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 Table of Contents  
ORIGINAL ARTICLE
Year : 2018  |  Volume : 15  |  Issue : 2  |  Page : 162-168

The impact of a hospital-based awareness program on the knowledge of pregnant women about hepatitis b virus


1 Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni Suef University, Beni Suef, Egypt
2 Department of Community Health Nursing, Faculty of Nursing, Beni Suef University, Beni Suef, Egypt

Date of Submission30-May-2018
Date of Acceptance12-Sep-2018
Date of Web Publication12-Nov-2018

Correspondence Address:
Amany A Goda
Department of Maternal and Newborn Health Nursing, Faculty of Nursing, Beni Suef University, Beni Suef
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ENJ.ENJ_12_18

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  Abstract 


Background Pregnant women are at a higher risk of getting infected with hepatitis B virus (HBV) and may transmit the infection to their fetuses and newborns. The aim of this study was to evaluate and improve the knowledge of pregnant women about HBV.
Patients and methods A convenient sample of 80 pregnant women attending the obstetric clinic of Beni Suef University Hospital participated in this educational program. The knowledge of women about HBV was first assessed by using an interview questionnaire. The awareness program included five sessions, each session focused on improving the awareness of the pregnant women over one aspect. Later, all women were assessed again over their knowledge about the five aspects using the same questionnaire.
Results Baseline assessment showed that only 23.8% women had optimal knowledge about HBV, 32.5% about what HBV is, 27.5% about transmission, 25% about fetal complications, 23.8% about other complications, and 30% about prevention. Educated women, working women, and those residing in urban areas had better knowledge (P<0.05). After the awareness program, the knowledge of the pregnant women improved to 97.5% with optimal knowledge (P<0.001), 93.8% about the nature of HBV, 93.8% about transmission, 96.2% about fetal complications, 92.5% about other complications, and 97.5% about prevention.
Conclusion This study found that there was a positive impact on the knowledge of pregnant women about HBV after taking the hospital-based awareness program.
Recommendation Further research should focus on the effect of HBV awareness programs over the practice and attitudes of women towards HBV vaccination.

Keywords: hepatitis B virus, knowledge, pregnant women


How to cite this article:
Helmy HK, Mohamed AA, Goda AA. The impact of a hospital-based awareness program on the knowledge of pregnant women about hepatitis b virus. Egypt Nurs J 2018;15:162-8

How to cite this URL:
Helmy HK, Mohamed AA, Goda AA. The impact of a hospital-based awareness program on the knowledge of pregnant women about hepatitis b virus. Egypt Nurs J [serial online] 2018 [cited 2018 Dec 14];15:162-8. Available from: http://www.enj.eg.net/text.asp?2018/15/2/162/245114




  Introduction Top


Hepatitis B virus (HBV) infection is a viral infection that attacks the liver and can cause both acute or chronic disease, and it is considered as a major public health problem, because it is the leading cause of morbidities and mortalities in both developed and developing countries (Chweitzer et al., 2015). More than 370 million had chronic infection with HBV, 240 million of them live in low-income and middle-income countries. Between 20 and 30% of those who become chronically infected will develop liver cirrhosis, liver failure, and hepatocellular carcinoma complications, and 650 000 people will die annually due to chronic hepatitis B. The main problems of HBV infection are that the majority of people are unaware of their HBV infection, because these liver problems may take time to develop, and infected persons may not have any signs or symptoms, which may lead to many transmissions of infection without the carrier being known (WHO, 2015).

HBV is transmitted between people by direct contact with infected blood, semen, and vaginal fluid. Modes of transmission are the same as those for the HIV, but the HBV is 50–100 times more infectious. Unlike HIV, the HBV can survive outside the body for at least 7 days; during this period, the virus can cause infection if it enters the body of a person who is not protected from HBV by the vaccine. In developing countries, the common period of infection is perinatal (from mother to baby at birth) and at early childhood (Gboeze et al., 2015).

HBV infection is an important cause of liver disease in pregnancy. During pregnancy, there are many changes in the maternal immune system, a shift in the Th1–Th2 balance towards a Th2 response, and increased amounts of regulatory T cells that contribute to a depressed immune response against HBV. Perinatal transmission is a common mode of HBV transmission worldwide. The Antibodies of hepatitis B antigen and anti-hepatitis B core antigen cross the placental barrier and do not appear in all babies before 12 and 24 months of birth (Borgia et al., 2012). Vaccination and implementation of the universal program for neonatal immune prophylaxis, may have resulted in reducing the incidence of HBV among pregnant women throughout, controlling both horizontal and vertical transmission (Yang et al., 2013).

