Correlation of literacy and awareness regarding hepatitis C: a survey of family members of hepatitis C patients’

Younus I 1, Sarwar S 2, Qaadir A 3, Butt Z 4, Nazir A 5, Choudry A6

1Irfan Younus, Nawaz Sharif Medical College, University of Gujrat, Pakistan, 2 Shahid Sarwar, Gujranwala Medical College, Gujranwala, Pakistan, 3Adnan Qaadir, Military Hospital Rawalpindi, Pakistan, 4Zamir Butt, Nawaz Sharif Medical College, University of  Gujrat, Pakistan, 5Aisha Nazir, Nawaz Sharif Medical College, University of Gujrat, Pakistan, 6Afzal Choudry, Nawaz Sharif Medical College, University of Gujrat, Pakistan.

Address for Correspondence: Dr. IrfanYounus, MD Gastroenterology, Assistant Professor Nawaz Sharif Medical College, University of Gujrat, Pakistan. Email: irfanyounis7887@gmail.com

Abstract

Objective: To determine the knowledge among family members of Hepatitis C patients and correlate it with their educational status. Study Design: A cross sectional observational study. Place and Duration: Outpatient department of Aziz BhattiShaheed Teaching hospital, Gujrat from 1st January 2015 to 31st march 2015. Methodology: Data was collected to assess the fundamental knowledge and mode of transmission in people coming with HCV infected patients. Collected data was analyzed by SPSS V.20. Results: Two hundred and forty one participants were included in study with mean age of 33 years (+11.940 SD). Male to female ratio was 3.30:1, 65.98% married and 104 were below matric (SSC). Two hundred twenty (90%) attendants knew that HCV can cause chronic inflammation, liver failure and liver cancer. Sixty three (26%) assumed it to be a bacterial infection. 164 (Sixty eight %) thought vaccine is available. More than 90 % of attendants knew that it is transmitted through sharing or reuse of syringes 236 (97.9%), blood transfusion without screening 235 (97.5%) and needle stick injuries 225 (93.4%). Two hundred thirty two (96.3 %) disagreed its transmission through holding hands, hugging and kissing. Ninety (37.3%) and fifty five (22.8%) assumed its spread through drinking polluted and unsafe sex respectively. Seventy (29%) disagreed its spread perinataly and contact with open wound. Male and above matric participants have significantly better knowledge (<0.05). Conclusion: Awareness about HCV among attendants of hepatitis C infected patients was inadequate and has lot of misconceptions especially among females and less educated people.

Key words: Awareness, Knowledge, Hepatitis C, Misconceptions, Education

Manuscript received; 24th July 2016, Reviewed: 8th August 2016
Author Corrected: 20th August 2016, Accepted for Publication; 4th September 2016

Introduction

Hepatitis C virus (HCV) is one of the major causes of severe liver disease, including hepatocellular carcinoma and cirrhosis-related end-stage liver failure. According to World Health Organization (WHO), there are 170 million people with chronic HCV infection worldwide [1]. Almost 366000 deaths occur due to hepatitis C annually [2]. As Pakistan is a populous country (165 million) and due to intermediate to high rates of infection, is among the worst suffering nations [2]. It has been estimated that 5% of the Pakistani population are chronic carriers of Hepatitis C whereas in the high-risk population prevalence of Hepatitis C is as high as 15-25% [3]. Majority of patients cannot afford the expensive treatment of HCV so it is essential that everyone, especially those living with HCV infected patients should be familiar regarding its preventive measures and mode of transmission. Misconceptions and lack of awareness about this infection can lead to missed opportunities for diagnosis, prevention, and appropriate care.  According to report of Institute of Medicine, knowledge and awareness about hepatitis C was lacking among health professionals, social-workers and the general public [4]. Since most people with hepatitis C do not have symptoms, they often do not get tested for hepatitis C; it is estimated that about 75% of people infected with hepatitis C are unaware of their infection [4].

Education plays an important role in increasing public knowledge of a specific disease and reduces discrimination [5,6]. Targeting inaccurate beliefs about viral hepatitis might improve public health interventions and better hepatitis outcomes [7].  Appropriate knowledge of HCV can be effective in prevention of spread of infection [8-10].

