Food Insecurity Pre- and Post the COVID-19 Pandemic and Economic Crisis in Lebanon: Prevalence and Projections

Regional Agriculture and Food Systems Amid the COVID-19 Pandemic: The Case of the Near East and North Africa Region

The COVID-19 pandemic affected agri-food systems worldwide. However, while the impacts differed from one country/region to another, the scholarly literature seems to focus on developed countries in the Global North. Consequently, this review scrutinizes the literature on the pandemic's impacts in the Near East and North Africa (NENA) region. A search on the Web of Science in March 2023 generated 334 documents, of which 151 were eligible for inclusion in the systematic review. According to the bibliometric analysis, the most active nations are Saudi Arabia, Egypt, Jordan, the United Arab Emirates, and Lebanon. In general, the coverage of studies is better in the Gulf region than in the less developed countries of North Africa and those suffering from wars (cf. Libya, Syria, and Yemen). Studies generally focus on crop production and the downstream food chain (cf. distribution and consumption). While the pandemic influenced every pillar of food security, this research concentrates on access and utilization. Meanwhile, the lion's share of the literature deals with the pandemic's socio-economic effects, especially those linked to food (in)security and health. The pandemic, which laid bare the agri-food system vulnerabilities, should be seized to foster the transition towards more resilient agri-food systems in the NENA region.

A systematic review of the direct and indirect COVID-19's impact on food security and its dimensions: pre-and post-comparative analysis

BACKGROUND

Since its emergence, the COVID-19 pandemic has compromised the food security both directly by impacting food supply chain and indirectly by overwhelming the individual health and/or personal financial situation. The overarching aim of the current study is to assess aspects of the food security crisis that have arisen due to COVID-19 and to identify which, if any, food security dimensions were specifically compromised.

METHODS

Primary research articles were initially identified through four online databases (Scopus, PubMed, Google Scholar, and Web of Science), with the references of each paper then also reviewed for additional article. The food security status of individuals and the wider community, both before and after the emergence of COVID-19, were examined.

RESULTS

Of the 2,057 studies initially identified, a total of ten were included in the final review. The included studies confirmed that COVID-19 had substantially impacted food security, with individuals, households and the wider community experiencing food insecurity. Nine of the included studies aruged that the food accessibility dimension was the most compromised.

CONCLUSION

To address the identified direct and indirect food security issues associated with COVID-19, it is proposed that a combination of prevention practices and proactive food security activities is required. Integrating food security interventions, supporting and facilitating food security resilience, and conducting further studies on the food security of COVID-19 are also recommended.

Triple-crises-induced food insecurity: systematic understanding and resilience building approaches in Africa

The triple crises of the COVID-19 pandemic, conflict and climate change have severely impacted food systems, leading to socio-economic consequences and undermining food and nutrition security across Africa. To address the malnutrition and poverty affecting approximately 700 million people in Africa, there is potential for the One Health approach implementation and operationalization to bring together multidisciplinary solutions for tackling food insecurity and ensuring food safety net. However, there is limited documentation on the potential of the One Health approach system thinking implementation to guide responses to triple crises-induced food insecurity. Therefore, this article aims to systematically understand the triple crises-induced food insecurity, connect existing solutions, and explore the role of the One Health approach in strengthening food and agriculture systems in Africa. Our finding showed the impact of triple crises exacerbating food system vulnerability in Africa and worldwide. Mitigating and resilient actions are urgently needed in tackling the emerging and persisting challenges, and infectious diseases menace and burden across Africa. We present a conceptual model illustrating the complex nature of triple crises-induced food insecurity, vulnerability areas within the food system, and actionable strategies for building community food resilience. Additionally, recommendations are provided to create an enabling environment that supports One Health approach implementation and addresses food insecurity challenges through innovative partnerships, local-led initiatives, and enhanced governance and artificial intelligence technology capacities in achieving sustainable and inclusive growth to reduce socio-economic inequalities. Stepping up integrated, actionable, and sustainable food systems programs and innovative long-lasting solutions requires investing in promoting new partnership and research collaboration in building conflict resolution and peace towards strengthening and reshaping local and global food security related climate change adaptations actions for most vulnerable communities' benefits. These are ingredients in fastening preparedness, prevention and control of infectious diseases prevention and control, reducing food supply chains disruption towards accelerating equitable benefits of Universal Health Coverage and Sustainable Development Goals, 2030 across Africa.

