Knowledge, Attitude and Practice (KAP) Survey about hepatitis B (HBV) and C (HCV) among migrant populations from Sub-Saharan Africa

  1. Frhat M. A. Saaed
  2. Jerry E. Ongerth
  3. Muna H. Ali

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Abstract

Background

Hepatitis B and C virus infections are serious blood borne diseases with global health concern particularly in developing countries. The association between survey participant’s knowledge, attitude, and practices (KAP) about HBV and HCV infection is rarely studied, particularly among migrants seeking resettlement. Libya is a main transient station for migrants northward toward Europe and the flow is increasing into Al Kufra from neighboring countries that have endemic intermediate and high HBV and HCV prevalence. The purpose of this exploratory descriptive study in Al Kufra was to assess the level of participating migrant’s KAP, regarding cause, transmission, prevention, and treatment of viral hepatitis due to HBV and HCV.

Method

A cross-sectional study was conducted among 674 sub-Saharan African migrants in Al Kufra, Libya from January to October 2021. Migrant’s KAP about HBV and HCV infection was assessed by interview questionnaire. Statistical and data analysis used SPSS version of 25.

Results

Out of 700 questionnaires distributed, 674 were returned with a response rate of 96.3%. The study population included 580 (86.1%) males, mean age of 29.6 ± 7.2 SD years. A majority, 508 (75.4%) were illiterate and elementary level, 8 2.483+.232, respectively. Positive significant linear correlations were found between knowledge-attitude (r = 0.524, p < 0.01) knowledge-practice (r = 0.123, p < 0.01) and attitude-practice (r = 0.278, p < 0.01). Ethnicity and education variables were significantly associated with mean KAP. Gender identity and marital status were both significantly associated with mean knowledge and attitude.

Conclusion

The migrant population from the neighboring and sub-Saharan African countries have inadequate KAP about HBV and HCV to limit infection.

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  1. PREreview

    This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/7770616.

    A contemporary study of an important issue of global concern. The study shed light on the great health problems of the migration and displacement, a major one is the HBV and HCV infections. The objective was to assess the level of migrants' knowledge, attitude, and practices, regarding infection due to HBV and HCV.. The results showed significant deficiency in knowledge of studied population about cause, transmission, prevention and treatment of viral hepatitis ..

    Conclusions of this study should help inform migration concerned parties such as the IOM, NGOs , and local health system to plan keenly for preventive measures including health education and provision of vaccination  when appropriate.

    Major issues:

    1. The setting is not clearly described and lacks sufficient explanation. It is not understood what made this 'apparently healthy' targeted population to be surveyed in a particular lab (while the study does not include performing or collecting certain lab investigation results). Were the subjects referred from a clinic? or sent for a certain screening by an authority? Or randomly?

    2. The Refrerences :The study utilized a plethora of references, but the in-text citation may need a comprehensive checking to ensure proper sequential order of their numbering within the main body. Also there are missing in-text citation of references 1,2 and3.

      Moreover, most of the references are relatively old; a third of them are older than 15 years. The rest are more than years back and only 6 out of 40 references are less than 5 years old.Because data within some of these references might have significantly changed with time, authors may wish to see newer references with update statistical data.

     Other moderate and minor remarks :

     1]Title: Is appropriate and attractive but to be fully informative it is suggested to include the geographic location. (e.g Al kufra city , Libya).

       2] In the abstract, sentence:" The association between  survey                … is rarely studied"

    Not clear; kindly rephrase to clarify

      3]"Al Kufra"

    Authors may wish define (city? town? Region?province?) at least on first mention in abstract and main body.

      4] sentence in introduction: "and C (HCV) virus are"

    "and hepatitis C virus (HCV) are"

      5] in-text citation [19]

    References should be entered in sequence order (the first cited reference should be No.[1], the next [2] ..etc)

      6]the last statement in introduction: "The purpose of this study… treatment and prevention"

    Incomplete. This is an important sentence that states the objective(s) of the study. It should be complete and should fully mention the whole aspects within.

      7] "The study area is located in"

    Authors may wish to present more details about geographical position (map is a good idea), population, demography and migration statistics and epidemiology of HBV HCV infection in the area.

      8] "Ethics Approval"

    Information entered under this subheading describe the "consent" but not "the ethical approval" The ethical approval is essential. It should be sought, obtained from the competent IRB commitee and declared here. The 'informed consent' comes next.

      9] Tables 2b, 2c:

    Are these tables missing a column?

      10] sentence in discussion:" the purpose of this study …. due to HBV and HCV"

    Unnecessary repetition of the objective.

      11] sentence in discussion:" as the country as a whole is classified… for hepatitis C"

    Authors may wish to include local and country statistics with updated epidemiological data.

     12] sentence in discussion:"The prevalence of hepatitis B surface antigen (HBsAg) and anti-HCV antibodies in sub-Saharan African migrants has been found to exceed 30-50% "

    This is confusing, and need rephrasing to clarify. There should be two separate values one for each test. However the cited reference states different data (23.4% for HBV and 31.2% for HCV).       

        13] sentence in discussion:" A plausible reason … preventing infection"

     Other pertinent causes should include fragile health systems because of economical and political factors in addition to social and traditional habits

      14] sentence in discussion:" The present study assessed …and HCV infection"

    Another unnecessary repetition.

      15] sentence in discussion:" Ethiopia has a population-wide prevalence … respectively"

    Kindly explain how this statement is related to the preceding sentence. However If authors chose to keep it, it is suggested to utilize it for enriching discussion by including it in a separate paragraph in the discussion along with comparative data of the other three countries whose citizenship are held by the studied migrants. That is in the context of showing status of disease in these countries of origin. It is also advisable to present newer/ update data.

      16] sentence in discussion:" A wide range of unsafe practices …blood borne diseases"

    It will be good to elaborate more on these practices by giving examples

      17] Sentence in conclusion: "In this screening study"

    The word 'screening' is confusing, authors may wish to delete.

      18] Sentence in conclusion: "emphasizing the need for education to limit the spread of the blood borne disease"

    This is an important recommendation based on this study . So kindly expand to present direct messages to concerned entities (NGOs in charge, IOM, local governmental and health authorities..) proposing explicit solutions.

      19] Last sentence in conclusion: "Poor knowledge and lack of awareness … in native countries"

    Barely relevant to objectives of the study, not suitable in the conclusion. Authors my move it up to discussion section and position it within a suitable context.

    Thank you

    Yasir E. A. Elsanousi, MBBCh, DTM&H, MeHM, EMDM Infectious Disease Specialist, Disaster Medicine Consultant

    Competing interests

    The author declares that they have no competing interests.

  2. Version published to 10.1101/2022.11.29.22282852v1 on medRxiv