KNOWLEDGE LEVEL OF THE MANAGEMENT OF HEPATITIS B DURING PREGNANCY AMONG SPECIALIST AND RESIDENTS OF THE OBSTETRICS AND GYNECOLOGY: A SURVEY STUDY FROM TURKEY

Salih Atakan Nemli; Meryem Özge Çakır Nemli

doi:10.35232/estudamhsd.1353004

Research Article

KNOWLEDGE LEVEL OF THE MANAGEMENT OF HEPATITIS B DURING PREGNANCY AMONG SPECIALIST AND RESIDENTS OF THE OBSTETRICS AND GYNECOLOGY: A SURVEY STUDY FROM TURKEY

Year 2023, Volume: 8 Issue: 3, 275 - 286, 29.10.2023

Salih Atakan Nemli Meryem Özge Çakır Nemli

https://doi.org/10.35232/estudamhsd.1353004

Abstract

In this study, it is aimed to assess the levels of knowledge of specialists and residents of gynecology and obstetrics in Turkey, concerning management of Hepatitis B virus (HBV)-positive pregnant women. A cross-sectional online survey study was conducted on Gynecology and Obstetrics specialists and residents between November 2019 and February 2020. Questionnaire form concerning management of HBV-positive pregnant women, which was prepared by researchers on the basis of literature, has been sent to Gynecology and Obstetrics Clinics and departments of Turkey via online means. The questionnaire form consisted of sections including socio-demographic characteristics (age group, gender, time spent as a specialist doctor/resident (years), place of work) and assessing the level of knowledge concerning the management of HBV(+) pregnant women. The questions in this section were created by the researchers based on the literature. These questions are not questions of a scale whose validity and reliability studies have been conducted. Knowledge Level Score on the management of HBV-positive pregnant women (KLS) has been calculated in a range of 0 to 18 points. Statistics Package for the Social Sciences (SPSS) version 25.0 was used for statistical analysis. A total of 215 physicians, including 50 residents (23.3%) and 165 (76.7%) specialists, have participated in the study. Since normal distribution was not observed as a result of normality evaluation, mean values are presented as median (25%-75%). Median KLS was found as 8.0 (7.0-10.0). In residents, KLS was 8.0 (6.75-9.0), and in specialists, it was 8.0 (7.0-10.0). There was no statistically significant difference between the scores of residents and specialists. The median level of knowledge of the physicians participating in the study about Hepatitis B treatment in pregnant women was 8.0 (7.0-10.0). This score was interpreted as “inadequate” out of a maximum of 18 points, by researchers. Despite limitations, this study has shown the inadequacy of level of knowledge of gynecologists and obstetricians in Turkey concerning management of Hepatitis B in pregnant women. There is a need for further studies and continuous training of Gynecologists and Obstetricians.

