Self-rated health disparities among disadvantaged older adults in ethnically diverse urban neighborhoods in a Middle Eastern country.

OBJECTIVES: This paper examines differentials in self-rated health (SRH) among older adults (aged 60+ years) across three impoverished and ethnically diverse neighborhoods in post-conflict Lebanon and assesses whether variations are explained by social and economic factors. DESIGN: Data were drawn from the Older Adult Component (n = 740) of the Urban Health Survey, a population-based cross-sectional study conducted in 2003 in a formal community (Nabaa), an informal settlement (Hey El-Sellom), and a refugee camp for Palestinians (Burj El-Barajneh) in Beirut, Lebanon. The role of the social capital and economic security constructs in offsetting poor SRH was assessed using multivariate ordinal logistic regression analyses. RESULTS: Older adults in Nabaa fared better in SRH compared to those in Hey El-Sellom and Burj El-Barajneh, with a prevalence of good, average, and poor SRH being respectively, 41.5%, 37.0%, and 21.5% in Nabaa, 33.3%, 23.9%, and 42.7% in Hey El-Sellom, and 25.2%, 31.3%, and 43.5% in Burj El-Barajneh. The economic security construct attenuated the odds of poorer SRH in Burj El-Barajneh as compared to Nabaa from 2.57 (95% confidence interval, CI: 1.89-3.79) to 1.42 (95% CI: 0.96-2.08), but had no impact on this association in Hey El-Sellom (odds ratio, OR: 2.12, 95% CI: 1.39-3.24). The incorporation of the social capital construct in the fully adjusted model rendered this association insignificant in Hey El-Sellom (OR: 1.49, 95% CI: 0.96-2.32), and led to further reductions in the magnitude of the association in Burj El-Barajneh camp (OR: 1.18, 95% CI: 0.80-1.76). CONCLUSIONS: The social context in which older adults live and their financial security are key in explaining disparities in SRH in marginalized communities. Social capital and economic security, often overlooked in policy and public health interventions, need to be integrated in dimensions of well-being of older adults, especially in post-conflict settings

Obesity/overweight and asthma control in LEBANESE adults: A cross-sectional study

Background: Studies exploring the association between weight and asthma are not conclusive. Both obesity and asthma have been increasing in Lebanon, their association is not yet documented. The aim of this study is to explore the effect of weight on asthma control in adults. Methods: This is a cross-sectional study, involving all consecutive asthma patients presenting to the outpatient allergy clinic at the Hotel-Dieu de France (HDF) University Hospital between January 1, 2014 and December 30, 2016. Patients included were those who consented to fill the Asthma Control Test (ACT) after 3 months of therapy. BMI was reported at the same time of the questionnaire. Results: A total of 183 records of diagnosed asthma cases in adults were included. Sixty-three (34.4%) were males and 120 (65.6%) females, with a mean age of 38.5 (SD = 14.3). Ninety patients (49.2%) were of normal weight, 65 (35.5%) overweight and 28 (15.3%) obese. Seventy-one percent had an ACT score ≤ 19, which corresponds to poor asthma control. Patients who were overweight or obese were more likely to have poor asthma control compared to patients who had a normal weight at the time of evaluation. Conclusion: In conclusion, our study showed a significant association between asthma control as assessed by the ACT and high BMI defining overweight or obesity. This is the first national study exploring the association between asthma and overweight/obesity in Lebanon. A larger study with sampling from different specialists' sites is needed to draw more conclusions about this association. © 2019 The Author(s)

Cardiovascular disease research in the Arab world: a scoping review from seven Arab countries (2000–2018)

Objectives: The objective of this study is to map cardiovascular disease (CVD) research productivity in Arab countries and identify gaps and opportunities that would inform future research agenda. Study design: This is a scoping review. Methods: A review of research output between January 2000 and December 2018 in seven Arab countries, selected to represent various economies and epidemiological transitions, was conducted. Data on quantity and quality, study design, setting and focus were extracted and analysed for trends by time and place. Results: Over the study period, a total of 794 articles were published, with an average of 7.3 publications per million population. While time trends showed a 6-fold increase in the number of publications over the study period, a decreasing trend in mean journal impact factor was noted (from 2.3 in 2000 to 1.5 in 2018). Most studies (71%) were observational, 56% were conducted in medical facilities (hospitals or clinics) and most of the experimental studies (10%) were based in laboratory settings. Behavioural risk factors were addressed in 52% of the studies, and there was a dearth of studies examining associations with diet, physical inactivity or family history. Conclusions: Findings from this review indicate gaps in robust methods and pertinent themes in CVD research in the Arab region. Greater attention should be paid to high-quality evidence and implementation research. Also, there is a need for a more targeted CVD research agenda that is responsive to local and regional health burden and needs. © 2019 The Royal Society for Public Healt

Lessons learned in the provision NCD primary care to Syrian refugee and host communities in Lebanon: The need to 'act locally and think globally'

