Combating Hepatitis C in Egypt

Viral Hepatitis has been one of the world’s most ‎pressing health problems. It affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.5 million people every year, mostly from hepatitis B and C. These infections can be prevented, but most people don’t know how.

Many Egyptians have been infected with hepatitis C as a result of inadequately sterilized needles during mass campaigns to treat Schistosomiasis which started in 1960s and continued through the early 1980s. Afterwards, the virus continued to spread through infected blood and relevant items.

By 2014, Egypt had one of the highest global burdens of hepatitis C virus infections in the world. It was estimated then that 4.4% of the population 1-59 years old and 7% of the population between 15 and 59 years are chronically infected. A new national strategy needed to be developed and implemented by national and international parties to meet this major challenge.

Source: EGYPT HEALTH ISSUES SURVEY 2015, p.41  https://dhsprogram.com/pubs/pdf/FR313/FR313.pdf

As senior communication adviser to the World Health Organization (WHO) in Egypt between 2014 and 2016, I contributed the following:

• Wrote the Communication Plan for Hepatitis C Awareness and prevention.
• Supervised the development and production of a documentary film on the HCV problem in Egypt.
• Designed and supervised the implementation of three KAP surveys in Egypt during 2015 on: (1) the general public, (2) hepatitis C patients, and (3) healthcare providers.
• Analyzed the data from the three surveys and concluded recommendations for the media strategy, communication messages, targeting, and appropriate media selection.
• Concluded the Priority Messages for the First Wave of Hepatitis C TV Spots in Egypt.
• Developed the first Egyptian national campaign on hepatitis C awareness and in 2016-2017, which included five television spots, a poster, and a pamphlet.
• The involvement of in the national effort to combat HCV continued after I left WHO, as I was nominated by Cairo University to help the Ministry of Health and Population as the senior communication adviser for the national drive to treat all infected persons in Egypt, which was launched in 2018 and continued for 7 months, from October 2018 to April 2019. As I recommended to the ministry, the campaign should never assume that the problem has completely disappeared. There is a very strong need to continue educating the public about prevention, alerting high risk groups to get a checkup, and upgrading the infection control knowledge, skills, and practices of healthcare providers. This is the link to this national drive: http://www.stophcv.eg/

The Communication Strategy & Plan for Hepatitis C Awareness and Prevention in Egypt

Overall Strategy Guidelines

This implementation plan addresses the role that communication can play in the prevention of Viral Hepatitis in Egypt and describes the sequence of events that will result in the desired change. It also describes a logical progress from the broad goals to objectives, accomplishments or outcomes and then to very concrete actions and activities.  The plan includes the following:

• Specific and measurable objectives, indicators, and activities within a specific time frame
• Defined action steps with accountability, deadlines and resources needed
• Links to the national Action Plan and to the Communication Strategy.

When put into use, this plan should be a dynamic tool. Target dates may need to be adapted, and actual results may be different than anticipated. This document is therefore a tool to document progress as well. 

Because the implementation plan is detailed with specific activities, and since the resources needed may be beyond the capabilities of one single entity, partner organizations can choose to be responsible for sponsoring specific appropriate sections or activities, which are consistent with their organization’s strategic plans.  Doing so will help to document their contributions to this collaborative endeavor and to track their efforts internally.

Another important use of this detailed implementation plan is its utility in process evaluation. When the campaign is evaluated, a thorough investigation must be undertaken to determine which activities have been implemented and which were not, and how the implementation itself took place.  As this plan is approved, the country can move into actual implementation where partners would use it as a foundation for implementation, monitoring, evaluation, and coordination.

The Plan of Action for the Prevention, Care & Treatment of Viral Hepatitis, Egypt 2014-2018 is the main background document that constitutes the source of what is considered in this implementation plan as goals, objectives, performance measures or indicators, and activities.

Goal: In this implementation plan, the overall goal is to reduce or eliminate new infections of HCV and to encourage currently infected persons to seek immediate treatment.

Objectives:

• Improve the general public’s knowledge and Behaviors and their understanding of HCV, its seriousness, care, treatment, and prevention.

• Help eliminate stigmatizing people infected with HCV.

• Improve knowledge, attitudes and practice of positive behaviors of infected ‎individuals and their family members regarding ‎diet, exercise, medical follow-up, prevention, and ‎seeking treatment.‎

• Increase correct knowledge and practice of prevention measures among healthcare providers, in public and private, formal and informal sectors.

• Enhance the enabling environment (namely decision makers and the media) through the constant supply of correct information and motivational messages.

Audience segmentation

• The general public
• Individuals living with HCV and their families
• Healthcare providers
• The media, opinion leaders and decision makers

Summary of recommended key approaches for target segments:

The General Public:

1. Baseline and follow-up KAP and media habits surveys as well as Focus Group Discussions (FGDs) utilized in message development and pretesting.
2. TV & Radio public service announcements
3. TV & Radio talk shows, popular/health/women/children’s programs
4. Special events including World Hepatitis day.
5. Stickers and pamphlets at P.O.S, public transportation, and workplaces.
6. Community mobilization in schools, universities, mosques, churches, NGOs, clubs, and local businesses.
7. Newspaper coverage of HCV news and events.

Persons with HCV:

1. Baseline and follow-up KAP and media habits surveys as well as Focus Group Discussions (FGDs) utilized in message development and pretesting.
2. The internet and social media (most popular Egyptian websites and social media, in addition to websites for NCCVH, the MOHP, the national program, and WHO.)
3. Upgrade, publicize and utilize the HCV hotline
4. SMS to mobile phones (The national control program has a database which includes more than one million mobile phone numbers for all those who applied through the NCCVH website for the new treatment.)
5. TV spots featuring celebrities and champions who have had the HCV treatment
6. A series of video magazines for patients in the waiting halls of liver institute and similar health providers

Healthcare Providers:

1. Establish a database for healthcare providers
2. Baseline and follow-up KAP and media habits surveys as well as Focus Group Discussions (FGDs) utilized in message development and pretesting.
3. Leaflets for healthcare providers specially those dealing with blood and injection.
4. A special mass-mailed letter with specific actionable instructions from the Minister or other senior MOHP leadership to all those involved in injection or blood.
5. Support outreach and mobilization of HCP in 5270 primary healthcare units and 450 hospitals within 5 years through supporting TOT and peer education efforts conducted by the MOHP.
6. Produce one educational film that clarifies the specific steps HCP should follow for infection control (IC).
7. Digital mass campaigns through SMS and the internet with essential information and instructions.

Media, Decision Makers and Other Opinion Leaders:

1. Content analysis of media coverage of HCV.
2. Press releases, press kits, lobbying services and story pitching to the journalists and media editors.
3. Special events and news conferences to keep the media and decision makers involved.
4. High-level advocacy activities including meetings and a regular newsletter to decision makers, particularly the parliamentary subcommittee on health and owners of large businesses to promote corporate social responsibility (CSR).

Highlights of the Strategy & Implementation Plan

Detailed activities, timeline, budget, expected results and responsibilities:

A special template was used to detail the above mentioned aspects of the implementation plan for each of the four objectives specified in the strategy. As can be noticed from the table of contents shown above, the plan was very detailed (44 pages). A picture of the template head is featured below:

Short and long-time indicators for all objectives:

Communication Messages

Detailed lists of messages and their supporting facts were drafted in the strategy and implementation plan. It was stressed, however that the lists were not final and that final message lists and contents are “To be revised on the basis of the baseline and follow-up 1 surveys“.

