Timeliness metrics for screening and preventing TB in household contacts of pulmonary TB patients in Kenya.

BACKGROUND: The study assessed whether a "7-1-7" timeliness metric for screening and TB preventive therapy (TPT) could be implemented for household contacts (HHCs) of index patients with bacteriologically confirmed pulmonary TB under routine programmatic settings in Kenya. METHODS: A longitudinal cohort study conducted among index patients and their HHCs in 12 health facilities, Kiambu County, Kenya. RESULTS: Between January and June 2023, 95% of 508 index patients had their HHCs line-listed within 7 days of initiating anti-TB treatment ("First 7"). In 68% of 1,115 HHCs, screening outcomes were ascertained within 1 day of line-listing ("Next 1"). In 65% of 1,105 HHCs eligible for further evaluation, anti-TB treatment, TPT or a decision for no drugs was made within 7 days of screening ("Second 7"). Altogether, 62% of screened HHCs started TPT during the "7-1-7" period compared with 58% in a historical cohort. Main barriers to TPT uptake were HHCs not consulting clinicians, HHCs being unwilling to initiate TPT and drug shortages. Healthcare workers felt that a timeliness metric was valuable for streamlining HHC management and proposed "3-5-7" as a workable alternative. CONCLUSIONS: The national TB programme must generate awareness about TPT, ensure uninterrupted drug supplies and assess whether the "3-5-7" metric can be operationalised.

CONTEXTE: L'étude a évalué si une mesure de rapidité "7-1-7" pour le dépistage et le traitement préventif de la TB (TPT) pouvait être mise en œuvre pour les contacts familiaux des patients index atteints de TB pulmonaire confirmée bactériologiquement dans le cadre d'un programme de routine au Kenya. MÉTHODES: Étude de cohorte longitudinale menée auprès de patients index et de leurs contacts familiaux dans 12 établissements de santé du comté de Kiambu, au Kenya. RÉSULTATS: Entre janvier et juin 2023, 95% des 508 patients index ont eu leur centre de santé inscrit sur la liste dans les 7 jours suivant le début du traitement antituberculeux (« First 7 ¼ ). Dans 68% des 1 115 centres de santé, les résultats du dépistage ont été vérifiés dans le jour suivant l'inscription sur la liste (« Next 1 ¼). Dans 65% des 1 105 centres de santé éligibles pour une évaluation plus approfondie, le traitement antituberculeux, le TPT ou la décision de ne pas prendre de médicaments a été prise dans les 7 jours suivant le dépistage (« Second 7 ¼). Au total, 62% des patients dépistés ont commencé un traitement antituberculeux au cours de la période « 7-1-7 ¼, contre 58% dans une cohorte historique. Les principaux obstacles à l'adoption du TPT étaient les suivants : les centres de santé ne consultaient pas les cliniciens, les centres de santé n'étaient pas disposés à commencer le TPT et les pénuries de médicaments. Les professionnels de la santé ont estimé qu'une mesure de la rapidité d'exécution était utile pour rationaliser la gestion des centres de santé et ont proposé le « 3-5-7 ¼ comme solution de rechange viable. CONCLUSION: Le programme national de lutte contre la TB doit sensibiliser au TPT, garantir un approvisionnement ininterrompu en médicaments et évaluer si la mesure « 3-5-7 ¼ peut être mise en œuvre.

Using timeliness metrics for household contact tracing and TB preventive therapy in the private sector, India.

Although screening of household contacts (HHCs) of TB patients and provision of TB preventive therapy (TPT) is a key intervention to end the TB epidemic, their implementation globally is dismal. We assessed whether introducing a '7-1-7' timeliness metric was workable for implementing HHC screening among index patients with pulmonary TB diagnosed by private providers in Chennai, India, between November 2022 and March 2023.This was an explanatory mixed-methods study (quantitative-cohort and qualitative-descriptive).There were 263 index patients with 556 HHCs. In 90% of index patients, HHCs were line-listed within 7 days of anti-TB treatment initiation. Screening outcomes were ascertained in 48% of HHCs within 1 day of line-listing. Start of anti-TB treatment, TPT or a decision to receive neither was achieved in 57% of HHC within 7 days of screening. Overall, 24% of screened HHCs in the '7-1-7' period started TPT compared with 16% in a historical control (P < 0.01). Barriers to achieving '7-1-7' included HHC reluctance for evaluation or TPT, refusal of private providers to prescribe TPT and reliance on facility-based screening of HHCs instead of home visits by health workers for screening.Introduction of a timeliness metric is a workable intervention that adds structure to HHC screening and timely management..

