Framework for developing cost-effectiveness analysis threshold: the case of Egypt.

BACKGROUND: Cost-effectiveness analyses rarely offer useful insights to policy decisions unless their results are compared against a benchmark threshold. The cost-effectiveness threshold (CET) represents the maximum acceptable monetary value for achieving a unit of health gain. This study aimed to identify CET values on a global scale, provide an overview of using multiple CETs, and propose a country-specific CET framework specifically tailored for Egypt. The proposed framework aims to consider the globally identified CETs, analyze global trends, and consider the local structure of Egypt's healthcare system. METHODS: We conducted a literature review to identify CET values, with a particular focus on understanding the basis of differentiation when multiple thresholds are present. CETs of different countries were reviewed from secondary sources. Additionally, we assembled an expert panel to develop a national CET framework in Egypt and propose an initial design. This was followed by a multistakeholder workshop, bringing together representatives of different governmental bodies to vote on the threshold value and finalize the recommended framework. RESULTS: The average CET, expressed as a percentage of the gross domestic product (GDP) per capita across all countries, was 135%, with a range of 21 to 300%. Interestingly, while the absolute value of CET increased with a country's income level, the average CET/GDP per capita showed an inverse relationship. Some countries applied multiple thresholds based on disease severity or rarity. In the case of Egypt, the consensus workshop recommended a threshold ranging from one to three times the GDP per capita, taking into account the incremental relative quality-adjusted life years (QALY) gain. For orphan medicines, a CET multiplier between 1.5 and 3.0, based on the disease rarity, was recommended. A two-times multiplier was proposed for the private reimbursement threshold compared to the public threshold. CONCLUSION: The CET values in most countries appear to be closely related to the GDP per capita. Higher-income countries tend to use a lower threshold as a percentage of their GDP per capita, contrasted with lower-income countries. In Egypt, experts opted for a multiple CET framework to assess the value of health technologies in terms of reimbursement and pricing.

Assessment of groundwater quality in arid regions utilizing principal component analysis, GIS, and machine learning techniques.

Assessing water quality in arid regions is vital due to scarce resources, impacting health and sustainable management.This study examines groundwater quality in Assuit Governorate, Egypt, using Principal Component Analysis, GIS, and Machine Learning Techniques. Data from 217 wells across 12 parameters were analyzed, including TDS, EC, Cl-, Fe++, Ca++, Mg++, Na+, SO4--, Mn++, HCO3-, K+, and pH. The Water Quality Index (WQI) was calculated, and ArcGIS mapped its spatial distribution. Machine learning algorithms, including Ridge Regression, XGBoost, Decision Tree, Random Forest, and K-Nearest Neighbors, were used for predictive analysis. Higher concentrations of Na, K, Ca, Mg, Mn, and Fe were correlated with industrial and densely populated areas. Most samples exhibited excellent or good quality, with a small percentage unsuitable for consumption. Ridge Regression showed the lowest MAPE rates (0.22 % training, 0.26 % in testing). This research highlights the importance of advanced machine learning for sustainable groundwater management in arid regions. Thus, our results could provide valuable assistance to both national and local authorities involved in water management decisions, particularly for water resource managers and decision-makers. This information can aid in the development of regulations aimed at safeguarding and sustainably managing groundwater resources, which are essential for the overall prosperity of the country.

Assessment of the potential occurrence of Cryptosporidium species in various water sources in Sharqia Governorate, Egypt.

