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Basha L, Hamze M, Socarras A, Akhtar M, Albaik A, Hussien I, Tarakji A, Hamadeh M, Loutfi R, Kewara M, Abbara A. Respiratory health and the Syrian conflict: a scoping literature review. Med Confl Surviv 2024; 40:111-152. [PMID: 38688705 DOI: 10.1080/13623699.2024.2343996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 04/13/2024] [Indexed: 05/02/2024]
Abstract
Conflict adversely affects respiratory health in both direct and indirect ways among populations whose health is already compromised through the compounding effects of conflict. Our aim is to review academic and grey literature relevant to respiratory health in the Syrian conflict (now more than a decade in duration) to explore its impacts on populations across Syria. We performed a scoping literature review of academic and grey literature on respiratory health in Syria between March 2011 (taken as the start of the conflict for practicality) and December 2023. Of 11,472 papers screened, 34 met the inclusion criteria, of which 29 were peer reviewed. Key themes identified included the impact of conflict on asthma diagnosis and management; the burden of respiratory tract infections (RTIs) and COVID-19; the impact of chemical weapon use and the impact of destruction and interruptions to the health system(s) across Syria on respiratory health. This review highlights the need for more in-depth exploration of the impact of conflict on respiratory health in Syria with focus on social determinants, for example, shelter, public health interventions, smoking cessation, and supporting early diagnosis and treatment of respiratory conditions to counter the effects that conflict has had on respiratory health.
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Affiliation(s)
- L Basha
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - M Hamze
- Research Department, Syrian American Medical Society, Gaziantep, Turkey
| | - A Socarras
- Advocacy Department, Syrian American Medical Society, Washington, DC, USA
| | - M Akhtar
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - A Albaik
- Information Management Department, Syrian American Medical Society, Gaziantep, Turkey
| | - I Hussien
- Information Management Department, Syrian American Medical Society, Gaziantep, Turkey
| | - A Tarakji
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - M Hamadeh
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - R Loutfi
- Program Department, Syrian American Medical Society, Washington, DC, USA
| | - M Kewara
- Glasgow Royal Infirmary, Glasgow, Scotland
| | - A Abbara
- Research Department, Syrian American Medical Society, Gaziantep, Turkey
- Department of Infectious Disease, Imperial College, London, UK
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2
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Gebreyohannes EA, Wolde HF, Akalu TY, Clements ACA, Alene KA. Impacts of armed conflicts on tuberculosis burden and treatment outcomes: a systematic review. BMJ Open 2024; 14:e080978. [PMID: 38453196 PMCID: PMC10921481 DOI: 10.1136/bmjopen-2023-080978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 02/26/2024] [Indexed: 03/09/2024] Open
Abstract
OBJECTIVES This systematic review aimed to summarise existing literature on the impacts of armed conflicts on tuberculosis burden and treatment outcomes. DESIGN A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES PubMed, Web of Science, Cumulative Index to Nursing and Allied Health Literature Plus, Scopus, ScienceDirect, Embase and medRxiv. DATA EXTRACTION AND SYNTHESIS Three reviewers independently screened, selected eligible studies and extracted data. A narrative review was undertaken to summarise the findings qualitatively. RESULTS Eleven studies were included in this review, reporting on tuberculosis incidence rates, prevalence and treatment outcomes, including mortality. Overall, the impact of armed conflicts on case notifications was variable. Six studies reported overall increases in tuberculosis case notifications following the onset of conflicts, while three studies reported overall decreases in tuberculosis case notifications. Factors, including limited access to healthcare services, challenges in surveillance and laboratory confirmation, the destruction of health systems and incapacitating the healthcare workforce, contributed to a decrease in the number of notified cases. The higher tuberculosis notification in some of the studies could be attributed to the disruption of tuberculosis prevention and control programmes as well as increased socioeconomic deprivation, including malnutrition, mass migration, poor living conditions and overcrowding that are worsened during conflicts. Armed conflicts without effective interventions were associated with worse tuberculosis treatment outcomes, including lower proportions of people with treatment success and higher proportions of people with loss to follow-up, mortality and treatment failure. However, implementing various interventions in conflict settings (such as establishing a National Tuberculosis Control Programme) led to higher tuberculosis notification rates and treatment success. CONCLUSION The impact of armed conflicts on tuberculosis notification is complex and is influenced by multiple factors. The findings of this review underscore the importance of concerted efforts to control tuberculosis in conflict settings using available resources.