Diagnosis of pulmonary tuberculosis in a pastoralist population in Ethiopia: are three sputum specimens needed?

OBJECTIVE: To assess the number of sputum specimens necessary for a reliable diagnosis of pulmonary tuberculosis (PTB) in a pastoralist population in Ethiopia. METHOD: Using routine data from Ethiopia, where three sputum specimens are currently recommended for the diagnosis of PTB, we documented, (i) the proportion of persons with suspected, PTB who submitted a first, second and third sputum specimen for smear examination and (ii) the incremental smear-positive yield from the first, to the second and third specimens. RESULTS: Of 505 persons with suspected PTB, 107 (22%) failed to submit three samples. Of 60 patients who submitted three sputum samples with at least one smear-positive sample, the first sputum sample was smear positive in 56 (93%) cases; the second sputum sample was the first to be positive in 3 (5%) cases and in only one case was the third sample the first to be smear positive (additional yield 2%). CONCLUSION: In a pastoralist setting, a reliable diagnosis of PTB can be achieved with two sputum specimens and PTB diagnosis may be adequate with just one sputum specimen. However, if this more radical approach was adopted, ways of increasing diagnostic sensitivity should be explored.

Surgical antibiotic prophylaxis administration practices.

SETTING: A referral hospital in Kavre, Nepal. OBJECTIVES: To assess 1) compliance with National Antibiotic Treatment Guidelines (NATG), specifically, whether the administration of surgical antibiotic prophylaxis (SAP) (initial dosing and redosing) was in compliance with NATG for patients who were and were not eligible, and 2) development of surgical site infections (SSIs) among patients who underwent surgery in the Department of General Surgery (July-December 2019). DESIGN: This was a retrospective cohort analysis. RESULTS: The analysis included 846 patients, of which 717 (85%) patients were eligible for SAP and 129 (15%) were ineligible. Of those eligible, 708 (99%) received the initial dose; while 65 (50%) of the ineligible did not receive any dose. Of those who received the initial dose, 164 (23%) were eligible for redosing. Of these, only 23 (14%) received at least one redosing and 141 (86%) did not receive it. Overall compliance with NATG was achieved in 75% (632/846) of patients. SSIs occurred in 23 (3%) patients, 8 (35%) of whom did not have SAP administered according to NATG. CONCLUSION: A relatively high overall compliance with NATG for SAP administration was reported. Recommendations were made to improve compliance among those who were ineligible for SAP and those who were eligible for redosing.

LIEU: Un hôpital de référence du district de Kavre, Népal. OBJECTIFS: Évaluer 1) le respect des directives nationales sur les traitements antibiotiques (NATG), plus particulièrement si l'administration d'une antibioprophylaxie chirurgicale (SAP) (dose initiale et nouvelle dose) respectait les directives NATG pour les patients qui y étaient ou non éligibles ; et 2) le développement d'infections du site opératoire (SSI) chez les patients ayant subi une intervention chirurgicale dans le service de Chirurgie Générale (juillet­décembre 2019). MÉTHODE: Il s'agissait d'une analyse de cohorte rétrospective. RÉSULTATS: L'analyse a inclus 846 patients, dont 717 (85%) étaient éligibles à une SAP et 129 (15%) n'y étaient pas éligibles. Parmi ceux qui y étaient éligibles, 708 (99%) ont reçu la dose initiale, alors que 65 (50%) des patients non éligibles n'ont reçu aucune dose. Parmi ceux ayant reçu la dose initiale, 164 (23%) étaient éligibles à une nouvelle dose. Parmi ces derniers, seuls 23 (14%) ont reçu au moins une nouvelle dose et 141 (86%) n'en ont pas reçu. Les directives NATG ont été respectées chez 75% (632/846) des patients. Des SSI ont été observées chez 23 (3%) patients ; pour huit (35%) de ces patients, la SAP n'avait pas été administrée conformément aux directives NATG. CONCLUSION: Un respect global relativement élevé des directives NATG pour l'administration de la SAP a été rapporté. Des recommandations ont été émises pour améliorer le respect de ces directives chez les patients non éligibles à la SAP et chez ceux éligibles à une nouvelle dose.

