Is the anti-HCV prevalence of immigrants consistent with the anti-HCV prevalence of the country of origin? Türkiye, Bursa Example

Is the anti-HCV prevalence of immigrants consistent with the anti-HCV prevalence of the country of origin? 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Türkiye, Bursa Example Beyza Nur KADİROĞLU, Züleyha ALPER This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6211803/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Migrant populations are more vulnerable to infectious diseases due to barriers in accessing healthcare services and unfavorable living conditions. The hepatitis C virus (HCV) poses a significant public health concern among migrant communities, as it remains asymptomatic for many years, necessitating early diagnosis. The World Health Organization (WHO) aims to eliminate viral hepatitis by 2030. However, there are substantial gaps in HCV screening and healthcare accessibility for migrants. This study aims to determine the seroprevalence of anti-HCV among regular migrants living in Bursa and to assess its consistency with prevalence rates in their countries of origin. Methods This study is a cross-sectional research conducted among regular migrants who presented to public hospitals, family health centers, and migrant health centers in Bursa between 2018 and 2022. A total of 11,558 individuals’ anti-HCV test results were analyzed. Statistical analyses were performed using SPSS v25, along with the chi-square test, the Kruskal-Wallis test, and Cramér’s V coefficient. Results Of the 11,558 migrants included in the study, 74% were women, with a median participant age of 25 years. The overall anti-HCV seroprevalence was determined to be 1.3%. The highest seroprevalence rates by country of origin were observed among migrants from Uzbekistan (5.8%), Turkmenistan (5.6%), and Kazakhstan (3.4%), respectively. Age group analysis revealed that the anti-HCV positivity rate was significantly higher among migrants aged 50 years and older (p<0.001). In terms of gender, no significant difference was found between men and women. The anti-HCV seroprevalence largely aligns with the endemicity levels of the migrants' countries of origin. Conclusion The hepatitis C seroprevalence among migrants living in Bursa is generally consistent with the endemicity levels of their countries of origin. Targeted screening of high-risk groups, improving migrants' access to healthcare services, and developing early diagnosis strategies are essential. Migrant Health Hepatitis C HCV screening Health disparities in migrants Background Migration has had a significant impact on public health throughout history. Turkey is one of the largest host countries for migrant populations worldwide ( 1 – 3 ). Migrants are more vulnerable to infectious diseases due to poor living conditions and limited access to healthcare services. Viral hepatitis is among the diseases that require particular attention in migrant communities. The World Health Organization’s Global Viral Hepatitis Elimination program highlights migrants as a high-risk group for viral hepatitis ( 4 ). From the perspective of global health security, the adverse experiences encountered by migrants—primarily from countries affected by conflicts, political instability, or economic crises— throughout their prolonged migration journey, along with the lack of surveillance, social assistance and healthcare services, undermine the effectiveness of disease control measures ( 5 – 7 ). These conditions of conflict and instability lead to disruptions in healthcare systems, interruptions in health screenings and treatments, and consequently, negatively impact migrants’ health even before they migrate ( 5 , 8 ). The overcrowded and unhygienic conditions experienced during migration and upon arrival, along with difficulties in accessing healthcare services in host countries, further exacerbate this situation for migrants ( 9 ). All these factors render migration a risk factor for the spread of infectious diseases from regions with high incidence and prevalence to other areas ( 6 ). Studies conducted worldwide on migrant populations have shown that migrants from regions with moderate to high endemicity tend to exhibit prevalence rates consistent with those of their countries of origin ( 10 ). In recent years, after receiving the highest number of migrants from Middle Eastern countries and Afghanistan, Turkey has also been receiving migration from Central Asian and Eastern European countries, which have the highest endemicity of hepatitis C in the world ( 11 , 12 ). Studies on the prevalence of hepatitis C among migrants in Turkey are limited. Existing research has been conducted at the provincial level and has primarily focused on migrants of Syrian and Afghan origin. This study aims to determine the seroprevalence of anti-HCV among regular migrants living in Bursa, compare it with prevalence rates in their countries of origin, and contribute to public health policies concerning migrant health. Methods Study Design This study is a cross-sectional investigation aimed at determining the prevalence of anti-HCV among regular migrants living in Bursa. Data were obtained from the Bursa Provincial Health Directorate for regular migrants who presented to public hospitals, family health centers, and migrant health centers in Bursa and underwent anti-HCV testing between January 2018 and December 2022. Initially, the dataset included 13,500 records; however, after excluding duplicate entries, the study was conducted with data from 11,558 individuals. The analysis incorporated anti-HCV test results along with demographic variables, including age, sex, and nationality. Nationalities with fewer than 100 individuals were grouped and analyzed under the world regions classified by the World Health Organization based on epidemiological data and regional proximity. Undocumented migrants and individuals who had acquired Turkish citizenship were excluded from the study. Statistical Analysis The normality of data distribution was assessed using the Shapiro-Wilk test. The chi-square test and the Fisher-Freeman-Halton test were used for categorical variables. Due to the large sample size, when statistical significance was detected in categorical comparisons, the results were interpreted using the Phi coefficient for 2×2 tables and Cramér’s V coefficient for 2×k and k×k (k>2) tables (13) Statistical analyses were performed using SPSS v25, with a significance level set at p<0.05. The interpretation of Phi effect size values was based on the ranges provided in Table 7 (49), as presented in Additional File. Results Demographic Characteristics In our study, anti-HCV data from 11,558 registered migrants were analyzed. The demographic and serological characteristics of the study population are presented in Table 1. A relatively young participant group was observed, with a median age of 25 years. The majority of participants were women (74%). When the distribution of migrants by age group was examined, a statistically significant but low-level difference was found (p<0.001). Table 1. Demographic and serological data of the study population Women Men Total ≤14 15-49 ≥50 Number of Participants 8572 (%74) 2986 (%26) 11558 459 10 502 597 Median Age 25 26 25 10 25 57 Age Range 0-91 0-90 0-91 0-14 15-49 50-91 Anti-HCV Positive 121 31 152 3 119 30 The details of the countries of origin of the 11,558 participants, predominantly from Syria, as well as from the Middle East, Central Asia, and Eastern Europe, are presented in Table 2. Nationalities with fewer than 100 individuals were grouped and analyzed under the world regions classified by the World Health Organization based on epidemiological data and regional proximity. Table 2. Distribution of the study population by country of origin Regions and Countries Number of Participants Syria 6043 Azerbaijan 1319 Russia 779 Kazakhstan 413 Uzbekistan 396 Kyrgyzstan 297 Ukraine 208 Greece 179 Bulgaria 174 Turkmenistan 142 Afghanistan 148 Morocco 146 Iraq 111 Other Eastern Mediterranean Region Countries (Table 2.a)* 340 Other European Region Countries (Table 2.b)* 370 African Region Countries (Table 2.c)* 129 Other Regions and Countries (Table 2.d; 2.e; 2.f)* 212 Stateless/Unidentified Nationality 153 Total 11558 * See Additional File Table 2. Upon examining anti-HCV values, 152 out of 11,558 migrants (1.3%) were found to be positive. When analyzing anti-HCV positivity rates by country and region, a statistically significant difference was observed, albeit at a low level (p<0.001). Among the countries of origin, Uzbekistan (5.8%), Turkmenistan (5.6%), and Kazakhstan (3.4%) had the highest prevalence rates (Table 3). Table 3: Comparison of anti-HCV positivity rates by country Region and Countries Anti-HCV (-) Anti-HCV (+) P value (Cramér’s V) n % n % Afghanistan 147 99.3 1 0.7 <0.001 (0.122) Morocco 146 100.0 0 0.0 Syria 6015 99.6 27 0.4 Iraq 111 100.0 0 0.0 Azerbaijan 1282 97.2 37 2.8 Turkmenistan 134 94.4 8 5.6 Kazakhstan 399 96.6 14 3.4 Kyrgyzstan 291 98.0 6 2.0 Uzbekistan 373 94.2 23 5.8 Bulgaria 173 99.4 1 0.6 Greece 178 99.4 1 0.6 Russia 766 98.3 13 1.7 Ukraine 202 97.1 6 2.9 African Region Countries 129 100.0 0 0.0 Other Eastern Mediterranean Region Countries 335 98.5 5 1.5 Other European Region Countries 367 99.2 3 0.8 Other Regions and Countries 210 99.1 2 0.9 Stateless/Unidentified Nationality 148 96.7 5 3.3 Total 11406 98.7 152 1.3 Participants were categorized into three