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Nemr E, Moussallem M, Nemr R, Kosremelli Asmar M. Exodus of Lebanese doctors in times of crisis: a qualitative study. FRONTIERS IN HEALTH SERVICES 2023; 3:1240052. [PMID: 38028945 PMCID: PMC10643131 DOI: 10.3389/frhs.2023.1240052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 10/13/2023] [Indexed: 12/01/2023]
Abstract
Introduction Since 2019, Lebanon is experiencing an unprecedented exodus of doctors, seriously threatening the national health system, which is expected to continue without quick and effective solutions. Therefore, this study aimed to understand the factors that push Lebanese doctors to migrate and the factors that retain others in the country. Additionally, this study aims to propose solutions to preserve an adequate supply of medical care amidst the crisis. Methods Qualitative semi-structured interviews and focus group discussions were conducted using pre-developed guides. Purposive and snowball sampling was adopted to recruit physicians who emigrated and physicians staying in Lebanon. Transcripts of interviews and focus groups were coded using Dedoose software and analyzed through a combination of inductive and deductive approaches. Results Emigration was found to be the result of numerous interconnected factors. The main drivers for emigration were declining income, career problems, reduced quality of care, unhealthy work environment, and the deteriorated political and socio-economic contexts leading to instability and insecurity. As for the retention factors, they included affective attachment and sense of belonging to the professional environment and the country, followed by recognition and valorization at work. Several recommendations were developed to maintain quality of care delivery, including reforms of the health system, development of focused human resource retention strategies based on resource mapping evidence, negotiations with recruiting institutions to endorse the code ethics ending unethical practices draining countries' human resources, provision of financial incentives to doctors, and the recognition and valorization of physicians. Other rapid interventions were suggested, such as short-term medical missions to mitigate shortages in certain specialties, telemedicine, adaptation of recruitment processes to compensate for resources shortages in certain specialties, and adoption of task-shifting approaches to alleviate the workload on overburdened specialists. Discussion The findings of this study shed the light on the different factors influencing migration while framing them in the Lebanese context. These findings and recommendations should inform stakeholders and policy makers about the interventions needed to restore the quality of care. The feasibility and sustainability of most formulated recommendations depend on several factors, with political and socio-economic security and stability being the most crucial ones.
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Affiliation(s)
- Elie Nemr
- Faculty of Medicine, Saint Joseph University, Beirut, Lebanon
| | - Marianne Moussallem
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
| | - Rita Nemr
- Department of Endocrinology, Lebanese American University, Beirut, Lebanon
| | - Michèle Kosremelli Asmar
- Higher Institute of Public Health, Faculty of Medicine, Saint Joseph University of Beirut, Lebanon
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Mourtada R, Melnikas AJ. Syrian refugee women's access to family planning services and modern contraception during overlapping crises in Bekaa, Lebanon. BMC Womens Health 2023; 23:475. [PMID: 37674178 PMCID: PMC10481481 DOI: 10.1186/s12905-023-02613-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Political, financial, and pandemic crises in Lebanon have affected both provision of reproductive health services including family planning and modern contraception methods as well as women's interest and ability to seek those services. This study aims to explore the impact of the compounding crises on the provision and use of family planning services including modern contraception methods for Syrian refugees in Lebanon focusing on the perspectives of Syrian refugee women. METHODS We carried out 12 Focus Group Discussions (FGDs) with 119 Syrian refugee women recruited from two cities in West Bekaa, Lebanon from inside and outside the informal tented settlements. We used Skype video calls to moderate the FGDs due to the limited mobility at the time of the study because of Covid-19. We used thematic analyses to analyse the data. RESULTS The crises seemed to exacerbate supply side barriers, which influenced provision of family planning services and women's demand for them. These included Covid-19 regulations and maltreatment by staff at public health facilities, disruption of outreach reproductive health services that provide family planning and modern contraception, and reduced supply of modern contraception methods. On the demand side, women reported financial limitations in accessing and paying for services, concern over being infected with Covid-19, and concerns about insecurity. CONCLUSIONS We suggest possible interventions to address these challenges and better reach these populations. These include using mobile health technology (mHealth) that may provide contraceptive counselling and/or can inform refugee women about where they may receive family planning and modern contraception. These services may also support Syrian refugees to access care they are entitled to receive and may also address disruptions in service provision due to overlapping crises, including availability and rising costs of contraceptives. These can be coupled with mobile outreach reproductive health services that provide family planning. We also suggest considering the provision of Long Acting Reversible Contraception (LARC) for Syrian refugee women, which would reduce a barrier of needing to revisit health facilities to obtain an additional supply of contraception pills.