Annual consumption of parenteral antibiotics in a tertiary hospital of Nepal, 2017-2019: a cross-sectional study.

SETTING: Patan Hospital, a tertiary care hospital in Lalitpur District, Nepal. OBJECTIVES: To describe the annual parenteral antibiotic consumption in 1) defined daily dose (DDD) and DDD per 100 admissions; 2) calculate DDD per 100 admissions and proportions by pharmacological subgroup, chemical subgroup and AWaRe categories; and 3) describe patient expenditure on parenteral antibiotics as a proportion of the total patient expenditure on drugs and consumables between 2017 and 2019. DESIGN: This was a cross-sectional study. RESULTS: Total DDD of parenteral antibiotics increased by 23% from 39,639.7 in 2017 to 48,947.7 in 2019. DDD per 100 admissions increased by 10% from 172.1 in 2017 to 190.2 in 2019. Other beta-lactam antibacterials comprised the most frequently consumed pharmacological subgroup. The chemical substance most often consumed was ceftriaxone, with an increasing trend in the consumption of vancomycin and meropenem. Parenteral antibiotics in 'Watch' category were the most consumed over the study period, with a decreasing trend in 'Access' and increasing trend in 'Reserve' categories. CONCLUSION: We aimed to understand the consumption of parenteral antibiotics at a tertiary care hospital and found that Watch antibiotics comprised the bulk of antibiotic consumption. Overconsumption of antibiotics from the 'Watch' and 'Reserve' categories can promote antimicrobial resistance; recommendations were therefore made for their rational use.

CONTEXTE: Hôpital de Patan, un hôpital de soins tertiaires du District de Lalitpur, Népal. OBJECTIFS: Décrire la consommation annuelle d'antibiotiques parentéraux en 1) dose définie journalière (DDD) et DDD pour 100 admissions ; 2) calculer la DDD pour 100 admissions et les pourcentages par sous-groupe pharmacologique, sous-groupe chimique et catégories de la classification AWaRe ; et 3) décrire les dépenses des patients en antibiotiques parentéraux en tant que proportion du total des dépenses des patients en médicaments et consommables de 2017 à 2019. MÉTHODE: Il s'agissait d'une étude transversale. RÉSULTATS: La DDD totale d'antibiotiques parentéraux a augmenté de 23%, de 39 639,7 en 2017 à 48 947,7 en 2019. La DDD pour 100 admissions a augmenté de 10%, de 172,1 en 2017 à 190,2 en 2019. Les autres bêtalactamines étaient le sous-groupe pharmacologique le plus consommé. La substance chimique la plus consommée était la ceftriaxone, avec une tendance à la hausse de la consommation de vancomycine et de méropénème. Les antibiotiques parentéraux du groupe « antibiotiques à utiliser sélectivement ¼ étaient les plus consommés pendant la période d'étude, avec une tendance à la baisse de ceux du groupe « antibiotiques dont l'accessibilité est essentielle ¼ et une tendance à la hausse de ceux du groupe « antibiotiques de réserve ¼. CONCLUSION: Nous avons cherché à comprendre la consommation d'antibiotiques parentéraux dans un hôpital tertiaire et avons observé que les « antibiotiques à utiliser sélectivement ¼ représentaient la majorité de la consommation d'antibiotiques. La surconsommation d'« antibiotiques à utiliser sélectivement ¼ et d'« antibiotiques de réserve ¼ peut favoriser la résistance antimicrobienne. Des recommandations ont donc été émises pour un usage raisonné de ces antibiotiques.

