Journal of High Institute of Public Health <p class="Default">JHIPH is an open access<strong>&nbsp;<a title="license" href="" target="_blank" rel="noopener">[CC BY-NC-ND 4.0 license]</a></strong><a title="license" href="$$$call$$$/api/file/file-api/download-library-file?libraryFileId=1" target="_blank" rel="noopener">,</a> peer reviewed journal, indexed on&nbsp;<strong><a href="">Google Scholar</a>, <a href=";">Egyptian Universities Libraries Consortium </a></strong>and<strong> <a href="">WHO Index Medicus of Eastern Mediterranean Region</a>&nbsp;</strong>and hosted by <a href="" target="_blank" rel="noopener"><strong>High Institute of Public Health</strong></a>, <a href="" target="_blank" rel="noopener"><strong>Alexandria University</strong></a> since 1970. Previously was Bull High Inst Public Health.</p> <p>JHIPH publishes original and review articles covering all areas of public health. It has a broad scope encompassing epidemiology, prevention and control of communicable and non-communicable diseases, primary family care, nutrition, environmental health, management of health systems and services, occupational medicine and industrial hygiene, health education and health promotion.</p> <p>It has a very proficient and diverse editorial board that reflects the scope of public health. They are concerned with the quality, and authenticity of research papers and other contributions in public health areas, thrive to place the journal among the top public health journals, to expand its international outreach by an online submission system and to increase its impact factor.&nbsp;</p> en-US <p><a title="license" href="" target="_blank" rel="noopener"><strong>Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Public License [CC BY-NC-ND 4.0] </strong>&nbsp;</a></p> <p>By exercising the Licensed Rights, You accept and agree to be bound by the terms and conditions of this Creative Commons Attribution-Non Commercial-No Derivatives 4.0 International Public License.&nbsp;<strong>&nbsp;</strong>This License does not reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License. You must give <a href="">appropriate credit</a> to the Licensed Material. You may do so by providing a URI or hyperlink to a resource that includes the required information Or by citing and referencing to research articles by scientific referencing styles. You may not use the material for <a href="">commercial purposes</a>. If you <a href="">remix, transform, or build upon</a> the material, you may not distribute the modified material. You may not apply legal terms or <a href="">technological measures</a> that legally restrict others from doing anything the license permits.&nbsp;</p> (Prof. Manal Riad Koura) (Alexandria University Portal) Sun, 01 Apr 2018 00:00:00 +0000 OJS 60 Effect of Health Education Program on Knowledge, Lifestyle and Health Profile of Prediabetic Employees in Zagazig University <p><strong>Background:</strong> Prediabetes is a risk factor for type 2 diabetes and cardiovascular diseases. So, its early detection and management are important.</p> <p><strong>Objective(s):</strong> To identify the prediabetics among employees of Zagazig University. To assess the effect of a health education program on prediabetics' knowledge, lifestyle and health profile.</p> <p><strong>Methods:</strong> Prediabetics were detected among 556 participants working in the managerial departments of Zagazig University, through two steps; firstly, screening by FINDRISC questionnaire then Fasting Plasma Glucose (FPG) and glycosylated haemoglobin (HBA1c) testing for those with FINDRISC scores of ≥ 15. The intervention was in the form of group education targeting adoption of a healthy lifestyle through providing knowledge and using behaviour change methods like goal setting, action planning and problem-solving with follow up for six months.</p> <p><strong>Results:</strong> The participants with FINDRISC scores of ≥ 15 were 46.9%, only 21.9% of them were actually prediabetics. After the intervention, there was highly significant increase in the percent of participants with satisfactory knowledge and healthy lifestyle practices (p=0.00), and highly significant reduction in the mean value of FPG, HbA1c, body mass index and waist circumference.</p> <p><strong>Conclusion:</strong> Health education was an effective tool that implicated a change in prediabetics' knowledge, lifestyle and health profile.</p> <p><strong><em>&nbsp;</em></strong><strong><em>Keywords</em></strong><strong>: </strong>Prediabetes, FINDRISC questionnaire, risk factors, lifestyle, health profile, health education.