Machine learning techniques for the identification of risk factors associated with food insecurity among adults in Arab countries during the COVID-19 pandemic

BACKGROUND

A direct consequence of global warming, and strongly correlated with poor physical and mental health, food insecurity is a rising global concern associated with low dietary intake. The Coronavirus pandemic has further aggravated food insecurity among vulnerable communities, and thus has sparked the global conversation of equal food access, food distribution, and improvement of food support programs. This research was designed to identify the key features associated with food insecurity during the COVID-19 pandemic using Machine learning techniques. Seven machine learning algorithms were used in the model, which used a dataset of 32 features. The model was designed to predict food insecurity across ten Arab countries in the Gulf and Mediterranean regions. A total of 13,443 participants were extracted from the international Corona Cooking Survey conducted by 38 different countries during the COVID -19 pandemic.

RESULTS

The findings indicate that Jordanian, Palestinian, Lebanese, and Saudi Arabian respondents reported the highest rates of food insecurity in the region (15.4%, 13.7%, 13.7% and 11.3% respectively). On the other hand, Oman and Bahrain reported the lowest rates (5.4% and 5.5% respectively). Our model obtained accuracy levels of 70%-82% in all algorithms. Gradient Boosting and Random Forest techniques had the highest performance levels in predicting food insecurity (82% and 80% respectively). Place of residence, age, financial instability, difficulties in accessing food, and depression were found to be the most relevant features associated with food insecurity.

CONCLUSIONS

The ML algorithms seem to be an effective method in early detection and prediction of food insecurity and can profoundly aid policymaking. The integration of ML approaches in public health strategies could potentially improve the development of targeted and effective interventions to combat food insecurity in these regions and globally.

Sustainable transformation agenda for enhanced global food and nutrition security: a narrative review

The world's population is currently growing at an exponential rate, which is estimated to be over 8 billion inhabitants as reported by United Nations on November 15, 2022. According to FAO, 870 million people out of this population do not have enough food to eat, with the vast majority of hungry people (98%) living in developing countries, where almost 15% of the population is undernourished. Furthermore, the world's population is estimated to come to 9 billion by 2050, which would incur severe food scarcity and would seriously hamper global food security. Food losses, especially post-harvest loss as a result of poor agricultural practices have also been reported to greatly impact the economy, the environment, and the livelihoods of low and medium countries and Sub-Saharan-African. Therefore, realistic options should be established for promoting sustainable agriculture systems, improving nutrition, and achieving food security to end hunger in our nations. This paper elucidates the drivers of food insecurity including food losses, escalating population growth, hunger, and food production, among others, and provided some transformation approaches such as value addition through appropriate and emerging food processing and preservation techniques, application of biotechnological options through genetically modified foods and functional foods consumption and integration of indigenous underutilized nutrient-dense food crops which could serve as all-inclusive and sustainable transformation options for enhanced food and nutrition security, especially in developing countries, which is where the hunger burden and the prevalence of malnutrition and non-communicable diseases are high.

Assessing the nutritional content and adequacy of food parcels among vulnerable Lebanese during a double crisis: COVID-19 pandemic and an economic meltdown

OBJECTIVES

This study aimed to explore the nutritional content and quality of food parcels distributed in Lebanon and assess their adherence to dietary guidelines during the COVID-19 pandemic and an unprecedented economic crisis.

DESIGN

Cross-sectional study (June-July 2020); phone survey (thirty items).

SETTING

Lebanon.

PARTICIPANTS

Food parcel providers (FPP; n 72) involved in food parcel distribution (FPD), mainly to Lebanese households.

RESULTS

FPP included international non-governmental organizations (INGO) (n 3), local non-governmental organizations (n 45) and personal initiatives (n 24). Overall, low adherence to the World Food Programme (WFP) food parcel guidelines were observed among FPP for specific food items, including vegetables, fish, legumes and cereals, whereas salt content significantly surpassed the guidelines (all P-values <0·001). On average, a food parcel provided 608·4 ± 55 kcal/d/person. The greatest contributors to total energy intake (TE) in the food parcel were carbohydrates (46·4 %) and fats (46·8 %), while protein contributed to 7 %TE. In addition, %TE from fats and sugars significantly surpassed the dietary reference intakes (DRI) for a single person per d (134-234 % and 185 % of DRI, respectively, P-values <0·001). Only 10-15 % of daily needs for key micronutrients, including Fe, Zn, thiamin, riboflavin and dietary folate, were met through the food parcels. Adequate food safety and hygiene practices were reported among FPP, yet dramatic changes in food costs due to overlapping crises affected the quality and quantity of food in parcels.

CONCLUSIONS

Findings highlight the need to improve the nutritional content of food parcels and adherence to dietary guidelines to alleviate food and nutrition insecurity while preventing diet-related diseases among vulnerable beneficiaries in Lebanon.

