scholarly journals Access to fludrocortisone and to hydrocortisone in children with congenital adrenal hyperplasia in the WHO Eastern Mediterranean Region: it takes a village…

2021 ◽  
Vol 6 (10) ◽  
pp. e007195
Author(s):  
Amanda Rowlands ◽  
Asma Deeb ◽  
Asmahane Ladjouze ◽  
Rasha T Hamza ◽  
Salwa A Musa ◽  
...  
Keyword(s):  
Congenital Adrenal Hyperplasia ◽  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Essential Medicines ◽  
Low Income Countries ◽  
Pharmaceutical Companies ◽  
High Morbidity ◽  
Adrenal Hyperplasia

Congenital adrenal hyperplasia (CAH), if untreated, carries high morbidity and mortality. A higher incidence of CAH is expected in countries where consanguinity is common, such as in the countries of the WHO Eastern Mediterranean Region (EMRO). CAH is managed through lifelong treatment with fludrocortisone and hydrocortisone. In this analysis, performed in the 22 EMRO countries and territories plus Algeria, we review which countries offer a neonatal screening programme for CAH and describe the barriers and opportunities to access oral fludrocortisone and oral and injectable hydrocortisone. Neonatal CAH screening was only available nationally in Qatar, Kuwait and partially in Lebanon and Saudi Arabia. We reviewed the national lists of essential medicines (NEMLs) and found that 13/23 (57%) countries included fludrocortisone and 18/23 (78%) included oral hydrocortisone. Fludrocortisone was not included by any of the low-income countries and oral hydrocortisone was only included by one low-income country. We then contacted paediatric endocrinologists in each country to assess perceived availability of these medicines. Overall, there was a relatively good consistency between inclusion of fludrocortisone and hydrocortisone in the NEML and their actual availability in a country. We propose several mechanisms to improve access, including prequalification by the WHO, a common registration process for groups of countries, pooled procurement, working with local pharmaceutical companies, special access status for medicines not yet registered in a country and compounding. We suggest that access to medicines requires a collaboration between health professionals, families of patients, health authorities, pharmaceutical companies and the WHO.

scholarly journals The Burden of Mental Disorders in the Eastern Mediterranean Region, 1990–2013

2017 ◽  
Vol 41 (S1) ◽  
pp. S156-S157 ◽  
Author(s):  
R. Charara ◽  
A. Mokdad
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Mental Disorders ◽  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Low Income Countries ◽  
Years Of Life Lost ◽  
Life Years

The eastern Mediterranean region (EMR) is witnessing an increase in mental illness. With ongoing unrest, this is expected to rise. This is the first study to quantify the burden of mental disorders in the EMR. We used data from the global burden of disease study (GBD) 2013. DALYs (disability-adjusted life years) allow assessment of both premature mortality (years of life lost–YLLs) and nonfatal outcomes (years lived with disability–YLDs). DALYs are computed by adding YLLs and YLDs for each age-sex-country group. In 2013, mental disorders contributed to 5.6% of total disease burden in EMR (1894 DALYS/100,000 population): 2519 DALYS/100,000 (2590/100,000 males, 2426/100,000 females) in high-income countries, 1884 DALYS/100,000 (1618/100,000 males, 2157/100,000 females) in middle-income countries, 1607 DALYS/100,000 (1500/100,000 males, 1717/100,000 females) in low-income countries. Females had a greater proportion of burden due to mental disorders than did males of equivalent ages, except for those under 15 years. The highest proportion of DALYs occurred in the 25–49 age group. The burden of mental disorders in EMR increased from 1726 DALYs/100,000 in 1990 to 1912 DALYs/100,000 in 2013 (10.8% increase). Depressive disorders accounted for most DALYs, followed by anxiety disorders. Palestine had the largest burden of mental disorders. Nearly all EMR countries had a higher mental disorder burden compared to global level. Our findings call for EMR health ministries to increase provision of mental health services and to address stigma of mental illness. Our results showing the accelerating burden of mental health are alarming as the region is seeing an increased level of instability.

scholarly journals Tackling Childhood Stunting in the Eastern Mediterranean Region in the Context of COVID-19

