14.2%) and contaminated water (9.3%) Regarding prevention, 77.2% correctly identified vaccination as a key measure, and 80.9% acknowledged the risk of nosocomial infection Although 75.5% were aware of the hepatitis B vaccine, only 70.2% had received it, and just 59.4% completed the vaccination schedule This highlights a significant issue of poor compliance among health workers, emphasizing the need for targeted health education campaigns to raise awareness of the risks associated with their profession (Samuel et al., 2009).
The assessment of Knowledge, Attitude and Practices in relation to HBV among
A study involving 500 clinicians and medical students at Jhalawar Medical College, Rajasthan, revealed that both groups exhibited moderate levels of knowledge, attitude, and practice (KAP) regarding Hepatitis B Virus (HBV) infection and vaccination, with notable gaps in knowledge The majority of participants were medical students (60.2%), and the mean scores for knowledge, attitude, and practice were 15.66 ± 1.9, 7.17 ± 1.15, and 6.8 ± 1.13, respectively Additionally, significant positive correlations were found between designation and knowledge (r = 49.18, p < 0.00) as well as vaccination status and knowledge (r = 28.88, p < 0.00).
< 0.001); duration of experience vs knowledge (r = 23.51, p < 0.001) and attitude vs vaccination status (r =3 0.14, p < 0.05) were observed (Baig et al, 2015).
Factors associated with knowledge of- and attitudes towards HBV prevention11
In Ethiopia soldiers aged ≥40 years (COR 7.6; 95 % CI 2.0–29.0, p = 0.003) were significantly associated with KAP of HBV prevention (Tigist, 2015)
In China, a study found that age was significantly linked to knowledge, attitudes, and practices (KAP) regarding HBV prevention among new military recruits (COR = 3.040, 95% CI 1.724-5.359, P < 0.001) (Li, 2017) Similarly, in Australia, age was also significantly associated with knowledge of HBV prevention among individuals with chronic HBV (P = 0.02) (Hajarizadeh, 2015).
In China, among new military recruits, gender (COR = 1.791, 95% CI 1.325-2.421, P < 0.001) was significantly associated with appropriate HBV prevention behavior (Li, 2017) In South Nigeria, among health workers,
HUPH sex or gender (X2 = 31.74; P = 0.00) was significantly associated with HBV prevention (Samuel, 2009)
In Saudi Arabia, a significant association was found between higher educational levels among military personnel and HBV prevention (p-value < 0.05) (Al-Thaqafy, 2012) Similarly, in Australia, individuals with chronic HBV demonstrated a significant link between education level and knowledge of HBV prevention (P=0.02) (Behzad, 2015).
In Ethiopia, a study revealed that soldiers with a history of hepatitis B virus (HBV) had a significant association with HBV infections (COR 4.3; 95% CI 1.14–16.4, p = 0.03) (Tigist, 2015) Similarly, research in Malaysia indicated that university students with a family history of HBV were significantly linked to HBV prevention efforts (p = 0.010) (Abdulrahman, 2016).
In Saudi Arabia, it was found that people who had a history of HBV were significantly associated with KAP of HBV prevention (Al-Thaqafy, 2012).
Conceptual framework
The conceptual framework for this research was developed after reviewing relevant empirical studies and considering the characteristics of the study population It identifies two key components that influence knowledge and attitudes towards HBV prevention among armed forces personnel in Vientiane Capital in 2019: individual factors and social factors For a detailed overview, refer to Figure 1.1, which illustrates these components and their sub-components.
Knowledge of and attitudes towards HBV prevention among armed forces personnel (Army Headquarters 605) in Vientiane Capital, 2019
- HBV vaccination campaigns HQ 605 camp
- Health education and communication on HBV in
Study population
The study population of this research consisted of military personnel from the 605th Army Headquarters in Vientiane Capital, Lao PDR, with a total strength of 1,400
1) Male and female army personnel who were administrative-, technical- or combat duty personnel (new recruits and permanent soldiers) who were able to answer the questions and sign an informed consent form
2) Military officers who were present and agreed to participate
1) Army personnel who were absent during the data collection and/or unwilling to answer the questionnaire.
Study site and duration
Army Headquarters 605, located in Xaythany District, Vientiane Capital, Lao PDR, is a significant battalion within the Lao People's Army Its substantial personnel count makes it a representative unit for both the military and the district, which aligns with the researcher's background Consequently, this camp was chosen as the study site The research was carried out over four weeks following ethical approval from the Institutional Ethical Review Board (IRB) at Hanoi University of Public Health and the Ethical Review Committee of the University of Health Sciences, Lao PDR.
