|Year : 2015 | Volume
| Issue : 2 | Page : 179-182
An epidemiological study to assess the awareness of hepatitis B infection in the dental students, college staff, practitioners, and auxiliary staff in city of Maharashtra
Atul A Pandharbale, Rajeev M Gadgil, Ajay R Bhoosreddy, Bhushan S Ahire, Varun R Kunte, Manila R Shinde
Department of Oral Medicine and Radiology, MGV'S KBH Dental College, Nashik, Maharashtra, India
|Date of Web Publication||18-Jun-2015|
Atul A Pandharbale
133/1 A E Ward Sadar Bazar, Kolhapur, Maharashtra
Source of Support: None, Conflict of Interest: None
Introduction: Hepatitis B is a major health problem worldwide and more serious in India. Hepatitis B virus has only human reservoir, and it is easily transmitted to one another. In the field of dentistry, it involves with saliva and blood, and it also involves many accidental injuries. Dentist with their associates are more prone to get infected. Aim: To assess the level of understanding and awareness about hepatitis B infection among the dental undergraduate and postgraduate students, institutional staff of a reputed dental college, dental practitioners, dental auxiliary, and paramedics of a city in Maharashtra. Materials and Methods: A cross-sectional survey was carried out in 350 subjects using a self-administered pretested questionnaire containing 15 questions on awareness about prevention and transmission, vaccination status of hepatitis B, awareness of postexposure prophylaxis (PEP), and complications associated with hepatitis B. Descriptive analysis was carried out and was presented as a percentage. Results: The response rate was 100% (n = 350). Majority of the undergraduate and postgraduate students, college staff, and dental practitioners were aware of hepatitis B infection, its vaccination, and its importance but knowledge and awareness regarding the incubation period, PEP, and complications associated were less. Dental auxiliary staff has the minimal knowledge and awareness about hepatitis B infection. Conclusion: Overall good knowledge and awareness are observed among the undergraduate and postgraduate students, college staff, and in the dental practitioners. The auxiliary and paramedical staffs are minimally aware.
Keywords: Awareness, hepatitis B virus, immunization, infection, postexposure prophylaxis
|How to cite this article:|
Pandharbale AA, Gadgil RM, Bhoosreddy AR, Ahire BS, Kunte VR, Shinde MR. An epidemiological study to assess the awareness of hepatitis B infection in the dental students, college staff, practitioners, and auxiliary staff in city of Maharashtra. J Indian Assoc Public Health Dent 2015;13:179-82
|How to cite this URL:|
Pandharbale AA, Gadgil RM, Bhoosreddy AR, Ahire BS, Kunte VR, Shinde MR. An epidemiological study to assess the awareness of hepatitis B infection in the dental students, college staff, practitioners, and auxiliary staff in city of Maharashtra. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 18];13:179-82. Available from: http://www.jiaphd.org/text.asp?2015/13/2/179/159060
| Introduction|| |
Hepatitis is a major public health problem worldwide.  Hepatitis B is an endemic and a leading cause of morbidity and mortality among the Indian population.  Seven types of the hepatitis virus have been identified and are named as hepatitis A to G, of which; F is hypothetical.  Hepatitis B remains the most serious type with a high risk of death from liver cirrhosis and cancer.  Hepatitis B, C, and D are transmitted by parenteral contact with infected body fluids including blood, semen, saliva, sweat, and tears, invasive medical procedures using contaminated equipment, vertical transmission, and from family member to child.  Hepatitis B virus (HBV) is a DNA virus with a human, the only reservoir. About one-third of the world's population, which accounts to 2 billion people, have been infected with HBV.  This virus can survive outside the body for at least 7 days and the incubation period is about 21-135 days.  Overall, approximately 45% of the global population live in areas of high chronic HBV prevalence.  In Sub-Saharan Africa, the Pacific, and particularly Asia, HBV infection is highly endemic, with the majority of individuals are infected during childhood only.  Acute infection with HBV is associated with acute viral hepatitis - an illness that begins with general ill-health, loss of appetite, nausea, vomiting, body aches, mild fever, dark urine, and then progresses to development of jaundice.  The incubation period is 30-180 days. Chronic infection with HBV may be either asymptomatic or may be associated with a chronic inflammation of the liver (chronic hepatitis), leading to cirrhosis over a period of several years.  The immunization status in India in a general population may be relatively lesser than the western nations.  A prospective study found that 52-59% of healthcare personnel in the different classes had taken hepatitis vaccine.  Dentistry involves the use of small, sharp instruments contaminated with blood or other fluids. Dental surgeons, dental students, and auxiliary staffs are at a high risk of inadvertent skin wounds. Such accidents include the possibility of transmission of hepatitis B, hepatitis C, and human immunodeficiency virus (HIV).  To decrease the risk of HBV infection, it is recommended that; dental personnel receives immunization against HBV and use personal protection. Hence, we, as a part of the dental profession should be aware of the risks involved in the treatment procedures and should take appropriate precautions in dealing with the patients. A study done by Tripati et al. in 2011 in the dental students, dental professionals, and dental hygienists showed that awareness in majority of the groups, but only few knew about the possible outcomes and complications.  A similar study on Chinese and South Asian Canadians showed that there is a need for creating awareness in this population group.  Dentistry comprises all these infections and with the risk of injuries and transmission, we need to know all the aspects of HBV. Through this study, we tried to evaluate the knowledge and awareness of hepatitis B infection in all the personnels of the dental profession, including all the quantities of a dental fraternity.
