Publications by authors named "Heba Fouad"

25 Publications

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Estimated and projected prevalence of tobacco smoking in males, Eastern Mediterranean Region, 2000-2025.

East Mediterr Health J 2021 Jan 23;27(1):76-82. Epub 2021 Jan 23.

World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Background: Three global reports published by the World Health Organization (WHO) report trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys.

Aims: The is study aimed to: (i) compare current and projected prevalence rates of tobacco smoking presented in these reports for males ≥ 15 years in countries of the Eastern Mediterranean Region; and (ii) assess changes in the prevalence rates in the context of changes in tobacco monitoring and control policies in these countries.

Methods: Regional and country-level data on tobacco smoking were extracted from the trend reports. Percentage point differences between the estimated prevalence of tobacco smoking in 2010 and the projected prevalence in 2025 were calculated for countries with available data. Data on implementation of national surveys and policies on tobacco use were obtained from relevant WHO reports.

Results: In the latest trend report (2019), the prevalence of male current tobacco smoking is projected to decrease by less than 2 percentage points in the Region (from 33.1% in 2010 to 31.2% in 2025). The projections for male tobacco smoking for 2025 in the 2019 report are more encouraging than in the 2015 report in seven of the eight countries of the Region. For five of these seven countries, implementation of tobacco monitoring and tobacco control policies improved over the same period.

Conclusions: Countries of the Region need to conduct additional national tobacco-use surveys to improve the accuracy of prevalence estimates and projections. Such data can help guide policy-makers to implement policies to control tobacco smoking.
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http://dx.doi.org/10.26719/2021.27.1.76DOI Listing
January 2021

Temporal trends in childhood cancer survival in Egypt, 2007 to 2017: A large retrospective study of 14 808 children with cancer from the Children's Cancer Hospital Egypt.

Int J Cancer 2021 Apr 15;148(7):1562-1574. Epub 2020 Oct 15.

Nuffield Department of Primary Care Health Sciences, Centre for Evidence Based Medicine, University of Oxford, Oxford, UK.

Childhood cancer is a priority in Egypt due to large numbers of children with cancer, suboptimal care and insufficient resources. It is difficult to evaluate progress in survival because of paucity of data in National Cancer Registry. In this study, we studied survival rates and trends in survival of the largest available cohort of children with cancer (n = 15 779, aged 0-18 years) from Egypt between 2007 and 2017, treated at Children's Cancer Hospital Egypt-(CCHE), representing 40% to 50% of all childhood cancers across Egypt. We estimated 5-year overall survival (OS) for 14 808 eligible patients using Kaplan-Meier method, and determined survival trends using Cox regression by single year of diagnosis and by diagnosis periods. We compared age-standardized rates to international benchmarks in England and the United States, identified cancers with inferior survival and provided recommendations for improvement. Five-year OS was 72.1% (95% CI 71.3-72.9) for all cancers combined, and survival trends increased significantly by single year of diagnosis (P < .001) and by calendar periods from 69.6% to 74.2% (P < .0001) between 2007-2012 and 2013-2017. Survival trends improved significantly for leukemias, lymphomas, CNS tumors, neuroblastoma, hepatoblastoma and Ewing Sarcoma. Survival was significantly lower by 9% and 11.2% (P < .001) than England and the United States, respectively. Significantly inferior survival was observed for the majority of cancers. Although survival trends are improving for childhood cancers in Egypt/CCHE, survival is still inferior in high-income countries. We provide evidence-based recommendations to improve survival in Egypt by reflecting on current obstacles in care, with further implications on practice and policy.
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http://dx.doi.org/10.1002/ijc.33321DOI Listing
April 2021

Contralateral Surgery for the Treatment of Third Nerve Palsy with Aberrant Regeneration.

Am J Ophthalmol 2021 02 7;222:166-173. Epub 2020 Aug 7.

Kellogg Eye Center, University of Michigan, Ann Arbor, Michigan, USA.

Purpose: To report the results of contralateral recession-resection of the horizontal muscles in oculomotor nerve palsy with aberrant regeneration to correct both the strabismus and the ptosis in one procedure.

Design: Retrospective case series.

Methods: This is an institutional study on patients with oculomotor nerve palsy with aberrant innervation who had contralateral eye muscle surgery in 2 different centers. Patients were included if they have both exotropia and aberrant regeneration with a ptosis that improved on adduction. All patients had contralateral lateral rectus recession and medial rectus resection. Ductions, versions, angle of misalignment, and degree of ptosis were evaluated before surgery and at last follow-up.

Results: Eleven patients were identified. The mean age at surgery was 15.0 ± 9.2 years. Five patients were male (45%). Trauma was the cause in 8 (72%) cases. The mean angle of exotropia was 42 ± 14 prism diopters. The mean degree of ptosis was 3.9 ± 1.6 mm. The mean lateral rectus recession was 8.2 ± 1.1 mm, and the mean medial rectus muscle resection was 6.7 ± 0.9 mm. The mean follow-up was 6.4 ± 2.5 months. After surgery, none of the patients had residual exotropia >10 prism diopters. The mean degree of ptosis after surgery was 0.9 ± 0.8 mm. None of the patients required further surgery for ptosis or strabismus.

