The study was conducted at Kankou Moussa University in Bamako. Established in 2009, Kankou Moussa University had a total of 837 students during the 2024-2025 academic year, distributed across 13 levels. Pharmacy training comprises 6 levels (1st to 6th year) with a total of 309 students, while the medical program comprises 7 levels (1st to 7th year) with 528 students.

This was a cross-sectional study conducted over a 12-month period, from January 1 to December 18, 2025.

The study population consisted of students enrolled at Kankou Moussa University.

2.3.1. Inclusion Criteria

Students enrolled at Kankou Moussa University (UKM) for the 2024-2025 academic year.Students who voluntarily agreed to participate in the survey.

2.3.2. Non-Inclusion Criteria

Students who were unavailable during the survey period.Students enrolled at Kankou Moussa University (UKM) who did not have a mobile phone number or a WhatsApp account.

2.3.3. Sampling

1)SamplingTechnique

We employed stratified random sampling based on the number of students, with each class constituting a stratum. The sample size was allocated proportionally according to the number of students in each class. Within each stratum, participants were selected using a random draw.

We ensured that the desired sample size was achieved in each class to maintain representativeness of the population. If the target number of participants was not reached in a given class, the shortfall was compensated by selecting additional students from other classes. The estimated sample size for the study was 424 students, distributed proportionally between pharmacy and medicine programs (see sample size calculation results). Accordingly, 157 participants were selected from pharmacy and 267 from medicine (Table 1). The allocation of participants to each class was performed as follows:

Step1: Calculate the percentage of students in each class based on the total number of students and the number of students per class.

837 -----------------------→ 100%Number per class--------------→ X%/class

Step2: Calculate the sample size for each stratum (class) based on the percentage obtained and the total sample size.

100% --------------------→ total sampleX%/class --------------→ X students/class

Table 1. Number of samples per class.

2)Samplesizecalculation

Assuming that approximately half of the students had good knowledge, attitudes, and practices (with a margin of error of 5%), and based on a 95% confidence interval (95% CI), as suggested by models in the literature [11][12], the sample size was calculated using the Daniel Schwartz formula.

n = sample size;

P = 50% (proportion of the event in a previous study);

I = desired precision (5%);

Q = 1 − P;

Zα =1.96 (test de l’écart réduit); Zα = 1.96 pour α = 5%).

To account for potential non-response, 10% was added to the minimum calculated sample size, resulting in a final sample size of n = 424.

The questionnaire was developed based on the literature. Questions assessing students’ level of knowledge, attitudes, and practices were evaluated using 34, 10, and 9 items, respectively, in accordance with data from the literature [13][14].

We assigned scores based on the answers to the questions asked. Thus, any correct response was scored 1 point and 0 points for any incorrect response.

The grades obtained were then dichotomized into good and bad according to a model from the literature [13][14]. The score obtained by the participants was considered good if it was greater than or equal to 70% (≥70%) for each KAP section and poor if it was less than 70% (<70%).

For the categorization of knowledge level, students who achieved 24 or more correct responses out of 34 (≥70%) were considered to have good knowledge, whereas those with fewer than 24 correct responses were considered to have poor knowledge of hepatitis B.

Concerning the attitude assessment, students who provided at least 7 correct responses out of the 10 expected were considered to have a “good attitude”, whereas those who obtained fewer than 7 correct responses were classified as having a “poor attitude”.

For the practice evaluation, students who correctly answered at least 6 out of the 9 questions were considered to have “good practice”. Those who provided fewer than 6 correct responses were classified as having “poor practice”.

The variables included were sex, training program, level of study, knowledge of HBV, contagiousness of HBV, modes of transmission, means of prevention, complications of hepatitis B, treatment, diagnosis, and screening; students’ attitudes toward hepatitis B; students’ behavioral practices regarding hepatitis B; family history of HBV; and experience in providing care or treatment.

