Knowledge, attitude and practice of staff of 4 hospitals in Yaoundé on the prevention of vertical transmission of hepatitis B

Introduction Hepatitis B virus infection is a public health concern in Cameroon and worldwide. With hepatitis C virus, it is the first cause of liver cancer in Cameroon. The high prevalence of 11.9% in Cameroon is associated with the premature contamination at the perinatal period, due to vertical transmission, from mother-to-child. To put into practice the preventives measures, actors need a good knowledge on premature contamination of a baby. The general objective of this study was to evaluate the influence of level of knowledge on the attitudes and the professional practices concerning prevention of mother-to-child transmission of hepatitis B (PMTCT/HBV) in Yaoundéhospitals and environs. Methods We carried out a cross sectional multicentric, KAP study from 10th March to 15th December 2015 in the obstetrics services of 4 hospitals in Yaoundéand environs. For each health care provider who gave his consent, we used a pretested questionnaire to collect socio-demographics and professional data as well as their knowledges, attitudes and practices on PMTCT/HBV. After given a grade to each item, we proceeded to a quantitative analysis of data using SPSS software and Epi info 7th version. Results 105 health care provider took part in the study, made up of 82 women (79%) and 22 men (21%). The ages were between 23 and 60 years, with a mean age of 40.9 ± 9.2 years. Only 21% of the participants had good knowledges on HBV/PMCT. This knowledge had a significant link with the profession, the professional experience and the duration in the same service. All the nurseaids had inadequate knowledges as well as the elders in the profession. Most of the participants (64.4%) had favorableattitude on PMTCT/HBV and that was significantly associated to good knowledges. (OR:5.34; CI 95% [1.47-19.47], p = 0.006). The practices on PMTCT/HBV were inappropriate in 57.1% of the participants. There were no significant relation between good knowledge and the practices (OR: 1.818, CI 95% [0.705-4.68]; p = 0.213) as well as between good attitudes and practices on PMTCT/HBV (OR: 0.932; CI 95% [0.423-2.058]; p = 0.862). Conclusion The healthcare provider in hospitals in Yaoundé and its environs are old. Their knowledge on PMTCT/HBV is inadequate and their practices inappropriate. Good knowledge doesn't always lead to good practices of PMTCT/HBV. There exist some obstacles or intermediate variables between good knowledge, good attitudes and appropriate practices of PMTCT/HBV.


Introduction
Hepatitis B is an inflammatory process of the liver caused by a viral infection that is found worldwide. The World Health Organisation (WHO) estimated that in 2015 about 240 million people were chronic carriers of hepatitis B virus (HBV) [1]. The severity of this affection is by its possible progression to late complications like liver cirrhosis and primitive liver cancer. HBV is a communicable disease whose mode of transmissions are well known; by blood and blood products, sexual transmission and vertical transmission from mother-to-child. Vertical transmission has been identified to be one of the causes of the high prevalence of HBV infection in Sub-Sahara Africa [2,3]. Actually, an early contamination in the perinatal period will provoke a chronic infection in 90% of infected children. This progressive risk is only 5% if the contamination occurs in adult life [4][5][6]. Therefore prevention of mother-to-child transmission (PMTCT) of HBV (PMTCT/HBV) constitute one of the main pillars in the fight against this infection in regions of high prevalence like Cameroon [7][8][9][10][11]. The main actors in the implementation of this prevention are health care providers in charge of pregnant women whose daily action should contribute to reduce the mother-to-child transmission of HBV, as is the case of HIV/AIDS. In Cameroon this strategy of prevention is still embryonic. The PMTCT of HBV varies with hospitals and even amongst practitioners. Data on knowledge, attitude and practice on PMTCT/HBV were graded with maximum grades of respectively 10, 6 and 10.
Knowledge on PMTCT/HBV of participants were grade from 1 to 10 and was quoted "good" if the grade was greater of equal to 7 and "insufficient" if less than 7. Assessment of attitude of care givers took into consideration their beliefs and perception of risk of MTCT/HBV and answers were graded from 1 to 6. A grade above 4 was quoted "favourable" or "good" attitude and a grade less than or equal to 4 was quoted "poor" attitude. Professional practice was grade from 1 to 10. It was quoted "poor or "inadequate" if the grade was less than 7 and "good" if the grade was greater than or equal to 7.
Statistical analysis: Data were analysed using SPSS 18 of IBM corporation. Chi square test and odds ratio were used accordingly and level of significance was p < 0.05.

Results
Amongst the 139 participant in the study, 105 gave their consent representing a participation rate of 75.54%. 68.6% of participants were from the Yaoundé General Hospital and Yaoundé Gynaecoobstetric and Paediatric Hospital, while only 9.5% were from Mfou District Hospital (

Discussion
We carried out a study on 105 participants in 4 different hospitals in Yaoundé and its environs. The ages of the participants ranged from 23 to 60 years with an average age of 40.9 ± 9.2 years. 56.2% of participants had more than 40 years. The average age of participants in our study is more than observed by Fouwou Njoya [12], on health care providers in Yaoundé which was 32. 4  We also found out that knowledge was closely related to level of

Competing interests
The authors declare no competing interests.

Authors' contributions
All the authors have read and agreed to the final manuscript. Tables   Table 1: Distribution of participant and health facilities