الفهرس 
Information on Hepatitis C VirusOnly 14 pages are availabe for public view
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Abstract
Hepatitis C is often referred to as the ‘silent epidemic. The World Health Organization (WHO) reports that approximately 3% of the world population, or approximately 170 million persons, are infected with the hepatitis C virus (HCV) with between 3 and 4 millions new infections each year. (1) Egypt has the highest prevalence of hepatitis C in the world. Overall, estimates of the HCV rate in the general population have range between 10 and 20 percent. (3) Geographically, the hepatitis C prevalence has been shown to be higher in Lower Egypt (Nile delta) than in Upper Egypt and lower in urban compared to rural areas. (4) Moreover, HCV infection has become the leading risk factor for HCC in Egypt (antibodies present in as many as 75–90% of HCC cases). (5)
According to 2008 Egypt Demographic and Health Survey (EDHS), use of contaminated needles/syringes during mass schistosomiasis treatment campaigns during the 1960s-1980s has been identified as a key mode of transmission for HCV infection (8), and in spite of termination of this program in Egypt and the implementation of measures designed to reduce hospital-related infection, the transmission of disease is still continued. (10)
Unlike other viral forms of hepatitis, the acute phase is rare. (10) The chronic form, presenting scarce and nonspecific symptoms, makes clinical diagnosis of the disease difficult. The infection lasts for decades and the patient may or may not be aware of its presence. (11) Additionally, HCV-infected people serve as a reservoir for transmission to others if left untreated. (5) Furthermore, people with CHC on combination therapy will go through phases of depression, anger, frustration and despair as a result of the symptoms of CHC and side-effects of therapy. (13) For these reasons many patients refuse to start treatment, probably due to concerns about adverse effects. (14)
Currently, there is no vaccine to prevent HCV infection and no postexposure prophylaxis (17) and it takes up to almost 20 years for a person to develop serious complications. This long survival with HCV leads to diminish Health-Related Quality Of Life (HRQOL) even in the absence of clinically significant liver disease; in particular the impact of HCV seems to be most dramatic in social and physical function, general health and vitality, such as the effects of hepatitis C on families, work environments, and on society as a whole. (16) Therefore, preventing exposure to HCV or modifying people’s behavior may help reduce the burden of disease in Egypt. (8)
Aim of the study
The present study was designed to measure the impact of an educational program on Health-Related Quality of Life among hepatitis C patients through the following;
1. To assess HRQOL among hepatitis C virus patients.
2. To determine factors associated with HRQOL among hepatitis C patients
3. To construct and implement an educational program for hepatitis C virus patients.
4. To evaluate the impact of the educational program on HRQOL for hepatitis C patients.
Target population and study sample:-
To fulfill this aim, the study was conducted on 400 hepatitis C virus patients chosen randomly from outpatient clinics in National Hepatology and Tropical Medicine Research Institute in Cairo. Across-sectional design was used to study QOL, its determinants. An intervention education program was constructed and implemented on sub-sample of 100 CHC patients will be chosen randomly from the previous sample.
Technical design:-
For the execution of the study:
A. A structured interview questionnaire was used to collect data from CHC patients about:
1. Socio-demographic characteristics
2. History of Hepatitis C Virus
3. HCV Knowledge, Opinions and Perception of seriousness
4. Behaviors of HCV’s patients
5. Health-Related Quality Of Life (HRQOL) assessment
a) Generic Health-Related Quality Of Life assessment (SF-36) Arabic version was used after modified to suit Egyptian patients
b) Disease-Specific Health-Related Quality Of Life Assessment.
B. A true- experimental design was used to construct and implement an educational intervention program for chronic hepatitis c patients. The patients were randomly allocated into two groups; experimental and control of 100 patients each. The main goal of the education was to fill the gap between CHC patients’ knowledge about HCV and change harmful behaviors aiming to reduce the risk of transmission of HCV infection to the others through a health education program. After collection of data, statistical analysis was performed using: arithmetic mean, standard deviation, non parametric tests and multiple liner regression analysis.
Results:
The results obtained in the present study could be summarized in the following items:
1. Socio-demographic characteristics and history.
Nearly two thirds of the sample were male with mean age was 43 years. Regarding education, 37.5% had high school level, while 30.1% were illiterate, read & write or got primary school education, 57.7% were lived in urban areas, 84.8% were married, 86% of patients were employed and nearly half (47.8%) of the sample had middle socioeconomic level. Almost all patients reported their need for educational program about HCV infection.
