HIV-related stigma and discrimination by healthcare workers in Egypt.

BACKGROUND: HIV-related stigma and discrimination (SAD) have imposed serious adverse health consequences on people living with HIV (PLHIV), including limited access to medical care and delayed diagnosis, which in turn limits the prevention and control of the disease. This study was conducted to explore the stigmatizing attitudes and behaviors of healthcare workers (HCWs) towards HIV patients and PLHIV. METHODS: A cross-sectional study targeted HCWs who attended the United Conference of Hepatogastroenterology and Infectious Diseases that was held on 25-28 September 2019 in Cairo governorate. A self-administrated questionnaire was completed by 359 HCWs. RESULTS: The majority of HCWs reported some discriminatory practices when rendering care to HIV patients, with nurses showing the highest significant number of discriminatory practices. A considerable proportion of HCWs reported witnessing HIV-related SAD at their health facilities. CONCLUSIONS: HIV-related SAD was prevalent among HCWs. Hence, HIV-related training relevant to the needs of different groups of HCWs is recommended. Provision of infection control supplies to protect against occupational exposure is also needed. The setting and enforcement of anti-stigma policies and guidelines in various healthcare settings are crucial.

Predictors of Foot Ulcers Among Diabetic Patients at a Tertiary Care Center, Egypt.

BACKGROUND AND PURPOSE: Diabetic foot ulcers (DFUs) markedly contribute to morbidity and mortality of diabetic patients. Hence, this study was conducted to investigate the predictors of foot ulcers among Egyptian diabetic patients. METHODS: A case-control study was conducted among 488 diabetic patients attending the inpatient departments and outpatient clinics at the National Diabetes Institute in Egypt. A pretested data collection sheet was designed to collect and record the following: socio-demographic data, diabetic history and lifestyle characteristics, recorded comorbidities, and the results of foot examination. RESULTS: Significant positive predictors of DFUs on multivariate logistic regression analysis included presence of three or more comorbidities; two or more diabetic complications; callus; and flatfoot. Significant protective (negative) predictors were management of diabetes by diet, oral hypoglycemic drugs (OHGs), and insulin; and intact vibration sense. CONCLUSION: Significant positive predictors of DFUs on multivariate analysis were presence of three or more comorbidities, two or more diabetic complications, callus and flatfoot, while protective predictors were management of diabetes by diet, OHGs, and insulin; and intact vibration sense. Hence, close monitoring should be provided to diabetic patients with comorbidities and complications to reduce the risk of DFUs.

Prevalence and Predictors of Self-Medication with Antifungal Drugs and Herbal Products Among University Students: A Cross-Sectional Study from Egypt.

BACKGROUND AND PURPOSE: Irrational use of drugs for self-medication (SM) is a worldwide public health problem which results in treatment failure, economic loss, and increased burden of morbidity and mortality. Thus, the purpose of this study was to explore SM with antifungal drugs and herbal products among university students in Egypt. METHODS: A cross-sectional sectional study was conducted over 7 months among 403 university students in Egypt. The students were invited to complete a self-administered questionnaire through an online Google form. Questionnaire items included socio-demographic characteristics of the students, practice of and attitude towards SM with antifungal drugs, and SM with herbal products. RESULTS: Prevalence of SM with antifungal drugs among students stood at 38.2%. The main reasons for SM with antifungal drugs were perceiving their health problem as being minimal, followed by having fears of a doctor's visit. About 73% of the students thought that SM was not a safe practice. Older age (AOR = 1.5, 95% CI= 1.3-1.8), affiliation to a private university (AOR = 3.7, 95% CI= 2.2-6.4), and being a medical student (AOR =2.4, 95% CI= 1.3-4.5) were the significant predictors of SM with antifungal drugs. A high prevalence of SM with herbal products (70.7%) was reported, with most students having used some form of herbal weight loss preparation (64%). Being a Cairo resident (AOR= 2.4, 95% CI =1.5-3.8, P<0.05) and being a medical student (AOR= 2.1, 95% CI =1.3-3.4, P<0.05) were the significant predictors of SM with herbal products. CONCLUSION: In the current study, SM was common among Egyptian university students. Providing counseling and public health education to university students with regards to SM is crucial. Implementing strict regulations and the full enforcement of excitant laws pertaining to the use of medication supplies is also needed. Herbal products should face the scrutiny of evidence-based medicine. Further studies are needed to evaluate the impact of SM among university students.

Prevalence and correlates of bullying and victimization among school students in rural Egypt.