Conclusion: Contralateral eye muscle in third nerve palsy with aberrant innervation offers the advantage of simultaneous correction of both strabismus and ptosis through a single procedure.
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http://dx.doi.org/10.1016/j.ajo.2020.07.044DOI Listing
February 2021

Use of cancer data for cancer control in the Eastern Mediterranean Region: Results of a survey among population-based cancer registries.

Int J Cancer 2021 Feb 13;148(3):593-600. Epub 2020 Aug 13.

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Data from population-based cancer registries (PBCR) are critical for planning, monitoring and evaluation of cancer control programs, but are frequently underutilized by key stakeholders. As part of the ongoing partnership of the International Agency for Research on Cancer (IARC) and the WHO Eastern Mediterranean Regional Office (EMRO) in cancer surveillance, we designed a cancer registry survey to assess the level of involvement of PBCR in national cancer control planning across the region. A questionnaire on registry characteristics, their contribution to cancer control and perceived barriers, was sent to 14 countries with operational PBCR. We obtained replies from Bahrain, Egypt, Iraq, Iran, Jordan, Kuwait, Lebanon, Morocco, Oman, Qatar, Saudi Arabia, Tunisia and the United Arab Emirates. We found a high participation of PBCR in cancer control planning (all registries involved, 46% routinely) and the evaluation of screening (92% registries involved, 46% routinely), but a much lower level of participation in palliative care and rehabilitation activities. Specified barriers included poor governance, a lack of awareness by policy makers, insufficient resources and a limited availability of data electronically, including mortality data. Appropriate planning to ensure the sustainability of PBCR (including the employment of permanent staff), increasing training, building research capacity and ensuring an efficient provision of high-quality data to policymakers, were among the proposed solutions. The results of our study reinforce the need for further tailoring of activities in support of cancer registration and enhanced networking among stakeholders, toward improving quality and use of cancer registry data for cancer control in the EMR.
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http://dx.doi.org/10.1002/ijc.33223DOI Listing
February 2021

Surgical outcome of exotropic Duane syndrome.

Semin Ophthalmol 2020 Jan 4;35(1):66-77. Epub 2020 Mar 4.

Faculty of Medicine, Cairo University, Cairo, Egypt.

: To evaluate the surgical outcome of exotropic Duane syndrome and the factors that can influence the outcome.: A retrospective study was performed on patients who had surgery for exotropic Duane syndrome with a minimum follow-up of 3 months. The ocular motility, the angles of deviation, the presence of abnormal head turn or overshoots, the surgical procedures performed, and their outcome were analyzed.: Sixty-seven patients were identified (mean age, 11.3 years). In unilateral cases with exotropia <25 PD (n = 28), ipsilateral lateral rectus (LR) recession was performed in all cases, and orthophoria was achieved in 25 patients (89.3%). In unilateral cases with angle ≥25 PD, ipsilateral LR recession was performed in 13 patients, bilateral symmetrical LR recession in eight patients, and unilateral LR recession and medial rectus (MR) resection in seven patients. Sequential contralateral LR recession for undercorrection was performed in seven patients. The success rate was highest in those who had unilateral LR recession and MR resection (66.7%). An increase in face turn occurred in 6 of 15 patients (40%) who had a simultaneous or sequential bilateral LR recession. In bilateral Duane syndrome, bilateral LR recession was performed in 10 patients, and was combined with ipsilateral MR resection in two patients with a success rate of 75%. Higher success rate was associated with young age at surgery ( = .03) and smaller angle of deviation ( = .04). The mean follow-up was 6.3 months.: Surgical results in exotropic Duane syndrome are better in small angles of deviation and in younger age groups.
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http://dx.doi.org/10.1080/08820538.2020.1730915DOI Listing
January 2020

Smoking prevalence in the Eastern Mediterranean Region.

East Mediterr Health J 2020 Jan 30;26(1):94-101. Epub 2020 Jan 30.

World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Background: Three global reports issued by the World Health Organization (WHO) track and report on trends in the prevalence of tobacco smoking from 2000 to 2025 based on data from national surveys.

Aims: This review aimed to compare regional and country-level projections for current tobacco smoking as presented in the WHO trend reports. These changes were considered in the context of improved monitoring and tobacco control policies.

Methods: Regional and country-level results in the WHO trend reports were considered in terms of the projected percentage point increase of current tobacco smoking between 2000 and 2025. Data on national surveys and policy implementation came from the relevant WHO reports.

Results: In the 2019 trend report, the prevalence of current tobacco smoking among males is projected to decrease by less than 2 percentage points by 2025. Eight countries featured in both the 2015 and 2019 WHO trend reports. Seven of these countries indicated a more encouraging projection (a decline in their projected increase between 2000 and 2025) for current male tobacco smoking in the 2019 report than in the 2015 report. For five out of these seven countries, their monitoring and tobacco control policy implementation improved over the same period.

Conclusion: Countries in the Region should implement additional national surveys to improve the accuracy of prevalence estimates, allow further projections to be performed and motivate policy-makers to make positive policy changes. Solutions to under-reporting biases during surveys should be considered. Governments should use trend projections to guide effective tobacco control policies to reduce tobacco use in the Region.
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http://dx.doi.org/10.26719/2020.26.1.94DOI Listing
January 2020

Outcomes and Complications Rate of Resident versus Attending Performed Eye Muscle Surgeries.

Semin Ophthalmol 2019 27;34(5):347-352. Epub 2019 May 27.

a Ophthalmology Department, Cairo University, Faculty of Medicine , Cairo , Egypt.