age groups: 0–14, 15–49, and ≥50 years. Accordingly, individuals aged 0–14 were defined as Group 1, those aged 15–49 as Group 2, and those aged 50 and above as Group 3. When analyzing the anti-HCV positivity rates across all migrant age groups, a statistically significant difference was observed (p<0.001). However, according to the Phi effect size, this significance was negligible. In pairwise comparisons, a statistically significant difference was found between individuals aged 50 and above and those in the 0–14 and 15–49 age groups (p<0.001). The positivity rate in the 50 and above age group was observed to be higher than in the other two age groups (Table 4). Among migrants of Syrian, Azerbaijani, and Kazakh origin, the positivity rate in the 50 and above age group was significantly higher compared to other age groups (Table 5). However, when positivity rates were analyzed by age groups in other countries and regions, no statistically significant difference was found (Table 4). No significant difference in anti-HCV prevalence was detected between female and male participants (Table 6). Table 4. Comparison of anti-HCV positivity rates by age groups across countries and regions of origin Region and Countries Grup 1 Grup 2 Grup 3 P value (Cramer’s V) n % n % n % Afghanistan 0 0.0 1 0.7 0 0.0 1,000 Syria 1 0.3 0 0.4 6 3.1 <0.001 (0.072) Azerbaijan 2 5.4 9 2.4 6 6.5 0,046 (0,068) Morocco 0 0.0 0 0.0 0 0.0 - Iraq 0 0.0 0 0.0 0 0.0 - Turkmenistan 0 0.0 7 5.4 1 9.1 0,521 Kazakhstan 0 0.0 0 2.7 4 14.3 0.018 (0.164) Kyrgyzstan 0 0.0 5 1.9 1 6.3 0.324 Uzbekistan 0 0.0 0 5.6 3 12.0 0.302 Bulgaria 0 0.0 0 0.0 1 2.5 0.240 Greece 0 0.0 0 0.0 1 2.4 0.252 Russia 0 0.0 1 1.6 2 5.4 0.185 Ukraine 0 0.0 6 3.1 0 0.0 1.000 African Region Countries 0 0.0 0 0.0 0 0.0 - Other European Region Countries 0 0.0 3 0.9 0 0.0 1.000 Other Eastern Mediterranean Region Countries 0 0.0 3 1.0 2 8.7 0.083 Other Regions and Countries 0 0.0 1 0.5 1 11.1 0.093 Stateless/Unidentified Nationality 0 0.0 3 2.1 2 22.2 0.063 Total 3 0.7 119 1.1 30 5.0 <0,001 (0,076) 1-2: 0.338 1-3: <0.001 2-3: <0.001 Table 5. Pairwise Comparison of Countries with High Anti-HCV Prevalence in Individuals Aged 50 and Above Region and Countries Grup 1 Grup 2 Grup 3 P value (Cramer’s V) Pairwise Comparisons P value n % n % n % Syria 1 0.3 20 0.4 6 3.1 <0.001 (0.072) 1-2 : 1.000 1-3: 0.017 2-3: <0.001 Azerbaijan 2 5.4 29 2.4 6 6.5 0.046 (0.068) 1-2 : 0.240 1-3 : 1.000 2-3 : 0.036 Kazakhstan 0 0.0 10 2.7 4 14.3 0.018 (0.164) 1-2 : 1.000 1-3 : 0.309 2-3 : 0.012 Table 6. Comparison of anti-HCV positivity rates by gender across countries and regions of origin Region and Countries Men Women P value n (%) n (%) Afghanistan 0 0.0 1 1.1 1.000 Morocco 0 0.0 0 0.0 - Syria 11 0.6 16 0.4 0.243 Iraq 0 0.0 0 0.0 - Azerbaijan 7 2.6 30 2.9 0.821 Turkmenistan 0 0.0 8 6.8 0.352 Kazakhstan 4 7.3 10 2.8 0.101 Kyrgyzstan 1 1.7 5 2.1 1.000 Uzbekistan 0 0.0 23 6.4 0.149 Bulgaria 0 0.0 1 0.7 1.000 Greece 0 0.0 1 0.8 1.000 Russia 2 2.0 11 1.6 0.673 Ukraine 0 0.0 6 3.2 1.000 African Region Countries 0 0.0 0 0.0 - Other European Region Countries 0 0.0 3 1.0 1.000 Other Eastern Mediterranean Region Countries 4 3.0 1 0.5 0.079 Other Regions and Countries 1 1.6 1 0.7 0.514 Stateless/Unidentified Nationality 1 2.4 4 3.6 1.000 Total 31 1.0 121 1.4 0.123 Discussion In our study, the anti-HCV prevalence among migrants living in Bursa was found to be 1.3%. Previous studies conducted on migrants in Turkey have reported higher anti-HCV prevalence rates compared to our findings ( 14 – 16 ). This discrepancy may be attributed to the fact that, unlike our study population, the majority of participants in those studies were irregular migrants, who are more likely to be exposed to poor and unhygienic conditions and to engage in high-risk behaviors. Additionally, these previous studies were conducted in earlier years and did not include Syrian migrants. As a result, their sample populations primarily consisted of migrants from regions with higher endemicity, such as Central and South Asia, rather than from Syria, which represents more than half of our study population and is considered a low-endemicity region. This factor may explain the significantly higher prevalence rates reported in those studies. According to the TURHEP study conducted in Turkey in 2012 and data from the Centers for Disease Control and Prevention in 2019, the anti-HCV prevalence was reported to be less than 1% and 0.4%, respectively ( 11 , 17 ). Based on these data, Turkey is classified as a very low-endemicity country. However, this status makes Turkey more vulnerable to the hepatitis C virus due to the high influx of migrants from regions with high endemicity. The Middle East, Central Asia, and Eastern Europe emerge as the primary regions from which Turkey receives the highest number of migrants ( 12 ). Similarly, in our study, the number of individuals from these regions seeking healthcare for hepatitis C assessment was higher than those from other regions (Table 2 ). In our study, participants were categorized into three age groups: 0–14, 15–49, and ≥ 50 years. Accordingly, individuals aged 0–14 were defined as Group 1, those aged 15–49 as Group 2, and those aged 50 and above as Group 3. This categorization was made based on a literature review indicating a higher prevalence of marriage and pregnancy among migrants aged 15 and older. Accordingly, individuals aged 14 and younger and those aged 15 and older were analyzed as separate groups ( 18 , 19 ). The anti-HCV prevalence among migrants aged 50 and above (5%) was found to be significantly higher than that in the 15–49 age group (1.1%) and the 0–14 age group (0.7%) (Table 4 ). This result is not surprising, as advanced age is widely recognized as one of the most significant determinants of hepatitis C infection, both globally and in studies conducted in Turkey ( 10 , 17 ) In our study, the highest prevalence was observed among individuals of Uzbek (5.8%) and Turkmen (5.6%) origin, consistent with the high endemicity rates reported in their home countries (Uzbekistan: 4.3%; 9.6%; 11.3% ( 20 – 22 ); Turkmenistan: 5.6%; ( 23 )). These were followed by Kazakhstan (3.4%), Ukraine (2.9%), Azerbaijan (2.8%), Kyrgyzstan (2.0%), and Russia (1.7%). The prevalence among migrants from these Central Asian and Eastern European countries aligns with the hepatitis C endemicity levels reported in their countries of origin, which range from moderate to high endemicity (2–5%) ( 24 , 25 ). A 2009 study conducted on undocumented migrants in Istanbul found similarly high hepatitis C prevalence rates in Turkmenistan, Uzbekistan, and Azerbaijan, as observed in our study. This was attributed to the widespread use of intravenous drugs in these former Soviet republics ( 16 ). In many countries with inadequate infection control measures, unsafe medical procedures, such as unsafe injections, remain the most common transmission route. However, intravenous drug use has become the dominant mode of transmission in the United States and Australia over the past 40 years. Moreover, in most countries, regardless of their income level—whether high, middle, or low—unsanitary conditions during drug preparation and the sharing of injection equipment have become the primary routes of transmission ( 11 ). In our study, the prevalence of anti-HCV among Syrian migrants—the largest migrant group and comprising more than half of our study population—was found to be 0.4%. This rate is consistent with the prevalence reported among Syrian migrants in both Europe and Turkey ( 26 – 28 ). It is likely that the adverse conditions imposed by war, including the necessity of performing elective or emergency blood transfusions without proper screening and the violation of infection control protocols during medical procedures, have exacerbated the previous situation, further increasing the prevalence of infectious diseases, particularly among high-risk groups. Indeed, a study conducted on Turkish and Syrian patients with thalassemia major found that out of the entire population, only two Syrian patients, aged 9 and 15, tested positive for anti-HCV. This finding suggests that war conditions may have contributed to gaps in blood screening practices ( 29 ). In our study, it was noteworthy that 74% of the participants were women. Except for the African region, the proportion of women among individuals tested for anti-HCV across all countries and regions ranged between 60% and 96%. We attribute this to antenatal screening. Although hepatitis C screening is not routinely recommended for pregnant women in Turkey unless a risk factor is present ( 30 ), HBsAg and anti-HCV testing is recommended for all pregnant women in the first trimester according to the Viral Hepatitis Management Algorithm developed by the Ministry of Health, as part of the Turkish Viral Hepatitis Prevention and Control Program. Consequently, routine antenatal testing is conducted ( 31 ). The high pregnancy rate among Syrian migrants may have contributed to the increased number of female individuals seeking medical care. Additionally, among migrants from Central Asia and Eastern Europe (Turkmenistan, Uzbekistan, Russia, Ukraine), the proportion of women ranged between 83% and 92%. It has been reported that due to financial difficulties, a significant number of female refugees from these regions work as janitors, cleaners, or even commercial sex workers ( 32 , 33 ). A 2018 review emphasized that migrant women