A rapid mixed-methods assessment of Libya's primary care system.

BACKGROUND: Libya has experienced decades of violent conflict that have severely disrupted health service delivery. The Government of National Unity is committed to rebuilding a resilient health system built on a platform of strong primary care. AIM: Commissioned by the government, we set out to perform a rapid assessment of the system as it stands and identify areas for improvement. DESIGN AND SETTING: We used a rapid applied policy explanatory-sequential mixed-methods design, working with Libyan data and Libyan policymakers, with supporting interview data from other primary care policymakers working across the Middle East and North Africa region. METHOD: We used the Primary Health Care Performance Initiative framework to structure our assessment. Review of policy documents and secondary analysis of WHO and World Bank survey data informed a series of targeted policymaker interviews. We used deductive framework analysis to synthesise our findings. RESULTS: We identified 11 key documents and six key policymakers to interview. Libya has strong policy commitments to providing good quality primary care, and a high number of health staff and facilities. Access to services and trust in providers is high. However, a third of facilities are non-operational; there is a marked skew towards axillary and administrative staff; and structural challenges with financing, logistics, and standards has led to highly variable provision of care. CONCLUSION: In reforming the primary care system, the government should consolidate leadership, clarify governance structures and systems, and focus on setting national standards for human resources for health, facilities, stocks, and clinical care.

Hepatitis B Virus Infection in Eastern Libya: Current Efforts for Overcoming Regional Barriers for Its Elimination.

Approximately 2.2% of Libyans have chronic hepatitis B (CHB) and are at the highest risk of developing end-stage disease complications. Several resource-limited countries, including Libya, may be far from achieving the WHO goal of hepatitis B elimination by 2030 as a result of several testing and linkage to care (LTC) barriers. In Libya, data about the current HBV infection situation is scarce. Therefore, our study aimed to evaluate the trends of HBV in eastern Libya, Tobruk region, and try to identify the region-specific gaps and barriers that could potentially delay the WHO goal of HBV elimination. An eighteen-year retrospective review of records of the main district medical center in the region was done to estimate the trends of HBV infection and qualitative interviews with the clinical staff of the CHB registry in the region were conducted to investigate the current status of HBV management. Out of 392,952 records, 371 (0.09%) HBV-positive were recorded and declining trends of the infection were noticed over the study period. Until late 2019, there was no linkage to care or follow-up for people with HBV infection. However, a CHB registry was established in late 2019 to manage HBV infections in the region, yet there are several barriers such as the lack of diagnostic infrastructure for liver function assessment and antiviral treatment. Despite the significant decline observed in the occurrence of HBV infection and introduction of important HBV management steps such as establishment of the CHB registry, there are still several barriers that could delay the elimination of the infection.

The oral health care system in Libya: a case study.

BACKGROUND: This study aims to describe the Libyan oral health care system in terms of its structure, function, workforce, funding, reimbursement and target groups. METHODS: A single descriptive case study approach and multiple sources of data collection were used to provide an in-depth understanding of the Libyan oral health care system. A purposeful sample of the key informants (Managers of oral health centers, dentists of various specialties with experience in the field, dentists, nurses, dental technicians, and officials in the affairs of medical insurance) was recruited. The case and its boundaries were guided by the study's aim. Both qualitative and quantitative analyses were conducted. Descriptive statistics were used for quantitative data. Framework analysis, informed by the study objectives, was used to analyze interviews and documents. RESULTS: The analysis showed that oral health services are integrated into medical services. The provision of dental care is mainly treatment-based, in the private sector. The oral health services in the public sector are mainly emergency care and exodontia. The dental workforce included in the study were mostly dentists (89% General Dental Practitioners (GDPs), 11% specialists), with a marked deficiency in dental technicians and nurses. Around 40% of dentists work in both the private and public sectors. The government provides the funding for the public sector, but the private sector is self-funded. No specific target group(s) nor clear policies were reported. However, the system is built around primary health care as an overarching policy. Dental caries is the most common oral problem among Libyan preschool children affecting around 70% and is the most common cause of tooth loss among adults. CONCLUSION: The oral health care system in Libya is mainly privatized. The public health services are poorly organized and malfunctioning. There is an urgent need to develop policies and plans to improve the oral health care system in Libya.

