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Dayer VW, Drummond MF, Dabbous O, Toumi M, Neumann P, Tunis S, Teich N, Saleh S, Persson U, von der Schulenburg JMG, Malone DC, Salimullah T, Sullivan SD. Real-world evidence for coverage determination of treatments for rare diseases. Orphanet J Rare Dis 2024; 19:47. [PMID: 38326894 PMCID: PMC10848432 DOI: 10.1186/s13023-024-03041-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/19/2024] [Indexed: 02/09/2024] Open
Abstract
Health technology assessment (HTA) decisions for pharmaceuticals are complex and evolving. New rare disease treatments are often approved more quickly through accelerated approval schemes, creating more uncertainties about clinical evidence and budget impact at the time of market entry. The use of real-world evidence (RWE), including early coverage with evidence development, has been suggested as a means to support HTA decisions for rare disease treatments. However, the collection and use of RWE poses substantial challenges. These challenges are compounded when considered in the context of treatments for rare diseases. In this paper, we describe the methodological challenges to developing and using prospective and retrospective RWE for HTA decisions, for rare diseases in particular. We focus attention on key elements of study design and analyses, including patient selection and recruitment, appropriate adjustment for confounding and other sources of bias, outcome selection, and data quality monitoring. We conclude by offering suggestions to help address some of the most vexing challenges. The role of RWE in coverage and pricing determination will grow. It is, therefore, necessary for researchers, manufacturers, HTA agencies, and payers to ensure that rigorous and appropriate scientific principles are followed when using RWE as part of decision-making.
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Affiliation(s)
- Victoria W Dayer
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA.
| | | | - Omar Dabbous
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | - Mondher Toumi
- Faculty of Medicine, Public Health Department, Aix-Marseille University, Marseille, France
| | | | | | | | - Shadi Saleh
- American University of Beirut, Beirut, Lebanon
| | - Ulf Persson
- The Swedish Institute for Health Economics, Lund, Sweden
| | | | - Daniel C Malone
- Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA
| | | | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, USA
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Saleh S, Dabbous O, Sullivan SD, Ankleshwaria D, Trombini D, Toumi M, Diaa M, Patel A, Kazazoglu Taylor B, Tunis S. A practical approach for adoption of a hub and spoke model for cell and gene therapies in low- and middle-income countries: framework and case studies. Gene Ther 2024; 31:1-11. [PMID: 37903929 PMCID: PMC10788266 DOI: 10.1038/s41434-023-00425-x] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 09/19/2023] [Accepted: 10/04/2023] [Indexed: 11/01/2023]
Abstract
In the rapidly evolving landscape of biotechnologies, cell and gene therapies are being developed and adopted at an unprecedented pace. However, their access and adoption remain limited, particularly in low- and middle-income countries (LMICs). This study aims to address this critical gap by exploring the potential of applying a hub and spoke model for cell and gene therapy delivery in LMICs. We establish the identity and roles of relevant stakeholders, propose a hub and spoke model for cell and gene therapy delivery, and simulate its application in Brazil and the Middle East and North Africa. The development and simulation of this model were informed by a comprehensive review of academic articles, grey literature, relevant websites, and publicly available data sets. The proposed hub and spoke model is expected to expand availability of and access to cell and gene therapy in LMICs and presents a comprehensive framework for the roles of core stakeholders, laying the groundwork for more equitable access to these lifesaving therapies. More research is needed to explore the practical adoption and implications of this model.
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Affiliation(s)
- Shadi Saleh
- American University of Beirut, Beirut, Lebanon.
| | - Omar Dabbous
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
| | - Sean D Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA, USA
| | | | | | | | | | - Anish Patel
- Novartis Gene Therapies, Inc., Bannockburn, IL, USA
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Dimassi H, Alameddine M, Sabra N, El Arnaout N, Harb R, Hamadeh R, El Kak F, Shanaa A, Mossi MO, Saleh S, AlArab N. Maternal health outcomes in the context of fragility: a retrospective study from Lebanon. Confl Health 2023; 17:59. [PMID: 38093261 PMCID: PMC10720064 DOI: 10.1186/s13031-023-00558-1] [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: 07/18/2023] [Accepted: 12/05/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND AND AIMS The Lebanese healthcare system faces multiple challenges including limited capacities, shortage of skilled professionals, and inadequate supplies, in addition to hosting a significant number of refugees. While subsidized services are available for pregnant women, representing the majority of the refugee population in Lebanon, suboptimal access to antenatal care (ANC) and increased maternal mortality rates are still observed, especially among socioeconomically disadvantaged populations. This study aimed to review the maternal health outcomes of disadvantaged Lebanese and refugee pregnant women seeking ANC services at primary healthcare centers (PHCs) in Lebanon. METHODS A retrospective chart review was conducted at twenty PHCs in Lebanon, including Ministry of Public Health (MOPH) and United Nations Relief and Works Agency for Palestine refugees (UNRWA) facilities. Data was collected from medical charts of pregnant women who visited the centers between August 2018 and August 2020. Statistical analysis was performed to explore outcomes such as the number of ANC visits, delivery type, and onset of delivery, using bivariate and multivariable logistic regression models. RESULTS In the study, 3977 medical charts were analyzed. A multivariate logistic regression analysis, revealed that suboptimal ANC visits were more common in the Beqaa region and among women with current abortion or C-section. Syrians had reduced odds of C-sections, and Beqaa, Mount Lebanon, and South Lebanon regions had reduced odds of abortion. Suboptimal ANC visits and history of C-section increased the odds of C-section and abortion in the current pregnancy. As for preterm onset, the study showed an increased likelihood for it to occur when being Palestinian, having current C-section delivery, experiencing previous preterm onset, and enduring complications at the time of delivery. CONCLUSION This study suggests the need for low-cost interventions aiming at enhancing access to ANC services, especially among pregnant women in fragile settings.
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Affiliation(s)
- Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Mohamad Alameddine
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
| | - Nadine Sabra
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | | | - Faysal El Kak
- Faculty of Health Sciences, American University of Beirut (AUB), Beirut, Lebanon
- Department of Obstetrics Gynecology, American University of Beirut, Medical Center (AUB) Medical Center, Beirut, Lebanon
| | - Abed Shanaa
- United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), Beirut, Lebanon
| | | | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Natally AlArab
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
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Brihmat N, Bayram MB, Ravi M, Bheemreddy A, Anjaria M, Momeni K, Saleh S, Forrest GF. Differential Corticospinal Excitability and Cortical Functional Connectivity Modulation by Spinal Cord Transcutaneous Stimulation-based Motor Training versus Motor Training alone in Able-bodied and SCI participants: A Multiple Case Study. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083293 DOI: 10.1109/embc40787.2023.10340957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Spinal cord transcutaneous stimulation (scTS) has shown its potential for boosting motor, sensory, and autonomic function recovery after a spinal cord injury. Despite the demonstrated benefits, little is known about the exact neuromodulatory mechanisms triggered by scTS and the cortex involvement in the beneficial effects observed. Here, we examine the effects of scTS-based motor training and motor training alone on sensorimotor cortical functional connectivity and corticospinal excitability in able-bodied and SCI participants.Clinical Relevance- The results show preliminary evidence of differential cortical involvement and modulation by scTS-based motor training in uninjured and spinal-cord injured individuals. A better understanding of scTS mechanisms of action could help optimize the intervention design and potentiate its benefits.
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Naal H, Daou T, Brome D, Mansour R, Sittah GA, Giannou C, Steiger E, Saleh S. Evaluating a research training programme for frontline health workers in conflict-affected and fragile settings in the middle east. BMC Med Educ 2023; 23:240. [PMID: 37055781 PMCID: PMC10099017 DOI: 10.1186/s12909-023-04176-6] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 03/20/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Health Research Capacity Building (HRCB) is key to improving research production among health workers in LMICs to inform related policies and reduce health disparities in conflict settings. However, few HRCB programmes are available in the MENA region, and few evaluations of HRCB globally are reported in the literature. METHODS Through a qualitative longitudinal design, we evaluated the first implementation of the Center for Research and Education in the Ecology of War (CREEW) fellowship. Semi-structured interviews were conducted with fellows (n = 5) throughout the programme at key phases during their completion of courses and at each research phase. Additional data was collected from supervisors and peers of fellows at their organizations. Data were analysed using qualitative content analysis and presented under pre-identified themes. RESULTS Despite the success of most fellows in learning on how to conduct research on AMR in conflict settings and completing the fellowship by producing research outputs, important challenges were identified. Results are categorized under predefined categories of (1) course delivery, (2) proposal development, (3) IRB application, (4) data collection, (5) data analysis, (6) manuscript write-up, (7) long-term effects, and (8) mentorship and networking. CONCLUSION The CREEW model, based on this evaluation, shows potential to be replicable and scalable to other contexts and other health-related topics. Detailed discussion and analysis are presented in the manuscript and synthesized recommendations are highlighted for future programmes to consider during the design, implementation, and evaluation of such programmes.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Tracy Daou
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Dayana Brome
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Rania Mansour
- St George's Hospital Medical School, St George's University of London, London, UK
| | - Ghassan Abu Sittah
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Christos Giannou
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Queen Mary University of London, London, UK
| | | | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
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AlArab N, Nabulsi D, El Arnaout N, Dimassi H, Harb R, Lahoud J, Nahouli L, Abou Koura A, El Saddik G, Saleh S. Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database. BMC Womens Health 2023; 23:81. [PMID: 36823589 PMCID: PMC9951425 DOI: 10.1186/s12905-023-02231-4] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/16/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.
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Affiliation(s)
- Natally AlArab
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- grid.411323.60000 0001 2324 5973School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Julien Lahoud
- grid.22903.3a0000 0004 1936 9801Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lara Nahouli
- grid.411654.30000 0004 0581 3406Department of Obstetrics and Gynecology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Abdulghani Abou Koura
- grid.411654.30000 0004 0581 3406Department of Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ghaidaa El Saddik
- grid.18112.3b0000 0000 9884 2169Beirut Arab University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020, Lebanon.