Pregnant women with HBV have higher incidences of preterm labor at less than 37 weeks, preterm birth at less than 34 weeks, gestational diabetes mellitus and antepartum hemorrhage; moreover, their infants have lower Apgar scores at the first and fifth minute, and increased incidence of intraventricular hemorrhage (Thompson et al., 2002). It is important to improve the national program about prevention and control of HBV infection, which will improve the practice and knowledge of pregnant women and all medical care teams, to decrease the incidence of HBV transmission among women during their childbearing period. HBV campaigns and awareness programs are commonly launched to improve knowledge of pregnant women about the routes of the virus transmission, screening methods, and management steps. Such programs encourage women to be more careful while handling sources of infections and promote HBV screening (Chweitzer et al., 2015). Every woman in the first trimester should be screened for HBV infection. If she is negative, she does not have to be routinely vaccinated during pregnancy, although it is considered safe, but it is preferred to take HBV vaccination before pregnancy or after (Borgia et al., 2012).

Although this subject is very important, the pregnant women in Egypt have limited awareness of the nature of HBV, its mode of transmission and prevention techniques; moreover, the health care team does not take care of the importance of improving the pregnant woman’s knowledge about HBV. The researcher in this study believed that improving the pregnant woman’s knowledge about HBV will decrease the complications that may occur to the mother and fetus. The nurse has an important role in counseling of the pregnant woman about HBV during pregnancy and labor, as it may be important for the pregnant woman to decrease the risk for infection and occurrence of complications to her and her fetus. This program can be providing to the pregnant woman with little effort and low cost.


  Significance Top


Pregnancy is a period when the woman is at high risk for contracting infectious diseases, and susceptibility to these infections is high. One of the infections that can affect pregnant women is HBV. HBV infection is a serious hazard to pregnant women’s health, and can cause liver disease during pregnancy. Despite the urgency of this topic, the pregnant women in Egypt have limited knowledge about HBV, its mode of transmission, and prevention techniques, and, at the same time, the health care team does not seem concerned about the importance of improving pregnant women’s knowledge about HBV. Hence, the researcher in this study seeks to improve the pregnant woman’s knowledge about HBV, which will decrease the complications that may occur to the mother and fetus, such as intraventricular hemorrhage, bleeding, abortion, and fetal distress, and will also decrease morbidity rate and cost involved to treat the previous complications.

Moreover, the researcher found that no available published studies have been carried out in Egypt about the knowledge and awareness of HBV infection during pregnancy. Hence, the researcher found it important to conduct this study among Egyptian women to clarify their actual knowledge. This study was carried out to provide baseline information about HBV infection among pregnant women attending the obstetric clinic of Beni Suef University Hospital. Furthermore, findings of this study will help the health care provider to apply health teaching program about HBV as a routine antenatal care for pregnant woman to improve their health and prevent complications of HBV.


  Aim Top


The aim of the current study is to evaluate and improve the knowledge of pregnant women attending the obstetrics clinic of Beni Suef University Hospital about HBV.

Hypothesis

H1. Pregnant women who attend to the antenatal clinic at Beni Suef University Hospital will have little knowledge about HBV according to the score of pretest.

H2. Pregnant women who follow the educational program about HBV will have improvement in their knowledge about HBV according to the score of posttest.


  Patients and methods Top


An interventional noncontrolled research design was used in this study. A convenience sample was utilized. A total of 80 pregnant women were recruited to participate in this awareness educational program according to the following inclusion criteria: pregnant, at any age, can read and write, and attending the obstetrics clinic of Beni Suef University Hospital. The setting of data collection and the sessions of the program have been given at the antenatal outpatient clinic at Beni Suef University Hospital in Egypt. The researcher collected the sample in the period between February and July 2017. The tools used for collecting data pertinent to the study were structured interviewing tool and knowledge assessment tool by using the pretest and posttest about what HBV is, methods of transmission, the effect of HBV on pregnancy, on the fetus and newborn, other complications caused by the virus, and the prevention methods.