Genome Sequencing of up to 6,000-Year-Old Citrullus Seeds Reveals Use of a Bitter-Fleshed Species Prior to Watermelon Domestication.

Iconographic evidence from Egypt suggests that watermelon pulp was consumed there as a dessert by 4,360 BP. Earlier archaeobotanical evidence comes from seeds from Neolithic settlements in Libya, but whether these were watermelons with sweet pulp or other forms is unknown. We generated genome sequences from 6,000- and 3,300-year-old seeds from Libya and Sudan, and from worldwide herbarium collections made between 1824 and 2019, and analyzed these data together with resequenced genomes from important germplasm collections for a total of 131 accessions. Phylogenomic and population-genomic analyses reveal that (1) much of the nuclear genome of both ancient seeds is traceable to West African seed-use "egusi-type" watermelon (Citrullus mucosospermus) rather than domesticated pulp-use watermelon (Citrullus lanatus ssp. vulgaris); (2) the 6,000-year-old watermelon likely had bitter pulp and greenish-white flesh as today found in C. mucosospermus, given alleles in the bitterness regulators ClBT and in the red color marker LYCB; and (3) both ancient genomes showed admixture from C. mucosospermus, C. lanatus ssp. cordophanus, C. lanatus ssp. vulgaris, and even South African Citrullus amarus, and evident introgression between the Libyan seed (UMB-6) and populations of C. lanatus. An unexpected new insight is that Citrullus appears to have initially been collected or cultivated for its seeds, not its flesh, consistent with seed damage patterns induced by human teeth in the oldest Libyan material.

Attitudes, Knowledge, and Perceived Barriers Towards Cancer Pain Management Among Healthcare Professionals in Libya: a National Multicenter Survey.

Cancer pain presents in approximately 66% of patients in advanced stages. Although several guidelines and pharmacological options are available for cancer pain management (CPM), assessment and treatment of cancer pain remain inadequate globally, particularly in developing countries. Lack of knowledge and negative attitudes towards CPM among healthcare professionals (HCPs) are important barriers to CPM. This survey aimed to evaluate nurses' and physicians' knowledge, attitudes, and potential barriers regarding CPM in Libya. This cross-sectional survey involved a convenience sample of 152 oncology nurses and physicians working in six oncology settings in Libya. The response rate was 76%. The Barriers Questionnaire II (BQ-II) was used for data collection (higher scores signify greater attitudinal barriers and poorer knowledge). Data analysis was carried out using Statistical Package for Social Sciences (SPSS), version 26 software. An independent t-test (unadjusted estimate) indicated that Libyan nurses showed higher mean barrier scores (mean = 3.8, SD = 0.7) to CPM than physicians (mean = 2.9, SD = 0.8), p < 0.001. The six most common differences in attitudinal barriers between nurses and physicians were "opioid side effects," "poor tolerance," "strong patient endures pain," "distract the physician," "drug addiction," and "opioids impair immune function," p < 0.001. Multiple regression results (adjusted estimate) indicated that nurses had more barrier scores to CPM than physicians (B = - 0.530, p < 0.05), and participants with higher educational levels were associated with lower barrier scores to CPM (B = - 0.641, p < 0.05). Our results suggest that Libyan oncology HCPs hold perceived barriers, lack of knowledge, and negative attitudes towards CPM. Professional education and training in CPM, addressing phobia and myths on opioid usage, and the benefits and complications of using opioids are likely to result in reduced barriers to CPM in Libya.

Association between dental caries and obesity among Libyan schoolchildren during the armed conflict in Benghazi.

