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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 4  |  Issue : 2  |  Page : 37-42

Perceptions and practices related to health hazards of patronizing traditional nail cutters and barbers among market men in Samaru – North Western Nigeria


1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Department of Community Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
3 Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria

Date of Web Publication29-Mar-2018

Correspondence Address:
Aisha A Abubakar
Department of Community Medicine, Ahmadu Bello University, Zaria
Nigeria
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DOI: 10.4103/ssajm.ssajm_48_16

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  Abstract 

Introduction: Several health hazards including infectious blood-borne communicable diseases and skin conditions are associated with traditional nail cutting and barbering. Negligence and accidents during the use of sharp instruments such as nail cutters, razors, shaving blades and clippers may be risk factors for blood-borne infections such as Hepatitis B virus (HBV), Hepatitis C virus (HCV) and Human Immune-deficiency Virus (HIV), causing serious health problems.
Materials and Methods: This was a cross-sectional descriptive study. Interviewer-administered questionnaires were administered to 231 market men in Samaru, Zaria. Data collected were coded and analyzed with IBM SPSS 20.0.
Results: Of 231 sampled men, 223 (96.5%) were aware of HIV infection and mentioned sexual contact as its main mode of transmission. Similarly, 220 (95.2%) knew HIV could also be transmitted through contaminated barbering and nail cutting instruments. Majority 146 (63.2%) had no knowledge of HBV and HCV infections and did not know they are health hazards associated with nail cutting and barbing. Most 196 (84.8%) think barbers and nail cutters should sterilize their instruments. Personal risk perception and knowledge scores were majorly fair for HIV (45.5%) and poor for HBV and HCV (78.4%).
Conclusion: Knowledge of market men in Samaru-Zaria about HIV was found to be higher than that of HBV and HCV infections. They have poor knowledge about HBV and HCV and their transmission. Majority have good perceptions and fair practices towards health hazards associated with barbering and nail cutting. Health authorities must carry out more health education and sensitization on HBV and HCV among market men (traders).

Keywords: Health hazards, market men, traditional barbering, traditional nail cutting


How to cite this article:
Abubakar AA, Dangana IA, John BA, Gobir AA, Ibrahim MS, Umar AA, Bashir SS, Shehu AU. Perceptions and practices related to health hazards of patronizing traditional nail cutters and barbers among market men in Samaru – North Western Nigeria. Sub-Saharan Afr J Med 2017;4:37-42

How to cite this URL:
Abubakar AA, Dangana IA, John BA, Gobir AA, Ibrahim MS, Umar AA, Bashir SS, Shehu AU. Perceptions and practices related to health hazards of patronizing traditional nail cutters and barbers among market men in Samaru – North Western Nigeria. Sub-Saharan Afr J Med [serial online] 2017 [cited 2020 Aug 11];4:37-42. Available from: http://www.ssajm.org/text.asp?2017/4/2/37/228962


  Introduction Top


In many areas of the world, personal hygiene care such as hair cutting, trimming, shaving, shampooing, dyeing, styling, face and scalp massaging, nail cutting, pedicure, and manicure are performed in hair or beauty salons. In addition, in Africa including Nigeria, large proportions of the populace also patronize local or traditional barbers and nail cutters.[1] This latter group, that is, the traditional nail cutters and barbers are itinerant people and are seen as roadside peddlers. Besides the nail cutting and barbering, they also perform circumcision, incision, and drainage of abscesses as well as uvulectomy.[2] Further, they often have low educational status and may not be conversant with the risks inherent or associated with their professions.[3],[4] Razor shaving which is common among traditional barbers has been identified as a key risk factor for the transmission of infectious diseases such as hepatitis B virus (HBV) and hepatitis C virus (HCV).[2],[3],[4] Similarly, bleeding due to the habit of removing the cuticles of the finger and toe nails, without appropriate sterilization of instruments can be an important factor of contamination by these same viruses.[5] HBV is 50–100 times more infectious than human immunodeficiency virus (HIV), yet it is transmitted by contact with blood or body fluids of an infected person in the same way as HIV.[5]

Besides the infectious diseases, other health hazards associated with barbering to which clients are exposed are the various types of chemical and thermal hazards in the barbershops as well as skin conditions, especially ringworm, caused by dermatophytes and easily transmitted through direct contact, infestation of head louse, staphylococcal infections, scabies through contaminated towels, combs, and aprons whereas HBV, HCV, HIV, and tetanus are transmitted through contaminated blades and clips.[2],[6]

If towels, apron, brush, combs, clippers, razors, and nail cutters are used on an infected client successively without proper cleaning and disinfection, the likelihood of spreading infectious diseases or infestation is almost certain.[2] The practice of barbering has thus continued to expose the practitioners and their clients to many infectious diseases.[4],[7]