Notice that the messages are drafted in consistency with the theory and methodology outlined elsewhere in this site. For more details, please see: Theory & Methodology

A detailed feature on the baseline study and its results is here (in English): Hepatitis C Knowledge, Attitudes, and Practices in Egypt and is here (in Arabic): Hepatitis C Knowledge, Attitudes, and Practices in Egypt (Arabic). A description of the campaign and how it was developed on the basis of the baseline study is available here: It’s either us or virus C!

Hepatitis C Knowledge, Attitudes, and Practices in Egypt

By: Farag Elkamel, PhD

Background and Objectives:

Viral Hepatitis is one of the world’s most ‎pressing health problems. It “affects hundreds of millions of people worldwide, causing acute and chronic liver disease and killing close to 1.5 million people every year, mostly from hepatitis B and C. These infections can be prevented, but most people don’t know how.” Egypt had one of the highest ‎global burdens of hepatitis C ‎virus infections. Now, it is estimated that 4.4 % of the ‎ population are chronically infected.[1]

In order for the communication program to be developed on the basis of solid data, the Ministry of Health and Population and the World Health Organization designed and commissioned three KAP surveys in Egypt during 2015 on: (1) the general public, (2) hepatitis C patients, and (3) healthcare providers.

The author designed the three surveys and supervised their implementation in his capacity as senior communication adviser to the World Health Organization (WHO). He also analyzed the data from the three surveys in order to write this paper.

Methodology and Sample:

The general public survey was a telephone poll conducted through cell phone numbers from May 20^th to 22^nd 2015 on a randomly drawn sample of the general public consisting of 1,027 respondents, 18 years of age and above. The sample was randomly drawn from all governorates, and weighted to represent gender and population distribution across all provinces in Egypt.

The Hepatitis C patients’ survey was also a telephone poll conducted from April 6^th to 9^th, ‎‎2015 among 1,000 patients who registered for treatment at 25 liver centers distributed as follows: ‎7 centers in urban governorates, 11 in Lower Egypt, 6 ‎in Upper Egypt, and one center in a frontier ‎governorate‎. The latest data available on regional distribution of ever-‎married women 15-49 years of age in the preliminary 2014 EDHS report was ‎utilized in determining the required frame of eligible individuals within each of the main ‎regions mentioned above.

The healthcare providers survey was conducted using face-to-face individual interviews during June 12-18, 2015 ‎on a sample of 556 persons, including 497 trained ‎medical service providers (physicians, pharmacists, nurses, and lab technicians) and 59 non-medical service providers (barbers and coiffures). The sample was randomly ‎drawn from a frame of healthcare service providers in 5 governorates, each representing a main region of the country, where Cairo represents urban governorates; Daqahleya ‎and Gharbya represent Lower Egypt; and Menya and Suhag represent Upper Egypt.

Main Findings

Prevalence and Awareness of Hepatitis C:

The general public survey results indicate that 3.6% of respondents know that they have hepatitis C. It is important to stress the fact that this figure doesn’t reflect the prevalence of hepatitis C in Egypt, but only those who know that they are infected from the sample of adults who are 18 years and above.  Almost all of them reported that they found out this fact accidentally, either while doing blood tests as a requirement for surgery or travel, or while attempting to donate blood.

Since the prevalence of hepatitis C among adults in Egypt is much higher than this figure, it is obvious that there are wasted opportunities to reduce the suffering of patients and to get proper treatment, since early diagnosis provides the best opportunity for effective medical support, and it also allows those infected to take ‎steps to prevent transmission of the disease to others, and allows lifestyle precautions to be undertaken to protect ‎the liver from additional harm.

Knowledge of hepatitis c and its treatment:

Despite the officially reported prevalence rate of hepatitis C in Egypt, 13.1% of the general public never heard of it. However there are striking significant differences based on the respondent’s level of education, where 31.6% of illiterates never heard of Hepatitis C, compared to less than 1% of respondents with university education. Of the general public sample respondents who knew of HCV, 38.5% said that they never heard of the new treatment. This figure increases to 70% of illiterate respondents.

On the other hand, all healthcare service providers in the sample, with exception of two non-medical persons were found to be aware of hepatitis C. However, there is a clear lack of knowledge regarding the new treatment, as illustrated in figure 1 below.

FIGURE 1: PERCENT AWARENESS OF HEPATITIS C AND ITS NEW TREATMENT

Prevention awareness:

In response to a question regarding different measure that people may take to protect themselves from contracting the hepatitis C virus from an infected person, quite modest percentages of the general public and of the HCV patients samples mentioned some of those ways (without being prompted). It is particularly alarming that only 40 percent of male HCV patients stated that shaving tools of an infected person can transmit the virus, and only 57 percent mentioned grooming tools of an infected person as potential sources of infection, as shown in figure (2) below.

Figure 2: Awareness of Prevention Measures Among The General Public and Patients

Healthcare providers were also asked what they actually do to protect themselves and their clients from HCV infection.  The results are shown in figure (3) below. Some essential measures, such as wearing gloves during work, were mentioned by less than two thirds of physicians and by less than 9% of barbers and coiffeurs.

Figure 3: Percent Using Protection Measures Among Healthcare Providers

Knowledge of Blood Safety and Safe Injection:

Respondents were asked a series of closed questions to investigate their knowledge of different aspects of blood safety and safe injection. They were asked whether or not an HCV infected person can donate their blood or not, and they were also asked on their knowledge of correct use of syringes. Figure (4) below illustrates blood safety knowledge among the three samples.

Figure 4: Percent Knowledge of Blood safety and safe Injection

Figure (4) above clearly demonstrates that the majority of respondents know the right thing to do with respect to blood donation and the use of syringes. Nevertheless, 19.4% of the general public are either unaware of HCV or stated that they didn’t know whether an infected person should donate their blood or not.

Misinformation about Casual Contact:

The study also investigated the presence of misinformation about how the hepatitis C virus may be transmitted. Respondents were asked to agree or disagree with a number of statements that represent misinformation regarding possibilities of transmission through casual daily contact with a person who is infected with HCV. Only those who said that they knew of HCV were asked the question. Figure (5) below shows the percentages of respondents who agreed with false statements regarding HCV transmission through casual contact, or said that they didn’t know, since both types of responses  represent knowledge problems that need to be addressed.

Figure 5: Percentage of Misinformation about Casual Contact as Causing HCV Infection

It is clear from Figure (5) above that there is a great mix up in this regard, where the general public seems to have quite a great deal of misconceptions about HCV transmission, followed by HCV patients and last by healthcare providers. Unless such misconceptions are addressed, there is a real risk in drawing attention away from the real causes and important behaviors that matter in prevention

Knowledge of HCV Transmission Modes:

It is rather impossible for individuals to “know” that HCV is preventable unless they know how it is transmitted. Respondents were therefore asked the following open-ended question: “How is hepatitis C transmitted?” Figure (6) shows percentages of respondents who mentioned various ways of transmission. Results of the general public survey reveal that knowledge of different aspects of infection and prevention is severely lacking. The situation however is better among persons who are infected, and is a lot better among healthcare providers. It should be noted, however, that most respondents mentioned blood, meaning blood transfusion, while the knowledge that HCV can be transmitted through items that are infected with blood, including needles, is severely lacking among all segments, including healthcare providers .

