Clinical Epidemiology and Global Health 7 (2019) 11–16

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Clinical Epidemiology and Global Health

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Risk perception and knowledge of hepatitis B infection among cleaners

in a tertiary hospital in Nigeria: A cross-sectional study
Olumide Abioduna,* , Olusola Shobowaleb , Charles Elikwub , Daniel Ogbaroc ,
Adebola Omotoshod, Beatrice Markd , Akinyemi Akinbolad
a
Department of Community Medicine, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State, Nigeria
b
Department of Medical Microbiology and Parasitology, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State, Nigeria
c
Department of Hematology and Blood Transfusion, Benjamin Carson School of Medicine, Babcock University, Ilishan-Remo, Ogun State, Nigeria
d
Department of Community Medicine, Babcock University Teaching Hospital, Ilishan-Remo, Ogun State, Nigeria

A R T I C L E I N F O A B S T R A C T

Article history: Background: Hepatitis B infection is a leading pathogenic infection that constitutes occupational hazard
Received 8 November 2017 to health care workers. The current study examines the knowledge of hepatitis B infection and hepatitis B
Accepted 5 December 2017 vaccination and uptake of the vaccine among the cleaners in a tertiary hospital in Nigeria.
Available online 6 December 2017
Materials and methods: A cross-sectional hospital-based study of 89 cleaners using a standardized
interviewer-administered questionnaire for data collection was conducted. Data were analyzed with
Keywords: SPSS version 21 software.
Healthcare workers
Results: Among the participants, 12 (13.5%), 12 (13.5%) and 19 (21.3%) had low, medium and high-risk
Hepatitis B infection
Hepatitis B vaccine
perception of acquiring hepatitis B infection respectively. Awareness of hepatitis B infection was low
Cleaners (65.2%). The mean knowledge scores concerning hepatitis B infection (4.24 out of 26) and hepatitis B
Risk perception vaccine (1.06 out of 26) were low. Twenty-five (28.1%) of the participants had ever had screening while
none of them reported being vaccinated against hepatitis B.
Conclusions: Hospital cleaners have poor risk perception, low level of awareness and poor knowledge
about hepatitis B infection. Health workers might differ in what they know about hepatitis B infection
and vaccine because of the differences in the levels of education, training, and perceived relevance within
hospital settings.
© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of INDIACLEN.

1. Introduction It is estimated that HBV accounts for 240 million chronic

infections and more than 780,000 annual deaths due to chronic
Hepatitis B infection is a viral infection caused by the hepatitis B liver diseases globally. Most of the chronic carriers of HBV live in
virus (HBV). The HBV is transmitted through mucosal or East Asia and sub-Saharan Africa where between 5 and 10% of the
percutaneous contact with infected blood and other body fluids, adult population are chronic carriers.1
particularly semen and vaginal fluid. Hepatits B infection is one of There is a huge risk of contracting Hepatitis B infection in
the leading bloodborne pathogenic infections that constitute an Nigeria because about 75% of the Nigerian adult population is at
occupational hazard to health care workers (HCWs).1 It is an risk of exposure to the virus and between 9% and 39% have inactive
infection that runs a chronic course, and in 15 to 40% of cases, it HBsAg state, in spite of very low vaccination rates.4 Different
may lead to chronic liver diseases, liver failure, hepatocellular reports have shown varying estimates of national and group
carcinoma and death.2 Hepatitis B infection may also cause the specific HBsAg prevalence rates. The prevalence is between 10 and
deposition of immune complexes, especially in the kidney. It has a 15% in the general population; 25.7% among surgeons; 23.4%
chronic carrier status resulting in inactive HBV carriers being able among voluntary blood donors and 16.3% among infants.5–8 It is
to transmit the virus.3 the major risk factor for chronic liver diseases in Nigeria. In
southern Nigeria, 58.1% of patients with chronic liver diseases were
found to be positive for hepatitis B surface antigen (HBsAg).9 A
systematic review of studies on hepatitis B infection in Nigeria
Abbreviations: HBV, hepatitis B virus; HCW, health care workers; HBsAg,
hepatitis B surface antigen; BUTH, Babcock University Teaching Hospital.
between the year 2000 and 2013 gave a pooled prevalence of
* Corresponding author. hepatitis B in Nigeria as 13.6%.10
E-mail address: olumiabiodun@[Link] (O. Abiodun).

