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ORIGINAL ARTICLE
Year : 2014  |  Volume : 27  |  Issue : 4  |  Page : 686-690

Seroprevalence and risk factors of hepatitis C virus infection among population in Kafr El Sheikh Governorate


Department of Internal Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt

Date of Submission12-Aug-2013
Date of Acceptance17-Feb-2014
Date of Web Publication22-Jan-2015

Correspondence Address:
Bahaa Abd El Hamid Mohamed
Damro, Sidi Salem, Kafr El Sheikh 33749
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1110-2098.149678

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  Abstract 

Objectives
The aims of the study were to estimate the antibodies prevalence and to determine risk factors of hepatitis C virus (HCV) infection in the population of Kafr El Sheikh Governorate.
Background
HCV infection is a major public health problem worldwide. Persistent HCV infection is a leading cause of serious liver disease, including cirrhosis and hepatocellular carcinoma.
Patients and methods
This study included 1000 participants; they were randomly selected from different districts at Kafr El Sheikh Governorate. All participants were subjected to thorough history taking, clinical assessment, and detection of HCV antibodies by one-step test device.
Results
The prevalence of HCV antibodies seropositive individuals in the study was 16.7% and it is higher among men and in rural areas than in women and in urban areas, respectively.
Conclusion
The prevalence of HCV infection in the population of Kafr El Sheikh Governorate is considered as public health problem. The evaluation of chronic HCV prevalence and risk factors for transmission represents a great challenge, which will pay off in achievement of efficient measures for HCV prevention.

Keywords: Hepatitis C virus, prevalence, risk factors


How to cite this article:
Boghdady IM, ElKafrawy NA, Shoaib AA, Mohamed BA. Seroprevalence and risk factors of hepatitis C virus infection among population in Kafr El Sheikh Governorate. Menoufia Med J 2014;27:686-90

How to cite this URL:
Boghdady IM, ElKafrawy NA, Shoaib AA, Mohamed BA. Seroprevalence and risk factors of hepatitis C virus infection among population in Kafr El Sheikh Governorate. Menoufia Med J [serial online] 2014 [cited 2020 Mar 29];27:686-90. Available from: http://www.mmj.eg.net/text.asp?2014/27/4/686/149678


  Introduction Top


Hepatitis C virus (HCV) infection is a major public health problem worldwide. An estimated 170 million persons have been infected with HCV globally. Persistent HCV infection is a leading cause of serious liver disease, including cirrhosis and hepatocellular carcinoma [1].

The variation in HCV prevalence could be related to the proportion of injection drug users in the population. One striking example of a large epidemic of HCV spread throughout the general population by contaminated medical injections occurred as a complication of the public health program in Egypt. This program was designed to prevent the transmission of schistosomiasis by treating humans with parenterally administered antiparasitic drugs in the community [2].

Egypt has possibly the highest HCV prevalence in the world; 10-20% of the general populations are infected and HCV is the leading cause of hepatocellular carcinoma and chronic liver disease in the country [3].

Determining the incidence of HCV infection (i.e. the rate of newly acquired infections) is difficult because most acute infections are asymptomatic, available assays do not distinguish acute from chronic or resolved infection, and most countries do not systematically collect data on cases of acute disease. Even in countries with well-established surveillance systems, acute disease reporting systems underestimate the incidence of HCV infection [4].


  Aims Top


The aims of the study were to estimate the antibodies prevalence and to determine risk factors of HCV infection in the population of Kafr El Sheikh Governorate.


  Patients and methods Top


Study design

Cross-sectional design was used.

The sample

The study was conducted in Kafr El Sheikh Governorate during a period between June 2012 and March 2013. A multistage systematic sampling technique is the most appropriate method for the sampling selection. Fewoa City and Qeprut village were randomly selected from Kafr El Sheikh districts and they were divided (every one separately) into three sectors using a geographical famous landmarks; one sector was randomly selected, within which houses were systematically selected every second house until the desired number of participants was reached. All available members of the households above 18 years of age up to 60 years were included in the study. Publication was performed through the health authority with determining the days of our work in the selected places.

Sample size

With the assumption that the prevalence of hepatitis C 15% at confidence level at 95%, the study power 80%, a sample size of 906 participants would be suitable for that design. Accounting for a dropout rate about 10%, we decided to reach the sample size to 1000. To get sufficient number of people to detect the above-mentioned prevalence, we considered Fewoa City and Qeprut village as the population suitable for this study.

