Edited by: Harshad Thakur, Tata Institute of Social Sciences, India
Reviewed by: Syed Faisal Zaidi, King Saud bin Abdulaziz University for Health Sciences, Saudi Arabia; Alshymaa Ahmed, Zagazig University, Egypt
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Hepatitis B is a potentially fatal liver infection caused by the hepatitis B virus (HBV). It is a serious issue for global health. It considerably raises the risk of cirrhosis and liver cancer-related death and can result in chronic infection. The risk of infection is high among health sciences students due to the risk of occupational contact with fluids of infected patients and the risk of needle stick injury. The most effective way of preventing HBV infection is the vaccination of students prior to their posting to healthcare settings. There is no data available about HBV vaccination uptake among Health Sciences students in Somalia. Therefore, this study aimed to determine HBV vaccination uptake and associated factors toward HBV among health science students in Somalia.
A cross-sectional study was undertaken among health sciences students from August to October 2022. Data were gathered using Kobo Toolbox using a standardized questionnaire with questions on characteristics, knowledge attitude, and HBV prevention practices. A total of 569 students were involved in the study. Stata version 15 was utilized for the analysis. Bivariate and multivariate logistic regression analysis, as well as descriptive statistics, were performed. In order to assess the existence and significance of the relationship between the outcome and risk factors, an adjusted odds ratio with a 95% confidence interval (CI) was used. Statistical significance was considered as a
Of the 569 study participants, 33.4% (95%CI: 29.6–37.4) received a full dose of the HBV vaccine in this study. Participants had good HBV prevention knowledge, attitudes, and practices at 69.6, 37.96, and 50.6%, respectively. The lack of access and the high cost of the vaccine were the reasons for not taking the vaccine. Second-year [AOR: 0.22 (0.12–0.43)]. Positive attitude [AOR: 0.54 (0.31–0.93)], and good practice [AOR: 6.99 (3.62–13.5)].
The study indicated that 33.4% of health sciences students had received the required HBV vaccination doses, academic year, attitude, and practice were significantly associated with full-dose vaccination status. The unavailability of the vaccine and the high cost of vaccination were the most common reasons for not taking the vaccine. It is recommended that students receive vaccinations before beginning clinical rotations, and give instruction on infection prevention strategies and general precautions, particularly regarding HBV infection.
Worldwide, hepatitis B virus (HBV) infection is a serious public health issue. Acute infections and chronic conditions, including hepatitis, cirrhosis, and hepatocellular carcinoma, account for a significant portion of the global burden of disease and mortality (
Only 16.4% of HCWs were found to have received all recommended doses of HBV vaccination in a study conducted in Bosaso, Puntland, and Somalia (
Vaccination is generally agreed upon as the most effective and practical method of preventing hepatitis B virus infection (
This study employed a cross-sectional online survey to ascertain the uptake of hepatitis B vaccination and associated factors among health sciences students in Mogadishu, Somalia. The research was undertaken for 3 months, from July to September 2022, and involved 569 students.
An online sample size calculator was used to determine an appropriate sample size for a study with a 3% margin of error and a 95% confidence interval. The target population was made up of 1,215 students. 50% since the Proportion of HBV vaccination status among health sciences students was unknown. As a result, the final sample size for the study for this study was 569. The population was sampled using purposive nonprobability sampling technique.
Participants’ information was collected using a structured questionnaire. The application was distributed
After making sure the questions were complete, consistent, and clear, version 15 of STATA was used to look at the data. The primary outcome variable of interest was the vaccination status and reasons for non-vaccination of respondents. For qualitative variables, descriptive statistics like percentage (%) and frequency were used, while the mean and standard deviation were used for quantitative variables. Using multiple logistic regression, the relationship between whether or not a full-dose vaccine had been given and other factors were looked into. Odds ratios were implemented as measures of the association’s strength. A value of
In this study, a total of 569 participants were included. The majority of participants were female (70.47%) and older than 20 years old (68.7%), with a mean age of 21.4
Sociodemographic characteristics of health sciences students.
| Variable | Category | Freq. | Percent |
|---|---|---|---|
| Gender | Male | 168 | 29.53% |
| Female | 401 | 70.47% | |
| Age category | Less than 20 years | 218 | 38.3% |
| Greater than 20 years | 351 | 68.7% | |
| Mean ± SD 21.4 ± 2.45 | |||
| Department | Medical Laboratory Sciences | 169 | 29.70% |
| Nursing | 162 | 28.5% | |
| PH | 143 | 25.13% | |
| Midwifery | 95 | 16.70% | |
| Academic year | First | 37 | 6.50% |
| Second | 119 | 20.91% | |
| Third | 139 | 24.43% | |
| Fourth | 274 | 48.15% | |
| Total | 569 | 100.00 | |
MLS, Medical Laboratory Sciences; PH, Public Health.
