Informal health providers and the transmission of hepatitis C virus: pilot study in two Egyptian villages.

The roles and practices of informal health care providers were studied in 2 Egyptian villages, focusing on practices which might be associated with the bloodborne transmission of hepatitis C virus (HCV). In the study areas, many people resorted to male providers for injections, dentistry, wound treatment and male circumcision. Traditional birth attendants oversaw > 50% of all births. "Injectionists", barbers and staff at pharmacies performed services that may be associated with HCV transmission. These providers knew little about HCV, but were willing to learn. As villagers trust these providers and visit them even if primary health care facilities are accessible, efforts should be made to upgrade their practices in order to reduce the transmission of HCV.

Informal health providers and the transmission of hepatitis C virus: pilot study in two Egyptian villages

The roles and practices of informal health care providers were studied in 2 Egyptian villages, focusing on practices which might be associated with the bloodborne transmission of hepatitis C virus [HCV]. In the study areas, many people resorted to male providers for injections, dentistry, wound treatment and male circumcision. Traditional birth attendants oversaw > 50% of all births. "Injectionists", barbers and staff at pharmacies performed services that may be associated with HCV transmission. These providers knew little about HCV, but were willing to learn. As villagers trust these providers and visit them even if primary health care facilities are accessible, efforts should be made to upgrade their practices in order to reduce the transmission of HCV

Schistosomiasis screening and health education for children: action research in Nile delta villages.

In Egypt an important component of the national schistosomiasis control policy is the regular screening of school children through the rural health units. In the Nile delta, a major challenge for the programme is the increasing predominance of Schistosoma mansoni, as compared to Schistosoma haematobium over the past 20 years, and the need to adjust strategies to this new reality. The action research project, growing out of an in-depth study of schistosomiasis in two Nile delta villages, is intended to provide recommendations for schistosomiasis control to the Egyptian Ministry of Health and Population. This paper explores the practice of school-based screening. We then describe the designing and testing of a revised screening procedure, which focuses on the collection of stool specimens to diagnose S. mansoni and which is comprehensive and gender-sensitive. Opportunities for health education are discussed briefly, as this is necessary for an effective screening procedure and to prevent reinfection. In conclusion, we mention the need to incorporate screening and health education into an integrated control strategy

Schistosomiasis in two Nile delta villages: an anthropological perspective.

In the rapidly changing Nile delta villages, applied research for schistosomiasis control requires a holistic view of the social and environmental setting of the disease. An interdisciplinary, participatory study of two delta villages studied human behaviour in relation to disease transmission, knowledge and treatment using the insights and methods of social science, especially anthropology. Through primarily qualitative techniques such as focus group discussions and participant observation, we found that most people who used the canals for domestic, recreational or agricultural activities thought that they had little alternative but to do so, even though they knew of the risk of exposure to schistosomiasis. The knowledge and behaviour of villagers with regard to schistosomiasis affected their utilization of the local provisions for schistosomiasis diagnosis and treatment. Our monitoring of diagnosis and testing for schistosomiasis at a local health centre identified areas which could be upgraded, and we trained health staff to improve their knowledge of schistosomiasis. Our findings reinforce the need for integrated research and implementation strategies, taking into account the knowledge and capabilities of all those involved in schistosomiasis control at the village level, and the fostering of effective communication between villagers, both women and men, and the local staff in rural health centres.

The public health implications of the increasing predominance of Schistosoma mansoni in Egypt: a pilot study in the Nile delta.

Over the past twenty years, Schistosoma mansoni has apparently replaced Schistosoma haematobium as the more prevalent species of schistosomiasis in the Nile delta. In this paper we show that this change has profound implications for public health strategies, in particular the provision and utilization of diagnostic and treatment services for the Egyptian rural population, and for health education programmes. The processes of providing and seeking treatment for the two forms of schistosomiasis are quite distinct as they have different signs and symptoms and are diagnosed in stool and urine samples respectively. In two Nile delta villages, where S. mansoni has almost completely replaced S. haematobium, we found that health services were geared primarily to S. haematobium, and hence many cases of S. mansoni remain undiagnosed and untreated. One reason for this is that health unit staff and local people lacked detailed knowledge of the two forms of schistosomiasis, indicating the need for health education.

Schistosomiasis control through rural health units.

