Publications by authors named "Yousef Khader"

385 Publications

Mental health impacts of COVID-19 on healthcare workers in the Eastern Mediterranean Region: a multi-country study.

J Public Health (Oxf) 2021 Oct 11. Epub 2021 Oct 11.

Al-Rusafa Health Directorate, Public Health Department, Ministry of Health, Baghdad, Iraq.

Background: Healthcare workers (HCWs) fighting against the COVID-19 pandemic are under incredible pressure, which puts them at risk of developing mental health problems. This study aimed to determine the prevalence of depression, anxiety, and stress among HCWs responding to COVID-19 and its associated factors.

Methods: A multi-country cross-sectional study was conducted during July-August 2020 among HCWs responding to COVID-19 in nine Eastern Mediterranean Region (EMR) countries. Data were collected using an online questionnaire administered using KoBo Toolbox. Mental problems were assessed using the Depression, Anxiety, and Stress Scale (DASS-21).

Results: A total of 1448 HCWs from nine EMR countries participated in this study. About 51.2% were male and 52.7% aged ≤ 30 years. Of all HCWs, 57.5% had depression, 42.0% had stress, and 59.1% had anxiety. Considering the severity, 19.2%, 16.1%, 26.6% of patients had severe to extremely severe depression, stress, and anxiety, respectively. Depression, stress, anxiety, and distress scores were significantly associated with participants' residency, having children, preexisting psychiatric illness, and being isolated for COVID-19. Furthermore, females, those working in a teaching hospital, and specialists had significantly higher depression and stress scores. Married status, current smoking, diabetes mellitus, having a friend who died with COVID-19, and high COVID-19 worry scores were significantly associated with higher distress scores.

Conclusions: Mental problems were prevalent among HCWs responding to COVID-19 in EMR. Therefore, special interventions to promote mental well-being among HCWs responding to COVID-19 need to be immediately implemented.
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http://dx.doi.org/10.1093/pubmed/fdab321DOI Listing
October 2021

Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis.

JMIR Public Health Surveill 2021 10 7;7(10):e32559. Epub 2021 Oct 7.

Global Health Development, Eastern Mediterranean Public Health Network, Amman, Jordan.

Background: All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects.

Objective: This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020.

Methods: Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019.

Results: Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older.

Conclusions: The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics.
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http://dx.doi.org/10.2196/32559DOI Listing
October 2021

Mental and physical health-related quality of life and their associated factors among students of a comprehensive allied health institution.

Work 2021 ;70(1):63-73

Department of Rehabilitation Sciences-Speech Pathology, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Jordan.

Background: Healthcare students are subjected to critical levels of mental and physical stress that might hinder their quality of life.

Objectives: This study comprehensively investigated physical and mental Health-related Quality of Life (HR-QoL) and their associated factors among Allied Health (AH) students of nine academic majors.

Methods: Participants completed anonymous questionnaire included demographics and life style, HR-QoL measured by the 12-item Short-Form Health Survey (SF-12), Depression Anxiety Stress Scale (DASS21), and Nordic Musculoskeletal Questionnaire. SF-12 Physical (PCS) and Mental (MCS) Components Summary scores were compared between gender and between academic majors. Multiple linear regressions were conducted to examine factor associated with PCS and MCS scores.

Results: A total of 838 students (77.4% females) participated in the study. The overall PCS was 45.64±7.93 and statistically different between majors (P < 0.001). The Overall MCS score was 39.45±10.86 and statistically greater in males (P < 0.001). PCS scores were significantly associated with anxiety score, GPA, diet self-evaluation, and upper back and hip musculoskeletal pain. MCS scores were significantly associated with weekly clinical training hours, stress score, depression score, gender, university year, GPA, sleep self-evaluation, diet self-evaluation, and neck musculoskeletal pain.

Conclusions: Low levels of mental and physical HR-QoL were observed among AH students and were associated with academic-related, health-related, and lifestyle-related factors. Longitudinal studies are needed to assess effective approaches to improve HR-QoL among AH students.
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http://dx.doi.org/10.3233/WOR-205226DOI Listing
October 2021

Factors Associated with Suboptimal Adherence to Hypertensive Medications Among Syrian Refugees - Cross-Sectional Study at the Zaatari Camp, Jordan.

Patient Prefer Adherence 2021 21;15:2125-2135. Epub 2021 Sep 21.

Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.

Objective: This study aimed to assess the level of medication adherence and associated factors among Syrian refugees with hypertension in Jordan.

Methods: This cross-sectional study included 180 randomly selected Syrian refugees diagnosed with hypertension residing in Zaatari camp, Jordan. The Adherence to Refills and Medications Scale (ARMS) was used to assess adherence to antihypertensive medications. Additional data were collected on sociodemographics, therapy-related factors, patients' behaviors and knowledge of hypertension disease and therapy, and health system-related factors. Multivariate linear regression was used to assess the association between adherence scores and other variables.

Results: The mean (SD) of ARMS scores was 15.7 (2.9). Based on ARMS scores, 22.8% of patients were adherents and 77.2% were non-adherents. Multivariate analysis showed that newly initiated therapy (≤2 years) and illiteracy were both strong predictors of lower adherence with p < 0.001 and p = 0.012, respectively. Other variables that were significantly associated with lower adherence included discontinuation of antihypertensive medications due to side effects (p = 0.032), reporting irregular availability of free antihypertensive medications dispensed by non-governmental organizations (NGOs) (p = 0.024), and dissatisfaction with health services (p = 0.022).

Conclusion: Suboptimal adherence to antihypertensive medications remains a substantial unmet need among Syrian refugees with hypertension. As illiteracy appears to have a negative impact on adherence levels, educational interventions that promote medication adherence and favorable health behaviors through auditory and visual aids are needed to better reach and engage people with limited literacy skills. Strengthening the pharmaceutical supply chain at various levels is strongly recommended to respond quickly to changes in demand and prevent an indirect negative impact on adherence levels.
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http://dx.doi.org/10.2147/PPA.S327903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8464360PMC
September 2021

Mobility indicators and COVID-19 growth ratio in Iraq: a correlation study.

J Public Health (Oxf) 2021 Sep 27. Epub 2021 Sep 27.

Medical Education and Biostatistics, Department of Community, Medicine, Public Health and Family Medicine/Faculty of Medicine, Jordan University of Science & Technology, Ar-Ramtha, Jordan.