The results showed that 72.1% of students had good knowledge of HBV prevention measures, while 27.9% had poor knowledge. Regarding specific knowledge items, 89.1% of students knew that HBV can cause liver cancer, while 84.9% knew that carriers can transmit the infection to others. Only 34.8% of students knew that HBV cannot be transmitted through casual contact such as holding hands, while 77.7% knew that HBV can be spread through contact with open wounds or cuts. Also, 91.9% of students knew that HBV can spread through blood and blood products that are contaminated as described in
Knowledge of health sciences students toward hepatitis B prevention.
| Item | Yes | No |
|---|---|---|
| Can the hepatitis B virus cause liver cancer? | 507 (89.1%) | 62 (10.9%) |
| Can HBV carriers transmit the infection to others? | 483 (84.9%) | 86 (15.1%) |
| Can hepatitis B be caught through casual contacts, such as holding hands? | 198 (34.8%) | 371 (65.2%) |
| Can hepatitis B be spread through contact with open wounds/cuts? | 443 (77.7%) | 126 (22.1%) |
| Can hepatitis B be transmitted by contaminated blood and blood products? | 523 (91.9%) | 46 (8.1%) |
| Can hepatitis B be transmitted by un-sterilized syringes, needles, and surgical equipment | 517 (90.9%) | 52 (9.1%) |
| Can hepatitis B be cured or treated | 260 (45.7%) | 309 (54.3%) |
| Can the HBV vaccine prevent hepatitis B? | 519 (91.2%) | 50 (8.8%) |
| Do you think HBV has laboratory tests? | 507 (89.1%) | 62 (10.9%) |
| Do you think that HBV has post-exposure prophylaxis? | 401 (70.5%) | 168 (29.5%) |
The results in
Attitude of health sciences students toward hepatitis B prevention.
| Item | Agree | Disagree |
|---|---|---|
| I am not at risk of getting hepatitis B | 270 (47.5%) | 299 (52.6%) |
| I do not believe in the hepatitis B vaccine | 143 (25.1%) | 426 (74.9%) |
| Changing gloves during blood collection and testing is a waste of time | 305 (53.6%) | 264 (46.4%) |
| All patients should be tested for HBV before they receive healthcare | 486 (85.4%) | 83 (14.6%) |
| I do not like treating people with HBV | 229 (40.3%) | 340 (59.6%) |
| Following infection control guidelines will protect me from being infected with HBV at work. | 470 (82.6%) | 99 (17.4%) |
The results showed that 76.6% of students had good practice in HBV infection prevention, while 23.4% had negative practice. With respect to particular items, 66.6% of students had undergone screening for HBV, while 33.4% had not. Additionally, 63.1% of students had received the HBV vaccine, while 36.9% had not. Furthermore, 89.6% of students reported always changing gloves for each patient during blood taking, while 10.4% reported not always changing gloves. Similarly, 83.7% of students reported always asking for a new syringe before use, while 16.3% reported not always doing so. In terms of needlestick injuries, 23.4% of students reported having had a needlestick injury. Of those who reported having had a needlestick injury, 92.5% reported the injury to their supervisor or occupational health department as shown in
Practice of health sciences students toward hepatitis B prevention.
| Item | Yes | No |
|---|---|---|
| Have you done the screening for hepatitis B? | 379 (66.6%) | 190 (33.4%) |
| Have you got yourself vaccinated against hepatitis B? | 359 (63.1%) | 210 (36.9%) |
| If your answer is yes to question #2, how many doses of hepatitis B vaccine did | One dose | 84 (14.8%) |
| Two doses | 85 (14.9%) | |
| Three doses | 190 (33.4%) | |
| I always change gloves for each patient during blood taking. | 510 (89.6%) | 59 (10.4%) |
| Do you ask for a new syringe before use? | 476 (83.7%) | 93 (16.3%) |
| Have you ever had a needle prick injury? | 322 (56.6%) | 247 (43.4%) |
| I always report for needle stick injury | 423 (74.3%) | 146 (25.7%) |
The result of the study revealed that 359 (63.1%) of the sample population had already received vaccination against hepatitis B. Among those who had been vaccinated, 84 (14.8%) received one dose of the vaccine, 85 (14.9%) received two doses, and the majority 190 (33.4%; 95CI 29.5–37.4) received the recommended three doses of the vaccine. However, 36.9% (210 individuals) of the participants reported that they had not been vaccinated against hepatitis B. The most common reason cited for not taking the vaccine was the unavailability of the vaccine (46.2%), high cost of vaccination (26.2%), lack of knowledge about the vaccine (21.4%) and fear of side effects of the vaccine (6.2%).