</p> Amira E. Abdelsalam, Randa M. Said ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Dietary Habits and Age at Menarche in Relation to Body Weight Among Preparatory School Girls in Alexandria <p><strong>Background</strong>: Overweight and obesity are a public health crisis among adolescents worldwide. Adolescence is a crucial period for learning and adopting healthy eating and lifestyle habits that persist into adulthood. Obesity in childhood is linked to early menarche which places the adolescent girl in high risk of developing metabolic diseases as Type 2 DM and cardiovascular diseases and hormone related cancer as breast and endometrial cancer.</p> <p><strong>Objective(s):</strong>&nbsp; The aim of this study was to assess the prevalence of overweight and obesity in preparatory school girls in Alexandria and to examine their relation to dietary habits and age at menarche.</p> <p><strong>Methods:</strong> A cross sectional study was conducted. A total of 730 preparatory school girls from 4 governmental schools were chosen using stratified random sampling. A self-administered questionnaire was used to collect demographic data, dietary habits, physical activity status and menstrual history. Anthropometric measurements were taken (weight, height, waist circumference, BMI) and percentiles were compared to CDC growth charts.</p> <p><strong>Results: </strong>In the present study, the prevalence of overweight in preparatory school girls was 14.7%, while that of obesity was 34.7% according to CDC charts. The prevalence of abdominal obesity was 24.7%. The prevalence of overweight/obesity was lower in girls whose mothers were working. Almost half (47.9 %) of girls who scored poor in the dietary habits questionnaire were obese, compared to 38% who had normal body weight. Dietary habits that were associated with obesity were eating meals away from home and consuming 2-3 loafs of “balady” bread daily. As for the age at menarche 51.9% of those who started menstruating before the age of 12 years were obese compared to 35.5% of girls who started menses after the age of 12 and this was statistically significant (p=0.004). Age at menarche was negatively correlated with BMI.</p> <p><strong>Conclusion and recommendations</strong>: About one third of preparatory governmental school girls were obese. This was negatively associated with the age at menarche. Dietary habits that were significantly associated with overweight/obesity included eating away from home and increased consumption of bread. These habits should be the targets for school based nutrition education campaigns.</p> <p><strong><em>&nbsp;K</em></strong><strong><em>eywords</em>: </strong>Dietary Habits, Menarche, Preparatory School Girls, Egypt</p> Rana H. Emara, Azza A. Mehanna, Ayat D. Aashour, Manal R. Koura, Hanan Z. Shatat ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Validity of PCR Versus Coproscopic Examination for Diagnosing Infection with Schistosoma mansoni in a Low Intensity Endemic Area in Egypt <p><strong>Background:</strong> Egypt is a Schistosoma endemic country with localized foci of transmission. Although ongoing public health control programs could reduce infection rates, yet the situation evaluation necessitates a good diagnostic technique.</p> <p><strong>Objective(s)</strong> As the current parasitological methods lack efficiency, the aim of present study was to assess the validity of conventional polymerase chain reaction (PCR) versus coproscopic techniques as gold-standard to diagnose <em>S. mansoni</em> infection in a low intensity endemic area in Egypt.</p> <p><strong>Methods:</strong> A cross sectional study was used to examine faecal samples of 120 primary schoolchildren; 74 (61.7%) were males and 46 (38.3%) were females with mean age of 10.16±0.798 years (range: 9-12 years). Three fresh stool samples were collected on three consecutive days from each study subject and examined by formalin-ether concentration (FEC); three slides from one fecal sample of the first day. Ten slides from three fecal samples on three consecutive days were examined by Kato-Katz technique; 6 slides on the first day and 4 slides from 2<sup>nd </sup>and 3<sup>rd</sup> day samples, 2 each. Lastly, one sample of the fecal specimen of the 1<sup>st</sup> day was tested by PCR.</p> <p><strong>Results:</strong> <em>S. mansoni</em> infection prevalence was 40.0 %, 69.2% and 80.8% by FEC, Kato-Katz, and PCR techniques, respectively. All infected cases were of low intensity infection (&lt;100 epg). The overall geometric mean egg count (GMEC) was 13.35 and 33.34 epg stool by FEC and Kato-Katz techniques, respectively. The Kappa index (0.75) and diagnostic parameters showed a good diagnostic value of PCR as compared to copromicroscopic examination.