Effect of health belief model-based educational intervention on prostate cancer prevention; knowledge, practices, and intentions.

BACKGROUND: Prostate cancer screening is a crucial preventive element for improving the survival rates of prostate cancer. Therefore, our research objective was to investigate the effect of health belief model-based education on prostate cancer knowledge, health beliefs, and preventive health practices among adult and older adult males. METHODS: A one-group pre-test/post-test quasi-experimental study design was carried out at the one-day outpatient clinics affiliated to General Alexandria Main University Hospital. We enrolled 110 men aged 45-75 years old in a health belief model-based educational intervention program. Various questionnaires were utilized to gather data before, immediately after, and three months following the intervention. These questionnaires included the socio-demographic questionnaire, Prostate Cancer Knowledge Questionnaire (PCKQ), Prostate Cancer Screening-Health Belief Model Scale (HBM-PCS), Prostate Cancer Preventive Practices Questionnaire (PCPPQ), and one question regarding the intention to undergo PC screening. RESULTS: Participants' knowledge about prostate cancer screening improved significantly immediately after the program and this positive change was maintained at the follow-up (p = 0.000). Furthermore, participants' perceptions and preventive practices towards prostate cancer screening had changed significantly after program completion and at follow-up (p = 0.000). After program completion, many of the participants (92.7%) expressed their intention to undergo prostate cancer screening within the coming six months (p = 0.000). The younger age group (45-49 years) showed higher scores in their perception of prostate screening (p = 0.001). Higher education and income were significantly associated with higher scores in the three scales (p = 0.000 in all scales). CONCLUSION: The study findings emphasized the effectiveness of the designed health educational program based on the HBM on PC preventive behaviors, through significantly improving participants' knowledge level, perceptions, practices, and intentions to PC screening. The program is highly recommended for prostate cancer preventive health practices among both adult and older adult males.

Prevalence and predictors of depression, anxiety, and stress among refugees in Egypt.

BACKGROUND: Many Refugees show multiple distressing psychological and mental health problems associated with stressful and adverse conditions in host countries. Even though Egypt is one of the top five destination countries hosting refugees and asylum-seekers in the MENA region, there is a lack of studies investigating mental health problems among refugees in Egypt. This study aimed to assess the prevalence and predictors of depression, anxiety, and stress symptoms among refugees living in Egypt. METHODS: A total of 398 refugees aged 18 and above were interviewed from migrants'/refugees' community centers in Giza, Alexandria, Dakahlia, and Damietta governorates. A predesigned structured interview questionnaire was used to collect socio-demographic and migration-related variables. The Arabic Version of Depression Anxiety Stress Scales (DASS-21) was used to assess the presence and severity of the three negative emotional states. RESULTS: Nearly two-thirds of the participants were Syrian (66.4%). The majority resided in Alexandria and Giza governorates (75.9%), were females (73.4%), and were married (71.1%). The most reported migration difficulty was housing (41.5%). Anxiety symptoms were reported among 63.3% (95% CI: 58.59%- 68.05%) of sampled refugees, followed by depression (61.3%, 95% CI: 56.52%-66.10%), and stress symptoms (51.5%, 95% CI: 46.56%-56.36%). Results of regression analysis showed that; female gender predicted anxiety (aOR 2.419, 95% CI: 1.485-3.941, p < 0.001) and stress (aOR 2.053, 95% CI: 1.197-3.519, p = 0.009), while younger age groups (18-25 yr. and 26-50 yr.) compared to the older age group (51 yr. and older) predicted depression (aOR 4.529, 95% CI: 1.696-12.097, p = 0.003 and aOR 2.177, 95% CI: 1.270- 3.733, p = 0.005, respectively) and stress (aOR 4.334, 95% CI: 1.556-12.074, p = 0.005 and aOR 1.808, 95% CI: 1.023-3.193, p = 0.041, respectively). Residence in Alexandria, housing, and employment difficulties predicted anxiety (aOR 2.354, 95% CI: 1.420-3.902, p < 0.001, aOR 1.726, 95% CI: 1.073-2.778, p = 0.025, and aOR 3.044, 95% CI: 1.248-7.425, p = 0.014, respectively), depression (aOR 1.949, 95% CI: 1.163-3.266, p = 0.011, aOR 1.666, 95% CI: 1.036-2.681, p = 0.035, and aOR 3.216, 95% CI: 1.321-7.828, p = 0.010, respectively), and stress (aOR 2.450, 95% CI: 1.431-4.195, p < 0.001, aOR 1.911, 95% CI: 1.187-3.078, p = 0.008, and aOR 4.482, 95% CI: 1.867-10.760, p < 0.001, respectively). CONCLUSION: Mental health problems are prevalent among the refugee population in Egypt that are compounded by the difficult post-migration socio-economic situation. Multisectoral attention towards refugees' mental health is urgently needed.

