Knowledge, attitudes and medical practice regarding hepatitis B prevention and management among healthcare workers in Northern Vietnam

Autoři: Thi T. Hang Pham aff001;  Thuy X. Le aff002;  Dong T. Nguyen aff002;  Chau M. Luu aff002;  Bac D. Truong aff002;  Phu D. Tran aff002;  Mehlika Toy aff001;  Selen Bozkurt aff003;  Samuel So aff001
Působiště autorů: Asian Liver Center, Department of Surgery, Stanford University School of Medicine, Palo Alto, California, United States of America aff001;  General Department of Preventive Medicine, Ministry of Health, Hanoi, Vietnam aff002;  Department of Biomedical Informatics, Stanford University School of Medicine, Palo Alto, California, United States of America aff003
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223733


Background and aim

Vietnam’s burden of liver cancer is largely due to its high prevalence of chronic hepatitis B virus (HBV) infection. This study aimed to examine healthcare workers’ (HCWs) knowledge, attitude and practices regarding HBV prevention and management.


A cross-sectional survey among health care workers working at primary and tertiary facilities in two Northern provinces in Vietnam in 2017. A standardized questionnaire was administered to randomly selected HCWs. Multivariate regression was used to identify predictors of the HBV knowledge score.


Among the 314 participants, 75.5% did not know HBV infection at birth carries the highest risk of developing chronic infection. The median knowledge score was 25 out of 42 (59.5%). About one third (30.2%) wrongly believed that HBV can be transmitted through eating or sharing food with chronic hepatitis B patients. About 38.8% did not feel confident that the hepatitis B vaccine is safe. Only 30.1% provided correct answers to all the questions on injection safety. Up to 48.2% reported they consistently recap needles with two hands after injection, a practice that would put them at greater risk of needle stick injury. About 24.2% reported having been pricked by a needle at work within the past 12 months. More than 40% were concerned about having casual contact or sharing food with a person with chronic hepatitis B infection (CHB). In multivariate analysis, physicians scored significantly higher compared to other healthcare professionals. Having received training regarding hepatitis B within the last two years was also significantly associated with a better HBV knowledge score.


Findings from the survey indicated an immediate need to implement an effective hepatitis B education and training program to build capacity among Vietnam’s healthcare workers in hepatitis B prevention and control and to dispel hepatitis B stigma.

Klíčová slova:

Eating – Hepatitis B – Hepatitis B virus – Hepatocellular carcinoma – Physicians – Vaccination and immunization – Vaccines – Vietnam


1. World Health Organization: Hepatitis B Factsheet (2018).

2. World Health Organization: Global hepatitis report 2017 (2017)

3. Global Burden of Disease Liver Cancer, C., The burden of primary liver cancer and underlying etiologies from 1990 to 2015 at the global, regional, and national level: Results from the global burden of disease study 2015. JAMA Oncology, 2017. 3(12): p. 1683–1691. 28983565

4. Kakumu S., Sato K., Morishita T., Trinh K. A., Nguyen H. B., Banh V. D., et al., Prevalence of hepatitis B, hepatitis C, and GB virus C/hepatitis G virus infections in liver disease patients and inhabitants in Ho Chi Minh, Vietnam. J Med Virol, 1998. 54(4): p. 243–8. 9557289

5. Hipgrave D. B., Nguyen T. V., Vu M. H., Hoang T. L., Do T. D., Tran N. T., et al., Hepatitis B infection in rural Vietnam and the implications for a national program of infant immunization. Am J Trop Med Hyg, 2003. 69(3): p. 288–94. 14628946

6. Nguyen V. T., McLaws M. L., and Dore G. J., Highly endemic hepatitis B infection in rural Vietnam. J Gastroenterol Hepatol, 2007. 22(12): p. 2093–100. doi: 10.1111/j.1440-1746.2007.05010.x 17645465