Keywords

Hepatitis B virus, pregnancy, gynecologists and obstetricians, survey, knowledge

References

1. Van Ommen C, Marquez V, Lowe C, Money D, Yoshida EM, van Schalkwyk J. Assessing Maternity Care Providers' Knowledge of the Management of Hepatitis B in Pregnancy. J Obstet Gynaecol Can. 2019;41(5):616 22. doi:10.1016/j.jogc.2018.06.011.
2. Frambo AA, Atashili J, Fon PN, Ndumbe PM. Prevalence of HBsAg and knowledge about hepatitis B in pregnancy in the Buea Health District, Cameroon: a cross-sectional study. BMC Res Notes. 2014;7:394. doi: 10.1186/1756-0500-7-394.
3. Cetin S, Cetin M, Turhan E, Dolapcioglu K. Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women. J Infect Dev Ctries. 2018;12(10):904-9. doi:10.3855/jidc.10018.
4. Calisir M Awareness of Hepatitis B Infection Amongst the People of Southeastern Anatolia: A Seroprevalence Study. Cumhur Dent J. 2018;21(2):145-51. doi:10.7126/cumudj.364088.
5. Peksen Y, Canbaz S, Leblebicioglu H, Sunbul M, Esen S, Sunter AT. Primary care physicians' approach to diagnosis and treatment of hepatitis B and hepatitis C patients. BMC Gastroenterol. 2004;4:3. doi:10.1186/1471-230X-4-3.
6. Çınar Tanrıverdi E, Özkurt Z, Göktuğ Kadıoğlu B, Alay H, Çalıkoğlu O, Koca Ö, et al. Seroprevalence of hepatitis B, hepatitis C, and HIV in pregnant women from Eastern Turkey. Turk J Gastroenterol. 2019;30(3):260-5. doi:10.5152/tjg.2018.17634.
7. Piratvisuth T. Optimal management of HBV infection during pregnancy. Liver Int. 2013;33(Suppl1):188-94. doi:10.1111/liv.12060.
8. Dunkelberg JC, Berkley EM, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol. 2014;34(12):882-91. doi:10.1038/jp.2014.167.
9. T.C. Sağlık Bakanlığı Sağlık Bilgi Sistemleri Genel Müdürlüğü. Türkiye’de Sağlık Eğitimi ve Sağlık İnsan gücü Durum Raporu [Internet]. Ankara: T.C. Sağlık Bakanlığı; 2014 [updated 2015 May 21; cited 2021 Mar 3]. Available from: https://www.saglik.gov.tr/TR,11659/saglik-bakanligi-turkiyede-saglik-egitimi-ve-saglik-insangucu-durum-raporu-2014.html
10. Tusdata. 2019 İlkbahar Dönemi Branş Branş Kontenjan Listesi [Internet]. Istanbul: Tusdata; 2019 [cited 2021 Mar 3]. Available from: https://www.tusdata.com/51794/2019-ilkbahar-donemi-brans-brans-kontenjan-listesi
11. Uyar Y, Cabar C, Balci A. Seroprevalence of Hepatitis B Virus among Pregnant Women in Northern Turkey. Hepat Mon. [Internet]. 2009 [cited 2021 Mar 9];9(2):146–9. Available from: https://brieflands.com/articles/hepatmon-70546.html
12. Gonçalves IC, Gonçalves MJ. Knowledge, attitudes and practices of nurses and doctors about the vertical transmission of hepatitis B. Rev Lat Am Enfermagem. 2013;21(5):1030-8. doi:10.1590/S0104-11692013000500004.
13. Patton H, Tran TT. Management of hepatitis B during pregnancy. Nat Rev Gastroenterol Hepatol. 2014;11(7): 402-9. doi: 10.1038/nrgastro.2014.30.
14. WHO guidelines on hepatitis B and C testing [Internet]. World Health Organization; 2017 [cited 2021 Mar 12]. Available from: https://apps.who.int/iris/handle/10665/254621
15. Sinha S, Kumar M. Pregnancy and chronic hepatitis B virus infection. Hepatol Res. 2010;40(1):31-48. doi:10.1111/j.1872-034X.2009.00597.x.
16. Chen YC, Chu CM, Liaw YF. Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B. Hepatology. 2010;51(2):435-44. doi:10.1002/hep.23348.
17. Kwon SY, Lee CH. Epidemiology and prevention of hepatitis B virus infection. Korean J Hepatol. 2011;17(2):87-95. doi:10.3350/kjhep.2011.17.2.87.
18. Ranger-Rogez S, Denis F. Hepatitis B mother-to-child transmission. Expert Rev Anti Infect Ther. 2004;2(1):133-45. doi:10.1586/14787210.2.1.133.
19. Pan CQ, Zou HB, Chen Y, Zhang X, Zhang H, Li J, et al. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis B surface antigen-positive women to their infants. Clin Gastroenterol Hepatol. 2013;11(10):1349-55. doi:10.1016/j.cgh.2013.04.026.
20. Chen X, Chen J, Wen J, Xu C, Zhang S, Zhou YH, et al. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus. PLoS One. 2013;8(1):e55303. doi:10.1371/journal.pone.0055303.
21. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10(5):452-9. doi:10.1016/j.cgh.2011.10.041.
22. Pan CQ, Duan Z, Dai E, Zhang S, Han G, Wang Y, et al; China Study Group for the Mother-to-Child Transmission of Hepatitis B. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med. 2016;374(24):2324-34. doi:10.1056/NEJMoa1508660.
23. Brown RS Jr, McMahon BJ, Lok AS, Wong JB, Ahmed AT, Mouchli MA, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology. 2016;63(1):319-33. doi:10.1002/hep.28302.

