Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Knowledge, Attitudes, and Practices (KAP) of

Healthcare Workers on Viral Hepatitis B and its
Vaccination in 12 Health Establishments in the Centre
Region of Cameroon
Justin Olivier Essindi1,2, Jacky Njiki Bikoï1, Donatien Serge Mbaga1, Etienne Atenguena Okobalemba3, Chris André Mbongue
Mikangue1, Alexandra Emmanuelle Membangbi1, Aicha Ngoutane1,4, Arnaud Franck Elang1, Sabine Aimée Touangnou-Chamda1,
Carole Stéphanie Sake1, George Ikomey Mondinde3,5, Sebastien Kenmoe6, Sara Honorine Riwom Essama1*
1-
Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
2-
Institut La Rosière Supérieure, Yaounde Cameroon
3-
Faculty of Medicine and Biomedical Sciences, The University of Yaounde I, Yaounde, Cameroon
4-
Institute of Medical Research and Medicinal Plant Study, Yaoundé, Cameroon
5-
Centre for the Study and Control of Communicable Diseases, Yaoundé, Cameroon
6-
Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon,
*Corresponding author: Sara Honorine Riwom Essama, Department of Microbiology,
The University of Yaounde I, Yaounde, Cameroon PO Box 812 yaounde

Abstract:- Introduction: Viral hepatitis B (HBV) is a attitudes of the staff, as well as with the 3 questions
major public health issue around the globe. At 2020, the concerning the practice of vaccination, namely the storage
WHO estimated that 296 million people were carriers of temperature of the vaccines, the volume of the dose of
chronic viral hepatitis B. During the same year, the vaccine administered and the site of vaccine
number of deaths from cirrhosis and hepatocellular administration (p<0.05). Conclusion: The level of
carcinoma was 80%. In 2019, a total of 1.5 million new knowledge regarding the HBV pathway observed in this
infections were reported. HBV is most commonly study is satisfactory. Nevertheless, efforts still need to be
transmitted through contact with blood or other body redoubled on the attitude of the staff towards infected
fluids during sexual intercourse with an infected partner, patients, on taking the full doses of vaccine, and finally on
sharing needles, syringes, or preparation materials during the practice of vaccination, particularly on the storage
injection drug use, and puncturing with a hollow needle or temperature, the volume, and the administration site. This
contact with sharp objects. Cameroon is one of the worst lack of adequate knowledge may explain the often-
hit countries with an HBV prevalence of 11.5%. observed lack of post-vaccination response as knowledge is
Healthcare workers (HCWs) who are constantly exposed usually the first step toward modifying desirable behavior.
to a variety of body fluids are at increased risk of
contracting and transmitting the virus. It is thus important Keywords:- Vaccination, Hepatitis B, Knowledge, Attitude,
to evaluate their knowledge, attitudes and practices Practice, HCWs.
regarding HBV. Methodology: This cross-sectional study
took place from February to July 2022. In total, 388 HCWs I. INTRODUCTION
were recruited for the study. knowledge of HBV,
particularly the routes of transmission, attitudes toward Vaccination is one of the most beautiful examples of
HBV, and vaccination practices were evaluated using a human control environment, illustrating the ongoing struggle
well-structured questionnaire. Data analysis was against microorganisms. Preventing diseases is here, the
performed using SPSS V.25.0. Results: In total, 388 HCWs expression of human ingenuity anticipating the aggression of
participated in the study. The recommended pathways for pathogenic agents [1]. Hepatitis B virus (HBV) is an envelope
HBV transmission were sexual intercourse, soiled objects, virus in the Hepadnaviridae family that infects the liver,
blood transfusion and contact with contaminated blood causing hepatocellular necrosis and inflammation [2]. HBV is
(100%). Among the participants, 236 (60.8%) gave the transmitted through percutaneous or mucous membrane
correct answers on the signs of viral hepatitis B. exposure to infected blood and a variety of body fluids [3]. In
Knowledge was significantly associated with the number of 2020, the WHO estimated that 296 million people had
years spent in the vaccination service (p<0.0001). Overall, chronically HBV [4]. Currently available treatments fail to
these HCWs possessed a satisfactory level of knowledge of eradicate the virus in most people treated, requiring potentially
HBV transmission pathways (388, 100%). Of the 388 longlife treatment [5] when we know that about 820,000 people
HCWs, only 65 (16.8%) had a positive attitude towards die each year because of chronic hepatitis B (OMS, 2020).
those infected with HBV. Up to 87 (22.4%) gave incorrect Cameroon is one of the countries in sub-Saharan Africa, with
answers regarding the need to test the effectiveness of the an estimated 11.5% prevalence of HBV infection [6].
vaccine. There was a significant association between the Healthcare Workers (HCWs), who frequently come into
service, the category, the number of years of work, and the contact with blood and other body fluids in the course of their

