Luận văn knowledge and attitudes towards hepathitis b virus prevention among armed forces personnel (army headquarter 605) in vientiane capital, lao pdr in 2019

MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH SOULIKONE PHAVONGXAY KNOWLEDGE OF AND ATTITUDES TOWARDS HEPATITIS B VIRUS PREVENTION AMONG ARMED FORCES PERSONNEL (ARMY HEADQUARTERS 605) IN VIENTIANE CAPITAL, LAO PDR IN 2019 MASTER OF PUBLIC HEALTH CODE: 8720701 HANOI, 2020 MINISTRY OF HEALTH UNIVERSITY OF HEALTH SCIENCES, FACULTY OF PUBLIC HEALTH AND MINISTRY OF EDUCATION AND TRAINING - MINISTRY OF HEALTH HANOI UNIVERSITY OF PUBLIC HEALTH SOULIKONE PHAVONGXAY KNOWLEDGE OF AND ATTITUDES TOWARDS HEPATITIS B VIRUS PREVENTION AMONG ARMED FORCES PERSONNEL (ARMY HEADQUARTERS 605) IN VIENTIANE CAPITAL, LAO PDR IN 2019 MASTERS OF PUBLIC HEALTH CODE: 8720701 SUPERVISORS: KONGMANY CHALEUNVONG, PhD VICE DIRECTOR INSTITUTE OF RESEARCH AND EDUCATION DEVELOPMENT, UNIVERSITY OF HEALTH SCIENCES DR LE THI KIM ANH MD, PhD DEPARTMENT OF BIOSTATISTICS FACULTY OF FOUNDATIONAL SCEINCES, HANOI UNIVERSITY OF PUBLIC HEALTH HANOI, 2020 i ACKNOWLEDGEMENTS This independent study would not have been possible without the help and support of many people I am very thankful to the Ministry of Health of the Lao PDR and the LEARN project for funding my studies at the University of Health Sciences in Laos and the Hanoi University of Public Health in Vietnam The assistance of the Department of Personal Health, Ministry of Health is also gratefully acknowledged for allowing me to study at the University of Health Sciences in Laos and the Hanoi University of Public Health in Vietnam I would like to thank my thesis advisor Dr Kongmany Chaleunvong, the Vice Director of the Institute of Research and Education Development, University of Health Sciences (UHS), Lao PDR and Dr Le Thi Kim Anh, MD, PhD, from the Department of Biostatistics, Health Data Science, Faculty of Foundational Sciences, Hanoi University of Public Health (HUPH), Vietnam, who steered me in the right direction whenever needed I would like to acknowledge the valuable comments and encouragement from the examination chair of my Independent Study Committee and I also wish to thank the external members of the Independent Study Committee I am most grateful to the leadership and personnel of the 605th Army Headquarters, who kindly agreed to help and participate in this research This study could not have been completed without their generous assistance I am grateful as well to all the lecturers, teachers and staff of the UHS and HUPH for their continuous assistance and helpful advice I would like to thank my classmates for their kindness during my studies at UHS and HUPH Finally, I would like to thank my family for their love, understanding, support, and encouragement during the time I was studying in Laos and Vietnam Soulikone Phavongxay ii TABLE OF CONTENTS ACKNOWLEDGEMENTS i TABLE OF CONTENTS ii ABBREVIATIONS iv LIST OF FIGURES vi SUMMARY viii INTRODUCTION CHAPTER LITERATURE REVIEW .4 1.1 Hepatitis B Virus (HBV) 1.2 Definitions of knowledge of and attitudes towards HBV prevention 1.4 Factors associated with knowledge of- and attitudes towards HBV prevention11 1.5 Conceptual framework 12 CHAPTER .14 RESEARCH METHODOLOGY .14 2.1 Study population 14 2.2 Study site and duration 14 2.3 Study design 15 2.4 Sample size 15 2.5 Sampling method 16 2.6 Data collection method 16 2.8 Ethical considerations 20 CHAPTER .22 RESULTS 22 iii 3.1 Demographic information of participants 22 3.2 Knowledge of and attitudes towards HBV prevention 25 3.3 Factors related to knowledge of HBV prevention 34 3.4 Multiple logistic regression analysis of dependent and independent variables44 CHAPTER .51 DISCUSSION, CONCLUSION AND RECOMMENDATIONS 51 4.1 DISCUSSION 51 4.2 CONCLUSION 55 N REFERENCES .58 ANNEXES 62 Annex 1: Questionnaire 62 Annex 2: Certificate of approval 72 Annex 3: Consent form 74 Annex 4: Thesis comments 76 Annex 5: Minutes of explanation after thesis defence 83 iv ABBREVIATIONS DNA Deoxyribonucleic Acid HBV Hepatitis B Virus KAP Knowledge, Attitudes and Practices Lao PDR Lao People‟s Democratic Republic UN United Nations WHO World Health Organization LSB Lao Statistics Bureau v LIST OF TABLES Table 3.1 Demographic information 22 Table 3.2 Distribution of sources of information on HBV prevention 24 Table 3.3 Distribution of information on social factors relating to HBV prevention 25 Table 3.4 Knowledge of the nature of HBV 26 Table 3.5 Level of knowledge of nature of HBV 27 Table 3.6 Knowledge of HBV transmission 28 Table 3.7 Level of knowledge of HBV transmission 29 Table 3.8 Knowledge of HBV prevention 30 Table 3.9 Level of knowledge of HBV prevention 31 Table 3.10 Knowledge of nature, transmission and prevention of HBV 32 Table 3.11 Attitudes towards HBV prevention 32 Table 3.12 Level of attitudes towards HBV prevention 34 Table 3.13a Association of knowledge