Children ◽  
2020 ◽  
Vol 7 (11) ◽  
pp. 239
Author(s):  
Ayoub Al Jawaldeh ◽  
Radhouene Doggui ◽  
Elaine Borghi ◽  
Hassan Aguenaou ◽  
Laila El Ammari ◽  
...  
Keyword(s):  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Reduction Rate ◽  
Eastern Mediterranean Region ◽  
Low Income Countries ◽  
Number Of Children ◽  
Important Health ◽  
Childhood Stunting ◽  
Children Under 5

Over 20 million children under 5 years old in the WHO Eastern Mediterranean Region have stunted growth, as a result of chronic malnutrition, with damaging long-term consequences for individuals and societies. This review extracted and analyzed data from the UNICEF, WHO and the World Bank malnutrition estimates to present an overall picture of childhood stunting in the region. The number of children under 5 in the region who are affected by stunting has dropped from 24.5 million (40%) in 1990 to 20.6 million (24.2%) in 2019. The reduction rate since the 2012 baseline is only about two fifths of that required and much more rapid progress will be needed to reach the internationally agreed targets by 2025 and 2030. Prevalence is highest in low-income countries and those with a lower Human Development Index. The COVID-19 pandemic threatens to undermine efforts to reduce stunting, through its impact on access and affordability of safe and nutritious foods and access to important health services. Priority areas for action to tackle stunting as part of a comprehensive, multisectoral nutrition strategy are proposed. In light of the threat that COVID-19 will exacerbate the already heavy burden of malnutrition in the Eastern Mediterranean Region, implementation of such strategies is more important than ever.

scholarly journals Variation in COVID-19 among Eastern Mediterranean Region countries: A comparative study

2020 ◽  
Author(s):  
Ahmed Hassan Albelbeisi ◽  
Ali Albelbeisi ◽  
Abdel Hamid El Bilbeisi ◽  
Amany El Afifi ◽  
Mahmoud Taleb
Keyword(s):  
Low Income ◽  
Death Rate ◽  
Mediterranean Region ◽  
United Arab Emirate ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Screening Tests ◽  
Low Income Countries ◽  
Substantial Variation ◽  
The World

Abstract Objective: Coronavirus disease 2019 (COVID-19) is spreads in 216 countries and territories among the world including all Eastern Mediterranean Region countries. The aim of the present study was to examine variation of COVID-19 in different income class countries of the Eastern Mediterranean Region. Methods: Five parameters such as the percentage of variation COVID-19 confirmed cases, the percentage of variation number of deaths, death rate per 1000 confirmed cases, the percentage of variation death rate per 1000 confirmed cases, and tests per one million were calculated. Results: The results demonstrated that all Eastern Mediterranean Region countries increase in percentage of COVID-19 confirmed cases except Tunisia, the increasing range from 53.5% in Libya to 4.7% in Morocco. Death rate per 1000 confirmed cases range from 230.1 in Yemen to 0.92 in Qatar. Majority of countries increase in percentage of COVID-19 deaths cases number, which range from 43.7% in Iraq to 1.4% in Morocco. Fourteen countries decrease in percentage of death rate per 1000, the decreasing range from 34.9% in Libya to 0.09 in Yemen. The tests per one million range from 265687 in United Arab Emirate to four in Yemen. Conclusion: The current study findings showed significant variations between the Eastern Mediterranean Region countries, the substantial variation is concerning. The low-income countries appeared more vulnerable compared to high-income countries; the low-income countries should not be alone with this pandemic. Hence then global should be helping these countries and particular plans have to be employed. These must include screening tests COVID-19 virus.

scholarly journals Nutritional Anaemia and Obesity in the Eastern Mediterranean Region: The Protective Role of Breastfeeding for Two Years

2018 ◽  
Author(s):  
Azza Abul-Fadl ◽  
Afaf Tawfik ◽  
Ayoub Al-Jawaldeh
Keyword(s):  
Pregnant Women ◽  
Low Income ◽  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Eastern Mediterranean Region ◽  
Protective Role ◽  
Overweight And Obesity ◽  
Low Income Countries ◽  
Income Groups

