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Counselling and Screening of Hepatitis B Virus Infection In Dukuh

Kupang Community, Dukuh Pakis District, Surabaya
To cite this article: C D K Wungu et al 2019 IOP Conf. Ser.: Earth Environ. Sci. 217 012048

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IOP Conf. Series: Earth and Environmental Science 217 (2019) 012048 doi:10.1088/1755-1315/217/1/012048

Counselling and Screening of Hepatitis B Virus Infection In

Dukuh Kupang Community, Dukuh Pakis District, Surabaya

C D K Wungu*, S Khaerunnisa, I Humairah, L Lukitasari, E Qurnianingsih, G I

Prabowo, Sudarno, R Handajani, Suhartati
Department of Medical Biochemistry, Medical Faculty of Universitas Airlangga,
Surabaya, Indonesia

* [email protected]

Abstract. Background. Indonesia is a country with high endemicity of Hepatitis B Virus (HBV)
infection. HBV infection is still a problem in society due to limited knowledge of the community
and lack of available access to its diagnosis and treatment. Patients with hepatitis B each year is
steadily increasing, especially in areas with high risk, including former prostitution area in
Surabaya such as in Dukuh Pakis District. Aims. This activity was aimed to give understanding of
HBV infection and perform early detection of HBV infection in Dukuh Kupang Community,
Dukuh Pakis District, Surabaya. Methods. A community service in the form of counselling to
increase knowledge and understanding of hepatitis B was done to community in Dukuh Kupang,
Dukuh Pakis Regency, Surabaya. Pretest and post test were conducted to determine the initial
understanding and post socialization knowledge for these people. Laboratory tests such as HBsAg
and ALT were performed for screening of HBV infection. Private counselling for participants who
positively detected infected with HBV was also done. Results. Based on the summary of pretest
and post test from the participants, an increase in participants' knowledge of hepatitis B was found.
The number of participants followed laboratory examination were 58 participants from 72
participants who attended counselling. From the laboratory results, as much as 3 positive
participants (5.17%) were newly found infected with HBV, proved with positive HBsAg. One
participant of them has increased ALT. Further counselling and assistance for participants with
positive HBsAg were performed. Conclusion. Counselling was effective to increase knowledge of
hepatitis B for Dukuh Kupang Community. Screening also found naive HBV infection in these
people. Similar program can be performed in communities in other areas to increase prevention
and early detection of HBV infection in Indonesia, especially Surabaya.

Keywords: Counselling, Screening, Hepatitis B Virus Infection, Surabaya

1. Introduction
Hepatitis is a public health problem in developing countries, including in Indonesia. The known hepatitis
virus types are A, B, C, D, E, and G, in which Hepatitis B Virus (HBV) is among the most highlighted.
The number of its occurrences is quite numerous until now. It also affects morbidity, mortality, and the
economy of community (1). According to WHO in A Strategy for Global Action (2012), HBV has
infected 2 billion people worldwide and more than 350 million of them are people with chronic HBV
infection. Every year, 780,000 people die from the virus infection. Hepatitis B virus infection is
dangerous because it can cause chronic complications such as liver cirrhosis and liver cancer (2).
Indonesia is a country with high endemic of hepatitis B, the second largest in the South East Asian
Region (SEAR) after Myanmar. Basic Health Research (Riskesdas) in 2013 reported that a study and test
of blood donors from the Indonesian Red Cross (PMI) donors was estimated among 100 Indonesians, 10
of them had been infected with HBV. Based on these data, it can predict of 28 million Indonesians
infected with HBV, about 14 million have the potential to become chronic, and from chronic infection 1.4
million people have the potential to suffer from liver cancer (3,4). The magnitude of the problem will

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IOP Conf. Series: Earth and Environmental Science 217 (2019) 012048 doi:10.1088/1755-1315/217/1/012048

