Egypt - Demographic and Health Survey - 2015

Publication date: 2015

Egypt 2015 Health IssuesSurvey Egypt 2015 H ealth Issues Survey EGYPT HEALTH ISSUES SURVEY 2015 Ministry of Health and Population Cairo, Egypt El-Zanaty and Associates Cairo, Egypt The DHS Program ICF International Rockville, Maryland, USA October 2015 Ministry of Health and Population El-Zanaty and Associates The 2015 Egypt Health Issues Survey (EHIS) was conducted on behalf of the Ministry of Health and Population by El-Zanaty and Associates. The 2015 EHIS is part of The DHS Program which is funded by the United States Agency for International Development (USAID). USAID/Egypt was the main contributor of funding for the survey. Support for the survey also was provided by UNICEF and UNFPA. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID, UNICEF or UNFPA. Additional information about the 2015 EHIS may be obtained from the Ministry of Health and Population, 3 Magles El Shaab Street, Cairo, Egypt; Telephone: 20-2-27948555 and Fax: 20-2-27924156. Information about DHS surveys may be obtained from The DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA; Telephone: 1-301-407-6500, Fax: 1-301-407-6501, E-mail: info@DHSprogram.com, and Internet: www.DHSprogram.com. Recommended citation: Ministry of Health and Population [Egypt], El-Zanaty and Associates [Egypt], and ICF International. 2015. Egypt Health Issues Survey 2015. Cairo, Egypt and Rockville, Maryland, USA: Ministry of Health and Population and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . v PREFACE . ix ACKNOWLEDGMENTS . xi MAP OF EGYPT . xii 1 INTRODUCTION . 1 1.1 Background and Major Objectives of the 2015 EHIS . 1 1.2 Organization and Implementation of the 2015 EHIS . 2 1.2.1 Organization . 2 1.2.2 2015 EHIS Timetable . 2 1.2.3 Sample Design . 3 1.2.4 Questionnaire Development . 3 1.2.5 Biomarker Data Collection . 4 1.2.6 Hepatitis Testing Protocol . 5 1.2.7 Pretest. 6 1.2.8 Recruitment and Training of Field Staff . 6 1.2.9 Fieldwork . 8 1.2.10 Data Processing Activities . 8 1.3 Survey Coverage . 9 2 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 11 2.1 Background Characteristics of Respondents . 11 2.2 Educational Attainment . 14 2.3 Exposure to Media . 15 2.4 Employment Status . 19 2.4.1 Current Employment . 19 2.4.2 Occupation . 22 3 KNOWLEDGE AND PREVALENCE OF HEPATITIS B AND C . 25 3.1 Knowledge of Hepatitis C . 26 3.2 Knowledge of Hepatitis B . 30 3.3 History of Hepatitis B and C and Liver Disease . 35 3.4 History of Treatment for Hepatitis C . 36 3.5 Hepatitis Testing in the 2015 EHIS . 37 3.5.1 Coverage of Hepatitis Testing . 37 3.5.2 Return of the Results of Hepatitis Testing . 39 3.6 Prevalence of Hepatitis B and C . 39 3.6.1 Prevalence of Hepatitis B and C by Age . 39 3.6.2 Prevalence of Hepatitis B and C by Socioeconomic Characteristics . 41 3.6.3 Prevalence of Hepatitis B and C by Lifetime Exposure to Medical Procedures . 44 3.7 Trends in the Prevalence of Hepatitis C . 49 4 KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS . 51 4.1 Knowledge of HIV/AIDS . 51 4.2 Knowledge of Mother-to-Child Transmission . 58 4.3 Accepting Attitudes toward People Living with AIDS . 60 4.4 Knowledge of a Source for HIV Testing . 61 4.5 Sources of Information about AIDS . 63 iv • Contents 5 NON-COMMUNICABLE DISEASES . 65 5.1 Self-Reported History of Diabetes, Hypertension, and Heart Attack or Stroke . 65 5.2 Use of Tobacco . 67 5.3 Nutritional Status . 69 5.4 High Blood Pressure . 73 6 FAMILY PLANNING AND FERTILITY . 81 6.1 Knowledge of Family Planning Methods . 81 6.2 Attitudes toward the Timing of Use of Family Planning . 82 6.3 Exposure to Family Planning Messages . 84 6.4 Ideal Number and Spacing of Births . 86 6.4.1 Ideal Number of Children . 87 6.4.2 Ideal Interval between Births . 89 6.5 Ideal Age at Marriage . 90 7 WOMEN’S REPRODUCTIVE HEALTH CONCERNS . 95 7.1 Breast Cancer and Cervical Cancer Screening . 95 7.2 Caesarean Deliveries . 98 8 FEMALE CIRCUMCISION . 103 8.1 Female Circumcision . 103 8.1.1 Prevalence of Circumcision among Women Age 15-49 . 103 8.1.2 Women’s Circumcision Experience . 105 8.2 Circumcision among Young Girls . 106 8.2.1 Prevalence of Circumcision among Girls Age 1-14 . 106 8.2.2 Girls’ Circumcision Experience . 107 8.2.3 Intention to Circumcise . 108 8.3 Support for Female Circumcision among Women and Men . 109 8.4 Beliefs about Female Circumcision . 112 8.5 Exposure to Information about Female Circumcision . 114 REFERENCES . 119 APPENDIX A: SAMPLE DESIGN . 121 A.1 Introduction . 121 A.2 Sample Selection . 121 A.3 Sample Implementation . 122 A.4 Sampling Weights . 124 APPENDIX B: ESTIMATES OF SAMPLING ERRORS . 127 APPENDIX C: HEPATITIS TEST RESULTS FOR THE POPULATION AGE 15-59 . 141 APPENDIX D: PERSONS INVOLVED IN THE 2015 EGYPT HEALTH ISSUES SURVEY . 149 APPENDIX E: QUESTIONNAIRES . 153 Tables and Figures • v TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Survey timetable, 2015 EHIS . 3 Table 1.2 Interview results . 9 2 BACKGROUND CHARACTERISTICS OF RESPONDENTS . 11 Table 2.1 Background characteristics of women and men age 15-59 . 12 Table 2.2 Background characteristics of children age 1-14 . 13 Table 2.3.1 Educational attainment: Women . 14 Table 2.3.2 Educational attainment: Men . 15 Table 2.4.1 Exposure to mass media: Women . 16 Table 2.4.2 Exposure to mass media: Men . 17 Table 2.5.1 Use of computers and digital media: Women . 18 Table 2.5.2 Use of computers and digital media: Men . 19 Table 2.6.1 Employment status: Women . 20 Table 2.6.2 Employment status: Men . 21 Table 2.7.1 Occupation: Women . 23 Table 2.7.2 Occupation: Men . 24 Figure 2.1 Occupation among employed women and men age 15-59, Egypt 2015 . 22 3 KNOWLEDGE AND PREVALENCE OF HEPATITIS B AND C . 25 Table 3.1.1 Knowledge of hepatitis C by background characteristics: Women . 26 Table 3.1.2 Knowledge of hepatitis C by background characteristics: Men . 27 Table 3.2.1 Knowledge of the ways a person can contract hepatitis C by background characteristics: Women . 28 Table 3.2.2 Knowledge of the ways a person can contract hepatitis C by background characteristics: Men . 29 Table 3.3.1 Knowledge of hepatitis B by background characteristics: Women . 31 Table 3.3.2 Knowledge of hepatitis B by background characteristics: Men . 32 Table 3.4.1 Knowledge of the ways a person can contract hepatitis B by background characteristics: Women . 33 Table 3.4.2 Knowledge of the ways a person can contract hepatitis B by background characteristics: Men . 34 Table 3.5 History of testing for hepatitis B and C . 35 Table 3.6 History of hepatitis and other liver disease . 36 Table 3.7 Current hepatitis B and/or hepatitis C infection . 36 Table 3.8 Treatment status and type of treatment received among adults age 15-59 ever infected with hepatitis C . 37 Table 3.9 Coverage of hepatitis testing among the de facto interviewed population age 1-59 . 38 Table 3.10 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by age . 40 Table 3.11 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by socio-economic characteristics . 42 Table 3.12 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by governorate . 44 vi • Tables and Figures Table 3.13 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by lifetime history of medical injections . 45 Table 3.14 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by lifetime history of hospitalization and medical procedures other than injection . 46 Figure 3.1 Percentage of women and men with an active hepatitis C infection by age, Egypt 2015 . 41 Figure 3.2 Trends in percentage of the population age 15-59 testing positive on the hepatitis C RNA test, Egypt 2008-2015 . 49 4 KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS . 51 Table 4.1 Knowledge of AIDS . 53 Table 4.2 Knowledge of HIV preventive methods . 54 Table 4.3.1 Comprehensive knowledge about AIDS: Women . 55 Table 4.3.2 Comprehensive knowledge about AIDS: Men . 56 Table 4.4 Comprehensive knowledge about AIDS among youth . 57 Table 4.5 Knowledge of prevention of mother-to-child transmission of HIV . 59 Table 4.6.1 Accepting attitudes toward those living with HIV/AIDS: Women . 60 Table 4.6.2 Accepting attitudes toward those living with HIV/AIDS: Men . 61 Table 4.7 Knowledge of a place where HIV testing is available . 62 Table 4.8.1 Sources of information about AIDS by background characteristics: Women . 63 Table 4.8.2 Sources of information about AIDS by background characteristics: Men . 64 Figure 4.1 Trends in the percentages of women and men age 15-49 having heard of AIDS, Egypt 2008-2015 . 52 5 NON-COMMUNICABLE DISEASES . 65 Table 5.1 History of diabetes, heart attack, stroke, and hypertension . 66 Table 5.2 Actions taken in response to diagnosis of diabetes or high blood pressure, heart attack, or stroke . 67 Table 5.3 Use of tobacco . 67 Table 5.4 Smoking behavior by background characteristics . 68 Table 5.5 Household members’ exposure to smoking . 69 Table 5.6 Anthropometric indicators of nutritional status . 70 Table 5.7.1 Nutritional status by background characteristics: Women . 71 Table 5.7.2 Nutritional status by background characteristics: Men . 72 Table 5.8.1 Levels of hypertension by socioeconomic characteristics: Women . 75 Table 5.8.2 Levels of hypertension by socioeconomic characteristics: Men . 76 Table 5.9.1 Levels of hypertension by health status measures: Women . 77 Table 5.9.2 Levels of hypertension by health status measures: Men . 78 Figure 5.1 Trends in the percentage overweight or obese among women and men age 15-59, Egypt 2008-2015 . 73 Figure 5.2 Awareness of condition and treatment status among hypertensive women and men age 15-59 . 79 6 FAMILY PLANNING AND FERTILITY . 81 Table 6.1 Knowledge of family planning methods . 82 Table 6.2.1 Attitude about timing of use of family planning among newly married couples by background characteristics: Women . 83 Table 6.2.2 Attitude about timing of use of family planning among newly married couples by background characteristics: Men . 84 Tables and Figures • vii Table 6.3.1 Exposure to family planning messages by background characteristics: Women . 85 Table 6.3.2 Exposure to family planning messages by background characteristics: Men . 86 Table 6.4 Ideal number of children . 87 Table 6.5 Mean ideal number of children among women and men by age and background characteristics . 88 Table 6.6 Ideal interval between births . 89 Table 6.7 Preference for closely spaced births . 90 Table 6.8 Ideal age for a girl to marry . 91 Table 6.9 Ideal age for a boy to marry . 93 Figure 6.1 Mean ideal number of children among all women and men age 15-49, Egypt 2015 . 88 7 WOMEN’S REPRODUCTIVE HEALTH CONCERNS . 95 Table 7.1 Breast examination awareness and experience . 96 Table 7.2 Pap smear awareness and experience . 96 Table 7.3 Awareness and experience with breast and cervical cancer screening . 97 Table 7.4 Caesarean deliveries by background characteristics . 98 Table 7.5 Timing of decision about most recent caesarean delivery . 99 Table 7.6 Reasons for most recent caesarean delivery . 100 Table 7.7 Attitude toward caesarean deliveries . 101 Figure 7.1 Number of caesarean deliveries among ever-married women age 15-49 ever giving birth . 99 Figure 7.2 Attitude about having future babies vaginally after a caesarean delivery according to women’s prior history with caesarean births . 102 8 FEMALE CIRCUMCISION . 103 Table 8.1 Prevalence of female circumcision . 104 Table 8.2 Age at circumcision among women age 15-49 by residence . 105 Table 8.3 Person performing circumcisions among women age 15-49 by residence . 106 Table 8.4 Prevalence of circumcision among girls 1-14 years by background characteristics . 106 Table 8.5 Age at circumcision among girls age 1-14 by residence . 107 Table 8.6 Person performing circumcisions among girls age 1-14 by residence . 107 Table 8.7 Expected future prevalence of female circumcision among young girls . 108 Table 8.8 Current and expected prevalence of circumcision among girls by background characteristics . 109 Table 8.9.1 Attitudes about continuation of female circumcision by background characteristics: Women . 110 Table 8.9.2 Attitudes about continuation of female circumcision by background characteristics: Men . 111 Table 8.10.1 Beliefs about female circumcision by background characteristics: Women . 113 Table 8.10.2 Beliefs about female circumcision by background characteristics: Men . 114 Table 8.11.1 Exposure to information regarding female circumcision by background characteristics: Women . 115 Table 8.11.2 Exposure to information regarding female circumcision by background characteristics: Men . 116 viii • Tables and Figures Figure 8.1 Trends in percentage circumcised among all women age 15-49 by age, Egypt 2008-2015 . 105 Figure 8.2 Trends in percentages of women and men age 15-49 who believe female circumcision is required by religion and who support continuation of the practice, Egypt 2008 and 2015 . 112 APPENDIX A: SAMPLE DESIGN . 121 Table A.1 Allocation of primary sampling units and household sample . 122 Table A.2 Sample implementation by residence . 123 APPENDIX B: ESTIMATES OF SAMPLING ERRORS . 127 Table B.1 List of selected variables for sampling errors, Egypt Health Issues Survey 2015 . 129 Table B.2 Sampling errors: Total sample, Egypt Health Issues Survey 2015 . 130 Table B.3 Sampling errors: Urban sample, Egypt Health Issues Survey 2015. 131 Table B.4 Sampling errors: Rural sample, Egypt Health Issues Survey 2015 . 132 Table B.5 Sampling errors: Urban Governorates sample, Egypt Health Issues Survey 2015 . 133 Table B.6 Sampling errors: Lower Egypt Total sample, Egypt Health Issues Survey 2015 . 134 Table B.7 Sampling errors: Lower Egypt Urban sample, Egypt Health Issues Survey 2015 . 135 Table B.8 Sampling errors: Lower Egypt Rural sample, Egypt Health Issues Survey 2015 . 136 Table B.9 Sampling errors: Upper Egypt Total sample, Egypt Health Issues Survey 2015 . 137 Table B.10 Sampling errors: Upper Egypt Urban sample, Egypt Health Issues Survey 2015 . 138 Table B.11 Sampling errors: Upper Egypt Rural sample, Egypt Health Issues Survey 2015 . 139 Table B.12 Sampling errors: Frontier Governorates sample, Egypt Health Issues Survey 2015 . 140 APPENDIX C: HEPATITIS TEST RESULTS FOR THE POPULATION AGE 15-59 . 141 Table C.1 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 15-59 by background characteristics . 141 Table C.2 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 15-59 by governorate . 143 Table C.3 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 15-59 by lifetime history of medical injections . 144 Table C.4 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 15-59 by lifetime history of hospitalization and medical procedures other than injections . 145 Preface • ix PREFACE ealth for all is a main objective of the Egyptian government. The Ministry of Health and Population (MOHP) has placed high priority on achieving this objective, developing a national system of health facilities providing services at all levels. The MOHP is committed to increasing the quality and coverage of the health care system. To monitor and evaluate progress toward the achievement of this goal, reliable data are needed. Beginning in 1980, a number of household surveys have been carried out in Egypt to obtain data from the community on their current health situation, including a series of Demographic and Health Surveys (DHS). Several of the DHS have included special components designed to provide in- depth data to investigate topics of particular concern. In 2008, for example, the Egypt DHS provided the first nationwide data on the prevalence of infection with the hepatitis C virus among the Egyptian population age 15-59. The 2015 EHIS builds on the 2008 EDHS experience, expanding the testing component to include hepatitis B as well as hepatitis C and expanding the population eligible for the testing component to include children age 1-14 in addition to adults age 15-59. Similar to the 2008 EDHS, the 2015 EHIS provides data on the prevalence of hypertension among adults and valuable information relating to other non-communicable diseases and associated risk factors. The EHIS also obtained information on several reproductive health issues, including knowledge and attitudes relating to Caesarean sections which the 2014 EDHS results indicate now occur in more than half of all births in Egypt. Together with the findings of the 2014 EDHS, the results of the 2015 EHIS are very important for assessing the achievements of the health program to date as well as for planning future interventions to address Egypt’s health and population challenges. Based on the above-mentioned considerations, it is very important that the results of the 2015 EHIS should be widely disseminated at different levels of health management, in central offices as well as local governments, and to the community at large. Dr. Ahmed Emad Minister of Health and Population H Acknowledgments • xi ACKNOWLEDGMENTS he 2015 Egypt Health Issues Survey (EHIS) continues the long-standing commitment and efforts in Egypt to obtain data on key health challenges facing the country including hepatitis C and non-communicable diseases. The wealth of health data that the survey provides will help in charting future directions for the health programs addressing these challenges. The EHIS could not have been implemented without the active support and dedicated efforts of a large number of institutions and individuals. Special thanks are owed to H.E. Prof. Dr. Ahmed Emad. The support and approval of H.E. Prof. Dr. Adel Adawy also was instrumental in securing the implementation of the EHIS. I am deeply grateful to the Ministry of Health and Population (MOHP) staff who contributed to the successful completion of this project, especially Dr. Amr Kandeel, First Undersecretary for Preventive Sector, who provided strong continuing support to the project and has shown great interest in the survey results. Special thanks also go to Dr. Alaa El-Sayed Eid, Head of Central Administration of Preventive Affairs, and Dr. Ehab Attia, the former Director of the National Program for Prevention and Control of Viral Hepatitis, for their continuous support during the survey. The hepatitis testing was carried out at the Central Health Laboratory (MOHP). I would like to thank Dr. Ahmed Safwat Abdel Ghani, Dr. Amal Mohamed Naguib, Dr. Salwa Abdel Latif Shendy, and all of the staff at the Central Laboratory involved in the survey for their dedication in completing the testing of more than 25,000 samples in a very timely fashion. I would also like to thank Dr. Mohamed Aly Saber, Dr. Kesmat Mohamed Maher, and Dr. Manal Mouhamed Kamel at the Theodur Bilharz Research Institute (TBRI) for the support during the quality assurance testing. USAID/Egypt through its bilateral health and population projects was the main contributor of funding for the survey. I gratefully acknowledge the support from the Office of Health and Population staff at USAID/Egypt, especially Dr. Nabil Alsoufi, Director, and Dr. Sally Saher. Ms. Shadia Attia, formerly the Senior Monitoring and Evaluation Advisor at USAID, provided invaluable inputs throughout the survey. I also acknowledge with gratitude the financial support from UNFPA and UNICEF. Technical assistance came from the USAID-sponsored DHS-7 project. Dr. Ann Way, who worked closely with us on all phases of EHIS, deserves special thanks for all her efforts. I would like to thank Mr. Guillermo Rojas for his assistance in preparing programs for tracking the test results at the Central Laboratory and in producing preliminary tabulations from the survey. Ms. Jeanne Cushing deserves my deepest thanks for her assistance with data processing and tabulation for this report. Mr. Dean Garrett and Dr. Hamdy Abdel Ghafar Moussa provided invaluable assistance with the hepatitis testing component of the survey. I would like to express my appreciation for all the senior, office, and field staff at El-Zanaty and Associates for the dedication and skill with which they performed their tasks. Finally, I would like to express my appreciation to all households and individuals who responded in the survey; without their participation this survey would have been impossible. Fatma El-Zanaty Technical Director T xii • Map of Egypt MAP OF EGYPT CairoKalyubia Menoufia Alexandria DakahliaKafr El- Sheikh Behera GharbiaSharkia Damietta Port Said North Sinai South Sinai Suez Ismailia Matrouh Giza ’Menya Beni Suef Fayoum Red Sea Red Sea Assiut Souhag Qena Aswan New Valley Mediterranean Sea Luxor Introduction • 1 INTRODUCTION 1 uality health care in Egypt is a constitutional right for all citizens and the government is committed to maintain and support a comprehensive health care system (State Information Service 2014). Understanding the health challenges which face the Egyptian population is crucial for planning for their prevention, treatment and control within the national health care system. In addressing the health challenges, it is important not only to understand the scope of the problems but to be able to assess the factors that are contributing to the problems. The 2015 Egypt Health Issues Survey (EHIS) was undertaken as part of the Ministry of Health and Population’s commitment to obtain data on a number of Egypt’s key health concerns, particularly the prevalence of hepatitis and of hypertension, smoking, and obesity, which are major risk factors for non-communicable diseases (NCDs) such as diabetes and cardiovascular disease. Egypt has the highest rate of hepatitis C infection in the world, and NCDs are among the leading causes of death in Egypt. The 2015 EHIS shared the same national sample as the 2014 Egypt Demographic and Health Survey (EDHS). Together, the results of the EHIS and EDHS surveys provide the Ministry of Health and Population (MOHP) with a rich body of data that can be used to improve the delivery of health care services in Egypt. 1.1 BACKGROUND AND MAJOR OBJECTIVES OF THE 2015 EHIS The 2008 Egypt Demographic and Health Survey was designed not only to collect information to track the progress of the country’s family planning and maternal and child health programs but also to investigate a number of critical health issues for which Egypt lacked nationally representative data. In particular, the 2008 EDHS was the first survey to investigate the health challenge of hepatitis C in Egypt (El-Zanaty and Way 2009). The 2008 EDHS documented a high level of hepatitis C in the adult population; 1 out of 10 respondents age 15-59 tested in the 2008 EDHS was found to have an active hepatitis C infection. When planning began for the latest round of the DHS in Egypt, priority was given again to expanding the objectives of the survey beyond the traditional focus on fertility, family planning and maternal and child health to include the collection of data relating to hepatitis and non-communicable disease. In order to achieve those objectives, it was decided that the EDHS would include two components: a survey of ever-married women to update key fertility, family planning and maternal and child indicators and a special separate survey to obtain updated information on other critical health problems facing Egypt including the prevalence of hepatitis B and C and the population’s experience with non-communicable diseases. Fieldwork for the first of these two components, the one covering ever-married women age 15-49 (referred to as the 2014 EDHS) was undertaken in April- June 2014 and a report on results was released in May 2015 (Ministry of Health and Population et al. 2015). This report presents results from the second component, the 2015 Egypt Health Issues Survey. As was the case in the 2008 EDHS, a primary focus of the 2015 EHIS was to obtain information on awareness and prevalence of hepatitis. The population eligible for hepatitis testing was expanded in the 2015 EHIS to include children age 1-14 as well as adults age 15-59. In addition, testing was conducted in the 2015 EHIS for hepatitis B as well as hepatitis C. Another key objective of the EHIS was to obtain information on the proportion of respondents who had been diagnosed and Q 2 • Introduction were being treated for non-communicable diseases including diabetes, heart attack, and stroke. The EHIS also collected blood pressure measurements and information on the proportion of adults who had previously been diagnosed and were being treated for high blood pressure in order to estimate the prevalence of hypertension. The survey obtained data on several factors including smoking and obesity which place Egyptians at higher risk of hypertension, diabetes, and cardiovascular disease. In addition, the EHIS investigated several reproductive health care issues including the extent to which women are being screened for breast and cervical cancer and factors that that may be contributing to the recent rapid expansion in the rate of caesarean deliveries. The survey took advantage of the fact that men were being interviewed to obtain information on male attitudes toward family planning use and ideal family size and their beliefs concerning the practice of female circumcision. Finally, USAID and the Ministry of Health and Population requested that consent be obtained to utilize residual blood collected for children age 12-59 months and their mothers to test for aflatoxins. They also asked that consent be obtained to collect and store capillary blood from children age 6-11 months for the aflatoxin testing and that a 24-hour dietary history be included in the EHIS for children age 6 -59 months and their mothers for use in the aflatoxin study. The aflatoxin study was planned to be undertaken after the EHIS was completed when the laboratory resources needed for the aflatoxin study would be available. Aflatoxins are harmful chemicals produced by molds that are believed to affect the growth of the child, in particular causing children to be stunted or too short for their age. The aflatoxin study is expected to contribute to an understanding of the role aflatoxins may play in causing stunting, which the 2014 EDHS showed affects around 1 in 5 young children in Egypt. 