Building the capacity of public health programmes to become data rich, information rich and action rich.

Good quality, timely data are the cornerstone of health systems, but in many countries these data are not used for evidence-informed decision making and/or for improving public health. The SORT IT (Structured Operational Research and Training Initiative) model has, over 8 years, trained health workers in low- and middle-income countries to use data to answer important public health questions by taking research projects through to completion and publication in national or international journals. The D2P (data to policy) training initiative is relatively new, and it teaches health workers how to apply 'decision analysis' and develop policy briefs for policy makers: this includes description of a problem and the available evidence, quantitative comparisons of policy options that take into account predicted health and economic impacts, and political and feasibility assessments. Policies adopted from evidence-based information generated through the SORT IT and D2P approaches can be evaluated to assess their impact, and the cycle repeated to identify and resolve new public health problems. Ministries of Health could benefit from this twin-training approach to make themselves 'data rich, information rich and action rich', and thereby use routinely collected data in a synergistic manner to improve public health policy making and health care delivery.

Des données de bonne qualité et disponibles rapidement sont la pierre angulaire des systèmes de santé, mais dans de nombreux pays ces données ne sont pas utilisées pour les prises de décision fondées sur des preuves et/ou pour améliorer la santé publique. Le modèle SORT IT (Structured Operational Research and Training Initiative) a, en 8 années, formé le personnel de santé des pays à revenu faible et moyen à l'utilisation des données pour répondre à d'importantes questions de santé publique en amenant les projets de recherche jusqu'à leur achèvement et à la publication dans des revues nationales ou internationales. L'initiative de formation D2P (données pour la politique) est relativement nouvelle et forme le personnel de santé à la manière d'appliquer l'analyse de décision et à l'élaboration d'énoncés de politiques à l'intention des décideurs politiques : ceci inclut la description d'un problème et les preuves disponibles, une comparaison quantitative des options de politique qui tiennent compte des impacts prédits en matière de santé et d'économie, et une évaluation de politique et de faisabilité. Les politiques adoptées à partir d'informations basées sur des preuves générées grâce aux approches SORT IT et de D2P peuvent être évaluées en termes d'impact, et le cycle répété afin d'identifier et de résoudre de nouveaux problèmes de santé publique. Les ministres de la santé pourraient bénéficier de cette approche de formation double afin qu'ils soient « riches de données, riches d'information et riches d'action ¼, et donc utiliser les données recueillies en routine d'une manière synergique afin d'améliorer les choix en matière de politique de santé publique et de prestation des soins de santé.

La buena calidad de los datos y su puntualidad constituyen los pilares de los sistemas de salud, pero en muchos países esta información no se utiliza con el fin de orientar la toma de decisiones basadas en la evidencia o mejorar la salud pública. El modelo de Investigación Operativa Estructurada e Iniciativa para la Formación (SORT IT) se ha aplicado durante más de 8 años en la capacitación de los profesionales de salud de países de ingresos bajos y medianos, en materia de aplicación de los datos para resolver importantes preguntas de salud pública, al acompañar los proyectos de investigación hasta su finalización y publicación en revistas de ámbito nacional o internacional. La iniciativa de formación D2P (de los datos a las políticas) es relativamente nueva e instruye a los trabajadores de salud sobre la forma de aplicar el 'análisis decisional' y formular documentos normativos destinados a las instancias decisorias; la iniciativa comprende la descripción de un problema y la evidencia disponible, una comparación cuantitativa de las opciones normativas que tiene en cuenta las repercusiones de salud y económicas previstas y una evaluación política y de factibilidad. Es posible evaluar las políticas adoptadas a partir de información basada en la evidencia científica generada por conducto de las estrategias SORT IT y D2P con el propósito de analizar su repercusión y se puede repetir el ciclo a fin de detectar y resolver nuevos problemas de salud pública. Los ministerios de salud pueden aprovechar este enfoque doble de capacitación con el objeto de alcanzar una situación de 'riqueza de datos, de información y de acción' y aplicar sinérgicamente los datos recogidos de manera sistemática con miras a optimizar la toma de decisiones de salud pública y la prestación de los servicios de salud.

