Effectiveness of Rapid Response Team implementation in a tertiary hospital in Egypt: an interventional study.

BACKGROUND: Rapid response teams (RRTs) help in the early recognition of deteriorating patients in hospital wards and provide the needed management at the bedside by a qualified team. RRT implementation is still questionable because there is insufficient evidence regarding its effects. To date, according to our knowledge, no published studies have addressed the effectiveness of RRT implementation on inpatient care outcomes in Egypt. OBJECTIVE: We aimed to assess the impact of an RRT on the rates of inpatient mortality, cardiopulmonary arrest calls and unplanned intensive care unit (ICU) admission in an Egyptian tertiary hospital. METHODS: An interventional study was conducted at a university hospital. Data was evaluated for 24 months before the intervention (January 2018 till December 2019, which included 4242 admissions). The intervention was implemented for 12 months (January 2021 till December 2021), ending with postintervention evaluation of 2338 admissions. RESULTS: RRT implementation was associated with a significant reduction in inpatient mortality rate from 88.93 to 46.44 deaths per 1000 discharges (relative risk reduction (RRR)=0.48; 95% CI, 0.36 to 0.58). Inpatient cardiopulmonary arrest rate decreased from 7.41 to 1.77 calls per 1000 discharges (RRR, 0.76; 95% CI, 0.32 to 0.92), while unplanned ICU admissions decreased from 5.98 to 4.87 per 1000 discharges (RRR, 0.19; 95% CI, -0.65 to 0.60). CONCLUSIONS: RRT implementation was associated with a significantly reduced hospital inpatient mortality rate, cardiopulmonary arrest call rate as well as reduced unplanned ICU admission rate. Our results reveal that RRT can contribute to improving the quality of care in similar settings in developing countries.

Rising trends in Caesarean section in 6 Egyptian governorates.

Background: Caesarean section (CS) is a life-saving operation when vaginal delivery is risky to the mother or baby. However, if not medically indicated or performed under suboptimal conditions, it can be harmful and resource-intensive. Aims: To estimate the prevalence of CS in 6 Egyptian governorates and identify possible risk factors (including demographic, social and healthcare services factors) stratified according to geographical areas. Methods: We used secondary data collected from a large survey to investigate the sociodemographic and health indicators of 6 purposefully selected Egyptian governorates with suboptimal health indicators: 3 from Upper Egypt (Sohag, Assiut and Menia) and 3 from Lower Egypt (Sharkia, Beheira and Ismailia). The survey data were gathered using an interview questionnaire that targeted household members. Results: The CS rate was estimated at 55.1% for the 3 years preceding the study, and the highest rate was 67.8% in Behira and the lowest was 49.0% in Assiut. In most governorates, the CS rate was higher in rural than in urban areas, but the difference was not significant. High CS rates were significantly related to higher social class and lower number of children (≤ 3). Conclusion: In the governorates investigated, CS was performed more often, with higher rates than those reported in the 2015 Egypt Health Issue Survey. The adoption of protocols for elective CS should be enforced with a more multisectoral effort. Pregnant women should be well informed of the risks associated with CS and its medical indications.

Effect of Zinc Supplementation in Children Less Than 5 Years on Diarrhea Attacks: A Randomized Controlled Trial.

Recurrent infections and weak immunity were found to be linked with zinc deficiency especially in children. The goal of this study is to measure the level of blood zinc in children aged 6 months to less than 5 years old, and to assess the effect of 4 months of daily zinc supplements on the incidence and the severity of diarrheal morbidity. A randomized controlled trial study was conducted in Pediatric Outpatient Clinic in Ain Shams University Hospital on 140 children less than 5 years old who are apparently healthy. Random assignment of the sampled children to group receiving zinc (70 children) or group receiving placebo (70 children) was done. A questionnaire containing questions about occurrence of diarrhea was used during follow up. Serum zinc at baseline was measured. The mean age was 25.26 ± 15.7 months. Mean of serum zinc was 51.08 µg/dL, with 70% had low baseline serum zinc level. Cumulative incidence of diarrhea, number of diarrhea episodes per child and frequency of stools/day decreased significantly in zinc group (P < .05). Risk ratio was found to be 0.79, 95% CI: 0.64 to 0.97. we concluded that incidence of diarrhea and its severity reduced in children received zinc daily for 4 months. This trial was registered at www.clinicaltrials.gov as NCT05002101.