Cryptosporidium species are enteric apicomplexan parasites associated with diarrhoeal disease in humans and animals globally. Waterborne outbreaks resulting from contamination with the infective oocysts are common worldwide. Updated reports on waterborne protozoal infections are needed to identify emerging pathogens and susceptible populations. Therefore, this study aimed to assess the current profile of Cryptosporidium contamination of various water sources in Sharqia Governorate, Northeastern Egypt. For this purpose, eighty samples were collected from five different water types (canal, tap, tank, filtered, and groundwater), distributed in four major cities (El-Hessenia, Fakous, Zagazig, and Belbies) in Sharqia Governorate. All water samples were examined using conventional microscopy, ELISA, and real-time PCR (RT-PCR) techniques. Based on microscopic analysis, the Cryptosporidium protozoan was identified in 25% of the tested water samples. The RT-PCR assay has allowed for the quantification of Cryptosporidium oocysts in different types of water. Canal water exhibited the highest Cryptosporidium contamination levels (mean = 85.15 oocysts/L), followed by water tanks (mean = 12.031 oocysts/L). The study also provided a comparative evaluation of ELISA and RT-PCR for the diagnosis of Cryptosporidium infection. RT-PCR performed better than ELISA in terms of analytical accuracy (97.50% vs. 86.25%) and specificity (100% vs. 83.33%). However, ELISA showed a higher sensitivity (95.00% vs. 90.00%) for Cryptosporidium recovery. Our findings could serve as a platform for further investigations into the potential risks associated with water contamination in Sharqia Governorate. Supplementary Information: The online version contains supplementary material available at 10.1007/s12639-024-01675-1.

Enhancing colorectal cancer prevention: a national assessment of public awareness in Egypt.

BACKGROUND: Despite the increasing incidence of colorectal cancer (CRC) in the Egyptian population, it still seems that there is a significant lack of awareness regarding the disease. This study aimed to assess the Egyptian population's awareness of CRC regarding its risk factors, the screening procedures, and the appropriate responses to its diagnosis. METHOD: A cross-sectional study was conducted in Egypt between July 2022 and March 2023 and recruited a convenient sample of adults from seven governorates representing different geographic areas, and socioeconomic and educational backgrounds with the help of the validated Bowel Cancer Awareness Measure (CAM) version 2.1. The modified Arabic questionnaire was validated through a pilot study including 30 patients. Then it was presented through a Google form before being shared via online methods and face-to-face interviews. The questionnaire provided both numerical and categorical data, which were analyzed accordingly. The Chi-square, the Fisher exact, and the Man-Whitney test were used to compare colorectal cancer poor and good knowledge groups. Logistic regression analysis was conducted to predict the factors that affected the awareness level of the study population. RESULTS: Nine hundred forty individuals participated in the survey. Their ages ranged from 18 to 86 years old, with an average of 37.38 ± 12.22 years. The mean Knowledge score was 14.29 ± 7.05 out of 37 with most of our participants (71%) having poor knowledge about CRC. Most of the participants (64.1%) chose colonoscopy as the best screening modality, followed by an abdominal CT (27.8%), and fecal occult blood (15.5%). The study revealed significant differences between participants with good and poor knowledge of colorectal cancer. (78.5%) of participants with good CRC knowledge lived in cities, (85.4%) attained university or higher educational level, and (87.2%) of them were nonsmokers (p < 0.05%). CONCLUSION: In general, there was a lack of awareness about Colorectal cancer among the Egyptian population especially among rural and lower educational levels, and more health education campaigns are required to enhance CRC prevention efforts in Egypt.

Policies for expanding family planning coverage: lessons from five successful countries.

Background: Enhancing the design of family planning interventions is crucial for promoting gender equality and improving maternal and child health outcomes. We identified, critically appraised, and synthesized policies and strategies from five selected countries that successfully increased family planning coverage. Methods: We conducted a policy analysis through a scoping review and document search, focusing on documents published from 1950 to 2023 that examined or assessed policies aimed at enhancing family planning coverage in Brazil, Ecuador, Egypt, Ethiopia, and Rwanda. A search was conducted through PubMed, SCOPUS, and Web of Science. Government documents and conference proceedings were also critically analyzed. National health surveys were analyzed to estimate time trends in demand for family planning satisfied by modern methods (mDFPS) at the national level and by wealth. Changes in the method mix were also assessed. The findings of the studies were presented in a narrative synthesis. Findings: We selected 231 studies, in which 196 policies were identified. All countries started to endorse family planning in the 1960s, with the number of identified policies ranging between 21 in Ecuador and 52 in Ethiopia. Most of the policies exclusively targeted women and were related to supplying contraceptives and enhancing the quality of the services. Little focus was found on monitoring and evaluation of the policies implemented. Conclusion: Among the five selected countries, a multitude of actions were happening simultaneously, each with its own vigor and enthusiasm. Our findings highlight that these five countries were successful in increasing family planning coverage by implementing broader multi-sectoral policies and considering the diverse needs of the population, as well as the specific contextual factors at play. Successful policies require a nuanced consideration of how these policies align with each culture's framework, recognizing that both sociocultural norms and the impact of past public policies shape the current state of family planning.

