Publications by authors named "Khalid A Altirkawi"

6 Publications

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Women's health in Northwestern Syria: Findings from Healthy-Syria 2017 study.

Avicenna J Med 2019 Jul-Sep;9(3):94-106

Department of Paediatrics, King Saud University, Riyadh, Saudi Arabia.

Objectives: Since the uprising in 2011, there have been limited health-care data from inside Syria regarding women's health. This study aimed to provide an updated account of women's health, including pregnancy, perinatal care, childbirth, and other conditions to identify obstacles and challenges to health-care delivery in Northwestern Syria.

Methods: This is a prospective data registry study, using a medical electronic records system that builds on the () codes. We collected data from one medical center in Northwestern Syria during 2017. We conducted a survey to understand patients' knowledge of and barriers limiting antenatal care (ANC).

Results: We studied 7213 patients' health status and surveyed 134 regarding ANC. Prenatal care, delivery, and miscarriage treatment represented the most common (70%) reasons for women's health-care visits, followed by menstrual disorders (17%). From 2057 delivery records, 70% delivered vaginally and 30% required cesarean delivery. Our findings showed that 1169 (24%) of the pregnant women (4936) in 2017 were adolescents, of them 22 (0.44%) were 14 years old. Regarding ANC visits, 85% of respondents did not have a single ANC visit in the first trimester, 82% had no visits in the second trimester, and 44% had no visits in the third trimester. Thirty-one percent had no ANC visit throughout the entire pregnancy. Only 13% had postnatal care (PNC) visits. Women who live in the refugee camp are 2.7 times less likely to meet the World Health Organization (WHO) criteria for focused ANC (FANC = 4 visits) compared to those who reside in town ( < 0.001), with only 14% having met the FANC. The major barrier to ANC is related to transportation (34%), followed by factors related to the study center (29%) and knowledge and education (19%). We estimated the number of obstetrics-gynecology doctors per 1000 populations to be 0.02.

Conclusions: We found a huge deficiency in ANC and PNC visits, a high adolescent birth rate, and a higher cesarean-to-vaginal delivery ratio than what is recommended by the WHO. We also found a severe shortage in the number of obstetrician-gynecologists serving this population.
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http://dx.doi.org/10.4103/ajm.AJM_190_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647916PMC
August 2019

Child and adolescent health in northwestern Syria: findings from Healthy-Syria 2017 study.

Avicenna J Med 2019 Apr-Jun;9(2):61-74

Department of Pediatrics, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia.

Objectives: Since the uprising in 2011, there has been limited health-care data from inside Syria in the academic literature. This study aims to provide an updated account of pediatric health needs in the northwestern part of Syria; this should help inform the management and delivery of health-care services in this population.

Methods: This is a prospective study, using a data registry, of all pediatric patients seen in a single center in northwestern Syria, between February and December 2017. We used international classification of diseases (ICD-10) codes to define cases, and tested several covariates, including age, sex, season of the year, and conditions of living for possible correlations with major illness categories.

Results: We included 11,819 patients, of whom 5,288 (45%) were male and 6,531 (55%) were female. Collectively, these patients had 23,427 encounters. Respiratory diseases were the most encountered illnesses among all age groups (6320 [27%]), except late teen females, among whom gynecological/obstetric complaints dominated. Infectious diseases caused the greatest disease burden across all age groups, with upper respiratory tract infections (URTIs), infectious diarrhea, and otitis media representing almost half (47%) of all cases in this category. Nutritional deficiencies were diagnosed in 978 patients (8%), mostly in infants and toddlers (92%). We identified 1192 (17%) cases of acute diarrhea among all age groups, making it the second most common condition after URTIs. As compared to town residents, patients living in camps for internally displaced people accounted for more cases of infectious diarrhea (58%), chronic anemia (60%), and malnutrition (66%), especially severe acute malnutrition (76% of malnutrition cases). Vaccine-preventable illnesses represented a sizable category; we reported 69 cases of hepatitis A, 2 of poliomyelitis, 9 of pertussis, 37 of varicella, 11 of mumps, 8 of rubella, and 1 case of measles.

Conclusion: We have identified urgent health-care issues in this population, including extreme malnutrition, high rates of infectious diseases, and high rates of teenage pregnancy. Also, we observed a relapse of some vaccine-preventable illnesses, such as mumps and rubella, which are likely associated with the decline in vaccination rates.
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http://dx.doi.org/10.4103/ajm.AJM_184_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530271PMC
May 2019

Burden of musculoskeletal disorders in the Eastern Mediterranean Region, 1990-2013: findings from the Global Burden of Disease Study 2013.

