The health and wellbeing of workforce is fundamental to the achievement of the organization’s current goals and future ambitions in both civil and military settings. More so, safety is a priority in the military. Nonetheless, needle-stick injury is still a silent challenge in Uganda’s health system. Nearly 27.2% of the sample experienced NSI during their career service. This rate was considerably lower than the national prevalence rate at 46%; however, the most recent national data was from 2003.  This is also slightly lower than the findings in other similar studies in Ethiopia, Malaysia and China which is 29.3%, 27.9% and 27.5% respectively. [12, 26, 27] In contrast, rates of NSI were higher than that found in Australia (17.7%) and much lower than findings from South Korea, Iran and Pakistan at 74% ,42.5% and 94% respectively. [28, 29] The relatively low prevalence rate of NSI in our sample (27.2%) does not necessarily reflect fewer injuries and good adherence to safety guidelines given the lack of reporting systems in Uganda. Developed countries like Germany and South Korea with robust reporting systems, standard operating procedures and accurate injury surveys have reported higher rates of NSI at 31.4% and 74% indicate that NSI is a serious challenge to healthcare industry. [29, 30] Thus, there may be significant underreporting of NSIs among HCWs in Uganda compared to nations with higher reported rates.
We found that female HCWs had a higher rate of NSIs compared to their male counterparts (59.7% vs. 40.3. This finding aligns with previous studies. [10, 29] and is likely due to fact that the number of female healthcare workers is by far higher than males in Ugandan hospitals. Indeed, many female HCWs are nurses who are on the frontline and are responsible for high-risk-activities. More so, women are more likely to experience stress at work than men due to gender inequality, often poor remuneration and burden of familial roles thus, more exposed to occupational risks. [31, 32] This contradicts studies done in USA where males were 4.5 times and in Nigeria were 10 times more likely to be injured than female HCWs. [23, 30] Similar to studies conducted in India at 70% and Iran at 57%, in this study the morning shift indicated the highest rate of NSI at 61%. [33, 34] This might be due to the small number of HCWs attending to the increased patient load at this period than any other shift. One study conducted in Ethiopia, in contrast, found that NSIs were most likely to occur on the night shift. 
The NSIs mostly occurred during drawing venous blood samples accounting for 49.4% of all incidents. [35, 36] However, several studies done indicate that most of the NSI occur during recapping of needles and injection. [37, 23] Kargin and Akyol  indicated in a study conducted in 3 hospitals in Turkey NSI were mainly attributed by injection needles at 35.8%. In another cross-sectional study done by Joukar et al. in 8 teaching hospitals of Rasht in Iran  the NSI were mainly due to recapping at 37.1%.
The underreporting of NSI by HCWs is documented in several studies ranging from 22–99%. [22, 27] The rate of reporting of NSI was 23.4% in this study, which is low compared with several studies. [37, 29] Furthermore, Bowman and Bohnker showed that underreporting of NSI was more prevalent in the civil health system than US military facilities.  This is in contrast with the findings of this study where NSI prevalence was similar in the two hospitals. Many reasons cited for underreporting were perception of low-risk infection, ignorance that it should be reported, time constraint and incident reporting protocols.  In contrast, in a study done by Maniar et al.  indicated that there was no underreporting among healthcare workers. Unfortunately, in Uganda HCWs do not consider incident reporting protocol with immense gravity. In this study, reasons adduced for underreporting were perception of low risk infection transmission at 68.9%.
Limitations Of The Study
Although this study has added depth and breadth to the picture of needle stick injury among healthcare workers it was cross-sectional in design. Hence, variables identified as being significantly associated with NSI may not be assumed to be predictive. A more accurate estimation of the number of and the types of NSI among healthcare workers would be to validate self-reports with administrative records, which was not possible for this study given the lack of an adequate reporting system in Uganda. Given this study is based on self-reports from HCWs, there is a likelihood of underreporting due to social desirability and recall bias respectively is likely.