Figure 6: Percent Knowledge of Hepatitis C Transmission Modes (‎Multiple responses were ‎permitted.)

Attitudes towards HCV Patients:

There is evidence in the results that HCV patients may be somewhat stigmatized. As shown in table (9) below, 10.2% of the general public respondents who are aware of HCV either blame the HCV patients (4.4%) or give other responses to the same effect (5.8%). Part of this negative attitude or confusion can be attributed to the spread of misinformation regarding casual daily contact, as shown earlier, which leads the general public to mistakenly believe that such contact transmits the hepatitis C virus. This may ultimately result in fear of and discrimination against hepatitis C patients.  

On the other hand, it is significant that 2.5% of healthcare providers blame HCV patients and the figure more than doubles to 5.3% on non-medical healthcare providers, namely barbers and coiffures.

Figure 7: Percent of Attitudes Towards HCV Patients

Preference of Injection vs. Oral Medicine:

It has been reported elsewhere that Egypt has high rates of injecting medicines in the world, and that “more recent studies[2] in China and Egypt found unnecessary health facility injection rates of 57% and 95%, respectively. Preference for injection as expressed by the general public, HCV patients, and healthcare providers was also investigated. The results reveal that the general public prefers injection over oral medicine, while the opposite is true among HCV patients and healthcare providers. Preference for injection was expressed by 41.6% of the general public sample, compared to 22% of HCV patients and 26.3% of healthcare providers, while oral medicine was preferred by 36.5% of the general public, 36.3% of HCV patients, and 50.2% of healthcare providers.

Figure 8: Attitude Towards Injection Vs. Oral Medicine

Upon looking more closely at the healthcare providers’ sample, however, we find significant differences among various providers. For example, while 21.2% of physicians prefer injections, the percentage increases to 28.5% of nurses and lab technicians, and rises sharply to 40.7% among barbers and beauticians. This is a significant finding because many of the barbers, particularly in rural areas, also serve as injectors, and often give relevant advice to the public.

Reduction of injection in favor of oral medicine continues to be a target for Egypt, despite what seems to be a comforting piece of evidence that an overwhelming 97.4% of the general public sample said that a syringe should only be used once, as mentioned earlier.

Hepatitis C Prevention Practices

Sharing Possibly Infected Items:

In an attempt to identify the magnitude of risky practices among the general public and HCV patients, as well as practices by barbers and beauticians at coiffures, respondents were asked to state whether or not they shared specific items with other members of their families, while barbers and coiffures were asked to state whether they used the same items for more than one client. The following figure presents percentages of respondents who said that they shared the specific items mentioned. While the percentages of HCV patients who engage in risky behaviors are lower than those of other segments of the population, one exception is alarming where the percentage of HCV infected persons who reported sharing their shaving devices is even higher than the corresponding percentage of the general public’s sample.  This of course poses a serious risk to those whom they share such devices with. In addition, figures reported by the general public and by barbers and coiffures are quite alarming and deserve immediate interventions.

Figure 9: Sharing Personal Grooming Tools

Disinfection practices:

Given the high percentages of sharing personal items, it is important to know if such items are properly disinfected after each use. Respondents were asked about their usual conduct with blood spills on clothes or other surfaces. ‎47.3% of the general public mentioned antiseptic/Dettol and 13.6% mentioned chlorine, while 38.0% and 10.6% of the HCV patients’ sample mentioned the same choices. As would be expected, healthcare providers have better disinfection practices as 48.5% mentioned using antiseptic/Dettol and 47.8% mentioned chlorine. The conclusion is that all segments need to do better with disinfection practices.

The percentages of respondents who said that they use only water or a dry piece of cloth to clean blood is quite alarming, as the combined percentages reach 41% of the general public, 35% of HCV patients, and 17.5% of healthcare providers.

 Figure 10: Substances Used to Disinfect Blood Spells

Conclusion and Recommendations

It is apparent from the findings that there are several areas of deficient knowledge and insufficient preventive practices, not only among the general public, but also among hepatitis C patients and even many healthcare providers. Furthermore, there is a great deal of rumors and misinformation regarding the ways hepatitis C spreads, that may result in stigmatizing patients and developing unjustified negative attitudes towards them. Finally, the fact that a significant number of patients are not aware that they are infected poses a special challenge, since they not only waste precious time to start treatment and make lifestyle changes that could save their lives, but also continue to pose a real threat of unknowingly spreading the virus to those around them.

A nationwide mass education campaign is badly needed. The campaign will benefit the general public, patients and even most healthcare providers if it is disseminated through mass media that have the highest level of penetration. Data on media habits and preferences gathered in the surveys indicate that mobile phones reach almost everyone, television is watched daily by 78% of the general public, radio is followed regularly by 33% of the public, and the same figure holds true for access to the internet.

Priority messages for this mass education campaign should disseminate appropriate prevention practices, dispel rumors, misinformation and prejudice against patients, encourage high risk groups to get tested for possible infection, and motivate patients to seek the new and effective treatment.

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[1] Http://onlinelibrary.wiley.com/doi/10.1111/liv.13186/abstract

[2] C. Gore1, J. V. Lazarus, R. J. J. Peck, I. Sperle and K. Safreed-Harmon, Unnecessary Injecting Of Medicines Is Still a ‎Major Public Health Challenge Globally. Tropical Medicine and International Health, volume 18 no 9 pp 1157–1159 ‎September 2013.

المعرفة والاتجاهات والسلوك نحو التهاب الكبد سى فى مصر

د. فرج الكامل

مقدمة

يعد التهاب الكبد واحدا من أهم المشكلات الصحية بالعالم، ذلك أنه “يصيب مئات الملايين من البشر مما يسبب أمراض الكبد المزمنة والحادة والتى تؤدى إلى وفاة ما يقرب من مليون ونصف شخص فى كل عام، معظمهم بسبب التهاب الكبد “بى” و “سى”. هذه الوفيات قابلة للمنع ولكن معظم الناس لا يعرفون كيف يفعلون ذلك”. وقد كانت مصر من أكثر دول العالم تأثرا بالتهاب الكبد ” و تصل نسبة المصابين بالتهاب الكبد “سى” المزمن إلى 4.4% من السكان بها.[1] ومن أجل تصميم الحملة الإعلامية على أسس سليمة من البيانات، قامت وزارة الصحة و السكان و منظمة الصحة العالمية فى عام 2015 بتصميم ورعاية ثلاث دراسات لقياس الرأى العام من خلال عينات تمثل (1) الجمهور العام (2)المصابين بالتهاب الكبد “سى” (3) مقدمى الخدمات الصحية.

وقام المؤلف بصفته المستشار الإعلامى لمنظمة الصحة العالمية بتصميم هذه الدراسات الثلاثة والإشراف على تنفيذها كما قام أيضا بتحليل بياناتها وكتابة هذه الورقة البحثية.

العينة ومنهج البحث

تكون بحث الجمهور العام من مسح بالعينة لعدد 1027 مبحوث من خلال مقابلات تم إجراؤها فى الفترة من 20 إلى 22 مايو 2015 مع عينة عشوائية من السكان البالغين من العمر 18 عاما على الأقل. وتم سحب العينة من أرقام التليفونات من جميع محافظات الجمهورية، كما تم وزنها لتمثيل الاناث والذكور وكذلك توزيع السكان فى مختلف مناطق الجمهورية.

