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Year : 2015  |  Volume : 60  |  Issue : 2  |  Page : 212
Body-art practices among undergraduate medical university students in Dar Es Salaam, Tanzania, 2014

Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania

Date of Web Publication3-Mar-2015

Correspondence Address:
Method R Kazaura
Department of Internal Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam
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Source of Support: Data collection was financially supported by the Ministry of Education and Vocational Training, Conflict of Interest: None

DOI: 10.4103/0019-5154.152567

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Background: Body-art practices are increasing among adolescents and young adults. Although substantial data are available in developed countries, little has been documented about body-art practices in developing countries. Objective: To determine the magnitude, types and reasons for practicing body-art practices among undergraduate medical University students in Dar es Salaam, Tanzania. Materials and Methods: A cross-sectional descriptive study was conducteed among undergraduate University students in Dar es Salaam involving 536 respondents from two Universities. We used a self-administered questionnaire to collect data. Analyses were based on summary measures and bivariate analyses. Results: While 7.5% of undergraduate students reported having tattoos, 20% reported having body puncturing or piercing. Body piercing is reported more among female university undergraduate students than their male counterparts. Reported main reasons for undergoing body-art include "a mark of beauty," 24%, "just wanted one," 18% and "a mark of femininity or masculinity," 17%. The majority (98%) of students were aware that unsafe body-art practices may lead to contracting HIV and more than half (52%) reported awareness of the risk of Hepatitis B infection. Conclusions: Despite high awareness of the potential risks involved in unsafe body arts that include tattoo and piercing, these practices are increasing among adolescents and young adults. There is need to have educational and counseling efforts so as to minimize associated health risks.

Keywords: Body-art, piercing, tattoo, Tanzania

How to cite this article:
Chacha CE, Kazaura MR. Body-art practices among undergraduate medical university students in Dar Es Salaam, Tanzania, 2014. Indian J Dermatol 2015;60:212

How to cite this URL:
Chacha CE, Kazaura MR. Body-art practices among undergraduate medical university students in Dar Es Salaam, Tanzania, 2014. Indian J Dermatol [serial online] 2015 [cited 2022 Jun 28];60:212. Available from:

What was known?
(1) Body-art practices are more common in developed countries, (2) Motives for these practices are diverse, (3) In less developed countries, little is known about body-art practices.

   Introduction Top

Body-art practices (BAPs) are reported to be on the rise especially among adolescents and youth. [1],[2],[3],[4],[5] The two major BAPs are tattooing and body piercing. Tattooing is having permanent marks or designs applied to the skin and not just temporary decals. Currently, tattoos are done by a rapid injection from an electrical device into the dermal layer to make permanent markings. In contrast, body piercing among women involved a jewelry object inserted in the skin on any part of the body except the earlobes and anywhere among men. Pierces are done by making an opening in the skin inserting a metal bar or a ring and sometimes using a piercing gun. [6]

BAPs have a long history in different cultures and societies. [7],[8],[9] BAPs have been performed for hundreds of years and have been widely practiced, especially on the Asian, African, and American continents. [10],[11] Some data on BAP among adolescents and young adults are available from developed countries. During the past decade, various studies among undergraduates in developed countries found between 30% and 60% of students reporting having body piercings at one point in their lifetime. [12],[13],[14],[15] Tattooing among young adults in colleges and universities is reported to be less prevalent than body piercing. [12],[13] Nevertheless, very high proportions of young adults having tattoos have been reported elsewhere. [16],[17]

In less developed countries like Tanzania, data on BAPs in the general population or among young adults are rare and in some regions non-existent altogether. However, due to the cross-culture and learning from the western experiences, BAPs are likely to be prevalent in these counties. The main objectives of this study were, therefore, to determine the magnitude, types and reasons motivating these young adults from Medical Universities in Dar es Salaam, Tanzania, to engage themselves in performing these practices.

   Materials and Methods Top

A cross-sectional study was conducted in two out of three Medical Universities in Dar es Salaam, Tanzania. One of the universities was a public institution (Muhimbili University of Health and Allied Sciences) and the other was private (Hubert Kairuki Memorial University). We estimated a sample of 600 undergraduates to be sufficient for the study. Equal allocation of students to be included in the sample from each of the universities was applied. Therefore, we planned to have 300 students from each university. Sampling (stratified sampling technique) was based on a random selection of students in their years of study (Year 1 through Year 5).

