Prevalence and predictors of depression, anxiety, and stress among refugees in Egypt.

BACKGROUND: Many Refugees show multiple distressing psychological and mental health problems associated with stressful and adverse conditions in host countries. Even though Egypt is one of the top five destination countries hosting refugees and asylum-seekers in the MENA region, there is a lack of studies investigating mental health problems among refugees in Egypt. This study aimed to assess the prevalence and predictors of depression, anxiety, and stress symptoms among refugees living in Egypt. METHODS: A total of 398 refugees aged 18 and above were interviewed from migrants'/refugees' community centers in Giza, Alexandria, Dakahlia, and Damietta governorates. A predesigned structured interview questionnaire was used to collect socio-demographic and migration-related variables. The Arabic Version of Depression Anxiety Stress Scales (DASS-21) was used to assess the presence and severity of the three negative emotional states. RESULTS: Nearly two-thirds of the participants were Syrian (66.4%). The majority resided in Alexandria and Giza governorates (75.9%), were females (73.4%), and were married (71.1%). The most reported migration difficulty was housing (41.5%). Anxiety symptoms were reported among 63.3% (95% CI: 58.59%- 68.05%) of sampled refugees, followed by depression (61.3%, 95% CI: 56.52%-66.10%), and stress symptoms (51.5%, 95% CI: 46.56%-56.36%). Results of regression analysis showed that; female gender predicted anxiety (aOR 2.419, 95% CI: 1.485-3.941, p < 0.001) and stress (aOR 2.053, 95% CI: 1.197-3.519, p = 0.009), while younger age groups (18-25 yr. and 26-50 yr.) compared to the older age group (51 yr. and older) predicted depression (aOR 4.529, 95% CI: 1.696-12.097, p = 0.003 and aOR 2.177, 95% CI: 1.270- 3.733, p = 0.005, respectively) and stress (aOR 4.334, 95% CI: 1.556-12.074, p = 0.005 and aOR 1.808, 95% CI: 1.023-3.193, p = 0.041, respectively). Residence in Alexandria, housing, and employment difficulties predicted anxiety (aOR 2.354, 95% CI: 1.420-3.902, p < 0.001, aOR 1.726, 95% CI: 1.073-2.778, p = 0.025, and aOR 3.044, 95% CI: 1.248-7.425, p = 0.014, respectively), depression (aOR 1.949, 95% CI: 1.163-3.266, p = 0.011, aOR 1.666, 95% CI: 1.036-2.681, p = 0.035, and aOR 3.216, 95% CI: 1.321-7.828, p = 0.010, respectively), and stress (aOR 2.450, 95% CI: 1.431-4.195, p < 0.001, aOR 1.911, 95% CI: 1.187-3.078, p = 0.008, and aOR 4.482, 95% CI: 1.867-10.760, p < 0.001, respectively). CONCLUSION: Mental health problems are prevalent among the refugee population in Egypt that are compounded by the difficult post-migration socio-economic situation. Multisectoral attention towards refugees' mental health is urgently needed.

Cost-effectiveness of EGCRISC application versus hepatitis C virus mass screening in Egypt.

BACKGROUND: The Egyptian model of care against hepatitis C virus (HCV) has a great success in treatment and treatment accessibility, but still screening efforts must be strengthened. HCV is a silent infection when most of infected people are unaware of their infection. EGCRISC is a newly developed and validated risk-based HCV screening tool in Egypt that has shown a considerably good performance but is still underused. This brief communication is to analyze its use cost-effectiveness versus mass screening. STUDY DESIGN: Mathematical comparative analysis for economic evaluation. METHODS: Its performance data as published recently were used, and a minimum cost of L.E. 20 was considered per one antibody testing. The 2015 health issue survey and population census were used for estimating the population, infected individuals and susceptibles. RESULTS: The analysis showed that using EGCRISC would save LE 0.43 billion accounting for about 21,646,227 unnecessary tests, while missing less than 70,000 cases when compared to mass screening. CONCLUSION: EGCRISC is a cost-effective tool that must be adopted nationwide as soon as possible in Egypt for the best outcome of HCV control.

Toward a simple risk assessment screening tool for HCV infection in Egypt.