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Affiliation(s)
- Eyob Alemayehu Gebreyohannes
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Allied Health, The University of Western Australia, Perth, Western Australia, Australia
- Quality Use of Medicines and Pharmacy Research Centre, Clinical and Health Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Haileab Fekadu Wolde
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Temesgen Yihunie Akalu
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Amhara, Ethiopia
| | - Archie C A Clements
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- Penninsula Medical School, University of Plymouth, Playmouth, UK
| | - Kefyalew Addis Alene
- Geospatial and Tuberculosis Research Team, Telethon Kids Institute, Perth, Western Australia, Australia
- School of Population Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
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Tarnas MC, Almhawish N, Karah N, Sullivan R, Abbara A. Communicable diseases in northwest Syria in the context of protracted armed conflict and earthquakes. THE LANCET. INFECTIOUS DISEASES 2023; 23:e477-e481. [PMID: 37419130 DOI: 10.1016/s1473-3099(23)00201-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 07/09/2023]
Abstract
The earthquakes in Türkiye and Syria in February, 2023, have caused further devastation in northwest Syria-an area already affected by protracted armed conflict, mass forced displacement, and inadequate health and humanitarian provision. The earthquake damaged infrastructure supporting water, sanitation, and hygiene, and health-care facilities. The disruptions to epidemiological surveillance and ongoing disease control measures resulting from the earthquake will accelerate and expand ongoing and new outbreaks of many communicable diseases including measles, cholera, tuberculosis, and leishmaniasis. Investing in existing early warning and response network activities in the area is essential. Antimicrobial resistance, which had already been an increasing concern in Syria before the earthquake, will also be exacerbated given the high number of traumatic injuries and breakdown of antimicrobial stewardship, and the collapse of infection prevention and control measures. Tackling communicable diseases in this setting requires multisectoral collaboration at the human-animal-environment nexus given the effect of the earthquakes on all these sectors. Without this collaboration, communicable disease outbreaks will further strain the already overburdened health system and cause further harm to the population.
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Affiliation(s)
| | | | - Nabil Karah
- Department of Molecular Biology. Umea University, Umea, Sweden
| | - Richard Sullivan
- Institute of Cancer Policy and the Centre for Conflict & Health Research, King's College London, London, UK
| | - Aula Abbara
- Syria Public Health Network, London, UK; Department of Infectious Diseases, St Marys Hospital, Imperial College London, London, UK.
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Basha L, Socarras A, Akhter MW, Hamze M, Albaik A, Hussein I, Tarakji A, Hamadeh M, Loutfi R, Kewara M, Abbara A. Impact of the Syrian conflict and forced displacement on respiratory health: an analysis of primary data from a humanitarian organisation. BMJ Open Respir Res 2023; 10:e001636. [PMID: 37730280 PMCID: PMC10510865 DOI: 10.1136/bmjresp-2023-001636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/29/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Despite a decade of conflict, there has been little exploration of respiratory health in Syria, notwithstanding the known impacts of conflict on lung health. Our aim is to explore the burden and trends of respiratory consultations in Syrian American Medical Society (SAMS) facilities in northwest Syria through an ecological analysis. METHODS We performed a retrospective review of routinely collected data relating to respiratory presentations in SAMS' facilities between March 2017 and June 2020; we compared data by facility type, infectious versus non-infectious aetiologies and age. RESULTS Data were available for 5 058 864 consultations, of which 1 228 722 (24%) were respiratory presentations, across 22 hospitals, 22 primary healthcare centres, 3 mobile clinics and 1 polyclinic. The median number of respiratory consultations per month was 30 279 (IQR: 25 792-33 732). Key findings include: 73% of respiratory consultations were for children; respiratory presentations accounted for up to 38% of consultations each month, seasonal variation was evident; respiratory tract infections accounted for 91% of all respiratory presentations. A steep decrease in consultations occurred between the end of 2019 (160 000) and the first quarter of 2020 (90 000), correlating with an escalation of violence in Idlib governorate. CONCLUSION This study presents the largest quantitative analysis of respiratory data collected during the Syrian conflict. It supports the need for improved measures to aid the prevention, diagnosis and management of respiratory conditions during conflict as well as further research to explore the impact of conflict on respiratory health.
