Development of a World Health Organization Programme for School Mental Health in the Eastern Mediterranean Region

Background: Schools provide an exceptional opportunity for mental health promotion and intervention. Aims: To describe the development of a World Health Organization (WHO) School Mental Health Program (SMHP) in the Eastern Mediterranean Region. Methods: Two tenets guided development of the SMHP: (1) it used a multitiered system of support framework including 3 tiers of interventions (universal, early and targeted); and (2) interventions must be feasible for implementation by non-mental health professionals. Results: The WHO SMHP is organized into a background section, followed by 3 modules: Social–Emotional Childhood Development; Mental Health Promoting Schools (Promotion and Prevention); and Addressing Student Mental Health Problems in Your Classroom, including specific classroom strategies and case examples. Conclusion: Developing an appropriate curriculum sensitive to the needs of individual countries requires involvement of those familiar with schooling in those countries, with mental health priorities and practices that promote mental health, and to coalesce school staff, parents and community members in the service of their children.

Precipitation Variability and Probabilities of Extreme Events in the Eastern Mediterranean Region (Latakia Governorate-Syria as a Case Study)

This study aimed at analysis of the general-index change for the mean annual and seasonal precipitation in six stations in Latakia Governorate (Syria). The data of precipitation were collected for 40 consecutive years (1970–2010) in order to figure out the extent of the changes and variability in precipitation rates and the impact of this change on changes in the potential density that might cause extremely high or low precipitation rates according to Gumbel distribution of the extreme precipitation rates. Results revealed a decrease of the annual precipitation rates in all stations, the reduction in precipitation ranged from 46 to 210 mm during the whole period of the study. Spring, however, recorded the highest and statistically significant reduction, which reached 46–210 mm, while winter precipitation increased by 21–82 mm. Spring also has witnessed a decrease of about 3–9% of the total annual precipitation as compared to winter precipitation which increased by 5–8% of the total. The potential density of extremely high winter precipitation rates increased in all stations as indicated from Gumbel distribution in winter, and a greater increase took place in the probabilities of occurrence of the extremely low spring precipitation rates. This shows significant probability of occurrence of drought during spring season. By contrast, probabilities of winter precipitation rates increased more, thus winter is relatively more humid than before and spring is relatively drier than before.

Microbial Load of Chicken Shawerma and the Handlers’ Compliance with Food Safety Practices in Jordan

Background: Shawerma is a popular traditional food in the Eastern Mediterranean region. Aim: The aim of this study was to assess the shawerma handlers’ compliance with food safety practices and determine the microbial load and pathogenic organisms in the ready-to-eat chicken shawerma sandwiches in the restaurants of Amman, Jordan. Methods: This cross-sectional study used mixed methods including observational checklists to determine the compliance of food safety practices by 120 chicken shawerma handlers from 40 randomly selected restaurants in Amman. Additionally, pathogenic microorganisms were assessed by laboratory analysis in the ready-to-eat chicken shawerma sandwiches. Results: Only 2.5% and 10% complied, respectively, with separating knives and boards used for chicken from the ones used for vegetables. The compliance for maintaining proper temperatures for freezers and chillers were only 62% and 67%, respectively. As for hand-washing techniques and using disposable drying papers, the adherence was 5% and 7.5%, respectively. Laboratory analysis showed that 27.5% of the ready-to-eat shawerma had unacceptable levels of microorganisms. Conclusion: Our findings showed poor compliance of food safety practices in chicken shawerma restaurants of Amman. There is a need for capacity building and periodic evaluations of food handlers’ knowledge and practices within a comprehensive food safety program, carried out by qualified trainers. Keywords: chicken shawerma, food safety, Jordan

A Protocol for a Scoping Review Comparative Bibliometric Analysis of Infectious Disease Research in Africa

