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De Luca GD, Lin X. The role of health and health systems in promoting social capital, political participation and peace: A narrative review. Health Policy 2024; 141:105009. [PMID: 38350755 DOI: 10.1016/j.healthpol.2024.105009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/29/2023] [Accepted: 01/09/2024] [Indexed: 02/15/2024]
Abstract
High levels of violence and insecurity are highly detrimental for societies. United Nations Sustainable Development Goal 16 is advocating for peaceful, accountable and inclusive institutions as one powerful channel to foster global development. Investing in health and health policies can potentially contribute achieving these objectives. After providing a conceptual framework, this article reviews the existing literature on the evidence of the role of health and health systems in promoting social capital and trust, political engagement and participation, and peace that closely relate to the objectives of Sustainable Development Goal 16. We provide evidence of a systematically positive impact of better physical and mental health on social capital, and on political participation, both contributing to the sustainability of inclusive democratic institutions. We also document that health and health systems can help supporting peace, both via the reduction of social inequality and grievances, and by reducing the disruptive effects of epidemic shocks. Overall, the study provides evidence that health and health systems can generate co-benefits outside the health domain by promoting social capital, political participation and peace.
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Affiliation(s)
| | - Xi Lin
- University of York, Heslington, YO105DD York, UK
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Shokr H, Rishworth A, Wilson K. Access to emergency care in Egypt: Tiered health care and manifestations of inequity. Soc Sci Med 2023; 336:116212. [PMID: 37783622 DOI: 10.1016/j.socscimed.2023.116212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/27/2023] [Accepted: 09/01/2023] [Indexed: 10/04/2023]
Abstract
Market-driven health care reforms and development strategies continue to drive the privatization of health care services across the world. When these measures are implemented, large disparities emerge and are maintained. Using a modified version of the access to care framework developed by Penchansky and Thomas, this paper examines the manifestations of inequity between private for-profit and public emergency care in the Greater Cairo Region and Asyut, Egypt. In-depth interviews with physicians working in both sectors reveals stark disparities in access between these two health care sectors in Egypt. Access issues identified include unaffordable care in the private sector, unavailable medical supplies and overcrowding in public hospitals, as well as a salary gap that drives health care workers from public to private practice, creating staffing shortages in public hospitals. The manifestations of these inequities are often severe, usually tangible, and according to health care providers, embodied in the experiences of service users.
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Affiliation(s)
- Hisham Shokr
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
| | - Andrea Rishworth
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
| | - Kathi Wilson
- Department of Geography, Geomatics, and Environment, University of Toronto Mississauga, Mississauga, Ontario, Canada.
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3
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Bwirire D, Crutzen R, Letschert R, Namegabe EN, de Vries N. Basic Health Service Delivery to Vulnerable Populations in Post-Conflict Eastern Congo: Asset Mapping. Healthcare (Basel) 2023; 11:2778. [PMID: 37893852 PMCID: PMC10606858 DOI: 10.3390/healthcare11202778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Populations in post-conflict settings often have increased healthcare needs, residing in settings where basic services needed to maintain good health may be non-existent or hard to access. Therefore, there is a need for better identification and reallocation of resources as part of the post-conflict health rehabilitation effort. Assets can be described as the collective resources that individuals and communities have at their disposal, which protect against adverse health outcomes and promote health status. This study applies an asset-based approach to explore the most optimal design of health services and to identify the resource constraints for basic health service delivery to the most vulnerable communities in eastern Congo. We implemented the asset mapping in two phases. Firstly, we combined a qualitative survey with community walks to identify the assets already present in the communities. Secondly, we conducted group discussions to map out assets that are the core of asset-based community development (ABCD) practice. We finally documented all assets in a Community Asset Spreadsheet. Overall, 210 assets were identified as available and potentially valuable resources for the communities in eastern Congo. Among them, 57 were related to local associations, 23 to land and physical environments, 43 to local institutions, 46 to individuals, 35 to economy and exchange, and only 6 to culture, history, and stories. Drawing upon the findings of the qualitative survey, community walks, and group discussions, we concluded that an important number of resources are in place for basic health service delivery. By activating existing and potential resources, the most vulnerable populations in eastern Congo might have the required resources for basic health service delivery. Our findings support the use of an asset-mapping research method as appropriate for identifying existing and potential resources for basic health services in a post-conflict setting.
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Affiliation(s)
- Dieudonne Bwirire
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 HA Maastricht, The Netherlands; (R.C.); (N.d.V.)
| | - Rik Crutzen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 HA Maastricht, The Netherlands; (R.C.); (N.d.V.)
| | | | - Edmond Ntabe Namegabe
- Faculté de Santé et Développement Communautaires, Université Libre des Pays des Grands Lacs (ULPGL), Goma 368, Democratic Republic of the Congo;
| | - Nanne de Vries
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6229 HA Maastricht, The Netherlands; (R.C.); (N.d.V.)
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Tiwari C, Jain N, Goli S, Puri P. Political determinants of health: (re) examining the role of governance in reducing maternal mortality. Health Econ Policy Law 2023; 18:248-273. [PMID: 36994657 DOI: 10.1017/s1744133123000026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
Abstract
Given change in the universal developmental agenda and the quality of governance in the last two decades, this paper re-examines the relationship between governance, health expenditure and maternal mortality using panel data for 184 countries from 1996 to 2019. By employing the 'dynamic panel data regression model', the study reveals that a one-point improvement in the governance index decreases maternal mortality by 10-21%. We also find that good governance can better translate health expenditure into improved maternal health outcomes through effective allocation and equitable distribution of available resources. These results are robust to alternative instruments, alternative dependent variables (such as infant mortality rate and life expectancy), estimation by different governance dimensions and at the sub-national level. Additional findings using 'Quantile regression' estimates show that the quality of governance matters more than the health expenditure in countries with a higher level of maternal mortality. While the 'Path regression' analysis exhibits the specific direct and indirect mechanisms through which the causal inference operates between governance and maternal mortality.
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Affiliation(s)
- Chhavi Tiwari
- Institut national d'études démographiques, 9 Course des Humanités, Aubervillers, Campus Condorcet, 93300 Aubervilliers-Paris, France
| | - Neha Jain
- Indian Institute of Foreign Trade, New Delhi, India
| | - Srinivas Goli
- Department of Fertility and Social Demography, International Institute for Population Sciences, Deonar, Mumbai-400 088, India
| | - Parul Puri
- Department of Survey Research and Data Analytics, International Institute for Population Sciences, Mumbai, India
- Research Fellow, The George Institute for Global Health, New Delhi, India
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Al Waziza R, Sheikh R, Ahmed I, Al-Masbhi G, Dureab F. Analyzing Yemen's health system at the governorate level amid the ongoing conflict: a case of Al Hodeida governorate. Discov Health Syst 2023; 2:15. [PMID: 37520515 PMCID: PMC10169293 DOI: 10.1007/s44250-023-00026-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/27/2023] [Indexed: 08/01/2023]
Abstract
Background Yemen is regarded as one of the Middle East's poorest countries. Decades of political, economic, and social difficulties have culminated in the current protracted conflict. As a result, the globe experienced its worst humanitarian catastrophe. The ongoing war has affected several public services, notably the health sector, which is operating at less than half its capacity. This study aims to examine Yemen's health system at the governorate level (Al Hodeida) amidst the current conflict. It analyzes current challenges and produces suggestions for enhancement. Methods The study used qualitative research methods such as Key Informant Interviews (KIIs) and document analysis. The study used WHO's health systems framework to measure health system performance. Twelve KIIs were conducted via Skype with several health stakeholders. In addition, documents were analyzed to inform the subject guide, generate themes, and aid in the triangulation of results. Results According to the study findings, the governorate health system managed to offer a minimum level of healthcare services while making some advances in outbreak control jointly with other partners. One of the main difficulties confronting the governorate's health system is a severe lack of financial resources forcing it to rely entirely on external aid. Furthermore, other significant deficiencies include inadequate health system organogram, low reporting capacities, insufficient funding, and scarcity of health professionals. Conclusion Yemen's frail health system has been weakened by almost eight years of insecurity and conflict. If the current scenario continues, most of Yemen's health system's operations and indicators will likely deteriorate. On the other hand, progress in some areas, such as primary healthcare (PHC) services and disease management, is remarkable. However, for better performance, Yemen's health system leadership and stakeholders should seek a holistic strategy to improve the entire dimensions of the health system.
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Affiliation(s)
- Raof Al Waziza
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
| | | | - Iman Ahmed
- World Health Organization, Gaziantep, Turkey
| | | | - Fekri Dureab
- Institute for Research in International Assistance (IRIA), Akkon Hochschule für Humanwissenschaften, Berlin, Germany
- Heidelberg Institute of Global Health, Medical School, Ruprecht-Karls-University, Heidelberg, Germany
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Ahmad NA, Ismail NW, Sidique SFA, Mazlan NS. Air pollution, governance quality, and health outcomes: evidence from developing countries. Environ Sci Pollut Res Int 2023; 30:41060-41072. [PMID: 36630041 DOI: 10.1007/s11356-023-25183-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 01/03/2023] [Indexed: 06/17/2023]
Abstract
While studies have demonstrated that air pollution can be catastrophic to the population's health, few empirical studies are found in the economic literature because a considerable proportion of the evidence comes from epidemiological studies. Because of the crucial role of governance in the health community, good governance has been a contentious issue in public sector management in recent years. Therefore, the aim of this study is to examine the effects of air pollution and the role of governance on health outcomes. This study employed the generalized method of moment (GMM) estimation techniques to analyse panel data for 72 developing countries from 2010 to 2017. The empirical results confirm that higher PM2.5 and CO2 levels have a detrimental influence on life expectancy and healthy life expectancy, whereas the role of governance has a positive impact on life expectancy and healthy life expectancy. Furthermore, the findings show governance quality plays a role in moderating the negative effect of PM2.5 on health outcomes. The ongoing rise in air pollution has had a significant impact on the health of developing countries. It appears that governance quality has improved health outcomes. The findings have important policy implications, such that strengthening governance can reduce air pollution emissions in developing countries. However, to reduce the health effects of air pollution, developing countries must implement effective environmental development policies and track the implementation and enforcement of such policies.
