Vaccination Coverage and Awareness Level for Hepatitis B Among the Nursing Students of Government Nursing College, Bhavnagar - A Cross Sectional Study

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Introduction
Hepatitis B is an infectious necro-inflammatory liver disease caused by the Hepatitis B virus (HBV).HBV infection can cause a wide spectrum of liver diseases ranging from acute to chronic hepatitis, which can progress to hepatocellular carcinoma or liver cirrhosis. [1]BV infection can be transmitted through blood transfusion and other body fluids such as semen, saliva, urine etc.Other modes of transmission include mother to child transmission, sexual transmission, sharing contaminated needles and syringes, tattooing etc. [2] HBV infection is a well-recognized occupational risk for health-care workers (including trainees), and others (e.g.housekeeping staff, emergency workers) exposed to infected blood and body fluids or bloodcontaminated environments.Because of their contact with patients or infective material, health-care workers are at considerably greater risk of HBV infection than the general population.Health-care workers are often unaware of all exposures to potentially infectious blood and body fluids, or contaminated environments.Even when exposures are recognized, health-care workers often do not seek post-exposure prophylactic management.Hepatitis B vaccination safeguards health workers when administered early, ideally before occupational exposure, and provides greater protection for patients from infection through exposure to contaminated environments or infected workers.Reports from Health Ministry of India indicate that only 16-60% of healthcare workers receives complete HBV immunization.Paramedics have a higher risk of HBV transmission and receive HBV vaccination less often than doctors. [3]ffective hepatitis B infection prevention is a product of high knowledge, good attitude and good practice of hepatitis B infection prevention.Knowledge of hepatitis B infection prevention in this context is the awareness and understanding of the aetiology of hepatitis B infection, its transmission, clinical manifestation, treatment, complications, vaccination and existence of post exposure prophylaxis for the management of accidentally exposed persons. [6]lthough healthcare workers are known to be four times at risk of hepatitis B infection compared to the general population, their trainees including nursing students have been acknowledged to carry a greater risk of infection by HBV, due to inexperience, inadequate training and sheer carelessness. [4]his study was conducted among the nursing students of Government Nursing College of Bhavnagar to estimate their vaccination coverage and awareness regarding Hepatitis B infection.And to identify reasons for being completely or partially unvaccinated with Hep B vaccine.

Methodology
A Cross Sectional Study was conducted among nursing students of government nursing college Bhavnagar, Gujarat during September 2023.There were four batches of B.Sc. nursing course in college, and there were 60 students in each academic batch.Thus total 240 students pursuing B.Sc. nursing were included in this study.Out of 240 students total 213 nursing students were available during data collection.Data was collected in pre-tested structured questionnaire by team of 5 trained 3 rd year MBBS students in their classroom after taking informed consent and giving detailed information about study.Structured questionnaire for data collection included demographic data of students, their vaccination status for Hep B vaccine, number of doses, reasons for not taking vaccine, knowledge and awareness regarding type of infection, post exposure prophylaxis, routes of transmission and complications of Hep B virus infection.The students who had received all 3 doses (0,1 and 6 months) of Hepatitis B vaccine were considered as the fully vaccinated.

Results
Table 1 shows the demographic data of nursing students, among the students 90.6% were females and 9.4% were males with age group of 17-22 years.There were almost equal participants from each academic year and most of them were living in hostel (83.6%).

Table 1: Demographic data of students (N=213)
Table 2 shows the vaccination status of nursing students.Out of 213 students, 43.7% (93) students were unvaccinated with Hep B vaccine and 56.3% (120) students received vaccine.Out of those who had received vaccine (120) for hepatitis B only 42.5% students had received all 3 doses of vaccine, while 17.5% and 40% students had received one dose and two doses respectively.taking vaccine followed by unawareness (27%), poor administrative management * (16%), forgetfulness (7%), no time to take vaccine (4%) and others (4%) were the reasons for not taking any dose of Hep B vaccine.
(*Poor administrative management included non-availability of vaccine or vaccinating staff)

Chart 1: Reasons for not taking any dose of Hep B Vaccine (N=93)
Chart 2 depicts the reasons for not taking 2 nd or 3 rd dose of vaccine.48% nursing students could not give a particular reason followed by forgetfulness (35%), no time for vaccination (7%), poor administrative management (3%) and others (7%) were the reasons for not taking 2 nd and 3 rd dose of Hep B vaccine.  3 shows that awareness regarding routes of transmission of Hep B virus was highest for blood transfusion (67.1%) among the nursing students, followed by needle stick injury (61%), mother to child transmission (53.5%) and sexual transmission (49.8%).Table 4 shows that awareness regarding complication of Hep B virus infection was 65.7%, 62.9%, 54.5%, 27.7% and 12.2% for chronic hepatitis, liver cirrhosis, acute hepatitis, death and HCC respectively.

