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Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In this paper, we walk you through our challenges, successes, and experience while participating in a Global Health Outreach Project at the University College Hospital (UCH) Ibadan, Nigeria. The scope of the project was to install a Picture Archive and Communication System (PACS) to establish a centralized viewing network at UCH's Radiology Department, for each of their digital modalities. Installing a PACS requires robust servers, the ability to retrieve and archive studies, ensuring workstations can view studies, and the configuration of imaging modalities to send studies. We anticipated that we might experience hurdles for each of these requirements, due to limited resources and without the availability to make a site visit prior to the start of the project. While we ultimately experienced delays and troubleshooting was required at each turn of the install, with the help of dedicated volunteers both on and off-site and the UCH staff, our shared goal was accomplished. [ABSTRACT FROM AUTHOR]

Background: Maternal death reviews and obstetric audits identify causes and circumstances related to occurrence of a maternal death or serious complication and inform improvements in quality of care. Given Nigeria's high maternal mortality, the lessons learned from past experiences can provide a good evidence base for informed decision making. We aimed to synthesise findings from maternal death reviews and other obstetric audits conducted in Nigeria through a systematic review, seeking to identify common barriers and enabling factors related to the provision of emergency obstetric care. Methods: We searched for maternal death reviews and obstetric care audits reported in the published literature from 2000-2014. A 'best-fit' framework approach was used to extract data using a structured data extraction form. The articles that met the inclusion criteria were assessed using a nine point quality score. Results: Of the 1,841 abstracts and titles at initial screening, 329 full text articles were reviewed and 43 papers fulfilled the inclusion criteria. Four types of barriers were reported related to: transport and referral; health workers; availability of services; and organisational factors. Three elements stand out in Nigeria as contributing to maternal mortality: delays in Caesarean section, unavailability of magnesium sulphate and lack of safe blood transfusion services. Conclusions: Obstetric care reviews and audits are useful activities to undertake and should be promoted by improving the processes used to conduct them, as well as extending their implementation to rural and basic level health facilities and to the community. Urgent areas for quality improvement in obstetric care, even in tertiary and teaching hospitals should focus on organisational factors to reduce delays in conducting Caesarean section and making blood and magnesium sulphate available for all who need these interventions. [ABSTRACT FROM AUTHOR]

Nowadays, an electronic health information management system (EHIMS) is crucial for patient care in hospitals. This paper explores the aspects and elements that contribute to the success of EHIMS in Nigerian teaching hospitals. The study adopted a survey research design. The population of study comprised 442 health information management personnel in five teaching hospitals that had implemented EHIMS in Nigeria. A self-developed questionnaire was used as an instrument for data collection. The findings revealed that there is a positive, close relationship between all the identified factors and EHIMS's success: technical factors (r = 0.564, P < 0.05); social factors (r = 0.616, P < 0.05); organizational factors (r = 0.621, P < 0.05); financial factors (r = 0.705, P < 0.05); and political factors (r = 0.589, P < 0.05). We conclude that consideration of all the identified factors was highly significant for the success of EHIMS in Nigerian teaching hospitals. [ABSTRACT FROM AUTHOR]

Background: Patients with chronic kidney disease (CKD) often complain of taste dysfunction. The prevalent taste dysfunction among patients with CKD predisposes them to malnutrition, poor quality of life, and worsen disease prognoses. To appropriately treat the taste dysfunction in this group of patients, it's imperative that factors that predict taste dysfunction and its severity are identified for prompt treatment. Aim: To identify factors associated with taste dysfunction and its severity among patients with CKD. Materials and Methods: This was a hospital-based case–control study of adult patients with CKD at the University College Hospital, Ibadan, Nigeria. The control group was made up of age- and gender-matched healthy volunteers with no clinical and laboratory evidence of CKD. Relevant clinical and social data obtained include demographics, symptoms, and signs of taste dysfunction and its risk factors. The 4 basic taste modalities namely sweet, sour, bitter, and salt taste senses of the participants were tested with validated "taste strips." Factors that predict taste dysfunction were identified among the spectrum of the disease. Results: There were 100 patients with CKD and 100 healthy controls, age ranges between 19 and 86 years (mean ± standard deviation [SD] = 46.3 ± 13.9 years) and 20 and 85 years (mean ± SD = 43.4 ± 14.9 years), respectively. There was no statistically significant difference between cases and control gender distribution (P =.57). Hypogeusia was found in 27.0% of patients with CKD, while total taste function score of all the control was within normal range. Increasing duration of CKD was identified as a predictor of taste dysfunction among patients with CKD (odds ratio: 4.889, P =.038). The stages of CKD had no statistically significant relationship with the severity of taste dysfunction (P =.629). Conclusion: The prevalence of taste dysfunction among patients with CKD was high and this showed significant correlation with increasing duration of CKD; in contrast, the severity of CKD is not significant in the development of taste dysfunction. [ABSTRACT FROM AUTHOR]

