Dissertation on "Hepatitis B Vaccine and Healthcare Service Providers"

Dissertation 22 pages (5522 words) Sources: 52

[EXCERPT] . . . .

84% respondents agreed that anti-HB testing was crucial after an injury. Respondents’ HBV-knowledge was poor- 67% underestimated HB-transmission risk; only 33% knew of it. 61% doctors (22% unknown, 39% known) weren’t HBV-immune.40

A 2005 cross-sectional Indian study aimed at evaluating HCWs’ HBV-immunization status and examining reasons for non-compliance. 254 susceptible HCWs (nurses, medical assistants, housekeepers, and paramedics) had to answer a set questionnaire for acquiring relevant information and ascertaining vaccination coverage. Findings were: 57.5% respondents were HBV-immunized; housekeepers showed least vaccine compliance; mean vaccinated-HCWs’ age was 30.5years, while 34.3% non-compliant individuals were aged 30+; 32.2% completed primary immunization following a decade in healthcare settings. 83.3% respondents cited reasons for non-compliance (risk-related beliefs/knowledge were key factors). 31.1% claimed vaccine non-accessibility as cause for dose-incompletion; the most prevalent reason cited was absence at vaccine drives (owing to temporary duty/leave).41

A cross-sectional study of 485 public/private sector HCWs in rural Tehsil Swabi, Northwest Pakistan in 2010 evaluated their vaccination status, investigated facilities and discovered personal characteristics linked to vaccination coverage. A questionnaire obtained socio-demographic information, and data on HBV-vaccination, knowledge of transmission modes, perceived vaccination benefits and disease severity. Participants were chosen from 483 primary healthcare centers (447 private, 36 public). 75% participants were physicians; the rest were dispensers. Mean HCW age was 38 years (10.4), while average experience in the field was 12.2 (8.6) years. 40% respondents self-reported complete immunization. HBV-immunization prevalence was: 41% physicians; 37.7% dispensers. Public HCWs showed higher vaccine compliance (76.8%) than private workers (35.4%). Qualified physicians showed highest coverage (86%) while dispensers without formal qualification showed lowest coverage (16%).42

HCWs from 2 Georgian hospitals in Kaspi and Batumi underwent a cross-sectional survey, in 2007, for measuring HBV-vaccination rates and determining vaccine compliance factors among them. They were given self-administered questionnaires with questions on demographic characteristics, HB-immunization status, vaccination barriers, and inclination to recommend HB-vaccine to peers. Lab tests identified HB-infected, immune and at-risk individuals. 91% HCWs responded (173 nurses, 124 physicians). Vaccine coverage was 12%; 54% participants agreed to recommend it to peers; 72% regarded the vaccine as safe (out of which 70% recommended it to others). 66% HCWs perceived cost to be an obstacle to vaccination, and believed it was imperative to offer free/economical vaccination. Probability of recommendation was linked to coworkers’ completion of vaccination. 37% formed attitudes and acquired knowledge on the vaccine from a harmful-event reporting mechanism, 27% from medical literature, 22% from vaccine testing for identifying contaminants, 7% from vaccine effectiveness reports.43

1.3.3 REGIONAL SITUATION

A 2011 cross-sectional Libyan research for assessing HCWs’ HBV-vulnerability and vaccine compliance surveyed 2705 HCWs for HBsAg and anti-HBs via a standardized self-reporting questionnaire, for obtaining demographic, HB-vaccine status and non-compliance information. Overall 78.1% respondents were immunized; 82.6% were administered ≥1 dose, and 72% received all three doses; 17.4% never received HB-vaccination. Paramedics showed highest vaccination coverage. Mean HB-surface-antigen prevalence was 1.1%, while that for anti-HBc was 17.3%.44

A descriptive, cross-sectional HCW survey for evaluating their attitudes, behavior and knowledge regarding HBV-protection/transmission was conducted in Kuwait’s capital, and Farwaniya Governorate, in 2011.A specially-designed questionnaire drawn from other published research was administered to 534 individuals; response rate was 55% .76.2% respondents knew that HBV can be transmitted to them via patients; 57.7% knew that worker-to-patient transmission was also likely; 81.5% knew of vaccination; 65% had information on overall vaccination schedule; and 44.4% had knowledge regarding the time gap between doses.74.7% PHCWs reported being vaccinated– of these, 84% received complete vaccination, 73.8% reported to requiring more information on the disease, and 79.3% individuals never vaccinated  had no specific cause for missing immunization.45

A 2008 cross-sectional Syrian University Hospitals’ research on HCWs’ HBV-immunization status, for outlining prevention priorities based on institutional injury data and highlighting the risk of sharp-object injuries, chose participants via computerized randomization. A self-formulated researcher-administered questionnaire on 316 HCWs showed the following results: 76.6% HCWs received ≥1 needle-stick injury in one year; 23.4%  were non-immunized; 56.1% completed vaccination course; and 20.6% were incompletely-immunized. Housekeepers, a high-risk group, depicted low HBV-vaccine coverage (4.5%).46