[Link]
2213-3984/© 2017 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of INDIACLEN.
12 O. Abiodun et al. / Clinical Epidemiology and Global Health 7 (2019) 11–16

Hepatitis B infection can be prevented by the practice of control of occupational exposure to HBV infection; and on the
standard precautions which includes ensuring personal hygiene; objectives and procedures of the research.
the use of relevant personal protective equipment; and by the
proper disposal of used sharps, and medical wastes in healthcare 2.3. Data management
settings. The implementation of safe blood and safe sex strategies
also protect against the infection.1 However, the mainstay of The completeness and consistency of the collected data were
hepatitis B prevention is hepatitis B vaccination. Hepatitis B checked daily by the study supervisors before submission to the
vaccine is safe, cost-effective, and gives protection for at least 20 Lead investigator. All the data were entered by two data clerks
years or for life. The vaccine is recommended for all children and independently. Data cleaning was done by the lead investigator by
high-risk individuals including health workers and other people examining summary tables of the data. Only properly filled
whose occupation expose them to blood and blood products.1 questionnaires were included in the analysis. Data was analyzed
Transmission of hepatitis B infections occurs in healthcare with SPSS version 21 software. Proportions, means, and standard
settings through needle pricks and the reuse of needles and deviations were derived and the data is presented with frequency
syringes.1 About 6% of the global populations of health care tables. Scores of 0 and 1 were allocated to good and bad responses
workers are exposed to hepatitis B virus.11 Studies carried out in to the HBV infection risk assessment and to the wrong and correct
South Africa, Sudan, Tanzania, and Morocco showed that health knowledge items respectively. Total scores for each of the
care workers had good knowledge about hepatitis B infection but participants were derived. Perceived risk of hepatitis B infection
poor knowledge and uptake of hepatitis B vaccination.11–15 was assessed by asking the participants to respond to the closed-
Cleaners, like other hospital workers, have an additional risk of ended question “How would you assess your risk of contracting
acquiring hepatitis B infection. They are exposed to blood and hepatitis B infection?” They were thus categorized as low,
medical wastes. Unlike other hospital workers, they are usually less moderate, or high risk perception groups. The participants were
educated, have little or no formal training, and often have their divided based on the assessment of their actual risk of hepatitis B
specific infection control-related training needs overlooked within infection into three groups. The first group; Low-risk group
the healthcare setting.16 While many studies examining the consisted of those whose risk scores were between 0 and 3. The
knowledge of health workers about hepatitis B infection exist, second group; moderate-risk group consisted of those whose risk
there is a paucity, if any exist, of studies that concentrate on this scores were between 4 and 5. Those with scores of 6 and above
group of health workers alone. We are not aware of any such study were regarded as high-risk. The participants were also categorized
in Nigeria and sub-Saharan Africa. into three groups; ‘poorly knowledgeable’, ‘fairly knowledgeable’
The risk of contracting hepatitis B infection remains persis- and ‘knowledgeable’ about HBV infection based on knowledge
