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Background & Objective(s): Self-medication with antibiotics is a worldwide problem and a major driver of the emergence of antimicrobial resistance. The objectives were to estimate the frequency, describe pattern and identify possible determinants of self-medication with antibiotics among adults in Misurata and to evaluate the impact of a mass media campaign on their knowledge and attitude regarding self-medication with antibiotics. Methods: In the 1st phase, a cross sectional design was used and 277 adults accompanying patients attending the outpatient clinics of Misurata Central Hospital were interviewed using a predesigned structured questionnaire. Data about pattern of antibiotic use, knowledge and attitude was collected. In the 2nd phase, an intervention design (one group pretest post-test design) was used. A two months mass media campaign in the form of a radio program (one episode/week for eight weeks), a TV episode and written articles in Misurata University magazine about the correct use of antibiotics was launched and its effect was assessed after three months. Results: Among adults using antibiotics, 39.5% used it as self-medication. Several defects in the pattern of antibiotic use was noticed including the duration of use, indication, and course completion. Almost two thirds had poor knowledge about antibiotics, while the majority had neutral or positive attitudes. The mean knowledge and attitude scores regarding antibiotics had significantly increased after the mass media campaign (from 9.03± 3.02 to 18.1± 4.21 and from 23.17± 5.11 to 25.81± 4.83, respectively). Conclusion: The study highlighted the extent of inappropriate use of antibiotics and the potential effectiveness of using mass media campaigns in raising the public awareness about antibiotics.

Background: Breast cancer (BC) has become a health priority due to its increasing incidence. It is curable when detected at an early stage, so there is an urgent need for its early detection. Mammography screening (MS) is the main recommended test for early detection of BC. Objectives: The aim of the study was to assess MS utilization behavior among female employees and to identify some factors based on the Health Belief Model that determines the likelihood of MS utilization behavior in terms of: health beliefs, knowledge about BC and its risk factors, and access and need for MS. Methods: The study was conducted among 400 female employees aged 40 years and older in four workplace sectors in Alexandria using a cross sectional approach. A predesigned interview questionnaire was used to collect socio-demographic data, habits, reproductive history, family history, culture affiliation, access to MS, reproductive health screening behavior, MS utilization behavior, need for MS, knowledge about BC and MS, perceptions towards BC and MS, perceived threat (susceptibility and severity), perceived benefits and perceived barriers to MS, (personal barriers, economic barriers, health care system barriers). Results: More than two thirds of females (69.7%) had bad MS utilization. Seventy two percent of females had poor knowledge about BC protective factors, signs and symptoms and risk factors of BC and about MS. The perception of the studied females was high concerning susceptibility and seriousness of BC and benefits of screening but there were some perceived personal, economic and health care system barriers to MS. Multiple linear regression analysis of the factors predicting MS utilization shows that age, accessibility, perceived need, total knowledge of BC, MS, and occupation sector were the significant predictors. Conclusion: The majority of female employees had poor knowledge about BC and MS. Increasing the females’ knowledge about BC and accessibility to screening areas are important strategies influencing their decisions about whether or not to participate in cancer preventive practices.

Trachoma is a leading cause of preventable blindness in the world. The disease is hyperendemic in rural Egypt, where more than 75% of children show signs of having had at least one episode of infectious trachoma during the first year of life. Earlier anthropological and epidemiological observations suggested that trachoma prevalence would decrease if children had their faces washed with soap and water at least once each day. We conducted a community-based intervention to increase face washing in order to control trachoma. In this paper we describe the overall design of this intervention trial and discuss how we integrated anthropological methods and ethnographic data into the design of this successful multi-disciplinary, cross-cultural project to prevent trachoma.

A cross-sectional study was conducted to determine the extent and pattern of self-medication among adults, to identify their knowledge and practice concerning the purchased drugs and to calculate prescribing and purchaser care indicators. Following WHO methods, 35 pharmacies were randomly selected from districts in Alexandria city, Egypt. Of 1294 clients interviewed at these pharmacies, 1050 (81.1%) purchased self-medication; the commonest reason given was a belief that the condition was minor. The most frequently dispensed drugs were those for the respiratory system. The mean number of drugs per encounter was 1.10, mean cost LE 7.29 and mean dispensing time 2.53 minutes. Purchasers' knowledge and practice regarding the purchased drugs were poor.