وكذلك تكونت عينة المصابين بالتهاب الكبد “سى” من ألف مبحوث تم إجراء مقابلات تليفونية معهم فى الفترة من 6 إلى 9 أبريل 2015، وتم سحب العينة من أرقام تليفونات المصابين التى اختاروها عند تقدمهم بتسجيل أسمائهم للعلاج فى 25 مركزا للكبد موزعة كالتالى: 7 مراكز فى محافظات حضرية، 11 مركزا فى الوجه البحرى، 6 مراكز فى الوجه القبلى، ومركزا واحدا فى إحدى المحافظات الحدودية. وقد تمت الاستعانة بتوزيع السيدات المتزوجات من 15-49 عاما فى المسح الصحى الديموغرافي لمصر عام 2014 كاطار لتوزيع العينة على المناطق المذكورة.

أما بالنسبة للبحث الذى أجرى على مقدمى الخدمة الصحية، فقد تم إجراء مقابلات مباشرة فى الفترة من 12 إلى 18 يونيو 2015 مع عينة مكونة من 556 شخصا تشمل 497 من مقدمى الخدمة الصحية الطبية (أطباء وصيادلة وممرضات وفنيي معامل طبية) بالإضافة إلى 59 من غير المدربين طبيا (العاملون فى صالونات الحلاقة ومحلات التجميل). وقد تم سحب العينة من إطار يشمل مقدمى الخدمة الصحية فى خمس محافظات تمثل كل منها أحد أقاليم الجمهورية، حيث تمثل القاهرة المحافظات الحضرية، وتمثل كل من الدقهلية والغربية محافظات الوجه البحرى، بينما تمثل المنيا وسوهاج محافظات الوجه القبلى.

النتائج الرئيسية

انتشار التهاب الكبد “سى” والعلم بالإصابة به

تشير نتائج بحث الجمهور العام إلى أن 3.6% من المبحوثين يعرفون أنهم مصابون بالتهاب الكبد “سى”. وذكر هؤلاء المصابون أيضا أنهم قد اكتشفوا اصابتهم بمحض الصدفة، سواء فى أثناء قيامهم بتحليل للدم قبل إجراء عملية جراحية أو السفر أو أثناء محاولتهم للتبرع بالدم. وهذا الرقم يشير إلى من يعلمون بإصابتهم من بين البالغين الذين أجرى عليهم البحث وليس مؤشرا لمعدل الإصابة بالفيروس فى مصر بشكل عام.

ويشير ذلك إلى أن هناك نسبة لا يستهان بها من المصابين الذين لا يعلمون بإصابتهم، وهو ما يعنى أن هناك فرصا ضائعة لتقليل مدى المعاناة من الإصابة بفيروس “سى” والإسراع بالعلاج منه، حيث أن التشخيص المبكر يعد أفضل فرصة للحصول على المساعدة الطبية. فهو يعنى قيام المصابين باتخاذ الاحتياطات اللازمة لمنع انتشار العدوى منهم إلى الآخرين، ويعنى أيضا إمكانية قيامهم بتغيير أسلوب حياتهم وأخذ الاحتياطات اللازم لحماية أكبادهم من المزيد من الأذى.

المعرفة بالتهاب الكبد “سى” وبالعلاج الجديد منه

برغم نسبة الاصابة بالتهاب الكبد “سى” والمعلن عنها رسميا فى مصر، فإن 13.1% من عينة الجمهور العام لم يسمعوا عنه من قبل، وتزيد هذه النسبة إلى 31.6% من الأميين، مقارنة بنسبة 1% فقط من ذوى التعليم الجامعى. وبالنسبة للعلاج الجديد، فإن 38.5% ممن لديهم معرفة بالتهاب الكبد “سى” لا يعرفون شيئا عن العلاج الجديد، وتزيد هذه النسبة إلى 70% من الأميين.

ومن ناحية أخرى، فمستوى معرفة مقدمى الخدمة الصحية تعتبر ممتازة، فجميع أفراد العينة باستثناء شخصين فقط قالوا أنهم سمعوا عن التهاب الكبد “سى”. وعلى الرغم من ذلك، فإن المعرفة بالعلاج الجديد ليست على نفس المستوى، كما هو واضح فى الشكل رقم (1).

الوعى بأساليب الوقاية

عندما وجهنا للمبحوثين سؤالا مفتوحا عن الإجراءات المختلفة التى يتعين اتخاذها للوقاية من انتقال العدوى من شخص مصاب بالتهاب الكبد “سى”، جاءت الاجابات أقل من المتوقع سواء من جانب عينة الجمهور العام أو عينة المصابين. فمن المثير للانتباه أن 40% فقط من الذكور ذكروا أن أدوات الحلاقة يمكن أن تنقل الفيروس، كما ذكر 57% فقط الأدوات الشخصية مثل المقص والمبرد والقصافة، كما هو موضح فى الشكل رقم (2).

وقد تم سؤال مقدمى الخدمة أيضا عن إجراءات الوقاية التى يتخذونها لحماية أنفسهم وعملائهم. وكما تشير النتائج المعروضة فى شكل رقم (3)، فإن أقل من ثلثى العينة ذكروا أنهم يرتدون القفاز الطبى أثناء العمل، وتنخفض النسبة إلى 9% فقط من العاملين فى صالونات الحلاقة والتجميل.

مستوى المعرفة بسلامة الدم والحقن الآمن

تم توجيه مجموعة من الأسئلة لعينات البحوث الثلاثة بهدف تقييم مدى معرفة المبحوثين بمفهوم سلامة الدم ومفهوم الحقن الآمن. ويوضح شكل (4) النسب المئوية للإجابات الصحيحة.

وتجدر الاشارة إلى أنه فى الوقت الذى يشير فيه الشكل رقم (4) إلى وجود معرفة جيدة بخصوص التبرع بالدم واستخدام السرينجات، فإننا لا يجب أن ننسى أن 13.1% من الجمهور العام ذكروا أنهم لم يسمعوا من قبل عن فيروس “سى”

المعلومات المغلوطة حول الاختلاط العادى مع المصابين

سعت البحوث الثلاثة أيضا إلى التعرف على مدى وجود معلومات خاطئة ومغلوطة لدى المبحوثين بشأن الاختلاط اليومى العادى مع المصابين بفيروس “سى”، وتم سؤالهم ليردوا بالإيجاب أو النفى على مجموعة من العبارات بشأن تسبب أشكال متعددة من الاختلاط فى نقل العدوى من عدمه. وقد تم توجيه هذه الأسئلة فقط لمن كانوا قد ذكروا أنهم سمعوا من قبل عن فيروس “سى”. وتمثل النسب المئوية المعروضة فى الشكل رقم (5) الإجابات الخاطئة التى أدلى بها المبحوثون سواء بموافقتهم على العبارات الخاطئة أو بالرد بأنهم لا يعرفون الاجابة الصحيحة.

ومن الواضح فى الشكل رقم (5) أن هناك معلومات خاطئة عديدة منتشرة ليس فقط بين أفراد الجمهور العام والمصابين، بل حتى بين مقدمى الخدمة الصحية وإن كان بدرجة أقل نسبيا. وتتمثل خطورة هذا الموقف فى أنه طالما استمرت هذه المعلومات الخاطئة فى التداول، فإن الاهتمام بالأسباب الحقيقة لنقل العدوى سوف يتأثر سلبا.

