ABSTRACT
The aim of this study was to identify and prioritize the risky behaviors and explore the newly emerging practices related to Egyptian habits that may lead to HCV transmission. From January 2011 until January 2012, a case control study matched on socio demographic factors was conducted comparing 540 hepatitis C patients and their contacts who were HCV serologically negative [102 subjects]. They were randomly selected from six governorates representing Upper Egypt, Lower Egypt, Middle and Canal regions. The questionnaire covered demographic data, risk exposures, behaviors, and practices for HCV infection. Focus group discussions were done with groups of professionals in Hepatology to discuss the observed emerging risk practices in Egypt. In univariate analysis, invasive medical procedures, wound stitches, illiteracy and marriage were significantly associated with HCV infection. Among women, delivery at home by traditional birth attendant was associated with 3 times [OR=2.91, CI=1.23-6.98] and 4 times [OR=3.94, CI=1.44-11.35] increase in HCV risk than delivery at hospital and by doctors respectively. Among males, shaving at barbershops was associated with 2 fold increase in the risk of infection [OR=2.6, CI=1.44-4.89]. Newly observed emerging risk practices were: sharing scarves' pins by veiled women in same houses, sharing loofah for personal cleaning and sharing toothpaste among family members. Increasing risk of HCV infection in Egypt reinforces the need for strict implementation of effective HCV prevention programs according to the prevailing risk behaviours
Subject(s)
Humans , Male , Female , Risk FactorsABSTRACT
Evidence showed that Egypt possesses risk determinants that play a crucial role in the persistence of communicable diseases. The present study is a healthy system research study that aims at identifying the challenges to best practice for prevention and control of group A communicable diseases which includes 15 diseases, according to MOHP surveillance system] at the education [Faculty of Medicine], and health system level [MOHP]. It focuses on situation analysis for the policies and strategies related to prevention and control of communicable diseases in Egypt. Study tools included a structured questionnaire designed to interview physicians and sanitarians working in the District Surveillance Units in Giza and Cairo governorates about prevention and control measures of communicable diseases under the study. In-depth interviews with professors at the Community Medicine Department in faculty of Medicine, Cairo University as well as staff of MOHP-Head Quarters. Content analysis for the community medicine book, MOHP guidelines and WHO publications was also performed. The main results of the in-depth interviews with community medicine department staff, addressed the institutional strengths within the medical schools in terms of enough staff and space and accessibility to field visits. The weaknesses within the medical education are related to overlap/ repetition of the same information. The practical training is not sufficient with shortage in facilities for transportation of students to the field visits. Challenges facing the medical schools include the big examination marks allocated to clinical medicine, compared to community medicine marks. The results of in-depth interviews with the staff of MOHP-HQ indicates the presence of political and institutional support for prevention and control of communicable diseases' programs. The surveillance unit [ESU] suffer many shortcomings. Opportunities are great for MOHP due to favourable change to work with international organizations. Challenges are related to the inadequate response of the private sector, non governmental organizations [NGOS] and the community to communicable diseases' prevention and control programs. The retained knowledge and skills of MOHP-CDC [including ESU] staff at the district level in prevention and control of communicable diseases are influenced to a great extent by the specific political support directed to some diseases [e.g. poliomyelitis] compared to other diseases which are not occupying a priority position in the policy makers' agenda. Additionally, some incorrect knowledge about national standard guidelines for prevention and control of communicable diseases with knowledge gaps between physicians and sanitarians were obvious. The study recommends regular revision and updating of community medicine curricula regarding prevention and control of communicable diseases and developing National Committee for continuous reviewing and updating of the guidelines for prevention and control of communicable diseases in MOHP. It also recommends periodic evaluation of the performance of MOHP-CDC [including ESU] staff at the district level