Epidemiology and aetiology of the 2023 meningitis outbreak among children in Iraq.

Background: Meningitis is still a major public health challenge globally. Both the viral and bacterial forms of the disease have been reported worldwide. In 2023, around 200 children with suspected meningitis were admitted to hospital in Halabja Governorate, Iraq. No outbreak of meningitis had been reported previously in that region. Aims: To investigate the aetiology and epidemiology of meningitis among children in Halabja Governorate, Iraq, and expedite clinical management and prevention. Methodology: Blood and cerebrospinal fluid specimens were collected from 197 children admitted to Halabja Paediatric and Maternity Teaching Hospital from 1 March to 1 July 2023 and analysed. The sample t-test was used to compare the haematological, serological and biochemical characteristics of the samples. Results: The majority (76.6%) of the children were aged 2-9 years and 54% were males. The clinical manifestations of the disease were fever (100.0%), headache (89.0%), vomiting (85.7%), and photophobia (72.4%); none of the children had convulsions. The mean values for both neutrophil count and C-reactive protein were statistically significantly raised (P < 0.05) and the red blood cells, white blood cells and neutrophil counts, and lactate dehydrogenase values were statistically significantly raised (P < 0.05). The causative organism was enterovirus (98.5%), with sporadic cases of streptococcal meningitis (1.5%). All the patients recovered fully. Conclusion: The rapid diagnosis of the disease was crucial to the therapeutic and prevention control measures for the outbreak. Although it is still unclear how and where this outbreak started, contaminated drinking water and transmission among children in nurseries and schools are suspected. Further investigations are recommended to determine the source of the enterovirus and identify the virus species and serotypes.

Epidemiological trends, antifungal drug susceptibility and SQLE point mutations in etiologic species of human dermatophytosis in Al-Diwaneyah, Iraq.

Dermatophytes show a wide geographic distribution and are the main causative agents of skin fungal infections in many regions of the world. Recently, their resistance to antifungal drugs has led to an obstacle to effective treatment. To address the lack of dermatophytosis data in Iraq, this study was designed to investigate the distribution and prevalence of dermatophytes in the human population and single point mutations in squalene epoxidase gene (SQLE) of terbinafine resistant isolates. The identification of 102 dermatophytes isolated from clinical human dermatophytosis was performed through morphological and microscopic characteristics followed by molecular analysis based on ITS and TEF-1α sequencing. Phylogeny was achieved through RAxML analysis. CLSI M38-A2 protocol was used to assess antifungal susceptibility of the isolates to four major antifungal drugs. Additionally, the presence of point mutations in SQLE gene, which are responsible for terbinafine resistance was investigated. Tinea corporis was the most prevalent clinical manifestation accounting for 37.24% of examined cases of dermatophytosis. Based on ITS, T. indotineae (50.98%), T. mentagrophytes (19.61%), and M. canis (29.41%) was identified as an etiologic species. T. indotineae and T. mentagrophytes strains were identified as T. interdigitale based on TEF-1α. Terbinafine showed the highest efficacy among the tested antifungal drugs. T. indotineae and T. mentagrophytes showed the highest resistance to antifungal drugs with MICs of 2-4 and 4 µg/mL, while M. canis was the most susceptible species. Three of T. indotineae isolates showed mutations in SQLE gene Phe397Leu substitution. A non-previously described point mutation, Phe311Leu was identified in T. indotineae and mutations Lys276Asn, Phe397Leu and Leu419Phe were diagnosed in T. mentagrophytes XVII. The results of mutation analysis showed that Phe397Leu was a destabilizing mutation; protein stability has decreased with variations in pH, and point mutations affected the interatomic interaction, resulting in bond disruption. These results could help to control the progression of disease effectively and make decisions regarding the selection of appropriate drugs for dermatophyte infections.

Molecular epidemiology of the Old World screwworm fly (OWSF) in Iraq, and the genetic structure of various OWSF populations worldwide.