: to compare the type, complications rate, and success rate of eye muscle surgeries performed by residents to those performed by attending consultants. : A retrospective review was done on the charts of all children who underwent an eye muscle surgery in Cairo University Hospital during the period from January 2015 to December 2017. Preoperative data including age, sex, and type of deviation were tabulated. Details of the operative procedure including the surgeon, the type of eye muscle surgery, the number of muscles operated upon, perioperative complications, and the final ocular alignment at the end of the third month after surgery were recorded. : A total of 319 patients were included; 143 patients (315 muscles) in the supervised resident group and 176 patients (387 muscles) in the attending group. More vertical and oblique muscles surgeries were done by the attending consultants than by residents. Surgical success after three months was higher in the attending group (n = 126, 72%) than the resident group (n = 91, 64%). However, the difference was not statistically significant ( = .129). The perioperative complications rate was significantly higher ( = .004) in the resident group (14%) than the attending group (6%). Accidental scleral perforation was the most commonly encountered complication in the resident group (n = 6, 1.9%) followed by extruded/exposed Tenon (n = 5, 1.6%), and muscle slippage (n = 4, 1.3%). : Success rate is similar in eye muscle surgeries performed by residents and attending consultants. However, perioperative complications are still more common among residents.
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http://dx.doi.org/10.1080/08820538.2019.1622024DOI Listing
August 2019

The value of prednisolone acetate provocative test before intravitreal triamcinolone acetonide injections.

Eur J Ophthalmol 2020 Jul 12;30(4):730-737. Epub 2019 Apr 12.

Department of Ophthalmology, Kasr El Aini Hospital, Cairo University, Cairo, Egypt.

Purpose: The aim of this study was to investigate the diagnostic value of a topical prednisolone acetate 1% provocative test for steroid-induced ocular hypertension before intravitreal triamcinolone acetonide injection.

Methods: This is a prospective, single-center, randomized controlled study at Kasr El Aini Hospital, Cairo University. Patients scheduled for intravitreal triamcinolone acetonide were enrolled and randomly allocated in a ratio 2:1 to either Group A: received prednisolone acetate provocative test and those who did not develop SIOH proceeded with intravitreal triamcinolone acetonide or Group B: did not receive prednisolone acetate provocative test and proceeded directly to intravitreal triamcinolone acetonide. Intraocular pressures were measured weekly for 4 weeks following intravitreal triamcinolone acetonide. Steroid-induced ocular hypertension is defined as intraocular pressure increase of 5 mmHg or more from baseline after prednisolone acetate provocative test or intravitreal triamcinolone acetonide.

Results: A total of 66 eyes (66 patients) were included. Of which, 10 eyes (23.8%) showed prednisolone acetate provocative test steroid-induced ocular hypertension during the 4-week period. Intravitreal triamcinolone acetonide steroid-induced ocular hypertension was less likely to develop in Group A (prednisolone acetate provocative test non-steroid-induced ocular hypertension, n = 32, 31.25%) than in group B (n = 24, 54.2%) (p = 0.006, odds ratio: 0.178, 95% CI: 0.53-0.596). Our test achieved a negative predictive value of 68.75%.

Conclusion: The topical prednisolone acetate provocative test may be a useful method to predict a steroid-induced ocular hypertension following intravitreal triamcinolone acetonide.
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http://dx.doi.org/10.1177/1120672119842731DOI Listing
July 2020

Proportion of cancers attributable to major lifestyle and environmental risk factors in the Eastern Mediterranean region.

Int J Cancer 2020 02 29;146(3):646-656. Epub 2019 Apr 29.

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Cancer is a major contributing cause of morbidity and mortality in the Eastern Mediterranean region. The aim of the current study was to estimate the cancer burden attributable to major lifestyle and environmental risk factors. We used age-, sex- and site-specific incidence estimates for 2012 from IARC's GLOBOCAN, and assessed the following risk factors: smoking, alcohol, high body mass index, insufficient physical activity, diet, suboptimal breastfeeding, infections and air pollution. The prevalence of exposure to these risk factors came from different sources including peer-reviewed international literature, the World Health Organization, noncommunicable disease Risk Factor Collaboration, and the Food and Agriculture Organization. Sex-specific population-attributable fraction was estimated in the 22 countries of the Eastern Mediterranean region based on the prevalence of the selected risk factors and the relative risks obtained from meta-analyses. We estimated that approximately 33% (or 165,000 cases) of all new cancer cases in adults aged 30 years and older in 2012 were attributable to all selected risk factors combined. Infections and smoking accounted for more than half of the total attributable cases among men, while insufficient physical activity and exposure to infections accounted for more than two-thirds of the total attributable cases among women. A reduction in exposure to major lifestyle and environmental risk factors could prevent a substantial number of cancer cases in the Eastern Mediterranean. Population-based programs preventing infections and smoking (particularly among men) and promoting physical activity (particularly among women) in the population are needed to effectively decrease the regional cancer burden.
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http://dx.doi.org/10.1002/ijc.32284DOI Listing
February 2020

MPOWER, needs and challenges: trends in the implementation of the WHO FCTC in the Eastern Mediterranean Region.

East Mediterr Health J 2018 Apr 5;24(1):63-71. Epub 2018 Apr 5.

Tobacco Free Initiative, World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Background: WHO MPOWER aims to help countries prioritize tobacco control measures in line with the WHO Framework Convention on Tobacco Control.

