INTRODUCTION:

A communicable disease is one that is spread from one person to another through a variety of ways that include: contact with blood and bodily fluids; breathing in an airborne virus; or by being bitten by an insect.¹ Hepatitis viruses are the most common cause of Hepatitis in the world but other infectious, toxic substances can also cause Hepatitis. Hepatitis A and E are typically caused by ingestion of contaminated food and water. Hepatitis A virus is present in the feces of infected persons and is most often transmitted through contaminated water or food and certain sex practices.The hepatitis A virus is transmitted primarily by the faecal-oral route. The incubation period of hepatitis A is usually 14–28 days. Symptoms of hepatitis A range from mild to severe, and can include fever, malaise, loss of appetite, diarrhoea, nausea, abdominal discomfort, dark-colored urine and jaundice. ²

NEED FOR THE STUDY:

Several outbreaks of Hepatitis A have been reported from Kerala state in recent years. Weekly reports of outbreaks retrieved from the official website of integrated disease surveillance project showed that there were 84 out breaks of Hepatitis A, reported from Kerala in the past five years; there were 22 deaths due to Hepatitis A in last two years. Hepatitis A has become almost endemic to the state, bringing to focus the poor hygiene and sanitation prevailing here.³ From the above studies, it is estimated that the knowledge of adults regarding Hepatitis A was not satisfactory. Improved sanitation, food safety and immunization are the most effective ways to reduce Hepatitis A and it can also be prevented by adequate supplies of safe drinking water, proper disposal of sewage within communities, personal hygiene, and regular hand-washing with safe water. So it is needed to assess knowledge of community regarding the prevention of communicable disease like Hepatitis A.

PROBLEM STATEMENT:

A descriptive study to assess the knowledge of adults regarding Hepatitis A in a selected rural community, Kottayam.

OBJECTIVES:

The objectives of the study are:

· Assess the knowledge regarding Hepatitis A among adults

· Find the association between knowledge of adults regarding hepatitis A and selected demographic variables

OPERATIONAL DEFINITIONS:

Hepatitis A: Hepatitis A is a highly contagious liver infection caused by Hepatitis A virus, which causes inflammation that affects the liver’s ability to function.⁴

Adults: Adults are someone who have achieved the self-concept of being responsible for their own life (>21 years).

Knowledge: It refers to the information collected from the rural population regarding Hepatitis A, assessed using a structured knowledge questionnaire with limits to a number of closed ended questions.

Hypothesis:

The hypothesis is tested at 0.05 level of significance.

H1: There is significant association between the knowledge level of adults regarding Hepatitis A and selected demographic variables.

Assumptions:

· Adults may have basic knowledge regarding Hepatitis A.

· Selected variables influence knowledge of adults.

· Knowledge of adults regarding Hepatitis A will help them to act spontaneously.

· Adult will cooperative to the study conducted by the researchers.

Delimitations:

The study is delimited to the adults who are above 21 years, living in Athirampuzha Panchayat, ward number nine and willing to participate in the study.

REVIEW OF LITERATURE:

A case control study on investigating a community wide outbreak of Hepatitis A in Nellikuzhy Panchayat of Kothamangalam taluk, Ernakulum district, Kerala, India was conducted. The objective of the study is to describe the epidemiological features of the outbreak and to identify the probable source. Cases were selected by simple random sampling from the line list and controls were age matched neighborhood individual without any history of jaundice. The result was around 223 Hepatitis A cases were identified. Attack rate was found to be highest among the age group of 16-30 years at1. 44% and was eight times higher among males. Observation and result of the study revealed that the probable of the Hepatitis A outbreak was a hotel. The study findings also add evidence to the changing epidemiology pattern of Hepatitis A in Kerala, and warrant the necessity to enforce food safety rules in state.⁵

A comparative study to assess the public awareness and practical knowledge regarding Hepatitis A, B and C was done in two countries .In first country data were collected through German online wizo panel .A small group of 9154 people was invited by e-mail to participate in the survey. Of those invited 2367 participant began the survey (25.95%) and 1989 completed it (84%). The average age was 40 years and 60.5% was women .In second country the data were collected through an online panel with a sample of 1044 people representing the Dutch population was invited by an e-mail, of those invited; 668 began and completed the survey, the average age was 49 years and 49.7% of participants were women. The result shows that; although the public awareness was high, practical knowledge regarding differences in the mode of transmission, consequences and the prevention was very low in both countries, especially with a lower level of education.⁶

A cross sectional study was conducted on 120 students regarding Knowledge attitude and practice of Malaysian public university students on viral Hepatitis. This study aimed to evaluate the knowledge, attitude and practice regarding viral Hepatitis amongst university students in Klang Valley Malaysia. A structured questionnaire was used to collect the data regarding demographic information and knowledge attitude and practice of students on viral Hepatitis. The total scores of knowledge, attitude and practice regarding viral hepatitis were significantly higher in medical as compared to non-medical science based participants. Although this study focuses on the student population, it can be a good start to open the eyes of the society to be alert and seeking more knowledge regarding Hepatitis. It is one of the crucial steps to improve the national health care system.⁷

RESEARCH DESIGN:

The research design is the overall plan for obtaining answer to the questions being studied and for handling some of the handling difficulties encountered during the research design.⁸ A descriptive survey design was selected to achieve the objectives of the study.