Through a house-to-house survey, 455 married adolescent women [< 20 years] and 455 married women aged 20-45 years from squatter areas in Alexandria were interviewed. Determinants of early marriage were consanguinity, illiteracy and unawareness of reproductive health. Of the currently pregnant adolescents, 22% were receiving antenatal care compared with 40% of the older women. Family planning methods were currently being used by 39% of the adolescents and 63% of the older wives. Determinants of non-use were: adolescence, illiteracy and previous miscarriage/stillbirth. There is a need to increase public awareness of reproductive health and change the behaviour of both groups of women in this under-privileged sector.

Summary Background Trachoma is the leading cause of preventable blindness. Pogrammes to prevent blindness due to trachoma are based on community-wide treatment with topical tetracycline. We assessed the potential of community-wide azithromycin treatment for trachoma control. Methods Pairs of villages in trachoma endemic areas of Egypt, The Gambia, and Tanzania were matched on trachoma rates in 1-10-year-old children, Villages were randomly assigned community-wide oral azithromycin treatment (three doses with intervals of 1 week) or treatment with 1% topical tetracycline (once daily for 6 weeks). Clinical examinations were done at baseline, 2-4.5 months, and 12-14 months after treatment Chhmydia tmchomatitis was identified by ligase chain reaction (LCR). Analyses were by intention to treat. Univariate comparisons and multivariate analyses were used to compare outcomes. Findings LCR positivity was correlated with clinical severity, but about 30% of Egyptian and Gambian villagers with no active disease were LCR positive, Village-wide LCR positivity ranged from 16-5% (Tanzania) to 43.6% (Egypt). Treatment compliance was over 90% except in the tetracycline treatment village in Egypt. Of the participants initially LCR positive, 866 (95%) of 924 who received at least one azithromycin dose and 482 (82%) of 587 who received 28 days or more topical tetracycline, were negative at follow-up. At 1 year, village-wide LCR positivity rates were substantially bwer than at baseline with both treatments; the decreases were greater with azithromycin than with tetracycline (93% us 77% in Egypt, 78 vs 66% in The Gambia, 64 vs 55% in Tanzania). Similarly, greater reduction in clinical activity occurred after azithromycin. In multivariate analyses, factors associated with being LCR positive at 1 year were: not receiving azithromycin; age under 10 years; and LCR positivity at baseline. Interpretation Community-wide treatment with oral azithromycin markedly reduces C tmchomatis infection and clinical trachoma in endemic areas and maybe an important approach to control of trachoma.

Transmission, control, and prevention of schistosomiasis are linked with a range of individual and collective human behaviors, perceptions, and social and environmental conditions. The objective of this study was to describe the social and cultural factors related to schistosomiasis transmission in three Egyptian villages where prevalence rates of diseases are high. Data reported are based on focus group interviews collected among children and adults. Topics discussed were knowledge about disease, transmission behaviors (risky behaviors), risk perceptions, prevention behaviors (response to risk), symptoms, treatment behaviors, treatment satisfaction, knowledge of prevention, source of information, and more general concerns and grievances. Both adults and children were concerned about schistosomiasis, and were knowledgeable about disease symptoms, transmission, control, and risky behaviors such as swimming in canals or polluting their banks. The adults were concerned with lack of collective solutions such as limited piped water supply, little sewage control, and governmental responsibility to solve village health problems. Findings support the notion that schistosomiasis transmission and control must be understood as sustained by environmental conditions and patterned sets of behaviors that are culturally embedded, their alteration a key to changing schistosomiasis' long history and widespread prevalence in Egypt.

