Santé Medical College

MPH Program

KNOWLEDGE, ATTITUDE, PREVENTION PRACTICE AND

ASSOCIATED FACTORS TOWARDS HEPATITIS B VIRUS
INFECTION AMONG BLOOD DONORS IN ADDIS ABABA,
ETHIOPIA

By: Yaregal Bante (BSc)

Advisor: Aster Tsegaye, PhD

A thesis submitted to Santé Medical College, Department of Public Health in partial

fulfilment of the requirement for the degree of Master of Public Health.

December 2020
Addis Ababa, Ethiopia
Acknowledgment

I would like to express my gratitude to my advisor Dr. Aster Tsegaye for her constructive and
unreserved comment, suggestion, and support in the development of this thesis. I would also like to
thank Santé Medical College for the wonderful guidance since the preparation of the proposal and
the successful completion of this work.

Blood donors who kindly participated in this study, Mr. Abiy Belay and Sr. Yemserach Melese who
assisted in the data collection and analysis as well as all those who directly or indirectly contributed
to this study are gratefully acknowledged.

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Abbreviations
ANC Antenatal Care
AOR Adjusted Odds Ratio
BTS Blood Transfusion service
COR Crude Odds Ratio
ETB Ethiopian birr
HB Hepatitis B
HBsAg Hepatitis B surface antigen
HBV Hepatitis B virus
HCV Hepatitis C virus
HCWs Health care workers
HIV Human immunodeficiency virus
KAP Knowledge, Attitude and Practice
MOH Ministry of Health
NBBS National Blood Bank Services
TTIs Transfusion-transmissible infections
WHO World Health Organization

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Table of Contents
Acknowledgment .............................................................................................................................................. i
Abbreviations ................................................................................................................................................... ii
List of Tables ................................................................................................................................................... v
Abstract ............................................................................................................................................................vi
1. Introduction .................................................................................................................................................. 1
1.1 Background ............................................................................................................................................ 1
1.2 Statement of the problem ....................................................................................................................... 2
1.3 Significance of the study ........................................................................................................................ 3
2. Literature review .......................................................................................................................................... 5
2.1 HBV transmission and prevention ......................................................................................................... 5
2.2 HBV epidemiology ................................................................................................................................ 5
2.3. KAP on HBV prevention ..................................................................................................................... 6
2.4. Factors associated with KAP regarding HBV infection ...................................................................... 7
2.4.1 Socio-Demographic factor ....................................................................................................... 7
2.4.2 Knowledge factor towards Hepatitis B .................................................................................... 7
2.4.3 Attitude factor towards Hepatitis B.......................................................................................... 8
2.4.4 Practice factors related to Hepatitis B ...................................................................................... 8
2.5. Conceptual framework ......................................................................................................................... 9
3. Objectives .................................................................................................................................................. 10
3.1 General objective ................................................................................................................................. 10
3.2 Specific objective ................................................................................................................................. 10
4. Materials and Methods ............................................................................................................................... 11
4.1 Study design, Study Area and period ................................................................................................... 11
4.2 Population ............................................................................................................................................ 11
4.2.1 Source population ......................................................................................................................... 11
4.2.2 Study population ........................................................................................................................... 11
4.3 Eligibility criteria ................................................................................................................................. 11
4.3.1 Inclusion criteria ........................................................................................................................... 11
4.3.2 Exclusion criteria .......................................................................................................................... 11
4.4. Study variables .................................................................................................................................... 12
4.4.1. Dependent variables ..................................................................................................................... 12
4.4.2. Independent variables .................................................................................................................. 12
4.5. Sample size determination and sampling technique ........................................................................... 12

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 4.5.1. Sample size determination ........................................................................................................... 12
4.5.2. Sampling Technique .................................................................................................................... 12
4.6. Data collection procedure ................................................................................................................... 13
4.6.1. Data collection tools: ................................................................................................................... 13
4.6.2. Variables: ..................................................................................................................................... 13
4.7. Data Quality Assurance ...................................................................................................................... 13
4.8. Data analysis and interpretation .......................................................................................................... 13
4.9. Ethical considerations ......................................................................................................................... 13
4.10. Dissemination of the result ............................................................................................................... 14
4.11. Operational Definitions ..................................................................................................................... 14
5. Result ......................................................................................................................................................... 16
5.1. Socio-demographic characteristics of study participants .................................................................... 16
5.2. Assessment of Knowledge towards HBV ........................................................................................... 17
5.3. Assessment of Attitude towards HBV ................................................................................................ 19
5.4. Assessment of Practice towards Prevention of HBV .......................................................................... 21
5.5. Association of socio-demographic characteristics and KAP .............................................................. 22
6. Discussion .................................................................................................................................................. 26
7. Limitation................................................................................................................................................... 28
7.2. Limitation............................................................................................................................................ 28
8. Conclusion and Recommendations ............................................................................................................ 29
81 Conclusion ............................................................................................................................................ 29
8.2. Recommendations ............................................................................................................................... 29
9. References .................................................................................................................................................. 30
Annexes ......................................................................................................................................................... 33
Annex I: Participant information sheet (English version)......................................................................... 33
Annex II: Consent form (English version) ................................................................................................ 34
Annex III: Information Sheet (Amharic version)...................................................................................... 35
Annex IV: Consent form (Amharic version) ............................................................................................ 36
Annex V: Questionnaire ........................................................................................................................... 37
Annex VI - Declaration by students ........................................................................................................... 42
Annex VII – Advisor approval sheet ......................................................................................................... 43
Annex VIII – Examiners’ approval sheet .................................................................................................. 44

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List of Tables
Table 1. Socio-demographic characteristics of blood donors who were donating blood in the center
of National Blood Bank Service, Addis Ababa, Ethiopia, 2020. ..................................................... 16

Table 2: Knowledge towards hepatitis B virus among blood donors who were donating blood in
the center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020. .................................... 18

Table 3: Attitude towards hepatitis B virus among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020. .......................................... 20

Table 4: Practice towards prevention of hepatitis B virus among blood donors who were donating
blood in the center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020. ...................... 21

Table 5: Factor associated with knowledge among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020 ........................................... 23

Table 6: Factor associated with attitude among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020 ........................................... 24

Table 7: Factor associated with practice among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020 ........................................... 25

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Abstract
Background: Hepatitis B is a major global health problem and potentially life-threatening liver
infection. It is the second major killer infectious disease after tuberculosis, and 9 times more people
are infected with hepatitis than human immunodeficiency virus (HIV).

Objective: to assess knowledge, attitude, and practice (KAP) towards Hepatitis B Virus (HBV)
infection and associated factors among blood donors at the National Blood Bank service, Addis
Ababa, Ethiopia.

Methods: This cross-sectional study was conducted from September to October 2020 at National
Blood Bank service, Addis Ababa, Ethiopia. Data was collected from 422 blood donors selected by
systematic random sampling. KAP towards HBV was assessed by using pretested self-administered
questionnaire. Data was entered and analyzed by using SPSS version 24.0. Logistic regression
analysis and their 95 % confidence intervals (CIs) from binary model were used to determine
associations between dependent and independent variables. P values less than 0.05 were taken as
statistically significant.

Result: Of the 422 participants, 344 (82.7%) were males. Most respondents 324 (77.9%) attained
university/college and above level of education. Overall, 76.3% of participants had good knowledge.
Of the total participants, 236 (63.4%) had positive attitude. Regarding practice only 208 (52.3%)
were having good practice. In the binary logistic regression analysis, income, and educational level
were associated with KAP for HBV infection and prevention.

Conclusion: participants scored good for most knowledge, attitude, and practice questions.
However, specific gaps for some of the questions including knowledge of common symptom and
mode of transmission of Hepatitis B have been seen.

Key words: Knowledge, Attitude, Practice, Hepatitis B, Blood Donors, Addis Ababa Ethiopia

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1. Introduction
1.1 Background
Blood transfusion contributes to saving millions of lives every year, improves life expectancy and
the quality of life of patients suffering from life-threatening conditions, and supports complex
medical as well as surgical procedures (1).

The blood safety program in Ethiopia has shown increment in geographical coverage of the
population/ hospitals accessing safe blood services. Thus, through a network of the blood bank sites,
safe blood and blood products have been made available to 420 health facilities across the country.
Total units of blood collected per annum were 223,432 units in 2019.

Voluntary blood donors have contributed to 98.4 % of the total units collected in the same year (2).
Blood can be a vector for harmful transfusion-transmissible infections (TTIs) that affect the safety
of blood intended for transfusion. These include human immunodeficiency virus (HIV), Hepatitis B
Virus (HBV), Hepatitis C Virus (HCV) and syphilis as well as other transfusion-transmissible
infections via several different routes (3). The risk of TTIs has been widely estimated by using the
incidence-window period model (4).

Hepatitis B and C infections are one of the leading infectious killers; yet most global leaders and the
public remain unaware. Both affect 325 million people worldwide, leading to about 1.4 million
deaths a year. It is the second major killer infectious disease after tuberculosis, and 9 times more
people are infected with hepatitis than HIV. In 2017, 1.1 million people were newly infected and
developed chronic hepatitis B infection and 1.75 million people developed chronic hepatitis C
infection (5).

Hepatitis B is a major global health problem and potentially life-threatening liver infection caused
by the hepatitis B virus (HBV). It can cause chronic infection and put people at high risk of death
from cirrhosis and liver cancer. The virus is most transmitted from mother to child during birth and
delivery, as well as through blood transfusion (6).

In Ethiopia, the National Blood Bank collected a total of 80,640 blood units from blood donors
during the period of 12 months from July 2018 to June 2019. All donor blood samples were screened
for HBV, HCV, HIV, and Syphilis. A total of 1576 blood units were discarded over this time period
due to positivity for different TTIs (7).