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
work, are exposed to blood-borne viral diseases such as HBV, B. Measured variables and statistical analyses
hepatitis C virus, and Human Immunodeficiency Virus [7,8]. HCWs who agreed to participate in the study completed a
HBV among HCWs (37%) is attributable to occupational structured questionnaire which was used to collect data on
exposure to lesions due to sharps [5]. The risk of occupational socio-demographic characteristics, knowledge of HBV
infections in developing countries is intensified by a variety of (particularly transmission), attitude towards HBV, and practice
factors, including overcrowding in hospitals, low staff-to- of vaccination against HBV. The information was given by the
patient ratios, insufficient or non-existent basic safety and Chief Medical Officer (if applicable), the General Supervisor,
protective equipment, reutilisation/reprocessing of and the Heads of Unit who were contacted respectively and
contaminated needles and sharp instruments, and partial asked to inform their staff of the study still in their respective
awareness of the risk of exposure to blood and body fluids [8]. establishment. An information notice was placed on the notice
Although seroconversion of hepatitis due to needle stick injury board of the hospital and hospital departments where available,
is quite rare, the costs of treatment and the anxiety associated to inform hospital staff of the study objectives and the timetable
with the possible consequences of exposure are severe [9]. That for its implementation. Finally, individual contacts were used
may be the reason why some HCWs refuse to serve patients to reach some staff. The questionnaire was completed in the
with blood-borne viral diseases, such as HBV [10]. Prevention presence of researcher to avoid participants sharing answers or
through immunization and improving knowledge, therefore, obtaining them online. Semi-structured, pre-designed, and pre-
appears to be the surest strategy against the high prevalence of test questionnaire items, with response options, have been
viral hepatitis among HCWs. Knowing the facts and adequate developed based on KAP (knowledge, attitudes, and practices)
awareness can influence the attitude of HCWs and control the with similar objectives [11, 14]. The questionnaire was
threat of disease [11]. Several studies in Africa have assessed validated according to the guidelines proposed by Jain et al in
the level of knowledge, attitude, and practice of HCWs vis-à- 2016 [14]. Knowledge of the route of HBV transmission was
vis HBV and their vaccination status [12]. The low level of assessed using five questions directly related to the route of
vaccination and the high prevalence of hepatitis B surface HBV infection. Knowledge was considered adequate when
antigen (HBsAg) recorded in different studies could be justified there were correct answers to all five questions. This minimum
by the low level of knowledge about HBV among HCWs [13]. of five correct answers to define a good level of knowledge may
Prevention remains a recommended guarantee against an seem rigorous. However, this minimum level justified the
epidemic of viral hepatitis. The knowledge and attitudes of reasonable difficulty of the questions. The attitude was
HCWs play a key role in preventing and spreading infection. assessed using the following criteria: attitude towards people
By Knowing the facts and having the appropriate awareness infected with HBV and HIV, frequency of glove use, frequency
and attitudes, the threat of this disease can be largely avoided. of needlestick injuries, and vaccination status. The attitude was
With that in mind, the objectives of this study are to assess the considered positive when a participant was able to give all
knowledge, attitudes, and practices of HCWs regarding HBV expected answers correctly, as HCWs are at the forefront of
in 12 health facilities in the Centre Region of Cameroon. health care delivery and should have an appropriate attitude
towards HBV. Vaccination practice was assessed using the
II. MATERIAL AND METHODES criteria vaccine storage temperature, volume of vaccine dose
administered, and site of administration. Information on
A. Type of study, setting, and population studied: vaccination knowledge, attitude, and practice were self-
This cross-sectional study was conducted among HCWs reported, and individual risk of bias cannot be completely ruled
from health structures in the Centre Region and those from the out. The variables collected were qualitative, recorded, and
international vaccination center in Yaounde, Cameroon. The processed in Excel. The analysis were performed using SPSS
samples were collected between February and July 2022 and V.25.0. Results were expressed as proportions and Pearson's χ2
included 12 health establishments in the Centre Region of (p<0.05) was used to assess the significance between study
Cameroon (one Centre hospital, three confessional hospitals, variables.
four district hospitals, one military hospital, one District
medical center, one private medical center and the international III. RESULTS
vaccination center). The participant sampling technique was
simple random. For each participant, the questionnaire was A. Sociodemographic parameters
self-administered and contained both closed and open In each health establishment, more than 50% of the
questions to assess respondents' knowledge, attitudes, and HCWs consented to participate in the study. These were
practices on HBV. HCWs that were present in the selected doctors, nurses, dentists, pharmacists, midwives, and
hospitals during the study period were informed and invited to laboratory technicians. A total of 388 HCWs participated in the
participate in the study. These were doctors, nurses, dentists, study. Among them, 287/388 (74%) were women. The age
pharmacists, midwives, and laboratory technicians. group (37-41 years) was the most represented 203/388 (52.3%).
Most participants were nurses 179/388 (46.1%) followed by
doctors 160/388 (41.2%). The number of years spent in the
service between (6-8 years) was the most represented 139/388
(35.8%) (Table 1).

