_____________________________________________________________________________________________________ *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 Eze et al.; AJI, 3(1): 253-258, 2020; Article no.AJI.57925 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. Eze et al.; AJI, 3(1): 253-258, 2020; Article no.AJI.57925 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 Eze et al.; AJI, 3(1): 253-258, 2020; Article no.AJI.57925 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 Eze et al.; AJI, 3(1): 253-258, 2020; Article no.AJI.57925 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. 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International Journal of Caring Sciences. 2016;9(3):939-54. ________________________________________________________________________________ © 2020 Eze et al.; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Peer-review history: The peer review history for this paper can be accessed here: http://www.sdiarticle4.com/review-history/57925 http://creativecommons.org/licenses/by/4.0