Exclusion criteria

Exclusion criteria were viral hepatitis other than HCV infection, especially hepatitis B virus infection whose candidates were being excluded using one-step test device (by ACON Laboratories). Other hepatitis viruses were excluded by history (being almost acute giving characteristic clinical picture).

Members of the study group were subjected to the following:

(1) Thorough history taking : History was taken from all members of the study group with special emphasis on symptoms and its duration (e.g. abdominal pain, enlarged abdomen, lower limb edema, fatigue, loss of weight, and jaundice).

(a) Special reference was given to host risk factors of HCV exposure in surgical wards, blood transfusion, dental therapy, needle sticks injuries, parenteral antischistosomiasis therapy, tattooing, and positive cases in the family habits of the patients, such as shaving, circumcision.

(2) Complete physical examination : With special emphasis on signs of liver cell failure (e.g. jaundice, ascites, hepatomegaly, splenomegaly, lower limb edema).

(3) Laboratory : Detection of HCV antibodies by one-step test device (by ACON Laboratories) [5].

Sampling and methods

Blood was collected from the patients by vacuum venipuncture (after taking their consent), using a dry 5-ml tube. The serum was separated, centrifuged, aliquoted, and stored at -20°C.

Statistical analyses

Statistical presentation and analysis of the present study was conducted using the mean, SD, and the c2 -test by SPSS (V.16; SPSS Inc., Chicago, Illinois, USA). Logistic regression was used to predict the outcome in exposed. P value greater than 0.05 was considered statistically nonsignificant. P value less than 0.05 was considered statistically significant [6].


  Results Top


[Table 1] presents the distribution of the studied sample by some sociodemographic characteristics. A total of 1000 participants were included in the study. Male patients constituted 71.5% of the candidates; 27.7% of our sample were fishermen and farmers were 20.1%. In all, 38.3% were below 40 years of age and 61.7% were above 40 years.
Table 1: Sociodemographic characteristics of the studied group

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[Figure 1] shows that the HCV antibodies prevalence among studied population (n = 1000) was 16.7%.
Figure 1: Hepatitis C virus (HCV) antibodies prevalence among studied population (n = 1000).

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[Table 2] presents seroprevalence of HCV among studied population according to sex. Male patients had higher risk for infection than female patients: 141 (19.72%) seropositive male patients from 715 male patients and 26 (9.12%) seropositive female patients from 285 female patients. The prevalence was statistically significant in seropositive male patients with respect to total number of male individuals.
Table 2: Seroprevalence of hepatitis C virus among studied population according to sex

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[Table 3] presents seroprevalence of HCV among studied population according to age. HCV antibodies prevalence sharply increases with age, 4.5% in 40 years of age or below and 36.2% in older age above 40 years, and the difference was statistically significant in both age groups.
Table 3: Seroprevalence of hepatitis C virus among studied population according to age

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In a comparison between seropositive candidates' occupations with respect to their own ages, we found that there is high seroprevalence in fishermen and farmers among all candidates' ages, but in those who are more than 40 years of age, medical staff, percentage is high then employee and least in workers, and in those who are less than 40 years, there is high seroprevalence in students and employee and lesser prevalence in workers and housewives.

[Table 4] shows HCV risk factors among studied population. We found that the highest risk factors occur with tarter emetic then tooth extraction and lowest with abortion and blood transfusion. There is statistically significant difference in operation, blood transfusion, and abortion risk factors.
Table 4: Hepatitis C virus risk factors among studied population

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[Table 5] presents HCV seroprevalence according to occupation. Medical staffs and fishermen represent the highest prevalence rate, whereas students represent the lowest prevalence. There is statistically significant difference in prevalence rate in students, medical staffs, and workers.
Table 5: Hepatitis C virus seroprevalence according to occupation

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[Table 6] presents HCV seroprevalence according to residence. There is high seroprevalence of HCV infection in rural areas than in urban areas, and it has statistically significant difference.
Table 6: Hepatitis C virus seroprevalence according to residence

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There were 54 (32.3%) individuals who had positive interfamilial exposure to HCV, whereas 113 (67.7%) individuals had negative interfamilial exposure. With respect to social class, 91 of 363 (54.5%) individuals of low class were HCV seropositive and 72 of 568 (43.1%) individuals from middle class were HCV seropositive and only four of 69 (2.4%) of high class were HCV seropositive. This indicates the high seroprevalence of HCV in low class then middle than high class.


  Discussion Top


Hepatitis C is a disease of significant global impact. According to the WHO there are 170-200 million people infected with HCV. There are considerable regional differences; in some countries (e.g. Egypt) the prevalence is as high as 22% [7].