who initially come to Turkey for regular employment often face economic hardships and may be forced into sex work. Indeed, studies on migrant women have reported that victims of sex trafficking were deceived by false job offers and subsequently coerced into sex work through violence and harassment, despite initially migrating to Turkey for legal employment ( 32 , 34 – 36 ). These disadvantaged conditions may have increased the number of migrant women seeking healthcare services, which could explain the high proportion of female patients in our study. Furthermore, intravenous drug use frequently coexists with such disadvantaged circumstances. Even independently of these factors, the psychological impact of being a female migrant and the challenges of coping with difficult living conditions may also contribute to this trend. This may explain the higher anti-HCV prevalence observed among female migrants from these countries. The prevalence among female migrants was found to be 6.8% for Turkmenistan, 6.4% for Uzbekistan, 3.2% for Ukraine, 2.9% for Azerbaijan, 2.8% for Kazakhstan, 2.1% for Kyrgyzstan, and 1.6% for Russia. Additionally, in migrants from Turkmenistan (6.8%), Uzbekistan (6.4%), and Ukraine (3.2%), all positive cases were women. When examining the literature, the majority of studies indicate no significant difference in prevalence between male and female individuals ( 37 ). However, large-scale observational and surveillance reports generally show higher prevalence rates among men ( 38 – 41 ). In contrast, among populations of intravenous drug users, women have been found to have higher prevalence rates ( 37 ). This has been attributed to various socio-behavioral factors, including not seeking medical assistance due to fears of stigma and losing child custody, experiences of trauma, engagement in sex work, sharing injection equipment with a partner, and relying on others for drug preparation and injection, which may increase the risk of contamination due to lack of proper disinfection practices or reuse of injection equipment ( 42 – 44 ). HCV is known to be rarely transmitted from mother to child. Estimates from large-scale studies suggest that the frequency of perinatal transmission ranges between 0% and 5% ( 45 , 46 ). While the exact timing of transmission remains unclear, the detection of HCV RNA within the first month of life in infants who were not breastfed suggests that intrauterine transmission may have occurred in some cases ( 45 ). Additionally, the mode of delivery has been found to have no effect on vertical transmission ( 47 ). Furthermore, hepatitis C treatment regimens cannot be administered during pregnancy. For these reasons, preconception screening is clearly a more effective strategy. In Turkey, preconceptional hepatitis C screening is only recommended when a risk factor is present. Premarital screening for hepatitis C is also conducted only if suspicion arises and with the individual's consent ( 48 ). Therefore, it may be necessary to screen female migrants from high-endemicity regions during the preconception period. However, since it may be challenging to reach migrants at the time of pregnancy planning, routine screening of at least intravenous drug-using female migrants aged 15–49 could be considered. If high-risk migrant women are not screened, their future children will be at risk of hepatitis C infection both due to perinatal transmission and the high likelihood of the infection progressing asymptomatically. Even if they have migrated through legal means, the awareness of seeking medical care during pregnancy may be low among migrants, depending on the development level of their countries of origin. Additionally, reaching these women may be challenging due to social factors; therefore, migration offices could provide information on preconception and antenatal care. Given the substantial number of migrants, this information could be disseminated through brochures in their native languages. Nevertheless, in many cases—perhaps even the majority—migrants do not engage in pre-pregnancy planning due to financial, cultural, and social factors. For this reason, screening mothers at the time of delivery could be an effective approach for those who have not been identified during the preconception or antenatal period. Since the prevalence of viral hepatitis is higher in risk groups compared to the general population, these groups must be evaluated separately. To ensure the success of the Turkey Viral Hepatitis Prevention and Control Program, it is essential to prevent high-risk groups from posing a threat to the healthy population. The long-term financial burden of undiagnosed cases—whether among citizens or migrants—due to complications is inevitable. To fully understand the extent of anti-HCV prevalence among migrants and to determine whether screening these populations is cost-effective, much more epidemiological data and research are needed. One of the key findings of this study is the necessity of assessing the cost-effectiveness of prioritizing the screening of women of reproductive age, individuals over 50 years old, and those from high-endemicity countries. The high prevalence observed among women is noteworthy. Implementing targeted interventions for migrant women of reproductive age is of great importance for protecting maternal and infant health and preventing undetected new infections that could hinder the elimination process. The feasibility, necessity, and cost-effectiveness of viral hepatitis screening among migrants—a critical issue for our country—should be evaluated in the coming years, as it is crucial for achieving elimination goals. Limitations In this study, causal relationships regarding anti-HCV positivity could not be determined due to the absence of individual data on migrants' risk behaviors. Additionally, the exclusion of irregular migrants from the study may have prevented us from accurately identifying the true migrant prevalence and the overall risk in our region. Conclusion The anti-HCV seroprevalence among migrants living in Bursa varies by country of origin, with the highest rates observed among Uzbek and Turkmen migrants. The positivity rate is significantly higher among individuals over 50 years of age. Migrants should also be evaluated in relation to intravenous drug use, which is one of the most significant contemporary risk factors. Given that intravenous drug users have a higher likelihood of hepatitis C infection, targeted programs should be developed and incorporated into action plans to ensure that this group is not missed. Notably, intravenous drug use poses an even greater risk for women of reproductive age. Another high-risk migrant group consists of undocumented migrants. Most undocumented migrants arriving in Turkey originate from high-endemicity regions. Therefore, measures should be taken to monitor irregular migrants and address the public health risks they may pose. The implementation of targeted screening and treatment programs for migrant groups could contribute to the viral hepatitis elimination process. Recommendations Development of targeted screening programs for migrant communities Comparison of migrant populations' health status with seroprevalence data from their countries of origin Implementation of preconceptional and antenatal care informing programs for female migrants of reproductive age Abbreviations HCV: Hepatitis C Virus Declarations Ethics approval and consent to participate Ethics approval was obtained by the Uludag University Faculty of Medicine Clinical Research Ethics Committee (Decision number: 2023-24/30). The data on anti-HCV testing conducted between Jan 2018 and Dec 2022 in migrants living in Bursa were obtained from the Bursa Provincial Health Directorate. Prior to obtaining the data, necessary permissions was obtained from Bursa Provincial Health Directorate. All methods were according to the ethical principles of the Declaration of Helsinki and approved by the ethical board above. Consent for publication Not applicable Availability of data and materials The data used in this study were obtained from the Bursa Provincial Health Directorate with official permission. Due to privacy and ethical restrictions, these data are not publicly available. However, access to the data may be possible upon reasonable request and with permission from the relevant authorities. Competing interests Not applicable Funding Not applicable Authors' contributions Beyza Nur Kadiroğlu: Writing, including obtaining and organizing the retrospective data from Bursa Provincial Health Directorate, conceiving the study and designing the methodology Züleyha Alper: conceiving the study and designing the methodology, contributing to manuscript writing and revisions References International Organization for Migration (IOM). MPM Migrant Presence Monitoring - Situation Report (December 2024). Turkey; 2025. https://dtm.iom.int/sites/g/files/tmzbdl1461/files/reports/Turkiye_Sitrep_12_December_24.pdf Accessed 10 Jan 2025 UNHCR. Mid-Year trends 2022. https://www.unhcr.org/statistics/unhcrstats/635a578f4/mid-year-trends-2022.html Accessed 25 Jun 2023 UNHCR. Mid-Year trends 2024. https://www.unhcr.org/mid-year-trends-report-2024. Accessed 5 Jan 2025 World Health Organization. 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Frequency of hepatitis B, hepatitis C, and HIV (human immunodeficiency virus) in thalassemia major patients having multiple transfusions. Ankem Derg. 2018;32(1):9–16. doi:10.5222/ankem.2018.009. Türk Karaciğer Araştırmaları Derneği, Viral Hepatitle Savaşım Derneği. Türkiye hepatit C tanı ve tedavi kılavuzu. 