المعرفة بطرق انتشار فيروس سى

من المستحيل أن يعرف الشخص أنه يمكنه حماية نفسه من انتقال فيروس “سى” إليه إلا إذا عرف أولا طرق انتشار هذا الفيروس. لهذا السبب تم توجيه السؤال المفتوح التالى للمبحوثين: “كيف ينتقل فيروس “سى” من شخص مصاب إلى شخص سليم؟ ويوضح الشكل رقم (6) النسب المئوية للمبحوثين الذين ذكروا طرقا متعددة لانتقال الفيروس. وتشير النتائج إلى وجود قصور شديد فى معرفة الجمهور العام بطرق انتشار الفيروس. ويزداد مستوى المعرفة بين المصابين كما أنه يزداد كثيرا بين مقدمى الخدمة الصحية. ولكن تجدر ملاحظة أن معظم المبحوثين ذكروا الدم، بمعنى نقل الدم كأهم وسيلة لنقل العدوى، بينما تقل كثيرا نسبة من ذكروا الأدوات الملوثة بالدم، مثل السرينجات، وينطبق هذا الوضع على الجمهور العام والمصابين وحتى مقدمى الخدمة الصحية.

الاتجاهات نحو المصابين بالتهاب الكبد “سى”

يوجد بالنتائج ما يشير إلى وجود ما يسمى بوصمة العار تجاه المصابين بفيروس “سى”. وتشير النتائج المبينة فى شكل رقم (7) أن 10.2% من عينة الجمهور العام الذين سمعوا من قبل عن فيروس “سى” يلقون باللوم على المصابين  بالفيروس (4.4%) أو يذكرون إجابات أخرى تحمل نفس المعنى (5.8%). ويمكن أن يكون أحد أسباب هذا الاتجاه السلبى هو انتشار المعلومات المغلوطة حول انتقال الفيروس عن طريق الاختلاط اليومى مع المصابين به، كما هو موضح من قبل، وهو ما يؤدى إلى الخوف من مخالطتهم والتحيز ضدهم.  ومن الجدير بالذكر أن 2.5% من مقدمى الخدمة الصحية يلومون المصابين أيضا، وتصل النسبة إلى أكثر من الضعف (5.3%) بين العاملين فى صالونات الحلاقة ومحلات التجميل.

الاتجاهات نحو الحقن والأدوية الفمية

تشير عدة دراسات إلى أن نسبة اعتماد المصريين على الحقن تعد من أعلى النسب في العالم، ووجدت  دراسات حديثة[2] أجريت في كل من الصين ومصر أن نسبة الحقن غير الضرورى في مراكز الخدمة الصحية يصل في كل من البلدين على الترتيب إلى 57% و95% .

وقد تم سؤال المبحوثين عما إذا كانوا يفضلون الحقن أو الأدوية التى تؤخذ عن طريق الفم، وتبين أن الجمهور العام يفضل الحقن أكثر من الأدوية الفمية، بينما العكس هو الصحيح بالنسبة لكل من المصابين ومقدمى الخدمة الصحية. فقد ذكر 41.6% من أفراد العينة الممثلة للجمهور العام أنهم يفضلون الحقن، بينما وصلت النسبة إلى 22% من عينة المصابين و26.3% من عينة مقدمى الخدمة. وفى نفس الوقت فقد بلغت نسبة من يفضلون الأدوية عن طريق الفم إلى 36.5% من الجمهور العام، و36.3% من المصابين، و50.2% من مقدمى الخدمة.

وتتفاوت نسب تفضيل الحقن بين الفئات المختلفة لمقدمى الخدمة الصحية، فبينما تصل النسبة إلى 21.2% بين الأطباء والصيادلة، فإنها ترتفع إلى 28.5% بين الممرضات وفنيي المعامل، وترتفع بشدة إلى 40.7% بين العاملين فى صالونات الحلاقة ومحلات التجميل، ولهذه النسبة الأخيرة دلالة هامة، حيث أن بعض الحلاقين فى المناطق الريفية بوجه خاص يقومون أيضا بإعطاء الحقن وكذلك النصائح الطبية لأفراد الجمهور العام.

ومن الأهداف التى تسعى إليها مصر خفض نسبة الحقن وزيادة الاعتماد على الأدوية الفمية بدلا منها، برغم أن نسبة هائلة تبلغ 97.4% من عينة الجمهور العام أقروا بأنهم يعرفون أن السرينجة لا يجب أن تستخدم إلا مرة واحدة فقط، كما ذكر سابقا.

السلوك الوقائى نحو فيروس “سى”

إعادة استخدام الأدوات المحتمل تلوثها

تم سؤال أفراد عينة الجمهور العام عن سلوكياتهم فيما يتعلق بالمشاركة مع الآخرين فى استخدام الأدوات الشخصية التى من المحتمل أن تنقل العدوى كما تم سؤال عينة العاملين فى صالونات الحلاقة ومحلات التجميل عن سلوكياتهم فيما يتعلق باستخدام نفس الأدوات لأكثر من عميل واحد. ويوضح الشكل التالى النسب المئوية للمبحوثين من الجمهور العام الذين أقروا بالاشتراك مع الآخرين فى استخدام نفس الأدوات، وكذلك النسب المئوية للعاملين فى صالونات الحلاقة والتجميل الذين قالوا أنهم يستخدمون نفس الأدوات لأكثر من عميل واحد.

وبينما تقل نسبة الممارسات الخطرة بين المصابين عن مثيلتها بين أفراد الجمهور العام، فإنه استثناء من تلك النتيجة نجد أن نسبة المصابين الذين يشاركون الآخرين فى أدوات الحلاقة تزيد عن مثيلتها بين أفراد عينة الجمهور العام، وهو ما يمثل خطورة حقيقية على غير المصابين. وبشكل عام فإن نسب الممارسات الخطرة بين الجمهور العام والعاملين فى صالونات الحلاقة والتجميل تعد مصدرا حقيقيا للقلق وتدعو إلى ضرورة التدخل الفورى.

تطهير الأدوات

حيث أن هناك نسبة مرتفعة فى تبادل استخدام الأدوات الشخصية كما هو موضح سابقا، فإنه من الضرورى معرفة مدى الالتزام بتطهير تلك الأدوات قبل إعادة استخدامها. وبسؤال المبحوثين عن سلوكياتهم بهذا الشأن، وجدنا أن 47.3% من عينة الجمهور العام ذكروا أنهم يستخدمون المطهرات والديتول، وذكر 13.6% أنهم يستخدمون الكلور، فى حين أن 38% و 10.6% من عينة المصابين ذكروا نفس الاختيارات. وتزيد نسبة السلوكيات الإيجابية بين مقدمى الخدمة الصحية، حيث بلغت نسبة من قالوا أنهم يستخدمون المطهرات والديتول 48.5% ونسبة من يستخدمون الكلور 47.8%. ونستخلص من هذه النتائج أن جميع فئات المبحوثين تحتاج إلى تحسين سلوكياتها بهذا الشأن. ومن المقلق بشدة أن نسبة من ذكروا أنهم يستخدمون الماء فقط أو قطعة من القماش الجاف لتطهير الملابس والأسطح من الدم تبلغ 41% من عينة الجمهور العام و35% من عينة المصابين و17.5% من مقدمى الخدمة.

