Social determinants of chronic diseases reporting among slum dwellers in Egypt.

The high prevalence of chronic diseases in urban slums poses increasing challenges to future social and economic development for these disadvantaged areas. Assessing the health status of slum residents offers guidance for formulating appropriate policies and interventions to improve slum residents' health outcomes. This research aimed to identify the social determinants of chronic diseases reporting among slum dwellers in Egypt. A cross-sectional survey was conducted from March to December 2021 in three slum areas in Giza governorate, Egypt, including 3,500 individuals. We constructed an asset index and a welfare index to measure the economic status and living conditions of slum residents, respectively. We used these indices, along with demographic and socio-economic factors, as independent variables in the analysis. We modeled factors associated with health status using a two-level mixed logistic model to control the effects of slum areas and the potential correlation between household members. The study contributed significantly to a better understanding of the context in which slum dwellers live and the interlinkages among poor living conditions, low economic status, and health outcomes. The results showed a high rate of self-reported chronic diseases among adults aged 18 and older, reaching more than 22%, while it did not exceed 2.0% among children in the slum areas. Therefore, measuring the determinants of chronic diseases was limited to adults. The sample size was 2530 adults after excluding 970 children. The prevalence of chronic diseases among adults ranged between 16.3% in Zenin and 22.6% in Bein El Sarayat. Our findings indicated that low socio-economic status was significantly associated with reporting chronic diseases. Future policies should be dedicated to improving living conditions and providing necessary healthcare services for these vulnerable areas.

Implications of labour market disruptions on subjective wellbeing during the COVID-19 pandemic in MENA countries.

COVID-19 has caused a global health crisis and severe economic and social consequences. Unprecedented economic disruption and high unemployment are the pronounced impacts of the pandemic. The current study is primarily concerned with the effects of COVID-19-induced labour market outcomes on workers' subjective wellbeing in four MENA countries using the Combined COVID-19 MENA Monitor Household Survey. The study documented that COVID-19-induced labour market changes negatively affected workers' subjective wellbeing after controlling for work characteristics, risks, social distancing, and socio-demographic variables. Job loss, income reduction, and wage delay were the most significant labour changes that deteriorated workers' subjective wellbeing. Our findings underscore the need for policy responses that reduce workers' vulnerability and sustain their livelihoods. Mental health services and income support policies are important tools to enhance subjective wellbeing of economically affected workers.

Predictors of mental health problems during the COVID-19 outbreak in Egypt in 2021.

Background: With the widespread outbreak of the coronavirus (COVID-19) pandemic, many countries, including Egypt, have tried to restrict the virus by applying social distancing and precautionary measures. Understanding the impact of COVID-19-induced risks and social distancing measures on individuals' mental health will help mitigate the negative effects of crises by developing appropriate mental health services. This study aimed to investigate the most contributing factors that affected individuals' mental health and how individuals' mental health has changed over the lockdown period in Egypt in 2021. Methods: The study draws on a nationally representative sample from the combined COVID-19 MENA Monitor Household Survey conducted by the Economic Research Forum. The data were collected in Egypt by phone over two waves in February 2021 and June 2021. The total number of respondents is 4,007 individuals. The target population is mobile phone owners aged 18-64 years. The 5-item World Health Organization Well-Being Index (WHO-5) is used to assess the individuals' mental health over the past 2 weeks during the pandemic. Penalized models (ridge and LASSO regressions) are used to identify the key drivers of mental health status during the COVID-19 pandemic. Results: The mean value of mental health (MH) scores is 10.06 (95% CI: 9.90-10.23). The average MH score for men was significantly higher than for women by 0.87. Rural residents also had significantly higher MH scores than their urban counterparts (10.25 vs. 9.85). Middle-aged adults, the unemployed, and respondents in low-income households experienced the lowest MH scores (9.83, 9.29, and 9.23, respectively). Individuals' mental health has deteriorated due to the negative impacts of the COVID-19 pandemic. Regression analysis demonstrated that experiencing food insecurity and a decrease in household income were independent influencing factors for individuals' mental health (p < 0.001). Furthermore, anxiety about economic status and worrying about contracting the virus had greater negative impacts on mental health scores (p < 0.001). In addition, women, middle-aged adults, urban residents, and those belonging to low-income households were at increased risk of poor mental health (p < 0.05). Conclusion: The findings reveal the importance of providing mental health services to support these vulnerable groups during crises and activating social protection policies to protect their food security, incomes, and livelihoods. A gendered policy response to the pandemic is also required to address the mental pressures incurred by women.

Combining COVID-19 and seasonal influenza vaccines together to increase the acceptance of newly developed vaccines in the Eastern Mediterranean Region: a cross-sectional study.

