Factors affecting age-appropriate timeliness of vaccination coverage among children in Lebanon [version 1; referees: 2 approved]

Background: The effect of immunization does not only depend on its completeness, but also on its timely administration. Routine childhood vaccinations schedules recommend that children receive the vaccine doses at specific ages. This article attempts to assess timeliness of routine vaccination coverage among a sub-sample of children from a survey conducted in 2016. Methods: This analysis was based on data from a cross-sectional multistage cluster survey conducted between December 2015 and June 2016 among caregivers of children aged 12-59 months in all of Lebanon using a structured survey questionnaire. The analysis used Kaplan–Meier curves and logistic regression to identify the predictors of age-appropriate immunization. Results: Among the 493 randomly selected children, timely administration of the third dose of polio vaccine, diphtheria-tetanus-pertussis (DTP)-containing vaccine and hepatitis B (HepB) vaccine occurred in about one-quarter of children. About two-thirds of children received the second dose of a measles-containing vaccine (MCV) within the age interval recommended by the Expanded Programme on Immunization (EPI). Several factors including socio-demographic, knowledge, beliefs and practices were found to be associated with age-appropriate vaccination; however, this association differed between the types and doses of vaccine. Important factors associated with timely vaccination included being Lebanese as opposed to Syrian and being born in a hospital for hepatitis B birth dose; believing that vaccination status was up-to-date was related to untimely vaccination. Conclusions: The results suggest that there is reason for concern over the timeliness of vaccination in Lebanon. Special efforts need to be directed towards the inclusion of timeliness of vaccination as another indicator of the performance of the EPI in Lebanon

Evaluating the governance and preparedness of the Lebanese health system for the COVID-19 pandemic: a qualitative study

From BMJ via Jisc Publications RouterHistory: received 2021-10-29, accepted 2022-05-16, ppub 2022-06, epub 2022-06-01Publication status: PublishedFunder: World Health Organization; FundRef: http://dx.doi.org/10.13039/100004423; Grant(s): 2002577199Objectives: This study aimed to assess the capacities and governance of Lebanon’s health system throughout the response to the COVID-19 pandemic until August 2020. Design: A qualitative study based on semi-structured interviews. Setting: Lebanon, February–August 2020. Participants: Selected participants were directly or indirectly involved in the national or organisational response to the COVID-19 pandemic in Lebanon. Results: A total of 41 participants were included in the study. ‘Hardware’ capacities of the system were found to be responsive yet deeply influenced by the challenging national context. The health workforce showed high levels of resilience, despite the shortage of medical staff and gaps in training at the early stages of the pandemic. The system infrastructure, medical supplies and testing capacities were sufficient, but the reluctance of the private sector in care provision and gaps in reimbursement of COVID-19 care by many health funding schemes were the main concerns. Moreover, the public health surveillance system was overwhelmed a few months after the start of the pandemic. As for the system ‘software’, there were attempts for a participatory governance mechanism, but the actual decision-making process was challenging with limited cooperation and strategic vision, resulting in decreased trust and increased confusion among communities. Moreover, the power imbalance between health actors and other stakeholders affected decision-making dynamics and the uptake of scientific evidence in policy-making. Conclusions: Interventions adopting a centralised and reactive approach were prominent in Lebanon’s response to the COVID-19 pandemic. Better public governance and different reforms are needed to strengthen the health system preparedness and capacities to face future health security threats

Development of a Lebanese food exchange system based on frequently consumed Eastern Mediterranean traditional dishes and Arabic sweets

The aim of this project was to convert the recipes of the Lebanese traditional dishes and Arabic sweets into meal planning exchange lists whose items are expressed in grams and adjusted to Lebanese household measures (cups and spoons) that could be used by healthcare professionals

Prevalence of Midwakh tobacco smoking in trend-setting Lebanon: an indicator of potential spread across the Arab world?