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Affiliation(s)
- Nor Asma Ahmad
- Faculty of Entrepreneurship and Business, Universiti Malaysia Kelantan, Kampus Kota, Pengkalan Chepa, 16100, Kota Bharu, Kelantan, Malaysia.
| | - Normaz Wana Ismail
- School of Business and Economics, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
| | - Shaufique Fahmi Ahmad Sidique
- Institute of Tropical Agriculture and Food Security, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
| | - Nur Syazwani Mazlan
- School of Business and Economics, Universiti Putra Malaysia UPM, 43400, Serdang, Selangor, Malaysia
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El Hasbani G, Jawad ASM, Uthman I. Rheumatology research output in the Arab World: despite the challenges. Reumatismo 2022; 74. [PMID: 36580063 DOI: 10.4081/reumatismo.2022.1520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 10/03/2022] [Indexed: 12/30/2022] Open
Abstract
Rheumatology is a field in which diagnostic, pathophysiological, and therapeutic advancements occur daily. These developments are the result of research in basic sciences, translational sciences, and clinical sciences. Physical and financial support, provided by individuals and institutions, is essential for all types of research. The political and economic instability in the Arab world has impacted the advancement of healthcare and the output of research. This review seeks to evaluate the quantity and quality of rheumatology-related research conducted in the Arab world. This review examined the number of rheumatological clinical publications produced by Arab countries between 2017 and 2021 and cited by PubMed/MEDLINE. Publications with authors from multiple nations were disqualified. Publications were then categorized by type, including randomized controlled trials (RCTs), cohort studies, cross-sectional studies, systematic reviews, narrative reviews, and case reports. Publications were also organized according to the regions of the Arab world: North and East Africa, the Middle East, and the Arabian Peninsula. The review also used data from the world bank to evaluate the gross domestic product (GDP) and total population of Arabian nations in order to calculate a ratio of publications to GDP and publications to population. Egypt had the highest number of publications among north and east African countries and Arab countries in general, with 261 publications, including the highest number of RCTs, which were 23. With 81 publications, Saudi Arabia had the highest number of publications on the Arabian peninsula. However, no individual country on the Arabian peninsula published an RCT. Lebanon had the most publications in the Middle East, but the majority were reviews and case reports. Tunisia had the highest ratio of publications to GDP. Notably, the number of publications increased during the coronavirus disease 2019 era in some countries. The Arab world is still able to produce clinical rheumatology publications despite its political instability and lack of resources. The influence of such publications on the daily practice of rheumatology is still debatable.
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Affiliation(s)
- G El Hasbani
- Department of Internal Medicine, Hartford HealthCare, St. Vincent's Medical Center, Bridgeport, CT.
| | - A S M Jawad
- Department of Rheumatology, The Royal London Hospital, London.
| | - I Uthman
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut.
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Katoue MG, Cerda AA, García LY, Jakovljevic M. Healthcare system development in the Middle East and North Africa region: Challenges, endeavors and prospective opportunities. Front Public Health 2022; 10:1045739. [PMID: 36620278 PMCID: PMC9815436 DOI: 10.3389/fpubh.2022.1045739] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/28/2022] [Indexed: 12/24/2022] Open
Abstract
Background Countries in the Middle East and North Africa (MENA) region have been investing in the development of their health systems through implementing reforms to improve health care delivery for their nations. However, these countries are still facing challenges in providing equitable, high quality healthcare services. There is limited published literature supporting the previous and ongoing attempts that have been made to improve health system performance in MENA countries. Aims This review aims to describe experiences of health system development efforts in the MENA region, highlight progress, identify challenges that need be addressed and future opportunities to achieve responsive and efficient health systems. It also aimed to provide recommendations to further support these health systems toward evolution and performance improvement. Methods A literature review was conducted by searching different databases including PubMed, Scopus, Google Scholar and other electronic resources to identify articles and publications describing health systems development in the MENA region from 1975 to 2022. It also included grey literature, reports and policy and planning documents by international organizations. The identified references were reviewed to extract, analyze, organize and report the findings. Results The review revealed emerging evidence describing governmental initiatives to introduce health system reforms at different levels in the MENA countries. These include initiatives targeting the various elements controlling health system reform: financing, payment, organization, regulation and behavior of providers and consumers. There are several challenges facing the health systems of MENA countries including the rising burden of chronic diseases, inequitable access to health services, deficiency in health workforce, shortage in the use of effective health information systems and leadership challenges. The review identified several key areas that can benefit from further improvement to support health system reforms. These include improving the structure, organization and financing of health systems, health workforce development, effective data management and engagement of key stakeholders to achieve adequate health system reforms. Conclusion The MENA countries have made significant steps to improve the performance of their health systems; yet achieving a comprehensive health reform will require collaboration of various stakeholders including health policy makers, healthcare professionals, and central to the success of the reform, the patients.
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Affiliation(s)
- Maram Gamal Katoue
- Department of Pharmacology and Therapeutics, College of Pharmacy, Kuwait University, Kuwait, Kuwait,*Correspondence: Maram Gamal Katoue
| | - Arcadio A. Cerda
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Leidy Y. García
- Faculty of Economics and Business, University of Talca, Talca, Chile
| | - Mihajlo Jakovljevic
- Institute of Advanced Manufacturing Technologies, Peter the Great St. Petersburg Polytechnic University, Saint Petersburg, Russia,Institute of Comparative Economic Studies, Hosei University Faculty of Economics, Tokyo, Japan,Department of Global Health Economics and Policy, University of Kragujevac, Kragujevac, Serbia
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Muacevic A, Adler JR. COVID-19 Statistics in the Arab World by the End of October 2022: A Cross-Sectional Study. Cureus 2022; 14:e32670. [PMID: 36660506 PMCID: PMC9845511 DOI: 10.7759/cureus.32670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2022] [Indexed: 12/23/2022] Open
Abstract
Background The coronavirus disease 2019 (COVID-19) has affected almost all world countries, including all 22 Arab countries. However, over the last 34 months, the world has suffered from the pandemic unevenly, and COVID-19 statistics are dynamic. Objectives The current study aimed to use COVID-19 data to examine COVID-19 statistics (including the number of cases/deaths/tests) in Arab countries by the end of October 2022 and compare the findings with global statistics. This study was also used to determine the extent to which statistics vary across Arab countries. Methods The primary data on COVID-19 for each Arab country were obtained from the "Worldometer" website. The data include the cumulative incidence of COVID-19 per country, the cumulative number of deaths, the total number of tests performed, the number of cases per million population, the number of deaths per million, the number of tests per million, and the total population. The case-fatality rate (CFR) was calculated (number of deaths/number of cases). In addition, the median age for each Arab country was extracted from the United Nations website. The rate of vaccination coverage (people who received two doses) was extracted from the "Our World in Data" website. COVID-19 statistics were further analyzed in Arab countries in Asia compared to those in Africa at the end of 2020, 2021, and October 2022. To compare the Arab countries to the globe, COVID-19 data for each continent were obtained. The Spearman correlation coefficient was used to determine the relationship between different variables across Arab countries. Results As of November 1, 2022, about 636 million COVID-19 cases and 6.6 million deaths had been recorded worldwide. Arab countries accounted for nearly 2.21% and 2.62% of all cases and deaths, respectively. In general, the mean deaths per million and the mean cases per million for Arab countries were lower than those of the world's countries, although Arab countries recorded a higher mean case-fatality rate. Alternatively, Arab countries in aggregate recorded fewer deaths per million (381) than the world (830). However, statistics across Arab countries have been inconsistent; Arab countries in Africa were less affected. Arab countries have performed approximately 359 million tests (5.29% of all tests), 93% of which were performed by Arab countries in Asia. Moreover, 54.4% of all tests were performed in the United Arab Emirates. Yemen, Somalia, Sudan, Algeria, Syria, Comoros, and Djibouti were the least affected Arab countries based on the number of deaths per million. With the exception of Comoros, these countries were among the least vaccinated in the Arab world. Conclusions In general, Arab countries have been less affected by the COVID-19 pandemic than the rest of the world. However, statistics vary across Arab countries, especially regarding the number of tests performed. Given the natural immunity acquired during the three years and the relatively good vaccine coverage in the Arab world, it is important to reconsider the definition of a suspected case and establish more specific criteria for testing.
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Piñeros M, Ginsburg O, Bendahhou K, Eser S, Shelpai WA, Fouad H, Znaor A. Staging practices and breast cancer stage among population-based registries in the MENA region. Cancer Epidemiol 2022; 81:102250. [PMID: 36115143 PMCID: PMC9693698 DOI: 10.1016/j.canep.2022.102250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/25/2022] [Accepted: 09/05/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Availability of stage information by population-based cancer registries (PBCR) remains scarce for diverse reasons. Nevertheless, stage is critical cancer control information particularly for cancers amenable to early detection. In the framework of the Global Initiative for Cancer Registry Development (GICR), we present the status of stage data collection and dissemination among registries in the Middle East and Northern Africa (MENA) region as well as the stage distribution of breast cancer patients. METHODS A web-based survey exploring staging practices and breast cancer stage was developed and sent to 30 PBCR in 18 countries of the MENA region. RESULTS Among 23 respondent PBCR, 21 collected stage data, the majority (80%) for all cancers. Fourteen registries used a single classification (9 TNM and 5 SEER), 7 used both staging systems in parallel. Out of 12,888 breast cancer patients (seven registries) 27.7% had unknown TNM stage (11.1% in Oman, 46% in Annaba). When considering only cases with known stage, 65.3% were early cancers (TNM I+II), ranging from 57.9% in Oman to 83.3% in Batna (Algeria), and 9.9% were stage IV cancers. Among the nine registries providing SEER Summary stage for breast cancer cases, stage was unknown in 19% of the cases, (0 in Bahrain, 39% in Kuwait). Stage data were largely absent from the published registry reports. CONCLUSION Despite wide stage data collection by cancer registries, missing information and low dissemination clearly limit informing efforts on early detection. The use of two classification systems in parallel implies additional workload and might undermine completeness. The favourable results of early cancer (TNM I+II) in two thirds of breast cancer patients needs to be interpreted with caution and followed up in time. Although efforts to improve quality of stage data are needed, our findings are particularly relevant to the WHO Global Breast Cancer Initiative.
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Affiliation(s)
- Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.
| | - Ophira Ginsburg
- Center for Global Health, US National Cancer Institute, MD, USA
| | | | - Sultan Eser
- Balıkesir University, Faculty of Medicine, Balikesir, Turkey
| | | | - Heba Fouad
- WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Ariana Znaor
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Kabakian-Khasholian T, Makhoul J, Ghusayni A. "A person who does not have money does not enter": a qualitative study on refugee women's experiences of respectful maternity care. BMC Pregnancy Childbirth 2022; 22:748. [PMID: 36199044 PMCID: PMC9533279 DOI: 10.1186/s12884-022-05083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 09/15/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Abstract
Background Women’s childbirth experiences in health facilities is at the core of quality of care. Their perceptions of poor-quality care, including disrespectful care at health facilities during childbirth, is recognized as a significant barrier to seeking care for subsequent births. Research that explores women’s perspectives of the dimensions of disrespect and mistreatment during childbirth in Arab countries is scarce, and there is none pertaining to refugee groups who carry the burden of multiple vulnerabilities and who suffer from discontinued care, especially in fragile health systems. This paper aims at presenting Palestinian, Iraqi and Syrian refugee women’s experiences, understanding and interpretation of disrespect and mistreatment during childbirth in hospitals in Lebanon. Methods This study employed phenomenology, a qualitative research design to generate data through in-depth interviews. Women who were 3 to 6 months postpartum were recruited through the non-governmental organizations (NGOs) that are actively engaged in providing welfare and healthcare services to different populations of refugee women in Lebanon. In total, 24 women were interviewed. All interviews were audio recorded, transcribed verbatim and subjected to thematic analysis. Results Of the 24 women who participated in this study, 9 were Palestinian, 12 were Syrian and 3 were Iraqi. The participants spoke of restricted choices to hospitals, care providers and to types of birth, while revealing adverse experiences during childbirth in healthcare facilities, including verbal and physical abuse, disrespectful verbal and non-verbal communication by healthcare providers. They also reported sub-standard care, denial of birth companions and breaches to their privacy. Our findings exemplify how the coverage of the cost of facility-based births by UN agencies and NGOs increase refugee women’s vulnerability to disrespect and mistreatment during childbirth. Conclusion This study shows how disrespect and mistreatment are intertwined in a complex system which is devised to ensure access to facility-based birth for displaced populations. Implications for programs and policies point to the need for strengthening capacity and for providing resources for the adaptation of global guidelines into context-specific strategies for the provision of quality maternity care during humanitarian crises and beyond. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-05083-2.
