Eastern Mediterranean Health Journal最新文献

Background: Dengue virus infection is spreading globally and most parts of Sudan have witnessed repeated dengue outbreaks, with the detection of DENV-1, DENV-2 and DENV-3 serotypes.

Aims: In this report we describe the dengue fever outbreaks that occurred in eastern Sudan (Kassala and Port Sudan cities) from August to November 2019.

Methods: We enrolled 79 (29.8%) suspected cases from Kassala and 186 (70.2%) from Port Sudan who presented with fever. The participants were medically examined and their clinical signs recorded. Blood samples were collected for complete blood count, detection of anti-dengue virus IgM, detection of NS1 dengue antigen and identification of the virus serotype using RT-PCR.

Results: The main clinical presentations were fever, abdominal pain, joint pain and vomiting, and thrombocytopenia was the main laboratory finding. One hundred and twenty-five blood samples tested positive for the anti-dengue IgM antibody, and 145 were positive for the NS1 antigen. Using RT-PCR, we identified 35 (24%) infections with DENV-2, 100 (69%) with DENV-3 and 10 (7%) with DENV-4 serotypes.

Conclusions: We identified multiple serotypes - DENV-2, DENV-3 and DENV-4 - as the causes of the outbreak. The presence of DENV-4 serotype was documented for the first time in Sudan.

Background: Hepatocellular carcinoma (HCC) is a significant health problem, and the associated mortality rate is increasing.

Aim: We aimed to determine the clinical characteristics and prognosis for HCC in member countries of the OncoBridge Study Group.

Methods: We recruited 630 patients diagnosed with HCC between 2013 and 2019 from 4 countries (Türkiye, Russia, Georgia, and Greece). Univariate and multivariate analyses were conducted to investigate clinical and laboratory prognostic factors. Receiver operating characteristic (ROC) analysis was used to determine the prognostic value of the neutrophil to lymphocyte ratio (NLR) and alpha-fetoprotein (AFP) value.

Results: The 3 most common etiological factors were hepatitis B infection (39.7%), hepatitis C virus infection (17.0%) and non-alcoholic fatty liver disease (9.0%). Median overall survival for the whole group was 25 [95% confidence interval (CI): 15.7-34.2] months. Cut-off values for AFP and NLR were accepted as 200 ng/mL and 3.45, respectively. The area under the ROC curve values for AFP, NLR and NLR+AFP were 0.625 (95% CI: 0.547-0.704), 0.589 (95% CI: 0.512-0.667) and 0.657 (95% CI: 0.583-0.731). From the multivariate analysis, advanced tumour size, lymph node involvement and metastasis (TNM) stage, presence of cirrhosis, high AFP, and high NLR values were associated with poor survival.

Conclusion: AFP, NLR, advanced TNM, and presence of cirrhosis may predict prognosis in patients with HCC. Studies involving more countries are needed to corroborate these findings.

Background: Morocco is actively working towards expanding its influenza vaccine policy to cover high-risk groups, as recommended by the World Health Organization (WHO).

Aims: We assessed the risk factors for influenza-associated hospitalization for severe acute respiratory infections (SARI) that occurred during the last 5 seasons.

Methods: We conducted a retrospective, analytical study among patients recruited in the ambulatory and hospital sites of the influenza sentinel surveillance system in Morocco between 2014 and 2019. Using multiple logistic regression, we compared the characteristics of influenza-positive patients with SARI to those with influenza-like illness (ILI) to identify factors associated with severe disease.

Results: We included 1323 positive influenza patients with either SARI (41.7%) or ILI diagnosis (58.3%). A(H1N1)pdm09, A(H3N2) and influenza B, respectively, contributed 49.2%, 29.5% and 20.6% of the cases. The main risk factors considered in the bivariate analysis were found in the multivariate analysis to be significantly associated with influenza-related hospitalization (SARI): age < 2 years (aOR = 7.08, P < 0.001); age ≥ 65 years (aOR = 3.59, P < 0.001); diabetes (aOR = 1.98, P = 0.017); obesity (aOR = 2.94, P = 0.034); asthma or chronic respiratory disease (aOR = 4.99, P < 0.001); chronic renal failure (aOR = 4.74, P = 0.005); pregnancy (aOR = 7.49, P < 0.001); and the A(H1N1)pdm09 subtype (aOR = 1.82, P < 0.001).

