HCV is one of the most significant occupational infection that waste handlers may face, as they are repeatedly exposed to blood and blood products, body fluids, saliva, and even suffer needle stick injuries . Accordingly, in order to reduce or stop the distribution of such infection to waste handlers, infection control strategies should be practical. This study was conducted to assess the level of knowledge, attitudes, and practice among waste handlers at different governmental hospitals in SNRS.
Overall, waste handlers in this study showed adequate knowledge (63.5%), positive attitude (54.3%) and good practice (69.5%) toward hepatitis C. Comparable results were also reported in other studies . Based on the results of this study, we can deduce that waste handlers have a fairly satisfied level of knowledge regarding HCV infection above 63%. This is in an agreement with some other studies that showed satisfied level of knowledge among waste handlers regarding HCV infection .
In a study conducted by  about 81.7% of the study subjects knew about the likelihood of HCV transmission via contaminated blood and body fluid, while in our study the figures were lower 75.9%. The vast majority of our study subjects knew vaccination availability for hepatitis B (78.4%). This result is much lesser than the result (95.1%)  among waste handlers in Al Jouf province in. This may reflect the importance of constant medical education programs in improving the health behaviors of waste handler workers.
The result of the this study showed a low rate (44%) of HCV screen practice for hepatitis C. which could be an indication to, HCV screening is not mandatory requirement by the waste handlers in public hospitals in different part of SNRS. This rate is much lower to that reported by other studies in UAE (98.8%), Brazil (90.8%) and Canada (100%) and Saudi Arabia (90%) . However, this rate is higher than that reported in other studies reported in India (38%) .
The positive correlations between knowledge-attitude, knowledge-practice and attitude-practice in this study confirm the relationship between knowledge attitude and practice with infection control measures. It is concluded that satisfactory knowledge can bring about a positive attitude, which leading to good practices. The findings are consistent with the results of some other studies .
The present results showed that 157 (55.7%) of the participants thought incorrectly that HCV can be transmitted by contaminated water/food prepared by person suffering with these infections, similarly another study conducted on Vietnamese Americans on knowledge and the prevalence of hepatitis C showed that there was a inadequate knowledge about HCV, 32.9% thought incorrectly HCV transmitted by contaminated water/food prepared by person suffering with these infections. The results also showed that there was a lack of knowledge regarding the treatment, 42.7% knew that there was treatment for HCV . Contrary, the current study found that the majority of the respondents 183 (64.9%) knew that there was treatment for HCV.
Another study done by Gürakar, Idilman, Keskin and Malik  in Turkey reported that 60% of the study subjects had knowledge that hepatitis C was a transmissible infection and a major cause of serious liver cancer. This study showed more knowledge that 199 (70.6%) of respondents knew that HCV was a major cause of serious liver cancer and had adequate knowledge 230 (81.6%) that hepatitis is epidemics. This may be due to the fact that the hospitals deliver different training for waste handlers at different time.
The study findings posited that the level of knowledge was not significantly associated with age and gender but it was significantly associated with education level of an individual. A study conducted among waste handlers in two maternity hospitals in Khartoum, Sudan on the contrary showed that the level of knowledge was not significantly associated with educational level . The differences may be due to the inclusion of a wider range of education level from illiteracy to tertiary in the current study compared to mentioned study which focused on waste handlers which have all attained tertiary education.
In this study, 86 (30.5%) of the study participates showed bad practice and 196 (69.5%) showed good practice. 124 (44%) had screened for hepatitis C, 114 (40.4%) always change gloves during waste collection and 139 (49.3%) report for needle stick injury. The findings were much higher than the findings reported by  which showed that 20.3% of study participants had good practice and 85.9% had not screened for HCV. Another study conducted in Honiara, Solomon Islands, in 2015 showed that 26.3% of study participants had good practice . This good practice in the current study could be as results of adequate of knowledge of respondents on HCV 179 (63.5%).
The results of this study showed that the respondents that had positive attitude towards hepatitis C is 153 (54.3%) and 129 (45.7%) of the respondents had negative attitude. In this study 220 (78.01%) of the respondents reported that they belive that they were at risk of contracting HCV by virtue of their work as waste handlers. 247 (87.5%) were approved to receive hepatitis vaccination ones offered a chance. These findings were slightly lower than a study findings done by , which found that the respondents had good attitude (91%) and 82.7% were willing to get vaccinated.
The findings of the current study was consistence with study conducted in Ethiopia on pregnant women attending antenatal care at the University of Gondar comprehensive specialized hospital which reported 54% had positive attitude . In addition, a study conducted in Bangladesh in 2012 showed that 50% of study participants had positive attitude. Having a positive attitude means that respondents may be willing to take preventive measures to help combat HCV infection. This willingness was seen in this study as 180 (63.8%) of the respondents proved to take training about HCV.