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Affiliation(s)
- Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Jihad Makhoul
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Aleni Ghusayni
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Ali AH, Awada H, Nassereldine H, Zeineddine M, Sater ZA, El-Hajj A, Mukherji D. Prostate cancer in the Arab world: Bibliometric review and research priority recommendations. Arab J Urol 2022; 20:81-87. [PMID: 35530565 PMCID: PMC9067956 DOI: 10.1080/2090598x.2021.2024984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective To conduct a scoping review examining the status of prostate cancer research in Arab countries and
systematically map publications across the cancer care pathway.
Prostate cancer incidence has been rising in the Arab world and
tackling its increasing burden will require evidence-based policies. Methods We searched Medline, PubMed and Scopus for peer-reviewed publications related to both our research topic and countries of interest by using controlled vocabulary and keywords. Search results were limited for the period between 2000 and 2020, screened for duplicates, and then included in our study based on pre-specified eligibility criteria. We used a structured data extraction form to extract information related to the article, its methodology, its cancer care pathway, funding status, and authorship. Results A total of 4142 publications were retrieved from our search, of which 874 articles remained after applying eligibility criteria. Trends show a steady increase in prostate cancer research in the Arab world. Most studies were focussed on diagnosis and treatment, whereas a lack in studies concerning screening and prevention, as well as epidemiological data, was evident. Most studies were not funded and had no female author. Country gross domestic product and population were positively correlated with its research output. The USA had the highest number of corresponding authors. The majority of Arab-based studies did not involve collaborations with other countries. Most research conducted was basic or clinical studies with a low level of evidence. Conclusion Our present review identified significant gaps and limitations in prostate cancer research in Arab countries. Priority areas for research investment have also been highlighted as a first step towards context-specific health policies. Abbreviations ASR: age-standardised rate; COVID-19: coronavirus disease 2019; GDP: gross domestic product; HDI: Human Development Index; KSA: Kingdom of Saudi Arabia; UAE: United Arab Emirates
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Affiliation(s)
- Adel Hajj Ali
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hussein Awada
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | | | | | - Zahy Abdul Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Albert El-Hajj
- Division of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Deborah Mukherji
- Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon
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13
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El-Gilany AH, Sameh E, Abou-ElWafa H. Challenges of COVID–19 prevention and control: A narrative review. J Acute Dis 2022. [DOI: 10.4103/2221-6189.355309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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14
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Abdul-Sater Z, Shamseddine A, Taher A, Fouad F, Abu-Sitta G, Fadhil I, Saab R, Sullivan R, Adib SM, Saleh S, Mukherji D. Cancer Registration in the Middle East, North Africa, and Turkey: Scope and Challenges. JCO Glob Oncol 2021; 7:1101-1109. [PMID: 34236931 PMCID: PMC8457856 DOI: 10.1200/go.21.00065] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
National cancer control strategies have been identified as essential tools for reducing and managing the growing burden of cancer in low- and middle-income countries. Cancer registration is an instrumental component of any cancer control strategy, providing the data to inform effective cancer policy. In the Middle East, North Africa, and Turkey (MENAT) region, cancer registration varies immensely and faces multifaceted challenges including protracted conflict. This study investigates and maps out the present capacities and outputs of cancer registration in the MENAT region and identifies thematic barriers facing implementation and utilization of cancer registry data.
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Affiliation(s)
- Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali Taher
- Department of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fouad Fouad
- Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Plastic Surgery and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon, Kuwait City, Kuwait
| | | | - Raya Saab
- Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Richard Sullivan
- Institute of Cancer Policy & Conflict & Health Research Group, King's College London, London, United Kingdom
| | - Salim M Adib
- Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Deborah Mukherji
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Hematology/Oncology, American University of Beirut Medical Center, Beirut, Lebanon
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15
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Idris A, Alabdaljabar MS, Almiro A, Alsuraimi A, Dawalibi A, Abduljawad S, AlKhateeb M. Prevalence, incidence, and risk factors of epilepsy in arab countries: A systematic review. Seizure 2021; 92:40-50. [PMID: 34418747 DOI: 10.1016/j.seizure.2021.07.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/03/2021] [Accepted: 07/29/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the prevalence, incidence, and risk factors of epilepsy in Arab countries. METHODS In this systematic review, electronic databases including PubMed, ProQuest Public Health and Cochrane Library were searched to identify relevant English articles published until April 2020. The search was conducted to cover all 22 Arab countries. Studies were eligible for inclusion if they assessed any of these epidemiological parameters of epilepsy: prevalence, incidence, and/or risk factors and focused on at least one of the Arab countries. The quality of the studies was evaluated using standardized quality assessment tools. RESULTS Twenty-nine articles met the inclusion criteria. Out of the 22 Arab countries, only 11 were found to have published studies reporting on the epidemiology of epilepsy. The median lifetime prevalence of epilepsy in Arab countries was found to be 6.9 per 1000. The median incidence is 89.5 per 100000. The most frequently identified risk factors were parental consanguinity, family history of epilepsy, and a history of perinatal infections/insults. CONCLUSION The prevalence and incidence of epilepsy varies in Arab countries. The most frequently reported risk factor is parental consanguinity. The lack of epidemiological studies on epilepsy in half of the Arab countries calls for more studies on this aspect to identify the burden and risk factors of epilepsy in this region.
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Affiliation(s)
- Anas Idris
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Alyaman Almiro
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Anas Alsuraimi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Ahmad Dawalibi
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Mashael AlKhateeb
- Department of Neurosciences, King Faisal Specialty Hospital, and Research Center, Riyadh, Saudi Arabia.
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16
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Mousa M, Al-Jefout M, Alsafar H, Kirtley S, Lindgren CM, Missmer SA, Becker CM, Zondervan KT, Rahmioglu N. Prevalence of Common Gynecological Conditions in the Middle East: Systematic Review and Meta-Analysis. Front Reprod Health 2021; 3:661360. [PMID: 36304010 PMCID: PMC9580651 DOI: 10.3389/frph.2021.661360] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/22/2021] [Indexed: 02/04/2023] Open
Abstract
Introduction: High prevalence of gynecological conditions in women of Middle Eastern origin is reported, likely due to regional risk factors and mediators. The objective of this systematic review and meta-analysis is to investigate the prevalence of polycystic ovary syndrome (PCOS), endometriosis, uterine fibroids, and adenomyosis in women of Middle Eastern origin. Methods: MEDLINE, EMBASE, PsycINFO, Global Health, and Google Scholar databases were searched from database inception until 14 February 2021 to identify relevant studies. Peer-reviewed research articles that reported the prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern population were written in English or Arabic. The primary outcome was the estimated pooled prevalence of PCOS, endometriosis, uterine fibroids, and adenomyosis in the Middle Eastern populations. The secondary outcome was to assess the evidence in the data for the presence of heterogeneity, by conducting subtype-pooled analysis of prevalence estimates of the conditions. Total weighted prevalence was calculated via Freeman-Tukey arcsine transformation and heterogeneity through the I 2 statistic. Quality control was performed using GRADE criteria. Results: A total of 47 studies, 26 on PCOS, 12 on endometriosis, eight on uterine fibroids, and seven on adenomyosis, were included. The pooled prevalence of PCOS diagnosed according to the NIH criteria was 8.9% (95% CI: 6.5-11.7; prevalence range: 4.0-27.6%), with a higher prevalence from the Gulf Arab states (18.8%, 95% CI: 9.5-30.3; range: 12.1-27.6%). According to the Rotterdam criteria, the pooled prevalence of PCOS was 11.9% (95% CI: 7.1-17.7; range: 3.4-19.9%) with studies limited to the Persian and Levant regions. Endometriosis was diagnosed in 12.9% (95% CI: 4.2-25.4; range: 4.2-21.0%) of women undergoing laparoscopy, for any indication. Uterine fibroid and adenomyosis prevalence of women was 30.6% (95% CI: 24.9-36.7; range: 18.5-42.6%) and 30.8% (95% CI: 27.1-34.6, range: 25.6-37.7%), respectively. Heterogeneity was present between studies due to statistical and methodological inconsistencies between studies, and quality of evidence was low due to sample size and unrepresentative participant selection. Conclusion: This is the first review that has reported the prevalence of gynecological diseases in the Middle Eastern population, suggesting that gynecological morbidity is a public health concern. Due to the health disparities in women, further research is required to understand the relative roles of environmental and genetic factors in the region to serve as a benchmark for evaluation and comparative purposes with other populations.
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Affiliation(s)
- Mira Mousa
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Moamar Al-Jefout
- Department of Obstetrics and Gynaecology, College of Medical and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
- Department of Obstetrics and Gynaecology No. 1. Moscow, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Habiba Alsafar
- Center for Biotechnology, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
- Department of Genetics and Molecular Biology, College of Medicine and Health Sciences, Khalifa University of Science and Technology, Abu Dhabi, United Arab Emirates
| | - Shona Kirtley
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, United Kingdom
| | - Cecilia M. Lindgren
- Li Ka Shing Centre for Health Information and Discovery, The Big Data Institute, University of Oxford, Oxford, United Kingdom
- Nuffield Department of Medicine (C.M.L.), Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Stacey A. Missmer
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States
- Department of Obstetrics, Gynaecology, and Reproductive Biology, College of Human Medicine, Michigan State University, Grand Rapids, MI, United States
| | - Christian M. Becker
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Krina T. Zondervan
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
| | - Nilufer Rahmioglu
- Nuffield Department of Women's and Reproductive Health, Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
- Wellcome Centre for Human Genetics, University of Oxford, Oxford, United Kingdom
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17
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Daoulah A, Al-Faifi SM, Alsheikh-Ali AA, Hersi AS, Lotfi A. Ventricular Arrhythmias in Patients with Spontaneous Coronary Artery Dissection: Findings from the Gulf Spontaneous Coronary Artery Dissection (Gulf SCAD) Registry. Crit Pathw Cardiol 2020; 19:146-152. [PMID: 32134792 DOI: 10.1097/hpc.0000000000000219] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of acute coronary syndrome in young women, with a wide clinical spectrum of severity. Ventricular arrhythmia (VA) can occur and worsen prognosis. The current study compared in-hospital and follow-up adverse cardiovascular events in patients with and without VA at presentation. METHODS Eighty-three cases of SCAD were collected retrospectively from 4 Gulf countries (KSA, UAE, Kuwait, and Bahrain) during the period from January 2011 to December 2017. We divided the patients into 2 groups: those with and without VA at presentation. VA was defined as ventricular tachycardia and/or ventricular fibrillation. In-hospital (recurrent VA, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared among the 2 groups. RESULTS The median age of patients in the study was 44 (37-55) years. Forty-two (51%) were women. VA occurred in 10 (12%) patients in the first 24-hour of hospitalization, and 5 (50%) of those patients had recurrent in-hospital VA. Among those with recurrent VA, 1 died during hospitalization and 1 died within the first year following hospital discharge. CONCLUSIONS In-hospital adverse cardiovascular events were significantly more frequent for patients with SCAD who presented with VA. However, follow-up events were not statistically significant between those with and without VA at presentation.