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Table 1: Sociodemographic parameters of participants

Variable Number Percentage

(N=388)
Sex Feminine 287 74.0
Male 101 26.0
27-31 21 5.4
Grouped age 32-36 48 12.4
37-41 203 52.3
42-46 116 29.9
Study level High 388 100.0
Welcome 21 5.4
Surgery 20 5.2
Gynecology 20 5.2
Service Laboratory 30 7.7
Maternity 65 16.8
Medicine 110 28.4
Pediatrics 38 9.8
Vaccination 84 21.6
Male nurse 179 46.1
Occupation Doctor 160 41.2
Midwife 19 4.9
Laboratory 30 7.7
technician
Status Contractual 275 70.9
individual 113 29.1
[3-5] 104 26.8
Number of years [6-8] 139 35.8
spent in service ≤2 48 12.4
≥9 97 25.0
No 181 46.6
Immunization Yes 207 53.4
activities
HBV vaccination No 181 46.6
activities
Yes 207 53.4

B. Knowledge about HBV transmission

A questionnaire comprising five questions was used to assess the knowledge of the staff of the various hospitals on the routes
of transmission of HBV and those recommended were sexual intercourse, soiled objects, blood transfusion, and contact with
contaminated blood 388/ 388 (100%), this corresponded to a satisfactory level of knowledge on the transmission routes of HBV
(table 2)

Table 2: Knowledge about HBV transmission

Percentage of the correct answer (%)

Nurse Doctor Midwife Laboratory
technician Overall
Questions (n=179) (n=160) (n=19) (n=30) (N=388)
About sex Yes 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388(100.0)
By soiled objects Yes 179(100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388 (100.0)
By blood transfusion Yes 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388 (100.0)
By contact with Yes 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388 (100.0)
contaminated blood
By physical contact No 130 (72.6) 117 (73.1) 19 (100.0) 10 (33.3) 276 (71.1)
Yes 49 (27.4) 43 (26.9) // 20 (66.7) 112 (28.9)
Modes of transmission Right 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388(100.0)
answer

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
C. Knowledge of the signs, complications, methods of prevention, and fear of HBV
Among participants, 236/388 (60.8%) gave good answers on the signs of viral hepatitis B. All of the participants mastered the
knowledge of the complications of hepatitis B 388/388 (100%). The staff that were afraid of the disease was 277/388 (71.4%) while
the prevention methods were known to all 388/388 (100%). The doctors were the best informed about the signs of HBV 120/388
(75%) and all the midwives 19/19 (100%) were afraid of illness followed by nurses 132/179 (73.7%) (Table 3).