Study design
This analytical, cross-sectional study conducted in 2019 focused on assessing the knowledge and attitudes towards Hepatitis B Virus (HBV) prevention among armed forces personnel at Army Headquarters 605 in Vientiane Capital The research aimed to identify the factors influencing their understanding and perceptions regarding HBV prevention.
Sample size
The sample size for this study was calculated using the formula \( n = 384.16 \), with a margin of error set at \( e = 0.05 \) and \( p \) representing the population proportion of individuals knowledgeable about HBV prevention.
Research on knowledge and attitudes towards HBV prevention in the Lao PDR is lacking To determine the optimal sample size for this study, a formula was applied, resulting in a minimum sample size of 384 participants, using a significance level of α = 0.05 and a Z-value of 1.96.
This sample size was added to by 10% in case of non-response participants or invalid questionnaires Thus, the final sample size was 422 persons
Sampling method
The study employed a systematic random sampling method to select respondents Initially, a name list of personnel from the camp's headquarters was obtained The sampling interval was determined by dividing the total number of soldiers (N) by the desired sample size (n), resulting in an interval of 3 (I = N/n, where I = 100/422 = 3) Consequently, sampling commenced at the first name on the list, with selections made at intervals of 3 (i.e., 1, 4, 8, and so on) until the list was exhausted.
Data collection method
Data collection commenced following the approval of the proposal, utilizing questionnaires as the primary tool Close-ended questions were designed to systematically gather data and insights from selected respondents.
The questionnaires were initially developed in English and subsequently translated into Lao They underwent a pre-testing phase with 30 military personnel from a nearby camp, leading to improvements based on the feedback received.
- A proposal was submitted for the data collection to the Headquarters of the
- A meeting was called with the selected survey participants
- Data collection was executed through self-administered structured questionnaires
- The researcher explained to the respondents the research objectives, read the approval letter from the Headquarters, and explained how to answer the questionnaires
- The questionnaires were collected on the same day; they were checked and the data was entered into Microsoft Excel computer program
The questionnaire contained mostly multiple-choice questions and consisted of four parts as follows:
Part 1: Information on individual factors:
The section included 13 questions addressing various factors such as age, gender, ethnicity, marital status, religion, educational grade, job duty, years of service, rank, history of chronic HBV, vaccination status, and both the record and frequency of blood donations.
Part 2: Information on social factors
The section included four questions aimed at gathering information from the military camp about the sources of information on Hepatitis B Virus (HBV), vaccination campaigns for HBV prevention, and health education and communication strategies related to HBV.
The section included a total of 29 questions, categorized into three areas: nine questions focused on understanding the nature of HBV, ten questions addressed the transmission of HBV, and another ten questions covered prevention methods for HBV.
Part 4: Attitudes towards HBV prevention
This part consisted of 10 items, gathering information on positive and negative attitudes
1) Measurement of knowledge of HBV:
To measure the knowledge of the military personnel on the nature, transmission and prevention of HBV, there were 29 questions (see
In Part 4 of the questionnaire, each response was categorized as "Yes," "No," or "Don't know," with correct answers earning one point Consequently, the total knowledge score varied from 0 to 29, translating to a percentage range of 0% to 100% The respondents' knowledge of HBV was subsequently classified into two distinct levels.
- The positive questions were in items 1, 2, 3, 4, 5, 6, 7, 8, 10, 11, 12,
13, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28 and 29 with answer choices and scores as follows:
- The negative questions were in items 4, 9, 15, 16, 17 and 18 with three answers each and scored as follows:
The knowledge level criterion was determined by the percentage of the knowledge score and categorized into two groups according to Bloom's taxonomy (Bloom, 1971) The personal knowledge scales in the questionnaire underwent pre-testing in a pilot study, utilizing the Kuder-Richardson 20 (KR-20) method The pilot study included 30 respondents to assess the reliability of the scales.
20) value was 0.9461 for the knowledge of HBV prevention
2) Measurement of attitudes on HBV prevention
The study assessed attitudes towards HBV prevention using 10 statements from a questionnaire, employing a five-point Likert scale for responses The maximum total score achievable was 50 points.
