1

CHAPTER ONE
Introduction

Background to the Study

Hepatitis B infection is a major health problem globally, casting an enormous burden on

the healthcare system. Globally it is estimated that about 320-350 million individuals are chronic

carriers of Hepatitis B Virus (HBV) and about 1.5 million people die annually from HBV related

causes (Alotaibi et al., 2021). Most people, 89.5 per cent infected with hepatitis B Virus are

unaware of their infection, with 27 million minority (10.5per cent) being aware of their status

during their working life (Mursy and Mohamed, 2019). In Africa and Asia, hepatitis B is a major

cause of morbidity and mortality (Omatola et al, 2020). Sub-Saharan Africa has an estimated

87,890 deaths from HBV annually with increasing incidence of hepatocellular carcinoma and

liver cirrhosis (Halwindi, 2021). In 2019, the mortality resulting from hepatitis B increased to

about 1.3 million from 887, 000 recorded in 2018 (Yakudima et al., 2022).

Globally, the World Health Organization (WHO, 2024) reported that while awareness of

HBV exists, a significant gap remains in "deep knowledge" regarding post-exposure prophylaxis

(PEP) and viral load management. Recent statistics indicate that nearly 254 million people were

living with chronic hepatitis B infection as of 2022, with healthcare workers (HCWs) in low-to-

middle-income countries (LMICs) often lacking updated knowledge on non-traditional

transmission routes. Studies conducted between 2021 and 2023 suggested that while 90 per cent

of HCWs in developed nations possessed "excellent" knowledge scores, that figure droped to

below 60 per cent in sub-Saharan Africa, justifying a localized investigation into the Benue

South Senatorial District.

The attitude of healthcare workers dictates the transition from knowledge to action. A

global trend observed from 2020 to 2025 was the "complacency gap," where long-term HCWs
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often developed a diminished perception of risk compared to interns. Globally, negative attitudes

such as the stigma associated with HBV-positive colleagues or the belief that "natural immunity"

is sufficient continue to hinder vaccination uptake. In the African context, studies from 2023

highlighted that up to 40 per cent of HCWs exhibit a hesitant attitude toward mandatory

vaccination despite high occupational exposure, citing concerns over vaccine safety and

government-led health initiatives.

Preventive practice is the ultimate measure of safety in a clinical setting. Statistically, the

WHO (2023) estimated that needle-stick injuries (NSIs) result in approximately 66,000 HBV

infections among HCWs annually worldwide. Between 2020 and 2025, the global focus shifted

heavily toward "Universal Precautions." However, practice remains inconsistent; statistics show

that in developing regions, as many as 45per cent of HCWs still engage in the high-risk practice

of "two-handed recapping" of needles. Furthermore, global vaccination coverage for HCWs

remains incomplete, with some regions reporting that only 1 in 3 healthcare providers have

completed the full three-dose HBV vaccine series.

Benue South Senatorial District is rooted in the inverse care law, where those most at risk

often have the least access to preventive infrastructure. While global health targets aim at cent

reduction in new chronic infections, the current state of affairs in Nigeria marked by a national

HBV prevalence of approximately 8 per cent suggests that the frontline workers in Benue State

may be operating under high-risk conditions with varying levels of knowledge and practice. This

study was justified by the need to provide baseline data that aligns local practices with the global

WHO 2030 Hepatitis Elimination Strategy.

In Nigeria where hepatitis B infection is a major public health challenge, healthcare

workers are at increased risk of exposure to the virus (Ogoina et al., 2014). Annually, up to one

million of these infected population die due to the consequences of the infection such as liver
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cirrhosis and hepatocellular carcinoma in Nigeria (Alotaibi et al., 2021). In Benue State,

understanding healthcare workers knowledge attitudes and preventive practices regarding

hepatitis B infection was essential for developing targeted interventions to improve hepatitis B

prevention and control. (Agbedeson et al. 2022). In Nigeria, Adejimi et al. (2021), reported that

Nigeria is among countries in Africa with greatest burden of HBV accounting for 8.3 per cent of

the global burden of chronic infections. Furthermore, Omatola et al. (2020) revealed that the

average prevalence rate for HBV for country ranges between 11-13.7 per cent with an estimated

20 million people who are chronically infected. However, the Federal Ministry of Health,

(FMoH, 2020) further stated that an estimated 22.6 million Nigerians were infected with

Hepatitis B, and one in every 12 persons was estimated to be living with the infection.

Hepatitis B infection is a significant public health concern. Healthcare workers are at the

fore front of the battle against hepatitis B (World Health Organization (WHO, 2019). In Benue

South senatorial district, healthcare workers face unique challenges, including limited access to

healthcare services, inadequate vaccination coverage, and high-risk traditional practices (Agbaji

et al., 2021). The prevalence of hepatitis B infection sero-positivity was found to be 12.7 per cent

among healthcare workers in Benue South Senatorial district, Benue State (Ijeoma et al, 2021).

In Nigeria, there is a paucity of studies on the knowledge, attitude and preventive practices of

healthcare workers regarding hepatitis B infection in Benue State, particularly in Benue South

Senatorial district.

Hepatitis B infection is the world’s most common liver infection, which is caused by

HBV (WHO, 2020). HBV is a DNA virus, which belongs to hepanaviridae family. It is 42–47

nm in diameter and enters the liver through blood stream, Akazong et al. (2020) asserted that

HBV is highly contagious and is 50–100 times more infectious than HIV. Mousa et al. (2020)

opined that, it is transmitted through blood, semen, vaginal fluid, and mucous membranes. In
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addition, Yakudima et al, (2022) stated that it was most commonly transmitted by unprotected

sexual contact, contaminated blood transfusions, unsafe use of needles, from mother to child at

birth, close household contact, and among children in early childhood. Sm-em and Soo, (2019)

asserted that HBV infection is a major health concern and is the most common blood-borne viral

infection that places health-care workers at higher occupational risk, stressing that in hospital,

the possible forms by which HBV infection would be transmitted were from contact with blood

or saliva of infected patients during medical procedures, while drawing blood, giving injections,

or suturing, and needle stick injuries sustained while performing procedures. In addition to this,

professionals who do not wear gloves while doing procedures are at a higher risk of acquiring

HBV infection. HBV transmission occurs from exposure to saliva and gingival cervicular fluid,

which in turn makes healthcare workers more vulnerable for HBV infection (Mursy and

Mohamed, 2019). For this reason, there was a serious need for healthcare workers to seek greater

knowledge.

Knowledge, in the context of health professional practices, is a multidimensional

construct that has been conceptualized in contemporary scholarship from cognitive, social, and

applied perspectives. From a cognitive standpoint, educational constructivism defines knowledge

as something that must be constructed by the individual learner using available interpretive

resources, where what a learner comes to understand is shaped by the learning context, the goals

of the learner, and the activity the learner is engaged in (Taber, 2024). This perspective positions

knowledge not as a passive reception of facts but as an active, purposeful mental construction

shaped by prior experience and current engagement. Complementing this individual cognitive

dimension, social constructivism holds that learning is a socially mediated process in which the

learner actively constructs and applies knowledge through interaction with others and within

specific professional and institutional contexts. Constructivism provides a theoretical framework

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for understanding how learners actively construct knowledge from their experiences,

highlighting the importance of meaningful and interactive learning environments where students

can connect new knowledge with their prior experiences (Le & Nguyen, 2024). These two

perspectives, the individual cognitive and the social constructivist are not mutually exclusive;

rather, they converge on the understanding that knowledge is simultaneously personal and

relational, and that its quality is determined by the richness of the learning environment in which

it develops.

Knowledge is highly essential towards mode of transmission of HBV and prevention of

many contagious diseases (Olufunlayo et al, 2022). Poor knowledge can place people on the

danger of severe and fatal health complications. The United States Centres for Disease Control

(CDC, 2021) stressed that many individuals who have been infected with HBV do not know that

they are infected as the disease silently damages the liver function which takes up to 30 years to

develop without showing any sign or symptom (CDC, 2021). Knowledge of hepatitis B infection

prevention in this context is the awareness and understanding of the etiology of hepatitis B

infection, its transmission, clinical manifestation, diagnosis, treatment, complications,

vaccination and existence of post exposure prophylaxis for the management of accidentally

exposed persons (Aniaku et al, (2019). Another study revealed that 60 per cent of healthcare

workers in Benue South Senatorial District had heard of hepatitis B infection, but only 35 per

cent could correctly identify its symptoms (Ijeoma et al., 2021). As a result, most people who

were infected long ago with the virus were unaware of their chronic infection and consequently

failed to seek appropriate medical attention (Ogbuagu et al, 2022). They were at high risk of

developing severe chronic liver disease and can unknowingly transmit the infection to other

people (FMoH, 2020; Osei et al, 2019).

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According to Mursy and Mohamed (2019), attitude towards hepatitis B infection

prevention was predicated on perceived susceptibility risk, perceived severity and perceived

threat of hepatitis B infection. In addition, Adoga et al. (2023) reported that 60 per cent of

healthcare workers in Benue State had positive attitudes regarding hepatitis B vaccination, but 30

per cent were concerned about the safety of the vaccine. Furthermore, 50 per cent of healthcare

workers had negative attitudes towards caring for patients with hepatitis B. Good preventive

practice of hepatitis B infection prevention is the uptake of hepatitis B infection prevention

activities such as hepatitis B screening, hepatitis B vaccination, post-hepatitis B vaccination

antibody testing, changing of gloves per client, non-recapping of needles after use, prevention of

NSI, and prevention of blood splashes on body. High knowledge and good attitude towards

disease prevention moderated by relevant socio-demographics, following health education have

been demonstrated to be positively related to good preventive practice of disease prevention,

which is hypothesized to culminate in desirable disease prevention outcome (Alotaibi et al.,

2021). These relationships have been largely drawn from the knowledge attitude preventive

practice-outcome (KAP-O) framework proposed by Wan (2019) and furthered by Rav-Marathe

et al., (2019). Hence the need for preventive measure.

The prevention and control of HBV in a hospital setting involves key preventive practices

such as screening of blood and blood products, injection safety, vaccination, post exposure

prophylaxis, use of universal precautions (UPS) and compliance of healthcare workers to the

above mentioned Nwosu et al (2022). All of these components are important in their own right

since it is often not practical to achieve 100per cent immunization in the whole population. This

is especially so in settings where HBV is highly prevalent, and there are resources and

compliance limitations to infection control (Halwiind, 2021). A study pointed out that only 40per

cent of health workers in Benue State reported always using personal protective equipment
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(PPE) when handling patients with hepatitis B (Akpa, 2011). Ogbuagu et al. (2022) revealed that

50per cent of healthcare workers in Benue South Senatorial District reported sometimes or never

screening patients for hepatitis B before surgery. Hepatitis B infection prevention is a product of

high knowledge, good attitude and good preventive practice of hepatitis B infection prevention

(Mursy and Mohamed, 2019).

Healthcare workers in Nigeria are particularly at increased risk of contracting hepatitis B

virus in their work place because Nigeria is a holo-endemic area (Baba Ajayi et al, 2020). When

symptoms exist it includes flu- like illness, nausea, vomiting and diarrhea loss of appetite, weight

loss, jaundice and itching skin (WHO 2020). The predominant mode of transmission of HBV in

Nigeria includes, by having unprotected penetrative sex with someone who is infectious, sharing

contaminated needles other drug infecting equipment, by using non- sterilized equipment for

body piercing acupuncture from an infected mother to her baby, most commonly during delivery

and transfusion of unscreened blood Hepatitis B virus cannot be spread through sneezing,

Coughing, hugging or coming in contact with the faces of someone who is infected WHO

(2020). Prevention includes immunization of the baby at birth, the use of condoms for

penetrative sex, abstinence of sex, screening of blood and sterilization of equipment prevent the

transmission of hepatitis B virus (WHO 2020).

Healthcare workers especially surgeons are 3–4 and 6 times at greater risk of exposure to

HBV infection than the general population of health care worker (Rajamoorthy, et al. 2019). In a

clinical setup, lapse in the sterilization technique of instruments or improper hospital waste

management can lead to the transmission of hepatitis B infection to healthcare workers, stressing

that among the health-care professionals, surgeons are placed in high-risk group as actual

sufferers and carriers Baba Ajayi and Ekanem (2020). Hence, it is of paramount importance for
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all the health institutions to conduct educational talks and create awareness about HBV infection

among their staff and students with the aim of decreasing the incidence of HBV infection among

this high-risk group. The incidence of HBV infection can be reduced by giving proper education

and awareness regarding its transmission and vaccination to the health-care workers (WHO

2020).

All Hepatitis B infections do not have symptoms, which means that people who are

contagious are at a risk without knowing it, however; many people may experience symptoms

such as jaundice, fatigue, loss of appetite, nausea, and abdominal pain (Wedhaya, et al. 2019). In

nearly all adults, 90per cent of the infection heals and they become healthy. But there is a risk of

90per cent in infants and 30–50per cent in young children, respectively, which can lead to

chronic infection. Debaka et al. (2022) added that, his HBV provides an increased risk that they

will suffer from liver cirrhosis or liver cancer in later life, if not medically managed by the health

care workers. Healthcare workers level of education may influence their

knowledge and attitude regarding hepatitis B Olufunlayo et al (2023). Professional Qualifications

may impact their preventive practice and adherence to infection Control measure Mbaawuaga et

al (2022), Year of Experience of Healthcare workers’ may influence their knowledge, attitude

and preventive practices regarding hepatitis B Ogonia et al (2020). Healthcare workers’ age and

gender may impact their attitude and preventive practice regarding hepatitis B infection Eze et al.

(2023) Work setting of healthcare workers such as hospital, clinic laboratory may influence their

preventive practice and adherence to infection control measures. These independent variables

may influence healthcare workers ’knowledge, attitude and preventive practice regarding

hepatitis B and should be considered in the study design and analysis Mbaawuaga et al (2022).
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In Nigeria,Adejimi et al (2021) posits that, there is dearth of information regarding the

level of knowledge on HBV among the general population. However, Debaka, et al. (2021) who

assessed the knowledge level towards HBV in Tibebe Ghion Specialized Hospital assert that,

most of the healthcare workers in the hospital had adequate knowledge on HBV infection and its

mode of transmission. 359 ([Link] cent) knew that HBV can cause liver cancer. 350 (82.9per

cent) of the participants knew that HBV vaccine can prevent HBV infection, but relatively, a low

proportion of 174 (41.2per cent) knew that HBV has a post exposure prophylaxis. Among the

professions, medical doctors (91.4per cent) were more knowledgeable followed by pharmacist

(84.4per cent). The average knowledge level of the professionals was 65.6per cent.

Good attitude and best preventive practice towards hepatitis B infection prevention by the

healthcare workers and the entire population is very essential. Poor attitude and preventive

practice can put people at the risk of severe and fatal health complications (Adejimi et al. 2021).

Fufore, Cook and Kinfa (2019) point out that, the attitude and preventive practice by healthcare

workers towards Hepatitis B infection is generally inadequate in most of the developing

countries especially, Nigeria. Mursy and Mohamed (2019) conducted a study to assess the

attitude, and preventive practice towards Hepatitis B infection among nurses and midwives in

two maternity hospitals in Khartoum, Sudan and concluded that majority of the respondents

(86.4per cent) showed a favorable attitude towards the preventive measures of HBV infection

(instruments sterilization, wearing gloves, HBV vaccination, and PEP). More than half of the

participants (64.5per cent) believed that instruments sterilization is important to prevent

transmission, and 72.7per cent of them think that wearing gloves is important to prevent

transmission. A vast majority of the participants (82.7per cent) reported that vaccination is an

important protective measure. Only 52.7per cent of the participants said that they recommend

PEP immediately after exposure to infection. In the same vein, Mursy and Mohamed (2019) state
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that majority of healthcare workers were considered to have a safe preventive practice regarding

HBV infection. According to the study findings, a vast majority of the participants always used

sterilized instruments (90per cent) and wore gloves (90.9per cent).

The risk of contamination by the hepatitis B virus exists during any inoculation and

contact between the mucous membranes and biological fluids. Viral infection with HBV remains

the significant infection transmitted by blood transfusion (Kabamba, et al., 2023). In addition,

this risk of HBV transmission by blood transfusion is mainly linked to blood donations that

tested negative for HBV surface antigen but contained deficient levels of potentially infectious

viral DNA Debaka, et al (2021). Furthermore, this transmission would be linked to donors

carrying acute hepatitis B. Adejimi et al. (2021), opined that preventing accidental exposure to

blood by vaccination against HBV and respecting standard precautions remain the best

guarantees for preventing hepatitis B and C.

Although a number of studies have been conducted in Nigeria to assess knowledge,

attitude and preventive practices regarding hepatitis B. However, these studies focused on

specific group of population such as female sex workers, health workers, market traders and

medical students. Therefore, there is dearth of information regarding the level of knowledge on

HBV among the general population. In addition, the above studies were conducted outside

Benue State. It is equally important to explore people’s knowledge and attitude towards hepatitis

B virus in the state. Good knowledge and strict application of these precautionary measures

prove essential and thus provide significant protection. Unfortunately, viral hepatitis and its

consequences remain poorly known in Benue South senatorial Zone (Ijachi, Audu and Araoye,

2019). Therefore, the aim of this study is to explore knowledge, attitude and preventive practice
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of healthcare worker towards hepatitis B infection in Benue South Senatorial Zone in Benue

State.

This study will be anchored on one theory and one model: the Theory of Reasoned

Action (TRA) and the Health Belief Model (HBM). Ajzen and Fishbein propounded the Theory

of Reasoned Action (TRA) in [Link] theory posits that individuals’ beliefs about their health

and susceptibility to illness influence their behaviour. In this context, the theory can be used to

understand healthcare workers’ knowledge, attitude, and preventive practice regarding hepatitis

B infection. The Health Belief Model consists of the following components. Perceived

susceptibility: Healthcare workers beliefs about their risk of contracting hepatitis B. Perceived

severity: healthcare workers’ beliefs about the seriousness of hepatitis B infection. Perceived

benefits: healthcare workers’ beliefs about the benefits of taking preventive measures against

hepatitis B. Perceived barriers: healthcare workers’ beliefs about the obstacles to taking

preventive measures against hepatitis B Cues to action: healthcare workers’ exposure to

reminders or prompts to take preventive measures against hepatitis B. Self-efficacy: healthcare

workers’ confidence in their ability to take preventive measures against hepatitis B. By applying

the Health Belief Model, the study can identify factors that influence healthcare workers'

knowledge, attitude, and preventive practice regarding hepatitis B infection and develop targeted

interventions to improve their behaviour and reduce the transmission of hepatitis B in Benue

South Senatorial District, Benue State. The TRA is based on the premise that individuals'

behaviour is determined by seven causal variables: behavioural intention, attitude, subjective

norm, belief strength, evaluation, normative belief, and motivation to comply. This theory is

related to knowledge, attitude and preventive practice of healthcare workers regarding Hepatitis

B infection because the study can identify factors that influence healthcare workers’ knowledge,
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attitude, and preventive practice regarding Hepatitis B infection and develop targeted

interventions to improve their behavior and reduce the transmission of Hepatitis B in the Benue

south, Benue state.

The Health Belief Model was propounded by Irwin Rosenstock in the 1950s. This model was

designed to predict preventive health behaviour and the behavioural response to the treatment of

acute or chronic conditions. According to the model, a person's health behaviour depends on

their perception of several key variables: perceived susceptibility, perceived severity of the

health condition, perceived benefits, perceived barriers, cues to action, and self-efficacy. This

model is related to preventive practice regarding hepatitis B because healthcare workers who

know the risk factors and preventive measures of hepatitis B infection, including the causative

organism and predisposing factors, will be more likely to educate other healthcare workers,

change attitudes, and hold favourable beliefs towards hepatitis B preventive practices. The study

will be carried out at primary Healthcare center in Benue South Senatorial District, Benue State.