1.2 ORGANIZATION AND IMPLEMENTATION OF THE 2015 EHIS 1.2.1 Organization The 2015 EHIS was conducted under the auspices of the MOHP and implemented by El- Zanaty and Associates. Technical support for the survey was provided by ICF International through The DHS Program. The DHS Program is sponsored by the United States Agency for International Development (USAID) to assist countries worldwide in conducting surveys to obtain information on key population and health indicators. USAID/Egypt provided the main funding to support the implementation of the survey. The United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) also contributed to the funding of the survey. The Central Public Health Laboratory was responsible for testing the blood samples obtained in the survey for hepatitis B and C, while the Theodor Bilharz Research Institute (TBRI) was responsible for external quality assurance activities related to hepatitis testing. 1.2.2 2015 EHIS Timetable The 2015 EHIS was executed in four stages. The first stage involved preparatory activities, including the selection of the household sample and the development, pretesting, and finalization of the survey questionnaires. The preparatory stage was initiated in September 2014, and all of its activities were completed by early January 2015. The second stage, which took place from mid- January through beginning of May 2015, involved the training of the field staff, the interviewing and collection of blood samples from eligible individuals, and the testing of the blood samples for hepatitis B and C at the Central Public Health Laboratory. The third stage encompassed all of the data processing activities necessary to produce a clean data file, including editing, coding, entering and verifying data and checking the data for consistency. This stage started soon after the beginning of the fieldwork and lasted until mid-May 2015. The focus of the fourth and final stage of the survey was on Introduction • 3 the return of the hepatitis test results and the analysis of the data and preparation the report. The process of returning results started in early June and was completed by mid-July. The analysis and report preparation activities began in mid-May 2015, with the production of preliminary tables and lasted through the end of September 2015. The activities involved in each of the stages are described in more detail below. The survey timetable is presented in Table 1.1. Table 1.1 Survey timetable, 2015 EHIS Activity Starting date Duration Sample selection September 2014 6 weeks Questionnaire design September 2014 2 months Preparation of training materials September 2014 2 months Pretest November2014 2 weeks Finalization of questionnaires December 2014 1 month Training of data collection staff January 2015 3 weeks Printing survey materials February 2015 2 weeks Fieldwork February 2015 3 months Hepatitis testing February 2015 3 months Re-interviews May 2015 2 weeks Return of the hepatitis test results June 2015 6 weeks Data entry March 2015 10 weeks Office editing and coding February 2015 10 weeks Computer editing April 2015 1 month Preliminary tables May 2015 1 week Detailed tabulations June 2015 2 months Final report preparation June 2015 2 months Final report review and finalization August 2015 1 month 1.2.3 Sample Design The 2015 EHIS took advantage of the sample developed for the ever-married women survey component of the 2014 EDHS. The 2014 EDHS was implemented in a total of 842 primary sampling units (PSUs) selected from 25 governorates. The frame for selection of these units was a list of all shiakhas and villages in Egypt. This list was obtained from the Central Agency for Public Mobilization and Statistics (CAPMAS) and updated as necessary to reflect any recent changes. For the EHIS, a sub-sample of 614 PSUs (shiakhas/villages) was selected from the 842 PSUs included in the 2014 EDHS sample. The household listing prepared during the 2014 EDHS for these PSUs was used to select the household sample for the 2015 EHIS. The selection was conducted in such a way that the EHIS household sample was totally independent of the 2014 EDHS sample, i.e., no household was included in both samples. It was expected that approximately 28,500 individuals age 6 months to 59 years, eligible for the 2015 EHIS testing and interviews, would be identified in the selected households. The sample for the 2015 EHIS was designed to provide estimates of the key health indicators that the survey was designed to measure including the prevalence of hepatitis B and C for the country as a whole and for six major subdivisions (Urban Governorates, urban Lower Egypt, rural Lower Egypt, urban Upper Egypt, rural Upper Egypt, and Frontier Governorates). The sample also allows for estimates of some key indicators at the governorate level. Additional information on the sample design and implementation is provided in Appendix A. 1.2.4 Questionnaire Development The 2015 EHIS involved three questionnaires: a household questionnaire, an adult questionnaire for eligible individuals 15-59 years, and a child questionnaire for eligible individuals 6 months-14 years. A considerable number of the questions in the EHIS questionnaires were based on 4 • Introduction the survey instruments developed for the 2008 Egypt DHS and, especially with respect to the household questionnaire, on the model questionnaires prepared in the DHS Program. In some cases, the questions were intended to collect information on new topics recommended by data users. All questionnaires were developed in English and then translated into Arabic. The 2015 EHIS household questionnaire was used to enumerate all usual members and visitors in the selected households and collect information on the socioeconomic status of the households. The first part of the household questionnaire collected information on the age, sex, marital status, educational attainment, and relationship to the household head of each household member or visitor. These questions were included in order to provide basic demographic data for the 2015 EHIS households. They also served to identify the eligible persons for the individual interviews. In the second part of the household questionnaire, there were questions on housing characteristics (e.g., the number of rooms, the flooring material, the source of water, and the type of toilet facilities) and on ownership of a variety of consumer goods. The adult individual questionnaire was administered to all individuals age 15-59 who were usual residents or who were present in the household during the night before the interviewer’s visit. It obtained information on the following topics: • Respondent’s background • Hepatitis • Knowledge of HIV/AIDS • Non-communicable diseases and other health issues • Female circumcision • Women’s health issues • Reproductive health knowledge and attitudes • Gender roles and attitudes • 24-hour dietary history for mothers of children under age five years • Blood pressure measurements • Biomarker testing The child questionnaire for children age 6 months-14 years was similar to the adult questionnaire but much shorter, covering the following topics: background information, hepatitis, circumcision and a 24- hour dietary history for children under five years, as well as biomarkers. It was administered to the mother of an eligible child or other adult caretaker responsible for the child at the time that EHIS interviewer visited the household. 1.2.5 Biomarker Data Collection The biomarker component of the 2015 EHIS involved: • Hepatitis B and C testing. In the 2015 EHIS, all individuals age 1-59 were eligible for hepatitis B and C testing. After obtaining informed consent, venous blood samples were collected from these individuals and tested for hepatitis B and hepatitis C at the MOHP Central Public Health Laboratory in Cairo. After the testing was completed, results were returned to all individuals providing samples for testing. More details on the procedures followed during the collection of the venous blood samples and the protocol followed during the hepatitis testing is presented below. Introduction • 5 • Aflatoxin testing. As discussed, blood samples from children age 6-59 months and their mothers will be tested for aflatoxins in a study that will be conducted after the 2015 EHIS is completed. • Blood pressure measurement. Blood pressure measurements were taken for all individuals age 15-59 who consented to the procedure. The measurements were taken at three points during the interview by interviewers using fully automatic digital blood pressure monitors with upper arm automatic inflation. Prior to taking the first blood pressure reading, the interviewer measured the respondent’s arm circumference in order to determine the appropriate cuff size to use. Respondents were asked for information about recent intake of food and caffeinated beverages as these factors can influence blood pressure readings. Respondents were given information on their blood pressure at the end of the interview. • Anthropometric data (height and weight measures). In the 2015 EHIS, anthropometric measures were obtained for all individuals age 15-59 who consented. Height and weight measurements were also obtained for all children age 6-59 months. Measuring boards produced by Shorr Productions were employed in collecting the height measures. Lightweight SECA scales with a digital screen were used to obtain the weight measures. 1.2.6 Hepatitis Testing Protocol The hepatitis testing component of the 2015 EHIS involved the collection of venous blood samples for testing at the Central Public Health Laboratory of the MOHP. All individuals age 1-59 years were eligible for the hepatitis testing. Blood specimens were collected from eligible individuals only after informed consent for the testing was obtained. Verbal informed consent was sought from all individuals age 18 and older and from married minors age 15-17. For non-emancipated minors age 15-17, consent was obtained first from the parent/guardian or other responsible adult, followed by assent from the respondent. For children under age 15, consent was obtained from a parent or other adult serving as the child’s caretaker. In addition to consent for the testing, consent was also sought for anonymous storage of the blood sample for unspecified testing and/or aflatoxin testing that might be undertaken after the survey was completed. At the time of the survey, all respondents, whether or not they consented to the testing, were given an informational brochure about hepatitis B and C. Respondents were told during the consent process that if they tested positive for hepatitis B and/or hepatitis C they would be referred to additional screening and counseling at a special Liver Treatment Center. They were also advised during the consent process that, because the hepatitis testing would be conducted at the Central Public Health Laboratory in Cairo, the results would not be returned to them for around three months. Permission was requested from each respondent to leave the results of the hepatitis testing in a sealed envelope with another household member if the respondent was not at home at the time the call back visits were made to return the test results. If a 2015 EHIS respondent consented to the testing, the laboratory technician drew approximately seven milliliters of venous blood in an EDTA vacutainer tube. The blood tube was labeled with a preprinted barcode identification number. Labels with the same barcode ID were also pasted on the household questionnaire and on the form used by the EHIS biomarker staff to track the collection of specimens from eligible respondents. Before starting work in a given area, each 2015 EHIS biomarker team established a temporary field laboratory. The tubes of blood collected during the fieldwork each day were stored in cool boxes prior to their transfer to the temporary field laboratory. In the field laboratory, the 2015 EHIS biomarker staff centrifuged the blood and transferred the serum to five microvials, labeled with the same barcode ID as the original vacutainer tube. The microvials containing the serum were stored in liquid nitrogen tanks. Samples were 6 • Introduction collected three times weekly, or sometimes more frequently, and transferred in coolers on dry ice to the Central Public Health Laboratory in Cairo. The hepatitis B testing protocol at the Central Public Health Laboratory involved an HBcAb test to screen for antibodies to the hepatitis B core antigen; the HBcAb test identified respondents who had ever been infected with the hepatitis B virus. An HBsAG test, which detects the presence of hepatitis B surface antigen in the blood, was used to identify individuals with an active hepatitis B infection. The hepatitis C testing protocol at the Central Public Health Laboratory included an initial round of screening to detect the presence of antibodies to hepatitis C. The presence of antibodies indicated that the individual had been exposed to hepatitis C virus (HCV) at some point. A third generation Enzyme Immunoassay (ELISA), Adlatis EIAgen HCV Ab test was first used to test for HCV antibodies. All positive samples and approximately 5 percent of negative samples from the ELISA screening were then tested again for the presence of HCV antibodies, using a more specific assay, the Chemiluminescent Microplate Immunoassay (CIA). Samples that were found to be positive on both ELISA and CIA tests were further tested to identify individuals with active (current) hepatitis infection. For this purpose, quantitative real time PCR was used at the Central Public Health Laboratory for the detection of HCV RNA, which is indicative of active (current) infection. For internal quality assurance, the Central Public Health Laboratory re-tested approximately 10 percent of the samples collected. In addition, the Theodur Bilharz Research Institute (TBRI) conducted external quality control on approximately 5 percent of the total number of samples tested at the Central Public Health Laboratory. The protocol for the hepatitis B and C testing was approved by the Scientific and Research Ethics Committee of the MOHP and the Institutional Review Board at ICF International. 1.2.7 Pretest A pretest was conducted during the preparation for the 2015 EHIS. After a two-week training course for the interviewers and health staff, the pretest fieldwork took place in late November 2014. Two supervisors, two field editors, and eight interviewers participated in the pretest. In addition, two health teams consisting of technicians/nurses were assigned for blood sample and height and weight measurements. The pretest was carried out in Beni Suef in Upper Egypt and Menoufia in Lower Egypt. A sample of 150 households was selected for the pretest: 75 households in each governorate. The data collection took about five days. A total of 131 households and 432 individual interviews were completed during the pretest. In addition, blood samples were drawn for 353 individuals. The questionnaires for the 2015 EHIS were finalized after the pretest. Both comments from interviewers and tabulations of the pretest results were reviewed during the process of finalizing the questionnaires. English versions of the final Arabic language questionnaires are included in Appendix E. 1.2.8 Recruitment and Training of Field Staff Staff recruitment. To recruit female interviewers and field editors, a list was obtained from those who worked with El-Zanaty and Associates of the staff who had participated in the 2014 EDHS. The female interviewers were ranked based on their performance during the 2014 EDHS, and the best 30 candidates were selected. A total of 15 male interviewers were recruited from those who worked in the 2014 EDHS quick count and listing stages and performed well. Introduction • 7 All candidates for the interviewer and field editor positions were recent university graduates. Another basic qualification was willingness to work in any of the governorates covered in the survey. As for the health team, the MOHP identified a large list of candidates for the positions. Senior staff interviewed all the candidates and those most promising were selected to participate in the training. A total of 27 physicians and 54 technicians/nurses were recruited for the training. Training materials. A variety of materials were developed for use in training personnel involved in the fieldwork. A lengthy interviewer’s manual, including general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the EHIS questionnaires, was prepared and given to all field staff. Other training materials including special manuals describing the duties of the team supervisor and the rules for field editing were prepared. Instructions for anthropometric data collection were included in a manual for use in training the staff who would be collecting the height and weight data. A special manual covering the procedures to be followed in the collection of the blood samples for hepatitis testing and a manual on the procedures for the blood pressure measurement were also prepared. Training for supervisors and interviewers. Training for the 12 candidates for the team supervisor positions was conducted over one day prior to the main fieldwork training. This training focused specifically on the supervisor’s duties, but it also covered the 2015 EHIS questionnaires in order to give the supervisors a basic understanding of the content of the survey prior to the main training program. Training for 54 candidates (supervisors, interviewers and field editors) for the 2015 EHIS data collection began in the third week of January. This training program, which lasted for more than two weeks, was held in Cairo. It included the following: • Sessions on how to fill out the questionnaire, using visual aids • Sessions on blood pressure measurement • Role playing and mock interviews • Three days of field practice in areas not covered in the survey • Two quizzes Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed the two quizzes were excluded immediately. Before the second field practice, a list was prepared for the 12 trainees who had performed best during both the classroom and field practices. Following the third field practice, nine of these trainees were chosen to be field editors (four females and five males). A special training session was held for the field editors after their selection. By the end of the training course, 36 out of the 42 candidates originally recruited for the interviewer position were selected to work as interviewers or field editors in the 2015 EHIS fieldwork. Nine supervisors were selected out of the 12 candidates to participate in the data collection. Training for health staff for hepatitis B and C testing. Eighty-one personnel were recruited for the health team training. The training included both classroom lectures and practice measurement and blood testing in a nursery school and in households contacted during the field practice sessions. The training of health staff started in mid-January 2015 and lasted for almost four weeks. The training was held in parallel to the main training of interviewers in two different classrooms. The supervisors 8 • Introduction attended most of the health staff training sessions including those on the procedures for drawing blood samples and the centrifuging and storage of the blood so they could monitor the activities involved in the collection, processing, and storage of the blood samples in the EHIS. At the end of the training program, 18 physicians and 36 technicians/nurses that were most-qualified (18 males and 18 females) were selected for the blood sample and height and weight measurements. As discussed earlier, all of the personnel involved in the collection of the blood samples in the EHIS had a medical background. The best three physicians were selected to supervise the medical teams in the field. 1.2.9 Fieldwork Fieldwork for the 2015 EHIS began in the second week of February 2015 and was completed in the first week of May 2015. The field staff was divided into nine teams; each team had one supervisor, one field editor, three interviewers (two females and one male), and two health subteams; each health subteam included one physician and two technicians/nurses. All supervisors were males, while the field editors and interviewers were females or males. At least one of the two health technicians/nurses on each team was a female. During the fieldwork, the nine field teams worked in separate governorates. Three governorates were assigned to each team with an equal workload for each team. As a quality control measure, field editors regularly conducted re-interviews using a shortened version of the 2015 EHIS questionnaire during the fieldwork period. The results of the re- interview were compared to the responses in the original interview and errors were discussed with the interviewer. The teams were closely supervised throughout the fieldwork by a fieldwork coordinator, two assistant fieldwork coordinators, two anthropometric consultants, and another senior staff. In addition, the best three physicians were selected to supervise the medical teams’ work in the field. Three personnel were selected to collect the blood samples from the field on a regular basis and deliver them to the Central Public Health Laboratory. Finally, the results of special tabulations, i.e., field check tables, prepared on a weekly basis throughout the data entry and editing of the questionnaires, helped to identify field staff whose performance was below expectation. They were the target of immediate feedback and more intensive monitoring. As a further quality control measure, after the main data collection was completed, a random sample of around 10 percent of the households was selected for each team for re-interviews using the shortened version of the questionnaire. The visits to the sample points to conduct the re-interviews also afforded an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit by the 2015 EHIS interviewers. Household or individual questionnaires in which there were significant errors that could not be corrected in the office were also assigned for re-interview. Special teams including staff who had worked in the main survey were organized to handle the re-interviews. During this phase of the survey, interviewers were not allowed to work in the same governorate in which they had worked in the initial fieldwork. Re- interviews began in early May 2015 and took around two weeks to complete. 