Prevalence, factors associated and management of needle phobia among the general population in Saudi Arabia and Egypt.

OBJECTIVE: This study aims to assess the prevalence of needle phobia among Saudi and Egyptian adult populations. In addition, underlying causes and strategies that can be utilized to address needle fear were investigated. METHODS: A cross-sectional online survey study was conducted in Saudi Arabia and Egypt between 1 May and 30 June 2023. Participants aged 18 years and above and living in Saudi Arabia and Egypt were eligible to complete the survey. Participants were invited to participate in this study through social media platforms (Facebook, X, Snapchat, and Instagram). A convenience sampling technique was used to recruit the study participants. A 21-item questionnaire consisting of four sections including a Likert scale score was used to answer the research objectives. Numeric data were presented as mean ± SD. For categorical variables, percentages were used. Comparison between groups were made by Student's t-test or Mann Whitney test according to data distribution. Chi squared tests for categorical values were conducted. A binary logistic regression analysis was conducted to investigate factors associated with needle phobia. RESULTS: A total of 4065 participants were involved in this study (Saudi Arabia: 2628 and Egypt: 1437). Around one-third of the study participants (36.5%) confirmed that they have needle phobia. Most of the study participants (81.1%) reported that they have had needle phobia since they were under 18 years of age. Pain, general anxiety, and fear of making a mistake during the procedure were the most commonly reported contributors for fear of needles during or before a medical procedure. Around 15.8% of the study participants reported that they have tried to get rid of phobia from needles. Non-surgical alternatives (such as oral medications and patches) and using smaller/thinner needles were the most commonly reported interventions that reduced fear of needles. Binary logistic regression analysis identified that females, those who are aged (41-50 years), widowed, those with bachelor's degrees and higher education, and those unemployed were more likely to have needle phobia compared to others. CONCLUSION: Our study highlighted the high prevalence of needle fear within an adult population in Egypt and Saudi Arabia. Females, those who are aged (41-50 years), those widowed, those with higher education degrees, those unemployed, those working in the health sector and people with low income were more likely to have needle phobia compared to others.

Relationship Between Alexithymia, Smartphone Addiction, and Psychological Distress Among University Students: A Multi-country Study.

Objectives: Increasing dependence on smartphones results in the appearance of psychological problems, especially among young people. This study aims to determine the rates of alexithymia and its relationship with smartphone addiction and psychological distress in university students. Methods: A total of 2616 students (mean age = 22.5±3.5 years; 73.1% female) from universities in Egypt, Oman, and Pakistan were included in a cross-sectional and comparative study conducted through a web survey during the COVID-19 pandemic from October to December 2021. The following scales were used: Toronto Alexithymia Scale (TAS-20), Depression Anxiety Stress Scale (DASS-21), and Smartphone Addiction Scale-Short Version (SAS-SV). The survey also included questions related to sociodemographic and smartphone usage patterns.

Tracking the Variations in Trace and Heavy Elements in Smoking Products Marketed in Oman and Egypt: Risk Assessment After Implementation of Constraining Protocols.

