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Knowledge of Hepatitis B Infection Vaccination Status, Risk Perception and Barriers among Hospital Cleaners at the University of Abuja Teaching Hospital Gwagwalada, Nigeria

Despite high levels of hepatitis B knowledge and risk perception among hospital cleaners at the University of Abuja Teaching Hospital, vaccination coverage remains critically low due to systemic institutional barriers such as the absence of enforceable vaccination policies and inadequate staff orientation.

Original authors: Adam Omotosho Abdulquadri, Biyaya Nwankwo, Saheed Ayodeji Adekola, Doyinsola Faiza Akano, Hassanat Taiye Aliyu, Al-Ghazali Etudaiye Muhammed

Published 2026-08-13

📖 5 min read🧠 Deep dive

CC BY 4.0

Original authors: Adam Omotosho Abdulquadri, Biyaya Nwankwo, Saheed Ayodeji Adekola, Doyinsola Faiza Akano, Hassanat Taiye Aliyu, Al-Ghazali Etudaiye Muhammed

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 hospital as a bustling, high-speed train station. Trains (patients) arrive and depart constantly, carrying all sorts of cargo, some of it dangerous. To keep the station running smoothly, a team of janitors (cleaners) sweeps up the tracks, wipes down the platforms, and clears away the debris. These workers are the unsung heroes who make sure the next train doesn't crash into a pile of trash. But here's the catch: sometimes the "trash" isn't just paper or dirt; it can be invisible, microscopic threats like viruses that hide in blood or sharp objects left behind. One of the most notorious of these threats is the Hepatitis B virus. Think of Hepatitis B as a sneaky, invisible graffiti tagger that can stick to surfaces for days and jump onto anyone who touches it, potentially causing serious, long-term damage to the liver.

To stop this graffiti, scientists have developed a "shield"—a vaccine. It's like giving your body a training manual and a set of armor so that if the virus ever tries to attack, your immune system knows exactly how to fight it back. Usually, you need three doses of this shield to make the armor complete. The big question for anyone running a train station (or a hospital) is: Are the janitors who clean up the mess actually wearing this armor? If they aren't, they are the most vulnerable people in the building, yet they are often the ones most likely to get hurt by the dangerous debris. This is the story of a group of researchers who decided to check the armor status of the cleaners at a major hospital in Nigeria, asking not just if they knew about the danger, but if they were actually protected.

The Story of the Cleaners and the Invisible Shield

Researchers at the University of Abuja Teaching Hospital decided to investigate the "armor" situation among the hospital cleaners. They didn't just guess; they went out and talked to 145 cleaners, asking them a series of questions to see what they knew, how they felt about the risks, and whether they had actually received the Hepatitis B vaccine.

What They Knew vs. What They Did
The results were a bit like finding a group of people who know the rules of a video game perfectly but haven't actually logged in to play. The study found that the cleaners were actually quite smart about the disease. A whopping 93.1% of them had "good knowledge" of what Hepatitis B is and how it spreads. They knew it could travel through sharp objects, blood, and even from mother to baby. Furthermore, 76.6% knew good things about the vaccine itself, and 73.1% felt they were at risk of getting the disease.

However, when the researchers asked, "So, have you gotten the vaccine?" the story changed dramatically. Despite knowing the rules and feeling the risk, only 33.8% of the cleaners had received even a single dose of the vaccine. Even worse, only 19 people out of the entire group (which is just 13.1%) had completed the full three-dose series needed to build that full armor. It's as if everyone in the station knew the train was coming and knew they needed a helmet, but only a few had actually put one on their heads.

The Real Danger
The study also looked at how often these workers actually got hurt. The numbers were startling: 33.1% of the cleaners said they had been pricked by a needle in the last year, and 33.8% said they had cut themselves. That means roughly one out of every three cleaners had a chance to catch the virus recently. Yet, less than half of them had received any training on how to handle these injuries in the past year.

Why the Armor Was Missing
So, why didn't they get vaccinated if they knew they needed to? The researchers asked the unvaccinated cleaners what stopped them, and the answers pointed a finger not at the cleaners, but at the hospital system itself. The biggest barriers were:

Lack of awareness: 66.2% said they simply didn't know they could get the vaccine or that it was for them.
No hospital policy: 57.9% said the hospital didn't have a clear rule or plan to give vaccines to cleaners.
Bad orientation: 53.8% said they were never properly introduced to these health benefits when they started their jobs.
Cost: 37.2% said they couldn't afford it.

The study suggests that the problem isn't that the cleaners are ignorant or afraid; it's that the "train station management" hasn't set up a system to hand out the helmets. The researchers found that older workers and those who had been there longer were slightly more likely to be vaccinated, suggesting that they might have just stumbled upon the vaccine over time rather than being part of a planned program.

The Bottom Line
The paper concludes that while the cleaners are well-informed and aware of the danger, the vaccination rate is critically low. The authors argue that the solution isn't just to teach the cleaners more facts—they already know the facts. Instead, the hospital needs to change its rules. They need to make vaccination a mandatory, free, and easy part of the job, especially for new hires. Until the hospital creates a system that automatically hands out the "armor," these frontline workers will remain vulnerable, even though they know exactly what they are up against.

