| Abstract|| |
Background : Blood-borne viruses constitute a major public health problem affecting millions of people worldwide. One mode of transmission of these viruses is use of contaminated razors and blades by barbers. The aims of this study were to assess the awareness of shop barbers and roadside barbers in Khartoum state regarding knowledge and modes of transmission of Hepatitis B virus, Hepatitis C virus and Human immunodeficiency virus and to observe their practice regarding proper use and disposal of razors and blades. Design and Setting : This is a cross-sectional comparative community-based study carried out in Khartoum state, Sudan. Materials and Methods : The study included two groups of barbers-shop barbers and roadside barbers. Barbers were questioned on their level of education, basic knowledge and modes of transmission of HBV, HCV and HIV, their knowledge about HBV vaccine and their vaccination status. Statistical Analysis: Was done using SPSS software program to calculate frequencies, X 2 and t-tests. P value was taken at a significant level of <0.05. Results: Barbers in both groups had good basic knowledge about HIV infection and its modes of transmission, while in both groups knowledge about hepatitis and its modes of transmission were poor. In both groups standard cleaning and sterilization of equipment procedures were not followed and special sharps' disposal containers were not used. Conclusion: Practice in both groups may lead to spread of HIV, HBV and HCV between customers. The public media should spend more effort on spreading information and knowledge about hepatitis as it does with HIV. Local authorities should distribute leaflets with detailed information on proper modes of cleaning and sterilization of equipment and of disposal of used blades to all those seeking to open a barber's shop and roadside barbers should be encouraged to use disposable razor blades on customers as they lack proper water supply and sterilization equipment.
Keywords: Barbers, Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Sudan
|How to cite this article:|
Eltayeb NH, Mudawi HY. Knowledge and practice of barbers regarding transmission of blood-borne viruses in Khartoum state. Ann Trop Med Public Health 2013;6:80-3
|How to cite this URL:|
Eltayeb NH, Mudawi HY. Knowledge and practice of barbers regarding transmission of blood-borne viruses in Khartoum state. Ann Trop Med Public Health [serial online] 2013 [cited 2020 May 28];6:80-3. Available from: http://www.atmph.org/text.asp?2013/6/1/80/115201
| Introduction|| |
Blood-borne viruses, mainly hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) constitute a major public health problem affecting millions of people worldwide. Prevalence of HBV infection in Sudan ranges between 6.8-26%,  prevalence of HCV ranges between 2.2-4.8%  and prevalence of HIV infection in 2009 was 1.1%.  Infected individuals are usually unaware of their condition, a fact which contributes to disease transmission.  One mode of transmission of these viruses is use of contaminated razors and blades by barbers. ,, Barbers in third-world settings are usually unaware of the concept of transmission of infectious agents, and razors and scissors are used repeatedly for different customers without intervening sterilization. In Africa barber shaving is thought to be one of the nonsexual practices contributing to the spread of blood-borne viruses through instrument sharing.  This study was conducted to assess the awareness of shop barbers and roadside barbers in Khartoum state regarding their knowledge about HBV, HCV and HIV and the modes of transmission of these blood-borne pathogens and to observe their practice regarding proper use and disposal of razors and blades.
| Materials and Methods|| |
This is a cross-sectional comparative community-based study carried out in Khartoum state, Sudan, during the period September-December 2008. The study included two groups of barbers: Group A were shop barbers who were licensed to practice by local authorities and had a designated shop to practice their profession, while Group B were roadside barbers working on the roadside with portable equipment such as chairs, mirrors, scissors, etc., All barbers working in shops in eastern Khartoum region (Group A) and a similar number of roadside barbers working in local markets in northern, central and southern Khartoum state (Group B) were interviewed by the study investigators using a specially designed pretested questionnaire. Barbers were questioned on their level of education, basic knowledge and modes of transmission of HBV, HCV and HIV, their knowledge about HBV vaccine and their vaccination status. Basic knowledge about hepatitis was defined as the knowledge that hepatitis was a disease of the liver causing jaundice, basic knowledge about HIV infection was defined as the knowledge that HIV causes a fatal disease also known as acquired immunodeficiency syndrome (AIDS). All those interviewed were also observed by the study investigators "using an observation checklist" while using razors and blades on customers and while cleaning and disinfecting reusable razors and how they disposed of blades. All barbers gave informed consent before being enrolled in the study and clearance to undertake the study was obtained from local health authorities in Khartoum state.