Public awareness, attitude, and practice regarding food labeling, Alexandria, Egypt.

BACKGROUND: Food labeling is an important public health tool allowing consumers to make informed and healthy choices. Considering how important it is for consumers to be aware of food labels while choosing healthy foods, this study aims at assessing public awareness, attitude, and practice regarding food labeling in Alexandria Governorate, Egypt. METHODS: A cross sectional study using a predesigned interview questionnaire to collect data from 719 adult consumers from both sexes (28.2% males: 71.8% females), recruited from different branches of one of the largest supermarkets in Alexandria. RESULTS: More than half of the participants (55.6%) reported reading food labels. The most frequently read information was production/ expiry date (76.8%), product name (68.3%), and ingredients (38.0%) while the least frequently read was nutritional facts (29.9%). More than half of the study sample (50.9%) had low awareness about the content of food labels, nevertheless, having higher scores on awareness about food labels predicted reading practice. Nearly three-quarters of the respondents had average to good food label reading practice. Most respondents (81.8%) had a favorable attitude about food labeling in its present form, however, higher attitude scores did not seem to influence their use of food labels. Being older (ß = 0.045, CI; 0.014-0.076, p = 0.005), being female (ß = 1.162, CI; 0.541-1.784, p = 0.000), having secondary education or equivalent (ß = 1.042,CI; 0.050-2.034, p = 0.040), having university education or beyond (ß = 3.090, CI; 2.132-4.048, p = 0.000), and having higher scores on awareness about food labels (ß = 1.407, CI; 1.324-1.490, p = 0.000) were significant predictors of reading food labels. CONCLUSIONS: Most of the studied consumers had a positive attitude towards food labeling, however, more than half of them had low awareness of food labeling content. Nutritional facts were the least frequently read by consumers. Reading food labels was significantly predicted by having higher education, being older, being a female, and having better awareness.

Adherence of healthcare workers to COVID-19 infection prevention practices and its relationship with SARS-CoV-2 seropositivity.

Background: Infection prevention and control (IPC) practices against COVID-19 should be adopted by healthcare workers (HCWs) at their workplaces to protect themselves, their patients, and their families from infection. Purpose: This study aimed to describe the relationship between the healthcare-related COVID-19 infection prevention measures adopted by HCWs and their SARS-CoV-2 seropositivity. Research Design: This cross-sectional study was conducted during the second and third COVID-19 waves in Egypt. Study Sample: The study included 416 unvaccinated HCWs from 39 hospitals in Egypt. Data Collection: Sociodemographic data, as well as COVID-19 IPC measures done at work, and protective measures performed by their healthcare facilities were collected. SARS-CoV-2 spike protein antibodies were measured by ELISA. Results: 58.2% of participants were seropositive for SARS-CoV-2. Among the previously undiagnosed HCWs, 125/271 (46.1%) were seropositive. Predictors of seropositivity were rural residence (aOR = 5.096; 95% CI: 1.583-16.403, p = 0.006), previous COVID-19 infection (aOR = 4.848, 95% CI: 2.933-8.015, p = 0.000), and examining 10-20 suspected COVID-19 patients daily (aOR = 2.329; 95% CI: 1.331-4.077, p = 0.003. Reporting low satisfaction (25-50%) with infection control implementation, working more than 40 h per week, reporting to "sometimes abiding by hand hygiene" compared to those who reported to "always" adhere to hand hygiene and shorter duration of hand washing (<20 s) were associated with significantly higher odds of seropositivity. Conclusions: Poor infection control measures and the high workload of HCWs (longer working hours and examining more patients) were modifiable risk factors for SARS-CoV-2 seropositivity among HCWs. Hand hygiene was better among HCWs working in urban versus rural areas.

