Sub-Saharan Africa
Bibliography of country-specific and regional needlestick, surveillance, and exposure risk studies
The bibliography is arranged by country, in alphabetical order; for each country, references are listed in chronological order, most recent articles first. Each citation includes an abstract, if available. If you would like to add a citation, contact us here.
Countries with articles listed:
- Botswana
- Burundi
- Cote d'Ivoire
- Democratic Republic of Congo
- Ethiopia
- Kenya
- Mali
- Nigeria
- Rwanda
- Senegal
- South Africa
- Sudan
- Tanzania
- Uganda
- Zaire
- Zambia
- Zimbabwe
REGIONAL DATA/POLICY
De Baets AJ, Sifovo S, Pazvakavambwa IE. Access to occupational
postexposure prophylaxis for primary health care workers in rural
Africa: a cross-sectional study. American Journal of Infection Control
2007;35:545-51.
ABSTRACT- Background: For many primary health care workers in
developing countries, the limited availability and cost of public
transport hinders timely access to occupational postexposure
prophylaxis (PEP) at referral hospitals. Adapted PEP training and a
starter's kit (for human immunodeficiency virus, hepatitis B virus, and
syphilis prophylaxis) could improve access. Methods: The evaluation
method, based on the 12 steps of the decentralized phase of PEP
management, calculated different scores from the responses for 51
anonymous surveys and allowed comparison among different groups. Listed
obstacles and clinic visits provided further information. Results:
Respondents who received in-service PEP training had significantly
higher mean knowledge and confidence scores but no different mean
attitude scores than those who did not. The mean total score for those
who received the adapted PEP training (10.7 of 12) was significantly
higher (P = .008) than for those who did not (8.8 of 12). Conclusion:
Decentralizing the first phase of PEP management for primary health
care workers in rural Zimbabwe attends to an unmet need. The evaluation
facilitates checking completeness of course contents, stresses the need
to pay equal attention to attitudes toward the referral and reporting
system, and identifies specific challenges for delivering PEP in rural
settings. The finding may inspire to improve access to PEP for other
health care workers and phlebotomists employed in remote areas.
Phillips EK, Owusu-Ofori A. Jagger J. Bloodborne pathogen exposure
risk among surgeons in sub-Saharan Africa. Infection Control and
Hospital Epidemiology 2007;28:1334-6.
ABSTRACT- To document the frequency and circumstances of bloodborne
pathogen exposures among surgeons in sub-Saharan Africa, we surveyed
surgeons attending the 2006 Pan-African Association of Surgeons
conference. During the previous year, surgeons sustained a mean of 3.1
percutaneous injuries, which were typically caused by suture needles.
They sustained a mean of 4.1 exposures to blood and body fluid,
predominantly from blood splashes to the eyes. Fewer than half of the
respondents reported completion of hepatitis B vaccination, and
postexposure prophylaxis for human immunodeficiency virus was widely
available. Surgeons reported using hands-free passing and blunt suture
needles. Non-fluid-resistant cotton gowns and masks were the barrier
garments worn most frequently.
Baggaley RF, Boily M-C, White RG, Alary M. Risk of HIV-1
transmission for parenteral exposure and blood transfusion: a
systematic review and meta-analysis. AIDS 2006;20:805-12.
ABSTRACT- Background: The role of iatrogenic transmission within the
HIV/AIDS pandemic remains contentious. Estimates of the risk of HIV
transmission from injections and blood transfusions are required to
inform appropriate prevention policy. Objectives: Systematic review and
meta-analysis of the literature on HIV-1 infectivity for parenteral
transmission and blood transfusion. Review methods: All identified
studies with relevant transmission probability estimates up to May 2005
were included. Statistical methods: When appropriate, summary estimates
for accidental percutaneous and blood product exposures were derived.
Results: Infectivity estimates following a needlestick exposure ranged
from 0.00 to 2.38% [weighted mean, 0.23%; 95% confidence interval (CI),
0.00-0.46%; n = 21]. Three estimates of infectivity per intravenous
drug injection ranged from 0.63 to 2.4% (median, 0.8%); a summary
estimate could not be calculated. The quality of the only estimate of
infectivity per contaminated medical injection (1.9-6.9%) was assessed.
Instead we propose a range of 0.24-0.65%. Infectivity estimates for
confirmed contaminated blood transfusions range from 88.3 to 100.0%
(weighted mean, 92.5%; 95% CI, 89.0-96.1%; n = 6). Conclusions:
Infectivity estimates for infected blood transfusions are larger than
for other modes of HIV transmission. Few studies on transmission risk
per contaminated injection were found. However, transmission risk per
needlestick injury, where needles are more likely to be rinsed or
disinfected between recipients (especially for medical injections), may
be representative of non-intravenous medical injections and lower than
the risk from intravenous injections, which are likely to be deeper and
to involve more fluids. Further work is needed to better estimate
transmission probability related to contaminated injections and its
likely contribution to overall HIV transmission.
Ekwueme DU, Weniger BG, Chen RT. Model-based estimates of risks of
disease transmission and economic costs of seven injection devices in
sub-Saharan Africa. Bulletin of the World Health Organization
2002;80(11):859-70.
ABSTRACT- Objective: To investigate and compare seven types of
injection devices for their risks of iatrogenic transmission of
bloodborne pathogens and their economic costs in sub-Saharan Africa.
Methods: Risk assumptions for each device and cost models were
constructed to estimate the number of new hepatitis B virus (HBV) and
human immunodeficiency virus (HIV) infections resulting from
patient-to-patient, patient-to-health care worker, and
patient-to-community transmission. Costs of device purchase and usage
were derived from the literature, while costs of direct medical care
and lost productivity from HBV and HIV disease were based on data
collected in 1999 in Cote d'Ivoire, Ghana, and Uganda. Multivariate
sensitivity analyses using Monte Carlo simulation characterized
uncertainties in model parameters. Costs were summed from both the
societal and health care system payer's perspectives. Findings:
Resterilizable and disposable needles and syringes had the highest
overall costs for device purchase, usage, and iatrogenic disease:
median US$ 26.77 and US$ 25.29, respectively, per injection from the
societal perspective. Disposable-cartridge jet injectors and automatic
needle-shielding syringes had the lowest costs, US$ 0.36 and US$ 0.80,
respectively. Reusable-nozzle jet injectors and auto-disable needle and
syringes were intermediate, at US$ 0.80 and US$ 0.91, respectively, per
injection. Conclusion: Despite their nominal purchase and usage costs,
conventional needles and syringes carry a hidden but huge burden of
iatrogenic disease. Alternative injection devices for the millions of
injections administered annually in sub-Saharan Africa would be of
value and should be considered by policy-makers in procurement
decisions.
Newman MJ. Infection control in Africa south of the Sahara [letter].
Infection Control and Hospital Epidemiology 2001;22:68-9.
No abstract; first paragraph: The translation of US-style infection
control practices into healthcare provision in Africa, especially for
the extremely poor African countries, is not an easy program to
envisage. Procedures that are standard practices in the United States
may be practically impossible to implement in most African countries.
This letter discusses some of the universal problems associated with
infection control in the African context. There are also problems due
to ignorance, poverty, and the resulting lack of even the most basic
resources for health care. Solutions to some of these problems are
suggested.
Sagoe-Moses C, Pearson RD, Perry J, Jagger J. Risks to health-care
workers in developing countries [Sounding Board]. New England Journal
of Medicine 2001;345:538-41.
ABSTRACT- The authors describe the increased risks and substantial
costs of occupational exposures to bloodborne pathogens in developing
countries, particularly in sub-Saharan Africa, and recommend specific
policy actions to help protect the lives of healthcare workers in these
regions.
de Graaf R, Houweling H, van Zessen G. Occupational risk of HIV
infection among western health care professionals posted in AIDS
endemic areas. AIDS Care 1998; 10:441-52.
ABSTRACT- In this study on occupational risks of HIV infection among 99
Dutch medics working in AIDS endemic areas, 61% reported percutaneous
exposures during an average stay of 21 months. The mean number of
injuries was lower among physicians (2.0 versus 3.9 per year) and
higher among nurses (1.9 versus 1.2) than in previous research
conducted in 1987-1990 among Dutch medics returning from Africa. But
the reduction of exposures among physicians might be explained by the
fact that the number of procedures they carried out was less in the
later study. Also among nurses a shift of tasks was seen. On the basis
of an estimated HIV prevalence in the patient population of 19%, a
chance of transmission per accident of 0.3%, and 1.9 percutaneous
exposures per year, the mean occupational risk of HIV infection per
year can be estimated at 0.11% per person. Besides length of stay and
number of activities, characteristics of the work setting were
associated with the frequency of different kinds of injuries. From the
analysis of 109 extensive descriptions of recent accidents, it appeared
that the majority of the injuries occurred during routine activities
and were self-inflicted. Injuries with hollow needles usually occurred
after the actual medical act (e.g. during recapping). Carelessness
(e.g. due to fatigue) or being in a hurry (e.g. because of an
emergency) were also often the cause of percutaneous injuries, as were
the poor quality of the equipment, lack of professional skills, or a
combination of these factors. Prevention activities are still important
to reduce the frequency of occupational exposures. But they will not
eliminate them totally; from the descriptions of recent exposures it
was clear that some of the injuries occurred in spite of
precautions.
Berkley S. Parenteral transmission of HIV in Africa. AIDS
1991;5:S87-S92.
ABSTRACT- HIV is known to be transmitted sexually, perinatally, and
parenterally. Parenteral transmission is defined as that which occurs
outside of the alimentary tract, such as in subcutaneous, intravenous,
intramuscular, and intrasternal injections. The relative percentage of
HIV infection caused by each of these routes depends upon the
prevalence of infection among particular groups of the population and
on their shared behaviors. Although heterosexual transmission is the
primary mode of HIV infection in Africa, health care providers and
traditional healers both in and out of the health care setting in
Africa administer a large number of injections. As such, parenteral
transmission could be contributing significantly to HIV infection in
the region. This paper reviews what is known about the parenteral
transmission of HIV in Africa. The biology of parenteral transmission
in blood and in interstitial fluid is described, then sections follow
on HIV transmission by injection, occupational transmission,
transmission by scarification, and transmission by immunization.
Available data suggest that while HIV may be occasionally transmitted
in Africa through injections, it is most likely not a major route of
infection in the region. Sterilizing needles and syringes, and using
injections as last resort therapy will greatly reduce the risk of
parenteral HIV transmission.
Chelenyane M, Endacott R.Self-reported infection control practices
and perceptions of HIV/AIDS risk amongst emergency department nurses in
Botswana. Accid Emerg Nurs 2006;14(3):148-54.
ABSTRACT - This descriptive exploratory study investigated the reported
practices and perceptions of emergency nurses related to infection
control in the context of the Human Immunodeficiency Virus/Acquired
Immune Deficiency Syndrome (HIV/AIDS) pandemic in Botswana.