Several microbiological reports and studies have supported the view that barbershops are contributing to the spread of infectious diseases and allergic conditions including scabies, ringworm, and dermatitis.[8],[9],[10],[11],[12],[13] In a cross-sectional seroprevalence study conducted in Morocco among 267 barbers and 529 clients, the overall prevalence of HBV seropositivity was found to be 28.1% in the barbers and 25.1% in the clients; 1.9 and 1.7% respectively had HBV infection, whereas 1.1 and 1.3% had HCV infection.[8] In another study to determine the prevalence of HCV antibody reactivity among patients admitted due to a medical condition and who have been visiting roadside barbers, it was found that out of 184 male patients included in the study, 70 (38%) were reactive to HCV antibodies. In comparison with younger patients, older patients as well as those with the longer duration of visits or patronage of roadside barbers and traditional nail cutters had a higher prevalence of reactivity to HCV antibodies.[9]

Given the above facts and scenario, the challenge here then is often a question of awareness, knowledge, perception, attitude, as well as practices. The study was conducted to assess the knowledge, attitude, and practice of market men toward health hazards associated with the patronage of traditional nail cutters and barbers in Samaru market.


  Materials and methods Top


This was a cross-sectional study of market men (traders) in Samaru market, Zaria, Nigeria.

Study population

This comprises men from different ethnic backgrounds who trade in Samaru market, and who patronize traditional nail cutters and barbers. A total of 231 men were recruited for the study.

The list of total number of shops and traders in the market was obtained from the market manager. Female traders were then excluded from the list. The required numbers of male respondents were selected from the remaining list by simple random sampling using the shop numbers. A pretested, structured, close-ended, and interviewer-administered questionnaire was used to collect data on knowledge, perception, attitude, and practices toward health hazards associated with the patronage of traditional barbers and nail cutters among the respondents. The questionnaires were translated to Hausa language for those who could not speak English. All traders could speak and understand English or Hausa or both languages. Questionnaires were administered to study participants at their convenience, when customers were not around. Data collected were checked for completeness and accuracy, cleaned, coded, and analyzed using International Business Machines Statistical Package for Social Sciences version 20.0 software (IBM SPSS Inc., United States). Results were presented in tables along with the output of their analyses. Knowledge scores for the three infectious diseases, HIV, HBV, and HCV, were assessed on a scale of 21 marks with one mark ascribed for each correct response and zero for wrong or “don’t know” responses, and then graded into three levels as (poor 0–7, fair 8–14, and good 15–21). The level of statistical significance for all analyses was P < 0.05.

Verbal informed consent was obtained from respondents. Ethical approval was obtained from the ABUTH Scientific and Ethical Review Committee. All participants were assured of the confidentiality of information collected. The information obtained from respondents could not be independently be verified as respondents could report socially desirable attitudes and practices.


  Results Top


A total of 231 questionnaires were administered with a response rate of 100%. More than a quarter of the respondents were in the age groups 21–30 years (25.9%) and 31–40 years (28.1%). Mean age was 40 years with a standard deviation of 12.4. Age range was 27–65 years. Majority were Hausa 142 (61.5%). Yoruba, Igbo, and other tribes were 30 (13%), 26 (11.3%), and 33 (14.3%), respectively. Majority were also Muslims 158 (68.4%) and married 163 (70.6%), whereas only 23 (10%) had tertiary education [Table 1].
Table 1: Sociodemographic profile of respondents

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Knowledge of human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infections

Most of the respondents (223; 96.5%) have heard of HIV with their sources of information being friends or relatives (70.6%), radio (55.4%), television (41.1%), and health workers (26.0%). Most (220; 95.2%) knew sexual contact as the main mode of transmission and blood (197; 85.3%), whereas 175 (75.8%) identified nail cutting and 171 (74%) barbering instruments also as a means of transmission, respectively. Weight loss was the most frequently cited symptom of HIV by the respondents (214; 92.6%). Few (12; 5.2%) said there is vaccine for HIV, whereas 164 (71%) knew drugs are available for treatment [Table 2].
Table 2: Knowledge of respondents on HIV

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Unlike a near universal knowledge and awareness of HIV, only a little above one-third of the respondents (85; 36.8%) have heard about HBV and HCV infections, with their sources of information being virtually same as that of HIV: friends and relatives (70.6%), radio (55.4%), television (41.1%), and health workers (26.0%). Majority, that is, 57 (24.7%), 54 (23.4%), 47 (20.3%), and 43 (18.6%) mentioned sexual contact, blood transfusion, contaminated nail cutting, and barbering instruments as a means of transmission, respectively. Jaundice was the most frequently cited symptom; 65 (28.1%) and 40 (17.3%) respondents knew that the infections may ultimately lead to liver cancer. Only 24 (10.4%) were aware of HBV vaccine, whereas 50 (21.6%) were aware of any form of drug management for both infections [Table 3].
Table 3: Knowledge of respondents on HBV and HCV

