Strengthening event-based surveillance (EBS): a case study from Afghanistan.

The sustained instability in Afghanistan, along with ongoing disease outbreaks and the impact of the COVID-19 pandemic, has significantly affected the country.During the COVID-19 pandemic, the country's detection and response capacities faced challenges. Case identification was done in all health facilities from primary to tertiary levels but neglected cases at the community level, resulting in undetected and uncontrolled transmission from communities. This emphasizes a missed opportunity for early detection that Event-Based Surveillance (EBS) could have facilitated.Therefore, Afghanistan planned to strengthen the EBS component of the national public health surveillance system to enhance the capacity for the rapid detection and response to infectious disease outbreaks, including COVID-19 and other emerging diseases. This effort was undertaken to promptly mitigate the impact of such outbreaks.We conducted a landscape assessment of Afghanistan's public health surveillance system to identify the best way to enhance EBS, and then we crafted an implementation work plan. The work plan included the following steps: establishing an EBS multisectoral coordination and working group, identifying EBS information sources, prioritizing public health events of importance, defining signals, establishing reporting mechanisms, and developing standard operating procedures and training guides.EBS is currently being piloted in seven provinces in Afghanistan. The lessons learned from the pilot phase will support its overall expansion throughout the country.

Implementation and expansion of laboratory capacity for molecular diagnostics in response to COVID-19 and preparedness for other emerging infectious diseases in the Islamic Emirate of Afghanistan.

Background: Afghanistan experienced various outbreaks before and during the Covid-19 pandemic, including dengue, Crimean Congo hemorrhagic fever (CCHF), measles, and acute watery diarrhea (AWD). Diagnostic and surveillance support was limited, with only the Central Public Health Laboratory equipped to handle outbreak responses. This article highlights initiatives taken to improve diagnostic capabilities for COVID-19 and other outbreaks of public health concern encountered during the pandemic. Background: The World Health Organization (WHO) Afghanistan Country Office collaborated with the WHO Eastern Mediterranean Regional Office (EMRO), Central Public Health Laboratory (CPHL), and National Influenza Center (NIC) to enhance COVID-19 diagnostic capacity at national and subnational facilities. To alleviate pressure on CPHL, a state-of-the-art laboratory was established at the National Infectious Disease Hospital (NIDH) in Kabul in 2021-2022, while WHO EMRO facilitated the regionalization of testing to subnational facilities for dengue, CCHF, and AWD in 2022-2023. Results: COVID-19 testing capacity expanded nationwide to 34 Biosafety Level II labs, improving diagnosis time. Daily testing rose from 1000 in 2020 to 9200 in 2023, with 848,799 cumulative tests. NIDH identified 229 CCHF cases and 45 cases nationally. Dengue and CCHF testing, decentralized to Nangarhar and Kandahar labs, identified 338 dengue and 18 CCHF cases. AWD testing shifted to NIDH and five subnational facilities (Kandahar, Paktia, Balkh, Herat, and Nangarhar labs), while measles testing also decentralized to nine subnational facilities. Conclusion: Afghanistan implemented a remarkable, multisectoral response to priority pathogens. The nation now possesses diagnostic expertise at national and subnational levels, supported by genomic surveillance. Future efforts should concentrate on expanding and sustaining this capacity to enhance public health responses.

