Hepatitis B and C Knowledge, Testing Uptake, and Vaccination Coverage Among Men Aged 15-49 in Nepal: A Nationally Representative Analysis of the 2022 Nepal Demographic and Health Survey

Hepatitis is a silent inflammation of the liver, often caused by viruses that travel through blood or bodily fluids. While many people carry these viruses without feeling sick, they can lead to severe liver damage or cancer over time. The World Health Organization has set a global goal to eliminate these viruses as a public health threat by 2030, a target that requires not just medical treatments, but also widespread awareness. For a virus to be stopped, people must know it exists, understand how it spreads, and be willing to get tested and vaccinated. In many parts of the world, public health campaigns have historically focused on women, particularly regarding pregnancy and child health, leaving a gap in our understanding of what men know and how they behave. Without knowing what men understand about these diseases, health officials cannot design effective programs to reach them, and the path to elimination remains incomplete.

A new study turns its attention to this missing piece of the puzzle by examining the knowledge of hepatitis among men in Nepal. Researchers analyzed data from the 2022 Nepal Demographic and Health Survey, a massive, nationally representative survey that interviews thousands of households. They focused specifically on men between the ages of 15 and 49, asking them a series of questions to gauge their understanding of hepatitis B and C. The questions were simple and direct: Do you know that hepatitis C can be spread through blood? Do you know that hepatitis C can be prevented? Do you know that hepatitis B can be cured? By combining the answers to these questions, the team created a score to measure how well-informed each man was. They then looked for patterns, checking if knowledge levels changed based on where a man lived, how much money his household had, his level of education, or whether he used the internet.

The results reveal a nation that is largely aware, yet deeply divided. Overall, about 72 percent of the men surveyed had what the researchers call "adequate knowledge," meaning they could correctly answer at least two of the three key questions. However, this average hides a stark reality: knowledge is not spread evenly across the country. The gap between the most informed and the least informed is significant. In the Gandaki province, more than 81 percent of men had adequate knowledge, whereas in the Madhesh province, that number dropped to just 58 percent. This difference of nearly 24 percentage points suggests that where a man lives in Nepal is a powerful predictor of whether he understands the disease. Similarly, wealth plays a role; men from the richest households were more likely to be knowledgeable than those from the poorest, though this gap narrowed when other factors were taken into account.

Education emerged as the single strongest factor influencing what men know. Men who had attended higher levels of school were far more likely to understand hepatitis than those who had never attended school. The study found that men with higher education were more than seven times as likely to have adequate knowledge compared to those with no schooling. Age also mattered, with older men generally knowing more than younger ones. Interestingly, access to the internet was a significant predictor of knowledge; men who used the internet were much more likely to be informed, suggesting that digital platforms are becoming a vital channel for health information. In contrast, simply living in a city versus a rural village did not make as much of a difference once education and internet access were considered.

Despite these findings on knowledge, the study hit a major wall when trying to measure action. The researchers hoped to see how many men had actually been tested for hepatitis or vaccinated against it, but the survey data was missing for almost everyone. For the question about testing, 99.5 percent of the responses were missing, and there was no data at all on vaccination history for men in the survey. This absence of data is a critical blind spot. It means that while officials can see that many men know about the disease, they have no way of knowing if that knowledge is translating into people getting tested or protected. The study concludes that without adding specific questions about testing and vaccination to future surveys for men, Nepal will struggle to track its progress toward eliminating hepatitis.

The researchers suggest that the current national strategy to fight hepatitis needs to be more targeted. Because knowledge is so low in specific provinces like Madhesh and Karnali, and among men with little formal education, broad, one-size-fits-all campaigns may not be enough. Instead, health messages need to reach these specific groups directly. The strong link between internet use and knowledge also points to a potential solution: digital health campaigns could effectively reach younger and urban men. However, relying solely on digital tools would leave behind the poorest and most rural men, who are often the least informed. A balanced approach that combines digital outreach with community-based education is likely necessary to ensure no one is left behind.

Ultimately, this study highlights a paradox in Nepal's fight against hepatitis. The country has made great strides in vaccinating children, but the adult population, particularly men, remains a mystery in terms of their health behaviors. The data shows that while a majority of men know enough to understand the basics of the disease, a significant minority does not, and this lack of knowledge is concentrated in specific regions and among the less educated. More importantly, the study reveals that knowing about the disease is not the same as acting on it, because the data on whether men are actually getting tested or vaccinated simply does not exist. To move forward, health officials must not only improve education in the most underserved areas but also fix the surveillance system to finally see the full picture of how men are engaging with hepatitis prevention.