Background: There is no prior study of the effect of mobility-limiting measures on the occurrence of COVID-19 in Iraq.

Objectives: To determine the relationship between publicly available mobility index data and the growth ratio (GR) of COVID-19.

Method: We used Google COVID-19 Community Mobility Reports to extract Iraq's mobility data and the official Ministry of Health COVID-19 statements. We used the data to calculate the Pearson's correlation coefficient and fit a linear regression model to determine the relationship between percentage change from the baseline in the mobility indices and the GR of COVID-19 in Iraq.

Results: There was a moderate positive correlation between each of the mobility indices except the residential index and COVID-19 GR in Iraq. The general linear model indicated that as each of the mobility indices increases by one unit, the GR of COVID19 increases by 0.002-0.003 except for the residential index. As the residential mobility index increases by one unit, the GR decreases by 0.009. All the findings were statistically significant (P-value < 0.0001).

Conclusion: Mobility-limiting measures may be able to reduce the growth rate of COVID-19 moderately. Accordingly, mobility-limiting measures should be combined with other public control measures particularly mass mask use.
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http://dx.doi.org/10.1093/pubmed/fdab332DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500103PMC
September 2021

Delayed admissions and efficacy of steroid use in patients with critical and severe COVID-19: an apprehensive approach.

J Public Health (Oxf) 2021 Sep 27. Epub 2021 Sep 27.

National Institute of Health, Islamabad 44000, Pakistan.

Background: Inadvertent delays in access to appropriate therapeutic interventions in high-risk group coronavirus disease 2019 (COVID-19) patients contribute to mortality in patients with severe/critical disease presentation.

Objectives: The aim of this study was to determine the effect of timely admission to the hospital on mortality of patients with severe/critical COVID-19. Another secondary aspect of this study was to observe the efficacy of time-dependent use of corticosteroids on mortality of critical/severe COVID-19 patients.

Methods: Clinical data of 659 patients with severe/critical COVID-19, admitted to four major tertiary care hospitals from the Islamabad-Rawalpindi region of Pakistan was retrospectively collected from a period February-August 2020. Multivariate logistic regression analysis was carried out to determine the predictors of mortality in severe/critical COVID-19 patients.

Results: Out of a total of 659 patients, 469 (71.2%) patients died. Age > 60 years, presence of hypertension, heart disease and kidney disease along with late admission (>5 days) were significant predictors of mortality in patients with severe/critical COVID-19.

Conclusions: The study highlights the importance of well-timed provision of appropriate medical interventions control COVID-19-associated mortality.
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http://dx.doi.org/10.1093/pubmed/fdab239DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500079PMC
September 2021

Public health workers' knowledge, attitude and practice regarding COVID-19: the impact of Field Epidemiology Training Program in the Eastern Mediterranean Region.

J Public Health (Oxf) 2021 Sep 27. Epub 2021 Sep 27.

Directorate of Public Health, Ministry of Health, Baghdad, Iraq.

Background: This study aimed to compare knowledge, attitude and practice (KAP) regarding COVID-19 between public health workers (PHWs) attended field epidemiology training program (FETP-trained) and those who did not attend FETP (non-FETP trained).

Methods: Multi-country cross-sectional survey was conducted among PHWs who participated in COVID-19 pandemic in 10 countries at EMR. Online questionnaire that included demographic information, KAP regarding COVID-19 pandemic was distributed among HCWs. Scoring system was used to quantify the answers, bivariate and Multivariate analysis performed to compare FETP-trained with non-FETP trained PHWs.

Results: Overall, 1337 PHWs participated, with 835 (62.4%) < 40 years of age, and 851 (63.6%) males. Of them, 423 (31.6%) had FETP, including that 189 (44.7%) had advanced level, 155 (36.6%) intermediate and 79 (18.7%) basic level training. Compared with non-FETP trained, FETP trained were older, having higher KAP scores. FETP participation was low in infection control, and PH laboratories. KAP mean scores for intermediate level attendees are comparable to advanced level.

Conclusions: FETP-trained are having better KAP than non-FETP PHWs. Expanding the intermediate level, maintain the Rapid Response training and introduce the laboratory component are recommended to maximize the benefit from FETP. Infection control, antimicrobial resistance and coordination are areas where training should include.
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http://dx.doi.org/10.1093/pubmed/fdab240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8500047PMC
September 2021

Perceptions of primary healthcare physicians in Jordan of their role in the COVID-19 pandemic: A cross-sectional study.

Int J Clin Pract 2021 Sep 5:e14797. Epub 2021 Sep 5.

Department of Anatomy, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE.

Background: Following the remarkable spread of coronavirus disease 2019 (COVID-19), worldwide, it quickly became apparent that many public health systems worldwide were not prepared to manage such a pandemic. We aimed to assess the perceptions of primary care physicians (PCPs) in Jordan towards their role during COVID-19.

Methods: A cross-sectional study using a self-administered questionnaire was performed. The study participants included PCPs from the Ministry of Health, academic institutions, and the private sector in Jordan.

Results: A total of 221 PCPs participated in the study. Most participants reported not having received any training on infection control (59.7%) or COVID-19 (81%). More than half PCPs (53.4%) felt positive about the way patients received and/or complied with their instructions. More than half PCPs (55.7%) educated their patients on protective measures against COVID-19 infection and considered this as part of their role and responsibility. Over 80% of the participants would apply social distancing, hand sanitation, facial masks, and patient education, but only half (51.1%) reported planning to order COVID-19 test kits.

Conclusions: PCPs had a positive attitude towards controlling COVID-19 infection and showed a willingness to educate patients on how to protect themselves. However, PCPs should be provided special training on COVID-19.
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http://dx.doi.org/10.1111/ijcp.14797DOI Listing
September 2021

Midwives and women's perspectives on family planning in Jordan: human rights, gender equity, decision-making and power dynamics.

Heliyon 2021 Aug 14;7(8):e07810. Epub 2021 Aug 14.

Global Health Development (GHD), Eastern Mediterranean Public Health Network (EMPHNET), 4 Abu Al Ataheya St. apt 5, Sport City, Amman, Jordan.

Objectives: This study explored midwives' and Jordanian and Syrian women's perceptions towards family planning (FP) counseling and the process of FP decision making mechanism to provide evidence for expanding the access and improving the quality and utilization of FP services in Jordan.