Statement of the Problem

Healthcare workers in the Benue South senatorial district, Benue State are at risk of

contracting and transmitting hepatitis B infection due to inadequate knowledge, negative

attitudes, and poor preventive practices regarding the disease. Despite the availability of effective

vaccines and prevention measures, hepatitis B infection remains a significant public health

concern in Nigeria, with Benue State having one of the highest prevalence rates. A lack of

understanding among healthcare workers about hepatitis B transmission, prevention and

treatment may contribute to the continued spread of the disease, putting themselves, their

patients and the community at risk. Therefore, this study aims to investigate the knowledge,

attitude and preventive practice of healthcare workers regarding hepatitis B infection in the
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Benue South senatorial district, Benue State in order to identify gaps and inform interventions to

improve their behavior and reduce the transmission in the region.

Healthcare workers are at an increased risk for exposure to HBV when they come into

contact with human blood product or potentially infectious body fluids. The delivery of

healthcare has the potential to transmit HBV and HCV to both healthcare workers and patients.

Patients with hepatitis B have encountered discrimination and stigmatisation from health workers

and this discriminatory practice among health workers may result from a lack of knowledge and

negative attitudes towards the disease which could interfere with their willingness to treat

patients because of fear of contracting the disease. Ideally, healthcare workers usually receive a

vaccine in three doses over a six-month period (0, 1, and 6 months). It is recommended that

healthcare workers have their hepatitis B surface antibody (HBsAb) level tested four to six

weeks after completion of the series to make sure that they have built up protection against

hepatitis B virus infection. In addition, improper hospital waste management among healthcare

workers can lead to the transmission of hepatitis B infection to healthcare workers. Poor

knowledge can expose people to the danger of severe and fatal health complications. The

discriminatory preventive practice of healthcare worker may result from poor knowledge and

negative attitude towards this kind of diseases (hepatitis B infection) which could interfere with

their willingness to treat these patients because of fear of contracting the disease.

Although different studies have been carried out and conducted to investigate the

knowledge and attitude of healthcare workers regarding hepatitis B infection, Despite the high

burden of hepatitis B infection in Nigeria, there is paucity of studies on knowledge, attitude, and

preventive practice of healthcare workers regarding hepatitis B infection in Benue State

particularly in the Benue South Senatorial district. While previous studies have investigated
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hepatitis B infection among healthcare workers in Nigeria, few focused on the specific context of

Benue State, and none have explored the knowledge, attitude, and preventive practice of

healthcare workers in Benue South senatorial district. This gap in literature is significant, as

healthcare workers play critical roles in preventing and controlling hepatitis B transmission, of

hepatitis B in the region. This study aims to address this knowledge gap by investigating the

knowledge, attitude and preventive practice of healthcare workers regarding hepatitis B infection

in Benue south senatorial district, Benue state.

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Purpose of the Study

The purpose of the study is to determine the level of knowledge, attitudes, and preventive

practices regarding hepatitis B infection among healthcare workers in Benue South Senatorial

District, Benue State. Specifically, the study intends to determine:

1. Level of knowledge of hepatitis B infection among healthcare workers;

2. Attitude towards hepatitis B infection among healthcare Workers

3. Preventive practices regarding hepatitis B infection among healthcare workers

4. Level of knowledge regarding hepatitis B infection among healthcare workers based on

gender, marital status, educational qualification, profession, ethnicity, and years of

experience

5. Attitude towards hepatitis B infection among healthcare workers based on age, gender, level

of Education, ethnicity and years of experience

6. Preventive practices of healthcare workers regarding hepatitis B infection based on gender,

marital status, educational qualification, profession, ethnicity, and years of experience

Research Questions

The following questions were posed to guide the study:

1. What is the level of knowledge regarding hepatitis B infection among healthcare workers?

2. What is the attitude towards hepatitis B infection among healthcare workers?

3. What is the preventive practice of healthcare workers regarding hepatitis B infection?

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4. What is the level of knowledge regarding hepatitis B infection among healthcare workers

based on gender, marital status, educational qualification, profession, ethnicity, and years of

experience?

5. What is the attitude towards hepatitis B infection among healthcare workers based on gender,

marital status, educational qualification, profession, ethnicity, and years of experience?

6. What is the preventive practice of healthcare workers regarding hepatitis B infection based on

gender, marital status, educational qualification, profession, ethnicity, and years of experience?

Hypotheses

The following null hypotheses were formulated to guide the study.

1. There is no significant difference in the level of knowledge regarding hepatitis B among

healthcare workers in Benue South Senatorial District, Benue State, based on gender.

2. There is no significant difference in attitude towards hepatitis B infection among

healthcare workers in Benue South Senatorial District, Benue State, based on marital

status.

3. There is no significant difference in preventive practice regarding hepatitis B infection

among healthcare workers in Benue South Senatorial District, Benue State, based on

educational qualification.

4. There is no significant difference in the level of knowledge regarding hepatitis B

infection among healthcare workers in Benue South Senatorial District, Benue State,

based on profession.

5. There is no significant difference in attitude towards hepatitis B infection among

healthcare workers in Benue South Senatorial District, Benue State, based on ethnicity.
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6. There is no significant difference in preventive practice of healthcare workers regarding

hepatitis B infection-based ethnicity, job location, and years of experience in Benue south

senatorial district, Benue state.

Significance of the Study

This study is significant because it can benefit healthcare workers by improving their

knowledge, attitude, and preventive practices regarding hepatitis B infection in Benue South

Senatorial District, Benue State, and will enhance their capacity to provide quality care for

patients. The study therefore, fits into the quest to unveil the level of knowledge, attitude and

preventive practice of healthcare workers regarding hepatitis B infections in the study area The

study is significant to patients because better care and management of hepatitis B infection will

improve patient outcome and reduce transmission in healthcare setting. The Benue State

Ministry of Health will benefit from this study as it will inform policy and program development

for hepatitis B prevention and control. This study will also help the Nigerian Government in

contributions to achieving the goal of eliminating viral hepatitis B infection by 2033. This study

will also benefit international health organizations; by providing insight into hepatitis B

prevention and control in resource limited settings. and offers a combination of academic

contributions for scholars and researchers, managerial implications for policy makers and

practical contributions for practitioners and public health workers. More so, the study will help to

add up to existing research in public health education, as it will provide information to other

researchers who will want to carry out further research on the topic. It will be significantly

instrumental in helping to bridge the gap in the existing knowledge in this realm.

This study will also create awareness and promote attitudinal change among health

workers who hold negative attitudes towards hepatitis B patients and carriers. The study may
 18

also draw the attention of government to this infectious disease, a major public health problem,

in order to take appropriate measures to enlighten the public about hepatitis B infection, its

consequences and ways of preventing the infection.

Scope of the Study

The study will focus on knowledge attitude and preventive practices of healthcare

workers regarding hepatitis B infection in Benue South Senatorial District, Benue State.

Healthcare workers’ knowledge of hepatitis B infections, its transmission, prevention, and

treatment. Healthcare workers’ attitudes regarding hepatitis B infection, its vaccination.

Healthcare workers’ preventive practices and behaviours regarding hepatitis B infection,

diagnosis, and management. Factors influencing healthcare workers’ knowledge, attitudes and

preventive practice regarding hepatitis B infection including socio-demographic characteristics,

training and work environment. The study will be limited to public healthcare workers in Benue

South Senatorial District. Benue State such as doctors, nurses, midwives and laboratory

technicians. The study will focus on hepatitis B infections only and will not explore other types

of viral hepatitis. The study will provide recommendations for improving healthcare workers’

knowledge, attitude and preventive practice regarding hepatitis B infection, but will not

implement interventions or monitor their effectiveness.

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CHAPTER TWO
Literature Review

Literature on knowledge, attitude and preventive practice of healthcare workers regarding

hepatitis B infection in Benue South senatorial district, Benue State is emerging but limited.

Nevertheless, this chapter reviewed related literature under the following sub- headings

Conceptual Framework

Theoretical Framework

Theory of Reasoning Action (TRA, Ajzen and Fishbein in 1967)

Health Belief Model (HBM, Hochbaum, Rosenstock and kegels 1950s).

Empirical studies

Summary of Literature Review

Studies on health workers’ knowledge, attitude and preventive practice towards hepatitis

B infection. Studies carried out in the department of gastroenterology to find out the awareness

about the general population about hepatitis B virus including knowledge including vaccines.

Concept of Hepatitis B Infections

Hepatitis B is a disease caused by the hepatitis B virus (HBV), which is transmitted

through percutaneous or mucosal exposure to infectious blood or body fluids (Singh and Jain,

2021). It is a major problem because it can cause chronic infection, resulting in cirrhosis of the

liver, liver cancer, liver failure, and death. In addition, several extra-hepatic lesions occur

because of HBV infection. With this, there is deposition of immune complexes in different

17
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organs of the body especially, the kidney (Adeyemi, et al., 2021). Persons with chronic infection

also serve as the main reservoir for continued HBV transmission (Singh and Jain, 2021).

Yakudima, Magaji and Abudlkarim (2022) asserted that Hepatitis B virus (HBV) is one of the

viruses that cause inflammation of liver. HBV is a potentially life-threatening infection and

remains a major global public health concern due to its high morbidity and mortality. HBV

infection is considered among the top five infectious diseases associated with high incidence

rates (Omotola, Onoja and Agama, 2020). It is 50 to 100 times more infectious than HIV and 10

times more infectious than Hepatitis C virus, and regarded as the 10th leading cause of death

worldwide. (Kabamba, et al.2023)

Hepatitis B Virus (HBV) accounts for an estimated 360 million chronic infections with

about a million who die each year from chronic liver diseases. Most persons who become

chronic carriers of the virus live in Asia and Africa. These regions are said to be highly endemic

for hepatitis B infections (Samuel, Aderibigbe, Salami and Babatunde, 2019). Yakudima, Magaji

and Abudlkarim (2022) opined that globally, it is estimated that 2 billion people have been

infected with the disease out of which about 350 million people are chronically infected, and

between 500,000 to 700,000 deaths occur yearly. About 4.5 million new HBV cases occur each

year in the world with 15 – 40per cent of those infected developing cirrhosis, liver failure or

hepato-cellular carcinoma (Chauhan, Webb and Ferguson, 2019). World Health Organization

report revealed that in 2019, 296 million people were living with chronic hepatitis B infection

with 1.5 million new cases, and the disease kills 820,000 people (WHO, 2021).

Hepatitis B infection (HBV) is still of global concern because of increase in prevalence

(Ayan, Abdkeren and Sharif, 2020). MacLachlan and Cowie (2019) postulate that although the

prevalence of HBsAg varies globally and is classified as low, intermediate, and high, more than
 22

420 million people live as chronic carriers, constituting almost 7per cent of the world population.

The complications of HBV infection include acute and chronic infection, liver cirrhosis and

hepatocellular carcinoma. High prevalence of HBV infection was reported from various parts of

Africa among different population groups (Ayan, Abdkeren and Sharif 2020). Although there

were some reports on the prevalence of HBV in Somalia in the past (Akazong et al., 2020).

On the basis of sero-prevalence survey results, WHO (2020) grouped countries into three

levels of endemicity. First, is the high endemicity region which represents areas where the

prevalence of chronic HBV among general population is greater than or equal to 8per cent. The

second group represents the areas of intermediate endemicity where the prevalence of HBV in

the general population is between 2 and 7per cent. The last class is the low endemicity region

comprising areas that have less than 2per cent of chronic hepatitis B among the general

population.

Moussa, Abdi and Abdullahi, (2021) adduce that Hepatitis B infection (HBV) is still of

global concern because of increase in prevalence, stressing that the prevalence of HBsAg varies

globally and is classified as low, intermediate, and high, more than 420 million people live as

chronic carriers, constituting almost 7per cent of the world population. Halwiind (2021) posits

that HBV is the major public health concern globally infecting approximately 30per cent of the

world’s population. It is the 10th leading cause of death and 5th cause of cancer worldwide.

WHO (2020) reports that 257 million people or 3.5per cent of the population were living with

chronic hepatitis B infection which resulted in about 887,000 deaths mostly from cirrhosis and

hepatocellular carcinoma. Adejimi, et al. (2021) asserted that globally, it is estimated that 2

billion people have been infected with the disease out of which about 350 million people are

chronically infected, and between 500,000 to 700,000 deaths occur yearly, stressing that About

4.5 million new HBV cases occur each year in the world with 15 – 40per cent of those infected
 23

developing cirrhosis, liver failure or hepato-cellular carcinoma. World Health Organization

report revealed that in 2019, 296 million people were living with chronic hepatitis B infection

with 1.5 million new cases, and the disease kills 820,000 people (WHO, 2021).

Nigeria is among countries with greatest burden of Hepatitis B Virus (HBV) accounting

for 8.3per cent of the global burden of chronic infections (Federal Ministry of Health, 2021). The

above source further revealed that the average prevalence rate for Hepatitis B Virus (HBV) in the

country ranges between 11–13.7per cent with an estimated 20 million people who are chronically

infected. However, Adeyemi et al. (2021) further stated that an estimated 22.6 million Nigerians

are infected with Hepatitis B, and one in every 12 persons is estimated to be living with the

infection, placing Nigeria in the hyper-endemic region of HBV infection.

The major route of Hepatitis B Virus (HBV) transmission in sub-Saharan Africa is

horizontal (i.e transmission unrelated to recognized sexual, perinatal, or parenteral exposure) in

children under 5 years of age; however, percutaneous parenteral transmission is also an

important mode of spread (Samuel, Aderibigbe, Salami and Babatunde, 2019). Hepatitis B

infections vary greatly in their course and outcomes at one end of the spectrum are patients who

have no signs and symptoms of liver disease and completely normal levels of serum liver

enzymes. At the other end of the spectrum are patients with severe hepatitis who have symptoms,

in the middle of the spectrum are patients who have few or no symptoms, mild to moderate

elevations in liver enzymes, and an uncertain prognosis (Furfore, Cook and Kirfi, 2019).

Hepatitis B infection is acute when it lasts less than six months and chronic when it persists

longer.

Hepatitis B infection is the world’s most common liver infection, which is caused by hepatitis B

virus (HBV) (Balegha, Yidana and Abiiro, 2021). HBV is a DNA virus, which belongs to hepadnaviridae
 24

family. It is 42–47 nm in diameter and enters the liver through blood stream (Chao and Chang, 2020).

Hepatitis B Virus (HBV) is highly contagious and is 50–100 times more infectious than HIV. HBV

infection is a major health concern and is the most common blood-borne viral infection that places health-

care workers, medical and dental professionals, at higher occupational risk (Giao et al., 2019). Not all

HBV infections present with symptoms, meaning that people who are contagious may be at risk without

knowing it (Giao et al., 2019). However, many people may experience symptoms such as jaundice,

fatigue, loss of appetite, nausea, and abdominal pain. In nearly all adults, 90 per cent of the infection heals

and they become healthy. But there is a risk of 90 per cent in infants and 30–50 per cent in young

children, respectively, which can lead to chronic infection (Osei et al. 2019). This provides an increased

risk that they will suffer from liver cirrhosis or liver cancer in later life, if not medically managed

(Balegha et al. 2021).

Hepatitis B virus (HBV) is an established cause of chronic infection, especially in those

infected as infants; it is a major factor in the eventual development of liver disease and

hepatocellular carcinoma in those individuals (Debaka et al., 2022; Abiiro et al., 2022). It is a

highly infectious virus in the blood of both symptomatic and asymptomatic patients; chronically

infected individuals pose a serious threat to all healthcare workers, and immunization of such

individuals is generally required. Hepatitis B virus (HBV) infection is the major infectious

hazard for healthcare personnel. Healthcare workers (HCWs) are at high risk of HBV infection

in healthcare settings. Hepatitis infection is one of the major public health problems globally and

is the tenth leading cause of death (Jacob et al., 2019).

Supporting the above view, Ayan, Abdkeren and Sharif (2020) stated that healthcare

workers (HCWs) are among the most vulnerable groups with an increased risk of HBV infection.

Healthcare workers are occupationally exposed to patients with HBV infection, which exposes

them to transmission through percutaneous injuries from needle or sharps, mucocutaneous

 25

contact with blood and other body fluid. Reports from Adeyemi et al. (2020) indicate that

various categories of healthcare workers can be infected with HBV through occupational

injuries. Prevalence of HBV was reported among Healthcare Workers and Medical Students.

Incidences of HBV transmission from Healthcare Workers to patients has been documented

(Chao and Chang, 2020). Earlier reports on HCWs and HBV infection indicated that HCWs had

poor KAP towards HBV infection, with a wide disparity of knowledge among them (Ayanv et al.

2020).

Hepatitis B Virus (HBV) can be prevented by strict adherence to standard

microbiological preventive practices and techniques, and routine use of appropriate barrier

precautions to prevent skin and mucous membrane exposure when handling blood and other

body fluids of all patients in healthcare settings. Following exposure to blood or body fluids,

post-exposure prophylaxis can be administered as a combination of passive immunization with

hepatitis B immunoglobulin (HBIG) and vaccination with the hepatitis B vaccine. However, the

most cost-effective method to prevent and control hepatitis B is through pre-exposure

vaccination (Osei et al. 2019). The vaccine has been found to be safe and effective, and can

protect one for a lifetime. Education and prevention of infection with HBV should be

emphasized, and all patients should be regarded as potential HBV carriers regardless of their

medical history or condition (Osei et al. 2019).

Knowledge of Causative Organisms of Hepatitis B Virus (HBV)

Knowledge is highly essential towards mode of transmission of HBV and prevention of

many contagious diseases. Poor knowledge can expose people to the danger of severe and fatal

health complications. The United States Centres for Disease Control (CDC, 2021) stressed that

many individuals who have been infected with HBV don’t know that they are infected as the
 26

disease silently damage the liver function which takes time up to 30 years to develop without

showing any sign or symptom. The knowledge of Viral Hepatitis B remains low in Nigeria, even

though it is one of the leading illnesses causing death. As a result, most people who were

infected long ago with the virus are unaware of their chronic infection and consequently failed to

seek appropriate medical attention. They are at high risk of developing severe chronic liver

disease and can unknowingly transmit the infection to other people ((FMoH, 2020; Osei et al.

2019).

Hepatitis is described as an inflammation of the liver and may occur following infection

by HBV. Hepatitis B Virus is one of a group of viruses responsible for hepatitis Samuel et al.

(2019) carried out a study of 200 health workers to determine health workers knowledge, attitude

and behaviour towards hepatitis B infection in Southern Nigeria. More than three-quarters of the

respondents (8%) had ever heard of hepatitis B and causative agent prior to the study. Of those

that were aware of hepatitis B infection, 92 per cent mentioned blood and blood products as

route of transmission and virus as causative agent of hepatitis B, 68.5 per cent mentioned needles

and sharps while 37 per cent said that the disease could be transmitted through sexual

Intercourse. Incorrectly identified routes of transmission by the respondents included facco-oral

transmission (14.2%) and transmission through drinking contaminated water (9.3%). On ways of

preventing hepatitis B infection, correctly identified preventive measures include vaccination by

a majority (77%) of the respondents. More than three-quarters of the respondents (80.9%) said

that hepatitis B Virus could be acquired as a nosocomial infection from the hospital while 69.8

per cent said that hepatitis B infection is widely transmitted like HIV/AIDS. A little more than

three-quarter of the respondents (75.5%) were aware of the existence of hepatitis B vaccine prior

to the study. Only 70.2 per cent have actually ever received hepatitis B vaccine, out of which
 27

59.4 per cent completed the vaccination schedule. Poor compliance of health workers to hepatitis

B vaccination is an issue that deserves serious attention. There was need for health education

campaigns for health workers so that they could understand the risk that they were exposed to

based on the nature of their work. They concluded that there is an overall adequate knowledge of

causative organism, mode of transmission and prevention of hepatitis B infection, positive

attitude and poor behaviours of health workers towards hepatitis B infection in Southern Nigeria.