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Hepatitis can be prevented, diagnosed, treated, and managed well. The hepatitis B vaccine is 98-
100% effective in preventing new infections. For hepatitis B, people should be tested and if found
positive and eligible, provided with lifelong treatment. People are becoming newly infected due to
lack of prevention services (5). Understanding the level of knowledge and perception of blood
donors assists in the design of prevention strategies.

Hence, this study assessed knowledge, attitude, and practice of blood donors towards this virus, to
design appropriate intervention to decrease the burden in the donor population in particular and the
general population at large.

1.2 Statement of the problem

Viral hepatitis is international global public health challenge, like the other major communicable
diseases, including HIV, tuberculosis, and malaria (8). A high seroprevalence of HBsAg was
detected in patients with liver cirrhosis ranging from 31%–61% (9).

The World Health Organization (WHO) estimates that in 2015, 257 million persons, or 3.5% of the
global population, were living with chronic HBV infection. According to latest WHO estimates, the
proportion of children under five years of age chronically infected with HBV dropped to just under
1% in 2019 down from around 5% in the pre-vaccine era ranging from the 1980s to the early 2000s.
The African and Western Pacific regions accounted for 68% of those infected (10).

In African region 6.1% of the adult population is infected. Whereas in Eastern Mediterranean, South-
East Asia and European Region, an estimated 3.3%, 2.0% and 1.6% of the general population is
infected, respectively. And in the Americas region, 0.7% of the population is infected (6).

In Ethiopia, the prevalence of Hepatitis B surface Antigen (HBsAg) varies from 3.5% to 7.9%
depending on the study population (11-14).

HBV infection remains the most common viral infection transmitted by blood transfusion (6). In
2018 from a total blood donation in lower- income countries, prevalence of HBV and HCV were
2.81% and 1.00%, respectively (15).

Different studies investigated the prevalence of TTIs among blood donors in Ethiopia. A study from
Bahir Dar showed that the total sero-prevalence of TTIs among blood donors was 6% (16). Whereas
a study from Jijiga showed that the sero-prevalence of TTIs among blood donors was 11.5% (17).

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The National Blood Bank which is found in Addis Ababa reported that 1576 blood units were
discarded during the period of 12 months from July 2018 to June 2019 due to positivity for different
Transfusion Transmissible Infections. Of those discarded, 52.3% were positive for HBsAg, 11.7%
for HIV, 9.3% for HCV, and 26.5% were positive for syphilis. About 0.13% was found with dual
infections (7).

Knowledge, attitude, and prevention practice towards HBV in particular influences the magnitude
and prevention of this virus among the blood donor population. A study conducted in Saudi Arabia
in 2017 showed that most of the participants had good knowledge regarding HB infection. The
attitude of subjects was good in 60% but the level of practice was poor among 66% of subjects as
most of them had not been screened or vaccinated for hepatitis B infection (18).

A study done in Bahir Dar, Northwest Ethiopia in 2012 showed that only 52% of health care workers
were knowledgeable about hepatitis B infection. In this study, only 62% of health care workers were
knowledgeable about hepatitis B vaccine. From the total respondents, only 20(5.4%) reported that
they took three or more doses of hepatitis B vaccine (19).

On the other hand, a study conducted in Gondar Comprehensive Specialized Hospital, Northwest
Ethiopia in 2018 showed that 73.4% pregnant women had poor knowledge. Close to half (43.8%) of
the participants think that they will never be infected with HBV while 47.7% of them will go to
traditional healers if they have symptoms of HBV.

Majority of the respondents (85.87%) had never been screened for HBV, and 28.5% of the
participants believed that hepatitis B can cause liver cancer (20). Documenting such information will
be useful to develop targeted intervention. However, published studies on KAP regarding HBV are
lacking at the National Blood Transfusion service in Addis Ababa, a gap this study is trying to
address.

1.3 Significance of the study

The expected results of this study are to measure the KAP towards HBV among blood donors and
to explore changes in the Knowledge, Attitude, and prevention Practices of blood donors. Assessing
the KAP among blood donors is the best way of HBV infection prevention, which ultimately will
reduce transmission by addressing on identified gaps. In addition, results obtained from this study is
important to different stockholders.

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Policymakers that can be added pre-donation serological screening of HBV. Blood banks, that can
be plan vaccination and other preventive strategies. Blood donor’s association that can conduct
health education strategy to their members. The findings will also serve as a reference for future
studies to other researchers.

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2. Literature review
2.1 HBV transmission and prevention
Blood transfusion is an essential part of patient care. The primary responsibility of a blood
transfusion service is to provide a safe, sufficient, and timely supply of blood and blood products.
When used correctly, it saves lives and improves health. In fulfilling this responsibility, the Blood
Transfusion service (BTS) should ensure that the act of blood donation is safe and causes no harm
to the donor as well as recipients. However, blood transfusion carries a potential risk of transfusion
transmitted infections (21-23).

The risk of transfusion-transmitted infections has been widely estimated by using the incidence-
window period model that affects the safety of blood intended for transfusion; these include HIV,
HBV, HCV, and syphilis and other TTIs (3-4).

Hepatitis B is a viral infection that attacks the liver and can cause both acute and chronic disease (6).
HBV is transmitted when blood, semen, or another body fluid from a person infected with the virus
enters the body of someone who is not infected (24).

Hepatitis B is also spread by needle stick injury, tattooing, piercing and exposure to infected blood
and body fluids, such as saliva and, menstrual, vaginal, and seminal fluids. The hepatitis B vaccine
is the mainstay of hepatitis B prevention. WHO recommends that all infants receive the hepatitis B
vaccine as soon as possible after birth, preferably within 24 hours. All children and adolescents
younger than 18 years and not previously vaccinated should receive the vaccine if they live in
countries where there is low or intermediate endemicity. In those settings it is possible that more
people in high-risk groups may acquire the infection and they should also be vaccinated (6).

2.2 HBV epidemiology

Hepatitis B prevalence is highest in the WHO Western Pacific Region and the WHO African Region,
where 6.2% and 6.1% of the adult population is infected, respectively. In the WHO Eastern
Mediterranean Region, the WHO South-East Asia Region and the WHO European Region, an
estimated 3.3%, 2.0% and 1.6% of the general population is infected, respectively. And in the WHO
Region of the Americas, 0.7% of the population is infected (6).

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A systematic review and meta-analysis done in Africa that are presented by 14 studies published
over a 16-year period representing multiple countries shows that there are striking differences in
seroprevalence by country and by region. For example, HBsAg prevalence in Northern Africa is
lower compared to Western and Southern Africa, but this difference cannot be explained only by
lower population exposure (anti-HBc) rates. Although exposure is lower in Northern than Western
Africa, there is no difference in exposure between Southern and Northern Africa. Indeed, the
predicted chronic hepatitis B prevalence was generally 30% to 40% lower in Northern than Southern
Africa for any given exposure. Central African regions display a different relationship between
HBsAg and anti-HBc, compared to other settings whereby high exposure is not associated with a
correspondingly high prevalence of chronic hepatitis B infection (25).

In Ethiopia different studies assessed the prevalence of HBV. A systematic review and meta-analysis
study reviewed 27 articles. A total of 308,188 samples were included in the meta-analysis done on
seroprevalence and factors associated with hepatitis B virus infection in blood donors in Ethiopia.
The finding showed that the pooled prevalence of HBV infection among blood donors in the country
was 4.91% (26).

On the other hand, a study conducted in Addis Ababa Ethiopia from May 2016 to June 2017 showed
that sero-prevalence of HBsAg and HCV was found to be 3.7% and 2.0%, respectively (27).

2.3. KAP on HBV prevention

A study in Kabul, Afghanistan conducted between November 2018 and January; 2019 showed that
knowledge, attitude, and practice score of HCWs regarding HBV were 86.58%, 34.73% and 61.22%,
respectively. Most of participants correctly identified HBV transmissions. The majority of the
participants had a poor attitude towards HBV prevention (53.98%). Only 77.45% of participants had
been screened for HBV and 56.37% of participants had been vaccinated against HBV, only 5.17%
had completed three doses of vaccine (28). Hepatitis B and C are one of the leading infectious killers,
yet the majority of global leaders and the public remain unaware (5). This indicates that efforts to
improve donated blood safety are still insufficient to ensure donor blood is safe for transfusion.

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2.4. Factors associated with KAP regarding HBV infection
2.4.1 Socio-Demographic factor
A study done in Pakistan among healthy population shows that among the investigated demographic
variables, only area of residence (locality) was significantly associated with mean KAP scores (p <
0.01) (29).

A study done among medical students of Karachi, Pakistan shows that female students showed
significantly higher awareness than male students (p=0.023). The students above 20 years of age
showed higher knowledge than younger ones (P<0.001) (30).

Among the demographic variables, area of residence, educational status, and income were
significantly associated with mean KAP scores (P<0.001). On the other hand, religion was
significantly associated with attitude and practice (P<0.001), while occupation was only associated
with practice according to a study from north Ethiopia which was carried out on Antenatal Care
(ANC) attendees (P<0.001 (20).

2.4.2 Knowledge factor towards Hepatitis B

A study done in Pakistan among healthy population shows that 75.4% were within the poor
knowledge range whereas 24.6% showed adequate knowledge about HB (29).

Published KAP studies on blood donors in Ethiopia are limited, thus data from other population
groups is also reviewed. For example, a study done on KAP towards Hepatitis B Virus among
Pregnant Women Attending Antenatal Care at the University of Gondar Comprehensive Specialized
Hospital, Northwest Ethiopia shows that 73.4% were within the poor knowledge range whereas
26.6% showed good knowledge. In this study from Gondar 68.9% of the participants did not know
the availability of vaccine against HBV, while 82.8%, 81.6%, and 85.8% of them did not know the
transmission way of HBV from mother to child, through contaminated blood, and through unsafe
sex, respectively. Moreover 68.7% of the participants responded that HBV affects liver (20).

