International Journal of Public Health

, Volume 59, Issue 2, pp 381–394 | Cite as

Hepatitis and liver disease knowledge and preventive practices among health workers in Mexico: a cross-sectional study

  • Noreen IslamEmail author
  • Yvonne N. Flores
  • Paula Ramirez
  • Roshan Bastani
  • Jorge Salmerón



To assess the knowledge and preventive practices regarding hepatitis and liver disease among a sample of participants in the Mexican Health Worker Cohort Study.


The study population consisted of 892 participants from Cuernavaca, Mexico. Demographic characteristics, knowledge about hepatitis B, hepatitis C, and liver disease in general, as well as information about prevention practices were obtained from self-reported questionnaires. Participants were grouped into categories that were created using information about their professional background and patient contact status. Knowledge and prevention practices were compared within these categories.


Inadequate levels of knowledge and preventive practices were found, even within the more highly educated group. Nearly 57 % of the participants had inadequate knowledge about liver disease in general, while 76 and 79 % had inadequate knowledge about Hepatitis B virus (HBV) and Hepatitis C virus (HCV), respectively. For general liver disease, the mean knowledge score increased significantly with education, history of HCV screening, and low alcohol consumption.


Health workers should be better educated about hepatitis and liver disease so they can reduce their own risk and share their knowledge of how to prevent liver disease with patients.


Liver disease Hepatitis Knowledge Health workers Mexico 



Body mass index


Hepatitis B virus


Hepatitis C virus


Instituto Mexicano del Seguro Social


Mexican Health Worker Cohort Study



This research was supported by a grant from CONACYT awarded to Dr. Flores (grant number SALUD-2005-01-14103) and funding from the Coordinación de Investigación en Salud of the Mexican Institute of Social Security (IMSS) awarded to Dr. Flores. Additional support was provided by the Unidad de Investigación Epidemiológica y en Servicios de Salud, Morelos (IMSS). Ms. Islam received a grant from the Monica Salinas Internship Fund for Latino and Latin American Health at UCLA to support her work on this study. The authors are very grateful to the MHWCS participants and their families, as well as the nurses and staff at IMSS. This manuscript is the result of Ms. Islam’s thesis work to obtain her Master’s degree in Epidemiology at the University of California, Los Angeles.

Conflict of interest

The authors declare that they have no competing interests to disclose.


