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Year : 2014 | Volume : 2 | Issue : 1 | Page : 31 - 33  


Short Communications
Attitude and practice regarding Hepatitis B vaccination among medical students in a teaching medical institution in Puducherry

Suganthi S1, Kanagarajan P2, Vaithiyanathan P3, Lokeshmaran A4

1Assistant professor, Tagore Medical college and Hospital, Chennai, 2Assistant professor, 3Assistant professor, 4Statistician, Dept of Community Medicine, Mahatma Gandhi Medical College & Research Institute, Puducherry

Abstract

The incidence of liver diseases associated with hepatitis B virus remains a global public health problem. Medical personnel are the first contact between such patients and health care and medical students are indeed at risk of the same. Present cross-sectional study was undertaken among second year medical undergraduates of MGMC and RI, Puducherry during August 2012, to assess the attitude and practices of medical students towards hepatitis B vaccination (HBV) and find out the vaccination coverage among them. After brief introduction about rationale of the study a pre-tested, self-administered, anonymous questionnaires was distributed. Information regarding background characteristics of participants, Hep-B vaccination coverage and reasons for poor acceptance/compliance were collected. The questionnaires were distributed on a single day in order to avoid sharing of information. Data was analyzed using statistical software using SPSSversion 16.0. Out of total 150 questionnaires circulated, 120 (response rate 80%) were returned (Male 53.3%, Female 46.7%). Among them 21 (17.5%) students had already received three doses of Hep-B vaccination. 22 (18.3%) students didn’t receive any dose. Reasons for poor coverage and/or non-compliance of Hep-B vaccination among medical students include forgot to complete the course (43.4%), not a mandatory process in the institution (26.3%), not compulsory for every individual (18.2%), fear of injections (4%) and expensive (5.1%). Coverage of Hep-B vaccination was poor among medical undergraduates in the present study. Concerted efforts should be made to motivate medical students and their family members towards Hep-B vaccination with support from medical college and medical council of India. The admission day can be utilized as an avenue for this initiative.

Key Words: Attitude, Practices, Hepatitis B vaccination.

Corresponding Author: Dr. Suganthi S, Assistant Professor, Department of Community Medicine, Tagore Medical College & Hospital, Chennai Email: kandaswamy22@gmail.com

 

Introduction

Hepatitis B is a potentially life-threatening and major global health problem caused by the hepatitis B virus. [1] Worldwide, an estimated two billion people have been infected with the hepatitis B virus and more than 240 million have chronic (long-term) liver infections. The hepatitis B virus is 50 to 100 times more infectious than HIV. [2] India has the intermediate endemicity of hepatitis B, with hepatitis B surface antigen prevalence between Two percent and 10% among the  population studied. The   number of carriers in India has been estimated to be over 40 million. [3] In many developed countries patterns of transmission are different from those in developing countries. The majority of infections in developed countries are transmitted during young adulthood by sexual activity and injecting drug use. Over one-third of patients with acute hepatitis B do not have readily identifiable risk factors. Professional blood donors constitute the major high risk group for HBV infection in India, with a hepatitis B surface antigen positivity rate of 14 %. [4] Hepatitis B is a major infectious occupational hazard of health workers. Medical personnel are the first contact between such patients and health care and medical students are indeed at risk of the same. Efforts to vaccinate persons in the major risk groups have had limited success because of the difficulties in identifying candidates belonging to high risk groups. Moreover, regulations have to be developed to ensure implementation of vaccination programs. So the present study was conducted to know the attitude and practice of Hepatitis B Vaccination among Medical college students.

Materials & Methods:

Among the eight medical colleges in Puducherry, (six private and two Government College) one medical college was selected by convenient sampling method. The present Cross sectional study was undertaken among second year medical undergraduates of Mahatma Gandhi Medical College & Research Institute (MGMCRI), Puducherry during the month of August 2012, all the students admitted between the year 2010 and 2011,with a total of 150 students were included in the study. After giving a brief introduction about rationale of the study, a pre-tested, self-administered, anonymous questionnaire were distributed and information regarding background characteristics of participants, Hepatitis B vaccination coverage and reasons for poor acceptance/compliance were collected. The questionnaires were distributed on a single day in order to avoid sharing of information. The data was analyzed using Statistical Package for the Social Sciences software for Windows version 16.0.Subject confidentiality was assured and maintained during and after data collection.

Results:

Table 1: Age and sex distribution of study subjetcts

Age (years)

N (%)

18

6 (5)

19

107 (89.2)

20

7 (5.8)

Sex

N (%)

Male

64 (53.3)

Female

56 (46.7)

Out of total 150 questionnaires circulated, 120 were returned with the response rate of 80%. Among them there were 53.3 %, male and 46.7% females.

Table 2: Vaccine Coverage

Number of vaccines received

Male N (%)

Female N (%)

1

13(10.8)

21(17.5)

2

28(23.3)

15(12.5)

3

13(10.8)

8(6.6)

None

10(8.3)

12(10)

Out of 120 students, 21 students had already completed three doses of Hepatitis-B vaccination. The remaining 22 students did not receive any dose of Hepatitis B Vaccination. The number of students who received the first and second dose of Hepatitis B Vaccination was 13 male &21female and 28 male & 15 female.