Setting of The Study:

The study was conducted in Kottayam district, which consisted of six municipalities and 70 Panchayats. From that Athirampuzha Panchayat was selected which comprised of 22 wards. Investigators selected ward number nine which has approximately 40,438 populations.

Population:

The population in this study was the adult people who are living in Athirampuzha Panchayat, Kottayam district.

Sample Size:

A total number of 30 adults who were living in Athirampuzha in ward number nine was selected. The sample size was estimated based on the previous studies and considering the time frame of present study.

Sampling Technique:

Sampling technique used in the study was non-random convenience sampling. This entitles using the most conveniently available people on study participants. The sample who met the inclusion criteria and available at the time of study was taken.

Criteria for Sample Selection:

Inclusion criteria:

Adults who are:

· Above 21 years.

· living in Athirampuzha Panchayat, ward number nine.

· Willing to participate in the study.

· Able to read and write Malayalam or English.

Exclusion criteria:

Adults who are:

· Health professionals.

· Absent at the time of study.

· Having any cognitive impairment

TOOL:

The tool used for this study was a structured self-administered questionnaire to assess knowledge regarding Hepatitis A among adults in a selected rural community, Kottayam. This instrument consists of two parts;

Part-1:

A semi structured questionnaire provided for collecting demographic data for adults. Demographic data including age, sex, religion, marital status, educational status, occupational status, monthly income, type of family, food is taken frequently from, source of drinking water, most common purification method of drinking water.

Part-2:

A structured knowledge questionnaire was developed with the intention to assess the knowledge regarding Hepatitis A among adult.

Score Interpretation:

The questionnaire include 30 multiple choice questions. Each items has only one correct answer and score of ‘one’ was allotted for each correct answer and score of ‘zero’ was given for each wrong answer. The highest possible score is ‘30’. According to the score obtained by each subject knowledge is classified into;

0-10 : poor

11-20 : average

21-30 : good

RESULTS:

Table 1: Frequency and percentage distribution of subjects based on age, sex, religion, marital status, education, and occupation. (n=30)

Demographic variables	Frequency	Percentage (%)
Age(Years)
21-30	5	16.6
31-40	3	10
41-50	826.6
51-60	7	21.4
Above 60	7	21.4
Sex
Male	4	13.3
Female	26	86.7
Religion
Hindu	2	6.7
Christian	26	86.7
Muslim	2	6.7
Marital status
Unmarried	3	10
Married	25	83.3
Widow	2	6.7
Education
Primary	1	3.3
High school	7	23.7
Higher secondary	9	30
Graduate	11	36.7
Post graduate	2	6.7
Occupation
Private	3	10
Government job	6	20
Self employed	3	10
House wife	15	50

Table 2: Frequency and percentage distribution of subjects based on income, family, source of drinking water, purification method, previous exposure, knowledge regarding Hepatitis A and source of previous knowledge (n=30)

Demographic variables	Frequency	Percentage (%)
Income
<15000 Rs	17	56.7
21000-25000 Rs	5	16.7
>25000Rs	8	26.6
Family
Nuclear family	25	83.3
Joint family	4	13.3
Extended family	1	3.4
Source of drinking water
Panchayat	1	3.3
Pipeline	5	16.7
Underground	24	80
Purification method
Chlorination	2	6.7
Boiling	28	93.3
Previous exposure
Yes	3	10
No	27	90
Knowledge regarding Hepatitis A.
Yes	23	76.60%
No	7	23.30%
Source of previous knowledge
Magazine or newspaper	9	39.1
Awareness program	4	17.39
Relatives or friends	1	4.34
Health workers	3	13.04
Medias	6	26.08

The above table reveals that 26.6% of adults were in the range of 41-50 years, 86.7% were females, More than half of the subjects (86.6%) were Christians, 83.3% were married, 36.7% were graduates, 50% were house wife, 20% were having government job, more than half (56.7%)of subjects had an income of <15000Rs, 83.3% were living as nuclear family, 100% of subjects were taking food from their home, 80% of the subjects were taking drinking water from underground, 93.3% of subjects rely on boiling as the purification method, 90% were not having any previous exposure to Hepatitis, 76.6% of subjects were having knowledge regarding Hepatitis A, and 39.1% of subjects had their source of knowledge from magazines and newspapers.