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Affiliation(s)
- Lena Basha
- School of Medicine, Medical Sciences & Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alex Socarras
- Research Department, Syrian American Medical Society, Washington, DC, USA
| | | | - Mohamed Hamze
- Information Department, Syrian American Medical Society, Gaziantep, Turkey
| | - Ahmad Albaik
- Information Department, Syrian American Medical Society, Gaziantep, Turkey
| | - Imad Hussein
- Information Department, Syrian American Medical Society, Gaziantep, Turkey
| | - Ahmad Tarakji
- Research Department, Syrian American Medical Society, Washington, DC, USA
| | - Mufaddal Hamadeh
- Research Department, Syrian American Medical Society, Washington, DC, USA
| | - Randa Loutfi
- Research Department, Syrian American Medical Society, Washington, DC, USA
| | - Mazen Kewara
- Information Department, Syrian American Medical Society, Gaziantep, Turkey
| | - Aula Abbara
- Research Department, Syrian American Medical Society, Washington, DC, USA
- Department of Infection, Imperial College London, London, UK
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5
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Daif A, Glazik R, Checchi F, Khan P. The effect of internal displacement due to armed conflict on tuberculosis treatment outcomes in northwest Syria, 2019-2020. J Migr Health 2023; 8:100195. [PMID: 37448909 PMCID: PMC10336245 DOI: 10.1016/j.jmh.2023.100195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/27/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
Background Northwest Syria accounts for over 4 million people of whom more than half are internally displaced persons (IDPs). More than 1 million IDPs reside in camps and many more live in settings which are overcrowded and poorly ventilated. Suboptimal social living conditions leave these populations susceptible to tuberculosis (TB) morbidity and mortality. This study aimed to assess the effect of internal displacement due to armed conflict on the risk of unsuccessful treatment outcomes among TB patients in northwest Syria. Methods All patients registered to start TB treatment at three centres in northwest Syria between the 1st June 2019 to the 31st December 2020 were included. Unsuccessful TB treatment outcome was defined as a composite outcome combining the WHO TB treatment outcomes of treatment failure, loss to follow-up, and death. We assessed the association between internal displacement and unsuccessful TB treatment outcomes using multivariable logistic regression. We also explored the risk of an unsuccessful treatment outcome by internal displacement setting (camp, village or city). Results Of the total 737 registered patients included in the analysis, 400 (54%) were documented as internally displaced. The median age of IDPs was 30 (IQR: 21.5-48) and the median age of residents was 34 (IQR:22-50). A significantly higher percentage of those who were IDPs had an unsuccessful treatment outcome compared to residents (40% vs 18%, p<0.001). After adjustment for confounders, the relative risk of having unsuccessful TB treatment was two-fold higher in internally displaced TB patients compared to residents (95% CI: 1.5-2.6). IDPs living in villages had a 30% lower risk of an unsuccessful treatment outcome compared to IDPs living in camps (RR 95% CI: 0.50-0.91), and IDPs living in cities had a 13% lower risk of an unsuccessful treatment outcome (RR 95% CI: 0.57-1.18). Conclusion This is one of few studies which aims to quantify the effect of internal displacement on TB treatment outcomes during times of conflict. Our findings starkly highlight how social determinants contribute to poor TB outcomes and act as a starting point for much needed research on how best to manage TB in humanitarian crisis settings.
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Affiliation(s)
| | - Rosanna Glazik
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Francesco Checchi
- Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Palwasha Khan
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Africa Health Research Institute, South Africa
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Langholz Kristensen K, Norredam M, Graff Jensen S, Seersholm N, Jørgensen ML, Exsteen BB, Huber FG, Munk-Andersen E, Lillebaek T, Ravn P. Tuberculosis screening among newly arrived asylum seekers in Denmark. Infect Dis (Lond) 2022; 54:819-827. [PMID: 36000199 DOI: 10.1080/23744235.2022.2106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) screening programmes among asylum seekers tend to focus on chest radiography (CXR) for early diagnosis, whereas knowledge on sputum examination is limited. We evaluated active TB screening using CXR and sputum culture among asylum seekers arriving in Denmark. In addition, we assessed the coverage of a voluntary health assessment. METHODS Between 1 February 2017 and 31 March 2019, all newly arrived asylum seekers in Denmark ≥ 18 years from TB high-incidence countries or risk groups, who attended a voluntary general health assessment, were offered active TB screening with CXR and spot sputum examination. Sputum samples were examined by culture and smear microscopy. RESULTS Coverage of the general health assessment was 65.1%. Among 1,154 referred for active TB screening, 923 (80.0%) attended. Of these, 854 were screened by CXR and one case of active TB was identified equivalent to a yield of 0.12%. Sputum samples were collected from 758 and one M. tuberculosis culture-positive TB case (also identified by CXR) was identified, equivalent to a yield of 0.13%. No cases were found by sputum culture screening only. In addition, screening found three cases of malignant disease. CONCLUSION We suggest that TB screening should focus on asylum seekers from TB high-incidence countries. Furthermore, early health assessments should be of high priority to ensure migrant health.
