ABSTRACT
Background
Needlestick and sharp injuries (NSSIs) represent a major occupational hazard for healthcare workers (HCWs), posing serious health risks and psychological stress. Globally, millions of HCWs experience such injuries each year, with the burden disproportionately higher in low‐resource settings. In postconflict regions like Somalia, these challenges are often intensified due to strained healthcare systems and limited resources. Despite the potential severity of the issue, there is a lack of comprehensive data on its prevalence and determinants in such contexts. This study aims to investigate the prevalence of NSSIs and identify associated risk factors among HCWs at a tertiary care hospital in Mogadishu, Somalia.
Methods
A cross‐sectional survey was conducted among 333 randomly selected HCWs from April to July 2024. Data were collected using a structured questionnaire covering demographics, occupational factors, safety practices and perceptions, and 12‐month recall of NSSIs events. Bivariate and multivariable logistic regression analyses were performed to identify factors associated with NSSIs.
Results
Although age was not a statistically significant factor (p = 0.1548), the highest prevalence of NSSIs was observed among HCWs aged 25–40 years (75.52%). In the multivariable analysis, perceiving a moderate risk of injury emerged as a significant predictor of NSSI occurrence (AOR = 4.26, 95% CI: 2.00–9.10). Conversely, caring for more than 10 patients/day was associated with reduced odds of experiencing an injury (AOR = 0.42, 95% CI: 0.21–0.88).
Conclusion
This study highlights significant associations between sex, education level, and the prevalence of NSSIs among HCWs at the surveyed tertiary hospital. These findings underscore the need for targeted, evidence‐based interventions to mitigate NSSI risks—particularly in postconflict, resource‐constrained healthcare settings like Somalia. Strengthening training, improving safety practices, and addressing occupational disparities can contribute to safer working environments for HCWs in similar contexts.
Keywords: associated factors, healthcare workers, Mogadishu, needlestick and sharps injuries, occupational health, prevalence, Somalia
1. Introduction
Needlestick and sharp injuries (NSSIs) are a major occupational hazard faced by healthcare workers (HCWs) worldwide, involving percutaneous injuries caused by contaminated medical instruments such as hypodermic needles, scalpels, and intravenous cannulas [1, 2]. These injuries are a leading route of transmission for bloodborne pathogens (BBPs), including hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) [3]. In addition to infection risks, NSSIs contribute to psychological distress, such as anxiety and fear, and increase healthcare costs due to the need for postexposure prophylaxis and long‐term monitoring [4, 5, 6].
Globally, the World Health Organization (WHO) estimates that millions of HCWs are exposed to NSSIs each year [3]. While the issue is global, the burden is disproportionately higher in low‐ and middle‐income countries (LMICs), especially in Africa and Asia, due to limited resources, higher infection rates, and insufficient safety infrastructure [7]. Studies from Ethiopia and East Africa report high prevalence rates, often linked to poor training, weak safety culture, and lack of proper disposal systems [4, 8]. Despite these risks, there is a scarcity of local data in Somalia.
Somalia's postconflict health system continues to face major challenges, including shortages of personal protective equipment (PPE), sharps containers, and safety‐engineered devices. HCWs are often overburdened with high patient loads and limited support, increasing their risk of injury [5, 9]. A recent retrospective study from a tertiary hospital in Mogadishu reported a 12‐month NSSIs prevalence of 72.97%, reflecting the severity of the issue in this context [5]. Similar high rates have been documented in countries such as Iran [10, 11], Indonesia [12], Saudi Arabia [13], Jordan [14], Kuwait [15], Pakistan [16], and Mongolia [17]. Even high‐income countries like Poland [18] and Turkey [19] continue to report NSSIs, though typically with better prevention systems. Young and inexperienced HCWs, especially nurses, lab workers, and cleaners, remain at elevated risk [20, 21], especially when working long shifts or with inadequate infection prevention and control (IPC) training [22].
This study aims to determine the prevalence and associated risk factors of NSSIs among HCWs at a tertiary care hospital in Mogadishu, Somalia. By generating context‐specific evidence, the findings will contribute to improved occupational safety, better infection prevention practices, and informed policymaking.