KADIN HASTALIKLARI VE DOĞUM UZMANI VE ASİSTANLARININ GEBELİKTE HEPATİT B YÖNETİMİNE İLİŞKİN BİLGİ DÜZEYİ: TÜRKİYE'DEN BİR ANKET ÇALIŞMASI

Year 2023, Volume: 8 Issue: 3, 275 - 286, 29.10.2023

Salih Atakan Nemli Meryem Özge Çakır Nemli

https://doi.org/10.35232/estudamhsd.1353004

Abstract

Bu çalışmada Türkiye'deki kadın hastalıkları ve doğum uzmanlarının ve asistanlarının Hepatit B virus (HBV) pozitif gebelerin yönetimine ilişkin bilgi düzeylerinin değerlendirilmesi amaçlandı. Kasım 2019 – Şubat 2020 tarihleri arasında Kadın Hastalıkları ve Doğum uzmanları ve asistanları üzerinde kesitsel çevrim içi anket çalışması yapılmıştır. Araştırmacılar tarafından literatüre dayalı olarak hazırlanan HBV pozitif gebelerin yönetimine ilişkin anket formu Türkiye'deki Kadın Hastalıkları ve Doğum Klinikleri ve bölümlerine çevrim içi olarak gönderilmiştir. Anket formu sosyo-demografik özelliklerin (cinsiyet, yaş grubu, uzman/asitan doctor olarak geçirilen zaman (yıl), çalışılan yer) yer aldığı ve HBV(+) gebelerin yönetimine ilişkin bilgi düzeyinin değerlendirildiği bölümlerden oluşmuştur. Bu bölümdeki sorular araştırmacılar tarafından, literatüre dayalı olarak oluşturuldu. Bu sorular geçerlik-güvenilirlik çalışması yapılmış bir ölçeğin soruları değildir. HBV pozitif gebelerin yönetimine ilişkin Bilgi Düzeyi Puanı (BDP) 0 ila 18 puan aralığında hesaplanmıştır. İstatistiksel analiz için SPSS v25.0 paket programı kullanılmıştır. Araştırmaya 50'si asistan (%23,3) ve 165'i (%76,7) uzman olmak üzere toplam 215 hekim katılmıştır. Normalite değerlendirmesi sonucu normal dağılım görülmediğinden ortalama değerler median (%25-%75) olarak sunuldu. Median BDP 8,0 (7,0-10,0) olarak bulundu. Asistanlarda median BDP 8,0 (6,75-9,0), uzmanlarda ise 8,0 (7,0-10,0) idi. Asistan ve uzman öğrencilerin puanları arasında istatistiksel olarak anlamlı bir fark bulunmadı (p:0,237). Çalışmaya katılan hekimlerin gebelerde Hepatit B tedavisine ilişkin ortanca bilgi düzeyi 8,0 (7,0-10,0) olarak bulundu. Bu puan maksimum 18 puan üzerinden “yetersiz” olarak değerlendirildi. Kısıtlılıklara rağmen bu çalışma Türkiye'deki kadın doğum ve doğum uzmanlarının gebelerde Hepatit B tedavisine ilişkin bilgi düzeylerinin yetersiz olduğunu ortaya koymuştur. Bu konuda daha ileri çalışmalara gerek duyulmaktadır. Kadın Hastalıkları ve Doğum hekimleri için gebelerde HBV enfeksiyonunun yönetimi konusunda sürekli eğitimlerin faydalı olabileceği düşünülmektedir.