Background Alternative tobacco product (ATP) use is increasing in Lebanon. Dokha (or 'diziness') is an ATP smoked in a pipe called a midwakh. Research evidence suggests high nicotine content, with resultant physiologic effects. The objective of this study was to assess prevalence and correlates of midwakh tobacco use among 7 th -12 th grade students in Lebanon. Methods The analyses is based on one question included in the 2016 Lebanon Global School-based Student Health Survey (GSHS) that assessed past 30-day (current) use of midwakh in a representative sample of 5708 7 th -12 th graders sampled from public and private schools. All analyses were weighted accounting for the multi-stage cluster sampling design. Results Overall, 4.6% of students were current midwakh users, varying between 3.9%-5.4% across grade levels. A significantly higher percentage of males than females currently smoked midwakh (6.7% versus 2.7% respectively). Current use was higher in public versus private school students (6.3% vs. 3.6% respectively) but this difference was not statistically significant. Midwakh use was significantly associated with current smoking of cigarettes [OR: 16.61; 95%CI=12.21-22.58], as well as initiating cigarette smoking prior to 14 years of age among cigarette smokers [OR: 2.31; 95%CI=1.53-3.49]. Midwakh smoking was also statistically significantly related to ever smoking of waterpipe [OR: 9.89; 95%CI=6.78-14.45], current use of any tobacco products other than cigarettes [OR: 14.29; 95%CI=8.53-23.94], parental smoking [OR: 1.61; 95%CI=1.13-2.2], and with second-hand smoking [OR: 1.73; 95%CI=1.11-2.70]. Conclusions This study is one of the few that has provided prevalence rates and determinants of midwakh use outside of the Arabian Gulf, where it has been mostly confined. Although prevalence remains low, its consistency across grade levels is concerning. In addition, the pattern of associations is in line with evidence on other tobacco products. A trans-disciplinary research agenda for midwakh is urgently needed to understand use and effects, and contain its spread

Development of a quality assurance tool for intensive care units in Lebanon during the COVID-19 pandemic.

BACKGROUND: During the coronavirus disease (COVID-19) pandemic, low- and middle-income countries have rapidly scaled up intensive care unit (ICU) capacities. Doing this without monitoring the quality of care poses risks to patient safety and may negatively affect patient outcomes. While monitoring the quality of care is routine in high-income countries, it is not systematically implemented in most low- and middle-income countries. In this resource-scarce context, there is a paucity of feasibly implementable tools to monitor the quality of ICU care. Lebanon is an upper middle-income country that, during the autumn and winter of 2020-1, has had increasing demands for ICU beds for COVID-19. The World Health Organization has supported the Ministry of Public Health to increase ICU beds at public hospitals by 300%, but no readily available tool to monitor the quality of ICU care was available. OBJECTIVE: The objective with this study was to describe the process of rapidly developing and implementing a tool to monitor the quality of ICU care at public hospitals in Lebanon. METHODS: In the midst of the escalating pandemic, we applied a systematic approach to develop a realistically implementable quality assurance tool. We conducted a literature review, held expert meetings and did a pilot study to select among identified quality indicators for ICU care that were feasible to collect during a 1-hour ICU visit. In addition, a limited set of the identified indicators that were quantifiable were specifically selected for a scoring protocol to allow comparison over time as well as between ICUs. RESULTS: A total of 44 quality indicators, which, using different methods, could be collected by an external person, were selected for the quality of care tool. Out of these, 33 were included for scoring. When tested, the scores showed a large difference between hospitals with low versus high resources, indicating considerable variation in the quality of care. CONCLUSIONS: The proposed tool is a promising way to systematically assess and monitor the quality of care in ICUs in the absence of more advanced and resource-demanding systems. It is currently in use in Lebanon. The proposed tool may help identifying quality gaps to be targeted and can monitor progress. More studies to validate the tool are needed

Impact of COVID-19 pandemic on the utilization of routine immunization services in Lebanon.