Correlates and reproductive consequences of consanguinity in six Egyptian governorates.

This study aimed to explore some correlates and potential reproductive consequences of consanguinity. We analysed data for 8515 ever-married women aged 15-49 derived from a household survey conducted in 2017 in six governorates. The prevalence of consanguineous marriage was 35.9%. The odds (OR (95%CI)) of consanguinity were higher in rural southern governorates (3.68 (3.03-4.46)), with less than secondary education (1.55 (1.42-1.7)), with unemployment (1.74(1.48-2.04)) and in the lowest wealth quintile (3.09 (2.66-3.6)). After adjusting for residence, education, wealth, age at marriage and the number of children; the OR (95%CI) for spontaneous abortion and still births with consanguinity were 1.31 (1.09-1.59) and 1.63 (1.18-2.25) respectively. Consanguinity remains highly prevalent in Egypt especially in rural southern governorates. Women empowerment in terms of attaining higher education and employment may reduce the problem. Consanguinity appears to be associated with adverse reproductive outcomes including spontaneous abortion and still birth.

Attitudes, beliefs and practice of Egyptian healthcare workers towards seasonal influenza vaccination.

BACKGROUND: Seasonal influenza vaccination is highly recommended for healthcare workers (HCWs) every year to protect them and reduce the risk of disease transmission at workplaces. Relatively few studies addressed influenza vaccination in the Eastern Mediterranean Region. OBJECTIVES: The main objective of this study was to explore the attitudes, beliefs and practice of Egyptian HCWs towards seasonal influenza vaccine. METHODS: This is a nationwide cross-sectional study. Data were collected through self-administered structured questionnaire. A sample of 3534 HCWs (physicians and nurses) was collected from different levels of healthcare facilities. RESULTS: The proportion of seasonal influenza vaccine uptake during the last season was 30.7% while the percentage of ever vaccinated was 46.8%. The most identified reason for non-compliance was lack of trust about vaccine efficacy and its adverse events. Around 80% of participants expressed positive attitude towards influenza vaccine and the vast majority (98%) agreed to uptake the vaccine during pandemic. There was significant positive association between attitude score and influenza vaccine uptake. Raising awareness about vaccine and ensuring vaccine availability were the main suggestions by HCWs to improve vaccine uptake. CONCLUSIONS: Although there was positive attitude towards influenza vaccine, yet vaccination coverage was suboptimal particularly among those working in university hospitals. Educational messages and operational strategies addressing motivators and barriers that emerged from this study are needed to optimize vaccine uptake.

Health Literacy Co-Design in a Low Resource Setting: Harnessing Local Wisdom to Inform Interventions across Fishing Villages in Egypt to Improve Health and Equity.

Fishermen in low resource settings have limited access to health services and may have a range of health literacy-related difficulties that may lead to poor health outcomes. To provide solutions and interventions based on their needs, co-design is considered best practice in such settings. This study aimed to implement a co-design process as a step towards developing health literacy interventions to improve health and equity in the Borollos Lake region of northern Egypt, a low resource setting with a high prevalence of chronic diseases. This study was guided by the Ophelia (Optimising Health Literacy and Access) process, a widely used and flexible co-design process that seeks to create local and fit-for-purpose health literacy solutions through genuine engagement and participation of community members and relevant stakeholders. Following a health literacy survey using the Health Literacy Questionnaire (HLQ), cluster analysis was conducted to identify the diverse health literacy profiles among the fishing communities. Seven health literacy profiles were identified. Vignettes, representing these profiles, were presented and discussed in ideas generation/co-design workshops with fishermen and health workers to develop intervention ideas. Seventeen fishermen, 22 wives of fishermen, and 20 nurses participated in four workshops. Fifteen key strategies across five themes, including 'Enhancing education among fishing communities', 'Provide good quality health services', 'Financial support for health', 'Social support for health', and 'Promote better health-related quality of life among fishermen', were generated. The ideas did not only target the individuals but also required actions from the government, non-government organizations, and fishermen syndicates. By harnessing local wisdom, the Ophelia process has created meaningful engagement with the local communities, leading to a wide range of practical and feasible solutions that match the special needs and environment of a low resource setting.