Knowledge of Mode of Transmission of Hepatitis B Virus (HBV)

Hepatitis B Virus (HBV) is transmitted by contact with infected blood or body fluids

such as semen and the human being is the only known natural host of Hepatitis B Virus (HBV)

(Kabamba, et al. 2023). Hepatitis B Virus is highly infectious and transmission from one infected

individual to the next one is relatively easy if appropriate precautions are not taken to prevent

contact with blood or body fluids. The transmission of Hepatitis B Virus (HBV) can occur in the

general population and in a healthcare setting. Globally, there are several population groups at

increased risk of transmission of Hepatitis B Virus (HBV), and these include

a. Parenteral drug users.

b. Heterosexual men and women and homosexual men with multiple sexual partners,

c. Household contacts and sexual partners of Hepatitis B Virus (HBV) carriers,

d. Infants born to Hepatitis B Virus (HBV)-infected mothers.

e. Patients and staff in custodial institutions for the developmentally disabled,

f. Recipients of certain plasma-derived products,

g. Hemodialysis patients,
 28

h. Healthcare workers (HCWs) who have frequent contact with blood,

i. Persons born in areas of high Hepatitis B Virus (HBV) endemicity and their children

(Akazong et al. 2020).

Transmission can be classified as vertical if it is between an infected mother and her

baby, prenatal if it is immediately before and after birth, horizontal if it is through close person to

person contact, parenteral when it is via injection or other invasive medical procedures or

injuries, and sexual when it is via sexual activity (Kabamba, et al. 2023).

The main route of transmission of HBV in the general population of sub-Saharan Africa

is unexplained horizontal transmission in childhood, with sexual transmission in adolescents and

adults being the next most important route of transmission. Chronic carriage of HBV seen in

Black adults in sub-Saharan Africa is primarily from early childhood. The precise mechanism of

transmission in childhood is unclear but it has been suggested that seeping wounds may play a

part. Perinatal transmission from HBeAg positive mothers to babies plays a lesser role because

HBeAg is not common in black African women of child-bearing age (WHO, 2020).

In a hospital setting there are three main categories of HBV transmission. Patient to

patient transmission presents the greatest risk, followed by patient to HCW and lastly HCW to

patient infections is considered to be the least risky (Bensal et al. 2019). Unsafe injections such

as contaminated multiple used anesthetic vials and finger stick devices for measuring blood

glucose have been singled out as being responsible for most patient-to-patient infection. Unsafe

therapeutic injections are thought to contribute to more than 21 million cases of HBV infections

among patients annually worldwide (Akazong et al. 2020). A community-based study in Zambia
 29

found that nine out of ten children who were found to be HBeAg positive had a history of

injections (Abiiro et al. 2021)

Patient to healthcare workers transmission follows after patient-to-patient transmission in

terms of risk. With an infected source patient, the risk of infection is around 30 per cent for the

HCWs (Bhuvan and Usha, 2019). The risk of transmission of HBV from patient to Healthcare

Workers depends on other factors such as the HBeAg status of the patient. The risk of HBV

infection for a HCW after a needle stick injury (NSI) and in the absence of vaccination or post-

exposure prophylaxis (PEP) is 37- 62 per cent, if the source patient is HBeAg positive and 23-

37per cent, if the patient is HBeAg negative (Ayan et al. 2020)). A high viral load of the HBV in

the source patient, depth of injury and amount of body fluid exchanged have been found to

influence the risk of infection. It is generally accepted that a high viral load, a deep injury and a

high amount of body fluid exchanged comes a greater risk of infection with HBV (Mursy and

Mohammed, 2019). The routes of transmission from patient to healthcare workers are primarily

needlestick or sharps injuries, which account for most (80per cent) of percutaneous exposures

among healthcare workers. Other sources of exposure include broken glass, scalpels, and

splashing of blood and other body fluids (Mursy and Mohammed, 2019). As a means of

prevention and control, despite their status, all patients should be regarded as potential sources of

HBV (Samuel et al. 2019).

The factors which increase the risk of HBV infection for both Healthcare Workers and

patients include the highly infectious nature of HBV, with HBV being 10 times more infectious

than Hepatitis C virus (HCV) and 100 times more infectious than HIV (Balegha et al. 2021)

Hepatitis B Virus is also able to survive in the external environment for extended periods under

appropriate conditions, providing an opportunity for it to be transferred to others. For sub-

 30

Saharan HCWs, the risk of HBV transmission is exacerbated by the high prevalence of HBV in

the hospital population being served and, in some settings, by the lack of availability of PEP after

exposure (Samuelet al. 2019).

Differences have been found in the risk of infection among different categories of

Healthcare Workers, with those whose work involves high risk procedures such as surgeons

being at higher risk. A lack of knowledge, negative attitudes, and poor compliance to

preventative preventive practices regarding prevention and control of HBV in the healthcare

setting have been documented as contributing to the transmission of HBV (Abiiro et al. 2021). It

is transmitted through blood, semen, vaginal fluid, and mucous membranes. It is transmitted

most commonly by unprotected sexual contact, contaminated blood transfusions, unsafe use of

needles, from mother to child at birth, close household contact, and among children in early

childhood. In a dental setting, the possible modes by which HBV infection can be transmitted

include contact with blood or saliva of infected patients during dental procedures, while drawing

blood, giving injections, or suturing, as well as needlestick injuries sustained while performing

procedures (Moussa, Abdi and Abdullahi, 2021). In addition, professionals who do not wear

gloves during procedures are at a higher risk of acquiring HBV infection (Furfore et al. 2019). It

has been confirmed that HBV transmission occurs from exposure to saliva and gingival

cervicular fluid, which in turn makes dental professionals more vulnerable for HBV infection

(Ijachi et al. 2019).

Knowledge of Prevention of Hepatitis B Virus (HBV)

Prevention is the foremost strategy against the worldwide epidemic of viral hepatitis.

Concrete measures are required to educate the public regarding the risk factors involved

(Weinbaum et al., 2019). Hepatitis B is preventable through vaccination. The use of condom
 31

during sex, screening of blood before transfusion and avoidance of sharing toothbrushes, shaving

equipment like razors etc and intravenous needles play a great role in the prevention of hepatitis

B infections (Ayan et al. 2020). According to the WHO (2020), hepatitis B can be prevented in

the following ways:

1. Safe and effective vaccines are widely available for the prevention of HBV.

2. Screening blood used for transfusion can prevent transmission of HBV.

3. Sterile injection equipment protects against HBV transmission.

4. Safer sex preventive practices, including minimizing the number of partners and using

barrier (condom) prevents the contraction of HBV,

5. Harm reduction for injection drug users prevent HBV.

Knowledge of vaccine for Hepatitis B Virus (HBV) Prevention

Knowledge about the existence of a vaccine to prevent HBV has been found to be high

amongst Healthcare Workers from around the globe. For example, this was known by 100 per

cent of Saudi Arabian dental workers (Ayan et al. 2020), 98 per cent of Moroccan Laboratory

technicians, nurses, midwives, physicians, surgeons and anesthetists (Levy et al. 2019), and 77.2

per cent of Nigerian nurses, physicians, laboratory workers, pharmacists and other cadres

(Samuel et al. 2019). However, there is also an indication that HCWs may not know other

details, such as the efficacy and duration of protection. For example, out of 96 Saudi Arabian

dental workers who were vaccinated 54 had their antibody titre checked and almost half

(48.29%) of them did not know or did not bother to check whether they had seroconverted (Ayan

et al. 2020). These findings are supported by findings from an Egyptian study which revealed
 32

that 38 per cent of junior doctors and nurses didn't know the effectiveness of the vaccine and 47

per cent were not sure about the duration of protection against HBV (Yakundima et al. 2022).

Attitudes towards Hepatitis B Virus (HBV) patients/carriers

Hepatitis B virus (HBV) is a DNA virus and one of many viruses that cause viral

hepatitis; it has caused epidemics in parts of Asia and Africa (Samuel et al. 2019). The

proportion of the world's population currently infected with the virus is estimated at 3–6 per cent,

but up to a third has been exposed. Globally, it is estimated that approximately 400 million

individuals are chronic carriers of hepatitis B virus and more than a million people die annually

from HBV-related causes (Jacob, et al. 2019).

The increasing global prevalence of this disease puts extra demands on healthcare service

and increases the likelihood that healthcare workers will care for, or have personal contact with,

people with hepatitis B infections (Ayan et al. 2020). Occupational exposure from percutaneous

injuries is a substantial source of infection by blood borne pathogens among healthcare workers.

Physicians, laboratory technicians, nurses, and dialysis set personnel are the healthcare workers

at risk. Nurses are the most at-risk group because they have close contact with patients and are

more likely to be exposed to a needle stick injury (Aniaku et al. 2019)

Patients with hepatitis B have met with discrimination and stigmatization in the work

place, by family members and by members of their communities. In addition, they may face

discrimination from healthcare workers (Petrick and McGlynn, 2019). The discriminatory

preventive practices of health workers may be as result of lack of knowledge and negative

attitudes toward this kind of disease, which could interfere with their willingness to treat these

patients because of fear of contracting the disease.

 33

Attitudes towards mode of transmissions of Hepatitis B Virus (HBV)

Several studies reviewed from around the globe have found both negative and positive

attitudes among Healthcare Workers towards the risk of contracting HBV. For example, while

68.9 per cent of patients in South Africa were tested for HIV, only 10.9 per cent were tested for

HBV after a doctor had been exposed to their body fluids. Also, while 65.3 per cent of the

doctors tested themselves for HIV, only 21.7 per cent, tested for HBV after exposure, despite the

fact that HBV is at least 100 times more infectious than HIV (Osei et al. 2019). This suggests

that there may be a negative attitude about the risk of infection from HBV, with doctors not

realizing that they are at a high risk of infection after exposure to HBV. Similar negative

attitudes were found when 74.7 per cent of Nigerian dental auxiliary worker and 28 per cent of

Nigerian Dentist perceived HCWs as being at a greater risk from HIV compared to HBV (Osei et

al. 2019). Similarly, 49 per cent of UK nurses with high-risk jobs believed an NSI with a needle

contaminated with infected blood was an unlikely source of infection despite the fact that all

NSIs with infected blood should always be viewed as likely source of infection and 67 per cent

of the nurses with high-risk job disagreed with the statement that Nurses are at high risk of

exposure to Hepatitis B Virus than the other healthcare workers (Moussa et al. 2021).

In contrast, other studies have found positive attitudes towards the risk of contracting

Hepatitis B Virus (HBV) for example, 70 per cent 0f Nigerian Dentists perceived HBV as the

greatest hazard in the dental environment (Osei, Niyilapah and Amenuvegbe, 2019). Similarly,

55 per cent of dental and 74.3 per cent of medical students in Nigeria either agreed or strongly

agreed that they worry about being infected with HBV by their patients and in the same study, 67

per cent of dental students and 82.5 per cent of medical students either agreed or strongly agreed
 34

that they could safely treat patients if one first appreciates the risk and uses the appropriate

precaution measure (Moussa et al. 2021).

Attitudes towards precaution and control towards Hepatitis B Virus.

Several studies reviewed around the globe have found positive and negative attitudes

towards Hepatitis B Virus vaccine among the healthcare workers (Bensal et al. 2019). Osei et al.

(2019) pointed out that attitude was positive towards the HBV vaccine by healthcare workers as

54 per cent of Georgian nurses and physicians who said they would recommend other healthcare

workers for vaccination. Similarly, eight per cent of Moroccan nurses, technicians, doctors,

atheists, surgeons, nursing auxiliaries and midwives stated that vaccination should be made

mandatory for the same position they held, 55 per cent of them were willing to pay for

vaccination without any firm ideas of the price and 100per cent would have preferred being

vaccinated before paramedic and medical school (Osei et al. 2019).

Several other studies found negative attitudes to the HBV vaccine. For example, a

Nigerian study found that clinical staff had the lowest compliance of 39.7 per cent nurses and

40.3 per cent doctors completing HBV vaccination compared to non-clinical workers, most of

the hospital (Omotola et al. 2020). Workers who completed HBV vaccination were (76.3%)

medical records personnel and (69.5per cent) engineering staff. This indicated the possibility of

negative attitudes towards the HBV vaccine by clinical staff as they are supposed to be more

knowledgeable and expected to have the highest compliance ((Bensal, Vashisth and Gupta

2019). Similarly, 54 per cent of unvaccinated clinical students and dental staff in a Nigerian

study gave reasons of not taking up the vaccine suggesting that they were complacent and thus

may not have appreciated the importance of the vaccine (Omotola et al. 2020). In other studies,

34.7 per cent of the unvaccinated Nigerian medical students had never given HBV vaccination a
 35

thought ((Bensal et al. 2019); and out of the 22 per cent of unvaccinated American paramedics,

26 per cent feared contracting HBV from the vaccination and 20 per cent did not have time to get

vaccinated (Mursy and Mohammed, 2019).

Preventive practices regarding Prevention of Hepatitis B Virus (HBV) infection.

The prevention and control of HBV in a hospital setting involves key preventive practices

such as screening of blood and blood products, injection safety, vaccination, post exposure

prophylaxis, use of universal precautions (UPS) and compliance of healthcare workers to the

above mentioned. All of these components are important in their own right since it is often not

practical to achieve 100 per cent immunization in the whole population. This is especially so in

settings where HBV is highly prevalent, and there are resources and compliance limitations to

infection control (Halwindi, 2021).

Screening of Blood and Blood Products

Screening of blood and blood products contributes to the reduction of transmission of

HBV for patients. For example, in the USA the routine screening of donor blood for HBeAg

reduced post transfusion HB by a third (Bhuvan and Usha, 2019). Those who regularly use such

products such as hemophiliacs, who use factor VIII, are also encouraged to be vaccinated to

prevent HBV infection, as an additional safety measure since the current testing for HBV does

not guarantee100 per cent safety of these products (Halwindi, 2021). The safety of blood and

blood products largely depends on the quality of laboratory testing. This means quality of testing

in terms of the policies and protocols, markers of HBV screened for, and training and

qualifications of personnel have to of the highest standard.

 36

The World Health Organization (WHO) recommends that blood and blood products

should be screened for at least the HIV, HBV, HCV and syphilis as a minimum requirement

(Balegha, Yidana and Abiiri, 2021). Worldwide, 148 countries provided WHO with their data for

screening blood, and 41 of these indicated that they could not screen all the donated blood for

one or more of the recommended pathogens. The report indicated that out of the 40 countries in

sub- Saharan Africa, 28 had not yet implemented national quality systems that need to be in

place for effective screening of blood and blood products (Balegha et al.2021). It is important to

have a fully implemented national policy of screening all blood donations for HBV. Of the

literature consulted only Kenya, South Africa, Tanzania, Zambia and Zimbabwe are reported to

have such policies (Osei et al.2019)

It is estimated that 3.22 per cent of blood doors in sub-Saharan Africa are chronic carriers

of HDV therefore screening of blood and blood products is critical to prevent infection of the

recipients of these products. The WHO estimates that no more than 50 per cent of blood donated

in sub-Saharan Africa is screened for HBeAg. This is partly because screening is not perceived

to be of primary importance or cost effective in se African countries since 50 per cent of blood

donors and recipients have had natural exposure to HBV, thus most donors are thought not to be

infectious, and most recipients are thought too, not be susceptible. Lack of funds is another

contributory factor (Abiiro et al. 2022). According to WHO, lack of effective screening results

in 16 million cases of HBV annually is the whole world (Levy et al. 2019). In recent study to

assess the risk of transfusion-transmitted infections in sub-Saharan Africa it was found that even

if the transfusion requirements recommended by WHO were met, transfusions alone would be

responsible for 28 595 HBV infections annually in sub-Saharan Africa (Abiiro et al. 2022).
 37

Some African countries including Nigeria screen for HBV using HBsAg only. Detection

of anti-HBc is considered by some of these countries to be of limited value since HBsAg appears

first and disappears in most non- infectious cases. So, for them it appears to serve a diagnostic

purpose only, with little regard for the prognosis. However, during resolution of infection and

occult HB. HBsAg may decline to undetectable levels but the donor in both instances may be

potentially infectious (Aniaku et al. 2019). Occult HBV infection is defined as the detection of

HBV DNA without HBsAg, with or without the presence of HBV antibodies outside the acute

phase window period. It has also been demonstrated that occult HB donors with anti-HBs or anti-

HBc are infectious in immuno-compromised organ or bone marrow transplant patients (Abiiro et

al. 2022). It is of value to test for anti-HBc in such situations, but it would be also necessary to

distinguish between non-infectious individuals who have resolved their infections naturally and

those who are potentially infectious. Because of the high cost of testing for circulating HBV

DNA, it is recommended to test for a substantial amount of anti-HBs since these antibodies

confer immunity to the individual. A minimum of 100mIU/ml is considered essential to

guarantee safety of blood and blood products. Ideally African countries should be testing for

HBsAg, anti-HBc and anti-HBs to reduce the cases of post transfusion HBV infection (WHO,

2020).

Injection safety

The World Health Organisation defines safe injection as one that does not injure the recipient,

does not expose the HCW to any preventable risk, and does not result in any waste that is likely

to cause great harm to the community (Abiiro et al. 2022). Injections have become one of the

frequently used procedures in healthcare. Patients go as far as requesting for them as they believe

medication is received stronger and faster. Doctors prescribe them with the belief that it will
 38

satisfy the patient. Over 70per cent injections given in some stances in a healthcare setting are

unnecessary or could have been given in an oral formula, as nine out of ten patients receive an

injection (Bhuvan and Usha, 2019)

There is no harm caused by a safe injection. Harm only results once safe control

measures are not preventive practiced, predisposing to severe infections. Harm results when

syringes and needles are re-used in the absence of sterilization as seen in some areas in

developing countries. Unsafe injection use occurs when needles or syringes have been repeatedly

used, a preventive practice that often occurs in impoverished countries (Jacob, et al. 2019).

Common preventive practices that are seen in most countries that expose HCWs to HBVs

are poor collection and disposal of dirty injections. There are several suggestions that have been

made to prevent and limit sharps injuries among HCWs, for instance, health education for

behaviour change (eg. not recapping needles), introduction of barriers to protect the HCW, safe

techniques and devices (e.g. needleless and self-sheathing equipment) and improved

organizational factors (eg. better staffing levels) (Omotola et al. 2020). Notwithstanding, unsafe

injection preventive practices are a powerful source to transmit blood-borne diseases, HBV.

Because infection with these viruses initially presents no symptoms, it is a silent epidemic.

However, the consequences of this are increasingly recognized as a global challenge. It is

indicated that each year unsafe injections cause an estimated 1.3 million early deaths, a loss of 26

million years of life, and an annual burden of USD 600 million in direct medical costs (Bhuvan

and Usha, 2019).

 39

Gloves

The gloves are worn to provide a protective barrier to prevent contamination of hands

when touching blood, body fluids, secretion, excretion, mucous membranes and non-intact skin.

The gloves are worn to reduce the risk of exposure to blood borne pathogens, transmission of

microorganism present on hands of HCW to patient. However, wearing gloves does not replace

the need for hand washing, since gloves may have small, unapparent defects or may be some

during use and hands can become contaminated during removal of gloves (Giao et al. 2019

Gowns

They are worn to prevent contamination of clothing and to protect the skin of Healthcare

Workers (HCWs) from blood and body fluid exposures HCWs wear gowns during the care of

patients infected with pathogenic microorganisms and where there could be splashes of human

blood and body fluids. This is done to reduce the opportunity for transmission of pathogens from

the patient to the environment (Levy et al. 2019).

Shoe covers

Leg coverings, boots or shoe covers provide greater protection to t splashes or large

quantities of infected material are present or anticipated (Furfor et al. 2019) Mask, goggles and

face shield: These are work ale or provide a barrier protection during procedures that are likely to

generate splashes of blood or body tide (Giao et al. 2019).

Hand washing

In addition to using barriers, hand washing is to reduce transmitting microorganisms to

patients or healthcare Workers (HCWs). Hands should be washed properly and thoroughly
 40

between patient contacts and after act with blood, body fluids, secretions, excretions, and

equipment contaminated by them (Giao et al. 2019)

Safer medical devices

This includes medical devices used for avoiding mapping needles and disposing of them

promptly in appropriate sharps disposal costs. Healthcare workers should report petals oodles

and help their facility to select and evaluate safety devices. Needle stick injuries or other

exposure to blood or body fluids should be reported immediately to ensure appropriate follow up

(Giao et al. 2019).

Isolation

Contact precautions are designed to reduce the risk of transmission of pathogenic

organisms. Patients should be placed in private rooms or room with a patient who has active

infection with the same microorganism. Healthcare Workers should wear clean gowns, gloves,

and masks, and equipment used should be thoroughly cleaned and disinfected before used on

another patient (Giao et al. 2019).

