Journal of Public Health in Developing Countries
Vol. 2, No. 1, pp. 94-101
http://www.jphdc.org/
ISSN 2059-5409
Original Contribution
Open Access
Assessment of Occupational Health Hazards Awareness and Common Practices amongst Barbers and Hairdressers in Cameroon Wilfred A. Abia1,2,3, Richard Fomboh2, Epolle Ntungwe2, Eucharia A. Abia3, Walters A. Serika3, Markjovert T. Ageh3 1
Integrated Risk Assessment Team, Integrated Health for All Foundation (iRATI-IHAF), Cameroon School of Toxicology, Occupational Safety/Health, and Risk Assessment, College of Science, Engineering and Technology (COSET), Institute for Management and Professional Training (IMPT), Yaounde, Cameroon 3 School of Project Management, College of Arts and Management Sciences (COAMS), IMPT, Yaounde, Cameroon 2
Correspondence to: Wilfred A. Abia, School of Toxicology, Occupational Safety/Health, and Risk Assessment, COSET, Institute for Management and Professional Training (IMPT), PO Box 31717, Yaounde, Cameroon. Email:
[email protected]
ARTICLE INFO
ABSTRACT
Article history:
Background: Barbers and hairdressers are exposed to several health hazards in their workplace. The aim of this study was to assess the knowledge and perceptions of barbers and hairdressers in Yaoundé VI, Cameroon on occupational hazards, and evaluate the influence of common workplace habits on exposures of these workers to chemical hazards.
Received: 23 Sep 2015 Accepted: 14 Dec 2015 Published: 4 Feb 2016
Keywords:
Workplace Health hazards Barbers Hairdressers Cameroon
Methods: We conducted a workplace-based cross-sectional study by randomly selecting 118 participants (barbers=54 and hairdressers=64) who were examined using structured questionnaires between March and May 2015. Results: Over 95% of the participants (96% barbers and 97% hairdressers) were aware of the workplace hazards. HIV/AIDS was the most frequently reported disease that can be transmitted through workplace practices (mentioned by 50% barbers and 66% hairdressers). The most commonly used protective measure was instrument sterilization (by 69% barbers and 75% hairdressers), followed by avoidance of crossusage of blades, 15.4% and 12.5%, and the use of protective equipment, 7.7% and 6.3%, respectively. Conclusions: Barbers and hairdressers were aware of workplace hazards, but do not routinely perform risk assessment of the hazards to protect themselves and their customers. Training on proper handling of cosmetic products and chemicals and improving occupational health and safety risk assessment are urgently needed to reduce workplace exposures in Cameroon.
Citation: Abia WA, Fomboh R, Ntungwe E, Abia EA, Serika WA, Ageh MT. Assessment of Occupational Health Hazards Awareness and Common Practices amongst Barbers and Hairdressers in Cameroon. J Public Health Dev Ctries. 2016; 2(1): 94-101.