Tobacco smoking is becoming one of the major worldwide concerns regarding environmental pollution as well as health threats. In 2005, the World Health Organization (WHO) released the Framework Convention On Tobacco Control (FCTC), which outlined protocols for controlling tobacco products. Oman was one of the leading countries to follow these protocols; however, Egypt has only followed these protocols recently in 2020. One of the main challenges in tobacco product control is the variation in their trace element's types and amounts from country to country owing to differences in agriculture techniques and used chemical additives. Smoking releases different toxic metal ions found in them into the air, and hence, analyzing trace amounts of metals in tobacco smoking products is becoming more critical. The proposed research aims to evaluate the current levels of 11 heavy metals (namely, As, Pb, Cd, Co, Cr, Be, Ba, Mn, Ni, Fe, and Hg) in 22 tobacco products available in Egypt and Oman using inductively coupled plasma optical emission spectroscopy and a direct mercury analyzer. Although some elements such as Be, Co, and Cd were absent, the positive detection of As and Pb and the levels of Ba, Cr, and Ni are still alarming, especially for heavy smokers. The obtained results were then statistically related to previously published data in 2017 to explore the effectiveness of implementing the FCTC protocols within the Egyptian market. The outcomes suggested a positive impact of FCTC protocol implementation in Egypt, besides the lower levels of elemental content for Omani products compared to the Egyptian market.

Distribution, speciation, and assessment of heavy metals in sediments from Wadi Asal, Red Sea, Egypt.

Globally, the environmental contamination of stream sediments due to geogenic and anthropogenic sources is of growing concern. In this study, the heavy metals (Cd, Co, Cr, Cu, Ni, Pb, and Zn) in 22 superficial sediments in Wadi Asal, Red Sea, Egypt, were explored to assess sediment sources, the mobility of chemical species, and the degree of contamination in sediments. Therefore, the total heavy metal values in the fine fraction (< 63 µm), a five-step sequential extraction on selective samples, risk assessment, and principal component analysis (PCA) were applied. The mobility of heavy metals in Wadi Asal sediments, according to non-residual fraction percent, declines in the following order: Cd (90.9%) > Pb (85.2%) > Co (84.4%) > Cu (80.8%) > Zn (75.9%) > Ni (48.4%) > Cr (39.6%); indicating the high mobility of Cd, Zn, Pb, Cu, and Co. The mean metal contamination factor (CF) order is Cd (10.96) > Ni (3.91) > Cr (2.77) > Zn (2.18) > Pb (2.10) > Co (1.12) > Cu (0.70). The Geo-accumulation Index (Igeo) is decreased in the following order: Cd (2.19) > Ni (0.78) > Cr (0.55) > Zn (0.44) > Pb (0.42) > Co (0.22) > Cu (0.14). The risk assessment code (RAC) revealed very high to high risk for Cd, Co, and Pb. The results pointed out that the metals Cr, Co, Cu, and Ni are from geogenic sources, while Zn, Cd, and Pb are from anthropogenic sources due to Pb-Zn mining activities. Based on the threshold effect level (TEL), Cd, Cr, Ni, and Pb have adverse effects on living organisms. According to these findings, the area along Wadi Asal and the downstream regions on the beach are highly polluted and heavy metal monitoring in sediments and aquatic organisms is recommended.

Assessment of seasonal warming trends at the Nile Delta: a paradigm for human-induced climate change.

Given its modern geographical and geomorphological characteristics, along with rapid socio-economic changes, the Nile Delta stands out as one of the world's most dynamic landscapes. The key drivers of the land use change in this region have been the reclamation of delta margins, changes in agricultural practices, and urban expansion. The present study aims to explore the variations in the seasonal daytime and nighttime trends of the land surface temperatures (LST) at this active agronomic system in response to the seasonal variations of vegetation cover as revealed by the normalized difference vegetation index (NDVI) during the past two decades. The data were exclusively acquired from the Moderate Resolution Imaging Spectroradiometer (MODIS) instrument for the period from January 2001 to December 2021, where geospatial and statistical analyses were accomplished to construct a LST/NDVI spatio-temporal pattern throughout the Nile Delta. Results revealed a robust negative and a significant relationship between the NDVI and the diurnal LST with high regression coefficients (R2) ranging from 0.78 to 0.97 (p value < 0.05). Maximal seasonal warming trends occurred during harvesting seasons (springs and falls), while the least warming was recorded during winters (the growing seasons). It was also observed that the nocturnal warming (0.72°C/decade) was almost as double as the corresponding value of the daytime trend (0.33°C/decade). The study recognized a seasonal climatic warming throughout the Nile Delta influenced by the human-induced land use change and agricultural practices.