Conclusion: This study provides epidemiological evidence for the expected benefit of an influenza vaccination strategy for high-risk groups as recommended by the WHO.

Background: The COVID-19 pandemic has caused an increase in medical waste in hospitals.

Aims: To evaluate how the COVID-19 pandemic is affecting medical waste management in hospitals in Isparta Province, south-western Türkiye.

Methods: We examined medical waste production in 3 different types of hospital (1 private, 1 public and 1 university) in Isparta Province, south-western Türkiye. We compared the number of patients, amount of medical waste and occupancy rates of the 3 hospitals during the pre-pandemic (2019-2020) and pandemic (2020-2021) periods. The data were analysed using SPSS, version 22.0, and statistical significance was set at P < 0.05.

Results: During the pandemic, the number of inpatients in the public and university hospitals decreased, while the number in the private hospital increased. The amount of medical waste during the pre-pandemic period was 8.4 kg per person in the public hospital, 7.7 kg per person in the university hospital and 6.3 kg per person in the private hospital. During the pandemic, these amounts were 14.2 kg, 10.1 kg and 7.6 kg per person, respectively.

Conclusion: There was a significant increase in medical waste during the COVID-19 pandemic. Health institutions in Isparta Province, Türkiye, need to review their medical waste management strategies to better manage the increased waste.

Background: Pulmonary tuberculosis is the most common type of tuberculosis and few studies have investigated the incidence and treatment outcome of smear-positive pulmonary tuberculosis in Golestan Province, Islamic Republic of Iran.

Aims: To estimate the cumulative incidence and trends in incidence of smear-positive pulmonary tuberculosis in Golestan Province between 2014 and 2019, and to determine the treatment outcomes.

Methods: All smear-positive pulmonary tuberculosis cases between 2014 and 2019 recorded in the tuberculosis registry in Golestan Province, Islamic Republic of Iran, were included in this study. The yearly incidence and cumulative incidence were calculated, and differences by sex and residence were examined. Treatment outcomes classified as success and failure were determined. The Mann-Kendall test was used to assess the significance of the trend in incidence.

Results: A total of 2047 smear-positive pulmonary tuberculosis cases were evaluated. The cumulative incidence was 18.52 [95% confidence intervals (CI): 17.72-19.33] per 100 000 population during 2014-2019. The incidence of smear-positive pulmonary tuberculosis declined from 23.84 (95% CI: 21.57-26.11) per 100 000 population in 2014 to 15.02 (95% CI: 13.29- 16.75) in 2019. Incidence rate was higher among men and among rural residents. Most patients (85.34%) were cured, 2.05% completed their treatment, 1.17% were lost to follow-up, 4.40% had treatment failure, and 6.45% died.

Conclusion: The incidence of pulmonary tuberculosis in Golestan Province, Islamic Republic of Iran, declined during the period of study. However, the proportion of patients who were cured decreased and the proportion who died increased. Interventions are needed to improve the treatment success rate for pulmonary tuberculosis in the province.

Background: Childhood visual impairment has a significant effect on social life, educational performance, and professional choices, and can lead to poverty.

Aims: To review the prevalence and causes of visual impairment among children aged 5-17 years in the Eastern Mediterranean Region (EMR).

Methods: This study was conducted in 2021 using the Preferred Reporting Items for Systematic reviews and Meta- Analyses (PRISMA) method. We searched Google Scholar, PubMed, Web of Science, Scopus, Index Medicus for the Eastern Mediterranean Region, and Medline for studies published between January 2000 and April 2020. The articles included were epidemiological studies of prevalence and causes of childhood visual impairment published in peer-reviewed journals.

Results: Of the 12 705 articles screened, 23 from 9 countries met the inclusion criteria. The pooled prevalence of uncorrected, presenting, and best-corrected childhood visual impairment was 11.57%, 8.34% and 1.21%, respectively. The most common causes of childhood visual impairment were refractive error (51.89%), amblyopia (11.15%), retinal disorders (3.90%), corneal opacity (3.0%), and cataract (1.88%). There was a highly significant heterogeneity between the studies (P < 0.0001).

Conclusion: The prevalence of visual impairment among children in the EMR was high, and the leading causes were uncorrected refractive error and amblyopia, which were avoidable. Access to eyecare services may help improve early diagnosis and treatment of preventable causes of childhood visual impairment.