2023. https://www.tkad.org.tr/wp-content/uploads/2023/11/TURKIYE-HEPATIT-C-TANI-VE-TEDAVI-KLAVUZU-2023.pdftkad.org.tr Accessed 1 Mar 2024 T.C. Sağlık Bakanlığı Halk Sağlığı Genel Müdürlüğü. Viral hepatitler eğitimci rehberi. Ankara; 2020. https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Rehberler/viral_hepatitler_egitimci_rehberi.pdf Accessed 11 Mar 2025 Şahin Ç. Türkiye'de kadın göçmen işçilerinin durumunun 'emek-sermaye çatışmasında' yeniden değerlendirilmesi. Çalışma ve Toplum. 2018;4(59):2155–92. https://dergipark.org.tr/tr/pub/ct/issue/71807/1155352. Bakar N, Çakır S. Düzensiz göç ve fuhuş amaçlı kadın ticareti: Türkiye örneği ve İsveç modeli üzerine tartışmalar [Master’s thesis]. İstanbul: T.C. İstanbul Üniversitesi, Sosyal Bilimler Enstitüsü; 2010. Kaşka S, Erder S. Irregular migration and trafficking in women: the case of Turkey. Geneva: International Organization for Migration; 2003. Coşkun E. Türkiye'de göçmen kadınlar ve seks ticareti. Çalışma ve Toplum. 2014;3(42):185–206. https://dergipark.org.tr/tr/pub/ct/issue/71770/1155588 Coşkun E. Türkiye'de kağıtsız göçmen kadınlar ve sosyal hizmetler. Çalışma ve Toplum. 2017;3(54):1299–1316. https://www.calismatoplum.org/makale/turkiyede-kagitsiz-gocmen-kadinlar-ve-sosyal-hizmetler/ Esmaeili A, Mirzazadeh A, Carter GM, Esmaeili A, Hajarizadeh B, Sacks HS, et al. Higher incidence of HCV in females compared to males who inject drugs: a systematic review and meta-analysis. J Viral Hepat. 2017;24(2):117–27. doi:10.1111/jvh.12628. Centers for Disease Control and Prevention. Hepatitis C surveillance 2022. https://www.cdc.gov/hepatitis/statistics/2022surveillance/hepatitis-c.htm Accessed 15 Dec 2024 European Centre for Disease Prevention and Control. Hepatitis C - annual epidemiological report for 2022. Stockholm: ECDC; 2024. https://www.ecdc.europa.eu/sites/default/files/documents/HEPC_AER_2022.pdf Accessed 12 Jun 2024 Public Health Agency of Canada. Hepatitis C in Canada: 2021 surveillance data update. 2023. https://www.canada.ca/en/public-health/services/publications/diseases-conditions/hepatitis-c-canada-2021-surveillance-data-update.html Accessed 15 Dec 2024 Wong K, Wong B, Ng AS, Poon S. Surveillance of viral hepatitis in Hong Kong - 2022 report. Hong Kong; 2023 Dec. https://www.chp.gov.hk/files/pdf/surveillance_of_viral_hepatitis_in_hk_2022_full_report.pdf Accessed 15 Dec 2024 Page K, Tsui J, Maher L, Choopanya K, Vanichseni S, Mock PA, et al. Biomedical HIV prevention including pre-exposure prophylaxis and opiate agonist therapy for women who inject drugs. J Acquir Immune Defic Syndr. 2015;69(Suppl 2):S169–75. doi:10.1097/QAI.0000000000000641 Evans JL, Hahn JA, Page-Shafer K, Lum PJ, Stein ES, Davidson PJ, et al. Gender differences in sexual and injection risk behavior among active young injection drug users in San Francisco (the UFO Study). J Urban Health. 2003;80(1):137–46. doi:10.1093/jurban/jtg137. Puri N, DeBeck K, Feng C, Kerr T, Rieb L, Wood E. Gender influences on hepatitis C incidence among street youth in a Canadian setting. J Adolesc Health. 2014;55(6):830–4. doi:10.1016/j.jadohealth.2014.07.006. Aygen B, Gürbüz Y, Çetinkaya RA, Çınar G, Kayabaş Ü, Örmen B, et al. Management of chronic hepatitis C virus infection: a consensus report of the Study Group for Viral Hepatitis of the Turkish Society of Clinical Microbiology and Infectious Diseases-2023 update. KLİMİK Derg. 2023;36(Suppl. 1):43–75. doi:10.36519/kd.2023.4672. Yeung LTF, King SM, Roberts EA. Mother-to-infant transmission of hepatitis C virus. Hepatology. 2001;34(2):223–9. doi:10.1053/jhep.2001.25885. McIntyre PG, Tosh K, McGuire W. Caesarean section versus vaginal delivery for preventing mother to infant hepatitis C virus transmission. Cochrane Database Syst Rev. 2006;(4):CD005546. doi:10.1002/14651858.CD005546.pub2. T.C. Sağlık Bakanlığı Türkiye Halk Sağlığı Kurumu Kadın ve Üreme Sağlığı Daire Başkanlığı. Evlilik öncesi muayene ve danışmanlık rehberi. Ankara: T.C. Sağlık Bakanlığı; 2013. https://dosyaism.saglik.gov.tr/Eklenti/10503/0/evlilik-oncesi-muayene-ve-danismanlik-rehberipdf.pdf Accessed 2 Oct 2024 Rea LM, Parker RA. Designing and conducting survey research. San Francisco (CA): Jossey-Bass; 1992. Additional Declarations No competing interests reported. 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Türkiye, Bursa Example","fulltext":[{"header":"Background","content":"\u003cp\u003eMigration has had a significant impact on public health throughout history. Turkey is one of the largest host countries for migrant populations worldwide (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Migrants are more vulnerable to infectious diseases due to poor living conditions and limited access to healthcare services. Viral hepatitis is among the diseases that require particular attention in migrant communities. The World Health Organization\u0026rsquo;s Global Viral Hepatitis Elimination program highlights migrants as a high-risk group for viral hepatitis (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFrom the perspective of global health security, the adverse experiences encountered by migrants\u0026mdash;primarily from countries affected by conflicts, political instability, or economic crises\u0026mdash; throughout their prolonged migration journey, along with the lack of surveillance, social assistance and healthcare services, undermine the effectiveness of disease control measures (\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). These conditions of conflict and instability lead to disruptions in healthcare systems, interruptions in health screenings and treatments, and consequently, negatively impact migrants\u0026rsquo; health even before they migrate (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The overcrowded and unhygienic conditions experienced during migration and upon arrival, along with difficulties in accessing healthcare services in host countries, further exacerbate this situation for migrants (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). All these factors render migration a risk factor for the spread of infectious diseases from regions with high incidence and prevalence to other areas (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Studies conducted worldwide on migrant populations have shown that migrants from regions with moderate to high endemicity tend to exhibit prevalence rates consistent with those of their countries of origin (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). In recent years, after receiving the highest number of migrants from Middle Eastern countries and Afghanistan, Turkey has also been receiving migration from Central Asian and Eastern European countries, which have the highest endemicity of hepatitis C in the world (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eStudies on the prevalence of hepatitis C among migrants in Turkey are limited. Existing research has been conducted at the provincial level and has primarily focused on migrants of Syrian and Afghan origin. This study aims to determine the seroprevalence of anti-HCV among regular migrants living in Bursa, compare it with prevalence rates in their countries of origin, and contribute to public health policies concerning migrant health.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a cross-sectional investigation aimed at determining the prevalence of anti-HCV among regular migrants living in Bursa. Data were obtained from the Bursa Provincial Health Directorate for regular migrants who presented to public hospitals, family health centers, and migrant health centers in Bursa and underwent anti-HCV testing between January 2018 and December 2022. Initially, the dataset included 13,500 records; however, after excluding duplicate entries, the study was conducted with data from 11,558 individuals. The analysis incorporated anti-HCV test results along with demographic variables, including age, sex, and nationality. Nationalities with fewer than 100 individuals were grouped and analyzed under the world regions classified by the World Health Organization based on epidemiological data and regional proximity.\u003c/p\u003e\n\u003cp\u003eUndocumented migrants and individuals who had acquired Turkish citizenship were excluded from the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe normality of data distribution was assessed using the Shapiro-Wilk test. The chi-square test and the Fisher-Freeman-Halton test were used for categorical variables. Due to the large sample size, when statistical significance was detected in categorical comparisons, the results were interpreted using the Phi coefficient for 2\u0026times;2 tables and Cram\u0026eacute;r\u0026rsquo;s V coefficient for 2\u0026times;k and k\u0026times;k (k\u0026gt;2) tables\u0026nbsp;\u003cspan lang=\"TR\"\u003e(13)\u003c/span\u003e Statistical analyses were performed using SPSS v25, with a significance level set at p\u0026lt;0.05. The interpretation of Phi effect size values was based on the ranges provided in Table 7 (49), as presented in Additional File.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eDemographic Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, anti-HCV data from 11,558 registered migrants were analyzed. The demographic and serological characteristics of the study population are presented in Table 1. A relatively young participant group was observed, with a median age of 25 years. The majority of participants were women (74%). When the distribution of migrants by age group was examined, a statistically significant but low-level difference was found (p\u0026lt;0.001).