BACKGROUND: Dental caries and Obesity in children are issues of public health concern. Even though researching the relationship between these two noncommunicable diseases has been conducted for many years, the results remain equivocal. This paper aimed to examine the association between dental caries and obesity among 12-year-old schoolchildren living in war-affected environment in Benghazi. METHODS: A secondary analysis of a cross-sectional study was conducted to determine the prevalence of caries among 12-year-old school children in Benghazi in 2017 during the armed conflict that affected the city. The data extracted for the analysis included sociodemographic of the participants (gender, maternal education and school type), caries experience (DMFT index), and anthropometric measures (height in cm, weight in kg, BMI and Z score for BMI). Comparisons of anthropometric measures were conducted according to caries experience. Linear regression models were developed to determine the association between Body Mass Index and Z score as outcome variables, caries as an explanatory variable, and covariates (gender, maternal education and school type). Beta coefficient (ß) and 95% confidence intervals were calculated. All statistical tests were conducted at p ≤ 0.05. RESULTS: There were 782 children with a mean (SD) BMI of 20.7 SD5.09 and an average z (SD) score of 0.56 SD1.51. Also, 159 (20%) children had obesity. No significant association was observed between caries and anthropometric measures. However, higher BMI was observed in children from a private school (p ≤ 0.001***), females (p ≤ 0.001***) and self-reported regular sugary drinks consumers (p ≤ 0.001***). CONCLUSION: The present study shows no significant association between dental caries and anthropometric measures. However, the study findings support the notion of tackling sugar intake as a common risk factor for caries and obesity, which should be encouraged in the Libyan culture.

Libyan Healthcare Professionals', Patients' and Caregivers' Perceptions and Religious Beliefs about Cancer Pain and its Management: A Descriptive Qualitative Study.

Cancer pain remains a significant problem worldwide. It is often undertreated and presents in about half of cancer patients. Although several guidelines and pharmacological interventions for cancer pain management (CPM) exist, inadequate assessment and undertreatment of cancer pain are well-documented globally, especially in developing countries, including Libya. Perceptions, cultural and religious beliefs of healthcare professionals (HCP), patients, and caregivers about cancer pain and opioids are reported as barriers to CPM globally. This qualitative descriptive study aimed to explore Libyan HCPs', patients', and caregivers' views and religious beliefs about CPM and involved semi-structured interviews with 36 participants: 18 Libyan cancer patients, 6 caregivers, and 12 Libyan HCPs. Thematic analysis was used to analyse the data. Patients, caregivers, and newly qualified HCPs were concerned about poor tolerance and drug addiction. HCPs perceived a lack of policies and guidelines, pain rating scales, and professional education and training as CPM barriers. Some patients were unable to pay for medicines if they faced financial difficulties. Instead, patients and caregivers emphasised religious and cultural beliefs for managing cancer pain, including the use of the Qur'an and cautery. Our results suggest that religious and cultural beliefs, lack of knowledge and training in CPM among HCPs, and economic and Libyan healthcare system-related factors negatively affect CPM in Libya.

Career expectations and the motivating factors for studying dentistry in Libya.

INTRODUCTION: This study investigated entry-level dental students' motives for studying dentistry at the University of Benghazi (UoB), Libya and career expectations among recent UoB graduates in an atypical context during the time of political unrest and identified factors associated with these motives.  METHODS: A cross-sectional survey was conducted in 2021-2022 for all entry-level dental students and recent dental graduates of UoB. A self-administered survey explored motives for studying dentistry, career expectation and associated factors. The questions were adopted from previous studies and pre-validated for use among Libyan students. Motives and career expectations were summarized, and their association with potential associated factors were assessed using chi-square test at p ≤ 0.05. RESULTS: One hundred eighty-four entry-level students and 156 recent graduates completed the surveys, response rates = 73.6% and 62.4%, respectively. The main motives to study dentistry were the desire to work in the healthcare field (183, 99.4%), interest in scientific knowledge (178, 96.7%) and because there were various dental specialities (168, 91.3%). The most common career expectations were setting up a business (107, 68.6%) and establishing a dental clinic (105, 67.3%). In addition, preference for working in the public sector (106, 67.9%), work-life balance (102, 65.4%) and financial gain (94, 60.3%) were the main factors associated with career expectations. CONCLUSION: The main motive to join a dental school in Libya was academic interest. However, recent graduates showed more pragmatic expectations related to private practice ownership.

