University of Virginia Health System

REPORT HIGHLIGHTS RISK TO HEALTH CARE WORKERS IN DEVELOPING COUNTRIES

Health care workers in developing countries are at high risk of infection from blood-borne pathogens such as HIV, hepatitis B virus and hepatitis C virus, according to a report by researchers at the University of Virginia Health System published in the August 16 issue of the New England Journal of Medicine. The researchers maintain that the risk of losing productive health care workers to occupational infections is highest in countries where their loss can least be afforded.

Janine Jagger, director of the International Health-Care Worker Safety Center at U.Va., led a team that included Dr. Charles Sagoe-Moses of the Ministry of Health in Accra, Ghana. They stress that the protection of health care workers in many developing countries, including those of sub-Saharan Africa, is overlooked as a health priority by national governments and international organizations that fund health care initiatives.

The researchers attribute this problem to the high prevalence of bloodborne pathogens in poorer regions of the world and the excessive handling of contaminated needles and lack of availability of protective equipment. Unsafe practices, such as the reuse of non-sterile needles when supplies are low and the unregulated disposal of hazardous waste, contribute to the risk of occupational transmission. Unregulated disposal of hazardous waste also can affect members of the community, including children who may be tempted to play with contaminated devices that are not securely contained. The lack of gloves, masks and barrier garments to protect against blood contact further increases the risk to health care workers.

There is an impressive mismatch between the high level of risk these health care workers face and the low level of attention paid to their welfare, Jagger said. Massive funding for AIDS-prevention initiatives have subsidized the purchase and distribution of condoms, but not the purchase of a single pair of gloves for a birth attendant to deliver the child of an HIV-infected mother. Gloves are condoms for health care workers.

The researchers recommend that at the policy level national governments and international agencies officially adopt the protection of health care workers as a health priority. With new funding opportunities becoming available for the prevention of AIDS and vaccine-preventable diseases, they also propose that health care worker protection be required as an integral component of all such programs.

Although the prevalence of blood-borne pathogens in many developing countries is high, the documentation of infections caused by occupational exposures in these countries is scarce. Seventy percent of the world's HIV-infected population lives in sub-Saharan Africa, but only four percent of worldwide cases of occupational HIV infection are reported from this region. By contrast, four percent of the world's HIV-infected population lives in North America and Western Europe, yet 90 percent of documented occupational HIV infections are reported from these areas. It is unlikely, that surveillance and reporting of occupational exposure to infected blood will be undertaken in places where postexposure prophylaxis, treatment and workers' compensation are lacking, the report said.

August 15, 2001