Seroprevalence and factors associated with SARS-CoV-2 infection among healthcare workers: cross-sectional study.

BACKGROUND: Healthcare workers (HCWs) are at a higher risk of contracting COVID-19 due to their close contact with infected patients. However, the true burden of COVID-19 among HCWs in Yemen is unknown due to the inadequate availability of healthcare and the subclinical nature of the disease. This study aims to estimate the seroprevalence of SARS-CoV-2 infection among HCWs in two Yemeni governorates and identify associated factors using a cross-sectional design. METHOD: A total of 404 HCWs were surveyed from June 2022 to September 2022 in Lahj and AL-Dhalea hospitals. A self-administered questionnaire collected demographic data, COVID-19 infection history, and vaccination status. A total of 404 human sera were tested using a specific electrochemiluminescence immunoassay assay. Association analysis was conducted to identify associations between antibody prevalence and demographic and vaccine-related variables. RESULT: The median age of the HCWs was 31 (Range 20-64) years, with 65.0% being male and 35.0% female. Of all HCWs, 94% were SARS-CoV-2 seropositive and 77.0% had no confirmed test of COVID-19-related symptoms. There was no significant association between seropositivity and demographic factors such as age, gender, occupation, or COVID-19 vaccination (P > 0.05). CONCLUSION: The seroprevalence of SARS-CoV-2 was high among HCWs in Yemen, primarily due to natural infection rather than vaccination. Compliance with infection prevention and control measures did not significantly affect seropositivity. This study highlights the need for improved healthcare systems and resources to reduce the burden of COVID-19 and promote infection prevention and control (IPC) measures among HCWs in Yemen.

The burden of leukemia in the Kingdom of Saudi Arabia: 15 years period (1999-2013).

BACKGROUND: Leukemia is a malignant neoplasm that arises from hematopoietic cells. The number of leukemia cases has dramatically increased from 297,000 to 437, 033 cases worldwide. As result, the the Saudi Cancer Registry ramked leukemia as the 5th type of cancer cases among both genders in Saudi Arabia. Data on the trend and incidence of leukemnia in Saudi Arabia is lacking. This study aims to report the trend and incidence of leukemia in Saudi Arabia using available data from the Saudi Cancer Registry (SCR), as a population-based cancer registry in the country over a period of 15 years (1999-2013). METHODS: Data of registered leukemia cases between years 1999-2013 were retrieved from the Saudi Council of Health, Saudi Cancer Registry. Data were coded using the International Classification of Diseases for Oncology (ICD-O). Main and essential variables were retrieved such as age, sex, years of incidence, residency, and histopathological type of leukemia. RESULTS: A total of 8712 cases of leukemia were analyzed in this study, 57.2% were males and 42.8% were females. Around 33.6% of cases were from the central region of Saudi Arabia. The most diagnosed type of leukemia was the Precursor B-cell lymphoblastic leukemia (18.7%), followed by Precursor cell lymphoblastic leukemia, NOS (17.3%) with equal percentage of reported cases between males and females in these subsets. CONCLUSION: Ove a period of 15 years, the trend of leukemia showed the likelihood of increase in rate particularly in males with highest incidence reported from the central region of Saudi Arabia which needs more investigation. Resources for diagnosis and treatment should be planned with more orientation toward the accurate diagnosis of leukemia to minimize the number of "none specific diagnosis".

Cancer incidence in Yemen from 1997 to 2011: a report from the Aden cancer registry.

