Driving anger dimensions and their relationship with aberrant driver behavior in Lebanon: Results from a national self-reported survey.

Driving anger may vary across countries due to culture. This might affect driver behavior, which, in turn, impacts the driving outcomes. This study aims to investigate the relationship between socio-demographic variables, driving anger, and the self-reported aberrant behavior among Lebanese drivers and to determine which anger dimension is linked to driving behavior. A cross-sectional study was conducted among eligible Lebanese drivers from all Lebanese governorates. Data were collected using an anonymous Arabic self-reported questionnaire that included demographic information, driving-related variables, and two scales: the Driver Behavior Questionnaire (DBQ) and the Driver Anger Scale (DAS). Four hierarchical regressions were performed taking the DBQ subscales as the dependent variable and the DAS subscales as independent variables. Out of 1102 surveyed drivers, 68.4% were males, having a mean age of 34.6 ± 12.3 years and an average driving experience of 13.5 ± 10.8 years. DBQ, DAS, and their subscales showed good reliability. Older age and female gender were negatively associated with the tendency of committing aggressive violations. However, being a professional driver and increasing annual mileage were positively associated with a higher tendency to commit aggressive violations. In addition to these factors, a higher educational level was found associated with a lower risk of driver's involvement in traffic violations. However, increased driving experience was associated with a higher tendency to commit aggressive violations. Reported driving errors were also found positively associated with older age, increasing mileage, and being a professional driver. However, larger driving experience and higher education were found protectors from erroneous behavior. Hierarchical regression showed that anger prompted by hostile gesture, discourtesy, police presence, traffic obstruction, and slow driving were positively associated with aggressive violations. All the DAS subscales were found to be positively associated with ordinary violations. traffic obstruction was also found associated with a higher tendency of drivers to commit lapses, as well as anger, which originated from police presence and slow driving which were found also positively associated with errors. Driver anger dimensions were found positively associated with aberrant driver behavior. To overcome road anger, there is a need to train drivers on coping strategies to restrain aberrant driving behavior.

Feasibility randomised controlled trial of the Early Adolescent Skills for Emotions psychological intervention with young adolescents in Lebanon.

BACKGROUND: Globally, there is a vast mental health treatment gap, whereby the majority of adolescents living in low- and middle-income countries requiring mental health services, do not have access to adequate care. To improve access, the World Health Organization (WHO) developed a range of interventions, designed to be low-cost and delivered by non-specialists. We conducted a two-arm, individually randomised group treatment feasibility trial of a new WHO group intervention for young adolescents with emotional distress ('Early Adolescent Skills for Emotions'; EASE) in Lebanon. METHOD: The aim of this study was to determine the feasibility of the intervention and study procedures. Adolescents aged 10 to 14 years were eligible to take part if they scored above a validated cut-off on the Child Psychosocial Distress Screener. Participants were randomized to EASE or enhanced treatment as usual (ETAU) control using a 1:1 ratio. EASE consisted of seven group sessions with adolescents and three sessions with caregivers. ETAU consisted of a single brief psychoeducation home visit. Child and caregiver outcomes were measured by blind assessors at baseline, endline (8 weeks post-randomisation), and three month follow-up (20 weeks post-randomisation), with the primary outcome measure being child psychological symptoms on the Pediatric Symptom Checklist. Qualitative interviews were conducted with adolescents (n = 13), caregivers (n = 17), facilitators (n = 6), trainers (n = 3), and outreach staff (n = 1) at endline to assess barriers and facilitators related to the feasibility and delivery of EASE and study procedures. RESULTS: Of 154 adolescents screened, 67 (43%) were eligible, completed baseline, and were randomized. Sixty adolescents (90%) completed endline assessments (31 EASE, 29 ETAU), and fifty-nine (88%) completed three-month assessments (29 EASE, 30 ETAU). Qualitatively, participants provided overall positive feedback about the intervention. Several challenges and suggestions for improvement were raised around logistics, intervention content, and acceptability of assessment measures. Implementation data highlighted challenges with intervention uptake and attendance. Outcome measures generally had strong psychometric properties (range: α = 0.77 to α = 87), however did not demonstrate change over time in either group. CONCLUSIONS: The EASE intervention and study procedures are acceptable and feasible for implementation with vulnerable adolescents in Lebanon, however several improvements are necessary prior to full-scale evaluation. TRIAL REGISTRATION: #ISRCTN60799626, retrospectively registered on 04/10/2022.