1.2.10 Data Processing Activities Office editing. Staff from the central office were responsible for collecting questionnaires from the teams as soon as interviewing in a cluster was completed. Limited office editing took place for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to note any problems detected while editing the questionnaires; the problems were reviewed by the senior staff and communicated to the field staff. If serious errors were found, the supervisor of the team was notified and advised of the steps to be taken to avoid these problems in the future. Introduction • 9 Machine entry and editing. Machine entry and editing began while interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing System (CSPro), a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. In addition, the transmittal forms as well as the blood sample worksheets which included the barcode were entered by two persons. Special computer programs were also set up to facilitate the tracking of the results of the testing of the blood samples collected during the survey at the Central Public Health Laboratory. The barcodes attached to the samples in the field were used for logging in and identifying the samples throughout the processing, which took place at three separate locations within the Central Public Health Laboratory. The barcode also served as the means to link the laboratory test results and the survey data file. Eight data entry personnel participated in the processing of the 2015 EHIS survey data. During the data processing, questionnaires were entered twice and the entries were compared to detect and correct keying errors. The data processing staff completed the entry and editing of data by mid- May 2015. 1.3 SURVEY COVERAGE Table 1.2 summarizes the outcome of the fieldwork for the 2015 EHIS by place of residence. The table shows that, during the main fieldwork and callback phases of the survey, out of the 7,813 households in the 2015 EHIS sample, 7,649 households were found. Among those households, 7,516 were successfully interviewed, which represents a response rate of 98.3 percent. The household response rate exceeded 96 percent in all residential categories. Table 1.2 Interview results Percent distribution of households and individuals by the result of survey interview and response rates, according to residence, 2015 Egypt Health Issues Survey Urban Rural Urban Gover- norates Lower Egypt Upper Egypt Frontier Gover- norates1 Total Result Total Urban Rural Total Urban Rural Households Sampled 4,112 3,701 1,665 2,836 1,036 1,800 2,894 1,095 1,799 418 7,813 Found 3,989 3,660 1,620 2,778 1,000 1,778 2,833 1,053 1,780 418 7,649 Interviewed 3,877 3,639 1,582 2,728 965 1,763 2,788 1,014 1,774 418 7,516 Household response rate 97.2 99.4 97.7 98.2 96.5 99.2 98.4 96.3 99.7 100.0 98.3 Children 1-14 Identified 4,763 6,134 1,633 3,806 1,162 2,644 4,703 1,401 3,302 755 10,897 Interviewed 4,744 6,134 1,630 3,800 1,156 2,644 4,693 1,391 3,302 755 10,878 Child response rate 99.6 100.0 99.8 99.8 99.5 100.0 99.8 99.3 100.0 100.0 99.8 Female adults 15-59 Identified 4,499 4,816 1,647 3,459 1,189 2,270 3,664 1,260 2,404 545 9,315 Interviewed 4,430 4,779 1,618 3,409 1,165 2,244 3,637 1,243 2,394 545 9,209 Female adult response rate 98.5 99.2 98.2 98.6 98.0 98.9 99.3 98.7 99.6 100.0 98.9 Male adults 15-59 Identified 3,993 3,874 1,480 2,911 1,005 1,906 2,988 1,142 1,846 488 7,867 Interviewed 3,766 3,696 1,389 2,761 933 1,828 2,833 1,083 1,750 479 7,462 Eligible men response rate2 94.3 95.4 93.9 94.8 92.8 95.9 94.8 94.8 94.8 98.2 94.9 Total respondents 1-59 Identified 13,255 14,824 4,760 10,176 3,356 6,820 11,355 3,803 7,552 1,788 28,079 Interviewed 12,940 14,609 4,637 9,970 3,254 6,716 11,163 3,717 7,446 1,779 27,549 Total response rate 97.6 98.5 97.4 98.0 97.0 98.5 98.3 97.7 98.6 99.5 98.1 1 Does not include North and South Sinai governorates 10 • Introduction A total of 28,079 individuals age 15-59 were identified as eligible to be interviewed in the 2015 EHIS. Out of these 27,549 were successfully interviewed, which represents a response rate of 98.1 percent. The response rate for eligible individuals 1-59 exceeded 97 percent in all areas. Out of the individuals 15-59 years, a total of 9,315 females and 7,867 males were identified for the interview, and a total of 9,209 females and 7,462 males were successfully interviewed. The response rate for females (98.9 percent) was higher than the response rate for males (94.9 percent). In the eligible households, a total of 10,897 children 1-14 years were identified, and among those, interviews with a parent or other adult caretaker (mainly the mother) were successfully completed for 10,878 children, a response rate of 99.8 percent. Background Characteristics of Respondents • 11 BACKGROUND CHARACTERISTICS OF RESPONDENTS 2 his chapter provides a profile of the men, women, and children for whom information was collected in the 2015 EHIS. The profile focuses on respondent characteristics that will facilitate understanding and interpretation of the findings presented in subsequent chapters. The chapter starts by presenting information on basic demographic and socio-economic characteristics for the entire 2015 EHIS survey population age 1-59 years. The chapter then explores in more depth the educational attainment of women and men age 15-59, their exposure to traditional mass media, use of computers and digital media, and their employment status. 2.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS All individuals age 1-59 that were usual residents or present in the EHIS sample households on the night before the EHIS interviewer’s visit were eligible for a detailed interview on a range of health issues. Individuals age 15-59 years were interviewed directly. Information was obtained from the child’s mother in the case of 92 percent of eligible children age 1-14 years. In the case of the remaining children, the information was obtained from another adult member of the household who was responsible for the child’s care on the day of the EHIS team’s visit. Table 2.1 presents the distribution of women and men age 15-59 years interviewed in the 2015 EHIS by selected background characteristics. Looking at the age distribution of respondents presented in Table 2.1, slightly more than 4 in 10 women and men were under the age of 30. Around the same proportion of women and men were in the age group 30-49 years while 14 percent of women and 16 percent of men were age 50-59. T Key Findings • Around two-fifths of adult respondents in the EHIS were under age 30 and around 15 percent were age 50 and above. • The majority of adult respondents (around 63 percent) were living in rural areas. • More than one-fifth of adult women never attended school, compared with only 8 percent among men. • Almost all adults (99 percent) watched television at least once a week. • Around one-quarter of adult women use a computer at least once a week and 21 percent use the internet, while 37 percent of adult men use a computer at least once a week and nearly the same percentage use the internet. • Overall, 14 percent of adult women were engaged in some economic activity in the week prior to the survey, while 83 percent of adult men were engaged in some economic activity during the same period. • Among employed respondents, more than half of women and a quarter of men worked in professional, technical, and managerial positions, while 4 percent of women and 16 percent of men worked in agriculture. 12 • Background Characteristics of Respondents Table 2.1 Background characteristics of women and men age 15-59 Percent distribution of women and men age 15-59 by selected background characteristics, Egypt 2015 Women 15-59 Men 15-59 Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 15.5 1,425 1,407 17.3 1,288 1,252 20-24 12.9 1,185 1,176 11.5 859 882 25-29 16.0 1,471 1,472 12.9 962 985 30-34 13.0 1,195 1,228 12.4 923 938 35-39 11.5 1,061 1,052 11.5 856 875 40-44 8.8 814 802 9.9 736 722 45-49 8.2 754 766 9.0 670 657 50-54 7.7 707 723 9.4 702 685 55-59 6.5 596 583 6.3 467 466 Marital status Never married 20.0 1,839 1,944 34.0 2,536 2,644 Married 71.1 6,552 6,461 64.6 4,819 4,696 Divorced/separated 2.8 254 269 1.0 75 88 Widowed 6.1 564 535 0.4 31 34 Urban-rural residence Urban 36.5 3,359 4,430 38.2 2,847 3,766 Rural 63.5 5,850 4,779 61.8 4,615 3,696 Place of residence Urban Governorates 13.3 1,223 1,618 14.0 1,044 1,389 Lower Egypt 48.9 4,506 3,409 49.6 3,698 2,761 Urban 11.5 1,056 1,165 11.5 854 933 Rural 37.5 3,450 2,244 38.1 2,844 1,828 Upper Egypt 37.1 3,417 3,637 35.7 2,664 2,833 Urban 11.4 1,048 1,243 12.3 919 1,083 Rural 25.7 2,369 2,394 23.4 1,745 1,750 Frontier Governorates1 0.7 63 545 0.7 56 479 Education No education 22.1 2,031 1,889 8.3 621 579 Some primary 8.4 773 756 9.2 686 629 Primary complete/ some secondary 25.5 2,345 2,364 29.6 2,207 2,099 Secondary complete/ higher 44.1 4,060 4,200 52.9 3,948 4,155 Wealth quintile Lowest 19.6 1,806 1,913 19.6 1,462 1,515 Second 19.7 1,810 1,609 19.1 1,424 1,232 Middle 19.9 1,833 1,328 18.5 1,379 1,012 Fourth 20.3 1,865 1,962 21.1 1,571 1,667 Highest 20.6 1,895 2,397 21.8 1,626 2,036 Total 15-59 100.0 9,209 9,209 100.0 7,462 7,462 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 1 Does not include North and South Sinai governorates Seven in 10 women and just under two-thirds of men were currently married. Reflecting the fact that men marry later women in Egypt, men were much more likely to be never married than women (34 percent and 20 percent, respectively). On the other hand, the proportion divorced and separated and, especially, the proportion widowed were higher among women than men. The majority of the respondents age 15-59 in the 2015 EHIS—more than 6 in 10 women and men—were living in rural areas. With regards to the place of residence, around half of women and men resided in Lower Egypt, and more than one-third lived in Upper Egypt. Around 1 in 8 respondents were from the Urban Governorates. Less than 1 percent were from the three Frontier Governorates covered in the survey. Background Characteristics of Respondents • 13 The educational level of the 2015 EHIS respondents varied considerably between women and men. The largest differential between men and women was in the proportion with no education. Twenty-two percent of women age 15-59 never attended school compared with 8 percent of men. Among women, 7 in 10 had completed primary school and more than 4 in 10 had completed secondary school or higher. Among men, more than 8 in 10 completed primary school and more than half had completed secondary school or higher. Adult respondents in the EHIS were fairly evenly distributed across the wealth quintiles.1 Table 2.2 presents background characteristics of children age 1-14 who were eligible for the EHIS. The age distribution shows that around one-third of children were less than five years old, 4 in 10 were age 5-10 years, and 1 in 4 children were age 11-14 years. Around one-third of children resided in urban areas. The highest proportion of children age 1-14 was found in Lower Egypt (just under half of girls and of boys). As for the distribution by wealth quintiles, the highest percentage of children age 1-14 was found in the middle quintile (23 percent of girls and 22 percent of boys). Table 2.2 Background characteristics of children age 1-14 Percent distribution of children age 1-14 by selected background characteristics, Egypt 2015 Girls Boys Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 1-2 16.1 849 873 16.2 905 917 3-4 16.5 873 852 18.3 1,023 1,012 5-6 15.9 837 842 15.5 868 857 7-8 13.8 729 707 12.9 724 752 9-10 12.9 682 691 12.7 712 721 11-12 12.1 639 636 12.2 682 657 13-14 12.7 671 671 12.2 684 690 Urban-rural residence Urban 31.5 1,662 2,290 31.9 1,788 2,454 Rural 68.5 3,619 2,982 68.1 3,809 3,152 Place of residence Urban Governorates 11.0 581 791 10.7 598 839 Lower Egypt 46.1 2,433 1,820 46.7 2,612 1,980 Urban 9.5 503 561 9.6 537 595 Rural 36.5 1,929 1,259 37.1 2,074 1,385 Upper Egypt 42.1 2,223 2,275 41.9 2,345 2,418 Urban 10.5 556 657 11.2 628 734 Rural 31.6 1,667 1,618 30.7 1,717 1,684 Frontier Governorates1 0.8 44 386 0.8 43 369 Wealth quintile Lowest 21.1 1,113 1,196 20.2 1,130 1,227 Second 20.0 1,055 990 20.8 1,162 1,066 Middle 23.2 1,224 856 21.7 1,217 889 Fourth 19.3 1,020 1,060 19.7 1,101 1,135 Highest 16.4 868 1,170 17.6 988 1,289 Total 1-14 100.0 5,280 5,272 100.0 5,598 5,606 1 Does not include North and South Sinai governorates 1 For further information on how the wealth quintiles were constructed, see the discussion in the second chapter of the 2014 Egypt DHS report (Ministry of Health and Population et al. 2015). 14 • Background Characteristics of Respondents 2.2 EDUCATIONAL ATTAINMENT Table 2.3.1 and Table 2.3.2 provide information on the relationship between the educational attainment of the women and men age 15-59 interviewed in 2015 EHIS and selected other background characteristics. Table 2.3.1 Educational attainment: Women Percent distribution of women age 15-59 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Egypt 2015 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-19 2.7 4.1 1.9 72.2 10.7 8.4 100.0 9.0 1,425 20-24 6.2 4.8 1.4 22.6 40.8 24.3 100.0 10.9 1,185 25-29 16.3 5.1 2.2 12.9 44.0 19.6 100.0 10.3 1,471 30-34 18.1 6.3 5.2 12.0 42.5 15.9 100.0 10.2 1,195 35-39 24.4 10.0 5.1 14.5 35.3 10.7 100.0 8.0 1,061 40-44 32.7 8.2 2.8 15.4 31.0 9.9 100.0 8.0 814 45-49 41.9 10.9 3.5 7.5 26.5 9.7 100.0 3.7 754 50-54 45.4 19.5 4.2 6.8 15.7 8.3 100.0 1.3 707 55-59 50.5 19.2 6.6 3.8 15.7 4.2 100.0 0.0 596 Urban-rural residence Urban 10.8 7.2 4.2 22.0 33.1 22.7 100.0 10.5 3,359 Rural 28.5 9.1 2.9 22.2 29.2 8.1 100.0 7.9 5,850 Place of residence Urban Governorates 11.0 6.5 6.2 23.4 31.1 21.8 100.0 10.4 1,223 Lower Egypt 20.0 8.3 3.0 20.8 33.5 14.3 100.0 10.0 4,506 Urban 8.2 7.2 3.4 19.5 34.1 27.6 100.0 10.9 1,056 Rural 23.7 8.6 2.9 21.3 33.3 10.2 100.0 8.9 3,450 Upper Egypt 28.7 9.2 2.8 23.3 26.7 9.3 100.0 7.7 3,417 Urban 13.2 8.0 2.6 22.7 34.4 19.0 100.0 10.3 1,048 Rural 35.6 9.7 2.9 23.5 23.3 5.0 100.0 6.0 2,369 Frontier Governorates3 21.2 5.6 4.2 23.6 30.3 15.1 100.0 9.9 63 Wealth quintile Lowest 40.5 10.1 3.3 21.7 20.0 4.3 100.0 4.4 1,806 Second 33.5 10.2 3.3 23.5 24.7 4.8 100.0 6.4 1,810 Middle 18.8 9.6 2.5 22.6 36.6 9.9 100.0 9.8 1,833 Fourth 13.5 8.0 4.9 22.9 36.2 14.6 100.0 10.1 1,865 Highest 5.1 4.3 2.8 19.8 35.2 32.8 100.0 11.3 1,895 Total 15-59 22.1 8.4 3.4 22.1 30.6 13.4 100.0 9.0 9,209 1 Completed 5 years (22-36 years of age), all others 6 years at primary level 2 Completed 6 years at the secondary level 3 Does not include North and South Sinai governorates The proportion with no education rises directly with age. For example, half of women age 55- 59 had never attended school compared to only 3 percent of women age 15-19. Twenty-two percent of men age 55-59 had no education compared to less than one percent of men in the 15-19 age group. At the other extreme of the education distribution, the proportion with more than secondary education is highest in the 20-24 age group (24 percent and 32 percent for women and men, respectively). The median completed number of years of schooling is 9.0 among women and 10.3 among men. Urban respondents are more highly educated than those from rural areas. Among urban women, for example, 56 percent had completed secondary education or higher, compared with 37 percent of rural women. Among urban men, 60 percent had completed secondary education or higher, compared with 48 percent of rural men. Considering the differentials by place of residence, educational levels were lowest in rural Upper Egypt, where 36 percent of women and 12 percent of men age 15-59 had never attended school. The highest educational levels were found in urban Lower Egypt; where only 8 percent of women and 4 percent of men had never attended school, and 62 percent of women and 62 percent of men had completed secondary school or more. Background Characteristics of Respondents • 15 Table 2.3.2 Educational attainment: Men Percent distribution of men age 15-59 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Egypt 2015 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-19 0.5 4.3 2.1 76.2 9.2 7.7 100.0 9.2 1,288 20-24 1.6 5.0 1.8 17.6 41.8 32.4 100.0 11.3 859 25-29 5.2 3.6 5.7 16.5 46.6 22.4 100.0 10.4 962 30-34 6.9 9.3 6.0 13.8 47.8 16.2 100.0 10.3 923 35-39 7.7 9.3 6.4 13.7 43.5 19.4 100.0 10.5 856 40-44 8.9 14.2 5.0 19.0 33.6 19.3 100.0 11.1 736 45-49 16.4 12.4 5.2 10.2 42.7 13.1 100.0 11.2 670 50-54 20.5 13.6 6.0 10.3 30.7 18.9 100.0 10.7 702 55-59 21.8 22.2 6.5 8.5 25.1 16.0 100.0 5.9 467 Urban-rural residence Urban 4.8 7.5 4.2 23.1 33.9 26.5 100.0 10.9 2,847 Rural 10.5 10.3 5.0 26.0 35.5 12.8 100.0 10.1 4,615 Place of residence Urban Governorates 5.7 7.1 5.2 23.8 31.9 26.4 100.0 10.8 1,044 Lower Egypt 8.3 9.4 5.2 25.9 34.4 16.7 100.0 10.2 3,698 Urban 3.8 7.0 4.0 23.3 32.6 29.4 100.0 11.0 854 Rural 9.7 10.2 5.6 26.7 35.0 12.9 100.0 10.1 2,844 Upper Egypt 9.4 9.8 3.8 24.0 36.6 16.5 100.0 10.3 2,664 Urban 4.8 8.5 3.2 22.3 36.9 24.3 100.0 10.8 919 Rural 11.8 10.4 4.0 24.9 36.4 12.4 100.0 10.1 1,745 Frontier Governorates3 7.9 6.0 3.6 20.5 42.5 19.5 100.0 10.7 56 Wealth quintile Lowest 15.5 12.8 4.9 27.6 31.2 8.0 100.0 8.5 1,462 Second 13.1 10.0 4.6 27.3 36.2 8.8 100.0 9.7 1,424 Middle 6.0 9.8 6.5 25.0 36.2 16.5 100.0 10.3 1,379 Fourth 5.7 10.5 5.4 25.0 36.2 17.1 100.0 10.3 1,571 Highest 2.1 3.4 2.4 20.0 34.8 37.2 100.0 11.5 1,626 Total 15-59 8.3 9.2 4.7 24.9 34.9 18.0 100.0 10.3 7,462 1 Completed 5 years (22-36 years of age), all others 6 years at primary level 2 Completed 6 years at the secondary level 3 Does not include North and South Sinai governorates As expected, educational attainment rises with wealth quintile. More than two-thirds of women in the highest wealth quintile completed secondary education or higher, while 41 percent of women in the lowest quintile never attended school. More than 70 percent of men in the highest wealth quintile had completed secondary education or higher, while 28 percent of men in the lowest quintile had no education or had not completed primary school. 2.3 EXPOSURE TO MEDIA The 2015 EHIS collected information on exposure of respondents to mass media. These data are important as they provide some indication of the extent to which Egyptians are regularly exposed to mass media that have been traditionally used to convey health messages to the population. In addition, a series of questions were asked to the 2015 EHIS respondents to assess exposure to digital media, which is an increasingly important channel for communication messages. Tables 2.4.1 and 2.4.2 present information on the percentage of women and men age 15-59 watching television, listening to the radio, or reading a newspaper/magazine at least once per week by background characteristics. The table also includes information on the percentage of women and men accessing all three media at least once per week and the percentage not exposed to any media on a weekly basis. 16 • Background Characteristics of Respondents Table 2.4.1 Exposure to mass media: Women Percentage of women age 15-59 who are exposed to specific media on a weekly basis, by background characteristics, Egypt 2015 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of respondents Age 15-19 11.5 99.7 24.2 6.4 0.2 1,425 20-24 13.6 98.4 27.0 6.9 1.2 1,185 25-29 13.5 99.2 27.1 7.0 0.4 1,471 30-34 12.7 99.3 31.5 9.1 0.5 1,195 35-39 11.6 98.5 28.5 7.2 1.0 1,061 40-44 13.2 99.2 30.1 8.4 0.6 814 45-49 16.0 99.0 25.9 9.2 0.8 754 50-54 9.3 98.5 23.0 4.9 1.3 707 55-59 11.1 98.7 30.1 7.2 1.1 596 Urban-rural residence Urban 19.3 99.3 36.2 12.4 0.5 3,359 Rural 8.7 98.9 22.4 4.5 0.8 5,850 Place of residence Urban Governorates 22.2 98.8 46.4 16.5 0.9 1,223 Lower Egypt 12.1 99.2 29.7 7.2 0.6 4,506 Urban 18.5 99.3 32.9 11.6 0.5 1,056 Rural 10.2 99.2 28.8 5.8 0.7 3,450 Upper Egypt 9.7 98.8 17.6 4.3 0.8 3,417 Urban 16.9 99.7 27.9 8.5 0.1 1,048 Rural 6.5 98.4 13.0 2.4 1.1 2,369 Frontier Governorates1 13.2 99.2 28.3 6.7 0.4 63 Education No education 0.1 98.3 16.9 0.1 1.3 2,031 Some primary 2.4 98.3 25.5 1.2 1.6 773 Primary complete/ some secondary 8.3 99.2 26.8 5.0 0.6 2,345 Secondary complete/ higher 23.2 99.4 33.4 13.5 0.3 4,060 Wealth quintile Lowest 4.9 98.4 17.0 2.8 1.1 1,806 Second 6.4 98.6 21.1 3.0 1.2 1,810 Middle 8.6 99.3 25.4 4.7 0.5 1,833 Fourth 14.6 99.2 29.2 7.1 0.6 1,865 Highest 27.5 99.6 43.6 18.6 0.2 1,895 Total 15-59 12.6 99.0 27.4 7.3 0.7 9,209 1 Does not include North and South Sinai governorates Television is clearly the main media channel among both women and men. Virtually all women and men age 15-59 watch television (99 percent each). Men have somewhat greater exposure to radio and print media than women; however, even among men, only around a third listen to the radio and slightly more than one-fifth read a newspaper/magazine at least once a week. Seven percent of women and 13 percent of men report regular exposure to all three media. Considering the differences in media exposure by background characteristics, there is almost no variation in the percentage of women and men age 15-59 who watch television. Looking at print media and radio, urban residents, especially those living in Urban Governorates and urban Lower Egypt, respondents with a secondary or higher education, and those in the highest wealth quintile were most likely to listen to the radio or read a newspaper/magazine on a weekly basis. Background Characteristics of Respondents • 17 Table 2.4.2 Exposure to mass media: Men Percentage of men age 15-59 who are exposed to specific media on a weekly basis, by background characteristics, Egypt 2015 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of respondents Age 15-19 12.6 99.6 26.6 7.3 0.0 1,288 20-24 20.7 98.8 30.6 11.9 0.5 859 25-29 22.2 98.8 34.1 12.9 0.7 962 30-34 22.3 98.2 34.9 12.4 0.9 923 35-39 24.8 99.0 41.7 15.8 0.5 856 40-44 22.0 98.5 35.0 10.6 0.6 736 45-49 22.7 97.5 36.7 14.1 1.6 670 50-54 32.3 98.8 40.0 20.9 1.0 702 55-59 28.2 99.0 40.1 19.5 1.0 467 Urban-rural residence Urban 30.9 99.2 42.7 20.3 0.5 2,847 Rural 16.5 98.5 29.7 8.7 0.8 4,615 Place of residence Urban Governorates 34.5 98.7 53.0 26.4 0.6 1,044 Lower Egypt 19.3 98.7 35.1 11.4 0.6 3,698 Urban 28.8 99.5 38.4 18.6 0.5 854 Rural 16.4 98.4 34.1 9.2 0.7 2,844 Upper Egypt 20.9 98.9 26.7 10.3 0.8 2,664 Urban 28.9 99.4 35.2 15.0 0.5 919 Rural 16.7 98.7 22.2 7.8 1.0 1,745 Frontier Governorates1 25.1 98.1 38.2 15.0 1.6 56 Education No education 0.6 96.4 23.9 0.3 3.4 621 Some primary 6.1 99.0 32.2 4.0 0.7 686 Primary complete/ some secondary 11.6 99.1 29.7 6.7 0.5 2,207 Secondary complete/ higher 34.0 98.9 39.5 20.3 0.4 3,948 Wealth quintile Lowest 14.6 98.1 24.4 7.0 1.3 1,462 Second 14.6 98.5 27.0 7.3 0.8 1,424 Middle 14.3 98.8 33.6 7.6 0.6 1,379 Fourth 22.4 98.9 37.3 13.3 0.6 1,571 Highest 41.5 99.4 48.9 28.2 0.3 1,626 Total 15-59 22.0 98.8 34.6 13.1 0.7 7,462 1 Does not include North and South Sinai governorates Tables 2.5.1 and 2.5.2 present information on the use of computers and digital media by women and men age 15-59. The results show that most women and men do not regularly use digital media. Only 37 percent of men and 25 percent of women report using a computer at least once per week. Around one-third of men and one-fifth of women report they access the internet or social media regularly. Looking at the differentials in the tables, younger women and men are much more likely to use a computer and access the internet and social media regularly than older respondents. For example, the proportion accessing all three digital media at least once per week decreases with increasing age, from a high of 32 percent of women age 15-19 to 4 percent of women age 55-59. Men under age 25 are more than four times as likely to access all three types of digital media as men age 55-59. 