Introduction: Evidence on authorship trends of health research conducted about or in Africa shows that there is a lack of local researchers in the first and last authorship positions, with high income country collaborations taking up these positions. The differences in authorship calls into question power imbalances in global health research and who benefits from the production of new discoveries and innovations. Health studies may further go on to inform policy and clinical practice within the region having an impact on public health. This paper aims to compare the differences in authorship between COVID-19 and relevant infectious diseases in Africa.Materials and Methods: We will conduct a bibliometric analysis comparing authorship for COVID-19 research during a public health emergency with authorship for four other infectious diseases of relevance to Africa namely: Ebola, Zika Virus (ZIKV), Tuberculosis (TB) and Influenza. Our scoping review will follow the framework developed by Arksey and O'Malley and reviewed by Levac et al. We will search MEDLINE (Ovid), African Index Medicus (AIM), Eastern Mediterranean Region (IMEMR) Index Medicus, Embase (Ovid), and Web of Science (Clarivate). We will compare the different trends of disease research between the selected diseases. This study is registered with OSF registries and is licensed with the Academic Free License version 3.0. The open science registration number is 10.17605/OSF.IO/5ZPGN.

“…All of a sudden, I realized I was not well prepared for the transition”: A Qualitative Exploration of University Students’ Perspectives on the Emergency Distance Education amidst the COVID-19 Crisis in Jordan

Our current study aimed at exploring the university students’ perspectives on the emergency distance education strategy that was implemented during the COVID-19 crisis in Jordan, one of the countries in the Eastern Mediterranean Region. Utilizing a qualitative design supported by Moore’s theory of transactional distance, a total of 17 semi-structured interviews were conducted with university students of various study levels and disciplines. Data were inductively analyzed using thematic analysis as suggested by Braun and Clarke. Seven themes have emerged, including, (i) psychological response, (ii) digital preparedness and equality, (iii) technical competencies and technostress, (iv) interpersonal communication, (v) learning materials, (vi) non-reliable evaluation methods, and (vii) opportunities. Our findings provide evidence that the sudden transition from traditional on-campus to the online distance education was significantly challenging in many aspects and was not a pleasant experience for many participants. Various factors under the jurisdiction of academic institutions and decision-makers are considered main contributing factors to the students’ educational experiences amid the pandemic crisis. Therefore, better planning and more sustainable utilization of educational resources have paramount importance in providing a high-quality education. Additionally, more dedicated efforts in terms of equitable, reliable, and credible evaluation systems should be considered in Jordan’s distance education strategy.

Estimated 24 Hour Urinary Sodium and Potassium Excretion in a Population of Moroccan Adults

Background: Excessive sodium (Na) intake and low potassium (K) intake are associated with adverse cardiovascular health outcomes. Morocco lacks data on actual Na and K intake in adults. The aim of this study was to estimate the mean intake of Na and K in a Moroccan population of adults using the 24-h urinary excretion and to examine their association with blood pressure (BP). Methods: A total of 371 adults, who participated in the urinary validation sub-study of the STEP-wise Survey-Morocco-2017-2018, have complete data on demographic, anthropometric and blood pressure and have provided a valid 24-h urine collection according to the standard protocol of the World Health Organization (WHO). Results: The mean 24-h urinary sodium excretion was 2794 mg (SD, 1394) and the median was 2550 mg (IQR, 1780-3726). The mean 24-h urinary potassium excretion was 1898 mg (SD, 1044) and the median was 1640 mg (IQR, 1170-2410). Sodium excretion was between 3000 and 5000 mg/day in 31% of participants, < 3000 mg/day in 64%, and > 5000 mg/day in only 5%. No significant association of urinary sodium or potassium with blood pressure was found. Conclusion: Sodium intake in the studied population of Moroccan adults was higher than WHO recommendation and was comparable to levels reported in countries from Eastern Mediterranean Region. The vast majority of participants had a sodium intake < 5000 mg/day, with only 5% were above this level. Potassium intake was in the range of 1000 to 3000 mg/day. Within these ranges, there was no association between sodium or potassium intake and blood pressure. This information is crucial to help implement the national strategy to reduce sodium intake as a cost-effective intervention to prevent chronic disease in Morocco.