2. Methods and Materials
2.1. Study Design and Setting
This study employed a quantitative, descriptive cross‐sectional design to determine the prevalence of NSSIs and identify associated risk factors among HCWs. The study was conducted at Mogadishu‐ Somalia Türkiye Recep Tayyip Erdoğan Training and Research Hospital, the largest tertiary care and referral hospital in Mogadishu. As a major teaching and training institution, the hospital provides services across multiple specialties and serves as a representative setting for assessing occupational health hazards among HCWs in Somalia.
Data were collected between April 15 and July 20, 2024, using a structured, self‐administered questionnaire. The tool captured data on sociodemographic and occupational characteristics, behavioral practices, exposure history, NSSI‐related risk factors, and institutional safety measures. It was adapted from previously published instruments and reviewed by IPC experts to ensure content validity. The questionnaire was piloted among 20 HCWs from departments excluded from the main sample to assess clarity, language, and cultural relevance. Minor revisions were made based on feedback. This cross‐sectional design was selected for its practicality in estimating prevalence and identifying associations at a single point in time, consistent with methodologies used in related studies from China and Ethiopia [4, 24].
Bivariate and multivariable logistic regression analyses were performed to explore the relationship between independent variables and the occurrence of NSSIs, allowing for the identification of significant predictors.
2.2. Data Collection Instrument and Procedure
A structured, self‐administered questionnaire was developed following an extensive review of the literature and similar studies on NSSIs. The final instrument consisted of 35 items, organized into four sections: (1) Sociodemographic information, (2) Occupational factors, (3) NSSI occurrence and reporting practices within the past 12 months, and (4) Knowledge and perceptions regarding NSSIs. To ensure content validity, the questionnaire was reviewed by an infectious disease specialist and a public health researcher. It was subsequently translated from English into Somali to enhance comprehension and contextual relevance. A pretest was conducted with 20 HCWs from a separate healthcare facility not included in the main study. This pilot phase assessed clarity, language accuracy, and cultural appropriateness. Minor modifications were made based on participant feedback to improve the tool's reliability and usability.
2.3. Study Population and Sampling
The study targeted all HCWs at a tertiary care hospital in Mogadishu, Somalia, who had potential direct or indirect occupational exposure to patients or contaminated materials. Eligible participants included full‐time or part‐time HCWs working in high‐risk areas such as clinical wards, operating theaters, emergency units, laboratories, and waste management units. The required sample size was calculated using Slovin's formula n = N/(1 + Ne 2)n = N/(1 + Ne 2)n = N/(1 + Ne 2), with a total population (N) of ~2000 HCWs, a 5% margin of error (e), and a 95% confidence level. This yielded a minimum sample size of 333 participants. Participants were selected using a nonprobability, convenience sampling method. All HCWs present during the data collection period who met the inclusion criteria and provided informed consent were enrolled. While this practical approach ensured adequate participation, we acknowledge that it limits the generalizability of the findings, as discussed in the study's limitations.
2.4. Variables
The dependent variable in this study was the occurrence of NSSIs. This was measured as a binary outcome (yes/no) from the question, “In the past 12 months, have you had any needlestick or sharp injury at work?”. The independent variables included… Work‐related factors: … and the availability of sharps disposal containers. These were assessed via specific items on the questionnaire Work‐related factors: presence of health and safety training, weekly working hours, departmental assignment, night shift duties, workload (assessed via a self‐reported average of patients served per day, categorized as “≤ 10 Patients” or “> 10 Patients”), and the availability of sharps disposal containers.
2.5. Statistical Analysis
Data were entered, cleaned, and analyzed using STATA version 16 (StataCorp, College Station, TX, USA). Data quality was ensured through completeness checks, verification of 10% of entries, and review of frequency distributions. Descriptive statistics (frequencies, percentages, means/SD, or medians/IQR) were used to summarize the sample and NSSIs prevalence. Bivariate analysis using Pearson's χ 2 or Fisher's Exact test (for cell counts < 5) assessed unadjusted associations with NSSIs. Variables with p ≤ 0.20 or theoretical relevance (e.g., Bazie 2020 [4]; Cho et al. 2013 [21]) were included in a multivariable logistic regression model. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. Multicollinearity was checked using variance inflation factors (VIFs < 10). Model fit was assessed using the Hosmer–Lemeshow test (p > 0.05). Statistical significance was set at p < 0.05.
