Knowledge, attitudes and practices related to avian influenza among a rural community in Egypt

Avian influenza [AI] is currently a threat to global health. Prevention and control largely depend on population awareness and behavior. Is to assess the rural community knowledge, attitudes, and practice [KAP] related to AI prevention and control. A household survey, using an interviewing questionnaire and observational checklist, was conducted in Bahetim district, Qalubeya Governorate. Of the total 399, 41.1% were dealing with poultry, of them 26% were raising poultry at their home. Vaccination of birds were reported by 66.6% of the respondents, hand washing regularly with water and soap by 54.6%, and by going far away from infected birds by 51.3% . Nearly 50% mentioned that AI disease cannot be transmitted from person to person and that AI is transmitted to human through contact with sick birds. Regarding their score level, 75.7% of the respondents had fair knowledge level, 87.5% had positive attitude towards prevention and control of AI and 58.1% had fair practice level. Younger persons, those who had completed secondary or higher level of education, those living in nuclear family had better knowledge and positive attitudes towards AI prevention and control [p<0.05], while age, sex, and education level did not affect their healthy behavior and sanitary practices. The level of community knowledge and practices about AI disease was moderate, but their attitudes were positive. Therefore, designing and implementing health educational programs about AI to improve the community practices should have the priority to encourage people to take a more active role

Epidemiology and management of type 1 diabetes mellitus at the Ain Shams University pediatric hospital

Type 1 diabetes mellitus is the most common metabolic disease in childhood. An interplay between genetic susceptibility and environmental factors [triggering or suppressive] may account for the pathogenesis of type 1 diabetes The diabetes control and complications trial [DCCT] showed the importance of strict metabolic control in delaying and preventing complications. The aim of this work was to describe the epidemiological features of type 1 diabetes mellitus [the pattern of seasonality at birth and at diagnosis, the initial symptoms of presentation, and the precipitating factors] and to compare the frequency of occurrence of long term complications [as microalbuminuria, and diabetic neuropathy and retinopathy] in relation to different insulin regimens among children attending pediatric hospital at Ain Shams University. This descriptive study was conducted on 416 patients of type 1 diabetes mellitus at pediatrics hospital, Ain Shams University. For each patient a questionnaire form was filled in through an interview with the patients and/or their parents and clinical examination was performed. Also, data were collected retrospectively from the patients' medical records. There was evidence of seasonality at diagnosis with overall predominance at summer. Also, seasonality at birth was clearly evident where 48.3% of cases were delivered during summer season. Polyuria and polydepsia were the most common presenting symptoms, 90.14% and 80.04% respectively. About 60.57% of cases were presented by Diabetic Ketoacidosis [DKA]. As regards the precipitating factors, infection preceded the diagnosis of 21.9% of cases, while psychological trauma was evident in 8.7% of cases. Frequencies of occurrence of long term complications were 9.6% for microalbuminuria, 2.4% for hypertension, 1.4% for orthostatic hypotension, 4.1% for diabetic retinopathy, and 3.1% for diabetic neuropathy. These complications were more frequent with conventional insulin regimen in comparison to the intensive regimen and the difference was statistically significant. Seasonal pattern was evident at diagnosis and at birth which is more common during summer. Diabetic children on intensive insulin therapy were experienced less long term complications than those on conventional regimen. Longitudinal studies are required to confirm the presence of seasonality at birth and at diagnosis including control from normal population .Intensive diabetes therapy should be encouraged among children with type 1 diabetes mellitus to delay onset of long term complications

Fetal chromosome abnormalities and congenital Malformations: an Egyptian study

Our objective were to determine and evaluate the role of genetic counseling and amniocentesis in early detection of chromosomal abnormalities or congenital malformations among women at risk. The study was performed on 784 pregnant women. The cause for seeking genetic counseling in 22.8% of the study cases was positive family history of CNS malformations, and in 17.9% was chromosomal abnormalities in previous child. Also, the results showed that the indications for amniocentesis in 60.8% were history of having previous child with Down syndrome, and in 15.3% were advanced maternal age. The results of chromosomal analysis of amniotic fluid samples; 21 cases [19.3%] had chromosomal abnormalities, where trisomy 21 [Down syndrome] were detected in 10 cases [9.2%], unbalanced translocation Down syndrome were detected in 9 cases [8.3%] and one had 46 XX, del [13-q], one had 45, XX, t[13;14] and 2.8% was 46, XX, +21, der[14;21][q10;q10]. The risk of complications of amniocentesis was associated with performing amniocentesis early in pregnancy, and with increased number of attempts. The results also showed that multiple cogenital anomalies [MCA] represented among 42.2%, congenital malformation of CNS represents 26.6%, congenital malformation of the skeletal system 20%, congenital polycystic kidney 8.8% andpyloric stenosis in 2.2%. Among the 21 women with abnormal karyotype of amniotic fluid, the decision to terminate the pregnancy was made in 3 [14.3%]. Among the 45 cases with abnormal findings suggesting fetal congenital malformation, 16 [35.6%] chose termination of their pregnancy. Public awareness of the risks and difficulties facing a child with chromosomal anomalies or congenital malformation and the effect on their future health and living is of great importance for acceptance of prenatal screening. Prenatal diagnosis may affect the reproductive descision after genetic counselling. It is essential that genetic counselling is noncoercive and nonjudjemental. The couple's decision [even if it is different from the counseller's views] should be respected