© The Authors 2016. All rights reserved, JPHDC. This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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INTRODUCTION In Cameroon, barbers (those who work in men’s salons) and hairdressers (those who work in women’s salons) generally work in small roadside men’s saloons (commonly referred to as barbers workshops) and women’s salons (alternatively referred to as hairdressers salons), respectively. Barbers shops and hairdressing salons are good avenues for promoting health education amongst customers [1,2]. Barbers and hairdressers perform their duties with the aid of mechanical tools (such as shaving machines by the barbers, and needles and blades by the hairdressers) and use cosmetic products (e.g. shampoo and alcohol). This leaves barbers and hairdressers exposed to mechanical, but more specifically chemical and biological hazards at the workplace. Cosmetics products are indispensible materials irrespective of whether they are for men’s or women’s beauty salons. These products include shampoos, creams, hair conditioners and dyes, and various sprays. They generally contain several different chemical mixtures. One of the chemicals which barbers are commonly exposed to is isopropyl alcohol. It has a low order of acute toxicity and causes irritation to the eyes, depression of the central nervous system and narcosis following repeated or prolonged exposure to pure form [3]. Ammonium lauryl sulphate, which is used in cleansing agents, hair shampoos and hair bleaches as an anionic surfactant; and formaldehyde (frequently used in nail hardener cosmetic preparations and aerosol sprays for cosmetic use) are known to be toxic once an individual is exposed to them via inhalation, skin contact (cause skin rashes and allergic skin reactions in case of formalin exposure), and swallowing. Lead-containing compounds generally have diverse effects on multiple body systems. Likewise, toluene’s low to moderate concentration can cause tiredness, confusion, weakness, drunken-type actions, memory loss, nausea, loss of appetite, and hearing and color vision loss. Other compounds commonly found in the usual cosmetic products include pbenzenediamine, o-benzenediamine, pphenylenediamine, p-toluenediamine, parabens, ammonia, phenols, glyceryl monothioglycolate, ammonium thioglycolate, ammonium chloride,
ammonium phosphate, hydrogen peroxide, carbon dioxide, and carbon monoxide [4-7]. Furthermore, the barbers and hairdressers are subjected to various other health hazards in their workplaces [8]. Problems such as poor posture, mechanical load on the joints, prolonged standing, longer working hours, missed meals, not taking breaks during working, as well as being subjected to physical factors such as noise and higher temperatures are important occupational health risks for these people [9-11]. The overall evaluation of occupational exposures of barbers and hairdressers to chemicals by the International Agency for Research on Cancer [12] revealed the likelihood of cancer development [13]. According to Omokhodion et al. [14], hairdressers in Nigeria are exposed to a number of occupational hazards including needles used for fixing hair attachments, hair relaxing creams, blades, handling hot water and electrical equipment. In the same study, joint pains, low back pain, and hand dermatitis were the most frequently reported illnesses among barbers and hairdressers [14]. The knowledge of barbers regarding unhealthy working practices and their awareness about threat of receiving hazardous infection from their customers has been found to be poor [15]. Due to negligence and poor instrument handling, barbers and hairdressers, and their customers, frequently get exposed to blood borne infections which may result in severe health implications [15,16]. Such infections may be facilitated by common tools (such as combs, towels, razors and scissors), especially where these tools are not appropriately disinfected. Some of the commonly transmitted infections include fungal infections, scabies, hepatitis B and C, staphylococcus infection, and HIV/AIDS [17]. Following repeated exposures to the cosmetic products, chemicals therein frequently serve as risk factors to several human health problems including respiratory, dermal, and ocular systems in barbers [18,19], and reproductive health issues and indoor air pollution amongst hairdressers [20]. An indoor air pollution measurement in hairdressing saloons revealed higher levels of carcinogenic chemicals (benzene, dichloromethane, and ethylbenzene); oestrogenic or endocrine disrupting chemicals (hexane, benzene, 95
methoxypropanol and toluene); as well as potential allergens (diethylphthalate and limonene) [7]. In view of such multiple chemical exposures, it may be speculated that the combined effect may be synergistic and may be above the commonly acceptable threshold levels. Therefore, the inner air in saloons is not only chemically unsafe and unhealthy; it may also be environmentally unsafe [21]. In Cameroon, like elsewhere, with the art of beauty (“looking good”) increasingly being recognized, especially within metropolitan cities such as Yaoundé, several small roadside salons are on the rise. However, the awareness of the barbers and hairdressers on workplace associated health hazards both to themselves and their customers is vague. The aim of this study was, therefore, to find out the knowledge and perceptions of barbers and hairdressers in Yaoundé VI, Cameroon on occupational hazards, and evaluate the influence of common workplace habits on exposures of these workers to chemical hazards.