Objectives: This paper assessed the progress and challenges in implementing the 6 priority policies of MPOWER in countries of the WHO Eastern Mediterranean Region since 2011.

Methods: A checklist was developed and scores assigned based on the MPOWER indicators (maximum score 37). MPOWER data for the Region in the 2015 and 2017 tobacco control reports were extracted and scored. Data from similar analyses for 2011 and 2013 were also included. Countries were ranked by scores for each indicator for 2015 and 2017 and for overall scores for 2011 to 2017.

Results: The Islamic Republic of Iran, Egypt and Pakistan had the highest scores in 2015 (33, 29 and 27 respectively) and the Islamic Republic of Iran, Pakistan and Yemen had the highest scores in 2017 (34, 31 and 27 respectively). The indicators with the highest and lowest combined score for all countries were for advertising bans and compliance with smoke-free policies: 67 and 18 respectively in 2015, and 73 and 15 respectively in 2017. Most countries (15/22) had higher total scores in 2017 than 2015: Afghanistan, Bahrain and Syrian Arab Republic had the greatest increases. The total score for the Region increased from 416 out of a maximum score of 814 in 2011 to 471 in 2017.

Conclusions: Although notable achievements have been made in the Region, many challenges to policy implementation remain and require urgent action by governments of the countries of the Region.
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April 2018

Scaling up prevention and control of noncommunicable diseases in the WHO Eastern Mediterranean Region.

East Mediterr Health J 2018 Apr 5;24(1):52-62. Epub 2018 Apr 5.

WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Surveillance is an essential component in the campaign to prevent and control noncommunicable diseases (NCDs), both globally and in the Eastern Mediterranean Region (EMR). In order to address the increasing burden from these diseases, countries must first evaluate their own systems and see what steps need to be taken to improve preparedness. Therefore, the WHO Regional Office for the Eastern Mediterranean in Cairo, Egypt, conducts country capacity surveys on a regular basis to compare each Member State's NCD provision to the Framework for Action to implement the UN Political Declaration (2011). Ten progress indicators cover governance and planning, reducing risk factors and healthcare provision. Each one is scored for whether a country is fully, partially or not achieving this goal. This review focuses on comparing the Progress Monitor reports for the 22 EMR countries in 2015 and 2017. While the criteria used to assess some of the indicators have been updated over this period, many categories still show strong improvements. However, others still require extensive work if countries are to meet the sustainable development goal of reducing by 25% the number of premature deaths from NCDs by the year 2025.
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April 2018

Prevalence of risk factors for noncommunicable diseases in adults: key findings from the Pakistan STEPS survey.

East Mediterr Health J 2018 Apr 5;24(1):33-41. Epub 2018 Apr 5.

World Health Organization, Regional Office for the Eastern Mediterranean, Cairo, Egypt.

Background: Pakistan lacks data on the prevalence of risk factors for common noncommunicable diseases (NCDs).

Objectives: This study aimed to determine the prevalence of risk factors for NCDs among a population-based sample in Punjab and Sindh provinces, Pakistan.

Methods: This study was conducted in 2013-2014. The NCD risk factors examined were: current daily smoking, eating fewer than 5 servings of fruits/vegetable a day, low physical activity, overweight and obesity. A total of 7 710 households were selected and 1 adult was enrolled from each household. Data were collected using the WHO STEPS instrument (Step 1 and 2), and analysed according to the STEPS statistical plan.

Results: The prevalence of tobacco use was 19.7%. The majority of the respondents (96.5%) consumed fewer than 5 servings of fruits/vegetables a day, 41.5% had a low level of physical activity, 26.3% were overweight and 14.9% were obese. The prevalence of stage I and stage II hypertension, including those on medication, was 37% and 15.9% respectively. The prevalence of NCD risk factors differed significantly by sex and occupation (P = 0.0001) but not by age group (P = 0.118), level of education (P = 0.668) and province (P = 0.056). Only 0.6% of the sample had none of the 5 NCD risk factors while 40% had 3-5.

Conclusion: The high prevalence of NCD risk factors in Punjab and Sindh provinces is of concern. Urgent public health interventions are needed to reduce them, especially in youth and young adults.
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April 2018

Comparison between medial rectus pulley fixation and augmented recession in children with convergence excess and variable-angle infantile esotropia.

J AAPOS 2016 10 16;20(5):405-409.e1. Epub 2016 Sep 16.

Cairo University Faculty of Medicine, Cairo, Egypt.

Purpose: To compare the outcomes of medial rectus (MR) muscle pulley fixation and augmented recession in children with convergence excess esotropia and variable-angle infantile esotropia.

Methods: This was a prospective randomized interventional study in which children with convergence excess esotropia or variable-angle infantile esotropia were randomly allocated to either augmented MR muscle recession (augmented group) or MR muscle pulley posterior fixation (pulley group). In convergence excess, the MR recession was based on the average of distance and near angles of deviation with distance correction in the augmented group, and on the distance angle of deviation in the pulley group. In variable-angle infantile esotropia, the MR recession was based on the average of the largest and smallest angles in the augmented group and on the smallest angle in the pulley group. Pre- and postoperative ductions, versions, pattern strabismus, smallest and largest angles of deviation, and angle disparity were analyzed.