Methods: Explorative qualitative study that purposively recruited 24 women for 4 focus group discussions (FDGs) and 17 midwives for in-depth interviews from two governorates in Jordan. The transcribed narratives were subjected to deductive content analysis.

Results: Two themes were extracted from the narratives: The power dynamics in FP decision-making process and the barriers and motivators of FP decision making. The first theme was built on the perceived influence of gender equity and social pressures and gender-based violence on FP decision making. The second theme was constructed on the respondents' beliefs about reproductive health including FP as a human right and their perceptions of the obstacles and facilitators of FP Decision Making. Overall, husbands have an influential role, and perhaps the final say, in deciding whether to use FP services or not as well as the type of method to use. However, wives must initiate the family planning conversation with her husband and do so in a way that will be pleasing to the husband. Whether the husband agrees with the wife's idea to use family planning and gives her permission and funds for use, depends largely on her presentation of the idea, her husband's education level, and his personality.

Conclusions: This study revealed several relevant issues that play a role in Jordanian and Syrian women's decision to seek FP services. While cultural and social norms related to family planning and decision making continue to exert pressure on women, women have a deep interest in continuing to broaden their knowledge about family planning services. Engaging men and incorporating digital technology in family planning counselling has the potential to improve shared FP decision-making process among Jordanian couples and overcome some of the barriers.
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http://dx.doi.org/10.1016/j.heliyon.2021.e07810DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8379452PMC
August 2021

Prevalence of fatty liver disease and its associated factors among Jordanian patients with type 2 diabetes mellitus: A cross-sectional study.

Ann Med Surg (Lond) 2021 Aug 6;68:102677. Epub 2021 Aug 6.

The National Center for Diabetes, Endocrinology and Genetics, The University of Jordan, Amman, Jordan.

Background: Diabetes mellitus (DM) is a well-known risk factor for Non-alcoholic fatty liver disease (NAFLD). Patients with type 2 DM (T2DM) who have NAFLD are at a higher risk of developing advanced stages of liver disease, including fibrosis, cirrhosis, and hepatocellular carcinoma compared to non-diabetic patients. This study aimed to estimate the prevalence of NAFLD among patients with T2DM, using hepatic ultrasonographic changes combined with derangement of hepatic transaminases level.

Materials And Methods: This cross-sectional study was conducted at the National Center for Diabetes, Endocrinology and Genetics (NCDEG) in Amman, Jordan. A total of 408 patients with T2DM and 90 non-diabetic subjects were included in this study. Body mass index (BMI), waist circumference, glycosylated hemoglobin (HbA1c), lipid parameters and abdominal ultrasonography were measured.

Results: Using the ultrasonographic criteria for the diagnosis of NAFLD, the prevalence of NAFLD was 80.4 % and 53.3 % among diabetic and non-diabetic participants, respectively. Among the diabetic participants, 25 %, 40.4 %, and 15 % had mild, moderate, and severe grades of steatosis, respectively. On the other hand, 24.4 %, 21.1 %, and 7.8 % of the non-diabetic participants had mild, moderate, and severe grades of steatosis, respectively. Diabetic patients between 25 and 45 years of age, patients with overweight or obesity, patients with increased waist circumference were significantly at higher risk of having NAFLD. High TG, lower HDL, elevated AST and ALT, and using sulfonylureas and metformin versus using metformin only were significantly associated with increased odds of having NAFLD.

Conclusions: NAFLD is highly prevalent among patients with T2DM. Overweight or obesity, abnormal cholesterol levels and treatment with sulfonylureas were significantly associated with NAFLD.
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http://dx.doi.org/10.1016/j.amsu.2021.102677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8358152PMC
August 2021

Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned.

JMIR Public Health Surveill 2021 09 17;7(9):e31930. Epub 2021 Sep 17.

Department of Public Health, Jordan University of Science and technology, Irbid, Jordan.

This report aimed to provide an overview of the epidemiological situation of COVID-19 in Morocco and to review the actions carried out as part of the national response to this pandemic. The methodology adopted was based on literature review, interviews with officials and actors in the field, and remote discussion workshops with a multidisciplinary and multisectoral working group. Morocco took advantage of the capacities already strengthened within the framework of the application of the provisions of the International Health Regulations (IHR) of 2005. A SWOT analysis made it possible to note that an unprecedented political commitment enabled all the necessary means to face the pandemic and carry out all the response activities, including a campaign of relentless communication. Nevertheless, and despite the efforts made, the shortage of human resources, especially those qualified in intensive care and resuscitation, has been the main drawback to be addressed. The main lesson learned is a need to further strengthen national capacities to prepare for and respond to possible public health emergencies and to embark on a process overhaul of the health system, including research into innovative tools to ensure the continuity of the various disease prevention and control activities. In addition, response to a health crisis is not only the responsibility of the health sector but also intersectoral collaboration is needed to guarantee an optimal coordinated fight. Community-oriented approaches in public health have to be strengthened through more participation and involvement of nongovernmental organizations (NGOs) and civil society in operational and strategic planning.
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http://dx.doi.org/10.2196/31930DOI Listing
September 2021

Evaluation of Advanced Field Epidemiology Training Programs in the Eastern Mediterranean Region: A Multi-Country Study.

Front Public Health 2021 22;9:684174. Epub 2021 Jul 22.

Center of Excellence for Applied Epidemiology, Global Health Development/Eastern Mediterranean Public Health Network, Amman, Jordan.

Field Epidemiology Training Programs (FETPs) are competency-based training programs aiming to strengthen the epidemiologic capacity of the public health workforce. This study aimed to evaluate the impact of the advanced FETPs in the Eastern Mediterranean region (EMR) and ascertain whether the expected objectives of the programs are met. A descriptive study was conducted based on Kirkpatrick's model for evaluating training programs. Data were collected from FETP graduates and FETP technical advisers on the practices of FETP graduates, their engagement in key areas of field epidemiology, and their perceived skills and capacity to perform such activities. A total of 166 FETP graduates responded to the online survey. Almost two-thirds of FETP graduates reported that they are often engaged in managing public health surveillance systems ( = 119, 71.7%), analyzing the surveillance data ( = 116, 69.9%), training public health professionals ( = 113, 68.1%), investigations on and response to outbreaks ( = 109, 65.7%), and managing staff and resources ( = 106, 63.9%). However, only 28.3% reported that they are often engaged in writing scientific research articles. More than two-thirds of graduates reported that the FETP helped them to perform most of the field epidemiology activities and rate their skills as good. In conclusion, the FETP graduates in the EMR were well engaged in many field epidemiology activities including managing public health surveillance systems, surveillance data analysis, training public health professionals, and investigations on and response to outbreaks. Therefore, the FETPs should continue supporting the graduates to work toward strengthening surveillance systems and investigating outbreaks and to participate in regional and global efforts as part of the Global Health Security.
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http://dx.doi.org/10.3389/fpubh.2021.684174DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339192PMC
August 2021

Prescribers' Knowledge, Attitudes and Behaviors on Antibiotics, Antibiotic Use and Antibiotic Resistance in Jordan.