Ethical considerations

After taking the approval from Beni Suef University Hospital, an official permission was obtained from the director of the antenatal clinic at the Beni Suef University Hospital to carry out the study. The researcher introduced herself to the pregnant women in the antenatal clinic and explained the purpose of the study in order to obtain their written acceptance to be recruited in this study as well as to gain their co-operation. In addition, ensuring their participation is voluntary, and confidentiality is assured through coding of data by the researcher. Every woman was assured that she had the right to withdraw from the study at any time without giving reasons, and that her withdrawal would not affect the care she was receiving or her relationship with the research investigator.

Fieldwork and data collection

Data was collected through a period of five months from first of February to the end of June 2017. Throughout the whole five months, the researched attended at the antenatal units 2 days per week to recruit cases.

The current study was carried out in four phases: interviewing phase, knowledge assessment phase; implementation phase and evaluation phase.

Interviewing phase

The researcher collected data from pregnant woman through interview and knowledge assessment. During the initial visit, the researcher met the pregnant women recruited for the study at the antenatal clinic at the Beni Suef University Hospital. Women were identified and recruited, and a written informed consent to participate in the research study was obtained from them. At the antenatal clinic, women were interviewed to collect data after the researcher introduced herself and explained the purpose of the research. In the interviewing phase, all pregnant women were interviewed individually to collect data related to sociodemographic status, present obstetrical history, as well as history of previous pregnancies and deliveries, utilizing the structured interviewing schedule. Personal interview was conducted by the researcher face to face with the mother; and the researcher asked questions in Arabic and recorded the answers in the special sheet. The interview took around 15 min to be completed for each interview.

Knowledge assessment

In this phase, the researcher started assessment of the women’s knowledge about HBV by using the pretest. The assessment included the knowledge of women about five aspects: (a) What is HBV? (b) Methods of transmission. (c) Effect of HBV on pregnancy, the fetus, and newborn. (d) Other complications caused by the virus. (e) Prevention methods from HBV infection. Every part of the five aspects included five open-ended questions. Correct answers were given a score of 1, making the score of each aspect 5, and the total score of the assessment 25. Reliability analysis for the questionnaire, as detected by Cronbach’s test, was 0.71. Women who achieved more than or equal to 60% of the score were considered to have optimal knowledge and those with lower scores were considered to have suboptimal knowledge.

Implementation phase

This educational program contains five sessions, with a duration of 20 min each. Each session focused on improving the awareness of the pregnant women over only one of the five aspects. Arabic-language brochures and leaflets, supported by illustrated figures and graphs, have been distributed as take-home notes. The researcher provided the awareness educational program over a period of 3 weeks; the first week, started immediately after finishing the interview and contained two educational sessions; each session took about 20 min, and there was a 10 min break between the two sessions. In the first educational session, the researcher discussed with pregnant women what HBV is and its signs, symptoms, and what is the occupation period of HBV. After finishing the first session, all women took a break for 10 min to eat some snacks and drink juice, and then started the second session, which contained the second point of the program and also contained the methods of transmission of HVB. The second week started by assessing the previous knowledge imparted in first week for every woman in the study; thereafter, the researcher provided a lecture about two aspects from the program, which were the effects of HBV on pregnancy, the fetus, and newborn, and what were the other nonobstetric complications caused by the virus on pregnant woman. The third week also started by review of the previous knowledge imparted in the last session; thereafter the researcher provided the last point of the program, which contained the prevention methods of HBV, such as screening methods, vaccination (when and how it is taken), and infection control methods (hand wash, wear gloves while dealing with blood or any human fluid). For any woman who missed sessions throughout the program, the researcher repeated them for her before starting a new session.

Evaluation phase

In the third week of the program, all women were assessed again over their knowledge about the five aspects, using the same questionnaire (posttest), and the scoring system was similar to the baseline assessment. Interview and score assessment of the pregnant women, whether at the baseline or after the awareness sessions, has been conducted by the same researcher to avoid observer bias.


  Results Top


The result will be discussed within the following three sections.

Section 1: description of the sample

This section included the sociodemographic characteristics of mothers, which included age, level of education, occupation, residence, and parity.

Age: a total of 80 pregnant woman were recruited for the study. Their age ranged from 20 to 37 years, with a mean age of 27±4.6 years for the study sample. More than half of them (56.2%) were in their third trimester, and 60% reported parity of more than or equal to 3 ([Table 1]).
Table 1 Sociodemographic characteristics of the study sample

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Educational level: 25% of the study sample were able to read and write, although 70% of the study sample had preparatory education, and highly educated mothers were 5% only. An overall 88.8% were housewives, and 83.75% were residing in rural areas ([Table 1]).