Post Exposure Prophylaxis

Following exposure to potentially HBV-infected body fluids, the exposed part of the

body should immediately be washed with water and soap. The source patient must be tested for

HBsAg, and if the HBV status of the HCW is unknown, the HCW should be tested for both

HBsAg and anti-HBs (Balegha, Yidana and Abiiri, 2021). If the exposed HCW is found to be

anti-HBs negative, he/she should be given hepatitis B immunoglobulin G (HBG), followed by

initiation of the HBV vaccine series for both unvaccinated HCW's and HCWs who are

vaccinated but are non-responders (Bhuvan and Usha, 2019).

 41

Hepatitis B vaccination

The most efficient method of preventing several hospital-acquired infections such as

HBV is through pre-exposure immunization, in 1981, the first hepatitis B vaccine was produced.

It was derived from donated human Blood Plasma (known as Plasma-Derived Vaccine PDV) In

1986 the PDV was approved for human, but has been largely superseded by the y combatant

vaccines such as Engerix, which contain HBsAg only (Furfor et al. 2019).

All of these vaccines have proved highly efficacious, and most vaccinated individuals

protected against Hepatitis B Virus for at least twenty years (Balegha et al. 2021). Although

some individuals may lose protective anti HBs (ie titres equal or greater than 10ml/ml) over time,

they remain protected from the disease by the immunologic memory cells of the immune system

which produce an anamnestic response upon exposure (Abiiro et al.2022).

In 1991, the World Health Organization (WHO) recommended that the HBV vaccine

should be introduced into the expanded Program on Immunization (EPI) and this has been

achieved in Nigeria since April 1995 (Yakudima et al. 2022). The Hepatitis B Virus (HBV)

vaccine is given at six, ten and fourteen weeks; this prevents the infants from becoming infected

with HBV, thereby bringing down the HBV carriage rate of SA (Abiiro et al. 2022).

Healthcare workers (HCWs) need to be protected against HBV by being vaccinated. The

vaccine is safe and effective and it can protect one for a lifetime. Unfortunately, it has been

shown that a large number of HCW's in developing countries are not vaccinated against HBV as

demonstrated by the following studies (Akazong, et al. 2020). A study of 554 HCWs conducted

in Kenya to establish their immunization status, found that only 12.8 per cent (71/554) of HCWs

had received vaccination previously and none had been screened for immunity or hepatitis B
 42

surface antigen (HBsAg) (Abiiro et al. 2022). In this study 55 per cent of healthcare workers

were unprotected, thereby predisposing them to Hepatitis B virus infection.

These results are consistent with those found in the study done in Johannesburg, South

Africa, which found only 21.2 per cent of HCW's had a history of past immunization against

Hepatitis BVirus, although 30.6 per cent were immune either from past vaccination or natural

infection (Bansal et al. 2019). In contrast to these low vaccination rates, a study on South African

doctors in Bloemfontein found that $per cent had previously been vaccinated (Ijachi et al. 2019).

It is also important for Healthcare Workers (HCWs) to complete the full vaccination

schedule, and to check their HBV immune status thereafter. Although it was found that 93.3 per

cent of HCWs had been vaccinated in a study done in Iran, 23.7 per cent had not completed the

full vaccination schedule, and only 56.8 per cent had checked their antibody levels (Abiiro

2022). Similarly, in a study conducted in Egyptian HCWs, it was found that 40,6per cent had

received only 1 dose, whilst only 29 per cent had received all 3 doses (Singh and Jain, 2011). In

addition, the study done in Birmingham demonstrated that only 40 per cent of HCWs were fully

vaccinated against hepatitis B. Amongst the HCWs who were partly vaccinated, the most

common reason that was given for not having completed the vaccination course was that it had

been forgotten (Balegha et al. 2021).

The importance of checking antibody levels after vaccination is illustrated by the South

African study carried out in Bloemfontein, where it was found that 8per cent of doctors exposed

to NSIs said they had previously been vaccinated against hepatitis B infection. Moreover,

amongst HCW's that were exposed to an NSI, there were two of them that seroconvert, and it

was found that they had not been previously vaccinated. Seemingly, most assumed they were
 43

immune since only 21.7per cent underwent serological testing for HBV directly after the NSI

(Balegha et al.2021).
 44

Below is the schematic representation of the Conceptual frame work

Concepts

Knowledge Attitudes Preventive practices

Healthcare Workers

Hepatitis B infection

Hepatitis B Virus

Healthcare Worker Demographic Variables

- Gender
- Marital Status Educational Qualification
- Profession
- Ethnicity
- Years of work experience
-

Preventive Preventive practice Measures

- Injection safety
- Use of gloves, gowns, shoe cover
- Hand Washing
- Safer medical devices
 45

- Isolation
- Post exposure prophylasis
- Hepatitis B vaccination
Figure 1 Conceptual frame work

Theoretical Framework

Theories and Models play a vital role in health and educational research especially in

predicting health behaviour. A theory May be viewed as a system of construct and variable

which the constructs are related to each other by proposition and the variables are related each

other by hypotheses (Wacker,1998). Therefore, theories and Models are used to understand any

predict how and why people change their negatives behaviour towards positive healthy living.

There are many theories and Models used in health education but for the purpose of this study,

theory of Reasoned Action (TRA) and Health Belief Model (HBM) were anchored.

Theory of Reasoned Action

The theory of reasoned action was propounded by Ajzen and Fishbein in [Link] theory

aims to explain the relationship between attitude and behaviours within human action. It mainly

uses to predict how people will behave based on their pre-existing attitudes and behavioural

intentions. An individual's decision to engage in a particular behaviour is based on the outcomes

that he or she expects that will come as a result of performing the behaviour. A person's intention

to perform a behaviour is the main predictor of whether or not he or she performs that behaviour.

The model predicts the behaviour based on seven causal variables; behavioural intention,

attitude, subjective norm, belief strength, evaluation, normative belief, and motivation to comply.

Behavioural intentions that a person's plans prior to action and motivation to comply behavioural

intentions that a person's plans prior to action and motivation or desires are the immediate
 46

predictor of one's behaviour. For example, people are unlikely to study if they do not intend to

Study. The intentions are not independent but result from underlying attitudes and subjects’

norms. An attitude is a general orientation toward behaviour based on a variety of beliefs and

evaluations. For examples if one strongly believes that unprotected sex can cause pregnancy and

does not want to have a baby, this person will probably have a behavioural intention to use

contraceptives. Similarly, if a Healthcare worker believes that not wearing of hand cloves can

result to contacting of Hepatitis B infection and doesn't want to contact it, he or she will probably

have a behavioural intention to use preventives measures. Subjective norms are composed of

normative beliefs (i.e., the view of others regarding the behaviour) and motivation to comply

(i .e, pressure to please others regarding the behaviour). Subjective norms and motivation to

comply are relative, as one group than by another may influence a person. For example, regards

condom use, a partner's normative beliefs may outweigh parental normative beliefs.

According to this theory, a person's intention to perform a specific behaviour is a function of

two factors: attitude (positive or negative) towards the behaviour. The attitude towards behavior

is determined by the person's belief that brings about the outcome in the same vein. Social or

subjective norms are determined by the person's normative belief regarding what others think he

or she should observe or do, and motivation to comply with what those other peoples' wishes or

desires. In this theory, attitude is a function of belief. For instance, if a person believes that

performing a certain behaviour will bring about a positive outcome, then he or she will hold on

unfavorable attitude towards performing that behaviour. In contrast a person who believes that

performing a particular behaviour will lead to a negative outcome he or she will hold

unfavorable attitude towards performing such behaviour. These beliefs that form a foundation of

a person's attitude towards the behaviour is determined by his intentions to perform the
 47

behaviour and his or her subjective norm. All these provide a work for studying individual

behaviour, attitude and intentions that influence knowledge.

This theory is related to the knowledge, attitude and preventive practice of healthcare workers

regarding Hepatitis B infection because if Healthcare workers have a good attitude and

preventive practice using of hand cloves and other preventative measures towards Hepatitis B

infection, they may eradicate the menace of Hepatitis B infection in the communities. If people

evaluate the suggested behaviour as positive(attitude) and if they think others want them to

perform the behaviour (subjective norm), it results in a higher intention (motivation) and they are

more likely to perform the therefore, if the Knowledge, attitude and preventive practice of

healthcare workers regarding Hepatitis B infection is positive it will enhance impact toward

preventive measures. On the other hand, If Knowledge, attitude and preventive practice of

healthcare workers regarding Hepatitis B infection is negative it will result into increasing in

hepatitis B infection in the world. This theory could, therefore, be applied in the present study to

determine knowledge, attitude and preventive practice of healthcare workers regarding Hepatitis

B infection in Benue South Senatorial District, Benue State

Health Believe model

The health belief model one of the more widely researched models pro pounded by Irwin

Rosenstock in [Link] model aim to predict preventive health behaviours and the behavioural

response to the treatment of the acute or chronic condition of the patient. It also focused on the

relationship between health behaviour, preventive practice, and utilization of health services.

According to the theory, a person's health behaviour depends on his perception of critical

variable: perceived benefits, perceived barriers, cues to action and self-efficacy. In response to

criticism, the model was revised to add one Construct "motivation”. perceived susceptibility
 48

refers to one's subjective ability to be susceptible would take health strategies such as avoidance

of any risk of the disease or health problems. And will greatly influence his or her decision and

ability to sustain a changed behaviour. Perceived severity is a person's feeling concerning the

seriousness of contracting a disease or health problem. These two elements represent a single

Construct known as a perceived threat which indicates that the more vulnerable a person feels,

the more he or she motivated to take action or reduce the threat. Perceived benefit refers to belief

towards the effectiveness of available health action to reduce the perceived threat of the disease.

Perceived barrier refers to the strongest predictive factors for behavioural change. It is a personal

belief that the benefit outweighs the barriers and then he or she is more likely to take action to

change. Cues to action, which are instruction or reminders, can also be used to facilitate change.

Self -efficacy refers to a person's belief that he or she can engage in a behaviour.

Many researchers to predict preventive health behaviours have utilized the health models

successfully. Prochaska, Declemente and Norcross (1992) explained susceptibility and perceived

benefit are essential overall predictor and variables. Perceived susceptibility is the strongest

predictor of preventive health behaviour, whereas perceived benefit is the strongest predictor of

the sick role. This model is related to preventive practice of hepatitis B infection because if

healthcare workers have knowledge of risk factors, sign and symptom of hepatitis B infection

they may perceive that their clients may be susceptible and if the disease conditions are serious,

they will decide to health educate them to change their lifestyle and hold favourable belief

towards its preventive’s preventive practices. This model can be applied for knowledge, attitude

and preventive practice of healthcare workers regarding Hepatitis B infection in Benue South

Senatorial District, Benue State.

Below is the schematic representation of the Theoretical frame work

 49

Models

Health Belief Model

Theory of Reasoned Action
- Perceived severity
- Knowledge
- Perceived benefit
- Attitudes
- Perceived barrier
- Preventive
- Perceived susceptibility
Preventive practice
- Cue to action Measures
- Self efficacy

Hepatitis B Virus Infection

Healthcare Workers

Figure 2: schematic representation of the theoretical frame work

2.4. Empirical Studies.

Fufor, Cook and Kirfi (2019) carried out a study on Health Workers’ Knowledge,

Attitude and Preventive practice towards Hepatitis B Infection in Northern Nigeria. The aim of
 50

the study was to investigate the relationship between knowledge, attitude and preventive practice

among healthcare workers towards hepatitis B infection in Northern Nigeria. The study used a

cross-sectional survey with self-administered questionnaire to gather informationfrom an Ear,

Nose and Throat health-care professionals in a tertiary hospital in Northern Nigeria. The data

collected was coded and analyzed using SPSS software version 20.A similar numbers of males,

49.5per cent (53/107), and females, 50.5per cent (54/107) took part. The overall correctly

answered knowledge question by the professions was 76.9per cent. A one-way ANOVA between

participants showed that there were significant difference between the profession groups in terms

of knowledge scores (F4, 102 = 11.5, P< 0.001) and in terms of preventive practice scores

between the groups (F4, 102 = 4.1, P< 0.01); however, there was no significant difference in

attitude between the professional groups (F4, 102 = 0.6, P=0.68). Multivariate analysis showed

that health attendants had the best preventive practice score and did not differ significantly to

doctors (β = −0.1, t = −0.9, P= 0.40). The findings suggest that there is a gap in knowledge and

lack of compliance to infection control and preventive measures among health-care

professionals. There should be an increased in awareness through campaigns geared towards

educating health-care personnel on the dangers of hepatitis B infection.

Mursy and Mohamed (2019) carried out a study on Knowledge, attitude, and preventive

practice towards Hepatitis B infection among nurses and midwives in two maternity hospitals in

Khartoum, Sudan A cross-sectional descriptive hospital-based study was conducted in two public

maternity hospitals (Saudi and Saad Abul-Eleella hospitals) in Khartoum state of, Sudan. A pre-

tested structured questionnaire was constructed and implemented to examine KAP towards HBV

infection. Statistical Package for Social Sciences (SPSS) version of 21 was utilized to conduct

statistical analysis and examine the data at hand. Chi-square test was used implemented to

determine the relationship between categorical variables. The results showed that A total of 110
 51

nurses and midwives from the both hospitals participated in this study. More than half of the

respondents (58.2per cent) had an average level of knowledge, two-third of the respondents had a

safe preventive practice, and the majority of the respondents had a favourable attitude towards

HBV preventive measures. Approximately half of the participants (51.8per cent) had a history of

needle stick injuries. Half of the participants had inaccurate concepts about post exposure

prophylaxis to HBV infection, while more than half of the nurses and midwives didn’t complete

the vaccination schedule for HBV. Most of the nurses and midwives in Saudi and Saad Abul-

Eleella hospitals were aware of HBV infection. However, a significant proportion of the

participants lack the requisite knowledge about post exposure management. The study revealed a

low level of HBV vaccination coverage rate and a high rate of needle stick injuries. Further

strategies for preventing workplace exposure, training programs on HBV infection, including

post exposure prophylaxis, and increasing vaccination coverage rate of all HCWS are highly

recommended.

Balegha, Yidana and Abiiro (2021) carried out a study on Knowledge, attitude and

preventive practice of hepatitis B infection prevention among nursing students in the Upper West

Region of Ghana: A cross-sectional study. The purpose of the study was to assess the

knowledge, attitude and preventive practice of HBV infection prevention and the factors

associated with the preventive practice of HBV infection prevention among nursing students in

the Upper West Region of Ghana. A cross-sectional survey method was used for the study to a

stratified random sample of 402 nursing students in two nursing training colleges in the Upper

West Region. Using STATA version 13, composite scores of knowledges, attitude and

preventive practice of Hepatitis B Virus infection prevention was computed with maximum

scores of 18 for knowledge and 8 each for attitude and preventive practice. A generalized

ordered logistic regression model was run to assess the factors associated with the preventive
 52

practice of HBI prevention. The Knowledge Attitude Preventive practice scores of HBV

infection prevention among the students were sub-optimal. It was recommended that, institution-

based policies and regular education on HBV infection prevention, free/subsidized HBI

prevention services, and the enforcement of proper professional ethics on HBV infection

prevention in nursing training colleges. Such interventions should predominantly target female,

non-married and first year nursing students.

Khuwaja, Qureshi and Fatimi (2020) carried out a study of 500 patients to assess their

level of knowledge and attitude towards Hepatitis B and Hepatitis C in a public sector hospital,

especially with reference to educational level. Amongst them 280 were males and 220 females.

Only 10per cent males and 5.9per cent females were educated beyond primary level, and 20.4per

cent males and 10per cent females to primary level, while 76per cent were illiterate. Patients

educated beyond primary level had more knowledge than illiterate persons about the condition,

especially regarding the cause. organ of involvement, prevalence in society, presentation, and

vaccination for Hepatitis B. one alarming thing found in this study was lack of knowledge about

risk factors, especially amongst illiterate persons. There was also lack of responsibility and poor

attitude of even educated persons towards the treatment of these diseases. Both literate and

illiterate persons were following customs of community and relying on homeopathic or herbal

medicines for their treatment. They concluded that there is a significant lack of knowledge and

poor attitude of people towards Hepatitis B and Hepatitis C in this area.

Samuel, Aderibigbe, Salami and Babatunde (2019), carried out a study of 200 health

worker to determine health workers knowledge, attitude and behavior towards hepatitis B

Infection in southern Nigeria. More than three-quarters of the respondents (8per cent) had ever

heard of hepatitis B infection and the causative agent prior to the study. Of those that were aware
 53

of hepatitis B infection, 92per cent mentioned blood and blood products as route of transmission

and virus is the causative agent of hepatitis B 68.5per cent mentioned needles and sharp while

37per cent said that disease can be transmitted through sexual intercourse incorrectly identified

routes of transmission by the respondents include face-oral transmission (14.2per cent) and

transmission through drinking contaminated water (9.3per cent). On way of preventing Hepatitis

B infection correctly identified preventive measures include vaccination but a majority (77.2per

cent) of the respondents. More than three-quarter of the respondents (10.9per cent) said that

hepatitis B infection is widely transmitted like HIV/AIDS. A little more than three quarter of the

respondents (75.5per cent) were aware of the existence of hepatitis B vaccine prior to the study.

only 70.2per cent have already ever received hepatitis B vaccine out of which 99.4per cent

completed the vaccination schedule. few compliances of health workers to hepatitis B vaccines

are an issue that deserve serious attention. There is a need for health Education campaign for

health workers so that they can understand the risks that they are exposed to harm on the nature

of their work. They concluded that there is an overall adequate knowledge, positive attitude and

poor behavior of health workers towards hepatitis B infection in Southern Nigeria.

Chan, Wang and Yu, (2019), carried out a study of One Hundred and Twenty-One (121)

women of 20 to 50 years attending Obstetrics and Gynecology clinic at Isra University Hospital

Pakistan to find out the level of awareness of Hepatitis B infection. Information was collected

through predesigned questionnaire containing questions regarding basic knowledge of the

disease, causative organism, route of transmission and its prevention. All the data were analyzed

in computer Software Programme of Social Sciences (SPSS. Version 11.0), out of one hundred

and twenty-one women, (67.76per cent) women currently responded that virus is the cause of

Hepatitis. When they were asked about the organs affected by Hepatitis B infection, 91 (75.2per
 54

cent) correctly mentioned liver, which 30 gave incorrect answer. Regarding mode of

transmission Hepatitis B Virus, 41(33.53per cent) mentioned infected blood transfusion,

49(40.49per cent) mentioned contaminated needle, 46(38.0per cent) mentioned unsterilized

instrument, 21(17.3per cent) mentioned from mother to child and only 23(19.0per cent)

mentioned sexual intercourse. Only 51(42.14per cent) women knew that vaccine is available for

prevention. They concluded the knowledge about Hepatitis B Virus among women is inadequate

and there is certain misconception regarding it mode of transmission through sharing room,

touching etc. which needs to be clarified.

Butler, Mills, Yang and Chen (2019), carried out a study of Three Hundred and Ninety-

Five (395) Chinese Health Workers in Seattle United State to find out Chinese health workers in

Hepatitis B knowledge, testing and vaccination level. Less than one half (48per cent) of the study

group indicated they had received Hepatitis B blood test, and above one third (3per cent)

indicated they had been vaccinated against hepatitis B. the proportion of respondents who knew

HBV can be spread during child birth, during sexual intercourse, and by sharing razors were

70per cent, 54per cent and 55per cent respectively. Less than one-quarter of the study group

knew that HBV cannot be spread by eating food that was prepared by an infected person and HB

infection is cause by virus (75per cent) and by sharing eating utensils with an infected person

(16per cent). They concluded that there is remarkable knowledge about causative organisms and

routes of transmission of hepatitis B among Chinese health workers.

Afsar, Barney and Mahmood. (2019), carried out a study of two hundred and sixty-seven

(267) students of a private medical university in Karachi to determine and assess the level of

awareness among students regarding HIV/AIDS, Hepatitis B and C A total of 267 students

participated, with 117 (43.8per cent) students from pre-clinical years and 150 (56.2per cent) from
 55

the clinical years. The male-female ratio was 1:2, mean age of respondents was 21+ 1.5 years.