Table 3: Reasons for poor coverage/Noncompliance of Vaccine Coverage

Reasons (n=99)

Sex

Total (%)

Males

Females

Fear of injections

2

2

4 (4)

Forgot to complete the course

24

19

43(43.4)

Not compulsory for every individual

10

8

18(18.2)

Expensive

3

2

5(5.1)

Not mandatory

9

17

26(26.3)

Waiting for next dose

3

0

3(3)

Total

51

48

99(100)

Reasons for poor coverage and/or non-compliance of Hepatitis B vaccination among medical students included forgot to complete the course 43 (43.4%), not a mandatory process in the institution 26(26.3%).

Discussion:

Medical students are susceptible to HBV infection during their exposure to clinical cases and different procedures. Hence, medical students were advised to have vaccination against HBV before coming to clinical side, as they acquire good immune response with immune memory. The main purpose of the study is to assess the Vaccination status among the second year medical college students and to suggest necessary recommendations. The main source of knowledge about Hepatitis B infection in the study is through the College similar to a study in Yemen where 74% of the tested population gained their knowledge from Schools and Colleges. [4] In the present study only 17.5% of the students had complete vaccination coverage which is more than a study in which 8.7% of the students had complete Vaccination coverage [5] and less than a study in France which showed Vaccination coverage for Hepatitis B infection was 22.28% among students. [8] This may be due to the low level of awareness about hepatitis among students but in another similar study a total of 81.55% of study subjects exhibited adequate level of awareness. [6] Unfortunately 18.3% of the students did not receive any vaccine in this study which is more than a study where only six percent of the students were without vaccination. Almost 96.66% of the students had incomplete vaccination majority of which are girls which is similar to a study conducted   in Portuguese the incomplete basic vaccination was more frequent in girls and children from low-income and black families. [7] The main reasons for poor coverage and/or non-compliance of Hep-B vaccination among medical students in the present study includes forgot to complete the course (43.4%) and not made mandatory in the institution which is similar to a study in which 38.8% [5] came out with the same reasons. Hence, it is suggested that the students and their parents/family members who come on the day of admission should be educated on HBV infection and motivated for successful and effective vaccination. The study also highlights the need for a national policy in countries where hepatitis B vaccination to health care personnel is not made mandatory. High risk groups and health care personnel should be educated to reduce the risk of contracting the virus and to reduce the chances for transmission to others, as well as to promote acceptance of vaccination schemes. [10]

Conclusion:

Coverage of Hep-B vaccination was poor among medical undergraduates in the present study. Concerted efforts should be made to motivate medical students and their family members towards Hep-B vaccination with support from medical college and medical council of India. The admission day can be utilized as an avenue for this initiative.

References:

  1. Park K, Text Book of Preventive and Social Medicine, 19th Edition, M.S. Banarsidas Bhanot, Jabalpur; 2007: 267.
  2. World Health Organization. Introduction of hepatitis B vaccine into childhood immunization services.Geneva, WHO, 2001 (unpublished).P.1-2.
  3. Malik AH, Lee WM. Chronic Hepatitis B Virus Infection.Treatment Strategies for the next   Millenium. Ann Intern Med May 2000;132(9):723-31.
  4. Gacche RN, Kaid AM. Epidemiology of Viral Hepatitis B and C Infections in Ibb City, Yemen. Hepat Mon 2012;12(7):460–2.
  5. Vinodhkumaradithyaa A, Srinivasan M, Sankarasubramanian R, Uma A, Ananthalakshmi I, Thirumalaikolundusubramanian P et al. Hepatitis B Vaccination Among Medical StudentsIndian J Community Med. 2008 January; 33(1):67–8.
  6. Rajiv Saini, Santosh Saini, RS Sugandha. Knowledge and awareness of Hepatitis B infection amongst the students of Rural Dental College, Maharashtra, India. Ann Nigerian Med 2010: 4(1):18-20
  7. Yokokura AV, Silva AA, Bernardes AC, Lamy Filho F, Alves MT, Cabra NA et al. Vaccination coverage and factors associated with incomplete basic vaccination schedule in 12-month-old children. Cad Saude Publica. 2013 Mar;29(3):522-34
  8. Faure E, Cortot C, Gosset D, Cordonnier A, Deruelle P, Guery B.Vaccinal status of healthcare students in Lille. Med Mal Infect. 2013 Mar;43(3):114-7.
  9. Tandon BN, Acharya SK, Tandon A. Epidemiology of Hepatitis B virus infection in India. 1996;38 Suppl 2:S56-9.
  10. Viral Hepatitis Prevention Board. Antwerp VHPB Report. Editorial. Control of viral hepatitis in Europe. Viral Hepatitis, 1996, 4(2), http://hgins.uia.ac.be/esoc/VHPB/vhv4n2.html.




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