Success Story: Protecting Health Workers against Hepatitis B in Uganda

Protecting Health Workers against Hepatitis B in Uganda

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Background

The day-to-day routine of a health care worker can be very rewarding, yet can also be difficult and sometimes even dangerous. For example, a 2007 outbreak of hepatitis B in Yumbe, a district in the West Nile region of Uganda, initially left one worker infected with hepatitis B, and later 17 others tested positive with the blood-borne virus.

Dr. Margaret Okello

"Now all students and health workers can be better protected against this professional hazard."

–Dr. Margaret Okello, Surgeon, Mulago National Referral Hospital, appointed to oversee development of a statute to vaccinate health care workers against hepatitis B.

According to the Uganda National Demographic and Sero-Behavioral Survey of 2006, estimates of prevalence of blood-borne pathogens, including hepatitis B, in different regions of Uganda range from 8 to 19 percent. Recent data from regional blood transfusion services show that the prevalence of hepatitis B ranges from 1.44 to 3.04 percent among screened blood donors(1). A serosurvey conducted among 311 health workers in Uganda in 2003 established that the overall prevalence of hepatitis B infection among health workers is 60.1 percent and that 9 percent of health workers were capable of transmitting the virus to others. The risk for health workers can occur through accidental needle-stick injuries or when infection control procedures are not strictly followed. Additionally, although a vaccine for hepatitis B exists, Uganda had no official policy in place to ensure that health care workers received it.

Intervention

To ensure that all health care workers are protected against the hepatitis B virus, AIDSTAR-One (funded by the U.S. President's Emergency Plan for AIDS Relief [PEPFAR] through the U.S. Agency for International Development [USAID]) collaborated with the Uganda Ministry of Health to spearhead an advocacy campaign targeting managers in health and vocational education sectors to promote vaccination. AIDSTAR-One held intersectoral meetings and health care waste management training sessions, and supported visits with health workers in order to educate, sensitize, and mobilize staff on the importance of vaccination. With support from AIDSTAR-One, the Ministry of Health drafted a statute for parliament approval mandating vaccination against hepatitis B for all health workers. The Ministry of Health also engaged senior management staff to identify potential procurement sources for the vaccine.

Outcome

The statute passed by the Ugandan parliament provided for the government-subsidized mandatory vaccination of health care workers and trainees against hepatitis B. It also set guidelines to help reduce the risk of transmission between patients and health care workers, students, interns, and trainees.

Dr. Amandua Jacinto

Dr. Amandua Jacinto, Uganda Commissioner of Health and Clinical Services, advocated for the vaccine.

AIDSTAR-One's training efforts proved to be invaluable during the initial stages of the statute's implementation. Health care workers were very willing to receive the vaccine after being educated on the necessity of the prevention and control of hepatitis B. Some efforts began even before the Ministry of Health's free vaccination program began. Christine Alura, a national trainer and supervisor for AIDSTAR-One and Principal of the Maska Comprehensive Nurses Training School, mobilized students and began vaccinations against hepatitis B in response to AIDSTAR-One's campaign. As a result of Alura's efforts, health training institutes now require students to show evidence of full vaccination against hepatitis B at the time of their enrollment.

Lessons Learned

The hepatitis B vaccine program's success can be attributed to several factors. Reliable epidemiological data helped researchers prioritize and target Uganda's most high-risk regions first. Timely advocacy encouraged senior health officials in Uganda's government to formulate a plan to protect health care workers, and hastened the approval of the legislation at the parliamentary level. When the program was in its beginning stages, education and sensitization efforts encouraged health care workers to get the vaccination. Throughout the process, the technical support provided by AIDSTAR-One kept the decision-making process on track. Uganda Commissioner of Health and Clinical Services, Dr. Jacinto Amandua, thanked the development partners "for maintaining vaccination of health workers [as] a priority area on the Ministry of Health agenda. Without this level of consistent effort, we would not have been able to achieve so much within this timeframe."

For more information, contact: Dr. Victoria Masembe, Country Director, John Snow, Inc., AIDSTAR-One Uganda Tel: + 256 414 221 581, email: vmasembe@mmis.co.ug

(1) Uganda Blood Transfusion Services statistics from January–December 2011.

Disclaimer: The authors' views expressed in this publication do not necessarily reflect the views of the United States Agency for International Development or the United States Government.