Despite being endemic in Iraq, no reports have been published in the past 10 years to update the molecular epidemiology of the Old World screwworm fly (OWSF), Chrysomya bezziana, in this country. In the present study, 130 sheep from 10 Iraqi governorates were found infected with C. bezziana larvae, whose identities were PCR-confirmed based on the cytochrome b (Cytb) gene, and 23 isolates from various tested governorates were successfully sequenced. Although most isolates (n = 20) belonged to the common haplotype circulating in Iraq, two new haplotypes were detected. Significant changes in OWSF epidemiology in Iraq were also suggested, since infestations were detected, for the first time, in Nineveh governorate. Isolates of the present study were combined to those previously published from Iraq and worldwide, collected after searching the GenBank, and various genetic and population structure analyses were conducted. These isolates displayed a great statistically significant value when tested for the purifying (negative) selection, suggesting the limited occurrence of genetic variations, which was evidenced by the high sequence conservation (C = 0.937) value detected. A few isolates from Africa were revealed during our search, and clustered in a separate lineage other than that of the Asian isolates. The latter displayed different genetic variation patterns when compared. For example, isolates from geographically separate regions, e.g., the Gulf Arab countries and South-Eastern Asia had marked genetic differences. On the other hand, isolates from regions with close geographic proximity (the Gulf Arab countries and Iran) had limited genetic subdivision. This is not the case when comparing isolates from 10 islands in the Indonesian Archipelago. Populations from Sumatra and Sumba were isolated and displayed high genetic variations toward the other populations. On the contrary, populations from Sulawesi, Lombok and Sumbawa displayed limited genetic variations. This is particularly important, since it can help detecting the dynamics of establishing the sterile insect technique over various regions as an effective control strategy against the OWSFs.

Physiological and epidemiological study of some parasitic and viral enteric infections in dromedary camels in Al-Muthanna province.

Understanding the normal physiology of the body is the key to study the changes that occur due to any infection. It is known that enteric infections play a considerable role in affecting normal body status. Thus, this study was designed for investigating the enteric infections in Arabian camels in Al-Muthanna Province. In this investigation, 588 fecal and blood serum samples (for diarrheic camels only) were collected from the camels in different areas of Al-Muthanna Province, Iraq from both sexes of different ages during the period from October 2020 up to the end of August 2021. The samples were examined using routine microscopic examination techniques, hematological techniques, and ELISA for parasitic and viral identification. Eimeria rajasthani, Isospora orlovi were recorded for the first time in Iraqi camels with clinical signs of diarrhea, dehydration, and emaciation. The study recorded four types of protozoa: Eimeria spp., Isospora, Cryptosporidium and Balantidium coli. The recorded types of Eimeria were E. dromedarii, E. cameli, and E. rajasthani. There was a significant effect of age on infection rates with Eimeria spp. as the highest Eimeria ratio was in ages of less than two years animals. The infection rates were also affected with months which reached the highest ratios of Eimeria in October while the lowest ratio of Eimeria was recorded in July. BVDV infection rate was found in camels that suffered from diarrhea. There is no significant effect of sex on the onset of the viral disease in camels. For hematological parameters, there were significant differences in RBCs, WBCs, Hb, and PCV values in protozoal and BVDV infections. In conclusion, different kinds of protozoal and viral infections were recorded. Some of the recorded infections were associated with acute clinical signs and have zoonotic importance.

An overview of neuro-ophthalmic disorders at Jenna Ophthalmic Center, Baghdad, Iraq (2021-2022).