Authors:
Maziar Moradi-Lakeh Mohammad H Forouzanfar Stein Emil Vollset Charbel El Bcheraoui Farah Daoud Ashkan Afshin Raghid Charara Ibrahim Khalil Hideki Higashi Mohamed Magdy Abd El Razek Aliasghar Ahmad Kiadaliri Khurshid Alam Nadia Akseer Nawal Al-Hamad Raghib Ali Mohammad AbdulAziz AlMazroa Mahmoud A Alomari Abdullah A Al-Rabeeah Ubai Alsharif Khalid A Altirkawi Suleman Atique Alaa Badawi Lope H Barrero Mohammed Basulaiman Shahrzad Bazargan-Hejazi Neeraj Bedi Isabela M Bensenor Rachelle Buchbinder Hadi Danawi Samath D Dharmaratne Faiez Zannad Maryam S Farvid Seyed-Mohammad Fereshtehnejad Farshad Farzadfar Florian Fischer Rahul Gupta Randah Ribhi Hamadeh Samer Hamidi Masako Horino Damian G Hoy Mohamed Hsairi Abdullatif Husseini Mehdi Javanbakht Jost B Jonas Amir Kasaeian Ejaz Ahmad Khan Jagdish Khubchandani Ann Kristin Knudsen Jacek A Kopec Raimundas Lunevicius Hassan Magdy Abd El Razek Azeem Majeed Reza Malekzadeh Kedar Mate Alem Mehari Michele Meltzer Ziad A Memish Mojde Mirarefin Shafiu Mohammed Aliya Naheed Carla Makhlouf Obermeyer In-Hwan Oh Eun-Kee Park Emmanuel Kwame Peprah Farshad Pourmalek Mostafa Qorbani Anwar Rafay Vafa Rahimi-Movaghar Rahman Shiri Sajjad Ur Rahman Rajesh Kumar Rai Saleem M Rana Sadaf G Sepanlou Masood Ali Shaikh Ivy Shiue Abla Mehio Sibai Diego Augusto Santos Silva Jasvinder A Singh Jens Christoffer Skogen Abdullah Sulieman Terkawi Kingsley N Ukwaja Ronny Westerman Naohiro Yonemoto Seok-Jun Yoon Mustafa Z Younis Zoubida Zaidi Maysaa El Sayed Zaki Stephen S Lim Haidong Wang Theo Vos Mohsen Naghavi Alan D Lopez Christopher J L Murray Ali H Mokdad

Ann Rheum Dis 2017 Aug 16;76(8):1365-1373. Epub 2017 Feb 16.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA.

Objectives: We used findings from the Global Burden of Disease Study 2013 to report the burden of musculoskeletal disorders in the Eastern Mediterranean Region (EMR).

Methods: The burden of musculoskeletal disorders was calculated for the EMR's 22 countries between 1990 and 2013. A systematic analysis was performed on mortality and morbidity data to estimate prevalence, death, years of live lost, years lived with disability and disability-adjusted life years (DALYs).

Results: For musculoskeletal disorders, the crude DALYs rate per 100 000 increased from 1297.1 (95% uncertainty interval (UI) 924.3-1703.4) in 1990 to 1606.0 (95% UI 1141.2-2130.4) in 2013. During 1990-2013, the total DALYs of musculoskeletal disorders increased by 105.2% in the EMR compared with a 58.0% increase in the rest of the world. The burden of musculoskeletal disorders as a proportion of total DALYs increased from 2.4% (95% UI 1.7-3.0) in 1990 to 4.7% (95% UI 3.6-5.8) in 2013. The range of point prevalence (per 1000) among the EMR countries was 28.2-136.0 for low back pain, 27.3-49.7 for neck pain, 9.7-37.3 for osteoarthritis (OA), 0.6-2.2 for rheumatoid arthritis and 0.1-0.8 for gout. Low back pain and neck pain had the highest burden in EMR countries.

Conclusions: This study shows a high burden of musculoskeletal disorders, with a faster increase in EMR compared with the rest of the world. The reasons for this faster increase need to be explored. Our findings call for incorporating prevention and control programmes that should include improving health data, addressing risk factors, providing evidence-based care and community programmes to increase awareness.
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http://dx.doi.org/10.1136/annrheumdis-2016-210146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5738600PMC
August 2017

Burden of Diarrhea in the Eastern Mediterranean Region, 1990-2013: Findings from the Global Burden of Disease Study 2013.

