Prevalence, Incidence, Trend, and Complications of Thalassemia in Iraq.

Globally, thalassemia is the most common hereditary hemoglobinopathy, and occurs in 4.4/10,000 live births. In the developing world, the majority of patients die before the age of 20 years. In Iraq, there is little data on the epidemiology and burden of thalassemia. The objectives of this study were to determine the prevalence, incidence, trend, and complications of thalassemia patients in Iraq. All thalassemia patients registered in the accessible 16 (of the 19) thalassemia centers in Iraq until December 31 2015, were included. Data were acquired from patients' files and the centers' registries. The total number of registered thalassemia patients was 11,165 representing 66.3% of all registered hereditary anemias in these centers. The prevalence of thalassemia had increased from 33.5/100,000 in 2010 to 37.1/100,000 in 2015, while the incidence rate had decreased from 72.4/100,000 live births to 34.6/100,000 live births between 2010 and 2015. ß-Thalassemia major (ß-TM) represented 73.9% of all types of thalassemia. About 66.0% of patients were under 15 years old; 78.8% were offspring of parents who were related, and 55.9% had at least one complication. Respectively, 13.5 and 0.4% of thalassemia patients were infected with hepatitis C virus (HCV) and hepatitis B virus (HBV) at some point in their lives. No patients were infected with the human immune deficiency virus (HIV). In conclusion, the prevalence of thalassemia in Iraq is slightly increasing in spite of decreasing incidence. Screening for carriers, and intensified premarital screening and counseling programs, coupled with strong legislation can help in further decreasing incidence rate.

Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks in 188 countries, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: The Global Burden of Disease, Injuries, and Risk Factor study 2013 (GBD 2013) is the first of a series of annual updates of the GBD. Risk factor quantification, particularly of modifiable risk factors, can help to identify emerging threats to population health and opportunities for prevention. The GBD 2013 provides a timely opportunity to update the comparative risk assessment with new data for exposure, relative risks, and evidence on the appropriate counterfactual risk distribution. METHODS: Attributable deaths, years of life lost, years lived with disability, and disability-adjusted life-years (DALYs) have been estimated for 79 risks or clusters of risks using the GBD 2010 methods. Risk-outcome pairs meeting explicit evidence criteria were assessed for 188 countries for the period 1990-2013 by age and sex using three inputs: risk exposure, relative risks, and the theoretical minimum risk exposure level (TMREL). Risks are organised into a hierarchy with blocks of behavioural, environmental and occupational, and metabolic risks at the first level of the hierarchy. The next level in the hierarchy includes nine clusters of related risks and two individual risks, with more detail provided at levels 3 and 4 of the hierarchy. Compared with GBD 2010, six new risk factors have been added: handwashing practices, occupational exposure to trichloroethylene, childhood wasting, childhood stunting, unsafe sex, and low glomerular filtration rate. For most risks, data for exposure were synthesised with a Bayesian meta-regression method, DisMod-MR 2.0, or spatial-temporal Gaussian process regression. Relative risks were based on meta-regressions of published cohort and intervention studies. Attributable burden for clusters of risks and all risks combined took into account evidence on the mediation of some risks such as high body-mass index (BMI) through other risks such as high systolic blood pressure and high cholesterol. FINDINGS: All risks combined account for 57·2% (95% uncertainty interval [UI] 55·8-58·5) of deaths and 41·6% (40·1-43·0) of DALYs. Risks quantified account for 87·9% (86·5-89·3) of cardiovascular disease DALYs, ranging to a low of 0% for neonatal disorders and neglected tropical diseases and malaria. In terms of global DALYs in 2013, six risks or clusters of risks each caused more than 5% of DALYs: dietary risks accounting for 11·3 million deaths and 241·4 million DALYs, high systolic blood pressure for 10·4 million deaths and 208·1 million DALYs, child and maternal malnutrition for 1·7 million deaths and 176·9 million DALYs, tobacco smoke for 6·1 million deaths and 143·5 million DALYs, air pollution for 5·5 million deaths and 141·5 million DALYs, and high BMI for 4·4 million deaths and 134·0 million DALYs. Risk factor patterns vary across regions and countries and with time. In sub-Saharan Africa, the leading risk factors are child and maternal malnutrition, unsafe sex, and unsafe water, sanitation, and handwashing. In women, in nearly all countries in the Americas, north Africa, and the Middle East, and in many other high-income countries, high BMI is the leading risk factor, with high systolic blood pressure as the leading risk in most of Central and Eastern Europe and south and east Asia. For men, high systolic blood pressure or tobacco use are the leading risks in nearly all high-income countries, in north Africa and the Middle East, Europe, and Asia. For men and women, unsafe sex is the leading risk in a corridor from Kenya to South Africa. INTERPRETATION: Behavioural, environmental and occupational, and metabolic risks can explain half of global mortality and more than one-third of global DALYs providing many opportunities for prevention. Of the larger risks, the attributable burden of high BMI has increased in the past 23 years. In view of the prominence of behavioural risk factors, behavioural and social science research on interventions for these risks should be strengthened. Many prevention and primary care policy options are available now to act on key risks. FUNDING: Bill & Melinda Gates Foundation.