Pathophysiology of bleeding in heat stress: an experimental study in sheep.

Widespread hemorrhagic manifestations commonly occur in patients with severe heat stroke. The pathogenesis of hemostatic disorders in these patients is not fully understood, although it is believed to be multifactorial in origin. The present investigation was designed to study the changes in blood platelets caused by heat stress in an experimental model of five merino sheep. The experiments were performed in two groups of five merino sheep each. In one group the sheep were subjected to a combination of heat (elevated environmental temperature) and exertional stress, and allowed to proceed throughout the experiment until a state of near collapse was reached (Task A). In the other group (Task B) the animals were heated in the same manner as those in Task A and also subjected to exertional heat; however, when the temperature reached 43.6 +/- 0.2 degrees C, the critical core temperature (CCT), they were subjected to evaporative cooling in a climatic chamber. Serial changes in the platelet counts and platelet functions were measured throughout the duration of the experiments. At the core temperature (CT) of 42.1 degrees C and above there was a significant impairment of adhesion of platelets to glass beads. During the early phases of elevation of CT, platelets showed hyperaggregation in the presence of different agonists (such as, collagen, ADP, ristocetin); this was followed by hypoaggregation when the CCT was raised above 43.6 +/- 0.2 degrees C. However, these impairments of platelet functions occurring at elevated CT and CCT were found to reverse to normal within 24 hours after the animals were cooled to 39 degrees C. It was also found that the hyperaggregation of platelets to different agonists induced by raised CT could be partially prevented by prior in vitro treatment of platelets with apyrase, a known enzyme destroying of ADP. The results of these experiments indicate that heat stress induced by exposing merino sheep to elevated controlled temperature directly activates the platelets. This may be an important contributing factor in causing altered hemostasis in heat stroke activated directly by heat. This mechanism may be operating in altered hemostasis in heat stroke.

Effect of increased ART-CPT uptake on tuberculosis outcomes and associated factors, Burundi, 2009-2013.

We retrospectively examined 3579 records of human immunodeficiency virus infected tuberculosis (TB) patients diagnosed from January 2009 to June 2013 in 55 TB treatment facilities in Burundi, to demonstrate whether improvement of combined cotrimoxazole preventive therapy and antiretroviral therapy (ART) uptake was accompanied by improvement of treatment outcomes, and to describe associated factors. Treatment success rates increased from 71% to 80% (P < 0.001). While loss to follow-up and transfer-out rates declined significantly, death rates decreased modestly, and remained high, at 14%. ART uptake was worse in suburban areas and private for-profit institutions. World Health Organization targets could be achieved if peripheral health facilities were prioritised.

Une étude rétrospective conduite de janvier 2009 à juin 2013 au Burundi chez 3579 patients co-infectées par la tuberculose (TB) et le virus de l'immunodéficience humaine dans 55 centres de diagnostic et de traitement de la TB, décrit l'évolution des résultats de traitement antirétroviral (ART) et cotrimoxazole et apprécie les facteurs liés à l'ART. La proportion des succès au traitement a augmenté de 71% à 80% (P < 0,001). Tandis que les taux de perdus de vue et de transferts ont baissé significativement, celui des décès n'a baissé que modestement, tout en restant élevée, à 14%. La couverture en ART est plus faible dans les centres de santé périphériques et dans ceux relevant du privé non lucratif. Les objectifs de l'Organisation Mondiale de la Santé pourraient être atteints si les districts sanitaires ruraux étaient inclus dans la fourniture des soins.