الخلاصة والتوصيات

تشير النتائج بوضوح إلى وجود قصور فى المعرفة وفى الإجراءات والسلوكيات الوقائية بين جميع فئات الجمهور بما فى ذلك الجمهور العام والمصابين ومقدمى الخدمات الصحية. وبالإضافة إلى ذلك فإن هناك العديد من الشائعات والمعلومات المغلوطة بشأن طرق انتشار فيروس “سى”، وهو ما يمكن أن يساعد فى تكوين الوصمة والاتجاهات السلبية نحو المصابين. وبالإضافة إلى ذلك فإن عدم معرفة نسبة كبيرة من المصابين بحقيقة اصابتهم يمثل تحديا كبيرا حيث يتسبب ذلك فى ضياع الكثير من الوقت الذى كان يمكنهم فيه من بدأ العلاج وتغيير سلوكياتهم لإنقاذ حياتهم فى الوقت المناسب. وبالإضافة إلى ذلك، فإن عدم وعى هؤلاء بإصابتهم يزيد من فرصة نقلهم للعدوى للآخرين من حولهم.

ويستدعى الأمر ضرورة البدء فى حملة قومية للإعلام والتوعية للجمهور العام والتى ستصل بالضرورة إلى المصابين ومقدمى الخدمات الصحية إذا استخدمت هذه الحملة أكثر الوسائل الاعلامية انتشارا. وتشير البيانات التى تم جمعها عن العادات الإعلامية للجمهور فى إطار هذا البحث إلى أن أجهزة التليفون المحمول قد أصبحت فى يد الجميع تقريبا، وأن 78% من الجمهور يشاهدون التليفزيون يوميا بانتظام، وأن حوالى 33% من المواطنين يستمعون إلى الراديو ويستخدمون الانترنت بشكل منتظم.

ويجب أن تركز الحملة على التوعية بأساليب الوقاية، وتفنيد الشائعات وتصحيح المعلومات المغلوطة، ومنع التحيز ضد المصابين، كما ينبغى على الحملة أيضا أن تشجع الفئات الأكثر عرضة للإصابة على إجراء اختبارات لمعرفة ما إذا كانوا مصابين بفيروس “سى” أم لا، وأت تحفز المصابين على الحصول على العلاج الجديد.

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[1] Http://onlinelibrary.wiley.com/doi/10.1111/liv.13186/abstract

[2] C. Gore1, J. V. Lazarus, R. J. J. Peck, I. Sperle and K. Safreed-Harmon, Unnecessary Injecting Of Medicines Is Still a ‎Major Public Health Challenge Globally. Tropical Medicine and International Health, volume 18 no 9 pp  1157–1159 ‎September 2013.

It’s either us or virus C : The HCV Campaign in Egypt

Results of the baseline study for the hepatitis C prevention and treatment campaign are published here:Hepatitis C Knowledge, Attitudes, and Practices in Egypt. A list of priority communication messages was extracted from the study findings, as shown just below.

Priority Messages for the First Wave of HCV TV Spots in Egypt

Based on Findings of the General Public Survey

By: Farag Elkamel, PhD. WHO Communication Expert

25/10/2015

This document summarizes the key results of the telephone poll that was conducted on a randomly drawn sample of the general public consisting of 1,027 respondents, 18 years of age and above. The sample was randomly drawn from all governorates, and weighted to represent gender and population distribution across all provinces in Egypt. The survey was conducted through cell phone numbers from May 20^th to 22^nd 2015. Furthermore, the current document concludes priority messages from these results for the first wave of TV spots targeting the general public

Prevalence

The study results show that 4.0% of respondents know that they have hepatitis C, and an additional 46.0 % know of someone else who has the virus.

When we look at age distribution, none of the 4% who knew that they have HCV is under 30 years old, while the percentage increases to 4.8% among respondents 30-50, and to 6.3% of those who are over 50 years old. It is interesting that these results are supported in large part by the findings of another KAP survey conducted on a sample of 1,000 persons who are infected with HCV. That survey revealed that only 7% were under 30, while 40% were 30-50 years old, and 53% were older than 50 years old. It is interesting that almost all of those who know that they have the virus found out this fact accidentally, either because they did blood tests because they got sick, or as a requirement for travel, or while attempting to donate blood.

Message Implications-1: HCV is widespread. Early diagnosis can lead to ‎a better response to medication. If you have ‎had ‎a surgery, blood transfusion, or injections ‎to treat bilharzias, asks your doctor’s advice for ‎blood ‎testing.‎

Knowledge:

Despite the very high prevalence of hepatitis C in Egypt, which is estimated by the EDHS 2014 to be 7% of the adult population, the KAP survey of the general public reveals that knowledge of different aspects of infection and prevention is severely lacking.

On the other hand, there are 13.1% who never heard of HCV, and of the rest who did, 38.5% never heard of the new treatment.

Message Implications-2: Good news for those who have HCV. There is a ‎new medicine which is highly effective. If you ‎have HCV, consult your doctor or register your ‎name at the NCCVH website immediately.‎

Respondents were asked the following important open question: “How is virus C transmitted?” The following are percentages of total respondents who mentioned various ways of transmission:

Through the blood‎	52.7
Through items that are infected with the blood of an HCV patient	23.2
Through injection‎	8.9
I don’t know	19.6

In response to a question regarding different ways a person can protect themselves from contracting the virus from an infected person, modest percentages of the total sample mentioned the following ways (without being prompted):

Don’t use an infected person’s tools	17.8
Don’t use an infected person’s shaving tools	5.3
Don’t do anything	20.2
I don’t know	13.8

Respondents who had heard of virus C were asked the following question: “If a person had HCV and was treated, can he/she still get it again or does he/she have ‎immunity against getting re-infected? ‎” It is quite alarming that only 35.5% gave the correct answer that the person can get re-infected, while 20.3% said that the person would have immunity, and 44.2% said that they didn’t know.

Message Implications-3: You can protect yourself. HCV is transmitted ‎only through blood or items that are ‎contaminated with it. No one should ever ‎share needles, razors, nail scissors, clippers, or ‎nail files with anyone else.‎

The study also investigated the presence of misinformation about how virus C may be transmitted. Respondents were asked to agree or disagree with a number of statements that represent misinformation regarding possibilities of transmission through casual daily contact with a person infected with HCV. Following are the percentages of the total sample who agreed with those false statements:

Sharing toilets	26.8
Drinking glasses	34.1
Eating utensils	36.8
Hugging, kissing or touching	46.4
Sexual intercourse	29.2

As will be discussed below, 90% of respondents believe that an infected person is not to blame for having the disease. However, 10% either blame the sick person or state that they aren’t sure whether to blame them or not. Part of this negative attitude or confusion can be attributed to the spread of the above mentioned misinformation, which leads the public to fear and avoid safe daily contact with infected persons, which contributes to the creation of an unnecessary stigma. There is another risk in not responding to these rumors, which is drawing attention away from the important behaviors that do matter in prevention.