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2.4.3 Attitude factor towards Hepatitis B
A study done in Pakistan among healthy population shows that majority of the respondents (79.7%)
believed that they can never get infected with HB. About 39.5% respondents stated that they will be
ashamed to get infected with HB. In this study 70.4% of respondents were of the opinion to use
complementary and alternative system in case of HB infection. In addition, 26.0% agreed to consult
a physician as their first choice of treatment. However, low number of respondents were ready to
disclose their disease to their spouse (n = 367, 47.1%) and parents (n = 207, 26.5%). Over all the
respondents had a negative attitude towards Hepatitis B with mean score of 3.72 ± 1.2 (29).

A study done on KAP towards Hepatitis B Virus among Pregnant Women Attending Antenatal Care
at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia showed that
54% were having positive attitude and 46% were having negative attitude towards HBV infection.
A large proportion of the participants 43.8% think that they will never be infected with HBV, and
47.7% of them will go to traditional healers when they have symptoms of HBV (20).

2.4.4 Practice factors related to Hepatitis B

A study done in Pakistan among healthy population showed that majority of the respondents, 96.9%,
never went for HB screening and 86.8% stated that they were not immunized against HB. Only
44.1% agreed with the statement that they ask for screening of blood and blood products before
transfusion.

However, on the contrary majority of the study participants (n = 635, 81.4%) revealed that they
avoid meeting a person infected with HB. Majority 93.7% agreed that they will go for further
investigation and treatment if they are infected with HB. In addition, a small number of respondents
(n = 14, 1.8%) have ever attended any educational program on HB. The mean score for HB related
practices was 2.76 ± 1.1 revealing poor practices among the study participants (29).

A study done on KAP towards Hepatitis B Virus among Pregnant Women Attending Antenatal Care
at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia showed that
79.7% were within the poor practice range while 20.3% showed good practice. Majority of the
respondents 85.87% had never been screened for HBV, and 97.7% were not immunized against
HBV (20).

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2.5. Conceptual framework

Lack of knowledge is a major obstacle in controlling HBV transmission. The literature review
suggested that education, screening and vaccination, specifically in high risk groups are essential for
prevention of new cases.

Educational interventions improve knowledge and attitude, and that improved knowledge enhances
self-care practice. The conceptual framework described in Figure 1 shows the relation between the
dependent variables and predicting factors.

Independent variables Dependent variables

• HBV is a Viral Disease

• HBV infection can cause liver
cancer
• Socio-demographic • It transmits by infected blood,
• Age, sex needle, tattooing, piercing and
exposure to and through unsafe sex Knowledge
• Religion
• Marital status • Hepatitis B is a major global health
problem.
• Residence
• Believe that you can be infected
• Educational status with HB. Attitude
• Consult a physician as your first
• Income choice of treatment.
• Occupation
Practice
• Ask for new syringe to medical
staff.
• Be yourself vaccinated against
Hepatitis B.

Figure 1: Conceptual framework of the study on assessments of KAP and associated factors towards
prevention of HBV infection prevention among blood donors. (Conceptual framework was
developed from different literature (29)).

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3. Objectives
3.1 General objective
To assess KAP towards Hepatitis B Virus (HBV) infection and associated factors among blood
donors in the National Blood Bank service, Addis Ababa, Ethiopia.

3.2 Specific objective

− To determine knowledge of Hepatitis B Virus (HBV) infection among blood donors in the
National Blood Bank service, Addis Ababa

− To determine attitude towards Hepatitis B Virus (HBV) infection among blood donors in the
National Blood Bank service, Addis Ababa

− To determine prevention practice towards Hepatitis B Virus (HBV) infection among blood
donors in the National Blood Bank service, Addis Ababa

− To determine factors associated with KAP towards Hepatitis B Virus (HBV) infection among
blood donors in the National Blood Bank service, Addis Ababa.

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4. Materials and Methods

4.1 Study design, Study Area and period

This cross-sectional study was conducted out from September to October 2020 at central blood
donation site in Addis Ababa, Ethiopia

The National Blood Bank service was established in 1969 by the Ethiopian Red Cross Society in
Addis Ababa. In 2012, The Federal Ministry of Health (MOH) made a policy decision to revert the
responsibility for the National Blood Bank Services (NBBS) from the Ethiopia Red Cross Society
(ERCS) to a Government-owned and managed service under the MOH. NBBS was established as
independent autonomous federal government institution in 2014 by the Ministers of Council
Regulation No.330/2014). The center is located in Lideta sub-city in the premises of the Federal
MOH. In the previous year (2019/20) total collected blood at NBBS was 112,153 unit of blood that
100% were from voluntary non remunerated blood donors.

4.2 Population
4.2.1 Source population
The source population were all repeat and first-time blood donors that were attending the central
blood donation site in Addis Ababa.

4.2.2 Study population

The study participants were those adults in the age range 18 to 65 years who were attending the
central blood donation site during the study period and fulfilling the eligibility criteria.

4.3 Eligibility criteria

4.3.1 Inclusion criteria
All blood donors who donated blood and volunteered to participate in the study were included.

4.3.2 Exclusion criteria

The study did not include blood donors who had adverse reactions during donation of blood and
blood donors that feel nauseous, lightheaded, or dizzy after donating blood were not included.

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4.4. Study variables

4.4.1. Dependent variables

− Level of Knowledge, Attitude and Practice towards Hepatitis B virus infection prevention.

4.4.2. Independent variables

− Sociodemographic characteristics (age, sex, religion, marital status, residence, educational
status, income and occupation)
4.5. Sample size determination and sampling technique

4.5.1. Sample size determination

A single population proportion formula was used to calculate the sample size by considering the
prevalence of blood donors who have adequate knowledge and practice about hepatitis B prevention
is 50%, a confidence interval of 95%, response rate is 90% and margin of error of 5%.
Therefore, the sample size was 422 based on the single population proportion formula calculated as
follow

1 (Z ά/2)² P(1 − p) Where:

𝑛=
1−f d² n = Sample size
z = critical value
α/2= confidence level
P= Estimated prevalence of
knowledge and practice
1 (1.96)2 0.5(1 − 0.5) d= margin of error
𝑛= = 422
1 − 0.1 0.05²
f = non response rate

4.5.2. Sampling Technique

A systematic random sampling technique was used by considering that on average 56 donors per
day donate blood at the central blood donation site in the National Blood Bank service so that data
collection was planned for one-month k=N/n = 1680/422 = 4. Then, every 4th blood donor that come
to the blood bank to donate blood from September to October 2020 and volunteering to participate
in the study was included in the sample until the required sample size was achieved. The first
participants randomly selected on the first day of the study.

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4.6. Data collection procedure

4.6.1. Data collection tools:

The data was collected by using structured self-administered questionnaire prepared by a section on
socio demographic details of the respondent and 3 other sections of questions to assess knowledge,
attitude, and practice in both English and Amharic and given to blood donors. Data collection was
supervised by supervisors and filled the questionnaire for participants who cannot read and write
(one participant).

4.6.2. Variables:
The questionnaire consists of two parts: socio-demographics and KAP. Socio-demographic variables
included age, sex, marital status, education, religion, income and occupation.

4.7. Data Quality Assurance

To assure the quality of data, A week prior to the actual data collection, the questionnaire was
pretested in 5% of the sample size from NBBS central collection site through self-administration to
check the understandability and clarity of questions to blood donors; and minor adjustments was
made accordingly. Data that were collected in the pre-test are not included in the analysis as part of
the main study. Regular supervision was made by the investigator during data collection to ensure
that all necessary data are properly collected. The collected data was reviewed and checked for
completeness before data entry.

4.8. Data analysis and interpretation

Data was entered and analyzed by using SPSS version 24.0. In descriptive statistics tables and
frequency used to present the information. Binary logistic regression analysis was used for
determining the association between dependent and independent variables. Adjusted odds ratios
(AOR) with 95% confidence interval and P values <0.05 were used to determine strength of the
association and statistical significance.

4.9. Ethical considerations

The study was carried out after the research proposal was evaluated by the Sante Medical College
Ethical Review Committee and permission was obtained from National Blood Bank service. The
participants were informed that they had the full right to participate or not to participate in the study
as well as to withdraw any time during the interview. To ensure privacy and confidentiality, name

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of respondents was not recorded in the questionnaire. Confidentiality was ensured by password
protection of electronic files and locking hard copies.

4.10. Dissemination of the result

The results of the study will be presented to Sante Medical College Department of Public Health as
it will also get shared to National Blood Bank Service. Effort will be made to present the findings in
local and international conferences and the findings will be published in a peer reviewed local or
international journal to make it accessible to a wider audience.

4.11. Operational Definitions

Knowledge: is the understanding level of blood donors about Hepatitis B virus. Knowledge in this
study was assessed by 20 questions. Each question was labeled with good knowledge or inadequate
knowledge. Knowledge was assessed by giving 1 to correct answer and 0 to the wrong answer. The
scale measured knowledge from maximum 20 to minimum 0. Scores < 12 were taken as poor, ≥ 12
(≥60%) as good knowledge of Hepatitis B.

Good knowledge: the respondents correctly answered 60% and above points of knowledge items.

Inadequate knowledge: the respondents answered less than 60 % of knowledge items.

Attitude: is intention of blood donors towards Hepatitis B virus. It was assessed through 7 questions.
Each question response was labeled with positive/favorable or negative/unfavorable attitude. A score
of 1 was given to positive while 0 was given to negative attitudes with a score range of maximum
of 7 to a minimum of 0.

Positive/favorable attitude: the respondents were correctly answered 60 % or more of attitude

items. The level categorized attitude as positive with score ≥ 5 (≥60%), and negative < 5. Majority

Negative/unfavorable attitude: if the respondents answered less than 60 % of attitude items.

Practice: is the practice of blood donors regarding Hepatitis B virus prevention. Practice in this
study was assessed by 8 questions. Each question was labeled with good practice or inadequate. A
score of 1 was given to good practice while 0 was given to inadequate practice with a score ranging
from maximum of 8 to a minimum of 0.