The attitudes were divided into two levels based on scores as follows:
- Positive attitude: 40 – 50 points, from responses of Strongly Agree and Agree;
- Negative attitude: 10 – 39 points, from responses of No Opinion, Disagree and Strongly Disagree:
- The positive questions were in items 1, 2, 3, 4, 5, 6, 7, 8, and 10 with five answers to choose from and scores as follows
“Strongly agree” = 5 points “Agree” = 4 points “No opinion” = 3 points “Disagree” = 2 points “Strongly disagree” = 1 point
- The negative questions comprised nine items, with five answers to choose from and scored as follows:
Logistic regression was used to analyze and assess factors associated with the knowledge of and attitude towards HBV prevention according to the aforementioned cut-off points or scores (Li 2017)
The data was coded, entered into Excel and analyzed with STATA software
Data analysis focused on the descriptive factors associated with the knowledge of HBV prevention:
1) Descriptive statistics was used to describe the basic features of the data Analysis was performed by computing the numbers and percentages of categorical variables and the means and standard deviations for the continuous variables
2) The outcome from analyzing the data on the knowledge of HBV was classified into two levels: a good and a poor level of knowledge
In the univariate analysis, variables were considered significant with a p-value of less than 0.05, utilizing a multivariable logistic regression model The multivariate analysis employed standard entry techniques, identifying variables with p-values below 0.05 as significant predictors Crude and adjusted odds ratios, along with their 95% confidence intervals, were calculated and presented in both text and tables.
Ethical considerations
All procedures in this study were conducted with consent from the Armed Forces supervisor, relevant authorities, and participants Data collection proposals received approval from the 605 military camp headquarters prior to engaging respondents The data was exclusively utilized for research aimed at assessing knowledge and attitudes towards HBV prevention Following the dissemination and publication of the study, all data and findings were destroyed It is hoped that the results will provide valuable insights for future reference.
HUPH serves as a vital resource for stakeholders aiming to enhance the health sector in Lao PDR, while also focusing on educating the Lao population and fostering positive attitudes towards the prevention of HBV.
Demographic information of participants
This research collected information from 422 soldiers (from Army Headquarters
In 2019, a study conducted in Vientiane Capital involved 422 participants, whose demographic characteristics were detailed in Table 3.1 This table includes information on age, gender, marital status, ethnicity, religion, educational level, type of military service, years of service, rank, history of HBV infection, HBV vaccination status, blood donation history, and the number of blood donations.
Number of years in service
The survey revealed that 53% of respondents were aged between 18 and 27, with a median age of 29.73 years, ranging from 18 to 59 years A significant majority, 82%, were male, and 66% identified as single The Lao Loum ethnic group comprised 94% of the participants, with the same percentage practicing Buddhism Half of the respondents had completed upper secondary education, while 60% were engaged in combat vocations, and nearly 50% had served for less than five years Those holding the rank of corporal or higher made up 67% of the ranks Notably, 93% had never been infected with HBV, and over 78% had not received vaccination Additionally, 61% had never donated blood, and among those who had, 20% had done so only once.
3.1.2 Sources of information on HBV prevention
Table 3.2 Distribution of sources of information on HBV prevention
Table 3.2 illustrates the sources of information regarding HBV prevention among military personnel at Army Headquarters 605, revealing that 51.9% of individuals, totaling 219, obtained this information through films or television.
198 (46.9%) received information from radio broadcasting channels, while the same number (198, 53.1%) received information on Facebook Some 187 (44.3%)
HUPH received information on YouTube; 139 (32.9%) received information from reading newspapers; 110 (26.1%) received information from reading magazines, while very few (6, 1.9%) learned it from Twitter
3.1.3 Information on social factors related to HBV prevention in the military camp
Table 3.3 Distribution of information on social factors relating to HBV prevention
Information on social factors related to HBV prevention
HBV vaccination campaign in the camp 127 30.1
Health education on HBV in the camp 140 33.2
Communication on HBV in the camp 134 31.7
The HBV vaccination campaign in the camp included health education and communication efforts, with 140 personnel (33.2%) receiving information on HBV prevention However, participation in discussions about HBV prevention was lower, with only 134 individuals (31.7%) engaging, and 127 personnel (30.1%) taking part in the vaccination campaign.