Neuro-ophthalmic disorders are often documented individually for each illness, with little data available on their overall incidence and pattern. The overall incidence of neuro-ophthalmic illnesses in Iraq is still not recorded. This study aimed to evaluate the clinical, demographic, and etiological features of patients seeking consultation at an Iraqi neuro-ophthalmology clinic. A prospective cross-sectional observational research was conducted at the Janna Ophthalmic Center in Baghdad, Iraq. The center serves a diverse patient population from various governorates. All newly diagnosed patients with neuro-ophthalmic disorders who visited the neuro-ophthalmological clinic, regardless of gender or age group, were included. The neuro-ophthalmologist established a diagnosis for each case by reviewing the patient's medical history, doing physical examinations, administering specific tests, and, in certain cases, using neuroimaging methods. The duration of the study was extended from March 2021 to November 2022. Among the 6440 patients evaluated, 613 cases were confirmed at the neuro-ophthalmology clinic. Ischemic optic neuropathy (NAION, AION, and PION) was the most prevalent diagnosis, accounting for 17.61% of newly reported cases in the field of neuro-ophthalmology. This was followed by sixth nerve palsy. Diabetes mellitus affected 42.7% of the cases, followed by hypertension, which affected 39.3% of the participants. The incidence of neuro-ophthalmic diseases tended to be high. Ischemic optic neuropathy and sixth nerve palsy, traumatic/compressive optic neuropathy, and papilledema were the most common neuro-ophthalmic disorders reported.

First detection of Koi herpesvirus disease (KHVD) in Garmian, Kurdistan region of Iraq: A clinical and molecular study.

INTRODUCTION: Koi herpesvirus disease (KHVD) is attributed to cyprinid herpesvirus-3 (CyHV-3) and predominantly affects common carp and ornamental koi carp (Cyprinus carpio). This viral infection leads to substantial morbidity and mortality among these fish species. This study aimed to confirm the presence of KHVD in the Kurdistan region of Iraq by employing clinical and optimized molecular assays on fish populations experiencing high mortality among common carp in carp farms. METHODOLOGY: The present research was conducted in the Kalar district, situated at the heart of Garmian province in Iraqi Kurdistan. four samples from common carp fish farms were received by our laboratory. These samples specifically displaying clinical signs associated with koi herpesvirus (KHV) infection, were subjected to clinical examinations, and PCR assay in addition to sequence analysis. RESULTS: The results of the current study revealed that the observed clinical signs, particularly gill necrosis, skin lesions, and sunken eyes, closely resembled the clinical signs of KHVD in common carp fish. In addition, PCR, nested PCR, and sequence analysis assay detected appropriate DNA fragments of the CyHV-3 major capsid protein gene confirming the first detection of KHVD in common carp fish in the Kurdistan region of Iraq. CONCLUSION: In this study, the results confirm the detection of KHVD in the Kurdistan region, Iraq, for the first time. This study revealed that CyHV-3 was responsible for KHVD-related signs and symptoms. Based on these results, it is strongly recommended that comprehensive studies be initiated to investigate the prevalence and distribution of CyHV-3.

Predictive modeling of multi-class diabetes mellitus using machine learning and filtering iraqi diabetes data dynamics.

Diabetes is a persistent metabolic disorder linked to elevated levels of blood glucose, commonly referred to as blood sugar. This condition can have detrimental effects on the heart, blood vessels, eyes, kidneys, and nerves as time passes. It is a chronic ailment that arises when the body fails to produce enough insulin or is unable to effectively use the insulin it produces. When diabetes is not properly managed, it often leads to hyperglycemia, a condition characterized by elevated blood sugar levels or impaired glucose tolerance. This can result in significant harm to various body systems, including the nerves and blood vessels. In this paper, we propose a multiclass diabetes mellitus detection and classification approach using an extremely imbalanced Laboratory of Medical City Hospital data dynamics. We also formulate a new dataset that is moderately imbalanced based on the Laboratory of Medical City Hospital data dynamics. To correctly identify the multiclass diabetes mellitus, we employ three machine learning classifiers namely support vector machine, logistic regression, and k-nearest neighbor. We also focus on dimensionality reduction (feature selection-filter, wrapper, and embedded method) to prune the unnecessary features and to scale up the classification performance. To optimize the classification performance of classifiers, we tune the model by hyperparameter optimization with 10-fold grid search cross-validation. In the case of the original extremely imbalanced dataset with 70:30 partition and support vector machine classifier, we achieved maximum accuracy of 0.964, precision of 0.968, recall of 0.964, F1-score of 0.962, Cohen kappa of 0.835, and AUC of 0.99 by using top 4 feature according to filter method. By using the top 9 features according to wrapper-based sequential feature selection, the k-nearest neighbor provides an accuracy of 0.935 and 1.0 for the other performance metrics. For our created moderately imbalanced dataset with an 80:20 partition, the SVM classifier achieves a maximum accuracy of 0.938, and 1.0 for other performance metrics. For the multiclass diabetes mellitus detection and classification, our experiments outperformed conducted research based on the Laboratory of Medical City Hospital data dynamics.

