Screening for hepatitis C virus infection among school children

Introduction

Hepatitis C virus is one of the most common viral hepatitis that affects the liver and was first identified in 1989 ⁽¹⁾. It is a lethal human virus that can cause a chronic lifelong infection of the liver resulting in progressive liver disease that culminates in the development of cirrhosis and hepatocellular carcinoma (HCC) ⁽²⁾. Globally, an estimated 130–170 million persons (2%–3% of the world's population) are living with HCV infection. More than 350 000 deaths are attributed to HCV infection each year, most of which are caused by liver cirrhosis and hepatocellular carcinoma (HCC) ⁽³⁾.

National Egyptian health (2015) issues survey was conducted to describe the prevalence of HCV infection. Age group of (15–59 years) age, the prevalence of HCV antibody was found to be 10.0% and that of HCV RNA to be 7.0%. while children 1–14 years old, prevalence of HCV antibody and HCV RNA were 0.4% and 0.2% respectively ⁽⁴⁾.

Hepatitis C virus is most commonly transmitted through exposure to infected blood. This can occur through; contaminated blood transfusions, blood products and organ transplants, injections given with contaminated syringes and needle-stick injuries in health-care settings. Other modes of transmission such as social, cultural, and behavioral practices using percutaneous procedures (e.g. ear and body piercing, circumcision,) can occur if inadequately sterilized equipment is used ⁽⁵⁾.

Data about Hepatitis C virus (HCV) infection in children is limited compared to adults. Many infected children remain unidentified as children are less likely to have symptoms from their HCV infection. New infections in children continue to occur because of maternal-neonatal transmission or infection transmitted from mother to newborn. The prevalence of pediatric infection varies from 0.05 to 0.36 % in the USA and Europe and a mount for 1.8–5.8 % in some developing countries ⁽⁶⁾.

Community health nurse’s roles during screening are ensuring that the client understands the reason for screening and the procedure, ensuring that follow-up is available, monitoring and evaluating screening activities, documenting both the process and the results, and using screening activities as an opportunity to provide health education ⁽⁷⁾

Significance of the study

Hepatitis C virus infection is a global health problem that can progress to cirrhosis and end stage liver disease in a substantial proportion of patients ⁽⁸⁾. In Egypt, the situation is quite worse. Epidemiologically, Egypt show higher level of anti HCV antibodies than other countries ⁽²⁾. Egypt has the highest recorded prevalence of HCV in the world with an estimate of 10 % of the population are infected while 7 % are chronically ill which is highly infectious, mortality is estimated by 40 000 Egyptians a year and at least 1 in 10 of the population aged 15 to 59 is infected ⁽⁹⁾.

Screening asymptomatic patients who may have an increased likelihood of being infected with HCV is an important step toward improving the detection and ultimately treatment of infected individuals ⁽¹⁰⁾. Even though HCV infection is one of the major causes of chronic hepatitis and HCC in Egypt, there are no nationally representative estimates of HCV prevalence among children under 15 years of age in Egypt⁽⁹⁾. So that screening for HCV is an important aspect for disease prevention among children by early detection of the virus and providing early and proper treatment and maintaining good health for all individuals in the community.

Aim of the Study

This study aimed to screen HCV infection among school children (aged 12-18) years old in Minia city.

Research questions

1. What is the percentage of school children who are probably infected with HCV?
2. What are the most common risk factors associated with HCV infection during school age?

Subject and Methods

Research design:

        A cross-sectional design was used to achieve the aim of the present study.

 Setting:

       The current study was conducted in Zohra secondary school located in Zohra village as a rural school and an Islamic preparatory school in Minia city..

Sample

-            Stage I:

Two areas: one rural and another urban were selected randomly; Zohra village and Minia city.

-       Stage II:

Two schools out of 62 (total preparatory and secondary in Minia district) were chosen randomly, Zohra secondary school from Zohra village and Islamic preparatory school from Minia city.

-       Stage III:

Among 510 of school children in Zohra village, 432 children (response rate 84.7%) and 318 out of 352 children in Islamic school (90.3%) were included in the study.