2.6. Ethical Consideration
The study received approval from the Clinical Research Ethics Committee of Mogadishu‐ Somalia Türkiye Recep Tayyip Erdoğan Training and Research Hospital, March 30, 2024 (Approval No.: 17693) and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Written informed consent was obtained from all participants before data collection. Participation was entirely voluntary, and only those who provided consent were included. HCWs who were absent or unwell during the data collection period were excluded. After giving informed consent, participants were provided with questionnaires to complete independently, allowing them to respond at their own pace and free from external pressure. This approach ensured adherence to ethical standards throughout the research process.
3. Results
3.1. Prevalence of NSSIs Among Healthcare Workers
The prevalence of NSSIs among HCWs was alarmingly high, with 72.97% reporting at least one incident in the 12 months preceding the survey, highlighting a serious occupational health concern. Only 27.03% remained injury‐free during that period.
Statistical analysis revealed significant associations between NSSI occurrence and several sociodemographic factors. Male HCWs experienced a higher rate of injuries (78.92%) than females (65.54%). Education level also showed a notable correlation: HCWs with no formal education (95.45%) and those with diplomas (80.77%) reported the highest injury rates, suggesting that training gaps may influence exposure risk (Table 1).
Table 1.
Sociodemographic characteristics of healthcare workers.
| Variable | NSSIs | Pearson's χ 2 | p | |
|---|---|---|---|---|
| (Yes) % | (No) % | |||
| Age | 3.73 | 0.1548 | ||
| < 25 | 51 (64.56) | 28 (35.44) | ||
| 25–40 | 182 (75.52) | 59 (24.48) | ||
| > 40 | 10 (76.92) | 3 (23.08) | ||
| Sex | 7.46 | 0.0063 | ||
| Male | 146 (78.92) | 39 (21.08) | ||
| Female | 97 (65.54) | 51 (34.46) | ||
| Marital status | 0.14 | 0.7037 | ||
| Married | 97 (71.85) | 38 (28.15) | ||
| Single | 146 (73.74) | 52 (26.26) | ||
| Cleaner | 42 (95.45) | 2 (4.55) | ||
| Education | 15.85 | 0.0012 | ||
| Diploma | 21 (80.77) | 5 (19.23) | ||
| Bachelor's degree | 144 (69.90) | 62 (30.10) | ||
| Master's degree | 36 (63.16) | 21 (36.84) | ||
| No formal education | 42 (95.45) | 2 (4.55) | ||
Abbreviation: NSSIs = needlestick and sharps injuries.
Specific occupational factors also showed a strong correlation with NSSI occurrence; cleaners (95.45%) and radiology technicians (93.33%) were among the most affected, likely due to their frequent contact with contaminated waste and equipment. Moreover, 84.72% of HCWs attending to more than 10 patients daily reported injuries, indicating that heavy workload may be a contributing factor. These findings underscore the need for comprehensive safety interventions, including targeted training, workload management, and rigorous adherence to infection prevention protocols, especially in high‐risk roles (Table 2).
Table 2.
Occupational and workplace factors related to needlestick and sharps injuries.
