Under-reporting of Needlestick Injuries Among Doctors in Teaching Hospitals in Sudan: A cross-sectional study

Abstract Background Needlestick injuries (NSIs) are a significant occupational hazard for healthcare workers, yet data on their prevalence, under-reporting, and associated factors are limited in conflict-affected, resource-limited settings. This study aimed to assess the 12-month prevalence and under-reporting rate of NSIs among physicians in Sudanese teaching hospitals, evaluate post-exposure management practices and knowledge of prophylaxis, and identify key predictors of reporting behavior. Methods A cross-sectional, multicenter study was conducted across six teaching hospitals in six Sudanese states. A validated, pilot-tested, structured questionnaire was used to survey 484 licensed physicians, including house officers, medical officers, residents, specialists, and consultants. Relationships between variables and reporting behavior were analyzed using Chi-square and Mann-Whitney U tests. Predictors were identified through two-stage logistic regression, providing adjusted odds ratios (aORs) with 95% confidence intervals (CIs). Results Among the 484 participants, 40.1% (n = 196) reported at least one NSI in the past year, with 49% of these injuries not being formally reported. A lack of awareness of hospital-based reporting systems was noted in 59.5% of respondents, and 18.6% were unvaccinated against hepatitis B. The main barriers to reporting included unfamiliarity with the process and beliefs that prior vaccination negated the need to report. Psychosocial barriers, such as embarrassment and career concerns, were largely rejected. Multivariate analysis showed two independent predictors of reporting: having a known infectious source (aOR 5.41; 95% CI 2.15–13.57; p < 0.001) and awareness of the reporting system (aOR 2.06; 95% CI 1.10–3.86; p = 0.025). Junior staff had lower reporting rates than senior physicians, but this association weakened after adjusting for awareness and source patient status. Conclusion Under-reporting of NSIs among Sudanese physicians is prevalent and mainly driven by infrastructural gaps and knowledge deficits rather than psychosocial factors. The recognition of reporting-system awareness as a modifiable predictor highlights the critical need for standardized, accessible reporting methods and targeted occupational health education—especially for junior physicians—in Sudan's conflict-affected healthcare system.