The purpose of this study was to identify risk factors for hepatitis C virus (HCV) infection in a rural village in the Nile Delta with a high prevalence of antibodies to HCV (anti-HCV). One half of the village households were systematically selected, tested for anti-HCV, and interviewed: 973 of 3,999 (24.3%) subjects were anti-HCV-positive (reflecting prior HCV infection but not necessarily current liver disease), with nearly equal prevalence among males and females. Anti-HCV prevalence increased sharply with age among both males and females, from 9.3% in those 20 years of age and younger to >50% in those older than 35, suggesting a cohort effect with reduced transmission in recent years. Multivariate regression was used to estimate independent effects of risk factors on seropositivity. Among those over 20 years of age, the following risk factors were significantly associated with seropositivity: age (P < . Previous studies of hepatitis C viral (HCV) infection in Egypt have shown a high prevalence of antibody to HCV (anti-HCV) among blood donors 1-4 and residents of rural areas endemic for schistosomiasis. 5 Anti-HCV was found in 12.1% of primary schoolchildren, 18.1% of residents of rural villages, and 22.1% of army recruits, 6 as well as in 31% of Egyptians applying to work abroad. 7,8 It is widely believed that parenteral exposure to the virus is the most important route for acquiring infection in Egypt. 7,9 We have recently reported data that suggest the very high prevalence of HCV infection in the adult population of rural areas of Egypt, particularly in men living in villages where schistosomiasis is endemic, is at least partially the result of extensive mass-control campaigns using parenteral tartar emetic conducted from the 1950s up until 1982. 10 Although the prevalence of infection among those too young to be exposed to these mass antischistosomiasis injection campaigns is lower than among the older population, infection in this younger cohort indicates that other modes of transmission have perpetuated the infection in the community. Uncertainty remains regarding the relative importance of various types of parenteral exposures and widely practiced community activities, e.g., circumcisions, goza smoking in a group, or being shaved at a community barber.To resolve this uncertainty, we conducted a large serologic survey in a rural Egyptian community. The purpose of this article is to report the observed associations of HCV infection with both the acknowledged parenteral exposures (e.g., blood transfusions, injections, invasive hospital procedures, dental treatment) and widely practiced community activities that are usually not considered to be determinants of HCV transmission. PATIENTS AND METHODSStudy Population. In 1997, one half of the households of a village in the Nile Delta, Aghour El Soughra, were systematically selected and interviewed with a structured questionnaire to identify potential exposures that might be related to HCV acquisition. Adults and children older than 10 years of age were interv...

Abstract. A population-based serosurvey in two rural Egyptian communities was used to assess age-specific prevalence of antibody to hepatitis E virus (anti-HEV). One community is in the Nile Delta (11,182 inhabitants; 3,997 participants) and the other in Upper Egypt (10,970 inhabitants; 6,029 participants). Samples were tested for anti-HEV with a commercial enzyme-linked immunoassay (ELISA) based on antigens derived from open reading frame (ORF)2 and ORF3. Although there was a clear difference in sensitivity among the lots of the commercial test used, it was still possible to determine the seroprevalence. The seroprevalence of anti-HEV exceeded 60% in the first decade of life, peaked at 76% in the second decade and remained above 60% until the eighth decade. Prevalence of this magnitude is among the highest reported in the world, with an age-specific pattern more similar to hyperendemic hepatitis A virus transmission than generally described. Lot-to-lot variation in the sensitivity of the commercial ELISA kit highlights a problem when comparing seroepidemiologic studies of different populations.

This report describes a cross-sectional survey of the prevalence of antibodies to hepatitis C virus (anti-HCV) in a rural Egyptian community in the Nile Delta. One half of the village households were systematically selected and examined by questionnaire and testing sera for anti-HCV and HCV RNA. Blood samples were obtained from 3,888 (75.4%) of 5,156 residents H5 years of age; an additional 111 samples were obtained from children younger than 5 years. Overall, 973 (24.3%) of 3,999 residents were anti-HCVpositive, and the age-and gender-adjusted seroprevalence was 23.7%. Anti-HCV prevalence increased sharply with age, from 9.3% in those 20 years of age and younger to G50% in those older than 35 years. Currently or previously married individuals were more likely to be seropositive than those never married, controlling for age (Mantel-Haenszel risk ratio ‫؍‬ 1.8; 95% CI: 1.3, 2.6). Of the 905 anti-HCV-positive samples tested, 65% were also positive for HCV RNA. Active schistosomal infection was not associated with anti-HCV status; however, history of antischistosomal injection therapy (reported by 19% of anti-HCV positives) was a risk for anti-HCV (age-adjusted risk ratio ‫؍‬ 1.3; 95% CI: 1.2, 1.5). This study, the largest community-based survey to date, supports earlier reports of high levels of anti-HCV among adults in rural areas of Egypt, although many of those who are seropositive will not have active liver disease. The large reservoir of HCV infection in the community provides an opportunity to investigate risk factors for transmission, the natural history of infection and effectiveness of preventive methodologies, and raises concern about the prospect of an increasing incidence of chronic liver disease in the coming decades. (HEPATOLOGY 2000;32:111-115.)In the United States and Europe, hepatitis C virus (HCV) infection has been detected in 1% to 2% of the general population and fewer than 1% of volunteer blood donors. [1][2][3]

Data collected during a prospective cohort study of infant feeding and health in rural Bilbeis, Egypt, were analysed to define prelacteal infant feeding practices, identify their determinants, and assess whether these practices were predictive of breastfeeding and supplementation patterns and diarrhoea incidence during infancy. Sixty per cent (89/149) of study infants were prelacteally fed sugar-water, teas, or both. Lack of milk in the mother's breast (74 per cent), and maternal exhaustion or illness following labour (29 per cent) were the two most commonly stated reasons for prelacteal feeding. After multivariate adjustment, significantly higher incidence of prelacteal feeding was associated with childbirth during the warmer months [odds ratio (OR): 2.4; 95 per cent confidence interval (CI): 1.1-5.1], birth attendants with modern training (OR: 5.5; 95 per cent CI: 1.7-17.5), and labour lasting > 8 hours (OR: 2.3; 95 per cent CI: 0.1-4.9). Prelacteally fed infants were significantly less likely to be exclusively breastfed in age periods 0-3, 4-7, and 8-11 weeks. Diarrhoea incidence was higher among prelacteally fed infants in age periods 0-11, 12-23, and 36-47 weeks. Indiscriminate practice of prelacteal feeding and early supplementation of breastfeeding need to be discouraged.

Recent data on the patterns and correlates of the timing of breastfeeding initiation in newborns are scanty for many countries including Egypt. To obtain such data in four villages in rural Bilbeis, we recruited apparently healthy, single neonates and their apparently healthy mothers within 4 days of child birth, and followed them prospectively during 1987 through 1989. All 150 neonates included in the analyses were breastfed for some duration. At the time of the first breastfeed, 36, 37, and 27 per cent of the neonates were aged < 2, 2-5, and > or = 6 hours, respectively. All neonates had received the first breastfeed by age 72 hours. In a multivariate, polytomous logistic regression model, modern birth attendants and longer ( > 8 hours) duration of labour were significantly associated with deferment of breastfeeding initiation till the neonate was aged > or = 6 hours. Breastfeeding initiation appeared to be unduly delayed in our study mothers and infants given that they were apparently healthy during the early post-partum period. Later initiation of breastfeeding was associated with indiscriminate prelacteal feeding, earlier termination of breastfeeding, and unwelcome supplementation practices. Our findings emphasize the need to initiate and/or strengthen programmes to promote appropriate breastfeeding practices in Bilbeis and other comparable areas.