BACKGROUND: This study aims to report on the trend and incidence of cancers in Yemen (Aden) using data from Aden Cancer Registry (ACR), as a population-based cancer registry in Yemen over a period of 15 years (1997-2011). Such comprehensive, valid and detailed information on cancer trend is badly needed for planning a cancer control program in the country. METHODS: All cancer cases were abstracted from patients' medical records - based on clinical, histopathology, and radiological diagnosis. Data were coded using the International Classification of Diseases for Oncology (ICD-O) and the International Classification of Childhood Cancer (ICCC-3) to code childhood tumors. The CanReg4 program was used to analyze the data for 15 years study period. RESULTS: A total of 6974 cases were included in this study, 47% were males and 53% females. The overall annual incidence rate was 21.6/100,000 populations; however, the incidence in males was little lower than in females (20.0 and 22.9 per 100,000 populations, respectively). The top five cancers among males were leukaemia (10.5%), nonhodgkin lymphoma [(NHL), 10.1%], colon (7.5%), Hodgkin diseases [(HD), 6.1%] and stomach cancer (5.1%). For females, breast cancer was the top (30.0%), followed by leukaemia (7.6%), NHL (6.6%), colonic (4.9%) and ovarian cancer (4.5%). CONCLUSION: Our findings reveal that, there is urgent need to commence the early screening of breast cancer due to its high frequency among Yemeni women. The government should give more support for cancer registries in the country to sustain its vital contribution to cancer care.

Hepatitis C virus genotypes in Saudi Arabia: a future prediction and laboratory profile.

BACKGROUND: Hepatitis C virus (HCV) genotypes and subtypes are considered an important tool for epidemiological and clinical studies and valuable markers for disease progression and response to antiviral therapy. The aim of this study was to identify the prevalence of HCV genotypes and their relation to socio-demographic factors particularly age and sex, various biochemical profiles and viral load. METHODS: The records (630) of Saudi patients positive for HCV (2007-2011) reported in the system of the Molecular Pathology Laboratory at a tertiary reference hospital in Riyadh, Saudi Arabia were analyzed. Socio-demographic characteristics, liver biochemical profile, viral load and co-infection with HBV and HIV were retrieved from the hospital database. The associations of continuous and categorical variables with genotypes were analyzed. RESULT: The overall mean age of the surveyed patients was 59 years ±0.5 years (21% were <50 years (p = 0.02). The rate of infection is lower in males than in females (47.6% vs. 52.4%). HCV genotype 4 was the most prevalent (60.7%), followed by genotype 1 (24.8%). However, genotype 1 and 3 were found more in males (29.7% vs. 20.3% and 6% vs. 2.1%, respectively, p = 0.001), while genotype 2 and 4 were more among females (4.8% vs. 2% and 68.5% vs. 52.3%, respectively). In addition, genotype 1 was found dominant in younger males (33.8%). Biochemical parameters across gender showed significant variation in particular for the ALT (p = 0.007). The mean viral load was significantly higher in genotype 1 than genotype 4 (4,757,532 vs. 1,435,012, p = <001). There is a very low overall percentage of co-infection of HBV or HIV in this study (around 2% for each). CONCLUSION: Although HCV genotype 4 shows an overall high prevalence in this study, a clear decline in the rate of this genotype was also demonstrated in particular among the younger age group who displayed increasing trends toward the global trend of genotype 1, rather than genotype 4. This finding would be of clinical interest in relation to future planning of the therapy for HCV infected patient.

Assessment of Pregnant Women's Satisfaction with Model of Care Initiative: Antenatal Care Service at Primary Health Care in Cluster One in Riyadh, Saudi Arabia.

The current study assessed pregnant women's satisfaction with antenatal care (ANC) services at primary health care centers (PHCs) in Riyadh Cluster One. The study was conducted at 11 PHCs where the ANC initiative has been implemented. A total of 646 pregnant women were enrolled. A questionnaire was completed by participants to measure the level of satisfaction with the provided services, care, and consultation. Subsequently, the data were analyzed to determine the significant differences and conduct regression analysis. The overall satisfaction with initial triage assessment, provided services, consultation, and examination was 93.7%, 87.8%, 71.8%, and 53.9%, respectively. Regarding ANC services, education was the only statistically significant variable that influenced patient satisfaction (p < 0.05). In contrast, satisfaction with the provided care was significantly related to all the variables studied. For consultation, education (p < 0.001) and monthly income (p < 0.05) were the statistically significant role players. In the regression analysis, secondary education was statistically significantly related to the provided services, consultation, and examination. Despite the satisfactory level of ANC at the selected PHCs, higher patient satisfaction could be achieved in the future by improving the consultation and examination practices. Overall satisfaction with the health care workers at PHCs is high. Incorporating implied ameliorations would enhance the quality of services and patient satisfaction.