Quality of life among the Arab population two years after COVID-19 pandemic.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has resulted in severe consequences worldwide. Our study aims to assess the quality of life (QoL) domains and its determinants among the general population in Arab countries after two years of the COVID-19 pandemic. METHODS: An anonymous online cross-sectional survey using the short version of World Health Organization QoL (WHOQOL-BREF) instrument was distributed among Arab adults in 15 Arab Countries. RESULTS: A total of 2008 individuals completed the survey. Amongst them, 63.2% were 18-40 years and 63.2% were females, 26.4% had chronic disease, 39.7% confirmed having contracted COVID-19, and 31.5% had experienced the unfortunate loss of relatives due to COVID-19. The survey revealed that 42.7% reported good physical QoL, 28.6% were satisfied with psychological QoL, 32.9% had a sense of well-being in the social domain, and 14.3% had good QoL in the environmental domain. The predictors of physical domains were as follows: being a male (ß = 4.23 [95%CI 2.71, 5.82]), being from low-middle income country (ß = -3.79 [95%CI -5.92, -1.73]) or being from high-middle-income country (ß = -2.95 [95%CI -4.93, -0.92]), having a a chronic disease (ß = -9.02 [95%CI -10.62,-7.44]) having a primary/secondary education (ß = -2.38 [95%CI -4.41, -0.054]), number of years of work experience ≥ 15 years (ß = 3.25 [95%CI 0.83, 5.73]), income-per-capita [ranged from (ß = 4.16 [95%CI -5.91, -2.40]) to (ß = -11.10 [95CI%, -14.22, -8.11])], a previous COVID-19 infection (ß = -2.98 [95%CI -4.41, -1.60]), and having relative died from COVID-19 (ß = -1.56 [95%CI -3.01, -0.12]). The predictors of psychological domain were having a chronic disease (ß = -3.15 [95%CI -4.52, -1.82]), a postgraduate education (ß = 2.57 [95% CI 0.41, 4.82]), number of years of work experience ≥ 15 years (ß = 3.19 [95%CI 1.14, 5.33]), income-per-capita [ranged from (ß = -3.52 [95%CI -4.91, -1.92]) to (ß = -10.31 [95%CI -13.22, -7.44])], and a previous COVID-19 infection (ß = -1.65 [95%CI -2.83, -0.41]). The predictors of social domain were being a male (ß = 2.78 [95%CI 0.93, 4.73]),  being single, (ß =-26.21 [-28.21, -24.32]), being from a low-income country (ß = 5.85 [95%CI 2.62, 9.13]), or from a high-middle-income country (ß = -3.57 [95%CI -6.10, -2.12]), having a chronic disease (ß = -4.11 [95%CI -6.13, -1.11]), and income-per-capita [ranged from (ß = -3.62 [95%CI -5.80, -1.41]) to (ß = -11.17 [95%CI -15.41, -6.92])]. The predictors of environmental domain were being from a low-middle-income country (ß = -4.14 [95%CI -6.90, -1.31), from a high-middle-income country (ß = -12.46 [95%CI -14.61, -10.30]), or from a low-income-country (ß = -4.14 [95%CI, -6.90, -1.32]), having a chronic disease (ß = -3.66 [95%CI -5.30, -1.91]), having a primary/secondary education (ß = -3.43 [95%CI -5.71, -1.13]), being not working (ß = -2.88 [95%CI -5.61, -0.22]), income-per-capita [ranged from (ß = -9.11 [95%CI -11.03, -7.21] to (ß = -27.39 [95%CI -31.00, -23.84])], a previous COVID-19 infection (ß = -1.67 [95%CI -3.22, -0.21]), and having a relative who died from COVID-19 (ß = -1.60 [95%CI -3.12, -0.06]. CONCLUSION: The study highlights the need for public health interventions to support the general population in the Arab countries and mitigate its impact on their QoL.

Quality of life among health care workers in Arab countries 2 years after COVID-19 pandemic.