Message Implications-4: Normal daily contact with a person who is ‎infected with HCV is safe, including kissing, ‎hugging, and the use of same drinking glasses ‎and eating utensils or using same bathroom.‎

Given the fact that almost half the households in Egypt either have someone who has HCV or know of someone who does, the essential knowledge necessary to cope with this disease becomes necessary to spread to the public. The current situation certainly requires an intervention given the following modest percentages of respondents who mentioned different practices that infected persons should engage in once they are diagnosed with HCV:

Go to a specialized doctor and follow his/her advice and get regular medical checkups	53.0
Eat a healthy and balanced diet that includes a lot of vegetables and fruit	12.1
Stay away from too much sugar and fat	6.3
Exercise regularly; and avoid smoking	1.1
Get the new treatment	28.4

It is recommended that the part of the campaign which targets healthcare providers includes messages to them regarding the need to give proper advice to HCV patients about lifestyle.

Attitudes:

Results show a mild indication of a stigma, as only 5.0% of those who ever heard of HCV say that infected persons only have themselves to blame, while 90.0% said that infected persons are victims and we should therefore support and stand by them. However, most of the remaining 5.0 stated that they didn’t know whether to blame or support the infected persons.

Injection is preferred over oral pills or tablets by 41.6% of respondents, compared with 36.5% who prefer the latter. The remaining 21.4% either didn’t have a clear preference or gave different answers that were mostly in favor of injection. When asked why they preferred injection, 87.7% of the respondents who made that choice said that injection has a faster and stronger effect, and 12% said that pills cause them stomach problems. On the other hand, 44% of respondents who preferred pills and capsules over injections said that pills and capsules  were easier, better and quicker, and 42.6% said that they didn’t like the pain associated with injections. Only 4.8 percent reject injection because it has the potential to transmit diseases.

It has been reported elsewhere that Egypt has one of the highest rates of injecting medicines in the world, and that “more recent studies in China and Egypt found unnecessary health facility injection rates of 57% and 95%, respectively[1].

Message Implications-5: Whenever possible, ask your doctor if you can ‎take an oral medicine instead of injection. ‎Oral medicine has the same treatment effect, ‎but is pain-free and avoids the risk of ‎infection.‎

Reduction of injection in favor of oral medicine continues to be a target for Egypt, despite what seems to be a comforting piece of evidence that an overwhelming 97.4% said that a syringe should only be used once. When we asked a follow up question on how to identify a new syringe, 98% of them said that a new syringe should be in a new and well-sealed wrapping.

Practices:

The study has also identified certain risky practices among the general public. Following are percentages of respondents who said that they shared specific items with other members of their families:

Shaving device (men only)	6.3
Nail clipper	49.2
Nail file	32.5
Nail Scissors	38.5
Toothbrush	2.4
Tools used for pedicure or ear piercing at a coiffeur (women only)	5.4

These results give additional confirmation to the urgent need for the content outlined in message implications-3 above.

Another aspect of risky practices that was investigated was what people do if blood is spelled over their clothes or other surfaces. The following percentages reflect the responses made by respondents regarding substances they use:

Water only	38.5
An antiseptic/Dettol	47.2
Chlorine	13.5
Washing powder or soap	18.8
Alcohol	1.1
A dry cloth or handkerchief	2.5

Finally, we asked those who said that they use chlorine a follow up question to investigate how they actually use it. Unfortunately, a small minority of them mentioned correct ways of using the substance. While the prototype message on this subject is to mix a cup of chlorine with four cups of water, only 7.2% of those who mentioned chlorine (1.0% of the total sample) gave this answer. Others either gave different answers or simply answered that they didn’t know. On the other hand, the healthcare providers’ survey showed that most of those who mentioned chlorine said that they mix one cup with nine cups of water, which may indicate a previous message or instructions to this effect. While the message on chlorine use as a disinfectant remains important, this issue of proper chlorine mixing needs to be sorted out in order to avoid confusion or negative feedback.

Communication Messages

There are plenty of messages that need to be communicated to the general public, HCV patients, and healthcare providers. Messages for all of these three segments of the audience have been presented here: Combating hepatitis-c in Egypt. Messages for the general public campaign were extracted from the baseline survey described above, and were organized according to Elkamel’s Knowledge & Social Change Model described elsewhere in this site.

Awareness Knowledge: (WHAT)

The objective of Awareness Knowledge is to make target audiences aware of hepatitis C and of the possibilities for its prevention and treatment. Awareness knowledge should thus include the following:

1. There is a serious disease called hepatitis C
2. There is a new and effective medicine to treat hepatitis C
3. Hepatitis B is a serious disease (for HCV patients and healthcare providers)
4. There is a vaccine for hepatitis B (for HCV patients and healthcare providers)

How-to-Knowledge: (HOW)

Individual need to know how they can protect themselves from getting infected, or get the treatment if they are hepatitis c patients. This facet of knowledge includes:

1. Hepatitis C can be transmitted through sharing or ‎reusing personal items of infected individuals such as razors, scissors, ‎nail clippers, nail files, toothbrushes, as well as tattoo, ‎pedicure and ear piercing tools.‎
2. Hepatitis C is not transmitted through casual daily contact including sharing toilets, drinking glasses or eating utensils, hugging, kissing or touching
3. Hepatitis C patients should not donate their blood.
4. Cured hepatitis C patients don’t have immunity. They can be re-infected just like anyone else if they are not careful.
5. Safe Injection: use a new syringe that was never used by ‎anyone else before and dispose of it safely.‎
6. If the same medicine is available in the form of injections or ‎oral tablets, choose the tablets because they are safer.‎
7. Disinfect and cover open cuts on your skin with bandage until ‎they heal.‎
8. Wash your hands thoroughly with soap and water if you ‎come in contact with blood.‎
9. Promptly clean and disinfect surfaces or items contaminated with ‎blood or other potentially infectious materials with chlorine ‎solution (Clorox, Bleach) using 1 part bleach for every 9 parts ‎water.‎
10. Hepatitis B can be prevented by getting its vaccine (for HCV patients and healthcare providers).

Principles Knowledge: (WHY)

This aspect of knowledge is meant to provide the rational for the actions that are promoted in the “how-to” messages, including:

1. ‎Hepatitis C is preventable
2. Virus C is transmitted only if the blood of an infected person enters the blood stream of another individual through ‎transfusion or infected instruments.‎
3. If left untreated, Virus C may lead to Liver failure and Liver Cancer.

Priority Messages for the first wave TV Spots:

What is listed below, however is a list of only five key and priority messages for the first wave of TV and radio spots targeting the general public. Other messages for the general public as well as other target groups should be the subject for subsequent communication initiatives.

The Media Campaign

The World Health Organization has never developed or produced a media campaign in Egypt. They aren’t structured to do this kind of activity, and they don’t generally have it in their budget.

Given the urgency of the hepatitis c problem in Egypt, I persuaded them that I could develop and produce an urgent campaign consisting of 5 television commercials for only 10 thousand dollars! This was the cost for renting a studio to record the voice-over and the fees for a free lancer to do pencilmation! The cost for the strategy, concept development and script was nil, as I did that myself as the WHO’s senior communication adviser. In addition, I developed the campaign slogan, designed a poster and a pamphlet which were printed with minor support from regular funding by the ministry of health and population, and secured free broadcasting of the spots on a number of public and private TV channels.

I should mention here that the 10 thousand dollars which were spent to produce the five TV spots constitute only a small fraction of the market rate for producing TV spots in 2016, where the average cost to produce only ONE spot through commercial production houses or advertising agencies was about ten times that amount!