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Abdul-Sater Z, Mukherji D, Adib SM, Shamseddine A, Abu-Sitta G, Fadhil I, Sullivan R, Omari AA, Saleh S, Taher A. Cancer registration in the Middle East, North Africa, and Turkey (MENAT) region: A tale of conflict, challenges, and opportunities. Front Oncol 2022; 12:1050168. [PMID: 36505790 PMCID: PMC9730320 DOI: 10.3389/fonc.2022.1050168] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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: 09/21/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
Abstract
Cancer registration is a core component of national and regional cancer control strategies. In the Middle East, North-Africa and Turkey (MENAT) region, capacity and resources for cancer registration is variable and shaped by multiple contextual challenges. This viewpoint maps out practical recommendations around cancer registration, in an attempt to inform cancer control planning, policy, and implementation. The recommendations laid out in this viewpoint are informed by the discussions held at the Initiative for Cancer Registration in the MENAT (ICRIM) virtual workshop, which convened registry managers, policy makers, and international agencies from 19 countries in the MENAT region. The discussions were distilled in four categories of recommendations, revolving around cancer registration procedures, collaborative governance, putting cancer registration on the map, and capacity building. This viewpoint provides a much-needed mapping of practical recommendations around cancer registration, informed by direct key stakeholders in the region. These practical recommendations offer a road map for policy making, cancer control planning, and future regional capacity strengthening initiatives.
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Affiliation(s)
- Zahi Abdul-Sater
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Deborah Mukherji
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Salim M. Adib
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Ali Shamseddine
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sitta
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Richard Sullivan
- Institute of Cancer Policy & Conflict & Health Research Group, King’s College London, London, United Kingdom
| | - Amal Al Omari
- King Hussein Cancer Center, Office of Scientific Affairs and Research (OSAR), Amman, Jordan
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ali Taher
- Department of Hematology/Oncology, American University of Beirut Medical Center, American University of Beirut, Beirut, Lebanon,*Correspondence: Ali Taher,
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Keidan T, Saleh S, Svorai Band S, Gannot G, Oron A. [DE QUERVAIN'S TENOSYNOVITIS - CLINICAL PRESENTATION AND TREATMENT]. Harefuah 2022; 161:706-708. [PMID: 36578243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION De-Quervain tenosynovitis, named after the Swiss surgeon Fritz De Quervain, is a condition characterized by pain and tenderness over the first extensor compartment of the wrist. This compartment contains the extensor pollicis brevis (EPB) and abductor pollicis longus (APL) tendons in their individual retinacular sheath. Non-inflammatory thickening of the tendinous sheath leads to entrapment of the individual tendons and increased friction. The condition is more common in women, particularly aged 30-50 years old and those 4-6 weeks in their post-partum period. It can be associated with trauma or repetitive motion but is typically of unknown etiology. While most cases are self-limiting, treatment is often required and comprises of non-operative treatment: anti-inflammatory medication, wrist splints and local steroid injection; and operative treatment: surgical release of the 1st dorsal compartment.
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Affiliation(s)
- Tomer Keidan
- Orthopedic Department, Hand Surgery Unit, Kaplan Medical Center, Rehovot, Israel
| | - Shadi Saleh
- Orthopedic Department, Hand Surgery Unit, Kaplan Medical Center, Rehovot, Israel
| | - Shani Svorai Band
- Orthopedic Department, Hand Surgery Unit, Kaplan Medical Center, Rehovot, Israel
| | - Gil Gannot
- Orthopedic Department, Hand Surgery Unit, Kaplan Medical Center, Rehovot, Israel
| | - Amir Oron
- Orthopedic Department, Hand Surgery Unit, Kaplan Medical Center, Rehovot, Israel
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Ababneh O, Ahmed Y, Syaj S, Hatamleh Z, Saleh S, Zaitoun A, Akhdar M, Alsaid Ahmad M, Al-shadiafat R, Hamouri S. EP08.02-121 The Landscape of Anti-neoplastic Drugs for Malignant Pleural Effusion in Non-small Cell Lung Cancer: A Systematic Review of Clinical Trials. J Thorac Oncol 2022. [DOI: 10.1016/j.jtho.2022.07.804] [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: 11/27/2022]
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Saleh S, Fouad FM. Political economy of health in fragile and conflict-affected regions in the Middle East and North Africa region. J Glob Health 2022; 12:01003. [PMID: 35959965 PMCID: PMC9373566 DOI: 10.7189/jogh.12.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fouad M Fouad
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Fuchs L, Saleh S, Ganot G, Oron A. [MULTIPLE GIANT CELL TUMOR OF TENDON SHEATH: A CASE REPORT OF THREE LESIONS ON THE SAME FLEXOR TENDON]. Harefuah 2022; 161:487-489. [PMID: 35979566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
We present a case report of a triple location Giant Cell Tumor of tendon sheath appearance on the same flexor tendon sheath of a single digit. There have been scarce descriptions of multiple Giant Cell Tumors of tendon sheath. Multiple tumors may predispose patients to a higher recurrence rate; therefore, recognition and treatment of this rare entity is important.
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Affiliation(s)
- Lee Fuchs
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Shadi Saleh
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Gil Ganot
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
| | - Amir Oron
- Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel
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12
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Terlezky S, Amster Kahn H, Saleh S, Gannot G, Oron A. [MEDIAL EPICONDYLITIS (GOLFER'S ELBOW) - CLINICAL PRESENTATION AND TREATMENT]. Harefuah 2022; 161:515-519. [PMID: 35979571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Medial epicondylitis, which is also called "Golfer's Elbow" is a pathology which typically presents as medial elbow pain. It affects 1% of the general population, yet affects 3.8% to 8.2% of work-related complaints. Golfer's elbow is common in the 40 to 60-year-old age group so those suffering from it are part of the workforce and hence, its economic impact. Women and men alike suffer from golfer's elbow, and microtrauma combined with attritional changes in the common flexor tendon origin at the medial aspect of the elbow are the culprit of this pathology. The first line of treatment is conservative therapy and only when it fails is an open surgical approach utilized. New approaches to treating this ailment such as use of Extra Corporeal Shock Wave therapy and the use of injectable blood derivatives, as well as new surgical techniques are also being applied.
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Affiliation(s)
- Svetlana Terlezky
- Kaplan Medical Center, Rehovot. Hand and Microsurgery Unit - affiliated to the Hebrew University
| | - Hagay Amster Kahn
- Kaplan Medical Center, Rehovot. Hand and Microsurgery Unit - affiliated to the Hebrew University
| | - Shadi Saleh
- Kaplan Medical Center, Rehovot. Hand and Microsurgery Unit - affiliated to the Hebrew University
| | - Gil Gannot
- Kaplan Medical Center, Rehovot. Hand and Microsurgery Unit - affiliated to the Hebrew University
| | - Amir Oron
- Kaplan Medical Center, Rehovot. Hand and Microsurgery Unit - affiliated to the Hebrew University
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Saleh S, Muhieddine D, Hamadeh R, Dimassi H, Diaconu K, Arakelyan S, Ager A, Alameddine M. The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon. Front Public Health 2022; 10:844864. [PMID: 35958868 PMCID: PMC9357988 DOI: 10.3389/fpubh.2022.844864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.MethodsWe conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.ResultsSignificantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).ConclusionThe study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Hani Dimassi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Mohamad Alameddine
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Mohamad Alameddine
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Gannot G, Saleh S, Arush Y, Oron A. [ACUTE INJURY TO FLEXOR TENDONS OF THE HAND: ASSESSMENT, DIAGNOSIS AND TREATMENT]. Harefuah 2022; 161:437-442. [PMID: 35833430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Hand lacerations are common injuries seen by the primary care physician. Even seemingly small cuts carry a high risk of injury to flexor tendons of the hand which requires surgical treatment by a specialist. Elucidation of the relevant history, along with a dedicated and focused physical examination is imperative for an early intervention which, along with a meticulous surgical technique and dedicated rehabilitation by occupational therapists, will lead to a much improved functional prognosis for the patient. This is a brief review of the anatomy and physiology of flexor tendons injury and repair, with historical milestones of developments in the approach to the injury. The article also highlights the surgical procedure brought forth by the late Professor Isidor Kessler, one of the founders of surgery of the hand in Israel, presented here as an overview and guidance to the primary care physician.
