Health status in selected post-communist European countries: a comparative study between Poland and Albania.

OBJECTIVES: The aim of this analysis was to compare selected health status indicators of the Albanian and Polish populations, pertinent to two former communist countries in Central and Eastern Europe (CEE). METHODS: This analysis was based on the estimates related to the Global Burden of Disease (GBD) 2019 study, reported by the Institute for Health Metrics and Evaluation (IHME). For Poland, IHME uses data mainly from the Central Statistical Office of Poland, whereas for Albania the information is based on the reports from the National Institute of Statistics. RESULTS: In 2019, life expectancy at birth was slightly higher in Albania compared to Poland (78.5 years vs. 78.1 years, respectively). Mortality rate from noncommunicable diseases was similar in both countries (about 520 deaths per 100,000 population). In 2019, the main risk factor for the overall mortality in both countries was the high systolic blood pressure. In Albania, high systolic blood pressure accounted for almost 32% of deaths from all causes, whereas in Poland it accounted for only 21% of all deaths. The second main risk factor in Albania concerned the dietary factors which were responsible for almost one in four deaths. In Poland, the second main risk factor for all-cause mortality concerned tobacco which was responsible for one in five deaths. The third leading risk factor in Albania was tobacco (responsible for one in five deaths), whereas in Poland it concerned the dietary risks (responsible for about 19% of the all-cause mortality). CONCLUSIONS: This analysis provides useful information about the current health status of two populations pertinent to the former Communist Bloc in CEE. While health indicators can provide important information about the differences in health status between populations, it is important to interpret these indicators in the context of the specific challenges and limitations facing each country.

Health policy developments in the Western Balkan Countries 2000-19: towards European Health and Health Care Policies.

BACKGROUND: Albania, Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia have committed to becoming European Union (EU) member states. This, among others, implies that candidate/potential candidate states adopt legally authorized EU policies, including health. The study aims to identify the main country-specific health policy areas critical to the EU accession health policy dimension and present the change in associated selected health indicators from 2000 to 2019. METHODS: The study draws on published reports and analyses of official statistics over time and cross-country. Health care policy adherence to the European Commission's recommended country-specific health actions was classified into five health policy areas: financing, payment, organization, regulation and persuasion. Key health policy areas for Western Balkan countries (WBCs) were identified. Health progress or lack thereof in catching up to the EU15 population health, health expenditure and the number of health professionals are measured. RESULTS: The European Commission prioritized financing and regulation for all WBCs in the five policy areas. Nine of the 18 analyzed selected health indicators showed divergence, and the other nine converged towards the EU15 averages. WBCs continue to face diverse public health challenges in improving life expectancy at birth, death rates caused by circulatory system diseases, malignant neoplasms, traffic accidents, psychoactive substance use, tuberculosis incidence, tobacco smoking prevalence and public-sector health expenditure. CONCLUSIONS: By 2019, there is limited evidence of WBCs catching up to the average EU15 health levels and health care policies. Closer attention towards EU health and health care policies would be favourable.

Prevalence of malocclusion and oral health-related factors among pre-school children in Northern Albania.

The aim of the present study was to investigate prevalence and association between malocclusion and caries among pre-school children aged 4-6 years frequenting public kindergartens in Shkodër, the largest city in North Albania. The sample for this descriptive and cross-sectional study included 389 pre-school children aged 4-6 years frequenting 20 public kindergartens in Shkodër, the largest city in North Albania. The participants were divided into two groups according to their caries experience evaluated, as determined by decayed-missing-filled index dmf (World Health Organization criteria) score. Those with dmf score of zero were considered to be free of caries. The prevalence of children with at least one malocclusion trait was 89%. The prevalence of caries was 66% (mean dmf score: 3.63). Increased overbite (43%), followed by increased overjet, were the most prevalent malocclusion traits observed in children with a dmf of zero. Among children with caries, the most prevalent trait was increased overjet (42%) and increased overbite. Almost half of the entire study population had a straight terminal plane and class I canine relationship. There was a similar prevalence of bilateral crossbite. Significant changes (p = 0.008) were observed between the groups with regards to the absence of spacing in the maxillary anterior region. Regression analysis further revealed that children with an absence of maxillary spacing were 2.564-fold more likely to have caries; those with a deepbite were 0.814-fold more likely to have caries. More than half of the children had caries. Increased overjet, overbite, crossbite and maxillary crowding were malocclusion traits observed in the population included in this study. A positive association was identified between maxillary crowding, deepbite and caries. The association between malocclusion and caries, highlights the necessity for an increased awareness of these two conditions that are commonly found among children of pre-school age.

Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania.

BACKGROUND: Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation. OBJECTIVE: The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania. METHODS: We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation. RESULTS: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation. CONCLUSION: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation.

What do we know about the epidemiology and the management of human echinococcosis in Albania?

Echinococcosis is a life-threatening neglected zoonotic disease. Cystic echinococcosis (CE) due to Echinococcus (E.) granulosus usually involves livestock and dogs; alveolar echinococcosis (AE) due to E. multilocularis involves rodents and canines such as foxes and dogs. Human hosts are infected accidentally via hand to mouth and/or foodborne/waterborne pathways. Albania is deemed to be endemic for cystic echinococcosis (CE), but there is a scarcity of data to confirm this. A systematic literature search was performed in PubMed, Google Scholar, and in other medical sources. Because of the scarcity of existing information, data confirming CE cases were reviewed from the medical hospital records of Albania's largest Hospital, the Mother Teresa University Hospital (UHCMT) Tirana, and from a large private laboratory in Tirana (Pegasus laboratory). A total of eight eligible publications on 540 CE patients were found. Three hundred forty seven additional cases hospitalized in UHCMT from 2011 to 2020 were confirmed, as well as 36 laboratory cases and 10 Albanian cases notified in Germany. Taking all cases into account and considering 162 overlapping cases, 771 cases were documented from 2011 to 2020. The only case reported as AE was most likely a multi-organic CE. Surgery was the most frequent therapy approach used (84.7%). Autochthonous human CE seems to be widespread, and transmission is ongoing in Albania. CE patients in Albania undergo surgery more frequently compared with CE cases in other European countries. In order to establish a realistic estimate of prevalence and incidence of CE in Albania, mandatory notification should be reinforced. Stage-specific therapy can be used in CE to reduce therapy cost and diminish mortality by avoiding surgical overtreatment.

Maternal and Perinatal Outcomes of Pregnant Patients with Coronavirus Disease 2019: Data from a University Hospital Setting in Tirana, Albania, May 2020 to November 2021.

Scientific evidence suggests an increased risk of maternal and obstetric complications in pregnant patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study is aimed at evaluating perinatal and maternal outcomes among patients with coronavirus disease 2019 (COVID-19) in a university hospital setting. This was a prospective cohort study of 177 pregnant women with confirmed SARS-CoV-2 infection at a tertiary hospital between May 2020 and November 2021. Both symptomatic and asymptomatic women with a positive reverse transcription-polymerase chain reaction test result at any time during pregnancy were included in this study. For the purpose of this study, we classified COVID-19 cases into two groups: mild and severe cases. The two groups were then compared to predict how the clinical presentation of COVID-19 affected adverse maternal and perinatal outcomes. Gestational age ≥ 20 weeks at the time of infection was significantly associated with the occurrence of severe forms of the disease (relative risk (RR) 3.98, p = 0.01). Cesarean section was the preferred mode of delivery, with 95 women (62.1%) undergoing surgery. A total of 149 neonates were delivered to women who had confirmed SARS-CoV-2 infection at any time during the course of pregnancy of which thirty-five (23.5%) were admitted to the neonatal intensive care unit (NICU). Severe forms of COVID-19 increased the risk of premature delivery (RR 6.69, p < 0.001), emergency cesarean delivery (RR 9.4, p < 0.001), intensive care hospitalization (RR 51, p < 0.001), and maternal death (RR 12.3, p = 0.02). However, severe forms of SARS-CoV-2 infection are not directly responsible for low birth weight or the need for neonatal resuscitation. Our findings suggest that pregnant women presenting with severe COVID-19 disease are at an increased risk of adverse maternal and perinatal outcomes, such as premature delivery, cesarean section, admission to the ICU, and maternal death. Infection after the 20th week of gestation increases the risk of developing severe forms of the disease.

Screening for Depression in Cardiovascular Patients in Albania: Findings from the Country Check-Up Program.