Table 3: knowledge of the signs, complications, methods of prevention, and fear of HBV
Answer (%)

nurse Doctor Midwife Laboratory

technician
(n=179) (n=160) (n=19) Total
(n=30) (N=388)

Signs of Right 116 (64.8) 120 (75.0) // // 236 (60.8)

Hepatitis B answer

Wrong 42 (23.5) // // // 42 (10.8)

answer

Insufficient 21 (11.7) 40 (25.0) 19 (100.0) 30 (100.0) 110 (28.4)

response

Knowledge of Right 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388 (100.0)
hepatitis B answer
complications

The different Right 179 (100.0) 160 (100.0) 19 (100.0) 30 (100.0) 388 (100.0)
methods of answer
prevention

No 47 (26.3) 54 (33.8) // 10 (33.3) 111 (28.6)

Fear of disease Yes 132 (73.7) 106 (66.3) 19 (100.0) 20 (66.7) 277 (71.4)

D. General knowledge of vaccination, staff attitudes, and frequency of correct answers on the practice of vaccination against HBV
Among the 388 HCWs, only 65 (16.8%) had good attitude towards people infected with HBV (Table 4). There was a significant
association between the service, the category, the number of years of work, and the attitudes of the staff, as well as with the 3 questions
concerning the practice of vaccination, namely the storage temperature of the vaccines, the volume of the dose of vaccine administered
and the site of vaccine administration (p<0.05) (Table 5). Nurses had the highest frequency of correct answers 157/179 (87.7%) while
55/160 (34.4%) of doctors had the highest frequency of wrong answers (Table 6).

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Table 4: General knowledge about vaccination

Answer (%)
Nurse Doctor Midwife Laboratory
(n=179) (n=160) (n=19) technician Overall
(n=30) (N=388)
No 56(31.3) // // 10(33.3) 66(17.0)
Be Yes 123(68.7) 160 (100.0) 19(100.0) 20(66.7) 322(83.0)
vaccinated
Complete No 56(31.3) 41 (25.6) // 10(33.3) 107 (27.6)
vaccination Yes 123(68.7) 119 (74.4) 19(100.0) 20(66.7) 281 (72.4)
Complete Yes // 41 (25.6) // // 41 (10.6)
your vaccine No answers 179(100.0) 119 (74.4) 19(100.0) 30(100.0) 347 (89.4)
Preferred Right 179(100.0) 160 (100.0) 19(100.0) 30(100.0) 388 (100.0)
vaccination answer
schedule
Right 153(85.5) 139 (86.9) 19(100.0) 30(100.0) 341 (87.9)
Vaccine answer
storage Insufficient 26(14.5) 21 (13.1) // // 47 (12.1)
response
temperature
Administratio Right 158(88.3) 126 (78.8) 19(100.0) 30(100.0) 333 (85.8)
n site answer
Wrong 21(11.7) 34 (21.3) // // 55 (14.2)
answer
Vaccine dose Right 123(68.7) 139 (86.9) 19(100.0) 20(66.7) 301 (77.6)
volume answer
Wrong 56(31.3) 21 (13.1) // 10(33.3) 87 (22.4)
answer

Right answer // // // 10(33.3) 10 (2.6)

Knowledge of Insufficient 179(100.0) 160(100.0) 19(100.0) 20(66.7) 378 (97.4)
names of response
HVB vaccines
Right answer 156(87.2) 133 (83.1) 19(100.0) 20(66.7) 328 (84.5)
Most used Insufficient 23(12.8) 27 (16.9) // 10(33.3) 60 (15.5)
vaccine response
The rationale Right answer 23(12.8) 27 (16.9) // 10 (33.3) 60 (15.5)
for most used
vaccine Insufficient 156(87.2) 133 (83.1) 19(100.0) 20(66.7) 328 (84.5)
response
Requires Right answer 133(74.3) 119 (74.4) 19(100.0) 30(100.0) 301 (77.6)
verification of
vaccine Wrong 46(25.7) 41 (25.6) // // 87 (22.4)
answer
efficacy
Vaccination Right answer 179(100.0) 133 (83.1) 19(100.0) 30(100.0) 361 (93.0)
of HIV+ Wrong // 27 (16.9) // // 27 (7.0)
answer
What to do in Right answer 179(100.0) 160 (100.0) 19(100.0) 30(100.0) 388 (100.0)
case of side
effects
Attitudes Right answer 45(25.1) 20 (12.5) // // 65 (16.8)
towards
Wrong 134(74.9) 140 (87.5) 19(100.0) 30(100.0) 323 (83.2)
infected answer
patients
Wearing Right answer 179(100.0) 160 (100.0) 19(100.0) 30(100.0) 388 (100.0)
gloves
Needle prick No 159(88.8) 160 (100.0) 19(100.0) 30(100.0) 368 (94.8)
Yes 20(11.2) // // // 20(5.2)