| Variable | NSSIs | Pearson's χ 2 | p | |
|---|---|---|---|---|
| (Yes) % | (No) % | |||
| Profession | 17.88 | 0.0031** | ||
| Nurse/midwife | 78 (69.64) | 34 (30.36) | ||
| Doctor | 65 (66.33) | 33 (33.67) | ||
| Radiology tech | 14 (93.33) | 1 (6.67) | ||
| Anesthesia tech | 10 (66.67) | 5 (33.33) | ||
| Student/trainer | 34 (69.39) | 15 (30.61) | ||
| Cleaner | 42 (95.45) | 2 (4.55) | ||
| Experience | 3.25 | 0.1967 | ||
| < 5 years | 102 (72.34) | 39 (27.66) | ||
| 5–10 years | 125 (75.76) | 40 (24.24) | ||
| > 10 years | 16 (59.26) | 11 (40.74) | ||
| Working night shift | 0.52 | 0.4725 | ||
| Yes | 174 (71.90) | 68 (28.10) | ||
| No | 69 (75.82) | 22 (24.18) | ||
| Working hours per week | 1.50 | 0.2202 | ||
| Up to 40 h | 191 (74.61) | 65 (25.39) | ||
| More than 40 h | 52 (67.53) | 25 (32.47) | ||
| Patients served per day | 17.76 | 0.0000*** | ||
| < 10 patients | 121 (64.02) | 68 (35.98) | ||
| > 10 patients | 122 (84.72) | 22 (15.28) | ||
| Training on infection prevention control | 7.60 | 0.0058** | ||
| Yes | 156 (68.42) | 72 (31.58) | ||
| No | 87 (82.86) | 18 (17.14) | ||
| Availability of waste containers | 10.71 | 0.0047** | ||
| All the time | 136 (67.66) | 65 (32.34) | ||
| Sometimes | 100 (83.33) | 20 (16.67) | ||
| Not available | 7 (58.33) | 5 (41.67) | ||
| Location of sharps container | 12.42 | 0.0061** | ||
| Within each procedure room | 38 (58.46) | 27 (41.54) | ||
| On the dressing trolley | 117 (80.69) | 28 (19.31) | ||
| In every patient ward | 86 (72.27) | 33 (27.73) | ||
| Not available | 2 (50.00) | 2 (50.00) | ||
| Recapping practice | 7.23 | 0.0270* | ||
| Always | 92 (66.19) | 47 (33.81) | ||
| Sometimes | 107 (75.35) | 35 (24.65) | ||
| Never | 44 (84.62) | 8 (15.38) | ||
| Presence of safety protocols | 11.30 | 0.0008*** | ||
| Yes | 166 (68.03) | 78 (31.97) | ||
| No | 77 (86.52) | 12 (13.48) | ||
Abbreviation: NSSIs = needlestick and sharps injuries.
p < 0.05;
p < 0.01;
p < 0.001.
3.2. Sociodemographic Characteristics of Healthcare Workers and Association With NSSIs
Bivariate analysis revealed a significant association between certain sociodemographic factors and NSSIs. Specifically, sex (χ 2 = 7.46, p = 0.0063) and education level (χ 2 = 15.85, p = 0.0012) were significantly related to the occurrence of NSSIs. Males and individuals with specific educational levels, notably those with no formal education (95.45%) and diploma (80.77%), had a higher likelihood of experiencing NSSIs. Age, while not statistically significant at the p < 0.05 level (p = 0.1548), showed a trend toward higher NSSI prevalence among HCWs in the 25–40 age group (75.52%) (Table 1).
3.3. Occupational and Workplace Factors and Association With NSSIs
Several occupational and workplace factors demonstrated significant associations with NSSIs. Profession (χ 2 = 17.88, p = 0.0031) was significantly related to NSSI occurrence, with cleaners exhibiting the highest proportion of injuries (95.45%), followed by radiology technicians (93.33%). The number of patients served per day also showed a strong association (χ 2 = 17.76, p < 0.0001), with HCWs serving > 10 patients/day reporting a significantly higher prevalence of NSSIs (84.72%). Furthermore, lack of training on IPC was associated with a higher incidence of NSSIs (χ 2 = 7.60, p = 0.0058) (82.86%). Availability (χ 2 = 10.71, p = 0.0047) and location (χ 2 = 12.42, p = 0.0061) of sharps containers, as well as recapping practices (χ 2 = 7.23, p = 0.0270), and the absence of safety protocols (χ 2 = 11.30, p = 0.0008), were significantly associated with NSSIs (Table 2).
3.4. Characteristics of NSSIs, Prevention Practices, and Association With NSSIs
The use of Hepatitis B vaccine prophylaxis (χ 2 = 7.25, p = 0.0071) and receipt of the tetanus vaccine (χ 2 = 11.24, p = 0.0008) were significantly associated with a lower incidence of NSSIs. Reporting the injury to the concerned department was also significantly associated with a reduced risk of NSSIs (χ 2 = 5.25, p = 0.0219) (Table 3).
Table 3.