For each year of study, systematic sampling was used to come up with individual participants who were explained about the objectives of the study. Participants were requested to consent orally before receiving self-administered questionnaires and were informed of voluntary participation and assured of confidentiality. Completed questionnaires were to be collected a week later, dropped in a safe-locked container. Permission to implement the study was independently requested from each of the two universities.

The questionnaire included background data of the student, reported BAPs and awareness of related health risks. We performed data analysis using the Statistical Package for Social Sciences (SPSS) computer software. Outputs are in the form of descriptive and bivariate analysis, relating BAPs and available independent variables.

   Results Top

Characteristics of the sample

Of the estimated sample size of 600, we retrieved 536 (89.3%) questionnaires. The majority, 351 (65.5%), were males. The mean age of all study participants was 23.9 (SD = 4.5) years. The majority, 272 (50.7%), of the study participants were from Muhimbili University of Health and Allied Sciences (MUHAS). Descriptive summaries for some of the background information are shown in [Table 1].
Table 1: Distribution of study participants by their background characteristics (n=536)

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Body-art practices

Reported BAPs among friends

BAPs are reported to be very common among young adults such that 449 (83.8%) of the study participants reported to have at least a friend wearing either a tattoo or having a body piercing. Of these, 218 (48.6) reported friends wearing a tattoo and 149 (33.2%) having a jewelry puncture [Figure 1].
Figure 1: Percent of study participants reporting type of BAPs among friends (n = 449)

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Self BAPs

Young adults were asked about wearing a tattoo. A total of 40 (7.5%) participants reported to have ever had a tattoo in life time. Among males, 24 (6.8%) reported having tattoos as compared to 16 (8.6%) females. Furthermore, 107 (20.0%) reported to have ever had pierced body. A significantly (χ2 = 49.9, P < 0.01) higher proportion of females, 68 (36.8%), as compared to males, 39 (11.1%), reported having body piercing. The mean age at first wearing a tattoo and piercing their body were 16.1 (SD = 5.0) and 12.4 (8.1) years, respectively. While the reported age range for having a first tattoo was between 6 and 24 years, the age range for body piercing was between 1 and 39 years. Females reported having body piercing at a significantly younger mean age, 11.0 (SD = 8.4) years, than males, 15.1 (SD = 6.8) years, (P < 0.05). There was no statistical significant difference in having a first tattoo between males and females [Table 2].
Table 2: Mean age (SD) at first wearing a tattoo and having body piercing

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Motive for having tattoos or body piercing

The main reported motives for having a tattoo or piercing include "a mark of beauty," 31 (23.7%), "just wanted one," 24 (18.3%), and "a sign of femininity/masculinity" 22 (16.8%). Other reported motives are presented in [Table 3].
Table 3: Reported main motives for having a body art (n=131)

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Reported health risks associated with BAPs

Although a large proportion, 479 (89.4%) consider places used for body art to be unsafe, yet 14 (35.0%) wear tattoo as compared to 43 (8.7%) reporting not having tattoos (χ2 = 27.0, P < 0.01). And, 19 (17.8%) have body piercing as compared to 38 (8.9%) reporting not having body piercing (χ2 = 7.14, P = 0.01). Almost everyone, 534 (99.6), was affirmative that unsafe BAPs can cause either infectious or non-infectious diseases. Fewer respondents mentioned non-infectious diseases than infectious diseases (84.3% against 99.3%). [Table 4] shows infectious and non-infectious diseases that could be transmitted through unsafe BAPs.
Table 4: Perceived main health risks due to unsafe body-art practices

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   Discussion Top

There is an increase in BAPs in the Western societies particularly among adolescents and young adults. Although these practices are rarely documented in developing, especially in the sub-Saharan countries, they are also becoming more and more common. Few studies in sub-Saharan Africa have discussed on related complications, for example, oral and ear piercing. [2],[18],[19] This study is an eye-opener to other developing countries like Tanzania.