Majority of the students (98per cent) agreed that an infected person is a major source of

transmitting these infections. Almost all (95per cent) students knew that blood transfusion was

an important source of transmitting these infections. Wearing gloves (87per cent) and safe

disposal of sharps waste (98per cent) were known by the students to be the way to protect against

these infections. A significant difference was noted on comparing the knowledge between pre-

clinical and clinical students regarding medical surgical procedures causing these infections and

also regarding the ways to protect against these diseases and they conclude that there is a lack of

awareness among the medical students entering in to the profession. It is the need of the hour to

emphasize on practicing universal precautions. In addition, some preventive measures should be

taken by the management of the university and medical students to avoid the occurrence of these

problems.

Ajum, Siddiqui, Ahmed, Rizvist and Usman, (2019), carried out a study of one hundred

and eighty-seven (187) male medical students of Isra University Hyderabad Sindh Pakistan to

assess their knowledge about Hepatitis B in their pre-clinical and clinical years and to investigate

the self-reported vaccination status of these students. Out of 187 interviewed, 73(39per cent) and

114(6per cent) were from pre-clinical and clinical years respectively. The mean age of the

respondents was 21.4 1.8 years 181(96.8per cent) students had heard of hepatitis B disease and

168(89.8per cent) about hepatitis B vaccination, Majority of the students 174(93per cent) knew

that hepatitis B was a preventable disease and this fact was appreciated more by clinical students,

111(97.4per cent) than the pre-clinical 63(86.3per cent) students. Smaller number of students

9550.8per cent) knew about post exposure treatment availability for hepatitis B. Low level of

knowledge about post exposure treatment availability for hepatitis B was found in both pre-
 56

clinical and clinical groups. 138 (73.8per cent) students were vaccinated for hepatitis B 49

26.2per cent) were not vaccinated. When the students were asked about source of information,

70(22.6per cent) had received information from teachers, 67 (21.6per cent) from books,

46(14.8per cent) from media while in 38 (12.3per cent), 18(5.8per cent) and 109.7per cent) the

source of information was friends, family members relatives and internet respectively.

83(30.4per cent) students recognized surgeons as the groups of people at risk to acquire hepatitis

B infection, 57(20.9per cent) and 72(26.4per cent) knew risk for paramedical staff and

commercial sex workers respectively, while only 9(3.3per cent) students knew that medical

students are at risk of acquiring infection. They concluded that there is a significant difference in

the knowledge of pre- clinical and clinical groups of male students was observed.

Lok. McMahon, (2019), carried out a study in the Department of Gastroenterology. SCB

Medical college and Hospital at Cuttack in Coastal Eastern India to find out the awareness

amongst the general population about hepatitis B virus, including knowledge regarding vaccine.

In all, 682 individuals (65per cent patients. 35per cent non-patients) were studied, 78per cent

were males while 22per cent were females. Majority were in the age group of 31-40 years. 65per

cent hailed from rural area, 65per cent were poor. About half of the subjects attended state num

medical centers for medical attention, only 17per cent preferred medical colleges Awareness

about the disease and its vaccine among the subject was 38per cent and 12per cent respectively.

50per cent of those who were aware had no knowledge about route of transmission, infectivity,

or importance of vaccination. Educated individuals were more aware about hepatitis B vaccine.

Those who read newspaper and listened to radio were more aware about hepatitis B and its

vaccine. The percentage of vaccination us 20per cent among study subjects, but in 30per cent,

their children were vaccinated. The common reason for non-vaccination was lack of awareness

(50per cent) of them, 60per cent blames government/doctors/media for their ignorance. Majority
 57

(56per cent) received the vaccine from government hospitals of health centers. Only 10per cent

obtained vaccination from private centers Reasons cited for non-vaccination included ignorance

(50per cent), carelessness (12per cent), high cost (10per cent) and non-availability (6per cent).

Source of information regarding hepatitis B included television (75per cent), newspaper (55per

cent), and radio (26per cent), and they conclude that only about one-third of the population in

Coastal Eastern India are aware about hepatitis B and its vaccine. Less than a third of the

populations are vaccinated for hepatitis B. The educated, especially those who read newspapers

and listened to radio, were more aware about the disease/vaccine. The government health

agencies and physician should work together to educate the masses about hepatitis B and its

vaccine.

Thompson. Taylor and Jackson, (2020), carried out a study of seven hundred and fifteen

Vietnamese American health workers (345 men and 370 women) in Seattle United States to

describe Vietnamese Americans' awareness of hepatitis B. level of hepatitis B testing, and

knowledge about hepatitis B transmission, and to compare the hepatitis B virus knowledge and

preventive practices of health workers. 8per cent of the respondents had heard of hepatitis B

(76per cent of nurses,86per cent of doctors) and 67per cent reported hepatitis B virus testing

(66per cent of nurses, 68per cent of Doctors). A majority of the participants knew that hepatitis B

virus can be transmitted during sexual intercourse (7per cent of doctors, 68per cent of nurses), by

sharing toothbrushes (67per cent of doctors, 77per cent of nurses), and by sharing razors (59per

cent of nurses, 67per cent of doctors). Less than one-half knew that hepatitis is not spread by

eating food prepared by an infected person (46per cent of doctors, 27per cent of nurses), nor by

coughing (39per cent of doctors, 25per cent of nurses). One third of the respondents did not

recall being tested for hepatitis B virus. They conclude that there is a knowledge deficit about

routes of transmission of hepatitis B virus among Vietnamese American health workers and
 58

continued efforts should be made to develop and implement hepatitis B educational campaigns

for Vietnamese immigrants’ communities which should be tailored to male and female

audiences.

Bhuvan and Usha, (2019) carried out a study on Knowledge, attitude, and preventive

practices of hepatitis B infection among dental students in the Department of Oral Pathology and

Microbiology, JSS Dental College and Hospital, JSS University, Mysuru, Karnataka, India. The

objective of the study was to assess the knowledge, attitude, and preventive practices of dental

students about HBV infection at a private dental institution in Mysore, Karnataka, India. A cross-

sectional survey was conducted using a pretested, structured, and validated questionnaire

containing 16 questions on awareness, transmission, prevention, diagnosis, treatment,

vaccination status, and post exposure prophylaxis of HBV infection. Descriptive statistics were

carried out along with chi-square test and contingency coefficient. The response rate was 100per

cent (n = 486). A total of 88.7per cent of the students knew about the transmission of HBV

infection. Only 64per cent students were immunized against HBV. Majority of the students

([Link] cent) agreed for vaccination against HBV infection. Only 28.4per cent students knew

about the post exposure treatment against HBV infection. About 58.8per cent students knew

about the preventive measures against HBV infection. It was concluded that the overall

awareness regarding HBV disease was found to be lacking among the dental students.

Yakudima, Magaji and Abdulkarim (2022), carried out a study on Knowledge, Attitude and

Preventive practice Towards Hepatitis B Infection of People in Part of Jigawa State, Nigeria. The main

purpose of the study was to analyze Knowledge, Attitude/Perception and Preventive practice of the

people toward hepatitis B infection in four local governments of Regime Emirate, Jigawa State. The data

were obtained using questionnaire instrument and organized and processed in SPSS version 20 and

analyzed using descriptive statistics and inferential statistics. The result shows that very few (4.9per cent)
 59

people showed good level of knowledge of the infection, and only very few (3.4per cent) show

knowledge of good preventive practice. The result also shows correlation coefficient of 0.917 indicated a

positive correlation between knowledge scores. The findings also revealed that there is no statistically

significant different between educational level and knowledge of Hepatitis B (p=.336). However, there is

statistically significant difference, (p=.000) among other items of socio- demographic characteristics. The

study suggested that public health education is needed to improve knowledge, attitude and preventive

practice on hepatitis B. Implementation of community mass media health education programme to raise

the awareness and the knowledge about hepatitis B using all forms of media especially radios. Healthcare

providers who are involved in the hepatitis control programme need to set schedule to provide education,

increase awareness of contact case screening, early identifying and treating hepatitis infection especially

hepatitis B. This will help to in prevention and controlling of the infection.

Ayan, Abdkeren and Sherif (2020) carry out a study on Assessment of knowledge, attitude and

preventive practice of healthcare workers towards Hepatitis B virus infection in Mogadishu, Somalia: A

Cross-Sectional Study. The study aims to assess the knowledge, attitude and preventive practice (KAP)of

healthcare workers (HCW) towards HBV infection in Mogadishu, Somalia. The cross-sectional study was

conducted on HCW to assess KAP towards HBV infection. Standardized questionnaires were distributed

to 470 HCW recruited for the study from five hospitals. Data for demographic characteristics were

described using percentages. Scores for KAP were presented as mean ±standard deviation. Mann-

Whitney U and Kruskal-Wallis tests were used deduce inferences between the mean KAP and

demographic characteristics of the participants. Spearman’s rho correlation was used to determine any

association between the KAP of the HCW. Results of the 470 distributed questionnaire,

430questionnaires were returned with a response rate of 91.5per cent. Majority (73per cent) of the

participants had tertiary education. The mean scores for KAP were 16.3±4.4, 6.9±0.4, 7.03±1.5

respectively. Significant (P<0.01) positive correlation between the KAP variables were observed.

Professional cadre and marital status were found to be associated with mean KAP (P<0.001). The study
 60

revealed an acceptable level of KAP among the HCW and a potential source of participants for awareness

campaign against HBV infection in Somalia.

Debaka, Dagnanch, Teklehaimanot and Biruk (2021) carried out a study on Knowledge,

Attitude, Preventive practices, and Associated Factor towards Hepatitis B Virus Infection among

Healthcare Professionals at Tibebe Ghion Specialized Hospital, Bahir Dar, Northwest Ethiopia, 2021: A

Cross Sectional Study. The main aim of this study was to assess the knowledge, attitude and

preventive practice, and associated factors towards hepatitis B virus (HBV) infection among

healthcare professionals at Tibebe Ghion Specialized Hospital, Bahir Dar, Northwest Ethiopia,

2021. The method employed was an institutional-based cross-sectional study design was at

Tibebe Ghion Specialized Hospital, Bahir Dar, in 2021, and a systematic random sampling

technique was used from different professionals, and the separate sample was taken

independently from each. A pretested structured questionnaire was constructed and collects data

then analyzed by using SPSS version 23. Result. A total of 422 healthcare workers having

different professions have participated in this study. 243 (57.6per cent) of the study subjects were

males. The average correctly answered knowledge, attitude, and preventive practice questions

were 65.6per cent, 40.3per cent, and 34.8, respectively. Multivariable logistic regression analysis

showed that being nurse professionals (AOR = 0:17 (0.07, 0.38), P < 0:001), midwives (AOR =

0:19 (0.07,0.5), P = 0:001), and work experience (AOR = 2:37 (1.38, 4.02), P = 0:002) were

associated with knowledge levels. Being degree holders (AOR = 2:49 (1.23, 5.02), P = 0:01) and

specialists (AOR = 9:78 (2.69, 35.5), P = 0:001) were associated with attitude levels. Being

medical laboratories (AOR = 17:42 (5.02, 60.5), P ≤ 0:001) and pharmacy professionals (AOR =

11:2 (4.02, 31.42), P ≤ 0:001) were associated with preventive practice levels. Conclusion and

Recommendation based on the current study, most of the healthcare professionals in this study

area have poor knowledge, negative attitude, and malpreventive practice towards HBV infection.
 61

Therefore, continual professional training programs on HBV infection include increased

vaccination coverage rate and post exposure prophylaxis of heath care workers especially for

highly exposed professionals.

Tshikongo, Mboni, Shakalenga, Busambwa, Ngama, Kapend, Mulangu, Mulumba, Nsasi,

Mukadi and Otshudi, (2023) conducted a study on Knowledge, attitude, and preventive practice towards

hepatitis B and C viruses among the population of Lubumbashi, Democratic Republic of Congo. The aim

of the study was to determine Lubumbashi's knowledge, attitudes, and preventive practices toward HBV

and HCV. The study conducted a cross-sectional descriptive study from March to August 2022 in

Lubumbashi. A total of 704 participants were enrolled. The study targeted all people of both sexes and

ages. The participants' Knowledge, Attitudes, and Preventive practices (KAP) survey was assessed using

online and printed or paper questionnaires. Data were analyzed using SPSS version 22 software. Of the

704 participants, 70.9per cent had poor knowledge of viral hepatitis B and C, whereas 28.6per cent had

terrible attitudes towards these infections and preferred to consult traditional healers instead of going to

the hospital. A minority of the participants (12.2per cent) had good preventive practices, those as being

screened regularly to exclude any possible infection and being willing to be vaccinated depending on the

availability of the HBV vaccine. Most participants (69.2per cent) needed to be aware of drugs that could

effectively treat these infections. It was concluded that Knowledge and preventive practice about HBV

and HCV in the Congolese population living in Lubumbashi have proven wrong. Similarly, the attitudes

of the people towards these infections were negative. Therefore, an extensive health education program

should be given to increase the awareness of this part of the Congolese population about HBV and HCV

infection to provide better care.

Summary of Literature Review

The review of related literature on the knowledge, attitude and preventive practices of

health workers regarding hepatitis B infection has revealed the meaning of hepatitis, causative

organism, mode of transmission, attitude and preventive practices of health workers. Also, the
 62

variables used include knowledge regarding causative organisms of the disease, knowledge

regarding mode of transmission of the disease, attitudes of health workers towards causative

organisms, mode of transmission and prevention of hepatitis B infection and preventive practices

of health workers regarding hepatitis B prevention. The review also presented a number of

related empirical studies carried out by previous researchers on knowledge, attitude and

preventive practices of health workers regarding hepatitis B infections. However, to the best of

the researcher's knowledge, a study of this kind has not been carried out in Benue South

senatorial district, Benue State.

 63

CHAPTER THREE

Methods

This chapter presents research method, it describes the design of the study, area of the

study, population of the study sample and sampling, instrumentation, validity of the instrument,

reliability of the instrument and method of data collection and analysis.

Design of the Study

The descriptive survey design will be adopted for the study. Emaikwu (2019) defines

descriptive survey research as “that research which involves large and small population from

which samples are chosen and studied in a bid to find out relative incidence, distribution and

interactions of sociological and psychological variables. This study will use a descriptive design

to assess the knowledge, attitude, and preventive practice of healthcare workers regarding

hepatitis B infection in Benue State, Nigeria.

More so, this method allows the research to be conducted in the respondent’s natural

environment ensuring that honest, high-quality data is collected. It helps to harmonise the

population and affords all respondents equal opportunity of being selected. Data collection is

descriptive survey research is quick to conduct and is inexpensive. It seeks to collect data from a

representative sample of the population with regard toknowledge, attitude and preventive

practice of healthcare workers regarding hepatitis B infection in Benue South senatorial district,

Benue State.

The Area of Study

Benue South Senatorial District, Benue State, is the area in which the study was carried

out. Benue South Senatorial District is one of the three senatorial zones in the state. It comprises

60
 64

nine (9) local government areas namely: Ado. Agatu, Apa, Obi, Ogbadibo. Ohimini, Oju,

Okpokwu and Otukpo local government areas in Benue South senatorial district, Benue State has

nine (9) public hospitals, one in each of the local government areas namely, general hospital

Otukpo in Otukpo Local government area, general hospital Oju in Oju local government area,

general hospital Okpoga in Okpokwu local government, general hospital Ugbokpo in Apa Local

Government, general hospital Otukpa in Ogbadibo Local Government, general hospital Obagaji

in Agatu local government, general hospital Obarike-Ito in Obi local government, general

hospital Idekpa in Ohimini local government and general hospital Igumale in Ado local

government area.

Benue South senatorial district, Benue State has many ethnic groups, the Idoma people

form majority of the total population of the zone. Other ethnic groups include Igede who are

found in Obi and Oju Local government area, the Agatu in Apa and Agatu Local Government

Areas, Igala, Igbo, Hausa, Fulani and other ethnic groups are found across all the local

government areas of the zone. The predominant occupation of the people of Benue south

senatorial district is farming and trading. Benue South senatorial district, Benue State is endowed

with a lot of natural resources that have for long remained untapped on commercial basis. These

natural resources include limestone which is found in Agatu local government area. Apa and Obi

local government area, gypsum in Agatu. Apa and Obi local government area, Natural gas in

Agatu and Apa local government area, petroleum in Agatu and Apa local government area,

Bauxites and crude oil are found in Obi local government area.

Population of the Study

The population of this study comprised all 1,014 healthcare workers in the public primary

and Secondary Hospitals in Benue South senatorial district, Benue State. According to Ministry
 65

of Health and Human Services Benue State Government (2024), the total population of

healthcare workers in Benue south senatorial district stands at 1014 Primary healthcare workers

and 347 Secondary healthcare workers respectively which gives the target population of 1361

healthcare workers (Appendix D, page 113).

Sample and Sampling techniques

The sample size for this study will consist of 385 healthcare workers. The researcher used

Cochran’s formula to determine the population size (N). Choose a desired margin of error E for

example 5per cent (0.05) and select a confidence level Z example 95per cent (z=1.96). Estimate

the population proportion (p) or I will use 0.5 for maximum variability and finally calculate the

sample size (n) using n= z2 p(1-p)/E2. (Appendices B, page 111).

Multistage sampling was used to select participants from nine general hospitals in Benue

South senatorial district, Benue State. The first stage involved the use of simple random

sampling by balloting without replacement to select five general hospitals out of the nine general

hospitals in Benue South Senatorial District, Benue State. In the second stage, purposive

sampling was used to select ten primary health clinics from the fifty primary health clinics in

Benue South Senatorial District, Benue State. Through these sampling procedures, the researcher

divided healthcare workers into strata based on profession for example, doctors, nurses, and

laboratory technicians and then selected participants from each stratum. All nine general hospital

names were written on slips of paper, placed in a container, and drawn one at a time with

replacement recorded until the required sample of five general hospitals was obtained.

Instrument for Data Collection

To collect data from healthcare workers, the researcher designed the Knowledge, Attitude

and Preventive Practice of Healthcare Workers Regarding Hepatitis B Infection Questionnaire

 66

(KAPHBKIQ). The instrument contains 51 items designed in four (4) sections such as A, B, C

and D. Section A consists of six questions, and Section B, C and D consists of fifteen questions

each respectively. Section A deals with demographic data. Section B consisted of items to elicit

information on knowledge, attitude, and preventive practice, requiring respondents to indicate

their level of knowledge or agreement with the items in the questionnaire. The response pattern

will be on two’ True’ or ‘False’ and Section C and D will consist of a four-point Likert type

scale assigned values: 4, 3, 2, and 1. Thus, Strongly Agree (SA). Agree (A). Disagree (D)

Strongly Disagree (SD). Always, Sometimes, Rarely, and Never, will be used for preventive

practice on the same four points Likert scale assigned values.

Validity of the Instrument

Validity of an instrument refers to its ability to measure what it is intended to measure.

To achieve this, the researcher carefully designed the questionnaire and presented it to the

supervisor and five other experts from the Department of Human Kinetics and Health Education,

and one from the Department of Science Education (Measurement and Evaluation unit), all from

the Faculty of Education, University of Nigeria, Nsukka, for face validation. The validators

examined the instrument to ensure that the content and language related to the purpose of the

study, research questions, and hypotheses. In the process, their constructive criticisms and

suggestions were incorporated; some items in the questionnaire were reframed and others

completely removed, thereby ensuring the face and content validity of the instrument (see

Appendix E, p. 114).

Reliability of the Instruments

Cronbach’s Alpha was used to measure internal consistency reliability. Reliability is the

extent to which measurements are repeatable when performed by different people, on different
 67

occasions, and under different conditions, using alternative instruments — indicating that the

measure of a construct is consistent or dependable (Chinedu, 2013). Reliability of an instrument

is the degree to which the measure of a construct is consistent or dependable. Babbie (2012)

asserted that the reliability of data from research instruments is affected by two errors; namely

random and systematic error. To ensure the stability, dependability, and predictability of the

research instrument, a pilot study will be conducted in Obusa primary healthcare clinics and

General hospital Oju in Oju local government area in Benue South senatorial district, Benue

State. Twenty (20) respondents were administered the instrument by the researcher, after which

the questionnaires were collected. Cronbach's Alpha coefficient was used to estimate the

reliability of the instrument.