MATERIALS AND METHODS Study Design and Setting This workplace-based cross-sectional study was conducted in the Yaoundé VI area from March to May 2015. Yaoundé VI is a council area with the city Yaoundé, which is the administrative capital of Cameroon and is located in the Central Region of the country. The target populations for this study were the salon workers. Due to the population (mostly civil servants and students), and by necessity, several barbering and hairdressing salons, are concentrated in the target area in this study, Yaoundé VI area. A total of 110 salons, barbers shops (n=54) and hairdressers salons (n= 56), in the Yaoundé VI area were randomly selected to participate in the study. One worker per barber shop or a hairdressing salon was recruited who was willing to participate voluntarily in the study. However, where a shop or a salon had more than three workers, a maximum of two were randomly selected to provide responses to the knowledge assessment questionnaires.
Survey Tool and its Administration A semi-structured, interviewer-administered questionnaire was used for the study. The questionnaire was prepared in English and was then translated into French. The questionnaire was developed based on the objectives of the study and information obtained from the literature and “hearsay” from consumers of barbering and hairdressing services. The study questionnaire was focused on awareness of health hazards in salons, how, why and when are equipment sterilized, chemicals used in the saloon, how dirt is disposed in the salons, specific diseases likely transmitted in the salons and what can be done to prevent their spread in these salons. The questionnaire consisted of six sections. The first section focused on socio-demographic information of the participants, the second and third sections concentrated on methods of sterilization of equipments and the chemicals (type, source of chemicals, and knowledge on the chemicals) used for sterilizing the equipments. Section four dealt with the cleaning routine of the shops and salons and included questions on the method, materials, time, and frequency of cleaning. Section five recorded the workers’ knowledge on disease transmission in their workplaces. Finally, the section six had respondents’ income related questions. Data were collected by pre-trained investigators, and all responses were recorded in the data collection tools.
Statistical Analyses The data were entered and analyzed with SPSS version 20 (IBM, NY, USA). Basic descriptive analysis consisting of means and proportions are presented.
RESULTS Demographic Respondents
Characteristics
of
the
A total of 110 salons participated in this study and 118 workers filled in the questionnaires. The workers included 54 barbers and 64 hairdressers. Eight of the hairdressing salons had more than three hairdressers and thus two 96
hairdressers were interviewed for each of these salons. The mean ages were 30±8.17 and 30.31±7.29 years for barbers and hairdressers, respectively. The barbers were all males, while for hairdressers, there were 8 males (12.5%) and 56 females (87.5%). Demographic characteristics for both barbers and hairdressers are presented in Table 1.
be the major preventive approach in order to reduce workplace disease transmission.
Chemicals Used in the Salons
Characteristics
Many barbers and hairdressers acknowledged the use of chemicals in their salons. Some of the chemicals used by barbers included: alcohol (46.2%), hair oils (11.5%), shampoo (19.2%), gel (7.7%), and conditioner (3.8%). The hairdressers used alcohol (15.6%), hair oils (28.1%), shampoo (34.4%), gel (12.5%), and conditioner (9.4%).
Sterilization Situation in the Salons
Table 1. Socio-demographic Characteristics of Respondents (n=118)*
Barbers [N=54]
Hairdressers [N=64]
n (%)
n (%)
54 (100)
8 (12.5)
0
56 (87.5)
32 (59.3)
22 (34.4)
20 (37)
38 (59.4)
Primary
32 (59.3)
10 (15.6)
Secondary
16 (30.8)
40 (62.5)
0
4 (6.3)
Owner
16 (30.8)
14 (21.9)
Employee
36 (61.5)
48 (75)
Gender Male Female Marital status Single Married Educational level
In both the barbering and hairdressing salons, information was obtained on what the workers used to sterilize their equipment, how did they sterilize and for how long the sterilization was done. Table 2 highlights the findings. Briefly, alcohol was predominantly used for sterilization (57.7% for barbers and 50% for hairdressers). The highest equipment sterilization frequency for barbers and hairdressers were 69.2% and 65.6% respectively, while the lowest frequency for barbers was on a daily basis (19.2%) as oppose to weekly basis (9.4%) for hairdressers. Most of the participants (barbers 46.2% and hairdressers 34.4%) sterilized their equipments for less than five minutes, whilst 7.7% of barbers and 6.3% of hairdressers sterilized their equipments for as long as 30-60 minutes and 10-30 minutes, respectively.