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Affiliation(s)
- Amin Daoulah
- From the Department of Cardiovascular Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Department of Internal Medicine, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
| | - Ahmad S Hersi
- Emergency Medicine Department, Cleveland Clinic Foundation, Cleveland, OH
| | - Amir Lotfi
- Department of Cardiac Sciences College of Medicine, King Saud University, Riyadh, Kingdom of Saudi Arabia
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18
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Daoulah A, Al-Faifi SM, Alhamid S, Youssef AA, Alshehri M, Al-Murayeh M, Farghali T, Maghrabi M, Balghith M, ElSayed O, Alasmari A, Arafat AA, Elmahrouk AF, Eldesoky A, Refaat WA, Alshahrani SS, Ghazi AM, Al-Azizi KM, Dahdouh Z, Lotfi A. Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry. Angiology 2020; 72:32-43. [PMID: 32787614 DOI: 10.1177/0003319720946974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P = .029).
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Department of Internal Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Sameer Alhamid
- Department of Emergency Medicine, 37849King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali A Youssef
- Department of Cardiology, 289167Saud Al Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia.,Department of Cardiology, 68831Suez Canal University, Ismailia, Egypt
| | - Mohammed Alshehri
- Department of Cardiology, 48077Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Mushabab Al-Murayeh
- Department of Cardiology, 48103Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Tarek Farghali
- Department of Cardiology, 68796Assiut University, Assiut, Egypt
| | - Mohamed Maghrabi
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiology, Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- Department of Cardiology, 48149King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Osama ElSayed
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Alasmari
- Department of Internal Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Faculty of Medicine, 68781Tanta University, Egypt
| | - Ahmed F Elmahrouk
- Cardiothoracic Surgery Section, Department of Cardiology, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Akram Eldesoky
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Al Qassim, Kingdom of Saudi Arabia
| | - Wael A Refaat
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Saif S Alshahrani
- Department of Emergency Medicine, 195017King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman M Ghazi
- Department of Cardiology, 289167Saud Al Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia
| | - Karim M Al-Azizi
- Department of Cardiology, 384526Baylor Scott & White The Heart Hospital, Plano, TX, USA
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, 21645Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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19
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Baloch Z, Ma Z, Ji Y, Ghanbari M, Pan Q, Aljabr W. Unique challenges to control the spread of COVID-19 in the Middle East. J Infect Public Health 2020; 13:1247-50. [PMID: 32690454 DOI: 10.1016/j.jiph.2020.06.034] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/19/2020] [Accepted: 06/28/2020] [Indexed: 01/08/2023] Open
Abstract
The COVID-19 pandemic is spreading at unprecedented pace among the Middle East and neighboring countries. This region is geographically, economically, politically, culturally and religiously a very sensitive area, which impose unique challenges for effective control of this epidemic. These challenges include compromised healthcare systems, prolonged regional conflicts and humanitarian crises, suboptimal levels of transparency and cooperation, and frequent religious gatherings. These factors are interrelated and collectively determine the response to the pandemic in this region. Here, we in-depth emphasize these challenges and take a glimpse of possible solutions towards mitigating the spread of COVID-19.
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20
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Aggarwal A, Patel P, Lewison G, Ekzayez A, Coutts A, Fouad FM, Shamieh O, Giacaman R, Kutluk T, Khalek RA, Lawler M, Boyle P, Sarfati D, Sullivan R. The Profile of Non-Communicable Disease (NCD) research in the Middle East and North Africa (MENA) region: Analyzing the NCD burden, research outputs and international research collaboration. PLoS One 2020; 15:e0232077. [PMID: 32339197 PMCID: PMC7185716 DOI: 10.1371/journal.pone.0232077] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 04/07/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives Despite the rising risk factor exposure and non-communicable disease (NCD) mortality across the Middle East and the North African (MENA) region, public health policy responses have been slow and appear discordant with the social, economic and political circumstances in each country. Good health policy and outcomes are intimately linked to a research-active culture, particularly in NCD. In this study we present the results of a comprehensive analysis of NCD research with particular a focus on cancer, diabetes and cardiovascular disease in 10 key countries that represent a spectrum across MENA between 1991 and 2018. Methods The study uses a well validated bibliometric approach to undertake a quantitative analysis of research output in the ten leading countries in biomedical research in the MENA region on the basis of articles and reviews in the Web of Science database. We used filters for each of the three NCDs and biomedical research to identify relevant papers in the WoS. The countries selected for the analyses were based on the volume of research outputs during the period of analysis and stability, included Egypt, Iran, Jordan, Kuwait, Lebanon, Oman, Qatar, Saudi Arabia, Turkey and the United Arab Emirates. Results A total of 495,108 biomedical papers were found in 12,341 journals for the ten MENA countries (here we consider Turkey in the context of MENA). For all three NCDs, Turkey's output is consistently the highest. Iran has had considerable growth in research output to occupy second place across all three NCDs. It appears that, relative to their wealth (measured by GDP), some MENA countries, particularly Oman, Qatar, Kuwait and the United Arab Emirates, are substantially under-investing in biomedical research. In terms of investment on particular NCDs, we note the relatively greater commitment on cancer research compared with diabetes or cardiovascular disease in most MENA countries, despite cardiovascular disease causing the greatest health-related burden. When considering the citation impact of research outputs, there have been marked rises in citation scores in Qatar, Lebanon, United Arab Emirates and Oman. However, Turkey, which has the largest biomedical research output in the Middle East has the lowest citation scores overall. The level of intra-regional collaboration in NCD research is highly variable. Saudi Arabia and Egypt are the dominant research collaborators across the MENA region. However, Turkey and Iran, which are amongst the leading research-active countries in the area, show little evidence of collaboration. With respect to international collaboration, the United States and United Kingdom are the dominant research partners across the region followed by Germany and France. Conclusion The increase in research activity in NCDs across the MENA region countries during the time period of analysis may signal both an increasing focus on NCDs which reflects general global trends, and greater investment in research in some countries. However, there are several risks to the sustainability of these improvements that have been identified in particular countries within the region. For example, a lack of suitably trained researchers, low political commitment and poor financial support, and minimal international collaboration which is essential for wider global impact.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
- Department of Clinical Oncology, Guy’s & St.Thomas’ NHS Trust, London, United Kingdom
- * E-mail:
| | - Preeti Patel
- Department of War Studies, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
| | - Grant Lewison
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
| | - Abdulkarim Ekzayez
- Department of War Studies, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
| | - Adam Coutts
- Department of Sociology, University of Cambridge, Cambridge, United Kingdom
| | - Fouad M. Fouad
- Global Health Institute/Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | | | - Rita Giacaman
- Institute of Community and Public Health, Birzeit University, Birzeit, West Bank, occupied Palestinian territory
| | - Tezer Kutluk
- Department of Pediatric Oncology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Rima Abdul Khalek
- Global Health Institute/Department of Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Mark Lawler
- Queen’s University Belfast, Centre for Cancer Research and Cell Biology, Belfast, United Kingdom
| | - Peter Boyle
- International Prevention Research Institute, Lyon, France
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Sullivan
- Institute of Cancer Policy, Cancer Epidemiology, Population & Global Health, School of Cancer Sciences, King’s College London, London, United Kingdom
- Conflict and Health Research Group, King’s College London, London, United Kingdom
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21
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Ashfaq A, Esmaili S, Najjar M, Batool F, Mukatash T, Al-Ani HA, Koga PM. Utilization of Mobile Mental Health Services among Syrian Refugees and Other Vulnerable Arab Populations-A Systematic Review. Int J Environ Res Public Health 2020; 17:E1295. [PMID: 32085422 DOI: 10.3390/ijerph17041295] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 02/13/2020] [Accepted: 02/14/2020] [Indexed: 12/29/2022]
Abstract
The global refugee crisis is at its most critical state in history; Syria alone has produced 12 million internally displaced persons, with another 5 million refugees seeking protection across the globe. Faced with the heavy burden of mental distress carried by a massive refugee influx, many host nations lack the service capacity to respond adequately. While mobile mental health (mMHealth) applications and platforms have the potential to augment screenings and interventions for vulnerable populations, an insufficient gender and cultural adaptation of technology may drastically hamper its uptake in Arab refugees. Reporting only papers originating from Middle Eastern and/or Arab nations or refugee host nations, this systematic review evaluates the available literature published between 2000 and 2019 on the usage acceptability of mMHealth in Syrian refugees and other vulnerable Arab populations. We conducted a systematic review in PubMed, PsychInfo, Association of Computing Machinery (ACM) and the Directory of Open Access Journals (DOAJ) using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify studies that addressed mMHealth implementation in these populations; of a total of 607 articles identified, only 10 (1.6%) available, unique articles met our search criteria. These studies discussed the feasibility and efficacy of mMHealth applications and the barriers to their uptake. The few existing studies show positive impacts of mMHealth on the access to services and on treatment outcomes but also reveal a paucity of literature on mMHealth for vulnerable Arab populations. These findings indicate a critical need for research on the barriers to mMHealth uptake, to bolster service capacity in the Arab Region and in the refugee diaspora of other, non-Arab host countries.
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22
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Akseer N, Wright J, Tasic H, Everett K, Scudder E, Amsalu R, Boerma T, Bendavid E, Kamali M, Barros AJD, da Silva ICM, Bhutta ZA. Women, children and adolescents in conflict countries: an assessment of inequalities in intervention coverage and survival. BMJ Glob Health 2020; 5:e002214. [PMID: 32133179 PMCID: PMC7042600 DOI: 10.1136/bmjgh-2019-002214] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 12/18/2019] [Indexed: 01/22/2023] Open
Abstract
Introduction Conflict adversely impacts health and health systems, yet its effect on health inequalities, particularly for women and children, has not been systematically studied. We examined wealth, education and urban/rural residence inequalities for child mortality and essential reproductive, maternal, newborn and child health interventions between conflict and non-conflict low-income and middle-income countries (LMICs). Methods We carried out a time-series multicountry ecological study using data for 137 LMICs between 1990 and 2017, as defined by the 2019 World Bank classification. The data set covers approximately 3.8 million surveyed mothers (15-49 years) and 1.1 million children under 5 years including newborns (<1 month), young children (1-59 months) and school-aged children and adolescents (5-14 years). Outcomes include annual maternal and child mortality rates and coverage (%) of family planning services, 1+antenatal care visit, skilled attendant at birth (SBA), exclusive breast feeding (0-5 months), early initiation of breast feeding (within 1 hour), neonatal protection against tetanus, newborn postnatal care within 2 days, 3 doses of diphtheria, pertussis and tetanus vaccine, measles vaccination, and careseeking for pneumonia and diarrhoea. Results Conflict countries had consistently higher maternal and child mortality rates than non-conflict countries since 1990 and these gaps persist despite rates continually declining for both groups. Access to essential reproductive and maternal health services for poorer, less educated and rural-based families was several folds worse in conflict versus non-conflict countries. Conclusions Inequalities in coverage of reproductive/maternal health and child vaccine interventions are significantly worse in conflict-affected countries. Efforts to protect maternal and child health interventions in conflict settings should target the most disadvantaged families including the poorest, least educated and those living in rural areas.