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Affiliation(s)
- Kristina Langholz Kristensen
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Marie Norredam
- Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark.,Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
| | - Sidse Graff Jensen
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Niels Seersholm
- Department of Internal Medicine, Section of Respiratory Diseases, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Marie Louise Jørgensen
- Department of Pulmonary- and Infectious Diseases, Nordsjaellands Hospital, Hilleroed, Denmark
| | - Banoo Bakir Exsteen
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark.,Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Franziska Grundtvig Huber
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | | | - Troels Lillebaek
- International Reference Laboratory of Mycobacteriology, Statens Serum Institut, Copenhagen, Denmark.,Global Health Section, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Ravn
- Department of Internal Medicine, Infectious Disease Section, Herlev and Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
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Osman M, Cummings KJ, El Omari K, Kassem II. Catch-22: War, Refugees, COVID-19, and the Scourge of Antimicrobial Resistance. Front Med (Lausanne) 2022; 9:921921. [PMID: 35814789 PMCID: PMC9263824 DOI: 10.3389/fmed.2022.921921] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Wars have hidden repercussions beyond the immediate losses of life, well-being, and prosperity. Those that flee wars and seek refuge in safer locations are not immune to the tragic impacts. Of particular concern is the susceptibility of the refugee populations to infectious diseases and antimicrobial-resistant pathogens. This poses a detrimental risk to these disenfranchised populations, who often have limited access to medical care, sanitation, and nutritious and safe food. Furthermore, antimicrobial-resistant pathogens in refugees can be both transmitted to and acquired from their hosting communities. The latter is particularly problematic when the host countries suffer from serious challenges such as limited resources, pollution, and widespread antimicrobial resistance (AMR). Here, we discuss AMR in refugees of the ongoing Syrian war, a conflict that resulted in the largest population displacement in recent history. We argue that Syrian refugees and their hosting communities are at an elevated risk of complicated and life-threatening AMR infections. We also call on the international community to address this grievous problem that threatens the disenfranchised refugee populations and can spill over across geographic borders to affect multiple countries.
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Affiliation(s)
- Marwan Osman
- Cornell Atkinson Center for Sustainability, Cornell University, Ithaca, NY, United States
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
- *Correspondence: Marwan Osman
| | - Kevin J. Cummings
- Department of Public and Ecosystem Health, College of Veterinary Medicine, Cornell University, Ithaca, NY, United States
| | - Khaled El Omari
- Quality Control Center Laboratories at the Chamber of Commerce, Industry & Agriculture of Tripoli & North Lebanon, Tripoli, Lebanon
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Sciences and Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Issmat I. Kassem
- Center for Food Safety, Department of Food Science and Technology, University of Georgia, Griffin, GA, United States
- Issmat I. Kassem
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Simpson RB, Babool S, Tarnas MC, Kaminski PM, Hartwick MA, Naumova EN. Dynamic mapping of cholera outbreak during the Yemeni Civil War, 2016-2019. J Public Health Policy 2022; 43:185-202. [PMID: 35614203 PMCID: PMC9192410 DOI: 10.1057/s41271-022-00345-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2022] [Indexed: 12/03/2022]
Abstract
Widespread destruction from the Yemeni Civil War (2014-present) triggered the world's largest cholera outbreak. We compiled a comprehensive health dataset and created dynamic maps to demonstrate spatiotemporal changes in cholera infections and war conflicts. We aligned and merged daily, weekly, and monthly epidemiological bulletins of confirmed cholera infections and daily conflict events and fatality records to create a dataset of weekly time series for Yemen at the governorate level (subnational regions administered by governors) from 4 January 2016 through 29 December 2019. We demonstrated the use of dynamic mapping for tracing the onset and spread of infection and manmade factors that amplify the outbreak. We report curated data and visualization techniques to further uncover associations between infectious disease outbreaks and risk factors and to better coordinate humanitarian aid and relief efforts during complex emergencies.
