Occupational Hazards among Healthcare Workers in Africa: A Systematic Review

Abstract

Background: While all healthcare workers are exposed to occupational hazards, workers in sub-Saharan Africa have higher rates of occupational exposure to infectious diseases than workers in developed countries. Identifying prevalence and context of exposure to blood and bloodborne pathogens may help guide policies for prevention. Objective: This systematic review examined occupational exposure rates to blood and bloodborne pathogen among healthcare workers in sub-Saharan Africa. Methods: In November 2017, a comprehensive literature search was conducted to identify studies reporting exposure of health workers in African coutnries to blood and bodily fluids. Title, abstract and full text screening were used to narrow our search. Studies more than 10 years old, or published in non-English languages were excluded. Findings: Fifteen studies reported a variety of exposures. The lifetime prevalence of needlestick injury ranged from 22–95%, and one-year prevalence ranged from 39–91%. Studies included a range of descriptive statistics of knowledge, attitudes, practice and access factors related to exposures. Two studies reported 21–32% of respondents linked poor knowledge or training with prevention of needlestick injuries. Rates of recapping needles ranged from 12–57% in four studies. Attitudes were generally positive toward occupational safety procedures while access was poor. Conclusions: The high burden of blood and bloodborne pathogen exposures demonstrated here indicates a high risk for contracting bloodborne illnesses. Although the data are sparse, implementation of preventative policies based on current knowledge remains critical to minimize risk and reduce exposure. There remains a pressing need for high quality data on occupational hazards to identify the burden of exposures and inform preventive policies in Sub-Saharan Africa. Additional studies are needed to determine whether differential exposures exist between professions and the associations with knowledge, attitudes, practices, and access factors to create targeted strategies to diminish occupational hazards.

Occupational exposure to HIV among healthcare workers in PMTCT sites in Port Harcourt, Nigeria

“…The findings where a quarter of our study participants received no training on prevention of occupational exposure and almost all the participants wished to be trained on infection prevention and control is worrisome. These findings on deficient training on infection prevention are comparable to outcomes from similar studies in sub Saharan Africa [21]. The display of infection prevention and patient safety signs in health facilities are critical to attitudes of healthcare workers towards infection prevention and patient safety practices.…”

“…Other important risk factors to occupational exposures which were also found in this study and that could influence the experience of healthcare workers occupational exposure to HIV infection are lack of training on infection prevention and patient safety, unavailability and/or irregular supply of personal protective equipment, and inadequate post-exposure prophylaxis and shortages of personnel to administer post-exposure prophylaxis. The existence of poor infection prevention modalities exposes healthcare workers to HIV infection in PMTCT setting [21]. PMTCT sites at all times ought to function with the highest levels of infection prevention and control, given their nature as a specialized site where healthcare workers care for confirmed HIV positive patients and are at higher risk of contracting HIV compared to health workers in other non-HIV special-care health facilities either private or public.…”

Occupational exposure to HIV among healthcare workers in PMTCT sites in Port Harcourt, Nigeria

“…These findings on deficient training on infection prevention are comparable to outcomes from similar studies in sub Saharan Africa [20]. The display of infection prevention and patient safety signs in health facilities are critical to attitudes of healthcare workers towards infection prevention and patient safety practices.…”

“…Other important risk factors to occupational exposures which were also found in this study and that could influence the experience of healthcare workers occupational exposure to HIV infection are lack of training on infection prevention and patient safety, unavailability and/or irregular supply of personal protective equipment, and inadequate post-exposure prophylaxis and shortages of personnel to administer post-exposure prophylaxis. The existence of poor infection prevention modalities exposes healthcare workers to HIV infection in PMTCT setting [20]. PMTCT sites at all times ought to function with the highest levels of infection prevention and control, given their nature as a specialized site where healthcare workers care for confirmed HIV positive patients and are at higher risk of contracting HIV compared to health workers in other non-HIV special-care health facilities either private or public.…”

Occupational exposure to HIV among nurses at a major tertiary hospital: Reporting and utilization of post-exposure prophylaxis; A cross-sectional study in the Western Cape, South Africa

“…This is despite reported positive perceptions regarding the treatment [8]. Determinates for poor uptake of HIV PEP by those exposed are not well known, although these may include poor knowledge, poor attitudes and lack of clear guidelines and reporting pathways [9].…”