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James Wright
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Hana Tasic
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karl Everett
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elaine Scudder
- Save the Children USA, Washington, District of Columbia, USA
| | - Ribka Amsalu
- Save the Children USA, Washington, District of Columbia, USA
| | - Ties Boerma
- Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Eran Bendavid
- Centers for Health Policy, Primary Care and Outcomes Research, Stanford University, Stanford, California, USA
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Aluisio J D Barros
- International Centre for Equity in Health, Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
| | | | - Zulfiqar Ahmed Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Ontario, Canada
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Khachfe HH, Sammouri J, Salhab HA, Fares MY, El-Najjar R. Maternal mortality and health in the Arab World: A 25-year epidemiological study. J Obstet Gynaecol Res 2019; 45:2369-2376. [PMID: 31581369 DOI: 10.1111/jog.14119] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/25/2019] [Indexed: 01/26/2023]
Abstract
AIM In this work, we aim to assess the maternal health in terms of maternal mortality ratios and lifetime risk of maternal death in of women in the Arab World. METHODS Data on maternal mortality rates (MMR) and lifetime risk of maternal death (LTR) were extracted from the official databases of the United Nations Children's Fund. Annual Percentage Change was calculated using Joinpoint regression model. Statistical significance among countries was determined using one-way analysis of variance (anova) on spss version 25.0 (IBM SPSS, 2017). RESULTS The MMR and LTR significantly decreased in almost all Arab countries. Somalia was found to be the country with the highest burden of MMR, while Gulf countries had the lowest burden. CONCLUSION Our study shows a decrease in the MMR and LTR of maternal death in the Arab world. Although there is a decrease in these rates, but continuous research and efforts must be undergone to better develop the health care system in a great number of Arab countries to decrease the burden of maternal deaths.
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Affiliation(s)
| | - Julie Sammouri
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Hamza A Salhab
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Mohamad Y Fares
- Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Roula El-Najjar
- Department of Obstetrics and Gynecology, Middle East Institute of Health, Bsalim, Lebanon
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Daoulah A, Al-Faifi SM, Hersi AS, Dinas PC, Youssef AA, Alshehri M, Baslaib F, Maghrabi M, Al-Murayeh M, Ghani MA, Refaat WA, Eldesoky A, Balghith M, Soofi MA, Alasmari A, Alasnag M, Hamad AK, Morshid M, Morsi YMA, Dahdouh Z, ElSayed O, Alama MN, Alasousi N, Tammam K, Almansori M, Khan AS, Alkhushail A, Aithal JK, Alqahtani AH, Lotfi A. Spontaneous Coronary Artery Dissection in Relation to Physical and Emotional Stress: A Retrospective Study in 4 Arab Gulf Countries. Curr Probl Cardiol 2019; 46:100484. [PMID: 31610953 DOI: 10.1016/j.cpcardiol.2019.100484] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/10/2019] [Accepted: 09/15/2019] [Indexed: 01/17/2023]
Abstract
Spontaneous coronary artery dissection (SCAD) has emerged as an important cause of acute coronary syndrome and sudden cardiac death. The triggers for SCAD often do not include traditional atherosclerotic risk factors. The most commonly reported triggers are extreme physical or emotional stress. The current study compared in-hospital and follow-up events in patients with SCAD with and without reported stress. Data from 83 patients with a confirmed diagnosis of SCAD were collected retrospectively from 30 centers in 4 Arab Gulf countries (KSA, UAE, Kuwait, and Bahrain) from January 2011 to December 2017. In-hospital myocardial infarction (MI), percutaneous coronary intervention (PCI), ventricular tachycardia/ventricular fibrillation, cardiogenic shock, death, ICD placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) events were compared between those with and without reported stress. Emotional and physical stress was defined as new or unusually intense stress, within 1 week of their initial hospitalization. The median age of patients in the study was 44 (37-55) years. Foty-two (51%) were women. Stress (emotional, physical, and combined) was reported in 49 (59%) of all patients. Sixty-two percent of women with SCAD reported stress, and 51 % of men with SCAD reported stress. Men more commonly reported physical and combined stress. Women more commonly reported emotional stress (P < 0.001). The presence or absence of reported stress did not impact on overall adverse cardiovascular events (P = 0.8). In-hospital and follow-up events were comparable in patients with SCAD in the presence or absence of reported stress as a trigger.
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Phillimore P, Sibai AM, Rizk A, Maziak W, Unal B, Abu Rmeileh N, Ben Romdhane H, Fouad FM, Khader Y, Bennett K, Zaman S, Mataria A, Ghandour R, Kılıç B, Ben Mansour N, Fadhil I, O'Flaherty M, Capewell S, Critchley JA. Context-led capacity building in time of crisis: fostering non-communicable diseases (NCD) research skills in the Mediterranean Middle East and North Africa. Glob Health Action 2019; 12:1569838. [PMID: 30721116 PMCID: PMC6366406 DOI: 10.1080/16549716.2019.1569838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: This paper examines one EC-funded multinational project (RESCAP-MED), with a focus on research capacity building (RCB) concerning non-communicable diseases (NCDs) in the Mediterranean Middle East and North Africa. By the project’s end (2015), the entire region was engulfed in crisis. Objective: Designed before this crisis developed in 2011, the primary purpose of RESCAP-MED was to foster methodological skills needed to conduct multi-disciplinary research on NCDs and their social determinants. RESCAP-MED also sought to consolidate regional networks for future collaboration, and to boost existing regional policy engagement in the region on the NCD challenge. This analysis examines the scope and sustainability of RCB conducted in a context of intensifying political turmoil. Methods: RESCAP-MED linked two sets of activities. The first was a framework for training early- and mid-career researchers through discipline-based and writing workshops, plus short fellowships for sustained mentoring. The second integrated public-facing activities designed to raise the profile of the NCD burden in the region, and its implications for policymakers at national level. Key to this were two conferences to showcase regional research on NCDs, and the development of an e-learning resource (NETPH). Results: Seven discipline-based workshops (with 113 participants) and 6 workshops to develop writing skills (84 participants) were held, with 18 fellowship visits. The 2 symposia in Istanbul and Beirut attracted 280 participants. Yet the developing political crisis tagged each activity with a series of logistical challenges, none of which was initially envisaged. The immediacy of the crisis inevitably deflected from policy attention to the challenges of NCDs. Conclusions: This programme to strengthen research capacity for one priority area of global public health took place as a narrow window of political opportunity was closing. The key lessons concern issues of sustainability and the paramount importance of responsively shaping a context-driven RCB.
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Affiliation(s)
- Peter Phillimore
- a School of Geography, Politics & Sociology , Newcastle University , Newcastle , UK
| | - Abla M Sibai
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Anthony Rizk
- b Department of Epidemiology & Population Health , American University of Beirut , Beirut , Lebanon
| | - Wasim Maziak
- c Department of Epidemiology , Florida International University, USA; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Belgin Unal
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | - Niveen Abu Rmeileh
- e Institute of Community and Public Health , Birzeit University , Palestine
| | | | - Fouad M Fouad
- g Department of Epidemiology & Population Health American University of Beirut , Lebanon; and Syrian Center for Tobacco Studies , Aleppo , Syria
| | - Yousef Khader
- h Public Health Department , Jordan University of Science and Technology , Irbid , Jordan
| | | | | | - Awad Mataria
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Rula Ghandour
- e Institute of Community and Public Health , Birzeit University , Palestine
| | - Bülent Kılıç
- d Department of Public Health , Dokuz Eylul University , Izmir , Turkey
| | | | - Ibtihal Fadhil
- k WHO Regional Office for the Eastern Mediterranean (EMRO) , Cairo , Egypt
| | - Martin O'Flaherty
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Simon Capewell
- m Institute of Psychology, Health & Society , University of Liverpool , Liverpool , UK
| | - Julia A Critchley
- n Population Health Research Institute , St George's, University of London , London , UK
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Affiliation(s)
- Mohammed Shahait
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.
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Khattab E, Sabbagh A, Aljerian N, Binsalleeh H, Almulhim M, Alqahtani A, Alsalamah M. Emergency medicine in Saudi Arabia: a century of progress and a bright vision for the future. Int J Emerg Med 2019; 12:16. [PMID: 31286863 PMCID: PMC6615245 DOI: 10.1186/s12245-019-0232-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 06/25/2019] [Indexed: 12/11/2022] Open
Abstract
Although emergency medical services (EMS) and pre-hospital care have existed in the Kingdom of Saudi Arabia (KSA) since 1934, emergency medicine (EM) is a relatively new medical field in the country that was not formally recognized as a medical specialty until 2001. In 2005, the Saudi Board of Emergency Medicine formed to develop, implement, and evaluate a standardized curriculum for EM residents. Since then, EM and the pre-hospital system in the KSA has evolved and grown. This article provides an overview of emergency medicine in Saudi Arabia and the progress it has made in the pre-hospital system, healthcare delivery system, and emergency medicine training. Finally, we will discuss the challenges and opportunities faced as this specialty continues to develop.
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Affiliation(s)
- Eyad Khattab
- Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC2, Boston, MA, 02215, USA. .,Department of Emergency Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Abdulrahman Sabbagh
- Department of Emergency Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Nawfal Aljerian
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of Health, Riyadh, Saudi Arabia
| | - Hashim Binsalleeh
- Prince Sultan bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Mobarak Almulhim
- Harvard Medical School, Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC2, Boston, MA, 02215, USA.,Royal Clinics of the Custodian of the Two Holy Mosques, Riyadh, Saudi Arabia
| | | | - Majid Alsalamah
- Department of Emergency Medical Services, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Ministry of Health, Riyadh, Saudi Arabia
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Ruiz-Cantero MT, Guijarro-Garvi M, Bean DR, Martínez-Riera JR, Fernández-Sáez J. Governance commitment to reduce maternal mortality. A political determinant beyond the wealth of the countries. Health Place 2019; 57:313-320. [PMID: 31146194 PMCID: PMC6873917 DOI: 10.1016/j.healthplace.2019.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 03/16/2019] [Accepted: 05/13/2019] [Indexed: 12/14/2022]
Abstract
Some countries reached, in 2015, the Millennium Development Goal of reducing maternal mortality to 96 or less maternal deaths per 100,000 live births. Others, however, did not. This paper analyses the strength of the association between maternal mortality and each of the six components of Governance-a political determinant scarcely explored in the literature-in 174 countries. It was found that the greater the governance, the lower maternal mortality, independently of a country's wealth. We used all six indicators of the World Bank's Worldwide Governance Indicators Project in 2015: government effectiveness, regulatory quality, rule of law, control of corruption, voice and accountability, and political stability and absence of violence. Findings were encouraging as maternal mortality in low-income countries with higher government effectiveness and regulatory quality was similar to that of medium-income countries with lower government effectiveness and regulatory quality. To achieve the post-2015 sustainable development goal on preventable maternal mortality-which persists despite economic development-all governance dimensions are essential and represent interdependent cornerstones.
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Affiliation(s)
| | - Marta Guijarro-Garvi
- Public Health Research Group, University of Alicante, Spain; Department of Economics, University of Cantabria, Spain.
| | - Donna Rose Bean
- School of Nursing & Health Studies, University of Miami, USA.
| | | | - José Fernández-Sáez
- Public Health Research Group, University of Alicante, Spain; Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i, Gurina (IDIAPJGol), Spain.
