Khaled M. Abd Elaziz

Effect of yearly mass drug administration with diethylcarbamazine and albendazole on bancroftian filariasis in Egypt: a comprehensive assessment

BACKGROUND Egypt was one of the first countries to implement a national programme to eliminate lymphatic filariasis based on WHOs strategy of repeated rounds of mass drug administration (MDA) with diethylcarbamazine and albendazole (target population, 2.5 million in 181 localities). We assessed the effect of five yearly rounds of MDA on filariasis in four sentinel villages in Egypt. METHODS We studied two areas with different infection rates before MDA: the Qalubyia study area had a low infection rate because of previous treatment with diethylcarbamazine; this was typical of most filariasis-endemic villages in Egypt before MDA. The Giza study area had a high baseline infection rate. We undertook repeated surveys in villages for treatment compliance and tests for microfilaraemia and circulating filarial antigenaemia, antibodies to filarial antigen Bm14 in schoolchildren, and infections in indoor-resting mosquitoes (assessed by PCR). FINDINGS MDA compliance rates were excellent (>80%). In Giza after MDA, prevalence rates of microfilaraemia and circulating filarial antigenaemia fell from 11.5% to 1.2%, and from 19.0% to 4.8%, respectively (p<0.0001). Corresponding rates in Qalubyia fell from 3.1% to 0% and 13.6% to 3.1%, respectively (p<0.0001). Rates of antifilarial antibody and circulating filarial antigenaemia in schoolchildren (aged about 7-8 years), fell from 18.3% to 0.2% (p<0.0001) and from 10.0% to 0.4% (p<0.0001) in Giza, respectively, and from 1.7% to 0% and 1.7% to 0% (both p=0.13) in Qalubyia, respectively. Mosquito infection rates fell from 3.07% (95% CI 2.38-3.88) to 0.19% (0.08-0.38) in Giza and from 4.37% (3.07-5.99) to 0% (0-0.05) in Qalubyia. INTERPRETATION MDA greatly affects variables related to infection (microfilaraemia and circulating filarial antigenaemia prevalence rates) and transmission (antifilarial antibodies in young children and mosquito infection rates). Our results suggest that after five rounds of MDA filariasis is likely to have been eliminated in most endemic localities in Egypt.

Chronic hepatitis C virus infection: Does it really impact health-related quality of life? A study in rural Egypt

Previous Western studies showed a consistent and marked reduction in health‐related quality of life (HRQOL) in patients chronically infected with hepatitis C virus (HCV). However, these studies were conducted on patients whose knowledge of their serological status may have affected their HRQOL. This HRQOL survey conducted in the Egyptian rural population provides a unique opportunity to clarify this issue among a population whose serological status is unknown. HRQOL was assessed by an Arabic translation of the Short‐Form 12, and a visual analog scale of the relative severity of ones health status. HCV chronic infection was defined by positive tests for anti‐HCV antibody and HCV‐RNA. HRQOL was compared according to HCV chronic infection status in linear mixed models adjusted for potential confounding factors, such as age, sex, education, and health care–related risk factors, and adjusted for interviewer as a random effect. One hundred forty‐six Egyptians chronically infected with HCV had similar Short‐Form 12 and visual analog scale scores, compared with 1,140 uninfected controls from the same rural community. In individuals chronically infected with HCV, serum aminotransferase levels did not correlate with HRQOL. In conclusion, this study did not find a significant reduction of HRQOL in patients chronically infected with HCV compared with uninfected, contemporaneous controls. This may be explained in part by a lower morbidity amongst patients chronically infected with HCV in rural Egypt and a higher morbidity amongst uninfected controls as compared with those of Western studies, as well as a lack of awareness of hepatitis C serological status. (HEPATOLOGY 2004;40:1434–1441.)

Coverage and side effects of influenza A(H1N1) 2009 monovalent vaccine among primary health care workers.