Results: Surgery was performed on 60 patients: 30 underwent bilateral augmented MR recession, and 30 underwent bilateral MR recession with pulley fixation. The success rate was statistically significantly higher (P = 0.037) in the pulley group (70%) than in the augmented group (40%). The postoperative smallest and largest angles and the angle disparity were statistically significantly lower in the pulley group than the augmented group (P < 0.01).

Conclusions: Medial rectus muscle pulley fixation is a useful surgical step for addressing marked variability of the angle in variable angle esotropia and convergence excess esotropia.
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http://dx.doi.org/10.1016/j.jaapos.2016.07.220DOI Listing
October 2016

Molecular detection of Mycobacterium tuberculosis in cattle and buffaloes: a cause for public health concern.

Trop Anim Health Prod 2016 Dec 12;48(8):1541-1545. Epub 2016 Aug 12.

Department of Zoonoses, Faculty of Veterinary Medicine, Cairo University, Cairo, 12211, Egypt.

Tuberculosis is a re-emerging disease causing a growing public health burden. The current study was conducted to investigate the occurrence of Mycobacterium tuberculosis among cattle and buffaloes with tuberculous lesions. Typical tuberculous lesions were collected from 34 cattle and 34 buffaloes (Bubalus bubalis) through postmortem examination of slaughtered animals in abattoirs. DNAs were extracted from samples, and M. tuberculosis was identified by PCR. Positive samples were examined for resistance against rifampicin and isoniazid using GenoType MTBDRplus. Moreover, sera from 90 slaughterhouse workers, butchers, or meat inspectors were examined for the presence of M. tuberculosis antibodies using ELISA. Five cattle (14.7 %) and three buffaloes (8.8 %) tested positive. M. tuberculosis from one cattle was resistant to rifampicin and another was resistant to isoniazid. In addition, the seroprevalence of M. tuberculosis IgG among examined humans was 5.6 %. The occurrence of M. tuberculosis in cattle and buffaloes is a public health concern.
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http://dx.doi.org/10.1007/s11250-016-1125-3DOI Listing
December 2016

Secondhand smoke exposure at home among one billion children in 21 countries: findings from the Global Adult Tobacco Survey (GATS).

Tob Control 2016 12 11;25(e2):e95-e100. Epub 2016 Feb 11.

Tobacco Free Initiative, World Health Organization, Geneva, Switzerland.

Objective: Children are vulnerable to secondhand smoke (SHS) exposure because of limited control over their indoor environment. Homes remain the major place where children may be exposed to SHS. Our study examines the magnitude, patterns and determinants of SHS exposure in the home among children in 21 countries (19 low-income and middle-income countries and 2 high-income countries).

Methods: Global Adult Tobacco Survey (GATS) data, a household survey of people 15 years of age or older. Data collected during 2009-2013 were analysed to estimate the proportion of children exposed to SHS in the home. GATS estimates and 2012 United Nations population projections for 2015 were also used to estimate the number of children exposed to SHS in the home.

Results: The proportion of children younger than 15 years of age exposed to SHS in the home ranged from 4.5% (Panama) to 79.0% (Indonesia). Of the approximately one billion children younger than 15 years of age living in the 21 countries under study, an estimated 507.74 million were exposed to SHS in the home. China, India, Bangladesh, Indonesia and the Philippines accounted for almost 84.6% of the children exposed to SHS. The prevalence of SHS exposure was higher in countries with higher adult smoking rates and was also higher in rural areas than in urban areas, in most countries.

Conclusions: A large number of children were exposed to SHS in the home. Encouraging of voluntary smoke-free rules in homes and cessation in adults has the potential to reduce SHS exposure among children and prevent SHS-related diseases and deaths.
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http://dx.doi.org/10.1136/tobaccocontrol-2015-052693DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488799PMC
December 2016

Regional contributions of six preventable risk factors to achieving the 25 × 25 non-communicable disease mortality reduction target: a modelling study.

Lancet Glob Health 2015 Dec 20;3(12):e746-57. Epub 2015 Oct 20.

MRC-PHE Centre for Environment and Health, Imperial College London, London, UK; Department of Health Statistics and Information Systems, World Health Organization, Geneva, Switzerland. Electronic address:

Background: Countries have agreed to reduce premature mortality from the four main non-communicable diseases (NCDs) by 25% from 2010 levels by 2025 (referred to as the 25 × 25 target). Countries also agreed on a set of global voluntary targets for selected NCD risk factors. Previous analyses have shown that achieving the risk factor targets can contribute substantially towards meeting the 25 × 25 mortality target at the global level. We estimated the contribution of achieving six of the globally agreed risk factor targets towards meeting the 25 × 25 mortality target by region.

Methods: We estimated the effect of achieving the targets for six risk factors (tobacco and alcohol use, salt intake, obesity, and raised blood pressure and glucose) on NCD mortality between 2010 and 2025. Our methods accounted for multicausality of NCDs and for the fact that, when risk factor exposure increases or decreases, the harmful or beneficial effects on NCDs accumulate gradually. We used data for risk factor and mortality trends from systematic analyses of available country data. Relative risks for the effects of individual and multiple risks, and for change in risk after decreases or increases in exposure, were from reanalyses and meta-analyses of epidemiological studies.

