Bridging Gaps in Hepatitis B Virus Prevention: A Systematic Review and Meta-Analysis of Knowledge, Attitudes and Preventive Practices in Ethiopia

Abstract

Background Hepatitis B virus (HBV) infection continues to pose a significant global health challenge, with prevention efforts heavily dependent on individuals’ knowledge, attitudes, and practices. Recognizing the critical role of comprehensive data in shaping policy, we sought to pool estimates from primary studies conducted across various regions of Ethiopia. Methods Full text studies published in English from December 31 st 2010 to May 31 st , 2025 were identified through searches in the PubMed, Embase, Web of Science, African Journals Online, Google Scholar, and Scopus databases using the medical subject headings and text words. The protocol was registered in the PROSPERO and the results were reported accordance with the PRISMA 2020. The heterogeneity was evaluated graphically and using statistical methods. Publication bias was assessed with a funnel plot and Egger’s regression (significant at P ≤ 0.05). A random-effects meta-analysis was performed to calculate the pooled estimates. Results The search identified 980 records and 26 studies met the eligibility criteria and were included. The pooled prevalence of a good level of knowledge, favorable attitudes, and good prevention practices was 47.45% (95% confidence interval (CI) 36.53, 58.36), 50.48% (95% CI 38.65, 62.30), and 36.22% (95% CI 27.22, 45.23), respectively. In the subgroup analysis, a good level of knowledge among barbers was only 11.14% (95% CI 8.55–13.74). Being a rural resident (pooled odds ratio (pOR) = 2.25, 95% CI 1.39, 3.63), illiterate (pOR = 2.22, 95% CI 1.30, 3.76), having poor knowledge (pOR = 2.13, 95% CI 1.56, 2.91), and having unfavorable attitudes (pOR = 3.56, 95% CI 1.17, 10.81) were significantly associated with poor HBV prevention practices. Conclusions and recommendations The results revealed elevated gaps in knowledge, attitudes, and practices related to the prevention of HBV infection. These results highlight the urgent need to strengthen public awareness campaigns, integrate HBV modules into adult literacy programs, and develop culturally sensitive communication strategies to counter cultural myths that hinder positive attitudes and practices toward HBV prevention and care, establish mobile clinics for rural communities, promote adult education programs for rural communities in local languages.