Understanding Determinants of Electronic Cigarette and Heated Tobacco Product Use among Young Adults in Lebanon: Prevention and Policy Implications.

In line with the global trends, electronic cigarettes (e-cigarettes) and heated tobacco products (HTPs) have found their way to the Lebanese market. The present study aims to explore the determinants of e-cigarette and HTP use among young adults in Lebanon. Convenience and snowball sampling were used to recruit participants aged 18-30 residing in Lebanon, who were familiar with e-cigarettes products. Twenty-one consenting participants were interviewed via Zoom and the verbatim transcriptions were analyzed thematically. The outcome expectancy theory was used to categorize the results into determinants and deterrents of use. HTPs were viewed by participants as another mode of smoking. The results showed that most participants perceived e-cigarettes and HTPs to be healthier alternatives to cigarettes/waterpipes and to be used as smoking cessation tools. Both e-cigarettes and HTPs were found to be easily accessible in Lebanon; although, in the recent economic crisis, e-cigarettes have become unaffordable. More research is needed to investigate the motivations and behaviors of e-cigarette and HTP users if effective policies and regulations are to be developed and enforced. Furthermore, greater public health efforts need to be made to increase awareness of the harmful impacts of e-cigarettes and HTPs and to implement evidence-based cessation programs tailored to those modes of smoking.

A Climbing (Bouldering) Intervention to Increase the Psychological Well-Being of Adolescents in the Bekaa Valley in Lebanon-Study Protocol for a Controlled Trial.

(1) Background: Adolescent refugees in Lebanon and Lebanese youth are both at high risk of suffering from reduced psychological well-being. Sport is an evidence-based strategy for improving mental and physical health, and climbing is a type of sport that may positively impact both. The aim of this study is to test the effect of a manualized, psychosocial group climbing intervention on the well-being, distress, self-efficacy, and social cohesion of adolescents in Lebanon. In addition, the mechanisms behind psychological changes will be investigated. (2) Methods: In this mixed-methods waitlist-controlled study, we are allocating a minimum of 160 participants to an intervention (IG) or a control group (CG). The primary outcome is overall mental well-being (WEMWBS) after the 8-week intervention. Secondary outcomes include distress symptoms (K-6 Distress Scale), self-efficacy (General Self-Efficacy Scale; GSE), and social cohesion. Potential mechanisms of change and implementation factors are being investigated through qualitative interviews with a subgroup of 40 IG participants. (3) Conclusions: The results may contribute to knowledge of sports interventions and their effects on psychological well-being and will provide insights regarding low-intensity interventions for supporting adolescent refugees and host populations in conflict-affected settings. The study was prospectively registered at the ISRCTN platform (current-controlled trials). ISRCTN13005983.

Association between Serum Vitamin D and Metabolic Syndrome in a Sample of Adults in Lebanon.

The evidence on the association between vitamin D and metabolic syndrome (MetS) is inconclusive. This was a cross-sectional study to explore the relationship between vitamin D serum levels and MetS in a sample of Lebanese adults (n = 230), free of diseases that affect vitamin D metabolism, recruited from an urban large university and neighboring community. MetS was diagnosed according to the International Diabetes Federation criteria. A logistic regression analysis was performed taking MetS as the dependent variable, and vitamin D was forced into the model as an independent variable. The covariates included sociodemographic, dietary, and lifestyle variables. The mean (SD) serum vitamin D was 17.53 (12.40) ng/mL, and the prevalence of MetS was 44.3%. Serum vitamin D was not associated with MetS (OR = 0.99 (95% CI: 0.96, 1.02), p < 0.757), whereas the male sex, compared with the female sex and older age, was associated with higher odds of having MetS (OR = 5.92 (95% CI: 2.44, 14.33), p < 0.001 and OR = 1.08 (95% CI: 1.04, 1.11), p < 0.001, respectively). This result adds to the controversy in this field. Future interventional studies are warranted to better understand the relationship between vitamin D and MetS and metabolic abnormalities.