18 • Background Characteristics of Respondents Table 2.5.1 Use of computers and digital media: Women Percentage of women age 15-59 who use a computer, the internet, and social media on a weekly basis, by background characteristics, Egypt 2015 Background characteristic Uses a computer at least once a week Uses internet at least once a week Uses social media at least once a week Uses all three digital media at least once a week Uses none of the three digital media at least once a week Number of respondents Age 15-19 42.3 37.5 34.6 32.0 55.0 1,425 20-24 35.3 31.9 29.8 27.7 62.2 1,185 25-29 27.3 22.0 20.1 18.4 70.8 1,471 30-34 24.3 18.5 16.3 15.5 74.7 1,195 35-39 20.9 14.9 12.2 11.4 77.7 1,061 40-44 17.2 13.1 11.1 10.2 81.8 814 45-49 15.4 11.3 8.2 7.8 83.9 754 50-54 12.1 7.2 5.6 5.4 87.7 707 55-59 8.9 5.9 4.4 4.1 90.7 596 Urban-rural residence Urban 40.8 34.8 31.3 29.4 57.0 3,359 Rural 16.4 12.4 10.9 9.9 82.5 5,850 Place of residence Urban Governorates 43.0 37.4 33.7 32.5 55.3 1,223 Lower Egypt 25.4 20.4 18.6 17.2 73.2 4,506 Urban 43.0 37.3 34.2 31.6 54.3 1,056 Rural 19.9 15.2 13.9 12.8 78.9 3,450 Upper Egypt 18.8 14.6 12.3 11.2 79.8 3,417 Urban 36.2 29.2 25.7 23.9 61.7 1,048 Rural 11.1 8.2 6.4 5.6 87.7 2,369 Frontier Governorates1 31.1 27.3 21.2 17.5 62.7 63 Education No education 1.8 0.4 0.3 0.2 98.0 2,031 Some primary 3.0 1.5 1.5 1.2 96.8 773 Primary complete/ some secondary 23.6 19.0 16.9 15.4 74.6 2,345 Secondary complete/ higher 42.3 35.2 31.4 29.3 55.4 4,060 Wealth quintile Lowest 8.5 5.7 4.2 3.7 90.7 1,806 Second 11.3 8.1 6.8 5.8 87.6 1,810 Middle 19.3 14.3 12.6 11.2 79.0 1,833 Fourth 30.0 24.0 21.6 20.2 68.6 1,865 Highest 55.8 49.3 45.0 42.9 41.5 1,895 Total 15-59 25.3 20.6 18.3 17.0 73.2 9,209 1 Does not include North and South Sinai governorates Urban residence, higher education, and greater wealth are also strongly associated with access to digital media among both women and men. Urban women are three times and urban men are more than twice as likely to access all three media compared to rural residents. Looking at the variation with education, the proportion of women accessing all three media varies from less than one percent among those with no education to 29 percent among those with secondary complete or higher education. Among men who completed the secondary level or higher, 41 percent access all three digital media at least once per week compared with 1 percent of men who never went to school. Considering the variation by wealth quintile, 43 percent of women in the highest wealth quintile report using all three media at least once a week compared with only 4 percent among women in the lowest wealth quintile. Men in the highest wealth quintile have the highest level of access to digital media of any subgroup. More than 6 in 10 men in the highest wealth quintile access all three digital media at least once per week compared with 13 percent of men in the lowest wealth quintile. Background Characteristics of Respondents • 19 Table 2.5.2 Use of computers and digital media: Men Percentage of men age 15-59 who use a computer, the internet, and social media on a weekly basis, by background characteristics, Egypt 2015 Background characteristic Uses a computer at least once a week Uses internet at least once a week Uses social media at least once a week Uses all three digital media at least once a week Uses none of the three digital media at least once a week Number of respondents Age 15-19 52.9 52.1 49.9 45.6 42.9 1,288 20-24 51.7 53.2 52.0 47.6 44.0 859 25-29 40.8 40.8 39.7 35.4 54.9 962 30-34 31.6 29.9 27.3 25.1 65.6 923 35-39 34.5 30.8 28.8 26.9 63.6 856 40-44 25.9 23.2 20.2 18.9 72.3 736 45-49 25.7 21.4 19.1 18.0 73.2 670 50-54 24.6 19.9 16.4 16.0 75.0 702 55-59 18.0 14.0 10.5 10.4 81.8 467 Urban-rural residence Urban 53.9 51.1 48.6 45.9 43.3 2,847 Rural 25.8 24.3 22.2 19.7 71.6 4,615 Place of residence Urban Governorates 59.8 58.7 56.2 52.7 36.8 1,044 Lower Egypt 34.7 32.6 30.7 28.5 62.9 3,698 Urban 55.6 51.6 49.8 47.7 42.3 854 Rural 28.5 27.0 24.9 22.8 69.1 2,844 Upper Egypt 29.6 27.5 25.0 22.2 67.6 2,664 Urban 45.7 41.9 38.8 36.7 52.0 919 Rural 21.1 19.9 17.7 14.7 75.8 1,745 Frontier Governorates1 49.0 46.4 43.3 38.2 45.5 56 Education No education 3.5 1.1 1.0 1.0 96.5 621 Some primary 5.6 2.9 2.2 2.0 94.2 686 Primary complete/ some secondary 30.8 30.7 29.3 25.8 65.5 2,207 Secondary complete/ higher 50.2 47.5 44.1 41.3 46.8 3,948 Wealth quintile Lowest 18.0 16.3 15.2 12.9 79.7 1,462 Second 18.8 17.8 15.9 13.6 78.9 1,424 Middle 29.8 27.9 24.9 22.5 67.3 1,379 Fourth 40.2 37.7 35.1 32.1 56.7 1,571 Highest 70.8 68.2 65.5 62.9 26.6 1,626 Total 15-59 36.5 34.6 32.3 29.7 60.8 7,462 1 Does not include North and South Sinai governorates 2.4 EMPLOYMENT STATUS Information on employment status was collected in the 2015 EHIS for both women and men age 15-59. Several questions were asked of respondents to ensure complete coverage of employment in both the formal or informal sectors. For those who were currently employed, information was collected on their occupation. 2.4.1 Current Employment Table 2.6.1 and Table 2.6.2 show the percent distribution of the women and men age 15-59 according to current employment. 20 • Background Characteristics of Respondents Table 2.6.1 Employment status: Women Percent distribution of women age 15-59 by employment status, according to background characteristics, Egypt 2015 Background characteristic Currently employed1 Not currently employed Total Number of respondents Age 15-19 2.3 97.7 100.0 1,425 20-24 9.5 90.5 100.0 1,185 25-29 13.5 86.5 100.0 1,471 30-34 14.3 85.7 100.0 1,195 35-39 16.2 83.8 100.0 1,061 40-44 20.8 79.2 100.0 814 45-49 23.2 76.8 100.0 754 50-54 20.7 79.3 100.0 707 55-59 18.4 81.6 100.0 596 Marital status Married 14.3 85.7 100.0 6,552 Divorced/separated/ widowed 19.9 80.1 100.0 819 Never married 10.2 89.8 100.0 1,839 Urban-rural residence Urban 20.7 79.3 100.0 3,359 Rural 10.1 89.9 100.0 5,850 Place of residence Urban Governorates 18.7 81.3 100.0 1,223 Lower Egypt 14.3 85.7 100.0 4,506 Urban 22.7 77.3 100.0 1,056 Rural 11.8 88.2 100.0 3,450 Upper Egypt 11.7 88.3 100.0 3,417 Urban 21.0 79.0 100.0 1,048 Rural 7.6 92.4 100.0 2,369 Frontier Governorates2 19.3 80.7 100.0 63 Education No education 7.2 92.8 100.0 2,031 Some primary 9.3 90.7 100.0 773 Primary complete/ some secondary 4.3 95.7 100.0 2,345 Secondary complete/ higher 23.8 76.2 100.0 4,060 Wealth quintile Lowest 7.8 92.2 100.0 1,806 Second 9.3 90.7 100.0 1,810 Middle 11.5 88.5 100.0 1,833 Fourth 16.7 83.3 100.0 1,865 Highest 24.0 76.0 100.0 1,895 Total 15-59 14.0 86.0 100.0 9,209 1 “Currently employed” is defined as having done work in the past seven days or the respondent reporting s/he has a job. Includes persons who did not work in the past seven days but who are regularly employed and were absent form work for leave, illness, vacation, or any other reasons. 2 Does not include North and South Sinai governorates Overall, 14 percent of women age 15-59 are currently engaged in some economic activity. The proportion of women who are currently employed increased with age, peaking at 23 percent in the 45-49 age group. With regard to other differentials in Table 2.6.1, urban women are around twice as likely as rural women to be currently employed. The highest employment rates are found among women who had completed secondary education or higher and women in the highest wealth quintile (24 percent each). Background Characteristics of Respondents • 21 Table 2.6.2 Employment status: Men Percent distribution of men age 15-59 by employment status, according to background characteristics, Egypt 2015 Background characteristic Currently employed1 Not currently employed Total Number of respondents Age 15-19 36.7 63.3 100.0 1,288 20-24 71.2 28.8 100.0 859 25-29 94.6 5.4 100.0 962 30-34 98.9 1.1 100.0 923 35-39 98.5 1.5 100.0 856 40-44 98.3 1.7 100.0 736 45-49 95.7 4.3 100.0 670 50-54 94.7 5.3 100.0 702 55-59 84.0 16.0 100.0 467 Marital status Married 96.6 3.4 100.0 4,819 Divorced/separated/ widowed 90.8 9.2 100.0 106 Never married 56.0 44.0 100.0 2,536 Urban-rural residence Urban 79.9 20.1 100.0 2,847 Rural 84.4 15.6 100.0 4,615 Place of residence Urban Governorates 76.3 23.7 100.0 1,044 Lower Egypt 83.9 16.1 100.0 3,698 Urban 80.7 19.3 100.0 854 Rural 84.8 15.2 100.0 2,844 Upper Egypt 83.5 16.5 100.0 2,664 Urban 83.0 17.0 100.0 919 Rural 83.8 16.2 100.0 1,745 Frontier Governorates2 86.2 13.8 100.0 56 Education No education 91.6 8.4 100.0 621 Some primary 94.8 5.2 100.0 686 Primary complete/ some secondary 66.3 33.7 100.0 2,207 Secondary complete/ higher 88.4 11.6 100.0 3,948 Wealth quintile Lowest 83.7 16.3 100.0 1,462 Second 84.8 15.2 100.0 1,424 Middle 85.1 14.9 100.0 1,379 Fourth 83.8 16.2 100.0 1,571 Highest 76.9 23.1 100.0 1,626 Total 15-59 82.7 17.3 100.0 7,462 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent form work for leave, illness, vacation, or any other reasons. 2 Does not include North and South Sinai governorates Table 2.6.2 shows that, as expected, men are much more likely to be employed than women; 83 percent of men age 15-59 were employed at the time of the survey. The proportion currently employed increases with age from 37 percent among men age 15-19 and 71 percent among men age 20-24 to more than 90 percent among men age 25-54. The lower current employment rates among men under age 25 reflect in part the fact that many young men are still attending school. Higher school attendance rates among young men may also in part explain the somewhat lower current employment rates found among urban men, men from the Urban Governorates, men with primary complete/some secondary education, and men in the highest wealth quintile. 22 • Background Characteristics of Respondents 2.4.2 Occupation To obtain information on occupation, all respondents who were currently employed were asked about the type of work they mainly do. The answers respondents gave to this question were recorded exactly as they gave them and were the basis for the coding of occupations done in the office after the survey was completed. Figure 2.1 shows that the majority of women who worked are employed in non-agricultural occupations. More than 60 percent of working women are employed in professional, technical, and managerial positions or in clerical occupations. An additional 27 percent are employed in sales and services, and 7 percent work in jobs categorized as skilled manual labor. Only 4 percent of working women are involved in some type of agricultural activity. Figure 2.1 Occupation among employed women and men age 15-59, Egypt 2015 As expected, the occupational profile of men age 15-59 shown in Figure 2.1 differs from that among women. The majority of men who work are employed in skilled manual occupations (35 percent) followed by professional, technical, and managerial positions (26 percent). An additional 17 percent are employed in sales and services. Only 16 percent are involved in agricultural activities. Professional/ technical/ managerial 53% Clerical 8% Sales and services 27%Skilled manual 7% Unskilled manual 1% Agriculture 4% Women Professional/ technical/ managerial 26% Clerical 3% Sales and services17% Skilled manual 35% Unskilled manual 3% Agriculture 16% Men Background Characteristics of Respondents • 23 Tables 2.7.1 and 2.7.2 present the occupational profiles of women and men age 15-59 who are currently employed by background characteristics. As expected, the proportions in professional, technical and managerial occupations and in clerical positions are higher among urban women and men than rural women and men. The proportions in these occupations also rise rapidly with both education and wealth. Among both women and men, the highest proportions employed in agricultural occupations are observed among those with no education and those in the lowest wealth quintile. Table 2.7.1 Occupation: Women Percent distribution of women age 15-59 who are currently employed by occupation, according to background characteristics, Egypt 2015 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of respondents employed Age 15-19 (12.8) (1.2) (41.4) (33.5) (8.0) (3.2) (0.0) 100.0 33 20-24 39.9 2.8 40.5 13.4 0.0 3.5 0.0 100.0 112 25-29 70.0 5.7 17.4 5.2 0.0 1.8 0.0 100.0 199 30-34 53.8 8.1 30.8 6.1 0.0 1.1 0.0 100.0 171 35-39 57.2 9.4 18.1 8.3 0.3 6.6 0.0 100.0 172 40-44 56.6 1.4 28.9 5.5 2.6 5.1 0.0 100.0 169 45-49 52.8 7.5 24.6 6.4 1.8 6.9 0.0 100.0 175 50-54 48.5 10.2 33.6 1.5 1.8 4.5 0.0 100.0 146 55-59 45.8 19.4 26.5 3.2 1.2 3.9 0.0 100.0 110 Marital status Married 57.5 7.3 24.6 4.9 0.9 4.8 0.0 100.0 936 Divorced separated/ widowed 43.1 10.7 33.9 6.9 2.0 3.3 0.0 100.0 163 Never married 42.3 5.7 33.2 16.0 1.4 1.4 0.0 100.0 188 Urban-rural residence Urban 55.7 9.9 28.1 5.0 1.2 0.1 0.0 100.0 695 Rural 50.8 4.7 25.7 8.9 1.0 8.9 0.0 100.0 592 Place of residence Urban Governorates 57.2 4.5 29.3 5.3 3.7 0.0 0.0 100.0 228 Lower Egypt 51.7 6.4 26.3 8.3 0.7 6.5 0.0 100.0 646 Urban 56.7 8.9 27.7 6.7 0.0 0.0 0.0 100.0 239 Rural 48.8 4.8 25.4 9.3 1.2 10.4 0.0 100.0 406 Upper Egypt 53.8 11.1 26.9 5.1 0.3 2.8 0.0 100.0 401 Urban 52.9 16.8 27.4 2.7 0.0 0.3 0.0 100.0 221 Rural 54.9 4.1 26.4 8.2 0.7 5.8 0.0 100.0 180 Frontier Governorates1 61.4 8.2 25.7 4.7 0.0 0.0 0.0 100.0 12 Education No education 10.4 0.0 48.9 10.8 3.6 26.3 0.0 100.0 147 Some primary 13.8 0.0 50.3 19.8 5.6 10.6 0.0 100.0 72 Primary complete/ some secondary 16.5 0.8 44.3 30.5 2.6 5.3 0.0 100.0 101 Secondary complete/ higher 66.8 9.9 20.2 2.7 0.3 0.2 0.0 100.0 968 Wealth quintile Lowest 36.9 6.7 23.2 9.9 0.5 22.8 0.0 100.0 140 Second 44.3 2.9 31.5 11.6 1.4 8.3 0.0 100.0 168 Middle 55.3 4.0 29.7 6.4 1.5 3.1 0.0 100.0 211 Fourth 48.4 9.2 30.0 9.6 2.7 0.2 0.0 100.0 312 Highest 64.6 10.0 23.2 2.3 0.0 0.0 0.0 100.0 455 Total 15-59 53.4 7.5 27.0 6.8 1.1 4.1 0.0 100.0 1,287 1 Does not include North and South Sinai governorates 24 • Background Characteristics of Respondents Table 2.7.2 Occupation: Men Percent distribution of men age 15-59 who are currently employed by occupation, according to background characteristics, Egypt 2015 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of respondents employed Age 15-19 4.1 0.5 16.0 54.8 3.2 21.4 0.0 100.0 473 20-24 16.9 1.4 17.9 46.6 4.6 12.6 0.0 100.0 612 25-29 25.3 1.8 16.5 40.2 3.5 12.6 0.0 100.0 910 30-34 22.9 2.6 16.3 42.0 2.3 13.7 0.3 100.0 912 35-39 27.6 1.9 18.6 34.2 2.2 15.5 0.1 100.0 843 40-44 32.6 2.1 17.5 27.4 2.8 17.6 0.0 100.0 723 45-49 31.3 4.2 15.4 25.9 3.9 19.2 0.1 100.0 641 50-54 34.8 4.4 17.7 22.6 2.0 18.3 0.2 100.0 665 55-59 35.9 5.0 18.6 16.7 2.7 20.7 0.4 100.0 392 Marital status Married 28.8 2.7 16.8 31.7 2.7 17.2 0.1 100.0 4,654 Divorced/separated/ widowed 26.6 2.9 22.0 37.5 4.3 6.9 0.0 100.0 97 Never married 16.7 2.1 17.8 45.9 3.7 13.8 0.0 100.0 1,421 Urban-rural residence Urban 36.0 3.3 18.4 36.2 3.1 2.9 0.0 100.0 2,274 Rural 20.1 2.2 16.4 34.3 2.9 24.0 0.1 100.0 3,897 Place of residence Urban Governorates 34.0 2.6 21.6 36.0 4.6 1.1 0.1 100.0 796 Lower Egypt 26.1 1.7 18.4 34.9 2.2 16.5 0.1 100.0 3,101 Urban 40.4 0.8 17.0 36.2 1.2 4.4 0.0 100.0 690 Rural 22.0 2.0 18.8 34.5 2.5 20.0 0.2 100.0 2,411 Upper Egypt 22.9 3.7 13.7 35.0 3.4 21.2 0.1 100.0 2,225 Urban 34.3 6.1 16.5 36.7 3.2 3.3 0.0 100.0 762 Rural 17.0 2.4 12.3 34.1 3.6 30.5 0.1 100.0 1,463 Frontier Governorates1 29.0 2.2 18.3 28.3 1.0 21.2 0.0 100.0 48 Education No education 6.4 0.4 12.6 28.5 6.0 46.0 0.0 100.0 569 Some primary 6.9 0.4 17.2 44.9 3.3 27.3 0.0 100.0 650 Primary complete/ some secondary 8.5 0.8 18.1 51.1 3.7 17.7 0.1 100.0 1,462 Secondary complete/ higher 40.0 4.1 17.5 27.5 2.1 8.7 0.1 100.0 3,490 Wealth quintile Lowest 10.1 2.2 13.4 24.7 3.8 45.5 0.3 100.0 1,223 Second 15.5 2.0 17.3 39.1 3.6 22.5 0.0 100.0 1,208 Middle 26.3 2.9 17.9 39.5 2.5 10.9 0.1 100.0 1,174 Fourth 28.9 1.7 19.3 43.5 3.8 2.8 0.0 100.0 1,316 Highest 48.2 4.2 17.7 28.2 1.1 0.7 0.0 100.0 1,251 Total 15-59 26.0 2.6 17.1 35.0 3.0 16.2 0.1 100.0 6,171 1 Does not include North and South Sinai governorates Knowledge and Prevalence of Hepatitis B and C • 25 KNOWLEDGE AND PREVALENCE OF HEPATITIS B AND C 3 nfection with the hepatitis C virus (HCV) is a major public health problem in Egypt. The high level of HCV infection has been attributed in part to the use of inadequately sterilized needles during mass campaigns undertaken to treat schistosomiasis during the 1960s through the early 1980s (Rao et al. 2002; Nafeh et al. 2000). Hepatitis B also is a significant public health challenge in Egypt, and co-infection with HBV and HCV is highly related to liver disease. The 2015 EHIS collected information on the extent to which women and men age 15-59 knew about hepatitis C and B and, among those who had heard about both viruses, their understanding of the modes of transmission and prevention of these infections and the sources from which they had recently received information about hepatitis C and B. Respondents were also asked if they had ever diagnosed as having any form of hepatitis or liver disease and the treatments they had received if they had ever been with hepatitis B or C. In addition, respondents were asked to provide venous blood samples for laboratory testing to determine if they had been infected with hepatitis B and C. This chapter presents results from both the survey interviews and the testing. I Key Findings • Around 9 in 10 women and men age 15-59 were aware of hepatitis C. In contrast, only one-third of women and 42 percent of men had heard about hepatitis B. • One percent of the population age 1-59, or nearly 800,000 individuals, had an active hepatitis B infection. • Four percent of the population age 1-59 years, or around 3.5 million Egyptians, had an active hepatitis C infection. • HBV and HCV infection rates were higher among males than females. • Rates of HCV infection increased sharply with age. Around 1 in 6 women and around 1 in 4 men age 50-59 had an active HCV infection at the time of the survey. • The proportion of the population age 1-59 with an active HCV infection was slightly lower in urban areas than rural areas. • Menoufia had the highest proportion of the population age 1-59 years with an active hepatitis C infection (8 percent). Other governorates in which the active hepatitis infection rate was 5 percent or higher included Sharkia, Menya, Gharbia, Dakhalia, Behera, Damietta, Fayoum, and Beni Suef. • The rate of active hepatitis C infection declined from 6 percent in the lowest wealth quintile to 3 percent in the highest wealth quintile. • Many Egyptians were infected with hepatitis C as a result of the use of inadequately sterilized needles during mass campaigns to treat schistosomiasis during the 1960s through the early 1980s. The rate of active hepatitis C infection is 11 percent among individuals who reported ever receiving an injection to treat schistosomiasis, compared to 3 percent among the population never receiving an injection. 26 • Knowledge and Prevalence of Hepatitis B and C 3.1 KNOWLEDGE OF HEPATITIS C Respondents age 15-59 were asked about their awareness of hepatitis C and the sources from which they have recently received information about the hepatitis C virus. Tables 3.1.1 and 3.1.2 show the results of those questions. Table 3.1.1 Knowledge of hepatitis C by background characteristics: Women Among women age 15-59, percentage knowing about hepatitis C; among women knowing about hepatitis C, percentage receiving information about hepatitis C during the six months prior to the survey; and, among women receiving information about hepatitis C recently, percentage who saw or heard about hepatitis C from various sources, by background characteristics, Egypt 2015 Percent- age knowing about hepatitis C Number of women Percent- age receiving information recently about hepatitis C Number of women knowing about hepatitis C Percentage who saw/heard about hepatitis C from: Number of women receiving informa- tion about hepatitis C recently Background characteristic TV Other media1 Contact with any health worker Home visit from health worker Facility visit with health worker Spouse/ other relatives/ friends/ neigh- bors Com- munity meeting/ educa- tional seminar/ other Age 15-19 77.8 1,425 43.0 1,109 85.1 1.6 2.2 0.4 1.8 59.7 5.6 478 20-24 88.7 1,185 48.1 1,051 89.3 4.0 6.3 2.3 4.4 59.0 1.7 505 25-29 89.1 1,471 45.5 1,310 87.3 4.1 6.0 1.7 4.8 54.1 3.0 596 30-34 89.4 1,195 44.5 1,068 87.9 2.2 2.8 1.5 2.3 55.7 1.3 475 35-39 89.0 1,061 47.1 944 88.8 4.9 6.7 1.4 5.2 57.3 0.8 445 40-44 86.4 814 44.2 703 87.6 1.8 6.0 1.3 5.5 57.6 0.8 311 45-49 88.0 754 47.0 664 87.9 1.2 5.3 0.2 5.3 59.9 3.5 312 50-54 84.1 707 50.2 594 86.5 1.8 6.1 0.9 5.2 54.7 1.1 298 55-59 79.5 596 40.0 474 91.9 3.5 7.7 2.0 5.7 59.1 0.0 190 Marital status Ever married 87.0 7,370 45.5 6,411 87.9 2.3 5.3 1.4 4.3 56.5 1.6 2,916 Never married 81.9 1,839 46.0 1,506 87.5 5.5 4.9 1.1 4.1 60.2 4.9 693 Urban-rural residence Urban 91.4 3,359 50.5 3,069 90.6 4.0 6.5 1.8 5.3 54.4 2.0 1,550 Rural 82.9 5,850 42.5 4,847 85.7 2.2 4.3 1.0 3.5 59.4 2.4 2,059 Place of residence Urban Governorates 90.9 1,223 55.9 1,111 90.9 3.0 6.5 0.2 6.3 47.3 1.3 621 Lower Egypt 87.3 4,506 40.9 3,933 89.2 2.5 4.1 1.7 3.1 63.0 1.4 1,610 Urban 91.8 1,056 43.0 969 92.2 3.2 6.1 3.0 4.6 59.3 1.7 417 Rural 85.9 3,450 40.2 2,964 88.1 2.2 3.4 1.2 2.6 64.3 1.4 1,193 Upper Egypt 82.6 3,417 48.0 2,822 84.8 3.4 6.0 1.4 4.7 55.5 3.6 1,353 Urban 91.8 1,048 51.9 962 88.9 5.6 6.9 2.7 4.5 59.4 3.0 499 Rural 78.5 2,369 45.9 1,859 82.3 2.1 5.5 0.6 4.9 53.2 3.9 854 Frontier Governorates2 80.6 63 49.4 51 87.6 5.9 4.5 1.4 3.1 31.4 1.8 25 Education No education 70.8 2,031 41.8 1,438 78.4 0.3 3.5 0.9 2.6 57.5 1.5 601 Some primary 83.6 773 39.9 646 84.8 1.5 4.2 0.7 3.7 55.4 0.0 257 Primary complete/ some secondary 82.8 2,345 43.3 1,942 89.1 1.0 3.8 1.1 3.2 52.5 2.5 841 Secondary complete/ higher 95.8 4,060 49.1 3,891 90.6 4.8 6.6 1.7 5.3 59.5 2.6 1,910 Work status Working for cash 95.5 1,269 55.0 1,212 90.5 6.5 11.8 2.3 10.9 56.9 4.7 667 Not working for cash 84.4 7,940 43.9 6,704 87.2 2.1 3.8 1.1 2.8 57.3 1.7 2,942 Wealth quintile Lowest 76.6 1,806 46.9 1,383 83.1 2.8 3.0 0.3 2.7 53.9 2.0 648 Second 80.5 1,810 43.9 1,457 84.8 1.8 5.3 1.8 3.9 62.2 3.0 639 Middle 88.1 1,833 35.1 1,615 86.4 0.7 3.6 0.8 3.0 65.9 2.2 567 Fourth 89.4 1,865 46.5 1,668 91.5 2.2 6.4 2.0 5.0 53.7 1.9 776 Highest 94.7 1,895 54.6 1,794 90.7 5.7 6.7 1.4 5.7 54.1 2.1 979 Total 15-59 86.0 9,209 45.6 7,917 87.8 2.9 5.2 1.3 4.3 57.3 2.2 3,609 1 Includes radio/newspaper/magazine, pamphlet/brochure, or poster 2 Does not include North and South Sinai governorates Knowledge and Prevalence of Hepatitis B and C • 27 Table 3.1.2 Knowledge of hepatitis C by background characteristics: Men Among men age 15-59, percentage knowing about hepatitis C; among men knowing about hepatitis C, percentage receiving information about hepatitis C during the six months prior to the survey; and, among men receiving information about hepatitis C recently, percentage who saw or heard about hepatitis C from various sources, by background characteristics, Egypt 2015 Percent- age knowing about hepatitis C Number of men Percent- age receiving information recently about hepatitis C Number of men knowing about hepatitis C Percentage who saw/heard about hepatitis C from: Number of men receiving informa- tion about hepatitis C recently Background characteristic TV Other media1 Contact with any health worker Home visit from health worker Facility visit with health worker Spouse/ other relatives/ friends/ neigh- bors Commu- nity meeting/ educa- tional seminar/ other Age 15-19 75.3 1,288 36.5 970 83.6 5.1 1.1 0.1 1.1 50.3 4.5 354 20-24 89.8 859 43.9 772 84.3 12.4 7.5 1.9 6.5 64.2 2.6 339 25-29 93.4 962 46.9 898 90.5 7.1 6.8 1.9 5.4 63.0 2.0 421 30-34 93.9 923 42.7 867 89.1 3.3 7.4 1.7 5.8 63.9 1.0 370 35-39 95.1 856 43.9 814 88.6 6.8 7.2 1.3 6.4 59.3 1.3 357 40-44 96.4 736 44.1 709 90.5 10.2 8.4 3.4 5.2 59.7 0.6 313 45-49 93.1 670 43.5 624 89.7 8.8 8.5 3.3 5.8 68.8 3.1 271 50-54 95.3 702 54.3 669 89.8 9.2 7.6 1.0 7.0 65.7 1.0 363 55-59 92.5 467 51.5 432 91.0 8.9 14.3 4.1 12.4 66.3 2.3 222 Marital status Ever married 94.1 4,926 46.1 4,636 89.8 6.9 8.5 2.3 6.7 64.1 1.5 2,139 Never married 83.5 2,536 41.1 2,119 85.4 10.0 4.3 1.1 3.9 57.0 3.3 871 Urban-rural residence Urban 92.7 2,847 50.0 2,639 91.2 9.9 6.9 1.8 5.9 58.7 2.0 1,319 Rural 89.2 4,615 41.1 4,115 86.3 6.2 7.6 2.0 6.0 64.6 2.0 1,691 Place of residence Urban Governorates 92.5 1,044 57.1 966 89.9 8.1 3.8 0.4 3.8 53.5 1.9 552 Lower Egypt 91.5 3,698 40.0 3,385 89.8 7.3 7.6 2.1 6.0 64.8 1.2 1,354 Urban 94.2 854 41.5 805 94.0 9.9 10.2 2.7 8.5 61.1 1.1 334 Rural 90.7 2,844 39.5 2,579 88.5 6.4 6.7 2.0 5.2 66.0 1.2 1,020 Upper Egypt 88.4 2,664 45.8 2,356 86.0 8.3 8.8 2.5 6.9 63.4 3.1 1,079 Urban 91.6 919 49.6 842 90.8 12.2 8.3 2.9 6.5 64.0 2.8 418 Rural 86.8 1,745 43.7 1,515 83.0 5.8 9.1 2.2 7.2 63.1 3.3 661 Frontier Governorates2 86.3 56 53.8 48 91.8 9.0 6.7 0.7 6.0 44.3 1.7 26 Education No education 81.7 621 46.3 507 86.3 1.9 6.5 2.8 5.0 62.6 0.0 235 Some primary 86.4 686 40.7 592 83.3 3.1 6.3 2.3 4.0 72.3 0.9 241 Primary complete/ some secondary 82.8 2,207 38.8 1,827 85.2 4.9 4.7 1.0 3.9 58.5 2.3 710 Secondary complete/ higher 97.0 3,948 47.7 3,828 90.7 10.3 8.5 2.1 7.1 62.0 2.3 1,825 Work status Working for cash 91.8 6,137 44.9 5,632 89.5 7.0 8.0 2.1 6.5 62.6 1.6 2,529 Not working for cash 84.7 1,325 42.8 1,123 83.4 12.1 3.6 1.1 3.1 59.4 4.4 481 Wealth quintile Lowest 83.2 1,462 44.6 1,216 82.9 5.5 5.6 1.5 5.1 64.8 2.8 543 Second 87.5 1,424 41.2 1,247 84.0 5.0 9.0 2.8 6.2 64.0 2.0 514 Middle 93.5 1,379 34.8 1,289 90.7 6.3 7.7 2.6 5.5 67.6 2.2 448 Fourth 91.7 1,571 44.6 1,441 90.0 7.2 7.5 1.4 6.8 60.4 1.3 643 Highest 96.0 1,626 55.2 1,562 92.4 12.2 7.0 1.7 5.8 57.5 1.9 862 Total 15-59 90.5 7,462 44.6 6,755 88.5 7.8 7.3 1.9 5.9 62.1 2.0 3,010 1 Includes radio/newspaper/magazine, pamphlet/brochure, or poster 2 Does not include North and South Sinai governorates Eighty-six percent of women and 91 percent of men were aware of hepatitis C. Among respondents who had heard about hepatitis C, more than two-fifths had received information about the illness within the six-month period before the survey. Television was the most commonly reported channel through which both women and men received information about hepatitis C (88 percent and 89 percent, respectively), followed by spouse, relatives, and friends (57 percent and 62 percent, respectively). Relatively few women and men mentioned hearing about hepatitis C from a health provider in the six months prior to the survey (5 percent and 7 percent, respectively). 