Hepatitis B and C Knowledge, Testing Uptake, and Vaccination Coverage Among Men Aged 15-49 in Nepal: A Nationally Representative Analysis of the 2022 Nepal Demographic and Health Survey

Background Nepal has integrated the commitment for hepatitis B and C as a public health threat into its National Strategy for Viral Hepatitis B and C(2023–2030). While the prevalence of chronic hepatitis in the general population is lower in Nepal, knowledge, testing and vaccination need to be known for potential elimination of viral hepatitis in this age group. Males are relatively under-represented in reproductive and child health surveys, but males’ knowledge and health-seeking behavior influence the household approach for prevention and hepatitis care cascade. The gendered study aims to assess the knowledge of hepatitis B and C, its sociodemographic determinants, and testing using the NDHS (2022) among males aged 15–49 years. Methods We used the data from the men’s recode dataset (NPMR82FL) of the 2022 NDHS, a cross-sectional nationally representative survey. The knowledge about Hepatitis was recorded as a composite variable from three items available on a binary response format in men’s module (hepatitis C is transmitted through blood, hepatitis C can be prevented, hepatitis B can be cured). The score was categorized into adequate and inadequate knowledge based on the median cut-off. The survey-weighted estimation (svydesign function in R) was used for adjusting for primary sampling unit (mv021), strata (mv022) and sampling weights (mv005/1,000,000). Weighted prevalence of adequate knowledge was calculated by province, wealth quintile, age group, place of residence and ecological zone. Factors associated with knowledge were studied through survey-weighted linear regression (continuous score) and logistic regression (adequate knowledge). Adjusted odds ratios (aOR) with 95% confidence intervals were reported. Receiver operating curve and area under the curve (ROC-AUC) was used to check the discrimination ability of the model. Concentration index was used to find out the equity related with knowledge of hepatitis on wealth quintile. A five-fold cross-validation procedure was used for internal validation. Results After applying survey weights, the prevalence of adequate knowledge varied significantly by province: Gandaki, 81.5% (95% CI: 76.5–86.5) and Sudurpashchim, 76.3% (72.1–80.5) were among the higher provinces and Madhesh was the lowest, at 58.0% (53.7–62.2). There was a clear wealth gradient for adequate knowledge, with 65.3% (61.8–68.9) in the poorest quintile to 82.0% (79.2–84.9) for the richest quintile. Logistic regression modeling for determinants of adequate knowledge showed that higher levels of education were the strongest predictor (compared to no education: secondary: aOR 3.48, 95% CI 2.56–4.72; higher education: aOR 7.09, 4.10-12.25). Other positive predictors were older age (35–49: aOR 1.85, 1.38–2.48); internet use (aOR 1.65, 1.35–2.02); and residence in the Hill ecological zone (aOR 1.45, 1.04–2.02). Significantly lower odds of adequate knowledge were found among men living in the Madhesh (aOR 0.53, 0.39–0.71) and Karnali (aOR 0.67, 0.47–0.97) provinces, compared to those living in the Koshi province. The model showed good discrimination (AUC = 0.703) and moderate explanatory power (McFadden pseudo-R² = 0.087) while the concentration index was − 0.030 indicating a slight pro-poor distribution of knowledge. Cross-validation indicated mean accuracy of 0.727 and mean AUC of 0.693. The proportion of respondents tested for hepatitis was available for only 23 respondents (99.5% missing), precluding any analysis regarding the testing uptake. Vaccination coverage data was not collected from the module for men. Conclusions Hepatitis knowledge disparities among Nepali men vary with education, geography and internet access. There are significant provincial differences in access to knowledge. While knowledge levels in absolute terms appear to be relatively high, the fact that nearly a third of men in the country lack adequate knowledge, particularly restrictive in targeted provinces such as Madhesh and Karnali, as well as household wealth indicates that there were fissures in health literacy that need to be addressed. The lack of hepatitis testing or vaccination status data among male respondents in the DHS module is a key surveillance gap that hinders the monitoring of Nepal’s hepatitis elimination progress and pathway to the 2030 elimination goals. It is recommended that these hepatitis indicators be included in future rounds of male questionnaires in the DHS and in national health information systems to provide for appropriate gender-disaggregated cascade monitoring.