En el presente estudio se analizaron 3579 registros de pacientes aquejados de coinfección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis (TB) en Burundi de enero del 2009 a junio del 2013, provenientes de 55 establecimientos de tratamiento de la TB, con el objeto de investigar si al aumentar la aceptación del tratamiento preventivo con cotrimoxazol en asociación con el tratamiento antirretrovírico (ART) se mejoraban los desenlaces terapéuticos y también se describieron los factores que se asociaban con esta situación. Las tasas de éxito terapéutico aumentaron de un 71% a un 80% (P < 0,001). Aunque las tasas de pérdida durante el seguimiento y de remisión a otros establecimientos disminuyeron de manera significativa, la disminución de las tasas de mortalidad fue leve y permanecieron en un nivel alto de 14%. La aceptación del ART fue más deficiente en las zonas suburbanas y en los establecimientos privados con ánimo de lucro. Sería posible cumplir con las metas de la Organización Mundial de la Salud si se da prioridad a los establecimientos sanitarios periféricos.

Drug-related hospitalization at a tertiary teaching center in Lebanon: incidence, associations, and relation to self-medicating behavior.

OBJECTIVE: In Lebanon there is very limited restriction on drug use. Accordingly, self-medication is highly prevalent. This study examined the influence of these factors on the development of drug-related illnesses that lead to hospitalization. METHODS: Patients admitted to the medical and pediatric wards of a tertiary teaching center in Beirut, Lebanon, over a period of 6 months were interviewed and their charts were reviewed. Admissions attributable to adverse drug reactions or therapeutic failures were identified and characterized with respect to demographic factors, medical history, drug intake, and self-medicating behavior. The influence of these variables on the development of drug-related illnesses was examined by logistic regression. RESULTS: Of 1745 adults and 457 children, there were 177 (10.2%) and 36 (7.9%) drug-related illnesses, respectively. Adverse drug reactions accounted for 7.0% and 5.7% and therapeutic failures for 3.2% and 2.2% of adult and pediatric admissions, respectively. Self-medication was commonly practiced (52.6% of adults and 41.6% of children). Logistic regression analysis revealed that female sex increased the risk of adverse drug reaction in adults, whereas self-medication decreased the risk. In children, the risk of adverse drug reaction was increased in lower socioeconomic groups, whereas the risk of therapeutic failure was increased by a positive history of atopy or drug reaction. CONCLUSIONS: These results provide the first detailed analysis of the problem of drug-related illnesses in a developing country and identify a number of related or risk factors. Despite the lack of regulation of drug dispensing and the unchecked access to drugs in Lebanon, the incidence of drug-related illnesses is not different from that in Western nations. This finding may have relevance to policies of drug regulation in other countries.

Reliability of death certificate diagnoses.

Consistency between death certificates and clinical records from 5 general hospitals in Kuwait was studied for 470 deaths with the following underlying or associated causes: hypertensive (HYP), ischaemic heart diseases (IHD), cerebrovascular diseases (CVD) and diabetes mellitus (DM). Direct causes were not considered since they are of little interest analytically. Only deaths with definite or most probable ascertainment were included. One cardiologist, who was provided with the WHO criteria and relevant documents on death certification, independently reviewed the records. To test the reviewer's bias and the reliability of his judgement, an adjudication process was effected by having one senior cardiologist re-review a random subsample of 140 records. The two reviewers showed good agreement. Specific diagnoses criteria for deciding the underlying cause of death in multiple morbid conditions by the reviewer were followed. Due to possible reviewer bias, we aimed at measuring the difference between initial certifiers and the reviewer rather than measuring the diagnostic accuracy of initial certifiers in reference to the reviewer. The agreement index kappa showed poor agreement between original and revised certificates. The original certificates under-estimated CVD as an underlying cause of death by 69.2%, DM by 60%, IHD by 33.5% and HYP by 31.8% in our sample. Associated causes were also consistently under-estimated by initial certifiers as compared with the reviewer. This bias calls for basing mortality statistics in Kuwait on hospital death committees' reports rather than on initial certifier death certificates, use of multiple-causes of death instead of one underlying cause and adequate training of the medical profession on the value and process of death certification.