BACKGROUND AND AIM: The World Health Organization (WHO) recommended the concomitant administration (co-administration) of inactivated seasonal influenza and coronavirus disease 2019 (COVID-19) vaccines, encouraging the practice for the 2021-2022 flu season. This study aimed to assess the acceptance of simultaneously receiving the seasonal influenza vaccine (SIV) and the COVID-19 vaccine in a single administration to reduce vaccine rejection towards the COVID-19 vaccination. METHODS: An online-based cross-section survey was conducted from 1 September to 9 November 2022, in the Eastern Mediterranean Region (EMR) through distributing the survey on different social media platforms, including Facebook, Twitter, LinkedIn and WhatsApp. We used the multi-level model to assess the variation of vaccine countries across EMR countries. RESULTS: In total, 3300 participants were included in this survey from 11 countries distributed in the EMR. More than one-third (40.7%) were aged 18-25 years, 60.6% were females, 54.0% had a university degree, 43.1% had previous COVID-19, and 41.9% had relatives or friends who died from COVID-19. In total, 43.3% accepted this combination because it is less costly (9%), safer (18%), more effective (17%), and has fewer doses (19%). Rejection of this combination was due to fear of side effects (31%), and no studies have been published on their effects (31%). There was a significant difference across countries, which accounted for 6% of the variance in the log-odds of accepting the combined vaccination. Multi-level analysis revealed that being male, African and losing a family member or friend from COVID-19 increased the acceptance of the theoretical combined vaccines. Additionally, the number of doses taken of the COVID-19 and influenza vaccines separately significantly affected the combined vaccine acceptance. However, previous COVID-19 infection and older age reduced the odds of accepting the combined vaccines. Occupational level, social status and educational level didn't significantly affect the acceptance odds. CONCLUSIONS: We can conclude that combining SIV and COVID-19 vaccines in one shot increased the overall acceptance of COVID-19 vaccines among vaccine rejectors.

Assessing disparities in medical students' knowledge and attitude about monkeypox: a cross-sectional study of 27 countries across three continents.

Background and aims: The recent monkeypox (Mpox) outbreak confirmed by the World Health Organization (WHO) underscores the importance of evaluating the knowledge and attitude of medical students toward emerging diseases, given their potential roles as healthcare professionals and sources of public information during outbreaks. This study aimed to assess medical students' knowledge and attitude about Mpox and to identify factors affecting their level of knowledge and attitude in low-income and high-income countries. Methods: A cross-sectional study was conducted on 11,919 medical students from 27 countries. A newly-developed validated questionnaire was used to collect data on knowledge (14 items), attitude (12 items), and baseline criteria. The relationship between a range of factors with knowledge and attitude was studied using univariate and multivariate analyses. Results: 46% of the study participants were males; 10.7% were in their sixth year; 54.6% knew about smallpox; 84% received the coronavirus disease 2019 (COVID-19) vaccine; and 12.5% had training on Mpox. 55.3% had good knowledge of Mpox and 51.7% had a positive attitude towards it. Medical students in their third, fifth, or sixth year high- income countries who obtained information on Mpox from friends, research articles, social media and scientific websites were positive predictors for good knowledge. Conversely, being male or coming from high-income countries showed a negative relation with good knowledge about Mpox. Additionally, a positive attitude was directly influenced by residing in urban areas, being in the fifth year of medical education, having knowledge about smallpox and a history of receiving the coronavirus disease 2019 (COVID-19) vaccine. Receiving information about Mpox from social media or scientific websites and possessing good knowledge about Mpox were also predictors of a positive attitude. On the other hand, being male, employed, or receiving a training program about Mpox were inversely predicting positive attitude about Mpox. Conclusion: There were differences in knowledge and attitude towards Mpox between medical students in low and high-income countries, emphasizing the need for incorporating epidemiology of re-emerging diseases like Mpox into the medical curriculum to improve disease prevention and control.

Attitudes of parents towards influenza vaccine in the Eastern Mediterranean Region: A multilevel analysis.