Menstrual hygiene is keeping the body clean while a woman is menstruating. Many females have encountered considerable difficulty maintaining menstrual hygiene because of a lack of awareness or access to menstrual products, particularly in low- and middle-income nations. However, knowledge and practice of menstrual hygiene among female undergraduates, especially in Nigeria, are understudied. This descriptive crosssectional study investigated the knowledge, practices and barriers associated with menstrual hygiene among female undergraduates of a private university in Nigeria. Three hundred and sixty-four participants were recruited using purposive sampling. Sociodemographic data, knowledge, practice and barriers associated with menstrual hygiene were assessed using a self-report knowledge and practice of menstrual hygiene questionnaire. Data were analyzed using descriptive statistics. The results revealed that most respondents (72.3%) had poor knowledge of menstrual hygiene, while around half (49.2%) maintained good practices. The most common barriers to practicing menstrual hygiene among the respondents were reported as fatigue and limited water access in their dormitories. Therefore, schools of higher learning need to ensure that students have regular access to clean water with adequate time between classes to allow for proper menstrual hygiene practice. Nurses could provide menstrual education for mothers and their adolescents before getting into university. Similarly, nurses working in institutions of higher learning should provide regular menstrual hygiene awareness programs on campus and advocate for access to clean water and hygiene facilities for female students undergoing menstruation. [ABSTRACT FROM AUTHOR]

Introduction: Adequate nutrition plays a major role in delaying disease progression and improving quality of life of people living with human immunodeficiency virus (PLHIV). Therefore, it is important to assess their nutrition knowledge and practice of dietary diversity, especially in resource-limited settings, where most HIV infections occur. Aim of the study was to assess the nutrition knowledge and dietary diversity practice of PLHIV in a resource-limited setting. Material and methods: This was a health facility-based cross-sectional analytical study conducted at two tertiary HIV clinics in Enugu, Nigeria. Using a systematic random sampling technique, 370 adult HIV patients were recruited. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with good nutrition knowledge and high dietary diversity among respondents. P-value < 0.05 was considered statistically significant. Results: Good nutrition knowledge was observed in 69.7% of the respondents, while 60.0% had high dietary diversity. In multivariate analysis, secondary educational level (AOR: 0.54; 95% CI: 0.29-0.97; p = 0.040) and earning a family monthly income of 31,000-60,000 (AOR: 2.12; 95% CI: 1.11-4.06; p = 0.024) were predictors of good nutrition knowledge. Number of children in a household (AOR: 2.09; 95% CI: 1.19-3.67) was predictive of high dietary diversity. Conclusions: Educational level and family monthly income are predictors of nutrition knowledge, while number of children in a household is a predictor of dietary diversity. Nutrition education should be incorporated into HIV care program targeting those with low educational levels and low family monthly incomes for improvement of their nutrition knowledge. [ABSTRACT FROM AUTHOR]