Tuberculosis is an important reemerging disease with increasing global morbidity and mortality. Tuberculosis control is hindered by patient noncompliance with treatment regimens. To study compliance to antituberculosis drug regimens, 172 patients diagnosed with tuberculosis during the first three months of 1995 were investigated. The patients were interviewed at their homes during July and August 1995. More than one-third [34.9%] of the patients were not adhering to the antituberculosis drug regimen. Factors increasing drug compliance included:disease symptoms, knowledge about the disease, family history of tuberculosis and hospitalization. More information about the disease and the importance of compliance should be provided to tuberculosis patients at the time of diagnosis and initiation of therapy. Supervision of drug administration by health care personnel is stressed

We evaluated dietary pattern and lifestyle characteristics of patients with colorectal cancer (CRC) in Jordan.The case-control study included 220 recently diagnosed CRC cases and 220 age and gender matched healthy subjects as a control group.The participating CRC cases had lower dietary intake of fibre, folate, vitamin B12, β-carotene, vitamin C and selenium as compared to controls (P0.05). The frequency of consumption of fruits and vegetables was also lower among CRC cases, while the frequency of consumption of red meat and saturated fat was higher and positively associated with CRC risk. Furthermore, family history for CRC played a positive role and the majority of CRC cases and controls had a low physical activity level.A sedentary lifestyle and a diet low in fruits and vegetables, and high in animal red meat and saturated fat, appeared associated with CRC among the studied Jordanian subjects. This is consistent with the reported CRC studies in developed nations indicating global causal effects for this tumour type.

Early detection and screening for colorectal cancer is important among first degree relatives (FDR) of colon cancer cases.Our target population comprised all such FDR, above 40 years of age, registered during the years 2003-2007, Jordan. Detailed information about cancer cases was collected from Jordan Cancer Registry. The screening study was conducted through two stages, where all FDR were examined at their homes for any suggestive related symptoms of colorectal cancer, then those who were suspected to have cancer were referred to hospital for confirmatory colonoscopy.First degree relatives amounted to 3,574 subjects, 153 (4.3%) were complaining of signs and/or symptoms suggestive of CRC. Of them 58 (37.9%) did not accept colonoscopy. The confirmation colonoscopy results for the remaining 95 (62.1%) indicated two confirmed CRC cases. Seventy three percent of the suspected cases complained mainly from change in bowel habit and about one fifth felt cramping.This study raised the question of cost effectiveness and cost benefits of running a nationwide screening program for such cancer in a developing country. On the other hand it highlights the importance of early detection activities in Jordan as it was the first study to be conducted among a community dwelling high risk population in the country.

Aim. To investigate the relationship between high blood pressure (HBP) and obesity in Egyptian adolescents.Methods. A cross-sectional study of 1500 adolescents (11–19 years) in Alexandria, Egypt, was conducted. Resting BP was measured and measurements were categorized using the 2004 fourth report on blood pressure screening recommendations. Additional measures included height, weight, and waist and hip circumferences. Obesity was determined based on BMI, waist circumference (WC) and waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) indicators. Crude and adjusted odds ratios were used as measures of association between BP and obesity.Results. Prevalence rates of prehypertension and hypertension were 5.7% and 4.0%, respectively. Obesity was seen in 34.6%, 16.1%, 4.5%, and 16.7% according to BMI, WHR, WC, and WHtR, respectively. Adjusting for confounders, HBP was significantly associated with overall obesity based on BMI (OR=2.18, 95%,CI=1.38-3.44) and central obesity based on WC(OR=3.14, 95%,CI=1.67-5.94).Conclusion. Both overall obesity and central obesity were significant predictors of HBP in Egyptian adolescents.

Trachoma, an infectious keratoconjunctivitis caused by Chlamydia trachomatis, is a leading cause of preventable blindness in developing countries. In this study we compared oral azithromycin with oxytetracycline/polymyxin eye ointment (once daily for 5 days every 4 weeks; total of six treatment cycles) for the treatment of active endemic trachoma in 168 rural Egyptian children. A suspension of azithromycin was administered to children as a dose of 20 mg/kg by one of three schedules: a single dose, one dose a week for 3 weeks, and one dose every 4 weeks for a total of six doses. The children's clinical status and chlamydial infection rates were evaluated for 1 year. The clinical cure rates were 35% 2 months after initial treatment, 16% at 8 months (during the annual autumn epidemic of purulent conjunctivitis), and 47% at 1 year. The pretreatment chlamydial infection rate of 33% (determined by direct immunofluorescence) decreased to 5% at 2 months and was 9% at 12 months. There were no significant clinical or laboratory differences among the four treatment groups. Thus, 1-6 doses of azithromycin were equivalent to 30 days of topical oxytetracycline/ polymyxin ointment and may offer an effective alternative means of controlling endemic trachoma.