IntroductionThe global abrupt progression of the COVID-19 pandemic may disrupt critical life-saving services such as routine immunization (RI), thus increasing the susceptibility of countries to outbreaks of vaccine-preventable diseases (VPDs). Being endemic to several infectious diseases, Lebanon might be at increased risk of outbreaks as the utilization of RI services might have deteriorated due to the pandemic and the country's political unrest following the October 2019 uprising. The aim of this study was to assess the changes in the utilization of RI services in both the public and private sectors following the COVID-19 pandemic.MethodsA self-administered cross-sectional survey was completed electronically, in April 2020, by 345 private pediatricians who are registered in professional associations of physicians in Lebanon and provide immunization services at their clinics. Means of the reported percentages of decrease in the utilization of vaccination services by pediatricians were calculated. As for the public sector, an examination of the monthly differences in the number of administered vaccine doses in addition to their respective percentages of change was performed. Adjustment for the distribution of RI services between the sectors was performed to calculate the national decrease rate.ResultsThe utilization of vaccination services at the national level decreased by 31%. In the private sector, immunization services provision diminished by 46.9% mainly between February and April 2020. The highest decrease rates were observed for oral poliovirus vaccine (OPV) and hepatitis A, followed by measles and pneumococcal conjugate vaccines. The number of vaccine doses administered in the public sector decreased by 20%. The most prominent reductions were detected for the OPV and measles vaccines, and during October 2019 and March 2020.ConclusionThe substantial decrease in the utilization of RI as a result of the COVID-19 pandemic requires public health interventions to prevent future outbreaks of VPDs

Ongoing Epidemic of Cutaneous Leishmaniasis among Syrian Refugees, Lebanon

In September 2012, a cutaneous leishmaniasis outbreak began among Syrian refugees in Lebanon. For 948 patients in whom leishmaniasis was not confirmed, we obtained samples for microscopic confirmation and molecular speciation. We identified Leishmania tropica in 85% and L. major in 15% of patients. After 3 months of megulamine antimonite therapy, patients initial cure rate was 82%

Clustering of lifestyle risk factors in relation to suicidal thoughts and behaviors in young adolescents: a cross-national study of 45 low- and middle-income countries

Abstract Background Prior research has reaffirmed lifestyle risk behaviors to cluster among adolescents. However, the lifestyle cluster effect on suicidal thoughts and behaviors (STBs) was unclear among adolescents in low- and middle-income countries (LMICs). No comparison of such associations was conducted across nations. Methods Data from 45 LMICs were obtained from the Global School-based Student Health Survey (GSHS) between 2009 and 2019. Lifestyle behavior factors were collected through a structured questionnaire. Suicidal ideation, plan, and attempt were ascertained by three single-item questions. Lifestyle risk scores were calculated via a sufficient dimension reduction technique, and lifestyle risk clusters were constructed using a latent class analysis. Generalized linear mixed models with odds ratio (OR) and 95% confidence interval (CI) were used to estimate the lifestyle-STB associations. Results A total of 229,041 adolescents were included in the final analysis. The weighted prevalence of suicidal ideation, plan, and attempt was 7.37%, 5.81%, and 4.59%, respectively. Compared with the favorable lifestyle group, the unfavorable group had 1.48-, 1.53-, and 3.11-fold greater odds of suicidal ideation (OR = 1.48, 95%CI: 1.30–1.69), plan (OR = 1.53, 95%CI 1.34–1.75), and attempt (OR = 3.11, 95%CI 2.64–3.65). Four clusters of lifestyle risk behaviors were identified, namely healthy lifestyles (H–L), insufficient intake of vegetables and fruit (V-F), frequent consumption of soft drinks and fast food (D-F), and tobacco smoking and alcohol drinking (S-A) clusters. Compared with H–L cluster, V-F cluster was associated with 43% and 42% higher odds of suicidal ideation and plan, followed by S-A cluster (26% for ideation and 20% for plan), but not significant in D-F cluster (P > 0.05). D-F cluster was associated with 2.85-fold increased odds of suicidal attempt, followed by V-F cluster (2.43-fold) and S-A cluster (1.18-fold). Conclusions Clustering of lifestyle risk behaviors is informative for risk stratification of STBs in resource-poor settings. Lifestyle-oriented suicide prevention efforts should be initiated among school-attending adolescents in LMICs