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Overall, the knowledge score was found to be fair for HIV − 105 (45.5%) of the respondents; and poor for HBV and HCV − 181 (78.4%) of the respondents [Table 4].
Table 4: Knowledge scores of respondents on HIV, HBV, and HCV

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Perceptions and practices toward health hazards associated with barbering and nail cutting

Majority of the respondents perceived the dangers and health hazards associated with barbering and nail cutting, as over 75% think they can be accidentally infected with either HIV or hepatitis viruses. However, not all are of the opinion that barbers and nail cutters should sterilize their instruments before use [Table 5]. Similarly, while most (200; 86.6%) wish to be vaccinated against HBV, only 11 (4.8%) had actually taken action and received the protective vaccination. Further, there are gaps in practices: while majority, 148 (64.1%), ask barbers and nail cutters if instruments have been disinfected and demand so before patronizing their service, only 65 (28.1%) refused such services if instruments had not been disinfected [Table 6].
Table 5: Perceptions toward health hazards associated with barbering and nail cutting

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Table 6: Practices toward health hazards associated with barbering and nail cutting

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  Discussion Top


This study has shown that while there is a high level of awareness and good knowledge about HIV, including the possibility of its transmission through contaminated barbering and nail cutting instruments, there is, however, a low level of awareness and poor knowledge of other common infectious diseases such as hepatitis B and C infections. Almost all the respondents (223; 96.5%) had heard about HIV, whereas a concomitant high number (171; 74.0%) have fair-to-good knowledge about the infection. Most (220; 95.2%) knew sexual contact as the main mode of transmission, whereas contaminated nail cutting and barbering instruments as the alternate means of transmission were also known to a large majority, 75.8 and 74.0%, respectively [Table 2].

In a sharp contrast, only 85 (36.7%) of the respondents have heard about HBV and HCV infections compared with 223 (96.5%) for HIV. Similarly, given the poor knowledge, there is low personal risk perception toward these hepatitis infections. This finding contrasts that of a study in Egypt in which a high knowledge of hepatitis infections and modes of transmission was found in 80% of the respondents.[14] In this study, sexual contact as a means of transmission of HBV and HCV was known to 25% of the respondents, whereas 23% knew it can be transmitted through blood. Nail cutting and barbering instruments were known also as a means of transmission of infection to 20.3 and 18.6% of the respondents, respectively [Table 3].

Moreover, jaundice and right upper abdominal quadrant pain were the well-known symptoms of hepatitis infection by 28 and 25% of the respondents, respectively whereas only 21.6% were aware of the availability of drugs for treatments, showing wide knowledge deficits also regarding symptoms and treatment. This finding on the availability of treatment is, however, similar to the 23% obtained in the study in Egypt and 21% in a study in Pakistan.[14],[15] Existence of vaccine against HBV was known by only 10.4% of the respondents as opposed to the 40% obtained from the Egyptian study and few (5.2%) erroneously claimed that there is vaccine for HCV infection [Table 3]. Therefore, findings from this Zaria study have further supported the assertion that the poor knowledge and lack of awareness of the general public about hepatitis B and C infections were among the main causes of the rapid spread of these infections in developing countries.[16],[17],[18],[19],[20],[21]

Furthermore, the study also found good perceptions toward the health hazards associated with the patronage of traditional nail cutters and barbers. Up to 75% of the respondents think they could be infected through the use of contaminated barbering and nail cutting instruments. This is relatively high compared to the study in Pakistan where only 45% of the respondents considered themselves at risk of hepatitis.[15] The low figure of HBV vaccination 4.8% among the respondents is, however, similar to 7% obtained in Pakistan.[15] This low level has been attributed to the lack of awareness about the existence and availability of the vaccine as majority (86.6%) admitted that they would like to be vaccinated against HBV [Table 6].

The study further revealed gaps in the practices of the respondents regarding the patronage of the services of the traditional barbers and nail cutters. Majority of the respondents (64%) have the good practice of verifying if instruments have been sterilized before use, in a similar pattern obtained in the Pakistani study where about 60.5% of the client respondents also verified the status of such instruments before patronage of the traditional nail cutters and barbers.[15] However, as shown by this study, verification alone is not sufficient as only 28% of the respondents refused shaving or nail cutting with unsterilized instruments, a figure contrasting the 43% seen in a study in Nagpur, India.[22] In addition, the practice of clients having their own personal instruments was found to be low as only 9% of the respondents take their instruments with them when they visit the barbers [Table 6].


