title: Occupational hazards of traditional healers: repeated unprotected blood exposures risk infectious disease transmission.
abstract: OBJECTIVE
  Healers provide support for acute and chronic illnesses in rural Mozambique, such as socially acceptable traditional 'vaccinations' (subcutaneous cuts in the skin to rub herbs directly into the bloody lesion). We aimed to document the frequency of blood exposure by traditional practitioners in Mozambique.
  
  
  METHODS
  We conducted surveys with a simple random sample of 236 traditional healers in Zambézia province. Chi-square and Wilcoxon rank-sum tests were used to compare 'injection' behaviours across districts.
  
  
  RESULTS
  Healers treated a median of eight patients in the past month (IQR: 4-15). About 75% conducted 'injections'. These healers 'injected' a median of four patients (IQR: 1-8), used a new razor a median of three times (IQR: 1-8), and almost never used gloves. Lifetime blood exposures among those who provided 'injections' during treatments were estimated to be 1758 over a healer's career.
  
  
  CONCLUSIONS
  The majority of healers are exposed repeatedly to patient blood. Given the high prevalence of HIV, hepatitis B and C virus, and other blood-borne agents, specific healer practices are an occupational hazard and reuse of razors is risky for their clients.
authors: Vanderbilt Institute for Global Health, Nashville, TN, USA. carolyn.m.audet@vanderbilt.edu.|Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA. carolyn.m.audet@vanderbilt.edu.
authors: Carolyn M
authors: CM
authors: Audet
authors: Friends in Global Health, Quelimane and Maputo, Mozambique.
authors: José
authors: J
authors: Salato
authors: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors: Meridith
authors: M
authors: Blevins
authors: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Friends in Global Health, Quelimane and Maputo, Mozambique.
authors: Wilson
authors: W
authors: Silva
authors: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Friends in Global Health, Quelimane and Maputo, Mozambique.
authors: Lázaro
authors: L
authors: González-Calvo
authors: Vanderbilt Institute for Global Health, Nashville, TN, USA.|Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, TN, USA.
authors: Sten H
authors: SH
authors: Vermund
authors: Department of Traditional Medicine, MISAU, Maputo, Mozambique.
authors: Felisbela
authors: F
authors: Gaspar
mesh_terms: D017848:Blood-Borne Pathogens; D005260:Female; D006801:Humans; D017758:Infectious Disease Transmission, Patient-to-Professional; D008297:Male; D016488:Medicine, African Traditional; D008875:Middle Aged; D009073:Mozambique; D012306:Risk; D012424:Rural Population
keywords: Blood exposure; HIV; Occupational Health; Traditional Healers; VIH; escarificación; exposición a sangre; exposition au sang; guérisseurs traditionnels; hepatitis; hépatite; salud ocupacional; sanadores tradicionales; santé du travail; scarification