Understanding the injuries and environments of vulnerable healthcare workers in Liberia and Ghana: a qualitative study

Authors

  • Laura Jean Ridge University of Cincinnati College of Nursing, Cincinnati, OH, USA; and University of Michigan School of Nursing, Ann Arbor, MI, USA https://orcid.org/0000-0002-6926-2370
  • Marjorie McCullagh University of Michigan School of Nursing, Ann Arbor, MI, USA https://orcid.org/0000-0002-6504-5176
  • G. Clinton Zeantoe United Methodist University Winifred J Harley School of Nursing, Ganta, Liberia
  • Lydia Aziato School of Nursing and Midwifery, College of Health Sciences, University of Ghana, Legon, Accra, Ghana
  • John Arko-Mensah Department of Biological, Environmental & Occupational Health Sciences, School of Public Health, College of Health Sciences, University of Ghana

DOI:

https://doi.org/10.3396/ijic.v22.23893

Keywords:

health personnel, needlestick injuries, Africa, Western, bloodborne infections

Abstract

Background: While sharps injuries are a hazard to healthcare workers globally, research has concentrated on high-income regions. West Africa, including Liberia and Ghana, has high rates of human immunodeficiency virus and hepatitis B virus infections, which can be transmitted via sharps injury. Use of safety-engineered devices is highly limited in this region.

Objective: To explore factors contributing to frequent sharps injuries and underreporting among health care workers in Liberia and Ghana, and to recommend potential interventions.

Design: Semi-structured interviews were conducted via an Internet-enabled platform among nurses, midwives, physicians and physician assistants in Liberia and Ghana. Questions focused on injury history, sharps injury prevention, and work environment. Interview transcripts were analyzed deductively. Recruitment ended when data saturation was reached.

Results: Sixteen interviews were conducted among seven Liberian and nine Ghanaian healthcare workers. Unexpected patient movement and colleagues contributed to seven of 16 injuries. Prelicensure sharps injury prevention training was limited, though more accessible post licensure. Many participants desired more training. Most (n = 12) did not report their injuries. While many viewed their work environment as adequate, others noted specific issues, including inadequate sharps disposal containers and limited supplies.

Discussion: Training deficiencies and systemic gaps were key contributors to injury and underreporting. Respondents showed interest in enhanced training and clearer procedures.

Conclusion: The results of this study suggest ways to reduce sharps injuries in Ghana and Liberia, including additional training for workers and more accessible sharps disposal containers. Materials developed to train these workers have the potential to be useful to workers anywhere resources are constrained.

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References

1.

Bouya S, Balouchi A, Rafiemanesh H, Amirshahi M, Dastres M, Moghadam MP, et al. Global prevalence and device-related causes of needle stick injuries among health care workers: a systematic review and meta-analysis. Ann Glob Health 2020; 86(1): 35. doi: 10.5334/aogh.2698

2.

Groneberg DA, Braumann H, Rolle S, Quarcoo D, Klingelhöfer D, Fischer A, et al. Needlestick injuries: a density-equalizing mapping and socioeconomic analysis of the global research. Int Arch Occup Environ Health 2020; 93(8): 995–1006. doi: 10.1007/s00420-020-01547-0

3.

World Health Organization. Hepatitis scorecard for the WHO Africa region [Internet]. 2019. Available from: https://www.afro.who.int/publications/hepatitis-scorecard-who-africa-region-implementing-hepatitis-elimination-strategy [cited 12 February 2024].

4.

Ridge LJ, Dickson VV, Stimpfel AW. The occupational health of nurses in the Economic Community of West African States: a review of the literature. Workplace Health Saf 2019; 67(11): 554–64. doi: 10.1177/2165079919859383

5.

Ridge LJ, Stimpfel AW, Dickson VV, Klar RT, Squires AP. How clinicians manage routinely low supplies of personal protective equipment. Am J Infect Control 2021; 49(12): 1488–92. doi: 10.1016/j.ajic.2021.08.012

6.

Lori JR, McCullagh MC, Krueger A, Oteng R. Sharps injuries among emergency department nurses in one tertiary care hospital in Ghana. Int Emerg Nurs 2016; 28: 14–19. doi: 10.1016/j.ienj.2015.11.007

7.