| Materials and methods|| |
The survey was conducted among dental practitioners, students, and staff of the dental institution in a city of Maharashtra for a period of 6 months. In this, 100 undergraduate, 50 postgraduate students, 50 staff, 100 practitioners, and 50 auxiliary staff from the city were approached.
Aim and objective
To identify the awareness regarding various characteristics of hepatitis B infection in dental fraternity and also make them aware of the true and correct answers or facts.
Sample design and sampling method
Three hundred and fifty participants were selected using a simple stratified sampling method; which included qualified dental professionals (BDS/MDS), dental undergraduate and postgraduate students, college staff, and dental auxiliaries. The undergraduate students included 3 rd year, 4 th year, and interns. They got enrolled in this study by the lottery method. Sample size was decided on the basis of study population available in that city of Maharashtra and by the total students of the institution.
A self-administered pretested ,, questionnaire containing 15 questions was prepared and given to 350 subjects; this was a close ended questionnaire, constructed on the basis of previously conducted studies, and based on the understanding of the diseases. Validity of questionnaire was assessed by checking it from the medical professionals, and some questionnaire papers used as a pilot study checked in by our study group and necessary corrections made. The subjects were asked to tick one of the most appropriate answers for each question. The questionnaire was prepared both in English and in regional language. Regional language questionnaire was given to the auxiliary and support staff. The subjects were personally interviewed, and the questionnaire was filled in the presence of the investigator. Anonymity was assured. Respondents were informed about the incorrect answers and the correct answers were discussed immediately. The answers in the questionnaire were kept unaltered. There was 100% response rate for all the questions by all the respondents. All the data collected were added in Microsoft Excel. After sorting it out, the total number of responses were calculated and compared. No statistical test has been applied, so the level of significance cannot be determined.
| Results|| |
Quantitative type of data collected from all the responses, which were calculated in the Microsoft Excel, as the number of responses given by the 100 participants taken as the percentage. Among the dental undergraduate students - awareness 94%, knowledge regarding most infectious type of hepatitis 83%, incubation period 36% and its transmission 82%, and immunization 83%, knowledge about postexposure prophylaxis (PEP) 31%. Knowledge about symptomatic and asymptomatic was 54 and 36%, respectively. Twenty-six percent undergraduate students knew liver cirrhosis as the complication. Among the postgraduate students - awareness 98%, knowledge regarding most infectious hepatitis 94%, incubation period 74% and its transmission 88%, immunization 80%, and PEP 54%. The postgraduate students - 46% said that it was symptomatic and 38% said asymptomatic. In PG'S, 42% knew liver cirrhosis as the complication of long-term hepatitis infection. Among dental college staff - awareness 98%, knowledge regarding most infectious hepatitis 94%, incubation period 56% and its transmission 90%, immunization 74%, and PEP 42%. As much as 56% said that it was symptomatic and 36% said asymptomatic. Likewise, 56% knew liver cirrhosis as the complication of long-term hepatitis infection. Among dental practitioners - awareness 99%, knowledge regarding most infectious hepatitis 87%, incubation period 51% and its transmission 80%, immunization 62%, and PEP 32% as these. Again 35% said that it was symptomatic and 55% said asymptomatic and 40% knew liver cirrhosis as the complication of long-term hepatitis infection. Results show that among the auxiliary and paramedic's awareness was 64%, knowledge regarding most infectious type of hepatitis 24%, incubation period 16% and its transmission 44%, immunization 18%, and PEP 10%. 44% said that it was symptomatic and 8% said asymptomatic. Only 6% know liver cirrhosis as the complication of long-term hepatitis infection and 80% did not knew about the complications [Table 1] and [Table 2].