Impact of the economic crisis on food consumption of Sri Lankans: An online cross-sectional survey

AIMS

This study investigated how the economic crisis has changed Sri Lankans' food consumption.

METHODS

A web-based cross-sectional survey was carried out in the month of July 2022, using an e-questionnaire based on Google Forms. The questionnaire assessed respondents' socio-demographics, food consumption, and dietary patterns before and during the economic crisis. The changes were compared using descriptive statistics and inferential statistics.

RESULTS

A total of 1095 respondents, aged ≥18 years were included in the survey. There was a significant reduction in the average consumption of main meals per day during the economic crisis (pre: 3.09 ± 0.42, post: 2.82 ± 0.47; P < 0.001). The intake of food items such as rice, bread, and snacks also reduced significantly (P < 0.001). The average daily milk intake frequency decreased from 1.41 ± 1.07 to 0.57 ± 0.80 meals/day (P < 0.001). On contrary, the intake of non-dairy beverages such as malted milk and "plain tea" has increased by several folds. Consumption of fruit and vegetables showed a significant reduction in both frequency and portion size. The consumption of meat, fish, eggs and dhal also decreased in around three-quarters of the study sample. During this period majority (81%) used food coping mechanisms and the most adopted strategy was buying less expensive food.

CONCLUSION

Sri Lankans' food consumption have been adversely altered due to the country's economic crisis. There has been an overall reduction in the amount and frequency of intake of many common food items.

The societal costs of multiple sclerosis in Lebanon: a cross-sectional study

INTRODUCTION

This study assessed the societal costs of multiple sclerosis (MS) in Lebanon, categorized by disease severity.

METHODS

This was a cross-sectional, prevalence-based, bottom-up study using a face-to-face questionnaire. Patients were stratified by disease severity using the expanded disability status scale (EDSS); EDSS scores of 0-3, 4-6.5, and 7-9 indicating respectively mild, moderate, and severe MS. All direct medical, nonmedical, and indirect costs related to reduced productivity were accounted for regardless of who bore them. Costs, collected from various sources, were presented in international US dollars (US$) using the purchasing power parity (PPP) conversion rate.

RESULTS

We included 210 Lebanese patients (mean age: 43.3 years; 65.7% females). The total annual costs per patient were PPP US$ 33,117 for 2021, 12.4 times higher than the nominal GDP per capita. Direct costs represented 52% (US$ 17,185), direct nonmedical costs 8% (US$ 2,722), and indirect costs 40% (US$ 13, 211) of the mean annual costs. The total annual costs per patient increased with disease severity and were PPP US$ 29,979, PPP US$ 36,125, PPP US$ 39,136 for mild, moderate, and severe MS, respectively.

CONCLUSION

This study reveals the huge economic burden of MS on the Lebanese healthcare system and society.

Food insecurity status and its contributing factors in slums' dwellers of southwest Iran, 2021: a cross-sectional study

BACKGROUND

One major factor causing food insecurity is believed to be poverty. Approximately 20 million Iranians live in slums with a vulnerable socioeconomic context. The outbreak of COVID-19, on top of the economic sanctions against Iran, has increased this vulnerability and made its inhabitants prone to food insecurity. The current study investigates food insecurity and its associated socioeconomic factors among slum residents of Shiraz, southwest Iran.

METHODS

Random cluster sampling was used to select the participants in this cross-sectional study. The heads of the households completed the validated Household Food Insecurity Access Scale questionnaire to assess food insecurity. Univariate analysis was utilized to calculate the unadjusted associations between the study variables. Moreover, a multiple logistic regression model was employed to determine the adjusted association of each independent variable with the food insecurity risk.

RESULTS

Among the 1227 households, the prevalence of food insecurity was 87.20%, with 53.87% experiencing moderate and 33.33% experiencing severe food insecurity. A significant relationship was observed between socioeconomic status and food insecurity, indicating that people with low socioeconomic status are more prone to food insecurity (P < 0.001).

CONCLUSIONS

The current study revealed that food insecurity is highly prevalent in slum areas of southwest Iran. The socioeconomic status of households was the most important determinant of food insecurity among them. Noticeably, the coincidence of the COVID-19 pandemic with the economic crisis in Iran has amplified the poverty and food insecurity cycle. Hence, the government should consider equity-based interventions to reduce poverty and its related outcomes on food security. Furthermore, NGOs, charities, and governmental organizations should focus on local community-oriented programs to make basic food baskets available for the most vulnerable households.

