Eastern Mediterranean health journal = La revue de sante de la Mediterranee orientale = al-Majallah al-sihhiyah li-sharq al-mutawassit最新文献

Background: Health systems, particularly in low- and middle-income countries, struggled to maintain essential noncommunicable disease services during the COVID-19 pandemic.

Aim: We assessed the extent of disruptions to non-communicable disease services in the Eastern Mediterranean Region during the COVID-19 pandemic, exploring the challenges and mitigation strategies.

Methods: From October to December 2021, we interviewed WHO country focal points for non-communicable disease from 16 Eastern Mediterranean Region countries and analysed the data.

Results: Emergency and primary care services were disrupted in most of the countries. One country experienced total disruption to primary care while 7 experienced at least 50% disruption. The proportion of fully disrupted essential non-communicable disease services was highest in the lower-middle income countries. Specialized services, including cancer screening and radiotherapy, were more severely affected, while dialysis was relatively well-maintained. The most frequently mentioned reasons for disruption were fear of contagion, staff redeployment to COVID-19 response, lack of access to services due to lockdowns, and cancellation of elective procedures. Two of the mitigation measures were use of telemedicine and community volunteers and home drug delivery.

Conclusion: COVID-19 caused disruptions to non-communicable disease services in the Eastern Mediterranean Region, however, some countries implemented measures to mitigate the disruptions. There is a need for long-term, sustainable, integrated and well-coordinated national and regional strategies that will ensure the continuity of non-communicable disease services during emergencies and pandemics.

A vibrant health workforce is the backbone of any health system and key to advancing health care goals. However, there is a general shortage of health workforce globally, as health workers remain overstretched, underpaid and sometimes undervalued. Without immediate and sustained investment in a resilient and well-supported workforce, we risk being unprepared for the next pandemic. We will be unable to control the surge in non-communicable diseases and fall short of achieving Universal Health Coverage and the health-related targets of the Sustainable Development Goals (SDGs) by 2030.

Background: Violence in healthcare is a major challenge in fragile and conflict-affected countries such as the occupied Palestinian territories.

Aim: To analyse and compare violence in healthcare in the occupied Palestinian territories with other conflict-affected settings.

Methods: From the Safeguarding Health in Conflict Coalition database, we collected data for 2017 to 2021 on health workers killed, injured, kidnapped, assaulted, sexually abused, threatened, and arrested, and on the destruction and damage to health care facilities for 15 conflict-affected countries and the occupied Palestinian territories. We collected similar monthly data for September 2022 to July 2024 for the occupied Palestinian territories. Using mixed-effects negative binomial regression we compared data from the occupied Palestinian territories with the 15 countries. Using negative binomial models, we conducted a pre-post analysis of the data from the occupied Palestinian territories, using October 2023 as the reference point.

Results: Between 2017 and 2021, there were significantly higher rates of attacks on health workers [IRR = 20.75 (95% CI: 2.66, 161.60)] and of the total number of violence incidents (22.26 [2.17, 228.64]) in the occupied Palestinian territories than in the 15 countries, but no significant difference in the attacks on health facilities. Attacks on health workers [IRR = 110 (30, 413)] and health facilities [IRR = 150 (31, 751)], and total violence incidents [IRR = 73 (24, 220)], increased significantly after October 2023 in the occupied Palestinian territories.

Conclusion: There is a need for multinational, multisectoral support systems to enhance safety and security for health workers and health facilities and to enhance the resilience of health systems against current and future conflicts in the occupied Palestinian territories.

Background: Although whooping cough is vaccine-preventable, its incidence is increasing globally, including in Kyrgyzstan.

Aim: To investigate the epidemiologic characteristics of whooping cough among children in Bishkek, Kyrgyzstan.

Methods: We collected and analysed data on 802 children aged 0-14 years, clinically diagnosed with whooping cough, and admitted at the Republican Clinical Infectious Diseases Hospital, Bishkek, Kyrgyzstan, from February 2014 to February 2024.

Results: Polymerase chain reaction test of the respiratory samples confirmed all the children positive for Bordetella pertussis. There was no case of Bordetella parapertussis. We observed a distinct cyclical pattern of the incidence of whooping cough during the 10-year period, with a significant peak in 2018. Between 2021 and 2023, the majority (60.0%) of cases occurred among infants <1 year old. Among the children, 58.7% were not vaccinated, while 41.3% had incomplete diphtheria, tetanus and polio vaccination. Severe cases were common among infants with comorbidities such as anaemia and hypoxia.

