Ultrapure water in haemodialysis: a step towards better quality in Lebanon

Globally the nephrology community is witnessing an increased use of high-flux membranes and ultrapure water in haemodialysis (HD) units, and in low-and middle-income countries, data are lacking regarding HD water quality. In Lebanon the Ministry of Public Health released a decree calling for a progressive change in the HD water treatment system in order to implement ultrapure water in all dialysis facilities. This article reports on the problems previously encountered regarding water quality in Lebanon. It exposes the recent changes in standards as recommended by the government, especially the mandatory three sessions per week and ultrapure water. In addition, it analyses the cost-effectiveness of ultrapure water implementation in a low/middle-income country and demonstrates that the cost is lower than in high-income countries. Finally, this article summarizes the obstacles met and suggests a practical approach to maintain this high level of water treatment quality

Lebanon's experience in surveillance of communicable diseases during a mass gathering: Sixth Francophone Games, 2009

In 2009, Lebanon hosted the 6th Francophone Games. Pandemic A[H1N1]2009 virus presented significant health threat at the time. A surveillance strategy was implemented for the timely detection and management of epidemiological events and outbreaks, in particular for A[H1N1]2009 virus cases. Data were collected and managed daily and feedback was generated through daily bulletins. A total of 299 medical consultations were reported, 29% of which related to infectious diseases. There were 10 cases reported as acute respiratory infections; all tested negative for A[H1N1]2009 virus within 24 hours. Twenty-three cases of gastroenteritis were reported, for which 11 stool cultures were negative. While pandemic A[H1N1]2009 did not interfere with the Games, it was essential to strengthen surveillance and to have timely epidemiological information. This was achieved through preparedness, a multi-disciplinary approach, timely management and coordination

Developing an interministerial substance use response strategy for Lebanon: process, content and lessons learned

Evidence on substance use in Lebanon shows an increase in usage, limited availability and accessibility to evidence-based services, and high level of stigma and discrimination. In line with the "Mental Health and Substance Use Strategy for Lebanon 2015-2020", the Ministry of Public Health initiated the process of developing a strategy focused on substance use response to address these challenges in collaboration with the Ministries of Education and Higher Education, Interior and Municipalities, Justice and Social Affairs. The result of this process was a strategy launched jointly by the ministries including six domains of action covering the whole spectrum of substance use response with strategic objectives addressing the challenges identified through stakeholders' consultations. The following key principles adopted throughout the process contributed to the successful development of the strategy: building on evidence and international frameworks, maximizing the participation of all stakeholders, prioritising national consensus, maintaining flexibility and maximizing transparency

Prevalence of hepatitis C virus genotypes and subtypes in Lebanese population and major high risk groups

Background and study aims: The prevalence of hepatitis C in Lebanon is low. It is estimated at 0.2% of the total population. The aim of our study is to evaluate the exact prevalence of each genotype on a large scale population and in each potential source of infection

Patients and methods: We reviewed all the data in the Ministry of Public Health related to patients who have submitted their file for treatment during a period of 9 years ranging from January 2005 till December 2013

Results: The genotype distribution in 1031 Lebanese patients was as following: Genotype 1 was the most predominant representing 47% followed by genotype 4 representing 34% then genotype 3 representing14%. Concerning sex distribution and routes of infection, there was a male predominance in intravenous drug users [IVDU], whereas approximately equal distribution was noted in haemodialysis and transfusion groups. A female predominance was noted in the "unknown" mode of infection. Concerning age distribution and routes of infection, a mean age of 27 was noted in the IVDU group, whereas mean age of 60 in the transfusion group and 50 in the haemodialysis group. In patients who acquired the infection post transfusion or during haemodialysis, genotype 1 was the most predominant, whereas in IVDU, genotype 3 was the most predominant. Concerning sub-genotyping: subtype 1b was the most predominant [84%] in genotype 1. in genotype 2 subtype b with 75%, all genotype 3 were subtype a, in genotype 4 subtype a represents 50% of genotype followed by subtype e in 30%

Conclusion: Our data concerning Lebanese population demonstrate that genotype 1 is the most prevalent genotype followed by genotype 4. In IVU, we noted genotype-3 and -1 being the most prevalent in relation to clustering in this high risk group. This distribution differs from most surrounding countries and all other Arab countries

