Molecular detection and prevalence of human-pathologic Enterocytozoon bieneusi among pet birds in Mosul, Iraq

Enterocytozoon bieneusi has been classified as an emerging infectious organism (microsporidium) due to the global increase in the number of cases infecting both humans and animals. The goal of this study was to use the polymerase chain reaction method to determine the prevalence and risk factors associated with E. bieneusi infection among pet birds in Mosul, Iraq. Faecal samples from a total of six hundred and twenty-eight pet birds belonging to fifteen (15) different species were analyzed by targeting the internal transcribed spacer (ITS) of the rRNA gene. Of the total number of pet birds sampled, 203 tested positive for the parasite, representing 32.32% (95% CI = 28.75-36.06) of the sampled population. There was a significant difference (p < 0.01) in the prevalence of E. bieneusi infection among the different species of pet birds, with the highest prevalence recorded among Eurasian bullfinches (Pyrrhula pyrrhula) (64.06%; 95% CI = 55.48-72.02), budgerigars (Melopsittacus undulatus) (48.72%; 95% CI = 40.93-56.55), Fischer's lovebirds (Agapornis fischeri) (25.00%; 95% CI = 13.45-40.05), and macaws parrots (Ara ararauna) (25.00%; 95% CI = 1.25-75.77). The order, source, and health status of pet birds were significantly (p < 0.05) associated with the prevalence of E. bieneusi infection among pet birds in Mosul, Iraq. In conclusion, the level of prevalence of E. bieneusi among pet birds may increase the risk of infection for owners of pet birds in Iraq.

War and oncology: cancer care in five Iraqi provinces impacted by the ISIL conflict

War and cancer have been intertwined in Iraq for over three decades, a country where the legacies and ongoing impacts of conflict have been commonly associated with both increased cancer rates as well as the deterioration of cancer care. Most recently, the Islamic State of Iraq and the Levant (ISIL) violently occupied large portions of the country's central and northern provinces between 2014 and 2017, causing devastating impacts on public cancer centers across central and northern Iraq. Focusing on the five Iraqi provinces previously under full or partial ISIL occupation, this article examines the immediate and long-term impacts of war on cancer care across three periods (before, during, and after the ISIL conflict). As there is little published data on oncology in these local contexts, the paper relies primarily upon the qualitative interviews and lived experience of oncologists serving in the five provinces studied. A political economy lens is applied to interpret the results, particularly the data related to progress in oncology reconstruction. It is argued that conflict generates immediate and long-term shifts in political and economic conditions that, in turn, shape the rebuilding of oncology infrastructure. The documentation of the destruction and reconstruction of local oncology systems is intended to benefit the next generation of cancer care practitioners in the Middle East and other conflict-affected regions areas in their efforts to adapt to conflict and rebuild from the legacies of war.

Health Care and Care-Seeking in Mosul 1 Year After Defeat of ISIS

OBJECTIVE

Our objective was to compare care-seeking patterns in Mosul, Iraq, in 2018, 1 y after Islamic State of Iraq and Syria (ISIS) control, with findings from neighborhoods that had been sampled in 2017.

METHODS

For this multi-stage randomized cluster household survey, we created one cluster in each of 20 neighborhoods randomly selected from the 40 neighborhoods in the 2016/17 survey; 12 in east Mosul, 8 in west Mosul. In each, 30 households were interviewed beginning at a randomly selected start house. Questions were derived from the 2016/2017 post-ISIS survey.

RESULTS

We interviewed the head of household or senior female in 600 households containing 3375 persons. One year after ISIS, some household demographic shifts had occurred. Diarrhea in children during the past 2 wk decreased from 50.1% to 7.5% (P < 0.001); however, cough/difficulty breathing increased from 15.5% to 33.6% (P < 0.01). Among adults, care-seeking for noncommunicable diseases increased from 22.3% to 43.5% (P < 0.001). Emotional and psychological complaints common in the previous survey were now nearly absent. Pregnancy complications diminished from 65.2% to 15.4% (P < 0.001).

CONCLUSIONS

Communicable diseases predominated among children and noncommunicable diseases among adults. Access to health care substantially improved, although barriers remained. Satisfaction with services was mixed, with dissatisfaction expressed about testing, medicine access, and costs, but the work of health providers was rated highly.