Health literacy strengths and limitations among rural fishing communities in Egypt using the Health Literacy Questionnaire (HLQ).

INTRODUCTION: Health literacy is an important determinant of health. The aim of this study was to use a multi-dimensional measurement tool to describe the health literacy of people living in a fishing community in northern Egypt. METHODS AND ANALYSIS: Data were collected from 436 people (fisherman and their families), using the Health Literacy Questionnaire (HLQ), which includes 9 scales. Effect sizes (ES) for standardized mean differences estimated the magnitude of difference between demographic groups. RESULTS: The mean age of participants was 42 years, 50% were male, 42% were working in the fishing sector, 17.9% had access to the Internet and 36.8% were illiterate. Male participants showed higher capabilities in scales 3. Actively managing my health and 4. Social support for health (ES = 0.21 and 0.27, respectively). In comparison to other occupations, fishing occupation had a negative impact on scale 7. Navigating the healthcare system (ES -0.23). Also, higher educational level was associated with higher HLQ indicators. Across all scales, scale 2. Having sufficient information to manage my health showed the lowest mean (SD) score; 2.23 (0.76) indicating that most people reported they didn't have enough information. CONCLUSIONS: This study has revealed that fishermen and their families have a wide range of health literacy difficulties which are likely to have profound negative effects on health behavior and health outcomes.

Workplace stress and its relation to cardiovascular disease risk factors among bus drivers in Egypt.

BACKGROUND: Driving buses exposes the drivers to many stressors that can increase their cardiovascular risk factors. AIMS: The objective of this study was to measure the prevalence of workplace stress and its association with cardiovascular risk factors among bus drivers in Egypt. METHODS: A cross-sectional study was conducted on 234 bus drivers in Cairo, Egypt. Data were collected over a period of 6 months from August 2016 to January 2017. For all drivers, blood pressure, body weight and height and random blood sugar were measured. Professional driving duration/age ratio was calculated. Comparison between cardiovascular risk factors and workplace stress score was made. Unadjusted and adjusted odds ratios and 95% confidence intervals were calculated using logistic regression models. RESULTS: A high prevalence of workplace stress (83.3%) was observed among bus drivers. Moreover, a high prevalence of cardiovascular risk factors, particularly tobacco smoking (65.0%), physical inactivity (93.6%) and hypertension (33.3%), was noted. After adjustment for age and other confounding factors, the risk factors associated with workplace stress were overweight/obesity and hypertension. CONCLUSIONS: There is a positive association between workplace stress and some cardiovascular risk factors, such as hypertension and overweight/obesity, among bus drivers in Egypt.

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital.

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride (TG), low-density lipoprotein (LDL) and high-density lipoprotein (HDL) were measured in all nurses. The predictors of high TG level were ages 30-39 and ≥ 40 years and night shift. The only predictor of high LDL level (> 130 mg/dl) was age ≥ 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary.

Association of rotating night shift with lipid profile among nurses in an Egyptian tertiary university hospital

The main objective was to identify whether night shift nurses are more prone to dyslipidaemia than day shift nurses. One hundred and fifty female nurses aged 20-49 years were recruited from Ain Shams University Hospitals, Egypt, from January to March 2016: 64 day shift and 86 night shift. Diet type was assessed by interview questionnaire and job satisfaction was assessed using the job satisfaction survey. Triglyceride [TG], low-density lipoprotein [LDL] and high-density lipoprotein [HDL] were measured in all nurses. The predictors of high TG level were ages 30-39 and >/= 40 years and night shift. The only predictor of high LDL level [> 130 mg/dl] was age >/= 40 years. An unhealthy diet and night shift were predictors of risky HDL levels. Seventy nurses were unsatisfied with their jobs, and 137 ate a semi-healthy diet. The findings emphasize that night shift nurses are at risk of abnormal lipid profile, therefore an occupational programme to help nurses cope with their employment conditions is necessary