Assessment of the Composition of Breastmilk Substitutes, Commercial Complementary Foods, and Commercial Snack Products Commonly Fed to Infant and Young Children in Lebanon: A Call to Action.

(1) Background: Nutrition for optimum growth and physical development is acquired by adequate infant feeding practices. (2) Methods: One hundred seventeen different brands of infant formulas (n = 41) and baby food products (n = 76) were selected from the Lebanese market and were analyzed for their nutritional content. (3) Results: Saturated fatty acid content was detected to be the highest in follow-up formulas (79.85 g/100 g) and milky cereals (75.38 g/100 g). Among all saturated fatty acids, palmitic acid (C16:0) accounted for the greatest proportion. Moreover, glucose and sucrose were the predominant added sugars in infant formulas, while sucrose was the main added sugar in baby food products. Our data showed that the majority of the products were non-compliant to the regulations and the manufacturers' nutrition facts labels. Our results stated also that the contribution to the daily value for the saturated fatty acids, added sugars, and protein exceeded the daily recommended intake for most infant formulas and baby food products. (4) Conclusions: This requires careful evaluation from policymakers in order to improve the infant and young children feeding practices.

An interdisciplinary approach to Iron Age Mediterranean chronology through combined archaeological and 14C-radiometric evidence from Sidon, Lebanon.

The construction of the Iron Age Mediterranean chronology began in the Levant based on historical evidence and has been additionally supported in recent decades by means of radiocarbon analysis, although with variable precision and ratification. It is only in recent years that new evidence in the Aegean and the western Mediterranean has opened discussion towards its further acceptance as an authoritative i.e. highly reliable, and widely applicable historiographic network. Altogether, the Mediterranean Iron Age chronology has only undergone minor changes during the last hundred years. The Phoenician metropolis of Sidon in southern Lebanon now provides a new, large and robust dataset obtained through a combination of archaeological and 14C-radiometric analysis of materials from stratified contexts that allow their statistical assessment. The appearance of substantial amounts of pottery of Greek, Cypriot and Egyptian origin together with Phoenician local wares in a long stratigraphy is a benefit for the synchronisation of regional pottery styles and allows wider geographic correlation of relative chronological systems. The close association of the archaeological data with a long series of AMS-14C-dates on short-lived samples provides new evidence for the absolute dating of many of the regional pottery styles that are represented in the stratigraphy of Sidon, and contributes towards a considerable improvement of the Mediterranean chronology.

The societal costs of multiple sclerosis in Lebanon: a cross-sectional study.

INTRODUCTION: This study assessed the societal costs of multiple sclerosis (MS) in Lebanon, categorized by disease severity. METHODS: This was a cross-sectional, prevalence-based, bottom-up study using a face-to-face questionnaire. Patients were stratified by disease severity using the expanded disability status scale (EDSS); EDSS scores of 0-3, 4-6.5, and 7-9 indicating respectively mild, moderate, and severe MS. All direct medical, nonmedical, and indirect costs related to reduced productivity were accounted for regardless of who bore them. Costs, collected from various sources, were presented in international US dollars (US$) using the purchasing power parity (PPP) conversion rate. RESULTS: We included 210 Lebanese patients (mean age: 43.3 years; 65.7% females). The total annual costs per patient were PPP US$ 33,117 for 2021, 12.4 times higher than the nominal GDP per capita. Direct costs represented 52% (US$ 17,185), direct nonmedical costs 8% (US$ 2,722), and indirect costs 40% (US$ 13, 211) of the mean annual costs. The total annual costs per patient increased with disease severity and were PPP US$ 29,979, PPP US$ 36,125, PPP US$ 39,136 for mild, moderate, and severe MS, respectively. CONCLUSION: This study reveals the huge economic burden of MS on the Lebanese healthcare system and society.

