Eastern Mediterranean Health Journal最新文献

Background: The relationship between gender disparity and the risk of developing noncommunicable disease and other social health determinants has not been well researched in the Islamic Republic of Iran.

Aims: To assess how gender disparity contributes to the overall risk of noncommunicable disease in the Islamic Republic of Iran.

Methods: This was a secondary analysis of data on about 11 000 adults aged 15-69 years from the 2011 WHO STEPwise approach to NCD risk factor surveillance (STEPS) survey in the Islamic Republic of Iran. The outcome variable in our analysis was the noncommunicable disease risk factor index. We used an extension of the Blinder-Oaxaca decomposition model to decompose the predicted mean difference in this index. Sampling method, study design and sex were considered in the analysis. The predictor variables were age, household assets index, education, employment status, ethnicity, and residence.

Results: The overall mean (standard deviation) noncommunicable disease risk score was 39.26 (22.4). The risk score for women was significantly higher than for men (41.75 versus 36.84; P < 0.001). About 35% of gender disparity in risk score was due to the differences in distribution of the predictor variables (explained component); of these, age contributed the most (23.79%), followed by education (7.82%). The different gender effects on work status and age made the largest contributions to the unexplained component of the disparity, 36.40% and 14.82%, respectively.

Conclusions: Policies to reduce the risk of noncommunicable diseases need to consider gender groups and how gender affects social determinants such as employment status to make some gender subgroups more vulnerable than others.

Background: Complementary and alternative medicine is widely used in Saudi Arabia. One of the common practices is the use of camel urine alone or mixed with camel milk for the treatment of cancer, which is often supported by religious beliefs.

Aims: To observe and follow-up cancer patients who insisted on using camel urine, and to offer some clinically relevant recommendations.

Methods: We observed 20 cancer patients (15 male, 5 female) from September 2020 to January 2022 who insisted on using camel urine for treatment. We documented the demographics of each patient, the method of administering the urine, reasons for refusing conventional treatment, period of follow-up, and the outcome and side effects.

Results: All the patients had radiological investigations before and after their treatment with camel urine. All of them used a combination of camel urine and camel milk, and treatment ranged from a few days to 6 months. They consumed an average of 60 ml urine/milk per day. No clinical benefit was observed after the treatment; 2 patients developed brucellosis. Eleven patients changed their mind and accepted conventional antineoplastic treatment and 7 were too weak to receive further treatment; they died from the disease.

Conclusion: Camel urine had no clinical benefits for any of the cancer patients, it may even have caused zoonotic infection. The promotion of camel urine as a traditional medicine should be stopped because there is no scientific evidence to support it.

Background: No single method of health technology assessment (HTA) can meet all the policy- and decision-making needs in a country. However, there should be minimum criteria for performing HTA worldwide, and many HTA agencies have reached a consensus on this.

Aim: This study aimed to assess the quality of HTA reports in the Islamic Republic of Iran.

Method: We examined all the HTA research reports published by the Iranian HTA office up to 2020, using the International Network of Agencies for Health Technology Assessment checklist for quality assessment.

Results: A total of 97 reports were examined, of which only 10.0% provided complete and appropriate contact details for further information and 5.6% clearly stated a conflict of interest. In 87.78% of the reports, the scope of assessment was clearly determined. The quality of the reports was relatively appropriate as well as details of the sources of information and text search strategies. Some 7.8%, 74.4%, 11.1%, 8.9%, and 4.4%, respectively, of the reports considered legal aspects, economic analysis, ethical implications, social implications, and other stakeholder perspectives.

Conclusion: We recommend that minimum standards be established for the HTA process so that healthcare policy- and decision-makers can make reliable decisions on the basis of the HTA reports.

Background: In addition to the general question about what works, policymakers consider whether health interventions will work in their context, and consider the social values such as affordability, acceptability, equity, equality, and human rights.

Aims: To highlight the importance of having and using an evidence governance system to inform health policymaking in Oman.

Methods: We reviewed the literature and analysed local documents on evidence governance systems in Oman.

Results: The Government of Oman has shown increasing interest in research and innovation in the past few decades. This interest was reinforced through the announcement in November 2021 of the intention to establish a decision-making support unit. Oman's strategies for evidence-informed policymaking provide direct and well-integrated channels for expert advice, however, the capacity for implementation remains challenging, and there is a lack of clarity in the evidence use mandate. It is not clear how evidence was selected, synthesized and used to inform some of the government policies on health. This can limit the scope of operation and subsequent achievements.

Conclusion: Efforts to strengthen evidence-informed policymaking should focus on building a system for good governance of evidence to ensure that rigorous, systematic, and technically valid evidence is used for policymaking.