Occupation and residence with regard to occupation, 88.75% of mothers in the study sample were housewives and 83.8% were residing in rural areas ([Table 1]).

Section 2: association between sociodemographic characteristics and pretest knowledge assessment of the sample

Baseline assessment showed that only 19 (23.8%) women had optimal knowledge about the different aspects of HBV distributed as follows: 26 (32.5%), about what is HBV; 22 (27.5%), about transmission methods; 20 (25%) about fetal and newborn complications, 19 (23.8%), about other nonobstetric complications, 24 (30%), about prevention and vaccination ([Table 2], [Figure 1]).
Table 2 Association between sociodemographic and obstetric characteristics and knowledge of the participating pregnant women about hepatitis B virus

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Figure 1 Assessment of women’s knowledge about HBV before and after attending the educational program. HBV, hepatitis B virus.

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A statistically significant difference was found between better knowledge scores and educated women, working women, and those residing in urban areas (P<0.05), while no statistically significant difference was found in relation to parity and weeks of trimesters ([Table 1]).

Section 3: improvement of the participating pregnant women’s knowledge about hepatitis B virus after attending the educational program

After the awareness program, the knowledge of the pregnant women improved significantly to 78 (97.5%) with optimal knowledge (P<0.001), distributed as follows: 75 (93.8%), about what is HBV, 75 (93.8%), about modes of transmission, 77 (96.2%), about fetal and newborn complications, 74 (92.5%), about other nonobstetric complications, and 78 (97.5%) about prevention and vaccination ([Table 2] and [Table 3] and [Figure 1]).
Table 3 Improvement of the participating pregnant women’s knowledge about hepatitis B virus after attending the educational program

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  Discussion Top


The current study showed that the levels of awareness of HBV among pregnant women in Beni Suef were markedly deficit, as only 23.8% of the assessed pregnant women had optimal knowledge. This finding is in consistence with previous studies carried out by Chan et al. (2012), Mkandawire et al. (2013), Adeyemi et al. (2013), and Frambo et al. (2014), who proved in their studies that the knowledge of pregnant women about HBV was unsatisfactory. In addition, these findings agree with studies carried out to assess the knowledge and awareness about hepatitis B infection among pregnant women attending the antenatal clinic at Federal Teaching Hospital, Abakaliki, Nigeria, and it was found that, there was poor knowledge and awareness among pregnant woman about HBV, especially about what HBV is and it is mode of transmission (Gboeze et al., 2015).

The findings of this research showed that educated pregnant women, those living in urban areas, and working women were more likely to be knowledgeable of HBV. This was expected because educated pregnant women residing in urban areas might have been in a better position to access information about HBV. Moreover, the educational level in urban areas in Egypt is known to be higher than in rural areas, which may explain why women residing in urban areas had higher scores of knowledge compared with their counterparts in rural areas. As the educational level is usually translated into job opportunities, working women in our study had significantly better knowledge about HBV.

These findings agree with studies done by Okoth et al. (2009), Chan et al. (2011), and Hwang and Cheung (2011); previous studies found a positive correlations between knowledge of women and their educational level, standard of living, and annual income. In addition, a study was carried out by Noreen et al. (2015), who conducted the study in a rural setting of Punjab province, Pakistan, to assess knowledge about HBV and vaccination among 430 women in childbearing age by using a semistructured questionnaire, and they reported that the knowledge of pregnant women was poor among the low socioeconomic women, and there was a statistically significant difference between age, level of education, obstetric history, and knowledge about HBV. Furthermore, this finding was in accordance with the study carried out by Gboeze et al. (2015), who reported that the level of awareness about HBV among the study group was low, and that the level of education and parity were associated with the awareness of hepatitis.

On the contrary, the previous study carried out by Noreen et al. (2015), which assessed women’s knowledge about HBV, reported that less than half of the women (43%) in the study had correct knowledge about HBV.

The current study showed that the multisessional program that targeted improving the knowledge of the pregnant women has greatly achieved its goals in raising the awareness of women about the nature of HBV, its modes of transmission, complications including the impact on the fetus and newborn, and vaccination and precautionary methods. The finding of this research agreed with those of Yang et al. (2013), who applied an educational program about HBV for pregnant women and proved that applying the educational program about HBV early will improve the pregnant woman’s awareness.

