Knowledge and perceptions of hepatitis C infection and pesticides use in two rural villages in Egypt

Egypt's Ambitious Strategy to Eliminate Hepatitis C Virus: A Case Study

A national hepatitis C virus elimination strategy rooted in mass screening and treatment can be effective in many middle-income countries. A strong public health infrastructure, political commitment, and technological advances are essential to such initiatives.

Introduction:

Chronic hepatitis C virus (HCV) infection is a major public health problem in many low- and middle-income countries. In 2015, Egypt's HCV infection prevalence of 7% among adults was among the highest in the world and accounted for 7.6% of the country's mortality. In 2014, Egypt embarked on an aggressive screening and treatment program that evolved into a national strategy to eliminate HCV as a public health threat by 2021.

Methods:

In this qualitative case study, we analyzed Egypt's HCV control strategy using the Kingdon framework to understand how the problem, policy, and political streams merged to create an opportunity to achieve an ambitious elimination goal. We describe key aspects of the implementation, identify lessons learned, and provide recommendations for other low- and middle-income countries aiming to eliminate HCV.

Results:

Between 2014 and 2020, Egypt screened more than 50 million and treated more than 4 million residents for HCV. Five key elements contributed to Egypt's successful HCV elimination program: (1) sufficient and reliable epidemiologic data to quantify and monitor public health threats; (2) a robust public health care infrastructure; (3) inclusive care that reached all sectors of society; (4) political commitment to public health through increased health care spending and a comprehensive long-term national control strategy; and (5) innovative scientific research and use of information technology.

Conclusion:

Egypt conducted a successful HCV screening program that covered more than 50 million residents and treated more than 4 million. It is poised to be the first country in the world to eliminate HCV within its borders. The lessons learned from this experience can inform the elimination plans of other low- and middle-income countries with high HCV burden.

Assessing the level of knowledge and available sources of information about hepatitis C infection among HCV-infected Egyptians

Background

Egypt has the largest proportion of hepatitis C virus (HCV) infection worldwide and there is an urgent need to increase community awareness and knowledge about the disease in the country. The main aim of this study was to assess the level of knowledge and awareness about HCV in clinically diagnosed HCV patients in Egypt.

Methods

This was a prospective, cross-sectional study conducted between 1 February 2014 and 30 April 2014 in Cairo, Egypt using validated questionnaire as an instrument for data collection. A structured questionnaire was developed based on similar published surveys. Data collected included demographic characteristics, exposure to the disease, health insurance status, the source of medical information, and knowledge of different routes of transmission; a point was given for each correct answer with a possible score of 0 to 12.

Results

A total of 203 patients took part in this study with a response rate of 90%. Most—142 (70%)—were married, 119 (63%) were unemployed, 127 (62.9%) were aged above 50 years, 88 (45.1%) were living in Cairo, and 45 (22.4%) had a college degree. Half of the participants believed that HCV infection is not transmitted through sex, while 79 (39.9%) did not know that HCV could be transmitted from a mother to her infant during labor. A quarter of participants believed that HCV vaccine is available, and 45 (24.6%) never knew if their treatment was successful. The median knowledge score of HCV infection in the survey was 7.5; 100 (50.3%) participants had ≤ median knowledge score of HCV infection. Logistic regression analysis showed a duration of infection (OR 1.647, CI 1.189–2.82) and the participants who visited physicians when only they felt sick were less likely to have the above median knowledge score (> 7.5) of HCV infection (OR 0.41, 95% CI 0.19–0.87).

Conclusions

Considering the unsatisfactory level of HCV knowledge among infected patients, Egyptian healthcare authorities should organize national awareness campaigns encouraging HCV testing based on educational interventions and activities to improve the level of knowledge. More investment in research is also needed to limit the further growth of the HCV disease burden in Egypt.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5672-6) contains supplementary material, which is available to authorized users.

