Commitment, partnerships and operational research: three priorities for 11 EMR countries to achieve TB elimination.

BACKGROUND: In 2022, 11 of 22 Member States of the WHO Eastern Mediterranean Region (EMR) had an estimated TB incidence of <20 cases per 100,000 population. We assessed preparedness for elimination and provided recommendations to pursue the process. METHODS: We surveyed 11 EMR national TB programme managers and collected information on eight TB elimination framework domains using a close-ended data collection tool. We compiled, consolidated and validated data, including a virtual consultation before triangulating data with other sources. RESULTS: Implementation was sufficient (≥74%) for 5 of 8 domains, highest for TB infection management, TB preventive treatment, laboratory service, drug management, drug-resistant TB and TB-HIV collaboration (89%, 83% and 78%, respectively). Countries ranked lowest for commitment (73%), operational research and infection control (63%), and partnership/collaborations (41%). Five countries reached >80% when consolidating the responses, reaching sufficient from all domains. Two reached <50%. CONCLUSION: Key identified obstacles to TB elimination in EMR were insufficient commitment/financing, sub-optimal partnerships/collaborations and operational research calling for 1) all-stakeholder-inclusive, sustainably funded TB elimination plans, 2) cost-effective tools to exchange strategic information and build operational research capacity, and 3) improved collaboration.

CONTEXTE: En 2022, 11 des 22 États membres de la Région de la Méditerranée orientale de l'OMS avaient une incidence de la TB estimée à moins de 20 cas pour 100 000 habitants. Nous avons évalué l'état de préparation à l'élimination et formulé des recommandations pour poursuivre le processus. MÉTHODES: Nous avons interrogé 11 responsables de programmes nationaux de lutte contre la TB dans la région de la Méditerranée orientale et recueilli des informations sur huit domaines du cadre d'élimination de la TB à l'aide d'un outil de collecte de données à questions fermées. Nous avons compilé, consolidé et validé les données, y compris lors d'une consultation virtuelle, avant de les trianguler avec d'autres sources. RÉSULTATS: La mise en œuvre était suffisante (≥74%) pour 5 des 8 domaines, les plus élevés étant la gestion de l'infection tuberculeuse, le traitement préventif de la TB, les services de laboratoire, la gestion des médicaments, la TB pharmacorésistante et la collaboration TB-VIH (89%, 83% et 78%, respectivement). Les pays se sont classés au dernier rang pour l'engagement (73%), la recherche opérationnelle et la lutte contre l'infection (63%) et le partenariat/la collaboration (41%). Cinq pays ont atteint >80% lors de la consolidation des réponses, atteignant un niveau suffisant dans tous les domaines. Deux pays ont atteint un taux de réponse inférieur à 50%. CONCLUSION: Les principaux obstacles à l'élimination de la TB dans les pays de l'Union européenne sont un engagement/un financement insuffisant, des partenariats/collaborations sous-optimaux et une recherche opérationnelle nécessitant 1) des plans d'élimination de la TB incluant toutes les parties prenantes et bénéficiant d'un financement durable, 2) des outils rentables permettant d'échanger des informations stratégiques et de renforcer les capacités de recherche opérationnelle, et 3) une meilleure collaboration.

Correlates of unintended pregnancy in Beheira governorate, Egypt.

This study looked at the frequency and determinants of unplanned births among women in Beheira governorate, Egypt, and the effects on antenatal and postnatal care sought by the mother for herself and her child. Unintended births comprised 23.6%; 13.8% were unwanted and 9.8% were mistimed. Contraceptive failure accounted for 28.8% of unintended pregnancies; 47.1% of women who reported unintended pregnancy were not using [corrected] contraception. Age, education and parity were predictors of unwanted pregnancy. Contraceptive use and maternal employment status predicted mistimed pregnancy. Unintended pregnancy was a barrier to antenatal care, but not to child care. Our findings suggest that family planning programmes should help women of reproductive age achieve spacing and fertility limits.

Correlates of unintended pregnancy in Beheira governorate, Egypt

This study looked at the frequency and determinants of unplanned births among women in Beheira governorate, Egypt, and the effects on antenatal and postnatal care sought by the mother for herself and her child. Unintended births comprised 23.6%; 13.8% were unwanted and 9.8% were mistimed. Contraceptive failure accounted for 28.8% of unintended pregnancies; 47.1% of women who reported unintended pregnancy were not using [corrected] contraception. Age, education and parity were predictors of unwanted pregnancy. Contraceptive use and maternal employment status predicted mistimed pregnancy. Unintended pregnancy was a barrier to antenatal care, but not to child care. Our findings suggest that family planning programmes should help women of reproductive age achieve spacing and fertility limits

Knowledge and perception of professionals towards school injuries.

As injuries remain a threat to children everywhere including school, this study was undertaken to reveal the knowledge and perceptions of school physicians, nurses, teachers and social workers regarding school injuries. To accomplish this aim, all school-based clinics operated by a physician were identified. All physicians and nurses were included in this survey. In addition, a teacher or a social worker was randomly selected from the same school. They were requested to fill in a questionnaire to collect relevant information. Findings indicate that school injury is not perceived as a priority problem by all social workers and 68.5% of teachers. Moreover, its economic burden was not perceived by one third of physicians and nurses. Regarding associated risk factors, more than 80% of the surveyed professionals recognized nine out of the 16 stated factors as a risk for school injuries. However, less than 80% viewed that the risk of school injury is higher in technical schools, schools which include more than one educational stage as well as in the evening shift. Moreover, less than 80% of nurses recognized that a higher risk is associated with poorly kept school building, primary schools and methods of transportation. Furthermore, less than 80% of teachers recognized that boys are at a much higher risk of injuries. Surveyed professionals ranked increase supervision, continuous maintenance of school building as well as health education activities as priority preventive strategies. Mass media was the method of health education that received the highest priority while the least were pupils' activities and the organization of an injury prevention day. It can be concluded that, school professionals, exceptionally teachers and social workers need to be aware of the extent of school injuries and the risks associated with their occurrence. Such awareness is the key issue in ensuring the safety of children while they are at school. Moreover, it is indispensable for the planning and implementation of effective preventive strategies. They should also recognize that pupils' involvement is a highly effective mean of creating awareness about safety and to encourage them to take the responsibility of their safety as well as that of other pupils. Organized training programs directed to all personnel in the area of school injuries are deemed essential.