Seroprevalence study of Toscana virus in Yafran area, Libya.

BACKGROUND & OBJECTIVES: In Mediterranean countries, infection of Toscana virus is a public health problem during the summer season, related to sandflies activity; it may cause aseptic meningitis and mild meningoencephalitis. We investigated the presence of antibodies (IgG) against the Toscana virus in the sera of individuals living in the area of Yafran, Libya. METHODS: During the period from December 2013 to February 2014, a total of 232 sera samples were collected from Yefran hospital. Demographic information of participants collected in a questionnaire; samples were analyzed by the serological method of enzyme-linked immunoassays specific for Toscana IgG antibodies. RESULTS: Seroprevalence of IgG antibodies among samples was 25% (n = 232). Seroprevalence varied among genders, age groups. The differences were not statically significant. INTERPRETATION & CONCLUSION: Our findings indicate and confirm local circulation of the Toscana virus. It also indicates that TOSV infection is neglected, and needs to be considered as one of the causes of meningitis or meningoencephalitis.

An assessment of the Libyan baccalaureate nursing education during political turmoil.

Since the Libyan Revolution in 2011, the country's nursing workforce has been struggling. Libyan nursing schools have focused on rebuilding the country's supply of nurses after many emigrated. Wanting to infuse the workforce with more baccalaureate-prepared nurses, Libyan nursing faculty invited nursing and public health representatives from a US-based academic medical institution and a non-governmental medical organization to collaborate with local stakeholders in a country-wide assessment. The purpose of this article is to outline the national programs' strengths and weaknesses and make recommendations for developing a strategy to elevate nursing education to meet international standards. This can serve as a launching point to strengthen Libya's health services provision capacity, particularly during this time of transition when opportunities may become available to move in new directions. The approach and findings may have wider application to other countries who are similarly experiencing civil and political turmoil.

Cross-cultural adaptation of the Arabic version of the DHEQ-15.

OBJECTIVES: Many patients who suffer from Dentine Hypersensitivity (DH) often go undiagnosed because they do not consider DH as serious problem that requires treatment. The use of patient-reported outcome measures can help in diagnosis and management of DH problems. The aim of the present study was to adapt cross-culturally the original English version of the Dentine Hypersensitivity Experience Questionnaire (DHEQ-15) for use in Arabic-speaking countries. METHODS: An Arabic version of DHEQ-15 was first developed by forward-backward translation and piloted among a group of dental patients. A cross-sectional study design was then used to test the psychometric properties of the Arabic DHEQ-15 in a wider convenience sample of Libyan dental patients diagnosed with DH. Confirmatory factor analysis was used to test the three-dimensional distribution of the subscales. The significance level of all statistical tests was set at p ≤ 0.05. RESULTS: The Arabic DHEQ-15 demonstrated good face and content validity. A total of 462 participants aged, on average, 39.2 ± 12.9 years took part in the psychometric testing of the Arabic DHEQ-15. The overall Cronbach's alpha of the questionnaire was 0.91, and overall Interclass correlation coefficient (ICC) for test-retest repeatability was 0.914. Participants with more severe DH had a significantly higher DHEQ-15 score than those with less severe DH (p < 0.001). Those who reported better global rating of their oral health had lower scores on the Arabic DHEQ-15 (p < 0.001). Confirmatory factor analysis confirmed three subscales of the Arabic DHEQ-15. CONCLUSIONS: The Arabic DHEQ-15 has been developed and further testing has demonstrated acceptable levels of psychometric properties in an Arabic population. The Arabic DHEQ-15 is a reliable measure of the quality-of-life impact of DH for use with Arabic-speaking populations.