Health screening exercises are important, as they enable early detection of diseases in individual subjects and also enable data collection, useful in estimating disease burden in the community. This paper describes the findings of a health screening exercise conducted in a semiurban population of Iloye, by the Rotary Club of Ota, Ogun State, Western Nigeria, as a part of its community-oriented services and projects. Three hundred and twenty six community members were screened during the exercise. There were 189 (57.97%) females and 137 (42.03%) males, with a mean age of 43.5 ± 14.88 yrs. Urinary abnormality and/or creatinine clearance less than 90 mls/min was detected in 147 (45.09%) participants. 99 (30.37%) participants had proteinuria, 16 (4.91%) had haematuria, and 5 (1.53%) participants had both haematuria and proteinuria. Eight (2.45%) participants had GFR less than 60 mls/min. Elevated blood pressure was found in 152 (46.63%), while 3 (0.9%) participants had diabetes, 71 (21.8%) were obese, 16 (4.9%) had hypercholesterolaemia, and 3 (0.9%) had hypertriglyceridaemia. Prevalence of both smoking and alcohol consumption was 6 (1.84%). It was concluded that the prevalence of indices of kidney damage and cardiovascular risk factors is high in Iloye community. [ABSTRACT FROM AUTHOR]

Background: High nurse-patient ratios are burdensome for nurses and seem to be associated with shift work disorder. This study determined nurses' workload using nurse-patient ratios as indexes and examined the influence of workload burden on shift work disorder (SWD) among nurses. Methods: An ex-post facto design was utilized and was conducted in selected tertiary hospitals in Southwestern Nigeria. A multistage sampling technique was used to select 422 respondents. A structured questionnaire was used to collect data. Data was analyzed with SPSS Version 20. Results Mean of respondents working on the wards was 13 ±5.1; the average nurse-patient ratio was 1: 8 ± 6.4. Prevalence of symptoms predictive of SWD was (49.6%). More than half of the nurses (55.9%) had high workload, while (44.1%) had low workload. Workload was significantly associated with insomnia (χ² = 7.07, p = 0.001), and sleepiness (χ²= 5.77, p = 0.01) among nurses. Conclusion: The study concluded that nurses who had more patients to care for had more symptoms predictive of shift work disorder. [ABSTRACT FROM AUTHOR]

Background: Unethical behavior among nurses is gradually becoming a severe problem in the health sector of Nigeria, and this calls for urgent concern. However, it may be associated with issues inside healthcare organizations. Therefore, this study aimed to investigate the relationship between role ambiguity, organizational justice, and unethical behavior among nurses. Methods: This was a cross-sectional study. In total, 300 participants were selected from Lagos State Teaching Hospital (LUTH) in Lagos metropolis using a convenience random sampling method. A structured questionnaire consisting of demographics and Unethical Behavior Scale (UBS), Role Ambiguity Scale (RAS), and Organizational Justice Scale (OJS) was used to collect the required data. Multiple regression model was used to analyze the obtained data in SPSS. Results: Among the subjects, 71.9% were females, and 28.1% were 99 males. Their age ranged from 24 to 57 years Mean±SD: 31.66±3.13. There was an independent relationship between role ambiguity and unethical behavior (ß=0.229; t=3.157; P<0.05). Additionally, there was an independent relationship between organizational justice and unethical behavior (ß=-0.317; t= -2.182; P<0.05). Conclusion: Role ambiguity and organizational justice predicted unethical behavior. Therefore, the authorities and hospital managers of Nigeria should design an intervention program tailored for resolving role ambiguity and improving organizational justice. This will help to reduce the menace of unethical behavior among these nurses. [ABSTRACT FROM AUTHOR]

Background: Many studies on transcutaneous electrical nerve stimulation (TENS) had been undertaken to explore its pain relieving efficiency on several medicals/surgical conditions but none, specifically, had been carried out to determine the effect it has on post-injection sciatic pain (PISP) which comes about from wrong administration of intramuscular pain. This study aims to assess the effects of TENS in the management of PISP. Methods: A total of 72 PISP subjects comprising 40 test subjects and 32 control subjects participated in a non-randomized controlled clinical trial in the current study. Participants were recruited from Department of Physiotherapy, Nnamdi Azikiwe University Teaching Hospital, Nnewi and Landmark Physiotherapy Services, Nnewi. The participants were however blinded to the intervention method they will receive before being allotted conveniently to test/experimental group (TG) or control group (CG). A written informed consent was obtained from participants before enrollments in the study. TENS and sham TENS (STENS) was applied to 40 test and 32 subjects respectively, 3 times a week, and 1 hour per session for the 10 weeks the study lasted. The Visual Analogue Scale was used to collect baseline data as well as those of 2nd, 4th, 6th, 8th and 10th weeks after TENS and STENS interventions. The data analysis was performed with the Descriptive statistic of Mean ± SD, mean comparison test, repeated analysis of variance and paired wise t-test. Statistical level of significance was set at P < 0.05. Result: Results of repeated measure ANOVA showed that the pain level among participants in the treatment group at the end (after 10 weeks) of the intervention was significantly lower than that of their counterparts in the control group (F = 16.26; p = 0.01); with the intervention accounting for the 19% of the variance. The effect size (partial eta squared) = 0.19. Conclusion: The outcome of this research has proved the effectiveness of TENS in the management of PISP and is being recommended in the management of PISP. Trial registration: Pan Africa Clinical Trial Registry (PACTR201805003408271). The study was registered retrospectively on the 29th May, 2018. [ABSTRACT FROM AUTHOR]

