The Journal of the Egyptian Public Health Association最新文献

Background: Obstructive sleep apnea (OSA) is a common condition in pediatrics that requires prompt recognition and management to minimize its negative impact on their health and development. Data on the prevalence of OSA among school-age minors in Jordan is scarce. This study aims to estimate the prevalence of OSA in children and adolescents and identify factors that make them more likely to have OSA and its impact on academic achievement.

Methods: This school-based cross-sectional study was conducted from January to March 2023. A questionnaire including information on demographic variables, school performance, and a validated sleep-related breathing disorder (SRBD) scale for pediatrics was distributed to 1798 students in schools all over Amman. The prevalence of OSA (defined as SRBD score > 33%) was reported as a proportion along with its 95% confidence interval.

Results: Out of the 2000 questionnaires distributed, 1798 were analyzed. Among these, 1079 (60%) were from children aged 5 to 10 years, and 719 (40%) were from adolescents aged 11 to 18 years. The prevalence of high risk for OSA (HR-OSA) was higher among adolescents than in children (25.6% vs. 20.8%). Adolescents with unemployed fathers were more likely to be HR-OSA (33.70 vs 17.57%, p < 0.001). In contrast, paternal employment did not affect the prevalence of HR-OSA in children. Sleep talking, bruxism, and sweating during sleep were more common among children with positive SRBD. Nocturnal enuresis (NE) was associated with positive SRBD in children and adolescents. HR-OSA was associated with poor academic performance in both study groups.

Conclusion: HR-OSA is highly prevalent in Jordanian children and adolescents. HR-OSA can occur alongside other sleep disorders, and it significantly impairs the academic performance of affected individuals. This study found an association between high risk for OSA and other sleeping disorders (sleep talking, sleep bruxism, and sweat during sleeping) and nocturnal enuresis which needs to be confirmed in larger studies.

Background: While antimicrobial use (AMU) in human healthcare has received significant attention as a key driver of antimicrobial resistance (AMR), less emphasis has been placed on AMU practices and attitudes in animal husbandry. To address this gap, this study examines the patterns and underlying drivers of AMU on animal farms.

Methods: A survey instrument was distributed to farm staff in 150 animal farms across 15 Egyptian governorates. Farms were selected from a list curated by a private platform specialized in Egypt's poultry and cattle industry. An online search was conducted to identify additional farms not included in the list or when the contact information was unavailable. The instrument covered key items related to AMU including types of antimicrobials used, indications, their perceived benefits, and the feed conversion ratio (FCR). Using the theory of reasoned action (TRA) as a guiding theoretical framework, this study assesses key factors influencing the AMU behavior of farm personnel.

Results: Out of 150 farm personnel invited to fill out the survey forms, 111 (74%) responded and agreed to participate. All surveyed personnel reported using antimicrobials, and almost two-thirds (65%) reported using them for non-therapeutic purposes. Non-therapeutic use of antimicrobials, however, had no impact on FCR across all farm types (poultry, cattle, and mixed). The most used antimicrobials were penicillins (81%), followed by macrolides (78%) and tetracyclines (72%). Half of the studied farms reported using colistin, with more than half of this segment (55%) reporting using it for non-therapeutic purposes. Farm personnel's AMU behavior was associated with the TRA constructs: perceived benefits of antimicrobials (attitude) and perceived AMU behavior in other farms (subjective norm).

Conclusions: Antimicrobials are unanimously used in animal farms in Egypt, including those classified as last-resort options, such as colistin. Using antimicrobials for disease prevention or growth promotion did not decrease the FCR. Interventions that target the farm personnel's attitude and the subjective norm should be carried out to change their behavior regarding the use of antimicrobials. Egyptian guidelines for AMU in livestock are urgently needed, along with training to raise awareness of AMR and safer practices. The use of last-resort drugs like colistin should be banned in animal farming, and national surveillance systems should monitor AMU and AMR trends.

Background: Metabolic syndrome (MetS) is an important public health issue that has been lately linked as a growing concern worldwide.

The objective: To find out which anthropometric and body composition indices can prognosticate MetS in Jordanian adult females.

Methods: A sample of 656 Jordanian adult females was recruited (January-March 2024) in the middle of Jordan. Weight, height, waist and hip circumference, lipid profile (triglycerides and high-density lipoprotein), fasting plasma glucose, and blood pressure were measured. Fat mass index (FMI), body mass index (BMI), fat-to-muscle ratio, and waist-to-hip ratio (WHR) were calculated. The presence or absence of MetS was the outcome of interest. Receiver operating characteristic (ROC) analyses were used to examine the predictive accuracy of the indices, and the area under the curve (AUC) was measured.

Results: 40.6% had MetS, and their mean age was 45.5 years. 90.2% of the participants with MetS were obese based on body fat percentage. The MetS participants had significantly higher means of all the anthropometric indices except the fat-to-muscle ratio. None of the MetS participants were underweight, and 70.8% and 73.8% were obese based on BMI and WHR, respectively (p < 0.001). The highest proportion of the MetS participants (35.5%) was within the Q4 of the FMI compared to those without MetS (p<0.001). The discrimination ability for all indices was almost equal in predicting the existence of MetS (fair prediction power; AUC = 0.66-0.72), except for the fat-to-muscle ratio, which had poor prediction power.