In June 2009, WHO declared the maximum phase alert against H1N1 pandemic flu. Health care workers (HCWs) are considered a strategic target for prevention of the occurrence of H1N1 influenza since they had the greatest risk of acquiring infection. The objectives of our study were (1) identifying the uptake of influenza A(H1N1) 2009 monovalent vaccine by primary health care workers in the southern part of Cordoba, and (2) reporting of the adverse events occurred after vaccination. We followed 240 HCWs in 12 primary health care centres at southern part of Cordoba for vaccine uptake and the occurrence of adverse events. The coverage rate with H1N1 vaccine was 20.5% which was lower compared to seasonal influenza vaccination rate 44.2% in 2009. Males had higher H1N1 vaccination rate compared to females with no significant difference. Senior HCWs complied more with seasonal influenza vaccine while this finding was not consistent with H1N1 vaccination. Multivariate analysis showed that the only independent variable that affected H1N1 vaccine was the compliance to the seasonal flu vaccine in the past three years with OR 5.1 and 95% CI (2.4-10.8). Adverse events occurred among 26.5% of those who complied with H1N1 vaccination. Those were local pain, irritation and induration at site of injection (38.5%), fever (15.4%), fever cough and rhinorrhea (15.4%) generalized pain and lumber pains (23.1%). The low vaccination rate in this study is consistent with previous studies done in many parts of the world and in Spain. Further studies should be done to explore the factors that hindered the uptake and resistance of HCWs to vaccination to H1N1 vaccine.

Mapping of Schistosoma mansoni in the Nile Delta, Egypt: Assessment of the prevalence by the circulating cathodic antigen urine assay

In line with WHO recommendations on elimination of schistosomiasis, accurate identification of all areas of residual transmission is a key step to design and implement measures aimed at interrupting transmission in low-endemic settings. To this purpose, we assessed the prevalence of active S. mansoni infection in five pilot governorates in the Nile Delta of Egypt by examining schoolchildren (6-15 years) using the Urine-Circulating Cathodic Antigen (Urine-CCA) cassette test; we also carried out the standard Kato-Katz (KK) thick smear, the monitoring and evaluation tool employed by Egypts national schistosomiasis control programme. Prevalence rates determined by the Urine-CCA test for all governorates were higher than those determined by KK (p<0.01). Of 35 districts surveyed in the five governorates, S. mansoni infection was detected in 19 districts (54.3%) using KK, and in 31 districts (88.6%) by Urine-CCA (χ2=9.94; P=0.0016). S. mansoni infections were detected by Urine-CCA, but not by KK in 12 districts (34.3%), and infection was not detected by either of the two diagnostic methods in four districts in Qalyubia governorate. Males and higher age-groups have significantly higher Urine-CCA prevalence rates. Based on the findings of the current S. mansoni mapping exercise, authorities of the Ministry of Health and Population (MoHP) adopted a new elimination strategy by readjusting thresholds for mass treatment with praziquantel and targeting all transmission areas. MoHP is now planning to remap in all other endemic governorates using Urine-CCA with the aim of identifying all areas of transmission where the elimination strategy should be applied.

Prevalence of metabolic syndrome and cardiovascular risk factors among voluntary screened middle-aged and elderly Egyptians

BACKGROUND Central obesity and diabetes mellitus are recorded at high percentages among Egyptians. The aim of this study is to determine the prevalence of metabolic syndrome (MetS) and cardiovascular risk factors among a group of middle-aged and elderly Egyptians. METHODS Our study included 220 middle-aged and senior Egyptians voluntary screened in an Egyptian private hospital with 800-bed capacity. Detailed medical history was obtained from all subjects, followed by clinical examination with weight and height measurement, body mass index calculation, waist hip ratio and arterial blood pressure measurement. Laboratory investigations done were complete blood picture, lipid profile and fasting blood glucose measurements. The diagnosis of MetS was based on the American Heart Association/Updated NCEP ATP III criteria. Cardiovascular risk assessment was calculated for each subject based on the Framingham/ATP III criteria. RESULTS The prevalence of MetS in this study was of 55% among the whole sample, 85.6% among diabetics and 76.6% among hypertensive patients. Based on Framingham scoring system, 48.2% of the sample had moderate to high risk of developing cardiovascular disease. Odds ratio for patients with MetS for developing cardiovascular disease in the next 10 years was 2.8 (95% confidence interval: 1.6-4.8). CONCLUSION The high prevalence of MetS among middle-aged and elderly Egyptians with the documented high prevalence of chronic diseases in Egypt calls for a nationwide screening program to detect MetS and tackle preventive strategies to face the epidemic of obesity and outcomes of MetS, particularly cardiovascular diseases.

Test Your Memory Test, Arabic Version:: Is It Practical in a Different Culture?