Quantitative and qualitative data were collected using a
self-administered questionnaire. Forty questionnaires were distributed
to nurses with emergency department experience in Botswana, with a
response rate of 55% (n = 22). Quantitative data were analysed using
descriptive statistics while qualitative data were subjected to
thematic and content analysis. The majority of respondents reported
compliance with universal precautions at the hospital emergency
department. However, qualitative data highlighted resource constraints
that may hinder compliance with universal precautions such as a lack of
appropriate facilities, a shortage of equipment and materials,
inadequate staffing and absence of sustainable in-service education
programs. Further, the reported compliance with Universal Precautions
had not removed the fear of exposure to HIV/AIDS and perceived risk of
transmission to family. The authors recommend in-service education and
practice initiatives to promote sustainable compliance with universal
precautions and realistic risk perception among nurses. Further
research is required to evaluate nurses' compliance with universal
precautions in developing countries using observational methods or
in-depth interviews. This would enable exploration of nurses' actions
regarding compliance with universal precautions.
Le Pont F, Hatungimana V, Guiguet M, Ndayiragije A, Ndoricimpa J,
Niyongabo T et al. Assessment of occupational exposure to human
immunodeficiency virus and hepatitis C virus in a referral hospital in
Burundi, Central Africa [letter]. Infection Control and Hospital
Epidemiology 2003;24:717-18.
ABSTRACT- The occupational risk of viral infection among healthcare
workers (HCWs) is well documented. Although universal precautions were
established many years ago, their application is difficult in
developing countries, owing to organizational problems and a lack of
necessary materials such as gloves and proper needle-disposal
facilities. Data on the frequency and circumstances of occupational
exposures in developing countries are sparse. We report data from
Burundi, a country with high rates of human immunodeficiency virus
(HIV) and hepatitis C virus (HCV) seroprevalence, based on a
questionnaire that surveyed HCWs and auxiliary staff regarding
perceptions of occupational exposure, frequency of exposures as defined
by Centers for Disease Control and Prevention criteria, circumstances
of exposures, and postexposure practices. We also estimated a
cumulative risk for seroconversion to HIV and HCV due to parenteral
exposure based on data from the survey.
Tarantola A, Koumare A, Rachline A, Sow PS, Diallo MB, Doumbia S,
Aka C, Ehui E, Brucker G, Bouvet E. Groupe d'Etude des Risques
d'Exposition des Soignants aux agents infectieux
(GERES). A descriptive, retrospective study of 567
accidental blood exposures in healthcare workers in three West African
countries [Cote d'Ivoire, Mali, Senegal]. Journal of Hospital
Infection. 2005;60:276-82.
ABSTRACT- We conducted a multi-centre study in West African hospital
wards to document accidental blood exposure (ABE) risks in these
settings, and assessed the incidence of ABE in participating healthcare
workers (HCWs) retrospectively. In total, 1241 HCWs participated in the
survey from 43 hospital wards. Among them, 567 (45.7%) had sustained at
least one ABE with an estimated incidence of 0.33 percutaneous injuries
(PCIs) and 0.04 mucocutaneous contacts (MCCs)/HCW/year in medical or
intensive care personnel and 1.8 PCIs/HCW/year in surgeons. The ABE was
a needlestick in 454 (80.1%) of 567 cases, a cut in 19 cases (3.4%), a
splash or contact with non-intact skin in 87 cases (15.3%), and was
undocumented in seven cases (1.2%). The source patient's human
immunodeficiency virus (HIV) serostatus was positive in 74 cases
(13.1%), negative in 65 cases (11.5%), and unknown in 416 cases
(73.4%). The ABE was not notified in the ward in 392 cases (69.1%).
Healthcare structures can improve HCWs' safety and reduce the stigma
against HIV-infected patients by improving access to training,
information, primary prevention (ABE prevention equipment) and
secondary prevention (postexposure prophylaxis) of occupational
infection risks.
DEMOCRATIC REPUBLIC OF THE CONGO:
Ngatu NR, Phillips EK, Wembonyama OS, Hirota R, Kaunge NJ, Mbutshu
LH, Perry J, Yoshikawa T, Jagger J, Suganuma N. Practice of universal
precautions and risk of occupational blood-borne viral infection among
Congolese health care workers. Am J Infect Control. 2012
Feb;40(1):68-70.e1. Epub 2011 May 17.
Abstract - The extent of occupational injuries among health care
workers in central Africa, particularly in the Democratic Republic of
Congo, is not documented. We sought to determine the incidence of
percutaneous injury and exposure to blood and other body fluids in
Congolese urban and rural hospitals in the previous year. Our data show
high rates of percutaneous injury and exposure to blood and other body
fluids, reflecting poor safety conditions for most Congolese health
care workers.
Borchert M, Mulangu S, Lefevre P, Tshomba A, Libande ML, Kulidri A,
et al. Use of protective gear and the occurrence of occupational
Marburg Hemorrhagic Fever in health workers from Watsa Health Zone,
Democratic Republic of the Congo. Journal of Infectious Diseases
2007;15(196 Suppl 2):S168-75.
ABSTRACT- BACKGROUND: Occupational transmission to health workers (HWs)
has been a typical feature of Marburg hemorrhagic fever (MHF)
outbreaks. The goal of this study was to identify cases of occupational
MHF in HWs from Durba and Watsa, Democratic Republic of the Congo; to
assess levels of exposure and protection; and to explore reasons for
inconsistent use of protective gear. METHODS: A serosurvey of 48 HWs
who cared for patients with MHF was performed. In addition, HWs were
given a questionnaire on types of exposure, use of protective gear, and
symptoms after contact. Informal and in-depth interviews with HWs were
also performed. RESULTS: We found 1 HW who was seropositive for MHF, in
addition to 5 cases of occupational MHF known beforehand; 4 infections
had occurred after the introduction of infection control. HWs protected
themselves better during invasive procedures (injections, venipuncture,
and surgery) than during noninvasive procedures, but the overall level
of protection in the hospital remained insufficient, particularly
outside of isolation wards. The reasons for inconsistent use of
protective gear included insufficient availability of the gear,
adherence to traditional explanatory models of the origin of disease,
and peer bonding with sick colleagues. CONCLUSIONS: Infection control
must not focus too exclusively on the establishment of isolation wards
but should aim at improving overall hospital hygiene. Training of HWs
should allow them to voice and discuss their doubts and prepare them
for the peculiarities of caring for ill colleagues.
Tadesse M, Tadesse T. Epidemiology of needlestick injuries
among health-care workers in Awassa City, Southern Ethiopia. Trop Doct.
2010 Apr;40(2):111-3.
Summary: Accidental needlestick injuries sustained by health-care
workers are a common occupational hazard and a public health issue in
health-care settings. An analytical cross-sectional study was
conducted and 30.9% of health-care workers had experienced at least one
needlestick injury in the previous year.
Taegtmeyer M, Suckling RM, Nguku PM, Meredith C, Kibaru J, Chakaya
JM, Muchela H, Gilks CF. Working with risk: Occupational safety issues
among healthcare workers in Kenya. AIDS Care. 2008;20(3):304-10.
ABSTRACT- The objective of this study was to explore knowledge of,
attitudes towards and practice of post-exposure prophylaxis (PEP) among
healthcare workers (HCWs) in the Thika district, Kenya. We used site
and population-based surveys, qualitative interviews and operational
research with 650 staff at risk of needlestick injuries (NSIs).
Research was conducted over a 5-year period in five phases: (1) a
bio-safety assessment; (2) a staff survey: serum drawn for anonymous
HIV testing; (3) interventions: biosafety measures, antiretrovirals for
PEP and hepatitis B vaccine; (4) a repeat survey to assess uptake and
acceptability of interventions; in-depth group and individual
interviews were conducted; and (5) health system monitoring outside a
research setting. The main outcome measures were bio-safety standards
in clinical areas, knowledge, attitudes and practice as regards to PEP,
HIV-sero-prevalence in healthcare workers, uptake of interventions,
reasons for poor uptake elucidated and sustainability indicators.
Results showed that HCWs had the same HIV sero-prevalence as the
general population but were at risk from poor bio-safety. The incidence
of NSIs was 0.97 per healthcare worker per year. Twenty-one percent had
had an HIV test in the last year. After one year there was a
significant drop in the number of NSIs (OR: 0.4; CI: 0.3-0.6;
p<0.001) and a significant increase in the number of HCWs accessing
HIV testing (OR: 1.55; CI: 1.2-2.1; p= 0.003). In comparison to uptake
of hepatitis B vaccination (88% of those requiring vaccine) the uptake
of PEP was low (4% of those who had NSIs). In-depth interviews revealed
this was due to HCWs fear of HIV testing and their perception of NSIs
as low risk. We concluded that Bio-safety remains the most significant
intervention through reducing the number of NSIs. Post-exposure
prophylaxis can be made readily available in a Kenyan district.
However, where HIV testing remains stigmatised uptake will be limited -
particularly in the initial phases of a programme.
M'ikanatha NM, Imunya SG, Fisman DN, Julian KG. Sharp-device
injuries and perceived risk of infection with bloodborne pathogens
among healthcare workers in rural Kenya [letter]. Infection Control and
Hospital Epidemiology 2007;28:761-3.
ABSTRACT- [W]e documented HCWs' concerns about and exposure to
bloodborne pathogens in a rural Kenyan setting where HIV and viral
hepatitis may be prevalent. Although there is a need for improvement,
some measures are being taken to prevent and respond to occupational
exposure to bloodborne pathogens. To support much-needed occupational
safety among HCWs in rural Kenya, it is hoped that coverage for HBV
vaccination will be expanded, access to sharps safety devices will be
increased, and postexposure prophylaxis will be offered for HIV
exposure. So that hospitals are not operating in isolation in regard to
this important public health activity, there is a need for national
campaigns to address cultural perceptions leading to the overuse of
injections and to support broader training for and implementation of
occupational safety measures to protect HCWs against bloodborne
pathogens.
Suckling RM, Taegtmeyer M, Nguku PM, Al-Abri SS, Kibaru J, Chakaya
JM, Tukei PM, Gilks CF. Susceptibility of healthcare workers in Kenya
to hepatitis B: new strategies for facilitating vaccination uptake. J
Hosp Infect. 2006;64(3):271-7.
ABSTRACT - Hepatitis B virus (HBV) infection is preventable, yet many
healthcare workers (HCWs) in resource-poor countries remain at risk.
The aims of this study were to evaluate the susceptibility of HCWs in a
Kenyan district to HBV infection, and the feasibility of expanding the
Extended Programme of Immunization (EPI) for infants to incorporate
hepatitis B vaccination of HCWs. HCWs in Thika district, Kenya were
invited to complete an interviewer-administered questionnaire about
their immunization status and exposure to blood or body fluids.
Participants were asked to provide a blood sample to assess natural or
vaccine-induced protection against HBV. All non-immune HCWs were
offered hepatitis B vaccination. Thirty percent (168/554) of HCWs
reported one or more needlestick injuries (NSIs) in the previous year,
with an annual incidence of 0.97 NSIs/HCW/year. Only 12.8% (71/554) of
HCWs had received vaccination previously and none had been screened for
immunity or for hepatitis B surface antigen. In total, 407 staff
provided blood samples; 41% were HBV core antibody, 4% expressed
hepatitis B surface antibody from previous vaccination, and 55% were
unprotected. Two hundred and twenty-two staff were eligible for vaccine
delivered through the EPI infrastructure. Self-motivated uptake of a
full course of vaccine was 92% in the smaller health centres and 44% in
the district hospital. This study demonstrates the importance of
hepatitis B vaccination of HCWs in parts of Africa where high exposure
rates are combined with low levels of vaccine coverage. High rates of
vaccination can be achieved using childhood immunization systems for
the distribution of vaccine to HCWs.