This is a retrospective study conducted in Vlora from January 2016 to April 2017 and the aim was to report the prevalence of depression in cardiovascular (CVD) patients. Depression assessment was done using the Patient Health Questionnaire (PHQ)-9 (PHQ-9). Data were derived from the patient records and the standard recommended cut-off point of PHQ-9 ≥ 10 was used. In total, data of 300 patients were analyzed. Depressive symptoms (PHQ-9 ≥ 10) were observed at 6% of the participants. Trouble falling asleep or staying asleep or sleeping too much, feeling tired or having little energy and having little interest or pleasure in doing things were the most common symptoms reported. In multivariate analysis, only family status showed statistical significance. Unmarried (mean rank = 207.22) are more likely to have moderate or severe depression level (OR 3.529; C.I. 95% 1.017-12.238). Future research should focus on the needed actions after depression screening (i.e. referral, treatment etc.).

Circulation of Enteric Viruses in Tirana, Albania: Situation Ten Years After the First Study.

A variety of enteric bacteria, viruses and protozoa are the leading causes of morbidity and mortality worldwide. To understand the evolution of gastroenteritis in Albania, in terms of distribution of aetiological pathogens, a one-year observational study was repeated in 2017, ten years after the first study performed in 2007. The data still show a clear circulation of viruses that cause gastroenteritis. Compared to the previous study in 2007, the data from the 2017 study showed the incidence of Norovirus and Adenovirus were significantly higher (p value <0.05), while Rotavirus was verified at a similar incidence rate.

Household Air Pollution and High Blood Pressure: A Secondary Analysis of the 2016 Albania Demographic Health and Survey Dataset.

Background: Hypertension is a significant public health problem in low- and middle-income countries (LMICs). This study aimed to examine the association between household air pollution (HAP) and blood pressure using data from the 2016 Albania Demographic Health and Survey (DHS). Methods: We computed the odds ratio (OR) for the prevalence of hypertension between respondents exposed to clean fuels (e.g., electricity, liquid petroleum gas, natural gas, and biogas) and respondents exposed to polluting fuel (e.g., kerosene, coal/lignite, charcoal, wood, straw/shrubs/grass, and animal dung). Result: The results show that participants exposed to household polluting fuels in Albania were 17% more likely to develop hypertension than those not exposed to household air pollution (OR = 1.17, 95% CI 1.10 to 1.24). Subgroup analysis revealed that the odds of hypertension were more significant among women (OR = 1.22, 95% CI 1.13 to 1.31), rural residents (OR = 1.12, 95% CI 1.04 to 1.22), and participants aged >24 years (OR = 1.35, 95% CI 1.12 to 1.62) who were exposed to household polluting fuels compared to their counterparts who were not exposed. In summary, the results of the study show significant associations between household air pollution and hypertension risk overall, especially among women, rural dwellers, and people aged >24 years in Albania. Conclusion: In this study, an association between household air pollution and the risk of hypertension was found, particularly among low-income households, those with no education, women, and those who live in rural areas.

COVID-19 vaccine effectiveness among healthcare workers in Albania (COVE-AL): protocol for a prospective cohort study and cohort baseline data.

INTRODUCTION: Critical questions remain about COVID-19 vaccine effectiveness (VE) in real-world settings, particularly in middle-income countries. We describe a study protocol to evaluate COVID-19 VE in preventing laboratory-confirmed SARS-CoV-2 infection in health workers (HWs) in Albania, an upper-middle-income country. METHODS AND ANALYSIS: In this 12-month prospective cohort study, we enrolled HWs at three hospitals in Albania. HWs are vaccinated through the routine COVID-19 vaccine campaign. Participants completed a baseline survey about demographics, clinical comorbidities, and infection risk behaviours. Baseline serology samples were also collected and tested against the SARS-CoV-2 spike protein, and respiratory swabs were collected and tested for SARS-CoV-2 by RT-PCR. Participants complete weekly symptom questionnaires and symptomatic participants have a respiratory swab collected, which is tested for SARS-CoV-2. At 3, 6, 9 months and 12 months of the study, serology will be collected and tested for antibodies against the SARS-CoV-2 nucleocapsid protein and spike protein. VE will be estimated using a piecewise proportional hazards model (VE=1-HR). BASELINE DATA: From February to May 2021, 1504 HWs were enrolled. The median age was 44 (range: 22-71) and 78% were female. At enrolment, 72% of participants were seropositive for SARS-CoV-2. 56% of participants were vaccinated with one dose, of whom 98% received their first shot within 4 days of enrolment. All HWs received the Pfizer BNT162b2 mRNA COVID-19 vaccine. ETHICS AND DISSEMINATION: The study protocol and procedures were reviewed and approved by the WHO Ethical Review Board, reference number CERC.0097A, and the Albanian Institute of Public Health Ethical Review Board, reference number 156. All participants have provided written informed consent to participate in this study. The primary results of this study will be published in a peer-reviewed journal at the time of completion. TRIAL REGISTRATION NUMBER: NCT04811391.

