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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.
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.
Objective The aim of this research is to investigate the perspective of citizens of Nepal on the management COVID‐19, the roll‐out of the vaccine, and to gain an understanding of attitudes towards the governments' handling of the COVID‐19 pandemic. Method A qualitative methodology was used. In‐depth interviews were conducted with 18 males and 23 females aged between 20 and 86 years old from one remote and one urban district of Nepal. Interviews were conducted in November and December 2021. A thematic approach was used to analyse the data, utilising NVivo 12 data management software. Result Three major themes were identified: (1) Peoples' perspective on the management of COVID‐19, (2) people's perception of the management of COVID‐19 vaccination and (3) management and dissemination of information. It was found that most participants had heard of COVID‐19 and its mitigation measures, however, the majority had limited understanding and knowledge about the disease. Most participants expressed their disappointment concerning poor testing, quarantine, vaccination campaigns and poor accountability from the government towards the management of COVID‐19. Misinformation and stigma were reported as the major factors contributing to the spread of COVID‐19. People's knowledge and understanding were mainly shaped by the quality of the information they received from various sources of communication and social media. This heavily influenced their response to the pandemic, the preventive measures they followed and their attitude towards vaccination. Conclusion Our study concludes that the study participants' perception was that testing, quarantine centres and vaccination campaigns were poorly managed in both urban and rural settings in Nepal. Since people's knowledge and understanding of COVID‐19 are heavily influenced by the quality of information they receive, we suggest providing contextualised correct information through a trusted channel regarding the pandemic, its preventive measures and vaccination. This study recommends that the government proactively involve grassroots‐level volunteers like Female Community Health Volunteers to effectively prepare for future pandemics. Patient and Public Contribution This study was based on in‐depth interviews with 41 people from diverse socioeconomic backgrounds. This study would not have been possible without their participation.
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