Findings: The probability of dying between the ages 30 years and 70 years from the four main NCDs in 2010 ranged from 19% in the region of the Americas to 29% in southeast Asia for men, and from 13% in Europe to 21% in southeast Asia for women. If current trends continue, the probability of dying prematurely from the four main NCDs is projected to increase in the African region but decrease in the other five regions. If the risk factor targets are achieved, the 25 × 25 target will be surpassed in Europe in both men and women, and will be achieved in women (and almost achieved in men) in the western Pacific; the regions of the Americas, the eastern Mediterranean, and southeast Asia will approach the target; and the rising trend in Africa will be reversed. In most regions, a more ambitious approach to tobacco control (50% reduction relative to 2010 instead of the agreed 30%) will contribute the most to reducing premature NCD mortality among men, followed by addressing raised blood pressure and the agreed tobacco target. For women, the highest contributing risk factor towards the premature NCD mortality target will be raised blood pressure in every region except Europe and the Americas, where the ambitious (but not agreed) tobacco reduction would have the largest benefit.

Interpretation: No WHO region will meet the 25 × 25 premature mortality target if current mortality trends continue. Achieving the agreed targets for the six risk factors will allow some regions to meet the 25 × 25 target and others to approach it. Meeting the 25 × 25 target in Africa needs other interventions, including those addressing infection-related cancers and cardiovascular disease.

Funding: UK Medical Research Council.
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http://dx.doi.org/10.1016/S2214-109X(15)00179-5DOI Listing
December 2015

Application of the Abridged SimSmoke model to four Eastern Mediterranean countries.

Tob Control 2016 07 16;25(4):413-21. Epub 2015 Jun 16.

WHO-EMRO, Cairo-Nasr City, Egypt, USA.

Introduction: The WHO established the MPOWER policy package to boost the implementation of the WHO Framework Convention for Tobacco Control (WHO FCTC) in 2008 and to provide practical guidance on policies effective at reducing smoking rates. An easily applied Abridged SimSmoke was developed to help countries gauge the effect of these policies using data from the WHO MPOWER/WHO Report (MPOWER Report) and is applied to four Eastern Mediterranean countries.

Methods: The number of smokers in a country is calculated using the country's smoking prevalence and population. Policy effect sizes, based on previously validated SimSmoke models, are applied to the smoker populations to determine the reduction in the number of smokers resulting from implementing policies. The number of smoking-attributable deaths is derived based on findings that half of those smokers alive today will die from smoking.

Results: Within 40 years, implementing the complete set of MPOWER policies is projected to reduce smoking prevalence by 29% (range 15%, 41%) and avert almost 1 (range 0.5, 1.4) million deaths in Egypt, reduce smoking prevalence by 52% (range 36%, 66%) and avert 156 000 (106 000, 196 000) deaths in Lebanon, reduce smoking prevalence by 56% (range 40%, 69%) and avert 3.5 (range 2.5, 4.3) million deaths in Pakistan, and reduce smoking prevalence by 37% (range 21%, 51%) and avert 245 000 (range 138 000, 334 000) deaths in Tunisia.

Conclusions: The Abridged SimSmoke model has been used to show the number of deaths from smoking and how MPOWER policies can be used to reach the WHO non-communicable deaths voluntary target for cigarette use reduction in four countries.
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http://dx.doi.org/10.1136/tobaccocontrol-2015-052334DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4681690PMC
July 2016

Awareness and Current Use of Electronic Cigarettes in Indonesia, Malaysia, Qatar, and Greece: Findings From 2011-2013 Global Adult Tobacco Surveys.

Nicotine Tob Res 2016 Apr 20;18(4):501-7. Epub 2015 Apr 20.

Global Tobacco Control Branch, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA;

Introduction: Increases in electronic cigarette (e-cigarette) awareness and current use have been documented in high income countries but less is known about middle and low income countries.

Methods: Nationally representative household survey data from the first four Global Adult Tobacco Surveys to assess e-cigarettes were analyzed, including Indonesia (2011), Malaysia (2011), Qatar (2013), and Greece (2013). Correlates of e-cigarette awareness and current use were calculated. Sample sizes for Greece and Qatar allowed for further analysis of e-cigarette users.

Results: Awareness of e-cigarettes was 10.9% in Indonesia, 21.0% in Malaysia, 49.0% in Qatar, and 88.5% in Greece. In all four countries, awareness was higher among male, younger, more educated, and wealthier respondents. Current e-cigarette use among those aware of e-cigarettes was 3.9% in Malaysia, 2.5% in Indonesia, 2.2% in Greece and 1.8% in Qatar. Across these four countries, an estimated 818 500 people are currently using e-cigarettes. Among current e-cigarette users, 64.4% in Greece and 84.1% in Qatar also smoked cigarettes, and, 10.6% in Greece and 6.0% in Qatar were never-smokers.

Conclusions: E-cigarette awareness and use was evident in all four countries. Ongoing surveillance and monitoring of awareness and use of e-cigarettes in these and other countries could help inform tobacco control policies and public health interventions. Future surveillance should monitor use of e-cigarettes among current smokers and uptake among never-smokers and relapsing former smokers.
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http://dx.doi.org/10.1093/ntr/ntv081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5100820PMC
April 2016

Management of large V-pattern exotropia with minimal or no inferior oblique overaction.

J AAPOS 2013 Dec 9;17(6):588-93. Epub 2013 Nov 9.

Cairo University Faculty of Medicine, Cairo, Egypt. Electronic address:

Purpose: To compare the outcomes of patients with large V-pattern exotropia and minimal inferior overaction who underwent bilateral lateral rectus recession combined with full-tendon-width upward transposition of the lateral rectus muscles or bilateral inferior oblique myectomy.