Risk factors for poor outcome of patients with Coronavirus disease 2019 (COVID-19) in Albania.

INTRODUCTION: The study aims to identify potential risk factors for the poor outcome of hospitalized patients with SARS-CoV-2 infection in Albania. METHODOLOGY: A retrospective observational study on 133 consecutive hospitalized patients at "COVID 1" Hospital, University Hospital Center of Tirana. The study analyzed the correlation between potential risk factors and in-hospital mortality. RESULTS: The study included 133 patients, 65.4% of the patients were male, age 60.46 ± 13.53 years. The mortality rate resulted in 22.6%. Univariate analysis revealed that early risk factors for mortality included: laboratory alterations on admission, such as lymphocytes count < 1.000/mm3 (OR = 3.30, 95% CI = 1.17-9.33), lactate dehydrogenase > 250 U/L (OR = 12.48, 95% CI = 1.62-95.78) and D dimer > 2 mg/L (OR = 4.72, 95% CI = 1.96-11.36); lung parenchymal involvement > 75% on chest computed tomography on admission (OR = 54.00, 95% CI = 11.89 - 245.11). Cox proportional hazard regression showed that independent risk factors for mortality were lung parenchymal involvement > 75% on chest computed tomography (HR = 8.31, 95%CI: 1.62-42.45) and occurrence of complications during hospital stay (OR = 10.28, 95% CI = 2.02-52.33). CONCLUSIONS: The risk of poor outcome can be predicted from the early stage of COVID 19 disease, using laboratory data and chest computed tomography. Among patients with COVID 19, lung parenchymal involvement and alterations > 75% on chest computed tomography on admission and laboratory findings, such as lymphocytopenia, and elevated lactate dehydrogenase and D dimer levels, turned out to be early risk factors for in-hospital mortality.

Relationship of Anthropometric Indicators of General and Abdominal Obesity with Hypertension and Their Predictive Performance among Albanians: A Nationwide Cross-Sectional Study.

Anthropometric indicators of general and abdominal obesity can predict cardiovascular disease outcomes. Their performance in predicting hypertension (HTN) varies across populations. We aimed to analyze the relationship of body mass index (BMI), waist circumference (WC), waist-to-height ratio (WHtR) and conicity index (CI) with HTN, to examine their predictive performance and to determine their optimal cut-offs in a nationally representative sample of Albanians aged 15-59 years (n = 20,635). Logistic regression models were fitted and sex-specific receiver-operating characteristic (ROC) curves were constructed. The indicators were positively associated with HTN. Sex modified the relationships, as associations appeared significantly stronger among females than males in the highest categories of the indicators. The area under ROC curves (AUCs) for BMI were 0.729 (95% confidence interval (CI): 0.720-0.738) among females and 0.648 (95% CI: 0.633-0.663) among males, and AUCs for WHtR were 0.725 (95% CI: 0.716-0.734) among females and 0.637 (95% CI: 0.622-0.652) among males. However, the AUCs for BMI and WHtR did not differ significantly among females (p = 0.279) and males (p = 0.227). BMI outperformed WC and CI in both sexes. The optimal BMI cut-offs were 27.0 kg/m2 among females and 25.6 kg/m2 among males, and that for WHtR were 0.53 among females and 0.54 among males. BMI and WHtR demonstrated similar discriminatory power, and the identified cut-offs may inform initiatives for structured HTN screening in Albania.

Epidemiology of Irritable Bowel Syndrome in Albania.