Road towards promoting patient safety practices among hospital pharmacists: Hospital-based baseline patient safety culture assessment cross-sectional survey.

ABSTRACT: Patient safety is a fundamental aspect of a healthcare system. The aim of this study was to assess the perception and determinants of the patient safety culture of pharmacists in hospitals, in Riyadh, Saudi Arabia.A survey was conducted with pharmacists in the pharmacies of governmental, /military and private hospitals in Riyadh, Saudi Arabia. The pharmacy survey on patient safety culture questionnaire developed by Agency for Healthcare Research and Qualtity, a hard copy was distriuted to the pharmacists. The positive response rate (RR) was calculated and compared across hospitals using a chi-square test. The predictors of patient safety grades were identified using the generalized estimating equation. The data was analyzed using SAS.A total of 538 questionnaires were distributed, of which 411 responded (RR 76.4%). Of the participants, 229 (56%) were females. The majority 255 (62%) were in the 18 to 34 years age range, and 361 (88%) had a bachelor's degree. The majority of the sample 376 (92%) was a pharmacist. The Positive RR (PRR) ranged between (25.6%-74%). The highest PRR was observed in teamwork (74.4%), followed by 'staff, training and skills' (68%), and 'organizational learning continuous improvement' (66%). The lowest PRR was observed in 'staffing, work pressure, and pace' (25.5%). Comparing the PPR of the various healthcare sectors, the governmental hospitals scored the highest in all patient safety domains. Generalized Estimating Equation analysis showed that with increase in scores of all patient safety culture domains increased the likelihood of reporting a better patient safety grade, whereas respondents' demographic characteristics had no effect except the working experience years 6 years and above had odds of poor reporting of the patient safety grade (odds ratio = 2.54, 95% confience interval (1.543, 4.194), (P = .0003).The grades achieved in the various domains of patient safety culture by pharmacists in Riyadh are below the expected standard. The highest scores were achieved in teamwork, with the lowest scores in staffing, work pressure and pace. Overall, pharmacists in government hospital settings have a better perception of patient safety than their peers in other settings. These results provide the baseline evidence for developing future interventional studies aiming at improving patient safety culture in hospital pharmacy settings.

Knowledge, attitudes, and practices among Saudi women regarding cervical cancer, human papillomavirus (HPV) and corresponding vaccine.

AIM: To our knowledge there are no studies exploring Saudi women's understanding of the importance of the human papillomavirus (HPV) vaccine. In the present study, we examined the awareness of HPV and women's attitudes toward the HPV vaccine. METHOD: Nine focus groups were formed in Riyadh City, Saudi Arabia, including 77 women between the ages of 18 and 45 years old. Face-to-face interviews were conducted in 58 female healthcare providers to examine women's awareness of cervical cancer, HPV, barriers, acceptance, beliefs, and attitudes towards the HPV vaccine. RESULTS: Focus group discussions revealed a lack of knowledge and awareness of cervical cancer, HPV, and the HPV vaccine. Cultural concerns regarding screening and vaccinating for a conventionally known sexually transmitted infection were an emerging theme in addition to not perceiving cervical cancer screening as necessary because women with no signs and symptoms considered themselves not at risk for developing cervical cancer. Approximately 30% of healthcare providers other than physicians were unaware of prevention methods, and 63.3% did not practice any screening methods for cervical cancer and attributed the lack of screening to "no specific reasons at all". CONCLUSION: Because of the unfavorable knowledge and attitude of HPV infection and the associated vaccine from the women in the present study, emphasis should be directed to educate and promote awareness of women to the risk factors of cervical cancer and to the need for screening programs and the administration of the vaccine.

Breast Cancer Screening Awareness and Practices Among Women Attending Primary Health Care Centers in the Ghail Bawazir District of Yemen.