Serostatus of Coxsackie B in a sample of women with miscarriage in Baghdad, Iraq.

BACKGROUND: The antibody that crosses transplacentally from mother to fetus is very important origin of protective passive immunity against infection neonatal with enterovirus. Important varieties of coxsackievirus B3 (CVB3) are responsible for infections in newborns. The purpose from this study is to investigate in the prevalence of Coxsackie B virus in a sample of Iraqi women with miscarriage and potential role of miscarriage risk. METHODS: Between November 2022 and June 2023, we included 91 parturient women (gestational age: 4-20 weeks) who were between the ages of 15 and 40. Every participant completed a questionnaire, and blood was drawn to assess maternal antibodies against CVB3. RESULTS: The blood seropositive rates were 46 out 91(50.54%), 2 out 46 were IgM positive (4.34%), (8-12 weeks) 23 from 46 (50%) (p-value 0.0294) gestational age more frequent among aborted women that positive for anti-coxsackie B antibody, The 25-35 age group was significantly overrepresented (51/91, 56%) compared to other age groups. CONCLUSION: This investigation posits Coxsackie B virus (CBV) as a possible etiology for miscarriage in the Iraqi female population. Further studies employing larger cohorts and robust methodologies, beyond the current detection technique, are warranted to corroborate these observations and elucidate the potential mechanisms by which CBV might induce miscarriage.

The impact of miRNA-155 in acute and chronic toxoplasmosis in Iraqi women.

Toxoplasmosis is a prevalent parasitic infection caused by Toxoplasma gondii known to induce complex immune responses, to control the infection. MicroRNAs (miRNAs) are a cluster of small noncoding RNAs that are reported to have regulatory functions in the immune response. The objective of this study is to assess the expression of miR-155 and its targets, Src homology-2 domain-containing inositol 5- phosphatase 1 (SHIP-1) and suppressor of cytokine signaling-1 (SOCS1), in non-pregnant Iraqi women seropositive for toxoplasmosis. The study included 55 non-pregnant women positive for toxoplasmosis (20 in the acute phase and 35 in the chronic phase) and 35 non-pregnant women negative for toxoplasmosis (control group). Serum samples were collected from all participants to investigate the expression of miR-155 by RT‒PCR, in addition to the levels of SOCS1 and SHIP-1 measured by ELISA. The results showed a significant increase in the expression of miR-155 in both groups of acute and chronic toxoplasmosis compared to the control group. Lower levels of SOCS1 and SHIP-1 were found in acutely infected women compared to those with chronic infection and non-infected women. These findings showed the possible critical impact of miR-155 on host immune response during T.gondii infection, proposing that miR-155 can be explored as a prospective target to support host immune response against infectious diseases, with special help in early detection and management of toxoplasmosis in high-risk immunocompromised patients. Further studies are needed to evaluate the molecular pathways by which miRNAs improve immunity against toxoplasmosis.

Premarital Screening is Pivotal in Reducing the Births of Babies Affected with Thalassemia Major in Iraq.