tently high in sub-Saharan Africa despite the availability of a safe scores of <9, 9–13, and >13 respectively out of a maximum
and cost-effective vaccine. The current study examines the possible score of 26. The participants were also determined to have
knowledge of hepatitis B infection and hepatitis B vaccination; ‘poor’, ‘average’ and ‘good’ knowledge about hepatitis B vaccine
and the uptake of the vaccine among the cleaners in a tertiary based on scores of <5, 5–7, and >7 respectively out of a maximum
hospital in Nigeria. possible score of 13. Two infectious disease specialists reviewed
the instrument and established content validity and suitability in
2. Materials and methods the study context. Test-retest reliability was conducted to assess
the stability of the instrument by estimating the intra-class
2.1. Study design and setting correlation coefficient (ICC). Twenty cleaners from a tertiary
hospital participants completed the questionnaire twice at two
This is a cross-sectional hospital-based study that was weeks interval. ICC values of 0.40 or above were considered
conducted between the 1st and 30th of June 2016 at the Babcock satisfactory. The study instrument was then pretested among 20
University Teaching Hospital (BUTH), Ilishan-Remo, Nigeria. BUTH cleaners in another tertiary hospital and necessary corrections
is a 250-bed teaching hospital and referral center that serves 3 were made.
southwestern states in Nigeria with a combined population of
about 23 million. The hospital had 98 Cleaners in its employment 3. Results
at the time of the study.
Eighty-nine of the ninety-eight cleaners in the employment of
2.2. Participants and samples the BUTH fully participated in the study giving a response rate of
90.8%.
The study was announced at the mandatory daily devotion for
all employees of the hospital for five consecutive days. Participa- 3.1. Socio-demographic characteristics of the participants
tion was voluntary and the cleaners were free to decline or
withdraw participation from the study at any time without any The average age of the participants was 46.00  8.49 years (95%
consequences. All cleaners who had been in the employment of the CI = 44.2, 47.7). The mean duration of their work experience was
hospital for at least six months were eligible to take part in the 5.20  2.65 years (95% CI = 4.7, 5.8). There were about the same
study. Signed consent was obtained from each participant. number of men and women. All the participants had completed at
An interviewer-administered questionnaire was used to collect least primary school education (Table 1).
information on demographics, the risk of contracting hepatitis B
infection (11 items), knowledge about hepatitis B infection (26 3.2. Actual and perceived risk of acquiring hepatitis B infection among
items) and vaccine (13 items), and the hepatitis B immunization the participants
status of the participants. The language of the interview was
English which is well understood by the participants. Blood The participants were required to give an assessment of their
samples were also taken to evaluate the HBV status of the perceived risk of acquiring hepatitis B infection. The participants
participants. The interviewers were conducted by trained research regarded themselves as having low (13.5%), medium (13.5%) and
assistants. These assistants were nurses who received a 2-day high-risk (21.3%) of acquiring hepatitis B infection respectively. The
training on infection control with emphasis on prevention and remaining 46 (51.7%) participants responded that they were unable
 O. Abiodun et al. / Clinical Epidemiology and Global Health 7 (2019) 11–16 13