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Good practice: when the study participants were at least able to answer 60 % or more practice items
correctly. The level categorized practice as good with score 5.

Inadequate practice: when the participants were unable to answer 60 % of practice items correctly.
The level categorized practice as inadequate practice with score < 5.

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5. Result

5.1. Socio-demographic characteristics of study participants

A total of 422 blood donors aged 18-61 years participated in this study. Of these participants 344
(82.7%) were males. The mean age of the participants was 33 years with standard deviation of 8.7
years. The majority were aged below 35 years (62.3%). About 183 (43.4 %) belong to the age group
25-34 years. Most (231, 54.9%) were single, 324 (77.9%) respondents were university/college and
above. Most of them (305, 74.6%) were Orthodox religion followers. Majority (84.8%) were
employed (Table 1).

Table 1. Socio-demographic characteristics of blood donors who were donating blood in the center of
National Blood Bank Service, Addis Ababa, Ethiopia, 2020.
Characteristics Response Frequency Percentage (%)
Under 25 80 19
Age, Years (N=422) 25 to 34 183 43.4
35 to 44 116 27.5
≥ 45 43 10.2
Male 344 82.7
Sex (N=416) Female 72 17.3
Orthodox 305 74.6
Muslim 40 9.8
Religion (N=409) Protestant 56 13.7
Other 8 2
Single 231 54.9
Marital status (N=421) Married 184 43.7
Divorced 6 1.4
Urban 422 100
Residence (N=422) Rural 0 0
Illiterate 1 0.2
Primary school 11 2.6
Educational status (N=416) Secondary School 80 19.2
University/College 324 77.9
No Income 31 7.5
<3000 81 19.7
Monthly Income (in ETB) 3001-5000 80 19.5
(N=411) 5001-10000 107 26.0
>10000 112 27.3
Unemployed 63 15.2
Government Employee 91 22
Private employee 111 26.8
Self-employed 141 34.1
Occupation (N=414) Other (NGO, UN, Embassy, Civic 8 1.9
Organization)

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5.2. Assessment of Knowledge towards HBV
Regarding knowledge about risk factors of hepatitis B, majority of the respondents 366 (86.9%)
knew that HBV infection affect liver function and 295 (70.9 %) knew that HBV infection associates
with liver cancer. Of the blood donors surveyed, 361 (86.4%) knew that HBV infection affects any
age group. Only 58.4% of the respondents knew that there may be no symptoms of the Hepatitis B
in some of the patients.

Regarding the mode of transmission of hepatitis B, 192 (46.2%), 130 (31.2%) and 93 (22.1%) of
them did not know the transmission way of HBV from mother to child, through unsafe sex and
through contaminated blood and blood products, respectively while 272 (65.7%) of the respondents
knew that it is not transmitted by contaminated water/food prepared by a person suffering from this
infection.

Regarding treatment of hepatitis B, only 23.3% of the blood donors knew that there is no curative
treatment for HBV.

Regarding the availability of HB vaccines, 127 (30.4%) of the participants did not know the
availability of vaccine that provides protection against HBV infection.

The overall knowledge score of blood donors mean score for knowledge was 13.06 ± 3.36 (mean ±
SD). That 76.3% of participants had good knowledge of HBV. Table 2 summarizes knowledge
assessment of blood donors towards HBV infection.

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Table 2: Knowledge towards hepatitis B virus among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020.

Hepatitis B Knowledge Items Frequency Percent

Have you ever heard of a disease termed as Hepatitis? No 66 15.6
Yes 356 84.4
Have you ever heard of a disease termed as Hepatitis B? No 64 15.2
Yes 357 84.8
Is Hepatitis B a viral disease? No 126 30.1
Yes 293 69.9
Can Hepatitis B affect liver function? No 55 13.1
Yes 366 86.9
Can Hepatitis B cause liver Cancer? No 121 29.1
Yes 295 70.9
Can Hepatitis B affect any age group? No 57 13.6
Yes 361 86.4
The early symptoms of Hepatitis B are same as cold and flu Yes 127 30.6
(fever, running nose, cough) No 288 69.4
Jaundice is one of the common symptoms of Hepatitis B? No 84 20.0
Yes 335 80.0
Are nausea, vomiting and loss of appetite common symptom of No 180 43.3
Hepatitis B? Yes 236 56.7
Are there no symptoms of Hepatitis B infection in some of the No 174 41.6
patients? Yes 244 58.4
Can Hepatitis B be transmitted by un-sterilized syringes, needles No 132 31.7
and surgical instruments? Yes 285 68.3
Can Hepatitis B be transmitted by contaminated blood and blood No 93 22.1
products? Yes 327 77.9
Can Hepatitis B be transmitted by using blades of the barber/ear No 154 36.8
and nose piercing? Yes 265 63.2
Can Hepatitis B be transmitted by unsafe sex? No 130 31.2
Yes 287 68.8
Can Hepatitis B be transmitted from mother to child? No 192 46.2
Yes 224 53.8
Can Hepatitis B be transmitted by contaminated water/food Yes 142 34.3
prepared by person suffering with these infections? No 272 65.7
Is Hepatitis B curable/treatable? Yes 320 76.7
No 97 23.3
Can Hepatitis B be self-cured by the body? No 366 87.1
Yes 54 12.9
Is vaccination available for Hepatitis B? No 127 30.4
Yes 291 69.6
Is specific diet is required for the treatment of Hepatitis B? Yes 250 59.7
No 169 40.3

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 Qn 4 86.9

Qn 2 84.8
Knowledge Qns

Qn 1 84.4

Qn 5 70.9

Qn 3 69.9

0 10 20 30 40 50 60 70 80 90 100
Percents

5.3. Assessment of Attitude towards HBV

Attitude towards HBV was assessed majority of the respondent 368 (88.9%) believed that they can
never get infected with HB and 383 (90.8%) agreed to consult a physician as their first choice of
treatment. Respondents were ready to disclose their disease to their spouse 43(10.2%), parents
21(5%), child 4 (0.9%), friends 19 (4.5%) and only 6 (1.4%) said they did not want to tell anyone
about their illness this was a negative reaction. About 165 (39.1%) participants did not know how
expensive the diagnosis and treatment of hepatitis B.

Overall, the respondents had a positive attitude towards Hepatitis B with mean score of 4.81 ± 0.92.
Of the total participants, and median was 5 (IQR: 2 to 7). Majority of participants 236 (63.4%) were
having positive/favorable attitude (Table 3).

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Table 3: Attitude towards hepatitis B virus among blood donors who were donating blood in the
center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020.
Hepatitis B Attitude Items N %
Yes 46 11.1
Do you think you can get Hepatitis B? No 368 88.9
Fear 156 37.0
What would be your reaction if you found Shame 6 1.4
that you have Hepatitis B? Surprise 156 37.0
Sadness 80 19.0
Physician 383 90.8
Spouse 43 10.2
Who would you talk to about your Parents 21 5.0
illness?
Child 4 0.9
Other Relatives 3 0.7
Friends 19 4.5
No one 6 1.4
Go to Health facility 414 99.3
What will you do if you think that you Go to Traditional healer 6 1.4
have symptoms of Hepatitis B? Will not go anywhere 1 0.2
Own treatment fails 22 5.2
After 3-4 weeks of the 72 17.1
If you had symptoms of Hepatitis B, at appearance of symptoms
what stage you will go to the health
Soon as I realize the symptoms 319 76.1
facility?
are of Hepatitis B
Will not go to physician 14 3.3
Free 68 16.1
How expensive do you think is the Reasonable 72 17.1
diagnosis and treatment of Hepatitis B? Somewhat expensive 69 16.4
Expensive 48 11.4
Do not know 165 39.1
Fear of death 45 10.7
What worries you most if you will be Fear of disease spread to family 346 82.0
diagnosed with Hepatitis B (applicable if Cost of treatment 43 10.2
worried)
Isolation from the society 17 4.0

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5.4. Assessment of Practice towards Prevention of HBV
According to the study findings, more than half of the respondents 230 (54.5%) had never been
screened for HBV and only 50 (11.9%) respondents had vaccinated against HBV. About 86 (20.8%)
of respondents never asked for a new syringe when required, 297 (70.5%) agreed with the statement
that they ask for screening of blood and blood products before transfusion and 322 (77.4%) of them
did not ask their barber to change the blade for safe equipment for ear and nose piercing.

Majority 400 (94.8%) of respondents agreed that they will go for further investigation and treatment
if they are infected with HB and only 50 (11.8%) have ever attended any educational program on
HB.

Over all the respondents reported to have mean score below the average 5 towards Hepatitis B with
mean score of 4.55 ± 1.39. Out of the total participants, only 208 (52.3%) were having good or
adequate practice (Table 4).

Table 4: Practice towards prevention of hepatitis B virus among blood donors who were donating
blood in the center of National Blood Bank Service, Addis Ababa, Ethiopia, 2020.

Hepatitis B Practice Items Yes No

N (%) N (%)
Have you done screening for Hepatitis B? 192 (45.5) 230 (54.5)
Have you got yourself vaccinated against Hepatitis B? 50 (11.9) 371 (88.1)
Do you ask for a new syringe before use? 328 (79.2) 86 (20.8)
Do you ask for screening of blood before transfusion? 297 (70.5) 124 (29.5)
Do you ask your barber to change blade/Or for safe equipment for 322 (77.4) 94 (22.6)
ear and nose piercing?
In case you are diagnosed with Hepatitis B, would you go for 400 (94.8) 22 (5.2)
further investigation and treatment?
Do you avoid meeting Hepatitis B patients? 159 (38.5) 254 (61.5)
Have you ever participated in health education program related to 50 (11.8) 372 (88.2)
HB?