Hepatitis C infection is a major health problem in our country and is associated with high morbidity and mortality. Lack of awareness and absence of preventive measures at community level has resulted in spread of this illness.  Many studies [11-14] are conducted in our country about awareness of hepatitis C, but no one tried to assess the knowledge of the family members of the HCV infected patients. They are the potential recipients of this illness due to close contact with patient. There awareness can significantly reduce risk of spread of this disease. This study will note knowledge and misconceptions among community and help in making future planning to fight against this disease.

Methods

It was across sectional observational study which was conducted among the attendants of HCV infected patients coming in Outpatient Department of Aziz Bhatti Shaheed Teaching Hospital, from 1st January 2015 to 31st march 2015. Two hundred forty one persons were selected by convenient sampling. Informed consent was taken from each participant after explaining the purpose of study base line demographic information including name, age, gender, marital status and education were collected from all the participants. A questionnaire was made, having 20 questions which were to be answered in YES or NO. It was given to the participants to assess the fundamental knowledge regarding HCV and its mode of transmission. Help was offered to those who had difficulty in understanding statements. Knowledge was considered as good if correct answers were 18 (90%), or more, average in those who gave 16 to 17 (80 to 89%).Knowledge was considered poor if less than 16 (80%) questions were answered correctly. All the information was kept confidential. All analysis was done by SPSS-20. Continuous and qualitative variables were mentioned as mean ± SD and number (percent), respectively. Continuous variables among groups were compared by the Independent Samples test and One-Way ANOVA, Chi-Square test was used for comparison of qualitative variables. Pearson correlation coefficient was used to assess the correlation between continuous variables. Statistical significance was accepted at P < 0.05.

Results

Two hundred and forty one participants were included in study with mean age of 33 years (+ 11.94 SD) and age ranges from 14 to 78 years. Male to female ratio was 3.30:1(male185and female 56). 65.98 %( n=159) of the participants were married. Educational status of 104(43.15%) participants were matric or below while above matric were 137 (56.85%)

Table-1 shows the information regarding fundamental knowledge of participants. More than 90% attendants knew that HCV can cause chronic inflammation, liver failure and liver cancer. Twenty six % (n=63) thought it to be a bacterial infection and 20.3% (n=49) did not consider it viral infection. One hundred and sixty four (68 %) stated that vaccine is available for hepatitis C.

Table-1: Assessment of fundamental knowledge of hepatitis C

No

Questions

Correct (%)

Incorrect (%)

1

It is a bacterial infection.

178 (73.9)

63(26.1)

2

It is a viral infection.

192(79.7)

49(20.3)

3

It can cause chronic inflammation.

218(90.5)

23(9.5)

4

It can cause liver failure.

222(92.1)

19(7.9)

5

It can cause liver cancer.

218(90.5)

23(9.5)

6

Its vaccine is available.

77(32.0)

164(68.0)

When we assessed the knowledge of participants about mode of transmission (Table .2) we found that more than ninety percentof attendants knew that it is transmitted through sharing or reuse of syringes (97.9%), blood transfusion without screening (97.5%) and needle stick injuries (93.4%). Two hundred thirty two (96.3%) were aware that it could not be transmitted through holding hands and two hundred nineteen (90.9%) participants knew that its transmission is impossible by hugging and kissing. 80 to 90% of the answers regarding transmission through sharing tooth brush and razors (89.6%), breast feeding to babies (84.6%), coughing and sneezing (84.6%), sharing eating and drinking utensils (83.0%),body piercing and tattooing (81.7%) were correct. Ninety participants (37.3%) considered HCV transmissible through drinking polluted water and 22.8% (55) through unsafe sex can spread illness. Seventy one (29.5%)disagreed with possibility of its transmission perinataly while 70(29%)were unaware that HCV can spread through contact with open wound.

Male participants of study have significantly higher knowledge score as compared to females ;(13.1081) vs. ( 9.6607) (p-value <0.05).

When we compared the participants on the basis of education levels, we found that people having above matric education had higher knowledge score (12.963+sd 1.729) as compared to matric or below(9.596+sd 1.675) and p-value was found significant.(0.005)

Table-2: Assessment of knowledge about mode of transmission

No

Questions

Correct (%)

Incorrect (%)

1

Sharing  or reuse of syringes

236(97.9)

5(2.1)

2

Unsafe sex

186(77.2)

55(22.8)

3

Perinatal transmission

170(70.5)

71(29.5)

4

Blood transfusion without screening

235(97.5)

6(2.5)

5

Contact with open wound

171(71.0)

70(29)

6

Hugging and kissing

219(90.9)

22(9.1)

7

Sharing eating and drinking utensils

200(83.0)

41(17.0)

8

Holding hands

232(96.3)

9(3.7)

9

Sharing tooth brush and razor

216(89.6)

25(10.4)

10

Coughing and sneezing

204(84.6)

37(15.4)

11

Needle stick injuries on

225(93.4)

16(6.6)

12

Breast feeding to babies

204(84.6)

37(15.4)

13

Body piercing & tattooing

197(81.7)

44(18.3)

14

Drinking polluted water

151(62.7)

90(37.3)

Table-3: Most common Misperceptions

Sr.No

Statements

Correct (%)

Incorrect (%)

1

Its vaccine is available.