Inclusion criteria:

-           School children 12-18 years old.

-           Both males and females.

-          Excluded students who are diagnosed with HCV

Tools of data collection:

Structured interview questionnaire: it was developed by the research investigator after extensive review of related literature with the consultation of the experts in the field of community health nursing and public health from faculties of medicine and nursing at Minia university. The questionnaire was in English language and composed of 23 questions within three parts as the following:

• Part I: Personal and demographic data: such as (age, gender, place of residence, number of family members, and occupation of parents…etc.).
• Part II: It includes risk factors associated with hepatitis c virus infection such as (blood transfusion, surgery, needle stick, attending dentistry clinic…etc.)
• Part III: Rapid HCV antibody test.

Validity and Reliability

        The content validity of the data collection tool was examined by three experts who were affiliated to Faculty of Nursing, and Faculty of Medicine Minia University at community health Nursing Department and Public Health and Preventive Medicine Department. The tool was examined for content coverage, clarity, relevance, applicability, wording. Based on experts` comments and recommendations; minor modifications had been made such as rephrasing and rearrangements of some sentences.

Ethical consideration:

        A written approval was obtained from the Research Ethical Committee the Faculty of Nursing, Minia University. An official permission was obtained from Directorate of Education in Minia city. Oral consent was obtained from the students’ parents. The directors of schools and the school children were informed about the nature, purpose of the study and its benefits.  School children were informed that participation in the study was voluntary and they have the rights to withdraw from the study at any time without giving any reason. Confidentiality was also assured through coding the data. Each participant was interviewed individually by the investigator to fulfill the necessary data.

Study procedure

The investigator initially introduced himself to all school children. Open discussion about HCV was initiated to discover to what extent the school children have knowledge about HCV and the purpose of study screening. Interview conducted to all school children to fill personal data and identify the risk factors they were exposed. The investigator asked school children questions in the questionnaire and marked their response in structured interview questionnaire. The time taken to conduct the structured interview questionnaire for each school child ranged from 3-4 minutes and rapid anti HCV test was done and the time taken until result obtained was 5-7 minutes. Rate was 18-20 school children / day. Data collection was conducted over a four months period extending from February 2016 till May 2016.

Statistical design:

        The collected data were, coded, categorized, tabulated, and analyzed using the Statistical Package for the Social Science (SPSS 20.0). Descriptive data were expressed as mean and standard deviation. Qualitative data were expressed as frequency and percentage. Fisher exact and Pearson correlation tests were used to investigate the presence of a statistical significance differences with P. value < 0.05.

Results:

Table (1): Distribution of common risk factors associated with HCV among school children (n = 750)

Table (1) shows the most prevalent risk factors among studied school children were ear piercing, history of taking any injectable medications from informal health care provider, circumcision, scarification and history of dental procedure 99.3, 94.9, 88.8, 88.5, and 62.5% respectively.

Table (2):  Percentage distribution of studied school children who may probably have HCV (n = 750).

             Table (2) reveals that the number of school children who may probably have HCV infection. As the results of advanced quality rapid HCV antibody test denoted that only 0.7% of school children were positive.

^{*p < 0.05}

Figure (1): Relationship between the result of anti-HCV test and the gender of studied school children, Minia district,2016.

Table (3) Relationship between the common risk factors and percentage of positive and negative anti HCV among school children (n = 750).

^{*P – value < 0.05}

Regarding exposure to risk factors for HCV infection and the results of anti HCV test among studied school children, blood transfusion, sharing shaving instruments and sharing of toothbrush were higher among positive school children than negative (40% versus 3.9%, 60% versus 12.8% and 80% versus 10.7%) respectively and these differences were statistically significant p = (0.02, 0.03, 0.002) respectively.

History of exposure to dental procedure, hospitalization, circumcision and needle stick injury were more frequent among positive anti HCV school children than negative ones but these differences did not reach to a statistical significance. All positive anti HCV school children don’t have HCV infection among their mothers and relatives.