Thalassemia major is one of the health problems in Iraq, especially in Kurdistan. Pre-marriage mandatory preventive screening program was established in Kurdistan in 2008, which allowed us to study the prevalence of different hemoglobinopathies among newly married young adults in this region. A total of 1154 subjects (577 couples) attending the Koya district, premarital Health center, were screened using red cell indices. Those who had mean corpuscular volume (MCV)<80 fl and mean corpuscular hemoglobin (MCH)<27 pg had high-performance liquid chromatography and iron studies. Out of 1154 individuals that were evaluated, 183 (11.9%) had low MCV and MCH. Of the former 183 subjects, 69 (5.97%) had ß-thalassemia trait, 10 (0.86%) had δß-thalassemia trait, and no other hemoglobinopathies were recorded in our study. There was second-degree consanguinity in 4.7% of all 577 couples. In two couples, both partners had ß-thalassemia trait and both were consanguineous. Both couples decided to separate after counseling. Based on the current study, the role of the premarital screening program in decreasing the number of new thalassemia major cases among the Kurdish population is laudable. Therefore, mandatory premarital screening is advised in all parts of Iraq.

Microbial risk assessment of dairy products from retail marketplaces in Basrah province, Iraq.

Background: Milk-borne bacteria cause degradation of milk products and constitute a significant risk to public health. Aim: The objectives of the present study are to determine the microbiological quality of dairy products and to investigate pathogenic microorganisms. Methods: A total of 60 samples of raw milk, homemade cheese, and yogurt were randomly selected from different retail marketplaces in Basrah. The bacteriological and biochemical tests were utilized to identify the pathogens in dairy samples, as well as the molecular technique was used as an accurate diagnostic test. Results: The prevalence of contamination of milk products with various isolates was estimated as 50% (95% Cl: 36.8-63.2). The mean of total bacteria count for cheese was 7.29 ± 2.70, raw milk 4.62 ± 2.86, and yogurt 2.87 ± 1.05, with a significant p-value (p = 0.001). The mean count of aerobic spore-forming (ASF) contaminated raw milk was analyzed as 3.77 ± 1.18 and less contamination detected in the yogurt samples with mean of ASF was estimated as 2.52 ± 1.47 SD log 10 CFU/ml. A range of important microorganisms to human health were identified by employing the VITEK_2 system and sequencing 16S rDNA gene, including Staphylococcus aureus, Escherichia coli, Pseudomonas aerogenosa, and Bacillus cereus. Conclusion: The study indicates that there is a high level of bacterial contamination in dairy products with different bacteria species, which is medically important. Therefore, food safety management must be implemented to reduce biological risks carried by dairy products and ensure healthy food for consumers.

The first molecular investigation of Besnoitia besnoiti infections among cattle in Mosul, Iraq.

BACKGROUND: Bovine besnoitiosis (elephant skin disease) caused by Besnoitia besnoiti is a costly endemic disease in the Middle East, Asia, and tropical and subtropical Africa and is also emerging as a significant problem in Europe. This study is aimed at determining the prevalence of B. besnoiti in blood and skin biopsies of cattle as well as evaluating the risk factors associated with the infection among cattle in Mosul, Iraq. METHODS AND RESULTS: To achieve this aim, four hundred and sixty apparently healthy cattle of different breeds, ages, and sexes were sampled from seven different locations in Mosul, Iraq. Blood and skin biopsies were carefully collected from each cattle, and these samples were subjected to molecular analysis. The detection of B. besnoiti was molecularly confirmed by the presence of 231 bp of ITS-1 in the rDNA gene of the protozoan. Besnoitia besnoiti DNA was present in 74 (16.09%; 95% CI = 13.01-19.72) and 49 (10.65%; 95% CI = 8.15-13.80) of the blood and skin biopsies, respectively, that were analyzed. Age, breed, and sex were significantly (p < 0.05) associated with the occurrence of B. besnoiti among cattle in the study area. CONCLUSIONS: Findings from this study will serve as baseline data in the epidemiology, prevention, and control of the protozoan among cattle in Iraq.

THE RELATION OF THYROID DISTURBANCE AND ISCHEMIC HEART DISEASE IN IRAQI PATIENTS.

