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1. ABDI AZIZ DAHIR HASHI Student’s ID: 0242320007273017 MPH program Major in ( Epidemiology and Biostatistics ) Daffodil International University

2. D epartment of Public Health Major MPH program Major in ( Epidemiology and Biostatistics ) THE RISK FACTORS OF HIV INFECTION AMONG HEALTHCARE WORKERS AT PRIVATE HOSPITALS IN HODAN DISTRICT IN SOMALIA

3. Research Question What is the relationship between Risk Factors Of Hiv Infection Among Healthcare Workers At Private Hospitals In Hodan District In Somalia?

4. Background of the study HIV/AIDS remains a global health crisis, with 38 million people affected worldwide (WHO, 2020 ). Sub-Saharan Africa bears the greatest burden, while Somalia reports a relatively low prevalence below 1% of the population, with about 10,500 people living with HIV/AIDS (Ministry of Health, 2020 ). However , stigma, discrimination, weak health infrastructure, poverty, gender inequality, and conflict severely hinder prevention, testing, and treatment (Mohamud et al., 2023 ). Healthcare workers (HCWs) face high occupational risks, including needlestick injuries, yet many lack regular screening, post-exposure prophylaxis, and adequate training ( Auta et al., 2017; Domkam et al., 2018). Limited awareness, unsafe practices, and reluctance to seek care further exacerbate vulnerability among HCWs ( Anshur , 2024).

5. Continue. Background of the study This study therefore examines HIV-related risks and discrimination in Somalia, focusing on healthcare workers in private hospitals, a group often neglected in national HIV prevention strategies . Economic hardship drives risky behaviors like transactional sex, while cultural beliefs and stigma discourage testing and treatment. Traditional norms that neglect safe sexual practices further heighten HIV transmission risks (Mohamud et al., 2023).

6. Continue. Background of the study Somalia’s weak healthcare system limits access to HIV testing, treatment, and prevention, leading to undiagnosed and untreated cases that fuel transmission. Multiple interrelated factors sustain the epidemic (Mohamud et al., 2023 ). Poverty, unemployment, conflict, and displacement increase risky behaviors, worsen living conditions, and weaken healthcare access, thereby heightening HIV vulnerability . Stigma, discrimination, and cultural norms discourage HIV testing and treatment, leading to late diagnoses and sustained transmission . Gender inequality increases women’s vulnerability to HIV and limits their access to care and support services .

7. Problem Statement HIV Risk Factors Among Healthcare Workers in Private Hospitals – Somalia High Impact in Sub-Saharan Africa: Nurses, the largest health workforce group, are disproportionately affected by HIV/AIDS, leading to reduced productivity and compromised patient care ( Tawfik & Kinoti , 2002). Data Gaps in Somalia: Exact infection rates among nurses are unknown; many keep their HIV status confidential. Affected staff continue to work without organized employer support (UNAIDS, 2004). Systemic Challenges: Staff shortages, limited health programming capacity, and weak healthcare infrastructure hinder quality care delivery .

8. Continue… Problem Statement HIV Risk Factors Among Healthcare Workers in Private Hospitals – Somalia High Impact in Sub-Saharan Africa: Nurses, the largest health workforce group, are disproportionately affected by HIV/AIDS, leading to reduced productivity and compromised patient care ( Tawfik & Kinoti , 2002). Data Gaps in Somalia: Exact infection rates among nurses are unknown; many keep their HIV status confidential. Affected staff continue to work without organized employer support (UNAIDS, 2004). Systemic Challenges: Staff shortages, limited health programming capacity, and weak healthcare infrastructure hinder quality care delivery. Workforce Strain: Experiences from Namibia show ART and PMTCT programs can further deplete staff, worsening workloads and reducing care quality ( Tawfik & Kinoti , 2002). Study Rationale: There is a critical need to examine HIV risk factors among healthcare workers in Somalia’s private hospitals to inform targeted interventions.

9. Objectives of the Study GENERAL OBJECTIVES OF THE STUDY The purpose of this research is Risk factors of HIV infection among healthcare workers at private hospitals in Hodan district in Somalia. SPECEFIC OBJECTIVES OF THE STUDY To examine the occupational exposure risks associated with HIV infection among healthcare workers in private hospitals in Hodan district, Somalia. To evaluate the availability and utilization of infection prevention and control measures in private hospitals in Hodan district to mitigate the risk of HIV infection among healthcare workers. To determine Awareness of HIV infection among healthcare workers at private hospitals in Hodan District.

10. Justification of Study Healthcare workers in Somalia face high HIV risk due to occupational exposure to blood and bodily fluids, compounded by inadequate safety protocols and limited PPE ( Anshur & Sheik, 2024). This study examines these risk factors to inform training, policy development, and improved occupational safety, ultimately protecting healthcare workers and enhancing public health outcomes. Justification of Study

11. Methodology

12. Study design The study was cross-sectional study design was adapted to assess and Investigate Risk Factors Of Hiv Infection Among Healthcare Workers At Private Hospitals In Hodan District In Somalia Study area The place of This study where conducted was done in hodan district that is under governmental hospital the main population works this hospital are the maternity women and their children in Mogadishu Somalia Study Period The study was conducted from (March 2025 to June 2025) Study population The total set of people of under investigation is referred to as the study population ( Sekeran , 2003). The study's target group consists of people 101 .