Epidemiology of school injuries in Alexandria.

This study was conducted to reveal the magnitude of school injuries in Alexandria, their epidemiological patterns and outcomes. All pupils attending the casualty department of Alexandria Students' Hospital during the scholastic year 1996-1997 with school injuries were included in this study. An interview questionnaire and a transfer sheet were used to collect relevant information. Data were analyzed and the 5% level was taken to judge the significance of the obtained results. During the study period, 3422 pupils sustained school injuries yielding a rate of 4.25 per 1000. This rate was significantly higher among boys (6.43 per 1000) as well as in secondary schools (8.11 per 1000). Most of these injuries occurred inside the school (72.0%). In relation to school activity, injuries occurred more frequently during breaks (28.1%), school trips (27.8%) and teaching sessions (25.6%). Falls were responsible for 52.3% of the injuries followed by struck by or against (25.2%), while 11.9% were due to road traffic accidents. The most commonly affected sites were the upper (46.2%) and lower (32.1%) limbs as well as the head and neck (16.6%). High proportions of the resulting injuries were minor, however, severe injuries namely, fractures (23.2%) and brain concussions (2.8%) were encountered. Significant differences were observed in this respect in relation to the pupils' gender and educational stage. Only 12.5% of the cases were hospitalized. All recovered completely except four cases of leg amputation and no deaths were recorded. School injuries appear to be a priority area for primary preventive activities. School personnel should receive safety rounds to recognize the potential environmental hazards. Stringent supervision is required in areas and during activities with high frequency of injuries. Moreover, safety education should be incorporated in the curriculum and activities involving school children.

Personal factors and working conditions as predictors of work injuries among industrial workers.

The purpose of this study was to determine the personal factors and working conditions that predict work injuries among industrial workers. To fulfill this aim, a case control study was conducted including 2003 industrial workers who sustained a work injury and an equal number of controls. All were subjected to an interview questionnaire to collect relevant information. Moreover, records were reviewed to obtain the medical history of enrolled workers. Data revealed that workers in the index and control groups are comparable in respect to their sociodemographic characteristics. The multivariate logistic regression analysis pointed out that safety training significantly reduces the risk of work accidents among industrial workers. On the other hand, work accidents are more likely to occur in the main working shift. Moreover, workers who suffer from chronic health problems calling for surgical treatment, as well as those who reported family problems, are more likely to experience work accidents. These workers should receive considerable attention to reduce the extent of work injuries. More importantly, safety-training programs are mandatory for accident prevention in industrial settings.

Child abuse and neglect: mothers' behaviour and perceptions

Mothers' behaviour relating to child maltreatment, their perceptions of such behaviour and its correlates to parents' characteristics and family background were investigated. Women with at least one child under 18 years were targeted and given an interview questionnaire. A high proportion of mothers reported maltreatment behaviour that constituted emotional [69.0%] and physical [57.1%] abuse as well as neglecting the child's safety [43.8%], education [46.1%] and medical care [53.3%]. Mothers tended to perceive neglectful behaviour rather than abusive behaviour as child maltreatment. Child maltreatment was significantly associated with parents' level of education, father's occupation, mother's working status, financial problems, mother's age at the birth of the first child, number of offspring, crowding index and maternal perceptions of maltreatment

Poliomyelitis, measles and neonatal tetanus: a hospital based epidemiological study.

Vaccine-preventable diseases constitute a major health problem contributing to the morbidity and mortality in many developing countries including Egypt. WHO adopted resolutions to eradicate poliomyelitis by the year 2000, eliminate neonatal tetanus by the year 1995, and reduce measles mortality by 95% and morbidity by 90%, compared to the pre-immunization levels by 1995. Evaluation of preventive programs for these diseases necessitates availability of up to date information on their occurrence. The present study was undertaken to determine the current epidemiological features of poliomyelitis, neonatal tetanus and measles, to identify the trends of these diseases as well as to determine their outcomes and hospital loads. Data about the admitted cases of poliomyelitis, neonatal tetanus and measles were collected from the hospital register of Alexandria fever hospital for five successive years (1992-96). Available information on age, sex, residence, diagnosis, outcome of treatment, dates of admission and discharge were collected. The total number of cases of the three diseases admitted to the hospital during the period 1992-96 were 1406, measles represented 85.4%, neonatal tetanus 13.9% and poliomyelitis 0.7%. The results revealed that in the year 1994 only one case of poliomyelitis was admitted and since then no other cases were reported. The number of measles cases increased gradually in the latter years and about 78% of them were older than five years of age. A significant increase in the age of measles occurrence was observed. A gradual decline in the number of neonatal tetanus cases was observed. These cases were more apt to occur among early neonates but still clustered in certain geographical areas. The results of the study pinpoint the long term impact of the well run program aiming at eradicating poliomyelitis in Alexandria. However, for elimination of neonatal tetanus and controlling measles morbidity, further activities are required including strengthening the surveillance activities for detection of the high risk geographical areas and the high risk factors.