This study conducted in Baghdad focused on patients with coronary heart disease admitted to three hospitals. The study included 60 Iraqi patients with coronary heart disease and a control group of 30 healthy individuals. Blood samples were collected from both groups after fasting. The study analyzed the demographic characteristics of the patients and control group, including age groups, sex distribution, and BMI. The majority of patients had hypertension, while 58.33% had diabetes. The study found that IHD patients had significantly higher T3 and T4 levels compared to the control group. However, there was no significant difference in TSH levels. The study also examined thyroid function parameters among different age groups and found no significant differences in individuals with hypothyroidism. The highest prevalence of hyperthyroidism was among individuals with hypertension, while the highest spread of hypothyroidism was among individuals with diabetes. The study observed significant differences in mean HbA1c levels among the three groups, with the highest levels in patients with hypothyroidism. In conclusion, this study suggests potential alterations in thyroid function associated with ischemic heart disease and emphasizes the need for further research on the clinical implications and underlying mechanisms involved.

Examining the Impacts of the COVID-19 Pandemic on Iraqi Refugees in Canada.

The COVID-19 pandemic has exacerbated health and social inequities among migrant groups more than others. Higher rates of poverty, unemployment, living in crowded households, and language barriers have placed resettled refugees at a higher risk of facing disparities during the COVID-19 pandemic. To understand how this most vulnerable population has been impacted by the ongoing pandemic, this study reports on the responses of 128 Iraqi refugees in the city of London, Ontario, to a survey on the economic, social, and health-related impacts that they have faced for almost two years since the beginning the pandemic. The analysis of the survey indicated that 90.4% of the study population reported having health concerns during the pandemic while 80.3% expressed facing financial distress. The results also show that 58.4% of respondents experienced some form of social isolation. These all suggest that refugees are faced with several barriers which can have a compounding effect on their resettlement experience. These findings provide resettlement and healthcare providers with some information that may assist in reducing the impact of COVID-19 and other possible health security emergencies on resettled refugees and their communities.

Role of endoplasmic reticulum aminopeptidase-1 gene polymorphism (rs13167972) in occurrence susceptibility of ankylosing spondylitis in a sample of Iraqi male patients.

BACKGROUND: Ankylosing spondylitis (AS) is a chronic and systemic seronegative inflammatory spondyloarthropathy, an autoimmune disease that has been associated with impaired Endoplasmic Reticulum Aminopeptidase (ERAP)-1 activity, which is involved in priming antigenic peptides. The purpose of this study is to investigate the association of 3-UTR of ERAP1 gene polymorphism (rs13167972) with the AS occurrence susceptibility in a sample of Iraqi male patients. METHODS: The AS patients were diagnosed clinically and by magnetic resonance imaging (MRI) and other clinical and laboratory criteria like symptoms, increased C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR). The blood grouping and Body Mass Index (BMI) were also investigated to be associated with AS occurrence. The genotyping of the 3-UTR region of the ERAP1 gene (rs13167972) was done by Sanger sequencing. RESULTS: The results revealed that the AS occurred significantly in the age group of 20-35 years (p = 0.013). The BMI shows that the AS patients were overweighted males (p = 0.013) and the most predominant blood group in AS patients was O- (p = 0.002). The ESR and serum level of CRP were significantly raised in AS patient sera (< 0.001). The results of the receiver-operating characteristics curve analysis (ROC) revealed that the CRP (AUC: 0.995, cut-off: 2.48 mg/L, had 95% %sensitivity, 100% specificity, p < 0.001) is more discriminative than BMI (AUC: 0.300, cut-off: 46.91 kg, had 0% sensitivity, 100% specificity, p = 0.001), and ESR (AUC: 0.808, cut-off: 7.50 mm/hr, had 60% sensitivity, 88% specificity, p < 0.001) in distinguishing between AS patients and control group. The genotyping of the 3-UTR region of ERAP1 gene (rs13167972) result shows that the AG and GG genotypes are significantly occurring in AS patients (70%, OR: 2.33, 95%CI: 1.02-5.36, p = 0.04). The G allele is significantly occurring in AS patients (47%, OR: 2.07, 95CI%: 1.15-3.71, p = 0.01). CONCLUSION: The AS occurred in young overweight males with blood group O-. The AG and GG genotypes are risk factors for AS development while the G allele is a risk factor that increases the chances for disease incidence.