Asymptomatic patients with HCV infection identified through screening program could benefit not only from treatment but also from other interventions such as counseling to maintain health and avoid risk behaviors. This might prevent the spread of infection and result in significant public health benefits. However, mass screening would quickly deplete resources. This work aims to develop a brief HCV risk assessment questionnaire that inquires initially about a wide range of risk factors found to be potentially associated with HCV infection in order to identify the few most significant questions that could be quickly used to facilitate cost-effective HCV case-finding in the general population in Egypt. An exhaustive literature search was done to include all reported HCV risk factors that were pooled in a 65 item questionnaire. After an initial pilot study, a case-control study was performed that included 1,024 cases and 1,046 controls. In a multivariable model, a list of independent risk factors were found to be significant predictors for being HCV seropositive among two age strata (<45 and >45 years) for each gender. A simplified model that assigned values of the odds ratio as a weight for each factor present predicted HCV infection with high diagnostic accuracy. Attaining the defined cut-off value of the total risk score enhances the effectiveness of screening. HCV risk factors in the Egyptian population vary by age and gender. An accurate prediction screening tool can be used to identify those at high risk who may benefit most from HCV serologic testing. These results are to be further validated in a large scale cross-sectional study to assess the wider use of this tool. J. Med. Virol. 88:1767-1775, 2016. © 2016 Wiley Periodicals, Inc.

Prevalence, risk factors, and predictors of nonalcoholic fatty liver disease among schoolchildren: a hospital-based study in Alexandria, Egypt.

BACKGROUND AND STUDY AIMS: Nonalcoholic fatty liver disease (NAFLD) is an emerging problem in children and adolescents worldwide. This study was done to investigate the prevalence of NAFLD in children and adolescents as well as to determine the associated risk factors of fatty liver and to explore the ability of some obesity indices to predict and consequently be used as a screening method of fatty liver disease at certain cutoff points in schoolchildren. PATIENTS AND METHODS: A cross-sectional, nested case-control study was carried out. Cases and controls were randomly selected from outpatient schoolchildren aged 6-18years attending the radiology clinic at Sporting Health Insurance Paediatric Hospital in Alexandria. They were subjected to ultrasonic examination as well as complete anthropometric and laboratory measurements including fasting plasma glucose (FPG) level, fasting insulin, alanine aminotransferase (ALT) level, and lipid profile. RESULTS: Fatty liver was prevalent in schoolchildren (15.8%) and increased significantly with age (p=0.004). Positive family history of diabetes mellitus (DM), hypertension (HTN), obesity, and liver disease were all statistically significant risk factors for fatty liver. Waist circumference (WC), body mass index (BMI) and its Z-score were significantly sensitive predictors. BMI was considered the best predictor of paediatric NAFLD at a cutoff=22.9. NAFLD was significantly associated with high triglycerides (TGs), low high-density lipoprotein cholesterol (HDL), homoeostatic model assessment (HOMA) percentile, and the number of metabolic syndrome (MS) components. CONCLUSION: Paediatric NAFLD is a substantial problem in schoolchildren and has a close relationship with obesity, dyslipidaemia, insulin resistance (IR), and consequently MS. BMI and WC can be used as useful predictors and screening tools for NAFLD in schoolchildren.

Occult hepatitis B virus infection among hepatitis C virus seropositive and seronegative blood donors in Alexandria, Egypt.

BACKGROUND AND AIMS: Occult hepatitis B virus infection (OBI, serum hepatitis B surface antigen negative but hepatitis B virus DNA positive) is an emerging problem in the safety of blood transfusion. The introduction of hepatitis B surface antigen in the screening panel for blood bank donors has substantially reduced, but not entirely eliminated, the risk of hepatitis B virus infection. It has been suggested that infection with hepatitis C virus may inhibit hepatitis B virus replication. Therefore, this study aimed at estimating the prevalence and risk factors for OBI among blood donors and determining its relationship with hepatitis C virus infection. SUBJECTS AND METHODS: Presence of hepatitis B virus DNA and hepatitis C virus RNA was investigated for among 508 hepatitis B surface antigen-negative blood donors in Alexandria, Egypt. Half of the donors were identified as hepatitis C virus antibody reactive. RESULTS: OBI was detected in 21 donors (4.1%) from the studied population: eight were among hepatitis C virus antibody positive donors (3.2%), among whom seven (33.3%) had hepatitis C virus RNA in their serum, and 13 (5.1%) were among hepatitis C virus antibody negative donors, with no statistically significant difference. The only significant risk factor for OBI among the studied blood donors was visiting local barbers. CONCLUSION AND RECOMMENDATIONS: OBI is a considerable risk in blood banks, making screening for hepatitis B virus infection only on the basis of surface antigenemia insufficient.

Environmental intervention for house dust mite control in childhood bronchial asthma.