28 • Knowledge and Prevalence of Hepatitis B and C Better-educated respondents and those in the highest wealth quintile were most likely to be aware about hepatitis C. For example, 96 percent of women who had a secondary education or higher were aware of hepatitis C, compared with 71 percent among those who had never attended school. Public awareness of the avenues through which the hepatitis C virus is contracted is important in reducing transmission of the disease. Tables 3.2.1 and 3.2.2 present information from the 2015 EHIS on the modes of transmission of the hepatitis C virus recognized by women and men who had heard about hepatitis C. Respondents were asked to name all of the ways they knew may lead to the spread of hepatitis C from one person to another, so the percentages naming the various modes of transmission add to more than 100. Table 3.2.1 Knowledge of the ways a person can contract hepatitis C by background characteristics: Women Among women age 15-59 knowing about hepatitis C, percentage who can name at least one way in which an individual can contract hepatitis C, and, among women knowing about a way hepatitis C can be contracted, percentage mentioning various ways hepatitis C virus can be transmitted, by background characteristics, Egypt 2015 Percentage knowing about hepatitis C who can name at least one way the illness can be contracted Number of women knowing about hepatitis C Percentage mentioning hepatitis C can be transmitted by: Number of women knowing about a way hepatitis C can be contracted Background characteristic Hetero- sexual relations Homo- sexual relations Blood trans- fusions Unclean needle Other contact with blood of infected person Mother- to-child trans- mission Casual physical contact with infected person Mosquito/ other insect bites/ other Age 15-19 44.2 1,109 2.8 0.2 67.8 40.9 49.1 2.5 23.1 7.1 490 20-24 60.4 1,051 3.3 0.0 77.0 43.6 52.0 0.8 22.0 5.2 635 25-29 57.5 1,310 3.7 0.0 78.0 42.9 55.8 0.5 21.8 5.0 753 30-34 65.0 1,068 4.7 0.0 78.5 49.5 55.6 0.5 19.9 2.7 694 35-39 61.5 944 5.7 0.0 85.6 47.9 57.5 0.9 15.8 4.7 581 40-44 63.4 703 3.6 0.4 81.9 52.9 54.2 0.4 19.9 2.4 446 45-49 61.5 664 4.6 0.0 83.6 52.4 56.9 0.0 14.0 3.0 408 50-54 55.3 594 5.1 0.1 80.8 42.3 57.7 0.1 22.1 4.4 329 55-59 56.3 474 4.4 0.4 77.0 47.5 60.9 0.7 22.5 2.2 267 Marital status Ever married 58.7 6,411 4.4 0.1 79.6 46.4 55.4 0.7 20.0 3.8 3,764 Never married 55.7 1,506 2.9 0.1 75.1 46.5 53.8 1.1 20.7 5.9 839 Urban-rural residence Urban 70.9 3,069 4.1 0.1 84.3 48.4 58.2 0.6 17.6 3.3 2,176 Rural 50.1 4,847 4.2 0.1 73.9 44.7 52.3 0.9 22.4 5.0 2,427 Place of residence Urban Governorates 71.8 1,111 3.4 0.0 83.1 43.2 54.0 0.6 12.3 2.5 797 Lower Egypt 57.0 3,933 4.1 0.1 80.2 49.9 56.5 1.2 20.0 3.5 2,240 Urban 73.5 969 5.0 0.1 86.5 53.6 61.6 1.1 19.3 3.2 712 Rural 51.5 2,964 3.7 0.1 77.2 48.2 54.1 1.3 20.3 3.6 1,528 Upper Egypt 54.5 2,822 4.5 0.1 74.8 43.3 53.8 0.2 24.4 6.1 1,537 Urban 67.5 962 4.1 0.0 83.6 49.5 59.8 0.1 22.1 4.6 650 Rural 47.7 1,859 4.8 0.1 68.4 38.8 49.4 0.3 26.1 7.2 887 Frontier Governorates1 55.6 51 7.0 0.0 67.7 33.2 48.6 0.0 21.8 9.3 28 Education No education 33.9 1,438 3.3 0.1 67.2 45.0 45.7 0.0 24.7 4.4 487 Some primary 41.3 646 6.0 0.2 69.0 37.6 49.0 0.0 27.0 3.9 267 Primary complete/ some secondary 47.6 1,942 4.6 0.1 76.0 42.5 46.4 1.6 19.0 6.2 925 Secondary complete/ higher 75.1 3,891 4.0 0.1 82.5 48.8 60.0 0.7 19.1 3.6 2,924 Work status Working for cash 78.9 1,212 5.1 0.2 86.6 50.7 63.3 0.3 19.1 4.5 956 Not working for cash 54.4 6,704 3.9 0.1 76.8 45.3 53.0 0.9 20.4 4.2 3,647 Wealth quintile Lowest 43.2 1,383 4.7 0.2 65.5 42.8 46.4 1.0 27.4 7.2 598 Second 49.4 1,457 4.3 0.2 74.9 46.0 51.8 0.9 22.6 5.2 720 Middle 50.7 1,615 4.3 0.0 77.6 48.5 54.4 0.6 19.6 3.8 819 Fourth 64.3 1,668 4.7 0.1 80.6 43.8 56.1 0.6 21.0 3.7 1,072 Highest 77.7 1,794 3.4 0.0 85.9 49.1 60.3 0.7 15.4 3.1 1,394 Total 15-59 58.1 7,917 4.1 0.1 78.8 46.5 55.1 0.7 20.1 4.2 4,603 1 Does not include North and South Sinai governorates Knowledge and Prevalence of Hepatitis B and C • 29 Table 3.2.2 Knowledge of the ways a person can contract hepatitis C by background characteristics: Men Among men age 15-59 knowing about hepatitis C, percentage who can name at least one way in which an individual can contract hepatitis C, and, among men knowing about a way hepatitis C can be contracted, percentage mentioning various ways hepatitis C can be transmitted, by background characteristics, Egypt 2015 Percentage knowing about hepatitis C who can name at least one way the illness can be contracted Number of men knowing about hepatitis C Percentage mentioning hepatitis C can be transmitted by: Number of men knowing about a way hepatitis C can be contracted Background characteristic Hetero- sexual relations Homo- sexual relations Blood trans- fusions Unclean needle Other contact with blood of infected person Mother- to-child trans- mission Casual physical contact with infected person Mosquito/ other insect bites/ other Age 15-19 47.7 970 1.2 0.1 69.5 40.6 63.3 0.4 19.9 5.6 463 20-24 62.2 772 1.8 0.6 79.2 50.9 67.5 0.5 19.8 4.3 480 25-29 65.2 898 2.2 0.7 76.7 55.2 66.5 0.1 13.9 3.4 585 30-34 64.7 867 2.5 0.0 83.7 47.2 60.6 1.3 15.0 3.6 561 35-39 69.1 814 3.7 0.4 84.6 52.2 64.5 1.2 11.9 1.6 563 40-44 73.7 709 3.4 0.1 89.3 53.6 65.7 1.0 12.4 3.1 523 45-49 75.2 624 5.1 1.2 83.3 58.5 70.4 0.3 12.6 2.5 469 50-54 75.7 669 5.2 0.4 81.1 57.6 67.8 2.4 14.0 1.9 507 55-59 75.3 432 3.6 0.5 84.8 58.2 69.8 0.1 12.5 4.3 325 Marital status Ever married 69.9 4,636 3.7 0.5 83.4 53.5 66.2 1.1 13.4 2.8 3,238 Never married 58.4 2,119 1.8 0.1 76.0 50.0 65.5 0.2 17.8 4.5 1,237 Urban-rural residence Urban 70.6 2,639 3.2 0.3 85.3 53.0 65.7 0.6 13.1 3.2 1,862 Rural 63.5 4,115 3.1 0.5 78.5 52.2 66.2 1.0 15.7 3.4 2,613 Place of residence Urban Governorates 71.2 966 3.2 0.0 84.7 51.1 61.6 0.4 11.2 3.8 687 Lower Egypt 66.2 3,385 3.2 0.3 80.5 53.6 66.2 1.0 14.4 2.7 2,240 Urban 73.8 805 3.7 0.2 85.9 55.2 66.9 0.5 12.7 2.6 594 Rural 63.8 2,579 3.0 0.4 78.6 53.0 65.9 1.2 15.1 2.8 1,646 Upper Egypt 64.5 2,356 3.1 0.8 81.1 51.8 67.7 0.7 16.4 3.9 1,519 Urban 67.0 842 2.8 0.7 85.7 53.1 69.4 0.8 15.9 3.0 564 Rural 63.1 1,515 3.3 0.9 78.3 51.0 66.8 0.7 16.7 4.4 955 Frontier Governorates1 60.5 48 5.1 0.0 80.8 43.8 63.2 0.0 16.9 5.3 29 Education No education 49.1 507 0.4 0.4 72.2 50.6 69.0 0.6 16.0 4.2 249 Some primary 49.0 592 3.2 0.4 72.2 50.6 62.5 1.2 15.6 3.5 290 Primary complete/ some secondary 52.2 1,827 1.9 0.4 75.4 43.4 60.6 0.6 17.4 4.6 953 Secondary complete/ higher 77.9 3,828 3.8 0.4 84.9 55.7 67.8 0.9 13.5 2.8 2,983 Work status Working for cash 67.2 5,632 3.5 0.5 81.8 53.2 66.0 0.9 14.1 3.0 3,785 Not working for cash 61.5 1,123 1.4 0.1 78.9 48.8 65.7 0.7 17.7 4.8 690 Wealth quintile Lowest 61.4 1,216 3.2 0.4 73.3 48.7 62.7 0.3 18.6 4.9 747 Second 60.3 1,247 3.0 0.6 77.9 54.9 66.5 1.3 16.1 3.8 752 Middle 64.3 1,289 2.8 0.3 82.1 51.7 67.9 1.8 12.5 2.6 829 Fourth 65.5 1,441 3.3 0.5 82.2 50.7 63.9 0.5 14.4 2.7 944 Highest 77.0 1,562 3.4 0.4 87.3 55.3 68.1 0.5 12.9 2.9 1,203 Total 15-59 66.3 6,755 3.2 0.4 81.3 52.5 66.0 0.8 14.6 3.3 4,475 1 Does not include North and South Sinai governorates Around 6 in 10 women who had heard about hepatitis C were able to name at least one way through which the illness is transmitted (Table 3.2.1). Of the women able to name an avenue of transmission for hepatitis C, the majority (79 percent) reported it could be contracted through blood transfusions, 55 percent said through other contact with the blood of an infected person, and 47 percent mentioned unclean needles. Men were somewhat more knowledgeable than women about 30 • Knowledge and Prevalence of Hepatitis B and C modes in which the hepatitis C virus can be transmitted. Around two-thirds of men who knew about hepatitis C were able to name at least one way in which the virus can be transmitted (Table 3.2.2). Similar to the pattern for women, the three modes of transmission most often mentioned by men were blood transfusions (81 percent), other contact with the blood of an infected person (66 percent), and use of unclean needles (53 percent). The risks of transmission of hepatitis C during sexual relations or from a mother to her child at birth or when breastfeeding are low, and few EHIS respondents mentioned those as possible ways to contract hepatitis C. Around 1 in 5 women and 1 in 7 men thought incorrectly that casual physical contact with an infected person was a way in which hepatitis C is transmitted. The results in Tables 3.2.1 and 3.2.2 indicate that knowledge about the routes of transmission of hepatitis C was more common among urban residents than rural residents, particularly among women. The percentages of women and men knowing about at least one way through which hepatitis C can be contracted rose with increasing education and wealth and were higher among those working for cash than those not working for cash. 3.2 KNOWLEDGE OF HEPATITIS B To obtain information about level of awareness of hepatitis B, EHIS respondents age 15-59 were asked a sequence of questions similar to the questions used to obtain information on knowledge of hepatitis C. Respondents were first asked if they had heard about hepatitis B. Those respondents who knew about the illness were asked about the sources from which they have recently received information about the hepatitis B virus. Tables 3.3.1 and 3.3.2 present the results for those questions. Overall, the level of awareness about hepatitis B is lower than hepatitis C. Slightly more than one-third of women and 42 percent of men were aware of hepatitis B. Among women who had heard about hepatitis B, half of them had received information about the illness within the six-month period before the survey. This proportion was only slightly lower among men (48 percent). Television was the main channel through which both women and men received information about hepatitis B (91 percent and 90 percent, respectively), followed by personal contacts (spouse, other relatives, friends, or neighbors), at 52 percent and 61 percent, respectively. Only 6 percent of women and 7 percent of men heard about hepatitis B from a health worker in the six months prior to the survey. The level of awareness of hepatitis B varies by background characteristics. For example, among both men and women, the level of awareness of the hepatitis B virus rises with increasing education as well as increasing wealth. In addition, awareness of hepatitis B is more common among urban residents than rural residents. Knowledge and Prevalence of Hepatitis B and C • 31 Table 3.3.1 Knowledge of hepatitis B by background characteristics: Women Among women age 15-59, percentage knowing about hepatitis B; among women knowing about hepatitis B, percentage receiving information about hepatitis B during the six months prior to the survey; and, among women receiving information about hepatitis B recently, percentage who saw or heard about hepatitis B from various sources, by background characteristics, Egypt 2015 Percentage knowing about hepatitis B Number of women Percentage receiving information recently about hepatitis B Number of women knowing about hepatitis B Percentage who saw/heard about hepatitis B from: Number of women receiving information about hepatitis B recently Background characteristic TV Other media1 Contact with any health worker Home visit from health worker Facility visit with health worker Spouse/ other relatives/ friends/ neigh- bors Commu- nity meeting/ educa- tional seminar/ other Age 15-19 22.2 1,425 42.0 316 85.2 2.7 2.9 0.0 2.9 58.1 10.6 133 20-24 37.3 1,185 51.5 442 91.0 6.0 7.2 1.3 6.3 52.7 1.5 228 25-29 36.1 1,471 50.3 530 90.3 4.6 7.5 3.1 5.1 49.1 0.8 267 30-34 35.8 1,195 47.4 428 86.9 3.5 2.5 0.0 2.5 48.0 1.6 203 35-39 37.5 1,061 53.4 398 93.7 3.9 4.2 1.0 3.2 55.0 3.7 213 40-44 37.8 814 48.5 307 95.7 2.2 8.1 3.8 6.7 46.3 0.2 149 45-49 39.9 754 54.0 301 91.3 3.3 7.2 3.0 5.4 51.8 5.7 162 50-54 33.2 707 50.3 234 92.9 3.1 6.1 0.7 5.3 46.2 2.9 118 55-59 34.1 596 50.7 203 90.8 4.2 5.8 0.0 5.8 65.8 0.0 103 Marital status Ever married 35.7 7,370 50.4 2,631 91.0 3.0 5.4 1.7 4.2 50.8 2.2 1,326 Never married 28.8 1,839 46.8 530 89.9 8.5 8.0 0.9 7.5 57.8 5.8 248 Urban-rural residence Urban 43.3 3,359 51.0 1,454 92.9 4.9 6.3 1.4 5.4 46.1 2.5 742 Rural 29.2 5,850 48.8 1,707 88.9 3.0 5.4 1.8 4.2 57.1 3.0 832 Place of residence Urban Governorates 44.1 1,223 52.0 539 91.0 4.6 7.4 1.6 6.2 31.8 3.1 281 Lower Egypt 34.4 4,506 46.5 1,550 94.4 3.8 4.4 1.5 3.8 60.7 1.5 720 Urban 43.6 1,056 44.0 461 98.1 4.7 4.6 1.8 3.9 59.6 1.6 203 Rural 31.6 3,450 47.5 1,090 93.0 3.4 4.3 1.4 3.8 61.1 1.5 517 Upper Egypt 30.8 3,417 53.9 1,053 86.2 3.7 6.7 1.6 5.2 51.0 4.2 567 Urban 42.2 1,048 57.6 442 90.9 5.4 6.2 0.7 5.5 51.4 2.5 255 Rural 25.8 2,369 51.2 611 82.4 2.4 7.1 2.4 4.9 50.7 5.5 313 Frontier Governorates2 29.4 63 35.0 18 87.4 2.3 10.6 0.0 10.6 31.3 4.9 6 Education No education 20.4 2,031 48.4 414 85.9 0.0 1.6 0.8 0.8 51.4 5.0 200 Some primary 24.8 773 48.8 192 84.7 1.3 1.8 0.8 1.0 56.8 0.0 94 Primary complete/ some secondary 26.7 2,345 45.2 627 92.4 0.7 4.2 1.8 3.2 52.7 4.0 283 Secondary complete/ higher 47.5 4,060 51.7 1,929 91.9 5.8 7.4 1.7 6.4 51.3 2.2 998 Work status Working for cash 55.3 1,269 57.1 702 91.8 8.3 15.2 3.7 13.7 47.4 3.5 401 Not working for cash 31.0 7,940 47.7 2,459 90.5 2.4 2.6 0.9 1.7 53.5 2.5 1,174 Wealth quintile Lowest 25.3 1,806 47.9 457 88.5 2.0 1.8 0.6 1.2 52.2 1.7 219 Second 31.2 1,810 51.6 564 84.9 2.1 6.8 2.6 5.0 60.2 4.4 291 Middle 26.7 1,833 45.0 490 90.4 3.6 4.8 0.0 4.8 61.9 2.8 221 Fourth 39.5 1,865 48.5 736 96.2 2.4 7.0 2.0 5.8 49.8 1.5 357 Highest 48.2 1,895 53.3 913 91.7 7.1 6.5 1.8 5.4 43.9 3.2 486 Total 15-59 34.3 9,209 49.8 3,161 90.8 3.9 5.8 1.6 4.8 51.9 2.8 1,575 1 Includes radio/newspaper/magazine, pamphlet/brochure, or poster 2 Does not include North and South Sinai governorates 32 • Knowledge and Prevalence of Hepatitis B and C Table 3.3.2 Knowledge of hepatitis B by background characteristics: Men Among men age 15-59, percentage knowing about hepatitis B; among men knowing about hepatitis B, percentage receiving information about hepatitis B during the six months prior to the survey; and, among men receiving information about hepatitis B recently, percentage who saw or heard about hepatitis B from various sources, by background characteristics, Egypt 2015 Percentage knowing about hepatitis B Number of men Percentage receiving information recently about hepatitis B Number of men knowing about hepatitis B Percentage who saw/heard about hepatitis B from: Number of men receiving information about hepatitis B recently Background characteristic TV Other media1 Contact with any health worker Home visit from health worker Facility visit with health worker Spouse/ other relatives/ friends/ neigh- bors Commu- nity meeting/ educa- tional seminar/ other Age 15-19 20.8 1,288 33.7 268 79.4 5.1 2.2 0.0 2.2 58.5 7.2 90 20-24 37.5 859 49.8 322 85.6 10.5 11.6 0.3 11.6 59.5 1.7 160 25-29 44.6 962 51.0 429 89.7 8.7 5.5 2.9 3.0 55.9 4.6 219 30-34 41.0 923 48.8 378 86.1 5.7 7.1 2.6 4.5 67.5 0.8 184 35-39 46.4 856 42.1 397 91.4 9.5 8.2 2.2 7.1 62.2 0.7 167 40-44 50.5 736 48.7 371 91.8 6.1 8.3 1.7 6.6 56.2 0.4 181 45-49 48.7 670 50.9 326 94.7 8.2 4.5 1.2 3.3 63.2 0.4 166 50-54 54.2 702 50.9 381 96.0 7.5 6.5 0.7 6.5 62.9 0.2 194 55-59 50.1 467 55.6 234 87.1 11.3 9.2 2.9 8.9 66.4 2.0 130 Marital status Ever married 46.9 4,926 49.5 2,311 90.6 7.5 7.6 1.9 6.0 62.0 1.4 1,143 Never married 31.4 2,536 43.8 796 87.2 10.1 5.9 1.0 5.9 59.0 3.0 349 Urban-rural residence Urban 46.3 2,847 51.7 1,317 92.2 10.3 7.0 1.4 6.2 54.7 1.1 681 Rural 38.8 4,615 45.3 1,789 87.7 6.2 7.3 2.0 5.8 66.8 2.4 811 Place of residence Urban Governorates 45.1 1,044 56.2 470 91.6 6.6 6.4 0.8 6.4 37.5 0.3 264 Lower Egypt 41.9 3,698 41.2 1,551 92.4 9.4 6.1 2.1 4.7 69.0 1.9 639 Urban 51.0 854 37.8 435 94.2 16.8 8.5 1.8 7.4 70.4 0.0 165 Rural 39.2 2,844 42.5 1,115 91.8 6.9 5.2 2.2 3.7 68.5 2.5 474 Upper Egypt 40.1 2,664 54.4 1,067 86.0 7.3 8.7 1.7 7.2 64.0 2.4 581 Urban 43.5 919 61.5 400 91.8 10.0 6.6 1.7 5.2 63.0 2.7 246 Rural 38.2 1,745 50.2 668 81.8 5.3 10.3 1.6 8.7 64.7 2.1 335 Frontier Governorates2 31.9 56 46.9 18 91.3 9.7 7.9 2.2 5.7 32.5 0.4 8 Education No education 29.1 621 62.3 181 89.1 0.0 3.9 1.2 3.9 65.7 0.0 113 Some primary 32.4 686 44.5 222 89.6 2.4 2.7 0.0 2.7 60.3 0.0 99 Primary complete/ some secondary 29.7 2,207 42.1 655 88.7 5.1 4.3 0.7 3.8 61.4 2.8 276 Secondary complete/ higher 51.9 3,948 49.1 2,048 90.2 10.4 8.8 2.2 7.2 60.8 1.9 1,005 Work status Working for cash 43.9 6,137 48.1 2,697 90.0 7.4 7.5 1.9 6.2 62.3 1.5 1,296 Not working for cash 30.9 1,325 47.9 410 88.3 12.8 4.7 0.2 4.7 54.5 3.6 196 Wealth quintile Lowest 35.0 1,462 48.6 512 84.4 3.7 5.0 0.0 5.0 62.0 5.0 249 Second 39.5 1,424 45.5 563 85.4 3.9 9.2 2.5 7.5 69.2 1.1 256 Middle 37.6 1,379 40.5 519 90.3 7.6 5.7 3.2 2.5 66.8 2.1 210 Fourth 41.4 1,571 46.1 650 93.1 9.1 7.6 1.4 6.7 61.7 0.6 300 Highest 53.0 1,626 55.4 862 92.6 12.2 7.6 1.7 6.8 53.9 1.0 477 Total 15-59 41.6 7,462 48.0 3,106 89.8 8.1 7.2 1.7 6.0 61.3 1.8 1,492 1 Includes radio/newspaper/magazine, pamphlet/brochure, or poster 2 Does not include North and South Sinai governorates During the 2015 EHIS, information also was obtained from respondents who had heard about hepatitis B regarding the modes through which the virus may be transmitted. Tables 3.4.1 and 3.4.2 present these results. Respondents were asked to name all of the ways they knew may lead to the spread of hepatitis B from one person to another, so the percentages naming the various modes of transmission add to more than 100 in the tables. Knowledge and Prevalence of Hepatitis B and C • 33 Table 3.4.1 Knowledge of the ways a person can contract hepatitis B by background characteristics: Women Among women age 15-59 knowing about hepatitis B, percentage who can name at least one way in which an individual can contract hepatitis B, and, among women knowing about a way hepatitis B can be contracted, percentage mentioning various ways hepatitis B can be transmitted, by background characteristics, Egypt 2015 Percentage of women knowing about hepatitis B who can name at least one way the illness can be contracted Number of women knowing about hepatitis B Percentage mentioning hepatitis B can be transmitted by: Number of women knowing about a way hepatitis B can be contracted Background characteristic Hetero- sexual relations Homo- sexual relations Blood trans- fusions Unclean needle Other contact with blood of infected person Mother- to-child trans- mission Casual physical contact with infected person Mosquito/ other insect bites/ other Age 15-19 37.1 316 5.6 1.0 69.3 41.9 49.2 2.5 29.9 2.2 117 20-24 49.1 442 8.5 0.0 79.4 42.0 57.9 0.4 25.1 3.5 217 25-29 48.6 530 8.9 0.1 77.3 42.9 55.0 0.5 18.1 4.7 258 30-34 54.0 428 5.9 0.2 80.2 45.4 54.2 1.9 22.3 4.9 231 35-39 57.7 398 9.9 0.0 79.5 42.9 56.2 1.1 23.4 2.2 230 40-44 63.9 307 5.7 0.4 78.5 50.4 59.2 0.0 21.6 1.5 196 45-49 54.6 301 6.5 0.0 84.4 41.2 56.8 0.4 23.7 0.7 164 50-54 53.4 234 6.7 0.6 79.3 45.5 58.9 2.1 28.8 4.8 125 55-59 62.1 203 4.0 0.0 79.6 56.6 59.6 1.3 21.4 1.1 126 Marital status Ever married 53.6 2,631 6.7 0.2 79.3 44.1 55.6 1.1 22.7 3.0 1,409 Never married 48.2 530 9.9 0.5 76.8 50.0 60.2 0.7 25.7 3.1 256 Urban-rural residence Urban 63.1 1,454 7.3 0.2 82.2 47.9 57.3 0.8 20.8 2.4 917 Rural 43.8 1,707 7.1 0.3 74.9 41.5 55.1 1.3 26.2 3.8 748 Place of residence Urban Governorates 68.1 539 6.5 0.0 84.9 42.4 58.2 0.9 14.6 0.7 368 Lower Egypt 45.8 1,550 8.0 0.2 77.8 51.7 57.7 1.2 25.0 2.7 710 Urban 57.0 461 9.0 0.2 79.3 60.9 59.9 0.5 22.6 4.3 263 Rural 41.0 1,090 7.4 0.3 77.0 46.3 56.4 1.6 26.4 1.7 447 Upper Egypt 55.0 1,053 6.7 0.3 76.7 38.5 53.5 0.8 26.3 4.8 579 Urban 63.6 442 6.8 0.3 81.7 43.1 53.9 0.9 26.9 2.7 281 Rural 48.7 611 6.6 0.4 71.9 34.2 53.0 0.8 25.9 6.7 297 Frontier Governorates1 49.2 18 4.8 0.0 63.1 42.4 58.0 0.0 25.4 12.1 9 Education No education 32.1 414 3.0 0.0 73.1 38.3 48.6 0.5 21.7 1.4 133 Some primary 41.2 192 5.9 0.4 68.9 31.4 48.3 0.0 32.6 3.9 79 Primary complete/ some secondary 40.4 627 6.7 0.7 74.5 37.9 50.7 0.5 27.2 3.3 253 Secondary complete/ higher 62.2 1,929 7.9 0.1 81.1 48.1 58.9 1.2 21.9 3.1 1,200 Work status Working for cash 70.1 702 9.1 0.2 81.4 50.4 58.7 0.4 24.6 3.6 492 Not working for cash 47.7 2,459 6.4 0.3 77.8 42.8 55.3 1.3 22.6 2.8 1,173 Wealth quintile Lowest 40.2 457 5.0 0.5 67.1 40.9 48.5 1.0 29.8 6.4 183 Second 42.6 564 4.9 0.1 77.7 38.5 50.1 1.7 21.6 3.7 241 Middle 46.6 490 7.3 0.2 76.9 48.8 58.3 1.7 29.7 2.9 229 Fourth 54.9 736 8.9 0.3 80.7 45.6 54.2 0.4 21.7 2.7 404 Highest 66.6 913 7.6 0.1 82.5 47.0 61.9 0.9 20.3 2.0 608 Total 15-59 52.7 3,161 7.2 0.2 78.9 45.0 56.3 1.0 23.2 3.0 1,665 1 Does not include North and South Sinai governorates 34 • Knowledge and Prevalence of Hepatitis B and C Table 3.4.2 Knowledge of the ways a person can contract hepatitis B by background characteristics: Men Among men age 15-59 knowing about hepatitis B, percentage who can name at least one way in which an individual can contract hepatitis B, and, among men knowing about a way hepatitis B can be contracted, percentage mentioning various