SARS-CoV-2 Surveillance in the Middle East and North Africa: Longitudinal Trend Analysis.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of millions and forced countries to devise public health policies to reduce the pace of transmission. In the Middle East and North Africa (MENA), falling oil prices, disparities in wealth and public health infrastructure, and large refugee populations have significantly increased the disease burden of COVID-19. In light of these exacerbating factors, public health surveillance is particularly necessary to help leaders understand and implement effective disease control policies to reduce SARS-CoV-2 persistence and transmission. OBJECTIVE: The goal of this study is to provide advanced surveillance metrics, in combination with traditional surveillance, for COVID-19 transmission that account for weekly shifts in the pandemic speed, acceleration, jerk, and persistence to better understand a country's risk for explosive growth and to better inform those who are managing the pandemic. Existing surveillance coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until an effective vaccine is developed. METHODS: Using a longitudinal trend analysis study design, we extracted 30 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in MENA as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. RESULTS: The regression Wald statistic was significant (χ25=859.5, P<.001). The Sargan test was not significant, failing to reject the validity of overidentifying restrictions (χ2294=16, P=.99). Countries with the highest cumulative caseload of the novel coronavirus include Iran, Iraq, Saudi Arabia, and Israel with 530,380, 426,634, 342,202, and 303,109 cases, respectively. Many of the smaller countries in MENA have higher infection rates than those countries with the highest caseloads. Oman has 33.3 new infections per 100,000 population while Bahrain has 12.1, Libya has 14, and Lebanon has 14.6 per 100,000 people. In order of largest to smallest number of cumulative deaths since January 2020, Iran, Iraq, Egypt, and Saudi Arabia have 30,375, 10,254, 6120, and 5185, respectively. Israel, Bahrain, Lebanon, and Oman had the highest rates of COVID-19 persistence, which is the number of new infections statistically related to new infections in the prior week. Bahrain had positive speed, acceleration, and jerk, signaling the potential for explosive growth. CONCLUSIONS: Static and dynamic public health surveillance metrics provide a more complete picture of pandemic progression across countries in MENA. Static measures capture data at a given point in time such as infection rates and death rates. By including speed, acceleration, jerk, and 7-day persistence, public health officials may design policies with an eye to the future. Iran, Iraq, Saudi Arabia, and Israel all demonstrated the highest rate of infections, acceleration, jerk, and 7-day persistence, prompting public health leaders to increase prevention efforts.

Revitalizing operational reliability of the electrical energy system in Libya: Feasibility analysis of solar generation in local communities.

The political upheaval and the civil war in Libya had a painful toll on the operational reliability of the electric energy supply system. With frequent power cuts and crumbling infrastructure, mainly due to the damage inflicted upon several power plants and grid assets as well as the lack of maintenance, many Libyans are left without electricity for several hours a day. As the country has a staggeringly immense potential of solar energy, it is inevitable to exploit such potential, to avert system-wide blackouts. This paper investigates the use of small-scale PV systems in local communities as non-wires alternative (NWA), offering excess energy exchange within local/neighboring microgrids (MGs) for reliable electric power supply. Different combinations of PV/storage/diesel distributed generations (DGs), with grid-interface options, were applied on a case study of a typical dwelling in the Eastern Libyan city of Benghazi. Technical and financial feasibility assessments were carried out to contrast between various supply combinations. Sensitivity analysis of the PV-grid system was also conducted using Net Present Value (NPV) and the payback time indicators to determine the impacts of Feed-in Tariff (FiT) rates, financial incentives, electricity tariff, and inflation rate on the economic viability of the PV grid system. Results show that the PV-grid system has a promising potential under reasonable set of varying system parameters. On top of its social and environmental-friendly advantages, the PV-battery system is found to be more economical when adopted as a standalone NWA solution as compared to the diesel generator option, even at the lowest diesel price. The PV-grid system does not only provide a short-term remedy to the rolling blackouts in Libya but also enhances system operational reliability by providing a NWA to rundown or shattered grid infrastructure, thus bolstering energy provision in residential neighborhoods.