Background: Beta (β)-endorphins are endogenous neuropeptides found in the plasma and cerebrospinal fluid (CSF) of humans but there have been reports of the relationship between the plasma and CSF β-endorphin levels in different clinical conditions. However, the relationship between β-endorphin levels in the plasma and CSF of children with cerebral malaria (CM) has not been reported. Aim: To determine the relationship between β-endorphin levels in the CSF and plasma of children with CM. Settings and Design: This cross-sectional study involved 40 children, aged between 6 months and 14 years, admitted with a diagnosis of CM at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria. Materials and Methods: One milliliter (mL) of venous blood and 1mL of CSF obtained from each subject at admission were used to determine the β-endorphin levels using enzyme-linked immunosorbent assay (ELISA) method. Statistical Analysis: Bivariate linear regression was used to determine the association between plasma and CSF β-endorphin levels using the correlation coefficient (r), coefficient of determination (R2), and P values. Results: The plasma β-endorphin levels significantly positively correlated with CSF β-endorphin (r = 0.568, P = 0.001) such that for every unit rise in plasma β-endorphin, CSF β-endorphin rose by 0.252 pmol/L (confidence interval: 0.132–0.371 pmol/L). Conclusion: The finding of positive correlation between plasma and CSF β-endorphin levels in this study suggests a possible direct link between plasma and CSF in CM, probably from the disruption of the blood–brain barrier that has been reported in CM. [ABSTRACT FROM AUTHOR]

Purpose: ST2 receptor, which is a member of the Toll-like/interleukin-1 (IL-1) receptor family, has been found to be increased in the serum of patients 1 day after myocardial infarction. Several other studies have shown that soluble ST2 levels correlate with severity of heart failure (HF), left ventricular ejection fraction, creatinine clearance, B-type natriuretic peptide and C-reactive protein, and are predictors of mortality in HF. Most of these studies were not only limited to ischemic heart disease but also concentrated on left-sided HF. We therefore decided to study the relationship between soluble ST2 and some markers of right ventricular (RV) function in a cohort of hypertensive HF subjects.Patients and Methods: This is a prospective cohort study of hypertensive HF patients presenting to the University of Abuja Teaching Hospital, Abuja, over a 12-month period. ST2 was measured in plasma sample by the enzyme-linked immunosorbent assay (ELISA) method. Right ventricular diameters in diastole (RVDD) and right atrial area (RAA) were obtained on echocardiography, while right ventricular systolic pressure (RVSP) was estimated from echocardiography by the addition of the pressure gradient between the right ventricle and right atrium (RA) to the pressure in the RA.Results: There was a significant correlation between RVSP and soluble ST2 (t=0.75, p<0.0001), RVDD (t=0.28, p=0.004) and RAA (t=0.46, p=0.002).Conclusion: In a cohort of hypertensive HF subjects, soluble ST2 correlates significantly with RVSP, RVDD and RAA. [ABSTRACT FROM AUTHOR]