Background: Assessment of the quality of life (QoL) among healthcare workers (HCWs) is vital for better healthcare and is an essential indicator for competent health service delivery. Since the coronavirus disease 2019 (COVID-19) pandemic strike, the frontline position of HCWs subjected them to tremendous mental and psychological burden with a high risk of virus acquisition. Aim: This study evaluated the QoL and its influencing factors among HCWs residing in the Arab countries. Methods: This was a cross-sectional study using a self-administered online questionnaire based on the World Health Organization QoL-BREF instrument with additional questions related to COVID-19. The study was conducted in three different languages (Arabic, English, and French) across 19 Arab countries between February 22 and March 24, 2022. Results: A total of 3,170 HCWs were included in the survey. The majority were females (75.3%), aged 18-40 years (76.4%), urban residents (90.4%), married (54.5%), and were living in middle-income countries (72.0%). The mean scores of general health and general QoL were 3.7 ± 1.0 and 3.7 ± 0.9, respectively. Those who attained average physical, psychological, social, and environmental QoL were 40.8, 15.4, 26.2, and 22.3%, respectively. The income per capita and country income affected the mean scores of all QoL domains. Previous COVID-19 infection, having relatives who died of COVID-19, and being vaccinated against COVID-19 significantly affected the mean scores of different domains. Conclusion: A large proportion of the Arab HCWs evaluated in this study had an overall poor QoL. More attention should be directed to this vulnerable group to ensure their productivity and service provision.

Exploring enablers and barriers toward COVID-19 vaccine acceptance among Arabs: A qualitative study.

Background: With the emergence of the coronavirus disease 2019 (COVID-19) and rapid vaccine development, research interest in vaccine hesitancy (VH) has increased. Research usually focuses on quantitative estimates which largely neglected the qualitative underpinnings of this phenomenon. This study aimed to explore the beliefs and views towards COVID-19 vaccination among Arabs in different countries. Furthermore, we explored the effect of confidence in the healthcare system, misinformation, and scientific approaches adopted to mitigate COVID-19 on how individuals are following the recommended preventative actions including vaccination. Methods: This study was based on the Strategic Advisory Group of Experts (SAGE)-VH Model: A qualitative design that utilized in-depth, online interviews. The study was conducted in seven Arab countries (Egypt, Qatar, Kingdom of Saudi Arabia, Libya, Sudan, United Arab Emirates and Jordan) from June 2020 to December 2021. Transcripts were analyzed using NVivo 12 Software. Results: A total of 100 participants, 44 males and 56 females, of different age groups (37.1 ± 11.56 years) were interviewed. Findings revealed six themes as enablers and barriers to COVID-19 vaccination. Many participants indicated trusting the vaccines, the healthcare systems, and the vaccination policies were the main driver to get the vaccine. Participants showed concerns towards potential long-term vaccine effects. A consistent inclination towards collective responsibility, which is the willingness to protect others by own vaccination, was also reported. Conclusion: Enablers and barriers of COVID-19 vaccination acceptance in the Arab region, from sociocultural and political perspectives, are critical to guide policymakers in designing target-oriented interventions that can improve vaccine acceptance.

Determinants of Schistosoma mansoni transmission in hotspots at the late stage of elimination in Egypt.