L'objectif principal de la présente étude consistait à déterminer si les équipes de nuit d'infirmières sont davantage sujettes à la dyslipidémie que les équipes de jour. Cent cinquante infirmières âgées de 20 à 49 ans ont été recrutées dans le centre hospitalier universitaire d'Ain Shams entre janvier et mars 2016, dont 64 travaillant dans des équipes de jour et 86 dans des équipes de nuit. Le régime alimentaire a été évalué dans un questionnaire d'entrevue, et une enquête sur la satisfaction au travail a été menée. Les triglycérides, les lipoprotéines de basse densité [LDL] et les lipoprotéines de haute densité [HDL] ont été mesurées chez toutes les infirmières. Un âge compris entre 30 et 39 ans, et supérieur ou égal à 40 ans, et le travail de nuit constituaient les facteurs prédictifs d'une élévation du taux de triglycérides. Etre âgé de 40 ans ou plus était le seul facteur prédictif d'un niveau élevé de LDL [supérieur à 130 mg/dl]. Un régime alimentaire malsain et le travail en équipes de nuit constituaient des facteurs prédictifs de taux à risque de HDL. Sept infirmières étaient insatisfaites de leur travail, et 137 avaient des régimes alimentaires partiellement sains. Les résultats mettent en évidence le fait que les infirmières qui travaillent en équipes de nuit ont un risque de présenter un profil lipidique anormal. Un programme de santé au travail est donc nécessaire pour aider les personnels infirmiers à faire face à leurs conditions de travail

Work-related and ergonomic risk factors associated with low back pain among bus drivers.

BACKGROUND: Low back pain (LBP) is the most common form of work-related musculoskeletal disorders, which cause huge economic losses to individuals as well as to the community. Bus drivers have been found to be at an increased risk of LBP owing to several factors associated with physical and occupational circumstances. There is scant knowledge on the problems of LBP among bus drivers in Egypt. AIM: To identify the prevalence of LBP among bus drivers and to determine the ergonomic and occupational risk factors associated with this problem. MATERIALS AND METHODS: This is a cross-sectional study including 180 public bus drivers who were interviewed using a questionnaire containing items on some sociodemographic, ergonomic, and occupational characteristics. Lifestyle risk factors such as BMI and history of tobacco smoking were also included in the questionnaire. RESULTS: The prevalence of LBP was high (73.9%). LBP was significantly associated with work duration of more than 10 years, working more than 8 h/day and more number of accidents while driving the bus in the previous year. Regarding ergonomic risk factors, those complaining of uncomfortable seat and steering wheels showed significantly higher prevalence of LBP. CONCLUSION: Public bus drivers in this study experienced high prevalence of LBP, which was associated with long duration of work, driving for more than 8 h daily and uncomfortable seat and steering wheels. Ergonomic and occupational risk factors associated with LBP can be modified by proper organizational strategies and health plans. Therefore, assessment of the sitting biomechanics and regular maintenance of buses are recommended to prevent any adverse health effects.

Prevalence and risk factors of sick building syndrome among office workers.

BACKGROUND: Sick building syndrome (SBS) is a group of symptoms relatively common among office workers; such symptoms could have an impact on the workers' productivity. The aim of this study is to measure the prevalence of SBS symptoms among office workers in the Faculty of Medicine, Ain Shams University, Cairo, Egypt, and to determine the possible risk factors. PARTICIPANTS AND METHODS: A cross-sectional study was carried out at the Ain Shams Faculty of Medicine including 826 workers. Data were collected through a self-administered questionnaire that included sociodemographic and occupational histories, work environment, and symptoms related to SBS. RESULTS: Fatigue and headache were the most prevalent symptoms (76.9 and 74.7%, respectively). Using univariate analysis, poor lighting, poor ventilation, lack of sunlight, absence of air currents, high noise, temperature, humidity, environmental tobacco smoke, use of photocopiers, and inadequate office cleaning were associated statistically with SBS symptoms (P<0.05). High work load and poor job satisfaction were also associated significantly with SBS symptoms (P<0.05). Logistic regression analysis showed that poor ventilation, poor lighting, environmental tobacco smoke, high temperature, poor job satisfaction, and inadequate office cleaning were the risk factors of SBS. CONCLUSION AND RECOMMENDATIONS: SBS was highly prevalent among office workers and was influenced by physical and psychosocial working conditions. Good ventilation, reducing room temperature, effective cleaning routines, providing proper lighting, restricting smoking in the workplace, and improving psychosocial working conditions are important ways to reduce SBS symptoms.