Knowledge , Attitude and Practice Regarding Hepatitis C among Patients ' Family Caregivers in El Minia Governorate

Hepatitis C is a global disease. Egypt has the largest endemic of hepatitis C virus (HCV) in the world. The aim of this study is to identify knowledge, attitude and practice about hepatitis C among patients’ family caregivers in El Minia Governorate. A total of 90 main responsible family caregivers’ hepatic C patients and their were included in the study. Data were collected for a period of six months starting from March to August 2009. The study was conducted at the hepatic patients homes where the main family’s caregiver are escorting. Data were collected through structured interviewed questionnaire at the patients’ homes by five tools. These tools included; sociodemographic data of the study participants’, as well as assessment of the patient’s environment. The family caregiver participants’ were assessed for their knowledge, practice and attitude by structured questionnaire, checklist and likert scale, respectively. As regard patient sociodemographic date, results it showed that half of them lied in age group 35-50 years. The majority were males (73.3%). On side of the family caregivers participants’, it was found that slightly more than one third were between 20-30 years (35.4%) and females represented the majority (85.6%). Environmental assessment revealed that nearly three quarters (74.4%) lived in home consisting of more than 3 rooms. As regard knowledge level; it was found that the majority of the study participants between fair and poor knowledge level (44.4% and 34.4%, respectively). While more than three-quarters of the study participants were having fair and poor practices level (43.3% and 34.5%, respectively). Concerning the study participants’ attitude; about half of the sample was having agreement responses (54.5%). Statistically significant differences were found (p<0.05) between both gender in aspects of knowledge, attitude and practice. It was concluded that the majority of the study participants’ were between fair and low level in knowledge and practice as well as positive attitude responses among half of them. It is recommended to increase patients and family caregiver’s awareness about HCV transmission and prevention.


INTRODUCTION
Hepatitis C virus (HCV) shows significant genetic variation in worldwide populations, evidence of its frequent rates of mutation and rapid evolution.Statistics reveal that Bull High Inst Public Health Vol.40 No. 2 [2010]   about 300 million people are infected with the hepatitis C virus worldwide.However, the number of new hepatitis C cases diagnosed each year in the US has been steadily decreasing.Based on current statistics for hepatitis C, it's estimated that 8,000 to 10,000 people die each year from chronic liver disease caused by this condition.Higher rates have been reported in Southeast Asian countries, including India (1.5%), Malaysia (2.3%), and the Philipines (2.3%).The incidence in Japan was 1.2%.Alarming rates were reported for many African nations, reaching as high as 14.5% in Egypt. (1,2,3) pt has a very high prevalence of HCV and a high morbidity and mortality from chronic liver disease, cirrhosis, and hepatocellular carcinoma.In Egypt the major route of exposure appears to be due to inadequate infection control practices.In addition to blood transfusion prior to 1994. (4)e most common methods of previous hepatitis C transmission were injection-based treatment for schistosomiasis and blood transfusions. (5)The high risks for HCV are direct blood to blood contact, blood transfusion product, sharing drug using equipment for injection and non injection drugs such as needles and cotton, occupational exposure; healthcare workers coming in contact with blood.The most common causes of transmission occur in needle-stick with large hallow borne needles and 5% of children borne to hepatitis C positive mothers. (6,7,8)xual transmission of HCV is uncommon.Most studies indicate that only a small percentage is acquired through unprotected heterosexual intercourse.
Virus can be transmitted by this way if a person has mouth sores, bleeding gums, or throat infection and it may be more efficiently transmitted through anal sex than vaginal sex and more likely to be sexually transmitted when women having menstrual period.In a few cases, people have been infected with hepatitis C by sharing objects that may have a tiny M Mo oh ha am me ed d et al., 393 amount of blood on them, such as a toothbrush, razor, or tools used for manicures.Hepatitis C can also be spread by sexual intercourse, but this is rare. (9,10)agnosis and monitoring can be in minimizing the transmission of infection. (12)mprehensive strategy to prevent and  The level of significance was set at 5%.