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Affiliation(s)
- Ryan B. Simpson
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Sofia Babool
- Neuroscience Department, The University of Texas at Dallas, Richardson, TX USA
| | - Maia C. Tarnas
- Community Health Department, Tufts University School of Arts and Sciences, Medford, MA USA
| | - Paulina M. Kaminski
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Meghan A. Hartwick
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
| | - Elena N. Naumova
- Nutrition Epidemiology and Data Science Division, Tufts University Friedman School of Nutrition Science and Policy, 150 Harrison Avenue, Boston, MA 02111 USA
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Mohandes AF, Karam B, Alrstom A, Alasadi L, Rajab Bek MW, Daher N, Alsuliman T, Abouhareb R. Primary psoas tuberculosis abscess with an iliac bone lytic lesion: a case report. J Med Case Rep 2022; 16:209. [PMID: 35581665 PMCID: PMC9115972 DOI: 10.1186/s13256-022-03417-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 04/18/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary psoas tuberculosis is the presence of "Koch's bacillus'' within the iliopsoas muscle caused by hematogenous or lymphatic seeding from a distant site. Muscular tuberculosis has relatively low prevalence in comparison with other cases of extrapulmonary tuberculosis, which explains the difficulties in establishing the diagnosis. CASE PRESENTATION In this report, we present a challenging diagnostic case of primary psoas tuberculosis in a 38-year-old middle eastern female from southern Syria. The diagnosis was based on the clinical orientation, the observation of pulmonary lesions on the computed tomography scan, and the necrotic signs in the vicinity of the infected area. Despite the misleading primary false-negative results, the final diagnosis was reached after sufficient repetition of tuberculosis-specific testing. The patient was treated with isoniazid-rifampin-pyrazinamide-ethambutol for 2 months, then isoniazid and rifampin for 7 months, with full recovery in follow-up. CONCLUSIONS This case highlights the importance of a clinical-based approach in the treatment of patients with psoas abscesses, especially in areas with high tuberculosis prevalence.
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Affiliation(s)
| | - Bahjat Karam
- Children’s Hospital, Faculty of Medicine, Damascus University, Damascus, Syria
| | - Ali Alrstom
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Lugien Alasadi
- Gastroenterology and Hepatology, Internal Medicine Department, AL-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Mohammad wahid Rajab Bek
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
| | - Nizar Daher
- Infectious Disease, Internal Medicine Department, Al-Mouwasat Hospital, Damascus University, Damascus, Syria
- Faculty of Medicine, Syrian Private University, Damascus, Syria
| | - Tamim Alsuliman
- Service d’Hématologie, hôpital Saint-Antoine, AP-HP, Sorbonne Université, 75012 Paris, France
| | - Raed Abouhareb
- Gastroenterology and Hepatology, Internal Medicine Department, AL-Mouwasat Hospital, Damascus University, Damascus, Syria
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The Ukrainian refugee crisis and the COVID-19 pandemic in Europe – Correspondence. Int J Surg 2022; 102:106671. [PMID: 35569760 PMCID: PMC9120829 DOI: 10.1016/j.ijsu.2022.106671] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/10/2022] [Indexed: 12/20/2022]
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11
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Khan FU, Khan FU, Hayat K, Chang J, Kamran M, Khan A, Malik UR, Khan A, Fang Y. Impact of Protracted Displacement on Delay in the Diagnosis Associated with Treatment Outcomes: A Cross-Sectional Study in Internally Displaced Tuberculosis Patients of Pakistan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211984. [PMID: 34831746 PMCID: PMC8621790 DOI: 10.3390/ijerph182211984] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/06/2021] [Accepted: 11/11/2021] [Indexed: 12/03/2022]
Abstract
Human displacement is on the rise globally, and the increase in the burden of tuberculosis (TB) is also attributed to migrations worldwide. A significant number of such displacements occur in regions with considerably higher areas of TB burden. Displacements may delay TB diagnosis and treatment, which will possibly lead to TB transmission among healthy individuals. In this study, we assessed the association of existing determinants after a protracted internal displacement of people with delay in TB diagnosis and treatment outcomes. A cross-sectional study was conducted on internally displaced TB patients (IDPs), registered at selected health facilities in three urban districts of Pakistan from March 2019 to February 2020. The univariate and multivariate logistic regression model was used to assess the delay in diagnosis and treatment outcomes. IDPs with delay in initiation of treatment beyond 30 days were at high possibility of unsuccessful TB treatment outcomes (adjusted odds ratio AOR, 2.60; 95% CI 1.06–6.40). Furthermore, the multivariate regression analysis showed a statistically significant association (p > 0.05) between TB patients who were aged 55 to 65 years (AOR, 2.66; 95% CI 1.00–7.07), female patients (AOR, 2.42; 95% CI 1.21–4.81), visited non-formal health provider (AOR, 8.81; 95% CI 3.99–19.46), self-medication (AOR, 2.72; 95 % CI 1.37–5.37), poor knowledge of TB (AOR, 11.39; 95% CI 3.31–39.1), and perceived stigma (AOR, 8.81; 95% CI 3.99–19.4). Prolonged delay in treatment was associated with unfavorable treatment outcomes among IDPs. Migrants and IDPs are more likely to experience an interruption in care due to overall exclusion from social and health care services. Therefore, it is imperative to understand the barriers to providing public health care services, particularly in preventing and treating TB.