Table 4: Awareness regarding Complications Hep B infection (N=213) Discussion
A study on Hep B vaccination status was conducted among 150 medical students of B J Medical college Ahmedabad by Singh A and Jain S showed that 68% student of 2 nd year, 60% student of 3 rd Part I and 58% student of 3 rd part II MBBS had received full vaccination of Hep B vaccine. [6]The similar study was conducted among nursing students of Ghana by Aniaku and Amedonu [4] which showed that the majority of participants were between the ages of 20-26 year.About 78.2% knew the disease is caused by a virus.Also, 69.8% reported transmission through needle stick injuries, and 49.4% have taken the full three doses of vaccines.While in our study it was found that only 56.3% nursing students of Government nursing college Bhavnagar had received Hep B vaccine and 43.7% students were totally unvaccinated.88.7% (189) students knew that Hep B is viral infection Other KAP study was conducted in upper west region of Ghana [5] among nursing students showed that students had moderate median scores for knowledge (12.00;IQR = 10-13) and attitude (6.00; IQR = 5.00-7.00)but a poor median score (5.00; IQR = 4.00-6.00)for the practice of Hep B infection prevention.A study was conducted among students of medicine and health sciences in Northwest Ethiopia [7] , in which majority of the study participants (>80 %) had an adequate knowledge on risk factors for HBV, its mode of transmissions, and preventions.However, only 5 (2 %) students had completed the three doses schedule of HBV vaccination.In present study most of students (42%) could not give a particular reason for not taking vaccine and other reasons were unawareness (27%), poor administrative management (16%), forgetfulness (7%), no time to take vaccine (4%).These reasons were similar to those found in study conducted by Paul N, Peterside O [8] among the medical students, that none of the respondents thought it unimportant to receive the vaccine, however, other reasons for lack of uptake ranged from; no time (30.4%),I'll take it latter (21.8%), no reason (17.4%) to fear of side effects (17.4%).

Conclusion
Among the nursing students of Govt.Nursing College Bhavnagar, 93(43.7%)students had not received any dose of Hep B vaccine.Among those who were vaccinated; only 51(42.5%)students had received all three doses of Hep B vaccine.Most of the nursing students could not give a particular reason for not taking vaccine, followed by unawareness and forgetfulness were the major reasons for not taking vaccine.Among the nursing students of Govt.Nursing College Bhavnagar, awareness regarding routes of transmission of Hepatitis B virus was highest (67.1%) for Blood transfusion and lowest for sexual transmission (49.8%).While awareness regarding complication of Hep B infection was highest (65.7%) for chronic hepatitis, while lowest for Hepatocellular Carcinoma (12.2%).

Recommendation
Sensitizing nursing students of Govt Nursing College Bhavnagar about the risks of Hep B infection and organizing a vaccination drive, may help in improving their vaccination status.
Financial support and sponsorship: None.

Conflicts of interest:
There are no conflicts of interest.
• Email: editor@ijfmr.comIJFMR240112689Volume6, Issue 1, January-February 2024 3Data entry and analysis was done in MS Excel 2021.Ethical consideration: Prior permission was taken from Community Medicine department of Govt.Medical College Bhavnagar and Principal of Govt.Nursing College Bhavnagar.Informed consent was taken and data of participants was kept confidential.

Chart 2 :Table 3 :
Reasons for not taking 2 nd & 3 rd doses of Hep B Vaccine (N=69) Awareness regarding routes of transmission of Hep B infection (assessment 88.7% (189) students knew that Hep B is viral infection, and 91.1% (194) students were aware that post exposure prophylaxis of Hep B includes vaccine and immunoglobulins.Table

Table 2 : Hep B vaccination status of nursing students (N=213)
taking any dose of Hep B vaccine.42% students could not give a particular reason for not

Infection can be transmitted by: No of Students aware %
While among the nursing students of Govt.nursing college Bhavnagar, 88.7% (189) students knew that Hep B is viral infection, 67.1% students reported transmission by Blood transfusion and 61% reported by needle stick injury.Awareness regarding Hep B virus causing chronic hepatitis was highest (65.7%) and lowest (12.2%) for Hepatocellular carcinoma.