</p> <p><strong>Conclusion: </strong>PCR demonstrated a good diagnostic performance for the detection of <em>S. mansoni </em>in low intensity endemic area versus coproscopic examination as gold-standard.</p> <p>&nbsp;<strong><em>Keywords: </em></strong>Diagnostic performance; formalin-ether concentration; Kato-Katz; PCR; <em>Schistosoma mansoni</em></p> Hassan K. Bassiouny, Safaa M. Eassa, Walaa A. Hazzah, Engy O. Elkomy, Rashida Barakat ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Impact of Educational Program on Reproductive Health Knowledge of Female Preparatory School Students in Alexandria Governorate <p><strong>Background:</strong> The integration of reproductive health (RH) into national strategies and programs is one of the targets of the Sustainable Development Goals (SDGs) adopted by the United Nations General Assembly in September 2015.</p> <p><strong>Objective:</strong> Assessment of the effectiveness of an educational program on reproductive health knowledge of preparatory school female students in Alexandria Governorate.&nbsp;&nbsp;</p> <p><strong>Methods:</strong> A pre-post study design was conducted on 102 preparatory school female students by using a pre-designed self-administered questionnaire, covering four RH domains: puberty and menstrual cycle, genitourinary and sexually transmitted infections (STIs), menopause and female genital mutilation (FGM), as a tool for assessment of their RH knowledge before and after 6 weeks of applying an educational program for them.</p> <p><strong>Results:</strong> The results revealed that the total RH knowledge of the female students improved significantly after intervention, as 64.7% of participated girls had a satisfactory level of knowledge after the educational program compared to zero % before intervention. The four RH domains: puberty and menstrual cycle, genitourinary infections, menopause and female genital mutilation all showed significant increase in their knowledge score percentage after intervention.</p> <p><strong>Conclusion &amp; Recommendation:</strong> RH educational program had a significant effect on the level of knowledge of the girls, thus we may recommend the integration of such education in the main school curriculum for the sake of improving their reproductive health.</p> <p><strong>&nbsp;</strong><strong><em>Keywords:</em></strong> Reproductive health knowledge, Interventional educational program, Adolescent girls</p> Noha S. Moustafa, Yasmine Y. Muhammad ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Determination of a Cut-off Point for Prostatic Specific Antigen to Avoid Unjustified Biopsy Among Asymptomatic Elderly Men <p><strong>Background: </strong>To our knowledge, there is no national screening program for prostate cancer in Egypt. The Uro-surgery department in Alexandria University established a screening program for prostate cancer among men aged 55 years or more in January 2012.</p> <p><strong>Objective: </strong>To determine a valid Prostatic Specific Antigen (PSA) cut-off point for performing Transrectal Ultrasonography (TRUS) guided biopsy among asymptomatic elderly men.</p> <p><strong>Methods: </strong>A screening cross sectional study was conducted on a convenient sample of 1207 men aged ≥55 years who were attending urology department, Alexandria University for non-prostatic symptoms during years 2013 and 2014. Digital Rectal Examination (DRE) and PSA level measurement were performed for all included subjects. TRUS guided biopsy was done for those who found to have PSA ˃ 4ng/ ml and or suspicious DRE.</p> <p><strong>Results: </strong>Among subjects who had PSA level of 4.1-10, the Positive Predictive Value (PPV) for cancer prostate was 54% among those with suspicious DRE findings as compared to 0 among those with non-suspicious DRE. For PSA level of 10.1-20 and &gt;20 with suspicious DRE, PPV was (77% and100% respectively). The mean serum total PSA was 77 and 0.6 ng/ ml for patients with and without prostatic cancer respectively (p= 0.0001). The yield of cancer prostate among all screened men was 103/1207= 8% and 103/157= 66% among those with PSA˃ 4 ng/ ml and or having suspicious DRE and were biopsied. Considering all men who had biopsy, ROC curve could derive a cut-off value of 10.05 ng/ml with a sensitivity of 92% and a specificity of 92.6%. Inability to perform biopsy for men with PSA ≤4 ng/ml was the main limitation.