Validity of multidimensional body mass index [B], airflow obstruction [O], dyspnea [D] and exercise capacity [E], BODE index as predictor of hospitalization for COPD

Patients with COPD have systemic manifestations that are not reflected by the FEV[1]. These systemic manifestations often correlate with increased risk of mortality and may be considered surrogates of disease severity. We hypothesized that the BODE [body mass index, airflow obstruction, dyspnea, and exercise capacity] index would better predict hospitalization for COPD than FEV1 alone. The purpose of this study was to test in a cohort of patients with COPD, how well a multidimensional grading system that assessed the respiratory and systemic expressions of COPD would better categorize and predict outcome in these patients. A total of 150 patients with COPD [ages 45-83 yr; 89% male] recruited from the outpatient clinic of Suez Canal University Hospital were enrolled in 30 months, prospective study and followed-up for a mean period of 12 months from January 2004-June 2006. The BODE index was calculated for each patient using variables obtained within 4 weeks of enrollment. The main outcome measure was the number of hospital admissions for COPD during follow-up. The following variables were assessed for each patient: Age, sex, pack years of smoking, FVC%, FEV[1]%, the best of two 6 minute walk tests done 30 minutes apart, degree of dyspnea, body mass index [BMI]. We evaluated the relationship between FEV[1]%, the level of dyspnea, BMI, the best of two 6 minute walk tests done 30 minutes apart and BODE scores with the number of hospital admissions. After 30 months, 126 patients were available for the follow-up examination [follow-up rate, 84%]. During the follow-up period, 85 [67%] of patients required at least one hospital admission and 6 [4.8%] died. In multivariate analysis a significant effect of BODE score on the number of hospital admissions was found [95% confidence interval [CI], 0.36 to 0.61; p<0.000]. In comparison, there was a significant but smaller effect of the pack years of smoking, BMI and BMI score on the number of hospital admissions [[95% confidence interval [CI], 0. 03 to 0.05; p<0.000], [95% CI, -0.32 to -0.09; p<0.01] and [95% CI, -1.6 to -0.12; p<0.05] respectively]. FEV[1]%, the level of dyspnea, and 6 minute walk test were significant predictors of hospitalization in univariate analysis [p<0.000] but were excluded in multivariate analysis. The BODE staging system, which includes in addition to FEV[1] other physiologic and clinical variables, is a better predictor of hospital admissions than FEV[1] in COPD

Safe injection practice among health care workers, Gharbiya, Egypt

A cross-sectional study was conducted in 25 health care facilities in Gharbiya governorate to assess safe injection practices among health care workers [HCWs]. Two questionnaires, one to collect information about administrative issues related to safe injection and the other to collect data about giving injections, exposure to needle stick injuries, hepatitis B vaccination status and safe injection training. Practices of injections were observed using a standardized checklist. The study revealed that there was lack of both national and local infection control policies and lack of most of the supplies needed for safe injection practices. Many safe practices were infrequent as proper needle manipulation before disposal [41%], safe needle disposal [47.5%], reuse of used syringe and needle [13.2%] and safe syringe disposal [0%]. Exposure to needle stick injuries were common among the interviewed HCWs [66.2%] and hand washing was the common post exposure prophylaxis measure [63.4%]. Only 11.3% of HCWs had full course hepatitis B vaccination. Infection control -including safe injections- training programs should be afforded to all HCWs

Domestic violence among women attending out-patient clinics in Ain Shams University Hospitals, Cairo, Egypt

Violence affects millions of women worldwide and it cuts across cultural and religious barriers, impeding the women's right to participate fully in the society. A descriptive cross sectional study was conducted to determine the prevalence of domestic violence among ever married females presenting to out patient clinics in Am Shams university hospitals and to identify factors affecting it. Out of a total number of 509 women, 89.8% had experienced one or more episodes of violent behavior by their husbands of which 56%, 88.4% and 47.9% suffered physical, control and threat violence. Both univariate and multivariate analysis was done. The most common form of violence among the study group was husband's shouting followed by being kept short of money. About 34.2% had been beaten by their husbands and 17.1% were forced to do sex. Using multiple logistic regression it was found that smoking husband and economic problems were independent significant factors associated with all forms of violence. Suffering violence was significantly associated with different forms of health complaints and only 9.1% had been asked by their doctors on domestic violence exposure. This proposes the importance of effective screening, diagnosis and management of domestic violence victims

Development of weight gain chain charts for healthy Egyptian pregnant women

A prospective study was conducted to develop weight gain charts for healthy Egyptian pregnant women and to determine the relationship between different anthropometric indicators and favorable birth weight. A total of 830 pregnant women were enrolled in the study. The mean total weight gain was 9.3 kg. The velocity growth chart that were developed for weight gain showed that the increment of weight was about one kg up to the 4[th] gestational month, then, a steady increase of 0.37 kg per week till the end of pregnancy. The mean total gain in mid upper arm circumference [MUAC] was 0.8 cm and in triceps skin fold was 1.9 mm. There was a highly positive correlation between all anthropometric indicators studied and the birth weight. However only total weight gain and weight of the mother at first trimester showed significant relation with birth weight after using multi regression analysis, it is recommended to use the developed weight gain charts for monitoring the nutritional status of pregnant women and the MUAC and triceps skin folds are to be used for screening women at risk for malnutrition