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5.5. Association of socio-demographic characteristics and KAP
The association between demographic characteristics and KAP score is shown in Table 5, 6 and 7.
In the binary logistic regression analysis, a factor that statistically significantly associated with
knowledge for HBV was educating in secondary school (AOR= 0.504, 95% CI: 0.263-0.967, P=
0.039). Participants with an education level of secondary level were about 50% less likely to have
knowledge about HBV than those attaining college or University level education (Table 5).

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Table 5: Factor associated with knowledge among blood donors who were donating blood in the center of
National Blood Bank Service, Addis Ababa, Ethiopia, 2020

Knowledge COR P- AOR P-

Characteristics Response Good Inadequate 95% CI value (95% CI) value
N (%) N (%)
Under 25 54 (14.2) 23 (6.1) 0.783 (0.329, 1.861) 0.579 0.532 (0.160, 1.770) 0.304
25 to 34 126 (33.2) 34 (8.9) 1.235 (0.55, 2.776) 0.609 1.246 (0.484, 3.204) 0.649
Age (Years) 35 to 44 80 (21.1) 23 (6.1) 1.159 (0.494, 2.720) 0.734 1.088 (0.428, 2.768) 0.86
≥ 45 30 (7.9) 10 (2.6) 1
Male 243 (64.6) 72 (19.1) 1.304 (0.703, 2.420) 0.4 1.009 (0.479, 2.124) 0.981
Sex Female 44 (11.7) 17 (4.5) 1
Orthodox 209 (56.5) 68 (18.4) 0.512 (0.061, 4.330) 0.539 0.611 (0.055, 6.832) 0.689
Muslim 25 (6.8) 10 (2.7) 0.417 (0.044, 3.916) 0.444 0.472 (0.038, 5.841) 0.559
Religion Protestant 41 (11.1) 10 (2.7) 0.683 (0.074, 6.336) 0.738 0.750 (0.061, 9.255) 0.822
Other 6 (1.6) 1 (0.3) 1
Single 164 (48.4) 45 (13.3) 0.911 (0.099, 8.355) 0.934 0.885 (0.081, 9.698) 0.921
Marital status Married 121 (35.7) 4 (1.2) 0.688 (0.075, 6.319) 0.741 0.647 (0.062, 6.755) 0.716
Divorced 4 (1.2) 1 (0.3) 1
Primary
7 (1.9) 4 (1.1) 0.449 (0.127, 1.583) 0.213 0.450 (0.113, 1.787) 0.256
Educational school
status Secondary
47 (12.5) 23 (6.1) 0.524 (0.295, 0.930) 0.027 0.504 (0.263, 0.967) 0.039
School
University/
234 (62.4) 60 (16) 1
College
No Income 22 (5.9) 5 (1.3) 0.972 (0.327, 2.893) 0.959 0.855 (0.157, 4.657) 0.856
Monthly <3000 51 (13.7) 23 (6.2) 0.490 (0.243, 0.986) 0.046 0.446 (0.171, 1.165) 0.099
Income (ETB) 3001-5000 53 (14.3) 15 (4) 0.781 (0.366, 1.667) 0.522 0.923 (0.396, 2.152) 0.853
5001-10000 71 (19.1) 26 (7) 0.603 (0.309, 1.179) 0.139 0.597 (0.289, 1.234) 0.164
>10000 86 (23.2) 19 (5.1) 1
Unemployed 44 (11.8) 12 (3.2) 1.222 (0.218, 6.845) 0.819 2.270 (0.191, 26.996) 0.516
Government
57 (15.3) 23 (6.2) 0.826 (0.155, 4.397) 0.823 0.579 (0.060, 5.576) 0.637
Employee
Occupation
Private
78 (21.0) 20 (5.4) 1.300 (0.244, 6.934) 0.759 1.266 (0.132, 12.148) 0.838
employee
Self-
98 (26.3) 32 (8.6) 1.021 (0.196, 5.312) 0.98 0.919 (0.098, 8.652) 0.941
employed
Other 6 (1.6) 2 (0.5) 1

23 | P a g e
Factors that statistically significantly associated with Attitude were monthly income of between 5,000 ETB
to 10,000 ETB (AOR = 0.376 CI 95% = 0.191-0.740, P = 0.005) (Table 6). Participants within monthly
income of between 5,000 ETB - 10,000 ETB were about 62% less likely to have positive attitude.

Table 6: Factor associated with attitude among blood donors who were donating blood in the center of
National Blood Bank Service, Addis Ababa, Ethiopia, 2020
Attitude COR P- AOR P-
Characteristics Response Positive Negative 95% CI Value 95% CI value
N (%) N (%)
Age (Years) Under 25 44 (11.8) 28 (7.5) 1.100 (0.479, 2.526) 0.822 1.339 (0.431, 4.156) 0.614
25 to 34 101 (27.2) 65 (17.5) 1.088 (0.513, 2.304) 0.826 1.045 (0.43, 2.54) 0.923
35 to 44 71 (19.1) 29 (7.8) 1.714 (0.764, 3.845) 0.191 1.727 (0.706, 4.222) 0.231
≥ 45 20 (5.4) 14 (3.8) 1
Sex Male 195 (53.1) 112 (30.5) 1.008 (0.568, 1.790) 0.978 1.000 (0.515, 1.942) 1
Female 38 (10.4) 22 (6) 1
Religion Orthodox 167 (46.1) 95 (26.2) 1.055 (0.247, 4.512) 0.943 1.416 (0.294, 6.814) 0.665
Muslim 28 (7.7) 11 (3) 1.527 (0.311, 7.506) 0.602 1.985 (0.353, 0.437
11.167)
Protestant 28 (7.7) 25 (6.9) 0.672 (0.146, 3.102) 0.611 0.830 (0.161, 4.278) 0.824
Other 5 (1.4) 3 (0.8) 1
Marital status Single 134 (36.0) 74 (19.9) 0.905 (0.162, 5.061) 0.91 1.181 (0.175, 7.973) 0.865
Married 98 (26.3) 60 (16.1) 0.817 (0.145, 4.595) 0.818 0.843 (0.129, 5.496) 0.859
Divorced 4 (1.1) 2 (0.5) 1
Educational Primary 6 (1.6) 4 (1.1) 0.781 (0.215, 2.833) 0.707 0.872 (0.224, 3.400) 0.843
status school
Secondary 35 (9.5) 32 (8.7) 0.570 (0.333, 0.974) 0.04 0.615 (0.324, 1.166) 0.136
School
University/ 192 (52.0) 100 (27.1) 1
College
Monthly No Income 17 (4.7) 9 (2.5) 0.613 (0.242, 1.553) 0.302 0.800 (0.176, 3.631) 0.772
Income (ETB) <3000 39 (10.7) 31 (8.5) 0.408 (0.211, 0.789) 0.008 0.405 (0.158, 1.041) 0.061
3001-5000 44 (12.1) 28 (7.7) 0.510 (0.263, 0.987) 0.046 0.533 (0.254, 1.116) 0.095
5001-10000 57 (15.6) 42 (11.5) 0.440 (0.239, 0.809) 0.008 0.376 (0.191, 0.74) 0.005
>10000 74 (20.3) 24 (6.6) 1
Occupation Unemployed 32 (8.8) 25 (6.8) 0.512 (0.92, 2.863) 0.446 0.903 (0.122, 6.684) 0.92
Government 57 (15.6) 19 (5.2) 1.200 (0.215, 6.702) 0.835 2.301 (0.365, 0.375
Employee 14.518)
Private 62 (17.0) 42 (11.5) 0.590 (0.109, 3.187) 0.54 1.023 (0.171, 6.125) 0.98
employee
Self- 77 (21.1) 44 (12.1) 0.700 (0.130, 3.760) 0.678 1.133 (0.188, 6.824) 0.892
employed
Other 5 (1.4) 2 (0.5) 1

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Regarding factors that statistically significantly associated with practice, donor’s monthly income of less
than 3000 ETB was significantly associated where those with low salary level were less likely to have good
practice regarding HBV (AOR = 0.363 95%CI = 0.152 - 0.865, P=0.022) (Table 7).

Table 7: Factor associated with practice among blood donors who were donating blood in the center of
National Blood Bank Service, Addis Ababa, Ethiopia, 2020
Practice COR P- AOR P-
Characteristics Response Good Inadequate 95% CI value 95% CI value
N (%) N (%)
Age (Years) Under 25 37 (9.3) 41 (10.3) 0.602 (0.278, 1.303) 0.198 0.739 (0.256, 2.129) 0.575
25 to 34 84 (21.1) 87 (21.9) 0.644 (0.320, 1.296) 0.217 0.674 (0.301, 1.509) 0.337
35 to 44 63 (15.8) 46 (11.6) 0.913 (0.436, 1.910) 0.809 0.855 (0.383, 1.910) 0.703
≥ 45 24 (6.0) 16 (4.0) 1
Sex Male 172 (43.9) 151 (38.5) 1.173 (0.697, 1.973) 0.549 0.938 (0.509, 1.729) 0.837
Female 34 (8.7) 35 (8.9) 1
Religion Orthodox 149 (38.6) 137 (35.5) 2.719(0.519,14.245) 0.237 3.934(0.696,22.225) 0.121
Muslim 21 (5.4) 16 (4.1) 3.281(0.562, 19.15) 0.187 5.00 (0.777, 32.192) 0.09
Protestant 30 (7.8) 26 (6.7) 2.885(0.516,16.139) 0.228 3.27 (0.542, 19.719) 0.196
Other 2 (0.5) 5 (1.3) 1
Marital status Single 117 (29.5) 101 (25.4) 1.158 (0.229, 5.867) 0.859 1.110 (0.186, 6.625) 0.909
Married 88 (22.2) 85 (21.4) 1.035 (0.203, 5.273) 0.967 0.798 (0.138, 4.600) 0.8
Divorced 3 (0.8) 3 (0.8) 1
Educational Primary
5 (1.3) 6 (1.5) 0.722 (0.216, 2.417) 0.597 0.947 (0.248, 3.611) 0.936
status school
Secondary
35 (8.9) 38 (9.7) 0.798 (0.479, 1.33) 0.387 0.881 (0.487, 1.594) 0.676
School
University/
165 (42.1) 143 (36.5) 1
College
Monthly No Income 12 (3.1) 17 (4.4) 0.562 (0.245, 1.293) 0.175 0.249 (0.061, 1.017) 0.053
Income <3000 31 (8.0) 45 (11.6) 0.549 (0.302, 0.997) 0.049 0.363 (0.152, 0.865) 0.022
3001-5000 37 (9.5) 36 (9.3) 0.819 (0.450, 1.489) 0.512 0.716 (0.371, 1.384) 0.321
5001-10000 62 (16.0) 42 (10.8) 1.176 (0.680, 2.034) 0.562 1.124 (0.618, 2.045) 0.701
>10000 59 (15.2) 47 (12.1) 1
Occupation Unemployed 26 (6.6) 34 (8.7) 1.020 (0.210, 4.958) 0.981 1.986 (0.28, 14.102) 0.493
Government
42 (10.7) 45 (11.5) 1.244 (0.263, 5.892) 0.783 0.879 (0.151, 5.125) 0.886
Employee
Private
62 (15.9) 42 (10.7) 1.968 (0.419, 9.249) 0.391 1.638 (0.286, 9.380) 0.579
employee
Self-
68 (17.4) 65 (16.6) 1.395 (0.301, 6.475) 0.671 1.204 (0.211, 6.867) 0.835
employed
Other 3 (0.8) 4 (1.0) 1