ways hepatitis B can be transmitted, by background characteristics, Egypt 2015 Percentage of men knowing about hepatitis B who can name at least one way the illness can be contracted Number of men knowing about hepatitis B Percentage mentioning hepatitis B can be transmitted by: Number of men knowing about a way hepatitis B can be contracted Background characteristic Hetero- sexual relations Homo- sexual relations Blood trans- fusions Unclean needle Other contact with blood of infected person Mother- to-child trans- mission Casual physical contact with infected person Mosquito/ other insect bites/ other Age 15-19 36.4 268 3.3 0.0 80.3 33.0 61.1 0.0 24.0 3.6 98 20-24 54.3 322 3.7 0.0 76.4 55.7 66.7 0.9 29.1 2.4 175 25-29 52.8 429 2.6 1.4 76.5 50.1 69.5 0.1 22.8 1.7 226 30-34 53.6 378 2.8 0.1 85.5 46.8 62.8 0.1 18.6 1.8 203 35-39 61.0 397 6.1 0.2 84.7 45.9 66.5 1.2 15.5 0.7 242 40-44 69.8 371 5.0 0.1 84.7 56.1 69.4 0.1 20.6 3.5 259 45-49 66.7 326 5.4 1.7 84.1 53.1 65.5 0.3 18.0 2.2 217 50-54 66.4 381 6.8 0.4 80.9 59.5 70.6 0.1 14.9 2.3 253 55-59 71.0 234 3.8 0.1 84.5 53.9 70.0 0.6 19.0 3.1 166 Marital status Ever married 62.1 2,311 4.9 0.6 83.0 51.9 67.3 0.4 18.5 2.2 1,436 Never married 50.7 796 3.3 0.1 78.9 50.9 67.7 0.2 23.9 2.5 404 Urban-rural residence Urban 65.3 1,317 5.0 0.3 85.9 51.0 62.8 0.4 18.6 2.3 859 Rural 54.8 1,789 4.2 0.7 78.8 52.2 71.3 0.4 20.7 2.2 980 Place of residence Urban Governorates 66.0 470 3.4 0.0 88.1 47.0 55.1 0.4 16.7 0.0 311 Lower Egypt 57.2 1,551 4.7 0.3 80.9 56.8 71.6 0.4 18.0 1.9 887 Urban 63.8 435 5.0 0.1 85.0 56.6 64.4 0.4 16.9 3.4 278 Rural 54.6 1,115 4.6 0.4 79.1 56.9 74.9 0.4 18.5 1.2 609 Upper Egypt 59.2 1,067 4.9 1.0 80.9 46.6 67.7 0.4 23.7 3.9 632 Urban 66.2 400 6.8 0.9 84.5 49.5 70.4 0.3 22.9 3.8 265 Rural 55.0 668 3.5 1.0 78.2 44.5 65.7 0.4 24.3 4.0 367 Frontier Governorates1 57.5 18 4.9 0.0 79.4 53.1 57.0 0.0 16.4 2.9 10 Education No education 41.1 181 1.9 0.0 74.4 53.3 79.9 0.5 19.9 1.0 74 Some primary 46.7 222 4.0 0.0 71.9 43.6 66.8 0.0 20.6 0.0 104 Primary complete/ some secondary 46.0 655 2.1 1.0 79.3 45.0 64.9 0.1 18.0 4.4 301 Secondary complete/ higher 66.4 2,048 5.3 0.5 84.0 53.7 67.3 0.5 20.0 2.0 1,360 Work status Working for cash 60.1 2,697 4.6 0.6 81.7 51.9 67.5 0.4 19.3 2.2 1,621 Not working for cash 53.3 410 4.0 0.0 85.2 49.6 66.7 0.2 23.1 2.5 218 Wealth quintile Lowest 56.4 512 2.9 0.2 75.9 49.6 68.3 0.4 21.4 3.0 289 Second 52.3 563 4.4 0.3 77.0 52.8 71.4 0.0 21.9 3.0 294 Middle 51.0 519 5.0 1.0 81.8 50.7 71.2 1.1 18.4 1.5 264 Fourth 60.4 650 5.4 0.7 83.7 51.4 66.5 0.0 17.5 1.6 393 Highest 69.5 862 4.8 0.4 86.7 52.6 63.8 0.5 19.9 2.3 599 Total 15-59 59.2 3,106 4.6 0.5 82.1 51.7 67.4 0.4 19.7 2.3 1,839 1 Does not include North and South Sinai governorates As Table 3.4.1 shows, just over half of women who knew about hepatitis B named at least one way through which the illness can be transmitted. Among women who were able to name an avenue of transmission for hepatitis B, the majority (79 percent) reported it could be contracted through blood transfusions, 56 percent said through other contact with the blood of an infected person, and 45 percent mentioned unclean needles. As was the case with hepatitis C, men were somewhat Knowledge and Prevalence of Hepatitis B and C • 35 more knowledgeable than women about ways through which hepatitis B could be contracted. Table 3.4.2 shows that almost 6 in 10 men who knew about hepatitis B were able to name at least one mode of transmission. Similar to the pattern for women, the three modes of transmission most often mentioned by men were blood transfusions (82 percent), other contact with the blood of an infected person (67 percent), and use of unclean needles (52 percent). Both sexual relations and mother-to-child transmission are common ways of contracting hepatitis B. Few EHIS respondents mentioned either of these modes of transmission. Around one- quarter of women and one-fifth men believed incorrectly that hepatitis B can be transmitted through casual physical contact. 3.3 HISTORY OF HEPATITIS B AND C AND LIVER DISEASE In the 2015 EHIS, respondents age 15-59 were asked if they had ever been tested for and diagnosed with hepatitis C and B and/or if they had symptoms of or had been diagnosed with liver disease. Similar information was collected for children age 1-14 from the mother or other adult informant in the child’s questionnaire. Table 3.5 presents information on the history of hepatitis testing for the population age 1-59. Overall, the EHIS results indicate that 7 percent of Egyptians age 1-59 were ever tested for hepatitis C and 2 percent had ever had a hepatitis B test. Testing rates are very low among children. Less than 1 percent of children age 1-14 had ever been tested for hepatitis B (0.3 percent) or hepatitis C (0.5 percent). Among adults, testing rates were higher for men than women. Two percent of women and 6 percent of men age 15-59 had ever been tested for hepatitis B, and 6 percent of women and 18 percent of men had ever been tested for hepatitis C. Table 3.5 History of testing for hepatitis B and C Percent distribution of individuals age 1-59 by whether or not they were ever tested for the hepatitis B and hepatitis C viruses, according to sex and age, Egypt 2015 Children 1-141 Adults 15-592 Total population 1-59 Hepatitis testing status Female Male Total Female Male Total Female Male Total Ever tested for hepatitis B virus Yes 0.1 0.4 0.3 1.7 5.8 3.5 1.1 3.5 2.2 No 99.8 99.6 99.7 32.6 35.7 33.9 57.1 63.1 59.9 Don’t know 0.1 0.0 0.0 0.1 0.2 0.1 0.1 0.1 0.1 Never heard about hepatitis B 0.0 0.0 0.0 65.7 58.4 62.4 41.7 33.4 37.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Ever tested for hepatitis C virus Yes 0.3 0.8 0.5 6.1 17.9 11.4 4.0 10.6 7.1 No 99.7 99.2 99.4 79.8 72.5 76.5 87.0 84.0 85.6 Don’t know 0.0 0.0 0.0 0.1 0.1 0.1 0.1 0.1 0.1 Never heard about hepatitis C 0.0 0.0 0.0 14.0 9.5 12.0 8.9 5.4 7.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,280 5,598 10,878 9,209 7,462 16,671 14,489 13,060 27,549 1 Children’s status reported by child’s parent or other adult caretaker 2 Self-reported status Table 3.6 summarizes information obtained in the EHIS for adults and children on their history of hepatitis infection, other liver disease, or symptoms of liver disease. Only a small proportion of adults or children had ever been diagnosed as having any form of hepatitis or other liver disease (4 percent and 2 percent, respectively). Adults most often reported having been told they had hepatitis C (1 percent of women and 4 percent of men), while children had most often been diagnosed 36 • Knowledge and Prevalence of Hepatitis B and C as having hepatitis A (1 percent of girls and 2 percent of boys). Ten percent of adults and 4 percent of children had experienced common symptoms of liver disease, most often dark urine (9 percent of adults and 4 percent of children). Table 3.6 History of hepatitis and other liver disease Percentage of individuals age 1-59 reported to have ever had hepatitis, other liver disease, or symptoms of liver disease, by sex and age, Egypt 2015 History of hepatitis and liver disease Children 1-141 Adults 15-592 Total population 1-59 Female Male Total Female Male Total Female Male Total Ever had any form of hepatitis or other liver disease 1.1 1.9 1.5 2.3 5.8 3.9 1.9 4.1 2.9 Ever had any form of hepatitis 1.1 1.8 1.5 2.0 5.3 3.5 1.7 3.8 2.7 Hepatitis A 1.0 1.5 1.2 0.5 0.8 0.6 0.7 1.1 0.9 Hepatitis B 0.0 0.0 0.0 0.1 0.4 0.3 0.1 0.2 0.2 Hepatitis C 0.0 0.1 0.1 1.2 4.1 2.5 0.8 2.4 1.6 Don’t know type 0.1 0.2 0.2 0.2 0.1 0.1 0.1 0.2 0.1 Ever had other liver disease 0.0 0.1 0.1 0.4 0.6 0.5 0.3 0.4 0.3 Ever had symptoms of liver disease 3.4 4.4 4.0 9.7 9.4 9.6 7.4 7.3 7.4 Ever had jaundice 1.5 2.3 1.9 1.3 1.6 1.4 1.4 1.9 1.6 Ever had dark urine 3.2 4.2 3.7 9.4 9.1 9.2 7.1 7.0 7.1 Number 5,280 5,598 10,878 9,209 7,462 16,671 14,489 13,060 27,549 1 Children’s status reported by child’s parent or other adult caretaker 2 Self-reported status Table 3.7 shows the proportions of adults and children reported as having been told by a doctor or other health professional that they currently had hepatitis B or C. Only 2 percent of adults reported they currently had hepatitis C, and only a very few adults (0.1 percent) had hepatitis B. No children were reported as having been diagnosed with a current hepatitis B or C infection. Table 3.7 Current hepatitis B and/or hepatitis C infection Percentage of individuals age 1-59 reported as having been told by a doctor or other health professional that they currently have a hepatitis B and/or hepatitis C infection by sex and age, Egypt 2015 Current hepatitis B or C infection Children 1-141 Adults 15-592 Total population 1-59 Female Male Total Female Male Total Female Male Total Currently have hepatitis B infection 0.0 0.0 0.0 0.1 0.2 0.1 0.0 0.1 0.1 Currently have hepatitis C infection 0.0 0.0 0.0 1.1 3.2 2.1 0.7 1.9 1.3 Currently have either hepatitis B or hepatitis C infection 0.0 0.0 0.0 1.2 3.4 2.2 0.7 2.0 1.3 Currently have hepatitis B and hepatitis C infection 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Number 5,280 5,598 10,878 9,209 7,462 16,671 14,489 13,060 27,549 1 Children’s status reported by child’s parent or other adult caretaker 2 Self-reported status 3.4 HISTORY OF TREATMENT FOR HEPATITIS C Questions were included in the 2015 EHIS to obtain information on treatment status for respondents who had ever been diagnosed as having hepatitis B or C. The number of children reported as having had hepatitis B and C and the number of adults reported as having had hepatitis B were too small to provide reliable data on treatment status. Thus, Table 3.8 presents information on the treatment status among adults age 15-59 reported as ever having hepatitis C. Knowledge and Prevalence of Hepatitis B and C • 37 Table 3.8 Treatment status and type of treatment received among adults age 15-59 ever infected with hepatitis C Among adults age 15-59 who had ever been told by a doctor or other health professional that they had hepatitis C infection, percent distribution by treatment status, and, among those ever treated for a hepatitis C infection, percentage mentioning receiving various treatments, by sex, Egypt 2015 Hepatitis C treatment status and type of treatment received Adults 15-59 Women Men Total Treatment status Received treatment 80.6 68.0 71.4 Did not receive treatment 19.4 32.0 28.6 Total 100.0 100.0 100.0 Number ever having hepatitis C infection 114 304 418 Type of treatment Interferon 23.7 37.4 33.2 Ribavirin 4.3 5.8 5.3 Legalon (Silymarin) 19.3 17.8 18.3 Sovaldi (Sofosbuvir) 1.8 1.5 1.6 Olysio (Simeprevir) 4.2 2.8 3.2 Herbal medicine 6.6 10.7 9.4 Vitamins 40.8 36.1 37.6 Other 30.1 12.6 18.0 Don’t know 6.0 12.0 10.1 Number ever receiving treatment for hepatitis C infection 92 207 299 Seven in 10 adults who had ever been diagnosed as having hepatitis C reported being treated for the disease. Women were more likely than men to report having received treatment. The most frequently reported treatment was vitamins (38 percent). The drugs that ever-infected adults reported most often receiving were interferon (33 percent) and Legalon (18 percent). Only 2 percent of ever- infected adults reported that they received Sovaldi as a treatment. This is not surprising since Sovaldi has only very recently become available to treat hepatitis C. 3.5 HEPATITIS TESTING IN THE 2015 EHIS In addition to responding to questions about hepatitis C and B, individuals age 1-59 were eligible to participate in the hepatitis testing component of the survey. The component involved the collection of venous blood samples from all individuals for whom informed consent was obtained during the survey. The testing of the blood samples obtained in the survey took place at the Central Public Health Laboratory (CPHL) in Cairo. The results of the hepatitis tests were returned to individuals in a separate field operation following the completion of the laboratory testing. The following sections describe the coverage of hepatitis testing and the outcome of the operation to return results of the testing. More details on the procedures that were employed during the collection of the blood samples and the protocols for the hepatitis B and C testing at the CPHL are provided in Chapter 1 of this report. 3.5.1 Coverage of Hepatitis Testing Table 3.9 shows that the coverage rate for hepatitis testing was high. A total of 27,549 adults and children were eligible for hepatitis testing. Around 5 percent refused to provide a blood sample for the testing or were not at home when the EHIS team visited their households. Blood specimens could not be collected or tested for various other reasons (e.g., inadequate volume of blood) for less than 1 percent of the eligible adults or children. The difference in the coverage rates for females and males was minimal, with 95 percent of females and 94 percent of males providing a blood sample for testing. 38 • Knowledge and Prevalence of Hepatitis B and C Table 3.9 Coverage of hepatitis testing among the de facto interviewed population age 1-59 Percent distribution of the de facto interviewed population age 1-59 by testing status, according to background characteristics (unweighted), Egypt 2015 Testing status Total Unweighted number Background characteristic Sample tested1 Refused to provide blood sample Absent at time of blood collection Other2/ missing Sex Female 94.7 4.6 0.1 0.7 100.0 14,481 Male 94.4 4.9 0.1 0.6 100.0 13,068 Age 1-4 89.8 6.6 0.1 3.5 100.0 3,654 5-9 93.2 6.2 0.1 0.5 100.0 3,863 10-14 94.0 5.1 0.4 0.5 100.0 3,361 15-19 96.6 3.2 0.1 0.2 100.0 2,659 20-24 96.0 3.9 0.0 0.0 100.0 2,058 25-29 96.0 4.0 0.0 0.0 100.0 2,457 30-34 95.8 4.1 0.0 0.0 100.0 2,166 35-39 96.1 3.7 0.0 0.2 100.0 1,927 40-44 96.3 3.7 0.0 0.0 100.0 1,524 45-49 97.0 2.9 0.0 0.1 100.0 1,423 50-54 94.7 5.0 0.1 0.2 100.0 1,408 55-59 94.4 5.6 0.0 0.0 100.0 1,049 Urban-rural residence Urban 92.4 6.8 0.1 0.7 100.0 12,940 Rural 96.5 2.9 0.1 0.6 100.0 14,609 Place of residence Urban Governorates 93.1 6.2 0.0 0.7 100.0 4,637 Lower Egypt 95.5 4.0 0.2 0.4 100.0 9,970 Urban 91.3 7.8 0.3 0.6 100.0 3,254 Rural 97.5 2.1 0.1 0.3 100.0 6,716 Upper Egypt 94.2 4.9 0.1 0.8 100.0 11,163 Urban 91.2 7.9 0.1 0.8 100.0 3,717 Rural 95.7 3.5 0.1 0.8 100.0 7,446 Frontier Governorates3 95.4 3.7 0.1 0.8 100.0 1,779 Education4 No education 97.1 2.8 0.0 0.2 100.0 2,468 Some primary 97.5 2.4 0.0 0.1 100.0 1,385 Primary complete/ some secondary 97.0 2.9 0.1 0.1 100.0 4,463 Secondary complete/ higher 94.9 5.0 0.0 0.1 100.0 8,355 Wealth quintile Lowest 96.8 2.5 0.1 0.6 100.0 5,851 Second 96.7 2.7 0.0 0.5 100.0 4,897 Middle 96.2 3.1 0.1 0.6 100.0 4,085 Fourth 93.7 5.3 0.2 0.9 100.0 5,824 Highest 90.8 8.5 0.1 0.6 100.0 6,892 Total 1-59 94.5 4.7 0.1 0.6 100.0 27,549 1 Includes all serum samples undergoing testing at the laboratory and for which there is a final result 2 Includes any cases where there were problems in the field collecting the sample or in completing the testing in the laboratory (e.g., not enough blood to complete confirmatory testing) 3 Does not include North and South Sinai governorates 4 Limited to respondents age 15-59 Considering the variation in coverage rates by age, Table 3.9 shows that the coverage rate was lowest among children age 1-4 (90 percent). The rate exceeded 95 percent in all other age groups except children age 5-14 and adults age 50-59. Testing coverage was slightly higher in rural areas (97 percent) than in urban areas (92 percent). By place of residence, the proportion with a sample tested was highest in rural Lower Egypt (98 percent) and lowest in urban Upper Egypt and urban Lower Egypt (91 percent). Coverage levels were 90 percent or higher in all governorates except Giza, where hepatitis tests were conducted for 88 percent of interviewed respondents (data not shown in table). Knowledge and Prevalence of Hepatitis B and C • 39 Coverage rates among individuals age 1-59 decreased with increasing wealth, from 97 percent in the lowest wealth quintile to 91 percent in the highest quintile. Among adults age 15-59, there was little variation in coverage rates by educational level. 3.5.2 Return of the Results of Hepatitis Testing After the testing of the blood samples was completed, a special field exercise was undertaken to return the test results to all respondents who had provided blood samples. Nine teams returned results to all but 53 respondents. At the time the results were returned, respondents who were found to be positive on the hepatitis B or hepatitis C tests were referred to special national liver centers or other health facilities for counseling and treatment, if needed. 3.6 PREVALENCE OF HEPATITIS B AND C 3.6.1 Prevalence of Hepatitis B and C by Age Table 3.10 presents the results of the hepatitis B and C testing for the population age 1-59 by age. The first two columns in Table 3.10 show the outcome of the HBcAb and HBsAG tests. The HBcAb test was used to detect the presence of hepatitis B core antibodies in the EHIS blood samples. These antibodies are produced by the body at the time of the first exposure to the hepatitis B virus to fight the infection. The antibodies persist for life whether or not an individual recovers from the HBV infection. Thus, a positive HBcAb test result indicated that an EHIS respondent had ever been infected with the hepatitis B virus. The HBsAG test was conducted on all blood samples found to be positive on the HBcAb test to detect the presence of HB surface antigen, a marker which identifies a current or chronic hepatitis B infection. Individuals with a positive result on the HBsAG test had an active hepatitis B infection. The third and fourth columns in Table 3.10 show the results of the tests for the hepatitis C virus. In the first step in the testing for the hepatitis C virus, an enzyme-linked immunosorbent assay (ELISA) test was carried out on the blood samples to detect antibodies to HCV. Because a significant number of false positives were expected on the ELISA test, a second test (Chemiluminescence) was used to confirm the presence of antibodies to the hepatitis C virus. A positive result on the Chemiluminescence test indicated that an individual had ever been infected with the hepatitis C virus. Polymerase chain reaction (PCR) was used to detect the presence of genetic material (RNA) from the hepatitis C virus in all of the blood samples that were positive on the HCV antibody test. A positive RNA test indicated an active (current or chronic) HCV infection. With respect to the hepatitis B test results, Table 3.10 shows that 10 percent of individuals age 1-59 had antibodies to the hepatitis B virus in their blood, indicating that they had been exposed to the virus at some point. Males were slightly more likely to be infected than females. The proportion testing positive on the core antibody test increases sharply with age, from less than 1 percent among children age 1-14 to a peak of 43 percent among respondents age 55-59. Overall, only 1 percent of individuals age 1-59 or nearly 800,000 persons1, had an active hepatitis B infection. The percentage of individuals with an active hepatitis B infection was very low among those under age 20 (0.2 percent or less). The rapid expansion of the coverage of hepatitis B vaccinations following their addition to the national immunization program in the 1990s likely means that the low hepatitis B infection rates observed among children and young adults will be the norm among older cohorts as well in the future. 1 The number of individuals with an active hepatitis B infection was estimated based on the projected population age 1-59 years as of July 1, 2014 (CAPMAS 2015). 40 • Knowledge and Prevalence of Hepatitis B and C Table 3.10 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by age Percentage of the de facto population age 1-59 with a blood sample tested for HBV and for HCV for whom the test result was positive, by age and sex, Egypt 2015 HBV prevalence HCV prevalence Number tested Age Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test FEMALES 1-59 1-14 0.5 0.1 0.2 0.1 4,890 1-4 0.4 0.1 0.4 0.3 1,550 5-9 0.4 0.1 0.0 0.0 1,778 10-14 0.7 0.0 0.2 0.2 1,563 15-59 13.2 1.2 8.1 5.5 8,838 15-19 1.1 0.0 1.2 0.9 1,354 20-24 4.5 0.9 2.1 1.5 1,139 25-29 7.9 1.8 2.8 1.9 1,428 30-34 10.4 0.7 5.6 3.2 1,148 35-39 16.1 2.2 7.1 5.3 1,022 40-44 16.8 0.8 9.0 7.3 790 45-49 24.0 1.5 14.8 10.4 730 50-54 27.1 1.8 24.3 16.1 666 55-59 38.7 1.1 27.6 17.6 560 Total 1-59 8.7 0.8 5.3 3.6 13,728 MALES 1-59 1-14 0.8 0.2 0.7 0.2 5,154 1-4 0.5 0.2 0.5 0.2 1,749 5-9 0.8 0.2 0.5 0.1 1,815 10-14 1.2 0.1 1.1 0.5 1,589 15-59 18.8 2.0 12.4 8.9 7,165 15-19 1.3 0.4 0.9 0.6 1,246 20-24 7.3 1.3 4.8 3.1 821 25-29 14.2 2.3 6.8 4.7 913 30-34 16.3 2.3 9.0 7.1 889 35-39 18.7 2.6 9.4 6.9 829 40-44 23.4 3.1 14.4 10.8 692 45-49 32.1 3.5 17.8 12.4 660 50-54 37.6 1.1 31.5 23.7 672 55-59 48.2 2.6 41.9 27.8 443 Total 1-59 11.3 1.2 7.5 5.3 12,319 TOTAL 1-59 1-14 0.7 0.1 0.4 0.2 10,044 1-4 0.4 0.2 0.4 0.2 3,299 5-9 0.6 0.2 0.3 0.0 3,593 10-14 1.0 0.1 0.7 0.3 3,152 15-59 15.7 1.5 10.0 7.0 16,003 15-19 1.2 0.2 1.0 0.8 2,600 20-24 5.7 1.1 3.2 2.2 1,960 25-29 10.4 2.0 4.4 3.0 2,341 30-34 13.0 1.4 7.1 4.9 2,037 35-39 17.2 2.4 8.2 6.0 1,851 40-44 19.9 1.9 11.6 9.0 1,482 45-49 27.8 2.5 16.3 11.3 1,391 50-54 32.4 1.5 27.9 19.9 1,338 55-59 42.9 1.7 33.9 22.1 1,003 Total 1-59 9.9 1.0 6.3 4.4 26,047 Note: The HBcAb (core antibody) test identifies respondents who ever were infected with the HBV virus. The HBsAG (surface antigen) test identifies those respondents with an active hepatitis B infection at the time of the survey. The HCV antibody test identifies respondents ever infected with the HCV virus. The HCV RNA test identifies those respondents with an active hepatitis C infection. Knowledge and Prevalence of Hepatitis B and C • 41 With regard to the hepatitis C results, Table 3.10 shows that 6 percent of individuals age 1-59 had a positive result on the hepatitis C antibody test, indicating that they had ever been exposed to the virus. Four percent of the population age 1-59 years, or an estimated 3.5 million Egyptians2, were found to have an active infection. Age was strongly related to the rate of active infection. The proportion found to have an active hepatitis C infection varied from less than 1 percent among individuals under age 20 to 22 percent among those age 55-59. Figure 3.1 shows that the prevalence of hepatitis C was higher among men than women in most age groups, with the age differential especially marked among those age 50-59. Figure 3.1 Percentage of women and men with an active hepatitis C infection by age, Egypt 2015 3.6.2 Prevalence of Hepatitis B and C by Socioeconomic Characteristics Table 3.11 provides information on the variation in the prevalence of hepatitis B and hepatitis C infection among the population age 1-59 by urban-rural residence, place or residence, and wealth, according to the respondent’s gender. Information on the variation in the rates of hepatitis infection among women and men age 15-59 by these characteristics and education is presented in Appendix C. The latter tables allow for comparison with the results of the 2008 Egypt DHS, where only adults age 15-59 were eligible for the hepatitis C testing. Table 3.11 shows only minor variations by residence or wealth in the prevalence of hepatitis B infection. The largest differentials in the proportion with active hepatitis B infection were observed by place of residence; the rate was highest in the population age 1-59 in the Urban Governorates and urban Upper Egypt (2 percent each) and lowest in three Frontier Governorates surveyed in the EHIS (0.6 percent). With regard to infection with the hepatitis C virus, Table 3.11 shows that the rate of active hepatitis C infection in the population age 1-59 was slightly lower in urban areas than in rural areas (3 percent and 5 percent, respectively). Considering the differences by place of residence, the highest prevalence of active HCV infections was found in rural Lower Egypt (6 percent) and the lowest in the three surveyed Frontier Governorates (2 percent). The rate of active infection declined from 6 percent in the lowest wealth quintile to 3 percent in the highest wealth quintile. 