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Al-Ghananeem AM, Malcom DR, Shammas S, Aburjai T. A Call to Action to Transform Pharmacy Education and Practice in the Arab World. Am J Pharm Educ 2018; 82:7014. [PMID: 30559504 PMCID: PMC6291664 DOI: 10.5688/ajpe7014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 04/22/2018] [Indexed: 05/05/2023]
Abstract
Globally, pharmacy education is evolving to reflect a more patient-centered, interprofessional approach to clinical practice. In the 22 countries of the Arab world, advancements in regulatory support for pharmacy practice and changes to the health care system have been slower than in Europe, Asia, and the Americas. Significant cultural, logistical, and legal barriers exist in many countries, and a consensus approach to accreditation, educational outcomes, and curricula design is lacking. This commentary briefly examines the current state of both pharmacy education and practice in the Arab world, and it highlights recent reports of curricular reform and innovation. Additionally, it provides potential strategies for improving the quality of education and for expanding pharmacy practice to ensure graduates and practitioners have adequate experiential opportunities and institutional support.
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Affiliation(s)
| | - Daniel R. Malcom
- Sullivan University College of Pharmacy, Louisville, Kentucky
- Associate Editor, American Journal of Pharmaceutical Education, Arlington, Virginia
| | - Samira Shammas
- Jordan Pharmacists Association, Good Pharmacy Practice Committee, Amman, Jordan
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Abstract
The World Health Organization has elaborated a maternal and neonatal near-miss reporting, audit and feedback system designed to improve the quality of care during and after childbirth. As part of a four-hospital comparative study in the Middle East, this article discusses the experiences of mothers whose newborns suffered from severe complications at birth in the Rafik Hariri University Hospital, the only public hospital in Beirut. Based on in-depth home interviews several weeks after childbirth, it aims to explore the experience of neonatal near-miss events through the mothers' birth narratives. The central concerns of these vulnerable and marginalised women regarded access to neonatal care, and how to negotiate hospital bureaucracy and debt. It argues that financial and bureaucratic aspects of the near-miss event should be part of the audit system and policy-making, alongside medical issues, in the quest for equitable access to and management of quality perinatal care.
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Affiliation(s)
- Livia Wick
- a Department of Sociology, Anthropology and Media Studies , American University of Beirut , Beirut , Lebanon . Correspondence:
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Akseer N, Kamali M, Bakhache N, Mirza M, Mehta S, Al-Gashm S, Bhutta ZA. Status and drivers of maternal, newborn, child and adolescent health in the Islamic world: a comparative analysis. Lancet 2018; 391:1493-1512. [PMID: 29395272 DOI: 10.1016/s0140-6736(18)30183-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Revised: 11/23/2017] [Accepted: 11/28/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The Millennium Development Goal (MDG) period saw dramatic gains in health goals MDG 4 and MDG 5 for improving child and maternal health. However, many Muslim countries in the south Asian, Middle Eastern, and African regions lagged behind. In this study, we aimed to evaluate the status of, progress in, and key determinants of reproductive, maternal, newborn, child, and adolescent health in Muslim majority countries (MMCs). The specific objectives were to understand the current status and progress in reproductive, maternal, newborn, child, and adolescent health in MMCs, and the determinants of child survival among the least developed countries among the MMCs; to explore differences in outcomes and the key contextual determinants of health between MMCs and non-MMCs; and to understand the health service coverage and contextual determinants that differ between best and poor or moderate performing MMCs. METHODS In this country-level ecological study, we examined data from between 1990 and 2015 from multiple publicly available data repositories. We examined 47 MMCs, of which 26 were among the 75 high-burden Countdown to 2015 countries. These 26 MMCs were compared with 48 non-Muslim Countdown countries. We also examined characteristics of the eight best performing MMCs that had accelerated improvement in child survival (ie, that reached their MDG 4 targets). We estimated adolescent, maternal, under-5, and newborn mortality, and stillbirths, and the causes of death, essential interventions coverage, and contextual determinants for all MMCs and comparative groups using standardised methods. We also did a hierarchical multivariable analysis of determinants of under-5 mortality and newborn mortality in low-income and middle-income MMCs. FINDINGS Despite notable reductions between 1990 and 2015, MMCs compared with a global esimate of all countries including MMCs had higher mortality rates, and MMCs relative to non-MMCs within Countdown countries also performed worse. Coverage of essential interventions across the continuum of care was on average lower among MMCs, especially for indicators of reproductive health, prenatal care, delivery, and labour, and childhood vaccines. Outcomes within MMCs for mortality and many reproductive, maternal, newborn, child, and adolescent health indicators varied considerably. Structural and contextual factors, especially state governance, conflict, and women and girl's empowerment indicators, were significantly worse in MMCs compared with non-MMCs within the high-burden Countdown countries, and were shown to be strongly associated with child and newborn mortality within low-income and middle-income MMCs. In adjusted hierarchical models, among other factors, under-5 mortality in MMCs increased with more refugees originating from a country (β=23·67, p=0·0116), and decreased with better political stability or absence of terrorism (β=-0·99, p=0·0285), greater political rights or government effectiveness (β=-1·17, p<0·0001), improvements in log gross national income per capita (β=-4·44, p<0·0001), higher total adult literacy (β=-1·69, p<0·0001), higher female adult literacy (β=-0·97, p<0·0001), and greater female to male enrolment in secondary school (β=-16·1, p<0·0001). The best performing MMCs were Azerbaijan, Bangladesh, Egypt, Indonesia, Kyrgyzstan, Morocco, Niger, and Senegal, which had higher coverage of family planning interventions and newborn or child vaccinations, and excelled in many of the above contextual determinants when compared with moderate or poorly performing MMCs. INTERPRETATION The status and progress in reproductive, maternal, newborn, child, and adolescent health is heterogeneous among MMCs, with little indication that religion and its practice affects outcomes systemically. Some Islamic countries such as Niger and Bangladesh have made great progress, despite poverty. Key findings from this study have policy and programmatic implications that could be prioritised by national heads of state and policy makers, development partners, funders, and the Organization of the Islamic Cooperation to scale up and improve these health outcomes in Muslim countries in the post-2015 era. FUNDING US Fund for UNICEF under the Countdown to 2015 for Maternal, Newborn, and Child Survival, the Centre for Global Child Health, Hospital for Sick Children, and the Aga Khan University.
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Affiliation(s)
- Nadia Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Mahdis Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Nour Bakhache
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Maaz Mirza
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Seema Mehta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Sara Al-Gashm
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Canada; Center of Excellence in Women and Child Health, the Aga Khan University, Karachi, Pakistan.
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Znaor A, Eser S, Anton-Culver H, Fadhil I, Ryzhov A, Silverman BG, Bendahou K, Demetriou A, Nimri O, Yakut C, Bray F. Cancer surveillance in northern Africa, and central and western Asia: challenges and strategies in support of developing cancer registries. Lancet Oncol 2018; 19:e85-e92. [PMID: 29413483 DOI: 10.1016/s1470-2045(18)30019-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 09/27/2017] [Accepted: 10/02/2017] [Indexed: 01/04/2023]
Abstract
The Global Initiative for Cancer Registry Development partnership, led by the International Agency for Research on Cancer (IARC), was established in response to an overwhelming need for high-quality cancer incidence data from low-income and middle-income countries. The IARC Regional Hub for cancer registration in North Africa, Central and West Asia was founded in 2013 to support capacity building for cancer registration in each of the countries in this region. In this Series paper, we advocate the necessity for tailored approaches to cancer registration given the rapidly changing cancer landscape for this region, and the challenges faced at a national level in developing data systems to help support this process given present disparities in resources and health infrastructure. In addition, we provide an overview of the status of cancer surveillance and activities country-by-country, documenting tailored approaches that are informing local cancer-control policy, and potentially curbing the growing cancer burden across the region.
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Affiliation(s)
- Ariana Znaor
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.
| | - Sultan Eser
- Izmir Cancer Registry, Izmir Provincial Public Health Directorate, Izmir, Turkey
| | - Hoda Anton-Culver
- Department of Epidemiology, University of California Irvine, Irvine, CA, USA
| | - Ibtihal Fadhil
- Non-communicable Diseases Department, Ministry of Health and Prevention, United Arab Emirates
| | - Anton Ryzhov
- National Cancer Registry of Ukraine, Ukrainian National Cancer Institute, Kiev, Ukraine
| | - Barbara G Silverman
- Israel National Cancer Registry, Israel Center for Disease Control, Ministry of Health, Ramat Gan, Israel
| | - Karima Bendahou
- Casablanca Cancer Registry, Mohammed VI Center for Cancer Treatment, Ibn Rochd University Hospital, Casablanca, Morocco
| | - Anna Demetriou
- Cyprus Cancer Registry, Ministry of Health, Nicosia, Cyprus
| | - Omar Nimri
- Jordan Cancer Registry, Ministry of Health, Amman, Jordan
| | - Cankut Yakut
- Izmir Cancer Registry, Izmir Provincial Public Health Directorate, Izmir, Turkey
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
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Dyson T, Cetorelli V. Changing views on child mortality and economic sanctions in Iraq: a history of lies, damned lies and statistics. BMJ Glob Health 2017; 2:e000311. [PMID: 29225933 PMCID: PMC5717930 DOI: 10.1136/bmjgh-2017-000311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 03/29/2017] [Accepted: 03/31/2017] [Indexed: 11/04/2022] Open
Abstract
In August 1990, Saddam Hussein's army invaded Kuwait and consequently the United Nations imposed economic sanctions on Iraq. In 1991, an international military alliance expelled the Iraqi army from Kuwait during a short war. Nevertheless, the economic sanctions remained in place-their removal required that Iraq should destroy its weapons of mass destruction. Subsequent years saw reports of acute suffering in Iraq. The sanctions undoubtedly greatly reduced the country's ability to import supplies of food and medicine. Particular concerns arose about the state of young children. These concerns crystalised in 1999 when, with cooperation from the Iraqi government, Unicef conducted a major demographic survey. The results of the survey indicated that the under-5 death rate in Iraq had increased hugely between 1990 and 1991 and had then continued at a very high level. The survey results were used both to challenge and support the case for the invasion of Iraq in 2003. And they were cited by Tony Blair in 2010 in his testimony to the Iraq Inquiry established by the British government. Indeed, the results of the 1999 Unicef/Government of Iraq survey are still cited. Since 2003, however, several more surveys dealing with child mortality have been undertaken. Their results show no sign of a huge and enduring rise in the under-5 death rate starting in 1991. It is therefore clear that Saddam Hussein's government successfully manipulated the 1999 survey in order to convey a very false impression-something that is surely deserving of greater recognition.
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Affiliation(s)
- Tim Dyson
- Department of International Development, London School of Economics, London, UK
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Hamid AA, Mohamed Ibrahim MI. A Systematic Scoping Review of the State of Pharmacovigilance and Governance in the MENA Region: Challenges and Opportunities. Pharmaceut Med 2017. [DOI: 10.1007/s40290-017-0212-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Asbu EZ, Masri MD, Kaissi A. Health status and health systems financing in the MENA region: roadmap to universal health coverage. Glob Health Res Policy 2017; 2:25. [PMID: 29202093 PMCID: PMC5683471 DOI: 10.1186/s41256-017-0044-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 06/24/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage. METHODS Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages. RESULTS Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care. CONCLUSION The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP and GDP growth rate, and high OOPS pose serious challenges for universal health coverage. Using multi-sector interventions, countries should develop and implement evidence-informed health system financing roadmaps to address these obstacles and move forward toward universal health coverage.