The concept of ​​the campaign is based on the idea of solidarity between the three segments of society: (1) the infected individuals (2) the healthcare providers, and (3) the families of infected persons and other members  of the general public, under the slogan “It’s Either US or Virus C.”

I also decided to use the pencilmation (two-dimensional cartoons) technique to convey simplicity and to avoid pinpointing specific characteristics of infected or susceptible individuals and to confirm the notion that everyone is vulnerable regardless of their age, gender or socio-economic status.

The popular movie and TV star Mohamed Henedi did the voice over totally free as a contribution to the campaign. In fact I’m grateful to his personal doctor whom I asked for help to persuade Henedi to this great service for the country.

Pretesting Campaign Materials

All materials mentioned above were pretested among experts, health officials, and the target audience. Below are sample shots of the script and story board for one of the TV spots. The storyboard received official approval by both WHO and MOHP before going into the final phase of producing the spots.

Dissemination

The campaign was disseminated in July-September 2016. Following is a review of the campaign elements.

TV Spot 1

HCV is widespread. Early diagnosis can lead to a better response to medication. If you have had a surgery, blood transfusion, or injections to treat bilharzia, asks your doctor’s advice for blood testing.

فيروس “سى” منتشر فى مصر. كل ما نكتشف المرض بدرى كل ما الاستجابة للعلاج تبقى أحسن. لو عملت عملية جراحية قبل كده أو اتنقل لك دم أو خدت حقن لعلاج البلهارسيا زمان، اسأل دكتور متخصص عن نوع تحليل الدم اللى مفروض تعمله عشان تتطمن على نفسك.

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TV Spot 2

Good news for those who have HCV. There is a new medicine which is highly effective. If you have HCV, consult your doctor or register your name at the NCCVH website immediately.

فيه أخبار هايلة للى عندهم فيروس “سى”. دلوقتى فيه علاج جديد وممتاز للمرض. أستشير دكتور متخصص وسجل اسمك فى موقع الانترنت بتاع اللجنة القومية لمكافحة الفيروسات الكبدية اللى تبع وزارة الصحة.

TV Spot 3

You can protect yourself. HCV is transmitted only through blood or items that are contaminated with it. No one should ever share needles, razors, nail scissors, clippers, or nail files with anyone else.

انت تقدر تحمى نفسك من فيروس “سى”. الفيروس ده بيتقل عن طريق الدم أو الحاجات الملوثة بدم شخص يكون مصاب بيه. عشان كده أوعى تستعمل سرنجة أو دبوس حجاب أو موس أو قصافة أو مقص أو مبرد ضوافر بتوع حد تانى.

TV Spot 4

Normal daily contact with a person who is infected with HCV is safe, including kissing, hugging, and the use of same drinking glasses and eating utensils or using same bathroom.

الاختلاط العادى مع أى حد مصاب بفيروس “سى” ما بينقلش العدوى. ممكن قوى نسلم عليه ونبوسه ونحضنه  وياكل ويشرب معانا فى نفس الاطباق والكوبايات ونستعمل نفس الحمام اللى بيستعمله… ومن غير ما نقلق خالص.

TV Spot 5

Whenever possible, ask your doctor if you can take an oral medicine instead of injection. Oral medicine has the same treatment effect, but is pain-free and avoids the risk of infection.

ياريت دايما نطلب رأى الدكتور لو ينفع ناخد كبسولات أو أقراص بدل الحقن. الكبسولات والاقراص ليها نفس المفعول بس ما بتوجعش، وكمان مفيش احتمال خالص انها تنقل فيروس سى.

Poster

Pamphlet

just like the poster shown above, the pamphlet was also designed to integrate with the TV and radio spots. in addition to conveying the same five messages, in the same order, the pamphlet also used visuals from the relevant spots.

[1] C. Gore1, J. V. Lazarus, R. J. J. Peck, I. Sperle and K. Safreed-Harmon, Unnecessary Injecting Of Medicines Is Still a Major Public Health Challenge Globally. Tropical Medicine and International Health, volume 18 no 9 pp 1157–1159 September 2013

The Cairo University Campaign

During the Fall semester of 2016, Cairo University used the poster and pamphlet mentioned above, in addition to the radio and TV spots when it launched a campus-wide campaign for a “university free of virus c”. It’s worth mentioning that Cairo University has more than 250,000 B.A level students, 8,500 M.A students, 1,000 PhD students and more than 12,000 teaching staff.

Logo for the “Virus C Free” Cairo University initiative

The poster and pamphlet were only modified to feature the university logo alongside those of the ministry of health and WHO, as shown below.

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Farag Elkamel YouTube Channel

Farag Elkamel is a YouTube channel dedicated to featuring media campaigns that have been planned, written, directed and produced by Dr. Farag Elkamel. Numerous evaluation studies indicate that these campaigns have been instrumental in saving a million lives.

(All videos have English subtitles.)

هذه القناة https://www.youtube.com/faragelkamel  مخصصة لعرض الحملات الإعلامية التى قام د. فرج الكامل بتخطيطها وكتابتها وإخراجها وإنتاجها. وتشير نتائج الدراسات التقييمية العديدة إلى أن هذه الحملات قد ساهمت فى إنقاذ مليون إنسان فى مصر من خطر الموت.

1. Hepatitis C Prevention & Treatment, Egypt 2015-2016 الحملة الإعلامية لمكافحة فيروس سى، مصر

2. The Family Planning Campaign, Egypt, 1987-1992 الحملة الإعلامية لتنظيم الأسرة، مصر

3. The Oral Rehydration Campaign, Egypt, 1983-1989 الحملة الإعلامية لمكافحة الجفاف، مصر

4. Polio Eradication Campaign, 1984-1993 الحملة الإعلامية للقضاء على شلل الأطفال، مصر

5. Environmental Protection and Water Conservation Campaign, Egypt, 1987-1995 الحملة الإعلامية للحفاظ على البيئة ومياه الشرب، مصر

6. Using Video to Change an Egyptian Village, 1995 استخدام الفيديو لتغيير قرية مصرية

7. HIV/AIDS Awareness Campaign, Saudi Arabia, 1991-1992 الحملة الإعلامية للتوعية بالإيدز، السعودية

8. Family Planning Campaign, Jordan 1986-2000 الحملة الإعلامية لتنظيم الأسرة، الأردن

9. Entertainment-Education TV Soap Operas, 1989-1997 استخدام المسلسلات الدرامية فى رفع الوعى الصحى والاجتماعى

10. “Your Health is Worth the Whole World” Project, 1984-1985 مشروع “صحتك بالدنيا”

Some suggested references on the impact of these campaignsبعض المراحع عن تأثير هذه الحملات:

Click to access sowc_1986.pdf

http://www.bmj.com/content/291/6504/1247

https://apps.nlm.nih.gov/againsttheodds/guest_column/2008/11/index.html

Click to access PNAAQ110.pdf

http://www.popline.org/node/416077

http://www.emro.who.int/emhj-volume-2-1996/volume-2-issue-3/article13.html

Click to access 109032.pdf

http://her.oxfordjournals.org/content/10/2/225.abstract

Click to access PNABY146.pdf

https://www.ncbi.nlm.nih.gov/pubmed/12288260/

http:www.un.org/popin/icpd/newslett/92_04

http://kczx.shupl.edu.cn/download/786444c9-20c1-4b5a-b0d6-d7544569a2ee.pdf (page 604)