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Affiliation(s)
- Farman Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Faiz Ullah Khan
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore 54000, Pakistan
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Muhammad Kamran
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.K.)
| | - Asad Khan
- Department of Pharmacy, Faculty of Biological Sciences, Quaid-i-Azam University, Islamabad 45320, Pakistan; (M.K.); (A.K.)
| | - Usman Rashid Malik
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
| | - Asif Khan
- District Bannu TB Control Program Unit, Headquarter Hospital Bannu, Bannu 28100, Pakistan;
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, Xi’an Jiaotong University, Xi’an 710061, China; (F.U.K.); (F.U.K.); (K.H.); (J.C.); (U.R.M.)
- Center for Drug Safety and Policy Research, Xi’an Jiaotong University, Xi’an 710061, China
- Shaanxi Center for Health Reform and Development Research, Xi’an Jiaotong University, Xi’an 710061, China
- Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, Western China Science & Technology Innovation Harbor, Xi’an 710061, China
- Correspondence:
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Alhaffar MHDBA, Janos S. Public health consequences after ten years of the Syrian crisis: a literature review. Global Health 2021; 17:111. [PMID: 34538248 PMCID: PMC8449996 DOI: 10.1186/s12992-021-00762-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/26/2021] [Indexed: 01/25/2023] Open
Abstract
Ten years of the Syrian war had a devastating effect on Syrian lives, including millions of refugees and displaced people, enormous destruction in the infrastructure, and the worst economic crisis Syria has ever faced. The health sector was hit hard by this war, up to 50% of the health facilities have been destroyed and up to 70% of the healthcare providers fled the country seeking safety, which increased the workload and mental pressure for the remaining medical staff. Five databases were searched and 438 articles were included according to the inclusion criteria, the articles were divided into categories according to the topic of the article. Through this review, the current health status of the Syrian population living inside Syria, whether under governmental or opposition control, was reviewed, and also, the health status of the Syrian refugees was examined according to each host country. Public health indicators were used to summarize and categorize the information. This research reviewed mental health, children and maternal health, oral health, non-communicable diseases, infectious diseases, occupational health, and the effect of the COVID − 19 pandemic on the Syrian healthcare system. The results of the review are irritating, as still after ten years of war and millions of refugees there is an enormous need for healthcare services, and international organization has failed to respond to those needs. The review ended with the current and future challenges facing the healthcare system, and suggestions about rebuilding the healthcare system. Through this review, the major consequences of the Syrian war on the health of the Syrian population have been reviewed and highlighted. Considerable challenges will face the future of health in Syria which require the collaboration of the health authorities to respond to the growing needs of the Syrian population. This article draws an overview about how the Syrian war affected health sector for Syrian population inside and outside Syria after ten years of war which makes it an important reference for future researchers to get the main highlight of the health sector during the Syrian crisis.
