Mapping of national population-based surveys for better reporting of health-related indicators in the Eastern Mediterranean Region

BACKGROUND

Population-based surveys are the main data source to generate health-related indicators required to monitor progress toward national, regional and global goals effectively. Although the Eastern Mediterranean Region of World Health Organization (WHO) member states conduct many population-based surveys, they are not led regularly and fail to provide relevant indicators appropriately. Therefore, this study aims two-fold: to map out population-based surveys to be conducted data for the health-related indicators in the Region and propose a timetable for conducting national population-based surveys in the Region.

METHODS

The study was conducted in six phases: 1) Selecting survey-based indicators; 2) Extracting and comparing relevant survey modules; 3) Identifying sources of data for the indicators; 4) Assessing countries' status in reporting on core health indicators; 5) Review and confirmation of the results by the experts.

RESULTS

Population-based surveys are the sources of data for 44 (65%) out of 68 regional core health indicators and two (18%) out of 11 health-related Sustainable Development Goals (SDG) 3 indicators. The Health Examination Survey (HES) could cover 65% of the survey-based indicators. A total of 91% of survey-based indicators are obtained by a combination of HES, Demographic and Health Survey (DHS), Multiple Indicator Cluster Survey (MICS) and Global School-based Student Health Survey (GSHS).

CONCLUSION

In order to effectively report health-related indicators, HES, DHS/MICS and GSHS are considered essential in national survey timetables. Each country needs to devise and implement a plan for population-based surveys by considering factors such as national health priorities, financial and human capacities, and previous experiences.

Burden of cardiovascular disease attributable to particulate matter pollution in the eastern Mediterranean region: analysis of the 1990-2019 global burden of disease

AIMS

Particulate matter pollution is the most important environmental mediator of global cardiovascular morbidity and mortality. Air pollution evidence from the Eastern Mediterranean Region (EMR) is limited, owing to scarce local studies, and the omission from multinational studies. We sought to investigate trends of particulate matter (PM2.5)-related cardiovascular disease (CVD) burden in the EMR from 1990 to 2019.

METHODS AND RESULTS

We used the 1990-2019 global burden of disease methodology to investigate total PM2.5, ambient PM2.5, and household PM2.5-related CVD deaths and disability-adjusted life years (DALYs) and cause-specific CVD mortality in the EMR. The average annual population-weighted PM2.5 exposure in EMR region was 50.3 μg/m3 [95% confidence interval (CI):42.7-59.0] in 2019, which was comparable with 199 048.1 μg/m3 (95% CI: 36.5-65.3). This was despite an 80% reduction in household air pollution (HAP) sources since 1990. In 2019, particulate matter pollution contributed to 25.67% (95% CI: 23.55-27.90%) of total CVD deaths and 28.10% (95% CI: 25.75-30.37%) of DALYs in the region, most of which were due to ischaemic heart disease and stroke. We estimated that 353 071 (95% CI: 304 299-404 591) CVD deaths in EMR were attributable to particulate matter in 2019, including 264 877 (95% CI: 218 472-314 057) and 88 194.07 (95% CI: 60 149-119 949) CVD deaths from ambient PM2.5 pollution and HAP from solid fuels, respectively. DALY's in 2019 from CVD attributable to particulate matter was 28.1% when compared with 26.69% in 1990. The age-standardized death and DALY rates attributable to air pollution was 2122 per 100 000 in EMR in 2019 and was higher in males (2340 per 100 000) than in females (1882 per 100 000).

CONCLUSION

The EMR region experiences high PM2.5 levels with high regional heterogeneity and attributable burden of CVD due to air pollution. Despite significant reductions of overall HAP in the past 3 decades, there is continued HAP exposure in this region with rising trend in CVD mortality and DALYs attributable to ambient sources. Given the substantial contrast in disease burden, exposures, socio-economic and geo-political constraints in the EMR region, our analysis suggests substantial opportunities for PM2.5 attributable CVD burden mitigation.