Statistical analysis was done using SPSS software program to calculate frequencies, X 2 and t-tests. P value was taken at a significant level of <0.05.
| Results|| |
A total of 194 barbers were interviewed, they were divided into two groups, Group A consisted of 96 shop barbers and Group B consisted of 98 roadside barbers. All barbers in the two groups were male with a mean age in Group A of 27.2 years SD ± 6.3 years and Group B of 26.2 years SD ± 6.3. In Group A 49% of the barbers were Sudanese nationals, the rest were Ethiopians, Egyptians and Turkish, while all barbers in Group B were Sudanese nationals. All those in Group A had a license to practice from the local authorities whereas none in Group B possessed such a license. Only 4.2% of shop barbers and 9.2% of roadside barbers were illiterate, the rest had received primary or secondary school education or were university graduates [Table 1].
|Table 1: Demographic characteristics of 194 barbers in Group A (96 barbers) and Group B (98 barbers)|
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All barbers in Group A had basic knowledge about HIV infection and its modes of transmission, and most of those in Group B knew about HIV and its modes of transmission (93.9% and 92.9% respectively). Basic knowledge about hepatitis and its modes of transmission and specific knowledge about HBV, HCV and HBV vaccine was poor in both groups. Both groups obtained their knowledge through the public media, mostly from radio, television and newspapers [Table 2]. Occupational health officers had a minor contribution to knowledge of barbers regarding HIV and hepatitis B, while this educational role was played by volunteer groups in the case of roadside barbers regarding knowledge on HIV (6.1%) and hepatitis (9.2%).
|Table 2: Knowledge of barbers about HIV, HBV, HCV and their mode of transmission and knowledge and status of HBV vaccine|
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Observation of the practice of barbers while working on customers showed that only 45.8% of shop barbers and 5.1% of roadside barbers washed their hands between customers. Two types of razor blades were used on customers: (a) straight razors with changeable blades; these were used by shop barbers (97.9%) and roadside barbers (79.6%) and (b) disposable razor blades; these were used more often by roadside barbers (20.4%) than shop barbers (2.1%). We noted that barbers using disposable razor blades and those using straight razors with changeable blades always discarded used blades and new razor blades or new blades in case of straight razors were used on customers. All shop barbers disposed of the used blades in the waste basket but only 25.5% of roadside barbers disposed of the used blades in the waste basket, the rest discarded used blades in the open. Local health authorities in Khartoum state recommend that all reusable instruments such as scissors and reusable straight razor blades in barbers' shops are cleaned thoroughly with soap and water and then sterilized by the autoclave. Barber shops which do not possess an autoclave are not given a license to practice. However, this information is only verbal and there are no written guidelines or leaflets explaining detailed modes of cleaning and sterilization of equipment nor on disposal of used blades, instead the only information distributed is general regulations on maintaining shops clean and having proper water supply and rubbish disposal facilities. These regulations are common to all those seeking a license for a small business such as a restaurant, grocery shop, a butcher or a barber's shop (personal communication).
