The on-going HIV epidemic has generally increased fear of needle-stick injuries (NSI) and renewed interest in the problem such injuries pose in Africa. The aims of the present study were to evaluate the frequency of NSI, explore the circumstances surrounding each injury and estimate the corresponding infection risk, among healthcare workers (HCW) in Uganda. Questionnaires, asking the recipients how many NSI they had suffered in the past year, how each of these NSI had occurred, what (perceived) risk of infection was associated with each injury, and what their practical and psychological reactions were, were sent to the HCW associated with the Mbarara Teaching Hospital in Uganda. Of the 280 individuals who received questionnaires, 180 (64%) responded and 100 (55% of the respondents) each reported suffering at least one NSI in the previous year. The total number of NSI reported (336) represented an incidence of 1.86 NSI/HCW-year. Interns suffered more NSI (annual mean=4.8) than any other occupational group. Most NSI occurred when patients moved during procedures, when HCW re-sheathed needles, or during suturing (each reported by 55 HCW--30% of those responding). Following NSI, 60 HCW said they squeezed the site of the injury and washed it with bleach, 43 believed they had a 10% risk of HIV infection, 87 felt anxious, 54 felt depressed, 40 prayed, 24 had an HIV test, and four were counselled. To estimate actual infection risk, 435 patients were screened for antibody to HIV (1 and 2) and for the surface antigen of the hepatitis B virus (HBSAg); 26% and 2.8% were found seropositive, respectively. These seroprevalences were multiplied by previously determined probabilities of transmission to give estimated risks of infection (following a single NSI) of 0.08% for HIV and 0.135% for hepatitis B. During 3 years of training as a clinician (i.e. 2 years as a medical student and 1 year as an intern), more than six in 1000 individuals would be infected with HIV as a result of NSI and almost 10 in 1000 would be infected with hepatitis B virus by the same route. NSI are common, preventable sources of infection and stress for HCW in Africa.

The aim of this study was to investigate whether a relationship exists between ethnicity and uptake of the first dose of mumps, measles and rubella (MMR1) vaccination, and to study important factors influencing the parental decision about vaccination. Examination of routine data on uptake of MMR1 vaccine among children living in the London borough of Brent, North West London, for associations with ethnicity was carried out. Six focus group interviews were held and a questionnaire on factors related to immunisation by convenience samples of mothers from Asian, Afro-Caribbean and White backgrounds was completed. The routine data reported MMR1 vaccine status for 6444 children living in Brent who were aged between 18 months and 3 years on 1 December 2003. A total of 37 mothers took part in the 6 focus group sessions. Significantly higher coverage by MMR1 vaccine in the Asian population (87.1%) compared with AfroCaribbeans (74.7%) and the White group (57.5%) was noticed. The qualitative data revealed clear differences between the ethnic groups with respect to awareness of the controversy surrounding MMR vaccination (related to use of English-language media) and influence of grandparents and health professionals in decisions about immunisation. A multiple logistic regression model showed that although coverage of MMR vaccination increased with increasing socioeconomic status, there was no evidence of a statistically significant interaction between socioeconomic status and ethnicity. An important association between ethnicity and uptake of MMR1 vaccine is observed. This has implications for efforts to improve the currently inadequate levels of MMR vaccination across the population as a whole.

This study demonstrates the value of using guidelines to improve timeliness and reduce over-utilisation of EEGs in general paediatric practice.

No abstract