  Conclusion Top


A large proportion of population, as typified by these sampled market men, patronizes the services of traditional nail cutters and barbers in our communities. They are a potential source of silent transmission of infectious diseases such as HIV, HBV, and HCV. Considering these grave consequences associated with the profession, health education and awareness creation about these health hazards among barbers and their clients could play a vital part in the prevention and control of these infections. In addition, enlightenment campaigns on hygienic measures for the equipment of traditional nail cutters and barbers would need to be embarked upon to prevent and control these infections.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Encyclopedia. History of Barbering. Available from: http://www.harherpole.com/artof.htrn. [Last accessed on 28 Oct 2014].  Back to cited text no. 1
    
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The Global Epidemiology of Infectious Diseases: World Health Organisation; 2006. Available from: www.who.org/int. [Last accessed on 2 Dec 2014].  Back to cited text no. 3
    
4.
Oyeduni S.A. Potential risk of HIV transmission in barbering practice among professional barbers in Ibadan, Nigeria. Afr Health Sci 2009;9:19-25.  Back to cited text no. 4
    
5.
Hepatitis B. Fact Sheet No. 204. World Health Organisation; Available from: http://www.who. Int/mediacentre/factsheets/fs204/en/. [Last accessed on 22 Nov 2014].  Back to cited text no. 5
    
6.
Hepatitis C. Fact Sheet No.164. Geneva: World Heath Organisation; 2000. Available from: https://apps.who.int/inf-fs/en/fact164.html. [Last accessed on 20 Oct 2014].  Back to cited text no. 6
    
7.
Janjua NZ, Khazir NM. Knowledge and practices of barbers about hepatitis B and C transmission in Rawalpindi and Islamabad. Pak Med Assoc 2004;54:116-9.  Back to cited text no. 7
    
8.
Belbacha I, Cherkaoul I, Akrim M, Dooley K, ElAouad R. Seroprevalence of hepatitis B and C among barbers and their clients in the Rabat region of Morocco. East Mediterr Health J 2011;17:911-9.  Back to cited text no. 8
    
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Makheja K, Abro AH, Kuniar S, Kirpal J, Maklieja D. Seroprevalence of hepatitis C antibodies in people visiting roadside barbers. Med Sci Pak 2010;26:402-6.  Back to cited text no. 9
    
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Salami K, Titiloye M, Brieger W, Otusanya S. Observations of barbers’ activities in Oyo State, Nigeria: Implications for HIV/AIDS transmission. Int J Community Health Educ 2006;24:319-30.  Back to cited text no. 11
    
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Enernuor SC, Oguntibeju OO. Evaluation of microbiological hazards in barbershops in a university setting. Sci Res Essays 2012;7:1100-12.  Back to cited text no. 13
    
14.
Shalaby S, Kabbash IA, ElSaleet G, Mansour N, Oman N, ElNawawy A. Hepatitis B and C viral infection: Prevalence, knowledge, attitude and practice among barbers and clients in Gharbia governorate, Egypt. East Mediterr Health J 2010;16:10-7.  Back to cited text no. 14
    
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Shahid A, Nasim S, Mernon AA. Insight and educational intervention concerning hepatitis among roadside barbers and their clients in Karachi, Pakistan. Infect J Dev Ctries 2013;7:125-9.  Back to cited text no. 15
    
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Preid R. Hepatitis may lurk at barbershops and nail salons. Am Coll Gastroenterol 2011;5:35-7.  Back to cited text no. 16
    
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Umesh RY, Manjual R, Ramesh M, Ghattargi C, Kalyan XX, Kulkarni P. Awareness among barbers about health hazards associated with their profession in Bagalkot, Karnataka. Int J Res Dev Health 2013;1:77-84.  Back to cited text no. 18
    
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Chanda S, Khan K. Sharing razor blades in salons and risk of spreading HIV in Bangladesh. The 3rd IAS Conference on HIV Pathogenesis and Treatment, Poster Exhibition, Abstract No. WePe l0.5p02, 2004.  Back to cited text no. 19
    
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21.
Enemuor SC, Ojih MI, Isah S, Oguntibeju OO. Evaluation of bacterial and fungal contamination in hair dressing and beauty salons. Afr J Microbiol Res 2013;7:1222-5.  Back to cited text no. 21
    
22.
Khandiat D, Ambadekar N, Vasudeo N. Knowledge and practice about HIV transmission among barbers of Nagpur city. Indian J Med Sci 1999;53:167-71.  Back to cited text no. 22
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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