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic and serological data of the study population\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" align=\"\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026le;14\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e15-49\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026ge;50\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eNumber of Participants\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e8572 (%74)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e2986 (%26)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e11558\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10 502\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e597\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eMedian Age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAge Range\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0-14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e15-49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e50-91\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eAnti-HCV Positive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eThe details of the countries of origin of the 11,558 participants, predominantly from Syria, as well as from the Middle East, Central Asia, and Eastern Europe, are presented in Table 2. Nationalities with fewer than 100 individuals were grouped and analyzed under the world regions classified by the World Health Organization based on epidemiological data and regional proximity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Distribution of the study population by country of origin\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 331px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegions and Countries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNumber of Participants\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eSyria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e6043\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eAzerbaijan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e1319\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eRussia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eKazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e413\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eUzbekistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e396\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eKyrgyzstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e297\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eUkraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e208\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eGreece\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e179\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eBulgaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e174\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eTurkmenistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e142\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eAfghanistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eMorocco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eOther Eastern Mediterranean Region Countries \u003cem\u003e(Table 2.a)*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e340\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eOther European Region \u0026nbsp; \u0026nbsp; Countries \u003cem\u003e(Table 2.b)*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e370\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eAfrican Region Countries \u003cem\u003e(Table 2.c)*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eOther Regions and Countries \u003cem\u003e(Table 2.d; 2.e; 2.f)*\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e212\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eStateless/Unidentified Nationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 331px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003e11558\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cem\u003e*\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eSee Additional File Table 2.\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUpon examining anti-HCV values, 152 out of 11,558 migrants (1.3%) were found to be positive. When analyzing anti-HCV positivity rates by country and region, a statistically significant difference was observed, albeit at a low level (p\u0026lt;0.001). Among the countries of origin, Uzbekistan (5.8%), Turkmenistan (5.6%), and Kazakhstan (3.4%) had the highest prevalence rates (Table 3).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3: Comparison of anti-HCV positivity rates by country\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"614\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 255px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion and Countries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti-HCV (-)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 125px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnti-HCV (+)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value (Cram\u0026eacute;r\u0026rsquo;s V)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAfghanistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"19\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;0.001 (0.122)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMorocco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSyria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e6015\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAzerbaijan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1282\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e97.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eTurkmenistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e94.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eKazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e96.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eKyrgyzstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e98.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eUzbekistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e373\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e94.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e5.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eBulgaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eGreece\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eRussia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e766\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e98.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eUkraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAfrican Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e100.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOther Eastern Mediterranean Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e335\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e98.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOther European Region \u0026nbsp;Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e367\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eOther Regions and \u0026nbsp;Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e210\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e99.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eStateless/Unidentified Nationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e148\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e96.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e3.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e11406\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 76px;\"\u003e\n \u003cp\u003e98.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 48px;\"\u003e\n \u003cp\u003e152\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 77px;\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eParticipants were categorized into three age groups: 0\u0026ndash;14, 15\u0026ndash;49, and \u0026ge;50 years. Accordingly, individuals aged 0\u0026ndash;14 were defined as Group 1, those aged 15\u0026ndash;49 as Group 2, and those aged 50 and above as Group 3. When analyzing the anti-HCV positivity rates across all migrant age groups, a statistically significant difference was observed (p\u0026lt;0.001). However, according to the Phi effect size, this significance was negligible.\u003c/p\u003e\n\u003cp\u003eIn pairwise comparisons, a statistically significant difference was found between individuals aged 50 and above and those in the 0\u0026ndash;14 and 15\u0026ndash;49 age groups (p\u0026lt;0.001). The positivity rate in the 50 and above age group was observed to be higher than in the other two age groups (Table 4). Among migrants of Syrian, Azerbaijani, and Kazakh origin, the positivity rate in the 50 and above age group was significantly higher compared to other age groups (Table 5). However, when positivity rates were analyzed by age groups in other countries and regions, no statistically significant difference was found (Table 4). No significant difference in anti-HCV prevalence was detected between female and male participants (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Comparison of anti-HCV positivity rates by age groups across countries and regions of origin\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"595\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 217px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion and Countries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value (Cramer\u0026rsquo;s V)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAfghanistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1,000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eSyria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt;0.001 (0.072)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAzerbaijan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0,046 (0,068)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eMorocco\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTurkmenistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e9.