INTRODUCTION: Women with from breast cancer often present to health care facilities with an advanced stage of disease. This study assessed the breast cancer screening awareness and practices among women presenting to primary health care centers in the Ghail-Bawazir district of Yemen. MATERIAL AND METHODS: A cross-sectional descriptive study was carried out from November 1, 2016 through January 31, 2017. A total of 317 women who attended primary health care centers in the Ghail-Bawazir district during the study period were randomly selected for inclusion in the study. Data analysis was carried out using the Statistical Package for the Social Sciences (SPSS) Version 20. Descriptive statistics and χ2 analysis were used to present the frequency distributions and associations that existed in the data. The data was displayed in tables and graphs. RESULTS: Very limited information on breast cancer was obtained from health care providers (14%). Around one-half of the respondents had satisfactory levels of breast cancer knowledge and awareness, whereas 30.3% were practicing self-breast examination, and only 1.6% had ever been exposed to a mammogram test. A significant association between marital status, level of education, working status, and level of knowledge and breast screening practice was reported (P = .01). By regression analysis, age and limited level of knowledge on self-breast examination were found determinant (P < .015) in factors associated with the use of clinical breast examination. CONCLUSION: The study reveals the satisfactory knowledge of women about breast cancer along with inadequate awareness of breast cancer screening and screening practices.

Capacity and readiness of primary health care centers for implementation of the basic strategy for prevention and control of non-communicable diseases in Saudi Arabia. A case study from the Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.

OBJECTIVE: To assess the capacity and readiness of primary healthcare centers (PHC) for the implementation of basic strategies for the prevention and control of non-communicable diseases (NCDs) at the Ministry of National Guard-Health Affairs (MNG-HA) in Saudi Arabia. METHODS: Facility-based face-to-face interviews were conducted in 41 PHCs included in this survey, using the World Health Organization (WHO) questionnaire. Main area survived were: availability of human resources, medical equipment, infrastructure, medicines, service utilization, referral systems, and community outreach.   Results: Approximately 90% of the PHC centers were located in urban areas of the country. The level of staff training on NCD prevention and control strategies was reported to be inadequate, particularly for nurses and other healthcare providers. As for diagnostic equipment, diagnostic tests, essential medication, access to referral facilities and medical records most of them were available in all the PHCs among the different categories. CONCLUSIONS:   The MNG-HA PHCs appear to have the capacity to integrate strategies for the prevention and control of NCDs as part of their daily functions. However, improvements are required in some areas to facilitate the integration process and training the health care workers (HCWs) on prevention and control of NCDs as part of their daily practice.

MERS-CoV infection: Mind the public knowledge gap.

In August 2015, the Corona outbreak caused by Middle East respiratory syndrome coronavirus (MERS-CoV) was the 9th episode since June 2012 in Saudi Arabia. Little is known about the public awareness toward the nature or prevention of the disease. The aim of this work was to assess the knowledge of the adult population in Riyadh toward the MERS-CoV. In this cross-sectional survey, a self-administrated questionnaire was distributed to randomly selected participants visiting malls in Riyadh. The questionnaire contained measurable epidemiological and clinical MERS-CoV knowledge level variables and relevant source of information. The study included 676 participants. Mean age was 32.5 (±SD 8.6) years and 353 (47.8%) were males. Almost all participants heard about the corona disease and causative agent. The study showed a fair overall knowledge (66.0%), less knowledge on epidemiological features of the disease (58.3%), and good knowledge (90.7%) on the clinical manifestation of the MERS-CoV. Internet was the major (89.0%) source of disease information, and other sources including health care providers, SMS, television, magazines and books were low rated (all <25%). In a multivariate logistic regression analysis age ≤30 years (Odds Ratio (OR)=1.647, 95%CI 1.048-2.584, P=0.030), male gender (OR=1.536, 95%CI 1.105-2.134, P=0.01), and no tertiary education (OR=1.957, 95%CI 1.264-3.030, P=0.003) were independent significant predictors of poor epidemiological knowledge. This study concludes that there was inadequate epidemiological knowledge received by the public and the reliance mostly on the clinical manifestations to recognizing the MERS-CoV disease. Comprehensive public health education programs is important to increase awareness of simple epidemiological determinants of the disease is warranted.

Does fasting in Ramadan increase the risk of developing urinary stones?