Methods: The medical records of consecutive patients with V-pattern exotropia (at least 20(Δ) greater in upgaze than in downgaze) with minimal inferior oblique overaction who underwent either of the above procedures and who had at least 6 months' follow-up were retrospectively reviewed. Pre- and postoperative ductions, versions, pattern strabismus, stereoacuity and fundus torsion were analyzed. Success was defined as esophoria <8(Δ)/tropia ≤5(Δ) to exophoria/tropia ≤8(Δ) in primary gaze.

Results: A successful outcome was achieved in 9 patients (56%) in the transposition group and 13 (72%) in the myectomy group (P = 0.48). Reduction of V pattern to <10(Δ) was achieved in 7 cases (44%) in the transposition group and 14 (78%) in the myectomy group (P = 0.04), with mean reductions of 16(Δ) ± 5(Δ) and 25(Δ) ± 5(Δ), respectively (P = 0.03). In the myectomy group, 4 patients (22%) had overcorrection with consecutive A patterns of 2(Δ)-6(Δ).

Conclusions: In patients with a V pattern exotropia and minimal inferior oblique over action, bilateral lateral rectus recessions plus bilateral inferior oblique myectomy can successfully eliminate the V pattern but the surgery may occasionally result in overcorrection with consecutive A pattern.
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http://dx.doi.org/10.1016/j.jaapos.2013.08.010DOI Listing
December 2013

Methodology of the Global Adult Tobacco Survey - 2008-2010.

Glob Health Promot 2016 Jun 16;23(2 Suppl):3-23. Epub 2013 Sep 16.

World Health Organization, Geneva, Switzerland.

In 2008, the Centers for Disease Control and Prevention (CDC) and the World Health Organization developed the Global Adult Tobacco Survey (GATS), an instrument to monitor global tobacco use and measure indicators of tobacco control. GATS, a nationally representative household survey of persons aged 15 years or older, was conducted for the first time during 2008-2010 in 14 low- and middle-income countries. In each country, GATS used a standard core questionnaire, sample design, and procedures for data collection and management and, as needed, added country-specific questions that were reviewed and approved by international experts. The core questionnaire included questions about various characteristics of the respondents, their tobacco use (smoking and smokeless), and a wide range of tobacco-related topics (cessation; secondhand smoke; economics; media; and knowledge, attitudes, and perceptions). In each country, a multistage cluster sample design was used, with households selected proportionate to the size of the population. Households were chosen randomly within a primary or secondary sampling unit, and one respondent was selected at random from each household to participate in the survey. Interviewers administered the survey in the country's local language(s) using handheld electronic data collection devices. Interviews were conducted privately, and same-sex interviewers were used in countries where mixed-sex interviews would be culturally inappropriate. All 14 countries completed the survey during 2008-2010. In each country, the ministry of health was the lead coordinating agency for GATS, and the survey was implemented by national statistical organizations or surveillance institutes. This article describes the background and rationale for GATS and includes a comprehensive description of the survey methods and protocol.
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http://dx.doi.org/10.1177/1757975913499800DOI Listing
June 2016

Tracking MPOWER in 14 countries: results from the Global Adult Tobacco Survey, 2008-2010.

Glob Health Promot 2016 Jun 16;23(2 Suppl):24-37. Epub 2013 Sep 16.

Headquarters, WHO, Geneva, Switzerland.

Background: The World Health Organization (WHO) MPOWER is a technical package of six tobacco control measures that assist countries in meeting their obligations of the WHO Framework Convention Tobacco Control and are proven to reduce tobacco use. The Global Adult Tobacco Survey (GATS) systematically monitors adult tobacco use and tracks key tobacco control indicators.

Methods: GATS is a nationally representative household survey of adults aged 15 and older, using a standard and consistent protocol across countries; it includes information on the six WHO MPOWER measures. GATS Phase I was conducted from 2008-2010 in 14 high-burden low- and middle-income countries. We selected one key indicator from each of the six MPOWER measures and compared results across 14 countries.

Results: Current tobacco use prevalence rates ranged from 16.1% in Mexico to 43.3% in Bangladesh. We found that the highest rate of exposure to secondhand smoke in the workplace was in China (63.3%). We found the highest 'smoking quit attempt' rates in the past 12 months among cigarette smokers in Viet Nam (55.3%) and the lowest rate was in the Russian Federation (32.1%). In five of the 14 countries, more than one-half of current smokers in those 5 countries said they thought of quitting because of health warning labels on cigarette packages. The Philippines (74.3%) and the Russian Federation (68.0%) had the highest percentages of respondents noticing any cigarette advertising, promotion and sponsorship. Manufactured cigarette affordability ranged from 0.6% in Russia to 8.0% in India.

Conclusions: Monitoring tobacco use and tobacco control policy achievements is crucial to managing and implementing measures to reverse the epidemic. GATS provides internationally-comparable data that systematically monitors and tracks the progress of the other five MPOWER measures.
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http://dx.doi.org/10.1177/1757975913501911DOI Listing
June 2016

Prevalence of tobacco use among adults in Egypt, 2009.

Glob Health Promot 2016 Jun 16;23(2 Suppl):38-47. Epub 2013 Sep 16.

CDC Foundation, Atlanta, Georgia, USA.

Introduction: We assessed the differences in overall use of tobacco and in the use of various tobacco products, by sex and by frequency of use across various demographic groups.