Predictors of anti-SARS-CoV-2 seropositivity: An Egyptian population-based study.

Background: Population-based studies on the determinants of COVID-19 seroprevalence constitute a cornerstone in guiding appropriate preventive measures. Such studies are scarce in Egypt, thus we conducted this study to explore risk factors for SARS-CoV-2 seropositivity. Methods: This survey included 2919 participants from 10 Egyptian governorates. Sera were tested for SARS-CoV-2 spike (S) and nucleocapsid (N) antibodies. Univariate and multivariate analyses were performed to identify associated factors and predictors of seropositivity regarding sociodemographic factors, clinical data, and personal practices of participants. A subgroup analysis was performed to investigate the occupational risks of seropositivity. Results: Seropositivity was recorded in 1564 participants (53.6%). Independent predictors of seropositivity included non-smokers (aOR = 1.817; 95% CI: 1.407-2.346, p = 0.000), having blood group A (aOR = 1.231; 95% CI: 1.016-1.493, p = 0.034), a history of COVID-19 infection (aOR = 2.997; 95% CI: 2.176-4.127, p = 0.000), COVID-19 vaccination (aOR = 4.349; 95%CI: 2.798-6.759, p = 0.000), higher crowding index (aOR = 1.229; 95% CI: 1.041-1.451, p = 0.015), anosmia and/or ageusia (aOR = 3.453; 95% CI: 2.661-4.481, p = 0.000) and history of fever (aOR = 1.269; 95% CI: 1.033-1.560, p = 0.023). Healthcare worker and Obesity/overweight were additional significant predictors of seropositivity among the working participants (aOR = 1.760; 95% CI: 1.301-2.381, p = 0.000 and aOR = 1.384; 95% CI: 1.059-1.808, p = 0.019, respectively). Additional factors showing association with seropositivity in the univariate analysis were: female gender, age group (15-39 years), higher educational level (preparatory and above), lack of environmental disinfection and having roommates at the workplace. There was a positive correlation between the titers of both antibodies. Age was weakly correlated with anti-S titer, while anti-N was significantly correlated with the number of protective measures applied by the participants. Both antibodies were significantly correlated with adult BMI, while both were significantly negatively correlated with the smoking index. Conclusions: SARS-CoV-2 seropositivity was associated with some personal and behavioral and occupation-related factors. Fever and anosmia and/or ageusia were the symptoms mostly associated with seropositivity.

COVID-19 vaccine acceptance rates and predictors among the Egyptian general population and Healthcare workers, the intersectionality of age and other factors.