Background: Prevention and control of non-communicable diseases (NCDs) remain inadequate in resource-scarce countries, particularly in conflict situations. This paper describes a multicomponent intervention for management of hypertension and diabetes among older adult Syrian refugees and the Lebanese host community and reflects on challenges for scaling up NCD integration into primary care in humanitarian situations. Methods: Using a mixed method approach, the study focused on monitoring and evaluation of the three components of the intervention: healthcare physical facilities and documentation processes, provider knowledge and guideline-concordant performance, and refugee and host community awareness. Results: Findings revealed overall high compliance of healthcare workers with completing data collection forms. Their knowledge of basic aspects of hypertension/diabetes management was adequate, but diagnosis knowledge was low. Patients and healthcare providers voiced satisfaction with the program. Yet, interruptions in medicines' supplies and lapses in care were perceived by all study groups alike as the most problematic aspect of the program. Conclusions: Our intervention program was aligned with internationally agreed-upon practices, yet, our experiences in the field point to the need for more 'local testing' of modified interventions within such contexts. This can then inform 'thinking globally' on guidelines for the delivery of NCD care in crisis settings. © 2019 The Author(s)

Review of Non-Communicable Disease Research Activity in Kuwait: Where is the Evidence for the Best Practice?

Background: Kuwait, a small country in the Middle East, is now facing rapid development, with non-communicable diseases (NCDs) accounting for the majority of deaths. Objectives: In this study, we review trends in NCD research productivity in Kuwait and examine to what extent it is aligned with disease burden. Methods: Systematic mapping of NCD papers produced between January 2000 and December 2013 yielded 893 publications. These were defined according to study design, study focus, and risk factors examined. Research gaps were assessed by examining disparities between literature produced and cause-specific proportional mortality rates (PMR) and disability-adjusted life years (DALYs). Findings: While annual publication rates increased more than two-fold during the study period, many of the study methodologies were descriptive (58%). Only 2.6% were based on high-evidence interventional studies. Cancer, CVD, and diabetes featured in 38.1%, 15.1%, and 9.2% of the publications, respectively. Compared to PMR and DALYs, there was a surplus of cancer research, most of which were laboratory-based studies (27.6%) or of the case-report/case-series study type (26.5%). Smoking was more likely to be addressed in relation to CVD (32.6%) than diabetes (6.1%) or cancer (2.1%). Physical inactivity was mostly examined in its relation to diabetes (14.6%), with negligible representation in the remaining study focus (range 0.3% to 2.2%). Conclusion: NCD research production in Kuwait is not aligned with disease burden or health priorities. We recommend a coordinated action between funding agencies, universities, and researchers in Kuwait to guide development of a comprehensive research agenda that is responsive to the country’s emerging needs

Cell Phone and Face-to-face Interview Responses in Population-based Surveys: How Do They Compare?

Findings on the reliability and cost-effectiveness of the use of cellular phones vis-à-vis face-to-face interviews in investigating health behaviors and conditions are presented for a national epidemiological sample from Lebanon. Using self-reported responses on identical questions, percentage agreement, κ statistics, and McNemar’s test were used to make the comparisons. Concordance was almost perfect (κ statistics, κ >.8) for measures including age, health insurance, cigarette smoking (ever and current), and diabetes; and substantial (0.6 ≤ κ ≤ 0.8) for other measures such as education, water pipe smoking, alcohol consumption, and hypertension. Moreover, cell phone interviewing saved approximately US$14 per person interviewed. Future research on their use for health research purposes in Lebanon and the region should address their use alone or in combination with landlines in obtaining nationally representative samples. © The Author(s) 2014

“Older people tend to be invisible”: a qualitative study exploring the needs and inclusion of older Syrian refugees in the context of compounding crises in host country, Lebanon

Background: Older Syrian refugees in Lebanon are a marginalized population with under-recognized health needs. The inclusivity of this population within the humanitarian response is poorly understood. This study aims to identify the unique needs of older Syrian refugees in the context of recent concurrent crises in Lebanon, and explore the extent to which they are being met and prioritized by local and international aid agencies. Methods: We conducted in-depth interviews with a snowball sample of 26 stakeholders from 11 organizations operating in the health, nutrition, and water, sanitation, and hygiene sectors. Data analysis followed principles of thematic analysis. Results: Concurrent political, economic, and public health crises in host country promoted income insecurity among older refugees and increased dependency on younger relatives, leading to food insecurity, neglect, and poor health outcomes, including the sequelae of untreated non-communicable diseases. Mental illness was perceived to be exacerbated by Covid-19 related challenges, including social isolation, uncertainty about the future, and additionally due to feelings of guilt related to economic dependence and fundamental exclusion from labor force participation. Despite their vulnerability, older refugees are overlooked by the humanitarian response, which may be related to a lack of data. Pervasive medication shortages in the setting of the economic collapse, as well as inaccessible physical environments and competing interests were all identified as major barriers to care. Conclusions: Older Syrian refugees in Lebanon experience dual vulnerability that is acutely exacerbated in the setting of concurrent crises. Sociopolitical, economic, and cultural barriers promote social exclusion and may confer an increased risk of income and food insecurity in this population, with significant implications for health. Humanitarian aid agencies operating in the context of fragmented, under-resourced health systems are currently unable to sufficiently address multi-faceted needs of this community. We recommend moving away from a donor-dependent model of aid by allocating resources toward strengthening inclusive national health systems that emphasize preventative care. We further call for age-disaggregation of routine data and normalization of data sharing among stakeholders in the academic and public health sectors in order to develop evidence-based initiatives that can meet the needs of this under-served community. © 2022, The Author(s)