25 | P a g e
6. Discussion
This study aimed to examined Knowledge, Attitude and Practices towards HBV among blood donors
who were donating blood in the center of National Blood Bank Service. The results of the study
showed that overall scores rated as good by answering 60% and above of the respective questions
were good knowledge (76.3%), positive attitude (63.4%) and good practice (52.3%). For specific
questions correct answer for Knowledge questions ranged from 15% to 90%; Attitude between
14.3% and 100%; Practice between 12.5% and 100%. To discuss responses with low scores for
selected KAP questions case by case, about 15.6% of donors were never heard about hepatitis B.
Moreover 22.1% of blood donors did not know the transmission of HBV through transfusion of
contaminated blood and blood products and 41.6% were unaware that there were no symptoms of
hepatitis B in some patients; 39.1% participants did not know how expensive the diagnosis and
treatment of hepatitis B. According to this study, 54.5% had never screened for HBV and only 11.9%
respondents were vaccinated against HBV.

Although specific studies in blood donors is limited, comparing to other studies the proportion of
good knowledge level observed in the current study (76.3%) is much better compared to a study in
Pakistan which reported only 24.6% of their study participants had adequate knowledge (29).
Moreover, consistent to the Pakistanis but in contrast to the current study, the overall knowledge
level towards HBV was lower in a study from Gondar, Northwest Ethiopia, which reported only
26.6% antenatal care attendees showed good knowledge (20). This is not surprising since majority
of the current study participants had attained College or University level education. The study from
Gondar which was conducted in 2018 showed that 43.8% of the participants think that they will
never be infected with HBV (20), whereas in this study 88.9% of participants believed that they can
never get infected with HBV.

The level of positive attitude in the current study (63.4%) was almost comparable to the report from
Saudi Arabia which observed good attitude in 60% of their participants (18) but higher than the
study from Gondar (54%) (20). Though the level of good practice in the current study (52.3%) is
low, it is better compared to the study from Saudi Arabia (34%) (18) as well as from Gondar which
reported that only 20.3 % pregnant women had good practice towards HBV (20). The good
knowledge level in the current study which is also supported by the educational status of the

26 | P a g e
participants (most above College level) could attribute to the relatively better attitude and practice
documented in the current study.

On the other hand, when specific items were analyzed, good knowledge was observed in the
participants with regards to availability of vaccination for Hepatitis B (69.6%) but 88.1% were not
vaccinated. So, there is a big gap between their knowledge and practice of immunization. The
practice of poor vaccination status seems somewhat general in other studies too though the
magnitude varies (86.6% in Saudi Arabia, 97.7% in Gondar) (18.20). So, National Blood bank
Service with the blood donor’s association shall plan health education strategy to their blood donors
about Hepatitis B infection. In the logistic regression analysis educating in preparatory school
significantly associated with knowledge and attitude and monthly income associated with attitude
and practice. Good education status and better salary level were factors that were positively
associated with good KAP towards HBV. Strengthening awareness regarding HBV could play a role
in preventing HBV infection among the donor population as well as reducing the number of packs
that are discarded. Of note, among those discarded units in the national blood bank during a one-
year period, the large proportion of them (52.3%) was due to HBsAg seropositivity (7). Thus,
identifying the level of KAP in the blood donor population helps to identify areas where the national
blood bank could act and reduce such wastages.

27 | P a g e
7. Limitation
7.2. Limitation
This study was conducted in the national blood bank service in Addis Ababa; thus, the results may
not be applicable to other parts of the country. Missing data was key limitation in this study.
Apart from socio-demographic variables, other possible confounders were not considered in the
multivariable analysis.

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8. Conclusion and Recommendations

81 Conclusion
The blood donors in Addis Ababa scored good on most of the knowledge, attitude and practice
questions indicating an overall good understanding of Hepatitis B virus infection. In this study, there
is a gap for some of the questions including knowledge of common symptom and mode of
transmission of Hepatitis B. Majority of them believed that they can never get infected with HB,
they were not vaccinated and never participated in health education program related to HB. Income,
and educational level were associated with KAP for HBV infection and prevention.

Based on the findings of this study it can be drawn that health education program and prevention
strategy needs to be strengthened.

8.2. Recommendations
− Blood donors should be encouraged to increase their knowledge in preventing themselves
from HBV by paying attention to the health education program during attending in the blood
bank for donation.
− All blood banks and blood donors club should play their role in providing HB education to
the society since blood donors are part of the general population.
− National Blood Bank Service shall provide vaccine against HBV for all regular blood donors.

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9. References
1. Aide-mémoire. Developing a national blood system. Geneva: World Health Organization;
2011. Available: https://www.who.int/publications/i/item/aide-m%C3%A9moire-
developing-a-national-blood-system Accessed June 16, 2020.
2. Federal Democratic Republic of Ethiopia - Ministry of Health: Health Sector Transformation
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towards ending viral hepatitis. Available at WHO | Global health sector strategy on viral
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B Virus infection and seroprotect ion of Hepatitis B vaccine among Children in Jima town,
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12. Gebremariam AA, Tsegaye AT, Shiferaw YF, Reta MM, Getaneh A. Seroprevalence of
Hepatitis B Virus and Associated Factors among Health Professionals in University of Gondar
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 13. Woldegiorgis AE, Erku W, Medhin G, Berhe N, Legesse M. Community-based sero-
prevalence of hepatitis B and C infections in South Omo Zone, Southern Ethiopia. PLoS ONE
14(12):https://doi.org/10.1371/journal.pone.0226890.
14. Tanga AT, Teshome MA, Hiko D, Fikru C, Jilo GK. Sero-prevalence of hepatitis B virus and
associated factors among pregnant women in Gambella hospital, South Western Ethiopia:
facility based cross-sectional study. BMC Infect Dis. 2019;19:602.
https://doi.org/10.1186/s12879-019-4220-z.
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https://www.who.int/news-room/fact-sheets/detail/blood-safety-and-availability Accessed
June 17, 2020.
16. Shiferaw E, Tadilo W, Melkie I, Shiferaw M. Sero-prevalence and trends of transfusion-transmissible
infections among blood donors at Bahir Dar district blood bank, northwest Ethiopia: A four-year
retrospective study. PLoS One. 2019;14(4):e0214755. doi: 10.1371/journal.pone.0214755.
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Infect Dis. 2015; 15, 30 .
20. Gebrecherkos T, Girmay G, Lemma M, Negash M. Knowledge, attitude, and practice towards
Hepatitis B virus among pregnant women attending antenatal care at the University of Gondar
comprehensive specialized hospital, Northwest Ethiopia. Int J Hepatol. 2020;
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Available: https://apps.who.int/iris/handle/10665/330062?show=full Accessed on 21 June
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 22. Aide-mémoire. Blood safety. Geneva, World Health Organization, 2002. Available:
https://www.who.int/bloodsafety/publications/who_bct_02_03/en/ Accessed on 21 June
2020.
23. The Melbourne Declaration on 100% voluntary non-remunerated donation of blood and blood
components. Geneva, World Health Organization, 2009. Available:
https://www.who.int/bloodsafety/events/consultation_vnrbd/en/ Accessed on 21 June 2020.
24. Centers for Disease Control and Prevention. Viral Hepatitis: Hepatitis B 2020. Available:
https://www.cdc.gov/hepatitis/hbv/index.htm Accessed on 21 June 2020.
25. McNaughton AL, Lourenço J, Bester PA, Mokaya J, Lumley SF, Obolski U, et al. Hepatitis
B virus seroepidemiology data for Africa: Modelling intervention strategies based on a
systematic review and meta-analysis. PLoS Med 2020; 17(4): e1003068.
https://doi.org/10.1371/journal.pmed.1003068
26. Fite RO, Kooti W, Azeze GA, Tesfaye B, Hagisso SN. Seroprevalence and factors associated
with hepatitis B virus infection in blood donors in Ethiopia: a systematic review and meta-
analysis. Arch Virol 2020;165 (5), 1039–1048. https://doi.org/10.1007/s00705-020-04591-w.
27. Biazin H, Teshome S, Ayenew Z, Abebe T, Mihret A, Aseffa A, et al. Determination of
seroprevalence and associated risk factors for hepatitis B and C Virus infections among
apparently healthy non-pregnant mothers in Addis Ababa, Ethiopia. Ethiop Med J. 2019;
Supp. 2: 129-138.
28. Roien R, Mousav SH, Delshad MH, Pourhaji F. Assessment of knowledge, attitude and
practice of health care workers towards Hepatitis B in Kabul, Afghanistan. Research Square,
Available: https://www.researchsquare.com/article/rs-23030/v1 Accessed on: 23 June 2020
29. ul Haq N, Hassali MA, Shafie AA, Saleem F, Farooqui M, Aljadhey H. A cross sectional
assessment of knowledge, attitude and practice towards hepatitis B among healthy population
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Annexes
Annex I: Participant information sheet (English version)
Title of the project: “Assessment of Knowledge, Attitude, Practice and Associated factors Towards Prevention
of Hepatitis B Virus Infection Among Blood Donors at The National Blood Bank Service in Addis Ababa, Ethiopia”
Name of Principal Investigator: Yaregal Bante
Advisors: Aster Tsegaye (Msc, PhD)
Name of institute: Sante Medical College
Funded by: Principal Investigator