Antibiotics (Basel) 2021 Jul 15;10(7). Epub 2021 Jul 15.

Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD13DH, UK.

More research is needed on the drivers of irrational antibiotic prescribing among healthcare professionals and to ensure effective prescribing and an adequate understanding of the issue of antibiotic resistance. This study aimed at evaluating prescribers' knowledge, attitudes and behaviors about antibiotic use and antibiotic resistance. A cross-sectional study was conducted utilizing an online questionnaire and included physicians and dentists from all sectors in Jordan. A total of 613 prescribers were included (physicians = 409, dentists = 204). Respondents' knowledge on effective use, unnecessary use or associated side effects of antibiotics was high (>90%), compared with their knowledge on the spread of antibiotic resistance (62.2%). For ease of access to the required guidelines on managing infections, and to materials that advise on prudent antibiotic use and antibiotic resistance, prescribers agreed in 62% and 46.1% of cases, respectively. 28.4% of respondents had prescribed antibiotics when they would have preferred not to do so more than once a day or more than once a week. Among respondents who prescribed antibiotics, 63.4% would never or rarely give out resources on prudent use of antibiotics for infections. The findings are of importance to inform antibiotic stewardships about relevant interventions aimed at changing prescribers' behaviors and improving antibiotic prescribing practices.
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http://dx.doi.org/10.3390/antibiotics10070858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8300611PMC
July 2021

Adapting Diabetes Risk Scores for Jordan.

Int J Gen Med 2021 28;14:4011-4016. Epub 2021 Jul 28.

Department of Medicine and Family Medicine, Faculty of Medicine, Hashemite University, Zarqa, Jordan.

Background: Diabetes risk score can be used as a simple non-invasive screening tool for identifying people with high risk of diabetes. This study aimed to assess the predictive power of various risk-scoring systems to predict pre-diabetes and diabetes in Jordanian adults.

Methods: This cross-sectional study was conducted among people attending 54 primary health care centers distributed throughout the 12 governorates of Jordan. Diabetes risk scores using the American Diabetes Association risk score, Canadian risk score, Finland risk score (FINDRISC), British Risk score, German and Australian risk score were calculated for each patient. Fasting blood sugar (FBS) was measured for all participants.

Results: This study included 392 participants: 231 patients with normal fasting blood sugar (FBG), 101 patients with pre-diabetes and 60 patients with type 2 diabetes. The FINDRISC, British, and Australian risk scores were strongly inter-correlated and weakly correlated with other systems' risk scores. Moreover, they correlated moderately and significantly with FBS. In contrast, other systems risk scores were associated weekly with FBS. Based on receiving operating characteristics (ROC) analysis and multivariate logistic regression, the FINDRISC risk score was superior to other risk scores to predict high FBS and identify pre-diabetes and diabetes.

Conclusion: FINDRISC risk score performed the best compared to other risk scores for predicting pre-diabetes, diabetes, and absence of diabetes. We recommend using the FINDRISC risk score assessment in Jordan.
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http://dx.doi.org/10.2147/IJGM.S321063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8326934PMC
July 2021

Knowledge, attitudes, and impact of COVID-19 pandemic among neurology patients in Jordan: a cross-sectional study.

Egypt J Neurol Psychiatr Neurosurg 2021 29;57(1):104. Epub 2021 Jul 29.

Department of Neurology, Princess Basma Teaching Hospital, Irbid, Jordan.

Background: The impacts of the COVID-19 pandemic on health services offered to patients with non-communicable diseases, including chronic neurological illnesses, are diverse and universal. We used a self-reported questionnaire to investigate these impacts on neurology patients in Jordan and assess their knowledge and attitudes towards the pandemic.

Results: Most respondents had positive attitudes towards the COVID-19 pandemic, with 96% reporting they believed in the seriousness of the pandemic and adhered to prevention measures. Nearly 97% resorted to the internet and media outlets for medical information about the pandemic. About one in five clinic visitors had their appointments delayed due to interruption of health services. A similar portion of patients with MS, epilepsy, and migraine or tension headache reported medication interruptions during the pandemic. One in two patients reported new events or worsening illness since the start of the pandemic, and sleep disturbances were reported by nearly one in three patients who had epilepsy or headache.

Conclusion: The COVID-19 pandemic's impacts on patients with neurological illnesses in Jordan were deep and diverse. Meanwhile, the majority of surveyed neurology patients demonstrated a positive attitude towards the pandemic.
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http://dx.doi.org/10.1186/s41983-021-00354-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8319703PMC
July 2021

Predictive Factors for Failure of Limb Salvage in Blunt Leg Trauma Associated with Vascular Injuries.

J Emerg Trauma Shock 2021 Apr-Jun;14(2):80-85. Epub 2021 Jun 25.

Department of Surgery, Jordan University of Science and Technology, Irbid, Jordan.

Introduction: Blunt leg trauma is common; however, it is rarely associated with significant vascular injury. This study was undertaken to determine the risk factors attributed to failure of limb salvage in acute postoperative period in blunt leg trauma with vascular injuries after revascularization.

Methods: A retrospective analysis was conducted of all patients with blunt leg trauma involving bone and soft tissue associated with vascular injuries. They were studied in terms of demographic data, associated comorbidities, mechanism of trauma, associated extra leg injuries, type and nature of bone fractures, soft-tissue injuries, nerve injuries, time of ischemia, Injury Severity Score (ISS), Mangled Extremity Severity Score (MESS), injured vascular segments, modality of vascular repair, modality of bone fixation, thrombosis at the site of vascular repair, complications, limb salvage failure, and mortality.