Molecular Detection of a Pathogenic Entamoeba among Symptomatic Children in Eastern Kurdistan of Iraq.

Entamoeba histolytica infects the large intestine of humans, causing a spectrum of clinical appearances ranging from asymptomatic colonization to severe intestinal and extra-intestinal disease. The parasite is identical microscopically to commensal nonpathogenic amoeba. To detect the pathogenic Entamoeba and estimate the precise prevalence of the parasite among the symptomatic pediatric population using molecular techniques. 323 fecal samples were collected from symptomatic children admitted to Sulaimani Pediatric Teaching Hospital, Sulaimaniyah Province, Iraq, from June to October 2021. A structured, validated questionnaire was prepared and used to report participants' gender, residency, and drinking water source. Then, stool samples were microscopically examined, and the positive samples were submitted to molecular analysis by amplifying the 18s rRNA gene using nested PCR to differentiate E. histolytica from other nonpathogenic Entamoeba. Finally, gene sequences were done to confirm the species. Microscopically, 58 positive samples represented Entamoeba species infection rate of 18% among symptomatic patients. However, only 18 samples were positive for E. histolytica based on molecular methods, which accounts for 31% of the positive by microscopy and 5.6% among the 323 symptomatic populations. NCBI, available in their database, gives the gene sequence and accession number. Patients' sociodemographic data and water sources were directly related to the infection rate. Classical microscopic examination provides a misleading profile about the prevalence of E. histolytica in an endemic region that might lead to unnecessary treatments and a lack of appropriate management for patients.

Intensification of integrated immunization services to recover routine vaccination coverage and bring COVID-19 vaccine to the population of Iraq in 2022.

INTRODUCTION: COVID-19 seriously impacted routine immunization (RI) in Iraq. Coverage declined to a 6-year low in 2021, and COVID-19 vaccination uptake was slow. In response, government implemented intensification of integrated immunization services (3IS), a nationwide approach comprising regular outreach sessions of COVID-19 vaccination and RI for children who had either missed doses or never commenced scheduled vaccination (zero-dose children). We describe the 3IS and its impact on vaccination coverage in Iraq. METHODS: 3IS comprised new outreach sessions for urban and rural communities where administrative data suggested there were gaps in coverage. Groups of six personnel from each of 1,321 primary healthcare centres implemented six outreach sessions per month during February-November 2022. Community engagement was an integral component. We compared RI administrative data (2019-2022) and data reported during 3IS activities to assess its impact. RESULTS: In total 4,189,859 vaccine doses were administered during 72,495 3IS outreach sessions, over one-fifth of 19,106,849 vaccine doses administered in Iraq over these 10 months. Among them, 957,874 (22.9 %) were COVID-19 vaccines, adding slightly to national coverage, and 3,231,985 (77.1 %) were RI vaccines, dramatically reducing zero-dose children, adding 18 %, 25 %, 21 %, and 31 % to 2022 penta1, penta3, measles first-dose and MMR1 vaccine coverage, and contributing to national coverage of 102.2 %, 94.5 %, 91.8 % and 96.3 % for these vaccines during February-November, respectively. Moreover, 3IS sessions delivered 133,528 doses of tetanus toxoid, 16,353 doses of adult HepB vaccine, and 315,032 vitamin A doses to eligible individuals. CONCLUSION: In the context of global encouragement to integrate vaccination services, Iraq's 3IS approach enabled dramatic improvements in RI coverage, virtual elimination of zero-dose status among children born during the pandemic, and small improvements in COVID-19 and adult vaccination. Our findings provide lessons for future integrated primary care towards universal health coverage in Iraq, and for other countries yet to undertake integration.