OBJECTIVES: To explore the frequency of renal colic (RC) secondary to urinary stones in Ramadan compared to other months and seasons of the year. METHODS: Retrospective cross-sectional study using medical records of 237 patients admitted through the emergency room (ER) with a diagnosis of RC secondary to urinary stones over a 10-year period at King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia. RESULTS: Patients fasting in Ramadan are 2 times more likely to present with a calculus of ureter as opposed to calculus in another location in the urinary tract, particularly when the holy month of Ramadan falls in the summer season. There was no significant difference in the frequency of urinary stones between Ramadan and non-Ramadan months. CONCLUSION: Fasting in Ramadan does not increase the risk for developing urinary stones compared to non-fasting months. However, fasting in Ramadan during the summer may increase the risk of developing ureter stones compared to fasting in Ramadan during the winter.

Validation of a diabetes numeracy test in Arabic.

BACKGROUND: The prevalence of diabetes Mellitus in Saudi Arabia is 24%, ranking it among the top ten Worldwide. Diabetes education focuses on self-management and relies on numeracy skills. Poor numeracy may go unrecognized and it is important to have an assessment tool in Arabic to measure such a skill in diabetes care. OBJECTIVES: To validate a 15-item Diabetes Numeracy Test (DNT-15) in the Arabic Language as a tool to assess the numeracy skills of patients with diabetes and to test its properties among Saudi patients with diabetes. METHODS: A 15-question Arabic-language test to assess diabetes numeracy among patients with diabetes on the basis of the diabetes numeracy test (DNT-15) was validated among a sample Arabic speaking Saudi patients with diabetes. Data collection included patients' demographics, long-term glycemic control, diabetes type, duration, co-morbidities, and diabetes related knowledge questions. Internal reliability was assessed using Kuder-Richardson Formula 20 (KR-20). RESULTS: The average score of Arabic DNT-15 was 53.3% and took an average of 30 minutes to complete. The scores significantly correlated with education, income, HbA1c, and diabetes knowledge (p<0.05). Content Validity Ratio (CVR) of 0.75 and Content Validity Index (CVI) of 0.89 supported good content validity. The Arabic DNT-15 also had good internal reliability (KR20 = 0.90). CONCLUSION: Patients with diabetes need numeracy skills to manage their disease. Level of education does not reflect level of numeracy, and low numeracy skills might be unnoticed by health care providers. The Arabic DNT-15 is a valid and reliable scale to identify Arabic speaking patients with difficulties in certain diabetes-related numeracy skills.

Five-year comparison of diabetic control between community diabetic center and primary health-care centers.

CONTEXT: Hyperglycemia is the most important factor for development of complications. A high level of hemoglobin A1c (HbA1c) is linked with such complications of diabetes. AIMS: The aim of this study was to compare diabetic care between community diabetic center (CDC) and primary health centers. SETTINGS AND DESIGN: This was a retrospective cohort study conducted at King Abdulaziz Medical City for National Guard Health Affairs at Riyadh, Saudi Arabia. SUBJECTS AND METHODS: Data were retrieved from electronic medical records for diabetes mellitus Type 2 patients who were treated at two settings: CDCs and primary healthcare. STATISTICAL ANALYSIS USED: SPSS (V21) was used to analyze the univariate and bivariate analysis, Student's t-test for continuous variables and Chi-square test for binary variables were used. P value was set as statistically significant if it is <0.05. RESULTS: The mean difference for HbA1c from first to last visits increased significantly +0.2 ± 1.67 with P = 0.002 while the low-density lipoprotein (LDL) on the other way around improved by decrease of -0.159 ± 0.74 and P < 0.000. Body mass index (BMI) among the sample increased by +0.134 ± 1.57 with no significant, P = 0.078. Among the sample, 39.5% improved their HbA1c while 56.8% deteriorated and 3.6% of the samples' readings remain the same. 55.3% of the sample improved in LDL and 52.4% in the high-density lipoprotein while 53.7% improved in triglycerides. The BMI was improved among 43.4% of diabetic patients. CONCLUSIONS: The 5-year management of diabetic patients failed to improve the A1c or BMI, at both CDC and primary health-care centers.

Health Beliefs Related to Diabetes Mellitus Prevention among Adolescents in Saudi Arabia.