Knowledge, Attitudes, and Practices of Consumers on Food Allergy and Food Allergen Labeling: A Case of Lebanon

The epidemiology of food allergies is increasing worldwide. International labeling standards were developed to enhance consumers' awareness of allergen-free foods. The main objective of the present study is to assess the characteristics of allergen labeling and consumers' knowledge, attitudes, and purchasing habits of food products with allergens in Lebanon. We evaluated the allergen labeling of 1000 food products form Lebanese supermarkets. A random sample of 541 consumers was recruited through an online survey (November 2020-February 2021). Descriptives and regression analysis were conducted. Results showed that wheat represents the largest group of food allergens on food labels, followed by milk and soybean. Furthermore, 42.9% of supermarket food products had a precautionary allergen labeling with "may contain traces of allergens". The majority of food products complied with local regulations for locally manufactured and imported products. One-quarter of survey respondents had a food allergy or were caregivers of food-allergic individuals. Regression analyses showed that "previous experience of a severe reaction" was negatively associated with food allergy-related knowledge and attitude scores respectively (β = -1.394, 95% CI: (-1.827, -1.034) and β = -1.432, 95% CI: (-2.798, -0.067)). The findings of this study provide practical insights on food allergy labeling issues for stakeholders and policymakers in the food supply chain.

Caught off guard and beaten: The Ukraine war and food security in the Middle East

The Ukraine war has led to a severe global food crisis due to complex supply disruptions and price increases of agricultural inputs. Countries of the Middle East have been directly affected because of their high dependence on food imports from Russia and Ukraine. Furthermore, this food crisis comes at times of high baseline vulnerability due to the compound impacts of COVID-19, repeated food shocks, and weakened states due to political-economic difficulties. This paper provides a detailed analysis of the food-related vulnerability of Middle Eastern countries in the wake of the Ukraine war. It contextualizes the varying impacts of this crisis in the region, and highlights country-level response strategies. The analysis shows a concerning and deepened crisis in the case of highly exposed and politically fragile countries with weakened food sectors; e.g., Lebanon, Sudan, and Yemen. Political-economic instabilities, limited domestic agriculture, and the lack of reliable grain reserves have aggravated the current food crisis in some countries. At the same time, indigenous short-term responses related to regional aid and cooperation have emerged, particularly in the Gulf countries, which have witnessed soaring revenues from higher energy prices. Alongside more regional frameworks for collaboration on food security, future action to mitigate such food crises should include the strengthening of local sustainable agriculture, storage capacities, and grain procurement strategies from international suppliers.

Prevalence of Malnutrition among Syrian Refugee Children from Lebanon

Today, the situation of Syrian refugees is one of the world's worst humanitarian crises. To estimate the prevalence of malnutrition among pediatric populations of Syrian refugees, 176 Syrian refugee children, with stays of more than two years at three refugee camps (Zalhé, Deddeh, and Kfar Jouz) or from the town of Yohmor, Lebanon were authorized by their parents to participate in this study. The children were anthropometrically evaluated and height-for-age Z-score (HAZ), weight-for-age Z-score (WAZ), and weight-for-height (WHZ) Z-scores were obtained and compared with WHO standards. Furthermore, mid-upper arm circumference (MUAC) was analyzed for screening children 6-59 months old. According to the anthropometric measures, no child met the criteria for chronic, global, acute malnutrition (CGAM), severe acute malnutrition (SAM), or moderate acute malnutrition (MAM). In the total sample, 49.4% of participants were moderately thin, with girls presenting a higher prevalence of thinness than that of boys. Thus, the absence of high rates of malnutrition was verified despite the magnitude of the Syrian refugee's problem. The data provided by this study identify the need to carry out further research to assess anthropometric growth and nutritional status among long-staying refugee children in order to prevent any health issues that may arise in the future.

Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study

Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.

The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students - results of a pilot study

BACKGROUND

The literature highly concentrates on disorders related to body image among women but only minimally when it comes to the male population; hence, in order to provide general practitioners, and primary care physicians in general, and psychiatrists in particular, with additional information concerning muscle dysmorphia among male university students in Lebanon, this study seemed essential, and was therefore conducted to (1) identify the prevalence of MDD, and (2) evaluate the indirect effect of eating attitudes in general and orthorexia nervosa in particular, in the association between perfectionism and muscle dysmorphic disorder (MDD) among a sample of male university students.

METHODS

In this cross-sectional study conducted between September 2021 and May 2022, 396 male university students from multiple universities in Lebanon filled the online Arabic questionnaire.