Awareness of Disease Transmission Risk in the Salons Around 96% of barbers and 97% of hairdressers were aware of the fact that certain diseases could be transmitted via their workplaces. Their knowledge on the types of diseases that can be transmitted is reported in Table 3. HIV/AIDS (50% and 65.5% for barbers and hairdressers, respectively) was the most frequently mentioned condition. The majority of participants (69.2% of barbers and 75% of hairdressers) indicated sterilisation of their materials and equipments to
Tertiary Shop ownership
Work experience (years) 10
14 (26.9)
8 (12.5)
Whether work provides sufficient income Yes
18 (34.6)
26 (40.6)
No
20 (38.5)
20 (31.3)
Not sure
6 (11.5)
12 (18.8)
*Numbers do not add up in some categories due to missing data
DISCUSSION Barbers and hairdressers and their customers are exposed to various health hazards in the
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Table 2. Sterilization Status of Salons*
Characteristics
Barbers [N=54]
Hairdressers [N=64]
n (%)
n (%)
Chemicals used for sterilization Alcohol
30 (57.7)
32 (50)
L’eau de Javel
12 (23.1)
16 (25)
Other solution
6 (11.5)
4 (6.3)
Both alcohol and L’eau de Javel
2 (3.8)
10 (15.6)
Frequency of sterilization Once a day
10 (19.2)
14 (21.9)
After every customer
36 (69.2)
42 (65.6)
0
6 (9.4)
Once weekly
Duration of sterilization (min) 1-5
24 (46.2)
22 (34.4)
5-10
12 (23.1)
10 (15.6)
10-30
10 (19.2)
4 (6.3)
30-60
4 (7.7)
16 (25)
*Numbers do not add up in some categories due to missing data
hairdressing salons. The situation requires attention in Cameroon as the barbering and hairdressing professions are still not formally regulated and several barbers and hairdressers operate at will. The majority of the barbers and hairdressers have inadequate knowledge on the potential toxic effects of the chemicals they use on daily basis. This study was aimed at evaluating the knowledge and perceptions of barbers and hairdressers on the occupational hazards, and to evaluate the influence of common workplace habits on exposures of these workers to chemical hazards. This result of this study provide preliminary information as a motivation or driving force for a large scale study and justify an evaluation of the state of the problem nationwide. From this study, we found that over 96% of the participants had good knowledge about
health hazards related to their work. This was higher than the 51% awareness levels in Jimma, Ethiopia [22], as well as the reported 42% in the district Gujrat in Kharian city, Pakistan [15]. During the study, we also found that there is a Yaoundé barbers association where the relevant workers are educated on the health hazard associated with their work. This may, in part, justify the high awareness levels amongst the barbers in this study. With respect to the education level of the barbers and hairdressers, the majority (61%) of barbers were primary school leavers. However, 62.5% of hairdressers had attended secondary school and 6.3% had tertiary level education. This highlights a complexity in hairdressing profession relative to barbering. However, overall, the observed educational levels reflect the degree of inadequate or unappreciated knowledge on the toxic effects of the routinely used chemicals on health of these workers and their clients. Generally, educational level of barbers and hairdressers showed no significant association with their knowledge about biological hazards related their work. Normally, workers in the secondary and tertiary educational level are more likely to have good knowledge about biological hazards related to their work when compared to those who only attained primary education. The most frequently used cosmetics containing chemicals in the Yaoundé VI area were shampoo, gel, conditioner, hair oil and alcohol. The barbers and hairdressers were using personal protective equipment (PPE) like aprons and occasionally gloves to reduce their exposure to the chemicals; the overall usage of PPEs was low. This requires attention for the safety of the workers and their clients. We noticed