A systematic review of the epidemiology of suicide in Iraq and Kurdistan region.

OBJECTIVES: The suicide rate has increased in Iraq in recent years, making it a major public health concern. This systematic review examines the prevalence of suicidal behaviours in the Iraq and Kurdistan region. MATERIALS AND METHODS: This study adhered to the PRISMA guidelines, conducting searches on PubMed, MEDLINE, Web of Science, and Google Scholar. Out of 153 initially identified publications, only 18 full articles met the inclusion criteria, with 135 articles excluded due to reasons such as eligibility criteria, duplication, predatory publications and lack of relevance and lack of quality data. RESULTS: The suicide crude rate in Iraq (excluding Kurdistan) rose from 1.09 to 1.31 per 100,000 between 2015 and 2016, while Kurdistan had an estimated rate of 3.83 per 100,000 during the same period. Limited data on reference group sizes and population figures make specific rate calculations challenging. Suicide is more prevalent among women, those aged 15-40, and individuals with mental disorders. Contributing factors include domestic violence, mental health issues, and traditional norms. Urban residents generally have higher suicide rates than rural residents. Common suicide behaviours include self-immolation, hanging, firearms, jumping from heights, and self-poisoning with pesticides. CONCLUSION: The prevalence of suicide in Iraq, as indicated by this systematic review, requires urgent attention and effective public health initiatives. The interplay of social, economic, cultural, and psychological factors emphasizes the need for comprehensive prevention programs. Additionally, a crucial requirement is the implementation of a standardised method for collecting suicide data to improve epidemiological understanding.

The violent death toll from the Iraq War: 2003-2023.

From the beginning of the Iraq war, in March of 2003, to the present day, controversy has swirled around the death toll of the war. This paper narrows down the range of uncertainty for the numbers and trends in violent deaths in the war. I assemble and appraise all primary sources that cover the period from March of 2003 onwards-six sample surveys plus a casualty recording project (Iraq Body Count [IBC]). Data permitting, I present cumulative monthly figures with, for the surveys, 95% bootstrapped uncertainty intervals. The analysis uncovers a core of high-quality mainstream sources that are highly consistent with each another. In addition, there are three outlier surveys that are compromised by serious flaws and produce estimates far outside the mainstream. Discarding the outlying and flawed surveys reveals a clear picture of the violent death toll from the Iraq war. IBC figures, extended to include combatants, occupy a central position within the mainstream range of estimates. The strong consistency across the high-quality sources provides a rare validation of three war-death-measurement methodologies-household-based surveys, sibling-based surveys, and casualty recording. Methodological success notwithstanding, we must transcend the numbers to truly comprehend the human costs of the war.

Prevalence of Taenia ovis (sheep measles) in small ruminants slaughtered by unlicensed butchers in Iraq capital city.

This study was aimed at investigating the prevalence of Taenia ovis (sheep measles) in sheep and goats among the unlicensed butcher's settings in Bagdad, Iraq. A total of 1194 sheep comprising 798 males and 396 females were inspected and out of these 41 and 17 (5.1 and 4.2%) were positive of T. ovis respectively. In goat a total of 162 comprising 122 males and 40 females were inspected out of which 39 and 19 (31.9 and 47.5%) were positive for T. ovis for male and female respectively. In this study, the prevalence of T. ovis in sheep of <18 months of age (5.3%) was higher as compared to those in sheep of over 18 months of age (4.9%), the prevalence of T. ovis was higher in male sheep (5.1%) as compared to the female sheep (4.2%). The trend of the prevalence of this parasite in goats was different from what was obtained in sheep, in this case the prevalence was higher in female goats as compared to male goats. Also the prevalence of T. ovis was significantly higher in older goats as compared to younger goats. For the breed the trend was similar to that of sheep where the local breed harbored more of T. ovis as compared to the imported breeds. Our results suggest that the high prevalence of the T. ovis infestations in the unlicensed butcher's settings is of great concern for public health, therefore authorities are to design a preventive program to curtail this problem.