RESULTS

The results showed that 26 (6.6%) of the participants had MDD. Orthorexia nervosa and eating attitudes mediated the association between perfectionism and MDD; higher perfectionism was significantly associated with higher ON and more inappropriate eating; higher ON and more inappropriate eating were significantly associated with higher MDD, whereas perfectionism had a significant total direct effect on MDD. The high prevalence of MDD among male university students in Lebanon implies further investigation on the national level in the country.

CONCLUSION

Awareness campaigns among the university students could be adopted at the national level to increase the level of knowledge on the concepts of obsessive self-destructive perfectionism, orthorexia nervosa and muscle dysmorphia.

Socio-demographic determinants of knowledge, attitude and practices towards food safety among Lebanese population during the economic crisis: a cross-sectional study

BACKGROUND

Lebanon has been gripped by an economic crisis and the local currency has lost more than 90% of its value; besides, a lack of consistent electricity supply which has contributed to rising concerns about food safety especially among households. This study aimed to assess Lebanese society knowledge, attitude and practice towards food safety during the economic crisis.

METHODS

A cross-sectional study was conducted in Lebanon between September 5 and January 30, 2021. Data was collected through an online survey that included information on socio-demographic characteristics, knowledge, attitude and practice of Lebanese consumers towards food safety. Two multivariate regression models were performed on the knowledge and practices as a dependent variable. 95% confidence interval was calculated. All tests were two-sided and statistical significance was set at p-value < 0.05.

RESULTS

The majority of participants had good knowledge regarding food safety (74.9%) while more than half of the respondents adopted good preventive practices (62.8%). Multivariate regression of factors associated with good knowledge regarding food safety showed married participants (adjusted OR = 2.1; p < 0.0001), who had university degree and above (adjusted OR = 2.0; p < 0.0001), and who had income < 1,500,000 LBP (adjusted OR = 1.7; p < 0.0001) had a significantly good knowledge score compared to their counterparts. Finally, participants aged more than 35 years old and who had income higher than 1,500,000 LBP (adjusted OR = 1.8; p < 0.0001 and adjusted OR = 1.9; p = 0.01 respectively) were positively associated to good practice towards food safety.

CONCLUSION

This study offers useful insights into the knowledge, attitude and practices of Lebanese consumers towards food safety during the economic crisis.

Food insecurity and eating habits of Lebanese children aged 5–11 years during the COVID-19 pandemic and the socioeconomic crisis: a national study

Background

Food insecurity is the lack of access to nutritious healthy food due to economic and financial insufficiencies. Food insecurity is expected to be higher during these difficult times in Lebanon, which is facing many financial, political, economic and health debates. The present study aims to find the prevalence of food insecurity among Lebanese children during the COVID-19 pandemic and its correlates.

Methods

This cross-sectional study enrolled 4001 participants from all Lebanese governorates (March–April 2022). The Ministry of Education and Higher Education randomly disseminated the link to parents of children aged between 5 and 11 years from public and private schools.

Results

The results showed that 1505 (37.6%) and 1497 (37.4%) had moderate and severe food insecurity. A significantly higher percentage of families with severe food insecurity was reported by fathers compared to mothers. In addition, participants who reported a bad overall health status of their children had a severe food insecurity. Moreover, those with a severe food insecurity had their children’s daily snacking habit between meals decreased, with a decreased quantity of meals, intake of vegetables/fruits, the intake of balanced diet, junk food, sugar-sweetened beverages, consumption of sweets/candies/chocolate, consumption of unhealthy food, intake of immunity-boosting food, intake of nutrition supplements, participation in the house chores, number of sleeping hours and sleep quality, as well as stress/anxiety decreased. Finally, a higher mean financial burden was seen in families with severe food insecurity compared to the other groups.

Conclusion

The current study found a high prevalence of moderate to severe food insecurity among Lebanese children during the COVID-19 pandemic. Food insecurity should be seriously discussed in Lebanon due to its rapid development in the middle of all the crises facing the country in order to avoid short and long term consequences on human’s health.

Prevalence and factors associated with food insecurity in eight high-altitude cities in Peru during the second wave of the COVID-19 pandemic: a retrospective, cross-sectional study

Background

Food insecurity has increased during the COVID-19 pandemic, affecting an estimated 260 million people. However, little evidence is available on how pandemic-related characteristics influence food security in a high-altitude population. The objective of this study was to assess factors associated with food insecurity in high-altitude Peruvian cities during the second epidemic wave of COVID-19.

Methods

A retrospective, cross-sectional study was conducted in eight Peruvian cities over 1,500 m above sea level. An online survey measuring food security, presence of anxiety & depressive symptoms, sleep quality, post-traumatic stress disorder (PTSD), resilience, and sociodemographic characteristics was disseminated through social networks between December 2020 and February 2021. Generalized linear models were used to identify an association between the study variables.