Background: Intimate partner violence (IPV) relates to poor physical and mental health in women. Women who have experienced it access healthcare facilities more frequently with symptoms that are often unrelated to violence. The objective of the study was to determine the prevalence of IPV and health-related factors in women in the study population. Method: This clinic-based, cross-sectional study was carried out between November 2010 and January 2011 at the general outpatient clinic of the University College Hospital, Ibadan, Nigeria. Four hundred women aged 15 years and older with previous or current intimate partners were recruited by simple random sampling. Data were collected using an interviewer-administered questionnaire to obtain information on the respondents' socio-demographic characteristics, lifetime experience of IPV and clinical data, i.e. presenting symptoms, body mass indices and blood pressure readings. The clinical data of women who had a lifetime experience of IPV were compared with those who did not. Results: The overall lifetime prevalence of IPV was 89.2%. Reported IPV types were controlling behaviour (79.5%), psychological violence (35.7%), and physical (19.8%) and sexual violence (9.8%). Non-specific complaints (p = 0.028), female genital complaints (p = 0.037), poor sleep (p = 0.049), headaches (p = 0.011), abrasions or scars (p = 0.012), suicidal ideation (p = 0.001) and obesity (p = 0.021) were significantly more common in women who had experienced IPV than in those who had not. The logistic regression analysis showed suicidal ideation as the most significant factor relating to IPV (odds ratio 12.658, 95% confidence interval: 1.248-29.677). Conclusion: The high prevalence of IPV in women who routinely present to this primary care clinic suggests that there is a need for IPV screening. The association of IPV with a spectrum of clinical factors signifies its ubiquitous occurrence and underscores the need for healthcare providers to have a high index of suspicion, especially in cases whereby women present with non-specific complaints. Suicide screening should also be performed on women found to be positive for IPV. [ABSTRACT FROM AUTHOR]

Background Malnutrition is an underlying factor in more than 50% of the major cause of infant mortality-Pneumonia, diarrhoeal disease and measles which account for 70% of infant mortality. Therefore, programs to promote adequate nutrition for age can help reduce mortality from these disease conditions and indispensible to achievement of MDG 4. Aim To describe the feeding practices of infants below six months of age and determine maternal socio-demographic factors that influences the practice of exclusive breastfeeding (EBF) among mothers in Nnewi, south-east Nigeria. Methods Four hundred mother-infant pairs attending the infant welfare clinic of the Nnamdi Azikiwe University teaching hospital (NAUTH) during 2012 were consecutively recruited after meeting the study inclusion criteria. Data on breastfeeding were based on infant feeding practice in the previous 24 hours. Exclusive breastfeeding was defined as infant feeding with only breast milk. Results Awareness (95.3%) and knowledge (82.0%) of EBF was high among surveyed mother but the practice of EBF (33.5%) was very low. Positive attitude towards EBF practice was shown by many (71.0%) of surveyed mothers. EBF practice decreased with increasing infant age, OR 0.72 (95% CI 0.34, 1.51) for 1-2 months, OR 0.58 (95% CI 0.23, 1.44) for 3-4 months and OR 0.20 (95% CI 0.06, 0.73) for 5-6 months compared to infants < 1 month old. Maternal education, socioeconomic class, mode of delivery and infants first feed were retained as important maternal predictors of EBF practice after adjustment for confounders. Decreased likelihood of EBF practice was found among mothers of lower educational attainment, OR 0.33 (95% CI 0.13, 0.81), mothers who delivered through caesarean section, OR 0.38 (95% CI 0.18, 0.84), mothers of higher socio-economic status [(middle class, OR 0.46 (95% CI 0.22, 0.99) and upper class, OR 0.32 (95% CI 0.14, 0.74)] while increased likelihood of EBF practice was seen in mothers who gave their infants breast milk as their first feed, OR 3.36 (95% CI 1.75, 6.66). Conclusion Knowledge and awareness does not translate to practice of EBF. More effort by health workers and policy makers should be directed to mothers along the fault lines to encourage the practice of EBF. [ABSTRACT FROM AUTHOR]