Conclusions: Our findings show that whooping cough incidence is increasing among children in Bishkek. There is therefore a need to strengthen prevention efforts, including public awareness and education, childhood immunisation and maternal vaccination, and intensify detection, diagnosis and isolation to reduce transmission.

Background: Antimicrobial resistance is a serious threat to healthcare globally and antimicrobial stewardship is fundamental in combating it.

Aim: To analyse the agenda-setting process for the development of an antimicrobial restriction policy in Islamic Republic of Iran using Kingdon's Multiple Streams Framework.

Methods: We conducted key informant interviews with 21 experts who were involved in agenda-setting for an antimicrobial restriction policy in Islamic Republic of Iran and reviewed relevant documents relating to the development of the policy. We analysed the data using Kingdon's Multiple Streams Framework.

Results: In 2019, Islamic Republic of Iran officially announced its antimicrobial restriction policy. Although national surveillance data were limited, multiple proxy indicators showed excessive use of antimicrobials and an increase in antimicrobial resistance in Islamic Republic of Iran. Based on available data, stakeholders made a compelling case for urgent policy actions to minimize irrational prescription and use of antimicrobials in the country. To balance antimicrobial stewardship with clinical needs, the antimicrobial restriction policy mandates infectious disease specialists to conduct laboratory and clinical assessment of patients, after taking the first antimicrobial dose, prior to treatment continuation.

Conclusion: In addition to evidence, demonstrating the clinical, economic and public health benefits can help improve system responsiveness to antimicrobial stewardship policy and programme development.

Background: Pedestrian crashes have become a major concern in Türkiye, accounting for 22% of traffic-related fatalities.

Aim: To examine the major risk factors increasing the fatality of pedestrian crashes in southern Türkiye.

Methods: We collected and analysed crash data for 2018-2023 in 3 cities along Türkiye's Mediterranean coast from the General Directorate of Security, and demographic data from the Turkish Statistical Institute. We used skewed logistic regression to identify major factors affecting the severity of pedestrian injuries. A total of 14 893 pedestrian crashes involving 15 116 injuries were included in the analysis.

Results: In total, 831 pedestrians were killed and 15 116 were injured. The main causes of the crashes were over-speeding (24%), failure to give way to pedestrians (14%) and pedestrians crossing the road carelessly (13%). Most crashes (96%) occurred in urban areas and male drivers were involved in 90% of the crashes. Fatality rate was higher among males than females. Fatality risk increased with pedestrian age and was higher in rural areas, at locations without street lighting, after midnight, and at ≥50 km/h speed.

Conclusion: Our findings show that over-speeding, poor lighting, large vehicles, as well as poor driver and pedestrian behaviours increased the risk of pedestrian fatalities. To improve pedestrian safety in Türkiye, speed limits should be enforced alongside better street lighting. Public awareness campaigns are needed to educate pedestrians and drivers about road safety, including special programmes for the elderly.

Background: The Global HEARTS Initiative was launched in 2016 as an evidence-based package to strengthen the prevention and management of cardiovascular diseases in primary health care.

Aim: To assess implementation of the Global HEARTS Initiative in Morocco.

Methods: Between July 2023 and March 2024, we interviewed 131 patients, 39 health care professionals and 9 health managers, and observed service provision, at 4 pilot health centres in the Tangier-Tetouan-Al Hoceïma Region of Morocco, on the implementation of the Global HEARTS Initiative. We analysed the data using Jamovi 2023.

Results: Most health care professionals (57.1%) interviewed were recommending one counselling session per quarter to patients, with majority (60.6%) preferring sessions lasting < 15 minutes. Majority of the patients (96.9%) interviewed reported receiving advice on healthy lifestyle practices. Availability of essential medicines and technologies varied across the centres. However, most of the health care professionals (76.3%) reported availability at their centres and most of the patients (98.5%) reported being counselled on the appropriate use of cardiovascular medicines. Patient registration in the HEARTS information system was low (3.9-12.1%) across centres. There were difficulties in obtaining essential medicines, only 25.6% of the health care professionals had received training on HEARTS, there were technical problems with the HEARTS information system, and persistent gaps in coordination and communication within and across different levels of the health system.

Conclusion: Certain systemic barriers hinder effective implementation of the Global HEARTS Initiative in Morocco. Addressing these barriers is critical to strengthening implementation, enhancing scale-up and sustainability, and achieving the objectives of the initiative.