This study showed that the educational program that targeted improving the knowledge of pregnant women has greatly achieved its goals in increasing the awareness of women about HBV. The success of the educational program could be attributed to many factors. The first being that the program was multisessional, and each session focused on only two aspects of knowledge about HBV; this offered a chance for women to have a better understanding of this aspect and the information related to it; in addition, the researcher repeated the session again to women who missed some sessions. Moreover, not starting another session before reviewing the previous knowledge taken before helped the woman to acquire good knowledge about HBV. Further, the program was tailored to suit women with lower levels of education by using simple definitions, direct sentences, and many illustrating figures. The researcher also supported the attendants to participate, express their attitudes, and asks their questions freely, which offered better access to knowledge.


  Conclusion Top


The findings of this research support the research hypotheses that pregnant women who take the health education program about HBV had a significant increase in their awareness about HBV, which particularly addressed the serious consequences of HBV, in particular on infants. A statistically significant difference was found between better knowledge scores and education, work and women living in urban areas.

Recommendations

  1. Further research should focus on the effect of HBV awareness programs on the practice and attitudes of women towards HBV vaccination.
  2. Training educational program should be provided to nurses working at antenatal clinics, to improve their knowledge about HBV, to prevent spread of infection of HBV among pregnant women.
  3. Educational program about HBV should be a part of antenatal care for every pregnant woman.
[14]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Adeyemi AB, Enabor OO, Ugwu IA, Bello FA, Olayemi OO (2013). Knowledge of hepatitis B virus infection, access to screening and vaccination among pregnant women in Ibadan, Nigeria. J Obstet Gynaecol 33:155–159.  Back to cited text no. 1
    
2.
Borgia G, Carleo M, Gaeta G, Gentile L (2012). Hepatitis B in pregnancy. World J Gastroenterol 18:4677–4683.  Back to cited text no. 2
    
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Chan OK, Lao TT, Suen SSH, Leung TY (2012). Deficient knowledge on hepatitis B infection in pregnant women and prevalence of hepatitis B surface antigen carriage in an endemic area: a review. Hepat Res Treat 2012:317451.  Back to cited text no. 4
    
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Chweitzer A, Horn J, Mikolajczyk RT, Krause G, Ott JJ (2015). Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet 386:1546–1555.  Back to cited text no. 5
    
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Frambo AA, Atashili J, Fon PN, Ndumbe PM (2014). Prevalence of HBsAg and knowledge about hepatitis B in pregnancy in the Buea Health District, Cameroon: a cross-sectional study. BMC Res Notes 7:394.  Back to cited text no. 6
    
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Gboeze AJ, Ezeonu PO, Onoh RC, Ukaegbe CI, Nwali MI (2015). Knowledge and awareness of hepatitis B virus infection among pregnant women in Abakaliki Nigeria. J Hepat Res 2:1029.  Back to cited text no. 7
    
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Hwang EW, Cheung R (2011). Global epidemiology of hepatitis B virus (HBV) infection. N Am J Med Sci 4:7–13.  Back to cited text no. 8
    
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Mkandawire P, Richmond C, Dixon J, Luginaah IN, Tobias J (2013). Hepatitis B in Ghana’s upper west region: a hidden epidemic in need of national policy attention. Health Place 23:89–96.  Back to cited text no. 9
    
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Noreen N, Kumar R, Shaikh BT (2015). Knowledge about hepatitis B vaccination among women of childbearing age: a cross-sectional study from a rural district of Punjab, Pakistan. East Mediterr Health J 21:129–133.  Back to cited text no. 10
    
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Okoth F, Mbuthia J, Gatheru Z, Murila F, Kanyingi F, Mugo F et al. (2009). Seroprevalence of hepatitis B markers in pregnant women in Kenya. East Afr Med J 83:485–493.  Back to cited text no. 11
    
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Thompson MJ, Taylor VM, Jackson JC, Yasui Y, Kuniyuki A, Tu SP et al. (2002). Hepatitis B knowledge and practices among Chinese American women in Seattle, Washington. J Cancer Educ 17:222–226.  Back to cited text no. 12
    
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WHO (2015). Global report on the prevention and control of viral hepatitis in WHO member states. Chapter 3, 23. Geneva and Switzerland: WHO.  Back to cited text no. 13
    
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Yang EJ, Cheung CM, So SK, Chang ET, Chao SD (2013). Education and counseling of pregnant patients with chronic hepatitis B: perspectives from obstetricians and perinatal nurses in Santa Clara County, California. Asian Pac J Cancer Prev 2013; 14:1707–1713.  Back to cited text no. 14
    


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    Tables

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