See above - Cote d'Ivoire.
Akinleye AA, Omokhodion FO. Work practices of primary health care
workers in urban and rural health facilities in south-west Nigeria.
Aust J Rural Health 2008 Feb;16(1):47-8.
No abstract.
Kushimo OT, Akpan SG, Desalu I, Merah NA, Ilori IU. Knowledge,
attitude and practices of Nigerian anaesthetists in HIV infected
surgical patients: a survey. Nigerian Postgraduate Medical Journal
2007;14:261-5.
ABSTRACT- In the light of increasing prevalence of the human
immunodeficiency virus (HIV), anaesthetists are likely to see more
patients with this virus in their practice. This study evaluated, using
a questionnaire format, the knowledge, attitude and practices of
anaesthetists in the management of HIV infected surgical patients. The
questionnaire sought demographic information, the knowledge of risks
involved as well as attitude and practices. One hundred (66.7%) out of
150 questionnaires distributed amongst members of the Nigerian Society
of Anaesthetists were completed and returned. Fifty-five per cent (55%)
of the respondents confirmed their willingness to be screened but only
45% had had a personal HIV screening test. Even though 23% of all the
respondents will transfuse unscreened blood in an emergency, only
1(8.3%) of the consultants will do so. This trend was also reflected in
gloving behaviour as 11(91.6%) of consultants will routinely wear
gloves whilst only 12(70.5%) of the senior house officers will
routinely glove for venepuncture despite the availability of gloves.
Other precautionary facilities such as goggles, sharp disposal bins,
routine screening of all surgical patients were more available in
private than in government hospitals. Ninety- six per-cent of all
respondents will initiate an action after a needle stick injury whilst
4% will ignore. General Anaesthesia was the choice of anaesthetic in an
HIV/AIDS infected patient by 43% of respondents whilst 22% of
respondents would choose regional technique. However, only 85% of
respondents were willing to anaesthetise an infected patient. This
study suggested a dearth of knowledge and perception of risks of
HIV/AIDs amongst Nigerian Anaesthetists. Appropriate training and
greater education is highly recommended. Rigorous infection control
policy is imperative and hospital authorities must ensure availability
of protective facilities.
Odusanya OO, Meurice FP, Hoet B. Nigerian medical students are at
risk for hepatitis B infection. Transactions of the Royal Society of
Tropical Medicine and Hygiene 2007;101:465-8.
ABSTRACT- Medical students are exposed to blood and body fluids. This
study was conducted to estimate the prevalence of hepatitis B virus
(HBV) infection amongst medical students of the Lagos State University
College of Medicine, Ikeja, Nigeria. Data were collected through a
self-administered questionnaire and through blood analysis for
hepatitis B surface antigen (HBsAg), hepatitis B 'e' antigen (HBeAg) as
well as antibodies to the core (anti-HBc), surface (anti-HBs) and 'e'
(anti-HBe) antigens. Three hundred and thirteen of 325 students (96%)
participated. The mean age was 24.3+/-3.98 years; 231 (74%) were
pre-clinical students and 82 (26%) were in the clinical years of study.
Only 8 (2.6%) had received three doses of vaccination against HBV.
Eighty-one (26%) tested positive for anti-HBc, 10 (3.2%) were positive
for HBsAg and 56 (17.9%) had anti-HBs antibodies. A significant
relationship was found between students who had a positive history of
hepatitis B in the family and anti-HBc (P=0.03). Age was also
significantly associated with HBsAg (P=0.012). Two hundred and
twenty-five (72%) students were susceptible to the infection and
required vaccination. Most students at this medical school are
susceptible to HBV infection and should be vaccinated.
Sofola OO, Folayan MO, Denloye OO, Okeigbemen SA. Occupational
exposure to bloodborne pathogens and management of exposure incidents
in Nigerian dental schools. Journal of Dental Education
2007;71(6):832-7.
ABSTRACT- The goal of this study was to determine the frequency of
occupational exposures to bloodborne pathogens amongst Nigerian
clinical dental students, their HBV vaccination status, and reporting
practices. A cross-sectional study of all clinical dental students in
the four Nigerian dental schools was carried out by means of an
anonymous self-administered questionnaire that asked questions on
demography, number and type of exposure, management of the exposures,
personal protection against cross infection, and the reporting of such
exposures. One hundred and fifty-three students responded (response
rate of 84.5 percent). Only thirty-three (37.9 percent) were fully
vaccinated against HBV. Ninety (58.8 percent) of the students have had
at least one occupational exposure. There was no significantly
associated difference between sex, age, location of school, and
exposure. Most of the exposures (44.4 percent) occurred in association
with manual tooth cleaning. There was inadequate protection of the
eyes. None of the exposures were formally reported. It is the
responsibility of training institutions to ensure the safety of the
students by mandatory HBV vaccination prior to exposure and adequate
training in work safety. Written policies and procedures should be
developed and made easily accessible to all workers to facilitate
prompt reporting and management of all occupational exposures.
Utomi IL. Occupational exposures and infection control among
students in Nigerian dental schools. Odonto-stomatologie tropicale
[Tropical Dental Journal] 2006;29(116):35-40.
ABSTRACT- Objective: To assess the incidence of occupational exposures
to body fluids and infection control practices among students in
Nigerian dental schools. Materials and methods: A self-administered
questionnaire survey of 112 students from three Nigerian dental
schools. Results: 57 (50.9%) of the students had experienced one or
more occupational exposures in the previous six months. There was no
statistically significant association between year group and reported
number of exposures (p > 0,05). There was also no statistically
significant association between sex and reported number of exposures (p
> 0.05). 50.7% of the exposures were percutaneous injuries, 26.1%
splatter of saliva and 23.2% splatter of aerosol. Percutaneous injuries
were most frequently caused by scalers (42.9%) and needlesticks (37.1%)
Most incidents occurred during scaling (37.7%), use of dental handpiece
(21.7%) and cleaning of instruments (18.8%). 96.4% of the exposures
were not reported. Only 36.6% of the students were immunized against
Hepatitis B. None of those immunized had been post-screened for
seroconversion. The routine use of gloves, masks and protective eyewear
was reported by 87.5%, 65.5% and 17% of students respectively.
Conclusions: This study indicates a high rate of exposure to body
fluids and low compliance with infection control guidelines. There is a
need for interventions to improve safe work practices, hepatitis B
vaccination, HBV post-immunization serology and use of protective
barriers. Also appropriate policies and procedures are needed for
reporting and managing exposures.
Aisien AO, Shobowale MO. Health care workers' knowledge on HIV and
AIDS: universal precautions and attitude towards PLWHA in Benin-City,
Nigeria. Niger J Clin Pract 2005;8(2):74-82.
ABSTRACT - OBJECTIVE: Health care workers are at risk of becoming
infected with blood-borne pathogens, including HIV. The study was
designed to test health care workers knowledge about HIV transmission,
universal precautions and their attitude towards people living with HIV
and AIDS. DESIGN: A cross-sectional study. SETTING: University of Benin
Teaching Hospital, Benin-City, Nigeria. PARTICIPANTS: 120 Health Care
Workers (HCWs) who were occupationally exposed to patient's blood and
body fluids completed a self administered structured questionnaire
between March and May 2004. The HCWs consisted of 50 doctors drawn from
obstetrics and gynaecology (25) and surgery departments (25). 70 nurses
from accident and emergency unit (23), labour ward (18), labour ward
theatre (4), main surgical theatre (22) and family planning clinic (3).
RESULTS: The mean age of the health care workers and duration of
practice were 39.8 +/- 8.0 years and 14.0 +/- 8.2 years respectively.
Though many of the respondents demonstrated good knowledge about HIV
transmission, more than 25% of them thought that HIV could be
transmitted through saliva, vomit, faeces and urine. They over
estimated their risk of acquiring HIV infection following needle stick
injury, exposure of mucocutaneous membrane and intact skin to infected
blood and body fluids. There was poor adherence to universal
precautions which was attributed to lack of knowledge and availability
of materials in 48% and 60% of the workers respectively. Over 40% of
the health care workers exhibited discriminatory attitude towards
people living with HIV and AIDS. There was no statistical significant
difference (p > 0.05) in the knowledge of HIV and AIDS transmission
and infection prevention practices amongst the doctors and nurses.
Similarly there was no significant difference in their discriminatory
attitude towards PLWHA. CONCLUSION: We recommend that seminars,
workshops should be organized on a continuous basis for health care
workers on universal precautions, stigma and discrimination reduction.
Those trained should train others on the job. The institution should
also make available materials needed to protect workers against the
risk of acquiring pathogenic infection in the course of providing
health services to their patients.
Fasunloro A, Owotade FJ. Occupational hazards among clinical dental
staff. Journal of Contemporary Dental Practice 2004;5(2):134-52.
ABSTRACT- Although identification of risks to dental healthcare workers
has been explored in several industrialized nations, very little data
is available from developing countries. This paper examines the
occupational hazards present in the dental environment and reports
survey results concerning attitudes and activities of a group of
Nigerian dental care providers. A survey on occupational hazards was
conducted among the clinical dental staff at the Dental Hospital of the
Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife in Osun
State, Nigeria. Thirty eight of the forty staff responded, yielding a
response rate of 95%. Subject ages ranged from 26 to 56 years
with approximately 25% in the 31-46 year old bracket. All of the staff
were aware of the occupational exposure to hazards, and the majority
had attended seminars/workshops on the subject. Only five staff members
(13.2%) owned a health insurance policy and 26 (68.4%) had been
vaccinated against Hepatitis B infection. All dentists (24) had
been vaccinated compared with only two non-dentists; this relationship
was significant (p= 30.07, x2=0.000). Fourteen members of the clinical
staff (36.8%) could recall a sharp injury in the past six months, and
the majority (71.1%) had regular contact with dental amalgam. Wearing
protective eye goggles was the least employed cross infection control
measure, while backache was the most frequently experienced hazard in
47% of the subjects. The need for Hepatitis B vaccinations for all
members of the staff was emphasized, and the enforcement of strict
cross infection control measures was recommended. The physical
activities and body positions that predispose workers to backaches were
identified and staff education on the prevention of backaches was
provided.
Adesunkanmi AK, Badmus TA, Ogunlusi JO. Accidental injuries and
cutaneous contaminations during general surgical operations in a
Nigerian teaching hospital. East African Medical Journal
2003;80(5):227-34.
ABSTRACT- Objective: To determine the prevalence of accidental injuries
and body contaminations among the operating personnel during general
surgical operation, those involved, the circumstances surrounding the
injuries or body contaminations and the factors affecting the
prevalence in a unit of a teaching hospital in Nigeria. Design:
Patients operated for general surgical conditions in a unit of a
Teaching Hospital Complex during a period of two years (1997-1998) were
studied. A proforma was designed to enter personal biodata,
preoperative and intra-postoperative clinical information of all the
patients. Setting: Wesley Guild Hospital a unit of teaching hospital
complex serving the large agrarian rural and semi-urban Nigerians.
