Acceptance of hepatitis B vaccine by workers in a Nigerian teaching hospital.

OBJECTIVES: To determine the pattern of vaccine uptake by hospital personnel in a specifically designed pioneer hepatitis B vaccination programme and to highlight major lessons for ensuring success in future programmes. DESIGN: A review of vaccination and employment records for a forty four-month period and comparative analysis on the basis of professional grouping and work units. SETTING: Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. SUBJECTS: A total of 2,548 employees of the teaching hospital that have worked for a minimum of one year on a continuous basis between April 1992 and December 1995. INTERVENTIONS: Procurement of recombinant hepatitis B vaccine (Engerix, SmithKline Beecham) by the hospital management and provision of the same to all interested employees of the teaching hospital at no cost under a vaccination programme which was conducted on an on-site basis. MAIN OUTCOME MEASURES: 'Participation' in the vaccination programme was defined as the uptake of at least one dose of hepatitis B vaccine, and 'compliance' defined as the receipt of the three prescribed doses of the hepatitis B vaccine. RESULTS: The level of participation in the vaccination programme was high with 91.9% of the target population of hospital workers receiving at least a dose of the vaccine, while only about half (53.8%) of the group complied with receiving the required three doses of the vaccine. In terms of participation, by professional grouping, laboratory workers and nurses recorded the lowest rates (82.5% and 84% respectively), while 100% participation was recorded in respect of the staff of engineering, medical records, pharmacy and physiotherapy departments. The highest rate of compliance (receipt of three doses) was also found among non-clinical workers (medical record personnel--76.3% and engineering staff--69.5%) while the lowest rate was found among nurses (39.7%) and doctors (40.3%). CONCLUSION: Workers with the highest possibility of knowledge of, and exposure to hepatitis B infection within the hospital setting--doctors, nurses, and laboratory workers--showed the greatest apathy to the vaccination programme. Reasons for this trend demand close examination, and subsequently, identification of specific action that needs to be taken to improve the uptake of the vaccine by the target population, particularly the high-risk groups, in future programmes. Among others, targeting all groups of workers with appropriate education on the infection; active involvement of professional groups in the planning and execution of the vaccination programme; and review of the implementation logistics are some of the key points to note for future programmes.