As shown in
Factors associated with full dose vaccination among health sciences students.
| Variable | Category | Full-dose of vaccination | AOR (95% CI) | |
|---|---|---|---|---|
| Yes | No | |||
| Age | ≤ 20 | 61 | 157 | 0.91 (0.57–1.46) |
| >20 | 129 | 222 | 1 | |
| Sex | Male | 44 | 124 | 1 |
| Female | 146 | 255 | 1.49 (0.91–2.83) | |
| Department | MLS | 52 | 117 | 1 |
| Nursing | 66 | 96 | 1.3 (0.77–2.19) | |
| PH | 38 | 105 | 0.93.(0.54–1.61) | |
| Midwifery | 34 | 61 | 0.86 (0.47–1.59) | |
| Academic year | First-year | 8 | 29 | 0.42 (0.17–1.06) |
| Second year | 16 | 103 | 0.22 (0.12–0.43) | |
| Third year | 47 | 92 | 0.72 (0.44–1.76) | |
| Fourth-year | 119 | 155 | 1 | |
| Attitude level | Positive attitude | 157 | 336 | 0.54 (0.31–0.93) |
| Negative attitude | 33 | 43 | 1 | |
| Practice | Good | 179 | 257 | 7.17 (3.71–13.82) |
| Poor | 11 | 122 | 1 | |
MLS, Medical Laboratory Sciences; PH, Public Health; AOR, Adjusted Odd Ratio.
In terms of the academic year, second-year students were much less likely to be vaccinated than fourth-year students, with an AOR of 0.22 (95% CI: 0.12–0.43). This means that second-year students were 78% less likely to be vaccinated compared to fourth-year students.
Regarding attitude level, students with a positive attitude toward vaccination were about 46% less likely to be fully vaccinated compared to those with a negative attitude, with an AOR of 0.54 (95% CI: 0.31–0.93). In terms of vaccination practice level, the results showed that students with good vaccination practices were almost 7 times more likely to be fully vaccinated compared to those with poor practices, with an AOR of 6.99 (95% CI: 3.62–13.5).
This study was conducted to assess the uptake of hepatitis B vaccination among health Sciences students in Mogadishu, Somalia. In developing countries, hepatitis B virus infection is a significant public health concern that results in high levels of illness and death (
The findings of the study report that only 33%(95% CI: 29.5–37.4) of vaccination status. The hepatitis B vaccination status in the current study is higher compared to the study conducted in Ethiopia (4.7%) (
The study found 33.4% of health sciences students received a full dose of HBV vaccine, a higher rate than a previous study in Bosaso (
The finding of the study reports that only 33% of study participants received a full dose of vaccination against hepatitis B. The most common reason reported for not taking the vaccine was the unavailability of the vaccine (46.2%), high cost of vaccination (26.2%). This finding was in agreement with studies conducted (
In term of academic year, there is a statistically significant difference in the likelihood of second-year students being fully vaccinated compared to fourth-year students. Second-year students are less likely to be fully vaccinated, which is consistent with the findings of a study conducted in Ethiopia (
Regarding attitude level, students with a positive attitude toward vaccination were about 46% less likely to be fully vaccinated compared to those with a negative attitude, with an AOR of 0.54 (95% CI: 0.31–0.93). This finding is line with study in Kenya (
This study has a few significant limitations. Firstly, the study’s cross-sectional design does not support a relationship between cause and effect. Lastly, this study may also be limited by the self-reported nature of the data, which may have introduced bias or inaccuracies into the results.
The study shows that only 33% of participants received a full vaccination against hepatitis B. Academic year, attitude, and practice were significantly associated with full vaccination. The unavailability of the vaccine and the high cost of vaccination were the most common reasons for not taking the vaccine. The study reveals that students who are in clinical training are very likely to get HBV because they do not get vaccinated. So, the study suggests that all healthcare students get vaccinated before they start their clinical placements, receive training on infection prevention techniques and universal precautions specifically for HBV, and raise awareness on attitudes that improve the uptake of the hepatitis B vaccination. Also, the study suggests that efforts should be made to ensure that the vaccine is more widely available and accessible to individuals who need it and that cost-reduction strategies should be implemented to ensure that students are not deterred from obtaining the vaccine due to financial constraints.
The datasets presented in this study can be found in online repositories. The names of the repository/repositories and accession number(s) can be found in the article/supplementary material.
Ethical approval for this study was obtained from the Ethics and Research Committee of Jamhuriya University of Science and Technology, Mogadishu, Somalia. The approval reference number is (JUREC0048/FMHS0027/052022). Before participating in the survey, all the participants provided their informed consent for inclusion. The current study’s methods were carried out in compliance with appropriate guidelines and regulations.
YH played an integral role in conceptualizing the research, developing the methodology, conducting formal analyses, investigating the results, and writing the original draft. SH contributed to the research by developing the methodology, conducting formal analyses, investigating the results, and reviewing and editing the manuscript. NA played an important role in conceptualizing the research, developing the methodology, reviewing and editing the manuscript, supervising the project, and acquiring the necessary funding to complete the study. All authors have reviewed and approved the final version of the manuscript.
The authors would like to thank the study participants who volunteered to provide all essential information for the study. They thank Jamhuriya University of Science and Technology.
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
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