Patients: Five hundred and eighty nine consecutive general surgical
patients. All types of general surgical operations were included,
emergency or elective, major or minor, carried out during the day or at
night. Intervention: All the patients were operated and operating
personnel observed for sharp injuries and body contamination. Main
outcome measures: Incidence of sharp injuries and cutaneous
contamination and personnel at risk determined. Results: Operating
personnel sustained 62 sharp injuries (10.5%), these were caused by
suture needle in 57 cases (92.0%), towel clips in three (4.8%), knife
cut in two (3.2%). Operating physicians sustained 56 cases of sharp
injuries (90.3%) and Scrub Nurses in six (9.7 %). Self-inflicted sharp
injuries in 49 (79 %) and in 12 cases (21%) injuries were inflicted by
the surgeons or their assistants. Left hand was injured in 39 cases
(63%) and right in 23 (37%). Cutaneous or mucosa membrane contamination
with blood or body fluid occurred in 232 cases (39.4 %). These were
made up of wet gown contamination in 124(53.5 %), glove failure in
72(31%) and splashing of blood or fluids into the face or eyes in 36
cases (15.5 %). Contamination occurred in more than one operating
personnel in more than half of the cases. Operating surgeons were
affected in 211 cases (91%). The risks of accidental injuries and blood
and body fluid contamination were significant, if the duration of the
operation was more than one hour, among the operating surgeons and if
the operation was major (p<0.05). Conclusion: This study has
demonstrated that cutaneous, percutaneous, and mucous membrane exposure
to patients blood and body fluids are common events during general
surgical operations. Most accidental injuries were due to solid suture
needle-sticks, mostly injured personnel were the primary operating
surgeons, injuries occurred predominantly on the left hand. This may
poses a significant risk of infection with blood borne pathogens when
operating on infected patients.
Arotiba JT, Odaibo GN, Fasola AO, Obiechina AE, Ajagbe HA, Olaleye
OD. Human immuno-deficiency virus (HIV) infection among oral surgery
patients at the University College Hospital, Ibadan, Nigeria. African
Journal of Medicine and Medical Science 2003;32(3):253-5.
ABSTRACT- The human immunodeficiency virus is a world-wide epidemic and
evidence abound that the infection is spreading rapidly in sub-Saharan
Africa with little or no control. Nosocomial transmission of HIV in the
Dental Surgery has been documented. This study was undertaken to
determine the prevalence of HIV among dental patients undergoing
extraction at the University College Hospital, Ibadan. Three hundred
patients requiring dental extraction at the dental clinic, UCH, Ibadan
who consented were enrolled for the study. Blood samples from these
individuals were tested for the presence of HIV antibodies using
commercially available ELISA (Monolisa Sanofi, Pasteur, France). All
initially reactive samples were confirmed by a commercial western
immunoblot assay (Bio-Rad Norapath HIV kit). A prevalence of 2.3%
(7/300) was obtained among individuals tested for this study. Four
(2.8%) of the 143 males and 3 (1.9%) of 157 females were positive for
HIV antibodies. All the seropositive patients except one were within
the age range 20-39 years and most of them (6 out of 7) do not use
condom during intercourse. More than half (57%) of the patients had
more than one sexual partner. This study shows that the risk of
transmitting HIV to DHCW during treatment is also a potential hazard in
this environment. Hence, adequate preventive measure should be observed
always.
Adebamowo CA, Ezeome ER, Ajuwon JA, Ogundiran TO. Survey of the
knowledge, attitude and practice of Nigerian surgery trainees to
HIV-infected persons and AIDS patients. BMC Surgery 2002;2:7.
ABSTRACT- Background: The incidence of HIV infection and AIDS is rising
in Nigeria. Surgeons are at risk of occupationally acquired infection
as a result of intimate contact with the blood and body fluids of
patients. This study set out to determine the knowledge, attitude and
risk perception of Nigerian surgery residents to HIV infection and
AIDS. Methods: A self-administered postal questionnaire was sent to all
surgery trainees in Nigeria in 1997. Results: Parenteral exposure to
patients' blood was reported as occurring 92.5% times, and most
respondents assessed their risk of becoming infected with HIV as being
moderate at 1-5%. The majority of the respondents were not aware of the
CDC guidelines on universal precautions against blood-borne pathogens.
Most support a policy of routinely testing all surgical patients for
HIV infection but 76.8% work in centers where there is no policy on
parenteral exposure to patients' blood and body fluids. Most (85.6%) do
not routinely use all the protective measures advocated for the
reduction of transmission of blood borne pathogens during surgery, with
the majority ascribing this to non-availability. Most want surgeons to
be the primary formulators of policy on HIV and surgery while not
completely excluding other stakeholders. Conclusions: The study
demonstrates the level of knowledge, attitude and practice of Nigerian
surgery trainees in 1997 and the need for policy guidelines to manage
all aspects of the healthcare worker (HCW), patients, and HIV/AIDS
interaction.
Ansa VO, Udoma EJ, Umoh MS, Anah MU. Occupational risk of infection
by human immunodeficiency and hepatitis B viruses among health workers
in south-eastern Nigeria. East African Medical Journal
2002;79(5):254-6.
ABSTRACT- Objective: To assess the occupational risk of infection by
human immunodeficiency virus (HIV) as well as hepatitis B virus (HBV)
among healthcare workers in south-eastern Nigeria. Design:
Cross-sectional study. Setting: Three tertiary health institutions in
south-eastern Nigeria. Subjects: Doctors, nurses, laboratory staff and
cleaners. Main outcome measures: Observation of the availability and
use of protective equipment and materials in the various departments of
the hospitals. Results: Materials and equipments needed for protective
and hygienic practices (adequate water supply, protective clothing and
availability of disinfectants) were inadequate in all hospitals. Where
available, they were found to be inconsistently used. Health workers in
the three institutions were thus constantly exposed unnecessarily to
blood and other body fluids which might be potentially infectious as
well as injury from used sharps. Conclusion: The risk of acquiring HIV
and HBV infections by health workers in this region of Nigeria in the
course of performing their duties is therefore still apparently high.
Though distinct viruses, they share similar mode of transmission and
risk factors. Use of personal protective equipment and adoption of
standard hygienic practices among health workers must be encouraged.
Supply of protective materials and equipment should be greatly
improved. It is recommended that reduction of occupational risks among
health workers using this approach should form part of control
strategies for both infections in the country.
Halim NK, Madukwe U, Saheeb BD, Airauhi LU. Hepatitis B surface
antigen and antibody to hepatitis C virus among accident and emergency
patients. East African Medical Journal 2001;78(9):480-3.
ABSTRACT- Objective: To determine the sero-prevalence and epidemiology
of antibody to hepatitis C virus (anti-HCV) and hepatitis B surface
antigen in accident and emergency patients. Design: A descriptive study
was performed on 150 accident and emergency patients. Sera was screened
for anti-HCV and HbsAg, using enzyme linked immunosorbent assay.
Personal information and risk factors involved were obtained using a
questionnaire. Setting: Haematology laboratory of the University of
Benin Teaching Hospital, Nigeria. Subjects: One hundred and fifty
adults consisting of 122 males and 28 females who were above the age of
21 years. Patients were randomly selected from all adults including
dental patients attending the emergency department for both surgical,
dental and medical emergencies. The age range was between 21-58 years.
In order to ascertain the epidemiology of both viruses a questionnaire
was used detailing the possible risk factors for transmission. These
included history of previous blood transfusion; history of life time
occurrence of multiple sexually transmitted diseases; history of
heterosexual exposure to partners at risk (for example prostitutes);
history involving the use of unsterilized blades; presence of
scarification marks and tattooing; low socio-economic status (low
annual income or unemployed): history of intravenous drug use and
heterosexual activity. Anti-HCV and HBsAg were both assayed using
different assay kits, based on the enzyme linked immuno absorbent assay
(ELISA) tests from different manufacturers. Results: The
sero-prevalence of anti-HCV was 14% and 29.3% for HBsAg. Anti-HCV
positivity was significantly associated with a past history of blood
transfusion and heterosexual exposure to partners at risk. The study
also revealed a significant association between HBsAg positivity and
all the risk factors. Conclusion: The high prevalence rate for anti-HCV
and HbsAg in accident and emergency patients increases the likelihood
of further spread from patients to health care providers especially if
adequate precautions are not observed.
Belo AC. Prevalence of hepatitis B virus markers in surgeons in
Lagos, Nigeria. East African Medical Journal 2000;77(5):283-5.
ABSTRACT- Objective: To determine the prevalence of hepatitis B virus
(HBV) markers in surgeons in a major city in Nigeria. DESIGN: A
cross-sectional, descriptive study. Setting: Three major hospitals in
Lagos, Nigeria. Subjects: One hundred and sixty seven surgeons (study
group) and 193 administrative staff (controls). Interventions: Blood
samples were taken from subjects and analysed for hepatitis B virus
markers (HBsAg, antiHBs and antiHBc) using the ELISA technique. Main
outcome measures: Hepatitis B virus marker sero-positivity. Results:
The prevalence of hepatitis B surface antigen (HBsAg) in the surgeons
was found to be 25.7% as compared to 15% in the control group (p=0.01).
The frequency of antibody to the surface antigen (antiHBs) was 22.2%
among the surgeons and 4.1% in the control group (p<0.001) and that
of antibody to the core antigen (antiHBc) was 61.7% in the surgeons as
compared to 53.4% in the control (p=0.11). At least one HBV marker was
found in 76.6% of the surgeons as compared to 57% in the control group
(p=0.0009). Conclusion: Health care workers should be immunised against
HBV. In Nigeria, HBV immunisation should be considered for inclusion in
the EPI.
Olubuyide IO, Ola SO, Aliyu B, Dosumu OO, Arotiba JT, Olaleye OA,
Odaibo GN, Odemuyiwa SO, Olawuyi F. Prevalence and epidemiological
characteristics of hepatitis B and C infections among doctors and
dentists in Nigeria. East African Medical Journal
1997;74(6):357-61.
ABSTRACT- A random sample of seventy five doctors and dentists at the
University College Hospital, Ibadan, Nigeria, was surveyed. They were
offered anonymous testing for hepatitis B surface antigen (HBsAg),
hepatitis B e antigen (HBeAg), antibodies to hepatitis B core antigen
(anti-HBc) and to hepatitis C virus (anti-HCV) by enzyme immunoassay.
The results suggest a high prevalence of hepatitis B virus (HBV) with a
high potential of transmissibility, as well as a high prevalence of HCV
infection. Most of the doctors and dentists use universal precaution
for protection against viral hepatitis less than 50% of the occasions
when they carry out procedures on their patients. Infection with HBV
was associated with type of specialty (surgeons and dentists) and lack
of HBV vaccination (p < 0.05). After logistic regression, these
factors were independently associated with HBV infection (p < 0.05).