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Affiliation(s)
| | - Sandor Janos
- Head of the Department of Public Health and Epidemiology, University of Debrecen, School of Health Sciences, Debrecen, Hungary
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13
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Kabbani M, Said RB, Aftimos G. Epidemiology of tuberculosis based on histopathological data and nucleic acid amplification techniques in Lebanon from January 2012 to December 2016. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2021. [DOI: 10.1016/j.cegh.2021.100750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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14
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Knipper M, Sedas AC, Keshavjee S, Abbara A, Almhawish N, Alashawi H, Lecca L, Wilson M, Zumla A, Abubakar I, Orcutt M. The need for protecting and enhancing TB health policies and services for forcibly displaced and migrant populations during the ongoing COVID-19 pandemic. Int J Infect Dis 2021; 113 Suppl 1:S22-S27. [PMID: 33775886 PMCID: PMC8752449 DOI: 10.1016/j.ijid.2021.03.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 11/29/2022] Open
Abstract
Disruption of health services due to the COVID-19 pandemic threatens to derail progress being made in tuberculosis control efforts. Forcibly displaced people and migrant populations face particular vulnerabilities as a result of the COVID-19 pandemic, which leaves them at further risk of developing TB. They inhabit environments where measures such as “physical distancing” are impossible to realize and where facilities like camps and informal temporary settlements can easily become sites of rapid disease transmission. In this viewpoint we utilize three case studies—from Peru, South Africa, and Syria—to illustrate the lived experience of forced migration and mobile populations, and the impact of COVID-19 on TB among these populations. We discuss the dual pandemics of TB and COVID-19 in the context of migration through a syndemic lens, to systematically address the upstream social, economic, structural and political factors that - in often deleterious dynamics - foster increased vulnerabilities and risk. Addressing TB, COVID-19 and migration from a syndemic perspective, not only draws systematic attention to comorbidity and the relevance of social and structural context, but also helps to find solutions: the true reality of syndemic interactions can only be fully understood by considering a particular population and bio- social context, and ensuring that they receive the comprehensive care that they need. It also provides avenues for strengthening and expanding the existing infrastructure for TB care to tackle both COVID-19 and TB in migrants and refugees in an integrated and synergistic manner.
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Affiliation(s)
- Michael Knipper
- Institute for the History of Medicine, University Justus Liebig Giessen, 35392 Giessen, Germany.
| | - Ana Cristina Sedas
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Salmaan Keshavjee
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - Aula Abbara
- Imperial College London, Department of Infectious Disease, St Mary's Hospital, London, UK; Syria Public Health Network, Syria.
| | - Naser Almhawish
- Assistance Coordination Unit (ACU), Early Warning Alert and Response Network (EWARN), Gaziantep, Turkey.
| | | | - Leonid Lecca
- Partners in Health, Lima, Peru, and Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | | | - Almuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London NIHR Biomedical Research Centre, UCL Hospitals NHS Foundation Trust, London, UK.
| | - Ibrahim Abubakar
- Institute for Global Health, University College London, London WC1N 1EH, UK.
| | - Miriam Orcutt
- Institute for Global Health, University College London, London WC1N 1EH, UK.
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15
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Chadwick S, Townes DA, Perrone LA. Utility of Point of Care and Rapid Diagnostics in Humanitarian Emergencies. J Appl Lab Med 2020; 6:236-246. [DOI: 10.1093/jalm/jfaa180] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/09/2020] [Indexed: 12/16/2022]
Abstract
Abstract
Background
In 2019, there were 70.8 million forcibly displaced people worldwide. Among the top causes of morbidity and mortality were measles, diarrhea, respiratory illness, and malaria. Availability of accurate diagnostics that are of low complexity, affordable, and produce timely results on site without the need for expensive laboratory equipment, extensive training, or distant transport of samples, are essential tools in the response to humanitarian emergencies (HE). Early detection of infectious diseases with epidemic potential and coordinated outbreak response, can result in significant decrease in morbidity and mortality.
Content
This review explores the utility of point of care and rapid diagnostic tests (POCT/RDTs) in HE and presents a review and analysis of the low complexity, availability, and ease of use of these diagnostic modalities that make them helpful tools in these settings, despite the generally lower test performance metrics associated with them over conventional laboratory-based assays. We review the literature to understand how POCT/RDTs have been used in HE response to produce lifesaving information without the need for a robust system for transporting test samples to more sophisticated laboratories, as this is often prohibitive in areas affected by conflict or natural disasters.
Summary
We propose that POCT/RDTs be considered essential healthcare tools provided to countries following a HE and suggest that UN agencies and vulnerable countries include effective RDTs in their essential diagnostics as part of their national preparedness and response plans.