BACKGROUND: In certain settings, the prevalence and severity of schistosoma infection do not lessen despite repeated rounds of preventative chemotherapy; these areas are known as hotspots. This study aimed to investigate the role of human practices, besides environmental and malacological factors, in the maintenance of the Schistosoma mansoni infection transmission chain in hotspot areas in Egypt. METHODS: This cross-sectional study was conducted between July and November 2019 in Kafr El-Sheikh Governorate, Egypt. A pre-designed structured interviewing questionnaire was used to collect humanitarian data. Stool samples were collected from children aged 6-15 years on three successive days and examined using the Kato-Katz technique. Simultaneously, water and snail samples were taken from watercourses surrounding houses. Snails were identified based on their shell morphology and structure and tested for cercaria shedding. Water samples were analyzed for their physicochemical and biological characteristics. RESULTS: A total of 2259 fecal samples (1113 in summer and 1146 in fall) were collected from 861 children. About 46.9% of the participants were males, and 31.8% were aged 6-10 years. The prevalence of S. mansoni infection was higher during the summer than during the fall (19.1% vs 7.2%, respectively, P < 0.01). The intensity of infection (light, moderate, and heavy) during summer versus fall was (93.55 vs 89.38%, 6.45 vs 8.85%, and 0.00% vs 1.77%), respectively (P < 0.05). A higher prevalence of human infection was observed among males than females [OR = 1.63, 95% confidence interval (CI):1.10-2.40, P = 0.015], children aged 11-15 years than among their counterparts aged 6-10 years (OR = 2.96, 95% CI: 1.72-5.06, P < 0.001), and mothers with a low level of education (OR = 3.33, 95% CI: 1.70-6.52, P < 0.001). The main identified risk factors were contacting the main body of water-canal for washing clothes (OR = 1.81, 95% CI: 1.12-2.49, P = 0.015), land irrigation (OR = 2.56, 95% CI: 1.32-4.96, P = 0.004), water collection (OR = 2.94, 95% CI: 1.82-4.73, P < 0.001), bathing (OR = 2.34, 95% CI: 1.21-4.31, P = 0.009), and garbage disposal (OR = 2.38, 95% CI:1.38-4.12, P < 0.001). The count of Biomphalaria alexandrina was distinct between seasons (P < 0.01) in consistent with statistically significant differences in water temperature, salinity, turbidity, the total concentration of coliforms, depth, velocity, and water level (P < 0.01). The presence of grasses and duckweeds was significantly associated with snail infection (P = 0.00 l). Significant effects of water depth, pH, temperature, and total dissolved solids on snail count were also observed (P < 0.05). CONCLUSIONS: The persistence of the infection is due to adoption of risky behaviors and environmental factors that enhance snail survival and infection. Schistosomiasis elimination in hotspots requires an integrated control approach that combines preventive chemotherapy with other complementary measures.

Usage of social media in epidemic intelligence activities in the WHO, Regional Office for the Eastern Mediterranean.

Social media platforms are a massive source of information being used for monitoring and detecting various actual events such as natural disasters and disease outbreaks. This paper aims to present the experience of WHO, Regional Office for the Eastern Mediterranean in using social media for the detection and monitoring of COVD-19 pandemic alongside the other event-based surveillance tools. Over the period of 29 January 2020 to 31 May 2021, information was collected from social media and other media outlets (web news) as being the source of health information for early detecting and monitoring the situation of COVID-19 events. Signals were categorised into new events and event updates; where event updates captured from social media were categorised into official and unofficial. A total of 10 160 COVID-19 information were captured, out of which 95.8% (n=9732) were detected through social media. None of the information captured were discarded. 50.0% (n=11) of the COVID-19 events in the Eastern Mediterranean Region (EMR) were primarily captured from social media compared with 4.5% (n=1) primarily captured from other media outlets. Almost all (99.4%) of the event updates captured from social media were official updates. Real-time, transparent and relevant information posted on different social media platforms, especially the governmental official social media accounts, strengthened the early detection and follow-up of public health events in the EMR, especially during the current COVID-19 pandemic.

Contact tracing in the context of COVID-19: a case study from Oman.

In April 2020, the Ministry of Health (MoH) in Oman, a high-income country in the Eastern Mediterranean Region (EMR), implemented a robust contact tracing (CT) system for COVID-19. To capitalise on Oman's experience, EMRO has developed a case study presenting the methodology used to conduct the CT activities, main functions of the system, challenges encountered, lessons learnt, and the way forward. To develop the case study, a key informant interview was conducted virtually with the CT focal point in the MoH, using a semistructured questionnaire adapted from the WHO questionnaire for the assessment of CT activities. The Oman MoH launched a CT system based on three complementary digital tools: Tarassud plus, Medical Scout and HMushrif applications. Oman's CT strategy classifies contacts into close and casual contacts. Only close contacts are listed using the Tarassud plus application, while casual contacts are requested to self-monitor for 14 days using the other two applications. With the evolution of the outbreak, Oman MoH implemented stricter policies and prioritised the follow-up of close contacts to keep the CT activity manageable. Community health workers and volunteers facilitated the CT activities through sensitisation of the local community to the follow-up process and reducing the COVID-19-associated stigma. Challenges encountered revolved around contact data management, given the offline in-operability of the applications, and lack of national risk communication guidelines to address community concerns and widespread rumours.

