A cross sectional study of hepatitis B, C, some trace elements, heavy metals, aflatoxin B1 and schistosomiasis in a rural population, Egypt.

Chronic liver diseases are disastrous to health. Many factors are associated with their prevalence, hence endemicity. These are mainly infectious, parasitic and toxic. A survey was conducted in a village south to Cairo. Large industries concerned with iron and steel industry, metals smelting, cement manufacturing and electric station were located north to the village. A systematic random sample of houses was selected. All individuals inside the houses were invited to share in the study. Sample size was 84 individuals. Hepatitis markers were done (HBsAg and anti-HCV antibodies). The levels of some heavy metals were assessed; which were lead, mercury, arsenic, aluminum, manganese, nickel, chromium and cadmium. Levels of some trace elements were assessed. These were copper, iron, selenium and zinc. Aflatoxin B1 was assessed in serum. Assessment of schistosomal circulating antigen and antibodies was carried out. Abdominal ultrasonograghy was done to assess liver condition. Univariate logistic regression analysis was done to assess the association between studied variables and HBsAg or anti-HCV sero-positive subjects. The association between studied variables and bilharzial or fatty liver, diagnosed by ultrasonography, were also assessed. The univariate logistic regression analysis revealed odds ratios at the following results. For HBsAg seropositive subjects, aflatoxin B1, lead, chromium and schistosomal antigen and antibodies were higher than negative ones where odds ratios were; 6.2, 1.6, 1.6, 1.6 and 1.7, respectively. None of the variables showed statistically significant difference. For anti-HCV antibodies sero-positive subjects, aflatoxin B1 and chromium had the highest odds ratios among the studied variables, (odds ratios were 2.5 and 2.4, respectively). Bilharzial liver showed higher significant positivity of anti-HCV antibodies and insignificant decreased level of zinc than negative ones (odds ratios were 7.2 and 4.5, respectively). Fatty liver cases showed higher statistically significant positivity of anti-HCV antibodies and chromium than negative ones. Odds ratios were 8.0 and 7.1, respectively. Statistically significant lower level of aflatoxin B1 was shown in fatty liver than normal liver subjects. Multivariate logistic regression analysis for fatty liver showed that only anti-HCV antibodies sero-positivity had statistically significant odds ratio in comparison to chromium level and aflatoxin B1. It is concluded that some heavy metals, and Aflatoxin B1 had a definite association with liver diseases in the area under study. Having anti-HCV antibodies had a relation with fatty liver and with bilharzial liver more than having HBsAg. It is recommended that environmental management to factories nearby the village is urgently needed to decrease exposure to heavy metals. Prevention of hepatitis infection and aflatoxin exposure through different means is also recommended, other wise health care authorities would be confronted with unusual cases of HCC in the nearby future.

Epidemiology of Schistosoma mansoni infection and its relationship to snail distribution in a village at the Nile bank south to Cairo.

The relationship between epidemiology of S. mansoni infection and snail distribution at a village, related to Guiza Governorate and lies south to Cairo, was investigated. A systematic random sample of houses was selected. All inhabitants of the houses were invited to share in the study. The Number examined was 704. Urine and stools were examined using Nucleopore filtration and standard Kato-Katz techniques, respectively. Snail collection was done from 35 sites along the water bodies related to the village. Snails collected were examined by cercariae shedding under light. Snail differentiation was done. The results showed that the prevalence of Schistosoma mansoni human infection was 25.1 % and GMEC was 2.4 +/- 5.5. Schistosoma haematobium infection was zero percent. Biomphlaria alexandrina snail infection rate was 3.7% with density equal 0.5 +/- 1.3. Bulinus truncatus snail infection rate was zero percent. The pattern of S. mansoni human infection was closely related to snail distribution and infection. Presence of a hybrid species of B. alexandrina and B. glabrata may explain the epidemiological pattern found in the studied village.

Development of mortality statistics at governmental hospitals, Egypt.