Figure 1. Doughnut diagram showing the percentage of subjects based on knowledge level of Hepatitis A.

Table 9 shows that among 30 subjects, majority of subjects (86.6%) had an average knowledge, whereas an equal number of subjects (6.7%) had poor and good knowledge.

Table 3: Mean and standard deviation of the overall knowledge score (n=30)

Overall knowledge score
Mean	Standard deviation	Range	Maximum score
15.8	3.506	12	30

The data presented in table 3, depicts that the mean knowledge score was 15.8 with a standard deviation of 3.506. The range of score was 12. The maximum score of questionnaire was 30. The study revealed that among 30 subjects, majority of subjects 26 (86.6%) had an average knowledge, whereas an equal number of subjects 2 each (6.7%) had poor and good knowledge. There is no significant association between the level of knowledge of adults regarding Hepatitis A and selected demographic variables.

CONCLUSION:

Knowledge of adults regarding Hepatitis A was assessed. The finding showed majority of subjects 26 (86.6%) had an average knowledge, whereas an equal number of subjects 2 each (6.7%) had poor and good knowledge. In the present study, there is no significant association between the level of knowledge of adults regarding Hepatitis A and selected demographic variables such as age, sex, religion, marital status, education etc

NURSING IMPLICATIONS:

Nursing Implication:

The finding of the study has implications in the field of nursing education, nursing practice, nursing administration, and nursing research.

Nursing Education:

· Nurses play a pivotal role in providing proper education about Hepatitis A.

· Nursing education brings changes in the occurrence of Hepatitis A by taking necessary precaution and preventable measures in emergency and routine procedures.

Nursing Administration:

· The nurses as competent administrators can play an important role in providing awareness in the prevention of Hepatitis A.

· Educational programs can be planned and conducted in the community regarding Hepatitis A, signs and symptoms and its management.

Nursing Practice:

· As a vital part of the health team, nurses can give greater contributions in improving the knowledge about Hepatitis A.

· Nurse’s plan self-administered questionnaires which can be used to improve knowledge regarding Hepatitis A.

· Among student nurses, the nurse’s approach through structured teaching program was helpful to improve the knowledge of Hepatitis A.

Nursing research:

· This study helps the nurse researcher to educate the nursing student to participate in the control and prevention of Hepatitis A.

· The findings of research studies can form the basis for future researches.

RECOMMENDATIONS:

· A similar study can be conducted with a large sample so that the findings can be generalized.

· A similar study can be conducted to assess the attitude regarding Hepatitis A.

· A similar study can be conducted in different target population such as people who are residing in an urban area.

· A similar study can be conducted in hospital setting also.

· A similar study can be conducted to assess the effectiveness of teaching program regarding Hepatitis A.

· A comparative study can be conducted between males and females to assess the knowledge regarding Hepatitis

REFERENCE:

1. Park K. Text book of preventive and social medicine.19^th ed. Jabalpur: Banarsidas Bhanot; 2017.p.225.

2. WHO. HepatitisA. Available from:https://www.who.int/news-room/fact-sheet/detail/hepatitis-a.

3. 84 outbreaks of Hepatitis A in last five years in Kerala State. Available from https://www.researchgate.net/publication/319416622_84_outbreaks_of_Hepatitis_A_in_last_five_years_in_Kerala_State_-_are_we_resigning_to_fate

4. Brunner and Suddarth’s. Text book of medical surgical nursing .1^3th ed.vol.1and 2.wolters kluwer; 2014.

5. Rakesh P S, Mainu C R, Raj A, etal. Investigating a community wide outbreak of Hepatitis A in Kerala India.2018 Nov 30;7(6):p.1537-41.Available from: https://www.researchgate.net/publication/329339754_Investigating_a_community_wide_outbreak_of_hepatitis_A_in_Kerala_India

6. Mohd Nazi NN. A Rahman NA, Mohd Shafri MA, A Rahman NI, Haque M. Knowledge, attitude and practices of Malaysian public university students on viral hepatitis.2019;9(1): p.46-53. Available from: https://www.researchgate.net/publication/330142009_Knowledge_Attitude_and_Practice_of_Malaysian_Public_University_Students_on_Viral_HepatitisHepatits outbreak from Kerala.

7. Crutzen R. Public awareness and practical knowledge regarding hepatitis A, B and C: a two country survey. Apr 2012; 5(2):p.195-98. Available from: https://pubmed.ncbi.nlm.nih.gov/22541268/

8. Sharma S. K. Nursing Research and statistics. 3^rd ed. New Delhi: Elsevier publications; 2014. p.46.

Received on 02.01.2022 Modified on 18.01.2022

Research J. Science and Tech. 2022; 14(1):53-58.

DOI: 10.52711/2349-2988.2022.00008