certainly have a huge impact on public health problems, productivity, life expectancy, and other social
economic impacts.
HBV infection is still a problem in the community, due to limited public knowledge about this disease,
lack of access to examinations for the lower middle class, or lack of access to hepatitis B treatment (5,6).
Treatment of chronic hepatitis B is also a problem because the present anti-viral drugs have not been able
to completely eliminate the virus. The goal of treatment for chronic hepatitis B is to extend life
expectancy and prevent complications (7).
The Hepatitis B virus is transmitted through blood or body fluids, both vertically and horizontally.
Vertical transmission occurs in the womb from positive HBsAg mothers. Horizontal transmission occurs
through blood transfusions, the use of alternating needles, tattoos, razors, or unsafe sex (2). Hepatitis B is
an iceberg phenomenon, where patients who are registered or who come to health services are less than
the actual number of sufferers. This is because hepatitis B is a chronic disease which generally does not
cause symptoms for years until complications arise or the patient is in terminal condition. Although the
patient looks like a healthy person in general, the transmission of the virus to other people can occur (8).
Considering the lack of knowledge of the public about the dangers of HBV infection and the low
awareness of the community to get hepatitis B detection before reaching the terminal condition, it is
necessary to conduct early awareness and detection of hepatitis B to increase knowledge and reduce the
incidence of hepatitis in Indonesia, especially in high-risk areas. Tropical medicine is one of the focus of
Medical Faculty of Universitas Airlangga. So, we should provide knowledge and facilities to the
community as a form of university's Tridarma in the form of community service.
The area of Dukuh Kupang, Dukuh Pakis Subdistrict, Surabaya is an area close to the largest ex-
commercial sex worker localization in Surabaya. This area consists of 8 RWs, a population of family.
Although the localization has been disbanded, covert commercial sex practices still occur and it becomes
difficult to monitor the health impacts. As described above, unsafe sex is one of the risk factors for
hepatitis B. Not only the men who are directly related to commercial sex workers, people around them,
especially families, are also at risk of hepatitis B transmission. The incidence of hepatitis B in the area is
not known yet, so the transmission risk is also unknown. Therefore, it is necessary to have awareness and
early detection of hepatitis B in PKK women and RT/RW heads as they have the potential to participate
in the prevention, early detection and treatment of hepatitis B.

2. Experimental Methods
This community service program used counselling methods adapted to the conditions of the community
in the target area. The target of this community-based science and technology program was the Dukuh
Kupang Community, Dukuh Pakis Subdistrict, Surabaya, especially the heads of RT and PKK Women in
Dukuh Kupang as many as 55 participants. Socialization and screening were performed on the first day,
while counselling and mentoring were performed on the second day. Socialization was filled by qualified
speakers in the field of hepatitis B infection and counselling and mentoring were carried out by the staffs
of the Department of Medical Biochemistry Faculty of Universitas Airlangga who also work as doctors.
The counselling themes were: Understanding hepatitis B infection, early detection, prevention,
complications, treatment and therapy. Counselling and mentoring were done especially for participants
with positive hepatitis B infection in the previous day’s screening.
This screening was carried out by taking participants' blood as much as 3 ml. This medical procedure was
carried out by skilled personnel from e-Telkom Medika clinical laboratory, Surabaya.
The results of the examination were given individually to the participants and summarized. The
confidentiality of the participants was guaranteed. Evaluation of this program was carried out by
performing pretest and post test questionnaire for the participants’ knowledge of hepatitis B.

3. Results and Discussion

Participants registered in the attendance list to attend the counselling event on the first day, were 72
participants. Before and after the socialization, participants were given questionnaire to find out the
effectiveness of this program. The pretest was conducted to find out the knowledge and initial

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IOP Conf. Series: Earth and Environmental Science 217 (2019) 012048 doi:10.1088/1755-1315/217/1/012048

understanding of the participants and the post test was given with the same questions. The questionnaire
included general knowledge about hepatitis B infection, and knowledge about detection, complication,
prevention, and treatment of hepatitis B infection.
The results of the pretest and post test recapitulation were obtained from 51 participants. This was
because there were participants who resigned before the post test was held. Based on the summary of
pretest and post test, we found an increase in participants' knowledge and understanding of hepatitis B
infection (table 1).

Table 1. The comparison of participants’ knowledge from pretest and post test
Questions Number of participants who Number of participants who
answered correctly at Pretest answered correctly at Post
(n = 51) Test (n = 51)
What is Hepatitis B? 45 (88,23%) 45 (88,23%)
Who are people with high risk of 33 (64,7%) 46 (90,2%)
hepatitis B?
What condition can cause 4 (7,84%) 12 (23,52%)
hepatitis B transmission?
How can Hepatitis B be 21 (41,18%) 41 (80,39%)
transmitted?
At which age does the person 14 (27,45%) 27 (52,94%)
have the highest risk of infected
by hepatitis B?
How is the treatment of hepatitis 36 (70,59%) 41 (80,39%)
B?
How is the prevention of hepatitis 43 (84,31%) 43 (84,31%)
B?
At which age is the first dose of 15 (29,41%) 25 (49%)
hepatitis B immunization given in
Indonesia?
What are the complications of 44 (86,27%) 48 (94,12%)
chronic hepatitis B?
Average 57,45% 73,92%

Through pretest, it was found that most participants received low scores on the transmission, risk
factors, and hepatitis B immunization sections. Only 4 people (7.84%) of the participants who knew about
the conditions that play a role in hepatitis B transmission, 14 people (27.45 %) participants who knew
about the age at risk of infected by hepatitis B, and 15 people (29.41%) participants who knew about
hepatitis B immunization. Knowledge of hepatitis B transmission and immunization is important to
prevent the transmission and infection of HBV infection. After socialization, there was an increase in
knowledge in which 12 people (23.32%) were able to answer correctly about knowing about the
conditions that play a role in hepatitis B transmission, 27 people (52.94%) participants who knew about
the age at risk of hepatitis B, and 25 people (49%) who were aware of hepatitis B immunization. From the
overall results of the pretest and post test, it was found that there was an increase in the number of
participants who answered correctly in the post test so that it could be concluded that there was an
increase in participants' knowledge before and after counselling (from 57.45% to 73.92%).