Recommendation for a Pilot MCDA Tool to Support the Value-Based Purchasing of Generic Medicines in the UAE.

Introduction: In recent periods the United Arab Emirates (UAE) has strengthened economic measures in its pharmaceutical policy by promoting local manufacturing and facilitating the use of generic medicines. International examples indicate the importance of quality control elements in the implementation of cost containment policies. Multicriteria Decision Analysis (MCDA) is increasingly used in health care to facilitate health care decision based on multiple objectives. Our objective was to develop a pilot MCDA tool for repeated use to support the value-based purchasing of generic medicines in the UAE. Methods: An international evidence framework was adapted to UAE in a multistakeholder workshop organized by Dubai Health Authority. After validating the relevance of nine criteria in the local jurisdiction, participants decided the ranking and weight of each criterion by anonymous voting. Results: The top four criteria focused on quality elements starting with real-world clinical or economic outcomes (with 19.8% weight), followed by the quality assurance of manufacturing (17.3%), then evidence on the equivalence with the original product (14.8%), and drug formulation and stability (12.3%). The pharmaceutical acquisition cost criteria ranked fifth with 9.4% weight. The bottom four criteria, including reliability of drug supply, macroeconomic benefit, pharmacovigilance and added value services related to the product had similar weights in the range of 5.5-7.7%. Conclusion: Policy-makers in Dubai put high emphasis of value-based health care by incentivizing manufacturers of off-patent pharmaceuticals to generate additional scientific evidence compared to the mandatory minimum and acknowledging efforts to improve quality standards. The MCDA tool is considered suitable to improve the transparency and consistency of decision making in UAE for off-patent pharmaceuticals, and subsequently for other health technologies.

Validation of a biomarker tool capable of measuring the absorbed dose soon after exposure to ionizing radiation.

A radiological or nuclear attack could involve such a large number of subjects as to overwhelm the emergency facilities in charge. Resources should therefore be focused on those subjects needing immediate medical attention and care. In such a scenario, for the triage management by first responders, it is necessary to count on efficient biological dosimetry tools capable of early detection of the absorbed dose. At present the validated assays for measuring the absorbed dose are dicentric chromosomes and micronuclei counts, which require more than 2-3 days to obtain results. To overcome this limitation the NATO SPS Programme funded an Italian-Egyptian collaborative project aimed at validating a fast, accurate and feasible tool for assessing the absorbed dose early after radiation exposure. Biomarkers as complete blood cell counts, DNA breaks and radio-inducible proteins were investigated on blood samples collected before and 3 h after the first fraction of radiotherapy in patients treated in specific target areas with doses/fraction of about: 2, 3.5 or > 5 Gy and compared with the reference micronuclei count. Based on univariate and multivariate multiple linear regression correlation, our results identify five early biomarkers potentially useful for detecting the extent of the absorbed dose 3 h after the exposure.

Evaluation of Praziquantel Effectivenss After Decades of Prolonged Use in an Endemic Area in Egypt.