Household recovery in Mosul one year after the defeat of ISIS

Background

Widespread devastation to structures and households in Mosul occurred during the three years of ISIS control and the military liberation campaign by Iraqi forces assisted by coalition forces. Military operations, particularly airstrikes, resulted in a greater loss of life than during ISIS control. In 2016/17, we assessed living circumstances in Mosul immediately following defeat of ISIS. In September 2018, we reassessed many of the same indicators in Mosul households to determine the extent of recovery.

Methods

For the 2018 survey, a random selection of 20 clusters were drawn from the 40 clusters surveyed in 2016/17. Of these 20 clusters, 12 were in east Mosul and 8 in west Mosul, the same proportion as the original survey. In each cluster, 30 households were interviewed. No households were included in both surveys. A team of four interviewers collected information using questions adapted from the 2016/17 questionnaire.

Results

Among the 3375 persons from the 600 households in the 2018 survey, there had been 18 deaths reported in the year since the end of ISIS control, a mortality rate of 6.1/1000 (CI_95% [2.4–9.8]). This compares with a mortality rate of 30.7/1000 (CI_95% [28.3–33.2]) during ISIS control and liberation. Fifteen deaths were from disease, one from a non-intentional injury and two deaths due to intentional violence. Damage to dwellings had been fully repaired in only 22 (5.5%) of houses, mostly in less damaged east Mosul. Dramatic improvements in access to water and electricity have occurred, with three quarters of households reporting uninterrupted access to both. The previously reported large number of early marriages among household members stopped with the departure of ISIS. Of the 31 household marriages reported over a 12-month follow on study, 6 (19.4%) involved a female member of the household. This compares with 131 household males and 688 household females married during ISIS occupation. If marriages had continued at the same rate as for ISIS years during our one-year follow-on study, there would have been and expected 24 marriages of household males and 126 marriages of household females (OD 32.8, CI_95%[10.5102.8]) p < 0.001. There were 657 children reported by households to be in primary school. However, by household listing there were only 380 of children in the usual primary school age range (6–11), suggesting older children are catching up on primary schooling missed during ISIS years. One report of physical violence between spouses occurred. By comparison, the adjusted number of reported violent spousal events during ISIS control and military action would have been 72.7 (OR 316.7, CI_95% [44.42259.9]), p < 0.001. Reported complications of pregnancy also declined (OR 10.3, CI_95% [5.4,19.4], p < 0.001.

Conclusions

Substantial improvements in household measures have occurred since the end of ISIS control and military action, though much remains for full recovery. Many household members are now employed, primary school attendance is high and early marriage of girls was not found. There are fewer reported complications of pregnancy than in the previous study.

Prevalence and climatic influence on hemoparasites of cattle and sheep in Mosul, Iraq

Objective:

Hemoparasitism is a condition commonly found in animals and it exerts negatively on the health, production, reproduction, and performance of the affected animals. This study is aimed at determining the prevalence of different hemoparasites affecting cattle and sheep in Mosul, Iraq, and to deduce the effect of climatic factors on the occurrence of these hemoparasites.

Materials and Methods:

Blood samples from cattle and sheep that were submitted to the Parasitology Laboratory of the Veterinary Hospital of Ninavah between 2008 and 2018 were examined for the presence of blood parasites using the thin blood smear preparation. Data were analyzed using percentages (%), tabulations, and graphs. Spearman’s rank correlation coefficient was used to measure the strength of association between the occurrence of hemoparasites of cattle/sheep and each climatic variable.

Results:

Anaplasma spp. Babesia spp. and Theileria spp. were the hemoparasites detected among cattle and sheep in the study, with Theileria spp. been the most prevalent among cattle, while Anaplasma spp. was the most prevalent among sheep. There was no distinct pattern in the yearly and monthly prevalence of these hemoparasites among cattle and sheep. Rainfall and relative humidity negatively influenced the occurrence of hemoparasites infections, while temperature favored their occurrences.

Conclusion:

This study appears to be the first to evaluate the correlation between climatic variables and the prevalence of hemoparasites of cattle and sheep in Mosul, Iraq. Climatic variables influenced the abundance of hemoparasites of cattle and sheep in the study area. The outcome of this study will add to the existing knowledge on the effect of climatic factors on the occurrence of parasitic diseases of ruminants in Middle East.

Health and Health Seeking in Mosul During ISIS Control and Liberation: Results From a 40-Cluster Household Survey

OBJECTIVES

ISIS seized Mosul in June 2014. This survey was conducted to assess health status, health needs, and health-seeking behavior during ISIS control and the subsequent Iraqi military campaign.

