Choudhuri Gourdas, Ojha Rajesh, Negi T S, Gupta Varun, Saxena Shipra, Choudhuri Arundhati, Pal Sanjoy, Choudhuri Jui, Sangam Alok
HOPE (Health Oriented Programs and Education) Initiative, www.hope.org.in, 422, Aradhana, Eldeco 2, Rae Bareli Road, Lucknow, UP 226025 India.
2Department of Gastroenterology and Hepatobiliary Sciences, Fortis Memorial Research Institute, Sector 44, Gurgaon, Haryana 122002 India.
Hepatol Med Policy. 2017 Jun 13;2:10. doi: 10.1186/s41124-017-0027-y. eCollection 2017.
India is home to one in 14 of all chronic hepatitis B virus (HBV) cases, meaning that it is important to develop HBV interventions that are applicable in the Indian context. Vaccination is the foremost tool for interrupting the HBV infection cycle. HBV vaccination was not included in India's government-sponsored expanded immunisation program until 2011, and many children born earlier remain unvaccinated. This study sought to observe the impact of the HOPE Initiative's school-based intervention to increase vaccination coverage by increasing HBV awareness among students in Lucknow, Uttar Pradesh.
At 430 schools in the administrative areas within and surrounding Lucknow, students viewed an educational documentary film on HBV and completed two questionnaires, one immediately before the screening and the other six weeks later. Both questionnaires asked the same 14 questions, which were organized into five domains: knowledge of the magnitude of the problem of HBV; knowledge of modes of HBV transmission; knowledge of consequences of HBV infection; awareness of HBV; and attitudes regarding HBV. The baseline questionnaire also asked students whether they had been vaccinated against HBV. At two-year follow-up, researchers measured vaccination levels at a subset of 30 intervention schools and six non-intervention schools to further assess the impact of the intervention.
Baseline questionnaires were completed by 11,250 students, and post-intervention questionnaires, by 9698 students. Scores for knowledge about the magnitude of the HBV problem improved from 41% at baseline to 74% at follow-up, and scores for knowledge about modes of transmission, from 38% to 75% ( < 0.05 for both). The baseline HBV vaccination level among students receiving the intervention was 21%. Two years after the intervention, 45% of students ( = 4284) reported being vaccinated at intervention schools compared to 22% ( = 1264) at non-intervention schools.
The observed increases in HBV awareness, knowledge and vaccination levels in this study indicate that school-based interventions can be used to achieve higher vaccination coverage among Indian children. The documentary film was found to be an affordable tool for reaching large audiences. More studies are needed to validate the impact of this intervention and to explore its applicability to other social causes.
印度的慢性乙型肝炎病毒（HBV）病例占全球总数的十四分之一，这意味着开发适用于印度国情的HBV干预措施至关重要。疫苗接种是阻断HBV感染循环的首要工具。直到2011年，HBV疫苗接种才被纳入印度政府资助的扩大免疫计划，许多更早出生的儿童仍未接种疫苗。本研究旨在观察“希望倡议”基于学校的干预措施对提高印度北方邦勒克瑙市学生的HBV疫苗接种覆盖率的影响，该措施通过提高学生对HBV的认识来实现。
在勒克瑙市及其周边行政区的430所学校，学生观看了一部关于HBV的教育纪录片，并完成两份问卷，一份在放映前立即填写，另一份在六周后填写。两份问卷都包含相同的14个问题，这些问题分为五个领域：对HBV问题严重程度的了解；对HBV传播方式的了解；对HBV感染后果的了解；对HBV的认识；以及对HBV的态度。基线问卷还询问学生是否接种过HBV疫苗。在两年的随访中，研究人员在30所干预学校和6所非干预学校的一个子集中测量了疫苗接种水平，以进一步评估干预措施的影响。
11250名学生完成了基线问卷，9698名学生完成了干预后问卷。关于HBV问题严重程度的知识得分从基线时的41%提高到随访时的74%，关于传播方式的知识得分从38%提高到75%（两者均P<0.05）。接受干预的学生中，基线时的HBV疫苗接种率为21%。干预两年后，干预学校中有45%（n = 4284）的学生报告接种了疫苗，而非干预学校中这一比例为22%（n = 1264）。
本研究中观察到的学生对HBV的认识、知识和疫苗接种率的提高表明，基于学校的干预措施可用于提高印度儿童的疫苗接种覆盖率。这部纪录片被认为是一种面向广大受众的经济实惠的工具。需要更多的研究来验证这种干预措施的影响，并探索其对其他社会问题的适用性。