| Discussion|| |
Hepatitis B virus is 50-100 times more infectious than HIV and is a major occupational risk for physicians, surgeons, and serious problem of public health. HBV is a major cause of morbidity and mortality especially in developing countries like India. ,, The present study demonstrates that there is both concern and desire for further HBV education. Among the 350 subjects, overall good knowledge and awareness was seen among the undergraduate and postgraduate students, college staff, and in the dental practitioners. The auxiliary and paramedical staff had an overall less knowledge. A similar study conducted by Tirupati et al.  among 367 subjects, 86.6% of subjects were aware of hepatitis B infection, 54% did not know that chronic HBV infection is often asymptomatic and 85.2% did not know that chronic HBV infection confers a high risk of cirrhosis, liver cancer, and premature death. Among the undergraduate students, there was suggestively less knowledge about the incubation period, symptoms, PEP, and complications associated with hepatitis B infection. Survey among 150 undergraduate dental students in Maharashtra conducted by Sain et al.  showed 81.55% and 94% were correct regarding their knowledge about transmission and vaccination, respectively. Studies among dental interns in Pondicherry showed that 92.7% of the interns were aware of immunization against HBV.  In the survey done to determine the vaccination status, knowledge, attitude, and practice regarding hepatitis B and C among medical students by Khan et al. in Karachi, Pakistan, only 57.1% had knowledge about the routes of spread of HBV and only 85% were aware of vaccine for hepatitis B when compared to our study.  Relatively good knowledge and awareness is seen in the postgraduate students and college staff, except for the PEP, and complications associated with hepatitis B infection. In our study, we knowingly kept two separate groups for institutional staff and active dental practitioners. Although they may have equal qualifications, the institutional staff is in constant touch with the current literature being published. Comparatively, less knowledge and awareness were seen in dental practitioners regarding incubation period (51%) and appearance of the hepatitis B infection (55%) and PEP (32%) and complications (40%). This should be higher in number as accidental injuries may occur in our routine practice. The professionals should be aware of the PEP regimen in the case of any accidental exposure to HBV.As recommended by centers for disease control and prevention, PEP includes hepatitis B immunoglobulin and/or hepatitis B vaccine series which should be initiated within 24 h to latest 1 week from the time of exposure after evaluation of the hepatitis B surface antigen status of the source and the vaccination and vaccine response status of the exposed person.  In a study of Kasetty et al.  among the dental professionals, of the 280 subjects, 2.15% showed a good level of awareness regarding the epidemiology and the route of transmission of hepatitis and 95.36% had good knowledge about vaccination of hepatitis B.  There was an alarmingly overall lack of knowledge and awareness about the hepatitis B infection among the auxiliary staff. Most of the risks are unknown to them. With minimal knowledge, they work in clinics and are prone to get infected as much as the practitioners. Dental professionals are responsible for the health of these persons. They need to educate them about the preventive measures and should immunize their staff also. Majority of the participants agreed on the fact that preventive measures and immunization should be taken for the prevention of hepatitis B infection. Majority of the participants agreed upon the risk of acquiring and transferring the Hepatitis B infection. However, if the findings to be generalized to all the professional individuals, this survey should be done with larger sample size. The knowledge can be further enhanced by conducting continuing dental education (CDE) program, seminars, and workshops. There is a need to stress on the teaching of infectious diseases and preventive measures for students at the institutional level. Of all the groups, the auxiliary staff is found to be the least aware. The reason behind that is, the scarcity of educational programs, workshops organized as per their needs. The overall awareness in rest of the groups is found to be comparatively superior. The lack of cognizance of these groups regarding certain aspects may be because of lack of focusing on UG and PG curriculums, CDE/continuing medical education programs, and cross infections. Special programs need to be taken by the local dental associations for increasing the knowledge of their support staff.