Authors:
Ibrahim Khalil Danny V Colombara Mohammad Hossein Forouzanfar Christopher Troeger Farah Daoud Maziar Moradi-Lakeh Charbel El Bcheraoui Puja C Rao Ashkan Afshin Raghid Charara Kalkidan Hassen Abate Mohammed Magdy Abd El Razek Foad Abd-Allah Remon Abu-Elyazeed Aliasghar Ahmad Kiadaliri Ali Shafqat Akanda Nadia Akseer Khurshid Alam Deena Alasfoor Raghib Ali Mohammad A AlMazroa Mahmoud A Alomari Rajaa Mohammad Salem Al-Raddadi Ubai Alsharif Shirina Alsowaidi Khalid A Altirkawi Nelson Alvis-Guzman Walid Ammar Carl Abelardo T Antonio Hamid Asayesh Rana Jawad Asghar Suleman Atique Ashish Awasthi Umar Bacha Alaa Badawi Aleksandra Barac Neeraj Bedi Tolesa Bekele Isabela M Bensenor Balem Demtsu Betsu Zulfiqar Bhutta Aref A Bin Abdulhak Zahid A Butt Hadi Danawi Manisha Dubey Aman Yesuf Endries Imad D A Faghmous Talha Farid Maryam S Farvid Farshad Farzadfar Seyed-Mohammad Fereshtehnejad Florian Fischer Joseph Robert Anderson Fitchett Katherine B Gibney Ibrahim Abdelmageem Mohamed Ginawi Melkamu Dedefo Gishu Harish Chander Gugnani Rahul Gupta Gessessew Bugssa Hailu Randah Ribhi Hamadeh Samer Hamidi Hilda L Harb Mohammad T Hedayati Mohamed Hsairi Abdullatif Husseini Nader Jahanmehr Mehdi Javanbakht Tariku Jibat Jost B Jonas Amir Kasaeian Yousef Saleh Khader Abdur Rahman Khan Ejaz Ahmad Khan Gulfaraz Khan Tawfik Ahmed Muthafer Khoja Yohannes Kinfu Niranjan Kissoon Ai Koyanagi Aparna Lal Asma Abdul Abdul Latif Raimundas Lunevicius Hassan Magdy Abd El Razek Azeem Majeed Reza Malekzadeh Alem Mehari Alemayehu B Mekonnen Yohannes Adama Melaku Ziad A Memish Walter Mendoza Awoke Misganaw Layla Abdalla Ibrahim Mohamed Jean B Nachega Quyen Le Nguyen Muhammad Imran Nisar Emmanuel Kwame Peprah James A Platts-Mills Farshad Pourmalek Mostafa Qorbani Anwar Rafay Vafa Rahimi-Movaghar Sajjad Ur Rahman Rajesh Kumar Rai Saleem M Rana Chhabi L Ranabhat Sowmya R Rao Amany H Refaat Mark Riddle Gholamreza Roshandel George Mugambage Ruhago Muhammad Muhammad Saleh Juan R Sanabria Monika Sawhney Sadaf G Sepanlou Tesfaye Setegn Karen Sliwa Chandrashekhar T Sreeramareddy Bryan L Sykes Mohammad Tavakkoli Bemnet Amare Tedla Abdullah S Terkawi Kingsley Ukwaja Olalekan A Uthman Ronny Westerman Mamo Wubshet Muluken A Yenesew Naohiro Yonemoto Mustafa Z Younis Zoubida Zaidi Maysaa El Sayed Zaki Abdullah A Al Rabeeah Haidong Wang Mohsen Naghavi Theo Vos Alan D Lopez Christopher J L Murray Ali H Mokdad

Am J Trop Med Hyg 2016 Dec 10;95(6):1319-1329. Epub 2016 Oct 10.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, Washington.

Diarrheal diseases (DD) are leading causes of disease burden, death, and disability, especially in children in low-income settings. DD can also impact a child's potential livelihood through stunted physical growth, cognitive impairment, and other sequelae. As part of the Global Burden of Disease Study, we estimated DD burden, and the burden attributable to specific risk factors and particular etiologies, in the Eastern Mediterranean Region (EMR) between 1990 and 2013. For both sexes and all ages, we calculated disability-adjusted life years (DALYs), which are the sum of years of life lost and years lived with disability. We estimate that over 125,000 deaths (3.6% of total deaths) were due to DD in the EMR in 2013, with a greater burden of DD in low- and middle-income countries. Diarrhea deaths per 100,000 children under 5 years of age ranged from one (95% uncertainty interval [UI] = 0-1) in Bahrain and Oman to 471 (95% UI = 245-763) in Somalia. The pattern for diarrhea DALYs among those under 5 years of age closely followed that for diarrheal deaths. DALYs per 100,000 ranged from 739 (95% UI = 520-989) in Syria to 40,869 (95% UI = 21,540-65,823) in Somalia. Our results highlighted a highly inequitable burden of DD in EMR, mainly driven by the lack of access to proper resources such as water and sanitation. Our findings will guide preventive and treatment interventions which are based on evidence and which follow the ultimate goal of reducing the DD burden.
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http://dx.doi.org/10.4269/ajtmh.16-0339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5154365PMC
December 2016

Health in times of uncertainty in the eastern Mediterranean region, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013.