BACKGROUND: Seasonal influenza vaccines (SIVs) can protect against influenza and substantially reduce the risk of influenza-related hospitalizations and fatalities in children. This study aimed to assess parental attitudes towards SIVs in the Eastern Mediterranean region (EMR). METHODS: Through an anonymous online survey conducted in 19 countries in the EMR, parents or caregivers over 18 years who had at least one child above 6 months filled out the Parent Attitudes about Childhood Vaccines questionnaire. As data had two levels; country and individual factors, we utilized multilevel binary logistic regression models. RESULTS: In total, 6992 respondents filled out the questionnaire. Of them, 47.4 % were residents of middle-income countries, 72.4 % of the mothers were between 26 and 45 years old, 56.5 % had at least a university degree, and approximately 51.6 % were unemployed. Nearly 50.8 % of the respondents were hesitant to vaccinate their children against seasonal influenza. Parental attitudes towards seasonal influenza vaccination differed significantly between countries, p < 0.001. The main predictors of parental seasonal influenza vaccine hesitancy (VH) were parents vaccination (odds ratio (OR) = 0.42, 95 % CI = 0.32-0.55, p < 0.001)), the mother's education if mother educated vs. who did not receive any education (OR ranged from 0.48 to 0.64, p < 0.05), living in low-income countries (OR = 0.52, 95 % CI = 0.35-0.77, p < 0.01), mountain residence (0.69, 95 % CI = 0.49-0.99, p < 0.05), health workers as a source of information (OR = 0.70, 95 % CI = 0.58-0.85, p < 0.001), children vaccination against COVID-19 (OR = 0.52, 95 % CI = 0.41-0.65, p < 0.001), not receiving routine vaccinations (OR = 1.93, 95 % CI = 1.09-3.44, p = 0.025), and if parents respondents could not remember whether their child had suffered from seasonal influenza in the previous year (OR = 1.57, 95 % CI = 1.33-1.84, p < 0.001). CONCLUSION: A high seasonal influenza VH rate was found in the EMR. Health authorities should implement different interventions targeting the identified modifiable risk factor to increase vaccine uptake among children, especially those at risk of complication from seasonal influenza infection.

New evidence of gender inequality during COVID-19 outbreak in the Middle East and North Africa.

The COVID-19 pandemic has significantly altered employment and income distribution, impacting women and men differently. This study investigates the negative effects of COVID-19 on the labour market, focusing on the gender gap in five countries in the Middle East and North Africa (MENA) region. The study indicates whether women are more susceptible to losing their jobs, either temporarily or permanently, switching their primary occupation, and experiencing decreased working hours and income compared to men during the COVID-19 outbreak. The study utilizes a multivariate Probit model to estimate the relationship between gender and adverse labour outcomes controlling for correlations among outcomes. Data are obtained from the Combined COVID-19 MENA Monitor Household Survey, covering Egypt, Tunisia, Morocco, Jordan, and Sudan. The findings of this study offer empirical evidence of the gender gap in labour market outcomes during the pandemic. Women are more likely than men to experience negative work outcomes, such as permanent job loss and change in their main job. The increased childcare and housework responsibilities have significantly impacted women's labour market outcomes during the pandemic. However, the availability of telework has reduced the likelihood of job loss among women. The study's results contribute to a better understanding of the impact of COVID-19 on gender inequality in understudied MENA countries. Mitigation policies should focus on supporting vulnerable women who have experienced disproportionate negative effects of COVID-19.

External validation of the parental attitude about childhood vaccination scale.

Introduction: Internal validation techniques alone do not guarantee the value of a model. This study aims to investigate the external validity of the Parental Attitude toward Childhood Vaccination (PACV) scale for assessing parents' attitude toward seasonal influenza vaccination. Methods: Using a snowball sampling approach, an anonymous online questionnaire was distributed in two languages (English and Arabic) across seven countries. To assess the internal validity of the model, the machine learning technique of "resampling methods" was used to repeatedly select various samples collected from Egypt and refit the model for each sample. The binary logistic regression model was used to identify the main determinants of parental intention to vaccinate their children against seasonal influenza. We adopted the original model developed and used its predictors to determine parents' intention to vaccinate their children in Libya, Lebanon, Syria, Iraq, Palestine, and Sudan. The area under the curve (AUC) indicated the model's ability to distinguish events from non-events. We visually compared the observed and predicted probabilities of parents' intention to vaccinate their children using a calibration plot. Results: A total of 430 parents were recruited from Egypt to internally validate the model, and responses from 2095 parents in the other six countries were used to externally validate the model. Multivariate regression analysis showed that the PACV score, child age (adolescence), and Coronavirus disease 2019 (COVID-19) vaccination in children were significantly associated with the intention to receive the vaccination. The AUC of the developed model was 0.845. Most of the predicted points were close to the diagonal line, demonstrating better calibration (the prediction error was 16.82%). The sensitivity and specificity of the externally validated model were 89.64 and 37.89%, respectively (AUC = 0.769). Conclusion: The PACV showed similar calibration and discrimination across the six countries. It is transportable and can be used to assess attitudes towards influenza vaccination among parents in different countries using either the Arabic or English version of the scale.

Determinants of parental seasonal influenza vaccine hesitancy in the Eastern Mediterranean region: A cross-sectional study.