Introduction: You are invited to participate in a study to be conducted by MPH student at Sante Medical College.
It is aimed at determining knowledge, attitude and practice towards prevention of Hepatitis B infection among
blood donors and to assess the associated factors of KAP. Assessing the KAP among blood donors is the best way
of HBV infection prevention. After the result of the study is disseminated, strategies will be designed to which
ultimately will reduce transmission by giving health education. Moreover, it will also be a useful for the health and
safety of the donors.
Purpose of the research: This study will assess the knowledge, attitude, and practice towards HBV among blood
donors attending for donation at the National blood Bank Service, Addis Ababa, Ethiopia
Study procedure: After agreeing that you can take part, you will be asked some questions which will take up to
15 minutes.
Risks of participating in this study: There are no known risks or discomforts associated with the study.
Confidentiality: All identified information obtained from this study will be kept strictly confidential; any
information that could be used to identify you will be kept under lock and key. Data files will not contain
potentially identifying information
Benefits of participation: The results obtained may important to policy makers and blood banks, to plan
vaccination and other preventive strategies that is useful for the health and safety of blood donors.

What are my rights as a participant of the study?

You have the right to withdraw yourself from the study at any time and the information you gave us will not be
used for the study purpose. If you have any question for further explanation you can contact us.

Contacts address
• Yaregal Bante: Tel
• Aster Tsegaye: Tel:0911696085
• Sante Medical College IRB: Tel:+251 11 3727434

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Annex II: Consent form (English version)

Consent Form: I have read and understood the above information, have had any questions answered
satisfactorily, and I willingly consent to participate in this study. I understood that if I should have
any questions about my rights as a research subject, I can contact the principal investigator by email
(yaregalbante@gmail.com) or by phone (+251912454500)
I Agree I Disagree

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Annex III: Information Sheet (Amharic version)

ስለ ጥናቱ መረጃ

ጤና ይስጥልኝ
ስሜ ያረጋል ባንቴ ይባላል፡፡ በሳንቴ የህክምናና ጤና ሳይንስ ኮሌጅ ውስጥ በህብረተሰብ ጤና
የማስተርስ ዲግሪ ተማሪ ነኝ፡፡ ደም ለመለገስ ወደ ብሔራዊ የደም ባክ አገልግሎት የሚመጡ በጎ
ፈቃደኛ ደም ለጋሾች ላይ ከሄፓታይተስ ቢ እራስን ስለመጠበቅ ያላቸውን እውቀት፣ አመለካከትና
ልምመዳቸውን ለማወቅ እና ተያያዥ ነገሮችን የመለየት የጥናት ጽሁፍ በመስራት ላይ እገኛለሁ፡፡
ስለዚህ ለጥናቴ ይረዳኝ ዘንድ እርሶ ይህንን የጽሁፍ ቃለ መጠይቅ እንዲሞሉልኝ በአክብሮት
እጠይቃለሁ፡፡

ስምዎት ከመረጃው ጋር አይካተትም፤ የሰጡኝን መረጃ ሁሉ በሚስጥር እንደምጠብቅልዎ ቃል

እገባለሁ፡፡ መጠይቁን ለመሙላት ቢበዛ 15 ደቂቃ ይወስድቦታል፡፡ ይህ ጊዜዎትን የሚይዝ
ቢሆንም ደም ለጋሾች ከሄፓታይተስ ቢ እራስን ስለመጠበቅ ያላቸውን እውቀት፣ አመለካከትና
ልምመዳቸውን ለማወቅ የበለጠ እውቀት ይኖረኝ ዘንድ ይረዳኛል በመሆኑም እንዲተባበሩኝ
እጠይቅዎታለሁ የተወሰኑ ደቂቃዎች ወስደው መጠይቁን ለመሙላት ፈቃደኛነዎት?

ፈቃደኛ ነኝ ፈቃደኛ አይደለሁም

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Annex IV: Consent form (Amharic version)

የፈቃደኝነት ማረጋገጫ
የምርምር ጥናቱ ክፍል የሆኑ መረጃዎችና ሂደቶች ተብራርተውልኛል፡፡ እኔም በተብራራልኝ
መንገድ ተረድቻለሁ፡፡ ምርምሩ ምንም አደጋ የማያስከትል በመሆኑ ለማደርገው ተሳትፎ የካሳ
ክፍያ አይኖረውም፡፡ ስለዚህ በዚህ የምርምር ጥናቱ ላይ ለመሳተፍ ፈቃደኛ መሆኔን በፊርማዬ
አረጋግጣለሁ፡፡

ፊርማ-------------------------ቀን------/-------/-------- ዓ.ም

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Annex V: Questionnaire
Demographic
Question Response
1. እድሜ / Age __________ዓመት /Years

2. ፆታ / Sex ☐ ወንድ /Male

☐ ሴት / Female
3. ኃይማኖት / Religion ☐ ኦርቶዶክስ / Orthodox
☐ ሙስሊም / Muslim
☐ ካቶሊክ Catholic
☐ ፕሮቴስታንት / Protestant
☐ ሌላ፤ ካለ ይጥቀሱ /other, specify _________
4. የጋብቻ ሁኔታ / Marital status ☐ ያላገባ(ች) / Single
☐ ያገባ(ች) / Marrie)
☐ የፈታ(ች) / Divorced
☐ በሞት የተለየ / Widowed
5. የመኖሪያ አካባቢ / Residence ☐ ከተማ / Urban
☐ ገጠር / Rural
6. የትምህርት ሁኔታ / Educational status ☐ ማንበብና መጻፍ / Illiterate
☐ የመጀመሪያ ደረጃ ትምህርት / Primary
☐ የሁለተኛ ደረጃ ትምህርት Secondary school
☐ ዩኒቨርስቲ / ኮሌጅ / University/College
☐ ሌላ፣ ካለ ይግለጹ / other, specify _________
7. ወርሃዊ የገቢ መጠን በብር / ☐ <3000 (ከ 3 ሺ ብር በታች )
Monthly Income (ETB) ☐ 3,001 – 5,000
☐ 5,001 – 10,000
☐ >10,000 (ከ 10 ሺ ብር በላይ)
8. ስራ / Occupation ☐ ስራ ፈላጊ / Unemployed
☐ የመንግስት ተቀጣሪ / Government employee
☐ በግል ድርጅት ተቀጣሪ / Private employee
☐ የግል ስራ / Self-employed
☐ የቤት እመቤት / Housewife
☐ ሌላ፣ ካለ ይግለጹ / other, specify _________

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Hepatitis B Knowledge Items
Question Response
1. ሄፓታይተስ ተብሎ የሚጠራ በሽታ እንዳለ ሰምተው ያውቃሉ? ☐ አዎ /Yes
☐ አይ / No
Have you ever heard of a disease termed as Hepatitis?
2. ሄፓታይተስ ቢ ተብሎ ስለሚጠራ በሽታ ሰምተው ያውቃሉ? ☐ አዎ /Yes
☐ አይ / No
Have you ever heard of a disease termed as Hepatitis B?
3. ሄፓታይተስ ቢ የቫይረስ በሽታ ነው? ☐ አዎ /Yes
☐ አይ / No
Is Hepatitis B a viral disease?
4. ሄፓታይተስ ቢ የጉበት ተግባር ላይ ተጽዕኖ ያሳድራል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B affect liver function?
5. ሄፓታይተስ ቢ የጉበት ካንሰርን ያስከትላል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B cause liver Cancer?
6. ሄፓታይተስ ቢ በማንኛውም የዕድሜ ክልል ላይ ሊከሰት ይችላል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B affect any age group?
7. የሄፕታይተስ ቢ የመጀመሪያ ምልክቶች እንደ ጉንፋን ማለትም ትኩሳት ፣ ☐ አዎ /Yes
አፍንጫ ፈሳሽ እንዲሁም ሳል ናቸው? ☐ No
The early symptoms of Hepatitis B are same like cold and flu (fever, running
nose, cough)
8. የአይን እና የቆዳ ቢጫ መሆን የሄፕታይተስ ቢ የተለመዱ ምልክቶች ውስጥ ☐ አዎ /Yes
☐ አይ / No
አንዱ ነው?
Jaundice is one of the common symptoms of Hepatitis B?
9. ማቅለሽለሽ ፣ ማስታወክ እና የምግብ ፍላጎት የተለመዱ የሄፕታይተስ ቢ ☐ አዎ /Yes
☐ አይ / No
ምልክቶች ናቸው?
Are nausea, vomiting and loss of appetite common symptom of Hepatitis B?
10. በአንዳንድ ሕመምተኞች ላይ የሄፕታይተስ ቢ የህመም ምልክቶች ☐ አዎ /Yes
☐ አይ / No
አይታዩም?
Are there no symptoms of the Hepatitis B in some of the patients?
11. ሄፕታይተስ ቢ በአግባቡ ባልተቀቀሉ የቀዶ ጥገና መሣሪያዎች እና ☐ አዎ /Yes
☐ አይ / No
መርፌዎች ሊተላለፍ ይችላል?
Can Hepatitis B be transmitted by un-sterilized syringes, needles and
surgical instruments?