Results

Of 700 participants, the median age was 23 years, and more than half were female (56.7%). The prevalence of food insecurity was 37.1%. Anxiety symptoms, depressive symptoms, and PTSD were present in 72.7%, 64.1%, and 15% of respondents, respectively. The prevalence of food insecurity was higher in people with fair (PR: 1.60, 95% CI: 1.23–2.07) and very bad perception of their health (PR: 4.06, 95% CI: 2.63–6.26), individuals seeking mental health support (PR: 1.42, 95% CI: 1.25–1.62), and in those who lost their job due to the pandemic (PR: 1.82, 95% CI: 1.62–2.04). Having moderate (PR: 1.52, 95% CI: 1.26–1.83) and moderate to severe depressive symptoms (PR: 1.58, 95% CI: 1.11–2.27) also increased the prevalence of food insecurity.

Conclusion

During the pandemic, the prevalence of food insecurity has increased in the Peruvian high-altitude population, revealing the need for preventive strategies. Identification of pandemic-related characteristics that influence food insecurity can guide interventions in at-risk individuals and reduce the long-term impact of this problem on overall health and quality of life.

A Retrospective Comparative Study Assessing Patients With Acute Appendicitis During the Pre and Through Lebanese Financial Crisis

Introduction

In the past three years, Lebanon, a country located in the Middle East, has faced a severe financial crisis. This crisis had many effects on several sectors in Lebanon, including the healthcare sector. The authors expected an increase in the rate of complicated appendicitis after the crisis due to the shortage of medical supplies. The aim of the study was to compare the rate of complicated acute appendicitis before and after the Lebanese crisis.

Methods

The study included two groups of patients with acute appendicitis. The first group included patients admitted in the period between November 2018 and November 2019 (before the crisis). The second group included patients admitted between November 2020 and November 2021 (during the crisis). The data were collected retrospectively and analyzed using SPSS software (version 25.00) (SPSS Inc., Chicago, IL). Ethical approval was obtained and the study was registered at Al Zahraa hospital, University Medical Center in Beirut, Lebanon.

Results

The study included 49 patients in the first group (before the crisis) and 46 patients in the second group (after the crisis). The percentage of complicated appendicitis has increased from 22.4% before the crisis to 28.3% during the crisis. The study showed a statistically significant difference between the two groups in the white blood cell count (10,831 versus 7180 cu.mm, respectively, p=0.006), the operating time (59.9 versus 79.0 minutes, respectively; p=0.004), the need to obtain an intra-peritoneal swab for bacterial culture (83.7% versus 58.7%, respectively; p=0.007), and the need for intra-abdominal abscess drainage (6.1% versus 28.3%, respectively; p=0.004). There were no significant differences in the demographics, the duration of postoperative antibiotic use, the duration of stay in the hospital, and the postoperative complications in the first month following surgery.

Conclusion

Due to the decreased financial income, the high cost of medical care during the Lebanese crisis, and the delay of patients’ presentation to the hospital, the rate of complicated appendicitis increased during the crisis.

Contributing Factors in Whether Displaced Households Want to Receive Humanitarian Information from Humanitarian Actors: Iraq Multi-Cluster Needs Assessment

Due to political conflict, insurgency, and the COVID-19, the number of displaced households in need of humanitarian support in Iraq has increased. This study investigated factors related to desire of displaced households to receive humanitarian information. Data from the eighth round of the Iraq Multi-Cluster Needs Assessment was used. We classified the household displacement status, identifying levels and types of humanitarian information that the households sought, together with whether the households were impacted by COVID-19. We identified safety and security, housing, water and electricity services, education, health care, and levels of humanitarian assistance resulted in significant differences between internally displaced person (IDP) and returnee households in terms of interest in receiving humanitarian information. The desire to receive humanitarian information was related to whether household members were unemployed due to COVID-19, displacement status, and walking time to reach the nearest health care facility and marketplace. Returnees and IDPs in Iraq are facing a new crisis. Their individual, structural, and environmental vulnerabilities are increasing commensurately. New strategies such as strategies using online or mobile communication that provide humanitarian information are needed to provide humanitarian information to vulnerable groups such as those who have lost jobs due to COVID-19, female heads of households, and those with health problems. In addition to traditional cash and voucher support, the use of the latest technologies such as smartphones and mobile clinics in humanitarian settings would be new strategies.

