Knowledge and self-reported practice of laboratory biosafety among medical laboratory professionals in selected public and private hospitals in Mogadishu, Somalia: a cross-sectional study

Background Laboratory biosafety protects healthcare workers, patients and the environment, yet evidence from fragile and resource-limited settings remains scarce. In Somalia, previous work has assessed infection prevention and control at the facility level, but the biosafety knowledge and practice of laboratory professionals themselves, and the relationship between the two, have not been characterized. This study assessed knowledge and self-reported practice of laboratory biosafety, and factors associated with good practice, among medical laboratory professionals in public and private hospitals in Mogadishu, Somalia. Methods A facility-based cross-sectional study was conducted among 164 eligible medical laboratory professionals in 12 hospitals selected by stratified random sampling from the public and private hospital sectors in Mogadishu. All eligible professionals within the selected hospitals were enumerated; the study is therefore a complete enumeration within sampled facilities rather than a census of all laboratory professionals in Mogadishu. Data were collected with a structured, self-administered questionnaire adapted from the WHO Laboratory Biosafety Manual and previously validated knowledge–practice instruments. Knowledge was measured with 8 dichotomously scored items (range 0–8; KR-20 = 0.60) and self-reported practice with 9 dichotomous items (range 0–9; KR-20 = 0.52), both classified using pre-specified modified Bloom’s cut-off points. Distributions were assessed with the Shapiro–Wilk test. Associations were examined using the Pearson chi-square test and Spearman’s rank correlation, and factors associated with good practice using univariable and multivariable binary logistic regression. Results The median knowledge score was 7 (IQR 5–7) of 8 and the median practice score 9 (IQR 8–9) of 9; both departed significantly from normality. Knowledge was high for hand hygiene (89.0%) and personal protective equipment (86.6%) but low for infectious waste colour-coding (53.7%). Overall, 83 participants (50.6%) had good knowledge, 51 (31.1%) moderate and 30 (18.3%) poor. Self-reported practice was high for lab coat use (98.2%), hand hygiene (98.2%) and glove use (97.6%), and lower for equipment inspection (78.7%) and accident reporting (81.7%); 134 participants (81.7%) were classified as having good practice. A statistically significant positive association was observed between knowledge level and practice level ( χ 2 = 19.58, df = 2, p < 0.001; Cramer’s V = 0.35; Spearman’s ρ = 0.296, p < 0.001), with good practice reported by 94.0, 74.5 and 60.0% of those with good, moderate and poor knowledge, respectively. In multivariable analysis, each additional correct knowledge answer independently increased the odds of good practice (aOR 1.73, 95% CI 1.33–2.24, p < 0.001), as did participation in a safety drill in the preceding year (aOR 2.80, 95% CI 1.09–7.15, p = 0.032). Only 64.6% of participants had taken part in such a drill. Conclusion Medical laboratory professionals in Mogadishu hospitals demonstrated moderate biosafety knowledge and high self-reported biosafety practice, although there were gaps in knowledge of infectious waste colour-coding. Knowledge scores were positively associated with self-reported practice, while recent participation in a safety drill was independently associated with reported participants’ practice. These findings suggest that regular safety drills and targeted reinforcement of infectious waste-management procedures may be useful areas for strengthening biosafety practices. However, the high reported practice scores and their potential effect underscore the need for future studies to assess biosafety practices through direct observation.