'Psychosis of civilization': a colonial-situated diagnosis.

In the late 1930s, when colonial psychiatry was well established in the Maghreb, the diagnosis 'psychosis of civilization' appeared in some psychiatrists' writings. Through the clinical case of a Libyan woman treated by the Italian psychiatrist Angelo Bravi in Tripoli, this article explores its emergence and its specificity in a differential approach, and highlights its main characteristics. The term applied to subjects poised between two worlds: incapable of becoming 'like' Europeans - a goal to which they seem to aspire - but too far from their 'ancestral habits' to revert for a quiet life. The visits of these subjects to colonial psychiatric institutions, provided valuable new material for psychiatrists: to see how colonization impacted inner life and to raise awareness of the long-term socio-political dangers.

Nasal colonization and antibiotic resistance patterns of Staphylococcus species isolated from healthy horses in Tripoli, Libya.

The present study investigated the colonization rates and antimicrobial susceptibility of Staphylococcus species isolated from the nostrils of healthy horses. A nonselective laboratory approach was applied, followed by confirmation using a Phoenix automated microbiological system. Among the 92 horses included in the study, 48.9% (45/92) carried Staphylococcus species of mostly the coagulase-negative staphylococci (CoNS) type yielding 70 Staphylococcus strains. Of these strains, 37.1% (26/70; 24 CoNS and 2 coagulase-positive staphylococci; CoPS) were identified as methicillin-resistant staphylococci (MRS) expressing significant resistance to important antimicrobial classes represented mainly by subspecies of CoNS. This is the first study reporting a high prevalence of various Staphylococcus species, particularly strains of CoNS expressing multidrug resistance patterns of public health concern, colonizing healthy horses in Libya.

Anti-HBc and hepatitis B virus DNA among HBsAg-negative blood donors from the main central blood bank units in Eastern Libya.

BACKGROUND: Post-transfusion hepatitis B virus (PTHB) infection is still a public health problem in the world. In many developed countries, nucleic acid testing (NAT) for detection of Hepatitis B Virus (HBV)-DNA has been implemented to enhance blood donation safety. In Libya, however, the testing for HBV infection is limited to the detection of HBV surface antigen (HBsAg) only. OBJECTIVES: To determine the frequency of anti-Hepatitis B core antibody (HBc) and HBV-DNA in HBsAg-negative, anti-HBc-positive blood donors in the main Central Blood Bank Units (CBBUs) in eastern Libya. METHODS: One thousand blood samples were obtained from healthy blood donors at the five main CBBUs in eastern Libya. The samples were screened for HBsAg and anti-HBc. Real-time polymerase chain reaction (PCR) was carried out to detect HBV-DNA in all anti-HBc-positive samples. RESULTS: A total of 94 (9.4%) donors were positive for anti-HBc. Of the 94 anti-HBc-positive samples, 9 samples (9.5%) tested positive for HBV-DNA by real-time PCR. CONCLUSION: The rate of anti-HBc among blood donors in this study (9.4%) was similar to that reported from other regions in the country. In the absence of advanced tests for the detection of HBV infection in blood donors, such as NAT, anti-HBc should be routinely tested for, at least for first-time donors.

May Measurement Month 2018: an analysis of blood pressure screening in Libya.