Results: Vascular injuries were identified in 45 arterial segments and 9 popliteal veins among 31 patients. The patients were 93% male, with a mean age of 31 years. The MESS ranged from 6 to 11, and the ISS ranged from 9 to 41. The main pathology of the injured vessels was contusion/thrombosis in 28 legs, which were repaired by interposition-reversed long saphenous vein graft. Seven patients developed postoperative thrombosis and underwent thrombectomy/embolectomy. Failure of limb salvage occurred in seven limbs with no mortality.

Conclusions: Severe multi-segmental bone fractures, prolong ischemic time of >10 h, and MESS of ≥9 are significant predictors of limb loss in patients with blunt leg trauma in association with vascular injuries.
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http://dx.doi.org/10.4103/JETS.JETS_37_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8312914PMC
June 2021

Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives.

J Med Internet Res 2021 Jul 28;23(7):e25947. Epub 2021 Jul 28.

Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan.

Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices.

Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services.

Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis.

Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional.

Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices.
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http://dx.doi.org/10.2196/25947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367154PMC
July 2021

Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives.

J Med Internet Res 2021 Jul 28;23(7):e25947. Epub 2021 Jul 28.

Global Health Development | Eastern Mediterranean Public Health Network, Amman, Jordan.

Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices.

Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services.

Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis.

Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women's empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional.

Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman's awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices.
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http://dx.doi.org/10.2196/25947DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367154PMC
July 2021

The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) System: Evaluation Study.

J Med Internet Res 2021 Jul 21;23(7):e29143. Epub 2021 Jul 21.

Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Background: The Jordan Stillbirth and Neonatal Mortality Surveillance (JSANDS) is an electronic surveillance system that automatically transfers the data on births, stillbirths, and neonatal deaths to the concerned authorities in the Ministry of Health. JSANDS was implemented and tested in 5 maternity hospitals during the period spanning May 2019 through December 2020.

Objective: This study aimed to evaluate the usefulness and performance of JSANDS to register births, stillbirths, and neonatal deaths, and determine their causes. Specifically, this study examined the JSANDS attributes of acceptability, simplicity, flexibility, stability, representativeness, sustainability, penetration, data quality, sensitivity, and adoption.

Methods: An evaluation study was conducted after 18 months of the JSANDS implementation using the Updated Guidelines for Evaluating Public Health Surveillance Systems. The evaluation focused on how well the system operated to meet its purpose and objectives. The indicators assessing the system attributes were scored on a Likert scale. Each indicator and overall attribute percentage score was represented as score rank and interpreted as excellent (score ≥80%), good (score ≥60 and <80%), average (score ≥40 and <60%), and poor (score <40%).

Results: A total of 270 health care professionals participated in this study and evaluated the system performance. The system users rated the usefulness of JSANDS as excellent (percentage score=85.6%). The overall acceptability (percentage score=82.3%), flexibility (percentage score=80.2%), stability (percentage score=80.0%), and representativeness (percentage score=86.6%) were also rated excellent. The overall simplicity was scored good (percentage score=75.4%). All participants were trained on JSANDS and used it in the past 12 months. Of the 270 respondents, 219 (86.2%) reported that they intend to continue using the JSANDS system to register neonatal deaths and stillbirths in the future. All variables in JSANDS had complete data with no missing values.

Conclusions: The performance of JSANDS in registering all stillbirths and neonatal deaths as well as their causes was excellent. Almost all attributes and indicators of JSANDS functionality were rated excellent. JSANDS can be scaled up to cover all maternity hospitals in Jordan. The potential for scaling up the system is very high for many reasons, including its usefulness, simplified stillbirth and neonatal death review tools, and ease of the reporting process.
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http://dx.doi.org/10.2196/29143DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8339976PMC
July 2021

Performance of the Severe Acute Respiratory Illness Sentinel Surveillance System in Yemen: Mixed Methods Evaluation Study.

JMIR Public Health Surveill 2021 Jul 9;7(7):e27621. Epub 2021 Jul 9.

Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbidjord, Jordan.

Background: The national severe acute respiratory illness (SARI) surveillance system in Yemen was established in 2010 to monitor SARI occurrence in humans and provide a foundation for detecting SARI outbreaks.

Objective: To ensure that the objectives of national surveillance are being met, this study aimed to examine the level of usefulness and the performance of the SARI surveillance system in Yemen.

Methods: The updated Centers for Disease Control and Prevention guidelines were used for the purposes of our evaluation. Related documents and reports were reviewed. Data were collected from 4 central-level managers and stakeholders and from 10 focal points at 4 sentinel sites by using a semistructured questionnaire. For each attribute, percent scores were calculated and ranked as follows: very poor (≤20%), poor (20%-40%), average (40%-60%), good (60%-80%), and excellent (>80%).

Results: As rated by the evaluators, the SARI surveillance system achieved its objectives. The system's flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as "excellent," and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as "good." The percent score for timeliness was 23% in 2018, which indicated poor timeliness. The overall data quality percent score of the SARI system was 98.5%. Despite its many strengths, the SARI system has some weaknesses. For example, it depends on irregular external financial support.

Conclusions: The SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trends of the disease, and promoting research for informing prevention and control measures. The overall performance of the SARI surveillance system was good. We recommend expanding the system by promoting private health facilities' (eg, private hospitals and private health centers) engagement in SARI surveillance, establishing an electronic database at central and peripheral sites, and providing the National Central Public Health Laboratory with the reagents needed for disease confirmation.
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http://dx.doi.org/10.2196/27621DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8304118PMC
July 2021

The effect of different calcium silicate-based pulp capping materials on tooth discoloration: an in vitro study.

BMC Oral Health 2021 07 2;21(1):330. Epub 2021 Jul 2.

Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Background: Variation in the composition of calcium silicate-based pulp capping materials could influence the discoloration potential of some of these materials, thus affecting the color and aesthetic appearance of the coronal tooth structure. Furthermore, contact with blood if hemostasis is not fully achieved may enhance this discoloration for some materials. Therefore the aim of this study was to evaluate in vitro the color change of coronal tooth structure after placing various calcium silicate-based materials in the pulp chamber in the presence or absence of blood.

Mehtods: Maxillary extracted premolars (n = 144) were sectioned and the crowns were separated from the roots. Pulp chambers were prepared to a standard size and then the tested materials (GMTA Angelus, ProRoot WMTA, Biodentine, TheraCal, and TotalFill) were placed with saline or with blood. Color change was assessed by spectrophotometry; prior to and after material placement at different time intervals of 24 h, 1 week, 1 month, 3 months, and 6 months. Color change (ΔE) values were calculated and statistically analyzed.