The promise of COVID-19 vaccines in ending the pandemic can only be achieved by overcoming the challenge of vaccine refusal. Healthcare workers (HCWs) are the trusted advisors of vaccination decisions. Recommendations for vaccinating children against COVID-19 are recently gaining more public health attention due to the role of children in disease transmission and associated morbidities. Vaccination is one of the first medical decisions parents or guardians make on behalf of their children. To investigate the determinants associated with vaccine acceptability among the general population through a direct interview questionnaire and assess guardians' views towards childhood COVID-19 vaccinations. This cross-sectional study included 2919 participants A pre-designed structured questionnaire about COVID-19 vaccination acceptability was completed by trained interviewers and interviewing the participants or their guardians (for those below 18 years old). Nearly two-thirds of participants (66.5%) accepted vaccination, 20.2% were refusing and 13.3% were hesitant. Most participants who were guardians of children below 12 years and from 13 to 17 years reported that they would accept vaccination of their children (72.5% and 70.5%, respectively). The acceptance rate among HCWs was 58.2%. The main reasons beyond vaccine refusal were mistrust of vaccine efficacy (39.5%) and having concerns regarding vaccine safety (38.8%). In a multivariable regression model, being male (OR 1.362, 95% CI 1.082-1.714, p = 0.008) resident in rural area (OR 1.796, 95% CI 1.435-2.247, p = 0.000), and lower education (OR 1.245, 95% CI 1.018-1.523, p = 0.033) were associated with an increased acceptance to be vaccinated. The acceptance rate for vaccinating children reported among their guardians was higher than adults for themselves. Extremes of age showed higher vaccine acceptance compared to young adults. Upper Egypt governorates (Faiyum and Giza) were outpacing Lower Egypt governorates in vaccination acceptance rates.

Seroprevalence of Hepatitis A, B and C Among a Sample of Refugees in Egypt: An Exploratory Survey.

BACKGROUND: Estimating the prevalence of infectious diseases, including viral hepatitis, among refugees is important for evaluating their health needs and predicting the burden on the health system of the host country. This study aimed at estimating the seroprevalence of viral hepatitis among refugees in Egypt. METHODS: This cross-sectional study involved a heterogeneous group of 501 refugees. Enzyme-linked immunosorbent assays were used to detect IgG antibodies against hepatitis A virus (HAV), B virus (HBV) surface antigen (anti-HBsAg), C virus (HCV), and HBV surface antigen (HBsAg). RESULTS: Anti-HAV was the most prevalent marker (n = 482, 96.2%), followed by anti-HBs (n = 142, 28.3%) and HBsAg (n = 21, 4.2%), while only four refugees (0.8%) had positive anti-HCV IgG. Anti-HBs was higher in males (p < 0.05). Older refugees and non-working subjects had significantly higher seropositive rates of anti-HAV (p = 0.051 and p = 0.023, respectively), while students and those below 15 years of age had higher rates of anti-HBs (p < 0.05). Positive HBsAg results were associated with history of hepatitis (p < 0.001). Obese participants were more likely to be positive for HBsAg (p = 0.025) and anti-HBs (p < 0.05). Sudanese refugees had significantly higher rates of anti-HAV antibodies (p = 0.049), while Yemini refugees had significantly higher rates for HBsAg (p = 0.019) positivity. Residents of Dakahlia had significantly higher rates of anti-HAV (p = 0.008) and anti-HBs (p < 0.05). None of the studied risk factors was significantly associated with anti-HCV. CONCLUSION: Refugees in Egypt have poor immunity against HBV with intermediate to high HBV and low HCV prevalence rates. Despite that 65% of refugees received the HAV vaccine, almost all had IgG anti-HAV, denoting previous infection.

Pneumonia among under-five children in Alexandria, Egypt: a case-control study.