2. Knowledge, behaviors and perception of seriousness of HCV.
The main areas showed poor and average level of knowledge were, general knowledge about HCV (50.6%), mode of transmission (77.3%), which factor’s makes further damage of liver (61.5%), how to protect infected person from having HAV&HBV (99.7%) and healthy diet of infected persons with HCV (99.7%).
The main area that showed poor and average level of behaviors was precaution of infected person from transmission of HCV infection to the others (99.2%).
Nearly three fourths of patients (72.0%) perceived HCV as a serious disease.
3. Health Related Quality Of Life (Generic and Specific).
The hepatitis c patients showed deteriorating mean scores of PCS & MCS of SF-36 and all its’ eight health domains.
The hepatitis c patients suffered from physical, psychological, social and spiritual impacts as a result of having HCV infection. The spiritual impact was observed the highest mean score while the social impact was observed as the lowest one.
4. Factors related to quality of life
The significant predictors of Physical Component Summary of SF-36 were old age, high perception of seriousness about HCV, diagnosing of HCV only after suffering from it’s symptoms and the housewives patients.
The significant predictors of Mental Component Summary of SF-36 were retirement, diagnosing of HCV only after suffering from it’s symptoms and high perception of seriousness about HCV.
The significant predictors of physical impact domain of disease specific scale were female, total knowledge and high educational level.
The significant predictors of psychological impact domain of disease specific scale were short duration of treatment, total behavior, high educational level and high perception of seriousness about HCV.
The significant predictors of social impact domain of disease specific scale were old age, female, high educational level, , diagnosing of HCV only after suffering from it’s symptoms, total knowledge and total behavior of HCV.
The significant predictors of spiritual impact domain of disease specific scale were young age, male, total behavior, total knowledge and high perception of seriousness about HCV.
5. Results of intervention
The program initiated a positive effect on the total knowledge score and all its’ items.
The program developed a positive effect on total behavior score and all its’ items.
The program created a positive effect on PCS and MCS of SF-36 domains and all its’ items.
The program developed a positive effect on its’ all items: physical, psychological, social and spiritual impacts.
Based on the results of the present study, the following may be recommended:
1. Recommendation concerning the designed booklet:
It is recommended to distribute the designed booklet in this study of “Protect yourself from having HCV infection” for infected people, nurses and community.
2. Recommendation concerning the hospitals and specialized centers:
Developing a health education unit in each hospital or specialized centers. A full-time qualified nurses, and one social worker as well as part time psychiatrist are needed to carry out the following activities:
A. In and out patient health education activities:
Behavioral counseling for infected HCV patients.
Conduct psycho-educational support groups for infected persons and those who live with them.
Educate infected HCV about HCV disease and how to live healthy with it.
Developing educational materials.
Incorporation of quality of life questionnaire in the periodic assessment of HCV.
Train and support HCV supporting groups or persons living with infected patients.
B. Training programs for health care providers (medical and paramedical personnel):
Periodic implementation of in-service training program regarding HCV.
More attention for using of Personal Protective Equipment (PPE).
Close monitoring for appropriate disinfection and sterilization.
Provide educational and psychological support for the infected patients with HCV.
3. Recommendation concerning community (population at risk and general population):
Mass media campaigns about the HCV disease
Improving and strengthening the announcement of the hot line for HCV.
Develop and implement a public education campaign with messages targeting the general population and at-risk populations.
Focus attention for hidden risky groups of transmission of HCV infections (pharmacists, dentists, barber, and hair dressers).
Special attention should focus on the fact that injection solutions and equipments are frequently purchased outside of the formal healthcare system.
Health screening and early detection programs of the high risk groups.
Integrated of the HCV infection in the school curriculum.
4. Recommendation concerning Ministry of Health (MOH) activities:
Allocate health inspectors to audit the infection control measures among barber, hair dressers, pharmacists, dentists and hospitals to provide annual or bi-annual state certifications.
5. Future research:
Social studies on the impact of HCV infection and its stigmatization (e.g. Employment, marriage, military,...etc).
Behavioral aspects leading to disease endemicity.
Educational and multimedia tools for HCV disease prevention, and raising of the relevant societal awareness.