Knowledge of and attitudes towards HBV prevention
The knowledge of HBV prevention is comprised of knowledge on the nature of
HBV, knowledge of HBV transmission, and knowledge of HBV prevention
Understanding HBV involves awareness of its infection, the organs it affects, and the causative microorganism It is important to know if HBV can be diagnosed through external symptoms and the methods used for its diagnosis.
Hepatitis B virus (HBV) infection can result in lifelong consequences for the infected individual, including the potential development of liver cirrhosis or liver cancer The severity of symptoms and the risk of mortality associated with HBV infection can vary significantly among individuals.
The respondents‟ knowledge on the nature of HBV depended on the correctness and incorrectness of the information that they had
Table 3.4 Knowledge of the nature of HBV
Organs affected by HBV infection 276(65.4) 146(34.6)
Type of HBV causative microorganism 133(31.5) 289(68.5)
Diagnosis of HBV infection from external appearance 55(13.1) 367(86.9)
Development of HBV infection into liver cirrhosis 153(36.3) 269(63.7) Development of HBV infection into liver cancer 144(34.2) 278(65.8)
HBV infection leading to death 137(32.5) 285(67.5)
Table 3.4 illustrates the knowledge distribution regarding HBV among respondents A total of 276 personnel (65.4%) correctly identified the organs affected by HBV infection, while 289 (68.5%) had misconceptions about the causative organisms Furthermore, 367 individuals (86.9%) incorrectly understood how to recognize HBV infection based on its external appearance In contrast, 287 personnel (68%) demonstrated accurate knowledge of HBV diagnosis, yet 314 (74.4%) were misinformed about the nature of lifelong HBV infections Additionally, 269 personnel (63.7%) held incorrect beliefs about the progression from HBV infection to liver cirrhosis, and 278 (65.8%) also exhibited incorrect knowledge in this area.
A significant portion of officers demonstrated a lack of understanding regarding Hepatitis B Virus (HBV) infection, with 67.54% incorrectly believing how HBV can lead to death and 53.4% misidentifying its symptoms The findings indicate widespread misconceptions about the nature of HBV, the microorganisms responsible for it, diagnostic methods based on external appearances, the chronic nature of HBV infection, its progression to liver cirrhosis or cancer, and the general symptoms associated with HBV infection.
3.2.2 Level of knowledge of nature of HBV
The level of knowledge of the nature HBV was divided into good and poor- knowledge
Table 3.5 Level of knowledge of nature of HBV
Knowledge of HBV nature Number (N) Percentage
Table 3.5 shows that 273 personnel (64.7%) had a limited comprehension of the nature of HBV while 149 (35.3%) revealed adequate knowledge of it
HBV transmission can occur through various means, classifying it as both a communicable and non-communicable disease Key transmission routes include exposure to infected blood, sexual intercourse, and contact with asymptomatic carriers Additionally, the virus can spread through casual interactions such as shaking hands, sharing contaminated clothing, sneezing, coughing, and sharing food or drinks Family members are also at risk, particularly when using the same needle.
Table 3.6 Knowledge of HBV transmission
HBV is a communicable or non-communicable disease
HBV is transmitted by blood 219(51.9) 203(48.1)
HBV is transmitted by sexual intercourse 122(28.9) 300(71.1) HBV is transmitted from an asymptomatic infected person
Hepatitis B virus (HBV) transmission can occur through various means, including handshakes, with 69.9% of respondents acknowledging this method Additionally, 62.3% believe that sharing contaminated clothing contributes to the spread of HBV Sneezing and coughing are also recognized as transmission routes, with 35.8% of individuals affirming this risk Furthermore, sharing food and drinks with an infected person is another potential way HBV can be transmitted.
HBV can be transmitted by family members 180(42.7) 242(57.3) HBV can spread by using the same needle 347(58.5) 175(41.5)
Table 3.6 reveals that 73.4% of camp personnel correctly identified HBV as a communicable disease, while 51.9% understood that it is transmitted through blood However, 71.9% held incorrect beliefs regarding other aspects of HBV transmission.
A significant portion of individuals demonstrated misconceptions about Hepatitis B virus (HBV) transmission Specifically, 51.6% incorrectly believed that HBV is transmitted through sexual intercourse, while 69.9% correctly identified that it can be transmitted by asymptomatic infected persons Additionally, 62.3% of officers understood that sharing contaminated clothes can lead to HBV transmission However, 54.2% held incorrect beliefs regarding transmission through sneezing and coughing, and a notable 75.1% mistakenly thought that sharing food and drink could spread the virus.