High seroprevalence of SARS-CoV-2 antibodies in household cats and dogs of Lebanon.

The COVID-19 pandemic has been declared in late 2019. It is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Flu-like symptoms and acute respiratory illnesses are the main manifestations of the disease. Recent studies have confirmed the susceptibility of domestic animals to SARS-CoV-2 infection. However, the seroprevalence of SARS-CoV-2 in household pets and the importance of pets in the epidemiology of this infection remain unknown. In Lebanon, there is no epidemiological data regarding SARS-CoV-2 infection in companion animals. Thus, this investigation aimed to determine the seroprevalence of SARS-CoV-2 antibodies in household pets of Lebanon during the COVID-19 pandemic. A cross-sectional study was carried out between April 2020 and February 2021. Blood samples from 145 cats and 180 dogs were collected from 12 veterinary clinics located in the North, Mount, and Beirut governorates. A validated ELISA assay was used to detect the anti- SARS-CoV-2 in the sera of the tested animals. An overall seroprevalence of 16.92% (55/325) was reported; 13.79% seroprevalence was found in cats (20/145) and 19.44% (35/180) in dogs. The young age and the cold season were significantly associated with an increased seropositivity rate to SARS-CoV-2 infection (P < 0.01). These results confirm the circulation of SARS-CoV-2 in household pets, in various geographical regions in Lebanon. Although, there is a lack of evidence to suggest that naturally infected pets could transmit the SARS-CoV-2 infection. Yet, owners diagnosed with COVID-19 should limit their contact with their animals during the course of the disease to curb the risk of transmission.

The dentition of the Early Upper Paleolithic hominins from Ksâr 'Akil, Lebanon.

There are scant human remains associated with Early Upper Paleolithic (EUP) industries. The rock shelter at Ksâr 'Akil, Lebanon, is one of the few circum-Mediterranean archaeological sites with EUP artifacts and associated fossils attributed to Homo sapiens. The skull and post-crania of the juvenile 'Egbert' (Ksâr 'Akil 1) from the EUP levels (conservatively dated from ∼43 to 39 ka) have been lost; the partial edentulous maxilla of 'Ethelruda' (Ksâr 'Akil 2) from the Initial Upper Paleolithic levels has only recently been rediscovered, leaving an isolated deciduous molar (Ksâr 'Akil 3) from Levantine Aurignacian strata. A fourth individual was found adjacent to Ksâr 'Akil 1 in 1938, but never described, and is apparently also lost. New archival research at the Peabody Museum of Archaeology and Ethnography uncovered photographs and radiographs of Ksâr 'Akil 1 and photographs of the fourth individual (which we designate Ksâr 'Akil 4). These new photographs and radiographs allow a comparative dental analysis of both individuals. Radiographs confirm an age of 7-8 years for Ksâr 'Akil 1 and photographs of Ksâr 'Akil 4 suggest a similar, if not slightly younger, age. Compared to other fossil H. sapiens, the teeth of Ksâr 'Akil 1 and Ksâr 'Akil 4 are remarkably modern. The upper deciduous third premolars lack a hypocone and metacone; the upper deciduous fourth premolars of Ksâr 'Akil 1 have reduced hypocones and both individuals have upper fourth premolars and first molars with square (as opposed to skewed) occlusal outlines, resulting from a hypocone that is smaller than, or equal in size to, the metacone. The lower first permanent molars of Ksâr 'Akil 1, and possibly Ksâr 'Akil 4, are four-cusped, which is a rare trait among Paleolithic and recent H. sapiens.

Association between the Timing of Pre-Workout Macronutrient Intake and Rated Appetite among Resistance-Trained Adults in Jbeil, Lebanon.