Background: The COVID-19 pandemic has increased awareness of the need for high-quality and timely evidence to support policy- and decision-making in emergency situations.

Aims: To describe the experiences of the National Institute of Health Research (NIHR), Islamic Republic of Iran, in adopting evidence-informed policymaking during the COVID-19 pandemic.

Methods: During the COVID-19 pandemic, NIHR institutionalized a rapid response system that was backed up by evidence-informed policy- and decision-making. Activities included establishment of a preparedness and response management committee, gathering and providing timely pandemic information to policymakers, establishing a timeline of actions and activities, and a feedback system for policy responses and queries.

Results: The COVID-19 rapid response committee addressed the questions of 40 policymakers by synthesizing and analysing evidence and making it available to relevant stakeholders. It developed and disseminated knowledge products to provide relevant information. We identified the need for more timely data and more reliable research evidence for pandemic management.

Conclusion: National institutions responding to health emergencies need to take responsibility for establishing and managing a robust rapid response systems that can provide valid and timely evidence to policymakers. Over time, their capacity should be monitored, evaluated and strengthened to adapt and respond appropriately to pandemics, outbreaks and epidemics.

Background: Rejection, hesitancy and low uptake of the COVID-19 vaccine are major public health challenges in Saudi Arabia.

Aims: To address COVID-19 vaccine hesitancy and rejection at the King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) using evidence-based strategies.

Methods: A questionnaire was administered electronically to participants at KSAU-HS to understand the reasons for vaccine hesitancy or rejection and develop an evidence-informed vaccination plan. Initial results from March 2021 showed that only 60% of respondents had taken at least 1 COVID-19 vaccine dose. Based on the results of the survey, KSAU-HS designed a 6-month vaccination campaign to raise awareness about the vaccine and its importance and increase acceptability rates. Mass media, social media, and direct messaging as reminders were used to address the barriers identified and to help the university community overcome fears and misconceptions about the COVID-19 vaccine.

Results: The evidence-based interventions helped achieve a significantly high vaccination rate in the university community, with 99.7% of individuals vaccinated by October 2021; one of the highest vaccination rates among public universities in Saudi Arabia.

Conclusion: Evidence-based interventions targeted at specific populations can help address prevailing concerns about the COVID-19 vaccine and other similar public health issues.

Background: Mapping of ethical governance structures is very useful in identifying strengths and weaknesses in order to uphold integrity and ensure standardization. However, reliable countrywide data about ethical review committees (ERCs) is unavailable in Pakistan.

Aims: To evaluate the research ethics governance mechanisms at national level and at key healthcare institutions in Pakistan.

Methods: This pilot mapping exercise used a mixed-methods approach, involving a cross-sectional survey of 19 key healthcare research institutions, and structured in-depth interviews with the chairs of the National Bioethics Committee and the Drug Regulatory Authority of Pakistan.

Results: Eighteen institutions responded to the ethics mapping survey. Twelve public sector ERCs had a permanent structure and 17 had formal terms of reference. Seven ERCs claimed accreditation, although no central accreditation agency exists in Pakistan. Eight ERCs were chaired by the heads of the institutions. There was no fixed tenure for the heads in 13 committees, and 14 committees allowed multiple terms. Six ERCs had follow-up mechanisms for ethical approvals, and 6 took punitive actions in response to any deviation from an approved protocol, or to a scientific misconduct. Two respondents recalled situations where applicants pressured committee members for favourable approvals. Survey respondents mentioned the lack of central research ethics guidelines as a weakness of the national governance system. Structured interviews revealed the need for formal training of committee members and capacity strengthening, particularly for administrative staff.

Conclusion: There is a need to develop guidelines for local ethics governance in Pakistan, and ensure accreditation of ERCs through the National Bioethics Committee to uphold the integrity of the ethics governance structure.

Background: Priority-setting for early access to vaccines during a pandemic optimizes the impact of vaccine rollout, however, low- and middle-income countries (LMICs) have little experience in policymaking on this. In the Islamic Republic of Iran, the national clinical ethics committee developed a policy for early access to COVID-19 vaccines with support from the national committee on COVID-19 vaccine.

Aims: This paper reports the process and results of a national COVID-19 vaccine priority-setting in the Islamic Republic of Iran and discusses its ethical and cultural aspects.

Methods: A multidisciplinary team of experts planned and developed a national guideline following an extensive literature review and face-to-face consultations.

Results: We present the list of priority groups and subgroups, tiered through a 4-phase process, as well as the ethical values and sociocultural issues underpinning COVID-19 vaccine prioritization in the Islamic Republic of Iran.

Conclusions: Our experience shows that a transparent and well-reasoned policymaking process can inform fair prioritysetting for pandemic vaccines, especially in LMICs.