Epidemiology of heat illnesses during the Makkah Pilgrimages in Saudi Arabia.

A review of the literature shows that our knowledge of the epidemiology of heat illnesses on a global and regional level is still lacking. Until now most of the information has come from the experience of European armies in hot environments. Recently increased interest has been shown following the epidemics of heat illnesses affecting civil communities in the United States. Of great importance and unique for the study of heat illness is the start of the hot cycle of the Makkah Pilgrimage which will continue for the next 15-16 years. Approximately two million people, the majority of whom are at great risk, will be exposed to the extremes of hot weather in May-September. Thousands of heat stroke cases are expected to occur. In this paper the conditions prevailing during the annual Makkah Pilgrimage are described as well as a review of the epidemiological and clinical findings observed by the author during the pilgrimages of 1980/81 when 176 cases and 467 cases of Heat Stroke were seen and treated respectively and a new physiological method of treatment of heat stroke which proved very successful in clinical field trials was introduced.

Tuberculosis among immigrants in the United Kingdom: the role of occupational health services.

Immigrant workers in the United Kingdom account for 7.8% of the working population. Their health problems fall into three groups--imported diseases, occupational accidents, and acquired diseases. In the latter group, tuberculosis is still a major problem. A retrospective study tracing notifiable cases of tuberculosis to points of entry at Heathrow Airport indicates that the majority of immigrants acquire the disease after entry. The occupational health services have a great role to play in detecting the new cases very early and in providing appropriate screening and follow-up. Proper co-ordination between occupational and community health services will give the best results and lead to a rapid decline of the disease.

Household crowding index: a correlate of socioeconomic status and inter-pregnancy spacing in an urban setting.

OBJECTIVES: This paper examines the effect of household crowding on inter-pregnancy spacing and its association with socioeconomic indicators, among parous mothers delivered in an urban environment. DESIGN: Cross sectional survey. METHODS: Sociodemographic data were obtained on 2466 parous women delivering at eight hospitals in Greater Beirut over a one year period. Statistical methodology comprised Pearson chi(2) test and logistic regression analysis. MAIN RESULTS: A significant inverse relation was observed between household crowding and socioeconomic status, defined as education and occupation of women and their spouses. Inter-pregnancy spacing increased with higher levels of crowding. Further analysis suggested that this positive association was confounded by maternal demographic characteristics. CONCLUSIONS: These data have shown that household crowding, a correlate of low parental socioeconomic status, is associated with longer birth intervals. This association, however, seems to be largely explained by maternal age and parity.

Epidemiology of multiple sclerosis in Arabs in Kuwait: a comparative study between Kuwaitis and Palestinians.

On December 31, 1988 there were 201 registered multiple sclerosis patients in Kuwait, an overall prevalence rate (PR) of 10.2 per 100,000; among them were 186 Arabs, of whom 72 were Palestinians and 51 Kuwaitis. Comparison of these two subgroups, who had a similar age distribution revealed that the disease was 2 1/2 times more frequent among Palestinians (PR 23.8/100,000) than among Kuwaitis (PR 9.5/100,000). Palestinians also showed significant differences from Kuwaitis in eye color, blood group distribution and HLA-DR and HLA-DQW epitopes frequency. This suggests that genetic rather than environmental factors might be the underlying cause for the high susceptibility to develop MS among Arabs originating from the Eastern Mediterranean basin.

Brucellosis in Kuwait: a clinico-epidemiological study.

The 160,000 population in Adan area, Kuwait, is served by Adan Regional Hospital. During the 6 months period mid-December, 1983 to mid-June, 1984, 68 cases of brucellosis were admitted to the hospital, an annual incidence of 85/100,000 population. Of these, 84% were Kuwaitis and Bedouins. The mean age was 32 years, range 12-70 years. The male female ratio was 1.4:1. 55 patients gave histories of consuming raw milk and 4 had close contact with animals. The highest incidence of the disease coincided with the animal delivery season and the desert camping period of Kuwaiti families. It appears that air transmission of contaminated soil is one of the main routes of Brucella infections in Kuwait.