Characteristics of needlestick and sharps injuries and related prevention practices.
| Variable | NSSIs | Pearson's χ 2 | p | |
|---|---|---|---|---|
| (Yes) % | (No) % | |||
| Hepatitis B vaccine prophylaxis | 7.25 | 0.0071** | ||
| Yes | 136 (67.66) | 65 (32.34) | ||
| No | 107 (81.06) | 25 (18.94) | ||
| Received tetanus vaccine | 11.24 | 0.0008*** | ||
| Yes | 172 (78.90) | 46 (21.10) | ||
| No | 71 (61.74) | 44 (38.26) | ||
| Personal protective equipment (PPE) use | 0.14 | 0.7060 | ||
| Yes | 204 (73.38) | 74 (26.62) | ||
| No | 39 (70.91) | 16 (29.09) | ||
| Method of sharps disposal | 0.04 | 0.8456 | ||
| Using safety box | 202 (73.19) | 74 (26.81) | ||
| Not using safety box | 41 (71.93) | 16 (28.07) | ||
| Frequency of injury | 2.32 | 0.3138 | ||
| Never | 64 (71.11) | 26 (28.89) | ||
| Once | 60 (68.18) | 28 (31.82) | ||
| More than once | 119 (76.77) | 36 (23.23) | ||
| Degree of injury | 1.88 | 0.3898 | ||
| No injury | 63 (70.00) | 27 (30.00) | ||
| Minor injury | 120 (71.86) | 47 (28.14) | ||
| Severe injury | 60 (78.95) | 16 (21.05) | ||
| Type of sharp object | 6.47 | 0.3727 | ||
| Sutures | 47 (77.05) | 14 (22.95) | ||
| Blood sugar lancet | 50 (64.94) | 27 (35.06) | ||
| Blood collection needle | 35 (76.09) | 11 (23.91) | ||
| Bisturi | 19 (76.00) | 6 (24.00) | ||
| IV cannula | 46 (75.41) | 15 (24.59) | ||
| Disposable needles | 39 (69.64) | 17 (30.36) | ||
| Other | 7 (100.00) | 0 (0.00) | ||
| When injury occurred | 6.21 | 0.2867 | ||
| During sutures | 74 (77.89) | 21 (22.11) | ||
| During patient care | 79 (69.91) | 34 (30.09) | ||
| During cannulation | 21 (63.64) | 12 (36.36) | ||
| During blood withdrawal | 21 (75.00) | 7 (25.00) | ||
| During waste disposal | 27 (84.38) | 5 (15.63) | ||
| Reported injury to concerned department | 5.25 | 0.0219* | ||
| Yes | 151 (68.95) | 68 (31.05) | ||
| No | 92 (80.70) | 22 (19.30) | ||
Abbreviation: NSSIs = needlestick and sharps injuries.
p < 0.05;
p < 0.01;
p < 0.001.
3.5. Knowledge, Attitudes, and Perceptions and Association With NSSIs
Perceived risk of needlestick injuries (χ 2 = 13.86, p = 0.0010) and the belief that needlestick injuries are avoidable (χ 2 = 14.66, p < 0.0001) were significantly associated with the occurrence of NSSIs, as shown in Table 4.
Table 4.
Knowledge, attitudes, and perceptions regarding needlestick and sharps injuries.
| Variable | NSSIs | Pearson's χ 2 | p | |
|---|---|---|---|---|
| (Yes) % | (No) % | |||
| Perceived risk of needlestick injuries | 13.86 | 0.0010 | ||
| Severe | 95 (84.07) | 18 (15.93) | ||
| Moderate | 118 (64.84) | 64 (35.16) | ||
| Low | 30 (78.95) | 8 (21.05) | ||
| Disease not transmitted by needlestick injuries | 11.87 | 0.0183 | ||
| HIV | 12 (80.00) | 3 (20.00) | ||
| HBV | 11 (61.11) | 7 (38.89) | ||
| HCV | 0 (0.00) | 3 (100.00) | ||
| Malaria | 193 (72.83) | 72 (27.17) | ||
| No idea | 27 (84.38) | 5 (15.63) | ||
| Reported injury to concerned department | 5.25 | 0.0219 | ||
| Yes | 151 (68.95) | 68 (31.05) | ||
| No | 92 (80.70) | 22 (19.30) | ||
| Awareness of disease transmission by needlestick injuries | 0.02 | 0.9018 | ||
| Yes | 182 (72.80) | 68 (27.20) | ||
| No | 61 (73.49) | 22 (26.51) | ||
| Afraid of needlestick injury | 0.31 | 0.5751 | ||
| Yes | 211 (73.52) | 76 (26.48) | ||
| No | 32 (69.57) | 14 (30.43) | ||
| Needlestick injuries avoidable | 14.66 | 0.0001 | ||
| Yes | 133 (65.52) | 70 (34.48) | ||
| No | 110 (84.62) | 20 (15.38) | ||
Abbreviation: NSSIs = needlestick and sharps injuries.
