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*Corresponding author: E-mail: ezenelson24@gmail.com; 
 
 
 

Asian Journal of Immunology 
 
3(1): 253-258, 2020; Article no.AJI.57925 
 

 
 

 

 

Knowledge, Attitude and Uptake of Hepatitis B 
Vaccine among Clinical Medical Students of a 

Tertiary Institution in Southeast Nigeria 
 

N. C. Eze1*, E. C. Egba2, J. E. Ogbanna2, S. N. Nwamini2, P. U. Nweke2  
and J. S. Amasianya2   

 
1
Department of Community Medicine, Federal Teaching Hospital, Abakaliki, Ebonyi State, Nigeria. 

2
Department of Community Medicine, Ebonyi State University, Abakaliki, Ebonyi State, Nigeria. 

 
Authors’ contributions 

 
This work was carried out in collaboration among all authors. All authors read and approved the final 

manuscript. 
 

Article Information 
 

Editor(s): 
(1) Dr. Wagner Loyola, Canada. 

Reviewers: 
(1) Sandi Alfa Wiga Arsa, Indonesia. 

(2) Nathalia Costa Gonzaga Saraiva, Federal University of Paraiba, Brazil. 
Complete Peer review History: http://www.sdiarticle4.com/review-history/57925 

 
 
 
 

Received 06 April 2020  
Accepted 13 June 2020 
Published 24 June 2020 

 
 
ABSTRACT 
 

Background: Hepatitis B virus infection is a global public health problem especially in developing 
countries like Nigeria. Good knowledge of Hepatitis B virus, its infection and positive attitude by the 
public are key to the prevention of Hepatitis B infection The infection can be prevented with 
Hepatitis B virus vaccine. This study aimed at assessing the Knowledge, Attitude and Uptake of 
Hepatitis B virus vaccine among Clinical Medical Students of Ebonyi State University, Abakaliki. 
Materials and Methods: The study is descriptive cross-sectional in design and comprised of 187 
Clinical Medical Students selected by consecutive sampling technique. Data was collected using 
pretested, semi-structured, self-administered questionnaires and analysed using Statistical 
Package for Social Sciences (SPSS) for Microsoft window version 22. 
Results: The mean age of the respondents was 25.6 ± 3.2 years. About 80.7% of the respondents 
(Clinical Medical Students of EBSU) had good knowledge of HBV infection. Also, all the 
respondents (100%) had good knowledge of HBV vaccine. Nearly, 74.3% of our respondents were 
concerned about being infected with HBV. However only 55.6% of them had tested for HBV surface 

Original Research Article 



 
 
 
 

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254 

 

antigen. Also 84.2% of the respondents said they would like to be vaccinated. Although the 
participants in this study had positive attitude towards HBV vaccination, only 29.4% of the 
respondents had received HBV vaccine. Most of those vaccinated received incomplete doses of 
the vaccine while only very few received complete doses of the vaccine. 
Conclusions: There should be sustained health education to Clinical Medical Students on the 
need to be vaccinated against HBV and also HBV vaccine should be made free to the general 
public so as to remove the challenge created by cost. 

 

 
Keywords: Knowledge; attitude; uptake; HB vaccine; clinical medical students; Abakaliki. 
 

1. INTRODUCTION 
 

Hepatitis B virus (HBV) infection is a global 
public health problem, especially in developing 
countries. Globally, over 2 billion people have 
been infected with HBV, and there are over 350 
million carriers [1]. Good knowledge of Hepatitis 
B virus, its infection and positive attitude by the 
public are key to the prevention of Hepatitis B 
infection. 
 

HBV infection poses a health risk to health care 
workers who are in close proximity to infected 
individuals and their bodily fluids [2]. Medical 
students in tertiary health institutions are 
particularly high-risk group in the current 
literature [2]. 
 

Hepatitis B is a serious blood born infection 
caused by hepatitis B virus (HBV). It is the most 
common cause of chronic hepatitis, liver cirrhosis 
and hepato-cellular carcinoma [3-5].  
 

HBV is spread through body fluids such as blood, 
vaginal secretions, semen. Its routes of infection 
include sexual intercourse, unintentional needle 
sticks or using of infected needles, organ 
transplantation and blood transfusions [6]. 
Infected pregnant women can also transmit the 
infection to their newborns during delivery [7]. 
 

WHO recommends that everybody belonging to 
an already identified high-risk group should be 
vaccinated. Some of these high-risk groups 
include: people who frequently require blood 
and/or blood products, dialysis patients, people 
interned in prisons, intravenous drug users, 
people with multiple sexual partners, healthcare 
workers, household and sexual contacts of 
people with chronic HBV infection [7]. The 
infection can be prevented with Hepatitis B 
vaccine uptake [7]. Good knowledge of Hepatitis 
B virus, its infection and positive attitude by the 
public are key to its prevention. This study 
therefore determined knowledge, attitude and 

uptake of HBV vaccine among clinical medical 
students of EBSU. 