Background: Seasonal influenza vaccine can reduce the risk of influenza-associated hospitalizations and deaths among children. Given that parents are the primary decision makers, this study examined the parental attitude toward childhood influenza vaccine and identified determinants of vaccine hesitancy (VH) in the Eastern Mediterranean region (EMR). Methods: A cross-sectional study was conducted using an anonymous online survey in 14 EMR countries. Parents of children aged 6 months to 18 years were included. The Parent Attitude about Childhood Vaccines (PACV) was used to assess VH. Chi square test and independent t-test were used to test for association of qualitative and quantitative variables, respectively. A structural equations model (SEM) was used to identify direct and indirect determinants of parental VH. Results: Almost half of the parents were hesitant about vaccinating their children against influenza (50.8%). Parental VH was significantly higher among older mothers (37.06 ± 8.8 years, p = 0.006), rural residents (53.6%, p < 0.001), high-income countries residents (50.6%, p < 0.001), and mothers with higher educational levels (52.1%, p < 0.001). Parents of school-aged children (5-9 years) (55.6%, p < 0.001), children free from any comorbidities (52.5%, p < 0.001), children who did not receive routine vaccination at all (51.5%, p = 0.03), children who were not vaccinated against COVID-19 (54.3%, p < 0.001), in addition to parents who were not vaccinated against influenza (57.1%, p < 0.001) were significantly associated with increased likelihood of VH. Parents who were depending on healthcare provider as a source of information regarding vaccines were less likely to report VH (47.9%, p < 0.001), meanwhile those who used social media as their source of health information showed a significantly higher VH (57.2%, p < 0.001). The SEM suggested that mother's age, residence, country income level, child gender, total number of children and source of information regarding vaccines had a direct effect on VH. Meanwhile, parents vaccinated against influenza, children completely or partially vaccinated with routine vaccines and children vaccinated against Coronavirus disease 2019 (COVID-19) had an indirect effect on VH. Conclusion: A high proportion of included parents were hesitant to vaccinate their children against seasonal influenza. This attitude is due to many modifiable and non-modifiable factors that can be targeted to improve vaccination coverage.

Predictors of catastrophic out-of-pocket health expenditure in rural Egypt: application of the heteroskedastic probit model.

BACKGROUND: Out-of-pocket (OOP) health expenditure is a pressing issue in Egypt and far exceeds half of Egypt's total health spending, threatening the economic viability, and long-term sustainability of Egyptian households. Targeting households at risk of catastrophic health payments based on their characteristics is an obvious pathway to mitigate the impoverishing impacts of OOP health payments on livelihoods. This study was conducted to identify the risk factors of incurring catastrophic health payments hoping to formulate appropriate policies to protect households against financial catastrophes. METHODS: Using data derived from the Egyptian Household Income, Expenditure, and Consumption Survey (HIECS), a multiplicative heteroskedastic probit model is applied to account for heteroskedasticity and avoid biased and inconsistent estimates. RESULTS: Accounting for heteroskedasticity induces notable differences in marginal effects and demonstrates that the impact of some core variables is underestimated and insignificant and in the opposite direction in the homoscedastic probit model. Moreover, our results demonstrate the principal factors besides health status and socioeconomic characteristics responsible for incurring catastrophic health expenditure, such as the use of health services provided by the private sector, which has a dramatic effect on encountering catastrophic health payments. CONCLUSIONS: The marked differences between estimates of probit and heteroskedastic probit models emphasize the importance of investigating homoscedasticity assumption to avoid policies based on incorrect evidence. Many policies can be built upon our findings, such as enhancing the role of social health insurances in rural areas, expanding health coverage for poor households and chronically ill household heads, and providing adequate financial coverage for households with a high proportion of elderly, sick members, and females. Also, there is an urgent need to limit OOP health payments absorbed by private sector to achieve an acceptable level of fair financing.

Estimating equivalence scales and non-food needs in Egypt: Parametric and semiparametric regression modeling.

This paper investigated the appropriate specifications of Engel curves for non-food expenditure categories and estimated the deprivation indices of non-food needs in rural areas using a semi parametric examination of the presence of saturation points. The study used the extended partial linear model (EPLM) and adopted two estimation methods-the double residual estimator and differencing estimator-to obtain flexible shapes across different expenditure categories and estimate equivalence scales. We drew on data of the Egyptian Household Income, Expenditure, and Consumption Survey (HIEC). Our paper provides empirical evidence that the rankings of most non-food expenditure categories is of rank three at most. Rural households showed high economies of scale in non-food consumption, with child's needs accounting for only 10% of adult's non-food needs. Based on semi-parametrically estimated consumption behavior, the tendency of non-food expenditure categories to saturate did not emerge. While based on parametrically estimated consumption behavior, rural areas exhibited higher deprivation indices in terms of health and education expenditure categories, which indicates the need to design specific programs economically targeting such vulnerable households.