OBJECTIVES: Knowledge on risk factors of bullying and victimization among school students is crucial for the implementation of preventive measures. This study was conducted to determine the prevalence and correlates of school bullying and victimization and their association with behavioral disorders among preparatory and secondary school students in rural Egypt. STUDY DESIGN: Cross-sectional METHODS: A total of 476 students from two mixed public schools in rural Egypt (one preparatory and one secondary) were enrolled. A pretested self-administered questionnaire was used to collect sociodemographic characteristics and correlates of bullying and victimization including personal and social, family, school, and community factors. Frequency of bullying and victimization was measured using the short version aggression and victimization scale. The Strengths and Difficulties Questionnaire (SDQ) was used for screening behavioral problems. RESULTS: Prevalence of bullying behavior was high (77.8%) among the studied group, of those 9.5% were unique bullies, 10.5% were unique victims, and 57.8% were bully-victims. On multivariate logistic regression analysis, failure in previous scholastic years (OR = 11.1, 95% CI 1.1-101.4, P = 0.033), witnessing family members using weapons (OR = 6.1, 95% CI 1.1-34.0, P = 0.038), male gender (OR = 2.3, 95% CI 1.1-5.0, P = 0.027), and mothers' education (university or higher) (OR = 0.1, 95% CI 0.02-0.7, P = 0.017) remained the significant predictors for bullying. However, only having a drug addict friend (OR 2.5, 95% CI 1.1-5.4, P = 0.025) was the significant predictor for victimization. The independent predictors for being bully-victims in order of importance were exposure to physical violence in the street (OR = 5.1, 95% CI 1.2-22.7, P = 0.031), male gender (OR = 3.2, 95% CI 1.8-5.6, P < 0.001), witnessing fights (OR = 3.1, 95% CI 1.7-5.7, P < 0.001) and insulting words (OR = 2.5, 95% CI 1.3-4.7, P = 0.007) among family members, exposure to insulting words in the street (OR = 2.1, 95% CI 1.2-3.7, P = 0.010), watching violent movies (OR = 2.0, 95% CI 1.2-3.4, P = 0.008), and younger age (OR = 0.7, 95% CI 0.6-0.8, P < 0.001). The self-reported SDQ revealed that the conduct problems scale scored significantly higher among bully-victims (2.8 ± 1.7 vs. 2.3 ± 1.6, P = 0.004). CONCLUSIONS: Prevalence of bullying behavior was high among rural adolescent school students. Establishment of a bullying prevention committee at school including all school personnel for addressing different factors associated with bullying behavior is recommended. Further follow-up and psychiatric assessment of students for predicting those prone to behavioral abnormalities are also recommended.

Helicobacter pylori among symptomatic Egyptian children: prevalence, risk factors, and effect on growth.

AIM: This study was carried out to determine the prevalence and predictors of Helicobacter pylori (H. pylori) infection among symptomatic children and the effect on growth. METHODS: A cross-sectional study was conducted in the Outpatient Clinics of the Gastroenterology Unit of the Pediatric Hospital, Cairo University. A total of 630 children complaining of any symptoms or signs suspicious of H. pylori infection were enrolled. Weight and height were measured for each child, and the standard deviation scores (Z-scores) for weight-for-age (WAZ), weight-for-height (WHZ), and height-for-age (HAZ) were calculated. H. pylori was diagnosed using a stool antigen test. RESULTS: The overall prevalence of infection was 64.6%. Socio-demographic variables significantly associated with H. pylori were residence in Upper Egypt (P = 0.013) and rural areas (P = 0.004), illiteracy of mothers (P = 0.017), household crowding index ≥ 3 (P = 0.011), absence of pure water supply (P = 0.005), and eating from street vendors (P < 0.001). Values of WAZ [median, interquartile range (IQR) in infected = - 1.3(- 2.7 to - 0.4) and non-infected = - 0.7(- 2.1 to - 0.1), P < 0.001], HAZ (P = 0.036), and WHZ (P = 0.005) were significantly lower in children infected with H. pylori. After performing a backward logistic regression analysis, eating from street vendors (OR = 1.879, 95% CI 1.346-2.625, P < 0.001), absence of pure water supply (OR = 1.725, 95% CI 1.162-2.561, P = 0.007), and overcrowding (OR = 1.547, 95% CI 1.100-2.177, P = 0.012) remained the significant predictors of H. pylori infection. CONCLUSION: A high prevalence of H. pylori infection among symptomatic children was detected. The extra-digestive effects of H. pylori were revealed in the form of affection of growth parameters and reduced levels of serum hemoglobin, iron, and ferritin.

