Commitment to protective measures during the COVID-19 pandemic in Syria: A nationwide cross-sectional study.

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 continues to impose itself on all populations of the world. Given the slow pace of vaccination in the developing world and the absence of effective treatments, adherence to precautionary infection control measures remains the best way to prevent the COVID-19 pandemic from spiraling out of control. In this study, we aim to evaluate the extent to which the Syrian population adheres to these measures and analyze the relationship between demographic variables and adherence. METHODS: This cross-sectional study took place in Syria between January 17 and March 17, 2021. A structured self-administered questionnaire was used to collect the data. The questionnaire was distributed in both electronic and printed versions. Our sample consisted of 7531 individuals. Collected data were analyzed using SPSS v.25. The chi-square test was used to address the correlation between adherence and demographic variables. RESULTS: Of the 10083 reached out, only 8083 responded, and 7531 included in the final analysis with an effective response rate of 74.7%. Of them, 4026 (53.5%) were women, 3984 (52.9%) were single, and 1908 (25.3%) had earned university degrees. 5286 (70.25) were in the high level of adherence category to protective measures. Statistically significant differences were documented when investigating the correlation between commitment to preventive measures and age, sex, marital status, financial status, employment, and educational attainment. Furthermore, those who believed that COVID-19 poses a major risk to them, or society were more committed to preventive measures than those who did not. CONCLUSION: The participants in this study generally showed a high level of adherence to the preventive measures compared to participants in other studies from around the world, with some concerns regarding the sources of information they depend on. Nationwide awareness campaigns should be conducted and focus on maintaining, if not expanding, this level of commitment, which would mitigate the pandemic's impact on Syrian society.

Clinical Characteristics and Prognosis of COVID-19 patients in Syria: A cross-sectional multicenter study.

Background: COVID-19 ignited a global pandemic that, in Syria, further strained a nation and its healthcare system already ravaged by years of war and sanctions. The first case in Syria was reported on March 22, 2020, and this is the first study that aimed to describe the clinical characteristics, comorbidities, and prognosis of COVID-19 patients in Syria. Materials and methods: Demographic and clinical data for this cross-sectional prospective study were collected on COVID-19 patients with positive polymerase chain reaction tests who were admitted to Al Assad and Al Mouwasat university hospitals between April 1 and January 31 of 2021. Results: This study included 701 patients. The majority were over age 60 (59%) and male (67.9%). The commonest symptoms were fever (86.6%) and shortness of breath (75.6%). The commonest comorbidities were hypertension (53.9%) and diabetes mellitus (41.5%). On multivariable analysis, risk factors found to be significantly associated with poor outcomes were advanced age (≥60 years); male gender; high respiratory rate (>35); respiratory failure (PaO2/FiO2 ratio<100); heart failure; chronic lung disease; elevated white blood cell counts, lactate dehydrogenase, c-reactive protein; prolonged international normalized ratio; and low lymphocyte counts. The clinical outcomes of our patients were as follows: 59.2% improved and were discharged from the hospital, 3.5% were discharged with persistent symptoms and 37.2% died. Conclusion: Several biomarkers can serve as early warning and prognostic indicators of severe illness and mortality from COVID-19 in the highest risk patients, especially males with multiple comorbidities over 60 years of age. In the context of a national healthcare system stretched thin by years of civil war and sanctions, and high COVID-19 mortality rates as a consequence, extra care should be taken to use the predictive power of these biomarkers to stratify high-risk patients in the earliest possible stages of the disease to minimize severe illness and reduce fatalities.

Oral cancer knowledge and practice among medical students: A cross-sectional study during the Syrian crisis.

Background: lack of medical practitioners' knowledge about oral cancer has contributed to delays in referral and treatment. Oral cancer is amenable to treatment when detected early, which leads to better prognosis and survival rates. In this study, we aimed to assess the knowledge of the Syrian medical students about the risk factors of oral cancer, oral cavity changes associated with oral cancer, and the relation between the relation with Human Papilloma Virus (HPV) and oral cancer. Methods: This is a cross-sectional study conducted at the Syrian Private University. Data were collected through self-administered questionnaires, which targeted social demographic information, general knowledge, risk factors, oral changes and HPV knowledge associated with oral cancer. Data was categorized and analyzed to assess and compare the levels of knowledge between clinical and preclinical students. Results: 301 out of 401 medical students responded to the questionnaires bringing the response rate to 75.25%. The study revealed adequate knowledge about oral cancer, general information, clinical features, risk factors and relation to HPV. Clinical students showed higher levels of awareness compared to pre-clinical students. No significance in knowledge was found between the genders. Conclusion: The findings of the present study suggest that there is a need to reinforce the medical curriculum concerning oral cancer education, particularly in prevention and early detection to improve practices.

A cross-sectional survey of COVID-19: attitude and prevention practice among Syrians.