1.3.4. NATIONAL SITUATION

A local cross-sectional study endeavored to assess Hajj-time HCWs’ (Arafat and Mina nurses and doctors) compliance in obtaining HBC, meningococcal, and influenza immunization. Anonymous, self-administered, researcher-supervised questionnaires obtained demographic/ vaccination history-related information. 392 HCWs enrolled in Hajj-medicine training; response rate was 100% (45.2% doctors, 54.8% nurses). 82.4% HCWs were meningitis-immunized, 5.9% were influenza-immunized, 66.3% were administered complete HBV course (of these, 51.5% were anti-HB-tested post-vaccination). 12.2% received only two HB-vaccine doses, 7.1% received only one dose, and 14.3% were non-immunized. No significant difference was seen between nurses’ and doctors’ compliance.17

A 2012 cross-sectional survey at Faculty of Dentistry, King Abdul-Aziz University, assessed HBV-vaccination coverage and infection controls among Saudi dentists. A questionnaire for obtaining information on post, service length, demographic data, HBV-vaccine status, anti-HB tests, needle-stick-injury history, disease history, and infection control precautions was administered to 402 dentists (226 female, 176 male). 80.5% received HB-immunization; 48.5% reported needle-stick injuries; none reported HBV-infection. Younger dentists used protective wear religiously and got vaccinated. A link was found between vaccination and protective barriers, but not between vaccination and needle-stick injuries.16

1.4 Study rationale

HBV represents a key occupational hazard because of enhanced exposure to HBV-transmitters. The Saudi occupational health division recommends, but doesn’t mandate, HBV-vaccine for HCWs. HCWs have a choice in getting vaccinated, and this hinges on their attitude/knowledge concerning HB-vaccination. There has been no such prior research in the country.

2.1. Aim and objectives

1-To identify HBV coverage of Al-Madinah Al-Munawarah’s PHCWs

2-To ascertain PHCWs’ knowledge regarding HBV-vaccination

3- To discover PHCWs’ attitudes regarding HBV-vaccination. 

4- To determine obstacles to HB-vaccine coverage of PHCWs.

2.2. Research Questions

1-What are the reported HB-vaccination coverage levels among Al-Madinah’s PHCWs?

2-What is their attitude and knowledge concerning HBV-vaccine?

3- What obstacles impact PHCWs’ HBV-coverage?

2.3. Research hypothesis

Around 50% of PHCWs had been administered all three HB-vaccine doses.

3.1 Study Design 

A descriptive cross-sectional research was carried out, via a quantitative method; a self-administered questionnaire was given to subjects.

3.2 Study Setting 

 The research was performed at Al-Madinah Al-Munawwarah, in January-June, 2014. Al-Madinah has 43 government health facilities with 1200 PHCWs.

3.3 Sample and sampling method

Sample size

Size was estimated, using the hypothesis of 50% HBV-vaccine coverage with 3% precision degree, to be 384 PHCWs, via stratified random sampling, out of 645 PHCWs.

Formula for determining sample size: n= (Z2pqD)/d2

Where n=Sample size  

Z=Standard normal deviate (1.96 at CI 95%).

p=Estimated target population covered (0.50).

q=I-p (remaining target population) 

d=Level of significance (0.05) 

D=Desired effect (1). 

N= (1.962x0.50x0.50)/0.052=384.

Sampling method

There are 4 administrative divisions in Al-Madinah. The 645 HWCs were proportionally allocated among sectors depending on the PHC centers per sector. 43 PHCCs exist in Al-Madinah [Therefore, 645/43=15, multiplied by total PHCCs in individual sectors gives HWCs chosen from each]. Average of HCWs in individual PHCCs in individual sectors was utilized for determining number of PHCCs to be studied; PHCCs were chosen randomly.

Inclusion criteria:

1-HCWs having job experience of over 6 months

2-PHCWs available during data collection  

3-Health Professionals from PHCCs

3.4 Study Population

Every qualified PHCW, who satisfied the aforementioned inclusion criteria, serving at Al-Madinah’s government PHCCs and willing to participate in the research were included. 

3.5 Data Collection Tools/Methods

A structured, self-administered, anonymous questionnaire, developed in English and translated into Arabic was used. Pilot study and to-and-fro checks were applied for ensuring validity. Both English and Arabic questionnaires were distributed among PHCWs.

The questionnaire explained survey significance, participation significance, voluntary participation, respondent benefit, confidentiality and estimated completion time. Questions were clarified before participants.

Questionnaire delivery was ensured via appointments with subjects through their manager. Willing participants were given the questionnaire. Completed questionnaires were gathered at pre-arranged times. A 3-time verbal reminder for completion and return was given, failing which, respondent was assumed to be unwilling, and replaced. The questionnaire had 4 sections:

1: Demographics: Participant gender, age, nationality, job category, and job experience (years). 

2: Knowledge: Participant knowledge of HBV-vaccine’s significance, effectiveness, complete dosage, route of immunization, and time gap between doses (months).

3: Attitude: Views on occupational risk from HBV; mandating of HBV-vaccination; perception of personal risk because of precautions during patient-contact and procedures; perception of pain inflicted by vaccine [on a 5-point strongly disagree--strongly agree scale]

4: Practice: Protection from and exposure to HBV; immunization; number of doses administered; immunity check post-vaccination; contaminated sharp-object injury history; obstacles to vaccine completion/administration.

3.7 Data Analysis

Study utilized Microsoft Access for entering gathered data; analysis was done via EPI INFO.  PHCWs’ vaccine coverage attitudes, knowledge and obstacles to completion/administration was analysed through… READ MORE

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