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Affiliation(s)
- Eyob Zere Asbu
- Health System Financing Division, Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Maysoun Dimachkie Masri
- Health System Financing Division, Health Authority Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Amer Kaissi
- Department of Healthcare Administration, Trinity University, San Antonio, TX USA
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Abstract
Since 2011, an estimated nine million Syrian refugees have fled to neighboring countries, and over four million have fled to neighboring countries of Lebanon, Turkey, and Jordan. Seventy five percent of Syrian refugees are women and children. In times of conflict, women's health disproportionately suffers. Based on an assessment of academic literature and international policy and development reports, this study explores the vulnerabilities of Syrian women and girls in Lebanon, Turkey, and Jordan, and how these countries approach Syrian refugee women's health care. In all settings, sexual and gender-based violence, reduced use of modern contraceptives, menstrual irregularity, unplanned pregnancies, preterm birth, and infant morbidity are ongoing issues. Recommendations for improved practice include taking a multilevel approach to eliminate social and service delivery barriers that prevent access to care, conducting thorough needs assessments, and creating policy and programmatic solutions that establish long term care for Syrian refugee women.
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Affiliation(s)
- Goleen Samari
- Population Research Center at the University of Texas at Austin
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Mehmood A, Allen KA, Al-Maniri A, Al-Kashmiri A, Al-Yazidi M, Hyder AA. Trauma care in Oman: A call for action. Surgery 2017; 162:S107-S116. [PMID: 28351526 DOI: 10.1016/j.surg.2017.01.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 01/19/2017] [Accepted: 01/20/2017] [Indexed: 11/17/2022]
Abstract
Many Arab countries have undergone the epidemiologic transition of diseases with increasing economic development and a proportionately decreasing prevalence of communicable diseases. With this transition, injuries have emerged as a major cause of mortality and morbidity in the Gulf Cooperation Council countries in addition to diseases of affluence. Injuries are the number one cause of years of life lost and disability-adjusted life-years in the Sultanate of Oman. The burden of injuries, which affects mostly young Omani males, has a unique geographic distribution that is in contrast to the trauma care capabilities of the country. The concentration of health care resources in the northern part of the country makes it difficult for the majority of Omanis who live elsewhere to access high-quality and time-sensitive care. A broader multisectorial national injury prevention strategy should be evidence based and must strengthen human resources, service delivery, and information systems to improve care of the injured and loss of life. This paper provides a unique overview of the Omani health system with the goal of examining its trauma care capabilities and injury control policies.
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Affiliation(s)
- Amber Mehmood
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
| | - Katharine A Allen
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | | | | | - Adnan A Hyder
- Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Jamaluddine Z, Sibai AM, Othman S, Yazbek S. Mapping genetic research in non-communicable disease publications in selected Arab countries: first step towards a guided research agenda. Health Res Policy Syst 2016; 14:81. [PMID: 27832776 PMCID: PMC5103400 DOI: 10.1186/s12961-016-0153-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 10/25/2016] [Indexed: 12/14/2022] Open
Abstract
Background In the Arab world, intervention and policy response to non-communicable diseases (NCD) has been weak despite extensive epidemiological evidence highlighting the alarmingly increased prevalence of chronic diseases. Generating genetic information is one key component to promote efficient disease management strategies. This study undertook a scoping review to generate the profile of the undertaken research on genetics of NCD publications in selected Arab countries. An analysis of the research produced examined the extent, range, nature, topic and methods of published research. The study aimed at identifying the gaps in genetic NCD research to inform policy action for NCD prevention and control. Methods The scoping review was conducted based on the five-stage methodological framework and included countries in Arab region selected to represent various economies and epidemiological transitions. Results The search identified 555 articles that focus on genetics-NCD research in the selected Arab countries over the duration of this study (January 2000 to December 2013). The most commonly conducted research was descriptive and clinically focused, rather than etiologically focused. Country-specific carrier and risk screening studies were not among the top research designs. The genetic component of certain highly heritable diseases, as well as diabetes, obesity, hypertension, chronic lung dysfunction and metabolic syndrome were all under investigated. Conclusions This scoping review identified gaps for further research in the context of bioinformatics and genome-wide association studies. Genetic research in the Arab region has to be redirected towards NCDs with the highest morbidity, heritability and health burden within each country. A focused research plan to include community genetics is required for its proper integration in the Arab community.
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Affiliation(s)
- Zeina Jamaluddine
- Medical Laboratory Sciences, American University of Beirut, Riad El Solh, P.O. Box 11-0236, 1107 2020, Beirut, Lebanon
| | - Abla Mehio Sibai
- Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Shahd Othman
- Epidemiology and Population Health, American University of Beirut, Beirut, Lebanon
| | - Soha Yazbek
- Medical Laboratory Sciences, American University of Beirut, Riad El Solh, P.O. Box 11-0236, 1107 2020, Beirut, Lebanon.
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Rabbani F, Shipton L, White F, Nuwayhid I, London L, Ghaffar A, Ha BTT, Tomson G, Rimal R, Islam A, Takian A, Wong S, Zaidi S, Khan K, Karmaliani R, Abbasi IN, Abbas F. Schools of public health in low and middle-income countries: an imperative investment for improving the health of populations? BMC Public Health 2016; 16:941. [PMID: 27604901 PMCID: PMC5015344 DOI: 10.1186/s12889-016-3616-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Public health has multicultural origins. By the close of the nineteenth century, Schools of Public Health (SPHs) began to emerge in western countries in response to major contemporary public health challenges. The Flexner Report (1910) emphasized the centrality of preventive medicine, sanitation, and public health measures in health professional education. The Alma Ata Declaration on Primary Health Care (PHC) in 1978 was a critical milestone, especially for low and middle-income countries (LMICs), conceptualizing a close working relationship between PHC and public health measures. The Commission on Social Determinants of Health (2005-2008) strengthened the case for SPHs in LMICs as key stakeholders in efforts to reduce global health inequities. This scoping review groups text into public health challenges faced by LMICs and the role of SPHs in addressing these challenges. MAIN TEXT The challenges faced by LMICs include rapid urbanization, environmental degradation, unfair terms of global trade, limited capacity for equitable growth, mass displacements associated with conflicts and natural disasters, and universal health coverage. Poor governance and externally imposed donor policies and agendas, further strain the fragile health systems of LMICs faced with epidemiological transition. Moreover barriers to education and research imposed by limited resources, political and economic instability, and unbalanced partnerships additionally aggravate the crisis. To address these contextual challenges effectively, SPHs are offering broad based health professional education, conducting multidisciplinary population based research and fostering collaborative partnerships. SPHs are also looked upon as the key drivers to achieve sustainable development goals (SDGs). CONCLUSION SPHs in LMICs can contribute to overcoming several public health challenges being faced by LMICs, including achieving SDGs. Most importantly they can develop cadres of competent and well-motivated public health professionals: educators, practitioners and researchers who ask questions that address fundamental health determinants, seek solutions as agents of change within their mandates, provide specific services and serve as advocates for multilevel partnerships. Funding support, human resources, and agency are unfortunately often limited or curtailed in LMICs, and this requires constructive collaboration between LMICs and counterpart institutions from high income countries.
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Affiliation(s)
- Fauziah Rabbani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Leah Shipton
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Franklin White
- Pacific Health & Development Sciences Inc., Victoria, Canada
| | - Iman Nuwayhid
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Leslie London
- Division Public Health Medicine, School of Public Health and Family Medicine University of Cape Town, Cape Town, South Africa
| | - Abdul Ghaffar
- Alliance for Health Policy and Systems Research, WHO, Geneva, Switzerland
| | - Bui Thi Thu Ha
- Hanoi School of Public Health, Giang Vo, Ba Dinh, Hanoi, Vietnam
| | - Göran Tomson
- Depts LIME & PHS, Karolinska Institutet Stockholm, Stockholm, Sweden
| | - Rajiv Rimal
- Department of Prevention and Community Health, George Washington University School of Public Health and Health Services, Washington, USA
| | - Anwar Islam
- School of Health Policy and Management, York University, Toronto, Ontario Canada
| | - Amirhossein Takian
- Department of Global Health & Sustainable Development, School of Public Health-Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Sha Tin, Hong Kong
| | - Shehla Zaidi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Kausar Khan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing & Midwifery and Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Imran Naeem Abbasi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Farhat Abbas
- Medical College, Aga Khan University, Karachi, Pakistan
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Parkinson SE, Behrouzan O. Negotiating health and life: Syrian refugees and the politics of access in Lebanon. Soc Sci Med 2015; 146:324-31. [DOI: 10.1016/j.socscimed.2015.10.008] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 11/21/2022]
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Krueger PM, Dovel K, Denney JT. Democracy and self-rated health across 67 countries: A multilevel analysis. Soc Sci Med 2015; 143:137-44. [PMID: 26356825 PMCID: PMC4711992 DOI: 10.1016/j.socscimed.2015.08.047] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 08/24/2015] [Accepted: 08/27/2015] [Indexed: 11/21/2022]
Abstract
Existing research has found a positive association between countries' level of democratic governance and the health of their populations, although that research is limited by the use of data from small numbers of high-income countries or aggregate data that do not assess individual-level health outcomes. We extend prior research by using multilevel World Health Survey (2002-2004) data on 313,554 individuals in 67 countries, and find that the positive association between democratic governance and self-rated health persists after adjusting for both individual- and country-level confounders. However, the mechanisms linking democracy and self-rated health remain unclear. Individual-level measures of socioeconomic status, and country-level measures of economic inequality and investments in public health and education, do not significantly mediate the association between democratic governance and self-rated health. The persistent association between democratic governance and health suggests that the political organization of societies may be an important upstream determinant of population health.
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Affiliation(s)
- Patrick M Krueger
- Department of Health & Behavioral Sciences, University of Colorado Denver | Anschutz Medical Campus, Denver, CO 80217, USA; Population Program, Institute of Behavioral Sciences, University of Colorado Boulder, Boulder, CO 80309, USA.
| | - Kathryn Dovel
- Department of Health & Behavioral Sciences, University of Colorado Denver | Anschutz Medical Campus, Denver, CO 80217, USA
| | - Justin T Denney
- Department of Sociology, Rice University, Houston, TX 77251, USA
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Sweileh WM, Al-Jabi SW, Abuzanat A, Sawalha AF, AbuTaha AS, Ghanim MA, Zyoud SH. Assessment of research productivity of Arab countries in the field of infectious diseases using Web of Science database. Infect Dis Poverty 2015; 4:2. [PMID: 25685346 PMCID: PMC4327970 DOI: 10.1186/2049-9957-4-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 12/22/2014] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To meet the future challenges of infectious diseases and limit the spread of multidrug resistant microorganisms, a better understanding of published studies in the field of infectious diseases is needed. The objective of this study was to analyze the quantity and quality of research activity in the field of infectious diseases in Arab countries and compare it with that in non-Arab countries. METHODS Documents published in Arab countries within the research category of "infectious diseases" were extracted and analyzed using the Web of Science database. The data analyzed represent research productivity during the time interval between 1900 - 2012. RESULTS Worldwide, the total number of documents published in the field of infectious diseases up to 2012 was 227,188. A total of 2,408 documents in the field of infectious diseases were published in Arab countries, which represents 1.06% of worldwide research output. Research output from Arab countries in the field of infectious diseases was low for decades. However, approximately a five-fold increase was observed in the past decade. Arab countries ranked 56(th) to 218(th) on the standard competition ranking (SCR) in worldwide publications in the field of infectious diseases. Egypt, with a total publication of 464 (19.27%) documents ranked first among Arab countries, while Kuwait University was the most productive institution with a total of 158 (6.56%) documents. Average citation per document published in Arab countries was 13.25 and the h-index was 64. Tuberculosis (230; 9.55%), malaria (223; 9.26%), and hepatitis (189; 7.8%) were the top three infectious diseases studied as according to the retrieved documents. CONCLUSION The present data reveals that some Arab countries contribute significantly to the field of infectious diseases. However, Arab countries need to work harder to bridge the gap in this field. Compared with non-Arab countries in the Middle East, research output from Arab countries was high, but more efforts are needed to enhance the quality of this output. Future research in the field should be encouraged and correctly directed.