OBJECTIVES: The incidence of type 2 diabetes mellitus (T2DM) is growing rapidly in the Saudi population. The purpose of this study was to assess the constructs of the health belief model (HBM) as they relate to T2DM lifestyle and prevention behaviours among adolescents. METHODS: A cross-sectional study was conducted between May and October 2013 among 426 non-diabetic secondary school students from randomly selected schools in Riyadh, Saudi Arabia. An Arabic version of an adapted English language questionnaire was used to assess knowledge and attitudes related to the severity and prevention of T2DM. A preventative behaviour assessment was also conducted to assess physical activity and dietary habits. RESULTS: The majority of the students (63.4%) had at least one diabetic family member. Obesity was more frequent in males compared to females (P = 0.013). Awareness about the importance of maintaining a healthy body weight to prevent T2DM was lower in males than females (P = 0.037), although males engaged in routine exercise more often (P = 0.001). Males were less likely than females to recognise the risks for T2DM, including obesity (P = 0.030), heredity (P = 0.013) and high fat intake (P = 0.001). CONCLUSION: An alarmingly high number of Saudi students were unaware of T2DM severity and associated risk factors. Female students were more aware of the benefits of T2DM preventative lifestyle behaviours than males, although males engaged in routine exercise more often. Raising adolescents' awareness about the primary prevention strategies for T2DM should be a public health priority in Saudi Arabia. The HBM could inform further research on diabetes prevention among Saudi adolescents.

Patterns of childhood cancer incidence in Saudi Arabia (1999- 2008).

BACKGROUND: Although childhood cancer is a rare disease, 100,000 children younger than 15 years of age die from cancer each year, the majority of them in developing countries. More data need to be gathered and published particularly in developing countries to better understand the scale of the problem. AIMS: This study aimed to describe the patterns of childhood cancers in Saudi Arabia over a period of ten years (1999-2008). MATERIALS AND METHODS: This descriptive retrospective study was based on secondary data from the Saudi Cancer Registry from 1999 to 2008. All Saudi cases (both genders), under the age of 15 years, who were diagnosed with cancer during the study period, were included in this study. RESULTS: Childhood cancer in Saudi Arabia, in the period between 1999 and 2008, accounted for about 8% of total cancer cases. The most common encountered cancers were leukemia (34.1%), followed by lymphoma (15.2%), brain (12.4%), and kidney cancers (5.3%). The overall incidence of childhood cancers increased from 8.8 per 100,000 in 1999 to 9.8 per 100,000 in 2008. The incidence rates of cancers per 100,000 in the years 1999 and 2008 were generally higher among males, (9.4 and 11.5 in males vs. 8.3 and 8.1 in females). The highest incidence rate in the surveyed years was apparent in the birth to age 4 years group. CONCLUSIONS: Cancer is an important public health problem in Saudi Arabia and a major ascending contributor to mortality and morbidity in children. More studies are required to describe the patterns of childhood cancers and related risk factors in Saudi Arabia.

Nocturnal enuresis among primary school children.

To determine the prevalence and personal and family risk factors for nocturnal enuresis (NE) among primary school children in Al-Mukalla City, Yemen, we conducted a cross-sectional survey using a self-administered, three-part structured questionnaire involving 832 school children aged 6 - 15 years between 2007 and 2008. We assessed participants' socio-demographic factors, family characteristics and factors related to the presence of NE. The mean age of the children was 11.5 (±2.7) years. The overall prevalence of NE was 28.6%, with a predominance of girls, and the prevalence decreased with increasing age (P <0.001). Factors likely to be associated with NE were pattern of sleeping (P <0.001), stressful social and psychological events (P <0.01), positive family history of enuresis (P <0.001), large family size (P >0.002) and a higher number of siblings (P = 0.01). Our findings reveal a high prevalence of NE among children in Al-Mukalla City, Yemen, with a higher prevalence in girls than in boys compared with the other studies. Sleep pattern, stressful life events, family history of NE, large family size and more children in the household may act as a risk factor for NE.

Why is hepatocellular carcinoma less attributable to viral hepatitis in Yemen?