Prevalence of nephropathy among type two diabetes patients in Eastern Mediterranean Region: A systematic review and meta-analysis

Objectives: The global epidemic of Diabetes Mellitus exerts a substantial burden on health services. This high prevalence of diabetes leads to an increase in diabetic complications, especially diabetic nephropathy, a leading cause of end stage renal disease and renal replacement therapies. Due to its’ the high prevalence reported by Individual studies in EMR, we conducted a meta-analysis of relevant studies to estimate diabetic retinopathy in EMR.Method: We searched for the relevant keywords in title and abstract of Medline/PubMed, Scopus, Embase, Web of knowledge, and Gray literature from Jan 1st, 2000 to December 13, 2019. The two-step screening was carried out by two independent researchers and relevant data were extracted. Estimation of summary proportions, subgroup analysis, meta-regressions, and publication bias assessment were performed. Results: Out of 3,225 identified citations, 38 articles were entered into meta-analysis, involving 112,235 patients. The prevalence of nephropathy in type two diabetes was 26.34% (95% confidence interval (CI)= 21.04, 32%); and it was 30.42% (95% CI= 23.38, 37.94%) in males and 22.1% (95% CI= 16.05, 28.79%) in females. The meta-regression analysis showed that HDI, publication year, mean duration of diabetes, mean age, and diagnostic test were not significant moderators (p = .332, .725, .280, .220, and .468, respectively).Conclusions: Diabetic nephropathy high prevalence in EMR implicates the importance of diabetes screening, periodic examinations, diabetes care, and risk factor controls. Large-scale longitudinal studies should be conducted in EMR.

COVID-19 financing strategies for refugees and migrants in the Eastern Mediterranean Region

Background: The COVID-19 pandemic has had devastating consequences on health care systems worldwide. While the world was slowly moving towards achieving health for all, the pandemic destroyed progress made over the past 25 years and exposed the vulnerability of health care systems and health insurance schemes as well as their lack of resilience. Heath care systems failed to respond in a timely and efficient manner, lives have been, and continue to be, lost and vulnerable populations, especially refugees and migrants, are more at risk than ever as many are left out of country vaccination programmes. Aims: The Eastern Mediterranean region hosts 13 million internally displaced persons and 12 million refugees as of 2018. Thus, adopting inclusive health financing mechanisms is crucial to addressing the crisis and protecting indigenous and displaced populations. Methods: By looking at regional best practices and the response of the United Nations, we outline possible financing tools for including refugees and migrants in health insurance schemes for COVID 19 and introduce novel solutions for addressing gaps in funding. Results: Among the suggested solutions are the inclusion of refugees and migrants in national health care systems, setting up community-based health insurance for migrant and refugee populations, as well as introducing a catastrophe bond financing scheme. Conclusions: While COVID-19 is far from over, many countries in the EMR have included migrants in their COVID-19 vaccine rollout plans. While this is not the first instance of inclusion in some countries, many others are unable or do not prioritize migrants in their health systems, to the detriment of the entire country. This paper, therefore, tackles the possible health financing measures which curb or prevent migrants from accessing such systems and presents possible solutions to change the status quo.

Correlation of Caesarean Section Rates to Maternal and Neonatal Mortality in the Eastern Mediterranean Region; A Population-Based Ecological Study

The physiological reaction of postocclusive local reactive hyperemia is regulated by neurovascular mechanisms and it reflects the function of microcirculation. Thermoregulatory changes occur first, in the form of increased skin surface temperature, which is usually followed by an increase in local blood flow. This study investigated a correlation between tourniquet duration on the upper arm, and the appearance of reactive hyperemia in the distal parts of the upper limb. Changes were registered with infrared thermometer and infrared thermography, which provided us a highly precise view of distribution of reactive hyperemia. Changes of oxygen saturation of peripheral arterial blood and blood pressure were also recorded. Our research has shown that longer duration of tourniquet leads to more intense and longer lasting reactive hyperemia in the palmar region, followed by higher temperatures of the skin surface, without any changes in postocclusive values of SpO2. Keywords: Infrared thermography, Microcirculation, Postocclusive hyperemia, Skin temperature, Tourniquet, Thermoregulatory changes.