PURPOSE: Praziquantel (PZQ) is the preferred drug for schistomiasis treatment because of its safety. As PZQ is used for mass drug administration (MDA) in schistosomiasis endemic areas, the effectiveness of the drug, used solely for decades, should be continuously monitored to detect drug resistance. We aimed to assess the effectiveness of PZQ to cure Schistosoma mansoni infection and to reduce the intensity of infection in an endemic area by estimating the cure rate (CR), egg reduction rate (ERR), and comparing these estimates to the levels recommended by the World Health Organization (WHO). METHODS: A total of 342 children aged 5-15 years living in Kafr-El-Sheikh were screened for S. mansoni infection. Stool samples were examined microscopically using Kato-Katz (KK) technique. Among the screened children, 106 children had S. mansoni ova in stool, 100 of them received the first dose of PZQ (40 mg/kg). Four weeks later, 96 of 100 children received the second dose of PZQ. Stool samples, collected 4 weeks after each dose of PZQ, were examined using KK. The effectiveness of PZQ was assessed based on ERR and CR. RESULTS: CR after the first dose of PZQ was 66.7%, increased to 79.12% after second dose (X2 = 3.05, P = 0.08). Median egg count before treatment was 30.00 (6.00-744), that significantly decreased after two doses of PZQ to 0.00 (0.00-221.33) (Z = 8.29, P = 0.001). Children aged 10-15 years showed higher CR (91.3%) than those aged 5-9 years (OR = 5.25, CI 1.58-17.40). CONCLUSIONS: PZQ is still an effective agent against S. mansoni in endemic areas, achieving a high CR and ERR with predominantly low intensity of infection. Age is a main predictor of response to PZQ.

A Radiogenomic Approach for Decoding Molecular Mechanisms Underlying Tumor Progression in Prostate Cancer.

Prostate cancer (PCa) is a genetically heterogeneous cancer entity that causes challenges in pre-treatment clinical evaluation, such as the correct identification of the tumor stage. Conventional clinical tests based on digital rectal examination, Prostate-Specific Antigen (PSA) levels, and Gleason score still lack accuracy for stage prediction. We hypothesize that unraveling the molecular mechanisms underlying PCa staging via integrative analysis of multi-OMICs data could significantly improve the prediction accuracy for PCa pathological stages. We present a radiogenomic approach comprising clinical, imaging, and two genomic (gene and miRNA expression) datasets for 298 PCa patients. Comprehensive analysis of gene and miRNA expression profiles for two frequent PCa stages (T2c and T3b) unraveled the molecular characteristics for each stage and the corresponding gene regulatory interaction network that may drive tumor upstaging from T2c to T3b. Furthermore, four biomarkers (ANPEP, mir-217, mir-592, mir-6715b) were found to distinguish between the two PCa stages and were highly correlated (average r = ± 0.75) with corresponding aggressiveness-related imaging features in both tumor stages. When combined with related clinical features, these biomarkers markedly improved the prediction accuracy for the pathological stage. Our prediction model exhibits high potential to yield clinically relevant results for characterizing PCa aggressiveness.

Infection control in child daycare centers: logistics, knowledge, and practices of caregivers.

BACKGROUND: Children attending daycare centers (DCCs) are at high risk of contracting infectious diseases due to several factors including lack of knowledge among the caregivers about infection prevention and control practices. The objectives were to describe the DCC features, infrastructure, and infection control logistics, to assess knowledge of DCC caregivers regarding infectious diseases, and to assess their infection control practices. METHODS: Using a cross-sectional design, 402 caregivers working in 59 DCCs in three districts in Alexandria, Egypt were included. Data were collected using a data collection sheet about the DCC features, a structured interviewing questionnaire to collect data on caregivers' personal characteristics, knowledge about infectious diseases, and the best infection control practices and an observational infection control practices checklist. Multiple analysis of variance was used to test the difference in two or more vectors of means (mean knowledge scores about infectious diseases and about infection control). Post hoc test using Tukey Honest Significant Difference was used to determine which groups in the sample differ. Regression analysis models were used to identify factors affecting knowledge score of caregivers, and to estimate the magnitude of the association between different variables and the level of practice of caregivers (poor/fair and good). RESULTS: Satisfactory features of the DCCs included the aeration, level of cleanliness, and availability of hand washing facilities, while the availability of gloves and aprons, alcohol-based products, and medical examination rooms were not satisfactory. Only 2.5% of caregivers had a good level of knowledge. Level of education was the only factor statistically associated with the level of knowledge. About 31% and 17% had poor and good practice score percent, respectively. District and daily working hours were the only variables statistically associated with the level of practice. CONCLUSION: The level of knowledge and practice of caregivers was below optimum.