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      Knowledge of and attitudes towards hepatitis B and its transmission from mother to child among pregnant women in Guangdong Province, China

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          Abstract

          Background

          Hepatitis B virus (HBV) infection remains a serious public health problem worldwide. Mother-to-child transmission (MTCT) of HBV is the major mode of transmission in HBV-endemic areas, including China, where little is known about pregnant women’s knowledge of and attitudes towards HBV infection and MTCT.

          Methods

          A cross-sectional survey, conducted in pregnant women in Guangdong Province, China, measured HBV knowledge and attitudes using a questionnaire, at one tertiary and two rural hospitals.

          Results

          The total response rate was 94.5% (737/780). Of the 11 knowledge questions, the mean score was 6.73 ± 3.04 (mean ± SD). Most pertinent to preventing MTCT, 53.3% of the respondents did not know that HBV can be transmitted through unprotected sexual intercourse and nearly 20% did not know that HBV can be transmitted from mother to infant. The results of the four attitude questions was better with 83% and 85% being willing to be screened for HBV and let their baby receive HBV vaccine and HBIg, respectively. However, only 16.5% of respondents agreed that they would be willing to take drugs that are known not to harm the fetus to prevent MTCT of HBV. In multivariable analysis, higher education level was associated with better knowledge and attitude scores.

          Conclusions

          Knowledge about HBV among pregnant women was poor and needs to be improved to prevent MTCT of HBV. Health education needs to be directed towards pregnant mothers, particularly less educated mothers, in high HBV endemicity settings.

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          Most cited references25

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          Viral hepatitis B.

          More than 400 million people worldwide are chronically infected by the hepatitis B virus. The virus is responsible for more than 300000 cases of liver cancer every year and for similar numbers of gastrointestinal haemorrhage and ascites. Major breakthroughs have been achieved in diagnosis and treatment of this virus. Hepatitis B vaccine reduces incidence of liver cancer. As with hepatitis C, advances have been made in molecular virology, especially for naturally occurring and treatment-induced mutant viruses. The clinical significance of low viral load and genotypes are also under investigation. Currently available monotherapies-interferon, lamivudine, and adefovir dipivoxil-very rarely eradicate the virus, but greatly reduce its replication, necroinflammatory histological activity, and progression of fibrosis. Lamivudine, and presumably other nucleoside analogues, can reverse cirrhosis of the liver.
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            Global elimination of mother-to-child transmission of hepatitis B: revisiting the current strategy.

            Mother-to-child transmission (MTCT) of hepatitis B virus (HBV) is a major route of HBV transmission worldwide despite an existing immunoprophylaxis regimen. The implementation of immunoprophylaxis has been challenging, especially in low-income and middle-income countries, where MTCT is common, because of difficulty obtaining and delivering the monovalent HBV vaccine and the HBV immunoglobulin. Global control of the HBV epidemic will need improved prevention of MTCT. We discuss research gaps that hinder development of new options for the elimination of MTCT as well as policy changes that may help the current vaccine-based strategy to live up to its full potential. We propose that decreasing hepatitis B viral concentrations before delivery, along with HBV vaccine use, could provide an alternative strategy that would decrease MTCT of HBV.
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              Characterizing hepatitis B stigma in Chinese immigrants.

              Health-related stigma is a cause of stress, alienation and discrimination that can serve as a barrier to prevention and care for infectious diseases such as HIV. Hepatitis B virus (HBV)-related stigma is common in Asian immigrants, but has not been formally evaluated. The aim of this study was to develop and validate the first HBV stigma instrument and to begin to evaluate HBV stigma in Chinese immigrants. The HBV stigma instrument was developed based on constructs from validated HIV stigma scales and organized into five domains. A written survey was compiled to include demographic data, HBV knowledge questions and stigma items. The survey was pilot tested in English and Chinese and then finalized. Data were obtained from 201 patients seen in an urban Chinatown Internal Medicine practice. The stigma items showed a high degree of reliability when assessed in aggregate (α = 0.85) as well as within individual domains. Stigma was greatest in the Fear of Contagion domain. Knowledge questions showed a corresponding deficit in understanding of modes of HBV transmission. An inverse relationship between stigma scores and familiarity with HBV provided evidence of construct validity. In multivariable analysis, having a family member with HBV and higher HBV knowledge subset scores were associated with lower degrees of stigma. In conclusion, the hepatitis B stigma instrument showed reliability and construct validity. The relationship identified between familiarity and knowledge regarding HBV with lower stigma scores provides the basis for the development of interventions to reduce HBV stigma. © 2011 Blackwell Publishing Ltd.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                2 June 2017
                2017
                : 12
                : 6
                : e0178671
                Affiliations
                [1 ]Department of Obstetrics and Gynecology, the Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong Province, China
                [2 ]Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, United States of America
                [3 ]Department of Medicine, Division of Infectious Diseases, Johns Hopkins University, Baltimore, United States of America
                TNO, NETHERLANDS
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                • Conceptualization: SE CLT KEN HYH YZY.

                • Data curation: ZYH HYH YZ XYB.

                • Formal analysis: ZYH XYB.

                • Funding acquisition: SE CLT KEN.

                • Investigation: ZYH YZ XYB.

                • Methodology: SE CLT KEN HYH YZY.

                • Project administration: HYH YZY ZYH.

                • Resources: HYH YZY.

                • Supervision: HYH YZY.

                • Visualization: ZYH HYH CLT.

                • Writing – original draft: ZYH.

                • Writing – review & editing: ZYH HYH CLT.

                Author information
                http://orcid.org/0000-0001-6681-6465
                Article
                PONE-D-16-42654
                10.1371/journal.pone.0178671
                5456270
                28575040
                3f2abb49-1b1b-4570-8ea7-f86610d8f26f
                © 2017 Han et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 15 November 2016
                : 17 May 2017
                Page count
                Figures: 0, Tables: 5, Pages: 9
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100007880, Johns Hopkins University;
                Award ID: pilot grant
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100007880, Johns Hopkins University;
                Award ID: pilot grant
                Award Recipient : Chole L Thio
                CLT, KEN and SE were funded by the Johns Hopkins University Pilot grant. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and health sciences
                Infectious diseases
                Viral diseases
                Hepatitis
                Hepatitis B
                Medicine and health sciences
                Gastroenterology and hepatology
                Liver diseases
                Infectious hepatitis
                Hepatitis B
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Medicine and health sciences
                Pathology and laboratory medicine
                Pathogens
                Microbial pathogens
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                Biology and life sciences
                Organisms
                Viruses
                Viral pathogens
                Hepatitis viruses
                Hepatitis B virus
                People and Places
                Geographical Locations
                Asia
                China
                People and Places
                Population Groupings
                Age Groups
                Children
                Infants
                People and Places
                Population Groupings
                Families
                Children
                Infants
                Medicine and Health Sciences
                Infectious Diseases
                Infectious Disease Control
                Vaccines
                Medicine and Health Sciences
                Women's Health
                Maternal Health
                Pregnancy
                Medicine and Health Sciences
                Women's Health
                Obstetrics and Gynecology
                Pregnancy
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Liver Diseases
                Chronic Liver Disease
                Chronic Hepatitis
                Medicine and Health Sciences
                Gastroenterology and Hepatology
                Liver Diseases
                Liver Disease and Pregnancy
                Custom metadata
                All relevant data are within the paper and its Supporting Information files.

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