Macronutrients play an important role in appetite regulation. In addition, adequate nutrient and energy intake, which may be altered by exercise-induced appetite fluctuations, is required to ensure important training outcomes. However, findings regarding appetite responses to macronutrient consumption before training and to different resistance training intensities remain inconclusive. This study investigated the association of three types of macronutrient intake before different intensities of resistance training with appetite. A purposive cross-sectional design was used to collect data from 280 resistance-trained individuals (mean age 26.4 ± 5.8 years) representing five gyms located in Jbeil, Lebanon, and who completed an online questionnaire. Data collected included socio-demographics, nutritional strategies followed by each respondent, training characteristics, and appetite rating before, during and after exercise using a validated visual analogue scale (VAS). A short-term suppression of appetite was reported during resistance-training, with no significant difference in exercise intensities (p > 0.05). In addition, low-fiber carbohydrate and protein food/beverage content consumed 30-60 min before training had an advantage in appetite suppression. In summary, these findings suggest that resistance training combined with pre-workout consumption of a whole meal was associated with appetite suppression, at least during the short period of exercise. From the perspective of appetite control and energy balance, the critical factor is the quantity and quality of macronutrient food sources, in addition to the timing surrounding training of nutrients ingested.

COVID-19 Vaccine Acceptance and Hesitancy Among Health Care Workers in Lebanon.

BACKGROUND: Lebanon endured its worst economic and financial crisis in 2020-2021. To minimize the impact of COVID-19 pandemic, it is important to improve the overall COVID-19 vaccination rate. Given that vaccine hesitancy among health care workers (HCWs) affects the general population's decision to be vaccinated, our study assessed COVID-19 vaccine acceptance among Lebanon HCWs and identified barriers, demographic differences, and the most trusted sources of COVID-19 information. METHODS: A cross-sectional study was conducted between January and May 2021 among HCWs across nine hospitals, the Orders of Physicians, Nurses, and Pharmacists in Lebanon. Descriptive statistics were performed to evaluate the COVID-19 vaccine acceptance, and univariate and multivariable to identify their predictors. RESULTS: Among 879 participants, 762 (86.8%) were willing to receive the COVID-19 vaccine, 52 (5.9%) refused, and 64 (7.3%) were undecided. Males (226/254; 88.9%) and those ≥ 55 years (95/100; 95%) had the highest rates of acceptance. Of the 113 who were not willing to receive the vaccine, 54.9% reported that the vaccine was not studied well enough. Participants with a previous SARS-CoV-2 infection and those who did not know if they had a previous infection (p = 0.002) were less likely to accept the vaccine compared to those with no previous infection. The most trusted COVID-19 sources of information were WHO (69.3%) and healthcare providers (68%). CONCLUSION: Lebanese HCWs had a relatively high acceptance rate for COVID-19 vaccination compared to other countries. Our findings are important in informing the Lebanese health care authorities to establish programs and interventions to improve vaccine uptake among HCWs and the general population.

Maternal and infant outcomes of Syrian and Palestinian refugees, Lebanese and migrant women giving birth in a tertiary public hospital in Lebanon: a secondary analysis of an obstetric database.

OBJECTIVES: This study aims to assess whether the characteristics, management and outcomes of women varied between Syrian and Palestinian refugees, migrant women of other nationalities and Lebanese women giving birth at a public tertiary centre in Beirut, Lebanon. METHODS: This was a secondary data analysis of routinely collected data from the public Rafik Hariri University Hospital (RHUH) between January 2011 and July 2018. Data were extracted from medical notes using text mining machine learning methods. Nationality was categorised into Lebanese, Syrian, Palestinian and migrant women of other nationalities. The main outcomes were diabetes, pre-eclampsia, placenta accreta spectrum, hysterectomy, uterine rupture, blood transfusion, preterm birth and intrauterine fetal death. Logistic regression models estimated the association between nationality and maternal and infant outcomes, and these were presented using ORs and 95% CIs. RESULTS: 17 624 women gave birth at RHUH of whom 54.3% were Syrian, 39% Lebanese, 2.5% Palestinian and 4.2% migrant women of other nationalities. The majority of women had a caesarean section (73%) and 11% had a serious obstetric complication. Between 2011 and 2018, there was a decline in the use of primary caesarean section (caesarean section performed for the first time) from 7% to 4% of births (p<0.001). The odds of preeclampsia, placenta abruption and serious complications were significantly higher for Palestinian and migrant women of other nationalities compared to Lebanese women, but not for Syrian women. Very preterm birth was higher for Syrians (OR: 1.23, 95% CI: 1.08 to 1.40) and migrant women of other nationalities (OR: 1.51, 95% CI: 1.13 to 2.03) compared to Lebanese women. CONCLUSION: Syrian refugees in Lebanon had similar obstetric outcomes compared to the host population, except for very preterm birth. However, Palestinian women and migrant women of other nationalities appeared to have worse pregnancy complications than the Lebanese women. There should be better healthcare access and support for migrant populations to avoid severe complications of pregnancy.

