Prevalence and risk factors of hepatitis C virus infection in Armenia, 2021

Background

Liver damage caused by hepatitis C virus (HCV) is common, especially in low- and middle-income countries. Chronic HCV infection is among the leading causes of chronic liver disease, cirrhosis and hepatocellular carcinoma. Data on prevalence and risk factors of HCV infection are important for planning effective interventions to fight the virus. This study investigated the prevalence of HCV, its genotypes and factors associated with chronic HCV infection in Armenia.

Methods

The study included 3838 individuals 18 years and older selected via stratified two-stage cluster sampling from all regions of Armenia. Anti-HCV antibodies were detected using a third generation immunoassay. Those testing positive were further tested by Polymerase Chain Reaction and genotyping. Shortly after testing, the participants underwent a telephone survey. Logistic regression model was fitted to identify factors associated with chronic HCV infection.

Results

The participants mean age was 49.5 years, 70.0% were female. The prevalence of HCV antibodies weighted by age and sex was 1.9% (95% CI 1.5, 2.3), and chronic HCV infection - 0.7% (95% CI 0.4, 0.9), with genotype 3 being the most common (41.7%), followed by genotypes 2 (37.5%) and 1 (20.8%). The prevalence of both antibodies and chronic infection were higher among 50-69 years old (3.4% and 1.3%, respectively). In weighted analysis, the risk factors for chronic HCV infection included male sex (95% CI 1.23, 11.59), having tattoos (95% CI 1.10, 7.80), and reporting liver disease (95% CI 1.24, 14.61). Being employed was protective (95% CI 0.14, 0.93).

Conclusions

This study was the first attempt to measure the prevalence of HCV infection among the general population of Armenia, creating prerequisites for estimating the HCV-related disease burden and developing strategies to cope with it. The identified risk factors demonstrate that there is still room for strengthening safety measures to prevent the transmission of HCV in Armenia.

Key messages

• The prevalence of HCV antibodies is 1.9% among adult population of Armenia, increasing with age. Over one-third of seropositive cases have chronic infection caused by HCV genotypes 3, 2 or 1.

• Having tattoos is associated with higher risk of being infected with HCV, demonstrating the need for strengthening safety measures during similar procedures to prevent viral transmission.

Depression among survivors of 1988 Spitak earthquake in Armenia: a prospective cohort study

Background

Mental health-related consequences of disasters can be very long lasting. Depression is one of the most prevalent psychopathologies among disaster survivors. Yet, compared to PTSD, it is studied much less among disaster victims. Studies of depression decades after the exposure are extremely rare. This study evaluated the prevalence and predictors of depression in a prospective cohort of Spitak earthquake survivors 23 years after the event.

Methods

A geographically stratified urban sub-sample of 1785 individuals underwent all three baseline waves of the cohort study during 1990-1992 and provided detailed sociodemographic, earthquake exposure and physical and mental health-related information. In 2012, 83.3% (n = 1487) of this subsample was traced and 40.6% (n = 725) interviewed. Depression status was measured via validated and adapted Armenian-language CES-D scale. A fitted linear regression model identified predictors of depression score in 2012.

Results

Twenty-three years after the exposure, the rate of depression in this cohort was 25.4%. Depression was highly comorbid with anxiety (62.0%) and PTSD (36.8%). Factors positively associated with depression score included number of stressful life events (95% CI 0.33, 1.20), poor self-rated health (95% CI 2.45, 5.40), earthquake-related deaths in the family (95% CI 0.12, 3.80), and strong phobia and fear at baseline (95% CI 0.51, 2.96). Age (95% CI -0.15, -0.06), social support score (95% CI -0.83, -0.55), quality of life score (95% CI -15.83, -10.77), and being married (95% CI -2.61, -0.35) were protective for depression. The fitted model explained 46.6% of the variance in the depression score.

Conclusions

This study found an increased prevalence of depression among earthquake survivors over two decades after the exposure. The identified potentially modifiable predictors of long-term depression create prerequisites for planning better targeted mental health recovery interventions among disaster survivors.

Key messages

Knowledge, attitude and practice towards antibiotic resistance among general practitioners in Armenia

Background

Antibiotic resistance is an important public health issue. This study sought to measure general practitioners' (GPs) knowledge, attitude, and practice on antibiotic resistance; explore the adjusted associations between their antibiotics prescribing practice score and knowledge and attitude scores, and identify barriers for rational prescription of antibiotics by GPs.

Methods

A cross-sectional self-administered survey was conducted among GPs. Multivariable linear regression was applied to analyze the data.

Results

Overall, 291 GPs participated in the study. Knowledge, attitude, and practice mean percent scores were 58.3%, 67.5%, and 63.0%, respectively. In the adjusted analysis, the practice percent score was significantly associated with the attitude percent score (β = 0.58; 95% CI: 0.41, 0.75; p < 0.001), though the relation between the practice and knowledge scores was insignificant. The main barriers reported by GPs: lack of rapid diagnostic tests, high costs of laboratory tests, high costs of some antibiotics, and lack of guidelines.

Conclusions

Identified low knowledge, attitude, and practice mean percent scores suggest a need for improvements in these areas. Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions could potentially prevent the development of antibiotic resistance.

Key messages

Availability of rapid and inexpensive diagnostic tests, enforcement of prescriptions, and regulation of antibiotics’ prices could help to improve antibiotics prescribing practices of GPs. Low knowledge, attitude and practice levels regarding antibiotic resistance among GPs in polyclinics suggests a need for improvement in these areas.

Psychometric value of the Center for Epidemiologic Studies Depression (CES-D) scale for screening of depressive symptoms in Armenian population

BACKGROUND

This study examined the psychometric value of the Center for Epidemiologic Studies Depression Scale (CES-D) translated for use with an Armenian population.

METHODS

Using data obtained from a country-wide health survey of 2310 households involving female and male respondents aged 18 and over, we investigated the response pattern to the CES-D items, the factor structure, internal consistency, inter-item correlations of the total scale and its negatively and positively formulated subscales. We used logistic regression analysis to relate the constructs measured by the CES-D and its subscales to known determinants of depression.

RESULTS

Armenian respondents of both genders significantly suppressed their positive emotions, thus over-endorsing positively formulated (reverse-coded) items, therefore producing artificially high depression scores. Factor analysis of the scale yielded a three-factor structure (combined Depressed/Somatic, Positive Affect, and Interpersonal). The Positive Affect factor correlated weakly with the other two factors, and its inclusion reduced the internal consistency of the whole scale. Unlike the 16-item subscale of negatively formulated items, Positive Affect was not related to several known determinants of depression and did not reflect known depression-specific differences between genders. The set of determinants of Positive Affect included mainly lifestyle and attitudinal variables.

LIMITATIONS

This study did not assess the concurrent and discriminate validity of the Armenian CES-D.

CONCLUSIONS

For Armenians, the construct measured by the four Positive Affect items of CES-D is not related to depressive symptoms as measured by the other items. It introduces ethnical/cultural response bias in CES-D score and reduces the cross-cultural comparability of the latter.