A significant portion of camp personnel demonstrated a lack of accurate knowledge about Hepatitis B Virus (HBV) transmission, with 57.3% incorrectly believing that HBV cannot be transmitted among family members Additionally, 58.5% correctly understood that HBV can spread through the use of the same needle These findings highlight the need for improved education on HBV among affected individuals.
Table 3.7 Level of knowledge of HBV transmission
Knowledge of HBV Transmission Number (N) Percentage
Table 3.7 reveals that 60.2% of respondents possess poor knowledge of HBV transmission, while only 39.8% demonstrate good knowledge This indicates that the majority of respondents lack adequate understanding of HBV transmission.
Understanding HBV prevention involves several key aspects: awareness of protective measures against HBV infection, the importance of vaccination, and the necessity of screenings for pregnant women and family members of those infected It is crucial to know the available medical treatments for HBV and the potential for complete recovery Vaccination stands out as the most effective prevention method, while it is important to recognize that HBV can be transmitted through close proximity to an infected individual, putting healthcare professionals at risk Additionally, ensuring vaccinations for all children at the appropriate age is essential for effective prevention.
Table 3.8 Knowledge of HBV prevention
Pregnant women to get HBV screening 222(52.6) 200(47.4)
Family members of HBV infected persons to have an examination or screening for HBV
Every child to have HBV vaccination 275(65.1) 147(34.9) When a child needs HBV vaccination 168(39.8) 254(60.2)
Medical treatment when somebody is infected by
Possibility of complete cure for HBV 54(12.9) 368(87.1)
Vaccination being the most effective method for
Doctors and medical students being at risk of acquiring hepatitis B infection from the patients
Table 3.8 illustrates the awareness of military personnel regarding HBV prevention, revealing that 312 individuals (73.9%) are knowledgeable about general prevention methods, while 282 personnel (66.3%) are aware of the availability of vaccines.
A significant portion of army personnel demonstrated a lack of accurate knowledge regarding hepatitis B virus (HBV) prevention and vaccination Specifically, 52.6% recognized the necessity of HBV screening for pregnant women, while 65.6% understood that family members of infected individuals should be screened Additionally, 65.2% were aware that all children require HBV vaccination, although 60.2% held incorrect beliefs about the timing of this vaccination Furthermore, 71.8% correctly understood the medical treatment options available for HBV infection, yet 87.1% mistakenly believed in the possibility of a complete cure Moreover, 60.9% acknowledged that vaccines are the most effective method for HBV prevention, while 58% incorrectly thought that doctors and medical students are at risk of contracting hepatitis B from patients Overall, the findings indicate a gap in knowledge among army personnel regarding critical aspects of HBV prevention and treatment.
3.2.5 Level of knowledge of HBV prevention
Table 3.9 Level of knowledge of HBV prevention
Knowledge of HBV Prevention Number (N) Percentage (%)
Table 3.9 presents the findings on HBV prevention knowledge, revealing that 53.5% of participants demonstrated good knowledge, while 46.4% exhibited poor knowledge This indicates that a slightly higher percentage of individuals possess good knowledge of HBV prevention, although a significant portion still lacks adequate understanding, as evidenced by a KR20 value of 0.8719.
Table 3.10 Knowledge of nature, transmission and prevention of HBV
Knowledge of HBV Prevention Number (N) Percentage
Table 3.10 reveals that 53% of participants demonstrated poor understanding of HBV's nature, transmission, and prevention, while 47% exhibited good knowledge This indicates that a significant majority, 52.9%, still lack adequate awareness regarding these critical aspects of HBV.
The attitudes of the military personnel towards HBV prevention were measured by their responses of how much they agreed or disagreed with ten statements in the questionnaire:
Table 3.11 Attitudes towards HBV prevention
Health staff must use a new needle every time when they give an injection
Barbers must get a new razor blade when they need to shave or do a haircut
Blood tests for HBV should be done before blood transfusion
Receiving an HBV vaccination will prevent HBV
Family members of HBV infected persons should be vaccinated against hepatitis B
People receiving HBV vaccinations should not be afraid of fever, pain or swelling
HBV screening for the military is a must
HBV vaccination should be free 215 59.4 137 32.4 22 5.2 12 2.8
HBV vaccination for HBV-carriers should be compulsory
HBV vaccination programs should be open and accessible to all
Note: SA = Strongly Agree, A = Agree, NO = No Opinion, DA = Disagree, SD Strongly Disagree
Factors related to knowledge of HBV prevention
Statistical methods were employed to examine the relationship between dependent and independent variables, focusing on the knowledge of HBV prevention and its sub-topics This analysis considered individual factors such as age, gender, marital status, ethnicity, religion, education level, type of military service, years of service, rank, history of HBV infection, vaccination status, and blood donation history, including the frequency of donations.