Conclusion: Fat mass %, muscle mass %, FMI, BMI, and WHR could be used as predictors of MetS in Jordanian females, while the fat-to-muscle ratio was not. We suggested that more extensive sample size studies from both genders and different age categories are necessary to develop a superior predictor for MetS in Jordan.

Background: Antibiotic resistance, a major global health concern, is primarily caused by the irrational use of antibiotics. Parents play a crucial role in antibiotic use by children, directly impacting their clinical outcomes. This study aimed to assess the pattern of antibiotic use among parents and its related factors.

Methods: A cross-sectional study was conducted among 400 parents randomly selected from the pediatric outpatient clinics of Al-Zahraa University Hospital, Cairo. Data were collected using a structured interview questionnaire about sociodemographic data, antibiotic use patterns, parental knowledge and attitudes, common sources of information, and reasons for self-prescribing antibiotics.

Results: Out of the 400 parents surveyed, 87.7% were mothers with a mean age of 31.9 ± 7 years, 76% were highly educated, almost half were not working, 63% came from urban areas, and 95.2% had sufficient income. As for their children, 57.5% had male children; their average age was 5.5 ± 3.7 years. The misuse of antibiotics was prevalent among 37.2% (95% CI = 32.5-42.2%) of parents. When assessing parents' knowledge and attitude towards antibiotic use, 30.2% (95% CI = 25.8-35.0%) had good knowledge which was significantly more common among highly educated, working, and high-income parents, while the majority (72%, 95% CI = 67.3-76.3%) had a positive attitude. Having more and older children significantly increased the probability of antibiotic misuse, while a higher level of parental education and a positive attitude decreased the likelihood of such misuse (odds ratio (OR) was 1.31, 1.09, 0.52, and 0.11, respectively). Most parents obtained their information about antibiotics from physicians (92%) followed by experience from previous prescription (58.5%). Moreover, among inappropriate users, previous prescriptions and the parent's perception of the child's illness as a nonurgent condition were the most frequently cited reasons for the parents' self-prescription of antibiotics (76.5% and 69.1%, respectively).

Conclusion: Approximately, one-third of surveyed parents demonstrated an inappropriate use of antibiotics. Despite possessing a highly positive attitude and a reasonable level of knowledge about antibiotics, parents often underestimate the potential adverse effects. Tailored measures to promote appropriate antibiotic use are therefore needed to combat the problem of antibiotic resistance.

Background: The World Health Organization (WHO) stresses the importance of worldwide vaccine coverage of coronavirus-19 (COVID-19) vaccination. This study fills a critical gap in the literature by providing empirical evidence on the factors influencing COVID-19 vaccine hesitancy and inequity in the Middle East and North Africa (MENA) region. This study investigated the determinants of psychological antecedents and other factors behind COVID-19 vaccination and their role in vaccine coverage in MENA.

Methods: An anonymous online cross-sectional survey was conducted in 11 MENA countries (Egypt, Sudan, Kuwait, Saudi Arabia, Morocco, Iraq, Yemen, Lebanon, Libya, Afghanistan, and Pakistan). The minimum required sample size from each country was 307, which was increased to 330 to accommodate a non-response rate of 7%. A multilevel logistic regression model was used to capture the clustering of observations in each country and estimate the explanatory variables' effects on each item of the 5C components of the psychological antecedents scale namely (confidence, constraints, complacency, calculation, and collective responsibility).

Results: The total number of respondents was 3630, 40.5% of them were between the ages of 18 and 25 years, 61.1% were females, 54.0% completed university education, 55.8% were unmarried, 19.5% had chronic diseases, 43.7% reported a previous COVID-19 and 42.4% had relatives who died from COVID-19. Much of the variation in the log of the odds in each item of the 5Cs was due to heterogeneity between different countries (intraclass correlation > 0.05). Therefore, this variability confirms the various effects of psychological antecedents on vaccination coverage, stimulating vaccination inequity among them. Increasing confidence in vaccines and collective responsibility towards relatives and the community is related to increasing acceptance of the COVID-19 vaccine. The reduction in complacency, calculations, and constraints was found to be associated with acceptance of the COVID-19 vaccine.

Conclusions: This study is novel in shedding light on the importance of psychological determinants as hidden causes of vaccine inequities by using a multilevel logistic regression model for COVID-19 vaccination intention. The findings suggest that targeted interventions addressing socio-demographic factors, psychological antecedents, and accessibility barriers are essential to mitigate vaccine inequity and improve vaccination rates.

Background: Electronic cigarette use has increased exponentially in Egypt and all over the world. However, there is insufficient information about their use among Cairo University medical students. This study aimed to assess e-cigarette knowledge, attitude, and use among Cairo University medical students.