| Limitations|| |
The limitation of this study is that it is carried out in a restricted geographical area. When talking about all constituents of dental fraternity and their knowledge, it has to be larger samples in the individual group and from all parts of the state or country. Thus, the results of our study need to be confirmed by larger sample size and extended the geographical area.
| Conclusion|| |
The present study reveals an overall good knowledge and awareness seen among the undergraduate, postgraduate students, college staff, and the dental practitioners. Auxiliary and paramedical staffs have shown minimal awareness about hepatitis B and its importance regarding transmission and prevention. With these kinds of studies, we tried to evaluate the need of creating awareness and motivate for getting immunized and to use proper preventive measures from these infectious diseases.
| References|| |
Tripati S, Kamala BK, Kiran K. Hepatitis B awareness among the dental professionals, students and dental hygienists in a dental school - An epidemiological study. Int J Contemp Dent 2011;2:45-50.
Kasetty S, Mohania A, Dwivedi D, Tijare M, Kallianpur S, Gupta S. A Cross-sectional study on the knowledge of hepatitis B infection among dental professionals. J Virol Microbiol 2013;2013:288280.
Vasanthakumar A, Dcruz A. Awareness regarding hepatitis B immunization among preclinical Indian dental students. J Oral Health Oral Epidemiol 2013;2:97-101.
Sharma R, Sharma CL, Khajuria R. The knowledge, attitude and practices regarding HBV infection of married women in reproductive age group living in cantonment area, Sunjawan, Jammu. JK Sci 2004;6:127-30.
Mahoney FJ. Update on diagnosis, management, and prevention of hepatitis B virus infection. Clin Microbiol Rev 1999;12:351-66.
World Health Organization. Hepatitis B Fact Sheets; 2000. Available from: http://www.who.int/mediacentre/factsheets/fs204/e. [Last cited on 2012 Aug 25].
Elmukashfi TA, Ibrahim OA, Elkhidir IM, Bashir AA, Elkarim MA. Hazards analysis, within departments and occupations, for hepatitis B virus among health care workers in public teaching hospitals in Khartoum state; Sudan. Glob J Health Sci 2012;4:51-9.
Singhal V, Bora D, Singh S. Hepatitis B in health care workers: Indian scenario. J Lab Physicians 2009;1:41-8.
Cheung J, Lee TK, Teh CZ, Wang CY, Kwan WC, Yoshida EM. Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community. Can J Gastroenterol 2005;19:245-9.
Chowdhury A. Epidemiology of hepatitis B virus infection in India. Hepat B Annu 2004;1:17-24.
Adoga MP, Gyar SD, Pechulano S, Bashayi OD, Emiasegen SE, Zungwe T, et al.
Hepatitis B virus infections in apparently healthy urban Nigerians: Data from pre-vaccination tests. J Infect Dev Ctries 2010;4:397-400.
World Health Organization. Childhood Diseases in Africa. Fact 6 Sheet N109. Geneva, Switzerland: World Health Organization; 1996. Available from: http://www.who.int/inf-fs/en/fact109.html. [Last cited on 2004 Sep 28].
Sain R, Saini S, Sugandha RS. Knowledge and awareness of hepatitis B infection amongst the students of Rural Dental College, Maharashtra, India. Ann Niger Med 2010;4:18-20.
Tirounilacandin P, Krishnaraj S, Chakravarthy K. Hepatitis-B infection: Awareness among medical, dental interns in India. Ann Trop Med Public Health 2009;2:33-6.
Khan N, Ahmed SM, Khalid MM, Siddiqui SH, Merchant AA. Effect of gender and age on the knowledge, attitude and practice regarding hepatitis B and C and vaccination status of hepatitis B among medical students of Karachi, Pakistan. J Pak Med Assoc 2010;60:450-5.
Centres for Disease Control and Prevention. Updated U.S. Public Health Service Guidelines for the Management of Occupational Exposures to HBV, HCV, and HIV and Recommendations for Post Exposure Prophylaxis; 2012. Available from: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5011a1.htm. [Last cited on 2012 Aug 30].
[Table 1], [Table 2]