Sixty (80%) of these health care workers had not received prior HBV
vaccination. The unvaccinated personnel were more likely to be
surgeons, dentists, less than 37 years of age and have fewer years of
professional activity (p < 0.05). After logistic regression, only
the fewer years of professional activity remained independently
associated with lack of vaccination (p < 0.05). We conclude that to
reduce the occupational exposure of HBV, universal precautions must be
rigorously adhered to when doctors and dentists carry out procedures on
their patients. It is necessary that these health care workers are
vaccinated with HBV vaccine and the currently anticipated HCV
vaccination, if not immune. No recent study exists that exclusively
addresses this problem in health care workers in tropical Africa.
Olubuyide IO. Doctors at risk of hepatitis B and HIV infection from
patients in Nigeria. J R Soc Health 1996;116(3):157-60.
ABSTRACT - The aim of this study was to assess the degree of residents'
concern about acquiring hepatitis B virus (HBV) and human
immunodeficiency virus (HIV) infection from their patients at the
University College Hospital, Ibadan, Nigeria. We surveyed 149 resident
doctors. The response was 89%. Nine per cent of the resident doctors
reported percutaneous exposures to needles contaminated with blood of
patients infected with HBV or HIV. Eighty per cent of the residents
experienced moderate to major concern about contracting these viral
infections from their patients. The majority of the doctors (54-64%)
indicated that they should be allowed to decide for themselves whether
to treat the infected patients. A substantial proportion of them
(46-49%) believed that refusing to take care of the patient was not
unethical. About 86-96% of the doctors believed that the hospital as
well as the Residency Training Programme administrators were not
concerned about the risk of acquiring the viruses from their patients.
In general, the results demonstrate a major degree of concern about
acquiring HBV and HIV infections among resident doctors. Moreover,
there is a need for the hospital and Residency Training Programme
administrators to formally address these concerns so as to motivate
well and reassure these doctors. No such study exists that exclusively
address this important and topical subject in doctors in tropical
Africa.
PIP: In Ibadan, Nigeria, 149 resident physicians completed a
questionnaire revolving around their degree of exposure to hepatitis B
virus (HBV) or HIV-infected patients, their concern about acquiring
these infections, and the effect of this concern on their caring for
patients and on the health policies of the University College Hospital.
9% had been stuck by a needle contaminated with the blood of an HBV- or
HIV-infected patient. The 12 residents reporting a needle stick had 21
needle-stick exposures altogether. 54% of the residents used universal
precautions while performing procedures no more than 50% of the time.
61-67% estimated their risk of acquiring these infections as no greater
than 1/10,000, which compares to the estimate found in the literature.
Yet 80% had moderate to high concern about acquiring HBV or HIV
infection from their patients. 32-34% of residents reported that their
concerns about acquiring these infections would not adversely affect
patient care. 60-77% of residents would continue to care for patients
with HBV or HIV infection if given a choice. 54-64% believed that they
should be allowed to decide themselves whether to provide care to
infected patients. About 50% did not consider it unethical to refuse to
care for infected patients. 86-96% thought that the hospital and the
residency training program administrators did not worry about the risk
of acquiring HBV or HIV infection from their patients. These findings
show that resident physicians are greatly concerned about acquiring HBV
and HIV infections. They also indicate a need for the hospital and
training program administrators to formally handle these concerns in
order to motivate and reassure the residents.
Adegboye AA, Moss GB, Soyinka F, Kreiss JK.The epidemiology of
needlestick and sharp instrument accidents in a Nigerian hospital.
Infection Control and Hospital Epidemiology 1994;15:27-31.
ABSTRACT- Objectives: To characterize the epidemiology of percutaneous
injuries of healthcare workers (HCWs) in Ile-Ife, Nigeria. Design: A
cross-sectional survey of a random sample of HCWs regarding details of
needlestick and sharp instrument injuries within the previous year.
Setting: University hospital and clinics in Ile-Ife, Nigeria.
Participants: Hospital personnel with potential occupational exposure
to patients' blood. Results: Needlestick accidents during the previous
year were reported by 27% of 474 HCWs, including 100% of dentists, 81%
of surgeons, 32% of nonsurgical physicians, and 31% of nursing staff.
The rate of needlestick injuries was 0.6 per person-year overall: 2.3
for dentists, 2.3 for surgeons, 0.4 for nonsurgical physicians, and 0.6
for nursing staff. Circumstances associated with needlestick injuries
included unexpected patient movement in 29%, handling or disposal of
used needles in 23%, needle recapping in 18%, accidental stick by a
colleague in 18%, and needle disassembly in 10%. Sharp instrument
injuries were reported by 15% of HCWs and most commonly involved broken
glass patient specimen containers (39%). Almost all HCWs were aware of
the potential risk of HIV transmission through percutaneous injuries,
and 91% considered themselves very concerned about their occupational
risk of HIV acquisition. Conclusions: The high frequency of
percutaneous exposure to blood among HCWs in this Nigerian hospital
potentially could be reduced by simple interventions at modest
cost.
Habimana P, Bulterys M, Usabuwera P, Chao A, Saah AJ. A survey of
occupational blood contact and HIV infection among traditional birth
attendants in Rwanda. AIDS 1994; 8:701-4.
ABSTRACT- Objective: To investigate the risk of occupationally acquired
HIV infection among traditional birth attendants (TBA) in Rwanda,
Africa. Design and methods: A survey was conducted among 219 TBA
practicing in a rural but densely populated area in southern Rwanda.
Each TBA was interviewed about sociodemographic information,
work-related habits and practices, and presence of nonoccupational risk
factors for HIV infection. The frequency of skin exposure to
HIV-infected blood was estimated for each TBA from HIV seroprevalence
data collected previously from pregnant women stratified by the
geographic zones in which the TBA practiced. Results: Four TBA (1.8%)
tested HIV-1-antibody-positive; all four had reported nonoccupational
risk factors for HIV infection. We estimated that the 215 HIV-negative
TBA had 2234 potentially infectious blood-skin contacts out of a total
of approximately 35,000 deliveries assisted in the past 5 years.
However, we found no evidence of HIV infection caused by occupational
blood contact (none out of 2234; upper limit of the 95% confidence
interval because of one potentially infectious blood-skin contact =
0.2%). Conclusion: Although these findings may not be universal to all
TBA in Africa, the risk of occupationally acquired HIV infection among
TBA appears small. The high frequency of blood-skin contact among TBA
in Rwanda highlights the need to include infection control precautions
in the training of TBA.
See above - Cote d'Ivoire.
Phillips EK, Pillay S, Goldberg P, Jagger J. Bloodborne
pathogen exposure risks among South African surgeons. South African
Gastroenterology Review 2011:9(1):6-9.
Abstract - Background: The operating room is a high-risk setting for
occupational sharps injuries and bloodborne pathogen exposure. In
Africa, where prevalence of bloodborne pathogens is often high and
resources are often low, the risks are especially high for surgeons.
This study systematically documents risk factors among South African
surgeons regarding bloodborne pathogen transmission during surgery.
Methods: A retrospective survey was conducted among surgeons attending
the ASSA biennial meeting. The survey results reflect patterns of risk
and availability and use of safety practices, garments and devices.
Results: Of 96 surgeons participating in the survey, 70% reported at
least one percutaneous injury during the previous year, with the
average rate of percutaneous injury 2.75 per year. Suture needles were
the most common source of injury (84%). More than half reported being
splashed by blood or body fluids, with an annual average of 3.5, most
often to the eyes. Sixty-nine percent reported complete HBV
vaccination, and HIV Post-Exposure Prophylaxis (PEP) was readily
available. Eyes were not sufficiently protected. Slightly more than
half reported using hands-free passing, and more than one-third
reported using blunt suture needles. Comparing surgeons who used a
combination of hands-free passing and blunt sutures and those who did
not revealed markedly different rates of injury. Conclusions: Risks of
blood exposure among South African surgeons are high. Wider adoption of
safe techniques, devices and personal protective equipment could reduce
the risks. Recommendations for injury prevention and safe practice that
can protect the health and lives of the surgical team are offered.
Briese T, Paweska JT, McMullan LK, Hutchison SK, Street C, Palacios
G, Khristova ML, Weyer J, Swanepoel R, Egholm M, Nichol ST, Lipkin WI.
Genetic detection and characterization of Lujo virus, a new hemorrhagic
fever-associated arenavirus from southern Africa. PLoS Pathog. 2009
May;5(5):e1000455. Epub 2009 May 29.
ABSTRACT - Lujo virus (LUJV), a new member of the family Arenaviridae
and the first hemorrhagic fever-associated arenavirus from the Old
World discovered in three decades, was isolated in South Africa during
an outbreak of human disease characterized by nosocomial transmission
and an unprecedented high case fatality rate of 80% (4/5 cases).
Unbiased pyrosequencing of RNA extracts from serum and tissues of
outbreak victims enabled identification and detailed phylogenetic
characterization within 72 hours of sample receipt. Full genome
analyses of LUJV showed it to be unique and branching off the ancestral
node of the Old World arenaviruses. The virus G1 glycoprotein sequence
was highly diverse and almost equidistant from that of other Old World
and New World arenaviruses, consistent with a potential distinctive
receptor tropism. LUJV is a novel, genetically distinct, highly
pathogenic arenavirus.
Paweska JT, Sewlall NH, Ksiazek TG, Blumberg LH, Hale MJ, Lipkin WI,
Weyer J, Nichol ST, Rollin PE, McMullan LK, Paddock CD, Briese T,
Mnyaluza J, Dinh TH, Mukonka V, Ching P, Duse A, Richards G, de Jong G,
Cohen C, Ikalafeng B, Mugero C, Asomugha C, Malotle MM, Nteo DM,
Misiani E, Swanepoel R, Zaki SR; Outbreak Control and Investigation
Teams. Nosocomial outbreak of novel arenavirus infection, southern
Africa. Emerging Infectious Diseases 2009 (Oct);15(10):1598-602.
SUMMARY - A nosocomial outbreak of disease involving 5 patients, 4 of
whom died, occurred in South Africa during September-October 2008. The
first patient had been transferred from Zambia to South Africa for
medical management. Three cases involved secondary spread of infection
from the first patient, and 1 was a tertiary infection. A novel
arenavirus was identified. The source of the first patient's infection
remains undetermined. [Note: The three secondary cases and the
tertiary case were all occupational infections of healthcare
workers.]
Kielkowski D, Wilson K, Vekinis D. Occupational health in health care facilities in South Africa: Where does infection control stop and occupational health start? [editorial] South African Medical Journal 2008 (Dec.);98(12):938-9.
Special Pathogens Unit and Epidemiology Division, National Institute
for Communicable Diseases. Arenavirus outbreak, South Africa.
Communicable Diseases Communiqué 2008 (Oct.);7(10):1-3.
SUMMARY - An outbreak of infection due to arenavirus was
identified in South Africa in early October 2008. The primary case was
a safari booking agent resident in Zambia who was flown to South Africa
in critical condition for medical treatment. Case 2 was a paramedic who
cared for case 1 during the transfer from Zambia. Case 3 was a nurse
who cared for case 1 in an intensive care unit. Case 4 was a
housekeeper who cleaned the room of case 1 shortly after he died. Case
5 was a nurse who cared for case 2 (the paramedic) after he became ill.
