A systematic review and meta-analysis of the catastrophic costs incurred by tuberculosis patients.

One of the strategies of the World Health Organization End Tuberculosis (TB) was to reduce the catastrophic costs incurred by TB-affected families to 0% by 2020.Catastrophic cost is defined by the total cost related to TB management exceeding 20% of the annual pre-TB household income. This study aimed to estimate the pooled proportion of TB affected households who incurred catastrophic costs. We searched PubMed, SciELO, Scopus, Embase, Google Scholar, ProQuest, SAGE, and Web of Science databases according to Preferred Reporting Items of the Systematic Reviews and Meta-Analysis (PRISMA) guidelines till November 20, 2020. Eligible studies were identified and data on catastrophic costs due to TB were extracted. We performed a meta-analysis to generate the pooled proportion of patients with TB facing catastrophic costs. From 5114 studies identified, 29 articles were included in the final analysis. The pooled proportion of patients faced catastrophic costs was (43%, 95% CI [34-51]). Meta-regression revealed that country, drug sensitivity, and Human immune-deficiency Virus (HIV) co-infection were the main predictors of such costs. Catastrophic costs incurred by drug sensitive, drug resistant, and HIV co-infection were 32%, 81%, and 81%, respectively. The catastrophic costs incurred were lower among active than passive case findings (12% vs. 30%). Half (50%) of TB-affected households faced catastrophic health expenditure at 10% cut-off point. The financial burden of patients seeking TB diagnosis and treatment continues to be a worldwide impediment. Therefore, the End TB approach should rely on socioeconomic support and cost-cutting initiatives.PROSPERO registration: CRD42020221283.

Non-communicable disease policy implementation in Libya: A mixed methods assessment.

The Libyan Ministry of Health is keen to understand how it can introduce policies to protect its population from non-communicable diseases (NCDs). We aimed to perform an implementation research assessment of the current situation, including challenges and opportunities. We used an explanatory sequential mixed methods design. We started with a quantitative assessment of NCD policy performance based on review of the WHO NCD Progress Monitor Reports. Once we had identified Libya's NCD policy gaps we performed a systematic review to identify international lessons around barriers and successful strategies for the policies Libya has not yet implemented. Finally, we performed a series of key stakeholder interviews with senior policymakers to explore their perspectives around promising policy actions. We used a realist paradigm, methods triangulation, and a joint display to synthesise the interpretation of our findings and develop recommendations. Libya has not fully implemented any of the recommended policies for diet, physical activity, primary care guidelines & therapeutics, or data collection, targets & surveillance. It does not have robust tobacco policies in place. Evidence from the international literature and policymaker interviews emphasised the centrality of according strong political leadership, governance structures, multisectoral engagement, and adequate financing to policy development activities. Libya's complex political and security situation are major barriers for policy implementation. Whilst some policies will be very challenging to develop and deploy, there are a number of simple policy actions that could be implemented with minimum effort; from inviting WHO to conduct a second STEPS survey, to signing the international code on breast-milk substitutes. Like many other fragile and conflict-affected states, Libya has not accorded NCDs the policy attention they demand. Whilst strong high-level leadership is the ultimate key to providing adequate protections, there are a range of simple measures that can be implemented with relative ease.

The coronavirus disease 2019 (COVID-19) vaccination psychological antecedent assessment using the Arabic 5c validated tool: An online survey in 13 Arab countries.

BACKGROUND: Following the emergency approval of the coronavirus disease 2019 (COVID-19) vaccines, research into its vaccination hesitancy saw a substantial increase. However, the psychological behaviors associated with this hesitancy are still not completely understood. This study assessed the psychological antecedents associated with COVID-19 vaccination in the Arab population. METHODOLOGY: The validated Arabic version of the 5C questionnaire was distributed online across various social media platforms in Arabic-speaking countries. The questionnaire had three sections, namely, socio-demographics, COVID-19 related infection and vaccination, and the 5C scale of vaccine psychological antecedents of confidence, complacency, constraints, calculation, and collective responsibility. RESULTS: In total, 4,474 participants with a mean age of 32.48 ± 10.76 from 13 Arab countries made up the final sample, 40.8% of whom were male. Around 26.7% of the participants were found to be confident about the COVID-19 vaccination, 10.7% indicated complacency, 96.5% indicated they had no constraints, 48.8% had a preference for calculation and 40.4% indicated they had collective responsibility. The 5C antecedents varied across the studied countries with the confidence and collective responsibility being the highest in the United Arab Emirates (59.0% and 58.0%, respectively), complacency and constraints in Morocco (21.0% and 7.0%, respectively) and calculation in Sudan (60.0%). The regression analyses revealed that sex, age, educational degrees, being a health care professional, history of COVID-19 infection and having a relative infected or died from COVID-19 significantly predicted the 5C psychological antecedents by different degrees. CONCLUSION: There are wide psychological antecedent variations between Arab countries, and different determinants can have a profound effect on the COVID-19 vaccine's psychological antecedents.

Arabic validation and cross-cultural adaptation of the 5C scale for assessment of COVID-19 vaccines psychological antecedents.

BACKGROUND: In the Arab countries, there has not been yet a specific validated Arabic questionnaire that can assess the psychological antecedents of COVID-19 vaccine among the general population. This study, therefore, aimed to translate, culturally adapt, and validate the 5C scale into the Arabic language. METHODS: The 5C scale was translated into Arabic by two independent bilingual co-authors, and then translated back into English. After reconciling translation disparities, the final Arabic questionnaire was disseminated into four randomly selected Arabic countries (Egypt, Libya, United Arab Emirates (UAE), and Saudi Arabia). Data from 350 Arabic speaking adults (aged ≥18 years) were included in the final analysis. Internal consistency was assessed by Cronbach's alpha. Construct validity was determined by concurrent, convergent, discriminant, exploratory and confirmatory factor analyses. RESULTS: Age of participants ranged between 18 to 73 years; 57.14% were females, 37.43% from Egypt, 36.86%, from UAE, 30% were healthcare workers, and 42.8% had the intention to get COVID-19 vaccines. The 5 sub-scales of the questionnaire met the criterion of internal consistency (Cronbach's alpha ≥0.7). The predictors of intention to get COVID-19 vaccines (concurrent validity) were young age and the 5C sub-scales. Convergent validity was identified by the significant inter-item and item-mean score of the sub-scale correlation (P<0.001). Discriminant validity was reported as inter-factor correlation matrix (<0.7). Kaiser-Meyer-Olkin sampling adequacy measure was 0.80 and Bartlett's sphericity test was highly significant (P<0.001). Exploratory factor analysis indicated that the 15 items of the questionnaire could be summarized into five factors. Confirmatory factor analysis confirmed that the hypothesized five-factor model of the 15-item questionnaire was satisfied with adequate psychometric properties and fit with observed data (RMSEA = 0.060, GFI = 0.924, CFI = 0.957, TLI = 0.937, SRMR = 0.076 & NFI = 906). CONCLUSION: The Arabic version of the 5C scale is a valid and reliable tool to assess the psychological antecedents of COVID-19 vaccine among Arab population.