Reproductive health of Syrian refugee women in Lebanon: a descriptive analysis of the Sijilli electronic health records database.

BACKGROUND: The Syrian conflict has been responsible for the highest exodus of refugees, with Lebanon hosting the greatest number of refugees per capita, which placed a significant strain on an already overburdened healthcare system. Women are the most vulnerable group in times of conflict and displacement, with sexual and reproductive health and rights often neglected. This study focuses on the obstetric characteristics and pregnancy outcomes of Syrian Refugee (SR) women in Lebanon, in Comparison to their pre-displacement data. METHODS: This study is a secondary analysis of de-identified data from the Sijilli database. The data reported and analyzed were the refugees' socio-demographics, obstetric history, pregnancy outcomes, experienced maternal and neonatal complications, breastfeeding history and duration, and contraception use and types. Data were reported in both frequencies and means/medians. Chi-square test, t-test, and ANOVA tests were used to compare pregnancies in Syria to those that happened in Lebanon. RESULTS: A total of 1065 female records were included in this study, with 634 ever-pregnant women and the total number of pregnancies being 3272. SR women were shown to get pregnant in Lebanon at a younger age compared to cases in Syria. The number of gravidities is equal in women who got pregnant in Syria and those who moved later to Lebanon. The mean spacing between pregnancies has decreased comparing SR women who got pregnant in Syria only versus those who got pregnant in Lebanon only. Among the mixed group, the mean spacing between pregnancies as well as the prevalence of spontaneous abortions significantly increased after displacing to Lebanon. C-section rate was higher among SR women after moving to Lebanon. Also, maternal complications and not breastfeeding have increased after moving to Lebanon. A prior pregnancy was significantly associated with higher contraception use rate. The most common methods of contraception were oral contraceptive pills and intra-uterine devices. CONCLUSION: The C-section deliveries, spontaneous abortions and maternal complications have all increased among SR women after being displaced to Lebanon. While the age at first pregnancy, mean spacing between their pregnancies and breastfeeding rates have decreased after moving to Lebanon. SR women are less likely to use contraceptives after their displacement. It is necessary to address access to reproductive healthcare and antenatal care delivery among displaced refugee women living in informal tented settlements.

Patterns and Determinants of Weight Gain among People Who Use Drugs Undergoing Treatment for Recovery in Lebanon.

Substance use disorder compromises the nutritional status and the eating habits of drug users, often leading to malnutrition. Once referred for treatment, hyperphagia and poor lifestyle practices leading to weight gain are observed. This study aimed to examine the patterns and extent of weight change as well as the determinants of weight gain in a sample of drug users who were receiving treatment in Lebanon. A total of 172 male participants undergoing either rehabilitation or opioid substitution treatment (OST) were included. Multivariate regression analysis was applied to assess the effect of different variables on weight gain while adjusting for potentially confounding variables. Approximately two-thirds (65.1%) of the participants gained weight (OST: 54.3%, rehabilitation: 78.2%; p < 0.05). The mean weight gain was 5.9 kg and was mainly reported among participants in the underweight, normal, and overweight pre-treatment categories and accentuated in the rehabilitation group (OST: 2 kg, Rehabilitation: 10.6 kg). Around half of the participants moved from the normal weight category to the overweight and obese categories during treatment. Weight gain was negatively associated with the number of previous treatment attempts (Odds Ratio = 0.86; Confidence Interval: 0.74-0.99), duration of current treatment (Odds Ratio = 0.98; Confidence Interval: 0.96-0.99), and pre-treatment body mass index (BMI) (Odds Ratio = 0.88; Confidence Interval: 0.80-0.96). Investigating other nutrition and lifestyle practices, neither nutrition knowledge, food addiction, physical activity level, nor sleep quality were associated with weight gain. Treatment through drug use was associated with meaningful weight gain that might lead to health risk factors. Developing health promotion programs is crucial to enhance treatment and decrease the risk of relapse.