A Cross-Sectional Study of Viral Hepatitis Perception among Residents from Southeast and North Regions of Brazil

Few data are available regarding viral hepatitis perception among the general global population. The present study aims to estimate the perception of viral hepatitis in a cohort of individuals living in two geographical regions of Brazil: North (Manaus city (MA)) and Southeast (Rio de Janeiro city (RJ)). A cross-sectional, descriptive study was carried out among 287 subjects recruited in MA (134) and RJ (153). All individuals answered a questionnaire assessing socio-demographic characteristics and viral hepatitis awareness. Participants’ responses were scored and divided using interquartile values. Associations between socio-demographic characteristics and knowledge were also evaluated. Interquartile analysis scored 0–21 correct answers as “Very Weak”; 22–27 as “Weak”; 28–31 as “Intermediate”; and 32–47 as “Desirable”. Mean ± standard deviations (SD) of correct responses were weak in both MA (24.1 ± 7.0) and RJ (26.3 ± 7.3). Bivariate analysis showed an association between viral hepatitis awareness and both education level (p < 0.001) and family income (p < 0.01). Desirable scores were more common in female participants (61%), those aged between 21–30 years (40%), those with a secondary education (51.7%), those who received high income (31.6%), and those from RJ (70.0%). Health education campaigns in these cities are recommended to increase knowledge and reduce the transmission of these viruses.

Hepatitis C virus infection in Jeddah city, Saudi Arabia: Seroprevalence and knowledge

The infection rate of the hepatitis C virus (HCV) in Saudi Arabia is among the lowest in the world. However, it is likely that poor knowledge and awareness of HCV infection could minimize the effectiveness of prevention and control programs in the kingdom. Thus, the study objective was to estimate the prevalence of HCV infection, and to assess current knowledge about it, in the targeted population. Data on 5482 Saudi people attending primary healthcare centers in Jeddah City in 2014/2015 were analyzed in this cross-sectional study. Questions that covered the natural history, risk behavior, and prevention, and treatment of HCV were collected using a predesigned questionnaire. HCV seroprevalence was assessed using an enzyme-linked immunosorbent assay. HCV prevalence of 0.38% (95% confidence interval: 0.22-0.54) was found. The level of knowledge of the natural history, risk behavior, and prevention and treatment of HCV was poor among the participants. The lowest level of knowledge for all participants pertained to its prevention and treatment. The prevalence of HCV was low in Saudi Arabia (0.38%). However, adequate knowledge of HCV was lacking. Thus, the need to increase knowledge and awareness of HCV in the Saudi population is warranted.

Preventing hepatocellular carcinoma in Egypt: results of a Pilot Health Education Intervention Study

BACKGROUND

Hepatocellular carcinoma (HCC), one of the most fatal malignancies, is particularly prevalent in Egypt, where we previously found deficiencies in knowledge concerning HCC and its risk factors. Hepatitis B and C viral infections are highly prevalent in Egypt, pesticides are very commonly used, and diets are often contaminated by aflatoxin, especially in rural areas.

METHODS

We conducted a study to pilot test a health education intervention addressing HCC, its risk factors, and its main modes of prevention. It included four health education modules: HCC, hepatitis viruses, pesticides and aflatoxin. We used a pre- and post-intervention set of questionnaires to assess knowledge gained by the participants.

RESULTS

A total of 25 participants from a village in the Nile Delta area attended the health education session and completed the questionnaires. The education intervention significantly increased the participants' knowledge on HCC and its risk factors, particularly regarding the use of pesticides at home and aflatoxin contaminated foods (both p < 0.05). Overall, there was a 12% increase in the number of participants who believed that HCC could be prevented, and they reported their intention to practice prevention for HCC risk factors.

CONCLUSIONS

We found that the education intervention we pilot tested was feasible and proved effective in increasing participants' knowledge. Future efforts should focus on implementing targeted education programs in high-risk populations in Egypt.