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Affiliation(s)
- Waleed M Sweileh
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Samah W Al-Jabi
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Alaeddin Abuzanat
- Department of Microbiology and Immunology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Ansam F Sawalha
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Adham S AbuTaha
- Department of Pharmacology and Toxicology, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mustafa A Ghanim
- Department of Biochemistry and Genetics, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Sa’ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
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Ben Romdhane H, Tlili F, Skhiri A, Zaman S, Phillimore P. Health system challenges of NCDs in Tunisia. Int J Public Health 2014; 60 Suppl 1:S39-46. [PMID: 25399240 DOI: 10.1007/s00038-014-0616-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 10/20/2014] [Accepted: 11/03/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES The objective of this study was to present a qualitative 'situation analysis' of the healthcare system in Tunisia, as it applies to management of cardiovascular disease (CVD) and diabetes. A primary concern was the institutional capacity to manage non-communicable diseases (NCDs). METHODS Research took place during 2010 (analysis of official documents, semi-structured interviews with key informants, and case studies in four clinics). Walt and Gilson's framework (1994) for policy analysis was used: content, actors, context, and process. RESULTS Problems of integration and coordination have compounded funding pressures. Despite its importance in Tunisian healthcare, primary health is ill-equipped to manage NCDs. With limited funds, and no referral or health information system, staff morale in the public sector was low. Private healthcare has been the main development filling the void. CONCLUSION This study highlights major gaps in the implementation of a comprehensive approach to NCDs, which is an urgent task across the region. In strategic planning, research on the health system is vital; but the capacity within Ministries of Health to use research has first to be built, with a commitment to grounding policy change in evidence.
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Affiliation(s)
- Habiba Ben Romdhane
- CVD Epidemiology and Prevention Research Laboratory, Faculté de Médecine de Tunis, Tunis, Tunisia
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Ciccone DK, Vian T, Maurer L, Bradley EH. Linking governance mechanisms to health outcomes: A review of the literature in low- and middle-income countries. Soc Sci Med 2014; 117:86-95. [DOI: 10.1016/j.socscimed.2014.07.010] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2013] [Revised: 06/16/2014] [Accepted: 07/04/2014] [Indexed: 10/25/2022]
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Abstract
The health consequences of the ongoing US-led war on terror and civil armed conflicts in the Arab world are much more than the collateral damage inflicted on civilians, infrastructure, environment, and health systems. Protracted war and armed conflicts have displaced populations and led to lasting transformations in health and health care. In this report, we analyse the effects of conflicts in Iraq and Syria to show how wars and conflicts have resulted in both the militarisation and regionalisation of health care, conditions that complicate the rebuilding of previously robust national health-care systems. Moreover, we show how historical and transnational frameworks can be used to show the long-term consequences of war and conflict on health and health care. We introduce the concept of therapeutic geographies--defined as the geographic reorganisation of health care within and across borders under conditions of war.
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Affiliation(s)
- Omar Dewachi
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Mac Skelton
- Department of Anthropology, The Johns Hopkins University, Baltimore, MD, USA
| | - Vinh-Kim Nguyen
- School of Public Health, University of Montréal, Montréal, QC, Canada
| | - Fouad M Fouad
- Syrian Center for Tobacco Studies Aleppo, Syria; Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Lebanon
| | - Ghassan Abu Sitta
- Plastic Surgery and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Zeina Maasri
- Department of Architecture and Design, American University of Beirut, Beirut, Lebanon
| | - Rita Giacaman
- Institute of Community Health, Birzeit University, Ramallah, West Bank, occupied Palestinian territory
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El-Zein A, Jabbour S, Tekce B, Zurayk H, Nuwayhid I, Khawaja M, Tell T, Al Mooji Y, De-Jong J, Yassin N, Hogan D. Health and ecological sustainability in the Arab world: a matter of survival. Lancet 2014; 383:458-76. [PMID: 24452051 PMCID: PMC4238938 DOI: 10.1016/s0140-6736(13)62338-7] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Discussions leading to the Rio+20 UN conference have emphasised the importance of sustainable development and the protection of the environment for future generations. The Arab world faces large-scale threats to its sustainable development and, most of all, to the viability and existence of the ecological systems for its human settlements. The dynamics of population change, ecological degradation, and resource scarcity, and development policies and practices, all occurring in complex and highly unstable geopolitical and economic environments, are fostering the poor prospects. In this report, we discuss the most pertinent population-environment-development dynamics in the Arab world, and the two-way interactions between these dynamics and health, on the basis of current data. We draw attention to trends that are relevant to health professionals and researchers, but emphasise that the dynamics generating these trends have implications that go well beyond health. We argue that the current discourse on health, population, and development in the Arab world has largely failed to convey a sense of urgency, when the survival of whole communities is at stake. The dismal ecological and development records of Arab countries over the past two decades call for new directions. We suggest that regional ecological integration around exchange of water, energy, food, and labour, though politically difficult to achieve, offers the best hope to improve the adaptive capacity of individual Arab nations. The transformative political changes taking place in the Arab world offer promise, indeed an imperative, for such renewal. We call on policy makers, researchers, practitioners, and international agencies to emphasise the urgency and take action.
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Affiliation(s)
| | | | | | - Huda Zurayk
- American University of Beirut, Beirut, Lebanon
| | | | - Marwan Khawaja
- UN Economic and Social Commission for Western Asia, Beirut, Lebanon
| | - Tariq Tell
- American University of Beirut, Beirut, Lebanon
| | - Yusuf Al Mooji
- UN Economic and Social Commission for Western Asia, Beirut, Lebanon
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47
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Affiliation(s)
- Tariq Tell
- Center for Arab and Middle East Studies (CAMES), American University of Beirut, Beirut, Lebanon.
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48
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Affiliation(s)
- Samer Jabbour
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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50
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Mokdad AH, Jaber S, Aziz MIA, AlBuhairan F, AlGhaithi A, AlHamad NM, Al-Hooti SN, Al-Jasari A, AlMazroa MA, AlQasmi AM, Alsowaidi S, Asad M, Atkinson C, Badawi A, Bakfalouni T, Barkia A, Biryukov S, El Bcheraoui C, Daoud F, Forouzanfar MH, Gonzalez-Medina D, Hamadeh RR, Hsairi M, Hussein SS, Karam N, Khalifa SEAH, Khoja TAM, Lami F, Leach-Kemon K, Memish ZA, Mokdad AA, Naghavi M, Nasher J, Qasem MBH, Shuaib M, Al Thani AAM, Al Thani MH, Zamakhshary M, Lopez AD, Murray CJL. The state of health in the Arab world, 1990-2010: an analysis of the burden of diseases, injuries, and risk factors. Lancet 2014; 383:309-20. [PMID: 24452042 DOI: 10.1016/s0140-6736(13)62189-3] [Citation(s) in RCA: 232] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Arab world has a set of historical, geopolitical, social, cultural, and economic characteristics and has been involved in several wars that have affected the burden of disease. Moreover, financial and human resources vary widely across the region. We aimed to examine the burden of diseases and injuries in the Arab world for 1990, 2005, and 2010 using data from the Global Burden of Diseases, Injuries, and Risk Factors Study 2010 (GBD 2010). METHODS We divided the 22 countries of the Arab League into three categories according to their gross national income: low-income countries (LICs; Comoros, Djibouti, Mauritania, Yemen, and Somalia), middle-income countries (MICs; Algeria, Egypt, Iraq, Jordan, Lebanon, Libya, Morocco, occupied Palestinian territory, Sudan, Syria, and Tunisia), and high-income countries (HICs; Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates). For the whole Arab world, each income group, and each individual country, we estimated causes of death, disability-adjusted life years (DALYs), DALY-attributable risk factors, years of life lived with disability (YLDs), years of life lost due to premature mortality (YLLs), and life expectancy by age and sex for 1990, 2005, and 2010. FINDINGS Ischaemic heart disease was the top cause of death in the Arab world in 2010 (contributing to 14·3% of deaths), replacing lower respiratory infections, which were the leading cause of death in 1990 (11·0%). Lower respiratory infections contributed to the highest proportion of DALYs overall (6·0%), and in female indivduals (6·1%), but ischaemic heart disease was the leading cause of DALYs in male individuals (6·0%). DALYs from non-communicable diseases--especially ischaemic heart disease, mental disorders such as depression and anxiety, musculoskeletal disorders including low back pain and neck pain, diabetes, and cirrhosis--increased since 1990. Major depressive disorder was ranked first as a cause of YLDs in 1990, 2005, and 2010, and lower respiratory infections remained the leading cause of YLLs in 2010 (9·2%). The burden from HIV/AIDS also increased substantially, specifically in LICs and MICs, and road injuries continued to rank highly as a cause of death and DALYs, especially in HICs. Deaths due to suboptimal breastfeeding declined from sixth place in 1990 to tenth place in 2010, and childhood underweight declined from fifth to 11th place. INTERPRETATION Since 1990, premature death and disability caused by communicable, newborn, nutritional, and maternal disorders (with the exception of HIV/AIDS) has decreased in the Arab world--although these disorders do still persist in LICs--whereas the burden of non-communicable diseases and injuries has increased. The changes in the burden of disease will challenge already stretched human and financial resources because many Arab countries are now dealing with both non-communicable and infectious diseases. A road map for health in the Arab world is urgently needed. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.
| | - Sara Jaber
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Fadia AlBuhairan
- King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | | | - Suad N Al-Hooti
- Kuwait Institute for Scientific Research, Kuwait City, Kuwait
| | | | | | | | | | | | - Charles Atkinson
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Alaa Badawi
- Public Health Agency of Canada, Toronto, ON, Canada
| | | | | | - Stan Biryukov
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Charbel El Bcheraoui
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Farah Daoud
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Diego Gonzalez-Medina
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | | | | | | | | | - Tawfik A M Khoja
- Health Ministers' Council for Cooperation Council States, Riyadh, Saudi Arabia
| | - Faris Lami
- Baghdad College of Medicine, Baghdad, Iraq
| | - Katherine Leach-Kemon
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | | | - Ali A Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Mohsen Naghavi
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Jamal Nasher
- Ministry of Public Health and Population, Sana'a, Yemen
| | | | | | | | | | | | - Alan D Lopez
- School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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