RESULTS
Table 1

DISCUSSION
Regarding the sociodemographic characteristics of the study participants in the present study, about two thirds (70%) of them were in age group (20-40) years and more than three quarter (85.6%) were females while 14.4% were males.This agrees with a study reporting that about 69.9% of cases had age ranging between 20-40 years and 71.2% were females while only 28.8% were males (8) .In addition, more than three quarter (88.9%) of participant caregivers were from rural area whereas 11.1% of them were from urban area.This disagree with another study which reported that about 95.7% of participants were from urban areas while 4.3% of cases were from rural areas (15) .The study showed that about third of participants were illiterate (31.1%) and about half (45.6%) of participant caregivers had basic education.This agreed with medhot et al., (2005) who reported that about 35.5% of participant cases were illiterate and 41.9% had basic education (8) .Regarding marital status the present study showed that the majority of caregivers participants were married (87.8%) which disagreed with talpur et al., (2007) who reported that the majority of cases (above than half of participants; 53.2%) were unmarried and 46.8% were married (14) .
The present study showed also that the majority (78.8%) of participant relatives and female friends also take great responsibility (12) .
Although the study showed slightly better total practices score for family caregivers being about 22.2% had good practices, 43.3% had fair practices and 34.5% had poor practices scores.
Negligence or practicing some of these activities increases the exposure to HCV and rises HCV incidence rates and so increasing disease burden.
Concerning family caregivers' attitudes towards patients with HCV a high percentage (54.4%) of participant caregivers agreed that patients need screening.It was reported that diagnosis and monitoring can be determined by the use of various tests (11) .If a person is suspected to have HCV infection, screening test should be requested through assessing HCV antibodies.Regarding the similarly, a high percentage (58.8%)agreed with taking precautions while dealing with patients' blood HCV is transmitted through infected blood (13,14) .If someone with intact skin comes into direct contact with this blood He/she will not become infected in most cases because the skin acts as the first line of defense and stops the virus from entering their bloodstream.This is supported by weinstock et al. (2008), who reported that the risk of infection becomes greater if there are open wounds on the skin which sometimes cannot be seen and should be avoided once high risk behavior as sharing needles or syringes is done.All open wounds Should be/covered (15) .
There was statistically significant difference (p<0.05) in the item of sympathy for HCV patients.The majority (70%) agreed.
Regarding with the family the study caregiver in providing care to an individual client at home is essential. (12)Moreover, that patients, 66.7% of participants disagreed.With HCV need psychological care.This contradicted the report stating that a caregiver is defined as the individual responsible for the majority of care giving tasks, including emotional support and supervision of the family member. (12)

CONCLUSION
The majority of the study participants were located between fair and low level in knowledge and practice as well as positive attitude responses among half of them.

RECOMMENDATION
• Improving knowledge and practices of the community regarding HCV through health education that should be disseminated by mass media and health campaigns. • determined by using various tests when a person is suspected to have HCV infection.Screening test should be requested through assessing HCV antibodies that indicates if a person has been exposed to HCV infection.The most common tests used are ELISA and PCR, in addition to Liver function tests.Raised serum levels of transaminases reflect higher necroinflammatory activity and determine the need for treatment. (11)According to the prevalence of the Ministry of Health about 61 million were spent last month on the anti-viral drug "Interferon" which is used to treat Hepatitis C. Approximately 7.5 million or 9.4 % Egyptians are infected with the virus according to the Ministry of Health. (4)Family caregivers play a major role in providing caregiving assistance and contact with hepatic patient.Family caregiving assisting clients to meet their basic needs and providing direct care such as personal hygiene, meal preparation, medication administration, and treatments.

A
scoring system was designed for the assessment of knowledge, attitude and practice about HCV.Eight degrees were given to knowledge, eight degrees for attitude, nine degrees for practice and one degree was allocated for right answer.Three scoring levels were determined as following: for knowledge; Poor knowledge Bull High Inst Public Health Vol.40 No.2 [2010] (<3 degrees), fair knowledge (3:5 degrees), and good knowledge (6 or more degrees).For attitude, it was considered as; negative attitude (<5 degrees) and positive attitude (6 or more degrees).As regard practice, it was as follows; poor practice (<4 degrees), fair practice (4:6 degrees) and good practice (7 or more degrees).Pilot study was done on 10% of the study participants to assure clarity and the understanding of the tools.It also helped in the estimation of the time needed to fill the form.Accordingly, some non critical modifications were done for the tools.For Ethical and administrative designs: an official permission and official approval was obtained from director of El Minia University Hospital.An ethical faculty committee approved the protocol of the study.A clear explanation of the nature and the aim of the study was given to the study participants to obtain their informed verbal consent which included the rights for privacy and confidentiality.The orientation of the researcher and the study participants were done at the outpatient clinic.During this orientation session the sociodemographic characteristics of study participants' were obtained that included address and telephone number and management of the home visit interview time.Each home visit was taken about 30:45 minutes to complete tools of data collection.The data collected were tabulated and analyzed using SPSS version16.Descriptive and inferential data were carried out including; frequency, percentage, chi-square and ANOVA test.