Helicobacter pylori infection: seroprevalence and predictors among healthy individuals in Al Madinah, Saudi Arabia

Background: Helicobacter pylori infection is one of the most common chronic bacterial infections among humans worldwide. However, there is no information on the epidemiology of H. pylori infection in Al Madinah, Saudi Arabia

Objective: This study was conducted to determine the seroprevalence of H. pylori in asymptomatic healthy individuals and the possible relationship between H. pylori infection and sociodemographic, lifestyle, and environmental factors in this region

Methods: A hospital-based cross-sectional study was conducted on a consecutive sample of asymptomatic healthy individuals. A pilot-tested interview format was used as the research tool. Venous blood was collected from individuals and sera were separated. The enzyme-linked immunosorbent assay was used to determine H. pylori IgG antibody levels in all serum samples

Results: A total of 456 samples were collected. H. pylori antibodies were found in 129 [28.3%] individuals. Seroprevalence of 16.9% was found in individuals younger than 20 years of age, which gradually increased with age and reached 36.8% by the age of 50. After controlling for the confounding factors, significant independent predictors of seropositive state were: rural residence [odds ratio [OR]=2.5, 95% confidence interval [CI]=1.3, 4.7], crowded housing [OR=1.6, 95% CI=1.1, 2.6], low socioeconomic status [OR=3.3, 95% CI=1.6, 8.8], using tanks for drinking water supply [OR=2.2, 95% CI=1.2, 7.4], active smoking [OR=5.6, 95% CI=3.2, 9.8], alcohol drinking [OR=2.3, 95% CI=1.5, 6.2], eating raw vegetables [OR=3.2, 95% CI=1.4, 7.1], eating spicy food [OR=2.1, 95% CI=1.3, 3.5], and presence of asthmatic/atopic symptoms [OR=2.5, 95% CI=1.3, 5.9]. No associations were found between infection and age, gender, source of sewage disposal, eating fruits, or family history of upper gastrointestinal symptoms

Conclusion and recommendations: Infection with H. pylori is declining among healthy individuals of Al Madinah, Saudi Arabia. Infection is acquired at an early age and reaches up to 36.9% as age advances. The risk of H. pylori seropositivity was related to socioeconomic, lifestyle, and environmental factors. A nationwide epidemiological study is warranted to determine the seroprevalence of H. pylori in Saudi Arabia

Adherence to and outcome of isoniazid chemoprophylaxis among household contact children of adults having pulmonary tuberculosis in Alexandria, Egypt

Background: Current international guidelines recommend 6-9 months of isoniazid [INH] preventive chemotherapy to prevent the development of active tuberculosis [TB] in susceptible children exposed to Mycobacterium tuberculosis. However, this is dependent on good adherence, as shown by previous studies

Objectives: This study was conducted to describe the outcome of screening of contact children aged 5 years or less with household exposure to an adult pulmonary TB index case to determine the prevalence and possible risk factors of infection among contact children and to determine the extent and outcome of adherence of contact children to unsupervised INH chemoprophylaxis for 6 months

Methods: A descriptive facility-based cross-sectional study was conducted from March 2009 to August 2010. Research settings were three of the National TB control program chest dispensaries [primary care facilities] in Alexandria, Egypt. Facility-based TB treatment registers of the previous 3 months were used to identify all new adult pulmonary TB cases. All children aged 5 years or less living in the same house as the index cases were identified and screened for TB. The contact children were given unsupervised INH preventive chemotherapy once active TB was excluded. Adherence to and outcome of preventive chemotherapy were followed up. Preventive chemotherapy consisted of unsupervised INH monotherapy for 6 months with monthly collection of tablets from the clinic. Adherence was documented after completion of the 6-month preventive treatment period. Adherence was considered reasonable if tablets were collected for more than 4 months, poor if collected for 2-4 months, and very poor if collected for less than 2 months

Outcome measures: [a] Prevalence of infection and disease and the possible risk factors among contacts. [b] The extent and outcome of adherence to unsupervised INH chemoprophylaxis among contact children. [c] Factors behind poor adherence

Results: In total, 197 adult TB index cases from 187 households were identified. In all, 297 children aged 5 years or less experienced household exposure, of whom 252 [84.9%] were fully evaluated. Tuberculin test was positive in 136 of the 252 child contacts [54.0%], of whom 130 were contacts of sputum-positive patients and six were contacts of sputum-negative patients. The important risk factors for transmission of TB infection were younger age, male sex, severe malnutrition, absence of BCG vaccination, contact with a sputum-positive adult who was a source case, household overcrowding, and exposure to environmental tobacco smoke. Thirty-three children were diagnosed and treated for TB at the baseline screening and 217 received preventive INH chemotherapy. Of the children who received preventive chemotherapy, only 36 [16.6%] completed at least 4 months of unsupervised INH monotherapy. During the subsequent follow-up period, eight children developed TB [secondary attack rate for TB disease was 3.7%], of whom four received no preventive chemotherapy and four were poorly adherent

Conclusion: The prevalence of TB infection and clinical disease among children in household contact with adult patients is high, and risk is significantly increased because of child contact, index patients and environmental factors. Adherence to 6 months of unsupervised INH chemoprophylaxis was very poor

Needle stick injuries among health care workers of Alexandria University hospitals