Table 1 namely; routes of transmission (6 items), at-risk-groups (7 items),

Socio demographic characteristics of the Cleaners at Babcock University Teaching
modes of prevention (6 items), and general questions (7 items).
Hospital, June 2016.
The mean hepatitis B infection knowledge score was 4.24  3.69.
Variable Frequent Percent The highest and lowest scores were 12 and 0 respectively. Eighty
Age (in years) (89.9%) of the participants had poor knowledge about hepatitis B
25–34 9 10.1 infection while the remaining nine (10.1%) had fair knowledge.
35–44 28 31.5
None of the participants had good knowledge about hepatitis B
45–54 33 37.1
55–64 19 21.3
infection. More than 50% of the participants gave the response ‘I
don’t know’ to all of the items across all the four domains.
Sex Misconceptions about all the four knowledge domains of hepatitis
Male 44 49.4 B infection also exist among significant proportions of the
Female 45 50.6
participants (Table 3).
Religion
Christianity 57 64 3.4. Knowledge of the participants about hepatitis B vaccine
Islam 30 33.7
Others 2 2.2
The participants were required to respond to 13 questions about
Ethnicity
hepatitis B vaccine. The mean hepatitis B vaccine knowledge score
Igbo 46 51.7 was 1.06  1.75. The highest and lowest scores were 8 and 2
Yoruba 35 39.3 respectively. Eighty-three (93.3%) of the participants had poor
Hausa 8 9 knowledge about hepatitis B vaccine while the five (5.6%) had fair
Others
knowledge. Only one (1.1%) of the participants had good
Highest level of education completed knowledge about hepatitis B vaccine. More than 60% of the
Primary 24 27 participants gave the response ‘I don’t know’ to all the 13 questions
Secondary 48 53.9 that were used to assess the knowledge about hepatitis B vaccine.
Tertiary 17 19.1 Misconceptions about hepatitis B vaccine were also noted among
Years of working experience
the participants (Table 4).
1–3 years 32 36
4–6 years 27 30.3 3.5. Hepatitis B screening and vaccination status of the participants
7–9 years 27 30.3
10 or more years 3 3.4
Twenty-five (28.1%) of the participants have ever had hepatitis
B screening while 64 (71.9%) had never been screened for hepatitis
to assess their risk of acquiring hepatitis B infection. Their actual B before. Seventy-two (80.9%) of the participants were not aware of
risk of acquiring hepatitis B infection was also assessed by asking their ‘current’ hepatitis B status. Fourteen (15.7%) of the 17
questions about previous occupational and non-occupational participants who were aware of their ‘current’ status were negative
exposures. Exposure to occupational and non-occupational risks while three (3.4%) were positive for HBsAg. Two of three who
factors for hepatitis B infection is prevalent among the participants claimed to be positive for hepatitis B said they completed the full
(Table 2). course of treatment while the remaining one had no treatment at
An assessment of the actual risk of acquiring hepatitis B all.
infection showed that 34 (38.2%), 39 (43.8%), and 16 (18.0%) had All the participants responded that they were not vaccinated at
low, moderate, and high-risk respectively. No statistically signifi- the time of the study. The main reasons they gave for not being
cant association was found between the participants’ actual and vaccinated were the lack of awareness (69.7%), inaccessibility of
perceived risk of acquiring hepatitis B infection (x2 = 2.413, df = 6, vaccine (23.6%), and cost (6.7%).
p = 0.878).
3.6. Perceived challenges to the implementation of hepatitis B infection
3.3. Knowledge of the participants about hepatitis B infection control program among the participants

Fifty-eight (65.2%) of the participants were aware of hepatitis B The participants identified the possible barriers to the
infection while thirty-one (34.8%) had not heard of hepatitis B successful implementation of hepatitis B infection control program
infection before. to include; low-risk perception among health workers, the poor
The participants were required to respond to 26 questions orientation of new workers, lack of or poor knowledge, and the
about hepatitis B infection. The questions were in four domains, poor implementation of hospital policies (Table 5).

Table 2
Hepatitis B infection risk (occupational and non-occupational) among the Cleaners at Babcock University Teaching Hospital, June 2016.

Variable Yes (%) No (%)

Have you ever been transfused with blood or blood products? 37 (41.6) 52 (58.4)
Have you ever had surgery done? 21 (23.6) 68 (76.4)
Do you use of gloves every time you carry out a procedure involving body fluids 17 (19.1) 72 (80.9)
Have you had a needle stick injury in the last one year? 24 (27.0) 65 (73.0)
Have you had any cut injury in the last one year? 28 (31.5) 61 (68.5)
Have you ever had exposure to blood or body fluids on your mucous membrane in the last one year? 30 (33.7) 59 (66.3)
Do you have any body scarification? 41 (46.1) 48 (53.9)
Have you had any training on infection in the last one year? 35 (39.3) 54 (60.7)
Have you ever had exposure to blood or body fluids on intact skin? 57 (64.0) 32 (36.0)
Have you ever had splash of blood or body fluids to eye or mouth? 9 (10.1) 80 (89.9)
Have you ever had splash of blood on cuts or unprotected skin? 18 (20.2) 71 (79.8)
14 O. Abiodun et al. / Clinical Epidemiology and Global Health 7 (2019) 11–16

Table 3
Knowledge of hepatitis B infection among the Cleaners at Babcock University Teaching Hospital, June 2016.