3.3.1 Association of knowledge level of HBV prevention with individual factors
Table 3.13a Association of knowledge level of HBV prevention with individual factors
Knowledge Total COR 95% CI p-value
Table 3.13a illustrates the correlation between individual factors and the knowledge level of HBV prevention Notably, military personnel over the age of 37 demonstrated a 2.3 times higher likelihood of being knowledgeable about HBV prevention compared to those aged 18.
A study found that individuals aged 27 years had a statistically significant correlation with knowledge of HBV prevention (COR=2.3, 95% CI=1.1-5.0, p-value=0.028) Additionally, males were 0.3 times less likely to possess this knowledge compared to females, which was also statistically significant (COR=0.3, 95% CI=0.1-0.4, p-value 0.05 HUPH
3.4.4 Association of attitudes towards HBV prevention with sources of information on HBV
Table 3.19 Association of attitudes towards HBV prevention with sources of information on HBV
Table 3.19 reveals that there is no significant correlation between the sources of information on HBV prevention and the respondents' attitudes towards HBV prevention, as indicated by a p-value greater than 0.05.
DISCUSSION
This thesis investigates the knowledge and attitudes towards Hepatitis B Virus (HBV) prevention among personnel at Army Headquarters 605 in Vientiane Capital, Lao PDR, in 2019 The study employs an analytical, cross-sectional design to assess the understanding and perceptions of HBV prevention among military members, while also identifying factors that influence their knowledge and attitudes.
4.1.1 Knowledge of and attitudes towards HBV prevention among armed forces personnel (of Army Headquarters 605) in Vientiane Capital, Lao PDR, 2019
The study reveals that most participants lack adequate knowledge about hepatitis B virus (HBV), including its nature, transmission, and prevention Specifically, a research conducted by Li et al (2017) found that only 16.4% of new military recruits demonstrated a good understanding of HBV Despite this knowledge gap, a significant number of respondents exhibited positive attitudes towards HBV prevention, indicating a disconnect between awareness and information access The findings highlight a critical need for improved HBV education, particularly within the armed forces in Vientiane, emphasizing the importance of campaigns focused on HBV awareness and prevention for both military personnel and the general population.
4.1.2 Association between independent and dependent variables
1) Knowledge of HBV prevention and age
Older respondents demonstrated a higher level of knowledge regarding HBV prevention, likely due to increased health concerns with age, as younger individuals are less affected by the disease This observation aligns with research, such as Tigist (2015), which found that soldiers aged 40 and above in Ethiopia exhibited better knowledge compared to their younger counterparts aged 18-27, who showed significantly less awareness and poorer attitudes towards HBV prevention (COR 7.6; 95% CI 2.0–29.0, p = 0.003) Similarly, a study in China revealed that age was significantly linked to knowledge, attitudes, and practices (KAP) related to HBV prevention among new military recruits (OR = 3.040, 95% CI 1.724-5.359, P < 0.001) (Li, 2017).
In Australia, a significant association was found between age and knowledge of HBV prevention among individuals with chronic HBV (P=0.02) (Behzad, 2015) This similarity in results may be attributed to the comparable age, career, and HBV knowledge of the subjects, particularly as military personnel often share a similar lifestyle.
2) Knowledge on HBV prevention and gender
This study reveals that male military officers possess a greater understanding of HBV prevention compared to female officers, suggesting that males have better access to relevant information However, male personnel exhibit riskier living habits, particularly in food consumption, while females demonstrate more careful and hygienic practices Consequently, males are more frequently exposed to HBV, which heightens their awareness of prevention measures Supporting this, research by Li et al (2017) in China indicates a significant association between gender and appropriate HBV preventive behavior among new military recruits.