2 The number of individuals with an active hepatitis C infection was estimated based on the projected population age 1-59 years as of July 1, 2014 (CAPMAS 2015). 1.5 1.9 3.2 5.3 7.3 10.4 16.1 17.6 3.1 4.7 7.1 6.9 10.8 12.4 23.7 27.8 1-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Percentage Age Women Men 42 • Knowledge and Prevalence of Hepatitis B and C Table 3.11 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by socio- economic characteristics Percentage of de facto population age 1-59 with blood sample tested for HBV and for HCV for whom the test result was positive, by sex and socio-economic characteristics, Egypt 2015 HBV prevalence HCV prevalence Number tested Background characteristic Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test FEMALES 1-59 Urban-rural residence Urban 8.8 0.9 4.1 2.5 4,762 Rural 8.6 0.7 5.9 4.2 8,966 Place of residence Urban Governorates 9.7 1.2 3.9 2.3 1,706 Lower Egypt 8.1 0.5 6.8 4.8 6,588 Urban 7.2 0.5 5.3 3.0 1,489 Rural 8.4 0.5 7.3 5.3 5,099 Upper Egypt 9.1 0.9 3.8 2.5 5,333 Urban 9.2 1.0 3.2 2.3 1,516 Rural 9.0 0.9 4.1 2.6 3,817 Frontier Governorates1 8.6 0.5 2.1 1.5 101 Wealth quintile Lowest 9.0 0.3 6.3 4.7 2,786 Second 10.4 0.9 5.6 4.0 2,747 Middle 7.8 1.0 5.2 3.6 2,858 Fourth 8.7 0.7 5.6 3.6 2,756 Highest 7.5 1.0 3.5 1.9 2,581 Total 1-59 8.7 0.8 5.3 3.6 13,728 MALES 1-59 Residence Urban 12.1 1.8 5.5 3.8 4,381 Rural 10.8 0.9 8.5 6.1 7,937 Place of residence Urban Governorates 12.3 2.2 5.6 3.6 1,558 Lower Egypt 10.8 0.9 9.0 6.4 5,944 Urban 11.2 1.1 7.2 5.2 1,306 Rural 10.7 0.8 9.5 6.7 4,638 Upper Egypt 11.6 1.4 6.2 4.4 4,723 Urban 12.8 2.1 4.0 2.8 1,466 Rural 11.1 1.1 7.2 5.2 3,257 Frontier Governorates1 7.6 0.7 2.2 1.8 93 Wealth quintile Lowest 10.8 0.8 9.7 7.1 2,469 Second 11.7 0.9 9.0 6.0 2,449 Middle 10.3 1.0 6.9 4.9 2,440 Fourth 13.1 1.9 6.4 4.9 2,535 Highest 10.5 1.5 5.4 3.3 2,427 Total 1-59 11.3 1.2 7.5 5.3 12,319 Continued… Knowledge and Prevalence of Hepatitis B and C • 43 Table 3.11—Continued HBV prevalence HCV prevalence Number tested Background characteristic Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test TOTAL 1-59 Residence Urban 10.4 1.4 4.8 3.1 9,143 Rural 9.7 0.8 7.1 5.1 16,904 Place of residence Urban Governorates 10.9 1.7 4.7 3.0 3,264 Lower Egypt 9.4 0.7 7.9 5.6 12,532 Urban 9.1 0.8 6.2 4.0 2,795 Rural 9.5 0.7 8.4 6.0 9,738 Upper Egypt 10.2 1.2 4.9 3.4 10,056 Urban 10.9 1.6 3.6 2.5 2,982 Rural 10.0 1.0 5.5 3.8 7,074 Frontier Governorates1 8.1 0.6 2.2 1.6 194 Wealth quintile Lowest 9.8 0.6 7.9 5.8 5,255 Second 11.0 0.9 7.2 5.0 5,196 Middle 9.0 1.0 6.0 4.2 5,298 Fourth 10.8 1.3 6.0 4.2 5,290 Highest 8.9 1.2 4.4 2.6 5,007 Total 1-59 9.9 1.0 6.3 4.4 26,047 Note: The HBcAb (core antibody) test identifies respondents who ever were infected with the HBV virus. The HBsAG test (surface antigen) test identifies those respondents with an active hepatitis B infection at the time of the survey. The HCV- antibody test identifies respondents ever infected with the HCV virus. The HCV-RNA test identifies those respondents with an active hepatitis C infection. 1 Does not include North and South Sinai governorates Table 3.12 presents the variation in hepatitis B and C infection levels among the population age 1-59 by governorate.3 The proportion with a positive result on the HBV core antibody test was highest in Luxor (18 percent) and Aswan (15 percent) and lowest in Matroh and Kafr El-Sheikh (6 percent). The proportion of the population age 1-59 years found to have an active hepatitis B infection was below 2 percent in all of the governorates. Looking at the variation in hepatitis C infection levels by governorate, the proportion of the population age 1-59 who were positive on the hepatitis C antibody test (i.e., who were ever infected with hepatitis C virus) was highest in Menoufia (11 percent) and lowest in Red Sea and New Valley (2 percent each). Not surprisingly, Menoufia also had the highest proportion of the population age 1- 59 years found to have an active hepatitis C infection (8 percent). Other governorates in which the active hepatitis infection rate was 5 percent or higher included Sharkia, Menya, Gharbia, Dakhalia, Behera, Damietta, Fayoum, and Beni Suef. The lowest rates of HCV infection were again observed in Red Sea and New Valley, where only 1 percent of the population age 1-59 were found to have an active hepatitis C infection. 3 Because the sample sizes are comparatively small at the governorate level, readers should use caution in interpreting differences in hepatitis infection between governorates. 44 • Knowledge and Prevalence of Hepatitis B and C Table 3.12 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by governorate Percentage of de facto population age 1-59 with blood sample tested for HBV and for HCV for whom the test result was positive, by governorate, Egypt 2015 HBV prevalence HCV prevalence Number tested Governorate Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test Cairo 11.7 1.9 5.1 3.2 2,311 Alexandria 9.2 1.3 3.6 2.4 850 Port Said 7.7 0.3 4.8 2.8 82 Suez 10.4 0.7 5.0 2.6 21 Damietta 7.5 0.3 9.0 5.2 500 Dakahlia 10.0 1.2 8.2 5.5 1,803 Sharkia 11.3 0.9 8.7 6.4 2,308 Kalyubia 10.2 1.0 5.9 3.7 1,219 Kafr El-Sheikh 6.2 0.5 6.1 3.4 1,034 Gharbia 7.8 0.2 7.7 6.2 1,741 Menoufia 13.5 1.1 10.5 7.7 1,252 Behera 7.5 0.2 7.4 5.4 2,462 Ismailia 10.4 0.8 5.4 2.8 213 Giza 9.8 1.2 3.4 2.6 2,395 Beni Suef 8.0 0.6 7.1 4.6 918 Fayoum 10.0 0.5 6.5 4.5 934 Menya 10.6 1.3 9.0 6.1 1,466 Assuit 8.9 1.3 3.5 2.4 1,528 Souhag 9.5 1.0 2.9 2.1 1,155 Qena 12.0 1.6 4.3 2.8 950 Aswan 14.8 1.6 4.4 3.7 434 Luxor 18.0 1.7 4.5 2.7 274 Red Sea 9.1 0.2 1.9 1.3 68 New Valley 9.9 1.0 1.6 1.4 57 Matroh 5.7 0.6 2.9 2.2 69 Total 1-59 9.9 1.0 6.3 4.4 26,047 Note: The HBcAb (core antibody) test identifies respondents who ever were infected with the HBV virus. The HBsAG test (surface antigen) test identifies those respondents with an active hepatitis B infection at the time of the survey. The HCV- antibody test identifies respondents ever infected with the HCV virus. The HCV-RNA test identifies those respondents with an active hepatitis C infection. 3.6.3 Prevalence of Hepatitis B and C by Lifetime Exposure to Medical Procedures Tables 3.13 and 3.14 show the variation in the rates of hepatitis B and C infection according to respondents’ lifetime exposure to medical procedures recognized as associated with a risk of exposure to blood-borne pathogens. Caution must be used in interpreting the results in these tables since it is not possible to directly link an individual’s infection with hepatitis to any particular procedure. Moreover, the interpretation of the findings is further complicated by the fact that individuals who contracted hepatitis may have an increased likelihood of being hospitalized or undergoing some of the procedures as part of the treatment they receive for the illness. Table 3.13 looks at the results of hepatitis testing according to lifetime history of medical injections among the population age 1-59. The table shows a prior history of receiving injections to treat schistosomiasis was clearly associated with the proportion testing positive for antibodies to both the hepatitis B and hepatitis C virus. Moreover, the proportion of individuals found to have an active hepatitis C infection (i.e., who tested positive on the HCV RNA test) was 11 percent among those who reported that they received an injection to treat schistosomiasis, compared with 3 percent among those who had not had a schistosomiasis injection. Knowledge and Prevalence of Hepatitis B and C • 45 Table 3.13 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by lifetime history of medical injections Percentage of de facto population age 1-59 with blood sample tested for HBV and for HCV for whom the test result was positive, by lifetime history of medical injections, Egypt 2015 HBV prevalence HCV prevalence Number tested Medical injections Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test FEMALES 1-59 Injection to treat schistosomiasis Yes 18.1 0.6 15.3 10.7 505 No 8.3 0.8 4.9 3.3 13,138 Don’t know/missing 11.4 0.0 6.6 5.4 85 Injection for purpose other than treatment of schistosomiasis Yes 8.7 0.8 5.3 3.6 13,595 No 3.5 0.0 3.5 2.5 131 Don’t know/missing * * * * 2 Injection in which a needle and syringe reused Yes 11.4 1.1 5.6 3.6 198 No/never received injection 8.6 0.8 5.3 3.6 13,525 Don’t know/missing * * * * 4 Total 8.7 0.8 5.3 3.6 13,728 MALES 1-59 Injection to treat schistosomiasis Yes 26.8 1.5 24.1 16.9 885 No 10.0 1.1 6.2 4.4 11,350 Don’t know/missing 22.6 10.4 7.9 2.1 84 Injection for purpose other than treatment of schistosomiasis Yes 11.3 1.2 7.5 5.3 12,223 No 6.8 0.8 3.1 1.3 96 Don’t know/missing * * * * 1 Injection in which a needle and syringe reused Yes 19.4 0.7 11.8 8.6 259 No/never received injection 11.1 1.2 7.4 5.2 12,041 Don’t know/missing * * * * 19 Total 11.3 1.2 7.5 5.3 12,319 TOTAL 1-59 Injection to treat schistosomiasis Yes 23.6 1.2 20.9 14.6 1,390 No 9.1 1.0 5.5 3.8 24,488 Don’t know/missing 17.0 5.2 7.3 3.7 168 Injection for purpose other than treatment of schistosomiasis Yes 10.0 1.0 6.3 4.4 25,817 No 4.9 0.3 3.3 1.9 227 Don’t know/missing * * * * 3 Injection in which a needle and syringe reused Yes 15.9 0.9 9.1 6.4 457 No/never received injection 9.8 1.0 6.3 4.3 25,566 Don’t know/missing (11.8) (0.2) (7.0) (7.0) 23 Total 9.9 1.0 6.3 4.4 26,047 Note: The HBcAb (core antibody) test identifies respondents who ever were infected with the HBV virus. The HBsAG (surface antigen) test identifies those respondents with an active hepatitis B infection at the time of the survey. The HCV antibody test identifies respondents ever infected with the HCV virus. The HCV RNA test identifies those respondents with an active hepatitis C infection. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 46 • Knowledge and Prevalence of Hepatitis B and C Table 3.14 shows the variation in the prevalence of HBV and HCV infection according to lifetime exposure of respondents to hospitalization and to medical procedures other than injections that may increase the risk of exposure to blood-borne pathogens. The results show that the proportions of individuals ever infected with HBV and HCV were higher among those who reported they had been hospitalized than those who had never been hospitalized. The proportions of individuals reporting they had ever been infected with HBV and HCV also tended to be somewhat higher among those reporting they had had the various medical procedures shown in the table than among those who had not had the procedures. The highest rates of infection with HBV and HCV were observed among individuals who had had a blood transfusion or endoscopy. Table 3.14 Outcome of testing for hepatitis B virus (HBV) and hepatitis C virus (HCV) among the population age 1-59 by lifetime history of hospitalization and medical procedures other than injection Percentage of de facto population age 1-59 with blood sample tested for HBV and for HCV for whom the test result was positive, by sex and lifetime history of hospitalization and medical procedures other than injection, Egypt 2015 HBV prevalence HCV prevalence Number tested Hospitalization/ Medical procedure Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test FEMALES 1-59 Ever hospitalized Yes 12.1 1.0 7.7 5.3 5,590 No 6.3 0.6 3.6 2.4 8,136 Don’t know/missing * * * * 2 Ever had surgery Yes 13.0 1.1 7.9 5.4 5,321 No 5.9 0.5 3.6 2.4 8,406 Ever had suture/stitches Yes 12.8 1.2 7.2 5.0 5,765 No 5.7 0.5 3.9 2.6 7,958 Don’t know/missing * * * * 4 Ever had intravenous line Yes 12.6 1.2 7.4 5.0 6,497 No 5.1 0.4 3.4 2.4 7,227 Don’t know/missing * * * * 5 Ever had urinary catheter Yes 17.0 1.4 8.0 5.8 1,176 No 7.9 0.7 5.0 3.4 12,548 Don’t know/missing * * * * 4 Ever had blood transfusion Yes 20.5 1.7 11.7 7.8 520 No 8.2 0.7 5.0 3.4 13,185 Don’t know/missing * * * * 23 Ever had endoscopy Yes 19.1 2.5 16.1 10.8 355 No 8.4 0.7 5.0 3.4 13,369 Don’t know/missing * * * * 4 Ever had dental treatment Yes 12.4 0.9 7.5 5.1 7,546 No 4.2 0.6 2.5 1.8 6,182 Total 8.7 0.8 5.3 3.6 13,728 Continued… Knowledge and Prevalence of Hepatitis B and C • 47 Table 3.14—Continued HBV prevalence HCV prevalence Number tested Hospitalization/ Medical procedure Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test MALES 1-59 Ever hospitalized Yes 15.1 1.5 11.1 7.9 4,385 No 9.2 1.1 5.5 3.8 7,933 Don’t know/missing * * * * 1 Ever had surgery Yes 16.9 1.8 11.8 8.4 3,640 No 8.9 1.0 5.7 3.9 8,679 Ever had suture/stitches Yes 16.2 1.9 10.8 7.8 4,745 No 8.2 0.8 5.4 3.7 7,567 Don’t know/missing * * * * 6 Ever had intravenous line Yes 14.9 1.5 10.9 8.1 4,648 No 9.1 1.1 5.4 3.6 7,660 Don’t know/missing * * * * 10 Ever had urinary catheter Yes 24.3 1.2 22.4 15.5 360 No 10.9 1.2 7.0 4.9 11,955 Don’t know/missing * * * * 4 Ever had blood transfusion Yes 20.3 2.9 23.9 18.6 426 No 11.0 1.2 6.9 4.8 11,871 Don’t know/missing (6.1) (0.0) (7.0) (7.0) 22 Ever had endoscopy Yes 26.4 3.1 21.7 15.7 323 No 10.8 1.2 7.1 5.0 11,988 Don’t know/missing * * * * 8 Ever had dental treatment Yes 16.7 1.8 10.7 7.6 6,247 No 5.7 0.6 4.1 2.8 6,070 Don’t know/missing * * * * 1 Total 11.3 1.2 7.5 5.3 12,319 Continued… 48 • Knowledge and Prevalence of Hepatitis B and C Table 3.14—Continued HBV prevalence HCV prevalence Number tested Hospitalization/ Medical procedure Percentage positive on HBcAb (core antibody) test Percentage positive on HBsAG (surface antigen) test Percentage positive on HCV antibody (Chemilumi- nescence) test Percentage positive on HCV RNA test TOTAL 1-59 Ever hospitalized Yes 13.5 1.2 9.2 6.5 9,975 No 7.7 0.8 4.5 3.1 16,070 Don’t know/missing * * * * 2 Ever had surgery Yes 14.6 1.4 9.5 6.6 8,961 No 7.5 0.8 4.7 3.2 17,086 Ever had suture/stitches Yes 14.3 1.5 8.8 6.2 10,510 No 6.9 0.7 4.6 3.1 15,526 Don’t know/missing * * * * 11 Ever had intravenous line Yes 13.6 1.3 8.8 6.3 11,145 No 7.2 0.7 4.4 3.0 14,887 Don’t know/missing * * * * 15 Ever had urinary catheter Yes 18.7 1.3 11.4 8.1 1,536 No 9.4 1.0 6.0 4.2 24,503 Don’t know/missing * * * * 8 Ever had blood transfusion Yes 20.4 2.2 17.2 12.7 945 No 9.5 0.9 5.9 4.1 25,056 Don’t know/missing 7.0 0.0 9.2 9.2 45 Ever had endoscopy Yes 22.6 2.8 18.8 13.1 678 No 9.6 0.9 6.0 4.1 25,357 Don’t know/missing * * * * 12 Ever had dental treatment Yes 14.3 1.3 9.0 6.2 13,793 No 4.9 0.6 3.3 2.3 12,252 Don’t know/missing * * * * 1 Total 9.9 1.0 6.3 4.4 26,047 Note: The HBcAb (core antibody) test identifies respondents who ever were infected with the HBV virus. The HBsAG (surface antigen) test identifies those respondents with an active hepatitis B infection at the time of the survey. The HCV antibody test identifies respondents ever infected with the HCV virus. The HCV RNA test identifies those respondents with an active hepatitis C infection. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. Knowledge and Prevalence of Hepatitis B and C • 49 3.7 TRENDS IN THE PREVALENCE OF HEPATITIS C Figure 3.2 shows trends in the proportions of women and men age 15-59 testing positive on the HCV RNA test between the 2008 EDHS and 2015 EHIS. During the roughly seven-year period between the two surveys, the percentage of adults positive on the test (i.e., who had an active hepatitis C infection) decreased by 30 percent. In large part, the decline reflects the aging out of the population tested of individuals who were age 53-59 at the time of the 2008 EDHS. Individuals in that age group accounted for around 25 percent of the active hepatitis infections at the time of the 2008 EDHS. Figure 3.2 Trends in percentage of the population age 15-59 testing positive on the hepatitis C RNA test, Egypt 2008-2015 10 8 12 7 6 9 Total Women Men Percentage 2008 2015 Knowledge and Attitudes about HIV/AIDS • 51 KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS 4 cquired immunodeficiency syndrome (AIDS) is one of the most serious public health and development challenges facing the world today. The disease is caused by the human immunodeficiency virus (HIV). Although the HIV infection rate is low in Egypt, there is a need to educate Egyptians about AIDS. To assist in these efforts, the 2015 EHIS collected information to assess the prevalence of knowledge of modes of HIV transmission and prevention and attitudes toward persons living with AIDS. The tables in this chapter present a number of indicators that have been used by UNAIDS and other international agencies for monitoring HIV/AIDS knowledge and attitudes in national populations (UNAIDS 2004; UNAIDS 2014; MEASURE Evaluation PRH 2015). Those indicators are generally reported for the population age 15-49. Thus, the tables in the chapter focus on this age group. However, information for the 50-59 age group and the total population age 15-59 is also shown in most tables. 4.1 KNOWLEDGE OF HIV/AIDS To obtain information on the extent of HIV/AIDS knowledge, women and men interviewed in the 2015 EHIS were asked a general question about whether they had heard of the illness. Those who knew about HIV/AIDS were asked additional questions about modes of prevention, including whether it is possible to reduce the chance of getting the AIDS virus by having just one faithful sexual partner and by using a condom at every sexual encounter. To explore possible misconceptions, respondents were also asked whether they think it is possible for a healthy-looking person to have the AIDS virus and whether a person can get AIDS from mosquito bites or sharing food with a person who has AIDS. The responses to these questions were used to assess the extent to which the 2015 EHIS respondents had comprehensive knowledge of HIV/AIDS. Comprehensive knowledge of HIV/AIDS is defined as (1) knowing that both condom use and limiting sex partners to one uninfected partner are HIV prevention methods, (2) being aware that a healthy-looking person can have HIV, and (3) rejecting the two common local misconceptions, that HIV/AIDS can be transmitted through mosquito bites and by sharing food. The 2015 EHIS found that 66 percent of women and 79 percent of men age 15-49 have heard about HIV/AIDS. Among both women and men, the proportions having heard of AIDS are lower than at the time of the 2008 EDHS (Figure 4.1). A Key Findings • More than 6 in 10 women age 15-49 and around 8 in 10 men in the same age group have heard of AIDS; however, only 1 in 17 women and 1 in 10 men age 15-49 have comprehensive correct knowledge about AIDS. • Comprehensive AIDS knowledge is very limited among youth (4 percent of women and 7 percent of men age 15-24, respectively). • Few women and men reported they had received information about AIDS recently, with television cited as the main source of information. 52 • Knowledge and Attitudes about HIV/AIDS Figure 4.1 Trends in the percentages of women and men age 15-49 having heard of AIDS, Egypt 2008-2015 Table 4.1 shows that knowledge of AIDS is lowest among women and men in the 15-19 age group. Urban women and men are more likely than rural women and men to report hearing about HIV/AIDS. Considering place of residence, knowledge levels among both women and men age 15-49 are highest in urban Lower Egypt and lowest in rural Upper Egypt. Knowledge about AIDS is strongly associated with the educational level, work status, and wealth quintile of the respondents. For example, the proportion having heard of AIDS varies from 35 percent of women with no education to 86 percent among women with secondary complete or higher education. A similar pattern is observed among men, with more than 9 in 10 men who have completed secondary school or higher having heard of AIDS compared to slightly over half of men with no education. 75 66 89 79 2008 EDHS 2015 EHIS Percentage Women Men Knowledge and Attitudes about HIV/AIDS • 53 Table 4.1 Knowledge of AIDS Percentage of women and men age 15-49 who have heard of AIDS by background characteristics, and among women and men age 50-59 and all women and men 15-59, percentage who have heard of AIDS, Egypt 2015 Women Men Background characteristic Have heard of AIDS Number of respondents Have heard of AIDS Number of respondents Age 15-24 59.8 2,611 67.8 2,147 15-19 50.1 1,425 57.3 1,288 20-24 71.5 1,185 83.5 859 25-29 68.6 1,471 84.6 962 30-39 72.0 2,257 85.3 1,779 40-49 64.5 1,568 84.7 1,405 Marital status Never married 60.1 1,827 71.1 2,527 Married 68.0 5,664 84.5 3,708 Divorced/separated/ widowed 62.4 415 78.4 58 Urban-rural residence Urban 78.7 2,791 85.0 2,323 Rural 58.8 5,115 75.7 3,970 Place of residence Urban Governorates 77.5 996 84.3 840 Lower Egypt 67.4 3,841 78.8 3,078 Urban 81.0 869 87.1 678 Rural 63.5 2,973 76.4 2,400 Upper Egypt 60.0 3,011 77.7 2,324 Urban 78.1 897 83.9 777 Rural 52.3 2,114 74.5 1,547 Frontier Governorates1 64.8 58 79.1 51 Education No education 35.0 1,409 53.4 375 Some primary 43.5 520 61.7 487 Primary complete/ some secondary 56.3 2,205 67.3 2,023 Secondary complete/ higher 86.1 3,771 91.4 3,409 Work status Working for cash 82.1 1,015 81.4 5,080 Not working for cash 63.5 6,891 69.4 1,214 Wealth quintile Lowest 47.6 1,543 67.2 1,229 Second 55.9 1,556 73.0 1,219 Middle 66.4 1,643 82.2 1,199 Fourth 72.2 1,578 81.4 1,333 Highest 86.5 1,585 90.7 1,313 Total 15-49 65.9 7,906 79.1 6,293 Total 50-59 47.9 1,303 80.4 1,169 Total 15-59 63.3 9,209 79.3 7,462 1 Does not include North and South Sinai governorates Although many women and men had a basic knowledge of AIDS, Table 4.2 shows that knowledge of actions that can reduce the risk of getting the AIDS virus was less common, particularly among women. When prompted, 72 percent of men age 15-49 and 58 percent of women in that age group mentioned that limiting sex to one uninfected partner would prevent a person from getting AIDS and 42 percent of men and 28 percent of women saw using condoms as a means of reducing the risk of transmission. Urban women and men, especially those from urban Lower Egypt; those with secondary complete or higher education; and those who are working for cash were more likely than other women and men to recognize these ways of reducing the risk of transmission of AIDS. 54 • Knowledge and Attitudes about HIV/AIDS Table 4.2 Knowledge of HIV preventive methods Percentage of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, and by having one sex partner who is not infected and who has no other partners, by background characteristics, and percentage of women and men age 50-59 and all women and men 15-59 with knowledge of AIDS prevention methods, Egypt 2015 Women Men Background characteristic Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of respondents Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Number of respondents Age 15-24 22.5 50.6 21.5 2,611 32.5 59.1 31.1 2,147 15-19 16.6 40.1 15.7 1,425 25.9 48.3 25.1 1,288 20-24 29.6 63.3 28.4 1,185 42.4 75.2 40.1 859 25-29 30.2 60.4 29.0 1,471 44.9 78.5 44.0 962 30-39 34.1 64.8 32.6 2,257 47.6 79.4 45.6 1,779 40-49 27.1 58.0 26.1 1,568 48.4 79.4 47.0 1,405 Marital status Never married 19.8 49.3 18.8 1,827 34.7 63.1 33.3 2,527 Married 31.1 61.0 29.9 5,664 47.3 78.7 45.8 3,708 Divorced/separated/ widowed 24.4 54.1 22.6 415 47.7 66.0 42.8 58 Urban-rural residence Urban 33.3 69.2 31.9 2,791 44.8 77.2 42.8 2,323 Rural 25.3 51.8 24.3 5,115 40.7 69.5 39.5 3,970 Place of residence Urban Governorates 25.5 66.3 24.7 996 45.0 76.1 43.1 840 Lower Egypt 31.9 60.6 30.7 3,841 42.6 72.1 41.0 3,078 Urban 40.1 71.5 38.3 869 47.0 77.5 44.0 678 Rural 29.5 57.5 28.6 2,973 41.4 70.5 40.2 2,400 Upper Egypt 24.4 51.8 23.1 3,011 40.8 71.3 39.5 2,324 Urban 35.9 70.4 34.2 897 43.0 77.9 41.7 777 Rural 19.5 43.9 18.4 2,114 39.7 67.9 38.4 1,547 Frontier Governorates3 21.1 55.1 18.8 58 40.0 73.3 38.9 51 Education No education 11.0 28.0 10.1 1,409 27.2 49.4 27.0 375 Some primary 17.4 36.6 16.5 520 36.0 56.2 35.2 487 Primary complete/ some secondary 21.7 48.3 20.9 2,205 34.0 59.1 32.4 2,023 Secondary complete/ higher 39.8 