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Affiliation(s)
- Gil Gannot
- Hand Surgery, Orthopedic Department, Kaplan Medical Center, Rehovot, Israel
| | - Shadi Saleh
- Hand Surgery, Orthopedic Department, Kaplan Medical Center, Rehovot, Israel
| | - Yoav Arush
- Hand Surgery, Orthopedic Department, Kaplan Medical Center, Rehovot, Israel
| | - Amir Oron
- Hand Surgery, Orthopedic Department, Kaplan Medical Center, Rehovot, Israel
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15
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Saleh S, Muhieddine D, Hamadeh RS, Dimassi H, Diaconu K, Noubani A, Arakelyan S, Ager A, Alameddine M. Outpatient use patterns and experiences among diabetic and hypertensive patients in fragile settings: a cross-sectional study from Lebanon. BMJ Open 2022; 12:e054564. [PMID: 35613758 PMCID: PMC9174831 DOI: 10.1136/bmjopen-2021-054564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES Assess and describe the health service use and delivery patterns for non-communicable disease (NCD) services in two contrasting fragility contexts and by other principal equity-related characteristics including gender, nationality and health coverage. SETTING Primary healthcare centres located in the urbanised area of Greater Beirut and the rural area of the Beqaa Valley. DESIGN This is a cross-sectional study using a structured survey tool between January and September 2020. PARTICIPANTS 1700 Lebanese and Syrian refugee patients seeking primary care for hypertension and diabetes. PRIMARY AND SECONDARY OUTCOMES The main outcome is the comprehensiveness of service delivery comparing differences in use and service delivery patterns by fragility setting, gender, nationality and health coverage. RESULTS Compliance with routine NCD care management (eg, counselling, immunisations, diagnostic testing and referral rates) was significantly better in Beirut compared with Beqaa. Women were significantly less likely to be offered lifestyle counselling advice and referral to cardiologists (58.4% vs 68.3% in Beqaa and 58.1% vs 62% in Beirut) and ophthalmologists, compared with men. Across both settings, there was a significant trend for Lebanese patients to receive more services and more advice related to nutrition and diabetes management (89.8% vs 85.2% and 62.4% vs 55.5%, respectively). Similarly, referral rates were higher among Lebanese refugees compared with Syrian refugees. Immunisation and diagnostic testing were significantly higher in Beirut among those who have health coverage compared with Beqaa. CONCLUSIONS The study discovered significant differences in outpatient service use by setting, nationality and gender to differentials. A rigorous and comprehensive appraisal of NCD programmes and services is imperative for providing policy makers with evidence-based recommendations to guide the design, implementation and evaluation of targeted programmes and services necessary to ensure equity in health services delivery to diabetic and hypertensive patients. Such programmes are an ethical imperative considering the protracted crises and compounded fragility.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Randa S Hamadeh
- Primary Healthcare Department, Lebanon Ministry of Public Health, Beirut, Lebanon
| | - Hani Dimassi
- Department of Pharmaceutical Sciences, Lebanese American University, Beirut, Lebanon
| | - K Diaconu
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University Edinburgh, Musselburgh, East Lothian, UK
| | - Mohamad Alameddine
- Health Services Administration, University of Sharjah College of Health Sciences, Sharjah, UAE
- Department of Clinical Sciences, Mohammed Bin Rashid University of Medicine and Health Sciences College of Medicine, Dubai, UAE
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16
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Saleh S, Brome D, Mansour R, Daou T, Chamas A, Naal H. Evaluating an e-learning program to strengthen the capacity of humanitarian workers in the MENA region: the Humanitarian Leadership Diploma. Confl Health 2022; 16:27. [PMID: 35596195 PMCID: PMC9121609 DOI: 10.1186/s13031-022-00460-2] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/12/2022] [Indexed: 11/11/2022] Open
Abstract
Background The Middle East and North Africa (MENA) region is consistently plagued with humanitarian crises while having little response capacity. Despite their obvious growing need, there exist limited educational opportunities for humanitarian workers to develop their capacity in humanitarian topics. The present study evaluates an online training program, the Humanitarian Leadership Diploma (HLD), which targeted humanitarian workers across the MENA region. Methods A mixed-methods design was used, comprising short and long-term quantitative and qualitative data, targeting individual and organizational-level outcomes. A total of 28 humanitarian workers across the MENA region enrolled in the program starting September 2019 until October 2020, 18 of which completed the full diploma. Short-term quantitative data such as knowledge assessments, course evaluations, and reflective commentaries were collected from all learners, whereas long-term qualitative data was collected only from those who completed the full diploma and from peers at their organizations, 6 months after completion. Data was triangulated, analyzed using qualitative content analysis, and reported as themes. Results The program was overall successful given multiple factors reported by participants such as enhanced knowledge, high satisfaction, and improved practice, with some important challenges being identified. Themes under the strengths category related to (1) online learning, (2) significance of diploma, (3) course content, (4) instructors, (5) transfer of learning into practice, and (6) personal development. Themes under the challenges category related to (1) barriers to applying changes in behavior and performance, (2) engagement and interaction, and (3) pedagogical approach. Conclusion This is one of very few evaluations of locally developed and delivered online learning programs for humanitarian actors in the MENA region. The findings are especially important as they may inform researchers and humanitarian actors looking to design and deliver similar programs in the MENA region or other fragile settings. Key recommendations are discussed in the manuscript, and include to combine synchronous and asynchronous approaches, design concise course materials, limit theoretical pedagogical approaches, ensure topics are contextualized to the region, and consider continuous engagement strategies for learners.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dayana Brome
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rania Mansour
- St George's Hospital Medical School, St George's University of London, London, UK
| | - Tracy Daou
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Amar Chamas
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
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17
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Saleh S, Ibrahim S, Diab JL, Osman M. Integrating refugees into national health systems amid political and economic constraints in the EMR: Approaches from Lebanon and Jordan. J Glob Health 2022; 12:03008. [PMID: 35356647 PMCID: PMC8932459 DOI: 10.7189/jogh.12.03008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Sarah Ibrahim
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Jasmin Lilian Diab
- Department of Social Sciences, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
- Institute for Migration Studies, School of Arts and Sciences, Lebanese American University, Beirut, Lebanon
| | - Mona Osman
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
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18
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Gannot G, Saleh S, Fuchs L, Oron A. Neglected congenital trigger thumb. Hand Surg Rehabil 2022; 41:415-417. [PMID: 35272068 DOI: 10.1016/j.hansur.2022.02.005] [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] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/28/2021] [Accepted: 02/10/2022] [Indexed: 11/25/2022]
Abstract
We present a case of neglected trigger thumb in a forty-year-old male. The patient presented to our clinic due to bilateral triggering of his fourth digit. He attested to having pain and limitation of joint movement of his left thumb since his childhood in the former Soviet Union, with occasional triggering. This eventually subsided and the thumb became stuck in relative flexion and could not be fully extended. We performed X-rays of both thumbs wherein the left affected thumb interphalangeal joint showed an aberrant configuration and sclerosis of both joint surfaces. The joint surface curvature was altered on the left side and contact area reduced. This presentation of altered thumb interphalangeal joint biomechanics following an untreated congenital trigger thumb further emphasizes the need for surgical intervention when indicated.
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Affiliation(s)
- G Gannot
- Orthopedics Department, Hand Surgery Unit, Kaplan Medical Center, 1 Pasternak Rd, Rehovot, Israel.
| | - S Saleh
- Orthopedics Department, Hand Surgery Unit, Kaplan Medical Center, 1 Pasternak Rd, Rehovot, Israel
| | - L Fuchs
- Orthopedics Department, Hand Surgery Unit, Kaplan Medical Center, 1 Pasternak Rd, Rehovot, Israel
| | - A Oron
- Orthopedics Department, Hand Surgery Unit, Kaplan Medical Center, 1 Pasternak Rd, Rehovot, Israel
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19
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Fuchs L, Gafni N, Brosh T, Saleh S, Kosashvili Y, Oron A. Ulnar Superficialis Slip Resection versus Radial Superficialis Slip Resection: A Biomechanical Pilot Study. Hand (N Y) 2021; 18:624-627. [PMID: 34937427 DOI: 10.1177/15589447211060416] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There are numerous clinical scenarios during which the surgeon contemplates whether the radial or ulnar slip of the flexor digitorum superficialis (FDS) should be sacrificed. To date no study has assessed the point of failure of each one of the FDS slips in each digit, aiding the avid surgeon in deciding which slip to sacrifice. METHODS A total of 41 digits were assessed, each digit was dissected, and a specimen containing the denuded bone of the middle phalanx with the attachments of the ulnar and radial FDS slips was obtained. An Instron 4502 device was utilized to biomechanically assess the point of failure of each slip of each digit. RESULTS There was no statistical difference between ulnar and radial slip point of failure when compared across all digits and subjects. There was no statistical difference between male and female subject's specimens. The point of failure was higher in the ulnar slips of the second and third digits, whereas the point of failure was higher in the radial slips of the fourth and fifth digits. CONCLUSIONS Sacrifice of a FDS slip may cause loss of grip strength. In several clinical scenarios one may be faced with the dilemma which FDS slip to sacrifice. Our findings show this is not an arbitrary choice. Hand surgeons should keep our findings in mind when deciding which slip to sacrifice, in effort to preserve function and strength in the injured hand.
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Affiliation(s)
- Lee Fuchs
- Kaplan Medical Center, Rehovot, Israel
| | - Nir Gafni
- Kaplan Medical Center, Rehovot, Israel
| | | | | | | | - Amir Oron
- Kaplan Medical Center, Rehovot, Israel
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Affiliation(s)
| | - Alaa Merhi
- American University of Beirut Faculty of Medicine, Beirut, Lebanon
| | - Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon.,Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
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21
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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. Int J Environ Res 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] [What about the content of this article? (0)] [Affiliation(s)] [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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22
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Saleh S, Abdouni L, Dimassi H, Nabulsi D, Harb R, Jammoul Z, Hachach N, El Arnaout N. Prevalence of non-communicable diseases and associated medication use among Syrian refugees in Lebanon: an analysis of country-wide data from the Sijilli electronic health records database. Confl Health 2021; 15:77. [PMID: 34663406 PMCID: PMC8524866 DOI: 10.1186/s13031-021-00411-3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Globally, the number of forcibly displaced individuals has reached 70.8 million. Lebanon, a middle income country, hosts the highest number of refugees per capita worldwide. The majority of refugees are Syrians who have fled the Syrian war that started in 2011. The migration journey exposes refugees to increased susceptibility to a wide range of medical issues including non-communicable diseases (NCDs). This study aims to determine the prevalence of NCDs among adult Syrian refugees in Lebanon, with a focus on hypertension, diabetes, cardiovascular diseases (CVD) and cancer. The study also aims to explore factors potentially related to the prevalence figures and understand the medication use associated with these morbidities.
Methods This study is a secondary analysis of de-identified data from the “Sijilli Electronic Health Records for Refugees” Database comprising data on 10,082 Syrian refugees from across informal tented settlements located all over Lebanon. A total of 3255 records of Syrian refugees aged above 18 years old and reporting having at least one condition of the following were included in the analysis: hypertension, diabetes, cardiovascular diseases or cancer. Pearson’s Chi-square, independent t-test, and multivariate logistic regressions were used for data analysis. Results Hypertension was the most prevalent (10.0%) NCD among refugees, and a higher age was associated with higher NCDs prevalence. A strong linkage has been reported between smoking status and alcohol intake, and increased risk for NCDs. Study findings also revealed that the hypertension, diabetes and CVDs were mainly observed among refugees originating from Idlib, Aleppo and Homs. An association between medication use and location of diagnosis was noted, with females who were diagnosed before moving to Lebanon being more likely to take corresponding medications compared to those diagnosed in Lebanon, with no difference reported among males. Conclusions Our findings suggest that efforts should be directed towards the employment of innovative low-cost approaches for NCD detection and control among refugees, with a focus on the importance of use of adequate medication. Such efforts remain imperative to control the increasing burden of NCDs amongst refugee populations and improve equitable access to NCD services.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Zeinab Jammoul
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Noha Hachach
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,American University of Beirut Medical Center, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
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23
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Morton B, Vercueil A, Masekela R, Heinz E, Reimer L, Saleh S, Kalinga C, Seekles M, Biccard B, Chakaya J, Abimbola S, Obasi A, Oriyo N. Consensus statement on measures to promote equitable authorship in the publication of research from international partnerships. Anaesthesia 2021; 77:264-276. [PMID: 34647323 PMCID: PMC9293237 DOI: 10.1111/anae.15597] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [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] [Accepted: 09/15/2021] [Indexed: 11/28/2022]
Abstract
Despite the acknowledged injustice and widespread existence of parachute research studies conducted in low‐ or middle‐income countries by researchers from institutions in high‐income countries, there is currently no pragmatic guidance for how academic journals should evaluate manuscript submissions and challenge this practice. We assembled a multidisciplinary group of editors and researchers with expertise in international health research to develop this consensus statement. We reviewed relevant existing literature and held three workshops to present research data and holistically discuss the concept of equitable authorship and the role of academic journals in the context of international health research partnerships. We subsequently developed statements to guide prospective authors and journal editors as to how they should address this issue. We recommend that for manuscripts that report research conducted in low‐ or middle‐income countries by collaborations including partners from one or more high‐income countries, authors should submit accompanying structured reflexivity statements. We provide specific questions that these statements should address and suggest that journals should transparently publish reflexivity statements with accepted manuscripts. We also provide guidance to journal editors about how they should assess the structured statements when making decisions on whether to accept or reject submitted manuscripts. We urge journals across disciplines to adopt these recommendations to accelerate the changes needed to halt the practice of parachute research.