Needle stick injury has been recognized as one of the occupational hazards which results in transmission of blood borne pathogens. As there was limited data on the national level about these injuries determinants of such injuries are important to investigate and to design effective prevention programs. The purpose of this study was to investigate the prevalence and circumstances of needle stick injuries among heath care personnel working at Alexandria University hospitals. Effectiveness of the existing control measures and practice of standard precautions were also assessed. A cross-sectional survey was carried out among 913 health care workers [HCW] in different clinical departments of the three teaching hospitals from January to December 2007. Data were obtained by an anonymous, self-reporting questionnaire. Health Belief Model [HBM] was used to explain standard precautions practice. Multiple linear regression was performed to predict factors associated with the practice of standard precautions. Of the recruited participants, 70.6% [645/913] had completed the questionnaires. Nurses had the highest response rate [92.5%]. More than two thirds [68.0%, n=438] of participanting HCWs had sustained at least one needle stick injury in the last 12 months. Risk of [Needle Stick Injuries [NSls] was significantly associated with younger age of the participants and fewer years of work experience. More specifically, of all occupational groups, nurses have the highest risk to experience needle stick injuries [62.3%]. Disposable syringes accounted for 38.4% of injuries. Most needle stick injuries [36.5%] occurred at the patient's ward. Evaluating the kind of activity under which the needle stick injury occurred, on average 36.0% of injuries occurred during recapping of a needle especially if this practice was handily done. High risk patients [one with a history of infection with HIV, hepatitis B, hepatitis C, or injection drug use] were involved in 8.2% of injuries. The majority of NSIs [73.1%] occurred at end of the shift. Most health care workers [77.4%] were mentally distressed during their injury. Factors increase possibility of infection transmission were the procedure involving a needle placed directly in patient's vein or artery, exposure to a source patient who had evidence of blood borne infection, low immune status of the HCW [i.e., no vaccination with HBV], deep injury, and lack use of personal protective equipment. A total of 327 respondents [74.7%] did not report the injury to an employee health service. Lack knowledge of appropriate procedure after injury was the most common cited reason for not reporting the injury. The survey revealed that use of preventive measures was inadequate. Only 10.0% of all participant workers knew new needless safety devices. The significant protective factors that decreased the frequency of needle stick injuries were using devices with safety features [OR=0.41], satisfactory adherence of a health care worker to infection control guidelines [OR=0, 42], having training in injection safety and appropriate work practices [OR=0.14], comfortable room temperature during injection [OR=O.32], and availability of written protocol for prompt reporting of such injuries [OR=0.37]. The mean standard precautions practice percent score for the health care workers was 46.32%. In multiple linear regression model, knowledge score of infection transmission [adj beta: 0.18] and the work experience [adj beta: 0.06] were the only significant predictors of standard precautions score. There is a high rate of needlestick injuries in the daily routine of Alexandria teaching hospitals with subsequent risk of infection transimission. Greater collaborative efforts are needed to prevent needlestick injuries. Such efforts are best accomplished through a comprehensive program that addresses all circumstances that contribute to the occurrence of needlestick injuries in health care workers. Critical to this effort is the elimination of needle use where safe and effective alternatives are available and the continuing development, evaluation, and use of needle devices with safety features. All such approaches must include serious initial and ongoing training efforts

Role of antenatal care in toxemia of pregnancy in Alexandria

Pre-cclampsia and eclampsia remain one of the major obstetrical problems in less developed countries. Proper antenatal care [ANC] with regular measurement of blood pressure remains the mainstay of screening for hypertension in pregnancy. The aim of the current study was to identify frequency and characteristics of women with toxemia of pregnancy, assess both the quantitative and qualitative adequacy of antenatal care among cases with toxemia of pregnancy and to evaluate the effect of antenatal care on maternal and perinatal outcome. A cross-sectional case series study design was utilized. The study population was all cases, with confirmed diagnosis of toxemia of pregnancy who were admitted to El-Shatby University hospital during the period from January to May 2005. A structured interviewing schedule was used to collect data on characteristics of cases, maternal and fetal outcome. Site, adequacy and quality of received antenatal care were assessed. Out of total cases [336], 14.29% were diagnosed as mild pre-eclampsia, 83.31% were found to have severe pre-eclampsia while 2.40% were suffering from eclampsia. The severity of the condition was significantly associated with older maternal age, multiple pregnancy, primigravity, nulliparity, low socioeconomic conditions, husband's smoking and excessive caffeine consumption. Three-quarters of eclampsia cases [75.0%] didn't receive antenatal care and 60.0% of severe pre-eclamptics received inadequate antenatal care. The mean percent score of quality care domains of antenatal care content for mild pre-eclamptics was 75.62 +/- 13.80%. This was significantly higher than that for those of severe [59.96 +/- 27.95%] or for eclampsia cases [48.75 +/- 20.04%] where X2 of Kruskal-Wallis=8.316 [F<0.001]. Adverse maternal and fetal outcome occurred in 79.4% of women and 72.3% of babies for those who received poor quality ANC. In conclusion, the complications of pre-eclampsia and eclampsia could be prevented by wide spread use of adequate antenatal care, education and training of primary medical care personnel, prompt diagnosis of high risk patients and timely referral to higher level health care