Mortality statistics are of crucial importance to epidemiological research. Sources of mortality data in Egypt are many. The first records are hospital records, which submit its data to health office records and lastly civil register office records. Hospital records include hospital death notification certificate and hospital mortician register. Health office records include mortality register, death certificate and death notification report to civil register office. The latter is designed to have a coded data and cause of death according to ICD-10. It is supposed that the death notification report that originates from the hospital is the source of data for the rest of records and registers. So, all these data for the same dead person must be the same. Quality of the original data will reflect itself on the rest of data. This study aims at establishment and assessment of automated system for management of mortality data at (hospital 1, affiliated to Ministry of Scientific Research) and comparing this system and its output with another one (hospital 2, affiliated to the Ministry of Health). The tools of this study are review of the above mentioned records and registers and personal interviews. Death certificate itself is not reviewed, as it is not found in the health office. One-year data sample was chosen for the study. Development of the system at hospital 1 is based on system analysis, design, implementation, and evaluation. Results showed that automated system of hospital1 have the values of automation as timely retrieval and decreasing the error of transcription. Epi-Info software package gives easy statistical analysis and the potential for record linkage. Comparison between hospital death notification certificate that originated from the hospital and health office register showed 97.4% matching for words or expressions in hospital 1 and 50.0% in hospital 2. Comparing hospital death notification report with that originated from health office to related civil office, showed 100.0% matching for hospital1 and 86.7% for hospital 2. As regards correctness of reporting the cause of death, 97.4% of deaths in hospital1, and 29.9% in hospital 2 showed non-specific cause of death reported as circulatory and respiratory distress, that is the actual cause of death is not reported. It is concluded that, unification and automation of the systems is a requirement. Record linkage between different locations of mortality data is recommended. Training on reporting and coding the cause of death is also recommended.

Pattern of water contact activities in relation to S. mansoni infection in rural area in Giza Governorate, Egypt.

Schistosomiasis is associated with human behavior in relation to water. Study of different patterns of water contact activities would help in planning strategies for control. This study aims to describe patterns of water contact activities in relation to S. mansoni infection in El-Shobak El-Sharki village in Giza governorate, in Egypt. A sample of 695 households was taken from about 127 houses. They provided stools samples and a water contact questionnaire for different activities, regions, sites, time of the day, duration of activities, patterns in different age and sex groups. Univariate and multivariate analysis of data was done. It was found that, adult males had the highest prevalence rate, then adult females while children had the least (33.5%, 27.5% and 17.4% respectively, p-value < 0.0001). Infection rate is higher in those having water contact activities, with Odds Ratio (OR) 2.01 and 95% Confidence Intervals (CI) (.94-4.24). Other significant factors are, the site of activities, time of the day and duration of contact, with p-value < 0.05. The highest score for the different patterns of activities in adult males are mainly occupational as agriculture and irrigation, their OR (95% CI) are 2.82 (.91-5.94) and 2.58 (.89-5.41), respectively. As regards females, the highest score is for domestic daily activities as washing infant clothes and utensils, their OR (95% CI) is 2.19 (.91-4.73) and 1.83 (.80-4.16) respectively. Children have the least score, their activities is mainly recreational as swimming, OR (95% CI) is 1.77 (.79-4.02). Multiple logistic regression analysis revealed that, male's activities and their longer duration are highly significant factors with prevalence as the dependant variable, OR (95% CI) is 3.07 (.73-8.19) for activities, and is 3.67 (.31-9.38) for duration. It is concluded that, human exposure pattern, in general, favors the transmission of S. mansoni. Prevalence of infection coincides with water contact activities in different age, sex and farming occupation. So, the control of S. mansoni in Egypt is not a pure medical affair. It needs multidisciplinary upgrading actions to be taken in different sectors of agriculture and irrigation reform in Egypt.

Upgrading of Kato-Katz technique for diagnosis of S. mansoni infection in rural Egypt.

Processing of the same stool samples was done using standard Kato-Katz (KK) technique with 41.7 mg of stools and one of the three modifications. These included KK technique using a higher concentration of glycerin (one and quarter, usual one) for preparation, or another stain (negrosin-eosin), with a specified formula, instead of the standard malachite green, or processing a smaller volume of stools (20mg). The results showed that, using cumulative infection rate from the two comparable tests as the reference, KK with higher concentration of glycerin was more sensitive than standard KK (sensitivities 77.6% and 61.2%. respectively). Using negrosin-eosin stain showed higher sensitivity (75.0%) in relation to standard KK technique (70.8%). Kato-Katz with higher concentration of glycerin showed the same sensitivity as KK with negrosin-eosin stain (85.7%) in relation to others. All comparisons showed statistically insignificant differences ((P>0.5). Using 20 mg of stools showed very low sensitivity in relation to standard KK technique (57.9% & 100.0% respectively). The statistical difference was highly significant. All specificities were 100%. Other screening indices showed the same trend of sensitivities. Degree of microscope clarity was optimal with higher concentration of glycerin. Negrosin-eosin showed better visualization of ova than the standard KK. All modifications took only an hour after processing to be examined. KK technique used with any of these modifications, is simple, inexpensive. use of either a higher concentration of glycerin or negrosin-eosin stain and recommended for both field studies and primary health care settings.