Epidemiology of hepatitis B and hepatitis C in Lebanon

Background and study aims: Hepatitis B and C are two potentially life threatening liver infections. Lebanon is ranked as a zone of moderate endemicity. This study aimed to determine the prevalence of hepatitis B and C in Lebanon and their distribution according to age, region and sex

Patients and methods: This national prospective cross-sectional study was conducted from January 2011 till December 2012 in the six Lebanese Governorates in collaboration with municipalities, the Ministry of Public Health, Health Centres and dispensaries. An upcoming screening for hepatitis B and C was announced? in different districts of each Governorate. All individuals presenting to local laboratory, not known to have chronic hepatitis, were asked for a blood sample and answered a questionnaire addressing sex, age, place of birth and residence. Screening tests were [Abbots] for hepatitis B and [Human Hexagon] for hepatitis C. PCR testing was used to confirm the positivity of the previous tests

Results: Of 31147 individuals screened, 542 had a rapid test positive for HBV [prevalence 1.74%, 95% CI 1.6-1.89] with a male to female ratio of 1.08. This prevalence was higher in the South and Nabatieh [1.9%] compared to Beirut [0.73%]. Of 31,147 individuals screened, 64 had a rapid test positive for HCV [prevalence 0.21%, 95% CI 0.16-0.27] with a male to female ratio of 0.85. This prevalence was higher in Nabatieh [0.61%] compared to Mount Lebanon [0.08%]

Conclusions: The prevalence of HBV and HCV in Lebanon is 1.74% and 0.21%, respectively with a higher prevalence in South and Nabatieh districts. These data rank Lebanon amongst countries with low endemicity for both viruses. Decrease in the prevalence of HBV is due to awareness campaign as well as success of the MOPH National Hepatitis Program in vaccinating all new born since 1998 and in screening and vaccinating high risk groups

[Guidelines for breast cancer screening in Lebanon public health communication]

The accumulation of national epidemiological data since the late 1990s has led to the adoption of evidence-based guidelines for breast cancer screening in Lebanon [2006]. Almost 50% of breast cancer patients in Lebanon are below the age of 50 years and the age-adjusted incidence rate is estimated at 69 new cases per 100,000 per year [2004]. This official notification calls for breast self-examination [BSE] every month starting age 20, and a clinical breast examination [CBE] performed by a physician every three years between the ages of 20 and 40 years. Starting age 40, and for as long as a woman is in good health, an annual CBE and mammography are recommended. Women with known genetic family history of breast cancer should start screening 10 years earlier than the first young patient in the family, or earlier depending on medical advice. The Breast Cancer National Task Force [BCNTF] recommends certification of mammography centers and continued training of personnel to assure high quality mammograms, and to minimize unnecessary investigations and surgeries. It recommends that a national program should record call-backs of women for annual screening and follow-up data on abnormal mammograms. BCNTF encourages the adoption of these guidelines and monitoring of their results, as well as follow-up of breast cancer epidemiology and registry in Lebanon, and scientific progress in early breast cancer detection to determine needs for modifications in the future

Medication use, gender, and socio-economic status in Lebanon analysis of a national survey

From data collected in Lebanon by the 1999 National Household Health Expenditures and Utilization Survey an analysis was made of reported medication use [n = 14,142]. Seventy-two percent of the population aged 25-64 reported taking a medication in the month preceding the survey. Medications with high frequencies of reported use were analgesics, psychotropics, antibiotics and vitamins. Women were more than one and a half times more likely than men to report taking any medication [OR = 1.6], and significantly more likely to report taking eight of the 19 medication types analyzed. Analyses of the association of medication use with socioeconomic variables show different effects for education and employment [inversely correlated with higher use], and higher socio-economic status [positively correlated with higher use]. Multivariate analyses were carried out on two of the frequently used medications, antibiotic and prescription psychotropie use, to further explore the simultaneous effects of socioeconomic variables The results of the analysis highlight a number of potential areas which may be targeted for intervention, in particular the higher use of antibiotics in rural areas, the greater use of psychotropics by women, and the possible obstacles to obtaining needed medications for those with lower incomes