Ridge LJ, Arko-Mensah J, Lambert J, Aziato L, Zeantoe GC, Duah H, et al. Sharps injuries among healthcare workers in Liberia and Ghana: a cross-sectional survey. Int J Qual Health Care 2024; 36(3): mzae066. doi: 10.1093/intqhc/mzae066

8.

Centers for Disease Control and Prevention (CDC). Workbook for designing, implementing and evaluating a sharps injury prevention program [Internet]. Atlanta, GA: CDC; 2008. Available from: https://www.cdc.gov/sharpssafety/pdf/sharpsworkbook_2008.pdf [cited 12 February 2024].

9.

Saunders B, Sim J, Kingstone T, Baker S, Waterfield J, Bartlam B, et al. Saturation in qualitative research: exploring its conceptualization and operationalization. Qual Quant 2018; 52(4): 1893–907. doi: 10.1007/s11135-017-0574-8

10.

Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res 2019; 29(10): 1483–96. doi: 10.1177/1049732318821692

11.

Akinleye AA, Omokhodion FO. Work practices of primary health care workers in urban and rural health facilities in south-west Nigeria. Aust J Rural Health 2008; 16(1): 47–8. doi: 10.1111/j.1440-1584.2007.00950.x

12.

Enware OO, Diwe KC. Knowledge, perception and practice of injection safety and healthcare waste management among teaching hospital staff in south east Nigeria: an intervention study. Pan Afr Med J 2014; 17: 218. doi: 10.11604/pamj.2014.17.218.3084

13.

Kingham TP, Kamara TB, Daoh KS, Kabbia S, Kushner AL. Universal precautions and surgery in Sierra Leone: the unprotected workforce. World J Surg 2009; 33(6): 1194–6. doi: 10.1007/s00268-009-0014-6

14.

Fofana DB, Somboro AM, Maiga M, Kampo MI, Diakité B, Cissoko Y, et al. Hepatitis B virus in West African children: systematic review and meta-analysis of HIV and other factors associated with hepatitis B infection. Int J Environ Res Public Health 2023; 20(5): 4142. doi: 10.3390/ijerph20054142

15.

Konlan KD, Aarah-Bapuah M, Kombat JM, Wuffele GM. The level of nurses’ knowledge on occupational post exposure to hepatitis B infection in the Tamale metropolis, Ghana. BMC Health Serv Res 2017; 17(1): 254. doi: 10.1186/s12913-017-2182-7

16.

Ramirez MS. Influence of undergraduate nursing student teaching methods on learning standard precautions and transmission-based precautions: experimental research. Nurse Educ Today 2018; 61: 101–5. doi: 10.1016/j.nedt.2017.11.007

17.

Tarigan LH, Cifuentes M, Quinn M, Kriebel D. Prevention of needle-stick injuries in healthcare facilities: a meta-analysis. Infect Control Hosp Epidemiol 2015; 36(7): 823–9. doi: 10.1017/ice.2015.50

18.

Onadeko MO, Balogun MO, Olanrewaju OO, & Omokhodion FO. Occupational exposure, attitude to HIV-positive patients and uptake of HIV counselling and testing among health care workers in a tertiary hospital in Nigeria. SAHARA J 2017; 14(1): 193–201. doi: 10.1080/17290376.2017.1398104

19.

Amira CO, Awobusuyi JO. Needle-stick injury among health care workers in hemodialysis units in Nigeria: a multi-center study. Int J Occup Environ Med 2014; 5(1): 1–8.

20.

Mossburg S, Agore A, Nkimbeng M, Commodore-Mensah Y. Occupational hazards among healthcare workers in Africa: a systematic review. Ann Glob Health 2019; 85(1): 78. doi: 10.5334/aogh.2434

Published

2026-04-17

How to Cite

Ridge, L. J., McCullagh, M., Zeantoe, G. C., Aziato, L., & Arko-Mensah, J. (2026). Understanding the injuries and environments of vulnerable healthcare workers in Liberia and Ghana: a qualitative study. International Journal of Infection Control, 22. https://doi.org/10.3396/ijic.v22.23893

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Section

Original Articles

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