BACKGROUND AND AIMS: Irritable bowel syndrome (IBS) is a chronic condition, with a relatively high prevalence and represents a burden for the healthcare budgets. Knowing the prevalence of IBS is important for scientific and practical estimation of its impact. The recent Rome IV global study has shed light on the prevalence of IBS in many countries, but reports are lacking from other countries. The aim of this study was to assess the prevalence of IBS in Albania, a country from which we do not have relevant information. METHOD: A prospective study was carried out in order to find out the prevalence of IBS in Albania. The target population was a sample of at least 500 Albanian adults (from a population of 2.2 million adults in this country. The questionnaires were distributed to the general population through three University centers from different areas of the country, through family doctors, chosen randomly, and by door to door by volunteer medical students. The questionnaires were self-completed by the participants and included 29 items: biographical data, IBS symptoms based on the Rome IV criteria, the symptoms that accompany IBS and the quality of life (QoL). The prevalence of IBS in the studied population, the sex ratio, the subtypes of IBS and the prevalence of different symptoms were calculated. RESULTS: We sent out 550 questionnaires and we received answers from 502 subjects (response rate 91%, 312 females, median age: 42 years). IBS was present in 43 cases (8.6%), without gender predominance. The IBS subtypes had the following values: IBS-C 58%, IBS-D 28% and IBS-M 14%. Women had a relatively higher risk for subtype IBS predominant constipation (OR=1.13, 95%CI: 0.32-3.95, p=0.84) but men appeared to be more prone to IBS predominant diarrhea (OR=1.3, 95%CI: 0.33-5.08, p=0.7). The most affected age was over 50 years and the least affected was between 18-30 years. Bloating was present in 81.4% of IBS respondents. The pain significantly influenced the daily activity in IBS: OR=12.9:1 (95% CI: 6.18-27.31, p<0.0001). Education seems to be an important risk factor; people with only middle school education or less had an OR=4.5 (95% CI: 2-10.54, p=0.0003) of developing IBS than people with a higher education. CONCLUSIONS: These are the first reported data on IBS in Albania. IBS in Albania is of 8.6%, more than the average data in the Rome IV global study, but in the range obtained from other studies. The most common type is IBS-C; there is no gender predominance; it is more common in less educated persons; the influence of pain on daily activity is higher in IBS.

Correlates of Lifetime Physical Abuse Among Schoolchildren Aged 15 Years in Post-communist Albania.

Aim: Our aim was to assess the prevalence and correlates of lifetime physical abuse among schoolchildren in Albania, a post-communist country in South Eastern Europe which is currently undergoing a rapid socioeconomic transition. Methods: The third wave of Health Behavior in School-Aged Children (HBSC) in Albania was conducted in 2017-18 including a nationwide representative sample of 1,708 schoolchildren aged 15 years (54% girls; response rate: 95%). Children were asked to report on lifetime physical abuse and a wide range of socio-demographic factors, lifestyle factors and health status characteristics. Binary logistic regression was used to assess the independent association of lifetime physical abuse with covariates. Results: Overall, the prevalence of lifetime physical abuse was about 32% (30% in boys vs. 32% in girls). In multivariable-adjusted logistic regression models, independent positive correlates of lifetime physical abuse among Albanian schoolchildren included lifetime smoking (OR = 1.5, 95% CI = 1.1-2.2), lifetime alcohol consumption (OR = 1.6, 95%CI = 1.2-2.1), irritability (OR[dailyvs.rarely/never] = 2.0, 95%CI = 1.3-3.0), and especially lifetime witnessed domestic violence (OR = 4.2, 95%CI = 2.2-7.9). Conversely, a higher score on life satisfaction was inversely related to lifetime physical abuse (P < 0.01). Conclusion: Our study provides novel evidence about the magnitude and selected independent correlates of lifetime physical abuse among schoolchildren in Albania, a country still embedded in an everlasting transition which is associated with tremendous changes in family structure, community links and societal norms and values. Irrespective of a wide range of sociodemographic factors and health characteristics, lifetime smoking, alcohol consumption, irritability, a lower score on life satisfaction and, particularly, witnessed domestic violence were strong and significant correlates of lifetime physical abuse among Albanian schoolchildren aged 15 years.

