The findings of this research suggest that there is indeed a low number (64/331, 19%) of HCWs vaccinated against hepatitis B in Lusaka district. In this study 281 (85.0%) of the HCWs knew that a vaccine against hepatitis B exists and 321 (97.0%) of the HCWs were willing to get vaccinated if the vaccine were to become available in their institution. A high knowledge base on the existence of the vaccine among HCWs and high willingness to be vaccinated suggests that the reason for low vaccination prevalence among HCWs is not by their own doing. Perhaps low vaccination rates can be due to the unavailability of the vaccine in the institution due to a non-stringent policy on the vaccination of HCWs.
Other studies have shown some interesting findings, for example, a study done in Uganda, found the prevalence of hepatitis B vaccination among HCWs at 38.4% [12] and 83.6% in Kuala lumpa [13]. In this study, out of the 64 HCWs that were vaccinated against hepatitis B, 35 (54.7%) had completed full vaccination (a total of 3 doses) and 29 (45.3%) had received either one or two doses. The study done in Uganda showed that only 6.2% of the HCWs had completed full vaccination which falls short to the 54.7% reported in this study. In Burkina Faso, 47.7% of HCWs had received at least one dose of hepatitis B vaccine and only 10.9% had received full vaccination [14]. South Africa also had a higher proportion of HCWs vaccinated against hepatitis B at 67.9%, however only 19.9% of these had received full vaccination [15]. In contrast to these observed low rates of full vaccination coverage in Africa, higher rates of 75.0% and 93.0% were reported among HCWs in the United States [16] and France [17] respectively.
Even though profession of the HCW was not significantly associated with vaccination status, it has been shown to be a strong predictor for hepatitis B vaccination. Literature shows that more doctors are vaccinated against hepatitis B compared to other HCWs [18]. This was not the case in this study with only 18 (5.4%) doctors being vaccinated against hepatitis B compared to laboratory personnel that had 28 (8.5%) HCWs being vaccinated. Most hospital laboratories in Zambia are taking part in enhancing the quality of work in their laboratories and one of the requirements to attain international accreditation is to have the laboratory personnel vaccinated against vaccine preventable diseases which include hepatitis B. This might be one of the reasons why the laboratory personnel had more vaccinated HCWs compared to other groups. The doctors that were vaccinated in this study consisted mainly of recent graduates and doctors that studied abroad. In Zambia, medical students are offered the hepatitis B vaccination under their regulatory body (Zambia Medical Association) at a fee. This could explain why the recently graduated doctors were vaccinated. Only 14 nurses (94.2%) were vaccinated against hepatitis B and they consisted of the largest group sampled (90 nurses). Most nurses vaccinated against hepatitis B was as a result of post prophylactic procedures mainly due to sharp injuries. The least vaccinated HCWs were the general workers, with only 4 (1.2%) being vaccinated against hepatitis B.
In this study, HCWs that had experienced at least one sharp injury in a year were 51 out of the total of 331 health care workers (15.4%). A study done in Pakistan reported that health care workers having experienced at least one sharp injury in a year was at 44% [19] with the highest frequency being in doctors. In this study nurses (37.3%) experienced the most sharp injuries per year at an average of 2 sharp injuries per year, followed by doctors (29.4%) at 1.6 sharp injuries per year, laboratory personnel (23.5%) at 1.2 sharp injuries per year and general workers (5.8%) at 1 sharp injury per year. In this study it is reported that the more sharp injuries per year a health worker experiences the more likely they are to be vaccinated against hepatitis B. Although the percentage of sharp injuries in this study is not too high, it should be minimized as it is one of the most significant modes of transmission. Moreover, needle prick injuries pose a greater risk than splashes and those from hollow-bore needles. Sharp injuries can be prevented by always wearing gloves, properly discarding needles and minimizing the contact with blood products of infected patients. HCWs that experienced a sharp injury would undergo post-prophylactic procedures (PEP), with a majority of them undergoing HIV PEP. The remainder of the health workers either did not undergo PEP or they underwent hepatitis B PEP which consists of taking 3 doses of the vaccine making them immunized against hepatitis.
The age of the health worker was also a determinant for hepatitis B vaccination. According to the analysis, with every increase in age a health care worker is 1.03 times more likely to be vaccinated against hepatitis B adjusting for sharp injuries per year and training in infection control. The odds ratio found in this study is not particularly high, but it does support literature findings that highlight that age indeed is a determinant for hepatitis B vaccination in HCWs. Ogoina states that, “it is plausible that younger health care workers had poorer vaccine uptake due to their lower access to hepatitis B vaccine or poorer knowledge of the need for hepatitis B vaccination” [18]. Due to more experience, older HCWs are more knowledgeable about hepatitis B and its risks and health impacts and are more likely to take extra precaution to prevent themselves from contracting hepatitis B. This would suggest that health education in safety practices be strengthened in colleges/universities in order for young graduates looking for employment in clinical setting be well informed about their options in preventing themselves from infection with hepatitis B.
All HCWs must be trained in ways to protect themselves from acquiring diseases in their work environment. Truth be told, HCWs are exposed to many diseases each and every day due to the contact that they have with patients and patients’ bodily fluids. All health institutions must make sure that their staff are trained in infection control practices in order to effectively protect themselves from acquiring diseases from the hospital environment in which they work. This study has shown that a health care worker trained in infection control is more likely to be vaccinated against hepatitis B compared to a health care worker not trained in infection control. Prior training in infection control of a HCW means they are more likely to be vaccinated against hepatitis B [18]. It is also suggested that training of a HCW in the practice of standard precautions makes them more likely to be vaccinated against hepatitis B [19].
Limitations of the study
The sample size of 331 was small for the study because of limited resources, and research on a similar study must be conducted to include a larger sample size. Information on whether a HCW knew their hepatitis B status and hepatitis B antibody titre was not collected. This would have helped in accessing the relevancy of a HCW being vaccinated against hepatitis B. True vaccination status of the HCWs is questionable because vaccination certificates were not being produced. However, the results give an idea of the prevalence of hepatitis B vaccination among HCWs.