Understanding inequities in child mortality in Egypt: Socioeconomic and proximate factors.

While there have been notable advancements in child health in Egypt, disparities in child mortality still exist. Understanding these disparities is crucial to addressing them. The objective of this study is to explore the factors linked to child mortality in Egypt, providing a comprehensive understanding of the disparities in child mortality rates. The study utilises cross-sectional data from Egypt's Demographic and Health Survey (EDHS) in 2014 to examine child mortality. The dataset consists of 15,848 observations from mothers with children born within five years prior to the survey. The choice of explanatory variables was guided by the Mosely and Chen Framework and logistic multivariate regression was used to conduct the analyses. The study finds lower education, early childbearing, insufficient birth spacing, lack of breastfeeding, and absence of improved toilet facilities (proxy for living conditions) were all significantly linked to an increased likelihood of child loss. Additionally, poorer people in rural settings experienced the worst child mortality. The findings align with the World Health Organization's Conceptual Framework for Action on the Social Determinants of Health (CSDH). Recommended policy interventions include targeting women in rural areas, improving living conditions and removing financial/other barriers to accessing care.

A smart economic way to control camel parasites and improve camel production in Egypt.

Treatment of the parasites in camels strategically by administration of the specific drugs (Ivomec 1% SC injection, Amprolium hydrochloride orally, Naganol SC injection and Deltamethrin, poure on) at a specially selected time concerning the transmission season of Nematodes, Coccidia, Trypanosoma, Ticks & mite infection respectively causes relief to the animal from the stress of the parasite, minimizes the number of eggs shedding, and improves its general health conditions. However, the present study designed and applied three selected treatment regimes to 300 parasitically infected and controlled camels in Middle Egypt. The first regime was performed by treating animals two times/year during the peak of infection; the first was in April against internal parasites, and in July against external parasites. The second program was conducted by treating animals three times/year; the first was in March against early-arrived internal parasites, the second was in June against external and internal ones, and the third treatment was in August against the rest of the external parasites. Furthermore, the last suggested regime was applied by applying 4 treatments/year: the first was in February against the internal parasites, the second was in May against the early infection by external parasites as well as the remaining internal parasites, and the third was in July against the external parasite. The fourth treatment was in September to eradicate the remaining internal parasite and keep the animal parasite-free during winter. Treatment was applied to the whole flock; however, the movement of treated and control animals was restricted. The study proved a significant decrease in the incidence and level of parasite burden in animals that received 3 and 4 treatments/year, associated with marked improvement in the mean body score, blood parameters, and rate of pregnancy and its related hormones, as well as enhancement in liver and kidney function parameters. The selection of 3 or 4 treatment regimens will be evaluated concerning their economic cost and total income after another year after each protocol's end.

Spatial distribution and pollution assessment of heavy metals in surface and bottom water along the eastern part of the Egyptian Mediterranean coast.

Seawater contamination with heavy metals (HMs) as a result of anthropogenic activities is a global challenge due to its negative impacts on marine environments and coastal communities. This study investigates the distribution of HMs (Fe, Zn, Cu, Mn, Cd, Ni and Co) and assesses the quality of surface and bottom seawater. Samples were collected in winter 2020 and summer 2021 from eleven sectors along the eastern Egyptian Mediterranean Sea coast. The water quality was evaluated using Water Quality Index (WQI), Metal Index (MI), heavy metal pollution index (HMI) and Metal Pollution index (MPI). The results indicated that, Eastern Harbour, Abu-Qir and Port Said sectors were polluted with HMs. Based on Two-Way ANOVA test there was seasonal variation for dissolved HMs (Zn, Ni, Cd and Mn in bottom layer and Cu in surface layer), while, (Cd, Co, Cu, Zn and Mn (in bottom layer)) revealed spatial differences among sectors.