A novel Mediterranean diet index from Lebanon: comparison with Europe

Purpose: To propose an index for assessing adherence to a Middle Eastern version of the Mediterranean diet as represented by the Traditional Lebanese Mediterranean diet (LMD), to evaluate the association between the LMD and selected European Mediterranean diets (EMD), and to examine socio-demographic and lifestyle correlates of adherence to Mediterranean diet (MD) among Lebanese adults. Methods: Using nationally representative dietary intake data of Lebanese adults, an index to measure Adherence to the LMD was derived. The choice of foods/food groups used for calculating the LMD score was based on results of previous factor analyses conducted on the same dataset. These foods/food groups included fruits, vegetables, legumes, olive oil, burghol, dairy products, starchy vegetables, dried fruits and eggs. Using Pearson’s correlation and scores tertiles distributions agreement, the derived LMD index was compared to previously published EMD indexes from Greece, Spain, Italy, France and EPIC/Europe. Results: Fruits, vegetables and olive oil were common denominators to most MD scores. Food groups, specific to the LMD, included burghol, dried fruits, and eggs. The LMD score significantly correlated with the EMD scores, while being closest to the Italian (r = 0.56) and farthest from the French (r = 0.21). Percent agreement between scores’ tertile distributions and Kappa statistics confirmed these findings. Multivariate linear regressions showed that older age and higher educational levels were associated with increased adherence to all MDs studied. Conclusion: A novel LMD index was proposed to assess adherence to a Middle Eastern version of MD, complementing international efforts to characterize the MD and its association with disease risk. © 2014, The Author(s)

Costs associated with management of non-communicable diseases in the Arab Region: A scoping review

Background Global mortality rates resulting from non-communicable diseases (NCDs) are reaching alarming levels, especially in low- and middle-income countries, imposing a considerable burden on individuals and health systems as a whole. This scoping review aims at synthesizing the existing literature evaluating the cost associated with the management and treatment of major NCDs across all Arab countries; at evaluating the quality of these studies; and at identifying the gap in existing literature. Methods A systematic search was conducted using Medline electronic database to retrieve articles evaluating costs associated with management of NCDs in Arab countries, published in English between January 2000 and April 2016. 55 studies met the eligibility criteria and were independently screened by two reviewers who extracted/calculated the following information: country, theme (management of NCD, treatment/medication, or procedure), study design, setting, population/sample size, publication year, year for cost data cost conversion (US$), costing approach, costing perspective, type of costs, source of information and quality evaluation using the Newcastle- Ottawa Scale (NOS). Results The reviewed articles covered 16 countries in the Arab region. Most of the studies were observational with a retrospective or prospective design, with a relatively low to very low quality score. Our synthesis revealed that NCDs' management costs in the Arab region are high; however, there is a large variation in the methods used to quantify the costs of NCDs in these countries, making it difficult to conduct any type of comparisons. Conclusions The findings revealed that data on the direct costs of NCDs remains limited by the paucity of this type of evidence and the generally low quality of studies published in this area. There is a need for future studies, of improved and harmonized methodology, as such evidence is key for decision- makers and directs health care planning. © 2018, Journal of Health Global

Adolescents' self-perceived and actual weight: Which plays a dominant role in weight loss behaviour in Lebanon?

Background: The decision to lose weight among adolescents is complex and is guided by a number of body-related factors. This study examined the extent of agreement between actual weight, measured as body mass index, and self-perceived weight and assessed their relative importance in weight loss behaviour among Lebanese adolescents. Methods: Data on 278 adolescents aged 13–17 years were drawn from the nationwide Nutrition and Non-Communicable Disease Risk Factor Survey (Lebanon, 2009). Binary multivariable logistic regressions were conducted to test associations with “effort to lose weight” as the outcome variable, controlling for a number of potential confounders. Results: Close to 36% reported trying to lose weight. Around 21% and 13% were overweight and obese, respectively, and 40% and 10% perceived their weight as slightly high and very high, respectively. Inaccurate perceivers, those underestimating or overestimating their weight, constituted 39%, with overall percent agreement between actual and self-perceived weight being 60.8% (kappa statistic = 0.319, 95% CI [0.242, 0.396]). About a third of the overweight adolescents (30.5%) and more than half of the obese (56.8%) underestimated their weight. In the multivariable analysis, self-perceived weight was statistically significant and a stronger predictor of weight loss effort than body mass index (adjusted odds ratios = 14.42 and 6.42 for slightly high and very high perceived weight, respectively, compared to odds ratios = 1.47 and 2.31 for overweight and obese adolescents, respectively). Conclusion: Health professionals need to consider self-perceived weight in conjunction with actual weight in their pursuit of weight management goals and in planning prevention programmes that guide weight loss behaviours for adolescents. © 2017 John Wiley & Sons Lt