Anemia among Syrian Refugee Children Aged 6 to 23 Months Living in Greater Beirut, Lebanon, including the Voices of Mothers' and Local Healthcare Staff: A Mixed-Methods Study.

Globally, the prevalence of anemia among children during the period of complementary feeding is high. A cross-sectional, mixed-methods study was conducted to examine the main determinants of anemia among Syrian refugee children aged 6 to 23 months (n = 215) and to illuminate the knowledge, attitudes and perceptions of their mothers and Lebanese healthcare staff on its causes and available treatment options. 42% of the children and 20% of their mothers were anemic. Determinants of child anemia were the mother having anemia or not knowing that fish/seafood is a source of iron; the child having been acutely ill the last two weeks or receiving cow's milk, but not consuming iron-rich infant formula, added fats/oils, or fruits in the previous 24 hours. Several Syrian mothers knew some causes of anemia and named dizziness as a leading symptom but did not mention flesh foods as a key source of heme iron. They reported financial constraints in accessing iron-rich foods and supplements. Lebanese doctors largely gave appropriate dietary advice and prescribed iron supplements as treatment. Multisectoral interventions are needed that combine medical and financial support with nutrition counseling for mothers to reduce the high burden of anemia among young children living in a multiple crises situation.

Access of Syrian refugees to COVID-19 testing in Lebanon.

Background: Polymerase chain reaction is a well-known method for testing COVID-19 infection, however, refugee populations often face difficulties in accessing testing. Several structural and cultural challenges have hindered access of Syrian refugees to COVID-19 testing in Lebanon, including financial barriers, stigma, and low perception of vulnerability. Aims: To explore barriers to accessing COVID-19 testing by Syrian refugees in Lebanon. Methods: This qualitative study conducted 10 focus group discussions among Syrian refugees and 21 individual semistructured interviews with healthcare workers. Ethical approval was obtained from the Institutional Review Board of the Lebanese International University, and the study followed the ethical principles of the Declaration of Helsinki. Results: Syrian refugees in Lebanon did not consider COVID-19 testing to be important. Despite the availability of free testing services, psychological, cultural, environmental, and financial barriers hindered them from getting tested. Some of them relied on consultation with pharmacists, who were easy to access and provided symptomatic treatment without the need to test for COVID-19. Fear of stigma, deportation, and isolation were common cultural barriers. Testing was considered unnecessary because of the perception of low disease severity and an attitude of negligence towards preventive practices. The harsh economic and living conditions were of greater concern to the refugees. Conclusion: Findings from this study add to existing literature regarding the social and cultural barriers to COVID-19 testing among Syrian refugees and should be considered when tailoring health promotion campaigns to halt the spread of the COVID-19 pandemic.

Response to COVID-19 in Lebanon: update, challenges and lessons learned.

The COVID-19 pandemic remains a public health problem threatening national and global health security. The socio-economic impact of COVID-19 was more severe on developing countries including Lebanon, especially due to the fragile healthcare system, weak surveillance infrastructure and lack of comprehensive emergency preparedness and response plans. Lebanon has been struggling with plethora of challenges at the social, economic, financial, political and healthcare levels prior to the COVID-19 pandemic. The COVID-19 pandemic in Lebanon revealed gaps and challenges across the spectrum of preparedness and response to emergencies. Despite these challenges, the Lebanese response was successful in delaying the steep surge of COVID-19 cases and hospitalisations through imposing strict public health and social measures. The deployment of the national vaccination plan in Lebanon in February 2021 coincided with the reduction in the number of cases and hospitalisation rates. The aim of this manuscript is to advance the epidemiologic evolution of COVID-19 in Lebanon pre- and post-vaccination, the challenges affecting the response and recovery, and the lessons learned.