BACKGROUND: Pneumonia among under-five children constitutes a major public health concern. Studies examining risk factors for pneumonia in Egypt are limited. AIM: To identify risk factors of pneumonia among under-five children in Alexandria, Egypt. METHODS: An observational case-control study was conducted over a 5-month period (September 2017-January 2018) in three main pediatric hospitals in Alexandria. A predesigned questionnaire was used to interview 660 mothers of under-five children (330 pneumonia cases and 330 control). The questionnaire included potential risk factors for pneumonia which were categorized into child-related factors, socio-demographic factors, and environmental factors. RESULTS: The mean age of the children was 23.14 ± 18.61 months with a range of 1-59 months. Nearly two-thirds (58.5%) were boys. Nine factors were found to be independently associated with pneumonia: age ≤ 12 months (OR = 1.925; 95% CI, 1.356-2.733; P < 0.001), male gender (OR = 1.646; 95% CI, 1.162-2.332; P = 0.005), birth order ≥ 4 (OR = 2.154; 95% CI, 1.282-3.617; P = 0.004), low birth weight (OR = 2.562; 95% CI, 1.718-3.821; P < 0.001), prematurity (OR = 2.019; 95% CI, 1.154-3.531; P = 0.014), place of delivery either at home (OR = 5.669; 95% CI, 1.063-30.237; P = 0.042) or at a public hospital (OR = 1.616; 95% CI, 1.131-2.310; P = 0.008), presence of concomitant illness (OR = 1.902; 95% CI, 1.043-3.469; P = 0.036), poor home aeration (OR = 3.586; 95% CI, 1.971-6.522; P < 0.001), and exposure to outdoor air pollution (OR = 2.403; 95% CI, 1.417-4.076; P = 0.001). CONCLUSION: Several risk factors were significantly related to pneumonia among under-five children. Identifying such factors is important for developing interventions to reduce pneumonia burden among under-five in Egypt.

Medical management of pneumonia in children aged under 5 years in Alexandria, Egypt: mothers' perspective.

BACKGROUND: Pneumonia is among the top causes of morbidity and mortality among the under-fives worldwide. AIMS: A cross-sectional study was conducted to assess health-seeking behaviour and first medical management of pneumonia among children aged under 5 years in Alexandria, Egypt from the mothers' perspectives. METHODS: Using a pre-designed questionnaire, we interviewed 507 mothers of pneumonic children aged under 5 years who had been admitted at 4 governmental children's hospitals. The study was conducted during August-November 2017. RESULTS: We found that 57.2% of children received home treatment before seeking medical advice. Around 26% of mothers waited ≥ 2 days before seeking medical advice; insufficient knowledge about the disease was their main contention (89%). Factors significantly associated with the delay were: rural residence (P = 0.006); low income (P = 0.002); home treatment given before seeking medical advice (P < 0.001) and previous episodes of pneumonia (P = 0.002). Diagnosis of pneumonia had not been made by more than half of the first consulted sources (52.7%). CONCLUSION: There is an urgent need to improve mothers' knowledge and train physicians for appropriate management of pneumonia in children under 5 years.

Insomnia among community dwelling elderly in Alexandria, Egypt.

BACKGROUND: Insomnia is a common problem in the elderly population. Poor sleep quality is associated with decreased memory and concentration, increased risk of falls, cognitive decline, and higher rate of mortality. Inadequate sleep hygiene such as irregular sleep schedules, use of stimulants, and daytime naps may predispose to insomnia. AIM: The aim of this study was to determine the prevalence of insomnia among community dwelling elderly in Alexandria and to assess some of the risk factors and comorbid conditions related to insomnia. PARTICIPANTS AND METHODS: This is a cross-sectional study conducted among 380 elderly people taken from different clubs in Alexandria using a predesigned structured interview questionnaire. Data on sociodemographic characteristics, medical history, and personal and sleeping habits were collected. The Insomnia Severity Index was used to assess insomnia and the Depression Anxiety Stress Scale was used to measure depression, anxiety, and stress. RESULTS: One-third (33.4%) of the elderly suffered from insomnia. On logistic regression, the most independent factors that were significantly associated with insomnia were number of chronic diseases [odds ratio (OR)=7.25 for having ≥5 diseases], being female (OR=2.37), anxiety (OR=1.91), watching television in bed before sleeping (OR=1.90), depression (OR=1.74), nocturia (OR=1.13), and daily sunlight exposure (OR=0.57). CONCLUSION AND RECOMMENDATIONS: Insomnia is a common problem among the elderly in Alexandria. Female sex, chronic diseases, mental health problems, and bad sleep hygiene practice increase the risk for insomnia. Improving knowledge among the elderly about the prevalence and risk factors of insomnia could help the development of effective public health prevention and intervention programs for better sleep quality.