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IOP Conf. Series: Earth and Environmental Science 217 (2019) 012048 doi:10.1088/1755-1315/217/1/012048

Table 2. Participants’ profile based on age

Age (y.o) Number of people %
1 < 30 0 0
2 31-40 1 1,72
3 41-50 13 22,41
4 51-60 14 24,14
5 61-70 20 34,48
6 >70 10 17,24
Total 58 100

Most of the participants were between 61-70 years old, in which these age range are vulnerable to the
occurrence of Chronic Liver Disease due to HBV infection. So when being viewed from the participants’
profile based on age, this program was in line with the target. 27.59% of participants had male gender and
72.41% of participants had female gender so that the distribution of participants based on gender was
fulfilled. The dominance of female participants was due to the purpose of this program which was
currently prioritized for improving the capacity and health awareness of urban villages based on PKK
women.

Table 3. Participants’ profile based on gender

Sex Number of people %

1 Male 16 27,59
2 Female 42 72,41
Total 58 100

Through programs held by the PKK, it was hoped that the socialization of hepatitis B in the
community can be encouraged. Women also play an important role in managing households. In addition,
women who are mostly housewives are more aware of the changes / early signs of hepatitis B symptoms
in their neighbourhood.

Table 4. Questionnaire from participants undergoing screening

Questions Yes (n = 58) No (n = 58)

Previous HBsAg test 5 53
History of acute hepatitis 4 54
Relatives with hepatitis infection 7 51
History of blood transfusion 5 53
History of hepatitis B immunization 6 52

Of the 58 participants who were examined for HBsAg and ALT, 5 participants had conducted previous
HBsAg test (2-20 years ago) and the results were negative. A total of 4 participants had a history of acute
hepatitis within > 20 years ago but the type of virus was unknown. Of the 50 participants, 7 participants
had close family members (husband / wife / parents / children / siblings) who had hepatitis, where 5
participants had close relatives who had hepatitis B and the remaining 2 did not know their type of
hepatitis virus infection. A total of 5 participants had a history of blood transfusion as one of the risk
factors for hepatitis B. The 58 participants, only 6 participants had ever received hepatitis B
immunization, of which only 1 person had received a hepatitis booster during adulthood and there was 1
new participant got the first hepatitis B immunization at adulthood (39 years). From these data we
obtained several things as risk factors for hepatitis B in these participants.
The 58 participants who underwent blood screening, 3 participants (5.17%) had positive / reactive

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IOP Conf. Series: Earth and Environmental Science 217 (2019) 012048 doi:10.1088/1755-1315/217/1/012048

HBsAg with 522.5-8104 IU / L titers. This data was less than the prevalence of positive HBsAg in
Indonesia based on Riskesdas 2007 data, which was 9.4% (9). Data from WHO (2015) also shows that
Indonesia is a country with a high prevalence of chronic hepatitis B (> 8%) (2). This could be caused by
the uneven distribution of hepatitis B in every region in Indonesia. Of the three positive HBsAg
participants, 1 participant had a child with positive HBsAg and 1 other participant had a husband with
positive HBsAg. This could indicate the possibility of HBV transmission in these participants. Of the
three participants, 1 participant had an increase in ALT above normal (> 41 IU / L) so there was a need to
watch out for inflammation in the liver of the patient. In participants who were infected with hepatitis B,
an approach was taken with confidential private consultations and reporting to the community health
center as a form of follow-up. These participants were then referred to the internist in hospital for further
care.

Tabel 5. The Results of HbsAg dan ALT Test of Participants

HbsAg ALT
Positive Negative Normal Increase
(reactive) (non reactive) (<41 IU/L) (>41 IU/L)
3 (5,17%) 55 (94,82%) 57 1

4. Conclusion
Counselling and screening can increase public awareness about HBV infection. Participants with positive
HBsAg in this program were 5.17% (3/58). In general, there was an increase in the knowledge of the
community service participants about HBV infection.
Counselling and early detection of health can improve environmental awareness towards hepatitis B
infection with support in the community, such as young community, PKK women ( a community of
housewife) and other existing community associations to participate in this problem. Similar programs
need to be carried out in other regions, especially in areas with a high risk of being infected with HBV to
increase public awareness and reduce the incidence of hepatitis B in Indonesia.

References
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Acknowledgement
The author would like to thank The Indonesian Ministry of Research, Technology, and Higher Education
for the funding of this program.