OBJECTIVES: This study was carried out to determine the effectiveness of physical and chemical environmental control measures for house dust mites (HDM) in controlling bronchial asthma in children. METHODS: A total of 160 asthmatic children who were sensitized to HDM underwent clinical and environmental assessment. The children were randomly allocated into one of four groups according to the intervention (chemical, physical, both chemical and physical, none) and the effectiveness of the intervention was assessed at 8 and 16 weeks. RESULTS: The group for which physical control measures were used showed significant improvement in all outcome measures, including mean differences of forced expiratory volume after 1 s (FEV1) and peak expiratory flow rate (PEFR), which were 2.05% and 4.65 l/min, respectively, at the 8-week follow-up evaluation. The percentage of severe asthma decreased from 45 to 22%. Similar results were obtained for the group with both chemical (tannic acid) and physical interventions (p < 0.05 for all measures). In the group where tannic acid was used as a chemical measure, the number of children with moderate and severe asthma decreased from 15 in each category to 11 and 7, respectively. In the control group, only the mean difference of PEFR (1.62 l/min) was significant after 16 weeks. Despite these promising findings, only the FEV1 was significantly different (p = 0.014) when the four groups were compared. CONCLUSIONS: Based on these results, we conclude that simple physical control measures have the potential to contribute to the control of asthma symptoms in asthmatic children sensitized to HDM allergen.

Quality of bottled water brands in egypt part I: physico-chemical analyses.

Consumers are reacting to the water quality problems by buying bottled water which is an expensive solution and only partially addresses the problem. Subsequently, sales of bottled water have increased dramatically in the last ten years. To assess the quality of bottled water in Egypt, samples of 14 Egyptian brands of uncarbonated natural bottled water were evaluated within 6 months. Physico-chemical parameters of a total of 84 samples were tested using standard methods comparing them with those reported on their manufacturer's labeling and/or with government-issued production licenses. A comparison between the water composition and the maximum contaminant levels imposed by the Egyptian standards and several other international guidelines for all parameters was reported and discussed. They varied in composition among the brands and from lot to lot for a particular brand. The results obtained showed that a significant number of bottled water brands contain some elements (e.g. fluoride and several heavy metals) above the maximum concentration allowed for bottled waters by the Egyptian standards and several other international organizations. These results suggest the need for more stringent standardization of the bottled water market, with particular attention to quality control, labeling, and continuous monitoring.

Quality of Bottled Water Brands in Egypt Part II: Biological Water Examination.

People can survive several days without food, but just a few days without water. People buy bottled water for a variety of reasons, including convenience, fashion, and taste or because they think it is safer than tap water. The taste of the water has to do with the way it is treated and the quality of its source, including its natural mineral content. However, taste does not always indicate safeness. Refrigeration has a significant effect on the bacteriological quality of the purchased bottle. To asses the quality of bottled water in Egypt, samples of 14 Egyptian brands of uncarbonated natural bottled water were evaluated within 6 months. Biological examinations of a total of 84 samples were carried out using standard methods comparing them with the Egyptian standards No. 1589/2005. Also bacteriological examinations of 56 samples were carried out after "1-3" months and "3-6" months storage time at room temperature to detect the effect of storage on their quality. More than half (54.8%) of biological parameters were violated the Egyptian standards. A percentage of 28.6% of all bottled water samples were contaminated with coliform, but surprisingly fecal coliforms and E.coli were not detected. Moreover, Staphylococcus aureus and Pseudomonas aeruginosa were isolated from 5.95% and 3.6%, respectively of all samples. Giardia lamblia cysts has been found in 2.4% of samples, while absence of Cryptosporidium oocysts in all samples was reported. More than half (52%) of the unrefrigerated samples were unacceptable compared to only 19.4% of the refrigerated bottles. These results suggest the need for continuous monitoring for evidence of contamination at source or during the bottling process.

Seropositivity of toxoplasmosis in patients with schizophrenia.

Recent studies indicate that infectious agents may contribute to some cases of schizophrenia. In animals, infections with Toxoplasma gondii can alter behavior and neurotransmitter function. In humans, acute infection can produce psychotic symptoms similar to those displayed by persons with schizophrenia. In the present study, an enzyme immunoassay (EIA) was employed to measure the level of Toxoplasma IgG antibodies in serum samples from 75 patients of schizophrenia and 85 matched controls. Percentage of positive sera for Toxoplasma IgG antibodies was significantly higher in schizophrenic cases than controls (80% vs. 52.9% respectively). Infection increased with age in both groups and no significant association was found with sex. No association was found with duration of illness or presence of family history of schizophrenia. Circumstantial evidence indicates that infection with Toxoplasma gondii may lead to some cases of schizophrenia.