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Affiliation(s)
- Rima Mourtada
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA.
| | - Andrea J Melnikas
- Population Council. One Dag Hammarskjold Plaza, New York, NY, 10017, USA
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Malaeb D, Sacre H, Mansour S, Haddad C, Sarray El Dine A, Fleihan T, Hallit S, Salameh P, Hosseini H. Assessment of medication adherence among Lebanese adult patients with non-communicable diseases during COVID-19 lockdown: a cross-sectional study. Front Public Health 2023; 11:1145016. [PMID: 37415710 PMCID: PMC10322190 DOI: 10.3389/fpubh.2023.1145016] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 05/25/2023] [Indexed: 07/08/2023] Open
Abstract
Background Medical treatment is considered a cornerstone in non-communicable diseases (NCDs) management, lack of adherence remains the main challenge that may compromise optimal therapeutic outcome achievement. Purpose This study aimed to evaluate treatment adherence levels and associated factors among Lebanese adult patients with non-communicable diseases. Materials and methods A cross-sectional survey conducted during the COVID-19 lockdown imposed by the Lebanese Government (between September 2020 and January 2021) enrolled 263 adult patients through an anonymous online questionnaire to assess adherence to medications using the Lebanese Medication Adherence Scale (LMAS-14). Results Of the total sample, 50.2% showed low adherence with a total mean adherence score of 4.41 ± 3.94. The results showed that depression (β = 1.351) and peptic ulcer (β = 1.279) were significantly associated with higher LMAS scores (lower adherence). However, age between 50 and 70 (β = -1.591, p = 0.011), practicing physical exercise (β = -1.397, p = 0.006), having kidney disease (β = -1.701, p = 0.032), and an intermediate (β = -1.336, p = 0.006) to high income (β = -3.207, p < 0.001) were significantly associated with lower LMAS scores (higher adherence). Conclusion Our study shed light on the factors affecting medication adherence in patients with non-communicable diseases. It showed that depression and peptic ulcer were associated with lower adherence, contrary to older age, exercising, having chronic kidney disease, and a higher socioeconomic status.
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Affiliation(s)
- Diana Malaeb
- College of Pharmacy, Gulf Medical University, Ajman, United Arab Emirates
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Hala Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - Sara Mansour
- School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - Chadia Haddad
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- School of Health Sciences, Modern University for Business and Science, Beirut, Lebanon
| | | | - Tamara Fleihan
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Souheil Hallit
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik, Jounieh, Lebanon
- Applied Science Research Center, Applied Science Private University, Amman, Jordan
- Department of Research, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - Pascale Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
- Faculty of Pharmacy, Lebanese University, Hadath, Lebanon
- Department of Primary Care and Population Health, University of Nicosia Medical School, Nicosia, Cyprus
- School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Hassan Hosseini
- INSERM U955-E01, IMRB, Henri Mondor Hospital, Créteil, France
- Department of Neurology, Henri Mondor Hospital, AP-HP, Créteil, France
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Fares MY, Musharrafieh U, Bizri AR. The impact of the Beirut blast on the COVID-19 situation in Lebanon. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2023; 31:575-581. [PMID: 34055571 PMCID: PMC8140319 DOI: 10.1007/s10389-021-01562-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/14/2021] [Indexed: 12/04/2022]
Abstract
Aim On August 4, 2020, a massive explosion hit Lebanon's capital city, Beirut. The aim of this study was to explore the effect of the Beirut blast on the COVID-19 situation in the country. Subject and Methods Data on COVID-19 were retrieved from the Lebanese Ministry of Public Health (LMOPH), where all the COVID-19 positive cases were reported. The study was divided into two periods, considering the incubation period of the COVID-19 virus: (July 27-August 9, 2020) and (August 10-23, 2020). Information obtained included daily number of cases, tests, deaths, hospitalized patients, intensive care unit (ICU) patients, and mode of acquisition (local vs. expat). Daily positivity rates were reported per 100 tests. An independent sample t-test and a Joinpoint regression analysis were used to determine significance. A p value less than 0.05 was considered significant. Results A total of 201,010 tests were conducted during our studied period, with 8993 positive cases, constituting a total positivity rate of 4.5 per 100 tests. Case fatality rate over the studied period was 0.8%. The positivity rate of the period prior to August 10, 2020, was 2.7 per 100 tests, significantly less than that of the period following the explosion, which was 6.4 per 100 tests (p < 0.001). During our studied period, daily positivity rates were significantly increasing at a slope of 0.29 (p < 0.001). A significant increase in slope was noted on August 13, 2020 (p < 0.001). The number of hospitalized patients increased from 139 patients on July 27 to 266 on August 23, 2020, and that of ICU patients increased from 36 to 75. Conclusion The port of Beirut explosion resulted in a significant increase in the daily number of positive COVID-19 cases. The aftermath of the explosion, the damage to healthcare facilities, and the overcrowding due to emergency efforts were contributing factors to that increase.