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0,521\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eKazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.018 (0.164)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eKyrgyzstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e6.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.324\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eUzbekistan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e12.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.302\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eBulgaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.240\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eGreece\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.252\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eRussia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.185\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eUkraine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eAfrican Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eOther European Region \u0026nbsp; \u0026nbsp; Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eOther Eastern Mediterranean Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e8.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.083\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eOther Regions and \u0026nbsp;Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eStateless/Unidentified Nationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e0.063\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 217px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e119\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 38px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 47px;\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u0026lt;0,001 (0,076)\u003c/p\u003e\n \u003cp\u003e1-2: 0.338\u003c/p\u003e\n \u003cp\u003e1-3: \u0026lt;0.001\u003c/p\u003e\n \u003cp\u003e2-3: \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Pairwise Comparison of Countries with High Anti-HCV Prevalence in Individuals Aged 50 and Above\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"548\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 113px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion and Countries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 1\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 79px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGrup 3\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value (Cramer\u0026rsquo;s V)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePairwise Comparisons\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eSyria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e\u0026lt;0.001 (0.072)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1-2 : 1.000\u003c/p\u003e\n \u003cp\u003e1-3: \u0026nbsp;0.017\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;2-3: \u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eAzerbaijan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e5.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.046 (0.068)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1-2 : 0.240\u003c/p\u003e\n \u003cp\u003e1-3 : 1.000\u003c/p\u003e\n \u003cp\u003e2-3 : 0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 113px;\"\u003e\n \u003cp\u003eKazakhstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e2.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 39px;\"\u003e\n \u003cp\u003e14.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.018 (0.164)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 123px;\"\u003e\n \u003cp\u003e1-2 : 1.000\u003c/p\u003e\n \u003cp\u003e1-3 : 0.309\u003c/p\u003e\n \u003cp\u003e2-3 : 0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Comparison of anti-HCV positivity rates by gender across countries and regions of origin\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"529\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eRegion and Countries\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 161px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e(%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eAfghanistan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eMorocco\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eSyria\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.243\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eIraq\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eAzerbaijan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.821\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTurkmenistan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eKazakhstan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e7.3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.101\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eKyrgyzstan\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eUzbekistan\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e6.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.149\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eBulgaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eGreece\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eRussia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.673\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eUkraine\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eAfrican Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eOther European Region \u0026nbsp;Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eOther Eastern Mediterranean Region Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.079\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eOther Regions and \u0026nbsp;Countries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e0.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.514\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eStateless/Unidentified Nationality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e3.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 75px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e121\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 80px;\"\u003e\n \u003cp\u003e1.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn our study, the anti-HCV prevalence among migrants living in Bursa was found to be 1.3%. Previous studies conducted on migrants in Turkey have reported higher anti-HCV prevalence rates compared to our findings (\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). This discrepancy may be attributed to the fact that, unlike our study population, the majority of participants in those studies were irregular migrants, who are more likely to be exposed to poor and unhygienic conditions and to engage in high-risk behaviors. Additionally, these previous studies were conducted in earlier years and did not include Syrian migrants. As a result, their sample populations primarily consisted of migrants from regions with higher endemicity, such as Central and South Asia, rather than from Syria, which represents more than half of our study population and is considered a low-endemicity region. This factor may explain the significantly higher prevalence rates reported in those studies.\u003c/p\u003e \u003cp\u003eAccording to the TURHEP study conducted in Turkey in 2012 and data from the Centers for Disease Control and Prevention in 2019, the anti-HCV prevalence was reported to be less than 1% and 0.4%, respectively (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Based on these data, Turkey is classified as a very low-endemicity country. However, this status makes Turkey more vulnerable to the hepatitis C virus due to the high influx of migrants from regions with high endemicity.