In this study, the perceived occupational risk of contracting hepatitis-B infection among dental surgeons was rated as either high or very high by majority of the respondents. This was comparable to the 78% of Malaysian dental practitioners who believed that their risk of contracting hepatitis B was high or very high[7
] and 66.6% among Malaysian dentists.[22
] This rating may be rooted on the high transmissibility potential of hepatitis-B virus in comparison to other blood-borne pathogens.[23
] The frequent exposure to blood and body fluid of patients and the prevalent inadequate infection control practices noted among dental surgeons in developing countries may have contributed to this level of risk perception among the respondents in this study.
In this study, the percentage of the respondents who had received three doses (complete dose) of the hepatitis-B vaccine is lower than 86% reported among health workers in tertiary care hospital, Karachi;[24
] 85.7% reported among dental professionals of the Military Hospital, Riyadh;[25
] and 74.9% among Brazilian dentists;[10
] 60% reported among healthcare worker in Lahore;[12
] 56.2% reported among Italian dentists;[27
] and 35.9% reported among Lithuanian general dental practitioners.[28
] The percentage of complete hepatitis vaccination among dentists in Benin City in this study was also lower than the figures reported in other Nigerian studies. Previously, 53.8% was reported among healthcare workers in a tertiary hospital in southwest Nigeria[28
] and 48.1% was reported among dental practitioners in Lagos, Ibadan, Ife, and Benin.[20
] It has been reported that healthcare workers in Nigeria, who are expected to have high knowledge of and exposure to hepatitis-B infection, showed the greatest apathy to the vaccination program, and this is a possible explanation for the result from this study.[29
] The fact that more than three-quarters of the respondents did not know anybody infected with hepatitis B may have deterred them from viewing this disease as serious, and therefore makes them lack the motivation to be vaccinated. Also, the vaccine was made available to the healthcare workers at no cost in most of the previous studies and this may account for the higher percentage of vaccinated health workers.
This study found a higher level of incomplete vaccination when compared with the results of several other previous studies.[10
] It therefore means that dental surgeons should not only be encouraged to receive hepatitis-B vaccine but also be encouraged to complete the dose to ensure the effectiveness of this vaccine. Those with incomplete vaccination status should also be encouraged to have anti-HBs titers measured to determine their level of protection and if there will be a need for a further dose of the vaccine. A few of the respondents in this study recommended that a reminder system should be developed to ensure the complete uptake of the vaccine .
The percentage of the respondents who were not vaccinated in this study is comparable to 32% reported among Malaysian dental practitioners,[7
] but higher than 27.7% reported among health workers in India,[30
] 22% documented among healthcare workers in Lahore,[12
] and 10% documented among dentists living in Montes Claros, southeast Brazil.[10
] However, it is lower than 50.8% and 37% reported among Lithuanian general dental practitioners[28
] and dental healthcare workers in Korea,[31
] respectively. The fact that most of the respondents in this study were young and had fewer years of practice may be responsible for the low rate of vaccination as Olubuyide et al
] in a study among Nigerian doctors and dentists reported that unvaccinated personnel were more likely to be surgeons or dentists less than 37 years of age and had fewer years of professional activity.
There is an association between hepatitis-B virus infection and lack of hepatitis-B vaccination among healthcare personnel.[32
] This makes the improvement of hepatitis-B vaccine uptake among the studied dental surgeons very important. In this study, one of the major barriers reported among the unvaccinated respondents was lack of opportunity. This tallied with the findings of Ibekwe and Ibeziako[11
] and Okeke et al
] who reported lack of opportunity as their major reason for non-vaccination among health workers and medical students in Enugu, southeastern Nigeria. Fear of the side effects of the vaccine was also a major barrier to hepatitis-B vaccination in this study and this is similar to findings of several studies in Greater Glasgow Area Health Board,[5
] Rhode Island,[4
] and United States.[6
] Doebbeling et al
] also reported that the concern about vaccine's side effects and problems with vaccine access were primarily related to refusal. This is hinged on the fact that perception of vaccine safety is the most important predictor for acceptance of hepatitis-B vaccination among health workers.[35
] Other previously reported reasons like lack of information,[7
] lack of perceived need for the vaccine,[6
] belief that they were not at risk,[9
] and never giving it a thought[13
] were also among the findings in this study.
In this study, the most commonly suggested way to increase the vaccination rate among the respondents was making the vaccine available at no cost. Sheikh et al
] suggested that hepatitis-B vaccine should be made available to healthcare workers at no cost. McGrane and Staines[14
] documented that the provision of free vaccine to healthcare workers had a strong positive influence on their decision to be vaccinated. Educating dentists on the merits of vaccination was the second most commonly suggested way of improving hepatitis-B vaccination among the dental surgeons in this study. This recommendation is expected to reasonably improve uptake since dissemination of information resulted in significantly improved knowledge and attitudes and acceptance rates among hospital personnel in a previous study.[36
] Acceptance of vaccination has been said to improve with improved knowledge of hepatitis B and improved confidence in vaccine efficacy and safety among hospital personnel.[37
The suggestion from this study that evidence of vaccination should be used as a requirement for annual practicing license renewal and employing dentists implies that vaccination should be mandatory. This mandatory recommendation has also been suggested in several studies.[12
] The recommendation was significantly associated with gender, with female dental surgeons recommending mandatory vaccination more than males. The better preventive health practices among females may have inclined them to recommending mandatory vaccination in this study.