Financial Wellbeing and Quality of Life Among a Sample of the Lebanese Population: The Mediating Effect of Food Insecurity

Background

Lebanon is undergoing multiple overlapping crises, affecting the food security, financial well-being, and quality of life (QOL) of its residents.

Objective

The primary objective was to assess the food insecurity (FI) status of a sample of the Lebanese population. The second objective was to explore factors related to QOL parameters and evaluate the mediating effect of food security between financial well-being and QOL.

Methods

The study was cross-sectional and enrolled 412 participants recruited online using the snowball sampling technique. The survey included questions related to sociodemographic and economic characteristics of Lebanese households and validated scales to assess FI, QOL measures, financial well-being, and fear of COVID-19.

Results

Almost 43% of the study participants reported being food insecure, with 31% experiencing mild FI, 10% moderate FI, and 1.5% severe FI. Compared to food-insecure participants, food secure participants had a significantly higher income (58.5% vs. 39.2%, p < 0.001), a university education level (96.6% vs. 88.1%, p = 0.002), an average perceived financial status (83.9% vs. 65.9%), higher financial well-being scores (5.14 vs. 3.19, p < 0.001), and lower crowding index (0.94 ± 0.4 vs. 1.09, p = 0.002). Multivariate analysis showed that FI was not associated with physical (Beta = −1.48, 95% CI: −3.10; 0.13) and mental (Beta = −1.46, 95% CI −3.68; 0.75) QOL, after adjusting for other demographic and socioeconomic correlates. This association remained non-significant when introducing the financial well-being variable to the model. Mediation analyses showed that the FI variable mediated the association between financial well-being and physical QOL (Beta = 0.19, 95% CI: 0.02; 0.36), but not the mental QOL (Beta = −0.02, 95% CI: −0.20; 0.14).

Conclusion

Food insecurity was prevalent in our study sample, and it mediated the association between financial well-being and physical, but not mental, QOL parameters. These findings call for evidence-based policies and programs to help improve the food security and well-being of Lebanese households amidst these unprecedented circumstances.

The Large and Diverse Family of Mediterranean Flat Breads: A Database

An in-depth survey was conducted by collecting information from web sources, supplemented by interviews with experts and/or bakers, to identify all the flat breads (FBs) produced in the nine Mediterranean countries involved in the FlatBreadMine Project (Croatia, Egypt, France, Greece, Italy, Jordan, Lebanon, Malta and Spain), and to have an insight into their technical and cultural features. A database with information on 143 FB types (51 single-layered, 15 double-layered, 66 garnished, 11 fried) was established. Flours were from soft wheat (67.4%), durum wheat (13.7%), corn (8.6%), rye, sorghum, chickpea, and chestnut (together 5.2%). The raising agents were compressed yeast (55.8%), sourdough (16.7%), baking powder (9.0%), but 18.6% of FBs were unleavened. Sixteen old-style baking systems were recorded, classified into baking plates and vertical ovens (tannur and tabun). Artisanal FBs accounted for 82%, while the industrial ones for 7%. Quality schemes (national, European or global) applied to 91 FBs. Fifteen FBs were rare, prepared only for family consumption: changes in lifestyle and increasing urbanization may cause their disappearance. Actions are needed to prevent the reduction of biodiversity related to FBs. Information in the database will be useful for the selection of FBs suitable to promotional activities and technical or nutritional improvement.

Presentations of Routine Dental Interventions in Children over a Six-Year Period

Aim

To evaluate over a six-year period, the prevalence of the dental procedures in primary and mixed dentitions, in males and females.

Materials and Methods

A retrospective descriptive study on dental treatments in primary and mixed dentitions was conducted in the Department of Pediatric Dentistry at the Faculty of Dental Medicine, Lebanese University, from 2015 to 2020. The total number of children was 1291. Data were classified and reviewed according to the dentition type, gender, and type of dental treatment.

Results

The number of children decreased from 741 for the period 2015–2017 to 550 during the period 2018–2020 (279 males and 271 females). No significant association was found between the admission periods and the genders. A significant relationship was found between the number of treatments performed in both genders and the dentition types (p value = 0,015). Males were slightly more likely than females to present for the treatment in mixed dentition (54.58% versus 45.2%, respectively). Results portrayed a significant relationship between surgical treatment and gender (p value = 0.049). However, no significant relationship between gender and other treatment types was noted. The comparison between the 2 time frames and the types of treatments showed a significant association in composite fillings (p value = 0.043), extractions (p value < 0.0001), sealants (p value = 0.039), preventive resin restoration (p=0.011), pulp therapies (p value < 0.0001), pediatric crowns (p value < 0.0001), and surgical interventions (p value = 0.013). A nonsignificant relationship was recorded for the appliances and composite crowns (p value = 0.45 and 0.14, respectively).