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Affiliation(s)
- B Morton
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - A Vercueil
- King's College Hospital NHS Foundation Trust, London, UK
| | - R Masekela
- Head of Department of Paediatrics and Child Health, School of Clinical Medicine, College of Health Sciences, University of Kwa-Zulu Natal, Durban, South Africa
| | - E Heinz
- Departments of Clinical Sciences and of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - L Reimer
- Department of Vector Biology, Liverpool School of Tropical Medicine, Liverpool, UK
| | - S Saleh
- Wellcome Trust Clinical, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - C Kalinga
- Department of Social Anthropology, University of Edinburgh, Edinburgh, UK
| | - M Seekles
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK
| | - B Biccard
- Department of Anaesthesia and Peri-operative Medicine, Groote Schuur Hospital and University of Cape Town, Cape Town, South Africa
| | - J Chakaya
- Global Respiratory Health, Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK.,Department of Medicine, Dermatology and Therapeutics, School of Medicine, Kenyatta University, Nairobi, Kenya
| | - S Abimbola
- School of Public Health, University of Sydney, Sydney, Australia
| | - A Obasi
- Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.,AXESS Clinic, Royal Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - N Oriyo
- National Institute of Medical Research, Dar es Salaam, Tanzania
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24
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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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25
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Sater ZA, Shamseddine A, Taher A, Fouad F, Abu-Sitta G, Fadhil I, Saab R, Sullivan R, Adib SM, Saleh S, Mukherji D. Abstract 56: Landscape and Challenges of Cancer Registration in the Middle East, North Africa and Turkey (MENAT). Cancer Epidemiol Biomarkers Prev 2021. [DOI: 10.1158/1538-7755.asgcr21-56] [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] [Indexed: 11/16/2022] Open
Abstract
Abstract
Purpose: National and regional 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 national cancer control strategy. In the Middle East, North-Africa and Turkey (MENAT) region, cancer registration varies immensely across countries and faces multifaceted challenges including protracted conflict. This study maps out the present capacities and outputs of cancer registration in the MENAT region and identifying thematic barriers facing implementation and utilization of cancer registry data.
Methods: We employed a mixed-method approach utilizing a self-administered online survey with open and close ended questions targeting national and institutional cancer registry managers in the MENAT countries. The questions focused on the country-wide and registry-specific status and challenges of cancer registration.
Results: Data from 20 MENAT countries were collected through the online survey. MENAT registry managers reported the presence of 97 population-based registries, 48 hospital-based registries, and 24 pathology-based registries. Most population-based registries were well or partially developed. Lack of accurate death records, complete medical records, communication between stakeholders, and trained personnel were critical challenges. These challenges are more severe in conflict-affected countries (both active conflict zones and neighbouring regions affected by conflict). Cancer registration challenges in these countries included weak health care infrastructure, absence of legislation mandating cancer registration, and cessation or disruption of cancer registration due to active conflict and loss of funding. Furthermore, refugee host countries such as Lebanon, Turkey and Jordan, also reported conflict-related challenges including refugee mobility and lack of accurate data on forced migrants.
Conclusion: This study provides a much-needed understanding of the current landscape and contextual challenges affecting cancer registration in the MENAT, especially in conflict affected settings. These data are important for identifying areas on which to focus regional capacity-strengthening initiatives.
Citation Format: Zahi Abdul Sater, Ali Shamseddine, Ali Taher, Fouad Fouad, Ghassan Abu-Sitta, Ibtihal Fadhil, Raya Saab, Richard Sullivan, Salim M. Adib, Shadi Saleh, Deborah Mukherji. Landscape and Challenges of Cancer Registration in the Middle East, North Africa and Turkey (MENAT) [abstract]. In: Proceedings of the 9th Annual Symposium on Global Cancer Research; Global Cancer Research and Control: Looking Back and Charting a Path Forward; 2021 Mar 10-11. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2021;30(7 Suppl):Abstract nr 56.
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Affiliation(s)
| | - Ali Shamseddine
- 2Department of Hematology/Oncology, American University of Beirut Medical Center,
| | - Ali Taher
- 2Department of Hematology/Oncology, American University of Beirut Medical Center,
| | - Fouad Fouad
- 3Faculty of Health Sciences, American University of Beirut,
| | | | | | - Raya Saab
- 5Department of Pediatrics and Adolescent Medicine, American University of Beirut Medical Center,
| | | | - Salim M. Adib
- 3Faculty of Health Sciences, American University of Beirut,
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut,
| | - Deborah Mukherji
- 2Department of Hematology/Oncology, American University of Beirut Medical Center,
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Mansour R, Naal H, Kishawi T, Achi NE, Hneiny L, Saleh S. Health research capacity building of health workers in fragile and conflict-affected settings: a scoping review of challenges, strengths, and recommendations. Health Res Policy Syst 2021; 19:84. [PMID: 34022883 PMCID: PMC8140497 DOI: 10.1186/s12961-021-00725-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 04/12/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Fragile and conflict-affected settings (FCAS) have a strong need to improve the capacity of local health workers to conduct health research in order to improve health policy and health outcomes. Health research capacity building (HRCB) programmes are ideal to equip health workers with the needed skills and knowledge to design and lead health-related research initiatives. The study aimed to review the characteristics of HRCB studies in FCASs in order to identify their strengths and weaknesses, and to recommend future directions for the field. METHODS We conducted a scoping review and searched four databases for peer-reviewed articles that reported an HRCB initiative targeting health workers in a FCAS and published after 2010. Commentaries and editorials, cross-sectional studies, presentations, and interventions that did not have a capacity building component were excluded. Data on bibliographies of the studies and HRCB interventions and their outcomes were extracted. A descriptive approach was used to report the data, and a thematic approach was used to analyse the qualitative data. RESULTS Out of 8822 articles, a total of 20 were included based on the eligibility criteria. Most of the initiatives centred around topics of health research methodology (70%), targeted an individual-level capacity building angle (95%), and were delivered in university or hospital settings (75%). Ten themes were identified and grouped into three categories. Significant challenges revolved around the lack of local research culture, shortages in logistic capability, interpersonal difficulties, and limited assessment and evaluation of HRCB programmes. Strengths of HRCB interventions included being locally driven, incorporating interactive pedagogies, and promoting multidisciplinary and holistic training. Common recommendations covered by the studies included opportunities to improve the content, logistics, and overarching structural components of HRCB initiatives. CONCLUSION Our findings have important implications on health research policy and related capacity building efforts. Importantly, FCASs should prioritize (1) funding HRCB efforts, (2) strengthening equitable international, regional, and national partnerships, (3) delivering locally led HRCB programmes, (4) ensuring long-term evaluations and implementing programmes at multiple levels of the healthcare system, and (5) adopting engaging and interactive approaches.
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Affiliation(s)
- Rania Mansour
- Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
- St. George’s, University of London, London, UK
| | - Hady Naal
- Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Tarek Kishawi
- Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Nassim El Achi
- Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
| | - Layal Hneiny
- Saab Medical Library, American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, 1107 2020 Lebanon
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G. Pedroza R, Saleh S, Russo V, Dickman C, Getsios S, Wadsworth S, Piret J. Engineering the design of cell encapsulated alginate fibres for the treatment of diabetes. Cytotherapy 2021. [DOI: 10.1016/s1465324921005089] [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: 11/26/2022]
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Saleh S, Shepherd W, Jewell C, Lam NL, Balmes J, Bates MN, Lai PS, Ochieng CA, Chinouya M, Mortimer K. Air pollution interventions and respiratory health: a systematic review. Int J Tuberc Lung Dis 2021; 24:150-164. [PMID: 32127098 DOI: 10.5588/ijtld.19.0417] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Indoor and ambient air pollution exposure is a major risk to respiratory health worldwide, particularly in low- and middle-income countries (LMICs). Interventional trials have mainly focused on alternatives to cooking stoves, with mixed results. Beyond cooking, additional sources of particulate matter also contribute to the burden of air pollution exposure. This review explores evidence from current randomised controlled trials (RCTs) on the clinical effectiveness of interventions to reduce particulate matter in LMICs.METHODS: Twelve databases and the grey literature (e.g., Government reports and policy papers) were searched. Eligible studies were RCTs conducted in LMICs aiming to reduce particulate exposure from any source and reporting on at least one clinical respiratory outcome (respiratory symptoms, lung function or clinical diagnoses). Data from relevant studies were systematically extracted, the risk of bias assessed and narrative synthesis provided.RESULTS: Of the 14 included studies, 12 tested 'improved' cookstoves, most using biomass, but solar and bioethanol cookers were also included. One trial used solar lamps and another was an integrated intervention incorporating behavioural and environmental components for the treatment and prevention of chronic obstructive pulmonary disease. Of the six studies reporting child pneumonia outcomes, none demonstrated significant benefit in intention-to-treat analysis. Ten studies reported respiratory symptom outcomes with some improvements seen, but self-reporting made these outcomes highly vulnerable to bias. Substantial inter-study clinical and methodological heterogeneity precluded calculation of pooled effect estimates.CONCLUSION: Evidence from the RCTs performed to date suggests that individual household-level interventions for air pollution exposure reduction have limited benefits for respiratory health. More comprehensive approaches to air pollution exposure reduction must be developed so their potential health benefits can be assessed.