Variable Correct (%) Wrong (%) I don’t know (%)

Routes of transmission
Sharps injury 25 (28.1) 9 (10.1) 55 (61.8)
Blood donation from infected person 13 (14.6) 14 (15.7) 62 (69.7)
Sexual intercourse with infected person 12 (13.5) 15 (16.9) 62 (69.7)
From mother to child during pregnancy 12 (13.5) 12 (13.5) 65 (73.0)
Faeco-oral 11 (12.4) 8 (9.0) 70 (78.7)
Polluted water 5 (5.6) 10 (11.2) 74 (83.1)

At risk groups
Commercial Sex Workers 26 (29.2) 17 (19.1) 46 (51.7)
Men who sleep with men 4 (4.5) 20 (22.5) 65 (73.0)
Individuals with multiple sexual partners 7 (7.9) 16 (18.0) 66 (74.2)
Sickle cell disease patients 7 (7.9) 24 (27.0) 58 (65.2)
Long distance drivers 15 (16.9) 15 (16.9) 59 (66.3)
Health care workers 9 (10.1) 18 (20.2) 62 (69.7)
Injection drug users 14 (15.7) 20 (22.5) 55 (61.8)

Modes of prevention
Vaccination 23 (25.8) 11 (12.4) 55 (61.8)
Proper disposal of sharps 8 (9.0) 19 (21.3) 62 (69.7)
Avoiding multiple sexual partner 11 (12.4) 13 (14.6) 65 (73.0)
Avoiding drinking contaminated water 20 (22.5) 6 (6.7) 63 (70.8)
Avoiding uncooked food 18 (20.2) 6 (6.7) 65 (73.0)
Consistent and appropriate use of gloves 7 (7.9) 13 (14.6) 69 (77.5)

Others
Hepatitis B infected person may be asymptomatic for long time 10 (11.2) 23 (25.8) 56 (62.9)
Every person exposed to hepatitis B virus will develop acute hepatitis immediately 29 (32.6) 10 (11.2) 50 (56.2)
Hepatitis B virus is highly infectious 24 (27.0) 17 (19.1) 48 (53.9)
Only small proportion of the world population is infected with hepatitis B virus 18 (20.2) 15 (16.9) 56 (62.9)
Hepatitis B virus mainly affects liver 19 (21.3) 13 (14.6) 57 (64.0)
Hepatitis B is more infectious than HIV 15 (16.9) 17 (19.1) 57 (64.0)
Hepatitis B infection is more common in Sub Saharan Africa 15 (16.9) 14 (15.7) 60 (67.4)

Table 4
Knowledge of hepatitis B vaccine among the Cleaners at Babcock University Teaching Hospital, June 2016.

Variable Correct Wrong I don’t know

(%) (%) (%)
There is effective vaccine to prevent hepatitis B infection 27 (30.3) 6 (6.7) 56 (62.9)
Hepatitis B vaccine can be given as post-exposure prophylaxis 7 (7.9) 15 67 (75.3)
(16.9)
Hepatitis B vaccine is contra indicated for immune compromised patients 7 (7.9) 8 (9.0) 74 (83.1)
Hepatitis B vaccine is effective to treat patients with acute hepatitis B infection 6 (6.7) 5 (5.6) 78 (87.6)
Hepatitis B vaccine is highly effective in preventing hepatitis B infection if given within 48 hours after exposure 6 (6.7) 3 (3.4) 80 (89.9)
Hepatitis B vaccine should be given to health care workers as part of work place safety 5 (5.6) 5 (5.6) 79 (88.8)
Full course of hepatitis B vaccine may give lifelong immunity but for Health professionals, one further booster after 5 years of the first 6 (6.7) 5 (5.6) 78 (87.6)
dose is recommended
After taking full dose vaccination of hepatitis B, there is no need for a blood test to confirm immunity against hepatitis B 7 (7.9) 3 (3.4) 79 (88.8)
Full dose hepatitis B vaccine provides 100% protection for 90% of adults 3 (3.4) 7 (7.9) 79 (88.8)
Full dose hepatitis B vaccine protects against HBV for at least 15 years 4 (4.5) 6 (6.7) 79 (88.8)
Hepatitis B vaccine causes problems if given to people who are already immune 5 (5.6) 2 (2.2) 82 (92.1)
Hepatitis B vaccine is recommended for all health care workers 5 (5.6) 5 (5.6) 79 (88.8)
One or two does of hepatitis B vaccine are sufficient to be fully immunized for an adult 6 (6.7) 7 (7.9) 76 (85.4)