Background: The preexistence of obesity with nutritional anaemia is becoming an increasing problem in the Eastern Mediterranean Region (EMR). Much controversy exists around the role of continued breastfeeding in alleviating the health and survival consequences of these problems in the region. Aim: To examine trends and relationships of nutritional anaemia (NA) in women and children under-five years of age (CU5) with obesity and breastfeeding practices in the EMR. Methods: Data from regional database banks of WHO and UNICEF for anaemia in pregnant and non-pregnant women and CU5 from 22 countries in EMR were retrieved, compiled, and statistically analyzed. Breastfeeding indicators for timely first suckle (TFS), exclusive breastfeeding (EBF) and continued breastfeeding for 12 (BFC12) and 24 months (BFC24), low-birth-weight (LBW), stunting, overweight, total fertility rates (TFR) and mortality rates (MR) were correlated with nutritional anaemia and analyzed by income groups into 5 low income countries (LIC), 11 middle income countries (MIC) and 6 high income countries (HIC). Results: Trends in mean prevalence of anaemia in women showed a concave curve increasing after a short decrease in the early 2000 in all income groups (P > 0.05). Trends in anaemia in the CU5 exhibited a steep decrease from a mean of 52.59 ± 16.4 in 2000 to 37.3 ± 14.9 in 2016 at P < 0.002, the steep decline was significant in HIC (P < 0.01) and MIC (P < 0.02), but not for LIC (P > 0.05). Anaemia prevalence in women and CU5 was significantly correlated to LBW, stunting, and with overweight and obesity in adults but negatively in CU5. All age specific MRs were highly correlated with anaemia in pregnant, non-pregnant and CU5 at P < 0.001 and TFR at P < 0.05. BFC for shorter durations was negatively correlated with anaemia in pregnant women (r-0.5) at P < 0.05 and was positively correlated in MIC and HIC. In non-pregnant women, BFC12 and BFC 24 correlated positively with anaemia prevalence in all three income groups at P < 0.01. Conclusions: Completing optimal breastfeeding for two years should be promoted to protect women and CU5 from anemia and obesity. Nutritional anemia during pregnancy increases regional rates of LBW, stunting and mortality. Spacing out births by encouraging longer duration of breastfeeding, to replenish iron stores, can help alleviate many of the health and nutritional problems in the region.

scholarly journals Global Prevalence Estimates of Toxascaris leonina Infection in Dogs and Cats

Pathogens ◽  
2020 ◽  
Vol 9 (6) ◽  
pp. 503
Author(s):  
Ali Rostami ◽  
Seyed Mohammad Riahi ◽  
Vahid Fallah Omrani ◽  
Tao Wang ◽  
Andreas Hofmann ◽  
...  
Keyword(s):  
Mediterranean Region ◽  
Eastern Mediterranean ◽  
Meta Analysis ◽  
Eastern Mediterranean Region ◽  
Global Prevalence ◽  
Stray Cats ◽  
Prevalence Estimates ◽  
Meta Regression ◽  
Paratenic Hosts ◽  
Toxascaris Leonina

Toxascaris leonina is an ascaridoid nematode of dogs and cats; this parasite affects the health of these animals. This study estimated the global prevalence of Ta. leonina infection in dogs and cats using random effects meta-analysis as well as subgroup, meta-regression and heterogeneity analyses. The data were stratified according to geographical region, the type of dogs and cats and environmental variables. A quantitative analysis of 135 published studies, involving 119,317 dogs and 25,364 cats, estimated prevalence rates of Ta. leonina in dogs and cats at 2.9% and 3.4%, respectively. Prevalence was highest in the Eastern Mediterranean region (7.2% for dogs and 10.0% for cats) and was significantly higher in stray dogs (7.0% vs. 1.5%) and stray cats (7.5% vs. 1.8%) than in pets. The findings indicate that, worldwide, ~26 million dogs and ~23 million cats are infected with Ta. leonina; these animals would shed substantial numbers of Ta. leonina eggs into the environment each year and might represent reservoirs of infection to other accidental or paratenic hosts. It is important that populations of dogs and cats as well as other canids and felids be monitored and dewormed for Ta. leonina and (other) zoonotic helminths.

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