that the hairdressers would wash the hair of their clients with bare hands (with no gloves) irrespective of the nature and condition of the hair. This is in line with other findings elsewhere in the world [23]. This is ironical but is not unexpected considering that, as is the case in the present study, a majority of barbers and hairdressers in Cameroon do not have any professional qualification for their jobs. Although the barbers and hairdressers who participated in this study did not have formal certificates to justify their professional ability, several of them indicated their interest in undergoing formal training. This was after they attended brief 98
sessions on awareness and knowledge enhancement on occupational safety and health following their participation in the study. These sessions were arranged by the study team. A majority of them wanted to undergo formal training for improving their health and safety practices, to earn more respect, develop entrepreneurial skills and reduce their and their clients’ exposures to occupational hazards (mechanical, chemical and biological) in and around their salons. The observed air-tide nature of the studied salons may make exposure to the chemicals worse. Window ventilation of these workplaces is amongst the effective measures to reduce exposure to the chemicals. This is in line with the report by Søsted et al. [5] who proposed that some diseases may aggravate with inappropriate indoor ventilation. Additionally, there may be low levels of exposures to individual chemicals, however, combined exposures to multiple chemicals may be more severe and should not be taken lightly, and worst still the degree of exposure may likely be higher in small air-tide busy workplaces like the studied salons. Furthermore, preparation of the chemicals e.g. the dyes is generally done in the same small air-tide busy room thus exposing all people inside the shop. The study participants were aware of some of the commonly transmitted diseases via salon tools to and from the salon workers and their clients. For example, blood related infections like HIV/AIDS was the most frequently reported workplace transmitted disease by the barbers (50%) and hairdressers 65.6%). The findings from this study corroborates with the report from Italy, which revealed that barbers have good knowledge on HIV and hepatitis transmission in the saloons [24], however, our results are in contrast with the situation observed in Yemen, where hairdressers’ and barbers’ knowledge on hepatitis and health hazards associated with their profession was found to be inadequate [23]. Again, it could be due to the Yaoundé barbers/hairdressers association where salon workers are educated on the health hazard associated with their work. Being conscious of the diseases that can be transmitted, the studied salon workers employed various strategies to minimize the rate of disease transmission in their workplaces. The most commonly used protective measures were instrument sterilization (barbers 69.2% and hairdressers - 75%), avoidance of
cross-usage of blades (15.4% and 12.5%), and the use of protective equipment (7.7% and 6.3%), respectively.
Table 3. Respondents Awareness of Disease Transmission Risk from Salons*
Characteristics
Barbers [N=54]
Hairdressers [N=64]
n (%)
n (%)
Diseases that can be transmitted HIV/AIDS
26 (50)
42 (65.6)
Dandruff
2 (3.8)
4 (6.3)
Fungi
2 (3.8)
10 (15.6)
Scabies
10 (19.5)
4 (6.3)
Hepatitis
2 (3.8)
0
Precautions for preventing disease transmission Sterilization Using protective equipment Preventing cross-usage of blades
36 (69.2)
48 (75)
4 (7.7)
2 (6.3)
8 (15.4)
8 (12.5)
*Numbers do not add up in some categories due to missing data
