Awareness and Knowledge of Hepatitis B and HIV/AIDS, Among the University of Kassala Students, Sudan

Fatima A. Khalid1*, Amna A. Eltayeb2 and NourEldaim E. Elbadawi3 1Tuberculosis Research Center, Faculty of Medicine and Health Sciences, University of Kassala, Kassala State, Sudan 2Department of Nursing program, Faculty of Medicine and Health Sciences, University of Kassala, Kassala State, Sudan 3Department of Biochemistry, Faculty of Medicine and Health Sciences, University of Kassala, Kassala State, Sudan


Introduction
Hepatitis B and human immunodeficiency virus (HIV) viral infections are serious global public health problems. Worldwide, two billion people are infected with HBV, and an estimated of 370 million chronic infections, affecting 5-7% of the world's population [1]. 600.000 persons die each year due to acute or chronic consequences of HBV [2]. Forty million people are living with HIV. About two million of these died of AIDS, and 2.7 million people were newly infected with the virus worldwide [3][4][5]. Among the HIV-infected persons, about 4 million have chronic HBV co-infection [1]. Both AIDS and HBV shared common routes of transmission including unsafe sexual practices, blood borne transmission and sharing of infected needles or syringes [6][7][8][9].
Sudan is one of the most severely affected countries with HBV and HIV. Estimated number of people living with HIV was 260,000, most of them above the age of 15 years. The death rate due to AIDS was estimated at 12,000 [3]. There are regional variations in the prevalence of HIV infection with higher prevalence in Eastern states, Khartoum state and White Nile state [10]. The prevalence of HIV among university students in Sudan was 1.1%.
Continual transmission of these diseases could be attributed to a bundle of reasons including: missing of opportunities for prevention, lack of awareness about their prevalence and prevention (vaccination), misdiagnosis, absence of medical care and poor health outcomes in infected people. Knowledge and awareness about the mode of transmission is important for the planning and preventive health education program. Disease control by preventive strategy is more effective than a curative one.
from April to July 2011. The study targeted 4000 students who were involved in Bachelor programs at the time of the study. Those students of non medical profession, were from the Faculties of Economics and Administrative Sciences, Computer Sciences and Technology information, and Education which has multiple departments (Biology and Chemistry, Arabic and Islamic Studies , Geography and History). Based on the students' knowledge of 50%, bound error 05% and confidence interval 95%. The sample size was 384.
To assess the students' knowledge and awareness about hepatitis B and AIDS, self administered questionnaire was used. The questionnaire comprised the infective nature of these diseases, infectious agents, mode of transmission, signs and symptoms. The other questions asked were concerned with the availability of vaccine and curability of the diseases, in addition to the preventive methods. Before the distribution of the questionnaire among 455 students, the objective of the study was explained to participants and they were informed that their participation was voluntary. Only 395 questionnaires were fully answered, The correct answers were grouped as: mode of transmission; 0-2= poor, 3=moderate and 4=good, signs and symptom; 0-2=poor and 3-4=moderate and 5=good, prevention 0-1=poor, 2=moderate, 3=good. The data were entered and analyzed using statistical package for social sciences (SPSS) version 16.0 software. Frequencies of variables were calculated and chi squire.
The ethical approval of this study was received from the Research Board Committee, Ministry of Health, Kassala, Sudan.

Results
A total of 395 students responded to the questionnaire, 185 (46.8%) were males and 210 (53.2%) were females. Their age ranged from 17 to 35 years with a mean (20.45 ± 2.89). The students were from different Faculties of the University. 143 (36.2%) of the students were from the Faculty of Education, 157 (39.7%) were from the Faculty of Economics and Administrative Sciences and 95 (24.1%) were from the Faculty of Computer Sciences and Information Technology.
The study revealed the weakness of general knowledge about AIDS and hepatitis B among students. However, they were more knowledgeable about AIDS. Their knowledge about the infectious nature of AIDS was 311 (78.7%), the infective agent 362 (91.6%), and the mode of transmission 272 (68.9%), but they were unaware of the symptoms and preventive measures. The symptoms and the prevention measures were well understood by only 38 (09.7%) and 133 (33.7%) respectively. 79 (20%) of the students understood that HIV had no vaccine (Table 1).
Regarding HBV, poor knowledge was found among the students of the University of Kassala. Its communicability which is significantly associated with gender (P=0.02), was found to be 223 (56.5%), most of them were females (130/ 223) (table 2). The causes of HBV, and its vaccination were known to 110 (27.8%) and 39 (09.9%) of the students respectively. Only 49 (12.4%) of the students were aware of the symptoms of the disease and 15 (3.8%) had good knowledge of the transmission route, while the prevention methods were known to be 50 (12.7%).
A significant difference was found between the students' knowledge on HIV and HBV concerning the transmission methods (P=0.009), signs and symptoms (P=0.000) and prevention methods (P=0.000). As shown in table 2 the significant difference was found associated with gender in infectious nature of HBV (P=0.020), and its signs and symptoms (P=0.022) and also associated with the route of transmission of AIDS (P=0.033).

Discussion
This study showed inadequate knowledge about AIDS and hepatitis B but the students were more knowledgeable about AIDS in contrast to HBV. The students understood the communicability of HIV especially in the area of causative agents and the mode of transmission. The same finding was reported in the study held in Pakistan by Khan [11] and in Turkey by Koksal [12]. Awareness regarding HIV/AIDS transmission methods was satisfactory among students, they were aware of transmission of disease through sexual intercourse, usage of unsterile sharp equipments, transfusion of contaminated blood and vertically from mother to child . A similar result was also reported in the study held in Pakistan [13], China [14], Karatchi [15], Kazakhistan [16] and Nigiria [17]. These findings may be attributable to the efforts of HIV/AIDS control program through mass media, lectures and seminars in Sudan. Inadequate knowledge about mode of transmission was reported among black students in the University of Western Cape, South Africa [18].
Regarding HBV, the study revealed that the students had poor knowledge of the infectious nature of the disease, causative agents, mode of transmission, symptoms and preventive measures. The studies which were conducted in Iran [19] and Turkey [20] reported poor knowledge on HBV which are consistent with our results. Other studies in Pakistan [13,21], and Oman [22] reported good knowledge of the disease. The findings of our study may be attributed to the absence of formal school based health education in our country which may be the most important reason for lower knowledge of viral diseases regarding HIV and HBV.

Conclusion
This study showed that the students had poor knowledge and awareness of viral diseases. As students act as a source of knowledge with their families, more efforts will be needed to develop knowledge and awareness among students, especially for non-biological sciences students to decrease the burden of these diseases.