7. Duong T. H., Nguyen P. H., Henley K., and Peters M., Risk factors for hepatitis B infection in rural Vietnam. Asian Pac J Cancer Prev, 2009. 10(1): p. 97–102. 19469633

8. Schweitzer A., Horn J., Mikolajczyk R. T., Krause G., and Ott J. J., Estimations of worldwide prevalence of chronic hepatitis B virus infection: a systematic review of data published between 1965 and 2013. Lancet, 2015. 386(10003): p. 1546–55. doi: 10.1016/S0140-6736(15)61412-X 26231459

9. Nguyen V. T., Law M. G., and Dore G. J., An enormous hepatitis B virus-related liver disease burden projected in Vietnam by 2025. Liver Int, 2008. 28(4): p. 525–31. doi: 10.1111/j.1478-3231.2007.01646.x 18266635

10. World Health Organization. International Agency for Research on Cancer. Global Cancer Observatory (2018).

11. Ferlay J, S. I., Ervik M, Dikshit R, Eser S, Mathers C, Rebelo M, Parkin DM, Forman D, Bray, F., GLOBOCAN 2012 v1.1, Cancer Incidence and Mortality Worldwide: IARC CancerBase: 2012. No. 11

12. Vietnam Ministry of Health, The National Action Plan for Viral Hepatitis Prevention and Control 2015–2019, 2015,

13. Chao J., Chang E. T., and So S. K., Hepatitis B and liver cancer knowledge and practices among healthcare and public health professionals in China: a cross-sectional study. BMC Public Health, 2010. 10.

14. Chao S. D., Cheung C. M., Yang E. J., So S. K., and Chang E. T., Low levels of knowledge and preventive practices regarding vertical hepatitis B transmission among perinatal nurses. J Obstet Gynecol Neonatal Nurs, 2012. 41(4): p. 494–505. 22697047

15. Wang J., Feng Q., Tam A., Sun T., Zhou P., and So S., Evaluation of the first open-access hepatitis B and safe injection online training course for health professionals in China. BMC Medical Education, 2016. 16(1): p. 81.

16. Bursac Z., Gauss C. H., Williams D. K., and Hosmer D. W., Purposeful selection of variables in logistic regression. Source code for biology and medicine, 2008. 3: p. 17–17. doi: 10.1186/1751-0473-3-17 19087314

17. Cuong N, T. D., Ngan N, Hai Phan, Knowledge, attitude and practice of Hepatitis B virus infection among health care workers in hospitals of Quang Binh province in 2012. Vietnam Journal of Preventive Medicine, 2012. Volume XXVI, 7 (180) 2016

18. Linh N, G. H., Son Ng, Minh Ng, Han P, Knowledge, attitude, practice towards hepatitis B transmission prevention of students of Hai Phong University of Medicine and Pharmacy 2015. Vietnam Journal of Preventive Medicine, 2015. Volume XXVI, No. 14 (187) 2016.

19. World Health Organization, Success Factors for Women’s and Children’s Health: Vietnam, 2015,

20. Hang Pham T. T., Le T. X., Nguyen D. T., Luu C. M., Truong B. D., Tran P. D., et al., Knowledge, attitudes and practices of hepatitis B prevention and immunization of pregnant women and mothers in northern Vietnam. PLOS ONE, 2019. 14(4): p. e0208154. doi: 10.1371/journal.pone.0208154 30969972

21. MacDonald N. E., Vaccine hesitancy: Definition, scope and determinants. Vaccine, 2015. 33(34): p. 4161–4. doi: 10.1016/j.vaccine.2015.04.036 25896383

22. Verger P., Fressard L., Collange F., Gautier A., Jestin C., Launay O., et al., Vaccine Hesitancy Among General Practitioners and Its Determinants During Controversies: A National Cross-sectional Survey in France. EBioMedicine, 2015. 2(8): p. 891–7. doi: 10.1016/j.ebiom.2015.06.018 26425696