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Affiliation(s)
- Mohamad Y. Fares
- grid.8756.c0000 0001 2193 314XCollege of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, Scotland UK
- grid.411654.30000 0004 0581 3406Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- grid.411324.10000 0001 2324 3572Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Beirut, Lebanon
| | - Umayya Musharrafieh
- grid.411654.30000 0004 0581 3406Department of Family Medicine, Director, COVID-19 Clinic, American University of Beirut Medical Center, Beirut, Lebanon
- COVID-19 Taskforce, Lebanese Society for Infectious Diseases and Clinical Microbiology, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdul Rahman Bizri
- COVID-19 Taskforce, Lebanese Society for Infectious Diseases and Clinical Microbiology, Beirut, Lebanon
- grid.411654.30000 0004 0581 3406Division of Infectious Diseases, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
- National Committee for Communicable Diseases, Beirut, Lebanon
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Matlin SA, Karadag O, Brando CR, Góis P, Karabey S, Khan MMH, Saleh S, Takian A, Saso L. COVID-19: Marking the Gaps in Migrant and Refugee Health in Some Massive Migration Areas. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12639. [PMID: 34886367 PMCID: PMC8657173 DOI: 10.3390/ijerph182312639] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/15/2021] [Accepted: 11/27/2021] [Indexed: 11/16/2022]
Abstract
The health of migrants and refugees, which has long been a cause for concern, has come under greatly increased pressure in the last decade. Against a background where the world has witnessed the largest numbers of migrants in history, the advent of the COVID-19 pandemic has stretched the capacities of countries and of aid, health and relief organizations, from global to local levels, to meet the human rights and pressing needs of migrants and refugees for access to health care and to public health measures needed to protect them from the pandemic. The overview in this article of the situation in examples of middle-income countries that have hosted mass migration in recent years has drawn on information from summaries presented in an M8 Alliance Expert Meeting, from peer-reviewed literature and from reports from international agencies concerned with the status and health of migrants and refugees. The multi-factor approach developed here draws on perspectives from structural factors (including rights, governance, policies and practices), health determinants (including economic, environmental, social and political, as well as migration itself as a determinant) and the human security framework (defined as "freedom from want and fear and freedom to live in dignity" and incorporating the interactive dimensions of health, food, environmental, economic, personal, community and political security). These integrate as a multi-component 'ecological perspective' to examine the legal status, health rights and access to health care and other services of migrants and refugees, to mark gap areas and to consider the implications for improving health security both for them and for the communities in countries in which they reside or through which they transit.
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Affiliation(s)
- Stephen A. Matlin
- Institute of Global Health Innovation, Imperial College London, South Kensington, London SW7 2AZ, UK;
- Global Health Centre, Graduate Institute of International and Development Studies, 1202 Geneva, Switzerland
| | - Ozge Karadag
- Center for Sustainable Development, Earth Institute, Columbia University, New York, NY 10115, USA
| | - Claudio R. Brando
- Education and International Relations Office, Hospital Universitario San Ignacio, Bogotá 11001, Colombia;
| | - Pedro Góis
- Faculty of Economics, University of Coimbra, 3004-512 Coimbra, Portugal;
| | - Selma Karabey
- Istanbul Faculty of Medicine, Istanbul University, Fatih, Istanbul 34093, Turkey;
| | - Md. Mobarak Hossain Khan
- Department of Social Relations, Faculty of Liberal Arts and Social Sciences, East West University, Dhaka 1212, Bangladesh;
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Amirhossein Takian
- Health Equity Research Center (HERC) and Department of Global Health & Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Luciano Saso
- Department of Physiology and Pharmacology Sapienza University of Rome, 00185 Rome, Italy;
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Abouzeid M, Halwani DA, Mokdad AH, Habib RR. A Generation at Risk: The Impacts of Lebanon's Escalating Humanitarian Crisis on Children. Front Public Health 2021; 9:704678. [PMID: 34485230 PMCID: PMC8415263 DOI: 10.3389/fpubh.2021.704678] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/20/2021] [Indexed: 11/29/2022] Open
Abstract
Lebanon is in the midst of a rapidly escalating, unprecedented humanitarian crisis that is plunging the country deep into poverty and threatens population well-being, economic development, social welfare and national and regional stability. The dire situation is due to the compounding effects of the August 2020 Beirut blast, massive economic collapse and the COVID-19 pandemic, in a setting of longstanding entrenched political corruption and a dysfunctional, mismanaged crisis response by the state. This current emergency occurs on the background of a turbulent history and complex regional geopolitical context – including the Syrian refugee crisis, the ongoing influence of foreign actors and their local proxies, the United-States-imposed sanctions, endemic corruption, a culture of nepotism and entitlement among the political dynasties, dysfunctional power-sharing and deep-seated sectarian divides. With over half the population now living in poverty, a generation of children are among those at risk. This Perspective provides a brief overview of Lebanon's current complex humanitarian crisis, discusses the impacts of the evolving situation on youth and proposes a suite of recommendations to mitigate the effects.