77.7 38.3 3,771 49.6 85.0 48.0 3,409 Work status Working for cash 40.7 75.6 39.0 1,015 44.3 75.0 42.8 5,080 Not working for cash 26.3 55.4 25.2 6,891 33.4 60.9 32.2 1,214 Wealth quintile Lowest 17.9 39.5 16.2 1,543 34.0 60.7 32.9 1,229 Second 23.0 49.4 22.5 1,556 43.0 68.0 41.1 1,219 Middle 31.9 59.0 30.7 1,643 45.1 74.5 43.9 1,199 Fourth 31.8 65.3 30.8 1,578 43.7 75.1 42.4 1,333 Highest 35.7 76.0 34.2 1,585 45.1 82.3 43.1 1,313 Total 15-49 28.2 57.9 27.0 7,906 42.2 72.3 40.7 6,293 Total 50-59 21.6 41.9 20.9 1,303 40.9 74.3 39.2 1,169 Total 15-59 27.2 55.7 26.1 9,209 42.0 72.6 40.5 7,462 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners 3 Does not include North and South Sinai governorates Tables 4.3.1 and 4.3.2 look at several other components included in the assessment of AIDS knowledge among EHIS respondents. First was the recognition that a healthy-looking person can have AIDS. Women age 15-49 were less likely than men in the age group to be aware that a healthy- looking person can have the AIDS virus (37 percent and 46 percent, respectively). Women were also somewhat less likely than men to reject two common misconceptions about how the AIDS virus can be transmitted (i.e., through mosquito bites or sharing food with an infected person). Only around 1 in 8 women and 1 in 6 men were aware that a healthy-looking person can have the AIDS virus and also rejected two misconceptions about the modes of transmission. Overall, only 6 percent of women and Knowledge and Attitudes about HIV/AIDS • 55 10 percent of men were classified as having comprehensive correct knowledge about AIDS, i.e., they were aware that use of a condom and limiting sex to one uninfected person were ways to prevent the transmission of the AIDS virus, they recognized that a healthy-looking person could be infected, and they rejected the common misconceptions that a person could be infected by a mosquito bite or by sharing food with an infected person. Table 4.3.1 Comprehensive knowledge about AIDS: Women Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with comprehensive knowledge about AIDS, by background characteristics, and the percentage of women age 50-59 and all women 15-59 with comprehensive knowledge about AIDS, Egypt 2015 Percentage of respondents who say that: Percentage who say that a healthy-looking person can have the AIDS virus and who reject two common local misconceptions1 Percentage with comprehensive knowledge about AIDS2 Number of respondents Background characteristic A healthy-looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites A person cannot become infected by sharing food with a person who has AIDS Age 15-24 32.1 24.3 28.1 9.1 4.1 2,611 15-19 24.8 19.7 23.4 6.8 2.7 1,425 20-24 41.0 29.8 33.8 12.0 5.8 1,185 25-29 38.1 31.4 35.8 13.2 7.0 1,471 30-39 41.9 32.7 37.6 14.4 7.0 2,257 40-49 37.6 31.0 36.2 14.8 7.8 1,568 Marital status Never married 32.0 26.2 30.3 9.7 3.6 1,827 Married 39.0 30.3 35.0 13.6 7.1 5,664 Divorced/separated/ widowed 33.3 30.6 33.6 10.6 6.0 415 Urban-rural residence Urban 46.0 40.2 44.7 18.3 9.4 2,791 Rural 32.2 23.4 27.9 9.4 4.5 5,115 Place of residence Urban Governorates 46.5 34.3 39.7 18.5 8.3 996 Lower Egypt 37.3 28.8 34.3 11.6 5.5 3,841 Urban 46.1 41.7 47.3 16.5 8.2 869 Rural 34.7 25.0 30.5 10.1 4.7 2,973 Upper Egypt 33.7 28.5 31.4 11.9 6.5 3,011 Urban 45.5 45.6 48.2 20.1 12.0 897 Rural 28.8 21.3 24.3 8.4 4.2 2,114 Frontier Governorates3 37.4 24.5 29.3 8.2 4.1 58 Education No education 17.0 8.5 9.7 2.8 1.1 1,409 Some primary 21.5 15.1 15.5 5.4 2.9 520 Primary complete/ some secondary 29.4 21.4 24.2 8.0 4.3 2,205 Secondary complete/ higher 51.3 43.7 51.1 19.8 9.7 3,771 Work status Working for cash 52.5 47.9 53.8 26.3 15.1 1,015 Not working for cash 34.8 26.6 30.9 10.5 4.9 6,891 Wealth quintile Lowest 26.5 16.6 17.9 5.6 2.4 1,543 Second 31.0 22.9 26.2 8.9 4.2 1,556 Middle 36.1 28.0 33.6 11.4 6.3 1,643 Fourth 40.2 33.8 39.6 14.1 6.8 1,578 Highest 51.4 45.0 51.5 22.4 11.2 1,585 Total 15-49 37.1 29.3 33.9 12.5 6.2 7,906 Total 50-59 27.1 22.1 26.0 10.1 5.1 1,303 Total 15-59 35.7 28.3 32.7 12.2 6.1 9,209 1 Two common local misconceptions: AIDS can be transmitted through mosquito bites or by sharing food with a person who has AIDS. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting two common local misconceptions about transmission or prevention of the AIDS virus. 3 Does not include North and South Sinai governorates 56 • Knowledge and Attitudes about HIV/AIDS Tables 4.3.1 and 4.3.2 also show differentials in the levels of the various AIDS knowledge indicators by background characteristics among women and men. Comprehensive AIDS knowledge is low in all subgroups among both women and men. For example, while education is directly related to knowledge, only 10 percent of women and 13 percent of men with secondary complete or higher education have comprehensive correct knowledge about AIDS. Table 4.3.2 Comprehensive knowledge about AIDS: Men Percentage of men age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of the AIDS virus, and the percentage with comprehensive knowledge about AIDS, by background characteristics, and the percentage of men age 50-59 and all men 15-59 with comprehensive knowledge about AIDS, Egypt 2015 Percentage of respondents who say that: Percentage who say that a healthy-looking person can have the AIDS virus and who reject two common local misconceptions1 Percentage with comprehensive knowledge about AIDS2 Number of respondents Background characteristic A healthy- looking person can have the AIDS virus The AIDS virus cannot be transmitted by mosquito bites A person cannot become infected by sharing food with a person who has AIDS Age 15-24 36.3 31.3 35.7 12.4 6.6 2,147 15-19 28.6 23.3 26.9 9.0 4.7 1,288 20-24 47.8 43.3 48.9 17.4 9.3 859 25-29 48.3 42.6 50.2 19.0 10.3 962 30-39 49.4 42.4 51.0 19.4 11.2 1,779 40-49 53.1 44.1 52.7 20.1 11.6 1,405 Marital status Never married 38.4 34.4 39.1 13.9 7.2 2,527 Married 50.5 42.1 50.8 19.2 11.1 3,708 Divorced/separated/ widowed 45.2 44.1 50.1 22.3 14.1 58 Urban-rural residence Urban 51.4 45.7 53.1 22.2 11.8 2,323 Rural 42.2 35.1 41.9 14.1 8.3 3,970 Place of residence Urban Governorates 54.4 42.4 51.3 24.4 12.8 840 Lower Egypt 44.3 36.5 44.5 15.3 8.4 3,078 Urban 51.7 44.5 55.0 20.0 10.7 678 Rural 42.2 34.3 41.5 14.0 7.8 2,400 Upper Egypt 44.0 41.3 46.4 16.8 9.8 2,324 Urban 47.6 50.8 53.8 21.8 11.7 777 Rural 42.2 36.6 42.7 14.3 8.9 1,547 Frontier Governorates3 52.0 29.7 40.4 17.7 9.5 51 Education No education 33.2 17.1 19.9 5.6 3.2 375 Some primary 33.4 23.2 29.1 9.4 7.2 487 Primary complete/ some secondary 35.2 29.0 32.3 10.1 5.9 2,023 Secondary complete/ higher 54.9 49.6 59.5 23.6 12.8 3,409 Work status Working for cash 47.3 40.6 48.0 17.8 10.2 5,080 Not working for cash 38.6 32.5 38.1 14.2 6.9 1,214 Wealth quintile Lowest 40.5 26.0 30.0 11.0 6.4 1,229 Second 39.4 34.1 39.3 11.5 5.6 1,219 Middle 44.5 41.4 50.4 16.6 11.1 1,199 Fourth 46.8 43.1 49.8 19.1 10.7 1,333 Highest 55.9 49.5 59.5 26.4 13.7 1,313 Total 15-49 45.6 39.0 46.1 17.1 9.5 6,293 Total 50-59 48.8 42.8 52.1 19.6 10.6 1,169 Total 15-59 46.1 39.6 47.0 17.5 9.7 7,462 1 Two common local misconceptions: AIDS can be transmitted through mosquito bites or by sharing food with a person who has AIDS. 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting two common local misconceptions about transmission or prevention of the AIDS virus. 3 Does not include North and South Sinai governorates Knowledge and Attitudes about HIV/AIDS • 57 Finally, one of the principal indicators for tracking progress toward the Millennium Development Goals is the extent to which youth and young adults age 15-24 have comprehensive correct knowledge of AIDS (United Nations Development Group 2003). Table 4.4 shows that such knowledge is very low among Egyptian youth. Only 4 percent of young women and around 7 percent of young men age 15-24 had comprehensive correct knowledge. The proportion with comprehensive knowledge was higher among older (20-24) than younger (15-19) youth. Urban youth, those with secondary complete or higher education, and those in the highest wealth quintile were most likely to have comprehensive knowledge. Table 4.4 Comprehensive knowledge about AIDS among youth Percentage of women and men age 15-24 who have comprehensive knowledge about AIDS, by background characteristics, Egypt 2015 Women Men Background characteristic Percentage with comprehensive knowledge about AIDS1 Number of respondents Percentage with comprehensive knowledge about AIDS1 Number of respondents Age 15-19 2.7 1,425 4.7 1,288 20-24 5.8 1,185 9.3 859 Marital status Never married 3.3 1,573 6.7 1,998 Married 5.1 1,003 4.9 146 Divorced/separated/ widowed (14.2) 35 * 3 Urban-rural residence Urban 5.3 908 8.8 836 Rural 3.5 1,703 5.1 1,311 Place of residence Urban Governorates 1.5 305 8.0 317 Lower Egypt 4.1 1,240 6.1 1,017 Urban 6.5 301 10.3 250 Rural 3.3 940 4.8 767 Upper Egypt 5.0 1,048 6.6 800 Urban 8.2 293 8.7 263 Rural 3.8 755 5.6 537 Frontier Governorates2 1.7 18 3.7 14 Education No education 0.2 112 (4.0) 20 Some primary 0.4 115 1.6 99 Primary complete/ some secondary 3.3 1,339 4.3 1,174 Secondary complete/ higher 6.1 1,044 10.4 854 Work status Working for cash 7.0 144 6.5 1,057 Not working for cash 4.0 2,467 6.6 1,091 Wealth quintile Lowest 2.7 527 1.7 492 Second 4.7 504 5.0 433 Middle 3.1 549 8.3 336 Fourth 4.8 519 8.7 415 Highest 5.4 512 9.9 471 Total 15-24 4.1 2,611 6.6 2,147 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting two common local misconceptions about transmission or prevention of the AIDS virus. 2 Does not include North and South Sinai governorates 58 • Knowledge and Attitudes about HIV/AIDS 4.2 KNOWLEDGE OF MOTHER-TO-CHILD TRANSMISSION To assess awareness of the ways in which AIDS can be transmitted from a mother to her child, women and men were asked if the virus that causes AIDS can be transmitted by breastfeeding and if the risk of transmission from mother to child can be reduced by the mother taking special drugs during pregnancy. As Table 4.5 shows, 26 percent of women and 29 percent of men age 15-49 knew that the virus can be transmitted from mother to child by breastfeeding, and 11 percent of women and 13 percent of men were aware that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking special drugs during pregnancy. Overall, only 8 percent of women and 9 percent of men knew both that the HIV virus can be transmitted by breastfeeding and that the risk of transmission can be reduced by the mother taking special drugs during pregnancy. Among women, knowledge of breastfeeding as a potential mode of transmission for the HIV virus was highest among those with secondary complete or higher education. Among men, those age 40-49 and those with secondary complete or higher education were most likely to be aware that AIDS can be transmitted by breastfeeding. The proportion who were aware that taking special drugs during pregnancy can reduce the risk of transmission from an infected mother to her baby was highest among women and men in the Frontier Governorates. Knowledge and Attitudes about HIV/AIDS • 59 Table 4.5 Knowledge of prevention of mother-to-child transmission of HIV Percentage of women and men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother- to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, and percentage of women and men age 50-59 and all women and men 15-59 with knowledge of modes of prevention of mother-to-child transmission of HIV, Egypt 2015 Women Men Background characteristic HIV can be transmitted by breastfeeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of respondents HIV can be transmitted by breastfeeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of respondents Age 15-24 22.1 10.3 7.5 2,611 21.8 9.9 7.1 2,147 15-19 16.6 7.7 5.5 1,425 18.7 8.1 6.8 1,288 20-24 28.6 13.6 9.8 1,185 26.6 12.5 7.6 859 25-29 28.4 14.0 10.1 1,471 29.2 10.6 6.7 962 30-39 29.8 11.3 8.6 2,257 31.9 13.8 9.8 1,779 40-49 25.6 11.1 7.7 1,568 36.4 16.3 12.5 1,405 Marital status Never married 20.6 8.8 6.5 1,827 23.4 9.6 7.1 2,527 Married 28.2 12.5 9.1 5,664 32.9 14.5 10.3 3,708 Divorced/separated/ widowed 23.7 8.0 6.3 415 30.5 11.6 7.2 58 Pregnancy status Currently pregnant 27.9 12.4 9.0 5,592 na na na 0 Not pregnant/not sure 22.0 9.1 6.7 2,314 na na na 0 Urban-rural residence Urban 29.2 12.9 9.0 2,791 30.0 11.4 7.6 2,323 Rural 24.5 10.6 8.0 5,115 28.5 13.2 9.8 3,970 Place of residence Urban Governorates 25.6 15.5 10.1 996 27.8 12.0 7.4 840 Lower Egypt 26.9 10.4 7.3 3,841 27.2 12.7 8.4 3,078 Urban 29.7 10.4 7.0 869 28.7 12.7 7.6 678 Rural 26.1 10.4 7.4 2,973 26.8 12.7 8.7 2,400 Upper Egypt 25.5 11.2 9.0 3,011 31.9 12.4 10.3 2,324 Urban 32.9 12.3 9.6 897 33.4 9.4 7.9 777 Rural 22.3 10.7 8.7 2,114 31.2 13.9 11.5 1,547 Frontier Governorates1 23.9 20.3 12.7 58 26.9 18.8 11.5 51 Education No education 13.6 6.9 5.2 1,409 21.8 10.7 10.1 375 Some primary 16.1 8.3 6.4 520 20.8 7.9 6.4 487 Primary complete/ some secondary 20.0 9.1 6.4 2,205 23.0 9.0 7.1 2,023 Secondary complete/ higher 35.9 14.9 10.9 3,771 34.6 15.5 10.4 3,409 Work status Working for cash 34.6 15.2 10.2 1,015 30.4 12.9 9.2 5,080 Not working for cash 24.9 10.9 8.1 6,891 23.5 11.2 8.0 1,214 Wealth quintile Lowest 20.6 11.0 7.4 1,543 28.5 12.3 9.2 1,229 Second 23.7 9.4 7.2 1,556 25.5 12.0 8.9 1,219 Middle 28.0 11.8 8.9 1,643 31.6 14.5 11.0 1,199 Fourth 29.6 10.2 7.7 1,578 29.7 12.9 9.0 1,333 Highest 28.7 14.7 10.4 1,585 29.9 11.2 7.0 1,313 Total 15-49 26.2 11.4 8.3 7,906 29.0 12.5 9.0 6,293 Total 50-59 21.4 9.9 7.8 1,303 33.4 12.3 9.7 1,169 Total 15-59 25.5 11.2 8.3 9,209 29.7 12.5 9.1 7,462 na = Not applicable 1 Does not include North and South Sinai governorates 60 • Knowledge and Attitudes about HIV/AIDS 4.3 ACCEPTING ATTITUDES TOWARD PEOPLE LIVING WITH AIDS Women and men age 15-59 who had heard of AIDS were asked questions in the 2015 EHIS to assess the extent of stigma associated with HIV/AIDS. The results shown in Tables 4.6.1 and 4.6.2 indicate that a relatively high proportion of women and men age 15-49 were willing to care for a relative with AIDS at home (84 percent of both women and men). On the other hand, comparatively few women and men would buy fresh vegetables from a shopkeeper with AIDS (10 percent and 11 percent, respectively) or allow a female teacher with AIDS to keep teaching (11 and 10 percent, respectively). Only around 1 in 5 women and men said that they would be open about having an HIV- positive family member. Accepting attitudes were expressed on all four indicators by less than 1 percent of women and men, indicating that some degree of stigma is almost universally associated with HIV/AIDS within Egyptian society. Table 4.6.1 Accepting attitudes toward those living with HIV/AIDS: Women Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, and percentage of women age 50-59 and all women 15-59 with accepting attitudes toward those living with HIV/AIDS, Egypt 2015 Percentage of women who: Percentage expressing accepting attitudes on all four indicators Number of women who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 82.1 8.0 10.8 20.6 0.8 1,561 15-19 78.2 8.4 10.2 21.4 0.6 714 20-24 85.4 7.7 11.3 19.9 1.1 847 25-29 85.3 10.0 12.4 17.9 0.2 1,009 30-39 85.9 9.7 11.0 20.9 0.4 1,624 40-49 83.2 11.3 10.6 19.8 0.2 1,012 Marital status Never married 79.4 8.9 13.0 20.7 0.8 1,098 Married 85.6 9.9 10.9 19.7 0.3 3,850 Divorced/separated/ widowed 82.7 7.5 6.7 21.3 0.7 259 Urban-rural residence Urban 81.7 10.4 12.9 21.4 0.3 2,197 Rural 85.9 8.9 9.8 19.0 0.5 3,009 Place of residence Urban Governorates 76.8 10.1 15.0 23.1 0.9 773 Lower Egypt 86.6 7.8 10.4 16.5 0.2 2,590 Urban 87.0 9.0 14.0 16.7 0.1 703 Rural 86.4 7.4 9.1 16.5 0.2 1,886 Upper Egypt 83.6 11.8 10.4 23.7 0.7 1,806 Urban 81.4 12.2 9.3 24.2 0.0 700 Rural 85.0 11.6 11.0 23.3 1.1 1,106 Frontier Governorates1 87.0 8.2 14.9 18.2 0.2 37 Education No education 90.1 6.7 5.7 19.1 0.5 493 Some primary 84.7 7.3 8.6 21.4 0.5 226 Primary complete/ some secondary 81.2 8.4 8.9 21.3 0.3 1,241 Secondary complete/ higher 84.3 10.6 13.0 19.5 0.5 3,246 Work status Working for cash 86.3 13.8 16.6 20.2 0.7 834 Not working for cash 83.7 8.7 10.1 20.0 0.4 4,372 Wealth quintile Lowest 85.2 10.9 9.3 16.5 0.7 734 Second 85.0 8.7 10.8 17.7 0.4 870 Middle 86.1 8.5 8.7 22.5 0.4 1,090 Fourth 83.6 8.9 12.0 20.9 0.2 1,140 Highest 81.9 10.7 13.5 20.5 0.5 1,371 Total 15-49 84.1 9.5 11.1 20.0 0.4 5,206 Total 50-59 80.9 9.4 10.5 21.6 0.2 624 Total 15-59 83.8 9.5 11.1 20.2 0.4 5,830 1 Does not include North and South Sinai governorates Knowledge and Attitudes about HIV/AIDS • 61 Table 4.6.2 Accepting attitudes toward those living with HIV/AIDS: Men Among men age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by background characteristics, and percentage of men age 50-59 and all men 15-59 with accepting attitudes toward those living with HIV/AIDS, Egypt 2015 Percentage of men who: Percentage expressing accepting attitudes on all four indicators Number of men who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher who has the AIDS virus but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Age 15-24 82.0 8.9 8.5 23.1 0.7 1,456 15-19 81.9 6.9 7.9 24.4 1.1 738 20-24 82.1 10.9 9.0 21.8 0.3 718 25-29 84.3 11.6 10.4 15.5 0.3 814 30-39 84.1 12.5 11.3 18.5 0.2 1,517 40-49 85.2 9.7 11.6 18.0 0.5 1,190 Marital status Never married 81.3 10.0 9.5 21.6 0.5 1,798 Married 85.2 11.0 10.9 17.8 0.4 3,134 Divorced/separated/ widowed 87.5 8.5 15.4 23.8 0.0 45 Urban-rural residence Urban 81.8 11.1 11.6 19.8 0.2 1,974 Rural 85.1 10.3 9.7 18.8 0.6 3,003 Place of residence Urban Governorates 78.9 8.3 12.4 22.0 0.0 708 Lower Egypt 85.6 9.4 9.0 16.2 0.2 2,424 Urban 86.3 8.7 9.5 16.1 0.4 590 Rural 85.4 9.7 8.8 16.3 0.2 1,834 Upper Egypt 83.3 13.0 11.4 22.3 0.8 1,805 Urban 80.7 15.9 12.2 21.0 0.1 652 Rural 84.7 11.3 10.9 23.0 1.2 1,153 Frontier Governorates1 84.6 17.7 18.5 14.4 0.9 41 Education No education 85.5 9.5 10.9 18.4 0.0 201 Some primary 82.4 10.4 5.7 20.2 1.1 300 Primary complete/ some secondary 82.7 8.1 6.3 19.7 0.5 1,361 Secondary complete/ higher 84.3 11.8 12.6 19.0 0.3 3,116 Work status Working for cash 84.2 10.7 10.4 18.2 0.3 4,136 Not working for cash 81.9 10.1 10.6 24.0 0.9 842 Wealth quintile Lowest 85.8 11.3 8.2 13.3 1.2 826 Second 83.5 9.7 9.3 16.8 0.2 891 Middle 85.3 9.7 10.7 24.8 0.5 986 Fourth 81.4 12.0 10.3 22.4 0.1 1,085 Highest 83.6 10.4 12.6 17.7 0.3 1,190 Total 15-49 83.8 10.6 10.4 19.2 0.4 4,978 Total 50-59 85.9 11.3 12.3 17.0 0.3 939 Total 15-59 84.1 10.7 10.7 18.9 0.4 5,917 1 Does not include North and South Sinai governorates In general, differences in attitudes toward those living with HIV/AIDS across background characteristics are not large. 4.4 KNOWLEDGE OF A SOURCE FOR HIV TESTING Another important aspect of AIDS awareness which was assessed in the 2015 EHIS was the level of knowledge of a place where HIV testing is available. Table 4.7 shows that only 7 percent of women and 10 percent of men age 15-49 knew where to go for an HIV test. Among women age 15- 62 • Knowledge and Attitudes about HIV/AIDS 49, knowledge of a source where HIV testing is available was highest among those working for cash (18 percent) and those in the highest wealth quintile (14 percent). Among men, knowledge was highest among those in the highest wealth quintile (16 percent), those with secondary complete or higher education (14 percent), and those from the Frontier Governorates (14 percent). Table 4.7 Knowledge of a place where HIV testing is available Percentage of women and men age 15-49 who know a place where HIV testing is available, by background characteristics, and percentage of women and men age 50-59 and all women and men 15-59 with knowledge of a place where HIV testing is available, Egypt 2015 Women Men Background characteristic Percentage knowing a place where HIV testing is available Number of respondents Percentage knowing a place where HIV testing is available Number of respondents Age 15-24 5.7 2,611 7.6 2,147 15-19 3.4 1,425 5.2 1,288 20-24 8.4 1,185 11.2 859 25-29 7.3 1,471 9.3 962 30-39 8.0 2,257 10.5 1,779 40-49 8.0 1,568 12.2 1,405 Marital status Never married 5.7 1,827 8.2 2,527 Married 7.7 5,664 10.7 3,708 Divorced/separated/ widowed 5.6 415 11.8 58 Pregnancy status Currently pregnant 7.5 5,592 na 0 Not pregnant/not sure 6.1 2,314 na 0 Urban-rural residence Urban 10.6 2,791 12.3 2,323 Rural 5.2 5,115 8.1 3,970 Place of residence Urban Governorates 8.9 996 12.4 840 Lower Egypt 5.1 3,841 6.9 3,078 Urban 10.5 869 11.7 678 Rural 3.6 2,973 5.6 2,400 Upper Egypt 9.0 3,011 12.3 2,324 Urban 12.4 897 12.6 777 Rural 7.5 2,114 12.1 1,547 Frontier Governorates1 10.2 58 14.1 51 Education No education 2.3 1,409 2.9 375 Some primary 3.1 520 4.4 487 Primary complete/ some secondary 3.5 2,205 4.8 2,023 Secondary complete/ higher 11.5 3,771 14.1 3,409 Work status Working for cash 17.8 1,015 9.9 5,080 Not working for cash 5.5 6,891 9.0 1,214 Wealth quintile Lowest 5.2 1,543 7.3 1,229 Second 5.2 1,556 7.5 1,219 Middle 4.4 1,643 7.4 1,199 Fourth 7.4 1,578 10.2 1,333 Highest 13.5 1,585 15.5 1,313 Total 15-49 7.1 7,906 9.7 6,293 Total 50-59 5.0 1,303 14.2 1,169 Total 15-59 6.8 9,209 10.4 7,462 na = Not applicable 1 Does not include North and South Sinai governorates Knowledge and Attitudes about HIV/AIDS • 63 4.5 SOURCES OF INFORMATION ABOUT AIDS EHIS respondents reporting that they had heard about AIDS were asked whether they had received any information about AIDS during the six months prior to the 2015 EHIS. Table 4.8.1 and Table 4.8.2 show that only 11 percent of women and 12 percent of men age 15-49 had received information about AIDS during the six months prior to the survey. When asked about the source(s) from which they had obtained information during this period, virtually all of the women and men cited television broadcasts (95 percent and 96 percent, respectively). Six percent of women and men mentioned spouse/other relatives/friends as a source of information. A health worker was reported by very few women and men as a source of information about HIV/AIDS (4 percent and 1 percent). Table 4.8.1 Sources of information about AIDS by background characteristics: Women Percentage of women age 15-49 knowing about AIDS who heard, saw, or received any information about AIDS in the six months prior to the survey and percentage of women receiving information about AIDS within the last six months who named various sources of information, according to background characteristics, and among women age 50-59 and all women age 15-59, percentage receiving information about AIDS recently, Egypt 2015 Percentage of respondents knowing about AIDS saying they had received information about AIDS recently Number of respondents knowing about AIDS Percentage of respondents who saw/heard/received information about AIDS from: Number of respondents receiving information about AIDS recently Background characteristic Tele- vision Other media1 Any contact with health worker Home visit from health worker Facility visit with health worker Spouse/ other relatives/ friends/ neighbors Community meeting/ educational seminar/ other Age 15-19 12.6 714 89.3 1.5 2.6 0.9 2.5 9.1 5.7 90 20-24 12.1 847 97.3 6.0 5.0 0.0 5.0 1.8 0.9 102 25-29 10.5 1,009 95.0 6.0 1.3 0.7 0.6 6.8 2.6 106 30-34 8.7 851 98.1 0.1 3.9 0.0 3.9 5.8 1.0 74 35-39 11.5 774 95.5 2.0 1.8 1.0 0.8 3.9 0.8 89 40-44 12.0 546 93.5 5.8 8.7 5.5 6.8 4.6 0.0 65 45-49 14.8 465 95.1 2.9 7.5 4.8 4.8 8.1 2.1 69 Marital status Ever married 14.0 1,098 92.7 6.5 4.6 0.5 4.5 6.4 4.1 154 Never married 10.7 4,108 95.6 2.6 3.9 2.0 2.8 5.4 1.2 442 Urban-rural residence Urban 12.5 2,197 94.0 3.9 4.3 1.5 2.8 5.3 2.5 274 Rural 10.7 3,009 95.6 3.4 3.9 1.7 3.6 5.9 1.5 321 Place of residence Urban Governorates 9.0 773 88.8 9.5 7.4 1.8 5.6 7.1 6.2 69 Lower Egypt 10.0 2,590 97.1 2.6 3.8 2.2 3.1 4.4 0.6 258 Urban 9.8 703 97.4 2.0 5.0 2.7 2.3 3.6 0.0 69 Rural 10.0 1,886 97.0 2.9 3.4 2.0 3.4 4.7 0.8 189 Upper Egypt 14.7 1,806 94.5 2.9 3.5 0.9 2.9 6.3 2.2 265 Urban 19.0 700 95.5 1.7

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