All cases except for case 5 were fatal. Infection with an Old
World arenavirus was confirmed in all 5 cases by positive PCR results
and virus isolation by SPU-NICD/NHLS and CDC. Testing indicated that
the virus associated with the outbreak was a distinct new member of the
Old World arenavirus family.
DeVilliers HC, Nel M, Prinsloo EAM. Occupational exposure to
bloodborne viruses amongst medical practitioners in Bloemfontein, South
Africa. South African Family Practice 2007;49(3):14.
ABSTRACT - Background: The possibility of occupational exposure to
bloodborne viruses such as HIV, hepatitis B virus (HBV) and hepatitis C
virus (HCV) is an everyday reality for healthcare workers. This study
reports on the extent and outcome of doctors' exposure to bloodborne
viruses in Bloemfontein. Methods: A descriptive study was done. Doctors
(n=441) actively involved in public and/or private medical practice
were requested to anonymously complete a questionnaire regarding
occupational exposure to bloodborne viruses (HIV, HBV and HCV).
Results: A response rate of 51.7% was obtained. More than half (54.2%,
95% CI [47.7%; 60.5%]) of the respondents were exposed to bloodborne
viruses. Of these cases, 48.3% occurred with HIV-positive patients and
4.3% with known HBV-positive patients. No cases involved positive HCV
patients. After the exposure had occurred, 68.9% of the patients were
tested for HIV, 10.9% for HBV and only 4.2% for HCV infection. The
frequency of serological testing for doctors immediately after exposure
was 65.3% for HIV, 21.7% for HBV and 8.2% for HCV. No seroconversion to
HIV or HCV was reported, while two seroconversions to HBV were
reported. Most of the exposures occurred as a result of needlestick
injury (85%), often in the operating theatre during procedures (59.3%).
The majority (59.8%) of exposed doctors did not take any prophylactic
treatment and those who did, did not always complete the treatment.
Conclusion: The risk of seroconversion to HIV after occupational
exposure was as expected, while seroconversion to HBV was less than
expected. The lack of adequate follow-up serological testing after
occupational exposure is alarming. It is the responsibility of the
occupationally exposed doctor to adequately comply with prophylactic
measures and undergo serological testing to ensure the least possible
risk of contracting infection from a bloodborne virus.
Mahomed O, Jinabhai CC, Taylor M, Yancey A. The preparedness of
emergency medical services against occupationally acquired communicable
diseases in the prehospital environment in South Africa. Emergency
Medicine Journal 2007;24:497-500.
ABSTRACT- Background: Emergency medical care is performed in an
uncontrolled environment and involves invasive procedures and life
support measures. The performance of these duties places emergency care
practitioners (ECPs) at risk of occupationally acquired injuries and
communicable diseases. Although legislative guidelines exist for the
protection of healthcare workers, little is known about the protective
measures available for and utilised by ECPs in the pre-hospital
environment in South Africa. Objectives: To review the availability and
implementation of emergency medical services (EMS)-specific infection
control policies and standard operating procedures in the pre-hospital
environment. Methods: Interviews with key informants were used to
collect data concerning policies on communicable diseases and infection
control in the EMS, the operational aspects of these policies, and
educational programmes on communicable diseases and infection control
for ECPs. Results: There is no national policy on communicable diseases
and infection control in EMS. Only KwaZulu-Natal, Eastern Cape and
Gauteng have EMS-specific standard operating procedures for
communicable diseases and infection control. Formal education and
in-service training is limited. Conclusions: A national communicable
disease and infection control policy specific to the EMS needs to be
developed together with an accredited training module on communicable
diseases and infection control for EMS in the pre-hospital
environment.
Nemutandani MS, Yengopal V, Rudolph MJ, Tsotsi NM. Occupational
exposures among dental assistants in public health care facilities,
Limpopo Province. SADJ: Journal of the South African Dental Association
2007;62:348,352-5.
ABSTRACT- The risk of dental assistants acquiring injury and infections
from the dental clinics has received little attention, especially in
South Africa. OBJECTIVES: To determine the prevalence of occupational
exposures among dental assistants working in public health care
facilities in Limpopo Province. METHODS: A cross-section study on
infection control practice and occupational exposures was conducted
among 73 dental assistants. RESULTS: The sample was predominantly
female (95%) with a mean age of 40.2 years (age range 23-54 years).
Almost half the respondents (49.1%) had no formal training for their
occupation, 22% were nursing assistants and only 10.2% had qualified at
a technical college (Technicon). The mean number of clinicians assisted
by each participant was 3.8 (SD +/- 1.9). Nearly half of the dental
assistants (n = 26) reported an occupational exposure, half of which in
turn occurred while handling instruments and 42.3% while assisting. The
most common type of injury was a direct puncture (65.3%). Treatment
included antiretroviral therapy (19.2%) and wound-cleaning (38.4%),
while 42.3% reported that they had had no treatment at all. About 23%
of incidents were not reported. Eighty percent changed gloves routinely
between patients but 67% did not use protective eye glasses; 62.7% were
not vaccinated against HBV. CONCLUSION: Occupational exposure was found
to be unacceptably high and compliance of infection control guidelines
was low.
Mosweu E, Sebitloane HM, Moodley J. Occupational exposure to HIV
amongst health care workers in the maternity unit at King Edward VIII
hospital, Durban, South Africa. Obstetrics & Gynaecology Forum
2005;15:5-7.
ABSTRACT- The increasing HIV sero-prevalence amongst pregnant women
places health care workers in busy labour wards at high risk of
occupational exposure to HIV. Aim: The aim of this study was to
determine whether there has been a change in the prevalence of
needle-stick and sharps injuries at King Edward VIII Hospital, Durban,
South Africa, since the first study done on the issue in 1999, and if
so - the reasons. Design: A cross-sectional retrospective survey
assessing the prevalence of needle-stick and sharps injuries which
occurred from January 2003 to December 2003. Setting: The study was
conducted at the Department of Obstetrics and Gynaecology, King Edward
VIII Hospital, Durban, South Africa. Method: Staff members in the
labour ward, including doctors, nurses, student nurses, and supportive
staff, i.e. cleaners, porters, and messengers were interviewed and
asked to fill in a structured questionnaire. Results: Healthcare
workers (114) were interviewed over a period of 1 year, from January to
December 2003. 49 of the 90 (54%) who agreed to participate reported an
incident of exposure to patients' body fluids, 19 of who were through
sharp injuries (21%); forty percent of exposures occurred with known
HIV infected patients, whereas at least 28% of patients sero-status was
unknown at the time of the exposure. Only 61% of the sharps injuries
were reported, and of these, only a third of the health workers
completed the prescribed 4 week course of prophylactic antiretroviral
treatment. Conclusion: This study showed an increase in the number of
HIV exposures amongst health workers, and most of these are as a result
of lack of adherence with preventative measures. Improved reporting
mechanisms which ensure confidentiality may assist health workers to
deal with this.
Rabbits JA. Occupational exposure to blood in medical students.
South Africa Medical Journal 2003;93(8):617-20.
ABSTRACT- Objective: To determine the extent of occupational exposure
to blood in medical students, details of the circumstances surrounding
the incidents and the subsequent experiences of the student. Design:
Prospective cohort study. Setting: Tygerberg Hospital, the Health
Sciences Faculty of the University of Stellenbosch during a 15-week
period from 4 February to 19 May 2002. Subjects: One hundred and
thirty-six student interns (Sis), i.e. final year medical students.
Method: All Sis received a questionnaire and a letter motivating them
to participate in the study and explaining the procedure. Regular class
meetings enabled continuous motivation and ongoing updates. In the case
of an incident during the 15-week period, the SI filled in the form and
placed it in a sealed drop-off box. Outcome measures: Specific focus on
the preceding events and the situation in which the incidents occurred
(department, time of day, procedure performed, and whether the student
was on call), exposure to HIV (patient's retroviral status), use of
post-exposure prophylaxis (PEP) (whether used, when initiated), and the
consequences of the exposure (emotional, on sexual behaviour during the
window period, and on career choice). Results: During the 15-week
period, 19 incidents were reported; the majority occurred while
students were on call, almost half occurred after hours, and a
disproportionate number occurred in three departments. Conclusions:
Occupational blood exposure is a very real problem and poses a
significant risk. SI suggestions should be considered in improving the
prevention and management of such incidents.
Karstaedt AS, Pantanowitz L. Occupational exposure of interns to
blood in an area of high HIV seroprevalence. South African Medical
Journal 2001;91:57-61.
ABSTRACT- Objective: To determine the epidemiology of work-related
exposure to blood among interns. Design: Interns were invited to
complete anonymously a questionnaire concerning their past percutaneous
and mucocutaneous exposures to blood. Setting: Chris Hani Baragwanath
Hospital, Soweto, and Johannesburg Hospital, Gauteng, where HIV
infection is common among patients. Results: Ninety-eight interns (96%)
were surveyed. Sixty-nine per cent of interns reported one or more
percutaneous exposures to blood during the intern year, and 33% of
interns recalled accidental percutaneous exposure to HIV-infected
blood. Forty-five per cent recalled a mucocutaneous exposure to
HIV-positive blood. Only 28 (64%) of 44 percutaneous injuries from
HIV-infected patients were reported. During their student clinical
training, 56% of interns had suffered a penetrating injury, and 18%
recollected needlestick injuries involving HIV-infected patients. The
most common mechanisms of injury included unexpected patient movement
(23%), needle recapping (17%), and withdrawal of the needle (17%). Half
of the injuries occurred during the first 4 months of internship. Only
22% of intern percutaneous exposures could have been avoided by
following universal precautions. Conclusions: Intern and medical
student exposure to blood is extremely common, but is markedly
underreported. Strict compliance with universal precautions will not
prevent the majority of exposures. Priorities should be the
introduction of safer techniques and equipment, skills training and
methods of reporting blood exposures.
Gounden YP, Moodley J. Exposure to human immunodeficiency virus
among healthcare workers in South Africa. International Journal of
Gynaecology and Obstetrics 2000;69(3):265-70.
ABSTRACT- There have been no reports in the literature on occupational
hazards of HIV in developing countries. The aim of this study was to
evaluate occupational exposure to HIV in healthcare workers in Durban,
South Africa. Individuals with occupational exposure to HIV were
interviewed. 13% of the staff reported injuries with HIV positive
patients. Registrars in training were the highest risk group (60%). Of
the injuries, 94% were percutaneous and 65% occurred during emergency
surgery. The commonest place of injury was the operating theater (46%)
and the commonest procedure associated with accidental exposure was
cesarean section (57%). 51% were not wearing eye protection during
procedures and although 83% initiated post-exposure prophylaxis, 48%
discontinued treatment due to side effects of the drugs. Occupational
exposure to HIV is common in the developing world. Rectifiable factors
identified in this study that contributes to the milieu of occupational
acquisition of HIV include less than proper adherence to universal
precaution; inadequate documentation procedures and failure of a large
percentage of respondents to complete post-exposure prophylaxis.
Bakry SH, Mustafa AF, Eldalo AS, Yousif MA. Knowledge, attitude and
practice of health care workers toward Hepatitis B virus infection,
Sudan. Int J Risk Saf Med. 2012 Jan 1;24(2):95-102.