Although most barbers' shops (Group A) had an autoclave for sterilization of equipment, none of them used the autoclave during observation; instead the autoclave was used for storage of equipment. We also noticed that shop barbers mostly cleaned their equipment by either soaking them in alcohol, a disinfectant solution (Dettol) or burned them with flame, while roadside barbers mostly rinsed the equipment with soap and water or wiped it with a piece of cloth [Table 3].
|Table 3: Practices of barbers in Group A and Group B regarding use and disposal of razors and blades|
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| Discussion|| |
In this study most barbers were young and had some form of education, only 4.2% of shop barbers and 9.2% of roadside barbers were illiterate, this is similar to barbers from Nagpur city in India where illiteracy was 11.5%,  and much better than barbers studied in the Rawalpindi and Islamabad in Pakistan where the illiteracy level was 48%.  This low level of illiteracy may help in education of barbers on the dangers of blood-borne infections by distributing leaflets on proper cleaning and sterilization of equipment as well as by distributing useful information about hepatitis and HIV and benefits of vaccination. We noticed also that the majority of barbers in both groups had good basic knowledge about HIV and its mode of transmission, this is similar to results from Ibadan in Nigeria;  on the contrary, knowledge about hepatitis was poor reflecting that the media concentrates on HIV but neglects education about hepatitis despite the fact that HBV is more prevalent than HIV in Sudan. This lack of knowledge about hepatitis was also noticed in barbers in Rawalpindi and Islamabad where only 13% had basic knowledge about hepatitis.  Only 1% of both groups were vaccinated against HBV, the vaccination level in Rawalpindi and Islamabad was 7%.  This low level of vaccination among barbers is alarming considering that barbers while shaving may accidentally be exposed to blood of their customers; studies from Turkey  and China  have shown that HBV and HCV markers were higher among barbers than control groups.
Despite adequate knowledge about HIV and its modes of spread in both groups, barbers' practice in preventing disease spread to their customers was not satisfactory, roadside barbers tended to use disposable razor blades more than shop barbers, but those who used straight razors with changeable blades cleaned the razors with soap and cold water or wiped them with a piece of cloth, it is known that during shaving, minor cuts may contaminate razors and if not sterilized in the proper manner will help in spreading blood-borne infections. A study from Turkey detected HBV DNA by polymerase chain reaction from 6.6% of used razor blades' samples and concluded that in hyperendemic areas sharing razor blades should be considered a very important risk factor for transmission of HBV because of the large number of carriers.  Studies from Egypt also concluded that shaving in barber's shops was a significant risk factor for transmitting HBV  and HCV  infection. Shop barbers in this study tended to use straight razors with changeable blades more often than disposable razor blades but none of them used the autoclave for sterilization, instead they relied on soaking in alcohol or a disinfectant. All barbers, however, changed the blades between customers unlike barbers from Rawalpindi and Islamabad  and from Nagpur city  where blades were reused on customers in 45.8% and 66.4% of cases respectively.
Both groups either disposed of the blades in the waste basket or in the open in case of roadside barbers, none used special sharps' disposal containers, this poses a major risk to road sweepers and garbage handlers and exposes them to the risk of transmission of blood-borne viruses if they get injured.
| Conclusion|| |
Barbers in both groups had good knowledge about HIV, but poor knowledge about hepatitis and HBV vaccine. Practice in both groups may lead to spread of HIV, HBV and HCV between customers. The public media should spend more effort on spreading information and knowledge about hepatitis as it does with HIV. Local authorities should distribute leaflets with detailed information on proper modes of cleaning and sterilization of equipment and of disposal of used blades to all those seeking to open a barber's shop. In case of roadside barbers, although they are not licensed to practice by local authorities, it remains a fact that it is a profession with a large number of customers, thus it seems wise to educate roadside barbers by distributing leaflets providing information on hepatitis and HIV and their modes of spread, as well as encouraging them to use disposable razor blades on customers as they lack proper water supply and sterilization equipment. Both groups should also be encouraged to seek vaccination against hepatitis B virus and to use proper sharps' disposal containers.
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Hatim Mohamed Yousif Mudawi
Department of Internal Medicine, Faculty of Medicine, University of Khartoum, Po box 2245, Khartoum
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2], [Table 3]