Keywords

Hepatit B virüsü, gebelik, kadın hastalıkları ve doğum, anket, bilgi

References

1. Van Ommen C, Marquez V, Lowe C, Money D, Yoshida EM, van Schalkwyk J. Assessing Maternity Care Providers' Knowledge of the Management of Hepatitis B in Pregnancy. J Obstet Gynaecol Can. 2019;41(5):616 22. doi:10.1016/j.jogc.2018.06.011.
2. Frambo AA, Atashili J, Fon PN, Ndumbe PM. Prevalence of HBsAg and knowledge about hepatitis B in pregnancy in the Buea Health District, Cameroon: a cross-sectional study. BMC Res Notes. 2014;7:394. doi: 10.1186/1756-0500-7-394.
3. Cetin S, Cetin M, Turhan E, Dolapcioglu K. Seroprevalence of hepatitis B surface antigen and associated risk factors among pregnant women. J Infect Dev Ctries. 2018;12(10):904-9. doi:10.3855/jidc.10018.
4. Calisir M Awareness of Hepatitis B Infection Amongst the People of Southeastern Anatolia: A Seroprevalence Study. Cumhur Dent J. 2018;21(2):145-51. doi:10.7126/cumudj.364088.
5. Peksen Y, Canbaz S, Leblebicioglu H, Sunbul M, Esen S, Sunter AT. Primary care physicians' approach to diagnosis and treatment of hepatitis B and hepatitis C patients. BMC Gastroenterol. 2004;4:3. doi:10.1186/1471-230X-4-3.
6. Çınar Tanrıverdi E, Özkurt Z, Göktuğ Kadıoğlu B, Alay H, Çalıkoğlu O, Koca Ö, et al. Seroprevalence of hepatitis B, hepatitis C, and HIV in pregnant women from Eastern Turkey. Turk J Gastroenterol. 2019;30(3):260-5. doi:10.5152/tjg.2018.17634.
7. Piratvisuth T. Optimal management of HBV infection during pregnancy. Liver Int. 2013;33(Suppl1):188-94. doi:10.1111/liv.12060.
8. Dunkelberg JC, Berkley EM, Thiel KW, Leslie KK. Hepatitis B and C in pregnancy: a review and recommendations for care. J Perinatol. 2014;34(12):882-91. doi:10.1038/jp.2014.167.
9. T.C. Sağlık Bakanlığı Sağlık Bilgi Sistemleri Genel Müdürlüğü. Türkiye’de Sağlık Eğitimi ve Sağlık İnsan gücü Durum Raporu [Internet]. Ankara: T.C. Sağlık Bakanlığı; 2014 [updated 2015 May 21; cited 2021 Mar 3]. Available from: https://www.saglik.gov.tr/TR,11659/saglik-bakanligi-turkiyede-saglik-egitimi-ve-saglik-insangucu-durum-raporu-2014.html
10. Tusdata. 2019 İlkbahar Dönemi Branş Branş Kontenjan Listesi [Internet]. Istanbul: Tusdata; 2019 [cited 2021 Mar 3]. Available from: https://www.tusdata.com/51794/2019-ilkbahar-donemi-brans-brans-kontenjan-listesi
11. Uyar Y, Cabar C, Balci A. Seroprevalence of Hepatitis B Virus among Pregnant Women in Northern Turkey. Hepat Mon. [Internet]. 2009 [cited 2021 Mar 9];9(2):146–9. Available from: https://brieflands.com/articles/hepatmon-70546.html
12. Gonçalves IC, Gonçalves MJ. Knowledge, attitudes and practices of nurses and doctors about the vertical transmission of hepatitis B. Rev Lat Am Enfermagem. 2013;21(5):1030-8. doi:10.1590/S0104-11692013000500004.
13. Patton H, Tran TT. Management of hepatitis B during pregnancy. Nat Rev Gastroenterol Hepatol. 2014;11(7): 402-9. doi: 10.1038/nrgastro.2014.30.