3.6. Predictors of Needlestick and Sharps Injuries: Multivariate Logistic Regression Analysis
The multivariate logistic regression analysis identified independent predictors of NSSIs, while controlling for potential confounders. Serving more than 10 patients/day was associated with a decreased odds of NSSIs (AOR = 0.4249, 95% CI: 0.2056, 0.8778, p = 0.021). HCWs who never recapped needles were less likely to experience NSSIs (AOR = 0.3737, 95% CI: 0.1446, 0.9654, p = 0.042). Storing sharps containers on dressing trolleys was significantly associated with reduced NSSIs (AOR = 0.3835, 95% CI: 0.1741, 0.8447, p = 0.017). Finally, perceiving a moderate risk of needlestick injuries was significantly associated with increased odds of NSSIs (AOR = 4.2645, 95% CI: 1.9987, 9.0990, p < 0.001), as shown in Table 5.
Table 5.
Predictors of needlestick and sharps injuries: multivariate logistic regression analysis.
| Variable | AOR | 95% CI | p |
|---|---|---|---|
| Sex | |||
| Female | 1.5997 | (0.8868, 2.8859) | 0.119 |
| Profession | |||
| Doctor | 1.2833 | (0.6391, 2.5765) | 0.483 |
| Radiology tech | 0.2424 | (0.0247, 2.3816) | 0.224 |
| Anesthesia tech | 2.4084 | (0.6017, 9.6402) | 0.214 |
| Student/trainer | 2.4909 | (0.9856, 6.2952) | 0.054 |
| Cleaner | 0.7085 | (0.0027, 188.2046) | 0.904 |
| Education | |||
| Bachelor's degree | 1.7545 | (0.5673, 5.4264) | 0.329 |
| Master's degree | 1.1923 | (0.3283, 4.3303) | 0.789 |
| No formal education | 0.4533 | (0.0018, 116.0689) | 0.780 |
| Patients served per day | |||
| More than 10 patients | 0.4249 | (0.2056, 0.8778) | 0.021 |
| Training on IPC | |||
| No | 1.9571 | (0.7310, 5.2392) | 0.181 |
| Availability of waste containers | |||
| Sometimes | 0.7852 | (0.3312, 1.8615) | 0.583 |
| Not available | 0.9221 | (0.2338, 3.6362) | 0.908 |
| Recapping practice | |||
| Sometimes | 0.6275 | (0.3377, 1.1661) | 0.140 |
| Never | 0.3737 | (0.1446, 0.9654) | 0.042 |
| Presence of safety protocols | |||
| No | 0.8957 | (0.2267, 3.5392) | 0.875 |
| Received HB vaccine prophylaxis | |||
| No | 0.6048 | (0.2788, 1.3119) | 0.203 |
| Location sharps container | |||
| On the dressing trolley | 0.3835 | (0.1741, 0.8447) | 0.017** |
| In every patient wards | 0.5030 | (0.2328, 1.0866) | 0.080 |
| Not available | 0.5145 | (0.0545, 4.8543) | 0.562 |
| Needlestick injuries avoidable | |||
| No | 0.6906 | (0.2854, 1.6714) | 0.412 |
| Received tetanus vaccine | |||
| No | 1.2380 | (0.6486, 2.3632) | 0.517 |
| Risk of needlestick injuries | |||
| Moderate | 4.2645 | (1.9987, 9.0990) | 0.000*** |
| Low | 2.9154 | (0.9891, 8.5928) | 0.052 |
| Constant (intercept) | 0.2635 | (0.0628, 1.1066) | 0.069 |
Abbreviation: AOR = adjusted odds ratio.
p < 0.05;
p < 0.01;
p < 0.001.