Authors:
Ali H Mokdad Mohammad Hossein Forouzanfar Farah Daoud Charbel El Bcheraoui Maziar Moradi-Lakeh Ibrahim Khalil Ashkan Afshin Marwa Tuffaha Raghid Charara Ryan M Barber Joseph Wagner Kelly Cercy Hannah Kravitz Matthew M Coates Margaret Robinson Kara Estep Caitlyn Steiner Sara Jaber Ali A Mokdad Kevin F O'Rourke Adrienne Chew Pauline Kim Mohamed Magdy Abd El Razek Safa Abdalla Foad Abd-Allah Jerry P Abraham Laith J Abu-Raddad Niveen M E Abu-Rmeileh Abdulwahab A Al-Nehmi Ali S Akanda Hanan Al Ahmadi Mazin J Al Khabouri Faris H Al Lami Zulfa A Al Rayess Deena Alasfoor Fadia S AlBuhairan Saleh F Aldhahri Suliman Alghnam Samia Alhabib Nawal Al-Hamad Raghib Ali Syed Danish Ali Mohammad Alkhateeb Mohammad A AlMazroa Mahmoud A Alomari Rajaa Al-Raddadi Ubai Alsharif Nihaya Al-Sheyab Shirina Alsowaidi Mohamed Al-Thani Khalid A Altirkawi Azmeraw T Amare Heresh Amini Walid Ammar Palwasha Anwari Hamid Asayesh Rana Asghar Ali M Assabri Reza Assadi Umar Bacha Alaa Badawi Talal Bakfalouni Mohammed O Basulaiman Shahrzad Bazargan-Hejazi Neeraj Bedi Amit R Bhakta Zulfiqar A Bhutta Aref A Bin Abdulhak Soufiane Boufous Rupert R A Bourne Hadi Danawi Jai Das Amare Deribew Eric L Ding Adnan M Durrani Yousef Elshrek Mohamed E Ibrahim Babak Eshrati Alireza Esteghamati Imad A D Faghmous Farshad Farzadfar Andrea B Feigl Seyed-Mohammad Fereshtehnejad Irina Filip Florian Fischer Fortuné G Gankpé Ibrahim Ginawi Melkamu Dedefo Gishu Rahul Gupta Rami M Habash Nima Hafezi-Nejad Randah R Hamadeh Hayet Hamdouni Samer Hamidi Hilda L Harb Mohammad Sadegh Hassanvand Mohammad T Hedayati Pouria Heydarpour Mohamed Hsairi Abdullatif Husseini Nader Jahanmehr Vivekanand Jha Jost B Jonas Nadim E Karam Amir Kasaeian Nega Assefa Kassa Anil Kaul Yousef Khader Shams Eldin A Khalifa Ejaz A Khan Gulfaraz Khan Tawfik Khoja Ardeshir Khosravi Yohannes Kinfu Barthelemy Kuate Defo Arjun Lakshmana Balaji Raimundas Lunevicius Carla Makhlouf Obermeyer Reza Malekzadeh Morteza Mansourian Wagner Marcenes Habibolah Masoudi Farid Alem Mehari Abla Mehio-Sibai Ziad A Memish George A Mensah Karzan A Mohammad Ziad Nahas Jamal T Nasher Haseeb Nawaz Chakib Nejjari Muhammad Imran Nisar Saad B Omer Mahboubeh Parsaeian Emmanuel K Peprah Aslam Pervaiz Farshad Pourmalek Dima M Qato Mostafa Qorbani Amir Radfar Anwar Rafay Kazem Rahimi Vafa Rahimi-Movaghar Sajjad Ur Rahman Rajesh K Rai Saleem M Rana Sowmya R Rao Amany H Refaat Serge Resnikoff Gholamreza Roshandel Georges Saade Mohammad Y Saeedi Mohammad Ali Sahraian Shadi Saleh Lidia Sanchez-Riera Maheswar Satpathy Sadaf G Sepanlou Tesfaye Setegn Amira Shaheen Saeid Shahraz Sara Sheikhbahaei Kawkab Shishani Karen Sliwa Mohammad Tavakkoli Abdullah S Terkawi Olalekan A Uthman Ronny Westerman Mustafa Z Younis Maysaa El Sayed Zaki Faiez Zannad Gregory A Roth Haidong Wang Mohsen Naghavi Theo Vos Abdullah A Al Rabeeah Alan D Lopez Christopher J L Murray

Lancet Glob Health 2016 10 25;4(10):e704-13. Epub 2016 Aug 25.

Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA.

Background: The eastern Mediterranean region is comprised of 22 countries: Afghanistan, Bahrain, Djibouti, Egypt, Iran, Iraq, Jordan, Kuwait, Lebanon, Libya, Morocco, Oman, Pakistan, Palestine, Qatar, Saudi Arabia, Somalia, Sudan, Syria, Tunisia, the United Arab Emirates, and Yemen. Since our Global Burden of Disease Study 2010 (GBD 2010), the region has faced unrest as a result of revolutions, wars, and the so-called Arab uprisings. The objective of this study was to present the burden of diseases, injuries, and risk factors in the eastern Mediterranean region as of 2013.

Methods: GBD 2013 includes an annual assessment covering 188 countries from 1990 to 2013. The study covers 306 diseases and injuries, 1233 sequelae, and 79 risk factors. Our GBD 2013 analyses included the addition of new data through updated systematic reviews and through the contribution of unpublished data sources from collaborators, an updated version of modelling software, and several improvements in our methods. In this systematic analysis, we use data from GBD 2013 to analyse the burden of disease and injuries in the eastern Mediterranean region specifically.

Findings: The leading cause of death in the region in 2013 was ischaemic heart disease (90·3 deaths per 100 000 people), which increased by 17·2% since 1990. However, diarrhoeal diseases were the leading cause of death in Somalia (186·7 deaths per 100 000 people) in 2013, which decreased by 26·9% since 1990. The leading cause of disability-adjusted life-years (DALYs) was ischaemic heart disease for males and lower respiratory infection for females. High blood pressure was the leading risk factor for DALYs in 2013, with an increase of 83·3% since 1990. Risk factors for DALYs varied by country. In low-income countries, childhood wasting was the leading cause of DALYs in Afghanistan, Somalia, and Yemen, whereas unsafe sex was the leading cause in Djibouti. Non-communicable risk factors were the leading cause of DALYs in high-income and middle-income countries in the region. DALY risk factors varied by age, with child and maternal malnutrition affecting the younger age groups (aged 28 days to 4 years), whereas high bodyweight and systolic blood pressure affected older people (aged 60-80 years). The proportion of DALYs attributed to high body-mass index increased from 3·7% to 7·5% between 1990 and 2013. Burden of mental health problems and drug use increased. Most increases in DALYs, especially from non-communicable diseases, were due to population growth. The crises in Egypt, Yemen, Libya, and Syria have resulted in a reduction in life expectancy; life expectancy in Syria would have been 5 years higher than that recorded for females and 6 years higher for males had the crisis not occurred.

Interpretation: Our study shows that the eastern Mediterranean region is going through a crucial health phase. The Arab uprisings and the wars that followed, coupled with ageing and population growth, will have a major impact on the region's health and resources. The region has historically seen improvements in life expectancy and other health indicators, even under stress. However, the current situation will cause deteriorating health conditions for many countries and for many years and will have an impact on the region and the rest of the world. Based on our findings, we call for increased investment in health in the region in addition to reducing the conflicts.

Funding: Bill & Melinda Gates Foundation.
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http://dx.doi.org/10.1016/S2214-109X(16)30168-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660972PMC
October 2016

Trisomy 18 syndrome: Towards a balanced approach.

Sudan J Paediatr 2014 ;14(2):76-84

Department of Pediatrics, College of Medicine and King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.

Trisomy 18 is a relatively common autosomal trisomy syndrome. It is due to either full or partial presence of an extra copy of chromosome 18. Its prevalence correlates positively with advanced maternal age. Affected infants usually exhibit a variable pattern of anomalies including growth restriction, marked psychomotor and cognitive disability and an array of physical findings including characteristic craniofacial features, clenched fists with overriding fingers, small fingernails, underdeveloped thumbs, short sternum and heart and kidney anomalies. The majority of these infants die within the first year of life; only 5% to 10% of them survive longer. Their death is primarily due to cardio-respiratory failure. In this case report of trisomy 18 we tried to highlight the importance of antenatal diagnosis and to emphasize the need for proper counseling at different points of time starting from the moment the condition is suspected until the point when diagnosis is confirmed and thereafter.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4949802PMC
August 2016