Data were collected online using smartphones through a survey link created with Google Forms. The questionnaire link was distributed electronically via WhatsApp. After data collection, the responses were exported to a Microsoft Excel file to create the study database. The data base was then cleaned prior to analysis.

The collected data were analyzed using SPSS software version 27.0.1. The analysis was conducted in three stages:

Descriptiveanalysis: This consisted of describing the study sample. Quantitative variables were expressed as means and standard deviations, while qualitative variables were presented as percentages.Univariateanalysis: This analysis examined associations between dependent variable variables (KAP) and various independent variables. Pearson’s chi-square test and Fisher’s exact test were used as appropriate.Multivariateanalysis: Binary logistic regression was used in the final model to identify factors independently associated with students’ KAP. Explanatory variables with a p-value ≤ 0.20 in the univariate analysis were included in the multivariate logistic regression model. Statistical significance was set at p < 0.05.

Permission was obtained from the university authorities prior to the conduct of the study. Participants were informed about the objectives and purpose of the study. Participation was voluntary and based on free and informed consent. Anonymity and confidentiality were guaranteed throughout the study process.

A total of 425 students participated in the study. The mean age was 21.25 ± 2.64 years and 18 - 24 age group accounted for 78.5% (n = 334) of the sample. Among the participants, 60.9% (n = 259) were female, and 64.2% (n = 273) were enrolled in the medical program. First-, second-, and third-year students represented 28.2% (n = 120), 21.2% (n = 90), and 18.6% (n = 79) of the sample, respectively.

Overall, 91.8% of students correctly identified the causative agent, 73.4% knew the modes of transmission, 74.8% were aware of prevention methods, and 60.9% understood the objectives of curative treatment. Only 28.0% recognized that newborns are a high-risk group for developing chronic hepatitis B, and 44.5% were aware of the main complications, including liver failure, cirrhosis, liver cancer, and premature death (Table 2).

Table 2. General knowledge of Kankou Moussa university students about hepatitis B in 2024-2025 (n = 425).

Regarding occupational risk, 67.3% of students reported fearing infection feared being infected with HBV, 64.2% perceived themselves to be at higher risk than the general population and 57.9% were aware of the risk during their practical training. Conversely, only 29.9% felt confident in managing a patient with hepatitis B (Table 3).

Table 3. Attitudes of UKM students towards the hepatitis B virus in 2024-2025 (n = 425).

In our study, 29.9% of students reported having been screened for HBV, and 45.6% had received vaccination. Regarding biosafety practices, 56.7% disposed of medical waste in appropriate medical bags, 29.9% discarded needles without recapping them, and 56.9% reported occasionally working without personal protective equipment (Table 4).

Table 4. Behavioral practices of Kankou Moussa university students regarding viral hepatitis B in 2024-2025, (n = 425).

The results showed that 50.1% of students had good knowledge, 88.7% demonstrated a favorable attitude, and 51.3% exhibited good practices related to hepatitis B (Figure 1).

Figure 1. Knowledge attitude and practice scores of Kankou Moussa university students regarding hepatitis B virus.

Multivariate analysis revealed a statistically significant association between students’ knowledge and educational level in favor of 4^th year (aOR = 0.30; 95% CI [0.11 - 0.78]). Student attitude was associated with age favoring the 18 - 24-year age group(aOR = 0.31, 95% CI [0.10 - 0.98]) educational level, favoring 2nd-year (aOR = 0.14; 9% CI [0.04 - 0.49]) and 3rd year students (aOR = 0.16; 95% CI [0.05 - 0.56]) and having participated in the care of hepatitis B virus (aOR = 2.18; 95% CI [1.14 - 4.16]. Students’ practice was associated with proximity to family members affected by HBV (ORa = 0.58; IC95% [0.34 - 0.98]) (Table 5).

Table 5. Distribution of factors associated with the knowledge, attitude and practice among Kankou Moussa university students in 2024-2025.

aOR*: Adjusted Odds Ratio.