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Table 5: General distribution of responses on the practice of vaccination

Vaccine storage p p Vaccine dose p

Administration
temperature volume
site n(%)
n(%)
n(%)
Service Welcome 21 (5.4) 21 (5.4) 21 (5.4)
Surgery 20 (5.2) 20 (5.2) 20 (5.2)
Gynecology 20 (5.2) 20 (5.2) 20 (5.2)
Laboratory 30 (7.7) < 0.0001 30 (7.7) < 0.0001 30 (7.7) < 0.0001
Maternity 65 (16.8) 65 (16.8) 65 (16.8)
Medicine 110 (28.4) 110 (28.4) 110 (28.4)
Pediatrics 38 (9.8) 38 (9.8) 38 (9.8)
Vaccination 84 (21.6) 84 (21.6) 84 (21.6)
State nurse 179 (46.1) 179 (46.1) 0.048 179 (46.1)
Doctor 160 (41.2) 0.048 160 (41.2) 160 (41.2) 0.048
Category of HCWs
Midwife 19 (4.9) 19 (4.9) 19 (4.9)
Laboratory 30 (7.7) 30 (7.7) 30 (7.7)
technician
Number of years spent in [3-5] 104 (26.8) < 0.0001 104 (26.8) < 0.0001 104 (26.8) < 0.0001
the vaccination service [6-8] 139 (35.8) 139 (35.8) 139 (35.8)
≤2 48 (12.4) 48 (12.4) 48 (12.4)
≥9 97 (25.0) 97 (25.0) 97 (25.0)
HBV vaccination activity Nope 181 (46.6) 0.008 181 (46.6) 0.008 181 (46.6) 0.008
Yes 207 (53.4) 207 (53.4) 207 (53.4)
Healthcare Workers: HCWs

Table 6: Frequency of correct answers on the practice of vaccination concerning the storage
temperature, the volume of the dose administered, and the site of administration.

Correct Wrong
Variables P-value
answer n(%) answer n(%)
Welcome 10 (47.6) 11 (52.4)
Surgery 20 (100.0) 0(0,0)
Gynecology 20 (100.0) 0(0,0)
Service Laboratory 20 (66.7) 10 (33.3) < 0.0001
Maternity 46 (40.0) 69 (60.0)
Medicine 75 (68.2) 35 (31.8)
Pediatrics 17 (44.7) 21 (55.3)
Vaccination 93 (83.8) 18 (16.2)
State nurse 157 (87.7) 22 (12.3)
Doctor 105 (65.6) 55 (34.4)
Category of HCWs Midwife 19 (100.0) 0 (0.0) 0.008
Laboratory 20 (66.7) 10 (33.3)
technician
Number of years spent [3-5] 87 (66.4) 44 (33.6)
in the vaccination [6-8] 129 (77.7) 37 (22.3) < 0.0001
service ≤2 27 (56.3) 21 (43.8)
≥9 58 (48.3) 62 (51.7)
Immunization activity No 125 (69.1) 56 (30.9) 0.119
Yes 176 (62.0) 108 (38.0)
HBV vaccination No 125 (69.1) 56 (30.9)
activity Yes 176 (62.0) 108 (38.0) 0.119
Healthcare Workers: HCWs

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Volume 7, Issue 8, August – 2022 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. DISCUSSION CONFLICTS OF INTEREST
The authors declare no conflict of interest
The level of knowledge on HBV transmission routes was
satisfactory (100%). Among the 388 HCWs, only 65 (16.8%) AUTHORS CONTRIBUTIONS
had good attitude towards people infected with HBV. There All authors contributed to this work. They read and
was a significant association between the service, the category, approved the final version of the manuscript
and the number of years of work of the staff, as well as with the
3 questions concerning the practice of vaccination, namely the ACKNOWLEDGMENT
storage temperature of the vaccines, the volume of the dose of
vaccine administered and site of vaccine administration The authors thank all the Healthcare Workers for their
(p<0.05). participation in the study. Our thanks also go to the
administrative and health authorities of the various structures
HCWs are at the forefront of HCWs delivery and are to have allowed access to their site and the smooth running of
expected to know the transmission routes of different infectious the study
agents to protect themselves and their patients from nosocomial
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