13. Selection Criteria INCLUSION CRITERIA This study covered the maternity staff of three hospitals in Hodan district. EXCLUSION CRITERIA Everyone else on staff who wasn't employed by three hospitals in Hodan district and wasn't supposed to take part in this study

14. Sample size To determine the sample size of this study was calculated by using sample size determination was used Cochran’s single population proportion formula which is calculated as: n n= the desired sample size. So we have 22% (0.22) as P, while q= 1-p (1-0.22) = 0.78 (78%). = the standard squared critical value usually set at 1.96 which correspondents to 95% confidence level. = is the squared value of the desired level of precision and we choose 0.08 or 8%. = 101 n=101  

15. DATA COLLECTION TOOL Data was collected by using interviewer-administered questionnaire. The main contents of the questionnaire related question to obtain the required and related information of the different and most used techniques from the working staffs of the three Hospitals . The questionnaire was pre-tested before starting the data collection.

16. Data Analysis After the collection of data, all interviewed questionnaires were checked for completeness, correctness, and internal consistency to exclude missing or inconsistent data, and those were discarded. Corrected data was entered into Statistical Package for Social Sciences (SPSS) statistical software version 25 for the analysis.

17. Ethical Consideration The study proposal was submitted to Daffodil International University (DIU) for approval. Prior to data collection, written informed consent was obtained from the participants. The confidentiality of the respondents was maintained, and they were informed that they could withdraw from the study at any point during the data collection process.

18. Results and findings

19. Response Rate A total of 101 questionnaires were distributed to healthcare workers in private hospitals within Hodan District, and all were completed and returned, resulting in a 100% response rate. This excellent participation rate minimizes non-response bias and strengthens the reliability of the study findings. The high response rate reflects strong engagement and interest among healthcare workers regarding HIV-related occupational risks. It also enhances the overall validity of the research conclusions.

20. 20 Table 4.2: Summary of Demographic Characteristics

21. Table 4.3: Cronbach’s Test of Reliability Objective N Cronbach’s Alpha Decision Occupational exposure risks associated with HIV infection among healthcare workers 101 0.81 Accept Availability and utilization of infection prevention and control (IPC) measures 101 0.76 Accept Awareness of HIV infection among healthcare workers 101 0.79 Accept

22. Table 4.4 occupational exposure risks associated with HIV infection Statement N Mean Std. Deviation Occupational exposure risks experienced by healthcare workers 101 3.75 0.82 Availability and utilization of infection prevention and control measures 101 3.40 0.90 Awareness of HIV infection among healthcare workers 101 4.10 0.75

23. Table 4. 3 : Correlation Analysis (N = 101) Variables Occupational Exposure Risks Availability & Utilization of IPC Measures Awareness of HIV Infection Occupational Exposure Risks 1.000 - 0.470 - 0.530 Availability & Utilization of IPC Measures - 0.470 1.000 0.580 Awareness of HIV Infection - 0.530 0.580 1.000

24. Table 4.4: Chi-Square Test of Association Between Study Variables Variables Occupational Exposure Risks Availability & Utilization of IPC Measures Awareness of HIV Infection Occupational Exposure Risks 1.000 - 0.470 - 0.530 Availability & Utilization of IPC Measures - 0.470 1.000 0.580 Awareness of HIV Infection - 0.530 0.580 1.000

25. Table 4.5: ANOVA – Risk Factors of HIV Infection and Healthcare Workers Model Sum of Squares df Mean Square F Sig. Regression 45.324 3 15.108 18.645 0.000 Residual 22.065 97 0.227     Total 67.389 100      

26. Table 4.13: Regression Coefficients Model Unstandardized Coefficients (B) Std. Error Standardized Coefficients (Beta) t Sig. (p-value) (Constant) 2.127 0.312 — 6.818 0.000 Occupational Exposure Risks 0.412 0.095 0.428 4.337 0.000 IPC Measures -0.285 0.091 -0.316 -3.132 0.002 HIV Awareness -0.321 0.088 -0.344 -3.648 0.001

27. Table 4.14: Regression Equation Summary Variable Coefficient (B) Interpretation Constant (Intercept) 2.127 Baseline risk when all predictors are zero Occupational Exposure Risks +0.412 Positive impact: risk increases with more exposure IPC Measures (Availability & Utilization) -0.285 Negative impact: risk decreases with better IPC use HIV Awareness -0.321 Negative impact: risk decreases with more awareness

28. Conclusion Conclusions: Study Goals Achieved: The findings suggest that the objectives of the study were successfully achieved. The study investigated the Risk factors of HIV infection among healthcare workers at private hospitals in Hodan district in Somalia . Significant Correlation: The results revealed a notable positive correlation between the independent and dependent variables impacting the Risk factors of HIV infection among healthcare workers at private hospitals . In conclusion, the study effectively explored the relationship between Risk factors of HIV infection among healthcare workers at private hospitals , highlighting a significant positive association among patients at the three Hospitals in Somalia .

29. Recommendation This study suggests to Improve and Enhance Occupational Safety Enhance Occupational Safety Conduct routine training on safe handling of sharps and exposure management. Promote prompt reporting and proper management of occupational exposures. Improve IPC Measures Ensure continuous access to protective equipment (gloves, masks, sterilization materials). Increase IPC supervision and enforce adherence to safety protocols. Strengthen HIV Awareness & Policy Development Conduct regular education sessions on HIV transmission, prevention, and post-exposure prophylaxis (PEP). Launch targeted campaigns to improve knowledge and confidence in managing exposure incidents. Advocate for policies supporting occupational health and HIV risk reduction in healthcare settings. 29

30. THANK YOU ধন্যবাদ

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