 
2. MATERIALS AND METHODS  

 
A descriptive cross-sectional design was used for 
the study. The study population comprised 
Clinical Medical Students of EBSU. A minimum 
sample size of 168 respondents was calculated 
using the formula: n= z

2
pq/d

2
. However, to allow 

for 10% non-response rate, a sample size of 187 
was used. Consecutive sampling technique was 
used for subject selection. Ethical approval was 
obtained from the Research and Ethics 
Committee (REC) of EBSU. Consent was 
obtained from the respondents. Data was 
collected using pretested, semi-structured, self-
administered questionnaires and analyzed using 
Statistical Package for Social Sciences (SPSS) 
for Microsoft window version 20. Data collection 
lasted for four weeks (July 2019). 

 
3. RESULTS 
 
Table 1 showed that the mean age of the 
respondents was 25.6 ± 3.2 years. Fifty seven 
point two percent (57.2%) of the respondents 
were within age range of 18-27 years with a 
significant proportion (89.8%) being single. Table 
2 below showed that a significant proportion of 
respondents (88.2%) have heard of HB vaccine. 
About 80.7% and 69% of the respondents knew 
that HB infection is caused by virus and the best 
way of prevention is by vaccination respectively. 
In Table 3 below, Majority (74.3%) of the 
respondents were worried about being infected 
with HBV. However, only 55.6% have been 
tested for HBV surface antigen. Also, 89.8% of 
the respondents expressed willingness to be 
vaccinated. In Table 4 below, only 29.4% of the 
respondents had received HB vaccine. Majority 
(64.2%) have not received HBV vaccine. About 
55.8% gave ‘not readily accessible’ as reason for 
not been vaccinated. 

 



 
 
 
 

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255 

 

Table 1. Socio-demographic characteristics of respondents (n=187) 
 

Age group (years) Frequency  Percentage  

18-27 107 57.2 
≥  27 80 42.8 
Mean age (25.6 ± 3.2 years)   
Sex    
Male  104 55.6 
Female  83 44.4 
Marital status   
Single  168 89.8 
Married  19 10.2 
Class level   
400 85 45.5 
500 81 43.3 
600 21 11.2 

 
Table 2. Awareness and knowledge of Hepatitis B virus vaccine (n=187) 

  

Have you heard of HBV vaccination  Frequency  Percentage  

Yes  165 88.2 
No 16 8.6 
Don’t know 6 3.2 
HBV is a viral infection    
Yes 151 80.7 
No 36 19.3 
Source of information   
Hospital  65 34.8 
Newspaper/Television/Radio 15 8.0 
Workplace 5 2.7 
School 102 54.5 
Best way of preventing HBV is by vaccination    
No 58 31.0 
Yes 129 69.0 

 
Table 3. Attitude towards HBV Infection and its vaccination (n=187) 

 

Worried about being infected by HBV Frequency Percentage 

Yes  139 74.3 
No 36 19.3 
Don’t know 12 6.4 
Tested for HBV   
Yes 104 55.6 
No  77 41.2 
Don’t know 6 3.2 
Would like to be vaccinated against HBV   
Yes 168 89.8 
No  6 3.2 
Don’t Know 13 7.0 

 

4. DISCUSSION 
 

Awareness and knowledge assessment in this 
study showed that a significantly high proportion 
of the respondents were aware of HB vaccine 
and a large proportion also had good knowledge 
of Hepatitis B vaccine. This proportion of 

respondents with good knowledge may be due to 
their daily participation in educational programs 
on Hepatitis B virus infection and prevention 
within and outside the academic setting as quite 
above half of the respondents got their 
information from the school. This finding is in 
agreement with the findings in another study at



 
 
 
 

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256 

 

Table 4. Uptake of HBV vaccine 
 

Have you been vaccinated against HBV Frequency Percentage 

Yes  55 29.4 
No  120 64.2 
Don’t know 12 6.4 
If not vaccinated, reasons for not being vaccinated  (n=120)   
Expensive  17 14.2 
Not readily accessible  67 55.8 
Not interested 22 18.3 
Others  14 11.7 
Reasons for being vaccinated (n=55)   
It was free 22 40.0 
Fear of being infected  17 30.9 
Advice from friend doctor 16 29.1 
No of doses received (n=55)   
1 dose 26 47.3 
2 doses 24 43.6 
3 doses 5 9.1 

 
Irua, Nigeria [8] and also comparable with the 
results of two other separate studies in Osun [9] 
and Lagos [2] both in Western Nigeria. It is 
however at variance with the findings in similar 
studies done at University of Jos [10] in 
Cameroon among medical students [11]. Poor 
knowledge was also reported among medical 
and health science students in a study done at 
Haramaya University, Ethiopia [4]. The findings 
in this study are however in contrast with two 
other separate studies done in India [12]. 
 