In Egypt the main effort in the campaign against schistosomiasis involves providing free diagnosis and treatment through primary care facilities, especially rural health units. The prospects for improving these services are considered below.

PIP: Schistosomiasis is a major health hazard in rural Egypt. Rural health units and the Ministry of Health, however, together provide curative and preventive services against the parasitic disease. 3500 rural health units form the basis of primary health care in rural Egypt. In 1987, there was one such unit for, on average, every 10,595 persons. Each rural health unit is comprised of one or two examination rooms, a pharmacy, a laboratory, and accommodation for a physician and 2-4 nurses. Patients wait to see the doctor on a covered veranda. These health units offer outpatient facilities in most main villages and some satellite villages in the densely settled areas of the Nile Delta and Nile Valley, where almost everyone lives within 5 km of a unit. There is no charge for the diagnosis and treatment of schistosomiasis at rural health units. Moreover, all children attending schools in the units' catchment areas receive routine annual testing and treatment for schistosomiasis. On the preventive side, the Ministry of Health coordinates schistosomiasis control activities, including health education.

A model for health education.

A model for health education has been devised in Egypt on the basis of studies made in two villages. Its purpose is to contribute to the solution of environmental health problems by using locally available resources. Present indications are that the model will be applicable not only to the different sectors of the population, e.g., women and children, but also to many other villages throughout the country.

PIP: In Egypt, a model for community health education which identifies appropriate materials and methods has been long needed. Such a model has now been developed based on a health education program in 2 villages numbering 4000 and 5000 people, respectively, in the Nile delta. More than 80 educators were trained, and more than 1000 women and 400 school children were involved in health education by means of collaboration between village, district, and governorate administrations. The strategy involved simple hygiene messages delivered in health units, schools, and homes by 85 health promoters (nurses, school teachers, and women leaders). The links between behavior, disease transmission, and environmental sanitation were stressed along with water and food storage, infant feeding, hand washing, cleanliness of latrines, and kitchen hygiene. In Egypt, diarrheal disease is the main cause of death among children under the age of 5. Schistosomiasis affects 15-20% of the rural population; drawing attention to swimming in canals could serve prevention. A booklet was also prepared for health promoters. Training relied on group discussion and audiovisual aids. Health unit staff and public health service candidates participated in short presentations. Literate hygiene promoters were trained in record- keeping for monitoring and follow-up. The educators were evaluated at the end of the initial training session. Women were targeted for the messages, especially those under the age of 40. Nurses proved to be the most successful health educators in changing the women's behavior. In the summer clubs, held twice a week over a 2-month period and attended by children aged 10-12 years, personal hygiene, food handling, environmental sanitation, and disease transmission and prevention were discussed. The girls often communicated health messages to their mothers while helping with household chores. The implementation of the model requires local staff and finance with some government funding to pay teachers in summer clubs.

Community participation for schistosomiasis control: a participatory research project in egypt.

Schistosomiasis remains one of the major public health problems in rural Egypt. Many rural people continue to be exposed to the disease as they enter irrigation canals during agricultural, domestic and recreational activities. Current control strategies focus on testing and treatment of cases in rural health units; apart from a TV media campaign, health education plays a small role. This article reports on an on-going participatory research project involving all the people and institutions in two villages who have an interest in schistosomiasis control at the village level. The project is studying human behavior and the transmission of schistosomiasis, with the ultimate aim of recommending appropriate control strategies. The research team worked with local staff at the clinic to improve testing and treatment for villagers, especially school children. It also trained local residents in social research techniques, so that they work with local villagers to understand why exposure to canal water persists and what can be done to minimize this contact.

A Multifaceted Approach to health Education: A Case Study from Rural Egypt.

This article describes and evaluates an environmental health education project, focusing on water and sanitation issues, which was carried out in two Egyptian villages in the Nile delta. The study is multifaceted as it involves various hygiene education strategies carried out by health unit staff, teachers, graduate volunteers and local village leaders who deliver simple environmental health messages in a variety of different settings. The project is also multifaceted in that it looks at health education in relation to specific health interventions, in this case in water and sanitation; it identifies the full context of relevant local behavior; and it collaborates with local people, especially women, in the design and implementation of the program. Based on the experience gained during this project, a broad based model for health education is presented.