Performance evaluation of health houses in Iraq 2021-2022: A descriptive study.

BACKGROUND: A health house (HH) is a basic health facility in rural Iraq. The function of a HH is to provide simple health services and treatments such as giving injections, dressing simple wounds, and monitoring mother and child health. The duties also include dispensing medications, measuring blood pressure, and the daily monitoring of chlorine levels in water. These HHs also provide awareness on different subjects. The main objectives of this study are to assess the availability of the basic features of the HHs and core components of the framework of the World Health Organization (WHO) building blocks. MATERIALS AND METHODS: A multistage sampling technique was used to select 50 HHs out of 497 in Iraq. A questionnaire comprising closed-ended questions was developed to be completed using the researcher's observations and interviews with the healthcare workers in the HHs. The questionnaire covered the basic features of HHs as recommended by the Iraq Ministry of Health (MOH) and the six WHO health system building blocks. RESULTS: Fifty HHs were enrolled in the study. The availability score of basic features was 43.6% and the general service score was 55.1%. The service-specific score was 23.3%, the health workforce score was 29.6%, and the health information system score was 79.5%. The availability of essential medicines score was 21.2%, the health financing system score was 0.0%, and the leadership and governance score was 66.7%. CONCLUSION: The HHs need to follow the standard criteria determined by the Iraq MOH to ensure the proper functioning of the health outlets.

Epidemiological characteristics of burn injuries in Iraq: A burn hospital-based study.

This study was conducted to determine the epidemiological and clinical characteristics of burn injuries, estimate the case fatality rate for burn patients, and determine the main determinants of the associated death among burn patients who were admitted to Baghdad Burn Hospital, Medical City Teaching Hospitals, Baghdad, Iraq during 2015. This study involved a retrospective review of medical records of all burn patients who were admitted to Baghdad Burn Hospital in 2015. Data were collected using a special form and included information on demographic characteristics and burn characteristics and outcomes. A total of 676 patients with burn were included in this study, who constituted 75% of admitted patients. The remaining was admitted for treatment of old scars. About one third of patients (37.0%) aged 21-30 years, 67.1% were males, 34.8% were military personnel, and 60.7% of the patients had primary school education. About 71.6% of patients were burned by flame and 23.4% were burned by hot fluid. Half of patients had a second degree burns. Almost half of patients had 11-20% of their body surface area affected. About 13% of patients died, mainly due to multiple organs failure (53.3%), septicemia (44.4%), and shock (2.2%). In conclusion, young adults and children, males, and low educated patients represent the majority of admitted burn cases in Iraq. Flame and scalds were the most important causes of burn. More than one tenth of patients died mostly due to septicemia and multi-organ failure.

Epidemiology of Colorectal Cancer in Iraq, 2002-2014.

OBJECTIVES: After cardiovascular diseases, cancer is one of the major causes of death in Iraq but there is scarcity of data on cancer. This study aimed to estimate the incidence rate of colorectal cancer in Iraq and its distribution and determine its trend in Iraq from 2002 to 2011. METHODS: The necessary data for recording the incidence of colorectal cancer in Iraq were obtained from three main sources including the cancer registry for the period of 2002-2014. Data included information on gender, age, geographical distribution, site of tumors, and histology types. RESULTS: A total of 7,246 cases of CRC were registered in the cancer registry for the period 2002-2011 and 706 cases in the National Cancer Hospital between 2012 and 2014. Male to female ratio varied from 1.17:1 to 1.28:1. About 40%-46% of cases were diagnosed in the age group of 40-59 years. The incidence rate increased from 2.75/105 pop in 2002 to 3.26/105 pop in 2011. Adenocarcinoma constituted 84.0% of all cases. Of the 706 registered cases during 2012-2014, 95% were diagnosed by histology of primary site. The degree of differentiation was moderate in 56% of cases. About 26% of cases were localized, 55.9% and 16% were with regional, and distant metastasis, respectively. CONCLUSION: Iraq has a low CRC incidence rate but with a steady increase overtime. It is crucial to implement preventive strategies to control CRC in Iraq and to establish public awareness program about CRC and the importance of screening.

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

BACKGROUND: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013. METHODS: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically. FINDINGS: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred. INTERPRETATION: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts. FUNDING: Bill & Melinda Gates Foundation.