October 2007, Vol. 36 No. 10 797 Knowlege of Hepatitis B Among Singaporeans—Wei Lu et al Original Article Public Misperceptions About Transmission of Hepatitis B Virus in Singapore Wei Lu, 1 MBBS, Belinda Mak, 1 RN, Seng-Gee Lim, 1 MBBS, FRACP, MD, Myat Oo Aung, 1 MBBS, Mee-Lian Wong, 2 MBBS, MPH, MD, Chun-Tao Wai, 3 MBBS, MRCP, MMed 1 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 2 Department of Community, Occupation, and Family Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 3 Asian Centre for Liver Diseases and Transplantation, Singapore Address for Correspondence: Dr Chun-Tao Wai, Consultant Transplant Hepatologist and Gastroenterologist, Asian Centre for Liver Diseases and Transplantation, Gleneagles Hospital Annexe Block #02-37, 6A Napier Road, Singapore 258500. Email: dr_desmond_wai@yahoo.com.sg Abstract Introduction: Hepatitis B virus (HBV) infection is endemic in Asia. Good public knowledge on disease transmission is one way of controlling spread of HBV. We aimed to study the general knowledge on HBV among the general public in Singapore, which is moderately prevalent with HBV. Materials and Methods: Before conducting a public education seminar on liver diseases, a 16-point questionnaire survey was conducted among the participants. Misperceptions (if any) were identified, and factors associated with knowledge score were analysed by multivariate analysis. Results: One hundred and ninety-two subjects completed the questionnaire. The mean age was 52 years, 78 (41%) were male, 183 (95%) were Chinese, 17 (9%) were known hepatitis B carriers and 73 (38%) had completed college education. The mean knowledge score was 10.7 (out of a maximum of 16). Most misperceptions were in the category of HBV transmission. At multivariate analysis, having college education was the only independent factor associated with a high knowledge score. Conclusion: Although HBV infection is moderately prevalent in Singapore, many misperceptions existed among the general public, especially on the mode of transmission. Better education was related to better knowledge of HBV. Further public education should be targeted to clear the misperceptions identified, and be specifically targeted to the less educated. Ann Acad Med Singapore 2007;36:797-800 Key words: Chronic hepatitis B, Knowledge, Public health Introduction Chronic hepatitis B (CHB) is an important global health problem, with more than 350 million individuals affected worldwide. CHB is particularly important in Asia, as 4% to 10% of the total population are affected, and approximately 75% of patients with CHB worldwide reside in Asia. 1,2 During the course of hepatitis B virus (HBV) infection, an estimated 15% to 40% of CHB patients would develop complications such as acute exacerbation, liver cirrhosis and hepatocellular carcinoma (HCC). 1-3 HBV infection imposes a significant socioeconomic burden in many Asian countries. 4,5 Singapore is a small, multiracial nation in Southeast Asia with a population of 4 million, and a racial distribution of 76% Chinese, 14% Malay, 8% Indian, and 2% others. HBV infection is intermediately prevalent in Singapore, affecting 4.1% of the total population. As a result, HCC is the 4 th commonest cancer among Singaporean males, with an age- standardised rate of 18.9 per 100,000 person-year. 5-9 HBV infection is a vaccine-preventable disease. However, despite the implementation of neonatal hepatitis B vaccination for all newborns since 1987, new acute HBV infection remains common in Singapore, with 64 cases reported in 2003, affecting those who are older and un- vaccinated. 10 Besides mass public catch-up vaccination, public education, especially on the mode of transmission, is also an important means of preventing the spread of the disease. Our previous studies showed that the knowledge of HBV infection among Singaporean patients with CHB is gener- ally good, except for a few misperceptions. 8,11 We also found that CHB patients with less education tended to have poorer knowledge on the disease, and therefore should be specially targeted for health education. However, how the general public perceives CHB in Singapore has not been evaluated. Most studies were performed in North America. Thompson et al 12 evaluated public knowledge on HBV among 147 Canadian Chinese and found their knowledge