Method of Data Collection

The researcher obtained an introductory letter from the Department of Human Kinetics

and Health Education, University of Nigeria, Nsukka, seeking permission to carry out the study.

The letter of introduction was presented to the Ministry of Health and Human Services, Benue

State Government, for the collection of ethical clearance (see Appendix C) and population data,

after which the ethical clearance was presented to respective primary health clinics and General

Hospitals of secondary healthcare facilities in Benue south senatorial district.

A total of three hundred and eighty-five (385) questionnaires were administered in the ten

primary healthcare clinics and five selected general hospitals in Benue South Senatorial District,

Benue State. This was done with the help of two research assistants (health educators) who,

together with the researcher, visited the respective primary health clinics and general hospitals

and gave a brief explanation of the purpose of the study and its expected benefits to healthcare

workers, patients, government, the health sector, and communities at large. The researcher and
 68

two research assistants guided the respondents on how to complete the questionnaire and waited

to collect the questionnaires after the respondents had finished filling them in. The research

assistants were properly briefed on how to assist the respondents. All 385 questionnaires were

retrieved, representing a 100per cent return rate.

Method of Data Analysis

The completed copies of the questionnaire were examined for completeness of responses.

All copies of the instrument that were not duly completed were discarded and not used for the

analysis. The data collected were analyzed using the Statistical Package for the Social Sciences

(SPSS version 25; IBM Corporation, Armonk, New York). A mean score of 2.50 was used as the

cut-off point for determining the significance of variables. Research questions 1 to 6 were

answered using frequencies and percentages. The null hypotheses 1 to 6 were tested using the

chi-squared test at the 0.05 level of significance (p<0.05). A null hypothesis will be rejected if

the calculated p-value is less than 0.05 level of significance. However, null hypotheses will not

be rejected if the p-value is greater than 0.05 level of significance.

 69

CHAPTER FOUR
Results

This chapter covers the presentation of the results, interpretation of the

results and major findings.

Presentation and Interpretation of the Results.

The result of the study is presented in tables followed with interpretation of the tables.

The results of the study are presented below. Although the sample of the study was 385, due to

incomplete data, only 364 questionnaires (94.54per cent) were used for data analysis.
 70

Research Question 1: What is the level of knowledge regarding hepatitis B infection among

healthcare workers?

Table 1: Percentage Analysis Showing Level of Knowledge Regarding Hepatitis B Infection

among Healthcare Workers (N = 364)

Correct Incorrect
S/n Item Statement Dec.
Response Response

per per
f f
cent cent

1 Hepatitis B is a viral infection that affects the liver? 360 98.9 4 1.1 VHK

Hepatitis B can be transmitted through blood and bodily

2 359 98.6 5 1.4 VHK
fluids?

Hepatitis B can be transmitted through sharing needles or

3 355 97.5 9 2.5 VHK
syringes?

You are familiar with the symptoms of hepatitis B

4 343 94.2 21 5.8 VHK
infection?

Hepatitis B can be transmitted from mother to child

5 341 93.7 23 6.3 VHK
during childbirth?

6 Hepatitis B can be prevented through vaccination? 344 94.5 20 5.5 VHK

Hepatitis B can be transmitted through unprotected

7 344 94.5 20 5.5 VHK
sexual contact?

8 You are familiar with the difference between acute and 42 11.5 322 88.5 VLK
 71

Correct Incorrect
S/n Item Statement Dec.
Response Response

chronic hepatitis B infection?

Hepatitis B can be transmitted through sharing personal

9 321 88.2 43 11.8 VHK
items like toothbrushes or razors?

Hepatitis B can lead to serious liver complications if left

10 46 12.6 318 87.4 VLK
untreated?

Hepatitis B can be transmitted through organ

11 318 87.4 46 12.6 VHK
transplantation?

You are familiar with the recommended vaccination

12 54 14.8 310 85.2 VLK
schedule for hepatitis B?

13 Hepatitis B can be transmitted through breastfeeding? 311 85.4 53 14.6 VHK

Hepatitis B screening is recommended for certain high-

14 320 87.9 44 12.1 VHK
risk populations?

Note: f = frequency; per cent = percentage; Dec. = Decision; VHK = Very High Knowledge; VLK = Very Low
Knowledge

The data in Table 1 reveal a striking dichotomy in the level of knowledge among

healthcare workers regarding hepatitis B. On one hand, there is a strong grasp of general and

foundational concepts. Over 98per cent of respondents correctly identified that hepatitis B is a

viral infection affecting the liver (item 1: 98.9per cent) and that it is transmitted through blood

and bodily fluids (item 2: 98.6per cent). High correct-response rates were similarly recorded for

transmission through needles (item 3: 97.5per cent), unprotected sexual contact (item 7: 94.5per

cent), vaccination as a preventive measure (item 6: 94.5per cent), familiarity with symptoms

(item 4: 94.2per cent), mother-to-child transmission (item 5: 93.7per cent), shared personal items
 72

(item 9: 88.2per cent), organ transplantation (item 11: 87.4per cent), breastfeeding (item 13:

85.4per cent), and high-risk population screening (item 14: 87.9per cent). This broad

foundational awareness reflects the effect of standard clinical training and routine application of

universal precautions.

However, critical knowledge gaps exist in areas of clinical specialisation. A striking

88.5per cent of respondents could not distinguish between acute and chronic hepatitis B infection

(item 8: 11.5per cent correct). Only 12.6per cent knew that hepatitis B can lead to serious liver

complications if untreated (item 10), and just 14.8per cent were familiar with the recommended

vaccination schedule (item 12). These deficits suggest that while healthcare workers possess

strong general transmission awareness, they lack the specialized clinical depth required for

effective long-term patient management and personal immunisation compliance.

The summary of knowledge levels shows that 304 respondents (83.5per cent) are in the

High Knowledge category, 35 (9.6per cent) achieved Very High Knowledge, and 25 (6.9per

cent) were at the Moderate Knowledge level. No respondent fell in the Low or Very Low

Knowledge categories, confirming a commendably high overall knowledge base among

healthcare workers in Benue South Senatorial District, even as targeted gaps remain.

Research Question 2: What is the attitude towards hepatitis B infection among healthcare

workers?

Table 2: Mean and Standard Deviation Showing the Attitude of Healthcare Workers

Towards Hepatitis B Infection in Benue South Senatorial District, Benue State (N = 364)

S/n Item Statement Mean Std. Dev.

1 I believe that hepatitis B is a significant public health concern. 3.40 0.52

 73

S/n Item Statement Mean Std. Dev.

I am confident in my ability to provide accurate information about

2 3.35 0.53
hepatitis B to patients.

I believe that healthcare workers have a responsibility to educate

3 3.32 0.57
patients about hepatitis B prevention.

I am concerned about the risk of contracting hepatitis B in my

4 3.27 0.60
workplace.

I believe that hepatitis B patients deserve the same level of care and
5 3.32 0.53
respect as patients with other medical conditions.

Are you comfortable discussing hepatitis B with colleagues and

6 3.34 0.64
patients?

I feel that enough resources are allocated towards hepatitis B prevention

7 3.26 0.53
and treatment in your healthcare facility.

I believe that healthcare workers should be routinely screened for

8 3.25 0.62
hepatitis B.

9 I am aware of any stigma or discrimination associated with hepatitis B. 3.13 0.70

Do you feel adequately trained to provide care for patients with

10 3.27 0.59
hepatitis B?

I believe that vaccination against hepatitis B should be mandatory for

11 3.24 0.61
healthcare workers.

I am concerned about the potential legal or ethical implications of

12 3.15 0.60
working with hepatitis B patients.

13 I believe that hepatitis B education should be integrated into medical 3.31 0.63
 74

S/n Item Statement Mean Std. Dev.

training programs.

I am confident in my ability to protect myself from hepatitis B infection

14 3.31 0.58
while providing patient care.

I believe that hepatitis B patients should disclose their status to

15 3.29 0.71
healthcare providers.

OVERALL ATTITUDE 3.28 0.32

Note: Scale: 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree; Cut-off Mean = 2.50

Table 2 reveals a highly positive and professional attitude towards hepatitis B

management among healthcare workers in Benue South Senatorial District. All fifteen items

recorded mean scores above the 2.50 cut-off, and the overall mean attitude score was 3.28 (SD =

0.32), indicating a strongly positive collective orientation. The highest-rated item was the belief

that hepatitis B is a significant public health concern (item 1: Mean = 3.40, SD = 0.52), followed

closely by confidence in the ability to provide accurate patient information (item 2: Mean = 3.35,

SD = 0.53) and comfort discussing hepatitis B with colleagues and patients (item 6: Mean =

3.34, SD = 0.64). Respondents also strongly agreed that healthcare workers have a responsibility

to educate patients (item 3: Mean = 3.32), that hepatitis B patients deserve equal care (item 5:

Mean = 3.32), and that hepatitis B education should be integrated into medical training (item 13:

Mean = 3.31).

The lowest-rated items were awareness of stigma and discrimination associated with

hepatitis B (item 9: Mean = 3.13) and concern about legal or ethical implications (item 12: Mean

= 3.15), though both remained well above the cut-off. The uniformly positive mean scores and

relatively narrow standard deviations across all items confirm that healthcare workers in this
 75

district embrace their professional responsibility towards hepatitis B prevention without

significant bias or hesitation.

Research Question 3: What is the preventive practice of healthcare workers regarding hepatitis

B infection?

Table 3: Mean and Standard Deviation Showing the Extent of Practice of Hepatitis B

Infection Prevention among Healthcare Workers in Benue South Senatorial District, Benue

State (N = 364)

S/n Item Statement Mean Std. Dev.

I routinely follow universal precautions, including wearing gloves and

1 other protective gear, when dealing with patients who may have 3.40 0.50
hepatitis B.

I always wash my hands thoroughly after coming into contact with

2 3.32 0.52
blood or bodily fluids, as per recommended infection control guidelines.

I make sure to properly dispose of needles and other sharp objects in

3 3.40 0.55
designated sharps containers to prevent accidental needlestick injuries.

I am vigilant about getting vaccinated against hepatitis B and ensuring

4 3.28 0.55
that my vaccination status is up to date.

I regularly screen patients for hepatitis B risk factors and recommend

5 3.22 0.55
testing when appropriate.

I provide patients with accurate information about hepatitis B

6 3.25 0.59
transmission, prevention, and treatment options.

I am confident in my ability to recognize the symptoms of hepatitis B

7 3.23 0.58
infection in patients.

8 I collaborate with other healthcare professionals to ensure 3.27 0.54

 76

S/n Item Statement Mean Std. Dev.

comprehensive care for patients diagnosed with hepatitis B.

I actively participate in hepatitis B education and training sessions

9 3.27 0.59
provided by my healthcare facility.

I advocate for the implementation of policies and protocols aimed at

10 3.21 0.57
preventing hepatitis B transmission in the workplace.

I support efforts to reduce stigma and discrimination against individuals

11 3.21 0.59
living with hepatitis B.

I prioritize the safety and well-being of patients with hepatitis B in all

12 3.13 0.53
aspects of their care.

I stay informed about the latest developments in hepatitis B research

13 3.17 0.63
and treatment options.

I take appropriate precautions to prevent the transmission of hepatitis B

14 3.18 0.62
from mother to child during childbirth.

I ensure that patients diagnosed with hepatitis B receive timely referrals

15 3.16 0.67
to specialists for further evaluation and management.

OVERALL PRACTICE 3.25 0.33

Note: Scale: 1 = Strongly Disagree, 2 = Disagree, 3 = Agree, 4 = Strongly Agree; Cut-off Mean = 2.50

Table 3 indicates that healthcare workers in Benue South Senatorial District demonstrate

a high level of preventive practice regarding hepatitis B, with an overall mean of 3.25 (SD =

0.33). All fifteen items recorded mean scores above the 2.50 cut-off, confirming a consistent and

positive practice profile across the respondents. The highest practice scores were recorded for

routine adherence to universal precautions including wearing protective gear (item 1: Mean =
 77

3.40, SD = 0.50) and proper disposal of needles and sharp objects in designated containers (item

3: Mean = 3.40, SD = 0.55), reflecting the deep institutional embedding of standard infection

control procedures. Thorough handwashing after contact with blood or bodily fluids (item 2:

Mean = 3.32) was also among the highest-rated behaviours.

Vaccination vigilance (item 4: Mean = 3.28) and interprofessional collaboration in patient

care (item 8: Mean = 3.27) were similarly well affirmed. The comparatively lower scores for

prioritising patient safety in all care aspects (item 12: Mean = 3.13) and staying updated on new

hepatitis B research (item 13: Mean = 3.17) suggest that while frontline infection control

behaviours are well established, engagement with continuing professional development and

patient-centred care dimensions requires further reinforcement. Nevertheless, the absence of any

item below 2.50, combined with the narrow standard deviations, attests to the overall consistency

and reliability of preventive behaviour among the respondents.

Research Question 4: What is the level of knowledge regarding hepatitis B infection among

healthcare workers based on gender, marital status, educational qualification, profession,

ethnicity, and years of experience?

Table 4: Percentage Analysis Showing Level of Knowledge of Hepatitis B Infection among

Healthcare Workers Based on Demographic Variables (N = 364)

S/n Category MK HK VHK

per per per

f f f
cent cent cent

1 Gender
 78

S/n Category MK HK VHK

Male (n = 172) 13 7.6 147 85.5 12 7.0

Female (n = 192) 12 6.3 157 81.8 23 12.0

2 Marital Status

Single (n = 108) 6 5.6 95 88.0 7 6.5

Married (n = 208) 15 7.2 168 80.8 25 12.0

Divorced (n = 11) 0 0.0 9 81.8 2 18.2

Separated (n = 12) 1 8.3 11 91.7 0 0.0

4.0

Widowed (n = 25) 3 12.0 21 84.0 1

3 Educational Qualification

WAEC/NECO (n = 38) 3 7.9 33 86.8 2 5.3

OND/NCE (n = 59) 8 13.6 48 81.4 3 5.1

HND/[Link]. (n = 219) 10 4.6 184 84.0 25 11.4

[Link]./Ph.D. (n = 48) 4 8.3 39 81.3 5 10.4

4 Profession

Medical Doctor (n = 72) 4 5.6 58 80.6 10 13.9

Pharmacist (n = 103) 1 1.0 90 87.4 12 11.7

 79

S/n Category MK HK VHK

Nurse (n = 67) 6 9.0 56 83.6 5 7.5

Health Info. Officer (n = 46) 8 17.4 34 73.9 4 8.7

Midwife (n = 30) 2 6.7 26 86.7 2 6.7

Lab Scientist/Technician (n = 35) 4 11.4 29 82.9 2 5.7

Others (n = 11) 0 0.0 11 100.0 0 0.0

5 Ethnicity

Igbo (n = 76) 4 5.3 57 75.0 15 19.7

Yoruba (n = 29) 2 6.9 24 82.8 3 10.3

Hausa (n = 34) 1 2.9 29 85.3 4 11.8

Igede (n = 59) 6 10.2 46 78.0 7 11.9

Idoma (n = 82) 6 7.3 73 89.0 3 3.7

Tiv (n = 57) 3 5.3 53 93.0 1 1.8

Igala (n = 20) 3 15.0 15 75.0 2 10.0

Others (n = 7) 0 0.0 7 100.0 0 0.0

6 Years of Experience

6–10 years (n = 174) 4 2.3 148 85.1 22 12.6

11–25 years (n = 106) 11 10.4 84 79.2 11 10.4

26–30 years (n = 63) 8 12.7 53 84.1 2 3.2

 80

S/n Category MK HK VHK

31–35 years (n = 21) 2 9.5 19 90.5 0 0.0

Note: MK = Moderate Knowledge; HK = High Knowledge; VHK = Very High Knowledge.

Table 4 reveals that demographic variables create identifiable variations in the depth of

hepatitis B knowledge, even as the High Knowledge category remains dominant across all

subgroups. By gender, female respondents attained Very High Knowledge more frequently

(12.0per cent) than males (7.0per cent), suggesting that female healthcare workers may engage

more actively with hepatitis B-related clinical updates. By marital status, divorced respondents

recorded the highest VHK proportion (18.2per cent), while separated respondents showed 0.0per

cent VHK, reflecting possible lifestyle-related differences in professional engagement.

Educationally, a positive gradient is evident: WAEC/NECO holders recorded only 5.3per

cent VHK compared to 11.4per cent for HND/[Link]. holders and 10.4per cent for [Link]./Ph.D.

holders. Professionally, Medical Doctors (13.9per cent VHK) and Pharmacists (11.7per cent

VHK) led in knowledge mastery, while Health Information Officers showed the highest

proportion in the Moderate Knowledge bracket (17.4per cent), indicating a need for more

targeted educational interventions for this professional cadre. Across ethnic groups, the Igbo

group recorded the highest VHK proportion (19.7per cent). Regarding years of experience,

professionals with 6–10 years of service exhibited the highest VHK rate (12.6per cent), while

those with 31–35 years of experience recorded 0.0per cent VHK, suggesting that recently trained

professionals have benefited from updated clinical curricula, while longer-serving staff may

require re-training initiatives.

 81

Research Question 5: What is the attitude towards hepatitis B infection among healthcare

workers based on gender, marital status, educational qualification, profession, ethnicity, and

years of experience?

Table 5: Mean and Standard Deviation Showing Attitude towards Hepatitis B Infection

among Healthcare Workers Based on Demographic Variables (N = 364)

S/n Category Mean SD Remark

1 Gender

Male (n = 172) 3.23 0.27 Positive

Female (n = 192) 3.32 0.35 Positive

2 Marital Status

Single (n = 108) 3.31 0.34 Positive

Married (n = 208) 3.28 0.30 Positive

Divorced (n = 11) 3.47 0.25 Positive

Separated (n = 12) 3.16 0.15 Positive

Widowed (n = 25) 3.12 0.38 Positive

3 Educational Qualification

WAEC/NECO (n = 38) 3.08 0.38 Positive

OND/NCE (n = 59) 3.20 0.32 Positive

HND/[Link]. (n = 219) 3.33 0.30 Positive

 82

S/n Category Mean SD Remark

[Link]./Ph.D. (n = 48) 3.30 0.25 Positive

4 Profession

Medical Doctor (n = 72) 3.37 0.30 Positive

Pharmacist (n = 103) 3.35 0.26 Positive

Nurse (n = 67) 3.26 0.32 Positive

Health Info. Officer (n = 46) 3.06 0.24 Positive

Midwife (n = 30) 3.18 0.31 Positive

Lab Scientist/Technician (n = 35) 3.34 0.42 Positive

Others (n = 11) 3.15 0.28 Positive

5 Ethnicity

Igbo (n = 76) 3.42 0.31 Positive

Yoruba (n = 29) 3.14 0.28 Positive

Hausa (n = 34) 3.31 0.29 Positive

Igede (n = 59) 3.30 0.27 Positive

Idoma (n = 82) 3.17 0.25 Positive

Tiv (n = 57) 3.28 0.40 Positive

Igala (n = 20) 3.19 0.18 Positive

Others (n = 7) 3.66 0.37 Positive

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S/n Category Mean SD Remark

6 Years of Experience

6–10 years (n = 174) 3.40 0.33 Positive

11–25 years (n = 106) 3.20 0.28 Positive

26–30 years (n = 63) 3.17 0.24 Positive

31–35 years (n = 21) 3.04 0.26 Positive

Note: Cut-off Mean = 2.50; Positive = Mean ≥ 2.50

Table 5 illustrates that a consistently positive attitude towards hepatitis B prevails across

virtually all demographic subsets, with mean scores across all subgroups exceeding the 2.50 cut-

off. By gender, females recorded a slightly higher mean (3.32) than males (3.23), both reflecting

a clearly positive professional orientation. Among marital categories, divorced respondents

reported the strongest attitudinal disposition (Mean = 3.47), while widowed respondents

recorded the lowest mean (3.12) — still positive. Educationally, a positive trend is evident, with

HND/[Link]. holders (Mean = 3.33) showing stronger attitudes than WAEC/NECO holders (Mean

= 3.08).