We found about 8% and 20% of young adults having tattoos and with pierced bodies, respectively. These reported proportions are far lower than previous studies from some developed countries [13],[16],[17] and almost of similar levels with a study from Italy [1],[12],[20] but higher than among adults reporting piercing in England. [21]

In this study, interest in body piercing is higher than having a tattoo, even after stratifying by sex. The proportion of males reporting body piercing is higher than those reporting having a tattoo. It is not evident as to why body piercing practices are more common than tattooing. However, the phenomenon of females reporting more of body piercing than males has been previously reported among high schools students in a Northeastern Italian Region. [22] Values such as mark of beauty may be pronounced with body piercing especially among females than males. Body piercing allows one to wear jewelry, use of which is prima facie higher among females.

High knowledge among young adults about potential health risks have been reported earlier too. [12] In this study young adults acknowledge places used to perform body art to be unsafe. There is a possibility that these young adults performed these practices before acquiring knowledge about health risks leading to an incongruous relationship between knowledge and use.

One of the potential limitations in this study is that these results apply largely to medical university students in Dar es Salaam, Tanzania. Nevertheless, inferences beyond this target population can be done with caution. But since reported BAPs are performed at young age, the proportions of reporting wearing a tattoo and having piercing may not differ significantly from adolescents and young adults from other higher learning institutions. High knowledge about BAPs may be a result of medical education exposures. Therefore, knowledge and awareness estimates on health hazards having unsafe BAPs may be lower in the general population of the same age bracket.

Furthermore, in this study we could not include variables and data collection design (for example qualitative approach) that may explain factors and reasons for having BAPs. Additional variables and qualitative information including an extended number of study participants in the general population may explain more about BAPs among young adults in developing countries.

To conclude, BAPs specifically among young adults in higher learning institutions are also common in developing countries like Tanzania. Nevertheless, places where body arts are practiced are considered to be unsafe. Unsafe settings warrant risks of infection and other complications. We recommend having registered centers as well as continued health education and counseling across lower education institutions.

   Acknowledgement Top

This study was partially financed by the Ministry of Education and Vocational Training.

   References Top

Majori S, Capretta F, Baldovin T, Busana M, Baldo V, Collaborative Group. Piercing and tatooing in high school students of Veneto region: Prevalence and perception of infectious related risk. J Prev Med Hyg 2013;54:17-23.  Back to cited text no. 1
Oberholzer TG, George R. Awareness of complications of oral piercing in a group of adolescents and young South African adults. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:744-7.  Back to cited text no. 2
Wohlrab S, Stahl J, Kappeler PM. Modifying the body: Motivations for getting tattooed and pierced. Body Image 2007;4:87-95.  Back to cited text no. 3
Latreille J, Levy JL, Guinot C. Decorative tattoos and reasons for their removal: A prospective study in 151 adults living in South of France. J Eur Acad Dermatol Venereol 2011;25:181-7.  Back to cited text no. 4
Carroll ST, Riffenburgh RH, Roberts TA, Myhre EB. Tattoos and body piercings as indicators of adolescent risk-taking behaviors. Pediatrics 2002;109:1021-7.  Back to cited text no. 5
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Balogou AA, Dodzro KC, Grunitzky EK. Traditional tattoos with neurological diseases in Togo. Bull Soc Pathol Exot 2000;93:361-4.  Back to cited text no. 9
Kaatz M, Elsner P, Bauer A. Body-modifying concepts and dermatologic problems: Tattooing and piercing. Clin Dermatol 2008;26:35-44.  Back to cited text no. 10
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Quaranta A, Napoli C, Fasano F, Montagna C, Caggiano G, Montagna MT. Body piercing and tattoos: A survey on young adults′ knowledge of the risks and practices in body art. BMC Public Health 2011;11:774.  Back to cited text no. 12
Mayers LB, Chiffriller SH. Body art (body piercing and tattooing) among undergraduate university students: "then and now". J Adolesc Health 2008;42:201-3.  Back to cited text no. 13
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Schorzman CM, Gold MA, Downs JS, Murray PJ. Body art: Attitudes and practices regarding body piercing among urban undergraduates. J Am Osteopath Assoc 2007;107:432-8.  Back to cited text no. 16
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What is new?
(1) Tattoos and body piercings are on increase among young adults specifically medical students in Tanzania. (2)Motives for these practices are similar to those in developed countries. (3)Although medical students know health risks involved when venues for performing these practices are unsafe, students persist to perform them. (4) Health education for possible adverse outcomes is still eminent among young adults.


  [Figure 1]

  [Table 1], [Table 2], [Table 3], [Table 4]


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