 A good knowledge of HB virus, its modes of 
infection as well as adequate vaccination may 
reduce infection rate. Studies carried out among 
health care workers in Sudan and Morocco 
revealed that most of them knew blood as a 
medium of infection but lacked adequate vaccine 
coverage. Inadequate knowledge of HBV among 
health workers may reflect their behavioural 
pattern to vaccination and safety measure [5,9]. 

 
In India, a study revealed that majority of the 
third year students knew about the vaccine type, 
vaccination schedule, type of syringes, route of 
administration, safe disposal of syringe and 
needles and other preventive strategies. On the 
contrary, very few second year students had 
correct knowledge regarding the same [12]. 

 
Among medical students at Northern Border 
University, Arar Kingdom of Saudi Arabia, a 
study showed that a significantly large proportion 
knew that vaccine could prevent HBV infection 
[13], but at variance with those in North West 
Ethiopia where a large proportion of the 
respondents were aware that they are at risk of 

contracting HBV and believed that HBV vaccine 
is effective and safe [14,15].  
 

Vaccine uptake and immune response to HBV 
infection study done in southwest region of 
Cameroon revealed that health care workers 
though few were the most vaccinated. Upon 
assessing the reasons for not being vaccinated, 
lack of awareness was topmost. Some of the 
participants had never heard about hepatitis B 
infection while others were not aware there was 
a vaccine against HBV infection. This 
automatically implies that there is low 
sensitization coverage on HBV infection in 
Cameroon despite the high HBV prevalence in 
the country. Although health care workers topped 
the number of vaccinated cases among the study 
groups, majority of them were still not vaccinated 
despite their awareness [16].  
 

Significantly high proportion of the respondents 
in this study affirmed they would like to be 
vaccinated. However, a large proportion were 
concerned about being infected by HB virus. This 
positive attitude could be adduced by their good 
knowledge of HBV infection and vaccine. These 
findings were comparable with the result of a 
study done in Iran [17] but however in 
discordance with the findings in other studies 
carried out in Port-Harcourt [18] and Jos [10]. 
 

Although, a significantly large proportion of 
respondents in this study had positive attitudes 
towards HBV vaccination, only few had received 
HBV vaccine. 
 

This low level of uptake may due to unavailability 
and expensive nature of the vaccine. These 



 
 
 
 

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257 

 

findings (reasons) were at variance with the 
results of studies done in Greece [19] and Iran 
[17] but comparable with the findings from other 
similar studies done in Port-Harcourt [18], Irua 
[14] and Jos [20] on the uptake of HBV vaccine. 
These variations in Greece and Iran could be 
due to better availability and accessibility of HBV 
vaccine among respondents.  
 

5. CONCLUSIONS 

 
This study found good knowledge among the 
respondents. There was positive attitude towards 
HBV vaccination among the respondents. 
However, uptake of HBV vaccine was poor. More 
intensive health education programs for the 
clinical medical students and indeed the general 
public on the need to be vaccinated against HBV 
is recommended. The HBV vaccine should be 
subsidized and/or made free to ameliorate the 
barrier created by cost. HBV infection is of public 
health importance in Nigeria. Health workers and 
clinical medical students who are at high risk of 
the infection should be tested and vaccinated 
against HBV infection accordingly.  
 

CONSENT AND ETHICAL APPROVAL 

 
Ethical approval was obtained from the Research 
and Ethics Committee (REC) of EBSU. Consent 
was obtained from the respondents. Data was 
collected using pretested, semi-structured, self-
administered questionnaires and analyzed using 
Statistical Package for Social Sciences (SPSS) 
for Microsoft window version 20. Data collection 
lasted for four weeks (July 2019). 
 

COMPETING INTERESTS 
 

Authors have declared that no competing 
interests exist. 
 

REFERENCES 
 

1. Alshammari MS, Alshamari NG, 
Alshammari AS, Kareem M. Electronic 
Physicians. 2017;(9):5388–94.  

2. Algadheeb AS, Al-alsheikh AS, Al-hamoudi 
WK, Alswat KA. Medical students’ 
awareness of and compliance with the 
hepatitis B vaccine in a tertiary care 
academic hospital : An epidemiological 
study. J Infect Public Health 2016;9:60-65. 

3. Bello FM, Health P, Anne CP. Health 
Workers’ knowledge, attitude and practice 
towards Hepatitis B Infection in Northern 
Nigeria. 2017;9(3):939–54.  