The budget impact of alteplase in the treatment of acute ischemic stroke in Egypt.

Introduction: Stroke is the second leading cause of mortality worldwide. Five percent of all the disability-adjusted life years (DALYs) lost around the world are attributed to stroke. This study aimed to assess the economic burden of acute ischemic stroke (AIS) in Egypt and reveal the benefits of alteplase treatment by measuring the resource use and costs associated with this treatment compared to the standard of care and extrapolate the overall budget impact of alteplase to the local Egyptian setting over a 5-year time horizon from a societal perspective. Methods: A budget impact model was developed to estimate the impact of adding alteplase to the current treatment of AIS patients within the Egyptian healthcare setting. The efficacy data for both arms of the model were sourced from a systematic review of the literature. Resource use and cost data were sourced from a retrospective study. Proportions of patients potentially eligible for treatment and the treatment time distributions were estimated from an analysis of the results of this retrospective data collection. A univariate sensitivity analysis was conducted to assess the robustness of the model results. The input parameters varied between plausible extremes based on a review of available evidence. Results: The total annual costs with alteplase treatment [i.e., drug, symptomatic intracerebral hemorrhage (ICH) management, acute hospitalization, and post-hospitalization costs] for the targeted patients from a societal perspective were estimated to be less than the total annual costs without alteplase. This resulted in savings of approximately EGP 37.2 million ($ 1.2 million), EGP 14.2 million ($ 458.06), EGP -33.0 million ($ -1.06 million), EGP -54.0 million ($ -1.74 million), and EGP -89.8 million ($ -2.89 million) for each of the 5 years, respectively. In year 1, more than 2,787 patients (+30.1%) achieved an excellent outcome and <1,204 patients (-22.3%) had a poor outcome when treated with alteplase. The savings in acute hospitalization and post-hospitalization costs offset the increase in drug and ICH management costs in the alteplase group compared to treatment without alteplase. The total cumulative cost savings for alteplase in AIS patients were estimated at EGP -228,146,871 ($ -7,359,576) over 5 years. Conclusion: The budget impact model estimates suggest that from a societal perspective, alteplase is likely to be a cost-saving option for the treatment of AIS in Egypt due to the treatment benefits, resulting in savings in acute hospitalization and annual post-hospitalization costs.

Access to emergency care in Egypt: Tiered health care and manifestations of inequity.

Market-driven health care reforms and development strategies continue to drive the privatization of health care services across the world. When these measures are implemented, large disparities emerge and are maintained. Using a modified version of the access to care framework developed by Penchansky and Thomas, this paper examines the manifestations of inequity between private for-profit and public emergency care in the Greater Cairo Region and Asyut, Egypt. In-depth interviews with physicians working in both sectors reveals stark disparities in access between these two health care sectors in Egypt. Access issues identified include unaffordable care in the private sector, unavailable medical supplies and overcrowding in public hospitals, as well as a salary gap that drives health care workers from public to private practice, creating staffing shortages in public hospitals. The manifestations of these inequities are often severe, usually tangible, and according to health care providers, embodied in the experiences of service users.

Plastic use for food and drinks and related knowledge, attitudes, and practices among a sample of Egyptians.