The origin of the HCV epidemic in Egypt has been attributed to mass campaigns of parenteral antischistosomiasis treatment during the 1960-1970s [8]. Treatment predominately targeted children and young adults living in schistosomiasis endemic areas, and consisted of weekly injections of antimony salts for 12-16 weeks. Insufficient sterilization of the injecting equipment used during this mass treatment campaign is considered to be the cause of the HCV transmission at that time [9].

Despite the broad-spread introduction of praziquantel in 1982, an oral drug to treat schistosomiasis [10], the transmission of HCV in Egypt has continued through a variety of mechanisms including blood transfusion [11], injections, dental treatment, surgery and invasive medical procedures, and instrumental delivery [12]. Most (>90%) HCV isolates found in Egypt belong to genotype 4 [13].

In the present study, the overall prevalence of positive population for HCV antibody in serum was 16.7%, which is slightly higher than in previous studies of national prevalence that reported a lower prevalence of HCV infection. The national prevalence rate of HCV antibody positivity has been estimated to be between 10 and 13% [14].

Several studies have been conducted in Egypt to determine the prevalence of HCV among blood donors. Saeed et al. [15] recorded a prevalence of 19.2 for blood donors, whereas Darwish et al. [16] demonstrated an overall positive rate of 14.1% among 90 serum samples from nonprofessional blood donors. In 1993, Darwish et al. [17] performed blood tests on 163 volunteer blood donors seen at one Cairo hospital and found the prevalence of HCV to be 13.6%. Furthermore, in 1995, Bassily et al. [18] tested 188 consecutive adult blood donors from four hospitals and one temporary donor center located in Cairo. Antibodies to HCV were detected by RIBA in 26.6% of the blood donors.

Abdel-Wahab et al. [19] recorded a prevalence of 18.1% for rural village residents in a cross-sectional study in Menoufia, Lower Egypt among 270 candidates. Another cross-sectional study in Menoufia Governorate by Elkareh et al. [20] recorded a prevalence of 12.7% in family replacement blood donors. Our study copes with the study by Kamel et al. [21] in Sada, Kafr El Sheikh, Lower Egypt, which recorded a prevalence of 15.9% of 1259 candidates for rural village residents. In antenatal clinic attendees studies recorded in 2009 by Zahran et al. [22], they recorded a prevalence of 8.0% in Assuit, Upper Egypt; AbdulQawi et al. [23] in 2008 recorded a prevalence of 8.6% in Benha, Qalubiya, Lower Egypt, whereas Kassem et al. [24] in 1996 recorded a prevalence of 19.0% in Alexandria City.

In 2008, nearly 15% of the population aged 15-59 years had antibodies to HCV (anti-HCV), and 10% (approximately five million persons) had chronic HCV infection. Overall, an estimated six million Egyptians had chronic HCV infection in 2008 [25].

However, this study agrees with the study by Awadalla et al. [26], which stated that 16.8% of the studied sample were seropositive for the anti-HCV antibodies. In this study, prevalence rate increases with age and this copes with the study by El Damaty et al. [27], which showed an increase with the increase of age.

In this study, the prevalence is higher among persons residing in rural versus urban areas (13.6 vs. 3.1%) and this copes with the study by El Zanaty et al. [25], which found that the prevalence is higher among persons residing in rural versus urban areas (12 vs. 7%).

Studies carried out in the 1970s suggested that about 7% of transfusion recipients developed non-A non-B hepatitis and that up to 1% of blood units might contain causation virus. The introduction of anti-HCV screening has obviously reduced the transmission [28].

Mostafa et al. [29] recommended screening of families of infected HCV patients as an essential part of case management for early detection and their further management.

Of even greater importance in the spread of HCV are unsafe therapeutic injections performed by both professionals and nonprofessionals. It has been estimated that approximately two million HCV infections are acquired annually from contaminated healthcare injections and may account for up to 40% of all HCV infections worldwide [30].


  Conclusion Top


The estimated prevalence of HCV infection in Kafr El Sheikh Governorate is considered as public health problem. We encourage similar studies to be conducted in all Egyptian governorates to evaluate this major health problem all over Egypt.

The evaluation of chronic HCV prevalence, genotype distribution, and risk factors for transmission represents a great challenge, which will pay off in achievement of efficient measures for hepatitis C prevention.


  Acknowledgements Top


The authors thank all the workers and participants who generously agreed to participate in the study.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

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Abstract
Introduction
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Patients and methods
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