Results: In the saline groups, Biodentine caused the least color change, while GMTA and WMTA caused the highest color change which were significantly different from the others (p < 0.001), TotalFill and TheraCal caused moderate changes. Adding blood increased the ΔE overall the tested materials to various degrees. Biodentine was the most affected by the blood, while MTA groups were the least affected, followed by TotalFill and then TheraCal. The increase in ΔE was significant over time up to 3 months, after which the increase was not significant.

Conclusions: Overall, WMTA and GMTA caused the most severe discoloration. In saline, Biodentine caused the least discoloration, but it was the most affected by the presence of blood, although it still caused the least discoloration similar to that observed with TotatFill. TheraCal caused moderate discoloration but more than that caused by Biodentine and TotalFill.
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http://dx.doi.org/10.1186/s12903-021-01677-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254364PMC
July 2021

Own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco in three Eastern Mediterranean countries: a volumetric choice experiment.

Tob Control 2021 Jun 30. Epub 2021 Jun 30.

Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon

Background: Waterpipe tobacco smoking rates in the Eastern Mediterranean region are among the highest worldwide, yet little evidence exists on its economics. Estimates of demand elasticities for tobacco products are largely limited to cigarettes. This study aimed to estimate own-price and cross-price elasticities of demand for cigarettes and waterpipe tobacco products in Lebanon, Jordan and Palestine.

Methods: A volumetric choice experiment was conducted using nationally representative household surveys. The choice experiment elicited respondents' stated purchases of eight cigarette and waterpipe tobacco product varieties by hypothetically varying prices. Data were analysed using zero-inflated Poisson models that yielded demand elasticity estimates of cigarette and waterpipe tobacco consumption.

Results: The study included 1680 participants in Lebanon (50% female), 1925 in Jordan (44.6% female) and 1679 in Palestine (50% female). We found the demand for premium cigarettes to be price elastic (range, -1.0 to -1.2) across all three countries, whereas the demand for discount cigarettes was less elastic than premium cigarettes in Lebanon (-0.6) and Jordan (-0.7) and more elastic in Palestine (-1.2). The demand for premium waterpipe tobacco was highly elastic in Lebanon (-1.9), moderately elastic in Jordan (-0.6) and inelastic in Palestine (0.2). The cross-price elasticity between cigarettes and waterpipe tobacco was near zero, suggesting that the two products are not considered to be close substitutes by consumers.

Conclusions: These results serve as a strong evidence base for developing and implementing fiscal policies for tobacco control in the Eastern Mediterranean region that address cigarettes and waterpipe tobacco products.
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http://dx.doi.org/10.1136/tobaccocontrol-2021-056616DOI Listing
June 2021

Trends in maternal characteristics, and maternal and neonatal outcomes of women with gestational diabetes: A study from Jordan.

Ann Med Surg (Lond) 2021 Jul 11;67:102469. Epub 2021 Jun 11.

Department of Pharmacy Practice, Faculty of Pharmacy, Yarmouk University, Irbid, 21110, Jordan.

Background: Gestational diabetes mellitus (GDM) is a major health issue that poses its risk on pregnancy. It is prevalence has been globally increasing.

Aim: This study aimed to examine trends in demographic and socioeconomic characteristics, maternal BMI, behavioral factors, obstetric interventions, pregnancy complications, and maternal pre-existing medical conditions and maternal and neonatal outcomes in women with GDM in Jordan. We also aimed to equate the occurrence of emergency cesarean delivery with GDM.

Methods: The study is a part of a comprehensive national study of perinatal mortality that was conducted in Jordan. This study included all women who gave birth in the selected hospitals during the study period. Maternal and medical conditions during pregnancy and neonatal outcomes were compared among women who did not develop gestational diabetes mellitus and those who developed gestational diabetes mellitus.

Results: The overall incidence rate of gestational diabetes mellitus (GDM) was 1.2%. Women with gestational diabetes had a higher weight, and BMI, more likely to be overweight, obese, or morbidly obese and less likelihood to be underweight. A significant association was detected between previous spontaneous abortions/miscarriages, previous preterm, previous stillbirths, previous children born with birth weight less than 2500 g, and previous children born alive and died before 28 days, and the incidence of GDM. Women with GDM were at high risk for complications in pregnancy such as hypertension, preeclampsia, premature delivery and labor induction. The offspring of GDM patients were at high risk of complications such as macrosomia, stillbirth, neonatal hypoglycemia, and neonatal jaundice and admittance to the NICU.

Conclusions: The incidence of GDM was linked to several clinical factors. Women with GDM are at high risk for complications of pregnancy and at higher risk of neonatal complications.
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http://dx.doi.org/10.1016/j.amsu.2021.102469DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8213882PMC
July 2021

Psychometric Properties of the Arabic Version of the Fear of COVID-19 Scale (FCV-19S) Among Jordanian Adults.

Int J Ment Health Addict 2021 Jun 18:1-14. Epub 2021 Jun 18.

Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

There is an urgent need to assess the impacts of the Coronavirus-19 disease (COVID-19) outbreak on mental health among the general population such as the Fear of COVID-19. The current study aimed to provide further validation of the Arabic version of the Fear of COVID-19 Scale (FCV-19S) for use among Jordanian adults. A cross-sectional study was conducted using an anonymous online survey between 1 and 12 May 2020. The forward-backward translation method was adopted to translate the FCV-19S into Arabic. The study sample included 725 Jordanian adults. The internal consistency (Cronbach's α) was 0.91 indicating excellent internal consistency. As for convergent validity, a significant positive correlation was found between the Fear of COVID-19 Scale (FCV-19S) and the three subscales of the Depression, Anxiety, and Stress Scale-21 (DASS-21), with the highest correlation being between the FCV-19S and the anxiety subscale (r = 0.54,  < .05), followed by the stress subscale (r = 0.51, p < .05), and lastly, the depression subscale (r = 0.46,  < .05). Construct validity was assessed using exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response theory (IRT). The unidimensional factor structure of the FCV-19S was confirmed on the study sample. The Arabic version of the FCV-19S is a reliable and valid instrument with good psychometric properties. The use of this scale for assessing the severity of fear related to the COVID-19 pandemic among Arabic-speaking populations is recommended. The findings may guide future COVID-19-related research and further validation testing.
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http://dx.doi.org/10.1007/s11469-021-00574-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212791PMC
June 2021

Incidence, Trend, and Mortality of Human Exposure to Rabies in Yemen, 2011-2017: Observational Study.