Technical Summary: Knowledge of Hepatitis B Infection, Vaccination Status, Risk Perception, and Barriers among Hospital Cleaners at UATH, Nigeria

Problem Statement
Hospital cleaners represent a frontline occupational group in healthcare infection control yet remain among the least studied populations regarding Hepatitis B Virus (HBV) risk. Despite the high prevalence of chronic HBV in Nigeria (estimated at 9.5% nationally, rising to 12.1% in the North West) and the virus's ability to persist on environmental surfaces for up to seven days, cleaners face disproportionate exposure through contact with contaminated sharps, body fluids, and clinical waste. While existing literature addresses HBV knowledge and vaccination among clinical staff (physicians, nurses), evidence regarding ancillary staff is sparse. Previous studies in Nigerian tertiary hospitals have indicated near-zero vaccination rates among cleaners, suggesting a systemic failure in occupational health provision rather than individual disengagement. This study addresses the gap by evaluating the knowledge, risk perception, vaccination status, and barriers to vaccination among cleaners at the University of Abuja Teaching Hospital (UATH), Gwagwalada.

Methodology
The study employed a descriptive, hospital-based cross-sectional design conducted at UATH, a 520-bed federal tertiary institution.

Population and Sampling: The target population comprised 198 active cleaners. Using the Yamane formula with a 5% margin of error and adjusting for a 10% non-response rate, a sample size of 145 was determined. Participants were selected via systematic random sampling (sampling interval $k=2$ ).
Data Collection: A structured, interviewer-administered questionnaire, adapted from a prior Nigerian study, was used. The instrument covered five domains: sociodemographics, HBV infection knowledge, HBV vaccine knowledge, risk perception, and vaccination barriers. Data were collected during closing hours by trained research assistants.
Outcome Measures:
- Knowledge: Assessed via 11 items for infection (transmission, at-risk groups, prevention) and 5 items for the vaccine. A score $\ge$ 50% defined "good knowledge."
- Risk Perception: Assessed via 6 items regarding exposure behaviors (e.g., glove use, injury history). A score $\ge$ 50% defined "good risk perception."
- Vaccination Status: Defined as receipt of at least one dose; "complete" status required all three recommended doses.
Analysis: Data were analyzed using SPSS version 23. Descriptive statistics (frequencies, percentages) summarized variables. Associations between sociodemographic characteristics and outcomes were tested using Pearson's chi-square test ( $p < 0.05$ ).
Ethics: Approval was granted by the UATH Health Research Ethics Committee. Written informed consent was obtained from all participants.

Key Results

Demographics: The study achieved a 100% response rate ( $n=145$ ). The mean age was 40.63 $\pm$ 9.96 years; 73.1% were female. 61.4% had secondary education, and 36.6% had over 10 years of work experience.
Knowledge Levels:
- HBV Infection: 93.1% (135/145) demonstrated good knowledge. Blood donation from infected persons (80.7%) and sexual transmission (78.6%) were well-recognized, while mother-to-child transmission was the least recognized route (67.6%).
- HBV Vaccine: 76.6% (111/145) had good knowledge. While 85.5% recognized healthcare workers should be vaccinated, critical gaps existed regarding post-exposure prophylaxis (PEP): only 44.8% knew the vaccine is most effective within 48 hours of exposure, and only 51.0% knew it could be used as PEP.
Risk Perception and Exposure:
- 73.1% (106/145) exhibited good risk perception.
- 89.0% reported routine glove use.
- However, significant occupational exposures were documented: 33.1% reported at least one needlestick injury in the past year, and 33.8% reported a cut injury. Only 48.3% had received infection-related training in the preceding year.
Vaccination Status:
- Coverage was critically low: Only 33.8% (49/145) had received at least one dose.
- Full series completion (3 doses) was achieved by only 13.1% (19/145).
- 65.5% remained completely unvaccinated.
Barriers: Among the unvaccinated or incompletely vaccinated ( $n=126$ $n = 126$ ), the primary barriers were:
- Lack of awareness (66.2%).
- Absence of an appropriate hospital vaccination policy (57.9%).
- Inadequate orientation for new staff (53.8%).
- Unaffordability (37.2%).
Associations: Vaccination status was significantly associated with age ( $p=0.023$ ) and years of working experience ( $p=0.005$ ). Older workers and those with longer tenure were more likely to be vaccinated. Sex was significantly associated with vaccine knowledge ( $p=0.032$ ) and risk perception ( $p<0.001$ ).

Significance and Claims
The study concludes that while hospital cleaners at UATH possess generally adequate knowledge of HBV and risk awareness, vaccination coverage remains critically low. The authors argue that the disconnect between high knowledge scores and low vaccination rates indicates that individual ignorance is not the primary driver of non-compliance. Instead, the findings point to systemic institutional shortcomings as the proximate barriers. Specifically, the absence of enforceable vaccination policies and structured orientation programs for new staff prevents the translation of knowledge into action.

The paper posits that the current low uptake is driven by institutional tenure (longer exposure time correlates with higher vaccination) rather than organized occupational health programs. Consequently, the authors assert that targeted policy reforms are urgently needed, including making HBV vaccination a mandatory component of occupational health onboarding, providing subsidized on-site delivery, and implementing tracking systems to ensure schedule completion. The study calls for similar research in other Nigerian and African institutions to determine the generalizability of these findings.

Technical Summary: Knowledge of Hepatitis B Infection, Vaccination Status, Risk Perception, and Barriers among Hospital Cleaners at UATH, Nigeria

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