14. WHO guidelines on hepatitis B and C testing [Internet]. World Health Organization; 2017 [cited 2021 Mar 12]. Available from: https://apps.who.int/iris/handle/10665/254621
15. Sinha S, Kumar M. Pregnancy and chronic hepatitis B virus infection. Hepatol Res. 2010;40(1):31-48. doi:10.1111/j.1872-034X.2009.00597.x.
16. Chen YC, Chu CM, Liaw YF. Age-specific prognosis following spontaneous hepatitis B e antigen seroconversion in chronic hepatitis B. Hepatology. 2010;51(2):435-44. doi:10.1002/hep.23348.
17. Kwon SY, Lee CH. Epidemiology and prevention of hepatitis B virus infection. Korean J Hepatol. 2011;17(2):87-95. doi:10.3350/kjhep.2011.17.2.87.
18. Ranger-Rogez S, Denis F. Hepatitis B mother-to-child transmission. Expert Rev Anti Infect Ther. 2004;2(1):133-45. doi:10.1586/14787210.2.1.133.
19. Pan CQ, Zou HB, Chen Y, Zhang X, Zhang H, Li J, et al. Cesarean section reduces perinatal transmission of hepatitis B virus infection from hepatitis B surface antigen-positive women to their infants. Clin Gastroenterol Hepatol. 2013;11(10):1349-55. doi:10.1016/j.cgh.2013.04.026.
20. Chen X, Chen J, Wen J, Xu C, Zhang S, Zhou YH, et al. Breastfeeding is not a risk factor for mother-to-child transmission of hepatitis B virus. PLoS One. 2013;8(1):e55303. doi:10.1371/journal.pone.0055303.
21. Pan CQ, Duan ZP, Bhamidimarri KR, Zou HB, Liang XF, Li J, et al. An algorithm for risk assessment and intervention of mother to child transmission of hepatitis B virus. Clin Gastroenterol Hepatol. 2012;10(5):452-9. doi:10.1016/j.cgh.2011.10.041.
22. Pan CQ, Duan Z, Dai E, Zhang S, Han G, Wang Y, et al; China Study Group for the Mother-to-Child Transmission of Hepatitis B. Tenofovir to Prevent Hepatitis B Transmission in Mothers with High Viral Load. N Engl J Med. 2016;374(24):2324-34. doi:10.1056/NEJMoa1508660.
23. Brown RS Jr, McMahon BJ, Lok AS, Wong JB, Ahmed AT, Mouchli MA, et al. Antiviral therapy in chronic hepatitis B viral infection during pregnancy: A systematic review and meta-analysis. Hepatology. 2016;63(1):319-33. doi:10.1002/hep.28302.

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Details

Primary Language	English
Subjects	Preventative Health Care
Journal Section	Research Article
Authors	Salih Atakan Nemli 0000-0002-2720-9870 Meryem Özge Çakır Nemli 0000-0002-2163-6150
Early Pub Date	October 29, 2023
Publication Date	October 29, 2023
Submission Date	August 31, 2023
Published in Issue	Year 2023 Volume: 8 Issue: 3

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Vancouver	Nemli SA, Çakır Nemli MÖ. KNOWLEDGE LEVEL OF THE MANAGEMENT OF HEPATITIS B DURING PREGNANCY AMONG SPECIALIST AND RESIDENTS OF THE OBSTETRICS AND GYNECOLOGY: A SURVEY STUDY FROM TURKEY. ESTUDAM Public Health Journal. 2023;8(3):275-86.

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