Children with sickle cell disease (SCD) are plagued with incessant crises. There are few studies on the effect of sickle cell crises on renal function as determined by the glomerular filtration rate (GFR). This study was done to assess the effect of sickle cell crises on GFR during crises and after recovery into the steady state. GFR was assessed using the formula derived by Schwartz et al., for consecutive SCD patients aged between 3 and 18 years who came in crises and after recovery into the steady state. A total of 81 patients with a mean age of 9.95 ± 4.15 years in 81 episodes of crises met the inclusion criteria. Majority of the children (47) had vasooclusive crises, 19 had hyperhaemolytic crises, and 15 had features of both vasooclusive and hyperhaemolytic crises. The means value of GFR in ml/min/1.73 m2 rose from 81.09 ± 22.92 to 116.24 ± 22.11 subsequent to recovery from vasooclusive crises into the steady state, from 77.45 ± 18.48 to 99.54 ± 17.71 following recovery from hyperhaemolytic crises into the steady state and from 90.95 ± 17.53 to 114.01 ± 22.44 following recovery from crises with features of both vasooclusive and hyperhaemolytic crises with corresponding significant P values of 0.000, 0.001, and 0.004 respectively. The reduced GFR observed during vasooclusive and hyperhaemolytic crises improved significantly following recovery into the steady state. [ABSTRACT FROM AUTHOR]

Copyright of African Journal of Reproductive Health is the property of Women's Health & Action Research Centre and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: The epidemic of HIV in sub-Saharan Africa varies significantly across countries in the region with high prevalence in Southern Africa and Nigeria. Cancer is increasingly identified as a complication of HIV infection with higher incidence and mortality in this group than in the general population. Without cancer prevention strategies, improved cancer treatment alone would be an insufficient response to this increasing burden among people living with HIV (PLHIV). Although previous studies have noted low levels of awareness of cancers in sub-Saharan Africa none has examined the knowledge and perceptions of cancer among people living with HIV/AIDS. Methods: Focus group discussions (FGD) and Key Informant Interviews (KII) were carried out in 4 high volume tertiary care institutions that offer HIV care and treatment in Nigeria. FGD and KII assessed participants' knowledge of cancer, attitudes towards cancer risk and cancer screening practices. Results: The mean age (SD) of the FGD participants was 38 (2.8) years. Most participants had heard about cancer and considered it a fatal disease but displayed poor knowledge of the causes of cancer in general and of AIDs associated cancers in particular. PLHIV in Nigeria expressed fear, denial and disbelief about their perceived cancer risk. Some of the participants had heard about cancer screening but very few participants had ever been screened. Conclusion: Our findings of poor knowledge of cancer among PLHIV in Nigeria indicate the need for health care providers and the government to intervene by developing primary cancer prevention strategies for this population. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B vaccination is the most effective method of prevention for hepatitis B virus infection. It is a major public health problem in Nigeria, and health workers are at increased risk. This study determined the uptake of hepatitis B vaccination and assessed its determinants among health care workers (HCWs).Methods: A hospital-based cross-sectional study was conducted between July and August, 2016 using self-administered structured questionnaires among 3132 HCWs in University of Nigeria Teaching Hospital, Enugu, South-East, Nigeria. Data was analysed using SPSS version 22. Binary logistic regression analysis was used to identify factors that influenced uptake of vaccination. Ethical clearance was obtained from the Research Ethics Committee of the health facility.Results: The uptake of hepatitis B vaccination was 14.2% (n = 445). The number of doses received were: 3 doses (218/3132, 48.9%), 2 doses (71/3132, 16.0%), and one dose (156/3132, 35.1%). The reasons for non-uptake of vaccination included: cost of vaccine 48 (10.8%), 'did not believe they could be infected' 28 (6.6%), long vaccination schedule, and lack of time 150 (35.1%). The Odds for uptake of hepatitis B vaccination were 22% lower among nurses compared to doctors (AOR = 0.78, 95% CI = 0.54-0.98, P = 0.037). It increased with increasing age (AOR = 1.30, 95% CI = 1.08-1.59, P <  0.001), increasing duration of work in the hospital (AOR = 1.19, 95% CI = 1.09-1.32, P = 0.032), and was about twice higher among those that had tertiary education than others that had less education (AOR = 1.96, 95 CI = 0.76-5.07, P = 0.164).Conclusions: The uptake of hepatitis B vaccination was low among HCWs in Enugu, Nigeria. Age, staff category, and duration of work in the hospital, were independently associated with hepatitis B vaccination. Provision of adequate hepatitis B surface antigen screening facilities and vaccination sites where the cost of vaccination is subsidized for all HCWs is recommended. [ABSTRACT FROM AUTHOR]