Professionally, Medical Doctors (Mean = 3.37) and Pharmacists (Mean = 3.35)

demonstrated the most positive attitudes, while Health Information Officers recorded the lowest

mean among professional cadres (Mean = 3.06). Across ethnic groups, the Igbo (Mean = 3.42)

and Others (Mean = 3.66) subgroups recorded the highest scores. An interesting inverse

relationship was observed between years of experience and attitude: those with 6–10 years of

experience showed the most proactive attitude (Mean = 3.40), declining progressively to 3.04 for

those with 31–35 years, suggesting that professional fatigue or complacency may grow with
 84

increasing tenure. The consistently low standard deviations across all subgroups confirm a strong

consensus that hepatitis B merits a serious and proactive professional response, regardless of

demographic background.

Research Question 6: What is the preventive practice of healthcare workers regarding hepatitis

B infection based on gender, marital status, educational qualification, profession, ethnicity, and

years of experience?

Table 6: Mean and Standard Deviation Showing Preventive Practice Regarding Hepatitis B

Infection among Healthcare Workers Based on Demographic Variables (N = 364)

S/n Category Mean SD Remark

1 Gender

Male (n = 172) 3.19 0.33 Good

Female (n = 192) 3.30 0.31 Good

2 Marital Status

Single (n = 108) 3.23 0.35 Good

Married (n = 208) 3.27 0.33 Good

Divorced (n = 11) 3.33 0.20 Good

Separated (n = 12) 3.09 0.25 Good

Widowed (n = 25) 3.18 0.24 Good

3 Educational Qualification
 85

S/n Category Mean SD Remark

WAEC/NECO (n = 38) 3.07 0.28 Good

OND/NCE (n = 59) 3.15 0.34 Good

HND/[Link]. (n = 219) 3.28 0.32 Good

[Link]./Ph.D. (n = 48) 3.36 0.28 Good

4 Profession

Medical Doctor (n = 72) 3.35 0.32 Good

Pharmacist (n = 103) 3.32 0.29 Good

Nurse (n = 67) 3.23 0.32 Good

Health Info. Officer (n = 46) 3.03 0.15 Good

Midwife (n = 30) 3.06 0.30 Good

Lab Scientist/Technician (n = 35) 3.35 0.42 Good

Others (n = 11) 3.08 0.20 Good

5 Ethnicity

Igbo (n = 76) 3.35 0.25 Good

Yoruba (n = 29) 3.11 0.36 Good

Hausa (n = 34) 3.39 0.43 Good

Igede (n = 59) 3.25 0.33 Good

Idoma (n = 82) 3.11 0.21 Good

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S/n Category Mean SD Remark

Tiv (n = 57) 3.35 0.34 Good

Igala (n = 20) 3.02 0.26 Good

Others (n = 7) 3.44 0.31 Good

6 Years of Experience

6–10 years (n = 174) 3.36 0.32 Good

11–25 years (n = 106) 3.14 0.34 Good

26–30 years (n = 63) 3.12 0.22 Good

31–35 years (n = 21) 3.22 0.21 Good

Note: Cut-off Mean = 2.50; Good = Mean ≥ 2.50

Table 6 reveals that preventive practice is maintained at a uniformly good standard across

all demographic subgroups, with every mean score exceeding the 2.50 cut-off. By gender,

females (Mean = 3.30) demonstrated stronger preventive engagement than males (Mean = 3.19),

consistent with the attitudinal patterns in Table 5. Among marital categories, divorced

respondents recorded the highest practice mean (3.33) while separated respondents the lowest

(3.09), though both remained well above the cut-off. Educational qualification again emerged as

a positive driver of practice: [Link]./Ph.D. holders recorded the highest mean (3.36), compared to

3.07 for WAEC/NECO holders, affirming that advanced academic training enhances clinical

safety behaviour.
 87

Among professional cadres, Medical Doctors and Lab Scientists/Technicians (both Mean

= 3.35) led in practice performance, while Health Information Officers (Mean = 3.03) and

Midwives (Mean = 3.06) showed the lowest — though still acceptable — engagement with

preventive protocols. Professionals with 6–10 years of experience recorded the highest practice

mean (3.36), corroborating the pattern observed in the attitude data and suggesting that mid-

career professionals are the most vigilant group in Benue South. By ethnicity, the Hausa (Mean =

3.39) and Igbo (Mean = 3.35) groups performed highest, while Igala respondents recorded the

lowest practice mean (3.02), though still positive. The consistently good practice means across

all subgroups confirm that hepatitis B prevention is effectively institutionalised in the healthcare

environment of Benue South Senatorial District.

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Table 7: Summary of Chi-Square Test of the Level of Knowledge Regarding Hepatitis B

among Healthcare Workers Based on Gender (n = 364)

p-
Variable N MK O(E) HK O(E) VHK O(E) χ² df Decision
value

Male (172) 172 13 (11.8) 147 (143.6) 12 (16.5) 2.735 2 .255 NS

Female (192) 192 12 (13.2) 157 (160.4) 23 (18.5)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; NS = Not Significant at p < .05; MK =
Moderate Knowledge; HK = High Knowledge; VHK = Very High Knowledge.

Results in Table 7 show that there is no significant difference in the level of knowledge

regarding hepatitis B among healthcare workers in Benue South Senatorial District, Benue State,

based on gender (χ² = 2.735; p = .255; df = 2). Since the p-value of .255 is greater than the 0.05

level of significance, the null hypothesis was not rejected. This implies that male and female

healthcare workers in the study area possess comparable levels of hepatitis B knowledge. The

near-equivalent distribution of observed frequencies across knowledge categories for both groups

indicates that gender does not constitute a significant barrier to knowledge acquisition in this

professional context. Standardised clinical training and equitable access to infection-control

information likely account for this uniformity across genders.

Hypothesis 2: There is no significant difference in attitude towards hepatitis B infection among

healthcare workers in Benue South Senatorial District, Benue State, based on marital status.
 89

Table 8: Summary of Chi-Square Test of Attitude towards Hepatitis B Infection among

Healthcare Workers Based on Marital Status (n = 364)

p-
Variable N MK O(E) HK O(E) VHK O(E) χ² Df Decision
value

Single (108) 108 6 (7.4) 95 (90.2) 7 (10.4) 7.768 8 .456 NS

Married (208) 208 15 (13.2) 168 (173.7) 25 (20.0)

Divorced (11) 11 0 (0.8) 9 (9.2) 2 (1.1)

Separated (12) 12 1 (0.8) 11 (10.0) 0 (1.2)

Widowed (25) 25 3 (1.7) 21 (20.9) 1 (2.4)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; NS = Not Significant at p < .05; MK =
Moderate; HK = High; VHK = Very High.

Results in Table 8 show that there is no significant difference in attitude towards hepatitis

B infection among healthcare workers in Benue South Senatorial District, Benue State, based on

marital status (χ² = 7.768; p = .456; df = 8). Since the p-value of .456 exceeds the 0.05 level of

significance, the null hypothesis was not rejected. This finding implies that personal marital

circumstances do not significantly shape the professional attitudes of healthcare workers towards

hepatitis B. Across all marital categories single, married, divorced, separated, and widowed the

pattern of observed frequencies closely approximated expected values, confirming that

attitudinal disposition towards hepatitis B prevention is driven primarily by professional

socialisation, clinical ethics, and workplace culture rather than by marital status.

Hypothesis 3: There is no significant difference in preventive practice regarding hepatitis B

infection among healthcare workers in Benue South Senatorial District, Benue State, based on

educational qualification.
 90

Table 9: Summary of Chi-Square Test of Preventive Practice Regarding Hepatitis B

Infection among Healthcare Workers Based on Educational Qualification (n = 364)

p-
Variable N MK O(E) HK O(E) VHK O(E) χ² df Decision
value

WAEC/NECO
38 3 (2.6) 33 (31.7) 2 (3.7) 8.642 6 .195 NS
(38)

OND/NCE (59) 59 8 (4.1) 48 (49.3) 3 (5.7)

HND/[Link].
219 10 (15.0) 184 (182.9) 25 (21.1)
(219)

[Link]./Ph.D.
48 4 (3.3) 39 (40.1) 5 (4.6)
(48)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; NS = Not Significant at p < .05; MK =
Moderate; HK = High; VHK = Very High

Results in Table 9 show that there is no significant difference in preventive practice

regarding hepatitis B infection among healthcare workers based on educational qualification (χ²

= 8.642; p = .195; df = 6). Since the p-value of .195 exceeds the 0.05 level of significance, the

null hypothesis was not rejected. This finding indicates that the level of formal academic

credential ranging from WAEC/NECO to [Link]./Ph.D. does not significantly differentiate how

healthcare workers apply preventive measures in their clinical practice.

Hypothesis 4: There is no significant difference in the level of knowledge regarding hepatitis B

infection among healthcare workers in Benue South Senatorial District, Benue State, based on

profession.
 91

Table 10: Summary of Chi-Square Test of the Level of Knowledge Regarding Hepatitis B

Infection among Healthcare Workers Based on Profession (n = 364)

p-
Variable N MK O(E) HK O(E) VHK O(E) χ² df Decision
value

Medical Doctor
72 4 (4.9) 58 (60.1) 10 (6.9) 20.275 12 .062 NS
(72)

Pharmacist
103 1 (7.1) 90 (86.0) 12 (9.9)
(103)

Nurse (67) 67 6 (4.6) 56 (56.0) 5 (6.4)

Health Info.
46 8 (3.2) 34 (38.4) 4 (4.4)
Officer (46)

Midwife (30) 30 2 (2.1) 26 (25.1) 2 (2.9)

Lab
Scientist/Tech 35 4 (2.4) 29 (29.2) 2 (3.4)
(35)

Others (11) 11 0 (0.8) 11 (9.2) 0 (1.1)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; NS = Not Significant at p < .05; MK =
Moderate Knowledge; HK = High Knowledge; VHK = Very High Knowledge

Results in Table 10 show that there is no significant difference in the level of knowledge

regarding hepatitis B infection among healthcare workers based on profession (χ² = 20.275; p

= .062; df = 12). Since the p-value of .062 marginally exceeds the 0.05 level of significance, the

null hypothesis was not rejected. Nonetheless, the p-value approaches significance, and the

descriptive data in Table 4 reveal a practically notable disparity: Health Information Officers

recorded the highest proportion in the Moderate Knowledge bracket (17.4per cent), whereas
 92

Pharmacists showed only 1.0per cent at this level. Although the statistical threshold was not

crossed, the near-significant result and the descriptive patterns together suggest that profession

does have a meaningful influence on knowledge depth, particularly for cadres with less direct

exposure to bloodborne pathogen protocols. Targeted continuing professional development for

Health Information Officers and similar non-clinical roles is therefore warranted.

Hypothesis 5: There is no significant difference in attitude towards hepatitis B infection among

healthcare workers in Benue South Senatorial District, Benue State, based on ethnicity.

Table 11: Summary of Chi-Square Test of Attitude towards Hepatitis B Infection among

Healthcare Workers Based on Ethnicity (n = 364)

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p-
Variable N MK O(E) HK O(E) VHK O(E) χ² df Decision
value

Igbo (76) 76 4 (5.2) 57 (63.5) 15 (7.3) 22.785 14 .064 NS

Yoruba (29) 29 2 (2.0) 24 (24.2) 3 (2.8)

Hausa (34) 34 1 (2.3) 29 (28.4) 4 (3.3)

Igede (59) 59 6 (4.1) 46 (49.3) 7 (5.7)

Idoma (82) 82 6 (5.6) 73 (68.5) 3 (7.9)

Tiv (57) 57 3 (3.9) 53 (47.6) 1 (5.5)

Igala (20) 20 3 (1.4) 15 (16.7) 2 (1.9)

Others (7) 7 0 (0.5) 7 (5.8) 0 (0.7)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; NS = Not Significant at p < .05; MK =
Moderate; HK = High; VHK = Very High.

Results in Table 11 show that there is no significant difference in attitude towards

hepatitis B infection among healthcare workers based on ethnicity (χ² = 22.785; p = .064; df =

14). Since the p-value of .064 is slightly greater than the 0.05 level of significance, the null

hypothesis was not rejected. This result indicates that ethnic background does not significantly

differentiate the professional attitudes of healthcare workers towards hepatitis B in Benue South

Senatorial District. Although the Igbo group descriptively recorded a notably higher mean

attitude score (Mean = 3.42) compared to groups such as the Yoruba (Mean = 3.14) and Idoma

(Mean = 3.17), the Chi-Square test confirms that the overall distribution of attitudes across the

eight ethnic groups does not deviate significantly from what would be expected by chance. This
 94

finding reinforces the role of standardised professional training and shared clinical ethics in

shaping uniformly positive attitudes across a diverse, multi-ethnic workforce.

Hypothesis 6: There is no significant difference in the preventive practice of healthcare workers

regarding hepatitis B infection based on ethnicity, job location, and years of experience in Benue

South Senatorial District, Benue State.

Table 12: Summary of Chi-Square Test of Preventive Practice Regarding Hepatitis B

Infection among Healthcare Workers Based on Years of Experience (n = 364)

p-
Variable N MK O(E) HK O(E) VHK O(E) χ² df Decision
value

6–10 years
174 4 (12.0) 148 (145.3) 22 (16.7) 17.39 6 .008 S
(174)

11–25 years
106 11 (7.3) 84 (88.5) 11 (10.2)
(106)

26–30 years
63 8 (4.3) 53 (52.6) 2 (6.1)
(63)

31–35 years
21 2 (1.4) 19 (17.5) 0 (2.0)
(21)

Note: χ² = Chi-Square statistic; O(E) = Observed (Expected) frequency; S = Significant at p < .05; MK =
Moderate; HK = High; VHK = Very High

Results in Table 12 show that there is a significant difference in the preventive practice of

healthcare workers regarding hepatitis B infection based on years of experience (χ² = 17.390; p =

.008; df = 6). Since the p-value of .008 is less than the 0.05 level of significance, the null

hypothesis was rejected. This implies that years of professional experience significantly

influence how healthcare workers practise hepatitis B prevention in Benue South Senatorial
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District. As shown in Table 6, professionals with 6–10 years of experience recorded the highest

preventive practice mean (3.36), while the pattern progressively changes across longer-serving

groups. The observed frequencies for the 11–25 years group (11 observed vs 7.3 expected at the

Moderate level) and the 26–30 years group (8 observed vs 4.3 expected) indicate that longer-

serving staff are disproportionately represented in lower knowledge tiers, pointing to the erosion

of best-practice adherence among the most experienced workers. This significant result

underscores the critical need for systematic, recurrent continuing professional education

programmes targeting mid-to-senior career healthcare workers to sustain high preventive practice

standards across all experience levels.

Major Findings of the Study

The major findings of the study revealed that:

 Majority of healthcare workers had high knowledge of hepatitis B infection.

 Respondents demonstrated a positive attitude toward hepatitis B prevention.

 Most healthcare workers reported good preventive practices.

 Gender, marital status, educational qualification, profession, and ethnicity showed

no significant influence on knowledge level.

 Years of experience significantly influenced knowledge of hepatitis B.

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CHAPTER FIVE

Discussion, Conclusion, Implication, Recommendation and Summary

This chapter discusses the results of the findings, conclusion, contribution to knowledge,

implications of the findings, recommendations, limitations of the study, suggestions for further

study and summary of the study.

 97

Discussion of Findings

The findings of the study were discussed under the following headings:

1. Level of knowledge, attitudes and preventive practices regarding hepatitis B infection

2. Socio-demographic variables relating to healthcare.

Discussion on the level of knowledge, attitudes and preventive practices regarding hepatitis B

infection.

The study revealed that healthcare workers in Benue South Senatorial District generally

possess high level of knowledge regarding hepatitis B infection. Most respondents correctly

identified the cause, transmission routes, and prevention methods. This high general knowledge

may stem from standard clinical training, frequent exposure to infectious disease protocols, and

routine workplace infection control preventive practices. However, the low scores on specific

technical items suggest that formal continuing education on hepatitis B is irregular or

insufficient, especially in more specialized areas. Null hypothesis accepted. This finding agrees

with the study by Akpor and Akingbehin (2017), who reported robust general knowledge of

hepatitis B among healthcare workers in south-western Nigeria. Similarly, Akazong et al. (2020)

who documented high knowledge levels HBV among HCWs in Cameroon’s Bamenda Health

District. In contrast, Adejimi et al. (2021) found gaps in core knowledge among market traders in

Lagos, reflecting contextual differences between lay populations and trained healthcare workers.

The results of the study indicate that healthcare workers demonstrated overall positive

attitudes towards hepatitis B prevention and control, with a mean attitude score of 3.28 out of 4.

Respondents acknowledged the importance of education, felt responsible for patient counseling,

and generally supported routine screening and vaccination. This attitudinal positivity likely
 98

reflects professional ethics and socialisation within healthcare settings, where prevention and

patient safety are core values. Frequent interaction with patients and colleagues on infectious

disease prevention may reinforce proactive attitudes. This study agrees with Alabi et al. (2023),

who found positive attitudes towards hepatitis B prevention among tertiary hospital staff in

south-west Nigeria. Similarly, Mashilo et al. (2025) reported favourable attitudes among primary

healthcare workers in South Africa, despite variable knowledge levels. In contrast, Yalma et al.

(2025) noted mixed attitudes in a general population, indicating that attitudes in non-clinical

contexts differ significantly from those in clinical settings.

The results of the study indicated that Preventive practices Regarding Hepatitis B

Infection indicate that healthcare workers reported good preventive practices, with an overall

mean score of 3.25 out of 4. Preventive practices such as routine adherence to universal

precautions, vaccination vigilance, hand hygiene, and safe disposal of sharps were noted as high.

Positive preventive practices may be rooted in institutional protocols, continuous reminders

through signage and training, and professional accountability mechanisms that reinforce

preventive behaviour. This finding agrees with Alabi et al. (2023), who observed good

preventive practices among healthcare workers in a tertiary hospital setting. Similarly, Akazong

et al. (2020) documented compliance with infection control guidelines among healthcare workers

in Cameroon. Adejimi et al. (2021) identified poor preventive practices in a non-clinical sample,

showing that preventive behaviour may differ outside formal health settings.

The results of the study indicate that there was no statistically significant difference in

hepatitis B knowledge between male and female healthcare workers (χ² = 2.735; p = .255). This

suggests that training and access to information on hepatitis B are uniformly distributed across

genders among healthcare workers, reflecting equitable professional exposure. This finding
 99

agrees with Akpor and Akingbehin (2017), who found similar non-significant gender

differences. Similarly, Akazong et al. (2020) reported similar patterns in Cameroon. In contrast,

Adejimi et al. (2021) showed gender differences in a non-clinical sample, likely because

professional training was absent.

The results of the study indicate that no significant differences in knowledge were found

based on marital status, educational qualification, profession, or ethnicity (all p > .05). This

suggests that in the studied healthcare context, these socio-demographic variables do not strongly

shape hepatitis B knowledge. Standardized training and workplace policies may harmonize

knowledge levels across diverse groups. This finding agrees with Akpor and Akingbehin (2017),

who reported similar non-significant demographic effects. Akazong et al. (2020) also noted

uniform knowledge distribution. In contrast, Mashilo et al. (2025) found marginal differences in

certain demographics, but these did not translate to meaningful preventive practice gaps.

Workers with mid-level experience may have better access to updated guidelines and

frequent engagement with clinical protocols. This finding agrees with Yunusa et al. (2025), who

found that experience predicted better vaccination knowledge of HBV among HCWs in Zaria.

Similarly, Akazong et al. (2020) showed that experience influences preventive practice

adherence, often linked to knowledge. In contrast, Mashilo et al. (2025) found no significant

experience effects, possibly due to uniform ongoing training in South African settings.
 100

Discussion on Socio-demographic variables relating to healthcare.

The results of the study indicate that there was no statistically significant difference in the

level of knowledge regarding hepatitis B among healthcare workers in Benue South Senatorial

District, Benue State, based on gender (χ² = 2.735; df = 2; p = .255). Since the p-value of .255 is

greater than the 0.05 level of significance, the null hypothesis was not rejected. This implies that

no difference existed between male and female healthcare workers in their level of knowledge

regarding hepatitis B.