Elevated blood pressure (BP) is an important public health concern and leads to several adverse cardiovascular outcomes. In the stepwise survey done in Libya by the Libyan Cardiac Society and National Centre for Disease Control in 2009, the percentage of hypertension was 40.6%. To raise awareness of high BP and to highlight the size of the problem and the need for screening. A cross-sectional opportunistic study included men and women aged ≥18 years. Blood pressure was measured three times and a questionnaire was completed. Hypertension was defined as BP ≥140/90 mmHg based on the mean of the 2nd and 3rd readings, or on antihypertensive treatment. Among 7279 participants, the mean age was 44.3 ± 14.8 years, 57.8% male, 2567 (35.3%) of the participants had hypertension of whom 63.4% were aware of having hypertension, 55.8% on medication, and of those on medication 50.9% had controlled BP. This survey identified a high proportion of individuals with high BP, which highlights the need for a more strategic approach to fighting hypertension.

Managing complex emergencies.

Complex emergencies, also known as major humanitarian emergencies, differ from emergencies related to natural disasters or major disease outbreaks, in that they are essentially political in nature and will, in most cases, erode the cultural, civil, political and economic stability of societies. They can be exacerbated by natural disasters and eventually require external interventions. National Veterinary Services are usually weakened or partially or totally disrupted. Interventions to support livestock-dependent communities should build on local capacity. Multisector, integrated disaster management plans should be in place and should include not only preparedness and response, but also mitigation, prevention and recovery strategies. National Veterinary Services and their partners should work in close collaboration and are encouraged to look beyond animal-health-related interventions, also addressing access to feed and water, and keeping marketing chains for livestock open. This paper also touches on the specific needs of displaced people, host communities, and pastoralists, as well as addressing disease eradication programmes in the context of complex emergencies.

Les situations d'urgence complexes (également appelées «urgences humanitaires majeures ¼) se distinguent des situations d'urgence dues à des catastrophes naturelles ou à des foyers majeurs de maladie par leur nature essentiellement politique et par le fait qu'elles nuisent généralement à la stabilité culturelle, civile, politique et économique des sociétés affectées. Elles sont parfois exacerbées par des catastrophes naturelles et peuvent nécessiter à terme une intervention extérieure. Les Services vétérinaires nationaux sont généralement affaiblis, voire partiellement ou totalement suspendus. Les interventions visant à soutenir les communautés qui vivent de l'élevage doivent s'appuyer sur les capacités locales. Il convient d'avoir établi des plans de gestion des catastrophes multisectoriels et intégrés comportant des stratégies non seulement de préparation et d'intervention mais aussi d'atténuation, de prévention et de rétablissement. Il est recommandé aux Services vétérinaires nationaux et à leurs partenaires de travailler en étroite collaboration et d'avoir une vision allant au-delà des interventions strictement liées à la santé animale afin de traiter également le problème de l'accès des animaux aux aliments et à l'eau et de faire en sorte que les filières de commercialisation du bétail demeurent ouvertes. Outre la problématique des programmes d'éradication des maladies dans le contexte des situations d'urgence complexes, les auteurs abordent également les besoins spécifiques des personnes déplacées, des communautés d'accueil et des populations pastorales.

Las emergencias complejas, también denominadas «grandes emergencias humanitarias¼, difieren de las emergencias causadas por desastres naturales o grandes brotes infecciosos en que son de carácter eminentemente político y en que casi siempre acaban erosionando la estabilidad cultural, civil, política y económica de la sociedad afectada. A veces se ven agravadas por desastres naturales y a la postre requieren intervenciones externas. Los Servicios Veterinarios nacionales suelen verse fragilizados o parcial o completamente desarticulados. Toda intervención de apoyo a poblaciones dependientes del ganado debería partir de los medios de acción existentes a escala local. Es preciso tener instituidos planes integrados y multisectoriales de gestión de desastres, que incluyan no solo mecanismos de preparación y respuesta, sino también dispositivos de mitigación, prevención y recuperación. Los Servicios Veterinarios nacionales y sus asociados deben trabajar en estrecha colaboración. A todos ellos se los alienta a que, lejos de limitarse a las intervenciones de salud animal, se ocupen también del acceso a los piensos y el agua y de mantener abiertos los circuitos de comercialización de ganado. Los autores abordan también aquí las necesidades específicas de las personas desplazadas, las comunidades de acogida y las poblaciones pastorales, así como los programas de erradicación de enfermedades en el contexto de emergencias complejas.