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Affiliation(s)
- S Saleh
- Liverpool School of Tropical Medicine, London, UK, Malawi-Liverpool-Wellcome Trust Programme, Lilongwe, Malawi
| | - W Shepherd
- Liverpool School of Tropical Medicine, London, UK
| | - C Jewell
- Lancaster University, Lancaster, UK
| | - N L Lam
- Schatz Energy Research Center, Humboldt State University, Arcata, CA
| | - J Balmes
- University of California, San Francisco, San Francisco, CA, University of California, Berkeley, CA
| | - M N Bates
- University of California, Berkeley, CA
| | - P S Lai
- Harvard Medical School, Boston, MA, USA
| | - C A Ochieng
- National University of Ireland Galway, Galway, Ireland, Stockholm Environment Institute, Stockholm, Sweden
| | - M Chinouya
- Liverpool School of Tropical Medicine, London, UK
| | - K Mortimer
- Liverpool School of Tropical Medicine, London, UK
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Kobeissi E, Menassa M, Moussally K, Repetto E, Soboh I, Hajjar M, Saleh S, Abu-Sittah G. The socioeconomic burden of antibiotic resistance in conflict-affected settings and refugee hosting countries: a systematic scoping review. Confl Health 2021; 15:21. [PMID: 33823882 PMCID: PMC8025481 DOI: 10.1186/s13031-021-00357-6] [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: 09/14/2020] [Accepted: 03/18/2021] [Indexed: 11/10/2022] Open
Abstract
Background Antibiotic resistance (ABR) is a major global threat. Armed and protracted conflicts act as multipliers of infection and ABR, thus leading to increased healthcare and societal costs. We aimed to understand and describe the socioeconomic burden of ABR in conflict-affected settings and refugee hosting countries by conducting a systematic scoping review. Methods A systematic search of PubMed, Medline (Ovid), Embase, Web of Science, SCOPUS and Open Grey databases was conducted to identify all relevant human studies published between January 1990 and August 2019. An updated search was also conducted in April 2020 using Medline/Ovid. Independent screenings of titles/abstracts followed by full texts were performed using pre-defined criteria. The Newcastle-Ottawa Scale was used to assess study quality. Data extraction and analysis were based on the PICOS framework and following the PRISMA-ScR guideline. Results The search yielded 8 studies (7 publications), most of which were single-country, mono-center and retrospective studies. The studies were conducted in Lebanon (n = 3), Iraq (n = 2), Jordan (n = 1), Palestine (n = 1) and Yemen (n = 1). Most of the studies did not have a primary aim to assess the socioeconomic impact of ABR and were small studies with limited statistical power that could not demonstrate significant associations. The included studies lacked sufficient information for the accurate evaluation of the cost incurred by antibiotic resistant infections in conflict-affected countries. Conclusion This review highlights the scarcity of research on the socioeconomic burden of ABR on general populations in conflict-affected settings and on refugees and migrants in host countries, and lists recommendations for consideration in future studies. Further studies are needed to understand the cost of ABR in these settings to develop and implement adaptable policies. Supplementary Information The online version contains supplementary material available at 10.1186/s13031-021-00357-6.
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Affiliation(s)
- Elsa Kobeissi
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Ernestina Repetto
- Medical Department, Operational Center Brussels, Médecins Sans Frontières, Brussels, Belgium
| | - Ismail Soboh
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Marwan Hajjar
- Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ghassan Abu-Sittah
- Conflict Medicine Program, Global Health Institute, American University of Beirut, Beirut, Lebanon. .,Division of Plastic Surgery, Department of Surgery, American University of Beirut Medical Center, P.O. Box 11-0236, Riad El Solh, Beirut, 1107-2020, Lebanon.
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Naal H, Mendelsohn R, Brome D, Noubani A, Nabulsi D, Muhieddine D, Saleh S. Evaluating a capacity building program on women's health for displaced community health workers in fragile settings in Lebanon. Hum Resour Health 2021; 19:37. [PMID: 33743708 PMCID: PMC7981387 DOI: 10.1186/s12960-021-00585-0] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 03/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Displaced populations in fragile settings experience health disparities that are seldom attended to. Task-shifting, which involves training non-specialized community health workers (CHW) to deliver basic education and health services is a favorable strategy to address this problem, however very little data exist on this topic in the Middle East region. We conducted a long-term evaluation of the Women's Health Certificate delivered to Syrian refugees and host community in informal tented settlements in Lebanon under the Mobile University for Health (MUH) program. The training was delivered through a mobile classroom approach that incorporated a blended learning modality. METHODS We collected short-term data from the 42 trained CHW (knowledge assessments and satisfaction measures) during the delivery of the intervention between March and August 2019, and long-term data (semi-structured interviews with 8 CHW and focus group discussion with 9 randomly selected community members) one year later between July and August 2020. The evaluation approach was informed by the Kirkpatrick evaluation model, and the qualitative data were analyzed using qualitative content analysis. RESULTS Data from the CHWs and community members were triangulated, and they showed that the training enhanced access to education due to its mobile nature and provided opportunities for CHWs to engage and interact with learning material that enhanced their knowledge and favorable behaviors regarding women's health. In turn, CHWs were empowered to play an active role in their communities to transfer the knowledge they gained through educating community members and providing women's health services and referrals. Community members benefited from the CHWs and called for the implementation of more similar training programs. CONCLUSION This is one of few studies reporting a long-term community-level evaluation of a task-shifting program on women's health among displaced populations in Lebanon. Our findings support the need to increase funding for similar programs, and to focus on delivering programs for a variety of health challenges. It is also essential to enhance the reach and length of recruitment to wider communities, to design concise, interactive, and engaging sessions, and to provide tools to facilitate circulation of learning material, and resources for referrals to health services.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Rebecca Mendelsohn
- Gerald R. Ford School of Public Policy, University of Michigan, Ann Arbor, USA
| | - Dayana Brome
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Seif El-Din SH, Salem MB, El-Lakkany NM, Hammam OA, Nasr SM, Okasha H, Ahmed LA, Saleh S, Botros SS. Early intervention with probiotics and metformin alleviates liver injury in NAFLD rats via targeting gut microbiota dysbiosis and p-AKT/mTOR/LC-3II pathways. Hum Exp Toxicol 2021; 40:1496-1509. [PMID: 33678036 DOI: 10.1177/0960327121999445] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/29/2022]
Abstract
Non-alcoholic fatty liver disease (NAFLD) constitutes a major health problem worldwide and intimately links with obesity and diabetes. This study aimed to explore the therapeutic impact of early treatment with metformin (MTF) alone or in combination with Lactobacillus reuteri DSM 17938 (L. reuteri) + metronidazole (MTZ) in male Sprague Dawley rats with high-fat diet (HFD)-induced NAFLD. Hepatic steatosis was induced by feeding rats HFD for 6 weeks. MTF (150 mg/kg/day) or L. reuteri (2 × 109 colony forming unit/day) were given orally for 4 weeks; meanwhile, MTZ (15 mg/kg/day, p.o.) was administered for 1 week. Administration of L. reuteri + MTZ in combination with MTF produced a superior effect concerning insulin resistance (IR), lipid profile, liver function, oxidative stress, inflammatory and autophagic markers than using each treatment alone. Besides, this combination resulted in disappearance of steatosis, inflammation and vacuolation within hepatic architecture. Moreover, it normalized short chain fatty acids (SCFAs) as well as Firmicutes and Bacteroidetes faecal contents. In conclusion, early treatment with L. reuteri + MTZ in combination with MTF could prevent NAFLD progression and liver injury through targeting gut dysbiosis, inflammation and autophagic pathways.
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Affiliation(s)
- Sayed H Seif El-Din
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - M B Salem
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - N M El-Lakkany
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - O A Hammam
- Pathology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - S M Nasr
- Biochemistry Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - H Okasha
- Biochemistry Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
| | - L A Ahmed
- Pharmacology and Toxicology Department, 110154Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - S Saleh
- Pharmacology and Toxicology Department, 110154Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - S S Botros
- Pharmacology Department, 230796Theodor Bilharz Research Institute, Warak El-Hadar, Imbaba, Giza, Egypt
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Noubani A, Diaconu K, Loffreda G, Saleh S. Readiness to deliver person-focused care in a fragile situation: the case of Mental Health Services in Lebanon. Int J Ment Health Syst 2021; 15:21. [PMID: 33653392 PMCID: PMC7923303 DOI: 10.1186/s13033-021-00446-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests wide variability in the provision of mental healthcare across countries. Countries experiencing fragility related risks suffer from a high burden of mental-ill health and additionally have limited capacity to scale up mental health services given financial and human resource shortages. Integration of mental health services into routine primary care is one potential strategy for enhancing service availability, however little is known about the experiences of currently active health care providers involved in mental health and psychosocial support service (MHPSS) provision at primary care level. This study aims to determine how healthcare providers offering MHPSS services at primary care levels in Lebanon perceive mental health and the health system's ability to address the rising mental ill-health burden with a view to identify opportunities for strengthening MHPSS service implementation geared towards integrated person focused care model. METHODS A qualitative study design was adopted including 15 semi-structured interviews and 2 participatory group model-building workshops with health care providers (HCPs) involved in mental healthcare delivery at primary care level. Participants were recruited from two contrasting fragility contexts (Beirut and Beqaa). During workshops, causal loop diagrams depicting shared understandings of factors leading to stress and mental ill health, associated health seeking behaviors, and challenges and barriers within the health system were elicited. This research is part of a larger study focused on understanding the dynamics shaping mental health perceptions and health seeking behaviours among community members residing in Lebanon. RESULTS Findings are organized around a causal loop diagram depicting three central dynamics as described by workshop participants. First, participants linked financial constraints at household levels and the inability to secure one's livelihood with contextual socio-political stressors, principally referring to integration challenges between host communities and Syrian refugees. In a second dynamic, participants linked exposure to war, conflict and displacement to the occurrence of traumatic events and high levels of distress as well as tense family and community relations. Finally, participants described a third dynamic linking cultural norms and patriarchal systems to exposure to violence and intergenerational trauma among Lebanon's populations. When describing help-seeking pathways, participants noted the strong influence of social stigma within both the community and among health professionals; the latter was noted to negatively affect patient-provider relationships. Participants additionally spoke of difficulties in the delivery of mental health services and linked this to the design of the health system itself, noting the current system being geared towards patient centered care, which focuses on the patient's experiences with a disease only, rather than person focused care where providers and patients acknowledge broader structural and social influences on health and work together to reach appropriate decisions for tackling health and other social needs. Barriers to delivery of person focused care include the lack of coherent mental health information systems, limited human capacity to deliver MHPSS services among primary health care staff and inadequate service integration and coordination among the many providers of mental health services in our study contexts. Critically however, provider accounts demonstrate readiness and willingness of health professionals to engage with integrated person focused care models of care. CONCLUSIONS Mental ill health is a major public health problem with implications for individual health and wellbeing; in a fragile context such as Lebanon, the burden of mental ill health is expected to rise and this presents substantive challenges for the existing health system. Concrete multi-sectoral efforts and investments are required to (1) reduce stigma and improve public perceptions surrounding mental ill health and associated needs for care seeking and (2) promote the implementation of integrated person focused care for addressing mental health.