Methods: We used data from the Global Adult Tobacco Survey (GATS), conducted in 2009 in Egypt. The data consist of answers to GATS by 20,924 respondents from a nationally representative, multistage probability sample of adults aged 15 years or older from all regions of Egypt. Current tobacco use was defined as current smoking or use of smokeless tobacco products, either daily or occasionally. We analyzed the differences in current cigarette, shisha, and smokeless tobacco use by sex and frequency of use (daily or occasional); and by demographic characteristics that included age, region, education level and employment status.

Results: Overall, 19.7% of the Egyptian population currently use some form of tobacco. Men (38.1% [95% confidence interval (CI) 36.8-39.4]) are much more likely than women (0.6% [95% CI 0.4-0.9]) to use tobacco. Almost 96% of men who use tobacco, do so daily. Men are more likely to use manufactured cigarettes (31.8% [95% CI 30.6-33.1]) than shisha (6.2% [95% CI 5.6-6.9]) or smokeless tobacco (4.1% [95% CI 3.4-4.8]). Few women use tobacco (cigarettes (0.2%), shisha (0.3%) and smokeless tobacco (0.3%)); however, all women who currently smoke shisha, do so daily. Lower educational status, being between ages 25-64 and being employed predicted a higher use of tobacco.

Conclusion: Egypt has implemented several initiatives to reduce tobacco use. The World Health Organization (WHO) MPOWER technical package, which aims to reverse the tobacco epidemic, is implemented at various levels throughout the country. Our findings show that there is significant variation in the prevalence of tobacco use and types of tobacco used by adult men and women in Egypt. GATS data can be used to better understand comparative patterns of tobacco use by adults, which in turn can be used to develop interventions.
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http://dx.doi.org/10.1177/1757975913499801DOI Listing
June 2016

Cross-country comparison of waterpipe use: nationally representative data from 13 low and middle-income countries from the Global Adult Tobacco Survey (GATS).

Tob Control 2014 Sep 11;23(5):419-27. Epub 2013 Jun 11.

Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Objective: Evidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys.

Methods: Data were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008-2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session.

Results: GATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness.

Conclusions: GATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use.
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http://dx.doi.org/10.1136/tobaccocontrol-2012-050841DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4145417PMC
September 2014

Hepatic arterial therapy with drug-eluting beads in the management of metastatic bronchogenic carcinoma to the liver: a multi-institutional registry.

J Oncol 2012 22;2012:292131. Epub 2012 Feb 22.

Radiology Department, Kasr Al-Aini Hospital, Faculty of Medicine, Cairo University, Cairo 11950, Egypt.

Introduction. There has been limited information reported on the use of hepatic arterial therapy in liver dominant hepatic metastases arising from lung cancer. The aim of this study was to evaluate the safety and efficacy of hepatic arterial therapy in the treatment of liver dominant hepatic metastases arising from lung cancer. Methods. Thirteen patients underwent a total of 30 treatment sessions with Drug-Eluting Beads. Eight of the thirteen received only doxorubicin DEB (17 of the total treatments), and four patients received Irinotecan DEB (7 of the total treatments). Results. The planned preprocedural dosage was a median of 75 mg (range 19-200), with total hepatic dose exposure being a median of 150 mg (range 0-458), with a technical success rate of 97% in all 29 treatments. There were 4 adverse events related to treatment, but no evidence of hepatic insufficiency. Overall 6-month and 12-month response rates were 50%. After a median followup of 24 months, the median overall survival in this cohort was 14 months (range 7-48 months). Conclusion. Drug-eluting beads loaded with doxorubicin (DEBDOX) or irinotecan (DEBIRI) can be safely and effectively used in treatment of patients with liver predominant metastatic disease from lung cancer.
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http://dx.doi.org/10.1155/2012/292131DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3317121PMC
August 2012

Tobacco use among Palestine refugee students (UNRWA) aged 13-15.

Prev Med 2009 Aug-Sep;49(2-3):224-8. Epub 2009 Jun 9.

UNRWA Headquarters, Amman, Jordan.

Objective: The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) has made tobacco use prevention a primary health issue. UNRWA provides education, health, relief and social services in five fields of operation: Jordan, Lebanon, Syria, Gaza Strip and the West Bank. The purpose of this paper is to compare tobacco use among Palestine refugee students and students in the general population of the five fields of operation.

Methods: Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in UNRWA schools in each of the five fields of operation in 2008. For comparison, previous data are included from GYTS conducted in Gaza Strip, Lebanon, and the West Bank (2005) and in Jordan and Syria (2007). Data are presented for three groups of students: refugees attending schools within and outside the camps and non-refugee students in the general population.

Results: In each of the five fields of operation, there was no difference in current cigarette smoking, current use of shisha, or susceptibility to initiate smoking among the three groups of students. Cigarette smoking and susceptibility was lowest in the Gaza Strip and highest in the West Bank; shisha use was lowest in the Gaza Strip but over 30% in Lebanon, Syria, and the West Bank. Exposure to secondhand smoke in public places was greater than 60% in almost all sites. Exposure to indirect advertising was almost 10%.

Conclusions: The similarity in tobacco use among the three groups of students suggests that a coordinated plan between the UNRWA and the governmental authority could be most beneficial in reducing the burden of tobacco-related morbidity and mortality.
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http://dx.doi.org/10.1016/j.ypmed.2009.06.001DOI Listing
February 2010