4. Discussion
NSSIs are a critical occupational hazard for HCWs worldwide, serving as a major route for the transmission of BBPs [3, 25]. This study assessed the prevalence and associated factors of NSSIs among HCWs at a leading tertiary care hospital in Mogadishu, Somalia. Alarmingly, the 12‐month prevalence was 72.97%, with nearly three‐quarters of participants reporting at least one NSSI during this period. This prevalence rate far exceeds the global pooled prevalence of 56.4% reported in a recent meta‐analysis [2] and surpasses estimates from many other regions [23].
In comparison, the prevalence observed here is significantly higher than that reported in North East Ethiopia (41.7%) [4], Saudi Arabia (20–30%) [13], and Jordan (27.6% over 6 years) [14]. However, it aligns more closely with data from other LMICs and postconflict settings, including previous findings from this same hospital [5]. These results suggest serious gaps in the implementation of preventive strategies, widespread underreporting, and a potentially weak institutional safety culture. The high prevalence underscores the urgent need for context‐specific interventions to strengthen occupational health and safety practices.
Consistent with global evidence, our study found significant associations between NSSIs and various sociodemographic and occupational factors. Male HCWs had a higher prevalence (78.92%) compared to females (65.54%), which contrasts with some literature reporting higher rates among female nurses due to their greater exposure to invasive procedures [21]. However, our findings align with studies suggesting gender‐based differences in job roles or risk behaviors in certain settings [13]. Moreover, lower educational attainment (no formal education or diploma) was strongly linked to higher NSSI rates, reaffirming the link between inadequate training and increased occupational risk [20, 21]. This emphasizes the need for accessible, ongoing training in IPC, particularly for auxiliary staff and those with limited education.
Notably, cleaners (95.45%) and radiology technicians (93.33%) reported particularly high injury rates. These findings are consistent with both local [5] and international studies [2], reflecting the unique hazards faced by these occupational groups. Such results highlight the necessity of role‐specific risk assessments and tailored safety interventions for high‐risk categories of HCWs.
Workload and specific work practices also significantly influenced NSSI risk. In the bivariate analysis, HCWs attending more than 10 patients/day had higher injury rates (84.72%), supporting established links between excessive workload, fatigue, and safety lapses [20]. Interestingly, in the multivariate analysis, attending to more than 10 patients/day appeared to be a protective factor. This counterintuitive finding may be due to residual confounding or the possibility that more experienced staff are assigned heavier patient loads, yet their skills help reduce risk. This underscores the limits of quantitative data in capturing workplace dynamics and highlights the need for complementary qualitative research.
Unsafe practices—particularly needle recapping—were widespread, with 66.19% of HCWs reporting that they always or sometimes recap needles. This behavior was significantly associated with increased risk of NSSIs. In the multivariate analysis, never recapping needles was found to be protective (AOR = 0.37), reinforcing the well‐documented dangers of this outdated practice. In contrast, many global healthcare settings have made significant progress in eliminating needle recapping through strict policy enforcement and training initiatives [12, 13], its continued prevalence here calls for urgent institutional action. Enforcing standard precautions through policy, routine training, and consistent reminders is crucial to reduce this risky behavior [25]. Environmental and organizational factors also played a significant role. Bivariate analysis showed that inadequate availability and poor placement of sharps containers were associated with increased injuries. Importantly, having sharps containers placed on dressing trolleys was protective, likely due to the ease of immediate, safe disposal—a key global recommendation for NSSI prevention [13, 14]. This finding highlights the importance of not just providing disposal containers, but ensuring they are strategically placed at the point of care.
Lack of IPC training was also associated with higher NSSI rates (82.86% among untrained vs. 68.42% among trained), underlining the importance of structured training in reducing occupational injuries—consistent with previous systematic reviews [22]. Similarly, the absence of institutional safety protocols correlated with a higher injury incidence, emphasizing the critical need for a strong organizational safety framework [7, 19]. While general awareness of bloodborne disease transmission was high, risk perception had a nuanced impact. Interestingly, HCWs who perceived a “moderate” risk had significantly higher odds of sustaining an NSSI compared to those perceiving a “severe” risk (AOR = 4.2645). This suggests that greater perceived risk may lead to more cautious behavior, while moderate risk perceptions may result in complacency or inadequate precautionary measures. The high prevalence of NSSIs among HCWs in the studied tertiary hospital highlights a serious occupational hazard, with risks of transmitting bloodborne infections such as hepatitis B, hepatitis C, and HIV [26]. This endangers frontline staff and undermines healthcare system safety and effectiveness. Key contributing factors include limited training, poor safety practices, and inadequate institutional protocols.