4. Discussion
Table 5
Perceived challenges to the implementation of hepatitis B infection control program Occupational exposure to blood, blood products, and other
among the Cleaners at Babcock University Teaching Hospital, June 2016. body fluids places health care workers at an additional risk of
Variable Yes (%) No (%) contracting hepatitis B infection over people in the general
population.1 The high response rate that was noted in this study
Inexistent hospital policy 36 (40.4) 53 (59.6)
Poor orientation of new health workers 46 (51.7) 43 (48.3) may underscore an interest in hepatitis B infection among the
Low risk perception among workers 54 (60.7) 35 (39.3) participants. The Cleaners have both occupational and non-
Poor implementation of hospital policy 40 (44.9) 49 (55.1) occupational exposure to the risk factors for hepatitis B infection.
Poor knowledge 42 (47.2) 47 (52.8) Most of them have low to moderate risk of acquiring hepatitis B
Fear of side effects of vaccine/injection 37 (41.6) 52 (58.4)
infection although a significant proportion has a high-risk of
 O. Abiodun et al. / Clinical Epidemiology and Global Health 7 (2019) 11–16 15

acquiring the infection. In contrast, most of the cleaners had no or receiving the vaccine, hepatitis B is widely available in Nigeria. The
poor risk perception of contracting hepatitis B infection. The vaccine is available for free as part of the National Programme on
perception of the risk of contracting hepatitis B infection is quite Immunization (NPI) for children less than one year both in the
low when compared with other health care workers.17,18 Ibekwe monovalent form and as part of the pentavalent vaccine.23,24 It is
and Ibeziako17 have also found statistically significant difference in also available for adults but at a cost. It is most likely that lack of
the risk perception for hepatitis B infection among ward attend- awareness/poor knowledge about HBV and cost are the major
ants and other health workers in a tertiary hospital in eastern barriers.
Nigeria. This difference may be because cleaners tend to be less Participants in this study identified the possible challenges to a
educated, have little or no medical training, and often have their successful implementation of hepatitis B control in health care
specific training needs overlooked within the healthcare setting.16 settings. The identified challenges are similar to those identified by
Poor risk perception in the presence of significant levels of actual other studies among the general and specified populations of
risk of contracting hepatitis B infection may actually lead to an health workers.18 Most of the participants listed inexistence of
increased risk. This is because the participants are unable to hospital policy as a barrier. However, the hospital has an
appreciate the dangers that they are exposed to and as such, are operational infection control policy with a duly constituted
less likely to take necessary precautions. This is the case among the infection committee. This may suggested that the policy is not
participants in this study among whom only 19.1% use gloves every well-disseminated and that the committee needs to device
time they carry out a procedure involving body fluids. appropriate strategies to disseminate the policy to different cadres
About 90% of the participant had poor knowledge about of health workers.
hepatitis B with a mean score of 4.24 out of the maximum possible However, the findings of this study should be interpreted with
score of 26. More than 50% of the participants had no knowledge of some caution. The data that was collected is subject to recall bias.
hepatitis B while misconceptions were highly prevalent. Other Besides, the single-site study provides some challenges for
studies among the general population of health workers and those external validity. However, the study provides useful insight to
among doctors and nurses have shown much higher levels of the possible peculiarity of nonclinical health workers which could
knowledge and significantly lower levels of misconceptions about be used as basis for future larger studies. It provides a basis of focus
hepatitis B infection.19–21 This difference suggests that cleaners both for research and policy for the inclusion hospital cleaners in
may differ significantly from other health workers in their hepatitis B infection control among health workers.
knowledge about hepatitis B infection. Health workers may not
be a homogenous group as it relates to their knowledge about 5. Conclusions
hepatitis B infection. This is probably one of the first times that the
risk and knowledge of hospital cleaners about hepatitis B infection Health workers, including cleaners, are at an increased risk of
have been described. It is important for future studies to hepatitis B infection compared to the general population because