</p> <p><strong>Conclusion: </strong>In a country of relatively low prevalence of prostate cancer like Egypt, a cut-off point of PSA in combination with DRE for doing TRUS biopsy could be 10.05 ng/ ml among asymptomatic men ≥55 years of age with a likelihood ratio of 12.43.</p> <p><strong>&nbsp;</strong><strong><em>Keywords:</em></strong> Prostate cancer, screening, Transrectal Ultrasonography guided biopsy, Prostatic Specific Antigen level, Egypt</p> Afaf G. Ibrahim, Samia Abou Khatwa, Mohamed A. Atta, Mona H. Ashry, Asmaa Ismail ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Comparative Study Between Integrated Management of Childhood Illness Guidelines and Traditional Methods in Management of Acute Pharyngitis among Children Under Five Years in Zagazig District, Egypt <p><strong>Background: </strong>Pharyngitis is one of the most frequently faced pediatric problems with serious complications in primary care.</p> <p><strong>Objective(s):</strong> To compare between Integrated Management of Childhood Illness (IMCI) guidelines and traditional management concerning diagnosis and antibiotic prescription for acute pharyngitis in children less than 5 years, as well as to determine validity of IMCI guidelines in diagnosis of acute pharyngitis by comparing their results to throat culture as a golden standard.</p> <p><strong>Methods:</strong> A comparative cross-sectional study was conducted in one primary health care center and one unit where IMCI guidelines were implemented; as well as one center and one unit where traditional management of acute pharyngitis was implemented in Zagazig district, on 343 children under five years complaining of sore throat or difficult feeding. About 86 children were randomly selected from each health facility during the period of first of January until end of June 2017. Doctor’s clinical diagnosis and antibiotic prescription were reported for all children, while throat swabs were taken from children managed according to IMCI guidelines for bacterial culture.</p> <p><strong>Results: </strong>According to IMCI, only 11 % of children were diagnosed as bacterial pharyngitis, antibiotic prescription was significantly lower among those managed according to IMCI compared to traditional methods (11% &amp; 96.5% respectively, P&lt;0.001). However, throat culture revealed that 28.5% of children managed according to IMCI guidelines had positive bacterial growth. Sensitivity of IMCI guidelines to detect bacterial cases of pharyngitis was only 36.7 % and Positive Predictive Value (PPV) was 94.7%, while their specificity to exclude bacterial and detect viral infection was about 99.2% and the Negative Predictive Value (NPV) was 79.7%.</p> <p><strong>Conclusion:</strong> Application of IMCI guidelines is considered valuable in prevention of antibiotic abuse.&nbsp; However, the sensitivity of IMCI guidelines to detect bacterial pharyngitis was 36.7%.</p> <p><strong><em>&nbsp;</em></strong><strong><em>Key words: </em></strong>integrated management of childhood illness guidelines, validity, acute pharyngitis</p> Abdalla H. M. Elsharkawy, Ghada M. Salem, Amal E. Mohamed, Maha S. Eltwansy ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 Patient Satisfaction with Emergency Departments in Governmental General Hospitals, Kuwait <p><strong>Background</strong>: Patient satisfaction is one of the essential determinants and indicators of the quality of health care and services delivery. Evaluation of patient satisfaction is considered an emergency department goal.</p> <p><strong>Objective: </strong>The objective of the current study was to evaluate patient satisfaction with the emergency department in Kuwait governmental general hospitals.</p> <p><strong>Methods</strong>: This cross-sectional study was conducted from January to March 2016 in all governmental general hospitals located in different governorates of Kuwait state. A systematic random sample of patients attending the emergency departments of these hospitals taking every 10<sup>th</sup> patient was selected to participate in the study. The 20-item-satisfaction questionnaire of the Press Ganey Institute was used as a tool for data collection. Totally, 713 pa­tients were enrolled in this study.