Menu
Menu
Menu
Menu
Background: There is a four-fold risk for hepatitis B infection among healthcare workers compared to the general population. Due to limited access to diagnosis and treatment of hepatitis B in many resource-constrained settings, there is a real risk that only few healthcare workers with viral hepatitis may get screened or diagnosed and treated. Studies on hepatitis B vaccination among healthcare workers in developing countries are sparse and this bodes ill for intervention and support. The aim of the study was to estimate the prevalence and explored the associated factors that predicted the uptake of the required, full dosage of hepatitis B vaccination among healthcare workers (HCWs) in five developing countries using nationally representative data. Methods: We used recent datasets from the Demographic and Health Surveys Program’s Service Provision Assessment Survey. Descriptive summary statistics and logistic regressions were used to produce the results. Statistical significance was pegged at p < 0.05. Results: The proportion of HCWs who received the required doses of hepatitis B vaccine in Afghanistan, Haiti, Malawi, Nepal, and Senegal were 69.1%, 11.3%, 15.4%, 46.5%, and 17.6%, respectively. Gender, occupational qualification, and years of education were significant correlates of receiving the required doses of hepatitis B among HCWs. Conclusions: Given the increased risk of hepatitis B infection among healthcare workers, policymakers in developing countries should intensify education campaigns among HCWs and, perhaps, must take it a step further by making hepatitis B vaccination compulsory and a key requirement for employment, especially among those workers who regularly encounter bodily fluids of patients.
In all, there were 13 developing countries who participated in the Service Provision Assessment (SPA) surveys under the Demographic and Health Survey (DHS) program. Only formal facilities are included in the SPA survey hence pharmacies and individual doctors’ offices are often excluded from the SPA. For the purposes of our study, we selected countries with recently conducted SPA surveys from 2013 up till now and having questions on hepatitis B screening for HCWs. The countries that met the criteria were Afghanistan (2018–2019), Haiti (2017–2018), Malawi (2013–2014), Nepal (2015), and Senegal (2019), and these SPA surveys were conducted by the countries’ respective national agencies with technical support from the Demographic and Health Surveys (DHS). Besides the standard DHS, the Service Provision Assessment survey is undertaken to evaluate the health system readiness to provide quality care, amongst others. The surveys used generic questionnaires to assess the availability of essential services and assessed the presence of standard facilities and equipment required to provide these essential services. These services included child welfare clinics, and immediate newborn care, maternal and child health, antenatal services, birth control, treatment for sexuality transmitted diseases, tuberculosis, malaria, and non-communicable diseases amongst other essential health care services. These generic questionnaires included “facility inventory questionnaire”, “health provider interview questionnaire”, “observation protocols for antenatal care, family planning, services for sick children, and normal obstetric delivery and immediate newborn care” and “exit Interview questionnaires for antenatal care and family planning clients and for caretakers of sick children whose consultations were observed”. The survey also assessed health system readiness to ensure infection prevention in the health environment. The healthcare facilities included governmental, private, and quasi-governmental facilities in both rural and urban areas. Along with data on health system preparedness, data on vaccination history of health care providers were obtained. The unit of measurement included both the health facility and individual health care providers. Computer-Assisted Personal Interviews (CAPI) were used to collect data from HCWs who were working in sampled healthcare facilities. For Afghanistan, the 1038 HCWs selected were all interviewed, representing 100% response rate [39]. For Haiti, 4461 HCWs were interviewed out of 4680; this represents 95.32% response rate [40]. For Malawi, the selected 2660.0 HCWs were all interviewed, representing 100% response rate [41]. For Nepal, 4057 HCWs were interviewed out of the selected sample of 4216; this represents 96.23% response rate [42]. For Senegal, 1353 HCWs were interviewed out of 1355; this represents 99.99% response rate [43]. The following demographic characteristics of the HCWs were collected: years of education, sex, and qualification. The following were the weighted analytic sample sizes for each of the countries included in the study: Afghanistan, N = 1038.0; Haiti, N = 4461.0; Malawi, N = 2660.0; Nepal, N = 4057.0; Senegal, N = 1353.0. There were no missing cases in the datasets. The outcome variable is complete dosing of hepatitis B vaccination among healthcare providers. The HCWs were asked the following ‘Yes/No’ question to know their hepatitis B vaccination status: “Have you received any dose of Hepatitis B vaccine?” Those who answered “YES” were further asked the following to determine complete vaccination status: IF YES, how many doses have you received so far? The forgoing question has the following response scale: 1 dose, 2 doses, 3 or more doses. HCWs who had received at least 3 doses were classified as those who have received complete hepatitis B vaccination. Explanatory variables under investigation included gender, occupation, and years of training. Data was analyzed using STATA version 14 software. Each of the selected countries was analyzed separately. Analysis was mainly in two stages. The first stage involved descriptive analysis during which weighted estimates of the outcome and associated 95% confidence intervals were provided. Weighting was done due to the unequal probability of inclusion of cases from certain subgroups in the DHS sample. All included health care facilities were selected from a sample frame of listed health care facilities stratified by facility type, regional location, and management type (i.e., public vs. private facilities). Hospital facilities are usually oversampled because of their relative numbers in each country. Sample weight is a function of the selection probability of health facility and the selection probability within the subgroup of the individual. Sample weights were normalized and estimated in six decimals but often presented in the DHS data without the decimals. Therefore, prior to applying the sample weights during analysis, the sample weight for each case was divided by 1,000,000. All weighting adjustments were done in STATA-14. Thus, sample weights were applied to adjust for representation and ensure accurate estimates of the outcome. Given that the outcome variable is binary, we used binary logistic regression to build the multivariable model showing estimates of the predictors of complete dosing of hepatitis B vaccination among healthcare providers. In the multivariable model, we reported odds ratios and its associated 95% confidence intervals. Data used for the present study is freely available after online request at https://dhsprogram.com/data/dataset_admin/index.cfm. Ethical clearance to undertake the survey was granted by the respective national authorizing bodies. Informed consent was obtained from the health care providers prior to being interviewed. Owing to the use of secondary data, no further consents were sought.
N/A