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Affiliation(s)
- Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK.
| | - Giulia Loffreda
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Saleh S, Naal H, Mokdad AH. It's all in the details: A call for administering the COVID-19 vaccine in Lebanon through a transparent and un-politicized collaborative approach. EClinicalMedicine 2021; 32:100748. [PMID: 33585806 PMCID: PMC7863766 DOI: 10.1016/j.eclinm.2021.100748] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 11/25/2022] Open
Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States
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Naal H, Nabulsi D, El Arnaout N, Abdouni L, Dimassi H, Harb R, Saleh S. Prevalence of depression symptoms and associated sociodemographic and clinical correlates among Syrian refugees in Lebanon. BMC Public Health 2021; 21:217. [PMID: 33499834 PMCID: PMC7836044 DOI: 10.1186/s12889-021-10266-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 01/19/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Since the outbreak of the Syrian war in 2011, close to 6 million Syrian refugees have escaped to Syria's neighbouring countries, including Lebanon. Evidence suggests rising levels of mental health disorders among Syrian refugee populations. Yet, to the best of our knowledge, large-scale studies addressing the mental health of adult Syrian refugees in Lebanon are lacking. We examined the prevalence of depression symptoms, which represent a common and debilitating mental health disorder among Syrian refugee populations in Lebanon, along with their sociodemographic and clinical correlates. METHODS A cross-sectional survey design was conducted as part of a collaborative project-"Sijilli"- led by the Global Health Institute at the American University of Beirut (Beirut, Lebanon) across 4 informal tented settlements for refugees (Beirut, Bekaa, North, South) in Lebanon among adult Syrian refugees (≥18), over a period extending from 2018 to 2020. The survey inquired about participants' sociodemographic and clinical characteristics, and screened participants for symptoms of depression through sequential methodology using the Patient Health Questionnaire (PHQ-2 and PHQ-9). RESULTS A total of 3255 adult Syrian refugees were enrolled in the study. Of those refugees, 46.73% (n = 1521) screened positive on the PHQ-2 and were therefore eligible to complete the PHQ-9. In the entire sample (n = 3255), the prevalence of moderate to severe depression symptoms (PHQ-2 ≥ 2 and then PHQ-9 ≥ 10) was 22% (n = 706). Further analyses indicate that being ≥45 years of age (OR 1.61, 95% CI 1.13-2.30), a woman (OR 1.34, 95% CI 1.06-1.70), widowed (OR 2.88, 95% CI 1.31-6.32), reporting a neurological (OR 1.73, 95% CI 1.15-2.60) or a mental health condition (OR 3.98, 95% CI 1.76-8.97) are major risk factors for depression. CONCLUSION Our study suggests that an estimated one in four Syrian refugees in Lebanon shows moderate to severe depression symptoms, and our findings have important public health and clinical implications on refugee health. There is a need to enhance screening efforts, to improve access and referral to mental health services, and to improve post-migration factors among Syrian refugees in Lebanon.
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Affiliation(s)
- Hady Naal
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Dana Nabulsi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Ranime Harb
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
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Zablith N, Diaconu K, Naja F, El Koussa M, Loffreda G, Bou-Orm I, Saleh S. Dynamics of non-communicable disease prevention, diagnosis and control in Lebanon, a fragile setting. Confl Health 2021; 15:4. [PMID: 33430916 PMCID: PMC7802297 DOI: 10.1186/s13031-020-00337-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/22/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Non-communicable diseases (NCD) present an increasing global health challenge, particularly for settings affected by fragility where access to care may be disrupted, and where high-quality continuous care delivery is difficult to achieve. This study documents the complex dynamics of NCD prevention and management in the fragile setting of rural Beqaa, Lebanon. METHODS Participatory system dynamics methods were used, including 30 semi-structured interviews and three Group Model Building (GMB) workshops. Participants included health care providers offering NCD care, and Lebanese host- and Syrian refugees community members affected by NCDs. RESULTS Participants across all groups articulated a shared complex understanding of both the structural and direct determinants behind NCD onset. Lebanese and Syrian community members further identified several barriers to health seeking, including restrictions in health coverage, limited availability of services in the Beqaa and perceptions of poor-quality care. Health providers and community members described a health system overtly focused on disease control and overwhelmed by delivery of care to people living with NCD across both communities. CONCLUSION Participants across all groups agreed on the need for health promotion and primary prevention activities and identified priority interventions in these areas.
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Affiliation(s)
- Nadine Zablith
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Karin Diaconu
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK.
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK.
| | - Farah Naja
- Nutrition and Food Sciences Department, Faculty of Agriculture and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Maria El Koussa
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Giulia Loffreda
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Ibrahim Bou-Orm
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, UK
| | - Shadi Saleh
- NIHR Global Health Research Unit on Health in Situations of Fragility, Musselburgh, UK
- Global Health Institute, American University of Beirut, Beirut, Lebanon
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Dimassi H, Maroun AB, Saadeh M, Khabsa J, Abdou JL, Saleh S. Views of community pharmacists in Lebanon on the unified prescription: a mixed method study. East Mediterr Health J 2020; 26:1539-1547. [PMID: 33355394 DOI: 10.26719/emhj.20.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 03/15/2020] [Indexed: 11/09/2022]
Abstract
Background The unified prescription was introduced in Lebanon in 2011; an aim was to save on medication expenditure. Aims The aim of this study was to evaluate the views of community pharmacists on the effect and usefulness of the unified prescription. Methods A cross-sectional telephone survey of community pharmacists from all governorates of Lebanon was conducted. A questionnaire was used to collect demographic data, pharmacists' views on the effect of the unified prescription on their work, the percentage of prescriptions in which the prescriber had indicated that the medicine should not be substituted with a generic equivalent and the percentage needing clarification from the prescriber. Face-to-face interviews were held with 12 pharmacists to explore their views further. Results Of 251 pharmacists interviewed, 56.8% did not think the unified prescription was useful, 34.8% thought it complicated their work and 24.0% that it reduced their autonomy. The in-depth interviews showed that autonomy was perceived to be restricted because of the difficulty in convincing patients to accept a substitute generic medicine, which the unified prescription allowed. The unified prescription complicated pharmacists' work because of increased paperwork and the need for more storage. Pharmacists felt that the large number of prescriptions in which the prescriber had indicated that the medicine should not be substituted undermined the purpose of the unified prescription. Conclusion The implementation of the unified prescription was not considered a success by community pharmacists in Lebanon. Efforts are needed to improve communication with prescribers and educate the public about pharmacists' role and generic medicines.
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Affiliation(s)
- Hani Dimassi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Aline Bou Maroun
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | | | - Joanne Khabsa
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Jessica-Lynn Abdou
- Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Shadi Saleh
- Department of Health Management and Policy, American University of Beirut, Beirut, Lebanon
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Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. Evaluation of global health capacity building initiatives in low-and middle-income countries: A systematic review. J Glob Health 2020; 10:020412. [PMID: 33110574 PMCID: PMC7568934 DOI: 10.7189/jogh.10.020412] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs. METHODS We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded cross-sectional studies, reviews, and book chapters that only assessed the effect of interventions. Data identifying the learning modality, and evaluation method, level, time interval, and approach were extracted from articles as primary outcomes. RESULTS Of 8324 identified studies, 63 articles were eligible for analysis. Most studies stemmed from Africa and Asia (69.8%), were delivered and evaluated face-to-face (74.6% and 76.2%), mainly to professionals (57.1%) and community workers (20.6%). Although the use of online and blended modalities showed an increase over the past 4 years, only face-to-face initiatives were evaluated long-term beyond individual-level. GHCB evaluations in general lacked standardization especially regarding the tools. CONCLUSION This is an important resource for evaluating GHCB initiatives in LMICs. It synthesizes evaluation approaches, offers recommendations for improvement, and calls for the standardization of evaluations, especially for long-term and wider impact assessment of online and blended modalities.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Maria El Koussa
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Melissa El Hamouch
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Beirut, Lebanon
- Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
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Kanavos P, Kamphuis BW, Fontrier AM, Colville Parkin G, Saleh S, Akhras KS. Pricing of in-patent pharmaceuticals in the Middle East and North Africa: Is external reference pricing implemented optimally? Health Policy 2020; 124:1297-1309. [PMID: 32962876 DOI: 10.1016/j.healthpol.2020.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/05/2020] [Revised: 07/29/2020] [Accepted: 07/31/2020] [Indexed: 11/28/2022]
Abstract
In this paper we outline and compare pharmaceutical pricing policies for in-patent prescription pharmaceuticals with emphasis on external reference pricing (ERP) in eleven countries across the Middle East and North Africa (MENA) region and explore possible improvements in their pricing systems. Primary and secondary evidence was used to inform our analysis. Comparative analysis of ERP systems across countries followed an analytical framework distilling ERP into twelve salient features, while ERP system performance was benchmarked against a framework of best practice principles across (a) objectives and scope, (b) administration and operations, (c) methods used, and (d) implementation. Results suggest that ERP is the dominant pricing method for in-patent pharmaceuticals. Although several good practice cases were identified, none of the eleven countries satisfy all best practice principles. ERP basket sizes vary significantly and are commonly composed using geographical proximity and low-price countries as criteria. Nine countries do not use the mean or median prices, but resort to using the lowest. Exchange rate fluctuations are routinely used to arrive at price reductions in local currency. Significant opportunities exist for MENA countries to develop their ERP regimes to achieve greater compliance with best practice principles. Over the short-term, incremental changes could be implemented to several ERP salient features and can be achieved relatively easily, thereby enhancing the functionality and performance of national ERP systems. Countries in the region can also focus on the development of explicit value assessment systems, and minimize their dependence on ERP over the longer-term.
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Affiliation(s)
- Panos Kanavos
- Department of Health Policy, Medical Technology Research Group - LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Bregtje W Kamphuis
- Department of Health Policy, Medical Technology Research Group - LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Anna-Maria Fontrier
- Department of Health Policy, Medical Technology Research Group - LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Georgia Colville Parkin
- Department of Health Policy, Medical Technology Research Group - LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, United Kingdom.
| | - Shadi Saleh
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Kasem S Akhras
- Government Affairs & Market Access, MEA Region, AstraZeneca FZ LLC, 2(nd)Floor Block D Building 27, Dubai Healthcare City, P.O. Box 5505070, Dubai, United Arab Emirates.