</p> <p><strong>Results: </strong>The data indicated that more than half of the subjects in this study were males (53.7%) and 46.3% were females. The minimum age of subjects was 18 years and the maximum 86 years, with an average value of 37.1±15.3 years. The overall satisfaction with emergency services was 58.4%, although 18.9% were dissatisfied. Items with high level of satisfaction included:&nbsp; Concern the nurse showed for doing medical orders (67.2%), physi­cian’s courtesy and behavior with the patients (66.6%), provider's efforts to get the patients involved in making decisions about their own treatment (60.7%), security guards' courtesy (60.3%) and nurses' courtesy with the patients (66.5%). The lowest level of satisfaction refers to the following items: Comfort and pleasantness of the waiting area (48.0%), waiting time for the first visit (46.4%), and overall cleanliness (55.8%). The data indicated that females were significantly more satisfied than males regarding courtesy of staff in the registration area (P=0.028), courtesy of security staff (P=0.001), courtesy of staff who transfer the patients (P=0.014), friendliness/courtesy of the care provider (P=0.019), concern the care provider showed for questions or worries (P=0.006), instructions the care provider gave about follow-up care (P=0.019). On the other hand, overall satisfaction with cleanliness was higher among males (P=0.012).</p> <p><strong>Conclusion</strong>: The study findings indicated that giving services to emergency clients was relatively agreeable. However, interventions are needed in some areas such as waiting area, length of waiting before examinations, amount of time physicians spend with patients and frequency of being visited by physicians. Time of visit and gender differences did not have a profound impact on satisfaction level.</p> <p><strong><em>&nbsp;</em></strong><strong><em>Key words:</em> </strong>patient satisfaction, emergency department, Kuwait</p> Saadoun F. Alazmi, Bashair A. Almutairi ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000 A Comparative study of Patients’ Satisfaction with Emergency Departments in Governmental General Hospitals, Kuwait <p><strong>Background: </strong>Patient satisfaction is commonly used as an indicator for evaluation of the quality of health care services provided in the Emergency Departments (EDs).</p> <p><strong>Objective: </strong>The objective of this study was to evaluate and compare the level of patient satisfaction with the Emergency Departments in different governmental public hospitals in Kuwait.</p> <p><strong>Methods:</strong> A comparative descriptive cross-sectional survey was conducted in five governmental general hospitals located in different governorates in Kuwait state from January to March 2016. A random sample of 657 patients, who attended the emergency departments of these hospitals was asked to participate in the study. A 20-item satisfaction questionnaire was used in this study. The three domains of satisfaction were computed namely; ED courtesy, environment and care-providers. The Pearson’s chi square test (χ2) was used to compare between the satisfaction categories. The Kruskal-Wallis test was used to compare between the median values of satisfaction scores of the five hospitals. For intergroup comparisons, Mann-Whitney test was used. The 5% was considered as the level of signifi­cance.</p> <p><strong>Results:</strong> &nbsp;A total of 657 pa­tients were enrolled in this study. &nbsp;More than half were males (53.9%), most of them were married (57.2%) and carriers of bachelor degree represented 40.9%. The minimum age of subjects was 18 years and the maximum 86 years, with an average value of 38.9±14.7 years. The majority was belonging to the same health region of the hospital (79.5%) and nearly two-thirds of them had been admitted (68.2%). The highest median for the overall patient satisfaction scores with emergency departments was in Amiri (4.2), and Jahra hospitals (4) followed by Mubarak and Adan hospitals (3.6 each) and the lowest median score was in Farwaniya hospital (3.15). The differences were statistically significant. Similarly, the highest median satisfaction scores for all domains (ED staff courtesy, ED environment and ED care providers) were reported in Amiri and Jahra hospitals, followed by Mubarak and Adan hospitals and the lowest median score was observed in Farwanyia hospital. Less than 20% of the participants attending Farwanyia hospital were satisfied with most items and only 12.9% of the participants attending Adan hospital were satisfied with the waiting area.</p> <p><strong>Conclusion:</strong> The study findings indicate that the need for intervention and development in emergency care service departments are required based on the study findings of relatively low level of satisfaction in the emergency department domains namely environment domain, staff courtesy domain and care providers’ domain in Farwaniya hospital.</p> <p>&nbsp;<strong><em>Keywords:</em> </strong>Patient satisfaction, emergency department, Kuwait</p> Saadoun F. Alazmi ##submission.copyrightStatement## Sun, 01 Apr 2018 00:00:00 +0000