Conclusion

The present study points out the implications of the COVID-19 outbreak and Lebanon's economic collapse on children's dental status, with the number of children receiving dental care dropping remarkably. A decrease in all types of dental procedures was noted in mixed dentition, whereas an increase in dental treatments related to aggravated carious lesions was reported in primary dentition. More medical and financial aids are required to encourage and support parents' attitude towards children dental care during unprecedented crises.

COVID-19 – Impact of the lockdown on the weight variation among the Lebanese population

The aim of this study is to assess lifestyle changes along with weight fluctuations during the COVID-19 lockdown in Lebanon. This cross-sectional study was conducted using a web-survey disseminated through social media platforms to a large sample of the Lebanese population between May 25th and June 8th, 2020, during the lockdown in Lebanon. Behavioral changes and weight variation during the confinement were assessed. Two thousand one hundred sixty-one participants (64.9% female) aged 18 to 78 years old were included in this study. On average, no net weight variation was reported by the participants. 59.3% of the smokers changed their smoking habits, 40.7% of the drinkers reported a decrease in alcohol consumption, 43.5% of the participants exercised less than one time weekly and 35.8% changed their diet. Increased frequency of physical activity, following a diet during lockdown, decreased weight dissatisfaction (P < 0.0001 for the three variables) were retained as significant factors associated with weight loss. Planning to engage in physical activity post lockdown was associated with weight gain (P = 0.021). In the Lebanese population, no net weight variation was reported during the lockdown. Increasing physical activity and initiating diet were associated with weight loss. Healthcare authorities should be alerted about the importance of these factors during the follow-up of the confined population.

Gendered Impacts of the COVID-19 Pandemic on Food Behaviors in North Africa: Cases of Egypt, Morocco, and Tunisia

The COVID-19 pandemic-related measures in the Near East and North Africa (NENA) region have resulted in many lifestyle modifications, including changes in diet and food buying patterns among adults. However, the pandemic has impacted women and men differently and exacerbated existing socio-economic and gender inequalities. Indeed, numerous studies conducted worldwide have shown that the COVID-19 pandemic had a disproportionately negative impact on women compared to males. Therefore, this paper aims to analyze the effects of COVID-19 on women's food behaviors in three countries of the North Africa sub-region, namely, Egypt, Morocco, and Tunisia. The study was based on an online poll conducted by SurveyMonkey from 15 September to 5 November 2020, with 995 participants. The outcomes of the research found that when compared to men, (1) women tend to consume more food out of fear, anxiety, or boredom; (2) women prefer to eat more unhealthy food; (3) women tend to stockpile a greater amount of food; and (4) women tend to modify their shopping habits more often. The findings should inform gender-sensitive strategies and policies to address the negative impacts of the pandemic and foster transition towards healthier diets and resilient food systems during the recovery period.

Food insecurity and mental health of college students in Lebanon: a cross-sectional study

The present study aimed to assess the prevalence of food insecurity (FI) among college students and explore its association with indicators of mental and psychosocial health. Data were collected using a cross-sectional online survey from college students in different universities in Lebanon during the Spring 2021 semester. FI was assessed using the validated eight-item food insecurity experience scale. The mental health of college students was assessed using validated screening tools for depression, anxiety and well-being, namely the Patient Health Questionnaire (PHQ-9), the General Anxiety Disorder-7 (GAD-7) and the World Health Organization (WHO-5) index, respectively. Multiple linear regression models were conducted to assess the relationship of FI with PHQ-9, GAD-7 and WHO-5 scores. A total of 745 students completed the online survey. Approximately 39 % of students in the sample were experiencing FI of which 27·4, 8·1, and 3·5 % were experiencing mild, moderate and severe FI , respectively. Low maternal education, low household monthly income and high levels of stress were significant correlates of FI among college students (P-trend < 0·001). In addition, 22·6 and 34·4 % of students showed severe symptoms of depression and anxiety, respectively. Regression models showed that FI was associated with higher scores on PHQ-9 and GAD-7 (β = 2·45; 95 % CI [1·41, 3·49]) and (β = 1·4; 95 % CI [1·1, 2·2], respectively) and lower scores on WHO-5 (β = −4·84; 95 % CI [−8·2, −1·5]). In conclusion, a remarkable proportion of college students reported experiencing different forms of FI, which was associated with poorer mental health and well-being outcomes. Public health programmes and interventions are needed to mitigate FI and improve student health-related outcomes.