In addition, we also found that sanitation and sterilization of equipment used in workplaces was not satisfactory. Most of the participants spend only a few minutes (up to five minutes) to sterilize equipments. Also, many of the barbers use alcohol and l’eau de javel for their sterilization. Workers who used UV sterilizer (11.5% of barbers, and 6.3% of hairdressers) were around two times more likely to practice safely during barbering and hairdressing services when compared to those who did not. Earlier studies have also shown inappropriate protection against blood-borne diseases in barbers and hairdressers [15] and this increases the chance of disease transmission to both the workers and clients in the hair salons. The reason for the use of less expensive methods for sterilization could be due to the fact that these 99
salon workers receive a low income per month from their work. This could also be because these salon workers do not have professional certificates. Furthermore, the regulation of work conditions in this sector continues to pose a challenge to occupational health authorities in developing countries [25]. There is a significant difference in the understanding of the occupational health hazards and risks associated with barbering and hairdressing among barbers and hairdressers. This might be a reason for the disparities in the quality and standards of salons and their level of compliance to health and safety and public health standards in Cameroon and other developing countries. Strategies are needed for raising awareness on regulations and barbers' and hairdressers’ practices as this pose health risk to the workers as well as their clients. With poor knowledge and poor enforcement of regulations, compliance to occupational health and safety standards cannot be adequately achieved [26]. For the first time in Cameroon, barbers and hairdressers have been studied for their awareness levels and occupational practices serving as risk factors to workplace accidents with health implications. Barbers and hairdressers were aware of their workplace hazards with indigenous safety practices, but unfortunately do not perform risk assessment of workplace hazards to protect themselves and their customers. This speculates that more efforts are needed from all stakeholders especially the health system and mass media to promote health education for all. Furthermore, training on proper handling of beauty products and chemicals, their toxicity, and occupational health and safety risk assessment trainings are urgently needed to reduce workplace exposures in Cameroon.
barbers and hairdressers to have formal training on occupational health hazards before taking up their services to increase their knowledge on the likely hazards. This can be done through the organization of training workshops for salon workers, as well as via barbering and hairdressing programs in vocational training schools. There is a need for improved specific health messages in media campaigns to general population on salon health hazards.
AUTHORS’ CONTRIBUTIONS WAA conceived the idea and refined the focus and scope of work. WAA, RF, and EAA designed the questionnaire. EAA, WAS and MTA administered the questionnaire. WAA, RF and EN managed the literature searches and produced the initial draft. All authors did the proofreading. All authors have read and approved the final manuscript.
ACKNOWLEDGEMENTS Our special gratitude goes to the Institute for Management and Professional Training (IMPT) for providing necessary resources and funding (as a way of promoting research amongst its staff) to enable the field work of this study to be performed. The authors remain grateful to the barbers and hairdressers who voluntarily participated in this study.
CONFLICT OF INTEREST Authors have declared that no competing interests exist.
REFERENCES CONCLUSIONS 1.
The knowledge and awareness of barbers and hairdressers on occupational hazards is inadequate in Yaoundé VI, Cameroon. The studied barbers and hairdressers and their customers are frequently exposed to biological and chemical hazards. There is a need for
2.
Linnan LA, D'Angelo H, Harrington CB. A literature synthesis of health promotion research in salons and barbershops. Am J Prev Med. 2014; 47: 77-85. Linnan LA, Ferguson YO. Beauty salons: a promising health promotion setting for reaching and promoting health among African American women. Health Educ Behav. 2007; 34: 517-30.