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 12. ሄፕታይተስ ቢ በደም ሊተላለፍ ይችላል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B be transmitted by contaminated blood and blood products?
13. ሄፓታይተስ ቢ በጸጉር ቤቶች ባሉ መቁረጫ እንዲሁም የጆሮና የአፍንጫ ☐ አዎ /Yes
☐ አይ / No
ቀዳዳ መብሻ መሳሪያዎች ይተላለፋል?
Can Hepatitis B be transmitted by using blades of the barber/ear and nose
piercing?
14. ሄፕታይተስ ቢ ልቅ በሆነ ወሲባዊ ግንኙነት ሊተላለፍ ይችላል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B be transmitted by unsafe sex?
15. ሄፓታይተስ ቢ ከእናት ወደ ልጅ ሊተላለፍ ይችላል? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B be transmitted from mother to child?
16. ሄፕታይተስ ቢ በሽታዎች በተያዘ ሰው በተዘጋጀ ምግብ/ ውሃ ይተላለፋል? ☐ አዎ /Yes
☐ No
Can Hepatitis B be transmitted by contaminated water/food prepared by
person suffering with these infections?
17. ሄፓታይተስ ቢ ሊታከምና ሊድን ይችላልን? ☐ አዎ /Yes
☐ አይ / No
Is Hepatitis B curable/treatable?
18. ሄፓታይተስ ቢ በራሱ ሊድን ይችላልን? ☐ አዎ /Yes
☐ አይ / No
Can Hepatitis B be self-cured by the body?
19. ለሄፕታይተስ ቢ ክትባት አለው? ☐ አዎ /Yes
☐ አይ / No
Is vaccination available for Hepatitis B?
20. ለሄፕታይተስ ቢ ህክምና የተለየ አመጋገብ ያስፈልጋል? ☐ አዎ /Yes
☐ አይ / No
Is specific diet is required for the treatment of Hepatitis B?

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Hepatitis B Attitude Items
Question Response
1. ሄፕታይተስ ቢ ሊገኝብኝ ይችላሉ ብለው ☐ አዎ / Yes
ያስባሉ? ☐ አይ / No
Do you think you can get Hepatitis B?
2. ሄፓታይተስ ቢ እንዳለብዎ ካወቁ ምን ☐ ፍርሃት / Fear
ዓይነት ስሜት ይሰጥዎታል? ☐ እፍረት (ሃፍረት) / Shame
What would be your reaction if you found ☐ መደነቅ / Surprise
that you have Hepatitis B? ☐ ሀዘን / Sadness
3. ስለ ህመምዎ ማን እንዲያነጋግረዎት ☐ ሐኪም / Physician
ይፈልጋሉ? ☐ የትዳር ጓደኛዬ / Spouse
☐ ወላጆቼ / Parents
Who would you talk to about your illness?
☐ ልጄ / Child
☐ ሌሎች ዘመዶቼ / Other Relatives
☐ ጓደኞቼ / Friends
☐ ማንንም ማናገር አልፈልግም / No one
4. የሄፕታይተስ ቢ ምልክቶች አሉኝ ብለው ☐ ወደ ጤና ተቋም መሄድ / Go to Health facility
ካመኑ ምን ያደርጋሉ? ☐ ወደ ባህል ህክምና መሄድ / Go to Traditional healer
What will you do if you think that you ☐ የትም አልሄድም / Will not go anywhere
have symptoms of Hepatitis B?
5. የሄፓታይተስ ቢ ምልክቶች ካሉብዎት ☐ በራሴ የምወስደው ህክምና ሳይሳካ ከቀረ
የትኛው ደረጃ ሲደርስ ወደ ጤና ተቋም Own treatment fails
ይሄዳሉ? ☐ የሕመም ምልክቶች ከታዩ ከ3-4 ሳምንታት በኋላ
If you had symptoms of Hepatitis B, at After 3-4 weeks of the appearance of symptoms
what stage you will go to the health ☐ የሄፓታይተስ ቢ በሽታ ምልክቶች አንዳሉኝ
እንደተረዳሁ ወዲያውኑ
facility? Soon as I realize the symptoms are of Hepatitis B
☐ ወደ ጤና ተቋም/ሃኪም አልሄድም
Will not go to physician
6. የሄፓታይተስ ቢ ምርመራና ሕክምና ምን ☐ ነጻ / Free
ያህል ውድ ነው ብለው ያስባሉ? ☐ አቅምን ያገናዘበ / Reasonable
How expensive do you think is the ☐ በመጠኑ ውድ / Somewhat expensive
diagnosis and treatment of Hepatitis B?
☐ በጣም ውድ / Expensive
☐ አላውቅም / Don't know
7. በሄፓታይተስ ቢ በሽታ ቢመረመሩ በጣም ☐ ሞትን ስለምፈራ / Fear of death
የሚያሳስብዎት ነገር ምንድንነው? ☐ ወደ ቤተሰቦቸ እንዳይተላለፍ ስለምሰጋ /
What worries you most if you will be Fear of disease spread to family
diagnosed with Hepatitis B (applicable if ☐ የህክምናው ወጭ / Cost of treatment
worried) ☐ ከማህበረሰቡ መገለል / Isolation from the society

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Hepatitis B Practice Items
Question Response
1. ለሄፕታይተስ ቢ ምርመራ አድርገው ያውቃሉ? ☐ አዎ /Yes
Have you done screening for Hepatitis B? ☐ አይ / No

2. ለሄፕታይተስ ቢ እራስዎን ለመከላከል ክትባት ወስደዋል? ☐ አዎ /Yes

Have you got yourself vaccinated against Hepatitis B? ☐ አይ / No

3. የሚጠቀሙበት መርፌ አዲስ መርፌ እነዲሆን ይጠይቃሉ? ☐ አዎ /Yes

Do you ask for a new syringe before use? ☐ አይ / No

4. ታካሚ ቢሆኑ ለእርስዎ ደም ከመሰጠቱ በፊት ደሙ ተመርምሯል ብለው ☐ አዎ /Yes

ይጠይቃሉ? ☐ No
Do you ask for screening of blood before transfusion?
5. የጸጉር ቤት መላጫ እንዲሁም ለጆሮ እና ለአፍንጫ ለመብሳት የሚጠቀሙበት ☐ አዎ /Yes
መሳሪያ ደህንነቱ የተጠበቀ መሳሪያ እንዲለወጥ ይጠይቃሉ? ☐ አይ / No
Do you ask your barber to change blade/Or for safe equipment for ear and nose
piercing?
6. ሄፕታይተስ ቢ እንዳለብዎ በምርመራ ከተረጋገጠ ለበለጠ ምርመራ እና ህክምና ወደ ☐ አዎ /Yes
ጤና ተቋም ይሄዳሉ? ☐ አይ / No
In case you are diagnosed with Hepatitis B, would you go for further investigation
and treatment?
7. ከሄፕታይተስ ቢ በሽተኞች እራስዎን ያገላሉ? ☐ አዎ /Yes
Do you avoid meeting Hepatitis B patients? ☐ አይ / No
8. ከሄፓታይተስ ቢ ጋር በተያያዘ የሚሰጡ የጤና ትምህርት ፕሮግራም ውስጥ ☐ አዎ /Yes
ተሳትፈው ያውቃሉ? ☐ አይ / No
Have you ever participated in health education program related to Hepatitis B?

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Annex VI - Declaration by students

Santé Medical College

Declaration Form for students

Declaration by students

I certify that this research is my own work, and that I have acknowledged all material and sources
used in its preparation, whether they be books, articles, reports, lecture notes, and any other kind of
document, electronic or personal communication. I also certify that this research work has not
previously been submitted for assessment in any other unit, except where specific permission has
been granted from all unit coordinators involved, or at any other time in this unit, and that I have not
copied.

To the best of my knowledge and belief, this research is my own work, all sources have been properly
acknowledged, and contains no plagiarism. I have not previously submitted this work or any version
of it for assessment in any other place.

I acknowledge that this assessment submission may be transferred and stored in a database for the
purposes of data-matching to help detect plagiarism.

Student’s Signature: ___________________________________________

Date of signing: _______________________________________________

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Annex VII – Advisor approval sheet

ADVISORS’ APPROVAL SHEET

SANTE MEDICAL COLLEGE

DEPARTMENT OF GRADUATE STUDIES

ADVISOR’S APPROVAL SHEET (submission sheet - 1)

This is to certify that the thesis entitled Assessment of Knowledge, Attitude, Practice and
Associated factors Towards Prevention of Hepatitis B Virus Infection Among Blood Donors at
The National Blood Bank Service in Addis Ababa, Ethiopia submitted in partial fulfillment of
the requirements for the degree of master’s with specialization in public health the Graduate program
of the department and has been carried out by Yaregal Bante Id. No. 0126/B4/11 under my
supervision. Therefore, I /We recommend that the student has fulfilled the requirements and hence
hereby can submit the thesis to the department.

Name of advisor Signature Date

Name of Candidate Signature Date

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Annex VIII – Examiners’ approval sheet

SANTE MEDICAL COLLEGE

DEPARTMENT OF GRADUATESUDIES

EXAMINERS’ APPROVAL SHEET -1

(Submission Sheet- 2)

We, the undersigned, members of the Board of Examiners of the final open defense by have read
and evaluated his/her thesis entitled “and examined the candidate. This is, there, fore, to certify that
the thesis has been accepted in partial fulfillment of the requirements for the degree.

Name of the Chairperson Signature Date

Name of Major Advisor Signature Date

Name of internal Examiner Signature Date

Name of External examiner Signature Date

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