Aim: This case-control study was aimed to evaluate the folate and vitamin B12 status among patients recently diagnosed with colorectal cancer (CRC), in Jordan. Materials and Methods: The study involved 220 recently diagnosed Jordanian CRC patients and 220 age- and gender-matched healthy controls. The dietary intake and biochemical assessment of folate and vitamin B12 were determined for all the study participants. Results: The CRC patients had lower daily intake and serum levels of both folate (189.28 ± 11.78 μg/day and 6.6 ± 1.3 μg/l, respectively) and vitamin B12 (1.09 ± 0.4 μg/day and 233.7 ± 17.9 pg/ml, respectively) as compared to their matched control groups (212.58 ± 13.18 μg/day and 16.2 ± 2.8 μg/l, respectively, for folate) and (2.49 ± 1.3 μg/day and 458.9 ± 30.9 pg/ml, respectively, for vitamin B12). Conclusion: The CRC Jordanian patients who participated in this study had a low status of folate and vitamin B12, and a well-established etiological factor for CRC.

Objectives: The objectives of the study were to investigate physician’s therapeutic practice and the compliance of diabetic patients attending rural primary health units in Alexandria. Material and Methods: A cross-sectional study was conducted and a multistage stratified random sample method was used for the selection of 600 diabetic patients. Data were collected by means of an interviewing questionnaire, an observation checklist, review of prescriptions and laboratory investigations. A scoring system was made for a diabetic patient’s knowledge and skills, patient’s compliance, doctor-patient relationship, and glycemic control. Results: About 57% always took their medication as prescribed by doctor and on time, only 2.2% always complied with dietary regimen while no one reported regular compliance with exercise regimen. Complications of the regimen was the commonest cause (63.3%) of noncompliance. A highly statistically significant difference was found between compliance with all regimens and patient’s knowledge of diabetes. The scores for doctor-patient relationship were all unsatisfactory. Results of glycosylated hemoglobin (HbA1c) revealed that metabolic control of four-fifth of the patients was satisfactory, 12% had fair and 8% had poor metabolic control. Conclusions: Patient’s compliance with most of the diabetes regimen was low. Doctor-patient relationship and patient’s compliance should be improved by conducting educational and training programs.

Background Health Related Quality of Life (HRQOL) instruments need disease and country specific validation. In Arab countries, there is no specific validated questionnaire for assessment of HRQOL in chronic kidney disease (CKD) patients. The aim of this study was to present an Arabic translation, adaptation, and the subsequent validation of the kidney disease quality of life-short form (KDQOL-SFTM) version 1.3 questionnaire in a representative series of Egyptian CKD patients. Methods KDQOL-SFTM version 1.3 was translated into Arabic by two independent translators, and then subsequently translated back into English. After translation disparities were reconciled, the final Arabic questionnaire was tested by interviewing 100 pre-dialysis CKD (stage 1-4) patients randomly selected from outpatients attending the Nephrology clinic at the Main Alexandria University Hospital. Test re-test reliability was performed, with a subsample of 50 consecutive CKD patients, by two interviews 7 days apart and internal consistency estimated by Cronbach’s α. Discriminant, concept, and construct validity were assessed. Results All items of SF-36 met the criterion for internal consistency and were reproducible. Of the 10 kidney disease targeted scales, only three had Cronbach’s α TM 1.3 were significantly inter-correlated. Finally, principal component analysis of the kidney disease targeted scale indicated that this part of the questionnaire could be summarized into 10 factors that together explained 70.9% of the variance. Conclusion The results suggest that this Arabic version of the KDQOL-SFTM 1.3 questionnaire is a valid and reliable tool for use in Egyptian patients with CKD.

We aimed to estimate the nationwide prevalence of anaemia among adolescents in Egypt and to study possible risk factors. A cross-sectional approach was used. Blood samples were collected from 1980 adolescents for haemoglobin estimation. The overall prevalence of anaemia was 46.6%, most of which was mild or moderate, with severe cases in less than 1.0% of the sample. Gender difference was almost nonexistent. A significant inverse relationship was observed between the level of anaemia and age [especially among boys], socioeconomic level and educational level. Anaemia was more prevalent in rural areas and in Upper [southern] Egypt. Anaemia is a major public health problem among Egyptian adolescents and wide-scale public health education is warranted.