  1. Alter MJ (2003) Epidemiology of hepatitis C. Hepatology 26(3):62S–65SGoogle Scholar
  2. Ansa VO, Udoma EJ, Umoh MS, Anah MU (2002) Occupational risk of infection by human immunodeficiency and hepatitis B viruses among health workers in south-eastern Nigeria. East Afr Med J 79(5):254–256PubMedCrossRefGoogle Scholar
  3. Bastani R, Glenn BA, Maxwell AE, Jo AM (2007) Hepatitis B testing for liver cancer control among Korean Americans. Ethn Dis 17(2):365–373PubMedGoogle Scholar
  4. Bastani R, Glenn BA, Taylor VM, Chen MS, Tung TN, Stewart SL, Maxwell AE (2010) Integrating theory into community interventions to reduce liver cancer disparities: the Health Behavior Framework. Prev Med 50(1–2):63–67PubMedCentralPubMedCrossRefGoogle Scholar
  5. Berkman A, Balakar N (2000) Hepatitis A to G: the facts you need to know about all the forms of this dangerous disease. Warner Books, New YorkGoogle Scholar
  6. Bosetti C, Levi F, Lucchini F, Zatonski WA, Negri E, La Vecchia C (2007) Worldwide mortality from cirrhosis: an update to 2002. J Hepatol 46(8):827–839PubMedCrossRefGoogle Scholar
  7. Buffington J, Damon S, Moyer L, Culver D (2000) Racial differences in knowledge regarding hepatitis C virus infection. JAMA 284(13):1651–1652PubMedCrossRefGoogle Scholar
  8. Centers for Disease Control and Prevention (2007) Surveillance for certain health behaviors among states and selected local areas, Behavior Risk Factor Surveillance System, US 2010. MMWR: Surveillance Summaries 59Google Scholar
  9. Chao J, Chang ET, So SKS (2010) Hepatitis B and liver cancer knowledge and practices among healthcare and public health professionals in China: a cross-sectional study. BMC Public Health 10:98PubMedCentralPubMedCrossRefGoogle Scholar
  10. Cheung J, Lee TK, The CZ, Wang CYM, Kwan WCP, Yoshida EM (2005) Cross-sectional study of hepatitis B awareness among Chinese and Southeast Asian Canadians in the Vancouver-Richmond community. Can J Gastroenterol 19(4):245–249PubMedGoogle Scholar
  11. Cox J, Graves L, Marks E, Temblay C, Stephenson R, Lambert-Lanning A, Steben M (2011) Knowledge, attitudes and behaviours associated with the provision of hepatitis C care by Canadian family physicians. J Viral Hep 16:e332–e340CrossRefGoogle Scholar
  12. Denova-Gutiérrez E, Jiménez-Aguilar A, Halley-Castillo E, Huitrón-Bravo G, Talavera JO, Pineda-Pérez D, Diaz-Montiel JC, Salmeron J (2008) Association between sweetened beverage consumption and body mass index, proportion of body fat and body fat distribution in Mexican adolescents. Ann Nutr Metab 53(3–4):245–251PubMedCrossRefGoogle Scholar
  13. El-Serag HB, Tran T, Everhart JE (2004) Diabetes increases the risk of chronic liver disease and hepatocellular carcinoma. Gastroenterology 126:460–468PubMedCrossRefGoogle Scholar
  14. Ezendinachi E, Ross MW, Meremiku M, Essien EJ, Edem CB, Ekure E, Ita O (2002) The impact of an intervention to change health workers’ HIV/AIDS attitudes and knowledge in Nigeria: a controlled trial. Public Health 116:106–112Google Scholar
  15. Festi D, Coleccia A, Sacco T, Bondi M, Roda E, Marchesisni G (2004) Hepatic steatosis in obese patients: clinical aspects and progressive significance. Obes Rev 5(1):27–42PubMedCrossRefGoogle Scholar
  16. Flores YN, Lang CM, Salmeron J, Bastani R (2012) Risk factors for liver disease and associated knowledge and practices among Mexican adults in the US and Mexico. J Community Health 37(2):403–411PubMedCrossRefGoogle Scholar
  17. Frazer K, Glacken M, Coughlan B, Staines A, Daly L (2011) Hepatitis C virus infection in primary care: survey of registered nurses’ knowledge and access to information. J Adv Nursing 67(2):327–339CrossRefGoogle Scholar
  18. Grundy SM, Brewer HB, Cleeman JI, Smith SC, Lenfant C (2004) American Heart Association; National Haert, Lung, and Blood Institute. Definition of metabolic syndrome: report of the National Heart, Lunch, and Blood Institute/American Hearth Association conference on scientific issues related to definition. Circulation 109(3):433–438PubMedCrossRefGoogle Scholar
  19. Haber PS, Warner R, Seth D, Gorrell MD, McCaughan G (2003) Pathogenesis and management of alcoholic hepatitis. J Gastroenterol Hepatol 18(12):1332–1344PubMedCrossRefGoogle Scholar
  20. Hoz FDL, Perez L, Wheeler JG, de Neira M, Hall AJ (2005) Vaccine coverage with hepatitis B and other vaccines in the Colombian Amazon: do health worker knowledge and perception influence coverage? Trop Med Intl Health 10(4):322–329CrossRefGoogle Scholar
  21. Instituto Mexicano del Seguro Social (2008) El IMSS Hoy. Instituto Mexicano del Seguro Social. Accessed 1 July 2011
  22. Kermode M, Jolley D, Langkham B, Thomas MS, Crofts N (2005) Occupational exposure to blood and risk of bloodborne virus infection among health care workers in rural north Indian health care settings. Am J Infect Control 33(1):34–41PubMedCrossRefGoogle Scholar
  23. Knaul FM, Arreola-Ornelas H, Mendez-Carniado O, Bryson-Cahn C, Barofsky J, Maguire R, Miranda M, Sesma S (2006) Evidence is good for your health system: policy reform to remedy catastrophic and impoverishing health spending in Mexico. Lancet 368(9549):1828–1841PubMedCrossRefGoogle Scholar
  24. La Vecchia C, Levi F, Lucchini F, Franceschi S, Negri E (1993) Worldwide patterns and trends in mortality from liver cirrhosis, 1955 to 1990. Ann Epidemiol 4(6):480–486CrossRefGoogle Scholar