Background: Social media posts that violate the International Code of Marketing of Breastmilk Substitutes (the Code) may influence societal opinions, views, attitudes, behaviours, and beliefs about breastfeeding, including among healthcare personnel who provide services to breastfeeding women and infants.

Aims: To investigate the literacy of healthcare personnel at Ankara Hacettepe University Hospitals, Türkiye, about the Code and their selection of social media posts about breastfeeding, after completing a breastfeeding counselling course.

Methods: This study included healthcare personnel who completed 2 breastfeeding counselling courses conducted at Hacettepe University in October 2018 and July 2019. They were asked to search for breast milk and breastfeeding on their favourite social media platforms, select 2-4 posts that attracted them, and evaluate the posts to know if they were supportive of breastfeeding. The counselling course facilitators assessed their responses.

Results: Twenty-seven nurses and 40 medical doctors participated in the study; 85.0% of them were female. The participants selected 82 (34%) posts from Instagram, 22 (9.1%) from Facebook, 4 (1.7%) from YouTube, and 134 (55.2%) from other social media platforms. The most common themes of the posts were benefits of breast milk, methods of giving breast milk, and use of infant formula instead of breast milk. The contents of the media were 68.2% (n = 165) favourable and 31.0% (n = 75) unfavourable to breastfeeding. The inter-rater reliability between the participants and facilitators was almost perfect (κ coefficient 0.83).

Conclusion: Sustainable support is needed in Türkiye to increase literacy among healthcare personnel about social media posts that violate the Code, especially those working at baby-friendly hospitals and those who care for breastfeeding mothers.

Introduction: Several studies have investigated COVID-19 vaccine acceptability and hesitancy, especially among healthcare workers (HCWs). However, acceptability of the vaccine by HCWs in Sudan remains unclear.

Aims: We investigated acceptability of the COVID-19 vaccine and its determinants among HCWs in Sudan.

Methods: Using a semi-structured questionnaire, we conducted a web-based cross-sectional study of COVID-19 vaccine hesitancy and its associated determinants among healthcare workers in Sudan during March-April 2021.

Results: A total of 576 HCWs responded to the survey. Mean age was 35 years. Females (53.3%), medical doctors (55.4%) and being located in Khartoum State (76.0%) each accounted for more than half of the participants. Absolute refusal of the COVID-19 vaccine was expressed by 16.0% of the respondents. Males were more than twice as likely to accept the vaccine as females. Lower acceptability was statistically significantly associated with the nurses (OR = 0.35, 95% CI: 0.15-0.82, P < 0.001), increased perceived harm from the vaccine (OR = 0.11, 95% CI: 0.05-0.23, P < 0.001), lack of confidence in the source of the vaccine (OR = 0.16, 95% CI: 0.08-0.31, P < 0.001) and lack of confidence in organizations or government sectors supervising the vaccination process (OR = 0.31, 95% CI: 0.17-0.58, P < 0.001).

Conclusion: This study highlights a moderate level of COVID-19 vaccine acceptability among HCWs in Sudan. Special consideration should be given to addressing vaccine hesitancy among female HCWs and nurses.

Background: Although vaccines play a critical role in the control of infectious diseases and disease outbreaks, vaccination rates have been declining in recent years because of vaccine hesitancy or refusal.

Aims: We aimed to determine the rates and reasons for parental hesitancy or refusal of vaccination for their children in Türkiye.

Method: A total of 1100 participants selected from 26 regions of Türkiye were involved in this cross-sectional study conducted between July 2020 and April 2021. Using a questionnaire, we collected data on the sociodemographic characteristics of parents, the status of vaccine hesitancy or refusal for their children, and reasons for the hesitancy or refusal. Using Excel and SPSS version 22.0, we analysed the data with chi-square test, Fisher's exact test and binomial logistic regression.

Results: Only 9.4% of the participants were male and 29.5% were aged 33-37 years. Just over 11% said they were worried about childhood vaccination, mainly because of the chemicals used in manufacturing the vaccines. The level of concern was greater among those who got information about vaccines from the internet, family members, friends, TV, radio, and newspapers. Those who used complementary health services were considerably more hesitant about vaccination than those who used mainstream services.

Conclusions: Parents in Türkiye have several reasons for hesitating or refusing to vaccinate their children, key among which are concerns about the chemical composition of the vaccines and their ability to trigger negative health conditions such as autism. This study used a large sample size across Türkiye, although there were differences by region, the findings would be useful in designing interventions to counter vaccine hesitancy or refusal in the country.