الفهرس 
Introduction and Aims of the studyOnly 14 pages are availabe for public view
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Abstract
Infection with HCV remains a significant public health problem for which sufficient screening and mass access to care and therapy are cost-effective ways to reduce its burden. The aim of the current study was to study HCV infection among children attending Alexandria University Children Hospital. A cross sectional study design was carried out on 720 Children aged (2-<6) years old attended emergency department and outpatient clinics of AUCH either for minor illnesses or for follow up visit for a chronic illness, blood transfusion and surgical interference in a period of six months started from January to June 2017. Blood samples were collected from the 720 patients at pediatric outpatient clinic and were tested for anti-HCV antibodies by enzyme immunoassay (EIA) technique. All the samples which showed positive results for the anti-HCV antibody testing were tested for HCV RNA by PCR testing. A sample of 60 mothers of high-risk group children were subjected to an intervention program which was constructed to assess, promote, and improve knowledge of the mothers about HCV infection, risk factors, and mode of transmission. Intervention program started in August 2018 and lasted for three months. Data were collected through:
• A predesigned structured interview questionnaire.
• General and abdominal examination of the included children.
• Blood sampling for HCV antibody testing done for the whole study population. Samples which showed positive results for the anti-HCV antibody testing were tested for HCV RNA by PCR testing.
The SPSS 20.0 statistical package was used for data entry and analysis.
The study’s finding was as follows:
• The mean age of the studied children is 4.3± 1.4 years. The percentage of boys and girls were 57.1% and 42.9% respectively. About one third (31.3%) represented the first child born to their families.
• Most of the mothers (92.1%) had no or low education and most of them were housewives (90.6%), similarly most of fathers had no or low education but the vast majority of them were working (98.7%). The mean family size was 4.82 ± 1.24. the mean crowding index was 2.16 ±0.97. The majority of the studied families (87.9%) had insufficient per capita income and loan. More than two thirds of families (68%) scored low SES, while 32% were of medium SES.
• More than one half (58.2%) of the studied children were born by CS. In the majority of children, mothers gave birth at hospital (88.3%), and the delivery managed by doctor (89%).
• Most of the studied children (91.1%) had history of hospital associated risk factors, 49.9% of the studied children had history of community associated risk factors and 55.1% of the studied children had history of household associated risk factors. Accidental exposure was noticed among 5.6% of the total children.
• History of surgical intervention was reported among 150 children, 100 children (13.8%) had history of major surgery and 7% had history of minor surgery. History of blood transfusion was reported among 250 children (34.7%), 185 children (25.7%) had history of multi-transfusion.
• The mean age of children (by years) is significantly higher among group of high probability risk (P<0.001). Almost two thirds (63%) of children of high probability risk lived in rural areas compared to 41% of children in low probability risk (P<0.001).
• All families of high probability risk children were of low SES compared to 56% of families of low probability risk children with significant difference between both (P<0.001).
• Positive HCV antibody titer and confirmatory PCR results were seen among 1% of the studied children, 3.5% of high-risk children, 2.7% among children with history of multiple transfusion and 6.1% among children with history of major surgery.
• Exactly 3.5% of children of high-risk group for HCV had positive HCV antibody titer compared to 0% of low-risk group with significant difference between both groups (P< 0.001). Those seven children had also confirmatory positive HCV PCR test.
• Frequency of HCV infection was significantly higher among age group older than five years (FEP=0.018).
• Children having positive HCV antibody titer were 48 times more likely to have history of accidental exposure than children with no HCV infection (OR= 48.43 & 95% CI (9.07- 258.46)). Also, HCV was more significantly prevalent among children with history of exposure to major risk factor as multiple transfusion, major operation (100% vs 27.1% respectively, FET, p< 0.001). Children having positive HCV antibody titer were about 35 times more likely to have history of exposure to major risk factor than children with no HCV infection.
• Significant difference was shown between history of chronic diseases among children with positive and negative antibody screening test (P<0.001).The risk of HCV infection was about 7.5times and 2.5 times higher among children who had a history of multiple transfusion and frequent injection respectively compared to those who had not.
• The percentage HCV seropositivity was significantly higher among those reported previous history of surgical intervention.
• The preintervention knowledge score ranged between 0-27 with mean knowledge of 9.3± 6.7. Most of mothers (81.7%) had poor preintervention knowledge level. Immediately after the intervention all mothers (100%) showed a good knowledge level.
Based on the current study findings, the following can be recommended:
• Implementing effective prevention and control strategies to minimize HCV transmission within the community and preventing horizontal HCV transmission at all levels especially among high-risk group and rural residents.
• Substantial efforts are required to accomplish stigma reduction, raise public awareness, and coordination of regular screening with treatment access and feasibility.
• Treatment should be prioritized as early treatment programs was successful in aiding prevention and reducing transmission. All HCV positive children must have access to FDA- approved DAA combination therapy.
• Health care providers need to be capacitated to provide information to mothers and caregivers and understand community beliefs and attitudes about HCV.
• Further research on study factors that predict HCV transmission, the course and natural history of HCV acquired in childhood and interventions that might interrupt this most important source of infection in children.
• Screening for the high-risk groups.
• Implement proper control measures.