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

Randomised double-blinded trial evaluating silymarin for chronic hepatitis C in an Egyptian village: study description and 12-month results.

BACKGROUND/AIMS: A double-blinded trial evaluating silymarin, an herbal supplement for liver disease, to prevent complications of chronic hepatitis C virus infection has not been done. SUBJECTS: One hundred and seventy-seven consenting residents of an Egyptian village with chronic hepatitis C virus were randomly assigned to receive either silymarin or multivitamin supplements. METHODS: Participants had baseline and follow-up clinical, ultrasound, blood tests and quality-of-life assessments. Community nurses visited weekly to ascertain compliance, distribute supplements and record adverse effects. RESULTS: At 12 months almost all of 141 remaining subjects reported feeling better, although symptoms and quality-of-life scores did not differ between the silymarin and multivitamin groups. Both the silymarin and vitamins were tolerated equally well; and >95% of supplements were taken by >95% of subjects. One in each group had no detectable hepatitis C virus antibodies while two in the silymarin group and three receiving multivitamins had undetectable hepatitis C virus RNA. Serum alanine aminotransferase elevations did not differ between groups. Serum hepatic fibrosis marker, hyaluronic acid and YKL-40, and abdominal ultrasound results were similar in both groups and may have progressed slightly at 12 months. CONCLUSIONS: The recommended dose of silymarin can be safely taken for 1 year and improves symptoms and general well-being, but has no effect upon hepatitis C virus viremia, serum ALT, or serum and ultrasound markers for hepatic fibrosis. More prolonged evaluation and a higher dose may be required to ascertain whether milk thistle supplements prevent complications of chronic hepatitis C virus.

Cervical changes associated with progestagen-only contraceptives: a team approach.

OBJECTIVES: To report clinical, cytologic and colposcopic findings among women using progestagen-only contraceptives for more than 3 years as compared to nonhormonal contraceptives; and to assess the role of nursing in increasing the women's knowledge about Pap test and risk factors for cervical cancer in a developing country set-up. DESIGN: A prospective cross-sectional comparative study. SETTING: Family-planning clinic of a tertiary care university hospital. SUBJECTS: A total of 325 current users of contraceptive methods for more than 3 years. INTERVENTIONS: Patients were divided into two groups. Group A included 200 patients using progestagen-only contraceptives. While group B comprised 125 patients wearing intrauterine devices. In both groups, the patient was asked about the risk factors and her knowledge about cancer cervix. Clinical and cytologic evaluations of the cervix were done. For each patient, two cervical smears were taken using Ayre's spatula and the endocervical brush. MAIN OUTCOME MEASURES: Clinical, cytologic and histopathologic cervical abnormalities after prolonged use, and the effect of health education or counseling on the patient's knowledge about preinvasive or invasive cervical cancer. RESULTS: Initial naked eye assessment of the cervix revealed statistically significant difference between both groups (p < 0.000). However, cytologic examinations revealed positive cases of low- and high-grade squamous intraepithelial lesions (SIL) in 38 (19%) and 22 (17.6%) in the study and control groups, respectively, without any statistically significant difference. There were no statistically significant differences in both groups regarding the frequency of positive cases whether using Ayre's spatula or the endocervical brush. Women's knowledge was compared in the first and last interviews by the nursing staff involved in health education or counseling. It increased in the counseling group; however, the difference was statistically insignificant. CONCLUSIONS: Prolonged use of progestagen-only contraceptives is not associated with increased risk of abnormal cytologic findings. There was a marked lack of women's knowledge as regards Pap test and cervical cancer with some statistically insignificant improvement after interview and counseling. Extended training of the nursing staff on the procedure of Pap smear would help establish screening programs in the developing countries.