Abstract - Objective: This study was set out to assess health care
providers' knowledge, attitude and practice towards hepatitis B virus
infection (HBV). Methods: A cross sectional study was carried out, in
four public hospitals in Wad Medani, Sudan. Anonymous pre-tested
questionnaire was completed by 295 different health care providers. The
response rate was 100%. Results: The study revealed that, 97.2% of
doctors, 98.6% of nurses, 94.8% of laboratory technicians and 95.7% of
other paramedical knew that HBV transmitted via blood. For hygienic
precautionary measure; the current study disclosed that (81%) of the
responding providers were routinely used to recap needles after use and
only (33%) of doctors were always wearing gloves. Gloves were not
readily available in all units where there is a high risk of infectious
occupational exposure. More than 50% (p < 0.001) of health care
workers were not vaccinated against HBV. Healthcare workers had poor
knowledge about Universal Standard Precautions Guidelines, and do not
fully appreciate their occupational risk regarding hepatitis B
infection. Set of recommendations was proposed for formulation and
implementation of standard precautions guidelines.
Manyele SV, Anicetus H. Management of medical waste in Tanzanian
hospitals. Tanzania Health Research Bulletin 2006;8:177-82.
ABSTRACT- A survey was conducted to study the existing medical waste
management (MWM) systems in Tanzanian hospitals during a nationwide
health-care waste management-training programme conducted from 2003 to
2005. The aim of the programme was to enable health workers to
establish MWM systems in their health facilities aimed at improving
infection prevention and control and occupational health aspects.
During the training sessions, a questionnaire was prepared and
circulated to collect information on the MWM practices existing in
hospitals in eight regions of the Tanzania. The analysis showed that
increased population and poor MWM systems as well as expanded use of
disposables were the main reasons for increased medical wastes in
hospitals. The main disposal methods comprised of open pit burning
(50%) and burying (30%) of the waste. A large proportion (71%) of the
hospitals used dust bins for transporting waste from generation points
to incinerator without plastic bags. Most hospitals had low
incineration capacity, with few of them having fire brick incinerators.
Most of the respondents preferred on-site versus off-site waste
incineration. Some hospitals were using untrained casual labourers in
medical waste management and general cleanliness. The knowledge level
in MWM issues was low among the health workers. It is concluded that
hospital waste management in Tanzania is poor. There is need for proper
training and management regarding awareness and practices of medical
waste management to cover all carders of health workers in the
country.
Gumodoka B, Favot I, Berege ZA, Dolmans WM. Occupational exposure to
the risk of HIV infection among health care workers in Mwanza Region,
United Republic of Tanzania. Bulletin of the World Health Organization
1997;75:133-40.
ABSTRACT- During 1993, we collected data on knowledge of human
immunodeficiency virus (HIV) transmission, availability of equipment,
protective practices and the occurrence of prick and splash incidents
in nine hospitals in the Mwanza Region in the north-west of the United
Republic of Tanzania. Such incidents were common, with the average
health worker being pricked five times and being splashed nine times
per year. The annual occupational risk of HIV transmission was
estimated at 0.27% for health workers. Among surgeons, the risk was
0.7% (i.e. more than twice as high) if no special protective measures
were taken. Health workers' knowledge and personal protective practices
must therefore be improved and the supply of protective equipment
supported. Reduction of occupational risk of HIV infection among health
workers should be an integral part of acquired immunodeficiency
syndrome (AIDS) control strategies.
Odongkara BM, Mulongo G, Mwetwale C, Akasiima A, Muchunguzi HV,
Mukasa S, Turinawe KV, Adong JO, Katende J. Prevalence of occupational
exposure to HIV among health workers in Northern Uganda. Int J Risk Saf
Med 2012 Jan 1;24(2):103-13.
Abstract - Background: The prevalence of HIV in Gulu district is 10.3%.
This poses a high risk of occupational exposure and transmission to
health workers in hospitals attending to these patients. The risk of
HIV transmission from a patient to a health worker has been shown to be
between 0.3% and 0.09% following percutaneous and mucocutaneous
exposure respectively. Objectives: This research aimed at determining
the prevalence of occupational exposure to HIV. Method: A cross
sectional study of health workers in Gulu Regional Referral Hospital
and St. Mary's Hospital Lacor, in northern Uganda was conducted to
establish the frequency of occupational exposures to human
immunodeficiency virus (HIV)-infected body fluids. Results: 108 (46%)
respondents were found to have been exposed to potentially infectious
body fluids. Needle stick injuries was the commonest route of exposure,
with a prevalence of 27.7%, followed by mucosal exposure 19.1%, contact
with broken skin (5.5%) and lastly by a cut with sharp objects (5.1%).
There is therefore need for more sensitization of health workers on
infection control and post exposure prophylaxis for health workers.
Brakaa F, Nanyunjaa M, Makumbib I, Mbabazia W, Kasasac S, Lewisa RF.
Hepatitis B infection among health workers in Uganda: Evidence of the
need for health worker protection. Vaccine 2006;24:6930-7.
ABSTRACT- Hepatitis B exposure was assessed in 311 health workers in
Uganda, a highly endemic country. Health workers were selected by
random sampling from a categorized list of health workers at district
level, proportionate to the population of each district. Whereas 60.1%
of health workers have evidence of hepatitis B infection, with 8.7%
being chronic carriers and one (0.3%) acutely infected, 36.3% are still
susceptible and could benefit from vaccination. Only 5.1% reported
having had at least one dose of hepatitis B vaccine and 3.5% were
apparently immune through vaccination. Needle stick injuries reported
by 77% of health workers were the most common mode of exposure to blood
and body fluids. Trends suggested duration of service as a predictor
while age and history of blood transfusion remained significant
independent risk factors for hepatitis B infection. 98% of health
workers are willing to be vaccinated. These results confirm the need
for protection and vaccination of health workers in Uganda against
hepatitis B.
Nsubuga FM, Jaakkola MS. Needle stick injuries among nurses in
sub-Saharan Africa. Tropical Medicine and International Health
2005;10(8):773-81. [Data is from one hospital in Kampala, Uganda]
ABSTRACT- Objectives: Despite a heavy burden of HIV/AIDS and other
blood borne infections, few studies have investigated needle stick
injuries in sub-Saharan Africa. We conducted a cross-sectional study at
Mulago national referral hospital in Kampala, Uganda, to assess the
occurrence and risk factors of needle stick injuries among nurses and
midwives. Methods: A total of 526 nurses and midwives involved in the
direct day-to-day management of patients answered a questionnaire
inquiring about occurrence of needle stick injuries and about potential
predictors, including work experience, work load, working habits,
training, and risk behaviour. Results: A 57% of the nurses and midwives
had experienced at least one needle stick injury in the last year. Only
18% had not experienced any such injury in their entire career. The
rate of needle stick injuries was 4.2 per person-year. Multiple
logistic regression analysis showed that the most important risk factor
for needle stick injuries was lack of training on such injuries (OR
5.72, 95% CI 3.41-9.62). Other important risk factors included working
for more than 40 h/week (OR 1.90, 95% CI 1.20-3.31), recapping needles
most of the time (OR 1.78, 95% CI 1.11-2.86), and not using gloves when
handling needles (OR 1.91, 95% CI 1.10-3.32). Conclusions: The study
showed a high rate of needle stick injuries among nurses and midwives
working in Uganda. The strongest predictor for needle stick injuries
was lack of training. Other important risk factors were related to long
working hours, working habits, and experience.
Newsom DH, Kiwanuka JP. Needle-stick injuries in a Ugandan teaching
hospital. Annals of Tropical Medicine and Parasitology
2002;96:517-22.
ABSTRACT- The on-going HIV epidemic has generally increased fear of
needle-stick injuries (NSI) and renewed interest in the problem such
injuries pose in Africa. The aims of the present study were to evaluate
the frequency of NSI, explore the circumstances surrounding each injury
and estimate the corresponding infection risk, among healthcare workers
(HCW) in Uganda. Questionnaires, asking the recipients how many NSI
they had suffered in the past year, how each of these NSI had occurred,
what (perceived) risk of infection was associated with each injury, and
what their practical and psychological reactions were, were sent to the
HCW associated with the Mbarara Teaching Hospital in Uganda. Of the 280
individuals who received questionnaires, 180 (64%) responded and 100
(55% of the respondents) each reported suffering at least one NSI in
the previous year. The total number of NSI reported (336) represented
an incidence of 1.86 NSI/HCW-year. Interns suffered more NSI (annual
mean=4.8) than any other occupational group. Most NSI occurred when
patients moved during procedures, when HCW re-sheathed needles, or
during suturing (each reported by 55 HCW--30% of those responding).
Following NSI, 60 HCW said they squeezed the site of the injury and
washed it with bleach, 43 believed they had a 10% risk of HIV
infection, 87 felt anxious, 54 felt depressed, 40 prayed, 24 had an HIV
test, and four were counselled. To estimate actual infection risk, 435
patients were screened for antibody to HIV (1 and 2) and for the
surface antigen of the hepatitis B virus (HBSAg); 26% and 2.8% were
found seropositive, respectively. These seroprevalences were multiplied
by previously determined probabilities of transmission to give
estimated risks of infection (following a single NSI) of 0.08% for HIV
and 0.135% for hepatitis B. During 3 years of training as a clinician
(i.e. 2 years as a medical student and 1 year as an intern), more than
six in 1000 individuals would be infected with HIV as a result of NSI
and almost 10 in 1000 would be infected with hepatitis B virus by the
same route. NSI are common, preventable sources of infection and stress
for HCW in Africa.
Kanyama I, Mmiro F, Mirembe F, Kaona F, Bagenda D, Siziya S. Risk of
occupational exposure to HIV among nurse-midwives and traditional birth
attendants. International Conference on AIDS 1993 Jun 6-11;9:93
(abstract no. WS-C12-2).
ABSTRACT- Objectives: To compare the prevalence of HIV infection among
nurse-midwives (NMs), other professional women including hospital
nurses (HNs), office workers and teachers (OW/Ts) in the same
communities; to compare the prevalence of HIV infection among
traditional birth attendants (TBAs) and other women (VLs) in the same
villages; and to identify risk behaviours and/or practices that may be
associated with HIV infection. Methods: A cross sectional study was
done in Uganda and Zambia among NMs and HNs, OW/Ts; among TBAs and
age-matched VLs. Socio-demographic data, information on sex behaviour,
hospital/traditional practices including skin-piercing injuries, was
obtained. Results: Preliminary results at one centre show an HIV
seroprevalence significantly higher among the NMs than the HNs (21% vs
12%, p = 0.005) but similar to the OW/T (21% vs 18%). HIV
seroprevalence among TBAs and VLs were similar (5% vs 8%). Final
results and correlation of HIV infection with practices and risk
factors will be presented.
N'Galy B, Ryder RW, Bila K, Mwandagalirwa K, Colebunders RL, Francis
H, Mann JM, Quinn TC. Human immunodeficiency virus infection among
employees in an African hospital [Zaire]. New England Journal of
Medicine 1988;319(17):1123-7.