Changes in the burden and underlying causes of heart failure in the Eastern Mediterranean Region, 1990-2019: An analysis of the Global Burden of Disease Study 2019

BACKGROUND

The burden of heart failure (HF) is high globally, but information on its burden in the Eastern Mediterranean Region (EMR) is limited. This study provides a systematic analysis of the burden and underlying causes of HF in the EMR, including at the country level, between 1990 and 2019.

METHODS

We used the 2019 Global Burden of Disease (GBD) data for estimates of prevalence, years lived with disability (YLDs), and underlying causes of HF in the EMR. Age-standardised prevalence, YLDs, and underlying causes of HF were compared by 5-year age groups (considering 15 years old and more), sex (male and female), and countries.

FINDINGS

In contrast with the decreasing trend of HF burden globally, EMR showed an increasing trend. Globally, the HF age-standardised prevalence and YLDs decreased by 7.06% (95% UI: -7.22%, -6.9%) and 6.82% (95% UI: -6.98%, -6.66%) respectively, from 1990 to 2019. The HF age-standardised prevalence and YLDs in the EMR in 2019 were 706.43 (95% UI: 558.22-887.87) and 63.46 (95% UI: 39.82-92.59) per 100,000 persons, representing an increase of 8.07% (95% UI: 7.9%, 8.24%) and 8.79% (95% UI: 8.61%, 8.97%) from 1990, respectively. Amongst EMR countries, the age-standardised prevalence and YLDs were highest in Kuwait, while Pakistan consistently had the lowest HF burden. The dramatic increase of the age-standardised prevalence and YLDs were seen in Oman (28.79%; 95% UI: 28.51%, 29.07% and 29.56%; 95% UI: 29.28%, 29.84%), while Bahrain witnessed a reduction over the period shown (-9.66%; 95% UI: -9.84%, -9.48% and-9.14%; 95% UI: -9.32%, -8.96%). There were significant country-specific differences in trends of HF burden from 1990 to 2019. Males had relatively higher rates than females in all age groups. Among all causes of HF in 2019, ischemic heart disease accounted for the highest age-standardised prevalence and YLDs, followed by hypertensive heart disease.

INTERPRETATION

The burden of HF in the EMR was higher than the global, with increasing age-standardised prevalence and YLDs in countries of the region. A more comprehensive approach is needed to prevent underlying causes and improve medical care to control the burden of HF in the region.

FUNDING

None.

Socio-economic, health and environmental factors influencing suicide rates: A cross-country study in the Eastern Mediterranean region

BACKGROUND

Suicide is a crucial concern for public health in the world. To date, there is no synthesized evidence about the cross-country impact of suicide risk factors in the Eastern Mediterranean (EMRO). This paper aims to cover the gap and assess socio-economic, health, and environmental (SHE) factors influencing suicide rates among the EMRO countries from 1990 to 2019.

METHODS

This analysis is a cross-sectional time-series design which uses random-effect panel data from 17 EMRO countries. SHE variables are inflation rate, economic growth, unemployment rate, urbanization, and female labor force participation rate, mental disorders prevalence and individuals using the internet.

RESULTS

The models indicate that male suicide rates was positively associated with inflation rate (coefficient = 0.002, p < 0.05) unemployment rate (0.06, p < 0.01), mental disorders prevalence (0.0008, p < 0.01), and urbanization (0.08, p < 0.05). Conversely, individuals using the internet (-0.019, p < 0.01) was related to a reduction in male suicide rates. Variables correlated with an increase in female suicide rates included inflation rate (0.001, p < 0.05), mental disorders prevalence (coefficient = 0.0004, p < 0.01) and urbanization (0.03, p < 0.01). Individuals using the internet (-0.006, p < 0.01) and education index (-4.8, p < 0.01) had negative effect on female suicide rates.

CONCLUSIONS

This research confirms that SHE factors appear to affect suicide. So policymakers should endeavor to control them if the nations are aimed at preventing suicides. Future researches are essential to scrutinize paradoxes in the field.

Comparative study of COVID-19 situation between lower-middle-income countries in the eastern Mediterranean region

Background and aims

The COVID-19 health crisis has created a disastrous situation worldwide. All nations are facing this pandemic, including eastern Mediterranean countries. The aim of this study is to assess and compare the impact of this devastating pandemic on lower-middle-income countries in the eastern Mediterranean region, identify the leading causes of its spread, examine the various risk factors associated with its virulence in each country, and provide effective intervention strategies to contain it.