1.791, 95% CI 1.325-2.421, P < 0.001) A study in South Nigeria in 2009, by Samuel reported that among health workers, sex was significantly associated with HBV measures or knowledge of prevention (p-value=0.00)
3) Knowledge of HBV prevention and type of military service
Research indicates that soldiers in combat roles possess a greater understanding of HBV prevention compared to their administrative counterparts This novel finding lacks prior studies for comparison, yet it aligns with expectations given the inherent job hazards associated with combat vocations.
4) Knowledge of HBV prevention and number of years in service
The study shows that the longer people served, the more knowledge they had of HBV prevention
5) Knowledge of HBV prevention and rank in service
Lance Corporals, Corporals, and higher-ranked personnel possess significantly greater knowledge of HBV prevention compared to Recruits and Privates It is essential to address the low levels of HBV prevention knowledge among the latter group.
6) Knowledge of HBV prevention and HBV vaccination status
Most respondents reported not receiving HBV vaccinations, and those unvaccinated exhibited lower awareness of HBV prevention methods This trend may be attributed to the high cost and time commitment associated with HBV vaccinations in Lao PDR Additionally, the military appears to prioritize immediate needs over long-term preventive measures.
7) Knowledge of HBV prevention and social factors
HBV vaccination campaigns in the camp revealed that participation was low among personnel, with non-participants demonstrating significantly less knowledge about HBV prevention compared to those who engaged in the campaigns This suggests that individuals who did not take part in the vaccination efforts may lack essential information on preventing HBV infection.
Health education on HBV infection in the camp has proven to be effective, as personnel who participated in the programs demonstrated significantly higher knowledge levels about HBV prevention compared to those who did not attend This underscores the importance of health education as a vital communication tool for promoting awareness and understanding of HBV prevention strategies.
Effective communication about HBV in the camp is crucial, as personnel who did not engage in discussions about HBV infection demonstrated lower knowledge levels regarding its prevention This highlights the importance of dialogue and debate as powerful tools for disseminating knowledge on health issues.
8) Knowledge on HBV prevention and sources of information on HBV prevention
The media, including social media platforms, significantly influences the knowledge of HBV prevention among military personnel in this study Participants who engaged with various media sources such as magazines, films, television, newspapers, radio, Facebook, and YouTube demonstrated higher awareness of HBV prevention methods This indicates that those who actively consume media content are more informed about disease prevention strategies.
Several key factors were significantly associated with knowledge of HBV prevention, including male gender, military rank (specifically Lance Corporal, Corporal, and higher), lack of HBV vaccination, participation in health education on HBV prevention within the camp, and engagement in discussions about HBV prevention.
This study on the "Knowledge of and attitudes towards HBV prevention among armed forces personnel (of Army Headquarters 605) in Vientiane Capital in 2019" faces several limitations Respondents may provide socially desirable answers rather than reflecting their true knowledge or attitudes Additionally, there is a scarcity of relevant research on this topic, particularly concerning military personnel, which restricts the study's context and applicability due to the limited number of existing studies.
CONCLUSION
This study reveals that personnel at Army Headquarters 605 in Xaythany District, Vientiane Capital, Lao PDR, have limited knowledge regarding the prevention of hepatitis B infection The findings suggest that the restricted access to information within the military may contribute to this lack of understanding, especially when compared to the broader availability of health education in the civilian population.
The findings enhance our understanding of HBV infection and prevention perceptions among military personnel This knowledge should encourage relevant agencies to provide targeted information about current diseases and their prevention strategies.
Acquiring accurate knowledge about hepatitis B and other diseases is essential for military personnel, as it equips them to tackle health issues in their environments This understanding not only benefits the military but also extends to their families, enabling everyone—military and civilian alike—to better prevent and protect themselves from HBV and other infections, ultimately promoting overall health.
While this study has provided valuable insights into HBV infection and prevention, future research should focus on enhancing the accessibility of information regarding HBV.
Screening military personnel for HBV infection and administering vaccinations to HBV-negative individuals is essential for both the armed forces and society at large Additionally, increasing awareness about viral infections and prevention strategies is crucial for public health.
Health authorities should screen for HBV infection in families with positive cases and administer vaccinations for individuals that test negative
Further research on HBV prevention should be conducted in various camps and locations to gain a deeper understanding and diverse perspectives Additionally, it is essential to enhance the education of military personnel regarding the transmission of parental viruses, including HBV, HCV, and HIV, to promote effective health precautions.