METHODS

Forty clusters were chosen: 25 from east Mosul and 15 from west Mosul. In each, 30 households were interviewed, representing 7559 persons. The start house for each cluster was selected using satellite maps. The survey in east Mosul was conducted from March 13-31, 2017, and in west Mosul from July 18-31, 2017.

RESULTS

In the preceding 2 weeks, 265 (5.4%) adults reported being ill. Some 67 (25.3%) complaints were for emotional or behavioral issues, and 59 (22.3%) for noncommunicable diseases. There were 349 (13.2%) children under age 15 reportedly ill during this time. Diarrhea, respiratory complaints, and emotional and behavioral problems were most common. Care seeking among both children and adults was low, especially in west Mosul. During ISIS occupation, 640 (39.0%) women of childbearing age reported deliveries. Of these, 431 (67.3%) had received some antenatal care, and 582 (90.9%) delivered in a hospital. Complications were reported by 417 (65.2%).

CONCLUSIONS

Communicable and noncommunicable diseases were reported for both children and adults, with a high prevalence of emotional and behavioral problems, particularly in west Mosul. Care-seeking was low, treatment compliance for noncommunicable diseases was poor, and treatment options for patients were limited. (Disaster Med Public Health Preparedness. 2019;13:758-766).

Living in Mosul during the time of ISIS and the military liberation: results from a 40-cluster household survey

BACKGROUND

In June 2014, an estimated 1500 fighters of the Islamic State of Iraq and Syria (ISIS) seized control of Mosul, Iraq's second city. Although many residents fled, others stayed behind, enduring the restrictive civil and social policies of ISIS. In December 2016, the military activity, known as the liberation campaign, began in east Mosul, concluding in west Mosul in June 2017.

METHODS

To assess life in Mosul under ISIS, and the consequences of the military campaign to retake Mosul we conducted a 40 cluster-30 household survey in Mosul, starting in March 2017. All households included were present in Mosul throughout the entire time of ISIS control and military action.

RESULTS

In June 2014, 915 of 1139 school-age children (80.3%) had been in school, but only 28 (2.2%) attended at least some school after ISIS seized control. This represented a decision of families. Injuries to women resulting from intimate partner violence were reported in 415 (34.5%) households. In the surveyed households, 819 marriages had occurred; 688 (84.0%) among women. Of these women, 89 (12.9%) were aged 15 years and less, and 253 (49.7%) were aged under 18 at the time of marriage. With Mosul economically damaged by ISIS control and physically during the Iraqi military action, there was little employment at the time of the survey, and few persons were bringing cash into households. The liberation of Mosul in 2017 caused extensive damage to dwellings. Overall only a quarter of dwellings had not sustained some damage. In west Mosul, only 21.7% of houses had little or no damage from the conflict, with 98 (21.7%) households reporting their house had been destroyed, forcing its occupants to move. No houses had regular electricity and there was limited piped water. Inadequate fuel for cooking was reported by 996 (82.9%) households.

CONCLUSION

The physical, and social damage occurring during ISIS occupation of Mosul and during the subsequent military action (liberation) was substantial and its impact is unlikely to be erased soon.

Notes from a field hospital south of Mosul

This short letter from the field is offered as a rapid communiqué of the emergency medical situation in Mosul and surrounding areas on the eve of the final onslaught to liberate the city. This letter is based on emergency medical work at two World Health Organization (WHO) and Ministry of Health (MoH) Iraq lead Role II+ Field Hospital facilities south of Mosul City from April to June 2017; these facilities are currently and temporarily managed and administered by private medical industry until full handover to MoH Iraq, with WHO support and expert facilitation. The prominence of non-state actors in the conflict, using hybrid warfare tactics that maximize casualties, makes health security a particular challenge for the global community. This challenge requires health leaders and other actors in the region to set clear strategic goals that support public health of the many millions displaced, maimed and affected by the war. Whether in clinical medicine, development, peace and stability operations, or global health diplomacy, the shared values and conviction to best serve vulnerable communities and mitigate morbidity must embrace the lessons of evidenced based practice derived from military medical experience. WHO is leading the charge in disaster response for the conflict in Iraq, and many challenges remain. This might also include developing a new process in emergency medical response that utilizes private contracting to improve efficiency in delivery and overall sustainability.