Methods

Using the analysis of variance method, this research compares infection, case fatality, recovery, and positivity rates in seven countries, namely, Morocco, Tunisia, Egypt, Djibouti, Pakistan, Sudan, and Palestine. It focuses on their daily reported confirmed incidents, recoveries, deaths, and tests.

Results

The results highlight the significant differences in the effect of COVID-19 in these countries. Regarding the infection rate, Djibouti and Palestine have the highest rate, which could be related to the high poverty and the young population in these countries. However, it has been demonstrated that Tunisia, Djibouti, Egypt, and Sudan have the greatest case fatality rate in this comparison, which might be attributed to the relatively old population in Tunisia, the co-morbidity in Egypt, and the deficiency of the healthcare system in Djibouti and Sudan. Furthermore, the comparison of the recovery rate in these countries indicates that Djibouti has the highest recovery rate, which might be due to the young population.

Conclusion

This work allows us to come up with recommendations that could support policymakers to act efficiently in containing the pandemic flare-up.

National accreditation programmes for hospitals in the Eastern Mediterranean Region: Case studies from Egypt, Jordan, and Lebanon

BACKGROUND

Many countries use external evaluation programmes such as accreditation in order to improve quality and safety in their healthcare settings. Hospital accreditation has developed in many low-and-middle-income countries (LMICs); however, the implementation and sustainability of these programmes vary in each country. This study addresses design and implementation issues of national hospital accreditation programmes. It identifies factors which may explain why programmes can be implemented successfully in one country but not in another and derives lessons for the design and implementation of national accreditation programmes in poor-resource settings.

METHODS

A multiple case study design was used, comprising three countries in the Eastern Mediterranean Region: Egypt, Lebanon and Jordan. In-depth semi-structured interviews were conducted with 27 key stakeholders in the three countries and experts from international organisations concerned with accreditation activities in LMICs.

RESULTS

The hospital accreditation programme was successful and sustainable in Jordan but experienced some difficulties in Egypt and Lebanon. The premature end of external funding and devastating political instability after the Arab Spring were problematic for the programmes in Egypt and Lebanon, but continuous funding and strong political will supported the implementation and sustainability of the programme in Jordan.

CONCLUSIONS

LMICs striving to improve their hospitals' performance through accreditation programmes should consider their vulnerability to a scarcity of financial resources and political instability. An important factor underpinning sustainability is recognising that the accreditation programme is an ongoing and developing quality improvement process that needs continuing and careful attention from funders and political systems if it is to survive and thrive.

Adapting evidence-based clinical practice guidelines for people with attention deficit hyperactivity disorder in Saudi Arabia: process and outputs of a national initiative

BACKGROUND

We recently adapted the published National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia.

METHODS

We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology.

RESULTS

The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include: (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources.

CONCLUSIONS

The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.

Intentional injuries in the Eastern Mediterranean Region, 1990-2015: findings from the Global Burden of Disease 2015 study

OBJECTIVES

We used GBD 2015 findings to measure the burden of intentional injuries in the Eastern Mediterranean Region (EMR) between 1990 and 2015.

METHODS

The Global Burden of Disease (GBD) study defines intentional injuries as a combination of self-harm (including suicide), interpersonal violence, collective violence (war), and legal intervention. We estimated number of deaths, years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for each type of intentional injuries.

RESULTS

In 2015, 28,695 individuals (95% UI: 25,474-37,832) died from self-harm, 35,626 (95% UI: 20,947-41,857) from interpersonal violence, and 143,858 (95% UI: 63,554-223,092) from collective violence and legal interventions. In 2015, collective violence and legal intervention was the fifth-leading cause of DALYs in the EMR and the leading cause in Syria, Yemen, Iraq, Afghanistan, and Libya; they account for 49.7% of total DALYs in Syria.

CONCLUSIONS

Our findings call for increased efforts to stabilize the region and assist in rebuilding the health systems, as well as increasing transparency and employing preventive strategies to reduce self-harm and interpersonal injuries.