Head shaving is considered to be an important potential means of transmission of communicable blood-borne diseases (BBDs), such as Hepatitis B (HBV), Hepatitis C (HCV), and human immune-deficiency virus (HIV). The malpractice's of barbers can make head-shaving during Hajj an optimum focal setting for spread of serious BBDs, particularly that nationals of some Islamic countries such as Pakistan, Nigeria, and Egypt, have relatively high prevalence rates of HBV and HCV. However, previous studies have lacked laboratory components that document the prevalence of these BBD among Hajjees or barbers. The objectives of this study were to determine the prevalence of HBV, HCV and HIV among barbers during Hajj, and to study other factors associated with BBDs among them.
In a cross-sectional study, barbers working at head-shaving sites at Jamarat, where there are more than 200 barber-chairs, were recruited. The study yielded a random sample of 158 barbers, whose consent was obtained to draw their blood; 158 blood specimens were collected, sera were tested for the presence of markers for HBV, HCV, and HIV.
The mean age of the barbers was 30.9 ± 8.8 years (Range 14-65 years), they were from eight different nationalities, the majority; 72 (45.6%), were from Myanmar, 27 (17.3%) were from Egypt and 22 (14.1%) were from Bangladesh. About two-thirds of the barbers; 101 (64%) were found to work during the Hajj season only, while professional licensed barbers were only 57 (36.1%). Most of the barbers had worked during previous Hajj seasons for a median of 2 to 5 years. More than four fifths of barbers, 128 (81%) reported that no diseases were transmittable by head shaving.
Laboratory tests revealed that 7 (4%) barbers tested positive for HbsAg, 16 (10%) for HCV, and one (0.6%) for HBeAg. None of the barbers tested positive for HIV, anti-HTLV 1&2. anti-HbsAg or Anti-HBc IgM.
There was a significant association between testing positive for HCV Antibody and nationality (x2 = 21.3, P<0.05). Around one third of Egyptian barbers (9 or 32.1%), 3 Pakistani barbers (15%), and 4 barbers from Mayanmar (5.6%) tested positive for HCV, but none of those from other countries. HCV was relatively higher among barbers who had practiced head shaving at least in one previous Hajj season.
Editorial note:
This study reports, for the first time, the prevalence of HBV, HCV and HIV among barbers serving Hajjees during the Hajj season. Head shaving has been reported to be an occupational risk factor for BBD among barbers. Prevalence rates of HCV as high as 38% have been reported among Italian barbers [1]. These results are certainly disturbing.
Barbers during Hajj are at risk to acquire a BBD from Hajjees, especially if they have a cut wound in their hand. A previous study documented that about a fourth of barbers had visible cut wounds in their hands. Conceivably, Hajjees are also at risk of being exposed to infected blood or contaminated head shaving instruments, especially if they have a cut wound on their scalps [2].
Strict supervision, screening and licensing of barbers is required to ensure that at least those working at areas supervised by the government are free from any Blood Borne Disease (see photo). Control measures have to be integrated with self-supervision by Hajjees themselves and barbers through intensified health educational programs
References
- Zuckerman AJ, Harrison TJ, Zuckerman JN. Viral Hepatitis. In: Manson's Tropical Diseases. Edited by Cook GC. Paston Press LTD, London, Norfolk, 20th edition, pp 660685.
- Al Salamah AA, El Bushra HE. Head shaving practices of barbers and pilgrims to Makkah. Saudi Epidemiol Bull 1998; 5: 3-4.