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Saleh S, El Arnaout N, Abdouni L, Jammoul Z, Hachach N, Dasgupta A. Sijilli: A Scalable Model of Cloud-Based Electronic Health Records for Migrating Populations in Low-Resource Settings. J Med Internet Res 2020; 22:e18183. [PMID: 32788145 PMCID: PMC7453321 DOI: 10.2196/18183] [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] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 05/19/2020] [Accepted: 06/03/2020] [Indexed: 11/13/2022] Open
Abstract
The world is witnessing an alarming rate of displacement and migration, with more than 70.8 million forcibly displaced individuals, including 26 million refugees. These populations are known to have increased vulnerability and susceptibility to mental and physical health problems due to the migration journey. Access of these individuals to health services, whether during their trajectory of displacement or in refugee-hosting countries, remains limited and challenging due to multiple factors, including language and cultural barriers and unavailability of the refugees’ health records. Cloud-based electronic health records (EHRs) are considered among the top five health technologies integrated in humanitarian crisis preparedness and response during times of conflict. This viewpoint describes the design and implementation of a scalable and innovative cloud-based EHR named Sijilli, which targets refugees in low-resource settings. This paper discusses this solution compared with other similar practices, shedding light on its potential for scalability.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Lina Abdouni
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Zeinab Jammoul
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Noha Hachach
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,American University of Beirut Medical Center, Beirut, Lebanon
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Naal H, El Koussa M, El Hamouch M, Hneiny L, Saleh S. A systematic review of global health capacity building initiatives in low-to middle-income countries in the Middle East and North Africa region. Global Health 2020; 16:56. [PMID: 32620141 PMCID: PMC7333284 DOI: 10.1186/s12992-020-00585-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Low-and Middle-Income Countries (LMICs) in the Middle East and North Africa (MENA) region are facing increasing global health challenges with a reduced ability to manage them. Global Health Capacity Building (GHCB) initiatives have the potential to improve health workforce performance and health outcomes, however little is known about the GHCB topics and approaches implemented in this region. This is the first systematic review of GHCB initiatives among LMICs in the MENA region. METHODS An academic database search of Medline (OVID), PubMed, Scopus, Embase.com , and Open Grey was conducted for articles published between January 2009 and September 2019 in English. Next, a grey literature search following a recommended search framework was conducted. Reviewed records addressed a global health topic, had a capacity building component, looked at specific learning outcomes, and reflected an LMIC in the MENA. Primary outcomes included country, topic, modality, pedagogy, and population. RESULTS Reports of GHCB initiatives were retrieved from grey sources (73.2%) and academic sources (26.8%). Most GHCB initiatives were mainly conducted face-to-face (94.4%) to professional personnel (57.5%) through a theoretical pedagogical approach (44.3%). Dominant global health themes were non-communicable diseases (29.2%), sexual and reproductive health (18.4%), and mental health (14.5%). When matched against the Global Burden of Disease data, important gaps were found regarding the topics of GHCB initiatives in relation to the region's health needs. There were limited reports of GHCB initiatives addressing conflict and emergency topics, and those addressing non-communicable disease topics were primarily reported from Egypt and Iran. CONCLUSION Innovative and practicum-based approaches are needed for GHCB initiatives among LMICs in the MENA region, with a focus on training community workers. Regional and country-specific analyses of GHCB initiatives relative to their health needs are discussed in the manuscript based on the results of this review.
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Affiliation(s)
- Hady Naal
- Global Health Institute at the American University of Beirut, Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
| | - Maria El Koussa
- Global Health Institute at the American University of Beirut, Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
| | - Melissa El Hamouch
- Global Health Institute at the American University of Beirut, Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon
| | - Layal Hneiny
- Saab Medical Library at the American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute at the American University of Beirut, Faculty of Health Sciences at the American University of Beirut, Beirut, Lebanon.
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Fuchs L, Saleh S, Oron A, Kosashvilli Y. [Neglected shoulder dislocation due to COVID-19 pandemic]. Harefuah 2020; 159:528. [PMID: 32720774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Lee Fuchs
- Orthopedic Department, Kaplan Medical Center
| | - Shadi Saleh
- Orthopedic Department, Kaplan Medical Center
| | - Amir Oron
- Orthopedic Department, Kaplan Medical Center
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Saleh S, El Arnaout N, Faulkner JR, Sayegh MH. Sijilli: a mobile electronic health records system for refugees in low-resource settings. Lancet Glob Health 2020; 7:e1168-e1169. [PMID: 31401996 DOI: 10.1016/s2214-109x(19)30334-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 07/01/2019] [Indexed: 01/18/2023]
Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut 1107 2020, Lebanon
| | | | - Mohamed H Sayegh
- Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
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Noubani A, Diaconu K, Ghandour L, El Koussa M, Loffreda G, Saleh S. A community-based system dynamics approach for understanding factors affecting mental Health and Health seeking behaviors in Beirut and Beqaa regions of Lebanon. Global Health 2020; 16:28. [PMID: 32228648 PMCID: PMC7106684 DOI: 10.1186/s12992-020-00556-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 12/28/2019] [Accepted: 03/10/2020] [Indexed: 02/05/2024] Open
Abstract
Background Available evidence on mental health and psychosocial problems in Lebanon is limited. Recent quantitative data suggests a high prevalence among Syrian refugees and their Lebanese host communities, with significant treatment gaps in both populations. This study aims to determine how Lebanese host and Syrian refugee communities perceive mental health, and identify health seeking behaviors and barriers to health access in two contrasting contexts of fragility. Methods A comparative qualitative study design was adopted whereby a total of 36 semi-structured interviews with Lebanese host and Syrian refugees’ community members were conducted, followed by a series of four participatory group model building (GMB) sessions. Participants were recruited from two contrasting fragility contexts: Beirut and Beqaa regions. During these sessions, causal loop diagrams were elicited depicting shared understandings of factors prompting the onset of mental health and psychosocial issues; health seeking behaviors, pathways and elements affecting the rate of health improvement and maintenance were also identified. Results Community members in both settings had similar perceptions of factors contributing to mental health. Participants named long-term effects of exposure to wars, political and social effects of conflicts, and financial constraints at the household level as precipitating factors prompting the onset of mental health and psychosocial stressors. Gender and integration related challenges between communities were identified as factors that affect condition onset and associated care seeking. Pathways for health seeking were found to be shaped by trust, the advice and support of loved ones, and the need to ensure confidentiality of affected individuals. Recurrent themes in discussion highlighted major barriers to healthcare access including significant delays in health care seeking from the formal health system, widespread social stigma, prohibitive service costs, lack of health coverage, limited awareness of mental health service availability and limited trust in the quality of services available. Conclusion Mental health and psychosocial support strategies need to be gender- and integration-sensitive, primarily focused on condition prevention and awareness raising in order to strengthen health-seeking behaviors.
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Affiliation(s)
- Aya Noubani
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Karin Diaconu
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Lilian Ghandour
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
| | - Maria El Koussa
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Giulia Loffreda
- NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon.,NIHR Research Unit on Health in Situations of Fragility, Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
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Affiliation(s)
- Alastair Ager
- NIHR Research Unit on Health in Situations of Fragility, Queen Margaret University, Queen Margaret Drive, Edinburgh, EH21 6UU, Scotland
| | - Shadi Saleh
- NIHR Research Unit on Health in Situations of Fragility, Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Haja Wurie
- NIHR Research Unit on Health in Situations of Fragility, College of Medicine and Allied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone
| | - Sophie Witter
- NIHR Research Unit on Health in Situations of Fragility, Queen Margaret University, Queen Margaret Drive, Edinburgh, EH21 6UU, Scotland
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Saleh S, Farah A, El Arnaout N, Dimassi H, El Morr C, Muntaner C, Ammar W, Hamadeh R, Alameddine M. mHealth use for non-communicable diseases care in primary health: patients' perspective from rural settings and refugee camps. J Public Health (Oxf) 2019; 40:ii52-ii63. [PMID: 30307516 PMCID: PMC6294037 DOI: 10.1093/pubmed/fdy172] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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] [Received: 04/11/2018] [Accepted: 09/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Non-communicable diseases (NCDs) account for 85% of deaths in Lebanon and contribute to remarkable morbidity and mortality among refugees and underserved populations. This study assesses the perspectives of individuals with hypertension and/or diabetes in rural areas and Palestinian refugee camps towards a population based mHealth intervention called 'eSahha'. Methods The study employs a mixed-methods design to evaluate the effectiveness of SMSs on self-reported perceptions of lifestyle modifications. Quantitative data was collected through phone surveys, and qualitative data through focus group discussions. Descriptive statistics and bivariate analysis were performed. Results About 93.9% (n = 1000) of respondents perceived the SMSs as useful and easy to read and understand. About 76.9% reported compliance with SMSs through daily behavioral modifications. Women (P = 0.007), people aged ≥76 years (P < 0.001), unemployed individuals (P < 0.001), individuals who only read and write (P < 0.001) or those who are illiterate (P < 0.001) were significantly more likely to receive and not read the SMSs. Behavior change across settings was statistically significant (P < 0.001). Conclusion While SMS-based interventions targeting individuals with hypertension and/or diabetes were generally satisfactory among those living in rural areas and Palestinian refugee camps in Lebanon, a more tailored approach for older, illiterate and unemployed individuals is needed. Keywords e-health, refugees.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.,Global Health Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Riad El Solh, Beirut, Lebanon
| | - Hani Dimassi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Christo El Morr
- School of Health Policy & Management, Faculty of Health, School of Health Policy and Management, York University, 4700 Keele St., Toronto ON, Canada
| | - Carles Muntaner
- Social & Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Walid Ammar
- Ministry of Public Health, Ministry of Public Health, Beirut, Lebanon
| | - Randa Hamadeh
- Ministry of Public Health, Ministry of Public Health, Beirut, Lebanon
| | - Mohamad Alameddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, Lebanon.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
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Honein-AbouHaidar G, Noubani A, El Arnaout N, Ismail S, Nimer H, Menassa M, Coutts AP, Rayes D, Jomaa L, Saleh S, Fouad FM. Correction to: Informal healthcare provision in Lebanon: an adaptive mechanism among displaced Syrian health professionals in a protracted crisis. Confl Health 2019; 13:44. [PMID: 31624495 PMCID: PMC6781308 DOI: 10.1186/s13031-019-0229-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gladys Honein-AbouHaidar
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon.,2Hariri School of Nursing, American University of Beirut, Beirut, Lebanon
| | - Aya Noubani
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Nour El Arnaout
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Sharif Ismail
- 3Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Hana Nimer
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Marilyne Menassa
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Adam P Coutts
- 4Department of Sociology and Magdalene College, University of Cambridge, Cambridge, UK
| | | | - Lamis Jomaa
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon.,6Department of Nutrition and Food Sciences, Faculty of Agricultural and Food Sciences, American University of Beirut, Beirut, Lebanon
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon.,7Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Fouad M Fouad
- 1Global Health Institute, American University of Beirut, Beirut, Lebanon.,8Department of Epidemiology & Population Health, Faculty of Health Sciences, American University of Beirut, P.O. Box 11-0236, Riad El Solh, Beirut, 1107 2020 Lebanon
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El Arnaout N, Rutherford S, Zreik T, Nabulsi D, Yassin N, Saleh S. Assessment of the health needs of Syrian refugees in Lebanon and Syria's neighboring countries. Confl Health 2019; 13:31. [PMID: 31297141 PMCID: PMC6598365 DOI: 10.1186/s13031-019-0211-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [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] [Received: 11/19/2018] [Accepted: 06/10/2019] [Indexed: 11/10/2022] Open
Abstract
Background Health needs of displaced Syrians in refugee hosting countries have become increasingly complex in light of the protracted Syrian conflict. The primary aim of this study was to identify the primary health needs of displaced Syrians in Iraq, Jordan, Lebanon, Turkey, and Syria. Methods A systematic review was performed using 6 electronic databases, and multiple grey literature sources. Title, abstract, and full text screening were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The target population was Syrian individuals displaced due to conflict in Syria and its neighboring countries. The outcomes of interest were health needs (i.e. health problems that can be addressed by health services), gaps in health services, training, and workforce. Studies on mixed refugee populations and Syrians displaced prior to the conflict were excluded. Results The Lebanon-specific results of the review were validated through two stakeholder roundtable discussions conducted with representatives from primary healthcare centers, non-governmental organizations and humanitarian aid agencies. A total of 63 articles were included in the analysis. Mental health and women's health were identified as the greatest health needs in the region. The most common health problems were Non-communicable diseases in Jordan, women's health in Lebanon and mental health in Turkey. Studies addressing gaps in services found the highest gap in general healthcare services, followed by women's health, mental health, and vaccinations. Sub-optimal training and availability of health workers was also noted particularly in Syria.Results from the stakeholders' discussions in Lebanon showed communicable diseases, women's health and mental health as the main health needs of Syrian refugees in Lebanon. Reported barriers to accessing health services included geographical barriers and lack of necessary awareness and education. Conclusion There is a need for an enhanced synchronized approach in Syria's refugee hosting neighboring countries to reduce the existing gaps in responding to the needs of Syrian refugees, especially in regards to women's health, mental health, and communicable diseases. This mainly includes training of healthcare workers to ensure a skilled workforce and community-based efforts to overcome barriers to access, including lack of knowledge and awareness about highly prevalent health conditions.