23. Ziraba A. K., Bwogi J., Namale A., Wainaina C. W., and Mayanja-Kizza H., Sero-prevalence and risk factors for hepatitis B virus infection among health care workers in a tertiary hospital in Uganda. BMC infectious diseases, 2010. 10: p. 191–191. doi: 10.1186/1471-2334-10-191 20587047

24. Jha A. K., Chadha S., Bhalla P., and Saini S., Hepatitis B infection in microbiology laboratory workers: prevalence, vaccination, and immunity status. Hepatitis research and treatment, 2012. 2012: p. 520362–520362. doi: 10.1155/2012/520362 23304474

25. Prüss-Üstün A., Rapiti E., and Hutin Y., Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine, 2005. 48(6): p. 482–490. doi: 10.1002/ajim.20230 16299710

26. Trépo C., Chan H. L. Y., and Lok A., Hepatitis B virus infection. The Lancet, 2014. 384(9959): p. 2053–2063.

27. Quang Vo T., Le Hoang Nguyen T., and Ngoc Pham M., Exploring knowledge and attitudes toward the hepatitis B virus: An internet-based study among Vietnamese healthcare students. Vol. 6. 2018. 458–470.

28. PD, M., Assess knowledge of injection safety and frequency of risk due to sharp objects for nursing-midwives in 8 provinces represent the first six months of 2005. Proceedings of the scientific research nationwide nursing; 2nd the Vietnam Nurses Association, 2005. 2005;(224–232.).

29. Van Tuong P, P. T., Anh BTM and Nguyen THT., Assessment of injection safety in Ha Dong General Hospital, Hanoi, in 2012. F1000Research 2017.

30. Pellissier G., Yazdanpanah Y., Adehossi E., Tosini W., Madougou B., Ibrahima K., et al., Is universal HBV vaccination of healthcare workers a relevant strategy in developing endemic countries? The case of a university hospital in Niger. PloS one, 2012. 7(9): p. e44442–e44442. doi: 10.1371/journal.pone.0044442 22970218

31. Duong, V. K., WHO Health care worker safety; Vietnam National Institute of Epidemiology, Research on needlestick injuries amongst health care workers and interventions in selected hospitals in Hanoi 2012. 2012.

32. Yasobant S., Saxena D., Puwar T., Trivedi P., Patel S., J Fancy M., et al., Knowledge of Hepatitis B among Doctors working in Public Health System of Gujarat, India: An Interventional Study. Vol. 4. 2017. 1136.

33. Bakry S. H., Mustafa A. F., Eldalo A. S., and Yousif M. A., Knowledge, attitude and practice of health care workers toward Hepatitis B virus infection, Sudan. Int J Risk Saf Med, 2012. 24(2): p. 95–102. doi: 10.3233/JRS-2012-0558 22751191

34. Abeje G. and Azage M., Hepatitis B vaccine knowledge and vaccination status among health care workers of Bahir Dar City Administration, Northwest Ethiopia: a cross sectional study. BMC Infectious Diseases, 2015. 15(1): p. 30.

35. Fufore M., Cook P., and Kirfi A., Health workers’ knowledge, attitude and practice towards Hepatitis B infection in Northern Nigeria. International Journal of Caring Sciences, 2016. 9(3): p. 955–965.

36. Chen Y. and Xie C., Knowledge regarding hepatitis B mother-to-child transmission among healthcare workers in South China. 2018. 25(5): p. 561–570.

37. Ishimaru T., Wada K., Hoang H. T. X., Bui A. T. M., Nguyen H. D., Le H., et al., Nurses’ willingness to care for patients infected with HIV or Hepatitis B / C in Vietnam. Environmental Health and Preventive Medicine, 2017. 22(1): p. 9. doi: 10.1186/s12199-017-0614-y 29165125

38. Asian Liver Center at Stanford University, Department of Preventive Medicine, Vietnam Ministry of Health. 2018. KnowHBVHCV.

Článek vyšel v časopise


2019 Číslo 10