Introduction: Coronavirus disease of 2019 has overwhelmed public health systems worldwide and forced governments to impose draconian lockdowns on entire populations. With no vaccine or treatment during the early days of the pandemic, it is of paramount importance to assess the public's awareness about COVID-19 so that prevention-focused educational campaigns can be sufficiently deployed. This study aimed to gauge the Syrian public's adherence to infection control measures by assessing attitudes and practices during the pandemic which ravaged an already war-torn Syria. Methods: The web-based cross-sectional study was conducted in March 2020, nearly 11 years into the Syrian crisis. The survey contained 3 sections: socio-demographic characteristics, attitudes, and practice. Multivariable logistic regression analysis was performed to identify factors associated with good practices and negative attitudes. Data were analyzed using the Statistical Package for Social Sciences version 25.0. Results: Of the 3586 participants, 68.2% were females, 50.8% were unemployed, and 79.2% were college-educated. Only 1402 (39.1%) participants wore face masks when leaving their homes. Multiple logistic regression analysis revealed that female, age, and residence were factors associated with good practices such as avoiding mass gatherings, wearing face masks, and maintaining a 1-meter interpersonal distance. However, age and occupation were factors associated with negative attitudes towards the closure of universities and schools, travel bans, and quarantines for travellers. Conclusion: This survey highlights the need to address specific populations using various measures; there should be a specialized method of prevention for each occupation, age group, and place of residence to contain further outbreaks of COVID-19. This can be achieved through targeted awareness campaigns.

Assessing diabetes mellitus knowledge among Syrian medical students: A cross-sectional study.

BACKGROUND: Diabetes mellitus is the fastest growing global health emergency of the 21st century. The Middle East and North Africa region have the highest prevalence of diabetes in the world. Since medical students are the pillars of future healthcare systems, their knowledge of the disease must be evaluated, updated, and enhanced appropriately. METHODS: A cross-sectional study was conducted at the Syrian Private University (SPU) in November 2019 on World Diabetes Day in Damascus, during the Syrian war crisis. Data were collected through self-administered questionnaires and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). RESULTS: Of the 275 students, 74 (26.9%) were preclinical students and 201 (73%) were clinical students with a mean age of 21.9 (±3.70) years. 67 (25.0%) are overweight, and 26 (9.7%) are obese. Students revealed a good level of knowledge regarding clinical features, risk factors, and complications; however, a lack of knowledge was noticed in the general information and the diagnostic criteria section. Clinical year students (4th, 5th, 6th) demonstrated higher levels of awareness compared to students in pre-clinical years (1st, 2nd, 3rd). CONCLUSIONS: Knowledge and awareness of medical students about diabetes mellitus were found to have some gaps. Health education efforts are required to reinforce its identification and management at all levels, while also encouraging lifestyle modifications among our students.

Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study.

BACKGROUND: Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students' knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors. METHODS: This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother's education, and source of information. Unpaired Student's T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption. RESULTS: Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years). CONCLUSION: This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.

Crisis within a crisis, COVID-19 knowledge and awareness among the Syrian population: a cross-sectional study.

OBJECTIVES: To gauge specific knowledge around clinical features, transmission pathways and prevention methods, and to identify factors associated with poor knowledge to help facilitate outbreak management in Syria during this rapid global rise of the COVID-19 pandemic. DESIGN: Web-based cross-sectional survey. SETTING: This study was conducted in March 2020, nearly 10 years into the Syrian war crisis. The Arabic-language survey was posted on various social media platforms including WhatsApp, Telegram, Instagram and Facebook targeting various social groups. PARTICIPANTS: A total of 4495 participants completed the survey. Participants with a history of COVID-19 infection, residing outside Syria or who did not fully complete the survey were excluded from the study. The final sample of 3586 participants (completion rate=79.8%) consisted of 2444 (68.2%) females and 1142 (31.8%) males. PRIMARY AND SECONDARY OUTCOME MEASURES: First, knowledge of COVID-19 in four areas (general knowledge; transmission pathways; signs and symptoms; prevention methods). Second, factors associated with poor knowledge. RESULTS: Of the 3586 participants, 2444 (68.2%) were female, 1822 (50.8%) were unemployed and 2839 (79.2%) were college educated. The study revealed good awareness regarding COVID-19 (mean 75.6%, SD ±9.4%). Multiple linear regression analysis correlated poor mean knowledge scores with male gender (ß=-0.933, p=0.005), secondary school or lower education level (ß=-3.782, p<0.001), non-healthcare occupation (ß=-3.592, p<0.001), low economic status (ß=-0.669, p<0.040) and >5 household members (ß=-1.737, p<0.001). CONCLUSION: This study revealed some potentially troubling knowledge gaps which underscore the need for a vigorous public education campaign in Syria. This campaign must reinforce the public's awareness, knowledge and vigilance towards precautionary measures against COVID-19, and most importantly aid in controlling the worldwide spread of the disease.