level of HBV prevention with individual factors 35 Table 3.14 Association of knowledge of HBV prevention with social factors 41 Table 3.15 Association of knowledge of HBV prevention with sources of information on HBV prevention 42 Table 3.16 Association of knowledge of HBV prevention with individual factors…………………………………………………………………………… 43 Table 3.17a Association of attitudes towards HBV prevention with individual factors and family factors 45 Table 3.18 Association of attitudes towards HBV prevention and social factors 48 Table 3.19 Association of attitudes towards HBV prevention with sources of information on HBV 49 vi LIST OF FIGURES Figure 1.1: Conceptual Framework: Knowledge of and attitudes towards HBV prevention among armed forces personnel (Army Headquarters 605) in Vientiane Capital, 2019 .13 viii SUMMARY Hepatitis B virus (HBV) infection is a global public health problem especially in low to low-middle income countries, which account for 90% of the total number of global HBV-infected patients Military personnel in the Lao PDR may often risk being infected because of their living in close quarters with others in camp, sharing personal items and equipment and frequent participation in blood donation drives Also, they are often less educated; thus, their knowledge of HBV infection is inadequate Although several studies have reported the prevalence of HBV infections among different risk groups, there has been no published data among military camps in the country, hence this research on the knowledge of and attitudes towards HBV prevention among armed forces personnel in Vientiane Capital, Lao PDR in 2019 This analytic, cross-sectional study explores knowledge and attitudes in relation to HBV prevention and identifies associated factors of armed forces personnel Some 422 members of Army Headquarters 605 in Xaithany District were selected through systematic random sampling and interviewed with a questionnaire The results indicate that the majority of the respondents show a very limited knowledge of the nature of HBV and its transmission, with only a marginally higher proportion understanding HBV prevention Most of the respondents, however, had positive attitudes towards HBV prevention Overall, the knowledge of HBV nature, transmission and prevention of this military group remains limited, possibly due to regimentation preventing easy access to information The findings have added insights into how HBV infection is perceived and how it is prevented by these army personnel Agencies concerned should be prompted to increase this awareness among not just the armed forces but also the general populace as well as their knowledge and understanding of the occurrence and prevention not just of hepatitis B infection but of other diseases as well INTRODUCTION Hepatitis B virus (HBV) infection is considered to be a global public health problem, especially in low to low-middle income countries because these countries account for 90% of the total number of global HBV-infected patients The virus is transmitted through contact with blood or other bodily fluids such as vaginal fluids, semen and mucous membranes of an infected person For example, HBV can be transmitted from mother to child at birth (perinatal transmission), by sexual contact with an infected person, by using infected needles and by infected blood transfusions, especially mother-to-infant transmission (Public Health Authority of Sweden, 2015) Unlike other sexually transmitted diseases, HBV can be prevented by vaccines (WHO, 2012) Humans are the only known host of HBV, which is an important cause of liver cancer or liver cirrhosis More than a third of the world‟s population has been infected with HBV at some stage during their lives Half of the estimated 350 million chronic HBV carriers worldwide live in the Asia-Pacific region Nearly 40% of these individuals will die of liver-related complications or regression hepatocellular carcinoma (Lavanchy, 2004) In Lao PDR, HBV infection is a public health problem Approximately 50% of adults are infected by the virus and the chronic infection rate is approximately 10% (Jutavijittum et al, 2007; Black et al, 2014; Jutavijittum et al, 2014) In addition, around 8% of blood donors are chronic carriers of HBV, which is a rather substantial percentage of those who have donated blood The government is trying its best to encourage Lao citizens to acknowledge the disease and to address its danger, but the prevalence and incidence of HBV infection remains high This could be caused by insufficient knowledge of HBV infection and the lack of a proactive attitude on HBV prevention in communities Since 2001, there has been a phased introduction of HBV vaccination into the national immunization schedule Currently, infants are scheduled to receive the HBV birth dose within 24 hours of birth, followed by multiple HBV vaccinations at the ages of 6, 10 and 14 weeks in