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Affiliation(s)
- Stephen Chadwick
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
| | - David A Townes
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
- Department of Emergency Medicine, School of Medicine, University of Washington, Seattle, WA
| | - Lucy A Perrone
- Department of Global Health, School of Public Health, University of Washington, Seattle, WA
- Department of Laboratory Medicine, School of Medicine, University of Washington, Seattle, WA
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16
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Tarnas MC, Desai AN, Lassmann B, Abbara A. Increase in vector-borne disease reporting affecting humans and animals in Syria and neighboring countries after the onset of conflict: A ProMED analysis 2003-2018. Int J Infect Dis 2020; 102:103-109. [PMID: 33002614 DOI: 10.1016/j.ijid.2020.09.1453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVES The protracted and violent conflict in Syria has resulted in large-scale displacement of people and destruction of health and sanitation infrastructure. The aim of this study was to examine epidemiological trends in vector-borne disease (VBD) outbreaks before and following the onset of the Syrian conflict (2011). METHODS ProMED, a digital disease surveillance tool, was queried for VBD outbreak reports affecting humans and animals in Syria and select bordering countries between 2003 and 2018. Data were normalized by dividing the number of unique VBD events by the total number of unique outbreak events reported by ProMED for each year. Suspected and confirmed case counts and deaths were manually extracted. RESULTS Reports on VBDs increased from a mean of 2.9/year pre-2011 to 12.8/year post-2011, a 343.5% (p < 0.05) increase. After normalization, reports increased by 485.5% (p < 0.05) over the time periods. Post-2011, the most commonly reported VBDs were leishmaniasis, Crimean-Congo hemorrhagic fever, and lumpy skin disease. Reported numbers of suspected and confirmed cases and deaths increased during the conflict period. CONCLUSIONS VBD outbreak events in ProMED increased in Syria and select bordering countries after the onset of the Syrian conflict in 2011. Enhanced disease surveillance is critical to detect and manage outbreaks in conflict settings.
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Affiliation(s)
- Maia C Tarnas
- ProMED, International Society for Infectious Diseases, Brookline, MA, United States; Community Research Initiative, Charlestown, MA, United States.
| | - Angel N Desai
- ProMED, International Society for Infectious Diseases, Brookline, MA, United States; University of California Davis Medical Center, Sacramento, CA, United States.
| | - Britta Lassmann
- ProMED, International Society for Infectious Diseases, Brookline, MA, United States.
| | - Aula Abbara
- Department of Infection, Imperial College, London, United Kingdom; Syria Public Health Network, London, United Kingdom.
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17
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Aljadeeah S, Wirtz VJ, Nagel E. Outpatient Antibiotic Dispensing for the Population with Government Health Insurance in Syria in 2018-2019. Antibiotics (Basel) 2020; 9:E570. [PMID: 32887446 PMCID: PMC7559287 DOI: 10.3390/antibiotics9090570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 01/21/2023] Open
Abstract
Little is known about antibiotic uses at the population level in Syria. The aim of our study is to present outpatient antibiotic dispensing (OAD) patterns and rates for patients with health insurance in the parts of Syria that are controlled by the Syrian government using different indicators. Outpatient data on all dispensed antibiotics for 81,314 adults with health insurance were obtained and stratified according to age, sex, governorate and annual season. OAD was mainly expressed as the number of defined daily doses (DDDs) per 1000 people per day (DID). OAD patterns were assessed according to the anatomical therapeutic classification (ATC) and the Access, Watch and Reserve (AWaRe) classification. OAD was 20.13 DID. Amoxicillin/clavulanic acid and clarithromycin were the most dispensed antibiotics (5.76 and 4.4 DID, respectively). Overall, a predominant consumption of broad-spectrum antibiotics was noted. The Watch group of the AWaRe classification had the biggest percentage of OAD (13.26 DID), followed by the Access and the Reserve groups (6.55 and 0.17 DID, respectively). There was a significant difference in OAD between the sex and age groups. The seasonal and regional variations in OAD were also significant. Broad-spectrum antibiotics dispensing was high compared to other studies from different countries. These results are concerning, as they can contribute to antibiotic resistance.
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Affiliation(s)
- Saleh Aljadeeah
- Institute of Medical Management and Health Sciences, University of Bayreuth, Prieserstr. 2, 95440 Bayreuth, Germany;
| | - Veronika J. Wirtz
- Department of Global Health, Boston University School of Public Health, Boston, MA 02118, USA;
| | - Eckhard Nagel
- Institute of Medical Management and Health Sciences, University of Bayreuth, Prieserstr. 2, 95440 Bayreuth, Germany;
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