Underreporting of sharp injuries remains a major challenge, often due to fear of blame, complex reporting procedures, or perceptions that incidents are too minor. Creating a confidential, nonpunitive reporting culture is essential for accurate surveillance and timely intervention. This problem is not unique to Somalia but is a global trend, with studies from the United States, Ethiopia, and India, similarly documenting substantial underreporting of NSSIs among HCWs [27, 28, 29].
An interesting finding was the reversal in the association between workload and injury risk. While higher patient loads initially appeared to increase NSSI risk, multivariate analysis showed a protective effect (AOR = 0.42), likely reflecting the influence of unmeasured variables such as worker experience. This underscores the importance of multivariate analysis in understanding complex occupational risks.
Overall, strengthening training, safety protocols, and reporting systems is essential for reducing NSSI risk, improving occupational health, and enhancing trust and efficiency in Somalia's healthcare system. Broader, multi‐center studies are needed to validate these findings and guide national prevention strategies.
4.1. Limitations
This study has several limitations. It relied on self‐reported data over a 12‐month period, which may be subject to recall bias or underreporting due to fear of stigma or professional consequences. Although a structured questionnaire with event‐specific questions was used to aid recall, minor incidents may have been forgotten. The single‐center design also limits generalizability. Variables such as staffing levels, psychological stress, device‐related risks, and institutional safety culture were not assessed. Additionally, factors like the presence of safety protocols were based on participants' perceptions rather than objective verification, which may vary across departments. The lack of a formal reporting system and limited awareness may have further contributed to underreporting.
5. Conclusion
This study found a high prevalence of NSSIs (72.97%) among HCWs in a major tertiary hospital in Mogadishu, Somalia. Male staff, cleaners, radiology technicians, and workers with lower education levels were disproportionately affected. Occupational and workplace factors—such as needle recapping, high patient load, poorly placed sharps containers, lack of IPC training, and inadequate safety protocols—were significantly associated with injury occurrence. Protective factors observed included hepatitis B and tetanus vaccination and timely reporting of injuries.
These findings highlight a serious occupational and public health concern within the studied hospital, emphasizing the urgent need for targeted interventions tailored to high‐risk groups and unsafe practices identified in this study. Broader recommendations—such as implementing safety‐engineered devices, structured training programs, and confidential reporting systems—are supported by global literature and best practices but are distinct from the results observed here. Future research should expand to other healthcare settings across Somalia and examine institutional safety culture, device‐specific risks, and the psychosocial impact of NSSIs to inform sustainable prevention strategies.
Author Contributions
Suad Abdikarim Isse: writing – original draft, validation, writing – review and editing, supervision, data curation. Mohamed Abdirahim Omar: software, methodology. Ahmet Doğan: investigation, formal analysis. Ali Kutta Çelik: data curation, supervision. Tigad Abdisad Ali: data curation. Sultan Pir: data curation. Sowda Abdikarim Sheikh: project administration, visualization, supervision. Jabir Abdullahi Wehlie: investigation, conceptualization, visualization. Rahma Yusuf Haji Mohamud: data curation, validation. Ahmed Mohamed Ali: data curation, supervision. Liban Ade Hussein: data curation, supervision. Iftin Mohamed Osman: data curation. Ifrah Adan Hilowle: data curation. All authors read and approved the final manuscript.
Ethics Statement
The study received approval from the Clinical Research Ethics Committee of Mogadishu‐ Somalia Türkiye Recep Tayyip Erdoğan Training and Research Hospital, March 30, 2024 (Approval No.: 17693) and was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki.
Consent
Written informed consent was obtained from all participants before data collection.
Conflicts of Interest
The authors declare no conflicts of interest.
Transparency Statement
The lead author Suad Abdikarim Isse affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.
Data Availability Statement
The data sets generated and/or analyzed during this study are available from the corresponding author upon reasonable request.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data sets generated and/or analyzed during this study are available from the corresponding author upon reasonable request.