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Under-reporting of Needlestick Injuries Among Doctors in Teaching Hospitals in Sudan: A cross-sectional study

This cross-sectional study of 484 physicians in Sudanese teaching hospitals reveals a high prevalence of needlestick injuries and significant under-reporting, primarily driven by infrastructural gaps and lack of awareness regarding reporting systems rather than psychosocial factors.

Original authors: Mohamed Ibrahim, Ali Shamsaldeen, Arif Mohd.Taha, Abdulrahman Mohammed, Salma Alsidig, Amany Hussien

Published 2026-07-15

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CC BY 4.0

Original authors: Mohamed Ibrahim, Ali Shamsaldeen, Arif Mohd.Taha, Abdulrahman Mohammed, Salma Alsidig, Amany Hussien

Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). ✨ This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer

Imagine a busy hospital in Sudan as a giant, chaotic game of "Catch the Needle." In this game, doctors are the players, and the needles are the sharp, dangerous tools they use every day. But sometimes, the needles get away from them and poke the doctors instead. This is called a Needlestick Injury (NSI).

This study went into six teaching hospitals across Sudan to ask 484 doctors: "Have you ever gotten poked by a needle in the last year? And if you did, did you tell anyone?"

Here is what they found, served up with a side of reality.

The Big Reveal: A Lot of Pokes, A Lot of Silence

The study found that 40.1% of the doctors (that's 196 out of 484) got poked at least once in the last year. That's a huge chunk of the player base! But here's the twist: nearly half of those pokes—49%—were never reported to the hospital bosses.

Think of it like this: If you get a scratch in a video game, you usually tell the system so you can get a health pack. But in these hospitals, almost half the players got scratched and just kept playing, hoping it would go away.

The "Why" Behind the Silence

You might think the doctors didn't report because they were embarrassed, scared of getting in trouble, or worried about their careers. The study actually rules out those ideas. When the researchers asked, most doctors said, "Nope, I'm not embarrassed, and I'm not scared of my boss."

So, what stopped them? The paper suggests two main culprits, which act like invisible walls:

The "Lost in the Maze" Problem: 59.5% of the doctors didn't even know a reporting system existed! It's like trying to find a secret exit in a building, but no one ever told you there was an exit. If you don't know the door is there, you can't walk through it.
The "I'm Safe" Myth: Some doctors thought, "I got my Hepatitis B vaccine, so I'm invincible. I don't need to report a poke." The study found that 18.6% of the doctors weren't even vaccinated, and even among those who were, some still skipped reporting because they felt safe.

The study also found that if a doctor knew the patient they were working on had a disease (like HIV or Hepatitis), they were 5.41 times more likely to report the injury. It's like if you knew the monster was actually dangerous, you'd definitely tell the guard. But if the monster looked harmless, or if you didn't know what it was, you might just ignore the scratch.

The Junior vs. Senior Gap

The study noticed that the newest doctors (House Officers) reported their injuries less often than the experienced ones (Consultants). However, the paper suggests this isn't because the juniors are braver or more reckless. Instead, it seems to be because they were less aware of the reporting systems and less likely to know if the patient was infectious. Once you account for those missing pieces of knowledge, the gap between juniors and seniors gets much smaller.

What the Doctors Knew (and Didn't Know)

The doctors were pretty good at knowing that needles can carry germs. 94.63% knew this. But when it came to the "what now?" part, the knowledge got fuzzy:

Hepatitis B: Most knew the fix, but some were confused.
HIV: Only about half knew exactly which three drugs were needed to stop the virus after a poke.
Hepatitis C: This was the big blind spot. Only 38.84% knew there is no vaccine for Hepatitis C. A third of the doctors thought there was one, and another third wasn't sure.

The Bottom Line

This study, which surveyed doctors between January and March 2026, suggests that the reason so many needle pokes go unreported isn't because doctors are hiding in shame. It's because the "instruction manual" for reporting is missing, broken, or too hard to find.

The authors point out that in a place where hospitals are already stretched thin by conflict and overcrowding, adding a clear, simple, and easy-to-find reporting system could fix a huge chunk of the problem. They suggest that if you teach the doctors how to report and make sure they know who to tell, the reporting rates will go up.

It's not a magic cure-all, and the study admits it can't prove exactly why things happen (since it just asked questions at one point in time), but it strongly suggests that fixing the "lost in the maze" problem is the key to keeping doctors safe.

Technical Summary: Under-reporting of Needlestick Injuries Among Doctors in Teaching Hospitals in Sudan

Problem Statement
Needlestick injuries (NSIs) represent a critical occupational hazard for healthcare workers (HCWs), serving as a primary vector for blood-borne pathogens such as Hepatitis B (HBV), Hepatitis C (HCV), and HIV. While global estimates suggest nearly 2 million NSIs occur annually, reporting rates remain critically low, with meta-analyses indicating under-reporting rates as high as 59.9%. This under-reporting delays post-exposure prophylaxis (PEP), obscures the true disease burden, and compromises surveillance data.