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Affiliation(s)
- Marian Abouzeid
- Alfred Deakin Institute for Citizenship and Globalisation, Deakin University, Burwood, VIC, Australia.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dana A Halwani
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
| | - Rima R Habib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Kheir WJ, Awwad ST, Bou Ghannam A, Khalil AA, Ibrahim P, Rachid E, El Salloukh NA, Yehia M, Torbey J, El Zein L, Jabbur NS, Noureddin B, Alameddine RM. Ophthalmic Injuries After the Port of Beirut Blast-One of Largest Nonnuclear Explosions in History. JAMA Ophthalmol 2021; 139:937-943. [PMID: 34351374 DOI: 10.1001/jamaophthalmol.2021.2742] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Importance A review of the injury patterns, treatment strategies, and responding physicians' experience during the Port of Beirut blast may help guide future ophthalmic disaster response plans. Objective To present the ophthalmic injuries and difficulties encountered as a result of the Port of Beirut blast on August 4, 2020. Design, Setting, and Participants A retrospective medical record review of all patients who presented to the emergency department and 13 ophthalmology outpatient clinics at the American University of Beirut Medical Center for treatment of ophthalmic injuries sustained from the explosion in Port of Beirut, Beirut, Lebanon, from August 4 to the end of November 2020. Patients were identified from emergency records, outpatient records, and operative reports. Main Outcomes and Measures Types of ocular injuries, final best-corrected visual acuity, and need for surgical intervention were evaluated. Visual acuity was measured with correction based on noncycloplegic refraction using the Snellen medical record. Exposures Ocular or ocular adnexal injuries sustained from the Port of Beirut explosion. Results A total of 39 blast survivors with ocular injuries were included in this study. Twenty-two patients presented with ocular injuries on the day of the blast, and 17 patients presented within the following 3 months to the ophthalmology clinics for a total of 48 eyes of 39 patients were treated secondary to the blast. Thirty-five patients (89.6%) were adults, and 24 (61.5%) were female. A total of 21 patients (53.8%) required surgical intervention, more than half of which were urgently requested on the same day of presentation (14 [35.9%]). Most eye injuries were caused by debris and shrapnel from shattered glass leading to surface injury (26 [54.2%]), eyelid lacerations (20 [41.6%]), orbital fractures (14 [29.2%]), brow lacerations (10 [20.8%]), hyphema (9 [18.8%]), open globe injuries (10 [20.8%]), and other global injuries. Only 7 injured eyes (14.5%) had a final best-corrected visual acuity of less than 20/200, including all 4 open globe injuries with primary no light perception (8.3%) requiring enucleation or evisceration. Conclusions and Relevance In the aftermath of the Port of Beirut explosion, a review of the ophthalmic injuries showed a predominance of shrapnel-based injuries, many of which had a delayed presentation owing to the strain placed on health care services. Reverting to basic approaches was necessary in the context of a malfunctioning electronic medical record system.
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Affiliation(s)
- Wajiha Jurdi Kheir
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Shady T Awwad
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Alaa Bou Ghannam
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ali A Khalil
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Perla Ibrahim
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elza Rachid
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | | | - Madeleine Yehia
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Julien Torbey
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lulwa El Zein
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nada S Jabbur
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon.,Department of Ophthalmology, Clemenceau Medical Center, Beirut, Lebanon.,Lebanese Ophthalmological Society, Beirut, Lebanon
| | - Baha Noureddin
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ramzi M Alameddine
- Department of Ophthalmology, American University of Beirut Medical Center, Beirut, Lebanon
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