Management of orthopaedic injuries in Libyan civil war: experiences of a distant hospital.

AIM OF THE STUDY: In this study, we aimed to evaluate the musculoskeletal injury types, infections, and treatments of the patients injured in Libyan civil war. METHODS: A total of 291 patients (288 male, 3 female) treated in our clinic, between November 2011 and April 2020, were included in our retrospective study. Patients' age, injury severity score (ISS), injury type, mechanism, location, accompanying traumas, infection, and operations in Libya and in our clinic were evaluated. RESULTS: Injuries were caused by gunshots in 172 patients, by explosives in 56, by missiles in eight, and by different mechanisms in the remaining 55 patients. Injuries were located mostly in lower extremities, followed by upper extremities and by both extremities. The most common fracture was tibial fractures, followed with femur and humerus. Plate-screw fixation was performed for 82 cases, intramedullary nailing for 42, external fixator for 41, K-wire fixation for 27, foreign body excisions for 26, arthrodesis for 15, amputation for , arthroplasty for 11, and soft tissue operations for 78. Infection was present among 50 (% 17.2) patients. Complications were seen in five patients. Three patients needed implant removal due to infection, one patient had a plate fracture, and one patient died because of sepsis. DISCUSSION: Difficulties in the treatment of war injuries begin in the battlefield. Patients' transfers and treatments may not be provided properly due to unsuitable conditions. Hospitals in neighbouring and distant countries can be helpful for supporting the treatment of increased numbers of injured patients. CONCLUSION: Wars cause excessive numbers of injuries. In this study, we want to show that hospitals far from war zones can be considered as alternatives for treatment of these injuries.

Prevalence and factors associated with traumatic dental injuries among schoolchildren in war-torn Libya.

BACKGROUND/AIMS: No previous epidemiological study has investigated the prevalence and associated factors of traumatic dental injuries (TDIs) among Libyan children. Such information is required for the planning and evaluation of health services. The aim of this study was to assess the prevalence of TDIs and associated factors among 12-year-old schoolchildren in Benghazi, Libya. METHODS: Data for this study were collected as part of a comprehensive, cross-sectional survey investigating oral health status and treatment needs of 12-year-old schoolchildren in Benghazi, Libya, between December 2016 and May 2017. Sociodemographic information was collected through a dental health questionnaire. The children were assessed for oral health status, including TDIs according to modified World Health Organization (WHO) classification criteria, in their classroom by trained and calibrated examiners. Anthropometric measures, lip competence and overjet were all assessed and reported. History of TDIs was sought among those affected. Logistic regression models were applied for TDIs as an outcome variable. The statistical significance for all tests was ≤0.05. RESULTS: Data from 1134 participants were included in this study. TDIs were observed in 10.3% of the sample. Most of these TDIs were enamel fractures only (55.6%) and enamel and dentine fractures (35.9%). "Falling" was the most common cause of TDIs, accounting for 51% of cases. While increased overjet appeared to be associated with higher risk of TDIs (OR: 1.92; 95% CI: 1.29-2.86), being female (OR: 0.34; 95% CI: 0.22-0.53) and overweight (OR: 0.33; 95% CI: 0.13-0.83) were also associated with lower risk of having TDIs. CONCLUSIONS: This survey showed that a considerable proportion (10.3%) of 12-year-old Libyan children had TDIs, with relatively high unmet treatment needs. More efforts are required to develop effective prevention programmes and to enhance the provision of dental treatment of TDIs for Libyan children.