In Sudan, the healthcare system faces compounding challenges due to ongoing conflict, resource scarcity, overcrowding, and weak occupational health infrastructure. Despite the high risk, there is a lack of detailed data regarding the prevalence of NSIs, the specific drivers of under-reporting, and the knowledge gaps among physicians in this context. Existing literature suggests that under-reporting is often driven by a mix of infrastructural deficits, knowledge gaps, and psychosocial factors (e.g., fear of blame), but these determinants have not been systematically evaluated within the Sudanese teaching hospital setting.

Methodology
This study employed a multicenter, cross-sectional design following STROBE guidelines to assess NSI prevalence, reporting behaviors, and associated factors among physicians in Sudan.

Study Population: The study surveyed 484 licensed physicians (house officers, medical officers, residents, specialists, and consultants) across six teaching hospitals in six Sudanese states (Wad Madani, Al-Qadarif, Kassala, Al-Manaqil, Port-Sudan, Sinjah, and Sinnar).
Sampling: Convenience sampling was used. The target sample size was calculated based on a single-proportion formula (95% confidence level, 5% margin of error, 50% expected prevalence), yielding a minimum of 385 responses. The final sample of 484 provided 80% power to detect small effect sizes and 99% power for medium-to-large differences.
Instrument: A validated, structured electronic questionnaire (Google Form) was administered between January and March 2026. The tool covered demographics, NSI prevalence (past 12 months), awareness of reporting systems, post-exposure management, barriers to reporting, and knowledge of PEP protocols. The questionnaire demonstrated good internal consistency (Cronbach's alpha = 0.8045).
Statistical Analysis: Data were analyzed using Python. Bivariate associations were assessed using Chi-square and Mann-Whitney U tests. A two-stage logistic regression approach was utilized to identify predictors of reporting behavior:
1. Bivariate Screening: Variables with $p < 0.20$ were retained for the multivariate model.
2. Multivariate Analysis: Adjusted Odds Ratios (aOR) with 95% Confidence Intervals (CI) were calculated to isolate independent predictors. Model fit was assessed using the Likelihood Ratio test and McFadden's Pseudo R².

Key Results

Prevalence and Under-reporting: 40.08% ( $n=196$ ) of participants reported at least one NSI in the past 12 months. Of these injuries, 49% were not formally reported.
Vaccination and Awareness: Only 52.69% of respondents had completed the full three-dose HBV vaccine series, while 18.6% were completely unvaccinated. A significant majority (59.5%) were unaware of any established NSI reporting system in their hospital.
Injury Characteristics: The most common injury mechanisms were syringes (43.88%) and suture needles (38.27%), occurring primarily during tool usage (56.63%).
Post-Exposure Management: Formal PEP protocols were rarely utilized; only 12.20% of exposed individuals received PEP, and 7.09% attended follow-up. Notably, 32.88% of participants took no action following their most recent injury.
Barriers to Reporting: The primary barrier identified was a lack of knowledge regarding how to file a report (22.84%), followed by the belief that prior vaccination negated the need to report (14.87%) and a lack of accessible reporting personnel (14.22%). Psychosocial barriers such as embarrassment or fear of career impact were largely rejected by the majority of respondents.
Predictors of Reporting Behavior:
- Multivariate Analysis: Two independent predictors significantly influenced the likelihood of reporting:
  1. Known Infectious Source: Physicians were 5.41 times more likely to report if the source patient was known to be infectious (aOR = 5.41; 95% CI: 2.15–13.57; $p < 0.001$ ).
  2. Awareness of Reporting System: Awareness of the system doubled the odds of reporting (aOR = 2.06; 95% CI: 1.10–3.86; $p = 0.025$ ).
- Seniority: While junior staff (house officers) showed lower reporting rates in bivariate analysis compared to senior physicians, this association was not statistically significant in the adjusted model, suggesting it was confounded by awareness and source patient status.
Knowledge Gaps: While general awareness of transmission risks was high (94.63%), specific clinical knowledge regarding PEP was variable. Only 51.65% correctly identified the antiretroviral regimen for HIV PEP, and a critical gap existed regarding Hepatitis C, where only 38.84% correctly identified that no vaccine exists.

Significance and Claims
The paper claims that under-reporting of NSIs among Sudanese physicians is prevalent and is driven primarily by infrastructural gaps and knowledge deficits rather than psychosocial factors like fear or stigma.

Systemic Drivers: The study highlights that the lack of a standardized, accessible reporting mechanism and the low rate of HBV vaccination are critical systemic failures. The finding that "awareness of the reporting system" is a modifiable predictor underscores the need for clear, simplified reporting pathways.
Targeted Interventions: The authors argue that educational initiatives must move beyond general awareness of risks to focus on the practical mechanics of reporting and post-exposure management. Special attention is required for junior physicians, who exhibit lower reporting rates, and for ensuring adequate vaccination coverage.
Contextual Relevance: In the context of Sudan's conflict-affected and resource-limited healthcare system, the study establishes a baseline for understanding occupational hazards. It posits that improving reporting is not merely a procedural fix but a critical step in ensuring timely PEP, reducing the economic and psychological burden on HCWs, and generating accurate epidemiological data for policy-making.

The authors conclude that addressing these structural and educational deficiencies is essential to mitigating the impact of needlestick injuries and improving healthcare worker safety in similar resource-constrained environments.