JMIR Public Health Surveill 2021 Jun 22;7(6):e27623. Epub 2021 Jun 22.

Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technolog, Irbid, Jordan.

Background: Rabies remains a neglected and poorly controlled disease throughout the developing world, particularly in Africa and Asia, where most human rabies deaths occur.

Objective: This study aimed to describe the epidemiology of rabies exposures, its trend, and its geographical distribution in Yemen.

Methods: Cumulative data from a rabies surveillance system for the period 2011-2017 were obtained from the National Rabies Control Program as paper-based annual reports. Data included the number of persons bitten by a suspected rabid animal, their gender and age, and the result of the animal's laboratory test. Human cases were defined as those exposed to rabies virus bitten by a suspected rabid animal, exposed to a confirmed rabid animal and then received postexposure prophylaxis (PEP), and deaths occurred after exposure to a confirmed rabid animal after having rabies symptoms during 2011-2017.

Results: From 2011 to 2017, a total of 76,049 persons were bitten by a suspected rabid animal. Of these, 21,927 (28.83%) were exposed to positively confirmed rabid animals and then received PEP, and 295 (0.38%) rabies-related deaths occurred. Of all cases with rabies exposure, 50,882 (66.91%) were males. The most affected age group by animal bites (31,816/76,041, 41.84%), positive exposure (8945/21,927, 40.79%), and rabies deaths (143/295, 48.47%) was 5-14 years. Rabies vaccines and immunoglobulins quantities were least available in 2016 and 2017. The annual incidence rate of exposure to animal bites and rabies exposure was 50 and 14 per 100,000, respectively. The annual mortality rate was 2 per 1,000,000. The highest incidence rate of animal bites was in Dhamar (112 per 100,000) and Ibb (94 per 100,000), whereas the highest incidence of exposed cases was in Amanat Al Asimah (40 per 100,000) and Ibb (37 per 100,000). Mortality rate was the highest in Amanat Al Asimah (6 deaths per 1,000,000) followed by Ibb and Dhamar (4 deaths per 1,000,000 in both).

Conclusions: Rabies remains a worrying health problem in Yemen with higher percentage reported among children and males. Targeting school-age populations by education, communication, and information campaigns about preventive measures is strongly recommended. An electronic system should be introduced to improve reporting. It is important to have a sufficient supply of vaccines and immunoglobulins in control units, especially in the at-risk or impacted governorates. Future studies are suggested to determine incidences and risk factors of disease progression.
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http://dx.doi.org/10.2196/27623DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8277343PMC
June 2021

Physicians' Knowledge and Attitudes Regarding Point-of-Care Pharmacogenetic Testing: A Hospital-Based Cross-Sectional Study.

Pharmgenomics Pers Med 2021 1;14:655-665. Epub 2021 Jun 1.

Department of Public Health, Jordan University of Science and Technology, Irbid, 22110, Jordan.

Introduction: Pharmacogenetic testing (PGx) is a diagnostic technique used by physicians to determine the possible reactions of patients to drug treatment on the basis of their genetic makeup. The aim of this study was to determine the impact of physicians' awareness, attitudes, and sociodemographics on the adoption of point-of-care (POC) PGx testing as a diagnostic method, as well as the impact of their knowledge, attitudes, and sociodemographics on its adoption.

Methods: A cross-sectional survey of 200 physicians and medical trainees working at the Clinics of King Abdullah University Hospital in Jordan was performed. Data on sociodemographics, knowledge and attitudes concerning PGx testing, genetic information sources, and barriers to POC-PGx testing adoption were gathered.

Results: Participants' perceived knowledge of the role of PGx testing in therapeutic decision-making was rated as "Excellent" (1.9%), "Very Good" (19.4%), "Good" (34.4%), "Fair" (32.5%), and "Poor" (11.9%). Physicians' actual knowledge of PGx testing was adequate (mean=3.56 out of 7, SD=1.2), but their attitudes were generally favorable (mean=3.64 out of 5.00, SD=0.52). According to Rogers' theory, many variables (eg, perceived need, relative advantage, compatibility) had a significant impact on physicians' willingness to endorse POC-PGx testing.

Discussion: The majority of physicians stated that they were unaware of PGx testing. Physicians' perceived knowledge of POC-PGx testing, however, was higher than those who participated in other studies. Participants were optimistic about the future benefits of PGx testing in prescribing effective medications and reducing potential side effects, which were consistent with previous studies. Physicians' willingness to accept and implement POC-PGx testing was hampered by a lack of PGx expertise, as well as concerns about patient confidentiality, employability, and insurability. More training and genetic courses are needed, according to the majority of participants.
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http://dx.doi.org/10.2147/PGPM.S307694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8179816PMC
June 2021

The Rotavirus Surveillance System in Yemen: Evaluation Study.

JMIR Public Health Surveill 2021 Jun 8;7(6):e27625. Epub 2021 Jun 8.

Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science & Technology, Irbid, Jordan.

Background: Rotavirus (RV) kills over 185,000 children <5 years every year and is responsible for over one-third of all child diarrheal deaths worldwide. The Rotavirus Surveillance System (RVSS) in Yemen was launched in 2007 at five sentinel sites to monitor the impact of the vaccine on RV morbidity and mortality.

Objective: This study aimed to determine the usefulness of the RVSS, assess its performance, and identify the strengths and weaknesses of its implementation.

Methods: The Centers for Disease Control and Prevention's updated guidelines on evaluating a public health surveillance system were used to evaluate the RVSS. In this assessment, qualitative indicators, such as usefulness, flexibility, stability, simplicity, and acceptability, were assessed through in-depth interviews with stakeholders at the central level and semistructured questionnaires with the sentinel site coordinators. The indicators for quantitative attributes-sensitivity, positive predictive value (PPV), completeness, and timeliness-were assessed by reviewing the results of laboratory samples and a random sample of case report forms. The scores for the indicators were expressed as poor (<60%), average (60% to <80%), and good (≥80%).

Results: The overall usefulness score of the RVSS was 73%, indicating an average rank. The RVSS was rated as having good flexibility (91%) and stability (81%), and average simplicity (77%) and acceptability (76%). In terms of quantitative attributes, the system was poor for sensitivity (16%), average for PPV (73%), and good for completeness (100%) and timeliness (100%).