Introduction: Plastic is extensively used in everyday life, particularly for food and beverage containers. The inappropriate use of these containers may lead to the leaching of various chemicals from plastic, such as bisphenol A, phthalate, and styrene, which cause numerous adverse health effects. This study aimed to assess the knowledge, attitudes, and practices toward using plastic for food and drinks among a sample of the Egyptian population. Materials and methods: A questionnaire was designed based on scientific literature to assess sociodemographic data, knowledge, attitudes, and practices toward the use of plastic for food and drinks. A total of 639 participants were recruited by employing the convenience sampling technique. Results: More than half of the participants (347, 54%) had poor knowledge scores. Personal experiences, social media, and web pages represented the most common knowledge sources. A comparison between plastic-related knowledge scores and the studied sociodemographic characteristics revealed statistically significant differences in age, gender, education, marital status, residence, working, and socioeconomic standard. A good attitude was reported by the majority (515, 80.6%) of participants. The majority (493, 77.2%) were occasional and frequent plastic users and the practice scores were significantly associated with age, education, residence, and socioeconomic standard. Higher educational level, gender (women), and rural residence were predictors of good participants knowledge, while lower socioeconomic status and urban residence were predictors of bad participants practice in a multivariate logistic regression analysis. Conclusion: The observed unsatisfactory knowledge and practice scores vs. the high attitude indicates a knowledge gap that can help direct future improvements. We call for public awareness programs about safe plastic use and the related health hazards of plastic chemicals. We also stress upon the urgent need for a collaboration between health authorities and the plastic and food industry to guarantee that information about proper plastic use is conveyed to consumers.

Projecting the Potential Budget Impact Analysis of Paliperidone Palmitate in Egyptian Adult Patients with Schizophrenia.

Background: Schizophrenia is a serious mental disorder that has greater negative consequences on role functioning than many other severe chronic diseases. Objective: We evaluated the economic impact of long-acting injections of paliperidone palmitate (PP) vs daily oral antipsychotics to treat chronic schizophrenia from a societal perspective over a 2-year period. Methods: A static budget impact model was developed to compare PP with daily oral antipsychotics (risperidone, olanzapine, and aripiprazole) in the treatment of patients with chronic schizophrenia. Our study included treatments used during relapse and hospitalization, validated by an expert panel. The clinical parameters were extracted from the PRIDE trial. Direct medical costs and indirect costs were measured. The unit cost of drug acquisition for all medications was extracted from the public sector. One-way sensitivity analyses were conducted. Results: The target population in our model was estimated to be 142 incident patients. In the first year, the total drug costs in Egyptian pounds (EGP) for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5.6 million, respectively. In the second year, the total drug costs for PP and oral antipsychotics were £2.7 million and £724 004, respectively, while the total medical costs for PP and oral antipsychotics were £3 million and £5 million, respectively. The total costs for PP (£11.6 million) over 2 years were less than those of oral antipsychotics without PP (£12.7 million). PP produced an estimated budget savings of £1 046 561 (budget savings per patient per year, £3667). In addition, PP resulted in the avoidance of 18 hospitalizations per year compared with the without-PP arm. Sensitivity analyses showed that the percent of hospitalizations for both oral antipsychotics and PP had the greatest impact on the results. Conclusion: The lower hospitalization rates associated with PP offset the increase in drug costs. PP may potentially be cost-saving compared with the standard of care in chronic schizophrenia in Egyptian representative healthcare settings. Policy makers may consider this approach to improve patient outcomes and budget sustainability.

Socioeconomic inequalities in diabetes prevalence: the case of Egypt between 2008 and 2015.

BACKGROUND: There is a steady increase in diabetes prevalence globally and many studies imply that high socioeconomic status (SES) is inversely related to diabetes prevalence. However, there is scarcity in literature from countries like Egypt regarding this topic. METHODS: This study aims to investigate prevalence of diabetes in Egypt between 2008 and 2015, and the effect of SES. Diabetes prevalence -based on self-reports of past diagnosis- was measured using two datasets Egypt DHS 2008 (10,917 participants) and EHIS 2015 (16,485 participants). Logistic regression and odds ratios (ORs) with 95% confidence intervals (CIs) were applied for diabetes controlling for age, gender, educational level, employment status and place of residence. Extend of difference in diabetes prevalence between the two time points was measured by combining the two datasets using the EDHS 2008 as reference. RESULTS: Diabetes prevalence was higher in 2015 (4.83%) compared to 2008 (3.48%). It was more in women at both time points (4.08% and 5.16% in 2008 and 2015 respectively) compared to men (2.80% and 4.43% in 2008 and 2015 respectively). Older age and living in urban areas were positively related to diabetes prevalence at both time points. Men had a significant higher chance of developing diabetes in 2015 (OR = 1.45, p-value = 0.001). Men with higher education had higher chance of developing diabetes (OR = 1.76), in contrast to women (OR = 0.59). Employment decreased the chance of developing diabetes for men (OR = .72), but had minimal effect on women (OR = 1.06). CONCLUSION: Diabetes prevalence in Egypt has increased between the years 2008 and 2015 and evident social inequalities were found. Women had more diabetes than men and were more affected with low SES. Unlike women, highly educated men had higher chance of developing diabetes in 2015 compared to 2008. This might be attributed to behavioral and sociocultural factors.