\u003c/p\u003e \u003cp\u003eThe Middle East, Central Asia, and Eastern Europe emerge as the primary regions from which Turkey receives the highest number of migrants (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Similarly, in our study, the number of individuals from these regions seeking healthcare for hepatitis C assessment was higher than those from other regions (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, participants were categorized into three age groups: 0\u0026ndash;14, 15\u0026ndash;49, and \u0026ge;\u0026thinsp;50 years. Accordingly, individuals aged 0\u0026ndash;14 were defined as Group 1, those aged 15\u0026ndash;49 as Group 2, and those aged 50 and above as Group 3. This categorization was made based on a literature review indicating a higher prevalence of marriage and pregnancy among migrants aged 15 and older. Accordingly, individuals aged 14 and younger and those aged 15 and older were analyzed as separate groups (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe anti-HCV prevalence among migrants aged 50 and above (5%) was found to be significantly higher than that in the 15\u0026ndash;49 age group (1.1%) and the 0\u0026ndash;14 age group (0.7%) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This result is not surprising, as advanced age is widely recognized as one of the most significant determinants of hepatitis C infection, both globally and in studies conducted in Turkey (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e)\u003c/p\u003e \u003cp\u003eIn our study, the highest prevalence was observed among individuals of Uzbek (5.8%) and Turkmen (5.6%) origin, consistent with the high endemicity rates reported in their home countries (Uzbekistan: 4.3%; 9.6%; 11.3% (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e); Turkmenistan: 5.6%; (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e)). These were followed by Kazakhstan (3.4%), Ukraine (2.9%), Azerbaijan (2.8%), Kyrgyzstan (2.0%), and Russia (1.7%). The prevalence among migrants from these Central Asian and Eastern European countries aligns with the hepatitis C endemicity levels reported in their countries of origin, which range from moderate to high endemicity (2\u0026ndash;5%) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). A 2009 study conducted on undocumented migrants in Istanbul found similarly high hepatitis C prevalence rates in Turkmenistan, Uzbekistan, and Azerbaijan, as observed in our study. This was attributed to the widespread use of intravenous drugs in these former Soviet republics (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). In many countries with inadequate infection control measures, unsafe medical procedures, such as unsafe injections, remain the most common transmission route. However, intravenous drug use has become the dominant mode of transmission in the United States and Australia over the past 40 years. Moreover, in most countries, regardless of their income level\u0026mdash;whether high, middle, or low\u0026mdash;unsanitary conditions during drug preparation and the sharing of injection equipment have become the primary routes of transmission (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, the prevalence of anti-HCV among Syrian migrants\u0026mdash;the largest migrant group and comprising more than half of our study population\u0026mdash;was found to be 0.4%. This rate is consistent with the prevalence reported among Syrian migrants in both Europe and Turkey (\u003cspan additionalcitationids=\"CR27\" citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). It is likely that the adverse conditions imposed by war, including the necessity of performing elective or emergency blood transfusions without proper screening and the violation of infection control protocols during medical procedures, have exacerbated the previous situation, further increasing the prevalence of infectious diseases, particularly among high-risk groups. Indeed, a study conducted on Turkish and Syrian patients with thalassemia major found that out of the entire population, only two Syrian patients, aged 9 and 15, tested positive for anti-HCV. This finding suggests that war conditions may have contributed to gaps in blood screening practices (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn our study, it was noteworthy that 74% of the participants were women. Except for the African region, the proportion of women among individuals tested for anti-HCV across all countries and regions ranged between 60% and 96%. We attribute this to antenatal screening. Although hepatitis C screening is not routinely recommended for pregnant women in Turkey unless a risk factor is present (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e), HBsAg and anti-HCV testing is recommended for all pregnant women in the first trimester according to the Viral Hepatitis Management Algorithm developed by the Ministry of Health, as part of the Turkish Viral Hepatitis Prevention and Control Program. Consequently, routine antenatal testing is conducted (\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e). The high pregnancy rate among Syrian migrants may have contributed to the increased number of female individuals seeking medical care. Additionally, among migrants from Central Asia and Eastern Europe (Turkmenistan, Uzbekistan, Russia, Ukraine), the proportion of women ranged between 83% and 92%. It has been reported that due to financial difficulties, a significant number of female refugees from these regions work as janitors, cleaners, or even commercial sex workers (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). A 2018 review emphasized that migrant women who initially come to Turkey for regular employment often face economic hardships and may be forced into sex work. Indeed, studies on migrant women have reported that victims of sex trafficking were deceived by false job offers and subsequently coerced into sex work through violence and harassment, despite initially migrating to Turkey for legal employment (\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan additionalcitationids=\"CR35\" citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e). These disadvantaged conditions may have increased the number of migrant women seeking healthcare services, which could explain the high proportion of female patients in our study. Furthermore, intravenous drug use frequently coexists with such disadvantaged circumstances. Even independently of these factors, the psychological impact of being a female migrant and the challenges of coping with difficult living conditions may also contribute to this trend. This may explain the higher anti-HCV prevalence observed among female migrants from these countries. The prevalence among female migrants was found to be 6.8% for Turkmenistan, 6.4% for Uzbekistan, 3.2% for Ukraine, 2.9% for Azerbaijan, 2.8% for Kazakhstan, 2.1% for Kyrgyzstan, and 1.6% for Russia. Additionally, in migrants from Turkmenistan (6.8%), Uzbekistan (6.4%), and Ukraine (3.2%), all positive cases were women.\u003c/p\u003e \u003cp\u003eWhen examining the literature, the majority of studies indicate no significant difference in prevalence between male and female individuals (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). However, large-scale observational and surveillance reports generally show higher prevalence rates among men (\u003cspan additionalcitationids=\"CR39 CR40\" citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e). In contrast, among populations of intravenous drug users, women have been found to have higher prevalence rates (\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e). This has been attributed to various socio-behavioral factors, including not seeking medical assistance due to fears of stigma and losing child custody, experiences of trauma, engagement in sex work, sharing injection equipment with a partner, and relying on others for drug preparation and injection, which may increase the risk of contamination due to lack of proper disinfection practices or reuse of injection equipment (\u003cspan additionalcitationids=\"CR43\" citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHCV is known to be rarely transmitted from mother to child. Estimates from large-scale studies suggest that the frequency of perinatal transmission ranges between 0% and 5% (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e, \u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). While the exact timing of transmission remains unclear, the detection of HCV RNA within the first month of life in infants who were not breastfed suggests that intrauterine transmission may have occurred in some cases (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e). Additionally, the mode of delivery has been found to have no effect on vertical transmission (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e). Furthermore, hepatitis C treatment regimens cannot be administered during pregnancy. For these reasons, preconception screening is clearly a more effective strategy. In Turkey, preconceptional hepatitis C screening is only recommended when a risk factor is present. Premarital screening for hepatitis C is also conducted only if suspicion arises and with the individual's consent (\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e). Therefore, it may be necessary to screen female migrants from high-endemicity regions during the preconception period. However, since it may be challenging to reach migrants at the time of pregnancy planning, routine screening of at least intravenous drug-using female migrants aged 15\u0026ndash;49 could be considered. If high-risk migrant women are not screened, their future children will be at risk of hepatitis C infection both due to perinatal transmission and the high likelihood of the infection progressing asymptomatically.\u003c/p\u003e \u003cp\u003eEven if they have migrated through legal means, the awareness of seeking medical care during pregnancy may be low among migrants, depending on the development level of their countries of origin. Additionally, reaching these women may be challenging due to social factors; therefore, migration offices could provide information on preconception and antenatal care. Given the substantial number of migrants, this information could be disseminated through brochures in their native languages. Nevertheless, in many cases\u0026mdash;perhaps even the majority\u0026mdash;migrants do not engage in pre-pregnancy planning due to financial, cultural, and social factors. For this reason, screening mothers at the time of delivery could be an effective approach for those who have not been identified during the preconception or antenatal period.