High prevalence of hepatitis B and poor knowledge on hepatitis B and C viral infections among barbers: a cross-sectional study of the Obuasi municipality, Ghana

Many traditional and low-paid barbers in developing countries earn their livelihood
by providing shaving services in the marketplace and on the street side 11]. Poor infection control during the use of sharp instruments may be a risk factor
for blood-borne infections, potentially causing serious health problems for both the
barber and the clients 12]. This cross-sectional study examined the prevalence of Hepatitis B viral (HBV) infection
and hepatitis C viral (HCV) infections among barbers in the Obuasi municipality of
Ghana. The prevalence of HBV and HCV among the barbers were 14.5 % and 0.5 % respectively.
Most of the participants had low level of knowledge on HBV and HCV infections.

The 14.5 % prevalence of HBV obtained in this study is higher than the 4.1 % prevalence
recorded in a cross-sectional study by Shalaby et al. 4] to determine the prevalence of both HBV and HCV infections among barbers and a sample
of their clients in Gharbia governorate, Egypt. However, it is lower than the 28 %
recorded by Belbacha et al. 5] in a cross-sectional epidemiological study to determine the prevalence of HBV and
HCV among traditional barbers and their clients in the Rabat region of Morocco. The
difference in prevalence rates could be due to the differences in sample sizes, geographical
location and sampling techniques used. It is also higher than the 8.2 % HBV prevalence
reported among blood donors in 2012 by Walana et al. 13] in a retrospective hospital-based study conducted at Kintampo municipal in Ghana,
and the 8.68 % prevalence observed by Amidu et al. 14] in a prospective study conducted at Kumasi in Ghana. This shows a high prevalence
rate of HBV among barbers compared to the general population.

The 0.5 % prevalence of HCV recorded is, however, lower than the 1.1 % prevalence
rate reported by Belbacha et al. 5] in Morocco and the 12.5 % prevalence rate reported by Shalaby et al. 4] in Egypt. The significantly lower prevalence of HCV found in this study compared
to the findings of Shalaby et al. might be due to the differences in sample size, and the higher endemicity of HCV
in Egypt 4]. It is also lower than the 2.3 % HCV prevalence reported among blood donors in 2012
by Walana et al. 13] in a retrospective hospital-based study conducted at Kintampo municipal in Ghana,
indicating a low HCV infection rate among barbers.

Dongdem and colleagues 15] in a cross-sectional study to estimate the prevalence of HBV among blood donors at
the Tamale Teaching Hospital in Ghana observed the highest prevalence of HBV among
donors within the ages of 20–29. This supports the finding of the highest prevalence
of HBV among barbers within the ages of 20–29 years in our study. The high prevalence
of HBV infection among the youth could be the result of risky lifestyles 15], 16].

The finding of no significant association between the risk factors and HBV infection
among the barbers in the multivariable logistic regression indicates a probable high
occupational risk of barbers to HBV infection. However, this assertion should be done
with caution since this study did not assess a causal relationship between HBV and
barbering.

Studies carried out in Morocco, Ethiopia and Pakistan showed that the level of knowledge
and awareness of barbers about the concept of infectious risk associated with blood
was generally very low 17], 18]. This is similar to the finding of majority of the study participants not being aware
of the HCV infection, and the modes of transmission of HBV and HCV. It is also in
line with the study by Belbacha et al. 5] which found that traditional barbers and their clients in Morocco are unfamiliar
with HBV and HCV and are mostly unaware of the transmission of blood borne pathogens
through shaving tools.

Majority of the participants did not perceive themselves to be at risk of HBV and
HCV infections. This is in line with the observations of Wazir et al. 19] in which the level of knowledge among barbers about health hazards associated with
their profession was found to be very poor, in a descriptive cross-sectional study
to assess awareness among barbers regarding health hazards related to their profession
and to identify professional practices linked with infection transmission in Pakistan.

Micro-trauma induced while shaving cause release of blood and other bodily fluids
which can cause transmission of HBV and HCV to barbers when they come in contact.
Also, contamination of the shaving instruments can pose a great risk to other clients.
Despite this, few barbers were aware of the risk posed by unsafe shaving practices
and the mode of transmission of HBV and HCV infections. For these reasons, awareness
campaigns are imperative and should be focused on both barbers and the general population
especially those who are at risk due to their occupation. Also, HBV vaccination should
be encouraged in order to curb the increasing incidence of HBV.

The study is limited by the smaller sample size, and the inability to use more sensitive
and specific diagnostic methods like polymerase chain reaction (PCR) due to lack of
resources. A causal relationship between barbering and HBV and HCV infections could
not be assessed due to the cross-sectional nature of the study.