Health agencies must prioritize the findings of this study, as a significant portion of the population lacks essential knowledge about disease prevention and access to information on disease management It is advisable for both civil and military organizations to include military personnel in all health training programs offered by the Ministry of Health This approach will enhance the learning process across all relevant organizations and ensure a uniform level of understanding regarding disease prevention.
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Questionnaire
Knowledge of and Attitudes towards the Prevention of Hepatitis B Virus Among Armed Forces Personnel at Army HQ605 in Vientiane Capital Lao PDR in
All respondents are requested to give the correct or most suitable answer to each of the following questions and fill in the blanks or mark in the boxes given
A Part 1: Information on individual factors
A1 1 What is your age? Age (years)……….……
A2 2 What is your gender? 1 Female
2 Male A3 3 What is your ethnic group?
3 Hmong A4 4 What is your marital status?
A6 6 What is your highest education level?
6 Higher than bachelor A7 7 What is your type of service in the 1 Administrative
3 Combat A8 8 How long have you served in the military? Year (s)………
A9 9 What is your rank in the military?
A10 10 Have you ever been infected with HBV? 1 Yes
A11 11 Have you ever received HBV vaccination? 1 Yes
A12 12 Have you ever donated blood? 1 Yes
2 No (If No, skip to A1)
A13 13 If yes, how many times have you donated blood?
B Part 2: Information on Social factors
What sources of information do you have access to on HBV prevention?
Tick '' Yes" if the mentioned source is your preferred source, tick “No" if that source is not your preferred source
B1.2 1.2 Films or television 1 Yes 2 No
B2 2 Have vaccination campaigns for HBV prevention been available to you in camp?
B3 3 Have you obtained health education on
HBV prevention from the doctors in
B4 4 Have you ever had a discussion about
HBV with colleagues in camp?
C1 Knowledge on Nature of HBV
C1 1 Which organs will be affected by HBV?
C2 2 Which micro-organism causes HBV?
Can HBV be diagnosed from external appearance?
Will an infected person remain infected for the rest of his/her life?
Can an infected person develop liver cirrhosis?
Can an infected person develop liver cancer?
C 8 8 Can HBV infection lead to death? 1 Yes
Do most people infected by HBV show symptoms?
Is HBV a communicable or non- communicable disease?
C 11 2 Can HBV be transmitted by blood?
Can HBV be transmitted by sexual intercourse?
Can HBV be transmitted through an asymptomatic infected person?
Can HBV be transmitted by shaking hands?
Can HBV be transmitted by sharing contaminated clothes?
Can HBV be transmitted by sneezing and coughing?
Can HBV be transmitted by sharing food and drinks with an infected person? ?
C 18 9 Can HBV be transmitted by family 1.Yes
C 19 10 Can HBV spread by using the same needle?
C20 1 Is there protection against HBV?
D21 2 Is there a vaccine to prevent HBV?
Should a pregnant woman have HBV screening?
Should family members of HBV infected patients have an examination or screening for HBV?
Should every child have access to HBV vaccination?
C25 6 When should a child have an HBV vaccination?
1 As soon as possible after birth
Is there medical treatment for HBV infected people?
C 27 8 Can HBV be cured completely?
C 28 9 Is vaccination the most effective method to prevent HBV?
Are doctors and medical students at risk of acquiring hepatitis B infection from t patients?
D Part 4: Attitudes towards HBV prevention
Health care workers must use a new needle every time they give an injection
Barbers must use a new razor blade every time they shave or cut hair
D3 3 Blood tests should be done for HBV before blood transfusion
D4 4 R eceiving a HBV vaccination will prevent
Family members of an HBV infected person should be vaccinated against hepatitis B
D6 6 People receiving an HBV vaccination should not be afraid of fever, pain, or
D7 7 HBV screening for military personnel is a must
D8 8 HBV vaccination should be free
HBV vaccination for HBV carriers should be compulsory
D10 10 HBV vaccination programs should be open and accessible to all
5 Strongly disagree Adapted from: [Li, 2017; Babar, 2016; Hajarizadeh, 2015; Jeddah, 2009] HUPH
Variables on Knowledge on and Attitudes towards HBV
No Variables Type of category and measure
Knowledge on and attitudes towards HBV prevention
7 Type of service in the military
10 History of HBV infection 1 Yes
12 History of blood donation 1 Yes
2 No (If No skip to B1)
13 If yes, how many times have you given blood?
1 Information source of HBV prevention
Health education and communication about HBV prevention in camp
4 Communication about HBV prevention in camp