Prevalence and In Vivo Assessment of Virulence in Shiga Toxin-Producing Escherichia coli Clinical Isolates from Greater Cairo Area.

Background: Shiga toxin-producing Escherichia coli (STEC) has been identified as an important etiologic agent of human disease in Egypt. Aims: To investigate the occurrence and describe the characterization as well as prevalence of STEC in Greater Cairo hospitals as well as molecular characterization of virulence and resistance genes. Methods: Four hundred seventy E. coli clinical isolates were collected from eight hospitals and analyzed by genotypic and phenotypic methods for STEC, followed by histopathological examination and scoring of different organs lesions. Results: The highest proportion of isolates was from urine (151 isolates), whereas the lowest was from splenic drain (3 isolates). In tandem, when serogrouping was performed, 15 serogroups were obtained where the most prevalent was O157 and the least prevalent was O151. All isolates were positive when screened for identity gene gad A, while only typable strains were screened for seven virulence genes stx1 (gene encoding Shiga toxin 1), stx2 (gene encoding Shiga toxin 2), tsh (gene encoding thermostable hemagglutinin), eaeA (gene encoding intimin), invE (gene encoding invasion protein), aggR (gene encoding aggregative adherence transcriptional regulator), and astA (aspartate transaminase) where the prevalence was 48%, 30%, 50%, 57%, 7.5%, 12%, and 58%, respectively. Of 254 typable isolates, 152 were STEC carrying stx1 or stx2 genes or both. Conclusions: Relying on in vivo comparison between different E. coli pathotypes via histopathological examination of different organs, E. coli pathotypes could be divided into mild virulent, moderate virulent, and high virulent strains. Statistical analysis revealed significant correlation between different serogroups and presence of virulence genes.

Risk assessment of toxic residues among some freshwater and marine water fish species.

Egypt has several beaches, as well as the Nile River and a few lakes; therefore, it could compensate for the lack of protein in red meat with fish. Fish, however, may become a source of heavy metal exposure in humans. The current study was to assess the level of five toxic metals, lead (Pb), cadmium (Cd), mercury (Hg), arsenic (As), and aluminum (Al), in six species, namely, Oreochromis niloticus (O. niloticus), Mugil cephalus (M. cephalus), Lates niloticus (L. niloticus), Plectropomus leopardus (P. leopardus), Epinephelus tauvina (E. tauvina), and Lethrinus nebulosus (L. nebulosus), collected from the El-Obour fish market in Egypt. The residual concentrations of the tested toxic metals in the examined O. niloticus, M. cephalus, L. niloticus, E. tauvina, P. leopardus, and L. nebulosus species were found to be higher than the European Commission's maximum permissible limits (MPL) for Pb and Cd by 10 and 20%, 15 and 65%, 75 and 15%, 20 and 65%, 15 and 40%, and 25 and 5%. In contrast, 30% of L. niloticus exceeded the MPL for Hg. It was shown that the average estimated daily intake (EDI) and the target hazard quotient (THQ) in fish samples are below safety levels for human consumption and hazard index (HI < 1). From the human health point of view, this study showed that there was no possible health risk to people due to the intake of any studied species under the current consumption rate in the country.