77(32.0)

164(68.0)

2

Drinking polluted water

151(62.7)

90(37.3)

3

Perinatal transmission

170(70.5)

71(29.5)

4

Contact with open wound

171(71.0)

70(29.0)

5

It is a bacterial infection.

178 (73.9)

63(26.1)

6

Unsafe sex

186(77.2)

55(22.8)

7

It is a viral infection.

192(79.7)

49(20.3)

Table-4: Knowledge score comparison in males and females through Independent sample t-test

 

Gender

N

Mean

Std. Deviation

P-value

Knowledge

Score

Female

56

9.6607

1.70855

0.036

Male

185

13.1081

1.72236

 

Table 5: Knowledge score comparison in matric and under matric by independent sample t-test
        

 

Education

N

Mean

Std.Deviation

P-value

Knowledge

Matric and Below

104

9.5962

1.67517

 

0.005

Above Matric

137

12.963

1.72954

Discussion

The aim of the present study was to identify the basic knowledge, misconceptions and awareness regarding possible modes of transmission of hepatitis C among people living with infected patients. We also compared the knowledge score on the basis of education levels in district headquarter hospital Gujrat. We were thinking of good awareness levels among them but results were otherwise. The participant’s fundamental knowledge was very poor, while knowledge about transmission was at suboptimal level.

The major misconception was about vaccine of hepatitis C. 68% of the participants think vaccine is available, same type of results were seen in an Indian study [15] nearly, 38% (38/100) of dental, 31% (31/100) medical and 49.1% (27/55) of nursing students claimed to have vaccination against hepatitis C infection whereas no viable vaccine against HCV exists at present.

A large number of participants think that it is spread through drinking polluted water while studies showed that lack of proper screening of the blood and blood products during transfusion, use of contaminated needles and instruments, intravenous drug use, unsterilized instruments usage by hair dresser, ear and nose piercing, tattooing, poor personal hygiene habits and medical practice by non-qualified people are the major causes of spread of disease [16-18].

Seventy one (29.5%) participants think that its spread from mother to fetus is impossible, while studies showed that approximately 5 out of every 100 infants born to women with chronic hepatitis C become infected from the mother [19,20].

Large numbers of participants consider it a sexually transmitted disease while transmission of hepatitis C through sexual contact appears to be uncommon, with transmission among long-term monogamous partners occurring in less than 1% of couples per year [21,23].

Our study showed that people with higher qualifications have significantly higher awareness about hepatitis C, the results are similar with the study conducted in Japan [24] in which people with higher education levels had better knowledge regarding HBV/HCV and less negative attitude towards HBV/HCV infected colleagues. Community-based studies proved that increasing the level of knowledge of HIV/AIDS and tuberculosis by education leads to a decrease in negative attitudes towards infected patients [25,26]. But a study conducted in Iran [27], no statistically significant difference was found in the mean of knowledge scores about hepatitis B and C with regard to participant’s gender, marital status and education level. The difference may be the setting of study, that study was performed among medical staff of teaching healthcare settings.

Conclusion

This study found that the awareness about HCV among attendants of the patients was inadequate. A significant number of participants have misconceptions about basic information and modes of transmission of disease. Education can improve the knowledge and help in stopping its spread.

Abbreviations Used
HCV         Hepatitis C Virus
WHO        World Health Organization
CI             Confidence Interval
CLD         Chronic Liver Disease

Funding: Nil, Conflict of interest: None initiated
Permission from IRB: Yes

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How to cite this article?

Younus I, Sarwar S, Qaadir A, Butt Z, Nazir A, Choudry A. Correlation of literacy and awareness regarding hepatitis C: a survey of family members of hepatitis C patients’.Int J Med Res Rev 2016;4(9):1576-1581.doi:10.17511/ijmrr.2016.i09.10.