Methods: A cross-sectional study of 300 consenting Cairo University medical students in the period of 1st November 2023 to 15th December 2023 was conducted using a self-administered questionnaire. A multistage sampling technique was used to randomly select 300 students: 150 students from the third year and 150 from the fifth year of the Cairo University Medical School.

Results: The mean age was 22.12 ± 1.87 years and 69.3% were males and 30.7% were females. Most of them (88.3%) had heard about e-cigarettes, with higher knowledge for students in their clinical years. The main sources of information were the media and friends (41.8% and 37.5%). By type, 14%, 12.7%, and 7.3% were cigarette, shisha, and e-cigarette smokers. Smoking prevalence was higher among males and students in their clinical years (12% and 4.7% in clinical and preclinical years respectively, p = 0.02). Among all, 39.3%, 10.2%, and 3.3% of the participants' friends, siblings, and parents smoked e-cigarettes respectively; compared to 16.7%, 17.9%, and 33% among the subset of participants who were e-cigarette smokers. A significantly lower percentage of e-cigarette smokers believed that e-cigarettes are addictive or cause respiratory problems, and a higher percentage thought that e-cigarettes are less harmful, help in smoking cessation, and that their nicotine content is lower than traditional cigarettes. Predictors of e-cigarette smoking were being in clinical years, cigarette and shisha smoking, and having friends who are e-cigarette smokers.

Conclusion: The study revealed several students' misconceptions and a wide variation in their attitudes about the harmful and addictive effects of e-cigarettes. This underscores the urgent need for the development of a medical school curriculum to provide accurate information about e-cigarettes to address the problem of its growing use in Egypt.

Background: Vaccine confidence is described as a belief that vaccines are effective, safe, and part of a trustworthy health system. The objective of this study was to develop and validate an Arabic tool to evaluate confidence in the received coronavirus disease 2019 (COVID-19) vaccines (ARAB-VAX-CONF).

Methods: The research team developed the ARAB-VAX-CONF based on three areas specified by the Centers for Disease Control and Prevention (CDC): confidence in vaccine effectiveness, confidence in vaccine safety, and confidence in the healthcare system. The analysis includes data from 406 eligible vaccinated persons (≥ 18 years). Cronbach's alpha was used to measure internal consistency, while convergent, discriminant, exploratory, and confirmatory factor analyses were used to verify construct validity.

Results: A total of 406 adults were recruited, with a mean age of 33.0 ± 12.2 years. A total of 63.1% were males, 56.7% were married, 21.9% had chronic conditions, 93.3% were nonsmokers, and 39.6% were obligated to obtain vaccines. The three domains of the scale met the criterion of internal consistency (Cronbach's alpha > 0.7). Convergent validity was identified by the significant inter-item and item-mean score of the domain correlation (P < 0.001). Discriminant validity was reported as the inter-factor correlation matrix (< 0.7). The Kaiser-Meyer-Olkin sampling adequacy measure was 0.80, and Bartlett's sphericity test was significant (P < 0.001). Exploratory factor analysis indicated that the scale could be summarized into three factors. Confirmatory factor analysis confirmed the adequate psychometric properties and fit with observed data (root-mean-square error of approximation = 0.08, comparative fit index = 0.945, Tucker-Lewis index = 0.924, standardized root-mean-square residual = 0.086, normed fit index = 0.918, and goodness-of-fit index = 0.909).

Conclusions: The ARAB-VAX-CONF developed in this study is valid and reliable for assessing confidence in vaccine effectiveness, safety, and confidence in the healthcare system. The ARAB-VAX-CONF can support decision-makers in addressing the gap in vaccine confidence among various populations.

Background: In light of the existing body of scientific data, many substances are now recognized or reasonably assumed to be human carcinogens. Public knowledge about modifiable environmental carcinogens is regarded as a crucial first step in primary prevention. This study aimed to assess Jordanians' awareness of some of the recognized environmental human carcinogens and general cancer information.

Methods: This study was conducted using a cross-sectional descriptive survey based on a questionnaire completed by Jordanian participants aged 18 or above. The questions consisted of the following sections: socio-demographic characteristics, questions about the prevalent and non-prevalent cancer types in Jordan and general causes of cancer, closed-ended questions to evaluate knowledge about environmental carcinogens as well as factors that influence the development of cancer, source of knowledge about carcinogens and interest in learning about human carcinogens, and the best way for prevention of cancer.

Results: A total of 579 questionnaires were completed. Among respondents, 55.6% (n = 322) had a knowledge score ≥ 8 indicating good knowledge. However, low awareness was demonstrated regarding cancer-causing substances such as wood dust, Nitrosamines, Aflatoxins, Formaldehyde, Naphthalene, Asbestos, Benzene, and Arsenic. A significant portion of the participants failed to categorize infectious pathogens linked to cancer as variables that either cause cancer or raise the risk of developing cancer.

Conclusion: This study demonstrated a good level of awareness regarding some environmental carcinogens but also highlighted the lack of knowledge about other environmental carcinogens. These findings may provide a guide for future awareness programs by health authorities.