Knowledge, Stigma and Prevalence of HBV among two populations from Nepal: a cross-sectional study

Abstract

Keywords Hepatitis B virus; health literacy; behavioural risk factors; public health Background Hepatitis B virus (HBV) remains a public health issue in many developing nations, including Nepal. In Nepal the vaccination program was implemented in 2002-3 and aimed to reduce national prevalence of HBV. This study investigated socio-demographic, behavioural, and health service factors associated with HBV infection in low (Pokhara) and high (Dolpa) prevalence populations. Methods A serosurvey of 400 participants from within each population was conducted (final N = 799). The study combined a blood-draw to ascertain HBV status and a questionnaire that included demographic questions and items on knowledge of HBV, behavioural, and social factors associated with the risk of HBV infection. The blood draws were used to confirm HBV status as well as identify any previous infections from which participants may have recovered. Results There were 8/399 (2.01%, 95% CI 0.87%, 3.91%) current HBV infections among participants from Dolpa, compared with 2/400 (0.5%, 95% CI0.06%, 1.79%) among participants from Pokhara. The average age of each of the cohorts was relatively high, indicating an unclear association between vaccination programs and the low prevalence observed in this study. There was evidence from both sites there had been previous infections within the community as many of the participants indicated some level of protection from HBV either through vaccination or past infection (Dolpa 58/399, Pokhara 21/400) and recent cases who had recovered (Dolpa 4/399, Pokhara 3/400). Due to the relatively low prevalence of active cases of HBV, no meaningful associations between demographic, behavioural, and healthcare factors could be calculated. In both samples low level of knowledge of HBV and stigma towards people with HBV was evident. Conclusions This study found a low prevalence of HBV infection in both low and putatively high prevalence populations. However, knowledge of how HBV can be spread was quite low in each of the groups, indicating participants are managing to avoid infections while not necessarily being cautious around behaviours representing the greatest infection risk. There was also evidence of stigma being associated with having an active HBV infection, which may reduce the willingness of individuals to seek diagnosis or treatment.