Conclusions: Although the system attributes were flexible, stable, capable of providing quality data, and performing timely data reporting, some attributes still needed improvements (eg, usefulness, simplicity, acceptability, and PPV). There is a need for a gradual replacement of donor funds with government funds to ensure sustainability. The RVSS in Yemen strongly requires a progressive increase in the number of sites in governorates and sensitivity enhancement.
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http://dx.doi.org/10.2196/27625DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8235281PMC
June 2021

Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis.

JMIR Public Health Surveill 2021 Jun 2;7(6):e27590. Epub 2021 Jun 2.

Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Background: As a consequence of war and the collapse of the health system in Yemen, which prevented many people from accessing health facilities to obtain primary health care, vaccination coverage was affected, leading to a deadly diphtheria epidemic at the end of 2017.

Objective: This study aimed to describe the epidemiology of diphtheria in Yemen and determine its incidence and case fatality rate.

Methods: Data were obtained from the diphtheria surveillance program 2017-2018, using case definitions of the World Health Organization. A probable case was defined as a case involving a person having laryngitis, pharyngitis, or tonsillitis and an adherent membrane of the tonsils, pharynx, and/or nose. A confirmed case was defined as a probable case that was laboratory confirmed or linked epidemiologically to a laboratory-confirmed case. Data from the Central Statistical Organization was used to calculate the incidence per 100,000 population. A P value <.05 was considered significant.

Results: A total of 2243 cases were reported during the period between July 2017 and August 2018. About 49% (1090/2243, 48.6%) of the cases were males. About 44% (978/2243, 43.6%) of the cases involved children aged 5 to 15 years. Respiratory tract infection was the predominant symptom (2044/2243, 91.1%), followed by pseudomembrane (1822/2243, 81.2%). Based on the vaccination status, the percentages of partially vaccinated, vaccinated, unvaccinated, and unknown status patients were 6.6% (148/2243), 30.8% (690/2243), 48.6% (10902243), and 14.0% (315/2243), respectively. The overall incidence of diphtheria was 8 per 100,000 population. The highest incidence was among the age group <15 years (11 per 100,000 population), and the lowest incidence was among the age group ≥15 years (5 per 100,000 population). The overall case fatality rate among all age groups was 5%, and it was higher (10%) in the age group <5 years. Five governorates that were difficult to access (Raymah, Abyan, Sa'ada, Lahj, and Al Jawf) had a very high case fatality rate (22%).

Conclusions: Diphtheria affected a large number of people in Yemen in 2017-2018. The majority of patients were partially or not vaccinated. Children aged ≤15 years were more affected, with higher fatality among children aged <5 years. Five governorates that were difficult to access had a case fatality rate twice that of the World Health Organization estimate (5%-10%). To control the diphtheria epidemic in Yemen, it is recommended to increase routine vaccination coverage and booster immunizations, increase public health awareness toward diphtheria, and strengthen the surveillance system for early detection and immediate response.
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http://dx.doi.org/10.2196/27590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8209531PMC
June 2021

Depression and Anxiety and Their Associated Factors Among Jordanian Adolescents and Syrian Adolescent Refugees.

J Psychosoc Nurs Ment Health Serv 2021 Jun 1;59(6):23-30. Epub 2021 Jun 1.

The purpose of the current study was to determine the prevalence of depression and anxiety and their associated factors among Jordanian adolescents ( = 1,878) and Syrian adolescent refugees ( = 1,773) aged 12 to 17 years. The Center for Epidemiologic Studies-Depression Scale for Children (CES-DC), Patient Health Questionnaire-9-Modified, and Generalized Anxiety Disorder-7 questionnaire were used in this study. Approximately 27.2% of Jordanian adolescents and 28.3% of Syrian adolescent refugees had depression as assessed by the CES-DC. Among males, 17.6% of Jordanian adolescents and 19% of Syrian adolescent refugees had anxiety. Among females, 28.1% of Jordanian adolescents and 27.3% of Syrian adolescent refugees had anxiety. Overall, Jordanian adolescents and Syrian adolescent refugees had high prevalence of depression and anxiety. Establishing community-based mental health care in Jordan is crucial. [(6), 23-30.].
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http://dx.doi.org/10.3928/02793695-20210322-03DOI Listing
June 2021

Modifiable Factors and Delays Associated with Neonatal Deaths and Stillbirths in Jordan: Findings from Facility-Based Neonatal Death and Stillbirth Audits.

Am J Perinatol 2021 May 31. Epub 2021 May 31.

Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Objective:  This study employed the "three-delay" model to investigate the types of critical delays and modifiable factors that contribute to the neonatal deaths and stillbirths in Jordan.

Study Design:  A triangulation research method was followed in this study to present the findings of death review committees (DRCs), which were formally established in five major hospitals across Jordan. The DRCs used a specific death summary form to facilitate identifying the type of delay, if any, and to plan specific actions to prevent future similar deaths. A death case review form with key details was also filled immediately after each death. Moreover, data were collected from patient notes and medical records, and further information about a specific cause of death or the contributing factors, if needed, were collected.

Results:  During the study period (August 1, 2019-February 1, 2020), 10,726 births, 156 neonatal deaths, and 108 stillbirths were registered. A delay in recognizing the need for care and in the decision to seek care (delay 1) was believed to be responsible for 118 (44.6%) deaths. Most common factors included were poor awareness of when to seek care, not recognizing the problem or the danger signs, no or late antenatal care, and financial constraints and concern about the cost of care. Delay 2 (delay in seeking care or reaching care) was responsible for nine (3.4%) cases. Delay 3 (delay in receiving care) was responsible for 81 (30.7%) deaths. The most common modifiable factors were the poor or lack of training that followed by heavy workload, insufficient staff members, and no antenatal documentation. Effective actions were initiated across all the five hospitals in response to the delays to reduce preventable deaths.

Conclusion:  The formation of the facility-based DRCs was vital in identifying critical delays and modifiable factors, as well as developing initiatives and actions to address modifiable factors.

Key Points: · Death review committees play key roles in identifying critical delays and modifiable factors.. · The "three-delay" model was successful in identifying preventable neonatal deaths and stillbirths.. · Death review committees are central in developing actions to reduce preventable deaths..
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http://dx.doi.org/10.1055/s-0041-1730434DOI Listing
May 2021
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