First evidence of Schmallenberg virus infection in domestic ruminants in Kosovo and Albania.

Schmallenberg virus (SBV), a novel Orthobunyavirus, emerged in European domestic ruminants in 2011 causing abortions and malformations in newborns and none or mild clinical symptoms in adult animals. Here, a total of 364 bovine, ovine and caprine serum samples were collected in Kosovo and Albania between May 2014 and August 2016 and analyzed for the presence of anti­SBV antibodies. Sera were tested using an enzyme­linked immunosorbent assay (ELISA), and 48 ELISA­positive samples were subsequently analyzed by serum neutralization test (SNT). The overall percentage of ELISA positive results was 17.9%; 23.1% (53/229) was the prevalence observed in Kosovo (cattle 45.5%, sheep 19.2% and goat 6.8%), while 8.9% (12/135) was that observed in Albania (cattle 11.1%, sheep 0% and goat 20.0%). SNT confirmed the presence of neutralizing antibodies against SBV in all samples tested. This is the first study reporting SBV circulation in domestic ruminants in Kosovo and Albania, with indication that this virus has been present in Kosovo and Albania at least since 2014 without being detected.

Extra-esophageal symptoms in individuals with and without erosive esophagitis: a case-control study in Albania.

INTRODUCTION: Erosive reflux esophagitis caused a large clinical spectrum of symptoms. Our aim was to assess the prevalence of extra-esophageal symptoms in individuals with and those without erosive esophagitis in Albania. METHODS: A case-control study was conducted at the Regional Hospital of Durres, the second main district in Albania, a transitional country in South Eastern Europe, including 248 patients with erosive esophagitis (aged 46.5 ± 16.3 years) and 273 controls (aged 46.4 ± 16.0 years; response rate: 70%) enrolled during the period January 2013-June 2014. Both cases and controls underwent upper endoscopy. Information on socio-demographic characteristics and lifestyle factors was also collected. Binary logistic regression was used to assess the association of erosive esophagitis and extra-esophageal symptoms. RESULTS: Patients with erosive esophagitis had a higher prevalence of excessive alcohol consumption, smoking, sedentarity, non-Mediterranean diet and obesity compared to their control counterparts (9% vs. 5%, 70% vs. 49%, 31% vs. 17%, 61% vs. 49% and 22% vs. 9%, respectively). Upon adjustment for all socio-demographic characteristics and lifestyle/behavioral factors, there was evidence of a strong association of erosive esophagitis with chronic cough (OR = 3.2, 95% CI = 1.7-5.8), and even more so with laryngeal disorders (OR = 4.4, 95% CI = 2.6-7.5). In all models, the association of erosive esophagitis with any extra-esophageal symptoms was strong and mainly consistent with each of the symptoms separately (fully-adjusted model: OR = 4.6, 95% CI = 2.9-7.3). CONCLUSION: Our findings indicate that the prevalence of extra-esophageal symptoms is higher among patients with erosive esophagitis in a transitional country characterized conventionally by employment of a Mediterranean diet.

Nursing students, mental health status during COVID-19 quarantine: evidence from three European countries.

BACKGROUND: The SARS-CoV2 pandemic obligated most of the European countries to implement strict measures and lockdowns to minimize the spread of the virus. Universities closed and on-line classes started. However, COVID-19 epidemic has significant impact on mental health of population. AIM: To assess depression level of nursing students (undergraduate and master) in Greece, Spain and Albania during COVID-19 pandemic as well as to identify possible determinants of depression level. METHODS: A multicenter cross-sectional study was conducted between April and May 2020. An on-line questionnaire was used to collect the data. The Patient Health Questionnaire-9 was used to evaluate the depression levels of nursing students. RESULTS: Seven hundred and eighty-seven nursing students participated in the study out of which 83.9% were of female gender, 92.9% single and 94.7% lived with others. One third of the nursing student population experienced mild depression, with higher depression levels noted for Spanish students (59.1%) followed by Albanian (34.5%) and Greek (21.8%) students. Multivariate linear regression analysis identified that Spanish students experienced more depression than Greek and Albanian (p < 0.001). Also, decreased age was associated with increased depression. CONCLUSION: The impact of lockdown and quarantine on nursing students mental health is clear. Provision of university based mental health interventions should be a priority.