100
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Organisation for Economic Co-operation and Development. SIDS Initial Assessment Profile (SIAP) on 1,4-Butanediol, 2000 (Accessed 15 September 2015, at http://www.chem.unep.ch/irptc/sids/OECDSIDS /110634.pdf) Hollund BE, Moen BE, Egeland GM, Florvaag E. Prevalence of airway symptoms and total serum immunoglobulin E among hairdressers in Bergen: a four-year prospective study. J Occup Environ Med. 2003; 45: 1201-6. Søsted H, Rastogi SC, Andersen KE, Johansen JD, Menné T. Hair dye contact allergy: quantitative exposure assessment of selected products and clinical cases. Contact Dermatitis. 2004; 50: 344-8. Lee A, Nixon R. Occupational skin disease in hairdressers. Australas J Dermatol. 2001; 42: 1-6. Ronda E, Hollund BE, Moen BE. Airborne exposure to chemical substances in hairdresser salons. Environ Monit Assess. 2009; 153: 83-93. English J. Disease at work: The perils of contact dermatitis for hairdressers’. Dermatology in Practice. 2004; 12: 12-3. Cherry NM, Meyer JD, Chen Y, Holt DL, McDonald JC. The reported incidence of workrelated musculoskeletal disease in the UK: MOSS 1997-2000. Occup Med (Lond). 2001; 51: 450-5. Mussi G, Gouveia N. Prevalence of workrelated musculoskeletal disorders in Brazilian hairdressers. Occup Med (Lond). 2008; 58: 367-9. Hollund BE, Moen BE, Lygre SH, Florvaag E, Omenaas E. Prevalence of airway symptoms among hairdressers in Bergen, Norway. Occup Environ Med. 2001; 58: 780-5. International Agency for Research on Cancer. Some aromatic amines, organic dyes, and related exposures. IARC Monographs on the Evaluation of Carcinogenic Risks to Humans. 2010; 57: 646. Ameille J, Pauli G, Calastreng-Crinquand A, Vervloët D, Iwatsubo Y, Popin E et al. Reported incidence of occupational asthma in France, 1996-99: the ONAP programme. Occup Environ Med. 2003; 60: 136-41. Omokhodion FO, Balogun MO, Ola-Olorun FM. Reported occupational hazards and illnesses among hairdressers in Ibadan, Southwest Nigeria. West Afr J Med. 2009; 28: 20-3. Wazir MS, Mehmood S, Ahmed A, Jadoon HR. Awareness among barbers about health
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
hazards associated with their profession. J Ayub Med Coll Abbottabad. 2008; 20: 35-8. W Khandait DW, Ambadekar NN, Vasudeo ND. Knowledge and practices about HIV transmission among barbers of Nagpur City. Indian J Med Sci. 1999; 53: 167-71. Amodio E, Di Benedetto MA, Gennaro L, Maida CM, Romano N. Knowledge, attitudes and risk of HIV, HBV and HCV infections in hairdressers of Palermo city (South Italy). Eur J Public Health. 2010; 20: 433-7. Anveden I, Lidén C, Alderling M, Meding B. Self-reported skin exposure--validation of questions by observation. Contact Dermatitis. 2006; 55: 186-91. Lind ML, Boman A, Sollenberg J, Johnsson S, Hagelthorn G, Meding B. Occupational dermal exposure to permanent hair dyes among hairdressers. Ann Occup Hyg. 2005; 49: 47380. Mounier-Geyssant E, Oury V, Mouchot L, Paris C, Zmirou-Navier D. Exposure of hairdressing apprentices to airborne hazardous substances. Environ Health. 2006; 5: 23. Murtagh MJ, Hepworth J. Hepatitis C in the workplace: a survey of occupational health and safety knowledge and practice in the beauty therapy industry. Aust N Z J Public Health. 2004; 28: 207-11. Zewudie T, Legesse W, Kurkura G. Knowledge, attitudes and practices among barbers in South-Western Ethiopia. Afr Newslett on Occup Health and Safety. 2002; 12:69–71. Al-Rabeei NA, Al-Thaifani AA, Dallak AM. Knowledge, attitudes and practices of barbers regarding hepatitis B and C viral infection in Sana'a city, Yemen. J Community Health. 2012; 37: 935-9. Talpur A, Memon N, Solangi R, Ghumro A. Knowledge and attitude of patients towards hepatitis B and C. Pak J Surg. 2007; 23:162–5. Valks R, Conde-Salazar L, Malfeito J, Ledo S. Contact dermatitis in hairdressers, 10 years later: patch-test results in 300 hairdressers (1994 to 2003) and comparison with previous study. Dermatitis. 2005; 16: 28-31. Ejokhio AH, Bhatti TA, Memon S. Knowledge, attitudes and practices of barbers about hepatitis B and C transmission in Hyderabad, Pakistan: Department of Community Health Sciences, Aga Khan University Karachi, Pakistan. East Mediterr Health J. 2010; 16: 1079-84.
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