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Knowledge and Practice Related to Compliance with Mass Drug Administration during the Egyptian National Filariasis Elimination Program

Lymphatic filariasis (LF) has been targeted for global elimination by 2020. The primary tool for the program is mass drug administration (MDA) with antifilarial medications to reduce the source of microfilariae required for mosquito transmission of the parasite. This strategy requires high MDA compliance rates. Egypt initiated a national filariasis elimination program in 2000 that targeted approximately 2.7 million persons in 181 disease-endemic localities. This study assessed factors associated with MDA compliance in year three of the Egyptian LF elimination program. 2,859 subjects were interviewed in six villages. The surveyed compliance rate for MDA in these villages was 85.3% (95% confidence interval = 83.9-86.5%). Compliance with MDA was positively associated with LF knowledge scores, male sex, and older age. Adverse events reported by 18.4% of participants were mild and more common in females. This study has provided new information on factors associated with MDA compliance during Egypts successful LF elimination program.

A measles and rubella (MR) catch-up vaccination campaign in an Egyptian University: vaccine uptake and knowledge and attitudes of students.

INTRODUCTION In 2008, following a rubella epidemic, the Egyptian Ministry of Health implemented a Measles Rubella (MR) catch-up campaign, based on WHO recommendations for supplementary immunization activities to eliminate measles by 2010. The age group targeted was 10-20 years. This campaign was unique in Egypt as it was the first national vaccination campaign which included university students. AIM To report uptake of MR vaccine and reasons for declining the vaccine among medical and non-medical students in the campaign and to assess the knowledge about the vaccine and the diseases. METHODS The study was conducted in two stages. In the first stage during the vaccination sessions, medical and other students (N=310) were given a questionnaire to assess their knowledge of the campaign and the vaccine. The second stage (N=341) was carried out when the campaign was completed to assess vaccine uptake among medical students. RESULTS Posters displayed inside the university were reported to be the main source of information about the campaign. Students were generally poorly informed about both vaccine adverse effects, and contraindications although medical students tended to be better informed than other students. Overall 64.8% medical students accepted the vaccine with higher uptake among females than males (85.9 and 58.3% respectively). Non-compliant students had a significantly higher mean age. Almost half of students who did not accept the vaccine gave their reason as having little information about the vaccine (43.3%). CONCLUSION The MR campaign in Ain Shams University may have been more successful with better use of health education messages.

Screening for hypertension among adults: community outreach in Cairo, Egypt.

BACKGROUND Studies have shown alarming levels of hypertension among adults in the Middle East. The aim of our study is to measure the prevalence rate of hypertension among adults in Cairo (Egypt), identify possible risk factors for the development of hypertension and assess the rates of undiagnosed and uncontrolled hypertension. METHODS Cluster sampling was utilized and the fieldwork was conducted by 12 teams; each team consisted of a house officer, community worker and senior epidemiologist. A formulated questionnaire that addresses risk factors for hypertension was filled by all participants. Also, weight and height measurements were done to calculate the body mass index. Blood pressure measurement was done by calibrated sphygmomanometers. Blood pressure measurement was done twice, and a mean recording was calculated. A case which recorded both systolic blood pressure of ≥140 and diastolic blood pressure of ≥90 was considered hypertensive. RESULTS The study included 774 adult residents of Al-Waily District (Western Zone of Cairo) in late 2011 and early 2012. The mean age of the study participants was 46.5 (SD 17.9) years. Female subjects constituted 67.1% of the studied sample. The prevalence rate of hypertension in our study was 16.5% (95% confidence interval (CI): 13.9-19.3). The rate of hypertension was higher among females and three times higher among obese compared with normal or overweight adults. The prevalence of undiagnosed hypertension was 11% (95% CI: 8.4-13.9), and uncontrolled hypertension was 30% (95% CI: 24.2-37). CONCLUSIONS Community outreach campaigns should be conducted regularly in the future for early detection of hypertension cases and proper health education about hypertension and its dangerous consequences.

Prevalence of injuries among high school students in Eastern and Western parts of Cairo, Egypt

BACKGROUND Injury is the leading cause of death and long term disability and a significant contributor to healthcare costs among children worldwide especially those aged 15-19 years. OBJECTIVES To determine the prevalence of injuries among secondary school students in Cairo, Egypt and to explore the associated risk factors for sustaining injury. METHODOLOGY A Cross-sectional study was conducted on secondary school students in eastern and western part of Cairo; self-administered questionnaire was used for assessing injuries sustained in previous 12 months and the associated risk factors for injury. RESULTS The overall prevalence of injuries was 68.5%. Unintentional injuries were the most common injuries falls (50%) and burns (38.6%). Significant factors associated with sustaining injury were truancy, smoking, alcohol use, quarreling behavior, carrying weapon, threatened by weapon and verbal bullying. CONCLUSION This study showed a high prevalence of injuries among high school students in Egypt which necessitates raising public awareness about the magnitude and burden of injuries among adolescents.