Awareness of the Management of Maternal Chronic Hepatitis B Infection among Family Physicians

Öz

Introduction and Aim: Hepatitis B virus (HBV) infection is an important disease in terms of public health and one exhibiting a global decreasing trend. The severity of the disease and whether or not treatment is required must be closely monitored in pregnant women identified as HBsAg-positive. The purpose of this study was to determine the awareness of maternal chronic hepatitis B management among family physicians in primary institutions providing close pregnancy and baby monitoring. Method: Family physicians working in primary health services were included in the study. Questions were produced concerning the management of maternal chronic hepatitis B infection to which participants could respond in an electronic environment. Results: Two hundred nineteen physicians were included, 125 (57.1%) women and 94 (42.9%) men. Forty-three (19.6%) participants were specialist family physicians, 97 (44.3%) were assistant family physicians, and 79 (36.1%) were working as general practitioners. Participants’ mean age was 31±7.36 years, and their mean length of work experience was 5±7.6 years. We asked the physicians whether they possessed sufficient knowledge concerning hepatitis B infection. One hundred thirty-seven (62.6%) physicians described themselves as possessing adequate knowledge. One hundred twenty-six physicians stated that the hepatitis B virus passes from the mother to the baby in the intrauterine period, 195 (47.2%) that transmission occurs during birth, and 92 (22.3%) in the postnatal period. One hundred eighty-seven (85.4%) stated there was no need to avoid breastfeeding. One hundred eighty-four (84%) physicians stated that mothers were screened for hepatitis B infection during pregnancy, and 143 (65.3%) stated that HBsAg- and AntiHBs-negative pregnant women can receive hepatitis B vaccination during pregnancy. One hundred fifty-six (36.4%) participants reported that they would refer an HBsAg-positive pregnant woman to an infectious diseases or gastroenterology specialist, while 178 (40.6%) and 197 (45%), respectively, stated that the baby of a mother with hepatitis B should receive hepatitis B vaccination and hepatitis B immunoglobulin. One hundred sixty-physicians (38.5%) stated that ‘I would refer a baby identified as HBsAg-positive to a pediatric infection clinic’ during the monitoring of a baby born to a mother with hepatitis B, while 76 (18%) responded ‘I would investigate AntiHBs following hepatitis B vaccination,’ and 112 stated “I would administer a further course of vaccination to babies with AntiHBs<10IU/ml’. Conclusion: There are information deficiencies regarding the management of maternal hepatitis B infection management among family physicians working in primary health institutions providing regular pregnancy and baby monitoring. Family physicians should be given training concerning the monitoring of pregnant women and babies, algorithms to assist the monitoring process must be established, and these must be incorporated into Health Ministry policies.

Anahtar Kelimeler

• Family physicians,
• hepatitis B infection,
• pregnancy

Aile Hekimlerinin Maternal Kronik Hepatit B Enfeksiyonu Yönetimi Hakkındaki Farkındalık Durumu

Öz

Giriş ve Amaç: Hepatit B virüs (HBV) enfeksiyonu tüm dünyada giderek azalma eğiliminde olan halk sağlığı açısından önemli bir hastalıktır. HBsAg pozitif saptanan gebede hastalığın şiddeti ve tedavi gerekip gerekmediği yakın takip edilmelidir. Bu çalışmada gebelik ve bebek takiplerinin yakından izleminin yapıldığı birinci basamak aile hekimlerinde maternal kronik hepatit B yönetimi hakkındaki farkındalıklarını belirlemeyi amaçladık. Yöntem: Çalışmaya birinci basamak sağlık hizmetlerinde görev yapmakta olan aile hekimleri dahil edildi. Katılımcılara maternal kronik hepatit B enfeksiyonu yönetimi ile ilgili ve elektronik ortamda doldurabilecekleri anket soruları oluşturuldu. Bulgular: Çalışmamıza 125 (%57.1)’i kadın ve 94 (%42.9)’ü erkek olmak üzere toplam 219 hekim katıldı. Hekimlerin 43 (%19.6)’ü aile hekimi uzmanı, 97 (%44.3)’si aile hekimliği asistanı ve 79 (%36.1)’i pratisyen hekim olarak çalışmaktaydı. Katılımcıların yaş ortalaması 31±7.36 yıl, çalışma yılı ortalaması 5±7.6 yıl idi. Hekimlere hepatit B enfeksiyonu hakkında yeterli bilgiye sahip olup olmadıklarını sorduk. 137 (%62.6) hekim yeterli bilgiye sahip olduğunu belirtti. Hekimlerin 126 (%30.5)’sı hepatit B virüsünün anneden bebeğe intrauterin dönemde geçtiğini, 195 (%47.2)’i doğum esnasında ve 92 (%22.3)’si postnatal dönemde geçtiğini ifade etti. Katılımcıların 187 (%85.4)’sinin emzirmede sakınca olmadığını belirtti. 184 (%84) hekim gebelik döneminde annelere hepatit B enfeksiyonu taraması yapıldığını, 143 (%65.3) hekim HBsAg ve AntiHBs negatif olan gebeye gebelik döneminde hepatit B aşısı yapılabileceğini belirtti. Katılımcıların 156 (%36.4)’sı HBsAg pozitif tespit edilen gebeyi enfeksiyon hastalıkları veya gastroenteroloji uzmanına yönlendirdiğini, hepatit B’li anne bebeğine hepatit B aşısı ve hepatit B immünglobulin yapılmalıdır diyen hekimlerin sayısı sırasıyla 178 (%40.6) ve 197 (%45) idi. Hepatit B’li anneden doğan bebeğin takibinde 163 (%38.5) hekim “HBsAg pozitif saptanan bebeği pediatrik enfeksiyon kliniğine yönlendiririm”, 76 (%18) hekim “hepatit B aşı uygulamasından sonra AntiHBs bakarım”, 72 (%17) hekim “hepatit B aşı uygulamasından sonra HBsAg bakarım” ve 112 kişi “AntiHBs<10IU/ml olan bebeklere bir kür aşı daha uygularım” şeklinde ifade etti. Sonuç: Gebelik ve bebek takiplerinin düzenli olarak yapıldığı birinci basamak sağlık kurumlarında görev yapan aile hekimlerinin maternal hepatit B virüs enfeksiyonu yönetimi konusunda bilgi eksiklikleri söz konusudur. Gebe ve bebeklerin takibi konusunda aile hekimlerine eğitimler verilmeli, takip süreçlerine yardımcı olacak algoritmalar oluşturulmalı ve Sağlık Bakanlığı politikaları içerisine dahil edilmelidir.

Anahtar Kelimeler

• aile hekimi
• hepati B enfeksiyonu
• gebelik

Kaynakça

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