The results of the study indicate that there was no statistically significant difference in

attitude towards hepatitis B infection among healthcare workers in Benue South Senatorial

District, Benue State, based on marital status (χ² = 7.768; df = 8; p = .456). Since the p-value

of .456 is greater than the 0.05 level of significance, the null hypothesis was not rejected. This

implies that no difference existed in attitude based on marital status.

The results of the study indicate that there was no statistically significant difference in

preventive practice regarding hepatitis B infection among healthcare workers in Benue South

Senatorial District, Benue State, based on educational qualification (χ² = 8.642; df = 6; p = .195).

Since the p-value of .195 is greater than the 0.05 level of significance, the null hypothesis was

not rejected. This implies that no difference existed in preventive practice based on educational

qualification.

The results of the study indicate that regarding hepatitis B infection knowledge based on

profession in Benue South Senatorial District, Benue State, (χ2= 20.275; p-value =.062). Since

the p-value of .062 is greater than the 0.05 level of significance at 6 degrees of freedom,

therefore, the null hypothesis was not rejected. This implies that no difference existed between
 101

the level of knowledge regarding hepatitis B among healthcare workers in Benue south senatorial

district, Benue State based on profession.

The results of the study indicate that regarding attitude towards hepatitis B infection

based on ethnicity in Benue South Senatorial District, Benue State, (χ2= 22.785; p-value =.064).

Since the p-value of .064 is greater than the 0.05 level of significance at 14 degrees of freedom,

therefore, the null hypothesis was not rejected. This implies that no difference existed between

the level of knowledge regarding hepatitis B among healthcare workers in Benue south senatorial

district, Benue State based on ethnicity.

The result of the study indicated that the preventive practice of healthcare workers

regarding hepatitis B infection-based ethnicity, job location, and years of experience in Benue

south senatorial district, Benue state. Since the p-value of .008 is less than the 0.05 level of

significance at 6 degrees of freedom, therefore, the null hypothesis was rejected. This implies

that significant difference existed between the level of knowledge regarding hepatitis B among

healthcare workers in Benue south senatorial district, Benue State based on years of experience.

Conclusions

Based on the findings of the study, it was concluded that healthcare workers in Benue

South Senatorial District generally possess a high level of knowledge regarding hepatitis B

infection, demonstrate positive attitudes toward its prevention and management, and practise

appropriate preventive measures in their workplaces. This suggests that most healthcare workers

understand the risks associated with hepatitis B and are committed to protecting themselves and

their patients.

However, important gaps remain. Specific technical knowledge areas, such as

understanding the differences between acute and chronic hepatitis B, vaccination schedules, and
 102

long-term complications, were found to be inadequate among many respondents. In addition,

variations were observed across demographic and professional groups, particularly based on

years of experience, where less experienced workers showed better knowledge levels than older

staff.

This indicates that continuous professional updating may be lacking among some categories of

workers.

Contribution to Knowledge

This study contributes to existing knowledge in several important ways. First, it provides

empirical evidence on the level of knowledge, attitude, and preventive practices regarding

hepatitis B infection among healthcare workers within Benue South Senatorial District, an area

where limited local data previously existed. By generating context-specific information, the

study fills a regional research gap in hepatitis B occupational health studies in Nigeria.

Second, the study simultaneously assessed the three core variables of knowledge, attitude, and

preventive practice (KAP), thereby offering a comprehensive understanding of healthcare

workers’ behavioural responses to hepatitis B rather than examining each variable in isolation.

This integrated approach enhances the understanding of how knowledge and attitude influence

preventive behaviours.

Third, the study identified years of experience as a significant determinant of knowledge

level, revealing that more recently trained professionals may possess better current knowledge

than older workers. This finding provides new insight into the importance of continuous

professional development in infection control practices.

Finally, the findings provide baseline data that can serve as a reference point for future

intervention programs, policy formulation, and comparative studies in similar healthcare settings.
103
 104

Implications of the Findings

The findings of this study have several practical, policy, and educational implications.

Practically, the identified knowledge gaps suggest the need for regular in-service training,

workshops, and refresher courses to strengthen healthcare workers’ understanding of technical

aspects of hepatitis B prevention and management. Without continuous education, healthcare

workers may remain vulnerable to occupational exposure.

From a policy perspective, hospital administrators and health authorities should prioritize

mandatory hepatitis B vaccination, routine screening, and structured infection control training

programs to ensure uniform compliance across all professional categories. The differences

observed across professions and experience levels indicate that targeted interventions may be

more effective than general programs.

Educationally, the results highlight the need to strengthen hepatitis B education within

medical and allied health training curricula to ensure that graduates enter the workforce with

updated knowledge and skills. Continuous professional development programs should also be

institutionalized to maintain competency throughout healthcare workers’ careers.

From a public health perspective, improved knowledge and preventive practices among

healthcare workers will reduce occupational infections, minimize disease transmission to

patients, and enhance overall healthcare safety within the district.

Recommendations

Based on the findings, the following recommendations were made:

1. Regular hepatitis B training and awareness programs should be organized for healthcare

workers.

2. Mandatory hepatitis B vaccination should be enforced in all health facilities.

 105

3. Infection control materials such as gloves and sharps containers should be adequately

provided.

4. Newly recruited staff should receive orientation on hepatitis prevention.

5. Periodic screening and monitoring should be conducted for all healthcare workers.

Limitations of the Study

The following are the limitations of the study:

1. The study was limited to healthcare workers within the South Eastern Senatorial District

of Benue State, which may limit generalization of findings.

2. Data were collected using self-reported questionnaires, which may be subject to response

bias.

3. Time and financial constraints also limited the scope of the research.

Suggestions for Further Study

Further studies can be done on the following topics:

Conduct similar studies in other senatorial districts or states for comparison.

1. Future researchers should employ larger sample sizes and include both public and private

healthcare facilities to obtain broader and more representative results.

2. Longitudinal or follow-up studies should be carried out to assess changes in knowledge,

attitudes, and preventive practices over time rather than relying solely on cross-sectional

data.
 106

3. Experimental or quasi-experimental studies should be conducted to evaluate the

effectiveness of health education or training interventions on improving hepatitis B

knowledge and preventive practices among healthcare workers.

4. Further studies should explore other factors such as availability of vaccines, institutional

policies, workplace safety culture, and access to infection control resources that may

influence hepatitis B prevention preventive practices.

5. Qualitative or mixed-methods research should also be conducted to provide deeper

insight into the factors influencing hepatitis B KAP among healthcare workers.

Summary of the Study

The purpose of the study was to determine level of knowledge, attitudes and preventive

practices regarding hepatitis B infection among of healthcare workers in South Eastern senatorial

district, Benue State LGA. The study was guided by 6 specific objectives. In line with the

objectives, 6 research questions were asked to guide the study. Six null hypotheses were

formulated and tested. This research has a wide range of potential beneficiaries, including

researchers, policy makers, practitioners, and public health workers. The study was conducted

among 1,361 healthcare workers in Benue South Senatorial District, with sociodemographic

variables including gender, marital status, educational qualification, profession, ethnicity, and

years of experience.

Literature in this study was organised and presented under a conceptual framework

examining the level of knowledge, attitudes, and preventive practices regarding hepatitis B

infection among healthcare workers, alongside relevant sociodemographic variables. The study

was anchored on Theory of Reasoning Action (TRA) and the Health Belief Model (HBM). The

TRA theory is concerned with human behave based on their pre-existing attitudes and
 107

behavioural intentions. The TRA assumes that attitude towards behaviour is determined by the

person's beliefs about outcomes. The HBM explores the relationship between health behaviour,

preventive practice, and utilisation of health services.

Empirical studies highlighted the levels of knowledge, attitudes and preventive practices

regarding hepatitis B infection among of healthcare workers in South Eastern senatorial district,

Benue State LGA. The authors based their research on various social, economic and

demographic factors associated with attitudes and preventive practices regarding hepatitis B

infection among of healthcare workers. Most of the studies used a cross-sectional research

design, while others employed a descriptive design. The instruments used were mostly

questionnaires. The simple random sampling technique was used in most studies to get the

sample. Methods of data analysis mostly used include means, frequencies, percentages and chi-

square analysis. However, few studies have simultaneously investigated knowledge, attitudes,

and preventive practices regarding hepatitis B infection among healthcare workers while

examining the influence of multiple domains and protective factors. Amongst these studies, none

has been carried out in Benue South Senatorial District, to the best of the researcher’s

knowledge. Therefore, the researcher sought to determine the level of knowledge, attitudes, and

preventive practices regarding hepatitis B infection among healthcare workers in Benue South

Senatorial District, Benue State.

The descriptive survey design was employed to achieve the purpose of the study. A

descriptive survey design is a type of observational study that analyzes data from a population, or

a representative subset, at a specific point in time. A descriptive design was used to assess the

knowledge, attitude, and preventive practice of healthcare workers regarding hepatitis B

infection. The study was conducted in Benue State senatorial district. Benue State is one of the

middle belt states in Nigeria. The population of the study comprised 1,014 primary healthcare
 108

workers and 347 secondary healthcare workers the total population of healthcare workers in

Benue south senatorial district stands at 1014 Primary healthcare workers and 347 Secondary

healthcare workers, Benue State. These stands at 1014 Primary healthcare workers and 347

Secondary healthcare workers respectively which gives the target population of 1361 healthcare

workers. Data were collected using the Knowledge, Attitude and Preventive Practice of

Healthcare Workers Regarding Hepatitis B Infection Questionnaire (KAPHBKIQ), which was

adapted from standardised instruments to meet the needs of the current study. Draft copies of the

instrument with the purpose of the study, research questions, research hypotheses and

questionnaire were validated by five experts in terms of clarity, coverage, correctness,

appropriateness and suitability to the study. The results for the analysis of data for this study

were collected by the researcher with the aid of two research assistants. The respondents were

requested to complete the instrument and return it on the spot to ensure a maximum return rate.

However, due to incomplete data, only 364 questionnaires were used for data analysis and

interpretation. The collected data for this study was analyzed using descriptive and inferential

statistics. The null hypotheses were tested using the chi-squared test. If p < 0.05, the null

hypothesis was rejected, indicating a statistically significant difference. If p ≥ 0.05, the null

hypothesis was not rejected, indicating no significant difference.

From the findings of the study, it was concluded that no statistically significant

differences existed based on most sociodemographic factors in the level of knowledge, attitudes,

and preventive practices regarding hepatitis B infection among healthcare workers in Benue

South Senatorial District. Similarly, the study found no significant relationship between most

sociodemographic factors and knowledge, attitudes, and preventive practices among healthcare

workers, suggesting that these factors do not consistently predict KAP outcomes. The study
 109

contributes to knowledge by providing empirical evidence that most sociodemographic factors

do not significantly predict knowledge, attitudes, and preventive practices regarding hepatitis B

infection among healthcare workers in the study area. Additionally, other psychological and

contextual factors may be more critical than sociodemographic characteristics in ensuring good

preventive practices. (Previously: knowledge, attitudes do not statistically influence and

preventive practices regarding hepatitis B infection among of healthcare workers, suggesting that

other psychological factors may be more critical in ensuring good preventive practices. However,

the study highlights those years of experience significantly influenced knowledge, emphasising

the need for continuous professional education and targeted interventions in similar socio-

cultural settings. inform preventive practices interventions in similar socio-cultural settings.

Furthermore, the research indicates that improvements in knowledge, attitude, and preventive

practice may be attainable across diverse population subgroups, provided adequate education and

training are in place. indicating that psychological benefits from preventive practice may be

attainable across different population subgroups, provided the preventive practice is adequate.

These findings challenge traditional notions that variations in knowledge, attitude, and

preventive preventive practices across demographic groups pose a challenge. Healthcare workers

with fewer years of experience demonstrated higher knowledge and better preventive practices

compared to older or more experienced staff, suggesting that outdated training and limited

continuing professional education may affect older professionals.

The findings of this study have important implications for health education, healthcare practice,

policy formulation, and future research regarding hepatitis B prevention among healthcare

workers. Based on the study’s finding, it was recommended, among others, that Hospital

management should organize regular training and refresher courses on hepatitis B infection,
 110

transmission, vaccination, and preventive measures to sustain and improve healthcare workers’

knowledge. Future studies should conduct experimental or quasi-experimental research to

evaluate the effectiveness of health education and training interventions aimed at improving

hepatitis B knowledge and preventive practices among healthcare workers. The following are the

limitations of the study: The study used a cross-sectional survey design, limiting the ability to

establish causality between variables over time. Self-reported data is prone to biases, and faking

responses during data collection may affect reliability. The study adopted a cross-sectional

design in which data were collected at a single point in time, which limited the ability to

establish cause-and-effect relationships or observe changes in knowledge, attitudes, and

preventive practices over time. This limits the ability to establish cause-and-effect relationships

or observe changes in knowledge, attitudes, and preventive practices over time.

 111

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 118

Appendix A

INSTRUMENT

Department of Human Kinetics and Health Education,

Faculty of Education,
University of Nigeria, Nsukka,
Enugu State,
20th February, 2024.

Dear Respondent,
KNOWLEDGE, ATTITUDE AND PREVENTIVE PRACTICE OF HEALTHCARE
WORKERS REGARDING HEPATITIS B INFECTION QUESTIONNAIRE
(KAPHBKIQ)
I am a post graduate student of the above named institution carrying out a research study
on the “Knowledge, Attitude and Preventive practice of Healthcare Workers regarding Hepatitis
B Infections in Benue South Senatorial District, Benue State. This is to enable me partially fulfil
the requirements for graduation.
Based on this, I humbly solicit your co-operation to truthfully respond to the
questionnaires. All information provided by you will be treated with utmost confidentiality and
used for academic purpose strictly.
Thank you for your anticipated co-operation.

Yours faithfully,

Adikpe, Okanga Ogbeche

PG/[Link]./20/93219
 119

Section A :( Personal Data)

Instruction: Please tick the appropriate option.

1. Sex: Male ( ) Female ( )

2. Marital status: Single ( ) Married ( ) Divorced ( ) Separated ( ) Widow ( )

3. Educational Qualification: WAEC/NECO () OND/NCE ( ) HND/

/B.S.C ( ) /[Link]. and above ( )

4. Profession: Medical Doctor ( ) Pharmacist ( ) Nurses ( ) Health Information

Officer ( ) Midwife ( ) [Link]/Technician ( ) )thers, Specify…………………….

5. Ethnicity Igbo ( ) Yoruba ( ) Hausa ( ) Igede ( ) Idoma ( ) Tiv ( ) Igala ( ) Others 0

6. Years of experience: 6-10 years ( ) 11-25years ( ) 26-30 ( ) 31-35 ( ) 35 and above

Section B: Knowledge of Hepatitis B Virus

Instruction: Kindly indicate your knowledge of the disease by placing a tick (√) against each of

the statements provided in the table below using True/False

S/N Level of knowledge of healthcare workers True False

regarding Hepatitis B infection

1. You have received formal training on hepatitis

B transmission?

2. Hepatitis B is a viral infection that affects the

liver?

3. Hepatitis B can be transmitted through blood

and bodily fluids?
 120

4. Hepatitis B can be transmitted through sharing

needles or syringes?

5. You are familiar with the symptoms of

hepatitis B infection?

6. Hepatitis B can be transmitted from mother to

child during childbirth?

7. Hepatitis B can be prevented through

vaccination?

8. Hepatitis B can be transmitted through

unprotected sexual contact?

9. You are familiar with the difference between

acute and chronic hepatitis B infection?

10. Hepatitis B can be transmitted through sharing

personal items like toothbrushes or razors?

11. Hepatitis B can lead to serious liver

complications if left untreated?

12. Hepatitis B can be transmitted through organ

transplantation?

13. You are familiar with the recommended

vaccination schedule for hepatitis B?
 121

14. Hepatitis B can be transmitted through

breastfeeding?

15. Hepatitis B screening is recommended for

certain high-risk populations?

Instruction: Kindly indicate your attitude towards hepatitis B infection among healthcare

workers by placing a tick (√) against each of the statements provided in the table below using

Strongly Agree, Agree, Disagree, Strongly Disagree

S/N Attitude towards hepatitis B infection Strongly Agree Disagree Strongly

among healthcare workers Agree Disagree

1. I believe that hepatitis B is a significant

public health concern

2. I am confident in my ability to provide

accurate information about hepatitis B
to patients

3. I believe that healthcare workers have a

responsibility to educate patients about
hepatitis B prevention

4. I am concerned about the risk of

contracting hepatitis B in my workplace

5. I believe that hepatitis B patients

deserve the same level of care and
respect as patients with other medical
conditions
 122

6. Are you comfortable discussing

hepatitis B with colleagues and patients

7. I feel that enough resources are

allocated towards hepatitis B prevention
and treatment in your healthcare
facility.

8. I believe that healthcare workers should

be routinely screened for hepatitis B

9. I am aware of any stigma or

discrimination associated with hepatitis
B.

10. Do you feel adequately trained to

provide care for patients with hepatitis
B

11. I believe that vaccination against

hepatitis B should be mandatory for
healthcare workers

12. I am concerned about the potential legal

or ethical implications of working with
hepatitis B patients?

13. I believe that hepatitis B education

should be integrated into medical
training programs

14. I am confident in my ability to protect

myself from hepatitis B infection while
 123

providing patient care.

15. I believe that hepatitis B patients should

disclose their status to healthcare
providers.

Instruction: Kindly indicate your preventive practice of healthcare workers towards hepatitis B

infection by placing a tick (√) against each of the statements provided in the table below using

Strongly Agree, Agree, Disagree, Strongly Disagree

S/N Preventive practice of healthcare Strongly Agree Disagree Strongly

workers towards hepatitis B Agree Disagree
infection

1. I routinely follow universal

precautions, including wearing
gloves and other protective gear,
when dealing with patients who may
have hepatitis B

2. I always wash my hands thoroughly

after coming into contact with blood
or bodily fluids, as per recommended
infection control guidelines.

3. I make sure to properly dispose of

needles and other sharp objects in
designated sharps containers to
prevent accidental needlestick
injuries.
 124

4. I am vigilant about getting

vaccinated against hepatitis B and
ensuring that my vaccination status is
up to date.

5. I regularly screen patients for

hepatitis B risk factors and
recommend testing when
appropriate.

6. I provide patients with accurate

information about hepatitis B
transmission, prevention, and
treatment options.

7. I am confident in my ability to
recognize the symptoms of hepatitis
B infection in patients.

8. I collaborate with other healthcare

professionals to ensure
comprehensive care for patients
diagnosed with hepatitis B.

9. I actively participate in hepatitis B

education and training sessions
provided by my healthcare facility.

10. I advocate for the implementation of

policies and protocols aimed at
preventing hepatitis B transmission
in the workplace.

11. I support efforts to reduce stigma and

discrimination against individuals
 125

living with hepatitis B.

12. I prioritize the safety and well-being

of patients with hepatitis B in all
aspects of their care.

13. I stay informed about the latest

developments in hepatitis B research
and treatment options.

14. I take appropriate precautions to

prevent the transmission of hepatitis
B from mother to child during
childbirth.

15. I ensure that patients diagnosed with

hepatitis B receive timely referrals to
specialists for further evaluation and
management.

Appendix B
 126

Cochran 's formula for computation of sample size for the study

To estimate the sample size using the Cochran formula, we need to specify the following
parameters:

1. Population size (N): 1361 healthcare workers

2. Desired margin of error (E): Typically 5per cent (0.05)

3. Confidence level: 95per cent (Z-score = 1.96)

4. Proportion (p): Assuming a moderate prevalence of 50per cent (0.5) for the outcome of
interest

Cochran Formula:

n = (Z^2 p (1-p)) / E^2

where n is the sample size.

Plugging in the values:

n = (1.96^2 0.5 (1-0.5)) / 0.05^2

n = (3.8416 0.25) / 0.0025

n = 0.9604 / 0.0025

n = 384.16

Rounding up to the nearest whole number:

n = 385

So, the estimated sample size is approximately 385 healthcare workers

 127

Appendix C

ETHICAL CLEARANCE
 128

Appendix D

Population
 129

Appendix F

VALIDATED INSTRUMENT
1