differentiate between the roles of clinical and nonclinical health of occupational exposure to body fluids. Hospital cleaners have
workers as it relates to the risk of hepatitis B infection. poor risk perception, low awareness, and knowledge about
Interventions aimed at the control of hepatitis B infection in hepatitis B infection. They have poor knowledge and uptake of
health care settings through the improvement of knowledge of hepatitis B vaccine. A lot of misconceptions and gaps also exist in
health workers may need to be structured to address the specific their knowledge. Their knowledge about hepatitis B vaccine and
needs of the various categories of health workers separately. infection is poorer than that of the general population of health
Knowledge gaps exist across all the four hepatitis B knowledge workers and some specific health professionals including Doctors
domains (routes of transmission, at-risk-groups, modes of and Nurses. It is likely that health workers differ in what they know
prevention, and general questions) that were assessed. In fact, about hepatitis B infection and vaccine. This may be due to the
more than a third of the participants were not aware of hepatitis B differences in the levels of education, training, and perceived
infection. There is, therefore, an urgent need for training for the relevance within hospital settings. This study underscores the
cleaners on the transmission, risk, prevention and sundry issues as weakness that is inherent in approaching hospital staff as a
it relates to hepatitis B infection. homogenous unit as it relates to hepatitis B control. Hospital
The participants’ awareness and knowledge about hepatitis B cleaners have an urgent need for training on the transmission, risk,
vaccine were also poor. This may be related to poor knowledge prevention and sundry issues as it relates to hepatitis B infection
about hepatitis B infection. The knowledge about the vaccine is and vaccine. In order to achieve effective control of hepatitis B
poorer and associated with more misconceptions that the infection in health care settings, hospital administrations should
knowledge about the infection. The cleaners have poorer pay attention to staff training and retraining with particular
knowledge about the vaccine when compared with findings attention being paid to categories of workers who may easily be
among general and other categories of health workers.11,18 The overlooked.
levels of awareness of hepatitis B infection and its vaccine have
been observed to be generally lower than that of HIV in spite of it Competing interests
being more infectious than HIV.22 The unusually low levels of
awareness and knowledge about hepatitis B vaccine, a potent The authors declare that they have no competing interests.
vaccine that has been around since 1981, calls for prompt action
among this group of hospital staff. Funding
None of the participants reported having received hepatitis B
vaccination. Studies have reported poor levels of vaccination This research did not receive any specific grant from funding
among health workers11,13–15 but even at that, a zero vaccination agencies in the public, commercial, or not-for-profit sectors.
level is unacceptable. This is particularly poor considering the risk
of occupational exposure that is prevalent in health workers Authors’ contributions
including cleaners. However, this may be explained by the low
level of awareness and poor knowledge of the infection and vaccine OA, OS, CE and DO conceived the study and conducted the
that is prevalent among the participants. Although some of the literature search. OA designed the study and wrote the first draft of
participants suggested that accessibility was a barrier to their the manuscript. AO, BM, and AA participated equally in data
16 O. Abiodun et al. / Clinical Epidemiology and Global Health 7 (2019) 11–16

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Acknowledgements
hepatitis B virus infection, immunization with hepatitis B vaccine, risk
perception, and challenges to control hepatitis among hospital workers in a
The authors would like to acknowledge the contributions of Dr. Nigerian tertiary hospital. Hepat Res Treat. 2015;2015:1–610.1155/2015/
Temitope Ashipa and Mrs. Basirat Okuboyejo to the success of the 439867.
19. Abiola A, Agunbiade A, Badmos K, Lesi A, Lawal A, Alli Q. Prevalence of HBsAg,
study. The Nigerian National Petroleum Corporation provided knowledge, and vaccination practice against viral hepatitis B infection among
hepatitis B vaccine to all eligible study participants. The authors doctors and nurses in a secondary health care facility in Lagos state, South-
are very grateful to the research assistants and study participants. western Nigeria. Pan Afr Med J. 2016;23:16010.11604/pamj.2016.23.160.8710.
20. Hassan M, Awosan K, Nasir S, et al. Knowledge, risk perception and hepatitis B
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