\u003c/p\u003e \u003cp\u003eSince the prevalence of viral hepatitis is higher in risk groups compared to the general population, these groups must be evaluated separately. To ensure the success of the Turkey Viral Hepatitis Prevention and Control Program, it is essential to prevent high-risk groups from posing a threat to the healthy population. The long-term financial burden of undiagnosed cases\u0026mdash;whether among citizens or migrants\u0026mdash;due to complications is inevitable. To fully understand the extent of anti-HCV prevalence among migrants and to determine whether screening these populations is cost-effective, much more epidemiological data and research are needed. One of the key findings of this study is the necessity of assessing the cost-effectiveness of prioritizing the screening of women of reproductive age, individuals over 50 years old, and those from high-endemicity countries. The high prevalence observed among women is noteworthy. Implementing targeted interventions for migrant women of reproductive age is of great importance for protecting maternal and infant health and preventing undetected new infections that could hinder the elimination process. The feasibility, necessity, and cost-effectiveness of viral hepatitis screening among migrants\u0026mdash;a critical issue for our country\u0026mdash;should be evaluated in the coming years, as it is crucial for achieving elimination goals.\u003c/p\u003e \u003cp\u003eLimitations\u003c/p\u003e \u003cp\u003eIn this study, causal relationships regarding anti-HCV positivity could not be determined due to the absence of individual data on migrants' risk behaviors. Additionally, the exclusion of irregular migrants from the study may have prevented us from accurately identifying the true migrant prevalence and the overall risk in our region.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe anti-HCV seroprevalence among migrants living in Bursa varies by country of origin, with the highest rates observed among Uzbek and Turkmen migrants. The positivity rate is significantly higher among individuals over 50 years of age. Migrants should also be evaluated in relation to intravenous drug use, which is one of the most significant contemporary risk factors. Given that intravenous drug users have a higher likelihood of hepatitis C infection, targeted programs should be developed and incorporated into action plans to ensure that this group is not missed. Notably, intravenous drug use poses an even greater risk for women of reproductive age. Another high-risk migrant group consists of undocumented migrants. Most undocumented migrants arriving in Turkey originate from high-endemicity regions. Therefore, measures should be taken to monitor irregular migrants and address the public health risks they may pose. The implementation of targeted screening and treatment programs for migrant groups could contribute to the viral hepatitis elimination process.\u003c/p\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eDevelopment of targeted screening programs for migrant communities\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eComparison of migrant populations' health status with seroprevalence data from their countries of origin\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eImplementation of preconceptional and antenatal care informing programs for female migrants of reproductive age\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHCV: Hepatitis C Virus\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthics approval was obtained by the Uludag University Faculty of Medicine Clinical Research Ethics Committee (Decision number: 2023-24/30).\u0026nbsp;The data on anti-HCV testing conducted between Jan 2018 and Dec 2022 in migrants living in Bursa were obtained from the Bursa Provincial Health Directorate. Prior to obtaining the data, necessary permissions was obtained from Bursa Provincial Health Directorate. All methods were according to the ethical principles of the Declaration of Helsinki and approved by the ethical board above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study were obtained from the Bursa Provincial Health Directorate with official permission. Due to privacy and ethical restrictions, these data are not publicly available. However, access to the data may be possible upon reasonable request and with permission from the relevant authorities.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBeyza Nur Kadiroğlu: Writing, including obtaining and organizing the retrospective data from Bursa Provincial Health Directorate, conceiving the study and designing the methodology\u003c/p\u003e\n\u003cp\u003eZ\u0026uuml;leyha Alper: conceiving the study and designing the methodology, contributing to manuscript writing and revisions\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eInternational Organization for Migration (IOM).\u003c/strong\u003e MPM Migrant Presence Monitoring - Situation Report (December 2024). 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Ankara; 2020. https://hsgm.saglik.gov.tr/depo/birimler/bulasici-hastaliklar-ve-erken-uyari-db/Dokumanlar/Rehberler/viral_hepatitler_egitimci_rehberi.pdf Accessed 11 Mar 2025\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eŞahin \u0026Ccedil;.\u003c/strong\u003e T\u0026uuml;rkiye\u0026apos;de kadın g\u0026ouml;\u0026ccedil;men iş\u0026ccedil;ilerinin durumunun \u0026apos;emek-sermaye \u0026ccedil;atışmasında\u0026apos; yeniden değerlendirilmesi. \u003cem\u003e\u0026Ccedil;alışma ve Toplum.\u003c/em\u003e 2018;4(59):2155\u0026ndash;92. https://dergipark.org.tr/tr/pub/ct/issue/71807/1155352.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBakar N, \u0026Ccedil;akır S.\u003c/strong\u003e D\u0026uuml;zensiz g\u0026ouml;\u0026ccedil; ve fuhuş ama\u0026ccedil;lı kadın ticareti: T\u0026uuml;rkiye \u0026ouml;rneği ve İsve\u0026ccedil; modeli \u0026uuml;zerine tartışmalar [Master\u0026rsquo;s thesis]. İstanbul: T.C. 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Sağlık Bakanlığı T\u0026uuml;rkiye Halk Sağlığı Kurumu Kadın ve \u0026Uuml;reme Sağlığı Daire Başkanlığı. Evlilik \u0026ouml;ncesi muayene ve danışmanlık rehberi. Ankara: T.C. Sağlık Bakanlığı; 2013. https://dosyaism.saglik.gov.tr/Eklenti/10503/0/evlilik-oncesi-muayene-ve-danismanlik-rehberipdf.pdf Accessed 2 Oct 2024\u003c/li\u003e\n \u003cli\u003eRea LM, Parker RA. \u003cem\u003eDesigning and conducting survey research.\u003c/em\u003e San Francisco (CA): Jossey-Bass; 1992.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Migrant Health, Hepatitis C, HCV screening, Health disparities in migrants","lastPublishedDoi":"10.21203/rs.3.rs-6211803/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6211803/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMigrant populations are more vulnerable to infectious diseases due to barriers in accessing healthcare services and unfavorable living conditions. The hepatitis C virus (HCV) poses a significant public health concern among migrant communities, as it remains asymptomatic for many years, necessitating early diagnosis. The World Health Organization (WHO) aims to eliminate viral hepatitis by 2030. However, there are substantial gaps in HCV screening and healthcare accessibility for migrants. This study aims to determine the seroprevalence of anti-HCV among regular migrants living in Bursa and to assess its consistency with prevalence rates in their countries of origin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study is a cross-sectional research conducted among regular migrants who presented to public hospitals, family health centers, and migrant health centers in Bursa between 2018 and 2022. A total of 11,558 individuals’ anti-HCV test results were analyzed. Statistical analyses were performed using SPSS v25, along with the chi-square test, the Kruskal-Wallis test, and Cramér’s V coefficient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOf the 11,558 migrants included in the study, 74% were women, with a median participant age of 25 years. The overall anti-HCV seroprevalence was determined to be 1.3%. The highest seroprevalence rates by country of origin were observed among migrants from Uzbekistan (5.8%), Turkmenistan (5.6%), and Kazakhstan (3.4%), respectively. Age group analysis revealed that the anti-HCV positivity rate was significantly higher among migrants aged 50 years and older (p\u0026lt;0.001). In terms of gender, no significant difference was found between men and women. The anti-HCV seroprevalence largely aligns with the endemicity levels of the migrants' countries of origin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe hepatitis C seroprevalence among migrants living in Bursa is generally consistent with the endemicity levels of their countries of origin. Targeted screening of high-risk groups, improving migrants' access to healthcare services, and developing early diagnosis strategies are essential.\u003c/p\u003e","manuscriptTitle":"Is the anti-HCV prevalence of immigrants consistent with the anti-HCV prevalence of the country of origin? 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