Global Journal of Health Science; Vol. 4, No. 6; 2012
ISSN 1916-9736 E-ISSN 1916-9744
Published by Canadian Center of Science and Education
Hazards Analysis, within Departments and Occupations, for Hepatitis
B Virus among Health Care Workers in Public Teaching Hospitals in
Khartoum State; Sudan
Taha Ahmed Elmukashfi1, Omer Ali Ibrahim2, Isam Mohamed Elkhidir3,
Abdelgadir Ali Bashir4, Mohammed Ali Awad Elkarim5
1 University of Khartoum, Faculty of Medicine, Department of Community Medicine, Sudan
2 University of Khartoum, Faculty of Economics, Department of Econometrics and Social Statistics, Sudan
3 University of Khartoum, Faculty of Medicine, Department of Medical Microbiology and Parasitology, Sudan
4 Khartoum State Ministry of Health, Sudan
5 University of Khartoum, Faculty of Medicine, Department of Community Medicine, Sudan
Correspondence: Taha Ahmed Elmukashfi, Department of Community Medicine, Faculty of Medicine, University
of Khartoum, Sudan. Tel: 249-918-096-771, 249-123-604-496. E-mail: firstname.lastname@example.org
Received: July 29, 2012 Accepted: August 15, 2012 Online Published: August 26, 2012
doi:10.5539/gjhs.v4n6p51 URL: http://dx.doi.org/10.5539/gjhs.v4n6p51
Background: Infection with hepatitis B virus (HBV) can lead to a range of clinical illnesses.
Objectives: To examine hazards of hepatitis B virus associated with clinical departments and occupations;
among health care workers in Public Teaching Hospitals in Khartoum State, Sudan.
Methods: The study was a cross sectional, facility-based study. It was conducted on stratified two-stage cluster
random sample of 843 subjects of whom 324 were at high-hazard, 445 at moderate hazard, and 74 at low hazard;
depending on degree of exposure to blood and body fluids of patients. To assess hazards of HBV among
departments and occupations of HCWs, non-parametric methods of Chi-square test, was used.
Results: For Anti-HBc vulnerable departments was Renal Dialysis (100%); while for occupations was midwives
(73.3%). For carrier rate (+ve HBsAg), highest rate found in department of Management (6.8%); while for
occupations was Midwives (6.7%). Regarding immunity (+ve Anti-HBs), the highest percentage found in the
department of Dentistry (25.9%); while for occupations was associated with Doctors (14.8%). For a profile of
high infectivity (+ve HBeAg), the most vulnerable department in terms of HBV hazards was the Surgery (1.4%);
while for occupations was nurses (0.9%).
Conclusion: There was a significant association for infection rate of HBV with occupation and type of
department. The most hazardous departments, was Surgery with a profile of high infectivity rate, followed by
other departments (medicine, pediatrics, psychiatry & ophthalmology). As for occupations, the most hazardous
group was nurses group with a profile of high infectivity rate
Keywords: HBV markers, HCWs, hazardous departments and occupation, public teaching hospitals, Khartoum
There are many causes of hepatitis; examples include alcohol, certain drugs, poisonous mushrooms, and viruses.
Hepatitis B was the first hepatitis virus identified by scientists. Infection with the hepatitis B virus (HBV) can
lead to a range of clinical illnesses (The Massachusetts Department of public health, 2002; Teo & Lok, 2006;
Lok, 2012). Healthcare workers have a high risk of occupational exposure to many blood-borne diseases
including HIV, Hepatitis B, and Hepatitis C viral infections. Of these Hepatitis B is not only the most
transmissible infection, but also the only one that is preventable by vaccination. HBV infection is a
well-recognized occupational risk for an HCW. The risk of HBV infection is primarily related to the degree of
contact with blood in the workplace and also to the hepatitis B-e antigen (HBeAg) status of the source person.
The risk of HCWs acquiring occupationally related HBV infection has been shown to be associated with several
www.ccsenet.org/gjhs Global Journal of Health Science Vol. 4, No. 6; 2012
factors. Two important factors are the degree of exposure to the infected body fluids or blood-contaminated
sharps such as needles and other medical instruments, and the duration of employment in an occupational risk
category (Singhal, Bora, & Singh, 2009). HCW who perform invasive procedures for example surgeons,
dentists, emergency workers and those who handle human specimens like the laboratory technicians have been
consistently shown to have higher prevalence of hepatitis B virus infection than their counterparts (Ziraba et al.,
According to endemicity of HBV, the world is divided into three areas: Low endemic area (HBsAg prevalence <
2%) in Western Europe and North America; intermediate endemic areas (HBsAg prevalence 2%-7%), in Middle
East, Indian Subcontinent; high endemic areas (HBsAg prevalence ≥ 8%), in Sub-Saharan Africa, most of Asia,
Pacific, Amazon, and Southern part of Eastern and Central Europe (WHO, N°204, 2008; Alavian et al., 2005;
Teo et al., 2006; Lavanchy, 2004).