4. Mesfin YM, Kibret KT. Assessment of 
knowledge and practice towards Hepatitis 
B among Medical and Health Science 
Students in Haramaya University, Ethiopia. 
Scientific Research Publishing. 2013; 
8(11):1–6.  

5. Reddy RS, Swapna LA, Ramesh T, 
Pradeep K. Knowledge, attitude and 
practice on hepatitis B prevention among 
dental professionals in India. Pan African 
Medical Journal. 2011;10(4).  

6. Mohammed A, Aldeen Z, Alelyani AM, 
Alshammari KS, Abdulaziz M, Alsaif B, et 
al. Assessment of knowledge, attitudes 
and practices toward prevention of 
Hepatitis B virus infection among medical 
students in Hail Region, Saudi Arabia Sky 
Jounral of Medicine and Medical Sciences. 
2017;3(4):31–5.  

7. Taher HA, Mansuri S. Hepatitis B infection 
control knowledge and practice of 
undergraduate students at college of 
dentistry, Madinah, Saudi Arabia. BMC. 
2015;3(4):47–51.  

8. Kesieme EB, Uwakwe K, Irekpita E, Dongo 
A, Bwala KJ, Alegbeleye BJ. Knowledge of 
Hepatitis B vaccine among operating room 
personnel in Nigeria and Their Vaccination 
Status.Hepat Res Treat. 2011;2011:7–12.  

9. Adekanle O, Ndububa DA, Olowookere 
SA, Ijarotimi O, Ijadunola KT. Knowledge 
of hepatitis B virus infection, immunization 
with hepatitis B vaccine, risk perception, 
and challenges to control hepatitis among 
Hospital Workers in a Nigerian Tertiary 
Hospital. Hepat Res Treat. 2015;2015:1–6.  

10. Daboer JC, Chingle MP, Banwat ME. 
Knowledge, risk perception and 
vaccination against Hepatitis B infection by 
Primary Healthcare Workers In Jos, North 
Central Nigeria. Pan African Medical 
Journal. 2017;6–10.  

11. Noubiap JJN, Nansseu JRN, Kengne KK, 
Ndoula ST, Agyingi LA. Occupational 
exposure to blood, hepatitis B vaccine 
knowledge and uptake among medical 
students in Cameroon.Open Access; 2013.  

12. Singh A, Jain S. Prevention of Hepatitis B-
knowledge and practices among medical 
students. BMC. 2012;(2):52–6.  

13. Reang T, Chakraborty T, Sarker M, Tripura 
A. A study of knowledge and practice 
regarding Hepatitis B among nursing 
students attending tertiary care hospitals in 
Agartala city. International Jurnal of 
Research in Medical Sciences 2015;3(7): 
1641–9.  



 
 
 
 

Eze et al.; AJI, 3(1): 253-258, 2020; Article no.AJI.57925 
 

 

 
258 

 

14. Abdela A, Woldu B, Haile K, Mathewos B, 
Deressa T. Assessment of knowledge, 
attitudes and practices toward prevention 
of hepatitis B virus infection among 
students of medicine and health sciences 
in Northwest Ethiopia. BMC Res Notes. 
2016;1–7.  

15. Demsiss W, Seid A, Fiseha T. Hepatitis B 
and C: Seroprevalence, knowledge, 
practice and associated factors among 
medicine and health science students in 
Northeast Ethiopia. Plos One. 2018;1–   
12.  

16. Meriki HD, Tufon KA, Anong DN, Tony J, 
Kwenti TE, Bolimo AF, et al. Vaccine 
uptake and immune responses to HBV 
infection amongst vaccinated and non- 
vaccinated healthcare workers, household 
and sexual contacts to chronically infected 
HBV individuals in the South West Region 
of BMC. 2018;185:1–18.  

17. Alavian SM, Mahboobi N, Savadrudbari 
MM, Azar PS, Daneshvar S. Iranian dental 
students’ knowledge of hepatitis B virus 
infection and its control practices.         
World Journal of Vaccines. 2011;12:1627–     
34.  

18. Paul N, Peterside O. Hepatitis B 
Vaccination rate among medical students 
at the University of Port Harcourt Teaching 
Hospital (UPTH). World Journal of 
Vaccines. 2015;(2):1–7.  

19. Papagiannis D, Tsimtsiou Z, 
Chatzichristodoulou I, Adamopoulou M. 
Hepatitis B virus vaccination coverage in 
medical, nursing and paramedical 
students: BMC. 2015;8(5):1–9.  

20. Fufore MB, Cook PA, Kirfi AM. Health 
workers’ knowledge, attitude and practice 
towards hepatitis B infection in Northern 
Nigeria. International Journal of Caring 
Sciences. 2016;9(3):939-54. 

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provided the original work is properly cited. 

 
 

 
 

 
 

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