  25. Lauer GM, Walter BD (2001) Hepatitis C virus infection. N Engl J Med 345(1):41–52PubMedCrossRefGoogle Scholar
  26. Méndez-Hernández P, Flores Y, Siani C, Lamure M, Dosamantes-Carrasco LD, Halley-Castillo E, Huitrón G, Talavera JO, Gallegos-Carrillo K, Salmerón J (2009) Physical activity and risk of metabolic syndrome in an urban Mexican cohort. BMC Public Health 31(9):276CrossRefGoogle Scholar
  27. Méndez-Sánchez N, Baptista-Gonzalez H, Sanchez-Gomez RH, Bordes-Aznar J, Uribe-Esquivel M (1999) Prevalence of type C and B hepatitis in blood donors at a third level hospital of Mexico City. Salud Publica Mex 41(6):475–478PubMedCrossRefGoogle Scholar
  28. Méndez-Sánchez N, Villa AR, Chávez-Tapia NC, Ponciano-Rodriguez G, Almeda-Valdés P, González D, Uribe M (2005) Trends in liver disease prevalence in Mexico from 2005 to 2050 through mortality data. Ann Hepatol 4(1):52–55PubMedGoogle Scholar
  29. Méndez-Sánchez N, Villa AR, Zamora-Valdés D, Morales-Espinosa D, Uribe M (2007) Worldwide mortality from cirrhosis. Ann Hepatol 6(3):194–195PubMedGoogle Scholar
  30. Mowe M, Bosaeus I, Rasmussen HH, Kondrup J, Unosson M, Rothenberg E, Irtun O (2008) Insufficient nutritional knowledge among health workers? Clin Nutr 27(2):196–202PubMedCrossRefGoogle Scholar
  31. National Heart, Lung, and Blood Institute (2011) Calculate your body mass index. US Department of Health and Human Services. Accessed 1 July 2011
  32. National Institute of Public Health (2012) Research Centers. National Institute of Public Health. Accessed 20 February 2013
  33. Reda AA, Fisseha S, Bezatu M, Vandeweerd JM (2010) Standard precautions: occupational exposure and behavior of health care workers in Ethiopia. PLoS One 5(12):1–6CrossRefGoogle Scholar
  34. Rivera-López MRF, Zavala-Méndez C, Arenas-Esqueda A (2004) Prevalence of seropositivity for HIV, Hepatitis B, and Hepatitis C in blood donors. Gac Méd Méx 140(6):657–660PubMedGoogle Scholar
  35. Shehab TM, Sonnad S, Gebremariam A, Schoenfeld P (2002) Knowledge of hepatitis C screening and management by internal medicine residents: trends over 2 years. Am J Gastroenterology 97(5):1216–1222CrossRefGoogle Scholar
  36. Shepard CW, Finelli L, Alter MJ (2005) Global epidemiology of hepatitis C virus infection. Lancet Infect Dis 5(9):558–567PubMedCrossRefGoogle Scholar
  37. Sistema Nacional de Información en Salud (2011) Principales causas de mortalidad general. Secretaria de Salud. Accessed March 4, 2013
  38. Soto-Salgado M, Suarez E, Ortiz AP, Adrovet S, Marrero E, Melendez M, Colon HM, Albizu C, del C. Santos M, Torres E, Perez CM (2010) Knowledge of viral hepatitis among Puerto Rican adults: Implications for prevention. J Comm Health 36(4): 565–573Google Scholar
  39. StataCorp. Stata Statistical Software (2007) Release 10. Statacorp LP, College Station (TX)Google Scholar
  40. Talaat M, Kandeel A, El-Shoubary W, Bodenschatz C, Khairy I, Ou S, Majoney FJ (2003) Occupational exposure to needlestick injuries and hepatitis B vaccination coverage among health care workers in Egypt. Am J Inf Control 31(8):469–474CrossRefGoogle Scholar
  41. Taylor VM, Jackson C, Chan N, Kuniyuki A, Yasui Y (2002) Hepatitis B: knowledge and practices among Cambodian American women in Seattle, Washington. J Comm Health 27(3):151–163CrossRefGoogle Scholar
  42. Taylor VM, Choe JH, Yasui Y, Li L, Burke N, Jackson C (2005) Hepatitis B awareness, testing and knowledge among Vietnamese American men and women. J Comm Health 30(6):477–490CrossRefGoogle Scholar
  43. Valdespino JL, Conde-González CJ, Olaiz-Fernández G, Palma O, Sepúlveda J (2007) Prevalencia en México de la infección y el estado de portador de la hepatitis B en adultos. Salud Pública Méx 49(3):404–411CrossRefGoogle Scholar
  44. Van de Mortel TF (2002) Health care workers’ knowledge of hepatitis C and attitudes towards patients with hepatitis C: a pilot study. Aust J Adv Nurse 20(1):13–19Google Scholar
  45. World Health Organization (2010) Cancer Fact sheet N°297. Word Health Organization. Accessed 7 June 2011
  46. Zafar A, Aslam N, Nasir N, Meraj R, Mehraj V (2008) Knowledge, attitudes, and practices of health care workers regarding needle stick injuries at a tertiary care hospital in Pakistan. J Pak Med Assoc 58(2):57–60PubMedGoogle Scholar
  47. Zani C, Pasquale L, Bressanelli M, Puoti M, Paris B, Coccaglio R, Lascioli I, Pieriacci G, Donato F (2011) The epidemiological pattern of chronic liver diseases in a community undergoing voluntary screening for hepatitis B and C. Dig Liver Dis 43:653–658PubMedCrossRefGoogle Scholar

Copyright information

© Swiss School of Public Health 2013

Authors and Affiliations

  • Noreen Islam
    • 1
    Email author
  • Yvonne N. Flores
    • 2
    • 3
  • Paula Ramirez
    • 2
  • Roshan Bastani
    • 3
  • Jorge Salmerón
    • 2
    • 4
  1. 1.Department of EpidemiologyUniversity of California, Los Angeles (UCLA), Fielding School of Public HealthLos AngelesUSA
  2. 2.Unidad de Investigación Epidemiológica y en Servicios de Salud, Instituto Mexicano del Seguro SocialCuernavacaMexico
  3. 3.UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control ResearchFielding School of Public Health and Jonsson Comprehensive Cancer CenterLos AngelesUSA
  4. 4.Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud PúblicaCuernavacaMexico

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