The hepatitis B virus (HBV) and the hepatitis C virus (HCV) are still public health problems in Yemen, with older individuals having much higher prevalence than younger generations. However, research on the prevalence of viral hepatitis in association with hepatocellular cancer (HCC) has not yet been undertaken in Yemen. The aim of this study was to determine the prevalence of HBV and HCV infection among HCC patients and to estimate the risk of these infections being associated with the development of HCC. A cross-sectional study was conducted on patients attending oncology outpatient in Sana'a, Yemen, through the period 2008-mid 2010 with confirmed diagnosis of HCC. A total of 88 cases were studied thoroughly with different investigations such as CT-scan, ultrasound, tumour marker, alpha-feto-protein and histopathological biopsy. A structured questionnaire was also applied and physical examination done to assess the general condition of the patients. Statistical package (SPSS version 16) was used for analysis of the data. The mean age of the cases was 61.2 years (± 12.6) with half over 60 years. There were fewer male patients (36%) compared to females and most (97%) only had basic /no formal education. Seventy nine (89%) were diagnosed as HCC cases with histopathological biopsy while the rest were diagnosed by ultrasound, CT scan, tumour marker, and alpha-feto-protein. Around one-third of the subjects were positive for HBsAg and HCV antibodies. Multivariate analysis showed infection with HCV and use of smoking was associated with HCC diagnosis. Although an association was observed between the occurrence of HCC and viral hepatitis (either HBV or HCV) and cigarette smoking, but the rate of viral infection was lower than what has been reported elsewhere.

Seroepidemiology and risk factors of hepatitis B virus in Aden, Yemen.

BACKGROUND: There is little published data concerning hepatitis B virus (HBV) infection in Aden and no data concerning risk factors for infection. This study aimed to determine the prevalence of HBV infection and risk factors for infection in Aden, Yemen. METHODS: A prospective cross sectional survey of individuals attending primary health care facilities was stratified by age and population size. Five hundred and thirty five participants were interviewed and serum was screened for the presence of Immunoglobin G HBV core antibodies (antiHBc). AntiHBc positive participants were tested for antibodies to hepatitis B surface antigen (HBsAg). A case-control analysis of risk factors for HBV was undertaken comparing risk factors between antiHBc positive cases and seronegative controls. RESULTS: The age-standardized seroprevalence for antiHBc was 16.2% (95% confidence interval (CI) 13.1-19.3) and for HBsAg was 1.5% (95% CI 0.5-2.5). The seroprevalence of antiHBc and HBsAg was estimated to range from 5.5% and 0% in infants to 40% and 4.6% in adults, respectively (p<0.001). Age (AOR=1.03, 95% CI=1.01-1.05), household size (>5-9 members, AOR=2.9, 95% CI=1.1-7.6) and ownership of a landline telephone (AOR=2.8, 95% CI=1.3-5.8) were independent risk factors for HBV infection. CONCLUSIONS: HBV is still a public health problem in this community, with older individuals having much higher prevalence than younger generations. The results of this study would categorise Aden as a low HBV endemic zone. Perinatal transmission does not seem to be a major route of transmission.

Seroepidemiology of hepatitis A and hepatitis E viruses in Aden, Yemen.

The burden of hepatitis A (HAV) and hepatitis E (HEV) infection is unknown in Aden, Yemen. This survey describes the prevalence of antibodies against HAV and HEV among individuals attending primary health care facilities in Aden, Yemen. Five hundred and thirty eight participants, stratified by age and district population size, were enrolled and screened for anti-HAV and 356 for anti-HEV antibodies. The age-standardized seroprevalence of antibodies was 86.6% (95% CI 83.7-89.5) for anti-HAV and 10.7% (95% CI 7.5-13.9) for anti-HEV. The prevalence of anti-HAV and anti-HEV ranged from 53% and 0% in infants to 100% and 15.3% in participants >18 years old, respectively (P<0.001). Viral hepatitis remains a major public health problem in Aden with trends of hyperendemicity for both infections. Priority should be given to improve water quality, sanitation coverage, and food hygiene and increase public health awareness concerning the risk of contracting infection.