Cancer Screening Knowledge and Attitudes of Under- and Post-Graduate Students at Kasr Al Ainy School of Medicine, Cairo University, Egypt.

BACKGROUND: Increasing knowledge and awareness of cancer screening significantly influence health promotion behavior which could markedly reduce incidence rates. In many countries, health care providers are the principal source of information concerning cancer screening. This study was carried out to assess the level of knowledge concerning cancer screening among medical students, house officers and residents and to explore their attitude towards cancer screening practices. MATERIALS AND METHODS: This cross-sectional study was conducted in Kasr Al Ainy Medical School at Cairo University in Egypt, with 300 undergraduate medical students and 150 postgraduates (interns and residents) enrolled. A pre-tested self-administered questionnaire was used to collect data from the study participants regarding personal and education-related information, knowledge about cancer screening and its sources, and attitude towards cancer screening. RESULTS: More than 64% of participants had knowledge scores of ≤ 10 points (out of 24). The total knowledge score (out of 6 points) for breast cancer screening increased from 1.9±1.0 to 2.3±1.2 and 2.4±1.1 for 4th, 5th and 6th year respectively, interns showed the highest score of 2.6 ±1.1, P= 0.001. Year of enrollment at medical school was a significant positive predictor of acquiring knowledge about cancer screening (post graduate vs. undergraduate students) (OR= 1.30, C.I =1.01-1.63), lack of or none receiving of orientation/training about cancer screening was the sole negative significant predictor for proper knowledge about cancer screening (OR=0.50, C.I=0.31-0.82). Over 92% of students agreed that they had insufficient knowledge about cancer screening, 88.2% appraised the need to have enough knowledge in order to direct/advice patients, relatives and friends, and 93.7% required that the faculty should emphasize the importance of cancer screening in the delivered curricula at medical school. CONCLUSIONS: A relatively low to moderate level of knowledge about cancer screening was detected among the selected medical students regardless of their year of enrollment at medical school or their graduation status, which may implicate a negative impact on early cancer detection especially in a low resource country like Egypt.

Colon Cancer among Older Saudis: Awareness of Risk Factors and Early Signs, and Perceived Barriers to Screening.

BACKGROUND: Colon cancer screening (CRCS) uptake is markedly affected by public awareness of the disease. This study was conducted to assess levels of knowledge of CRC, to explore the pattern of CRCS uptake and identify possible barriers to screening among Saudis older than 50 years of age and primary care providers (PCPs) in Al Hassa region, Saudi Arabia. MATERIALS AND METHODS: This cross-sectional study was conducted in randomly selected primary health care (PHC) centers, 884 Saudis and 39 PCPs being enrolled for data collection. Structured interviews were conducted to obtain information regarding socio-demographic characteristics, personal information relevant to CRC, awareness about early signs/symptoms and risk factors, and barriers to CRCS. Also, a self- administered data collection form was used to assess barriers to CRCS from the physicians' perspectives. RESULTS: More than 66% of participants were lacking knowledge about CRC. Participants with higher educational levels, having ever heard about CRC, and having relatives with CRC had a significantly higher awareness of the disease. The rate of reported CRCS was low (8.6%). After conducting a logistic regression analysis, it was observed that female gender (OR=0.28; 95% CI=0.14-0.57; P=0.001), being unmarried (OR=0.11; 95% CI=0.10-0.23; P=0.001), lower levels of education (OR=0.36; 95% CI=0.16-0.82; P=0.015), and having no relatives with CRC (OR=0.30; 95% CI=0.17-0.56; P=0.001) were significantly associated with a lower CRCS uptake. There was a significant difference between most of the perceived barriers to CRCS and gender. Exploratory factor analysis showed that personal fear (especially fear of the screening results and shyness) was the major factor that hindered CRCS with high loading Eigen value of 2.951, explaining 34.8% of the barriers of the included sample toward utilization of CRCS, followed by lack of awareness of both person and providers (high Eigen value of 2.132, and explaining 23.7% of the barriers). The most frequently cited barriers to CRCS from the physicians' perspectives were lack of public awareness, lack of symptoms and signs, and fear of painful procedures. CONCLUSIONS: Poor levels of knowledge about CRC were found among older Saudis attending PHC centers in Al Hassa, Saudi Arabia. It is crucial to implement an organized national screening program in Saudi Arabia to increase public awareness.