Serologic markers for HBV were detected in 68% of sexually active heterosexuals in Port Sudan and Suakin
(McCarthy et al., 1989). In Khartoum, Sudan, HBsAg was found to be positive in 4% of control-hospitalized
patients and 67% in patients with hepatocellular carcinoma (Itoshima et al., 1989). In Khalwat and Salem (two
villages, in Gezira State), HBsAg was found in 18.7% and seropositivity for any HB markers (HBsAg,
Anti-HBs, or anti-HBc) was found in 63.9% (Hyams et al., 1989). In the South of Sudan (Juba), prevalence of
HBsAg was found to be 26% and that of Anti-HBcore is 67% (McCarthy et al., 1994). In a study for
Seroprevalence of Hepatitis B and C among health care workers in Omdurman, Sudan; the occupation risk of
HBV infection among the HCW in this study was high for the nurses and cleaning staff (Nail, Eltiganni, &
HBV is a major infectious occupational hazard of HCWs. HCWs, who considered as carriers, may present a
threat to patients (WHO, N°204, 2008; Gully, 1997). In USA, the CDC estimated that in 1985 about 12,000
HCWs were infected with HBV. There is evidence among some groups of HCWs, such as dentists, that rates of
exposure are decreasing over time, temporally associated with increased awareness and compliance with the
practice of standard precautions (Beltrami, et al., 2000).
A combination of factors believed to be responsible for HBV transmission from HCWs to patients. One factor
associated with increased hazard of transmission is the HCW being HBeAg positive, indicating a higher level of
infectivity (CPSA Guideline, 1998). Hepatitis B is a well documented occupational hazard for health care
workers, including both laboratory and nursing personnel (Sheikh, Hasnain, Majrooh, Tariq, & Maqbool, 2007).
Apart from lack of hepatitis B vaccination, nurses and non-professional staff on their own were found to be
significantly more susceptible to HBV infection than others (Shrestha & Bhattarai, 2006).
To measure HBV markers i.e. Anti-HBc, HBs Ag, Anti-HBs & HBe Ag in the blood of HCWs.
To assess hazards of HBV infection among HCWs within the different departments and occupations.
3. Materials and Methods
3.1 Study Design
It was a cross sectional, facility-based study.
3.2 Study Population
Those who joined the work in hospitals for not less than 45 days in 17 Federal Public Teaching Hospitals (6753
HCWs) and 13 State Public Teaching Hospitals (1680 HCWs) in Khartoum State, Sudan. Some of these
hospitals have all departments, others have more than one department, and some have only one department.
The study population was divided into three groups:
High-hazard group: Those who were working in haemodialysis, surgical departments, blood banks,
obstetrical and gynecological departments, dental clinics, laboratories, and ENT departments.
Moderate hazard group: Composed of physicians, pediatricians, and psychiatrists.
Low hazard group: Managerial staff.
This division was based on the degree of contact of the health workers with blood and other body fluids of the
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Seyed Moayed Alavian, et al. (2005). Hepatitis B prevalence and risk factors in blood donors in Ghazvin, IR.
Iran. Journal of Hepatitis Monthly, 4(5), 117-122.
Sheikh, N. H., Hasnain, S., Majrooh, A., Tariq, M., & Maqbool, H. (2007). Status of hepatitis B vaccination
among the health care workers of a tertiary hospital, Lahore Jinnah Hospital, Allama Iqbal Medical College,
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Singhal, V., Bora, D., & Singh, S. (2009). Hepatitis B in Health Care Workers: Indian Scenario. J Lab
Physicians, 1(2), 41–48. http://dx.doi.org/10.4103/0974-2727.59697
Teo, E. K., & Lok, A. S. F. (2006). Epidemiology, transmission & prevention of Hepatitis B virus infection.
The Massachusetts Department of public health. (2002). Facts about Hepatitis B Disease and Hepatitis B
WHO. (2008). Hepatitis B Fact sheet, N°204.
Ziraba, A. K., Bwogi, J., Namale, A., Wainaina, C. W., & Mayanja-Kizza, H. (2010). Sero-prevalence and risk
factors for hepatitis B virus infection among health care workers in a tertiary hospital in Uganda. BMC
Infectious Diseases, 10, 191. http://dx.doi.org/10.1186/1471-2334-10-191