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Affiliation(s)
- Nour El Arnaout
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Spencer Rutherford
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Thurayya Zreik
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Dana Nabulsi
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Nasser Yassin
- 2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,3Issam Fares Institute for Public Policy and International Affairs, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
| | - Shadi Saleh
- 1Global Health Institute, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon.,2Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Riad El Solh, Beirut, 1107 2020 Lebanon
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Rutherford S, Saleh S. Rebuilding health post-conflict: case studies, reflections and a revised framework. Health Policy Plan 2019; 34:230-245. [PMID: 30929027 DOI: 10.1093/heapol/czz018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2019] [Indexed: 11/12/2022] Open
Abstract
War and conflict negatively impact all facets of a health system; services cease to function, resources become depleted and any semblance of governance is lost. Following cessation of conflict, the rebuilding process includes a wide array of international and local actors. During this period, stakeholders must contend with various trade-offs, including balancing sustainable outcomes with immediate health needs, introducing health reform measures while also increasing local capacity, and reconciling external assistance with indigenous legitimacy. Compounding these factors are additional challenges, including co-ordination amongst stakeholders, the re-occurrence of conflict and ulterior motives from donors and governments, to name a few. Due to these complexities, the current literature on post-conflict health system development generally examines only one facet of the health system, and only at one point in time. The health system as a whole, and its development across a longer timeline, is rarely attended to. Given these considerations, the present article aims to evaluate health system development in three post-conflict environments over a 12-year timeline. Applying and adapting a framework from Waters et al. (2007, Rehabilitating Health Systems in Post-Conflict Situations. WIDER Research Paper 2007/06. United Nations University. http://hdl.handle.net/10419/63390, accessed 1 February 2018.), health policies and inputs from the post-conflict periods of Afghanistan, Cambodia and Mozambique are assessed against health outputs and other measures. From these findings, we developed a revised framework, which is presented in this article. Overall, these findings contribute post-conflict health system development by evaluating the process holistically and along a timeline, and can be of further use by healthcare managers, policy-makers and other health professionals.
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Affiliation(s)
- Spencer Rutherford
- Global Health Institute, American University of Beirut, Old Pharmacy Building, Room 202, Riad El-Solh, Beirut, Lebanon
| | - Shadi Saleh
- Global Health Institute, American University of Beirut, Old Pharmacy Building, Room 202, Riad El-Solh, Beirut, Lebanon
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Saleh S, El Harakeh A, Baroud M, Zeineddine N, Farah A, Sibai AM. Costs associated with management of non-communicable diseases in the Arab Region: a scoping review. J Glob Health 2018; 8:020410. [PMID: 30546867 PMCID: PMC6287209 DOI: 10.7189/jogh.08.020410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Global mortality rates resulting from non-communicable diseases (NCDs) are reaching alarming levels, especially in low- and middle-income countries, imposing a considerable burden on individuals and health systems as a whole. This scoping review aims at synthesizing the existing literature evaluating the cost associated with the management and treatment of major NCDs across all Arab countries; at evaluating the quality of these studies; and at identifying the gap in existing literature. METHODS A systematic search was conducted using Medline electronic database to retrieve articles evaluating costs associated with management of NCDs in Arab countries, published in English between January 2000 and April 2016. 55 studies met the eligibility criteria and were independently screened by two reviewers who extracted/calculated the following information: country, theme (management of NCD, treatment/medication, or procedure), study design, setting, population/sample size, publication year, year for cost data cost conversion (US$), costing approach, costing perspective, type of costs, source of information and quality evaluation using the Newcastle-Ottawa Scale (NOS). RESULTS The reviewed articles covered 16 countries in the Arab region. Most of the studies were observational with a retrospective or prospective design, with a relatively low to very low quality score. Our synthesis revealed that NCDs' management costs in the Arab region are high; however, there is a large variation in the methods used to quantify the costs of NCDs in these countries, making it difficult to conduct any type of comparisons. CONCLUSIONS The findings revealed that data on the direct costs of NCDs remains limited by the paucity of this type of evidence and the generally low quality of studies published in this area. There is a need for future studies, of improved and harmonized methodology, as such evidence is key for decision-makers and directs health care planning.
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Affiliation(s)
- Shadi Saleh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Amena El Harakeh
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Maysa Baroud
- Refugee Research and Policy Program, Issam Fares Institute for Public Policy and International Affairs. American University of Beirut, Beirut, Lebanon
| | - Najah Zeineddine
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Abla Mehio Sibai
- Department of Epidemiology and Population Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Saleh S, Farah A, Dimassi H, El Arnaout N, Constantin J, Osman M, El Morr C, Alameddine M. Using Mobile Health to Enhance Outcomes of Noncommunicable Diseases Care in Rural Settings and Refugee Camps: Randomized Controlled Trial. JMIR Mhealth Uhealth 2018; 6:e137. [PMID: 30006326 PMCID: PMC6064041 DOI: 10.2196/mhealth.8146] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [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: 07/24/2017] [Revised: 03/23/2018] [Accepted: 04/10/2018] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Rural areas and refugee camps are characterized by poor access of patients to needed noncommunicable disease (NCD)-related health services, including diabetes and hypertension. Employing low-cost innovative eHealth interventions, such as mobile health (mHealth), may help improve NCDs prevention and control among disadvantaged populations. OBJECTIVE The aim of this study was to assess the effect of employing low-cost mHealth tools on the accessibility to health services and improvement of health indicators of individuals with NCDs in rural areas and refugee camps in Lebanon. METHODS This is a randomized controlled trial study in which centers were allocated randomly into control and intervention sites. The effect of an employed mHealth intervention is assessed through selected quality indicators examined in both control and intervention groups. Sixteen primary health care centers (eight controls, eight interventions) located in rural areas and Palestinian refugee camps across Lebanon were included in this study. Data on diabetic and hypertensive patients-1433 in the intervention group and 926 in the control group-was extracted from patient files in the pre and postintervention periods. The intervention entailed weekly short message service messages, including medical information, importance of compliance, and reminders of appointments or regular physician follow-up. Internationally established care indicators were utilized in this study. Descriptive analysis of baseline characteristics of participants, bivariate analysis, logistic and linear regression were conducted using SPSS (IBM Corp). RESULTS Bivariate analysis of quality indicators indicated that the intervention group had a significant increase in blood pressure control (P=.03), as well as a significant decrease in the mean systolic blood pressure (P=.02), mean glycated hemoglobin (HbA1c; P<.01), and in the proportion of HbA1c poor control (P=.02). Separate regression models controlling for age, gender, and setting showed a 28% increase in the odds of blood pressure control (P=.05) and a 38% decrease in the odds of HbA1c poor control (P=.04) among the intervention group in the posttest period. Females were at lower odds of HbA1c poor control (P=.01), and age was statistically associated with annual HbA1c testing (P<.01). Regression models for mean systolic blood pressure, mean diastolic blood pressure, and mean HbA1c showed that a mean decrease in HbA1c of 0.87% (P<.01) pretest to posttest period was observed among the intervention group. Patients in rural areas belonging to the intervention group had a lower HbA1c score as compared with those in refugee camps (P<.01). CONCLUSIONS This study underlines the importance of employing integrative approaches of diseases prevention and control in which existing NCD programs in underserved communities (ie, rural and refugee camps settings) are coupled with innovative, low-cost approaches such as mHealth to provide an effective and amplified effect of traditional NCD-targeted care that can be reflected by improved NCD-related health indicators among the population. TRIAL REGISTRATION ClinicalTrials.gov NCT03580330; https://clinicaltrials.gov/ct2/show/NCT03580330 (Archived by WebCite at http://www.webcitation.org/70mhVEUwQ).
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Affiliation(s)
- Shadi Saleh
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Angie Farah
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Hani Dimassi
- School of Pharmacy, Lebanese American University, Beirut, Lebanon
| | - Nour El Arnaout
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | - Joanne Constantin
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Mona Osman
- Department of Family Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Christo El Morr
- School of Health Policy and Management, Faculty of Health, York University, Toronto, ON, Canada
| | - Mohamad Alameddine
- Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.,Health Management and Policy, College of Medicine, Mohammed bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
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