Abstract:
Background: Hepatitis B (HBV) poses a higher risk to healthcare cleaners due to frequent
exposure to contaminated blood and fluids. Regular screening and vaccination for at-risk
professionals are recommended. However, the prevalence of HBV among cleaners is not well
studied. Evaluating liver enzymes and the aspartate aminotransferase to platelet ratio index
is essential for managing HBV-infected patients effectively.
Objective: The main aims of this study was to determine the magnitude of hepatitis B, the
liver status of the cases, and associated factors among cleaners and cases of hepatitis B in
government and private hospitals in Jimma town, south-west Ethiopia, from April 20 to May
20, 2024.
Methods: A mixed-type, institutional-based, multi-centered, cross-sectional and retrospective
study was conducted. Data were collected from 501 eligible cleaners and 114 hepatitis B
surface antigens (HBsAg) positive cases using KoboCollect, an Android app linked to
KoboToolbox for mobile data collection. Structured questionnaires were administered
through interviews. Each participant provided about 5 milliliters of venous blood for HBsAg
cassette tests, while liver function tests and complete blood counts were conducted for those
who tested HBsAg-positive. Descriptive statistics, ROC analysis, and bivariable and
multivariable Firth penalized logistic regression were performed using STATA version 14.
Results: From the total of 501 cleaners, the magnitude of HBV was 0.6% (95%CI; 0.1%
1.7%), none of them were vaccinated against HBV infection; 34.73% experienced needle
stick injuries in the workplace and 26.75% had a history of exposure to blood or fluids. The
study participants who had not married were associated with an increased risk of having
HBV infection [AOR=1.86; 95% CI, 1.12-2.67; p=0.001]. However, we found no evidence
that any other factors were associated with HBV infections. Among 114HBsAg positive
cases; 34.2% (95% CI; 25.6% - 43.7%) exhibited abnormal liver status and 29.82% (95%
CI; 21.6%-39.1%) were eligible for antiviral treatment.
Conclusion and recommendation: The magnitude of HBV was low per WHO classification,
but abnormal liver enzymes were noted in HBV-positive cases, with over a quarter eligible
for antiviral therapy. Screening and vaccination for HBV are essential for medical waste
cleaners. Unmarried individuals should limit sexual partners to reduce HBV risk, and early
evaluation of liver function tests, CBC, and APRI is crucial for slowing cirrhosis progression