ABSTRACT- To define the prevalence and course of human immunodeficiency
virus (HIV) infection, we examined prospectively a cohort of 2002 adult
hospital workers in Kinshasa, Zaire. From 1984 to 1986 the prevalence
of HIV infection increased from 6.4 percent to 8.7 percent. Over the
two years there was a cumulative incidence of new HIV infection of 3.2
percent. The prevalence was higher among women (16.9 percent) and men
(9.3 percent) under the age of 30 than among women (9.0 percent) and
men (6.2 percent) over 30. Prevalence rates were similar among
physicians (5.6 percent), laboratory workers (2.9 percent), and
clerical workers (7.9 percent), but they were higher among female
nurses (11.4 percent) and manual workers (11.8 percent). Despite marked
differences in the intensity of nosocomial exposure, female nurses had
similar infection rates on the female internal medicine ward (9.9
percent), in pediatrics (10.8 percent), and in the delivery room (10.7
percent). The attributable risk of HIV infection from a transfusion was
5.9 percent. Neither medical injections nor scarification was a risk
factor for HIV infection. Of the 101 seropositive asymptomatic
employees in the 1984 survey, 16 percent had AIDS-related complex, 3
percent had AIDS, and 12 percent had died of AIDS by 1986. Previous
studies have revealed a seroprevalence of 8.4 percent among women
attending an antenatal clinic near the hospital in 1984 and 1986, and
of 5.8 percent (in 1984) and 6.5 percent (in 1986) among men donating
blood at the hospital's blood bank. We conclude that there is a
continuing high prevalence of HIV infection among hospital workers in
Kinshasa, Zaire, which appears to be representative of that in the
community and not nosocomial.
Mann JM, Francis H, Quinn TC, Bila K, Asila PK, Bosenge N et al. HIV
seroprevalence among hospital workers in Kinshasa, Zaire. Lack of
association with occupational exposure. Journal of the American Medical
Association 1986;256(22):3099-102.
ABSTRACT- A study of seroprevalence of the human immunodeficiency virus
involving 2384 (96%) of Mama Yemo Hospital's (Kinshasa, Zaire) 2492
personnel found 152 (6.4%) to be seropositive. Prevalence was higher
among women than among men (8.1% vs 5.2%); in women peak seroprevalence
(13.9%) occurred in 20- to 29-year-olds. Workers most likely to be
seropositive were those who were relatively young, those who were
unmarried, those reporting a blood transfusion or hospitalization
during the previous ten years, and those receiving medical injections
during the previous three years. Medical, administrative, and manual
workers had similar seroprevalence (6.5%, 6.4%, and 6.0%,
respectively), and seropositivity was not associated with any measure
of patient, blood, or needle contact. These findings are consistent
with other hospital-based studies indicating low risks for occupational
transmission of human immunodeficiency virus.
Phillips EK, Simwale OJ, Chung MJ, Parker G, Perry J, Jagger JC.
Risk of bloodborne pathogen exposure among Zambian healthcare workers.
J Infect Public Health. 2012 Jun;5(3):244-9. Epub 2012 Apr 12.
Abstract - PURPOSE: Understanding the risks of bloodborne pathogen
transmission is fundamental to prioritizing interventions when
resources are limited. This study investigated the risks to healthcare
workers in Zambia. DESIGN: A survey was completed anonymously by a
convenience sample of workers in three hospitals and two clinics in
Zambia. Respondents provided information regarding job category,
injuries with contaminated sharps, hepatitis B vaccination status and
the availability of HIV post-exposure prophylaxis (PEP). RESULTS:
Nurses reported the largest number of injuries. The average annual
sharps injury rate was 1.3 injuries per worker, and service workers
(housekeepers, laundry, ward assistants) had the highest rate of these
injuries, 1.9 per year. Injuries were often related to inadequate
disposal methods. Syringe needles accounted for the largest proportion
of injuries (60%), and 15% of these injuries were related to procedures
with a higher-than-average risk for infection. Most workers (88%)
reported the availability of PEP, and only 8% were fully vaccinated
against hepatitis B. CONCLUSIONS: The injury risks identified among
Zambian workers are serious and are exacerbated by the high prevalence
of bloodborne pathogens in the population. This suggests that there is
a high risk of occupationally acquired bloodborne pathogen infection.
The findings also highlight the need for a hepatitis B vaccination
program focused on healthcare workers. The risks associated with
bloodborne pathogens threaten to further diminish an already scarce
resource in Zambia - trained healthcare workers. To decrease these
risks, we suggest the use of low-cost disposal alternatives, the
implementation of cost-sensitive protective strategies and the
re-allocation of some treatment resources to primary prevention.
Consten EC, van Lanschot JJ, Henny PC, Tinnemans JG, van der Meer JT. A
prospective study on the risk of exposure to HIV during surgery in
Zambia. AIDS 1995; 9(6):585-8.
ABSTRACT- Objective: To investigate the relative risk of occupational
HIV transmission for surgeons practising in tropical Africa compared
with their western colleagues. Design and setting: From June to
November 1993, a prospective study was performed at St Francis'
Hospital, Katete, Zambia (350-bed hospital which serves a community of
300,000 people). Methods: The HIV seroprevalence among consecutive
surgical patients and the incidence of occupational parenteral
exposures to blood during surgery were prospectively studied in a
Zambian district hospital. HIV seroprevalence was determined by taking
blood from the surgical patients on admission into the operating
theatre. Serum was stored at -20 degrees C and transported to the
Academic Medical Centre of the University of Amsterdam, where the
presence of HIV antibodies was tested by enzyme immunoassay and
seropositive samples confirmed by Western blot. Number of parenteral
exposures during the study period was scored by interviewing the seven
surgeons and their personnel after each surgical procedure about
accidental parenteral exposures to blood. The total number of
parenteral exposures per surgeon per year was obtained by
extrapolation. The cumulated risk of seroconversion due to parenteral
blood exposure can be calculated as: 1-(1-fp)ny, where f is the
population seroprevalence, p the chance of transmission per incident
(estimated to be 0.46%), n the number of parenteral exposures per year
and y the years of practice. Results: HIV seroprevalence in the
surgical patient group was 22.3%. Twelve parenteral exposures to blood
(surgeons, n = 8; other personnel, n = 4) took place in 1161
operations. Number of parenteral exposures per surgeon was extrapolated
to three per year. The non-dominant index finger was exposed in 10 out
of the 12 parenteral exposures. Based on these data, the risk of
contracting HIV infection for a surgeon practising in Zambia for 5
years is 1.5%. The risk for a surgeon working in a western hospital
when f = 0.23%, n = 20 per year (5.6% of 350 operations) and y = 5 is
estimated at 0.1%. Conclusions: Although occupational exposure rate was
relatively low, the HIV seroprevalence was so high that the relative
cumulated seroconversion risk for surgeons in tropical Africa is
estimated to be 15 times higher than in western countries. This implies
that health-care organizations should bear in mind that each year one
out of 300 employees working in tropical Africa may become
occupationally infected with HIV.
Watters DAK. Surgery, surgical pathology and HIV infection: lessons
learned in Zambia. Papua New Guinea Medical Journal
1994;37:29-39.
ABSTRACT- In Zambia, 10-15% of urban adults are reported HIV positive,
as are over 80% of prostitutes. The HIV seroprevalence rate in a Lusaka
hospital's intensive care unit was 21% (27% for surgical and 18% for
trauma admissions). HIV-infected patients could be clinically
recognized by risk factors or symptoms and signs: weight loss, chronic
cough, chronic diarrhea, sepsis, septic arthritis, subacute
hematogenous osteomyelitis, a history of sexually transmitted diseases
(STDs), death of a spouse or of a child under age 2, recent pregnancy
unable to go to term, poor quality or thin hair, appearance of aging
beyond years, mental slowness, persistent or unexplained fever,
lymphadenopathy, aggressive atypical Kaposi's sarcoma, oral thrush,
hairy leukoplakia of the tongue, shingles scars, and scars of
maculopapular dermatitis. Common sites for HIV-related sepsis are the
female genital tract, anorectum, pleural cavity, soft tissues (e.g.,
necrotizing fascitis), and bone and joints. Autologous blood
transfusion and use of donor blood screened for HIV antibodies,
preferably limited to emergencies, would reduce the likelihood of
iatrogenic HIV transmission. Surgeons should wear two pairs of gloves,
a waterproof gown, and goggles to protect themselves from HIV
transmission. If they have skin rashes, cuts, or abrasions on the hands
or arms, they should not perform operations. Proper cleaning and
disinfection of endoscopes are required. The risk of infection from a
needle stick is small (< 0.4%).
Kanyama I, Mmiro F, Mirembe F, Kaona F, Bagenda D, Siziya S. Risk of
occupational exposure to HIV among nurse-midwives and traditional birth
attendants. International Conference on AIDS 1993 Jun 6-11;9:93
(abstract no. WS-C12-2).
ABSTRACT- Objectives: To compare the prevalence of HIV infection among
nurse-midwives (NMs), other professional women including hospital
nurses (HNs), office workers and teachers (OW/Ts) in the same
communities; to compare the prevalence of HIV infection among
traditional birth attendants (TBAs) and other women (VLs) in the same
villages; and to identify risk behaviours and/or practices that may be
associated with HIV infection. Methods: A cross sectional study was
done in Uganda and Zambia among NMs and HNs, OW/Ts; among TBAs and
age-matched VLs. Socio-demographic data, information on sex behaviour,
hospital/traditional practices including skin-piercing injuries, was
obtained. Results: Preliminary results at one centre show an HIV
seroprevalence significantly higher among the NMs than the HNs (21% vs
12%, p = 0.005) but similar to the OW/T (21% vs 18%). HIV
seroprevalence among TBAs and VLs were similar (5% vs 8%). Final
results and correlation of HIV infection with practices and risk
factors will be presented.
De Baets AJ, Sifovo S, Pazvakavambwa IE. Access to occupational
postexposure prophylaxis for primary health care workers in rural
Africa: a cross-sectional study. American Journal of Infection Control
2007;35:545-51.
ABSTRACT- Background: For many primary health care workers in
developing countries, the limited availability and cost of public
transport hinders timely access to occupational postexposure
prophylaxis (PEP) at referral hospitals. Adapted PEP training and a
starter's kit (for human immunodeficiency virus, hepatitis B virus, and
syphilis prophylaxis) could improve access. Methods: The evaluation
method, based on the 12 steps of the decentralized phase of PEP
management, calculated different scores from the responses for 51
anonymous surveys and allowed comparison among different groups. Listed
obstacles and clinic visits provided further information. Results:
Respondents who received in-service PEP training had significantly
higher mean knowledge and confidence scores but no different mean
attitude scores than those who did not. The mean total score for those
who received the adapted PEP training (10.7 of 12) was significantly
higher (P = .008) than for those who did not (8.8 of 12). Conclusion:
Decentralizing the first phase of PEP management for primary health
care workers in rural Zimbabwe attends to an unmet need. The evaluation
facilitates checking completeness of course contents, stresses the need
to pay equal attention to attitudes toward the referral and reporting
system, and identifies specific challenges for delivering PEP in rural
settings. The finding may inspire to improve access to PEP for other
health care workers and phlebotomists employed in remote areas.
