Female Genital Cutting and Hepatitis C Spread in Egypt

A recent analysis of Egypt’s first nationally representative survey of hepatitis C virus (HCV) infection found female genital cutting (FGC) to be an independent risk factor for HCV infection for women in urban areas. We use the same dataset to extend this analysis. In an ecological analysis, we find a strong association between FGC and HCV prevalence (Pearson —74%;？？ ). HCV prevalence is significantly higher if FGC is performed by a non-Doctor (15.4%) than a Doctor (4.2%; ), and the calculated population attributable fraction of FGC for prevalent HCV seropositivity is high in women (79.8%). 1. Introduction Why is Egypt’s hepatitis C (HCV) epidemic so much more intense than elsewhere? Numerous lines of evidence point to the key role that the widespread use of parenteral antischistosomal therapy (PAT) played in this regard [1, 2]. However, question marks remain: numerous other countries have experienced similarly intense mass intravenous injections campaigns with inadequate attention to injection sterility without dramatic HCV epidemics [3, 4]. Furthermore, numerous contemporary studies have found that less than 20% of those testing HCV seropositive in Egypt have a history of PAT exposure [1, 2]. Although there is some evidence of a reduction in incidence [5], this is disputed [6], and HCV incidence has remained high [6]. Nonsterile medical and dental activities have been convincingly shown to be important in this regard [2, 6], but little or no evidence has been provided that these practices are more prevalent in Egypt than other middle-income countries. These considerations suggest that there may be other cofactors which may have been important in the generation of Egypt’s uniquely high HCV prevalence. The results of a study to investigate the risk factors for prevalent HCV in Egypt using the country’s first nationally representative sample found that female genital cutting (FGC) was associated with HCV on multivariate analysis but only in urban areas [1]. Since Egypt is one of a small number of countries where FGC is widespread this relationship merits more attention. In this paper we extend the investigation of the link between FGC and HCV. 2. Materials and Methods The Egyptian Demographic and Health Surveillance (EDHS), conducted in 2008, entailed a three-stage probability sample that provided a representative sample of 12,780 men and women aged 15–59. 11,126 (87.1%) of these agreed to provide blood for HCV testing. A third generation enzyme-linked immunosorbent assay was used to detect HCV antibodies (Adaltis EIAgen HCV Ab, Casalecchio di Reno,